Journal of clinical and diagnostic research

Cutaneous Diphtheria by Nontoxigenic Corynebacterium Diphtheriae in Diabetic Patient: A Case Report

Pooja Singla, Pratibha Mane, Prashant Singh

Chronic diabetes mellitus is a significant risk factor for skin and soft tissue infections. Corynebacterium diphtheriae is a rare cause of wound infection in chronic diabetic patients. Here, a rare case of wound infection by non-toxigenic Corynebacterium diphtheriae in a chronic diabetic 45-year-old female patient has been reported. She presented with multiple discharging punched out ulcers on lower back. Diagnosis was confirmed by conventional PCR detecting rpoB gene and toxigenicity testing by Elek’s gel precipitation test. Patient was treated with IV benzylpenicillin and regular dressing. Isolation of single opportunistic microorganism creates a characteristic feature in the present case.

Syncephalastrum racemosum as a Rare Agent of Rhino-orbital Mucormycosis: A Case Report and Review

Neelam Gulati, Poonam Gupta, Charu Nayyar, BL Sherwal, Sunil Kumar

Fungal infection of the paranasal sinuses is an increasingly recognised entity both in immunocompetent and immunocompromised individuals. Aspergillus species are the most common aetiologic agents of this disease. Zygomycete agents are the common culprits in the immunocompromised group. The most common agent causing human disease is Rhizopus species followed by Rhizomucor spp. The important risk factors are uncontrolled diabetes mellitus and immunsupression. Here, a rare case of pansinusitis with Syncephalastrum racemosum was reported in a 13-year-old male child with aplastic anaemia. Syncephalastrum racemosum has been debated for its role in human diseases and very few reports are documented. To the best of our knowledge this was the third report of rhino-orbital infection caused by this fungus. Syncephalastrum racemosum should be considered as one of the aetiologic agents of rhino-orbital infections especially in the immunocompromised group.

Genital Wart during Pregnancy: A Rare Case

Vandana Verma, Pragya Shree, Shweta Kumar

Condyloma Acuminata (CA) or wart is a benign lesion which is caused by Human Papillomavirus (HPV) type-6 or type-11 infection. During pregnancy, condyloma has a tendency to proliferate and may have recurrence. This is because during pregnancy physiological changes takes place to the external genitalia and immunological effects during pregnancy promote HPV replication, and increased vaginal secretions contacting the skin and mucous membranes in pregnancy also lead to proliferation of CA in pregnancy. A 25- year-old primigravida presented to our hospital at 36 weeks pregnancy with extensive genital warts. These lesions regressed itself one month postpartum and remained only on vulva. Podophyllum resin application was planned for remaining lesions two months postpartum. The few treatments that have been tested and recommended for use in pregnancy are Bi and Tri Chloro Acetic Acid (BCA/TCA) application, cryotherapy, electrocautery and surgical excision, including laser treatment.

Angioleiomyoma of the Uterus with Extensive Hyaline Degeneration- A Rare Case Report with Brief Review of Literature

Angioleiomyoma (AL) or vascular leiomyoma is a distinct variant of leiomyoma with prominent vascular component, usually occurs in extremities and very rarely arise in internal organ. It has been documented in female genital tract including cervix, uterus, ovary and broad ligament. Uterine leiomyoma is very rare and is a distinct variant of conventional leiomyoma which has prominent vascular component. The diagnosis of this variant requires histopathological examination since it does not have specific clinical and radiological features unlike in soft tissues where it presents as subcutaneous painful swelling. Like conventional leiomyomyoma, AL can also undergo degenerative changes like hyalinisation, infarction, calcification and myxoid change. Here, a rare case of uterine AL with ovarian seromucinous cystadenoma is reported in a 38-year-old female who was diagnosed incidentally when she was evaluated for abnormal uterine bleeding. Magnetic Resonance Imaging (MRI) pelvis revealed a intramural fibroid of size 5×4.5 cm noted in anterolateral myometrium of uterus and a large multiloculated cystic lesion of size 12.5×12.5×8.8 cm seen arising from left ovary. Abdominal hysterectomy was done. Grossly, sectioning of myometrium showed well-circumscribed grey white to grey brown intramural fibroid measuring 4.5×3.5 cm. Histologically the lesion showed fascicles of spindle cells swirling around the thick walled blood vessels and immunohistochemically these cells were positive for Smooth Muscle Actin (SMA). Here, this rare case of uterine AL with brief review of literature is reported.

Malignant Phyllodes Tumour with Rhabdomyosarcomatous Differentiation: A Rare Phenomenon

Kusum Yadav, Jitendra Singh Nigam, Anshul Singh, Vatsala Misra

DOI: 10.7860/JCDR/2021/46499.14696 Date of Submission: Sep 03, 2020 Date of Peer Review: Oct 16, 2020 Date of Acceptance: Feb 11, 2021 Date of Publishing: Apr 01, 2021 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Sep 05, 2020 • Manual Googling: Jan 22, 2021 • iThenticate Software: Mar 09, 2021 (11%) ETYMOLOGY: Author Origin

Poststreptococcal Glomerulonephritis without Hypertension in a Patient with Concealed Skin Lesions

Swarna Krishnamoorthy, Viswanathan Pandurangan, V Siva Prakash, RB Sudagar Singh

Poststreptococcal Glomerulonephritis (PSGN) is an acute inflammation of renal glomerular parenchyma and is sequelae of pharyngitis or skin infection caused by nephritogenic strains of group A beta-Haemolytic Streptococcus. PSGN is conventionally diagnosed based upon clinical findings and demonstration of recent streptococcal infection by a positive skin/throat culture or serologic tests. Hereby, authors present a case of PSGN in an 18-year-old normotensive male is reported who presented with anasarca. On evaluation, the patient had subnephrotic range proteinuria without haematuria and normal serum creatinine. Concealed healing skin lesions in the gluteal region, suggestive of impetigo were noted and hence, arrived at the diagnosis of PSGN. He was treated with intravenous antibiotics, following which symptoms improved. Young patients with acute presentation of oedema or proteinuria with possible renal cause warrants thorough head to foot examination for unseen skin lesions in otherwise overlooked areas. PSGN responds promptly with early antibiotic therapy.

Neonatal Umbilical Myiasis- A Rare Case Report

Sonu Kumar, Poonam Dalal, Neha, Ankit Singla

Myiasis is an infestation of live vertebrates (humans and/or animals) by larvae of dipterous fly. Although, it usually infects domestic and wild animals but humans may be rarely affected if they are reared in unhygienic condition. The index case is a seven-day-old male neonate born by normal vaginal delivery, who presented to the Emergency Department with complaint of passage of worms from umbilicus which do not extend to deeper tissues. On examination, periumbilical erythema was also visible along with white glistening worms. After application of turpentine oil to the umbilical stump, the worms were mechanically removed with the help of forceps. Umbilical myiasis is a very rare presentation indicating poor hygiene and a preventable condition.

Clear Cell Sarcoma of Kidney in Adult with Extensive Invasion of Pelvic Veins: Dual Aberration

Clear Cell Sarcoma of Kidney (CCSK) is a highly malignant renal tumour. The mean age of diagnosis is between 12-36 months. Due to heterogeneous histological appearance and age group affection similar to wilms tumour, it often leads to misdiagnosis. It has a tendency to metastasise distantly to bone and its therapeutic response differs from other childhood kidney tumours. So use of Immunohistochemical (IHC) markers becomes essential in many cases in differentiating CCSK from other paediatric renal neoplasms. It is extremely rare in adults, till now only 26 adult cases have been reported in the medical literature. Here, the case of a 49-year-old male presenting with haematuria and pedal oedema is reported. On radiological examination, he had a large left renal mass with tumour extension to Left Renal Vein (LRV) and Inferior Vena Cava (IVC) as thrombi. Histology and Immunohistochemistry (IHC) study revealed CCSK ruling the other differentials. This case is presented for its rarity in adult patients, unusual clinical feature of widespread vascular invasion rather than bone metastasis, simulating Renal Cell Carcinoma (RCC) and aggressive clinical behaviour. The diagnostic challenges faced by pathologist and clinicians further necessitate the proper diagnosis of the tumour for better management of such cases.

Popliteal Nerve Block as an Alternative to Spinal Anaesthesia for Ankle Surgery in Co-morbid Patient- A Case Report

Priya Kishnani, Dharmishthaben Chakarani, Jigisha Mehta, Malini Mehta

In high-risk patients with significant cardiovascular and other systemic disorders, administration of central neuraxial block or general anaesthesia is usually associated with adverse haemodynamic effects and high perioperative mortality. This case report is about a 57-year-old male patient with known case of Diabetes Mellitus (DM) posted for lower limb debridement. He had comorbidities like cellulitis, sepsis, uncontrolled diabetes, multiorgan dysfunction and was haemodynamically unstable. Peripheral nerve blockade keeps the haemodynamic more stable as compared to central neuraxial blockade and general anaesthesia. Therefore, popliteal nerve block was given to the patient in prone position. Peripheral nerve locator was used and after eliciting the response of foot twitch local anaesthetic drug was deposited. Adequate sensory motor block was achieved and surgery was carried out uneventfully. Patient was vitally stable throughout the surgery. Thus, it was seen that peripheral nerve blocks are an effective alternative to central neuraxial blockade and general anaesthesia in high risk patients undergoing below knee surgeries.

Isolated Proximal Ureteric Injury after a Penetrating Stab Wound to Lumbar Region

Manav Goyal, G Sivasankar, J Sivabalan

Urological injuries fall far behind other abdominal injuries when it comes to involvement during trauma. Amongst urological trauma, ureteral injuries account for 1-2.5%. An isolated ureteral injury is infrequently encountered because of a safe retroperitoneal location and a smaller diameter of the ureter as compared to other organs. A high index of suspicion is needed as a delayed or missed diagnosis of penetrating ureteral trauma or an unrecognised and mismanaged ureteral injury can lead to significant complications, including formation of urinoma, abscess, ureteral stricture or urinary fistula, and potential loss of the ipsilateral kidney. The present case report is of a 35-year-old male who presented to the Emergency Department of tertiary care hospital with a stab injury in left lumbar region and was diagnosed with isolated ureteral injury on Contrast Enhanced Computed Tomography (CECT). Without much delay, ureteroscopy was done, a double J stent was placed and ureteroureterostomy was performed.

Complex Percutaneous Coronary Intervention Salvages a Patient with Recurrent Acute Coronary Syndrome and Ischaemic Heart Failure with Multiple Life Threatening Co-morbidities: A Case Report

Brajesh Kunwar, Farah Ingle, Atul Ingle, Chandrasekhar Tulagseri

More than 422 million people are suffering from Diabetes Mellitus (DM) worldwide. Majority of the affected population resides in lower and middle income countries. This chronic, metabolic disease gradually does serious damage to heart, blood vessels, eyes, kidneys and nerves; eventually causing cardiovascular diseases, peripheral vascular diseases, retinopathy, nephropathy and neuropathy. Here, a rare case of a 58-year-old male was present who had history of uncontrolled DM with dry gangrene in right forefoot, acute kidney injury and Coronary Artery Disease (CAD) involving Left Main (LM) bifurcation presented with recurrent acute coronary syndrome with heart failure. Patient in view of multiple co-morbidities was unfit for Coronary Artery Bypass Grafting (CABG) was managed successfully with complex coronary intervention involving LM bifurcation.

Functional Magnetic Resonance Imaging in Granulosa Cell Tumour of the Ovary: A Case Report

Granulosa Cell Tumour (GCT) is a rare malignant ovarian tumour. Adult GCT variety is more common than juvenile variety and occurs usually in postmenopausal women. It showed a spectrum of the imaging findings due to various histological appearances. It may present with solid masses, multilocular cystic lesion or completely cystic lesion. Here, authors present an interesting case of a 27-year-old young female, who presented with a large lump in the abdomen. On Magnetic Resonance Imaging (MRI) there was a large well-defined, multilocular cystic lesion at superior aspect of the lesion and complex cystic, solid mass at inferior aspect. Functional MRI like diffusion weighted imaging which provides good image contrast helped in determining the malignancy despite a benign diagnosis on ultrasound guided biopsy and furthering the patient for histopathological examination to come to a final diagnosis.

Splenic Hydatid Cyst- A Case Report

Although involvement of spleen is rare in cases of hydatid disease, it should always be considered as a differential diagnosis for a cystic lesion in any of the solid organs, abdomen, lung or brain. The current case report is of a 60-year-old female patient who presented to Emergency Department with complaints of left upper quadrant pain which was continuous and dull aching. Ultrasound abdomen revealed a well-defined multicystic lesion with septations in spleen. Computed tomographic examination and magnetic resonance imaging confirmed the same and the lesion showed the characteristic T2 hypointense rim, consistent with hydatid disease. Splenectomy was performed for the patient and proved to be splenic hydatid cyst.

Invasive Aspergillosis of Right Maxillary Sinus with Orbital Extension in an Immunocompetent Individual

Sachin Daigavane, Madhumita Prasad, Sana Beg, Jigna Motwani

Secondary involvement of orbit in aspergillosis following paranasal sinus fungal infection is rare. A case of invasive aspergillosis of right maxillary sinus in a 31-year-old immunocompetent male patient was referred to Ophthalmology OPD with unilateral proptosis. Patient developed proptosis in right eye since six months, which was insidious in onset, progressive, not associated with painful movements. It showed regression since last one month. On examination, best corrected visual acuity was 6/12 in right eye with light projection accurate in all quadrants on presentation, with progressive diminution of vision over 15 days, normal colour vision, pupil was normal in size, reacting to light. Extraocular movements were reduced on lateral side. Left eye examination was within normal limit. Magnetic resonance imaging showed involvement of intra and extraconal compartment upto apex of orbit of right eye, pushing optic nerve medially, with erosion of lamina papyrecea. Intravenous amphotericin B was started and functional endoscopic sinus surgery with maxillary sinus debridement was done. Regular follow-up was kept to prevent the optic nerve involvement.

Pentasomy X Syndrome in Neonate: A Rare Disorder

Pentasomy X is a rare syndrome with variable phenotype, that affects females with characteristic clinical features such as severe mental retardation with delayed speech, short stature, facial dimorphism’s, osseous, articular/skeletal/limb abnormalities, and congenital heart defects. Clinical course of the disease seems to be adverse as there has been no evidence of life till adulthood. This case study was of one-month-old girl referred for cytogenetic evaluation that revealed 49,XXXXX karyotype, indicating Pentasomy X syndrome. Studies have mentioned meiotic successive nondisjunction errors in maternal meiosis or combined maternal and paternal origin as a mechanism for Pentasomy X formation which has been supported by genotyping studies using Short Tandem Repeats (STR) X-linked polymorphic markers. An early restricted fetal growth and movements along with increased nuchal fold in pregnancy could suggest referral to prenatal karyotyping studies. Prenatal diagnosis of Pentasomy X syndrome is a challenge due to absence of advanced maternal age and maternal screening markers along with subtle nonspecific Ultrasonography (USG) abnormalities that are detected late in the pregnancy. Hence, there is a strong need of Non Invasive Prenatal Screening (NIPS) with clinical coverage of sex chromosomes in routine pregnancy management along with 3D high resolution USG evaluation as a mandatory workup to rule out Pentasomy X irrespective of advanced maternal age. Management frame work through genetic counseling help patients to adapt to the challenging diagnosis and early interventions for patient management.

A Novel Methyl-CpG Binding Protein 2 (MECP2) Variant in an Indian Girl with Rett Syndrome

Pratiksha Chheda, Shailesh Pande, Tavisha Dama, Dollar Goradia, Sushant Vinarkar

Rett syndrome is an X-linked dominant disorder that is primarily seen in females and is linked to mutations in the gene coding for Methyl-CpG Binding Protein 2 (MeCP2). It is a neurodevelopmental disorder characterised by impairments in language, repetitive movements, early-onset seizures, delayed growth, autistic features, intellectual disability and abnormal Electroencephalograms (EEG). Author’s reported a case of three year six months old Indian girl who was born of a nonconsanguineous marriage presented with stereotypic hand movements, gradual loss of speech, inability to walk independently and frequent episodes of seizure. Genetic testing for analysis of MeCP2 mutations was performed and a novel de novo missense variant (c.361G>A, p.Asp121Asn) was identified, which was predicted to be disease causing on the basis of insilico analysis and clinical findings. The study suggested that a careful evaluation of the pathogenic nature of MeCP2 variants supports clinical diagnosis and aids in genetic counseling and patient management.

Recurrent Myxoid Chondrosarcoma of Mandible: A Case Report

Prabha Verma, Rohini Khurana, Sambit Swarup Nanda, Satyajeet Rath

Myxoid chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin, characterised by the presence of chondroid and myxoid matrix. These are traditionally radio resistant tumours, so wide surgical resection remains the mainstay of treatment. However, radiotherapy is generally advised for high-grade lesions with poor prognostic factors with adjuvant chemotherapy. The treatment decisions are primarily guided by the histological grade, extent of surgical resection, and site of the neoplasm. A case of a 28-year-old male who presented with recurrent painful swelling in the mandibular region is discussed here. To date, very few cases of Extraskeletal Myxoid Chondrosarcoma (EMC) occurring in the mandible region have been reported. So, due to the paucity of available literature, controversies still exist regarding effective treatment approaches in newly diagnosed and recurrent cases. This case reports the clinical presentation, histopathology, radiological characteristics, immune profile, and treatment modalities used in EMC with a comprehensive and relevant review of the literature.

Unique Case of Mediastinal Teratoma with Unusual Components

Anand Deodhar, Dinesh Kulkarni

Mature teratoma is a benign, slow growing tumour. It usually affect adults in 20-40 years of age. Teratomas with mature pancreatic tissue are extremely rare. There are only a few cases of teratoma containing mature pancreatic tissue that have been reported in literature. Authors report a case of a 25-year-old male having a large solid cystic anterior mediastinal mass, which on excision, histologically revealed large areas of mature pancreatic tissue along with squamous epithelium with sebaceous glands and keratin, pseudostratified columnar ciliated epithelium, mucin secreting glands, cartilage, pigment and other germ cell derived mature elements. This is a unique case with unusual microscopic findings in the form of predominant pancreatic and also brain tissue along with other elements.

Cellular Testicular Fibroma of Gonadal Stroma with Extensive Myoid Differentiation: A Mimicker of Testicular Leiomyoma

Anuradha CK Rao, Sanila Rahim, Nazran Akbar Hussain

Fibroma of the testis is a rare benign Sex Cord Stromal Tumour (SCST) of probable gonadal stromal origin, occurring in adult males. Characterised by slow and insidious growth, it is devoid of hormonal association and serum markers. Clinically, it can mimic seminoma and requires histopathological examination for identification. Microscopic characteristics include hypercellular spindle cell areas and hypocellular hyaline plaques. Authors report a case of a 41-year-old male presenting with complaints of lower abdominal pain and dysuria. Ultrasonography (USG) showed enlarged left testis with heterogenous echotexture. With a clinical diagnosis of testicular tumour, orchidectomy was performed. Histology showed a well circumscribed, encapsulated cellular neoplasm comprising of spindle and fusiform cells in fascicles, nodules and bundles. The cells showed fusiform vesicular nuclei and eosinophilic cytoplasm, focal epithelioid cells with grooved nuclei and occasional mitotic figure. Stromal collagen fibres and hyalinisation were noted. Testicular tissue was seen compressed peripherally. The tumour cells demonstrated positive reactivity for Smooth Muscle Actin (SMA), h-Caldesmon and inhibin, negative for S-100 and CD34 (Cluster of Differentiation) on Immunohistochemistry (IHC). Literature review helped in arriving at a diagnosis of cellular Testicular Fibroma (TF) with myoid differentiation. Testicular spindle cell lesions are rare, and comprise of different entities, one of which is TF. Histology and IHC are useful aids in diagnosis. Awareness of the differential diagnosis and the IHC markers can help in arriving at a conclusive diagnosis.

Primary Cutaneous Cryptococcosis: A Rare Masquerading Presentation of Cryptococcus Infection

Tanisha Bharara, Shalini Upadhyay, Mohinder Pal Singh Sawhney, Manisha Khandait

The yeast, Cryptococcus is widely present in the environment. Its main portal of entry is the respiratory tract. Clinical and experimental evidences indicate that cryptococcosis is usually a reactivation of a dormant infection. They have been recovered from soil contaminated with avian excreta, especially pigeon droppings and from decaying wood, fruits, vegetables and dust. Cryptococcus may be found on skin of healthy subjects without causing any manifestation but it is known to cause life threatening infection in immunocompromised hosts. Primary Cutaneous Cryptococcosis (PCC) is an uncommon condition which is characterised by localised cryptococcal skin eruptions without dissemination to internal organs. Clinicians are aware of the typical presentation of cryptococcal infections occurring mostly in immunocompromised patients. Rare manifestations like PCC may go unnoticed leading to prolonged morbidity and health care cost. The present article is a case report of PCC in a 39-year-old immunocompetent male who presented with two months history of scattered erythematous indurated papules and plaques on his right foot, arm and abdominal region developed after having suffered minor injury at the cement factory. The patient was started on fluconazole to which he responded well.

Mounier-Kuhn Syndrome- A Rare Case Report

Yash Rana, Ujwal Jain, Saket Kumar, Arti D Shah, Kusum V Shah

Mounier-Kuhn Syndrome (M-K Syndrome) also known as Tracheobronchomalacia (TBM) often seen in middle aged and elderly people. Weakness of the tracheal and bronchial walls allows the posterior and anterior walls to draw nearer together during expiration and coughing, producing a varying obstruction. The main complaints are dyspnoea, cough, phlegm and haemoptysis. Acquired TBM often presents with recurrent respiratory tract infections and mistreated as chronic bronchitis, pneumonia and the dyspnoea, often treated as asthma, with poorer outcomes. Here, a case of 70-year-old male was presented with complaints of cough with expectoration since four months. Bronchoscopy, cineradiography, spirometry and intrabronchial pressure measurements are the diagnostic methods used. TBM is a progressive condition and to be considered in the diagnosis of obstructive pulmonary diseases and in the assessment of the functioning capacity of dyspneic patients. Treatment is conservative and symptomatic; in selected cases surgery may also be beneficial.

Use of Dexmedetomidine as an Adjuvant to Propofol along with Neurophysiological Monitoring of the Seventh Cranial Nerve during Cerebello- Pontine Tumour Excision Surgery

Pooja Arpan Shah, Gayatri Vasagadekar, Akhilesh Chhaya

Cerebello-Pontine Angle (CPA) surgeries are very challenging for neurosurgeons as it lies very close to brain stem so various cranial nerves are at risk of damage. Generally, such surgeries require neuromuscular monitoring of various cranial nerves. For that we have to discontinue neuromuscular blocking agents and inhalational agents. Total Intravenous Anaesthesia (TIVA) avoids the use of neuromuscular blocking agents as well as inhalational agents. However, prolonged infusion of propofol is associated with risks, such as hypotension, delayed awakening, and metabolic acidosis, known as “Propofol Infusion Syndrome”. Dexmedetomidine now-a-days is used very commonly as an adjuvant to propofol and it significantly reduces the anaesthetic requirement. Addition of dexmedetomidine provides haemodynamic stability during such neurosurgeries. Here, authors have described anaesthetic management of a 46-year-old female patient posted for CPA excision along with seventh cranial nerve monitoring using dexmedetomidine with propofol.

Monoclonal Gammopathy Presenting as Peripheral Neuropathy

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a disorder of peripheral nervous system, which presents with a long duration (eight weeks) of sensory and/or motor, symmetric/asymmetric symptoms. Aetiology ranges from infections, inflammations, autoimmune disorders, to vasculitis and malignancies. Hereby, authors report a case of a 40-year-old male patient who presented with complaints of bilateral lower limb numbness and weakness, and bilateral upper limb numbness, since two months, which was gradually progressive. On examination, he was found to have muscle wasting in his bilateral upper limb web spaces, left anterior thigh muscle, decreased tone in bilateral upper limbs and lower limbs, decreased power in both his upper limbs distally and decreased power in both his lower limbs (distal>>proximal) was seen. Superficial reflexes were normal with bilateral plantar being equivocal. Deep tendon reflexes were absent in bilateral upper and lower limbs. Tremors of bilateral upper limbs on extension were present. Loss of vibration sense throughout, loss of joint position sense at bilateral big toe and ankle joint and foot drop of his left lower limb were noticed. A diagnosis of CIDP with underlying plasma cell disorder was made after serum electrophoresis, immune-fixation and electrodiagnostic studies. The patient was started on prednisone 60 mg once daily, discharged and advised for monthly follow-up. Diagnosis of CIDP and the underlying cause is multifactorial, which can be misdiagnosed, presenting as a challenge. Hence, a detailed clinical examination, appropriate investigations are very crucial in diagnosing and treating a case of CIDP and its underlying cause.

Severe Acute Acrocyanosis and Digital Gangrene as a Sign of Catastrophic COVID-19 Infection

Arun Agarwal, Ambika Sharma, Rekha Jakhar, Mudit Agarwal

Coronavirus Infection Disease-2019 (COVID-19) may present with different symptoms and complications during its course. Emerging evidence suggests that it induces a hypercoagulable state with micro and macroangiopathy. This hypercoagulopathy has been identified in a subset of critically ill COVID-19 patients. However, extremity ischaemia with acrocyanosis and digital gangrene has not been commonly reported with COVID-19. It is caused due to microangiopathic and immunothrombosis phenomenon, and may be accompanied by microvascular involvement of other organs. Here, a case of critically ill 67-year-old male COVID-19 patient is reported who developed digital acrocyanosis and gangrene in lower limbs while being mechanically ventilated for severe Acute Respiratory Distress Syndrome (ARDS) despite being haemodynamically stable (i.e., not needing vasopressor) and on therapeutic anticoagulation. He subsequently succumbed to his disease due to multiorgan dysfunction. This suggests that extremity ischaemia correlates with poor prognosis in this small subset of critically ill COVID-19 patients, and can have a prognostic role in the disease outcome. It may be the first clinical manifestation even in non-vasculopathic patients.

A Case of BRASH Syndrome, Refractory Acidosis Necessitating Multimodal Approach to Treat it

Siva Kumar Aytha

A 69-year-old female patient with hypertension and diabetes mellitus, was brought to Emergency Department in unresponsive state. The initial evaluation revealed that the patient had wide complex junctional bradycardia owing to hyperkalemia; hypoglycaemia, metabolic acidosis. Treatment was started in an attempt to establish definitive airway; correct glucose levels, cardiac membrane stabilisation. Interim, patient had a cardiac arrest and the Return of Spontaneous Circulation (ROSC) was achieved and then stabilised. Later, she was found to have viral hepatitis complicated with ischaemic hepatitis due to urosepsis. Managing a coding patient with severe metabolic acidosis in a resource limited setting is always challenging. Numerous paradoxes including usage of alkali therapy, choice of inotropes, achievement of haemodynamic neutral intubation is extensively studied yet debated. The present case encompasses the difficulties and possible solutions in managing such patient with refractory acidosis, Bradycardia, Renal failure, Atrioventricular (AV) nodal blockers, Shock, Hyperkalemia syndrome (BRASH).

Perioperative Management of Button Battery Foreign Bodies in the Paediatric Aerodigestive Tract- A Case Series and Review of Literature

Vibha Chhabra, Mukul Kumar Jain, Poonam Motiani, Abhishek Gupta, Apurva Sadhoo

The use of Button Battery (BB) has increased rapidly now-a-days. Children are prone to inadvertent ingestion, aspiration or insertion of BBs while playing with toys. It poses a serious health hazard as it is corrosive. Hence, early diagnosis and quick treatment are essential to prevent its fatal complications. A thorough evaluation of each case is necessary based on a detailed history taking, physical examination, blood and radiological investigation, and diagnostic endoscopy. General anaesthesia is usually preferred during endoscopic examination and removal of BB foreign bodies. The complications depend on the duration and site of impaction. This is a case series of three children with different presentations of BB foreign bodies and author’s experience in the diagnosis and management.

Optic Neuritis in Patients with Type 2 Diabetes Mellitus: A Case Series

Niharika Krishna Shetty, Divya Prasad

Diabetes mellitus is a group of metabolic disorders characterised by a high blood sugar level over a prolonged period of time. Ocular associations of diabetes include diabetic retinopathy, cataract, diabetic papillopathy, ocular movement disorders and optic neuritis. Optic neuritis is a clinical condition causing inflammation of the myelin sheet of optic nerve. This leads to alteration in the nerve conduction towards the brain. Diabetics are more commonly affected with anterior ischaemic optic neuropathy compared to papillitis or optic neuritis. The present case series is of diabetes associated papillitis. The patients were in the age range of 35-60 years. All the patients had poor visual acuity at presentation, mild disc oedema and disc elevation with no peripapillary haemorrhage, suggestive of papillitis. The patients had minimum background retinopathy and were hyperglycaemic at the time of presentation. The response to Intravenous (IV) methyl prednisolone, at a dose of 1 gm IV in 100 mL of normal saline was good. Improvement to vision was seen within 3-5 days and improvement in colour vision was seen at the end of 11-15 days. Papillitis can be a manifestation of diabetes and should be kept as a differential diagnosis to non-arteritic ishaemic optic neuropathy. Optic neuropathies and background retinopathy may not co-exist. Poor systemic control of glycaemic level may directly co-relate to papillitis manifestation.

A Case Series on Neuroborreliosis- An Emerging Infection in India

Rachna Sehgal, Meenakshi Bhatt

Lyme disease is a zoonotic disease spread by the bite of Ixodes ticks. These ticks are known to be found in wooded or grassy areas. The disease manifestations can be divided into early Lyme disease and late Lyme disease. The manifestations of late Lyme disease may include arthritis, cranial nerve palsies, short-term memory deficits and Lyme carditis. The disease is diagnosed by a two-step process of Enzyme immunoassay followed by Western blot Test. Disseminated disease is treated with Intravenous (IV) ceftriaxone, cefotaxime or penicillin G, or a combination of oral and IV regimens or in some cases, only oral drugs for up to 28 days. Lyme disease is endemic in temperate regions, especially in America. However, over the years the disease has been reported from various countries of Asia including in India, where there have been sporadic cases. Hereby, the author presents three paediatric cases with varied presentations. The neurological symptoms ranged from Lower Motor Neuron (LMN) facial nerve palsy to acute encephalitis. One patient also had non-erosive arthritis.

Prevalence and Clinical Characteristics of Nonalcoholic Liver Disease in Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Lakshmi Ravansamudram Hariharan , Jayanty Venakata Balasubramaniyan2

Introduction: A refined diagnostic and classification strategy incorporating phenotypic characteristics of patients with Type 2 Diabetes Mellitus (T2DM) along with their blood glucose profile, lipid levels and evidence of Nonalcoholic Fatty Liver Disease (NAFLD) will help in identifying high risk population. Aim: To determine the prevalence and assess the clinical characteristics of NAFLD in T2DM patients from August 2016 to February 2017. Materials and Methods: This cross-sectional analysis was conducted on 100 T2DM patients with no history of alcohol intake, at the time of their screening. Physical examination and anthropometric measurements such as Body Mass Index (BMI) and Waist to Hip Ratio (WHR) were calculated. Fasting Blood Glucose (FBG), Post-Prandial Blood Glucose (PPBG), glycated haemoglobin (HbA1c), serum bilirubin, liver enzymes, lipid profile and ultrasound of the abdomen to diagnose NAFLD were done. Statistical analysis was carried out using student’s t-test and Statistical Package for the Social Sciences (SPSS) Version 19. Results: The prevalence of NAFLD in T2DM patients was 52%. The mean age was 52.27±1.82 years, with 40% males in the study cohort. There was a significant statistical correlation between the higher BMI (p<0.001), higher WHR (p=0.046), prevalence of upper body obesity (p<0.001) and the presence of NAFLD. The glycaemic control was poorer in patients with NAFLD with higher FBG (p=0.0027), PPBG (p=0.0027) and HbA1c p<0.001) than the non-NAFLD group. The serum cholesterol, triglycerides, Serum Glutamic Pyruvic Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT) were significantly higher in the NAFLD group. Duration of diabetes was not significantly different among the groups. Conclusion: The incidence of NAFLD is common in T2DM patients with poor glycaemic control, dyslipidaemia, and obesity being associated factors. Duration of diabetes is not a significant predictor of NAFLD.

Effect of Teriparatide in Fracture Healing in Lower Limbs- An Interventional Study

Sanjeev Kumar, Girish Sahni, Harjit K Singh Chawla, Daljinder Singh

Introduction: Many of the trauma patients presenting to the orthopaedic departments suffer from lower limb fractures. This often leads to prolonged period of morbidity and absence from work. Fracture healing can be delayed in elderly patients, postmenopausal women and in communited fractures. Teriparatide (TPH) given subcutaneously for 6 to 9 months, in such cases, may promote clinical and radiological union of bone. Aim: To know the effect of TPH in improving clinical and radiological union and also to evaluate early weight bearing, improvement in pain and functional outcome. Materials and Methods: In this prospective interventional study, a total of 125 patients were initially enrolled for the study and then after meeting inclusion criteria total 104 patients were selected for the study. They were allocated into two groups by randomisation by 1:1 method-group A was test group of 52 cases in which subcutaneous injection TPH 20 mcg daily (for six months) was given along with standard dosage of calcium and vitamin D; while in 52 cases in group B (control group) only calcium and vitamin D were given. Injection TPH was started within 10 days of fracture and given for six months. No placebo injection was given in control group. Time to weight bearing, time to clinical and radiological union and pain by Visual Analogue Score (VAS) were noted at regular follow-up at one month, three months, six months and 12 months and were compared in both the groups. Functional outcome by Disabilities of the Arm, Shoulder and Hand (DASH) score was noted as an additional tool, as DASH score questionnaire shows many activities of daily living that require mobility and stability of lower limb too. Adverse reactions were noted and compared within test and control groups. The collected data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0 software and Mann-Whitney U test was used to calculate p-value. Results: Average time period for full weight bearing with or without support for test group A was 11±2.7 weeks and 16±1.8 weeks in control group B (p-0.001). Average time to clinical union in test group was 12±1.9 weeks and in control group 16±2.2 weeks (p-0.001). Average time to radiological union was 13±1.4 weeks in test group while 22±2.2 weeks in control group (p-0.001). Pain score by VAS and functional outcome by DASH were improved in test group (p-0.001). There was no difference in adverse reactions in both the groups (p>0.05). Conclusion: Regular intake of TPH 20 mcg subcutaneous daily for six months can reduce time to clinical and radiological fracture union, promote early weight bearing and provide better pain control. Hence, better functional outcome and prefracture ambulatory status can be achieved with no significant adverse events.

Effect of Enamel Pre-etching with Sodium Hypochlorite Deproteinisation and Bonding Agent on Retention and Microleakage of Pit and Fissure Sealants: An In-vitro Study

VV Mubeena, Tharian B Emmatty, Kumar Kavita, Bijimole Jose, AM Riswana

Introduction: Sealants have proved to be one of the easiest methods of caries prevention in young permanent teeth, the placement of which is very technique sensitive. The non-invasive method of pretreating the enamel surface by deproteinising it with 5.25% sodium hypochlorite (NaOCl) for 60 seconds prior to etching has proven to be a promising method for improving retention and reducing microleakage of sealant. Aim: To evaluate the effect of enamel pre-etching with sodium hypochlorite deproteinisation and bonding agent on retention and microleakage of pit and fissure sealants. Materials and Methods: This in-vitro experimental study was conducted in Department of Paediatric and Preventive Dentistry at Annoor Dental College, Muvattupuzha, Kerala and Nanotechnology Lab at Amrita Institute of Medical Science. Freshly extracted Intact permanent maxillary and mandibular 20 third molars and 20 premolars mounted on acrylic blocks were divided into 4 groups containing 5 teeth in each group. Molars and premolar were taken for assessing the rate of retention and microleakage, respectively. Teeth in Group 1 were subjected to acid etching only, Group 2 were deproteinised prior to acid etching, Group 3 were subjected to acid etching followed by bonding and Group 4 were subjected to deproteinisation, etching and bonding. Then, all teeth were sealed with pit and fissure sealant and underwent thermocycling in artificial saliva bath for evaluation of sealant retention and microleakage. After thermocycling, retention was assessed on molar by one pre-calibrated blinded examiner by passing a 0.5 mm diameter probe along the margins of the sealant placed to verify integrity, failure, or loss of continuity based on Simonsen’s criteria (1989). To assess microleakage, premolar samples were immersed in rhodamine B, sectioned longitudinally, and examined under a stereomicroscope for assessment of microleakage. Collected data were statistically analysed using Chi-square and Mann-Whitney u test. Results: The results showed 100% retention for teeth in Group 2a, Group 3a, Group 4a, while partial sealant loss was present in 3 teeth from Group 1a. The differences between the groups for retention was statistically significant (p=0.014). In the case of microleakage, Group 3b showed more microleakage and group 4b showed least microleakage and the difference between them was statistically significant (p=0.009). Conclusion: Deproteinisation and use of bonding agent increases retention of the pit and fissure sealants. However, deproteinisation is a more effective method to control microleakage when compared to bonding agent. Thus, it can be considered as an effective method for pretreating enamel surface before sealant placement.

Clinical Efficacy of Ambu Aura Gain vs Laryngeal Mask Airway Proseal in Paediatric Patients undergoing Elective Surgery under General Anaesthesia: A Randomised Controlled Trial

Nidhi Agrawal, Shailly Kumar, Arushi Gupta

Introduction: Laryngeal Mask Airway ProSeal (LMA-P) is considered a gold standard among second generation supra glottis airway devices as an effective, safe and reusable ventilatory device. Ambu Aura Gain (AAG) is a newer single use second generation airway device with a soft inflatable cuff and preformed shape. Aim: To compare the clinical effectiveness and oral pharyngeal seal pressures between LMA ProSeal and AAG in children receiving controlled ventilation. Materials and Methods: This study was conducted in 100 paediatric patients in age group of 1 to 12 years, weighing 5 to 30 kg, fulfilling the criteria of American Society of Anaesthesiologists (ASA) Physical Status I and II and undergoing elective surgical procedures. Patients were randomised into two groups. Secondary objective was to compare the ease, success and total time for achieving effective ventilation and ease of placement of gastric tube and fibreoptic visualisation of glottis view in both the groups. Quantitative variables were compared using Independent t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test/Fisher’s-Exact test. Results: The median (IQR) Oropharyngeal Seal Pressure (OSP) was much higher with AAG 22 cm (21-23) of water as compared to LMA ProSeal 21 cm (20-22) of water and the difference was statistically significant (p-value <0.0001). Time taken for achieving effective ventilation {median (IQR)} was significantly less with AAG {18 (17-19) seconds} as compared to that with LMA ProSeal {19 (18-20) seconds} (p=0.0005). The two devices were comparable in terms of success and ease of insertion of device, ease of placement of gastric tube and fibreoptic visualisation of glottis view. Conclusion: The study suggests that AAG, a single use device, is a useful substitute to LMA ProSeal to ventilate paediatric patients undergoing elective surgical procedures.

Anticonvulsant Effect of Nebivolol alone and in Combination with Phenytoin against Maximal Electroshock-induced Seizures in Mice

Anuranjani Dhamodharan, Nitya Selvaraj, R Meenakshi

Introduction: Phenytoin is widely used in treatment of generalised tonic clonic seizures but its adverse effects make its usage limited. Hence forth, there is a need for newer antiepileptics. Studies have shown antiepileptic property for nebivolol in combination with phenytoin hence, reducing the dosage of phenytoin and its adverse effects and toxicities. Aim: To evaluate the anticonvulsant property of nebivolol alone and in combination with phenytoin against Maximal Electroshock Seizures (MES) in a mouse model. Materials and Methods: This was an experimental animal study on total of 36 swiss albino male mice were randomly assigned to six groups with six animals in each group in December 2019 at Sri Manakula Vinayagar Medical College and Hospital. Group 1 was considered as normal control, Group 2 received Phenytoin 25 mg/kg Intraperitoneal (IP); Group 3 and 4 received Nebivolol 0.25 mg/kg oral and 0.50 mg/kg oral, respectively; Group 5 received 12.5 mg/kg IP and nebivolol 0.25 mg/kg oral; Group 6 received Phenytoin 12.5 mg/kg IP and nebivolol 0.50 mg/kg oral. Anticonvulsant effect of the drugs nebivolol and phenytoin was elicited in mice by MES test. After induction following parameters were recorded for onset of Tonic Hind Limb Extension (THLE), duration of clonus, duration of THLE, number of jerks, recovery time. Statistical analysis was done by ANOVA followed by post-hoc Dunnett t-test. Results: Significant reduction in duration of THLE (p<0.01) and clonus (p<0.001) was observed in the group treated with phenytoin (12.5 mg/kg) and nebivolol (0.50 mg/kg). Conclusion: The present study concludes that the lower dose of phenytoin in combination with nebivolol can reduce seizures induced by MES in mice model.

Vitamin B12 Deficiency in Eastern India: A Hospital Based Cross-sectional Study

Debasmita Bandyopadhyay, Jayati Roy Choudhury, Kasturi Mukherjee

Introduction: The prevalence of vitamin B12 deficiency is common (around 40%) in people older than 65 years of age and in people who are strict vegetarians. The major sources of Viamin B12 are meat, fish, dairy products and fortified cereals. Aim: To study the prevalence and common types of presentations of vitamin B12 deficiency among 20-80 years aged, non-vegetarian people attending a tertiary care hospital in a state of Eastern India. Materials and Methods: This hospital based cross-sectional study was conducted at IPGME&R and SSKM Hospital between July 2018 to December 2019. Serum samples were collected from 478 adult patients presenting with different symptoms like pallor, fatigue, numbness and tingling sensation in limbs, memory loss, alopecia etc., which may be related to vitamin B12 deficiency. These samples were screened for serum vitamin B12 level by chemiluminescence method in ADVIA, Centaur CP (SIEMENS). Data were analysed statistically by graph pad prism 8 software. Significance of the difference between means were detected using Student’s unpaired t-test and calculating the p-value (p-value <0.05 were considered as significant). Results: Among 184 females, 50 (27.17%) were found to be Vitamin B12 deficient (VBD). Among them, 18 (36%) had mild deficiency (serum vitamin B12 level 201-220 pmol/L), 22 (44%) had moderate (serum vitamin B12 level 150-200 pmol/L) and 10 (20%) had severe deficiency (serum vitamin B12 level <150 pmol/L). A total of 35 (70%) of the VBD females were of <50 years of age. Among 294 males, 83 (28.23%) were found to be VBD. Among them, 34 (41%) had mild deficiency (serum vitamin B12 level 201-220 pmol/L), 36 (43%) had moderate (serum vitamin B12 level 150-200 pmol/L) and 13 (16%) had severe deficiency (serum vitamin B12 level <150 pmol/L). Total 43 (51.8%) of VBD male persons were of <50 years age. Among VBD female patients, 24 (48%) had neuropathy and among VBD male patients, 54 (65%) had neuropathy. Conclusion: So, it can be concluded that if regular screening is done for serum vitamin B12 in symptomatic patients irrespective of age, a number of problems can be reduced or cured by diagnosing VBD patients and treating them with vitamin B12 either by dietary modification or medicinal supplementation.

Effect of Inhalation of Pyrethroid Based Mosquito Vaporisers Fumes on the Body Weight of Male Albino Wistar Rats- An Experimental Study

Swati Yadav, Rakesh Kumar Dewan, Anita Rani, Jyoti Chopra

Introduction: Pyrethroid based mosquito vaporisers are commonly used as Personal Protective Measure (PPM) to avoid mosquito borne diseases. Effective control of mosquito borne diseases with the use of general public health measures are yet to be achieved in our country, so there is increasing use of PPM like mosquito coils, liquid vaporisers, mats, insecticide treated bed nets in Indian population but data regarding the safety profile of PPM is still scarce. Aim: To analyse the change in the body weight of male albino wistar rats exposed to pyrethroid based mosquito vaporiser. Materials and Methods: This was an experimental study on total 12 male albino wistar rats from July 2015 to October 2016. They were randomly divided into group I and II. Each group contained six rats. Group I animals served as control and Group II animals were exposed to mosquito vaporiser, 8 hours/day for six days in a week for 90 days. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Independent samples t-test was used to compare between group differences. A p-value less than 0.05 were considered to be significant. Results: Pyrethroid exposure results in reduced weight gain in exposed group rats. The mean difference in body weight between the groups at the end of study was 37.32±24.47 gm (p=0.165). Weight gain in both the group rats was almost similar till 8th postexposure week, after that from 9th week onwards decremental trend in weight was seen in group II. Conclusion: The assessment suggests that inhalation of pyrethroid based mosquito vaporisers fumes have toxic effects, reflected

Mortality Profile of Critical Patients in Medical Intensive Care Unit of Government Medical College of Central India

Jyoti Tiwari, Sumit Rawat, Anju Jha, Ramesh Pandey

Introduction: Mortality rate is always very high in Intensive Care Units (ICU) even with the best possible set ups, we should try to cater the need of the society according to the disease burden so that better care can be provided. Aim: To estimate the prevalence of various medical disease mortality profile of critically ill patients admitted in Medical Intensive Care Unit (MICU) of our institution. Materials and Methods: This was a retrospective observational study done at MICU of Bundelkhand Medical College and Hospital Sagar, Madhya Pradesh, India for a duration of one year (1st January 2019 to 31st December 2019). Data was retrieved from Medical Records Department (MRD) and total data of 349 deaths were registered. Disease was classified based upon ICD 10 (International Statistical classification of Diseases and related health problems) Score. Results: A total of 349 deaths occurred in MICU during the period of one year at the institution, out of which male deaths were 55.9% and female deaths were 44.1%. MICU deaths occurred in higher numbers in males with male: female ratio of 1.2:1. This difference in ratio of male and female mortality was not statistically significant (p-value >0.05). Mean age of males at time of death was 58.4±16.3 years whereas mean age of females were 55.2±19.7 years. This difference in mortality with age and gender was not statistically significant (p-value >0.05). In present study, most common systemic causes of mortality were cardiovascular (29.8%), followed by respiratory (17.5%), renal (16.5%) and cerebrovascular diseases (13.8%). Mortality was documented in 276 (79%) individuals within duration of seven days of admission, whereas mortality in 46 (13.1%) and 27 (7.7%) cases were documented within 8 to 14 days and >14 days, respectively. The present study documented no statistically significant association between length of stay and age of patients (p-value >0.05). Conclusion: Cardiovascular diseases are the most common causes leading to mortality especially in elderly male patients. Also, higher number of deaths is reported within seven days of admission signifying severity of illness at the time of admission.

Clinical Significance of DJ Stent Culture in Patients with Indwelling Ureteral Stents Prior to Endourological Intervention- A Single Centre Prospective Cohort Study

Introduction: Ureteral Double J Stenting (DJS) is commonly done prior to endourological interventions for various indications. Aim: To compare Urine Culture (UC) with DJ Stent Culture (SC) in patients with indwelling ureteral stents prior to endourological intervention and to evaluate the clinical significance of SC with postendourological intervention sepsis. Materials and Methods: A prospective single centre observational cohort study was conducted in the Department of Urology, Army Hospital Research and Referral, New Delhi, India, from August 2017 to March 2019. A total of 100 patients underwent DJS prior to definitive endourological intervention. Patient’s demographic profile was recorded along with preoperative, intraoperative and postoperative parameters. UC was also recorded at these intervals along with SC. The data was analysed and compared using Statistical Package for the Social Sciences (SPSS) software. Results: Intraoperative UC of 14 patients were colonised, SC was colonised in 11 patients. Six patients developed Urosepsis, Postoperative UC was colonised in four patients. The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of intraoperative UC for detecting stent colonisation with identical pathogens were 63.64%, 92.13%, 50% and 95.35%, respectively. Patients with colonised intraoperative UC, SC cranial tip and SC caudal tip had sepsis rates of 28.6%, 50%, and 44.4%, respectively. The sensitivity and PPV of SC in predicting postoperative sepsis were low at 83.33% and 45.45%, respectively, whereas the specificity and NPV were high at 93.6% and 98.8%. A 15.8% of diabetic patients and 50% immunocompromised patients developed urosepsis. E.Coli was the commonest isolated pathogen from UC and SC. On univariate logistic regression analysis, operative time, positive intraoperative UC, positive SC were associated with postintervention sepsis. While on multivariate analysis, none of these factors were associated with postendourological intervention sepsis. Conclusion: Performing routine SC may not be cost effective but could be recommended in cases at higher risk of developing postoperative urosepsis such as those with Diabetes Mellitus (DM) or immunocompromised patients and those expected to take longer operative time.

Effect of Six Months Yoga Intervention on Metabolic Profile and Carotid Intima Media Thickness in Prediabetes

Neha Saboo, Sudhanshu Kacker, Jeevraj Rathore

Introduction: Diabetes, the most common endocrine disorder, is projected to show a worldwide increase from 366 million people in the year 2011 to 552 million in the year 2030, out of which around 101 million is expected to be contributed by India. Moreover, the disease manifestations start in the early stages of diabetes and before it gets established as a full blown condition in the pre-stage called prediabetes. Aim: To highlight the importance of yoga intervention on metabolic profile and Carotid Intima Media Thickness (CIMT) in prediabetic subjects and implement it as a therapy for primary prevention of diabetes. Materials and Methods: This interventional study was done among adults aged 31-50 years in RUHS College of Medical Sciences and Associated Rukmani Devi Beni Prasad Jaipuria Hospital in Jaipur City, Rajasthan, India. A total of 250 prediabetic subjects were recruited from Jaipuria Hospital. These were divided into two groups, Study group (Group A, n=125) were engaged in yoga session and Control group (Group B, n=125) did not perform any yoga session. Written informed consent was taken from the participants in the local language. Study was conducted over a period of six months from July to December 2018. Statistical analysis was done by student’s paired t-test for intragroup comparison before applying this test the Smirnov-Kolmogorov test was conducted to confirm the normality of each parameter. Results: Yoga intervention resulted in a significant decline in blood glucose (p<0.0001), Glycated haemoglobin (p<0.01), lipid profile Cholesterol (p<0.01), Triglyceride (p<0.01), Low Density Lipoprotein (LDL) (p<0.01), High Density Lipoprotein (HDL) (p-value >0.05) and Very Low Density Lipoprotein (VLDL) (p-value >0.05), CIMT (p-value <0.05) relative to the control group. Conclusion: Yoga intervention was found to be helpful in control of metabolic profile and CIMT in prediabetes subjects. This preliminary study indicates that a yoga intervention would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach in reducing cardiometabolic risk factors, atherosclerosis and Cardiovascular (CV) events.

Evaluation of Concurrent Malaria and Dengue Infections among Febrile Patients- A Cross-sectional Study

Sangita Devubhai Vasava, Sucheta Jitendra Lakhani, Jitendra Devjibhai Lakhani

Introduction: There are several tropical mosquito borne infections, such as Malaria and Dengue, these are the two major and common arthropod borne infections that cause high morbidity and mortality in many patients and are major public health concern worldwide. Concurrent malaria and dengue infection is an important condition that is infrequently reported. Aim: To find out the prevalence rate of co-infection for both dengue and malaria and also to associate the severity of such co-infections with symptoms and haematological parameters. Materials and Methods: In observational cross-sectional study, samples were collected from 604 febrile patients clinically suspected for malaria and dengue attending the Medicine Out Patient Department (OPD) of Dhiraj Hospital, Gujarat, India. The samples were diagnosed for malaria by using rapid malaria antigen test kit and peripheral blood smear microscopy for the identification of Plasmodium spp. The dengue NS-1 antigen, (Immunoglobulin) IgM and IgG antibodies rapid kit were use to rule out dengue infection. The statistical analysis done by software EPI info. Results: In the present study, out of 604, 58 patients (9.6%) were positive for malaria and 80 patients (13.24%) were positive for dengue, while 21 patients (3.47%) were having concomitant infection with both dengue and malaria. The most affected age group was 31-60 years, 45.53%. The study revealed male preponderance (61.59%), hepatomegaly and jaundice were seen in 52.38% patients, haemorrhagic manifestations in 23.80%, kidney failure in 4.76% (1), and thrombocytopenia (platelet count <150,000/cubic millimeter (cmm)) were noted in 95.23% patients. Conclusion: It is mandatory to test any febrile patient for both malaria and dengue so that the diagnosis of the patient is not held back by missing any one. The clinicians who treat febrile patients in or from endemic areas must thoroughly examine and diagnose for both malaria and dengue, still one or the other is positive. Vector control, health education and good hygiene are community based preventive measures that are needed to control both the diseases.

Umbilical Cord Abnormalities and Maternal and Perinatal Outcome: A Prospective Observational Study

Kalpna Kulshrestha, Debbarma Sukla, Kalpana Verma

Introduction: The umbilical cord is the vital extension of the fetal circulatory system which regulates blood flow in both directions, thus allowing mother-child communications viz., immunological, oxygenation, fetal nutrition, cardiac function. Umbilical cord abnormalities are associated with the adverse maternal and perinatal outcome. Aim: To assess prevalence of various umbilical cord abnormalities and its association with maternal complications and perinatal outcome. Materials and Methods: This prospective observational study was conducted at Saraswathi Institute of Medical Sciences Pilkhuwa, Hapur, Uttar Pradesh, India from June 2019 till March 2020. Total number of deliveries during this period were 1284. After satisfying exclusion criteria, total 600 deliveries of more than 37 weeks of gestation were included in the study at random. Examination of cord was done during delivery for presence of loops of cord around the neck or body, any knots, true or false. After the delivery, the cord was clamped 5 cm from the fetal end and the total length was measured from the cut end till the placental insertion site, and 5 cm added therein. Umbilical cord was examined for any abnormalities and numbers of coils recorded and Umbilical Coiling Index (UCI) measured. Apgar score and NICU admissions noted. Results: Out of 600 patients, umbilical cord abnormalities were seen in 194 (32.33%) patients, while in 406 (67.67%) no abnormality was detected. The mode of delivery was vaginal in 441 cases (73.5%) while 159 (26.5%) had Lower Segment Cesarian Section (LSCS). Out of 194 cases with umbilical cord abnormality, 89 (45.87%) had LSCS and out of 406 cases with no cord abnormality, only 70 cases (17.24%) had LSCS (p-value <0.0001). Mean UCI was 0.25±0.09. Total 269 (44.83%) had maternal complications and 143 cases (53.16%) had umbilical cord abnormalities. While 126 (46.84%) cases with maternal complications did not show any cord abnormality. Apgar score of <7 at one minute was seen in 43 cases (22.16%) and 23 (11.86%) were admitted in Neonatal Intensive Care Unit (NICU) with umbilical cord abnormality. Conclusion: The umbilical cord abnormalities were associated with the adverse maternal and perinatal outcome and increased rate of LSCS (p-value <0.0001). The study shows the importance of knowledge of cord abnormalities. The cord abnormality should be looked for after each delivery, with the aim to reduce perinatal morbidity

Variability of Standard Liver Volume by 2D Ultrasound: A Cross-sectional Study from Eastern India

Partha Sarathi Ain, Uttam Kumar Roy, Krishna Sen, Debes Ray, Jayanta Pal

Introduction: Liver volume estimation is an essential component prior to major hepatic surgery and liver transplantation. Liver volume is evaluated with different formulae, gold standard Computed Tomography (CT) volumetry and Magnetic Resonance Imaging (MRI). As per literature review, studies comparing ultrasonography with formula based liver volume estimation are very few. Ultrasonography is non-invasive in nature and inexpensive. It is gaining popularity among clinicians as it helps in rapid evaluation of liver volumes. Aim: To compare variability of liver volume using 2D ultrasound with a standard well-established method based on formula derived by Johnson et al. Materials and Methods: This was a cross-sectional study done between August-October 2020 and patients were selected by the physician from general Outpatient Department (OPD) pool and clinically screened for further biochemical studies. Participants aged 20-60 years with normal liver function test were recruited in the study. Images were taken on a Siemens Ultrasound System. Study variables included were liver volumes estimated by two methods, age, weight, height and Body Surface Area (BSA). F test was used to compare variability between liver volumes estimated by two different methods. Bivariate correlation between ultrasonography-based liver volume and different body indices was also tested. Results: Variability comparison using F test shows no significant difference (F=1.095, df1=149, df2=149, p=0.29). Liver volumes estimated by two methods showed good correlation with each other and is significant at the 0.01 level, r=0.574. The mean difference (125 cc) in volumes between two methods were statistically significant (t=10.92, degree of freedom=149, p<0.001) and were not in agreement with each other. Body parameters were correlated with liver volume estimated by 2D ultrasound. Conclusion: Ultrasonography is a useful tool in estimating liver volume prior to major hepatic resection. Formula based calculation of Standard Liver Volume (SLV) does not agree with USG based volume and underestimates the mean liver volume obtained by USG method.

Interpretation of Variation in Corneal Parameters with Age using Pentacam: A Cross-sectional Study

Harvinder Nagpal, Mandeep Kaur

Introduction: Previous equipments used to study cornea were mostly Placido based which could only analyse anterior surface of cornea, while Pentacam is based on elevation based imaging method that helps to study the curvature of cornea, its elevation and thickness profile more accurately. There are numerous studies published to study the thickness of cornea, this study outlines the importance of changes introduced in various corneal parameters with age which in itself is an important factor with possible positive correlation. Aim: To determine various corneal parameters and to interpret the variations in these with increasing age. Materials and Methods: This cross-sectional study included a cohort of 60 healthy patients attending Outpatient Department (OPD) of Ophthalmology from July 2019 to February 2020. Two sets of values were determined, studied and compared between different age groups. First set of values included, keratometry values in the flat (K₁ ) and steep (K₂ ) and maximal keratometry values of the front surface (Kmax). Second set of values included, Anterior Elevations (AE), Posterior Elevations (PE), PE minus AE from Best Fit Sphere of 8 mm (BFS) and PE from the Best-fit Toric Ellipsoid (BFTE), apex thickness (CCT), pachymetry at the thinnest-point thickness (TCT), average corneal Pachymetry Progression Indices (PPI avg) and average Ambrosio’s Relational Thickness indices (ART avg). Based on age, three groups were created with 20 participants in each, Group A with age 18 to 25 years, Group B with age between 26 and 40 years and Group C with age more than 40 years. Scanning of all study subjects was done using Pentacam. Mann-Whitney U test and Spearman correlation test were used for the statistical analysis. Results: The average age was 21±2.42 years in group A, 30.9±4.3 years in group B and 42.45±1.65 years in group C. When AE, PE and PE-AE values were compared among three age groups, results were highly significant with p-value <0.00001. Thus, the elevation indices from BFS were found to be correlated with age. On comparison of PPI average between group A and B, group B and C values were statistically insignificant (p-values 0.51 and 0.19, respectively). Though in comparison between Group A and C, average corneal PPI avg was found to be of statistical significance (p-value=0.048). Average ART indices (ART avg) was found to produce highly statistically significant results among 3 groups (p-value <0.00001). Conclusion: The corneal parameters are significantly altered from their normative values with age. This study outlines that elevations indices and avg ART values are significantly altered with increasing age.

Clinical Pattern and Management of Retroperitoneal Teratomas in a Tertiary Paediatric Centre: A Retrospective Study

Prasanta Kumar Tripathy, Pradeep Kumar Jena, Kaumudee Pattnaik

Introduction: Retroperitoneal Teratomas (RPT) are rare germ cell tumours. Preoperative imaging features often overestimate the tumour size and may be misleading. Surgical exploration of RPT is a challenge because of enormous size and adherence to surrounding organs. The current knowledge on childhood RPT is limited due to rarity of these cases and limited number of studies. Aim: To analyse the demographic pattern, clinical profile and outcome of RPTs managed in a tertiary care paediatric hospital. Materials and Methods: This retrospective study was conducted on hospital records of the children between June 2013 and May 2020. The diagnosis was based on clinical, radiological, intraoperative findings and histopathology and data were collected for demographic pattern, clinical findings, pathological features and outcomes. Statistical analysis was done using Microsoft Excel software. Fisher's-exact test was used for comparison between various groups. Results: Out of 88 cases of intra-abdominal solid tumours operated during the study period, RPT was found in 16 cases (18.18%). A male preponderance was observed among RPT patients in comparison to other intra-abdominal solid tumours (p=0.26) and 12 patients (75%) were below five years of age. Complete excision of teratoma was performed in all cases. Benign mature teratoma was detected in 81% cases and immature teratoma in 18%. Additionally, two rare observations were made in the present study: (i) In one patient, the histology revealed; teratoma with papillary carcinoma of thyroid as malignant component and chemotherapy was advised; (ii) renal atrophy secondary to RPT was found in another patient. There was no mortality or tumour recurrence; as monitored by serum Alpha-Fetoprotein (AFP). Conclusion: RPTs are uncommon childhood tumours, which usually present before five years of age. Complete excision is possible, without damage to surrounding organs, as they are mostly benign. But, finding of malignant component in the tumour warrants further chemotherapy..

Morphometry of the Thyroid Gland and its Correlation with Various Anthropometric Parameters in Asymptomatic Indian Young Adults- A Cross-sectional Study

Introduction: The volume, shape and size of the thyroid gland varies with age and sex. Morphometry of the thyroid with particular emphasis on its volume is an essential and most important parameter which must be evaluated. It is helpful in the diagnosis and monitoring of various thyroid diseases. Aim: To evaluate the volume of the normal thyroid gland and thickness of thyroid isthmus by ultrasonography and to observe its correlation with sex, height, weight, Body Mass Index (BMI), Neck Circumference (NC), Body Surface Area (BSA) and Lean Body Mass (LBM) in asymptomatic subjects. Materials and Methods: This was a cross-sectional study which included 100 volunteers (50 males and 50 females) from among 1st year MBBS/BDS students, who were attending classes in the Department of Anatomy, King George's Medical University, UP, Lucknow during April 2019-March 2020. Detailed information (sex, height, weight, NC) was recorded for every subject. Also, BMI, BSA and LBM were calculated for each. Thereafter, ultrasound was performed to measure the dimensions of the thyroid gland. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 24. Student t-test (to test the significance of two means), Analysis of Variance (ANOVA) and bivariate correlation using Karl Pearson correlation coefficient (r) were used as statistical tests; and p-value <0.05 was regarded as statistically significant. Results: The mean volume of the right lobe of the thyroid gland was found to be 3.89±1.28 mL and of left side was 3.59±1.09 mL. The mean total volume of thyroid gland was 7.48±2.22 mL. In males, it was found to be 8.32±2.30 mL and in females, it was 6.63±1.78 mL. The mean thickness of thyroid isthmus was 2.09±0.66 mm. The correlation of total thyroid volume with all the anthropometric parameters was significant, while correlation of isthmus thickness was statistically significant with LBM and NC only. Conclusion: Present study provides a normative reference data for the physicians and surgeons to consider while dealing with everyday cases of thyroid hypoplasia or goiter in their Outpatient Department (OPD)/Inpatient Departments (IPDs).

Presence of Chaperone during Pelvic Examination: Women’s Opinions and Preferences in a Tertiary Hospital in Abakaliki, Ebonyi State, Nigeria

Introduction: Pelvic examination in the evaluation of patients can be a source of dissatisfaction and litigation from patients. A chaperone is beneficial in militating against unforeseen circumstances surrounding this clinical examination. Aim: To access the opinions and preferences of patients in pelvic examinations and factors associated with the use of chaperones in Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Materials and Methods: The present study was a cross-sectional study. Women were recruited between October 2017 to April 2018 among patients attending the Gynaecological Clinic at the Federal Teaching Hospital, Abakaliki, Nigeria. A structured questionnaire was used to collect data such as the socio-demographic characteristics, feelings towards pelvic examinations, and preferences about the gender of the examining doctor as well as the presence of a chaperone. Data analysis was done using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) Statistics version 20.0 (IBM Corp., Armonk, NY, USA). Results: Out of 423 questionnaires distributed, 395 respondents completed the survey giving a response rate of 93.4%. The mean age of the respondents were 29.2±6.2 years. Majority of the respondents would prefer to be seen by a female gynaecologist 342 (86.6%). About 50 (12.7%) respondents would decline pelvic examination. The commonest reason given for refusing gynaecologic examination was uncomfortable environment 25 (50%). More than two-third 264 (76.5%) would prefer to have a chaperone present at any pelvic examination. Avoidance of sexual molestation was the commonest reason given for wanting a chaperone to be present 207 (78.4%). Nulliparous women (OR=2.25 95% CI 1.13-4.50) and those with at least a secondary education (OR=7.91 95% CI 4.54-13.78) were also more likely to request a chaperone. Conclusion: Majority of the women in present study wanted the presence of a chaperone during a pelvic examination. It is therefore recommended that chaperones should routinely be offered during pelvic examination in Abakaliki, Ebonyi, Nigeria.

Influence of Isolation Methods on Retention of Pit and Fissure Sealants in Young Permanent Teeth based on Simonsen’s Criteria: A Randomised Clinical Trial

Madhuri Bandi, Sreekanth Kumar Mallineni, Sivakumar Nuvvula

Introduction: Pit and Fissure Sealants (PFS) are chemically-active liquid materials that are introduced into the occlusal surface of caries-susceptible teeth. These form a micro mechanically bonded, protective layer preventing access to caries-producing bacteria, from rest of the oral environment. Aim: To evaluate the retention of PFS placed on young permanent teeth using two isolation methods. Materials and Methods: This clinical study was carried out in the Department of Paediatric and Preventive Dentistry, at Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India. One hundred Permanent First Molars (PFM) from 25 healthy, cooperative children in the age group of 6-9 years were assigned by block randomisation into two groups (isolation type); each group containing the upper and lower PFMs of the right and left side receiving two different treatment modalities (split-mouth design). In Group I (n=50 teeth), the teeth received sealant with rubber dam isolation, and in Group II (n=50 teeth), with cotton roll isolation. The sealant was applied to all the PFMs as indicated. All the teeth were evaluated using Simonsen’s criteria at regular intervals of 3, 6, and 12 months. The data collected were subjected to statistical analysis using the SPSS statistical package (version 17) and statistical significance was set at 0.05. The difference in the retention of PFS with the two isolation methods was analysed using the Chi-square test. Results: After 12 months, the marginal integrity rate for sealants placed with a rubber dam and cotton roll isolation were 75% and 64%, respectively. The results were better in Group I than in Group II, although there were no statistically significant differences with respect to marginal integrity, discolouration, and anatomical failure. Conclusion: Retention of PFS in young permanent teeth was better with rubber dam than cotton rolls for isolation, though the results were not statistically significant.

Effect of Preoperative Nebulised Dexamethasone and Nebulised Magnesium Sulphate on Postoperative Sore Throat in Prone Position Surgeries- A Randomised Double Blind Study

Introduction:Postoperative Sore Throat (POST) is a frequently encountered complication after general anaesthesia with tracheal intubation and positional changes. Magnesium Sulphate (MgSO₄ ) is a N-Methyl D-Aspartate (NMDA) receptor antagonist and dexamethasone is a glucocorticoid, both drugs helps in reducing POST by various mechanisms. Aim: To compare the effects of preoperative dexamethasone nebulisation vs preoperative MgSO₄ nebulisation on sore throat in prone position surgeries. Materials and Methods: Eighty patients undergoing lumbar spine surgeries from October 2017 to April 2019, under general anaesthesia in prone position, were randomly allocated into two groups- A and B. Thirty minutes before surgery patients in each group were nebulised with respective drugs, dexamethasone 8 mg in group A and 250 mg of MgSO₄ in group B. Haemodynamic parameters during laryngoscopy were noted. A standardised protocol for providing general anaesthesia was followed for all patients. After extubation, at 0, 4, 6 and 24 hours all patients were asked to grade POST, hoarseness and cough. The severity of POST was graded with four-point scale. Continuous variables were expressed as mean±SD and analysed using student t-test. The p-value <0.05 was considered statistically significant. Results: The overall incidence of sore throat in dexamethasone group was 37.5% and 20% in MgSO₄ group. The incidence (p=0.026) and severity (p=0.011) of POST was significantly decreased in MgSO₄ group at 6 hours where none of the patient had sore throat compared to dexamethasone where 15 (37.5%) of them had sore throat (p=0.026). None of the patients had cough and hoarseness in both groups. Conclusion: Nebulisation with MgSO₄ preoperatively significantly decreases the incidence and severity of POST when compared to dexamethasone and there was no statistically significant haemodynamic variability between the two groups.

Estimation of Perceived Stress among Doctors in a Peripheral Tertiary Government Medical College of West Bengal: A Cross-sectional Study

Ranjan Das, Nazrul Mallick, Ashis Debnath, Bijit Biswas, Sumit Mukherjee

Introduction: Doctors working in a tertiary care teaching hospital suffers higher symptoms of psychological distress. The impact of excessive stress may affect the individual employee and the organisation in terms of productivity and performance. Aim: To estimate the perceived stress among doctors and to find out the sources of their stress in a peripheral Government Medical College of West Bengal. Materials and Methods: This was an observational study, cross-sectional in design, conducted to assess the perceived stress and specific stressors among 95 doctors who were posted in a peripheral Government Medical College from June to November 2019. A Perceived Stress Scale (PSS 10) questionnaire was used to assess the perceived stress. Psycho-social and Environmental stressors were assessed using 11 items questionnaire. Data were analysed using the IBM statistical package for social sciences, (SPSS) software program (version 20.0) (Chicago, USA). Results: The majority of the participant (80%) had moderate level of stress, while 10.5% had low stress and 9.5% had severe stress. The mean PSS score in this study was 20.49±5.61. In univariate logistic regression analysis, significant association was found with loneliness {Odds Ratios (OR) 9.3; 95% Confidence Interval (CI)= 2.9-29.9}, family problem (OR 2.7; 95% CI=1.1-6.6) and quality of food (OR 2.9: 95% CI=1.2-7.0). Finally, loneliness (AOR 9.6; 95% CI=2.7-34.1) and family problem (AOR 3.7; 95% CI=1.3-10.1) came out to be statistically significant predictors of stress in multivariable logistic regression. Conclusion: Majority of doctors had moderate level of stress and they felt upset, nervous and stressed in last one month of preceding the survey. Professional counseling for the doctors to improve their coping and resilience behaviours is highly recommended.

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

OP Jamshad, Jacob Mathew, Raju Karuppal

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12- 14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

Utility of Kumkum as a Counterstain in Histopathological Evaluation of Cervix: An Unexplored Archaic Behooveful Colourant

N Navya, BN Kumarguru, AS Ramaswamy, GK Swethadri, P Janakiraman

Introduction: The turmeric extract has been used as a potential alternative for eosin on routine histopathology sections. Kumkum is made from saffron flowers of Crocus sativus L. with mild use of turmeric. Aim: To evaluate the staining characteristics of kumkum solution as a counterstain and to compare the staining characteristics of kumkum solution and turmeric solution in histopathology sections of cervix tissue. Materials and Methods: It was a prospective observational study conducted at a rural tertiary care referral institute, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from May 2019 to July 2019. For each case, cervix tissue sections were stained with Haematoxylin and Eosin (H&E), Haematoxylin and Turmeric (H&T) and Haematoxylin and Kumkum (H&K). The staining characteristics of H&T and H&K was documented and evaluated using a scoring system by comparing with that of conventional H&E sections. The parameters were analysed for statistical significance. Chi-square test and two-sample t-test were the statistical tools used to analyse the data. All statistical calculations were done through statistical software STATA version 14.1. Results: A total of 57 cases were analysed. H&K was better than H&T with respect to contrast at low power, morphological details of cytoplasm, nucleus and acellular structures (p<0.001). The overall performance of H&K was better than H&T and was statistically highly significant (p<0.001). Conclusion: Kumkum appears to be an efficient counterstain for demonstrating various structures in histopathology sections of cervix tissue. It may be considered as an unexplored archaic behooveful colourant. The utility of kumkum may be extended to study the histopathology of other tissues and organ systems in the body.

Knowledge and Self-perceived Confidence Level in Oral and Maxillofacial Surgery among Dental Interns in Riyadh

Introduction: Minor oral surgical procedures are practiced in dental teaching. Interns are required to be competent, wellprepared and acknowledge its basics before their practice. Lack of training and knowledge could lead to serious consequences during clinical practice. Aim: To assess the knowledge and confidence level between male and female dental interns in private and governmental Riyadh dental schools in performing simple dento-alveolar procedures. Materials and Methods: A cross-sectional observational study was conducted at Princess Nourah bint Abdulrahman University in Riyadh, Saudi Arabia in January 2020 among dental interns from all Riyadh dental schools. A cross-sectional survey containing 23 items was used. The first part included the informed consent and demographic data (item 1-3). The second part consisted of 10 case scenarios to assess the knowledge level (item 4-13), and the third part was developed to self-rate their confidence level (item 14-23). Around 300 participants belonging to five Riyadh dental schools comprised the study population. All interns were included in the study after obtaining informed consent. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 21.0 and Microsoft Excel 16.16. Groups were compared using Pearson chi-square and unpaired sample t-test. The p-value of <0.05 was considered statistically significant. Results: Out of 300 interns invited to participate, 210 submitted the electronic survey (70%). The final study population included 117 (56%) females and 93 (44%) males. A total of 111 (53%) belonged to governmental college, and 99 (47%) belonged to private college. There was no statistically significant difference between females and males in total knowledge (p<0.272) and confidence score (p<0.850), respectively. However, a statistically significant difference in knowledge and confidence between government and private colleges was found (p<0.001). A weakly positive significant correlation (r=0.217, p=0.002) was found between the total score of knowledge and the total score of confidence in performing surgical procedures. Conclusion: The study provides baseline data on the knowledge and perceived confidence of dental interns in Saudi Arabia about certain clinical procedures in oral surgery, where respondents were most knowledgeable in prescribing an appropriate medication. They were confident in giving effective local anaesthesia. All in all, interns had a superficial knowledge about the classification of impacted teeth and they were least confident in managing cases of an intraoral abscess.

Correlation of Pulmonary Function Tests with Anthropometry and Glycaemic Control in Type 2 Diabetes Mellitus: A Cross-sectional Study

Aiswarya Roy Karintholil, Akshatha Rao Aroor, Joel Sabu, Joshua Chacko
Introduction: Diabetic patients are found to have reduced lung functions compared to their controls and their relationship with the duration of diabetes, glycaemic control, and Body Mass Index (BMI) is poorly characterised. Aim: To determine the correlation between the pulmonary function abnormalities with anthropometry, glycaemic control, and duration of diabetes in type 2 diabetic patients. Materials and Methods: A total of 80 type 2 diabetic patients were studied. BMI, Waist Circumference (WC), Waist-Hip Ratio (WHR), Fasting, postprandial blood sugar and glycosylated haemoglobin (HbA1c) were assessed from July 2018 to September 2018. Spirometry was done in accordance with the guidelines from the American Thoracic Society (ATS). Reduced pulmonary functions were defined as patients with restrictive Forced Expired Volume in 1 second (FEV1)/Forced Vital Capacity (FVC) ≥0.7 and FVC <80% predicted or obstructive (FEV1/FVC <0.7) impairment. Statistical analysis was done using ANOVA test and Karl Pearson Correlation coefficient. Results: The mean values of FEV1/FVC (0.8±0.08) and FVC% predicted (60.29±11.39) showed a restrictive pattern. FEF (25-75%) (r=0.241, p=0.031) and Peak Expiratory Flow Rate (PEFR) (r=0.245, p=0.029) positively correlated with duration of diabetes. BMI had a negative correlation with FVC% predicted (r=0.239, p=0.033). A negative correlation between FEV1% and Waist Circumference (WC) was observed (r=-0.232, p=0.038). HbA1c negatively correlated to FEV1/FVC (r=-0.227, p=0.043). Conclusion: Patients with type 2 Diabetes Mellitus (DM) were found to have an asymptomatic restrictive pulmonary impairment. Increased duration of diabetes, increased BMI, increased WC was associated with decreased lung functions in diabetics.

Antibacterial Efficacy of Different Herbal Based Irrigant Solutions in Deciduous Teeth

Naamatullah Ahmed Mohammed, Bahar Jaafar Selivany
Introduction: Endodontic infection requires the successful removal of microorganisms from the root canal system. The most effective irrigant solution is sodium hypochlorite, but possible problems due to its toxicity require the look for new alternatives. Constant increases in antibiotic resistance and side-effects caused by chemical irrigation have shifted research towards the production of herbal alternatives, especially in paediatric dentistry. Aim: To evaluate and compare the antibacterial efficacy of miswak, green tea, chamomile and 0.5% NaOCl as an endodontic irrigants against Enterococcus faecalis in primary root canals. Materials and Methods: The in-vitro study was conducted at the Department of Conservative Dentistry and Department of Microbiology, College of Dentistry, University of Duhok from January 2020 till June 2020. Seventy five freshly extracted intact human mandibular primary molars were decoronated at Cemento-Enamel Junction (CEJ) and distal roots were separated and biomechanically prepared up to F3 Protaper file and stored in normal saline. The specimens were inoculated with Enterococcus faecalis suspension and incubated for 72 hours. Specimens were divided into five groups containing fifteen teeth each (n=15). Freshly prepared alcoholic extracts of miswak, green tea and chamomile were used as an irrigant solution against E.faecalis compared to NaOCl as positive control and normal saline as negative control. Swabs were collected using F3 protaper paper points. The number of colonies was counted in suitable plate under good illumination and manual lens for magnification. Statistical analysis was performed by using Kruskal-Wallis one-way Analysis and Student-Newman-Keuls Method. Statistical Package for the Social Sciences (SPSS) version 26.0 was used. The p-values more than 0.05 were considered as statistically non significant. Results: Green Tea, among the herbal experimental groups, had the most effective antibacterial effect against E.faecalis. No significant statistical difference was detected between green tea (p=0.272) and NaOCl; however, there was significant difference between miswak, chamomile and NaOCl as well as between the rest herbal experimental groups and normal saline. Conclusion: NaOCl remains the gold standard as irrigant in primary teeth. Green tea extract may help in reducing E.faecalis inside the canals of primary teeth. Good efficacy against E.faecalis was also shown by Miswak and chamomile however the results obtained were not significant when compared with NaOCl.

A Survey to Assess the Knowledge, Attitude and Practice about COVID-19 Pandemic from West Bengal, India
Introduction: The Coronavirus Disease-2019 (COVID-19) that originated in China in December 2019 was declared a pandemic by the World Health Organisation (WHO) on 11th March, 2020. It has resulted in extensive lockdown measures in India and in the state of West Bengal. Both Central and State Governments have made considerable efforts to increase awareness about the pandemic among the general public. Aim: This study was conducted to assess the Knowledge, Attitude, and Practice (KAP) among the general public of West Bengal about the pandemic as no such data is available till date. Materials and Methods: The retrospective survey was undertaken among the general public of the state of West Bengal, India, by means of social media platforms (Facebook, Instagram, Linkedin and WhatsApp) through a validated e-questionnaire containing 10 questions during 18th April, 2020 to 3rd May, 2020. Data was captured on Google Forms, which were analysed using appropriate tools. Results: A total of 355 responses were obtained. A 97% of responders were completely aware of the pandemic with 92% practising preventive measures, such as social distancing, washing hands, and wearing a mask. Majority of the participants were young (18-30 years of age) with 51% being males. A 99% of the responders were literate and 86% were from urban dwelling. Total 61% of the participants stated that they have learnt something new after participating in this survey. Conclusion: KAP about COVID-19 pandemic was found to be high in the general population of West Bengal. Involvement of various social media platforms is required for generating mass awareness about COVID-19 in rural West Bengal. Continuous communication and survey by the Government is necessary to spread public awareness as information about COVID-19 is constantly evolving.

Comparison of Depot Medroxyprogesterone Acetate and Postpartum Intrauterine Contraceptive Device in a Teaching Institute of Rural Bengal: A Longitudinal Cohort Study

Sougata Kumar Burman, Jayeeta Mukherjee, Ranita Roy Chowdhury, Soumen Deb
Introduction: Contraception is one of the proximate determinants of fertility and the most important predictor of fertility transition. Depot Medroxyprogesterone Acetate (DMPA) and Intrauterine Contraceptive Device (IUCD) share some common featuresboth are Long Acting and Reversible Contraceptives (LARC), but the mechanisms are different. DMPA is a non invasive, hormonal manoeuvre while IUCD is an invasive, non hormonal one. Aim: To compare the acceptance and reasons for refusal or non compliance between DMPA and Postpartum Intrauterine Contraceptive Device (PPIUCD). Materials and Methods: A longitudinal cohort study was done in which total of 110 postpartum women (55 in each group) using either DMPA or IUCD were selected randomly and were interviewed and followed-up for minimum of six months. Data (variables- number of candidates accepting or refusing PPIUCD or DMPA) from the questionnaires were entered in Microsoft Office Excel 2007 and was transferred to IBM SPSS software, version 20.0 (SPSS Inc. Chicago, IL, USA). Pearson’s Chisquare test was used for variables and p-values were calculated using to find out the statistical significance of the variables and p-value <0.05 was considered statistically significant. Results: The overall acceptance of DMPA (87.3%) was found to be much more than that of PPIUCD (63.6%). In respect to different age groups, the acceptances of both PPIUCD and DMPA were significantly higher in women of age group 21-25 years. In respect to parity, acceptance of PPIUCD was more in women with one child, whereas the acceptances of DMPA were almost similar in women with either one or two children. Among women using PPIUCD, 36.4% refused to continue with the method, whereas only 12.7% of DMPA users refused further injections, the main reason for both the groups being the same irregular bleeding. Conclusion: The acceptance as well as compliance of DMPA as a method of postpartum contraception is much better than PPIUCD in women of this part of rural Bengal.

Morphological Study of Psoas Minor Muscles with Embryological Basis and Clinical Insights

Deepshikha Singh, Sneh Agarwal
Introduction: The psoas group of muscles belongs to the posterior abdominal wall. The psoas minor is an inconstant, vestigial, fusiform, slender muscle. Researchers have frequently paid attention to the anatomy, morphology, frequency of this muscle and its clinical, racial, ethnic correlation. Aim: To investigate and study the psoas minor muscle, with regard to its frequency, agenesis, origin, insertion, morphological variations, its embryological basis and clinical significance. Materials and Methods: The present observational study was conducted at Lady Hardinge Medical College, New Delhi, between December 2018 to May 2019 in the Department of Anatomy. Nine cadavers were studied during routine dissection of the posterior abdominal wall (three females and six males). The prevalence, morphology, morphometry, laterality, sexual dimorphism for psoas minor muscle was assessed. The mean, standard deviation and coefficient of variation of the morphometric parameters were also evaluated. Results: Psoas minor muscle was present in 55.55% (5/9) cadavers. The muscle was bilateral in 22.22% (2/9) cases and unilateral in 33.33% (3/9) cases. In all the cases, the muscle took origin from the T12-L1 vertebra and the intervertebral disc. However, the muscle showed a variation in its distal attachment in one of the cadavers. The muscle was unilateral in both the female cadavers and bilateral in two male cadavers. Conclusion: The prevalence of psoas minor muscle was found to be 55.55%. Knowledge about the incidence of psoas minor muscle is of significant academic interest to anatomists as well as clinicians, for diagnostic purposes (particularly in abdominal pain) and during radiographic imaging.

Assessment of Birth Preparedness and Complication Readiness among Postnatal Mothers in Tertiary Care Hospital, West Bengal

Bratadipa Sau, Santanu Ghosh, Amrita Samanta
Introduction: Maternal mortality still remains a major public health challenge in India. Delays in seeking, reaching and obtaining to appropriate intranatal care are the crucial factors determining maternal mortality. Birth Preparedness and Complication Readiness (BPACR) is the process of planning for normal birth and anticipating the actions needed in case of an emergency. It is a logical process of addressing delays in delivery. Aim: To assess BPACR status of postnatal mothers using BPACR index and to determine association between socio-demographic and other variables and BPACR status among them. Materials and Methods: The cross-sectional, observational study was conducted on 200 postnatal mothers of Indoor Patient Department (IPD), Department of Gynaecology and Obstetrics, in a tertiary care hospital in West Bengal. Socio-demographic information and information on antenatal history, decision makers during pregnancy, type and distance of nearest health facility, knowledge of danger signs, identification of the skilled birth attendant, mode of transport, arrangement for money and other variables were collected by interviewing the patients with a predesigned, pretested, semi structured schedule and by reviewing records. BPACR is the process of planning for normal birth and anticipated actions needed during an emergency. To assess BPACR status among postnatal women, BPACR index is measured which consists of a set of indicators. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Proportion and Chi-square test were used wherever applicable. The p-value of less than 0.05 was taken as statistically significant. Results: The final BPACR index was 61.07. All participants identified skilled birth attendants for delivery. Almost all were aware of Janani Suraksha Yojana (JSY). Among 200 women, about 90% of them had knowledge about transportation services provided by the government. Only 63.5% of the mothers (127/200) availed Antenatal Care (ANC) by skilled provider. About 38.5% (77/200) of study participants identified the mode of transportation, and 38% (76/200) of them saved money for delivery expenses. No participant could identify more than eight danger signs of pregnancy. Overall, 75% (150/200) of participants were well-prepared. On bivariate analysis, good preparedness have been found to be significantly associated (p-value <0.05) with age group, type of decision maker during pregnancy and presence of the husband accompanying their wives in any of the ANC visits. Conclusion: Majority of the population were well-prepared, but awareness on danger signs was very low. Women empowerment in terms of behavior change communication at family, community and tertiary care level to be carried out through formal and informal approaches are the needs of the hour.

A Study of the Clinico-epidemiological Profile of COVID-19 Patients Admitted in a Tertiary Care Hospital in India

Charvi Patel, Sonali Palkar, Purwa Doke, Rupeshkumar Deshmukh
Introduction: India is the second country with the highest Coronavirus Disease-2019 (COVID-19) case burden in the world. In India, Maharashtra state has the highest number of cases. Aim: To study the clinico-epidemiological profile of COVID-19 patients admitted in a COVID-19 designated tertiary care centre in Pune, Maharashtra, India. Materials and Methods: The authors retrospectively investigated epidemiological, demographic, clinical, laboratory, radiological and treatment data of 413 Real Time-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients from 14th April 2020 to 30th June 2020. The data was analysed using the Mann-Whitney U test for continuous variables with non-normal distribution. Also, the multivariate logistic regression was used for analysis. Results: Among the 413 laboratory confirmed COVID-19 patients, 249 (60.29%) were males, majority {87 (21.07%)} of the patients belonged to the age group of 51-60 years. The most common co-morbid condition found was diabetes mellitus {102 (24.69%)}. The most common symptoms were fever {185 (44.79%)} and cough {146 (35.35%)} followed by breathlessness {134 (32.45%)}. History of close contact with a confirmed COVID-19 case was present in 205 (49.64%) patients. The mean time from the onset of symptoms to hospital admission was 3.75 (SD±2.64) days. There was a strong association between increasing age and the need for intensive care. Total 63 (80.77%) out of 78 patients above 60 years of age had abnormal Chest X-Ray (CXR) findings during hospitalisation. Furthermore, the maximum number of deaths i.e., 31 patients (58.49%, n=53) occurred in the age group of more than 60 years of age. Conclusion: The findings suggest that increased value of serum Lactate Dehydrogenase (LDH) and Urea can be used as predictors for mortality rate. Patients aged more than 60 years are more prone for severe disease with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pneumonia and this subset of patients requires urgent medical attention.

Prospective Cohort Study Comparing Varying Doses of Cisatracurium and Atracurium on Intubating Conditions in Patients Undergoing Laparoscopic Cholecystectomy

Chandrasekharan Anjali, Korumbil Raghavan Radha, Kannammadathy Poulose Biji
Introduction: Cisatracurium and atracurium are nondepolarising muscle relaxants belonging to benzylisoquinolinium group. Intubating dose of cisatracurium is found to be safer than atracurium owing to the histamine release and resultant respiratory and cardiac side-effects associated with the latter. However, intubating conditions of twice the ED95 dose (2xED95) of cisatracurium are not as satisfactory as equipotent dose of atracurium because of its higher potency. Aim: To compare the time of onset, intubating conditions and mean duration of action of three and four times ED95 doses (3 and 4xED95) of cisatracurium with 2xED95 dose of atracurium so as to find out an ideal intubating dose of cisatracurium that is comparable with 2xED95 of atracurium. Materials and Methods: The present study was a prospective cohort study that included 102 patients who underwent elective laparoscopic cholecystectomy. They were divided into three groups of 34 each to receive atracurium 0.5 mg/kg (group A), cisatracurium 0.15 mg/kg (group B) or cisatracurium 0.2 mg/kg (group C) for intubation. Onset and duration of neuromuscular block were assessed using Train of Four (TOF) stimuli. Total time for intubation and mean intubation scores were also noted. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 18.0. Qualitative data were compared using Chi-square test and quantitative data compared using Analysis of Variance (ANOVA). Results: Onset of neuromuscular blockade in groups A, B and C were 292.06±61.486, 204.71±39.407 and 120.88±37.284 seconds (p-value <0.001), respectively. Mean intubation score was highest in group C along with least intubating time (p-value <0.001). The mean duration of action in groups A, B and C were 40.44±5.275, 48.24±5.888 and 63.38±7.659 minutes, respectively (p-value <0.001). Conclusion: The 3 and 4xED95 doses of cisatracurium was found to be superior to 2xED95 dose of atracurium in providing faster onset of action, better intubating conditions, shorter intubation time and longer duration of action. The 4xED95 dose of cisatracurium may be considered for rapid intubation in two minutes.

Plasma Total Thiols and Total Thiol/Albumin Ratio in Patients Suffering from Depression

AS Meenakshi Sundaram, Krishnananda Prabhu
Introduction: Increased oxidative stress has been reported in patients who suffer from depressive disorders. Albumin acts as a target for plasma protein oxidation during oxidative stress. The plasma thiols act as significant in-vivo antioxidants. Major SH-groups are found on the surface of albumin molecules. Since depressive disorders are related to oxidative stress. Only a few studies have been done that correlate plasma total thiols with major depressive disorder. The authors intended to draw a relationship between oxidative stress, thiols and major depressive disorder by estimating total plasma thiols and calculating the ratio of thiol/albumin. The study may throw some light in understanding whether the use of anti-oxidant supplements to counter oxidative stress in depressed patients. Aim: To estimate plasma thiols, albumin and obtain a plasma thiol/albumin ratio in people suffering from depression and compare the levels with the control group. Materials and Methods: This case control study was conducted in Kasturba Medical College, Manipal. Plasma thiols were estimated using Ellman’s method. Plasma albumin levels were estimated using Bromo cresol green dye binding method. MannWhitney U test was used for analysing the data for total thiols and thiol/albumin ratio. A p-value <0.05 was considered significant. Results: The study group was made up of 43 (22 males and 21 females) patients and the control group was made up of 40 (18 males and 22 females) healthy controls. Plasma thiol levels and the plasma total thiol/albumin ratio were significantly elevated (p<0.001) in cases (depression) as compared to that of the controls. Conclusion: Plasma total thiols can be used as an early marker for understanding the risk for major depressive disorders and also be used as a prognostic indicator in the follow-up of patients suffering from major depressive disorder who are under treatment.

Expression of p16 and Galectin3 in Squamous Cell Carcinoma of Uterine Cervix, in Relation to the Histomorphological Variants: A Cross-sectional Analysis

Sarbashis Hota, Tushar Kanti Das
Introduction: Cancer of uterine cervix comprises a big chunk of cancer registration worldwide. Now-a-days the immunohistochemical marker p16 has emerged as the surrogate marker of high risk Human Papilloma Virus (HPV) infection in cervical tissue. Galectin-3, a ubiquitous agent likely to modulate different pro-survival properties necessary for neoplastic cells, is recently emerging as the guardian of tumour microenvironment. Aim: To study the expression of p16 and galectin-3 in different histomorphological variants of cervical Squamous Cell Carcinoma (SCC) and their association with grade and stage. Materials and Methods: An observational cross-sectional study was undertaken in the Department of Pathology in a tertiary care hospital in East India, from January 2019 to June 2020. Fifty three samples diagnosed as invasive Squamous Cell Carcinoma (SCC) of uterine cervix were taken by systematic random sampling. Immunohistochemical examination was done using monoclonal antibodies against p16 and galectin-3 after obtaining thin sections from formalin fixed paraffin embedded blocks and retrieval of antigen. The data was interpreted by light microscopy using a semi-quantitative method with respect to prefixed parameters and statistical analysis was done by Chisquare test and Fisher's exact test using Statistical Package for the Social Science (SPSS) version 25.0. Results: Fifty two out of fifty three cases (98.1%) of squamous cell carcinoma in this study showed almost 100% block posivity of p16 in the tumour cells -strongly corroborative with high risk HPV infection. The non-keratinizing and the basaloid variant showed the strongest intensity of staining (3+). Only one case showed complete negativity of p16 expression. In galectin-3 positive cases, strong expression of this marker is found in the invasive tongues of the tumour cells at the junction of tumour stromal interface, consistent with our knowledge regarding the importance of galectin-3 in regulating the tumour microenvironment. The strongest galectin-3 positivity(3+) was found in the single case of Lymphoepithelioma like squamous cell carcinoma and showed almost 100% positivity among the neoplastic cell population; whereas the non-keratinizing and Basaloid variant showed almost negative expression. Significant association (p=0.00021) found between tumour grade and p16 intensity. Conclusion: The non-keratinizing and basaloid variants of squamous cell carcinoma have shown statistically significant association with highest intensity of p16 staining along with diminished expression of galectin-3. Increased tumour grade is also significantly associated with strong staining intensity of p16 and decreased galectin-3 expression. However, no significant association is found between galectin-3 expression or intensity of p16 expression and the stage of tumour.

Evaluation of Risk Factors for Septic Complications after Laparotomy for Abdominal Trauma: A Longitudinal Cohort Study
Introduction: Septic complications are the most common cause of death in trauma patients who survive beyond 48 hours. Early diagnosis and treatment of infectious complications is essential to prevent life threatening complications like Systemic Inflammatory Response Syndrome (SIRS) and MultiOrgan Dysfunction Syndrome (MODS). Aim: To study the various risk factors for septic abdominal complications following laparotomy for trauma. Materials and Methods: A prospective longitudinal cohort single-center study was conducted from November 2016 to March 2018. Sixty patients above the age of 12 years, who underwent laparotomy for abdominal trauma in the Surgical Department of tertiary care hospital, were included in the study. Various patient variables were compared with postoperative septic abdominal complications like wound infection, wound dehiscence, anastomotic leak and intra-abdominal abscess. Data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In the total 60 patients (35.60±16.54), significant association was seen between wound infection and dehiscence with the time interval between trauma and surgery (p<0.001), lesser Revised Trauma Score (RTS) (p<0.001) and greater Injury Severity Score (ISS) (p<0.001). A significant association of all septic complications was seen with the need for Intensive Care Unit (ICU) stay (p<0.001) and the presence of associated injuries (p<0.001). Variables such as age, gender, co-morbidities, Body Mass Index (BMI), pre-hospital care received, intraoperative findings and duration of ICU stay had no association with outcomes (p>0.05). Conclusion: In trauma patients, factors like low RTS score, high ISS score, need for ICU stay and the presence of associated injuries may help the surgeons to decide in which patients to go for techniques like delayed closure of the wound, stoma instead of bowel anastomosis, etc., which may help to reduce postoperative septic complications.

Knowledge, Attitude and Practice for Brucellosis amongst Migratory Animal Handlers: A Cross-sectional Study in Maharashtra, India

Satish L Ghugey , Maninder Singh Setia , Jyotsna S Deshmukh
Introduction: Brucellosis is a highly infectious zoonosis affecting humans and animals. It is a multi-burden disease leading to severe economic losses due to disability in humans, and it also causes abortion, infertility, and reduced milk production in animals. An essential element for effective prevention and control of brucellosis is to improve Knowledge, Attitude and Practice (KAP) of the community. b#Aim: To evaluate KAP for human brucellosis to determine the risk factors among Migratory Animal Handlers (MAH) in Nagpur and Chandrapur district of Maharashtra state in India. b#Materials and Methods: A cross-sectional study was conducted on 143 subjects chosen randomly from Nagpur and Chandrapur districts, Maharashtra. A structured and validated questionnaire was used for demographic characteristics and KAP. Data was entered in Microsoft Excel and analysed by SPSS. Descriptive statistics accustomed to demographic feature and KAP. b#Results: All 143 respondents (87 from Nagpur and 56 from Chandrapur) were males. Age ranged from 20 to 50 years. The majority of 139 (97%) respondents were married. Of 143 respondents, none had heard of brucellosis, 125 (87%) consumed unpasteurised milk, 37 (26%) assisted during calving, and 34 (24%) milking the animal. None of the respondents used protective clothing while assisting in animal delivery or handling birth products. One hundred and thirty six (95%) respondents informed that they treated the animal without consulting a veterinarian. b#Conclusion: This study showed poor knowledge and high-risk behaviours and self-reported practices for brucellosis among MAH. Public health education for MAH should be enhanced with full capacity as an integral part of the National Control Program on Brucellosis in India.

Remdesivir versus Standard of Care in Moderate to Severe COVID-19 Patients: A Retrospective Study

JM Jeetendra Kumar, SB Vaibhav, HR Avinash, P Pratheek

Introduction: In December 2019, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), a novel coronavirus, was first identified as the cause of a respiratory illness designated Coronavirus Disease 2019 (COVID-19). Since then, several antiviral drugs have been evaluated for the treatment of COVID-19, but none have shown any efficacy. The only drug which showed some efficacy was Remdesivir (RDV). Aim: To assess the effect and efficacy of RDV and to compare the outcome of patients who are receiving RDV and those receiving standard treatment protocol without RDV. Materials and Methods: A retrospective study was conducted. The data was collected from the case sheets of the case files of patients presenting to the Department of General Medicine Triage who were admitted from the month of July 2020 to December 2020 and analysis was done in January 2021. The method of sampling employed was a non-probability sequential sampling method. Results: Age and sex distributions were comparable in both the groups. The percentage of the patients who expired was 10% and 9% (n=10 and 9, respectively) in NonRDV and RDV groups respectively, this was statistically insignificant (p-value=0.809). However, the duration of hospital stay in those who received RDV was 10 (9-12) days while those receiving standard of care without RDV was 12 (10-15) days (p-value=0.0018) which was statistically significant. Also, after a comparison between the two groups it was evident that there was a significant difference in inflammatory markers D-dimer and Lactate Dehydrogenase (LDH) with p-value=0.001 and 0.029, respectively. Conclusion: Study concludes that there was no significant difference in outcome of patients who received RDV. However, the duration of hospital stay was found to be decreased in patients receiving RDV and also there was a significant improvement in inflammatory markers like LDH and D-dimer.

Role of Immunohistochemical Markers p53 and Ki-67 in Grading of Glial Tumours: A Prospective Study

Introduction: Gliomas are the tumours of neuroepithelial tissues and are named according to their cell of origin. Squash cytology and sterotactic biopsies with Haematoxylin and Eosin (H&E) staining form the backbone of diagnosis, nevertheless recent advances in Immunohistochemistry (IHC) have revolutionised the way gliomas are diagnosed and graded. Aim: To evaluate expression and correlation of p53 and Ki-67/ MIB-1 amongst a series of gliomas diagnosed morphologically according to World Health Organisation (WHO) classification of Central Nervous System (CNS) tumours 2007. Materials and Methods: The present prospective study was conducted over a period of 18 months from December 2016 to May 2018 at a tertiary care centre in Uttarakhand, India. The study group comprised all consecutive cases of glial tumours that were clinically diagnosed and histopathologically confirmed as Gliomas during this period. Histopathological sections were made from formalin fixed tissue and stained with H&E and grading was done according to the WHO grading system 2007 for CNS neoplasms. Subsequently, IHC sections were taken on poly L-lysine coated slides and IHC staining of p53 and MIB-1 (Ki-67) was performed. The IHC scores were calculated and correlated with histopathological grade. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: A total of 40 cases of glial tumours diagnosed on histopathology were included in the study. They showed M:F ratio of 1.22:1 with peak age incidence of 21-30 years. Astrocytoma, grade IV was the most frequent diagnosis followed by grade II on H&E. On IHC, grade II diffuse astrocytomas, grade III Anaplastic Astrocytomas (AA), and Glioblastoma Multiforme (GBM) demonstrated a mean p53 positivity of 29.5, 50.83 and 47.66, respectively and a Ki-67 positivity of 32.5, 48.33 and 58.08, respectively. For ependymomas grade I, II and III, the mean p53 positivity was 9, 5.26 and 12, respectively and the mean Ki-67 positivity was 2, 7.93 and 40, respectively. Amongst oligodendrogliomas grade II and III showed a p53 positivity of 6 and 8.25 and Ki-67 positivity of 12 and 30.5, respectively. An association was found between an increase in histologic grade and proliferation markers. Conclusion: Histologic grade was the most important prognostic factor with respect to patient survival in glial neoplasms. The immunopositivity for p53 and Ki-67 correlated well with histological malignancy grade in all glioma subtypes, but a considerable overlap of proliferative index was observed between different subtypes.

Early Quadriceps Wasting after Anterior Cruciate Ligament Reconstruction in Young Adults: A Prospective Study

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee that requires surgical intervention. The weakness of quadriceps muscle is a sequele of ACL tear that can persist even after reconstruction. Muscle wasting if identified in early postoperative period can help to formulate structured protocols for rehabilitation that can help patient to recover. Best available method for scan of the same includes Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, but it is neither accessible nor affordable to masses of population. Aim: To evaluate the quadriceps thickness using an easily available modality i.e., Ultrasonography (USG) and thigh circumference to detect early wasting. Materials and Methods: This prospective longitudinal study was done on 48 patients between the age range of 18-45 years with ACL tear operated arthroscopically. After six months of surgery, all patients were evaluated for quadriceps thickness using USG and thigh circumference using traditional measuring tape at the same points. Paired t-test was used for evaluation of the results. Results: This study quantifies quadriceps thickness using USG at two distinct levels of the thigh and found a significant deficit of 13.05% in the involved extremity at 1/3rd of femur length from knee joint and a deficit of 11.72% in involved extremity at 2/3rd of femur length from knee joint. This study established that the quadriceps of the involved extremity definitely goes under atrophy despite early rehabilitation. Also, there was a deficit of 5.04% in thigh circumference at 1/3rd of femur length from knee joint and 4.43% at 2/3rd of femur length from knee joint in the operated limb. There was no positive correlation between both the methods. Conclusion: This study concluded that USG is an easily available and affordable method to determine quadriceps thickness and it’s wasting early in the postoperative rehabilitation phase. It can assist in establishing early vigorous rehabilitation protocols. The traditional method of measuring thigh circumference using measuring tape to quantify quadriceps muscle bulk can be misleading as its underestimates the atrophy due to various factors.

Bacterial Profile and Antimicrobial Susceptibility Pattern of Chronic Suppurative Otitis Media from a Tertiary Care Hospital in Kannauj, Uttar Pradesh, India

Kiran Yadav, Sandeep Kaushik, Kumkum Rani, Anuj Kumar Tyagi

Introduction: Chronic Suppurative Otitis Media (CSOM) is a chronic and persistent inflammation of the mucosal lining of middle ear cleft which presents with recurrent ear discharge through a tympanic membrane perforation. CSOM is a worldwide disease and has higher prevalence in developing countries causing serious local damage and threatening complications. Aim: To determine the profile of CSOM, its causative agents and their antibiotic susceptibility pattern. Materials and Methods: The present study was a retrospective study in which data for culture and antimicrobial susceptibility profile of CSOM cases was retrieved from Microbiology department of Government Medical College, Kannauj, Uttar Pradesh, India, from January 2019 to October 2019 the analysis of data was done in February 2020. Two hundred pus swabs from discharging ears were processed during the study period for aerobic bacterial culture and antimicrobial susceptibility pattern in Microbiology department using standard microbiological techniques. The result analysis of the study was expressed as percentage and proportion for distribution of CSOM cases. Results: Out of 200 patients, 114 (57%) were males and 86 (43%) females. Among the 200 cases, 147 (73.5%) cases showed growth and 53 (26.5%) showed no growth. The most common organism isolated in this study was Pseudomonas aeruginosa, 67 (42.40%) followed by Staphylococcus aureus. 48 (30.37%) and Klebsiella spp. 23 (14.55%). Gentamicin (85%) and amikacin (83%) had high level of antibacterial activity on all the isolates. Meropenem was found to be most effective drug for gram negative isolates. All Staphylococcus spp isolates were sensitive to vancomycin (100%). Conclusion: Pseudomonas aeruginosa was the most predominant organism isolated in otitis media patients. Most of the isolates were sensitive to meropenem.

Validity of Hysteroscopy and Transvaginal Sonography in Evaluating Abnormal Uterine Bleeding- A Retrospective Study

Sangam Jha, Monika Anant, Upasna Sinha

Introduction: Abnormal Uterine Bleeding (AUB) affects 14-25% of women of reproductive age group and accounts for 66% of hysterectomies. Accurate diagnosis of the cause of AUB will reduce the hysterectomy burden, but the ideal evaluating tool to accurately diagnose the cause of the same is debatable. Aim: To evaluate the diagnostic accuracy of Transvaginal Sonography (TVS) and hysteroscopy in the evaluation of abnormal uterine bleeding, using histopathological diagnosis as gold standard. Materials and Methods: This retrospective descriptive study was conducted on patients who underwent transvaginal sonography and hysteroscopy for evaluation of abnormal uterine bleeding from January 2017 to January 2020. Data including demographic details, sonographic details, preoperative diagnosis, anaesthesia used, operative notes, complications and histopathological diagnosis were obtained from clinical record sheet of the patients. Sensitivity, specificity, diagnostic accuracy of TVS and hysteroscopy was calculated using MedCalc software version 19.2.6. Results: A total of 214 patients were enrolled in the study. Hysteroscopy reported >95% diagnostic accuracy for all intrauterine pathology compared to TVS which revealed diagnostic accuracy of 73.13% for polyp, 77.1% for endometrial hyperplasia and 73.6% for all other pathology. Hysteroscopy revealed strong to almost perfect correlation with histopathological diagnosis for all pathology compared to TVS which demonstrated weak correlation for various intrauterine pathology. Conclusion: Hysteroscopy should be used as initial evaluating tool in AUB as it is simple and minimal-invasive with high diagnostic accuracy

Maternal Near Miss Events in Tertiary Care Hospital: A Retrospective Observational Study

SonaliJ Ingole, Shilpa N Chaudhary

Introduction: Over the years, continuous efforts have been made for improving reproductive health status of women. In India, Ministry of Health and Family Welfare (MoHFW) has set Maternal Near Miss (MNM) review operational guidelines. Aim: To analyse the incidence and causes of MNM cases in tertiary care hospital. Materials and Methods: This retrospective observational study was undertaken at a tertiary care hospital from January 2010 to September 2018. MNM cases were identified according to the criteria given by MoHFW, MNM review operational guidelines. Following parameters (variables) were noted viz., age, parity, obstetric haemorrhage, severe anaemia, sepsis, therapeutic interventions, etc., and were analysed. Quantitative data was analysed by calculating means, ratios and proportions, using Statistical Package for the Social Science (SPSS) software (version 21.0). Results: There were total 36,366 deliveries during the study period. A total of 315 Maternal Near Miss (MNM) cases were noted. Hypertensive disorders n=133 (42.22%) in pregnancy was the leading cause of MNM events at the hospital. This was followed by obstetric haemorrhage n =97 (30.79%), and severe anaemia constituting n=36 (11.42%), and sepsis n=30 (9.52%). Mortality index was highest in the sepsis group n=5 (14.28%) followed by severe anaemia n=3 (7.69%). Conclusion: Hypertensive disorders were most common cause of near miss cases followed by obstetric haemorrhage. Sepsis was most common cause of maternal mortality. Early identification of hypertensive disorders in pregnancy, obstetric haemorrhage, severe anaemia and sepsis; and prompt treatment of these causes may help in reducing near miss and maternal mortality.

Predicting Significance of Blood Parameters in Diagnosis of Prostate Carcinoma in a Tertiary Centre in Udaipur, Rajasthan

Introduction: In development of cancer chronic inflammation plays a major role. Most established determinants of Prostate Carcinoma (PCa) are modern lifestyle, genetics, and age. In the first prostate biopsy, approximately 1 out of 5 men i.e., 20% with PCa may be misdiagnosed. Therefore, there is clear requirement of novel markers, which can detect both clinically significant PCa, and prevent unnecessary biopsy. Some solid tumours found to have association of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR) and Red cell Distribution Width (RDW). Aim: To study the significance of association of Prostate Specific Antigen (PSA), PLR, NLR and RDW with PCa. Materials and Methods: This study was conducted using the cross-sectional method in the Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan between January 2018 to November 2020. In this crosssectional study, 84 patients who underwent Trans Rectal Ultrasound (TRUS) guided prostate biopsy were included. Complete Blood Count (CBC) was used to determine PLR, NLR and RDW and biochemical test for PSA. Patients were divided into two groups; having benign and malignant pathology. Unpaired t-test, Mann-whitney U test, logistic regression analysis and correlation were performed for statistical analysis. Results: With the use of univariate logistic regression, association between PSA, NLR, PLR, RDW values and PCa detection was determined. Serum PSA was significantly more in the PCa group (as BPH and prostatitis are both benign conditions so are kept in non-PCa group) compared to other two groups (p<0.001). There was no statistically significant difference in NLR, PLR and RDW values (p=0.150, p=0.070, p=0.441, respectively was found in non-PCa and PCa group). Conclusion: PSA has statistically significant association with PCa group but PLR, NLR and RDW was not considered to be the significant predictor in benign as well as malignant group.

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Adult-Onset Still Disease, their Relationship with Baseline Disease Activity and Subsequent Disease Course: A Retrospective Cohort Study

Firdevs Ulutas, Hande Senol, Veli Ã‡obankara, Ugur Karasu, Serdar Kaymaz

Introduction: Adult-onset Still Disease (AoSD) is a rare systemic polygenic non-familial autoinflammatory disease of unknown aetiology. The long-term course of the disease can be categorised in three different definitions including self-limited course, intermittent course or chronic course. Recently, Neutrophilto-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) were investigated in various rheumatic diseases as an informative markers in evaluating severity of inflammation and disease activity. Aim: To explore association between baseline NLR, PLR, disease activity score and subsequent disease course in patients with AoSD. Materials and Methods: This retrospective cohort study enrolled 61 patients with AoSD and 61 age-matched patients with Fibromyalgia Syndrome (FMS). Pouchot score was specifically used in AoSD patients to assess disease activity based on symptoms, physical examination findings and laboratory results from April 2020 to July 2020. Patients with AoSD were subgrouped into three groups: self-limited; intermittent; and chronic course. The association of NLR and PLR with disease activity score was analysed between groups by using independent samples t-test, Mann-Whitney U test and Kruskal Wallis Variance Analysis. Differences between categorical variables were analysed using Chi-square test. A p=0.05 was considered statistically significant. Results: The mean follow-up of the 61 patients with AoSD was 74 months (range, 14-169). Eighteen patients (29.5%) had a self-limited disease course, nine patients (14.8%) an intermittent disease course and 34 (55.7%) a chronic disease course. AoSD patients had significantly higher serum NLR, PLR and lower Mean Platelet Volume (MPV) values than FMS patients {6.68 (1.67-19.7), 1.83 (1.1-4) p=0.0001; 187 (82.9-549), 114 (72-246) p=0.0001; 8.3 (6.4-11.3), 9.3 (7.7-11.7) p=0.0001, respectively}. NLR, PLR and Pouchot score were similar among AoSD subgroups, which were grouped according to disease pattern. The majority of patients in the self-limited and chronic course groups had higher baseline Pouchot score without statistical significance. The NLR and C-Reactive Protein (CRP) were significantly higher in AoSD patients with active disease than inactive disease {7.02 (1.8-19.7), 4.17 (1.67-14.8) p=0.06; 13 (1.9-29.5), 9 (1.6-20.9) p=0.046, respectively)}. Conclusion: High NLR and elevated CRP levels are related to active disease in AoSD patients. Although NLR, PLR and Pouchot score were similar among subgroups, patients with a chronic course or self-limited course had higher NLR values and more active disease at diagnosis compared with patients with an intermittent course.

Clinicopathological Features, Management and Outcome of Paediatric Solid Renal Tumours in Southeast Nigeria: The Need for Protocol and Multidisciplinary Collaboration

Introduction: Renal malignancies are common in children and they constitute 6-7% of all childhood tumours and nephroblastoma is the most common solid renal tumour in children. Currently, standardised institutional protocols in management of renal tumours in children are the norm. Large scale collaborative studies have started emerging, yet not much has been documented on the clinical presentation, pathology and outcome of solid renal tumours particularly in Africa. Aim: To review the presentations, pathology and the management-outcome of solid renal tumour in the centre in the absence of a coordinated protocol and multi disciplinary collaboration. Materials and Methods: This was a nine and a half year longitudinal retrospective audit study of consecutive patients with solid renal tumours managed in a single tertiary centre: Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. It took place from January 2009-June 2018. Relevant data on demography, clinical features, management and outcome were extracted from records. Results were analysed using Statistical Package for Social Sciences (SPSS) version 22. Categorical data were tested for independence using Chi-square test and significant p-value set at <0.05. Results: Twenty two paediatric cases (15 males and 7 females) were included in the study. The mean age at presentation was 50.10±45.18 months. The mean duration of symptoms was 5.5 months; 21 (95.5%) presented with abdominal masses while 6 (27.3%) had gross haematuria and 13 (59.1%) were emaciated. Tumours involved left kidney in 15 (68%). Histological reports were available in 9 cases with nephroblastoma being the most common 6 (27.3%). The most common stage was stage 3, 10 (45.5%) and most common procedure was nephroureterectomy, 11 (50%). Neo-adjuvant and adjuvant therapies were inconsistent. Conclusion: Late presentation, discordant treatment protocol, non completion of treatment and poor collaboration, were found to contribute largely to poor outcome of solid renal tumours in children in our setting. It is strongly believed that adoption of standard protocol and a multidisciplinary collaboration in management will improve records keeping and outcome.

Tuberculosis Masking Hodgkin’s Lymphoma: A Case Report

Nitin Rustogi, Bishakha Swain

Concomitant Tuberculosis (TB) and Hodgkin’s Lymphoma (HL) is a rare entity, more commonly reported in the paediatric and adolescent populations. HL presents with fever, weight loss and lymphadenopathy. Disseminated TB also presents with fever, weight and appetite loss and generalised or localised lymphadenopathy with/without pulmonary symptoms. Both diseases together pose a diagnostic challenge for the clinicians because of the similar mode of presentation. This case report discusses the clinical scenario of a 48-year-old lady presenting with generalised lymphadenopathy and was initially diagnosed with disseminated TB. Due to clinical worsening despite regular Anti-TB Therapy (ATT), she was re-evaluated and later turned out to have co-existing HL.

COVID-19 Pandemic: A Speed Breaker for Routine Immunisation

Sumit Singh Bhadoria , Durgesh Shukla , Ashutosh Joshi

Introduction: Immunisation services are affected by Coronavirus Disease-2019 (COVID-19) pandemic due to lockdown and fear of COVID among public along with problems of workforce management and vaccine supply. All these factors have led to decrease in vaccination coverage. It may further lead to increase in risk of vaccine preventable diseases. Aim: To assess the overall trend and evaluate the vaccination coverage during COVID-19 pandemic in a tertiary care hospital in Gwalior district. Materials and Methods: This cross-sectional study was conducted on record based secondary data from the immunisation Out Patient Department (OPD) of the tertiary care hospital Gwalior, Madhya Pradesh, India, for the period of 1st February 2020 to 31st August 2020 was utilised in current study. Data were entered into Microsoft Excel version-2007 and analysed. Frequency, percentage, mean, and standard deviation were calculated as a descriptive measures and graphical presentation to show time trends. The p-value was calculated at 5% level of significance. Results: In the study, 817 children were included, with mean age of 7.46±13.59 months. Total 61.1% (499) children were male and 38.9% (318) were female. During the study period, all the children were vaccinated for Bacille Calmette-Guerin (BCG) (10.6%) Pentavalent-1 series (36.4%), Pentavalent-2 series (17.4%), Pentavalent-3 series (12.2%), Measles-Rubella (MR-1) (6.5%), Booster-I (11.8%) and Booster-II (5.1%). Delayed vaccination was seen in 51 (6.20%) children. The delay was observed for Pentavalent-2 series (43.1%), pentavalent-3 series (51.0%) and MR-1 (5.9%) and the difference is significant at p-value <0.05. Conclusion: Immunisation services were severely interrupted and completely suspended in April 2020. Certain amount of delay in various doses was also observed. Maintaining routine immunisation is essential in preventing an outbreak of vaccine preventable diseases.

Effects of Hand Strengthening Exercise on Various Hand Functions in Female Patients of Chronic Rheumatoid Arthritis: A Case-control Study

Dimple Choudhry, Joginder Yadav, Harpreet Singh, Savarna, Poonam Dhankher

Introduction: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease which hampers the physical activity of an individual due to presence of pain, stiffness and fatigue. As it is progressive in nature, regular exercise of sufficient intensity is needed to maintain muscle strength. Aim: To find the effectiveness of hand strengthening exercise programme with therapeutic putty on grip strength and functional movement in chronic rheumatoid hand. Materials and Methods: A total of 206 female patients of chronic RA were randomly divided in two groups- control and experimental groups. Control group received care which included active hand exercises with hot water fomentation while experimental group received strengthening exercises with therapeutic putty and hot water fomentation. Grip strength was measured by hand dynamometer, key pinch strength of dominant hand was measured by digital pinch meter, pain severity was assessed by Brief pain inventory scale and hand function was measured by SF-SACRAH (Score for Assessment and Quantification of Chronic Rheumatic Affections of Hands) at 0 week, after 4 week, 8 week and 12 week for both groups. Treatment effects were compared by one-way ANOVA followed by post-hoc analysis. The results were analysed by Statistical Package for Social Sciences (SPSS) version 16.0. Results: After 12 weeks of exercise programme, a significant improvement (p<0.01 and p<0.005) was observed in all outcome measures of hand function including reduction in pain severity score from baseline in experimental group. While in control group there was no significant changes in all four parameters from baseline to after 12 week exercise programme. Conclusion: A significant improvement was seen in experimental group as compared to control group after hand strengthening exercise protocol using therapeutic putty suggesting that, hand strengthening exercise programme by using therapeutic putty is effective in chronic RA hand.

Incidence of Catheter Related Thrombosis in Chronic Kidney Disease Patients Admitted in Intensive Care Unit and their Outcome: An Observational Study

Kamlesh Kanwar Shekhawat, Vivek Parasher

Introduction: Central Venous Catheter (CVC) insertion is a commonly performed procedure in the Intensive Care Unit (ICU) to facilitate administration of intravenous fluids and drugs, Central Venous Pressure (CVP) measurement, and Haemodialysis (HD). It is associated with various complications including thrombus formation. Aim: To determine the incidence of thrombus, its extent, associated risk factors and outcomes, in the triple lumen HD catheter inserted in Internal Jugular Vein (IJV) in Chronic Kidney Disease (CKD) patients admitted in the ICU. Materials and Methods: This was a prospective observational study including a total of 100 patients (63 males and 37 females) of CKD, who required HD in the ICU at Pacific Institute of Medical Sciences (PIMS), Girwa, Udaipur, Rajasthan, India. The study was done from March 2017 to March 2018. After admission in ICU, Arterial Blood Gas (ABG) was performed and Electrocardiography (ECG), Noninvasive Blood Pressure (NIBP), Oxygen Saturation (SpO₂ ) monitoring was done. A triple lumen HD catheter was inserted in the IJV under all aseptic precautions. After two weeks of insertion, a colour doppler Ultrasonography (USG) neck was performed to see the presence, size and extent of thrombus in the CVC. All the pre and postprocedural demographic and clinical data of relevant investigations, past history, risk factors and complications were compiled together and compared in Microsoft excel sheet and Statistical Package for the Social Sciences (SPSS) softwares for relevant results. Results: The study found that 30% were having thrombus after two weeks of HD catheter in the IJV and most commonly detected in the diabetic patients with CKD-10 (33.33%), followed by hypertension-2 (6.66%), cerebro-vascular accidents-1 (3.33%), chronic liver diseases-1 (3.33%) and no thrombus was detected in patients suffering from ischemic heart diseases. The most common risk factor for thrombus formation was chronic smoking-12 (40%), followed by bedridden patients-2 (6.66%), and chronic alcoholic patients-2 (6.66%). Conclusion: This study found that early catheter-related thrombus was common in male patients with diagnosed diabetes mellitus and chronic smoking is the most common associated risk factor.

Is Tunneled Cuffed Catheter a Viable Link to Arteriovenous Fistula? An Experience from a Tertiary Care Centre

R Sowrabha, GK Prashant, Arpana Kedlaya

Introduction: The Tunneled Cuffed Catheter (TCC) is used as a bridge access for haemodialysis. Non-availability of fluoroscopy for insertion of TCC results in unnecessary waiting times and inappropriate use of non-tunneled catheters. Recently, ultrasound guidance is being used widely in developed countries for TCC insertions for urgent haemodialysis initiation. Aim: The aim of the present study was to look at whether ultrasound guided TCC is a useful bridge to Arteriovenous Fistula (AVF) in haemodialysis patients and also to look at the incidence of catheter insertion complications, infective and bleeding complications and have data on catheter longevity. Materials and Methods: This was a prospective observational study on 106 TCC insertion procedures which were performed between July 2017 and December 2018. The study was done in Nephrology interventional suite at St Johns Medical College and Hospital, Bengaluru, Karnataka, India, using ultrasound guidance for accessing Internal Jugular Vein (IJV) by Nephrologist. Fluoroscopy was used in none. The success rate, insertion complications, infections and other catheter outcomes like bleeding, catheter blocks and catheter longevity of TCC inserted using ultrasound guidance alone were studied. Further, the patients were followed-up for a minimum period of nine months. Data was recorded in the predesigned Epi info version 7.0 proforma and analysed by Statistical Package for the Social Science (SPSS) software version 24. Results: There was 100% success rate for uncomplicated insertions of right IJV. No increase in major/minor bleeding complications was noted. Of the 106 insertions, only a single patient had a catheter kink. Mean blood flow was 230.3 mL/min. Cather Related Blood Stream Infection (CRBSI) rate was 1.65 per 1000 catheter days. On follow-up, 59 of 72 patients underwent AVF creation, five underwent renal transplant and another five were converted to Continuous Ambulatory Peritoneal Dialysis (CAPD) and three patients with Acute Kidney Injury (AKI) requiring prolonged dialysis had renal recovery. Conclusion: TCCs for haemodialysis initiation can be safely placed by using ultrasound guidance. It can be used for longer period and is a useful bridge to AV fistula. There is 100% success rate for right-sided jugular TCC insertions using ultrasound alone. There are very less infective and bleeding complications with TCC usage.

Correlation of Gamma Glutamyl Transferase with Traditional Risk Markers of Cardiovascular Disease in Different Obesity Phenotypes

Amit Kumar Meena, Sonali Sharma, Barkha Gupta, Asrar Ahmed

Introduction: The increased prevalence of overweight, obesity, and metabolic syndrome has revealed that liver enzymes have a potential role as determinants of metabolic conditions such as, hyperlipidemia, and Cardiovascular Disease (CVD). Aim: The study aimed to investigate the correlation between liver enzymes with anthropometric indices of obesity and lipid profile in different obese phenotypes at a tertiary care. Materials and Methods: The present observational study was conducted on a total of 180 obese participants of either gender in the age group 18-59 years for a from December 2018 to May 2019. These were further divided into two phenotypic groups viz., Metabolically Healthy Obese (MHO group; n=90) and Metabolically Unhealthy Obese (MUHO group; n=90) according to National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP) criteria. Traditional cardiovascular risk factors were evaluated in the study participants through anthropometric viz., Body Mass Index (BMI), Waist Circumference (WC), Hip Circumference (HC), Waist–Hip Ratio (WHR), blood pressure and biochemical investigations i.e., serum glucose, lipid profile and liver enzymes. Data was analysed by using Microsoft excel software. Results: Among 180 obese participants, 76 were males and 104 females with mean age 40.42±10.84 years. In MUHO phenotype, Gamma Glutamyl Transferase (GGT) showed a strong positive correlation with BMI (r=0.413, p=0.00001), lipid parameters viz., LDL-C (r=0.3785, p=0.0001), TC (r=0.2953, p=0.0023), TG (r=0.2623, p=0.006) and negative correlation with HDL-C (-r=0.3167, p=0.0011). No significant correlation was found in MHO phenotype between liver enzymes, BMI and lipid profile parameters. Conclusion: The results of this study indicated that GGT shows a strong positive correlation with traditional risk factors in MUHO participants. Thus, raised GGT may be considered as a risk marker of CVD in MUHO phenotype.

Assessment of Knowledge and Premarital Screening Regarding Sickle Cell Disease among Adults

Prerana Tarachandji Sakharwade, Vaishnavi Dipak Joshi

Introduction: Sickle Cell Disease (SCD) is the disorder of the blood having tendency to get transferred from one generation to the next generation. Sickle cell disorder may be avoided if people become conscious of their carrier status and can do so by enhancing awareness and undertaking premarital screening. Understanding that even the Government of India promotes premarital screening of SCD before marriage. Aim: To assess the knowledge and screening regarding SCD among unmarried adult. Materials and Methods: An analytical research study with a cross-sectional research design was used. A total of 40 unmarried adults including male and female were participated in the study from November 2019 to December 2019. The samples were selected using purposive sampling technique and structured questionnaire was used for data collection and sickling test was used for premarital screening. Results: Most of the unmarried adults had average (40% subject) and good (42.5% subject) level of knowledge (Mean score 9.10±3.07) for SCD, 17.5% of adults had positive premarital screening results. There was significant association of knowledge score in relation to education (p-value=0.02) and caste (p-value=0.047) of the adults. Conclusion: The study concluded that considering seriousness of SCD it is needed to get control over SCD and prevent transfer of it from one generation to next generation through public education, screening of SCD and other preventive measures.

Retrospective Study on Safety and Efficacy of Transperitoneal Laparoscopic Surgery and Open Surgery for Retrocaval Ureter

Dilip Kumar Pal, Ashutosh Kumar Tiwari, Krishnendu Maiti

Introduction: Retrocaval ureter is a rare congenital anomaly which remains silent until the 3rd or 4th decade of life. But once a patient develops symptoms, it mandates treatment in the form of surgical management. Open surgery has traditionally been considered as the standard of care but it has its own downside or limitations. It requires a relatively large skin incision causing significant postoperative pain and thus prolonging convalescence. Transperitoneal laparoscopic approach is the preferred approach by most surgeons owing to large working space and familiar anatomy. Aim: To compare the safety and efficacy of transperitoneal laparoscopic and open surgery for definitive management of retrocaval ureter. Materials and Methods: Clinical data of fifteen patients, that underwent surgery for retrocaval ureter from December 2013 to January 2020 and the study of this data was done from June 2020, at Urology Department were analysed retrospectively. Out of 15 patients, seven were treated by open surgery while eight underwent transperitoneal laparoscopic surgery. Ureter was transpositioned to normal anatomic position followed by ureteroureterostomy. Student t-test was applied to interpret and analyse the data obtained in both the groups using Statistical Package for the Social Science (SPSS) version 24. Results: Total of 15 patients data was studied (7 open surgery + 8 transpertional laparoscopic surgery, age group between 21- 45 years). Intraoperative and postoperative data were compared between the transperitoneal laparoscopic and open surgery group. A statistically significant difference was found for operative time (p-value <0.001), estimated blood loss (p-value <0.05), analgesic requirement (p-value <0.001), drain removal (p-value <0.05) and hospital stay (p-value <0.001) between the two groups. Superficial surgical site infection was noted in two patients in open surgery group. For rest 13 patients postoperative period was uneventful. The follow-up of all patients was done for 12-36 months. Conclusion: Transperitoneal laparoscopic uretero-ureterostomy as a definitive treatment of retrocaval ureter is safe, effective and reliable option with less trauma and faster recovery. This minimally invasive technique can be considered as the first choice for treatment of retrocaval ureter on account of familiar anatomy and easier learning curve in contrast to retroperitoneal laparoscopic or robotic surgery

Prevalence of the Caroticoclinoid Foramen in Brazilian Dry Skulls

Introduction: The Caroticoclinoid Foramen (CCF) is a variation found in the sphenoid. It gives passage to the internal carotid artery and it is a surgically significant structure when dealing with the cavernous sinus. There is debate, however, regarding its prevalence, especially in populations from South America. Aim: To assess the prevalence and size of the CCF in a Brazilian sample. Materials and Methods: This was a cross-sectional study carried out for a period of 10 months during March 2019 and January 2020. The present study was conducted in 365 dry human skulls from two Universities in the Southeast region of Brazil. The caroticolinoid foramen was observed and if present, measured. Results: Of the 365 skulls examined, the foramen was present in 101 (prevalence of 27.6%). The foramen was bilateral in 88 cases, while 13 skulls presented this variation unilaterally (7 on the right and 6 on the left side). Regarding its classification, out of 190 CCF analysed, 69 were pertaining to the complete type, while 120 cases were classified as incomplete and 1 from the contact type. The mean anteroposterior diameter was 4.87±0.69 mm (right side) and 4.86±0.79 mm (left side), and the Transverse Diameter (TD) was 4.85±0.75 mm (right side) and 4.74±0.73 mm (left side). Sixty-nine skulls had data regarding sex and age. The age ranged from 1 month old to 104-year-old (mean of 37.79±21.85-year-old). The male to female ratio was 2:1, being the only relation with statistical significance (p<0.05). Conclusion: The CCF can be a common variation depending on the population analysed. Thus, the surgeon should always be concerned of its presence, as its misidentification may lead to a negative surgical outcome.

Bilayer Mesh Repair for Inguinal Hernia-An Open Alternative to Laparoscopic Repairs

Introduction: In 1999, Gilbert described the technique of using a bilayer mesh device, Prolene Hernia System (PHS) for tension free repairs of inguinal hernias through an open anterior approach. This provides an anterior, posterior and plug repair, and hence successfully covers the myopectineal orifice, the lack of which is a glaring drawback for the Lichtensteins repair. This also confers the same benefit provided by the laparoscopic hernia repairs which uses the preperitoneal space to cover this same region that is, Transabdominal Preperitoneal Patch Plasty (TAPP) and Total Extraperitoneal patch Plasty (TEP). Aim: To observe the overall outcome of using an open bilayered dual mesh in a population of Odisha, attending a tertiary care hospital. Materials and Methods: All patients admitted with inguinal hernias in the Department of General Surgery, Pradyumna Bal Memorial Hospital, KIMS, Odisha, India were included in the study. They all underwent the PHS bilayer mesh repair. The relevant patient specifics like, preoperative clinical findings and intra and postoperative results were noted in a master chart. Patients were followed-up for one year, and further long-term complications were noted, if any. Results: There were a total of 40 patients. The mean duration for the procedure was 61.5 minutes (SD-22.8) and there was no inadvertent injury. The patients were encouraged to resume all physical activities from the first postoperative day. All the patients had an uneventful recovery, with a mean hospital stay of four days. Four patients presented with seroma after one week of surgery, while 22 patients had cord oedema. Both subsided spontaneously within three weeks, without further intervention. No recurrence was noted in any of the patients. Conclusion: The PHS bilayer dual mesh repair is ideally suited for population in a low resource setting. It ensures coverage of the entire vulnerable area of groin along with a considerably shorter duration of operation, minimal risk of intraoperative injury.

Effectiveness of a Nutritional Education Intervention Focussed on Iron among School Children in National Capital Region and Mumbai

Introduction: Anaemia is a major health problem in India. Various studies mention poor nutrition knowledge and education as main factors of malnutrition. Aim: This study aims at assessing the effect of nutritional education on iron among school children. Materials and Methods: A cross-sectional interventional study was undertaken to improve nutrition literacy in schools from April 2018 to February 2019. The outreach platform used was Eat Right School program by Food Safety and Standards Authority of India (FSSAI). A study tool employed was data collection using self-developed questionnaire for pre and post-intervention knowledge assessment. School children from Delhi NCR and Mumbai participated in this study. Knowledge intervention was done on 5 key elements related to iron including role, sources, iron deficiency anaemia, iron absorption and knowledge of fortification. Chi-square test was applied for comparison. Results: It was found that 54% (n=18,626) of school children studied were in the age group 11-14 years. From 27355 participants who reported the gender, 58.1% (n=15899) were males and 41.9% (n=11456) were females. Comparison of pre and post-intervention assessment revealed that percentage of students knowing importance/role of iron increased from 27.30% to 59.50%, iron deficiency anaemia from 34.03% to 59.85%, sources of iron from 25.20% to 51.70%, iron absorption from 36.00% to 61.2% and knowledge of fortification from 55.4% to 76.9%. Thus, significant shift (p≤0.001) in all the parameters was observed; improvement in scores ranged from 21.5% to 32.20% with highest increase seen in understanding the role of iron. Conclusion: Results of the study reject the null hypothesis leading to acceptance of alternate hypothesis. The alternate hypothesis highlights the role of nutrition education in improving the nutritional literacy of school children in the area of iron and iron deficiency anaemia. Results of the current study increased the knowledge of children on all parameters related to iron education module. Thus, nutritional literacy is imperative in improving nutritional status and adolescent age-group is the window of opportunity to correct it.

Can Needle Bevel Tip Orientation Influence Pain Perception Associated with Intravitreal Injection?

Rakesh Kumar Jha, Sankalp Seth

Introduction: Reduction of pain perception associated with intravitreal injections is crucial factor for improving compliance of the patient to the planned subsequent injections. Aim: This study aimed to evaluate relation of pain perception with initial needle bevel tip orientation during intravitreal injection. Materials and Methods: A prospective interventional study conducted on 120 eyes of 120 patients at the single tertiary care centre between December 2017 to January 2020 , who never underwent any intravitreal injection and were planned for their first intravitreal injection of ranibizumab in either of their clinically indicated eye for conditions such as Neo-vascular Age Related Macular Degeneration (ARMD), central Diabetic Macular Oedema (DME) and macular oedema secondary to Retinal Vein Occlusion (RVO). Fifty per cent (50%) of the patients received intravitreal injection with needle bevel tip oriented parallel to limbus margin and fifty per cent (50%) of patient received intravitreal injection with needle bevel tip oriented perpendicular to the limbus margin. The primary outcome was to compare the level of pain perception of the subject patients by using Visual Analogue Scale (VAS) in the immediate postprocedure period. Data collected in MS excel and analysed by using SPSS Version 24.0. Independent t-test was used for the comparison of the two groups. Chi-square test was used for the comparison of nominal variables of subject groups. Pearson’s correlation test was used to evaluate the relationship between quantitative variables and pain scores. The p-values smaller than (<0.05) were considered as statistically significant. Results: Pain perception scores assessed on the VAS (0-100mm) ranged from 0.8 to 39, with a mean of 18.13±7.65. Significant correlation was found with two different mode of orientation of needle bevel tip. Patients perceived less pain with needle bevel tip oriented perpendicular to the limbus margin compared to parallel to limbus margin (p=0.0001). Conclusion: Pain perception associated with intravitreal injection can be further minimised by orientating the bevel needle tip as perpendicular to limbus margin while initiating the insertion of injection into the indicated eye.

Vernal Keratoconjunctivitis- A Survey on Practice Patterns and Perspectives of Indian Ophthalmologists

Shwetha N Chandranna, Ratthiga Balagopal, Santosh Achappa, Kaushal Kumar

Introduction: Vernal Keratoconjunctivitis (VKC) is a common chronic allergic condition mostly affecting children and their childhood. At present, the choice of medication varies greatly for the same severity of disease from one ophthalmologist to another. A standardised grading system and a comprehensive approach towards VKC including Quality of Life (QOL) assessment is the need of the hour. Aim: To learn the practice patterns and perspectives of Indian Ophthalmologists in the management of VKC and to propose strategies for the holistic approach. Materials and Methods: A cross-sectional survey was conducted in July 2020. A semi-structured questionnaire was sent via Google form to 200 ophthalmologists. Data was entered in excel and analysis was performed using the Statistical Package of Social Sciences (SPSS) software version 20. Results: Out of 200 ophthalmologists, 146 (73%) participated in the survey. Among the participants, 43.8% used combination therapy in the management of VKC and 68.5% resorted to steroid therapy in severe cases. Tacrolimus (0.03%) was the most preferred immunomodulator among 56% ophthalmologists and only 11% assessed QOL in the patients periodically. Conclusion: Majority (around 2/3rd) felt immunotherapy and vitamin D supplementation can be tried in the management of VKC and there was a consensus on administering a QOL questionnaire in all patients with VKC in future which would provide holistic care.

A Prospective Observational Study on the Effects of Antidepressant Treatment on Hypothalamic-Pituitary-Adrenal Axis Regulation in Treatment Resistant Depression

Introduction: Dysregulation of Hypothalamic-Pituitary-Adrenal (HPA) axis can reduce the effects of antidepressants. Salivary cortisol level and Hamilton Depression Rating (HAM-D) score can be used to assess the level of improvement in the HPA axis and depressive disorders. Aim: To evaluate the changes in salivary cortisol level and HAM-D score in patients of Treatment Resistant Depression (TRD) and to investigate the association between them. Materials and Methods: The present prospective cohort study was conducted in the Department of Pharmacology and Psychiatry at Pt. JNM Medical College and Dr. BRAM Hospital Raipur (CG) over a period of one year, from June 2014 to June 2015. The participants were 52 diagnosed cases of TRD according to Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria, who were taking antidepressant medications for at least four weeks. The salivary cortisol values and HAM-D scoring were done at baseline and follow-up at eight weeks and 16 weeks and compared by student's t-test and one-way ANOVA. Results: A significant difference (p<0.001) was noted in the mean salivary cortisol levels (1.15±0.31 and 0.72±0.24) and mean HAM-D (29.67±1.43 and 16.26±7.08) scores at baseline and subsequent follow-up, respectively. Conclusion: The therapeutic benefit of antidepressants could be due to alteration of HPA axis functioning.

Screening for Non-alcoholic Liver Disease in Type 2 Diabetic Patients and its Association with Age, BMI and Duration of Diabetes Mellitus- A Cross-sectional Study

Ajoy Tewari, Vineeta Tewari, Jay Tewari

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes share a bidirectional relationship. NAFLD can increase the severity of diabetic microvascular and macrovascular complications. Ultrasonography, the most commonly used method of assessment of NAFLD in India, is associated with intra-operator variability and false positives. Transient elastography and Liver Stiffness Measurement (LSM) have emerged as one of the best modalities to screen NAFLD in people with diabetes. Aim: Screening for NAFLD in people with Type 2 Diabetes and its association with age, Body Mass Index (BMI) and duration of diabetes. Materials and Methods: This was a prospective cross-sectional study conducted on patients with known Type 2 Diabetes Mellitus (T2DM) who visited the study center between July 2019 and November 2019 for consultation. A total of 287 people with diabetes were subjected to FibroScan test and LSM was done. The other variables-age, gender, duration of diabetes, height, weight, BMI and HbA1c were recorded for all subjects and the collected data was correlated using Spearman rho test. Results: The study population included 61% males and 39% females. The mean age was 46.96 years and the mean duration of diabetes was 10.98 years. The mean Glycated haemoglobin (HbA1c) value was 9.28%. The median value of LSM by M probe was 7.16. Out of the total, 78 (27.2%) were identified with advanced fibrosis with LSM >9.6. Advanced fibrosis was strongly correlated with HbA1c (r=0.820), age (r=0.562) and duration of diabetes (r=0.596) and moderately with BMI (r=0.375). Conclusion: The screening of people with type 2 diabetes for NAFLD using LSM revealed 27.2% subjects with advanced fibrosis, it correlated positively with age, BMI and duration of diabetes.

Comprehensive Analysis of Zachary’s Modification of Jones Tendon Transfer in Isolated High Radial Nerve Palsy

Neeraj Kant Agrawal, Mahendra Kumar Gupta

Introduction: The radial nerve is the most frequently injured nerve caused by fractures of the humeral shaft. It results in loss of hand function which can considerably impair the person’s ability to perform normal activities of daily living as well as professional competence. Primary nerve repair provides best results but is often not possible because of badly traumatised nerve or late presentation. In such cases, tendon transfers are considered best to restore lost functions. Among the various transfers described for radial nerve palsy, Jones tendon transfer was popular and often practiced but the procedure had a major shortcoming of using both the wrist flexors. The Zachary’s modification is postulated as more advantageous as it preserves one wrist flexor. Aim: The study is intended to critically analyse modified Jones tendon transfer and discuss its implications with other standard methods of tendon transfer. The results of the study were evaluated extensively with emphasis on surgical details and finer technical skills. Materials and Methods: This retrospective cohort study was carried out in the Department of Plastic Surgery in eastern Uttar Pradesh, the clinical records from January 2017-December 2019, were studied to isolate the patients with high radial nerve palsy. A total of 26 patients were found to fulfil the inclusion criteria and their records were comprehensively analysed. Modified Jones tendon transfer was used. Postoperative results were evaluated using Bincaz score. Results: Amongst the data of total 26 patients studied, 80.77% patient’s radial nerve was injured due to fracture of the humerus. With metacarpophalangeal joints extended, wrist extension was 48.6°±9.64°, the minimum being 20°. Wrist flexion was 54.8°±10.25°. The position of metacarpophalangeal joints was vital to get rid of the tenodesis effect. Neutral position of the metacarpophalangeal joints has been defined at 0° without hyperextension. The study demonstrated deficit of 18°±6.78° short of the neutral position. Thumb extension and subsequent opening of first web space was more limited and we obtained 37.6°±7.51° with incomplete thumb extension in four patients. Abduction of the thumb at carpometacarpal joint and interphalangeal joint extension returned to normal range. Seventeen patients rated the results as excellent using postoperative evaluation by Bincaz score. Conclusion: Flexor Carpi Ulnaris (FCU) based tendon transfers returned encouraging results in high radial nerve palsy. Technical superiority in performing modified Jones tendon transfer was essential to obtain good results in patients with isolated high radial nerve palsy

Parental Outlook and Problems Faced during Lockdown in COVID-19 Pandemic: Experience from a Paediatric Haematology-Oncology Unit in a Developing Country-A Questionnaire Based Survey

Supriya Maheshwari, Sumit Mehndiratta, Amitabh

Introduction: Corona Virus Disease 2019 (COVID-19) pandemic has resulted in disruption of essential healthcare services. Children with cancer are very vulnerable group and delay in seeking treatment or defaulting scheduled medications adversely affects the outcome. Aim: To obtain insight into barriers and to evaluate concerns, outlook and challenges faced by parents of children suffering with malignancy in accessing the healthcare services during lockdown imposed due to COVID-19 pandemic. Materials and Methods: A questionnaire-based survey was conducted from parents of children newly diagnosed (during lockdown restrictions) with malignancy and previously diagnosed and under treatment at Paediatric Haematology Oncology unit in a Tertiary care centre. The responses were recorded in predesigned proforma during 15 days period after restrictions were relaxed. Results: Fifty-five responses were recorded and analysed. Father was the respondent in most cases. Acute Leukaemia (n=37) and Lymphoma (n=14) patients comprised majority of the patients. Major challenges faced were transportation (98.2%), financial burden (96.4%) and loss of job (65.4%). Fear of contracting COVID-19 infection was a primary barrier in seeking treatment for most respondents. Conclusion: The success and outcome of children with malignancy has been suboptimal in low-income and middle-income countries due to effect of lack of timely access of healthcare services, delayed diagnosis, treatment abandonment, poor compliance and financial constraints. The COVID-19 pandemic and associated setbacks have accentuated these factors and may have long term impact in final outcome for such patients.

Clinical Study on Outcome of Treatment for Herpes Zoster

Introduction: Herpes Zoster (HZ) is caused by reactivation of Varicella Zoster Virus (VZV). It is characterised by occurrence of grouped vesicles on erythematous base which involves the entire dermatome innervated by a single spinal or cranial sensory ganglion and is associated with radicular pain. Antivirals (Acyclovir, Famciclovir and Valacyclovir) started within 72 hours of onset of lesions are the agents of choice. Aim: To study the clinical manifestations, co-morbidities, efficacy and safety of Acyclovir, complications and sequelae associated with HZ. Materials and Methods: A three year longitudinal cohort study was conducted in 212 adult patients (>18 years of age) suffering with HZ in the Department of Dermatology, Dhiraj General Hospital, Pipariya, Gujarat, India. In this study 212 patients with HZ were prescribed oral Acyclovir in a dose of 800 mg five times a day for seven days. All patients were analysed in terms of clinical manifestations, pre-existing co-morbidities and incidence of complications. The clinical history and findings were recorded in a prestructured proforma. All patients were subjected to cytological examination (Tzanck smear) and Human immunodeficiency viruses (HIV) testing Enzyme-Linked Immunosorbent Assay (ELISA). Diagnosis was made primarily on the basis of clinical findings and presence of multinucleated giant cells in Tzanck smear. All the patients were treated with Oral Acyclovir. Cases were followed-up fortnightly for six weeks and evaluated for relief of symptoms, treatment outcome and complications/sequelae. Results: Two hundred and twelve cases were studied, 142 cases were in the 4th and 5th decades of life, 63 cases had comorbidities like diabetes mellitus in 31, autoimmune diseases like pemphigus vulgaris, systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease in 19 and AIDS in eight cases. Five cases had malignancy/lymphomas and were receiving chemotherapy for the same. In the majority, HZ occurred de novo without any co-morbidities. The most common dermatomes involved were cervical and thoracic. Out of 212 cases, oral Acyclovir 800 mg was well tolerated by 74. Most common complication was Postherpetic Neuralgia (PHN), seen in 80 cases. Conclusion: The treatment of HZ with Oral Acyclovir 800 mg five times a day for seven days is efficacious for healing of skin lesions and also reduces the chances of PHN if instituted within 72 hours.

Evaluation of Grape Seed Formulation as an Adjunct to Scaling and Root Planing on Oxidative Stress, Inflammatory Status and Glycaemic Control in Type 2 Diabetic Patients with Chronic Periodontitis: A Randomised Controlled Trial

Sameekshya Acharya, Sheela Kumar Gujjari, KA Sudarshan Murthy, Rishika Battula

Introduction: Nutraceuticals are food derived products that provide health benefits, in addition to basic nutritional value of the food. Grape Seed Extracts (GSE) contain a high concentration of proanthocyanidin which is known to possess strongest antioxidant property. Control and modulation of Reactive Oxygen Species (ROS) activity is normally achieved by synthesis and accumulation of antioxidants. Increased ROS production due to oxidative stress results in hyperinflammatory state and worsens the glycaemic status in diabetic patients with chronic periodontitis. Aim: The aim of the present study was to evaluate the effect of grape seed formulation as an adjunct to scaling and root planing (SRP) on oxidative stress, inflammatory status and glycaemic control in type 2 diabetic patients with chronic periodontitis. Materials and Methods: This was a double blind randomised clinical trial where 48 diabetic patients with chronic periodontitis were selected from the Outpatient Department of Periodontology, JSS Dental College, Mysore, Karnataka, India. The duration of the study was 10 months. Patients were randomly divided into two groups of 24 each: test group (SRP+grape seed formulation) and control group (SRP+placebo) which was given once daily for two months. Clinical parameters such as Plaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD) and Clinical Attachment Level (CAL); metabolic parameters such as glycated Hb (HbA1c), Fasting Blood Sugar (FBS) was carried out at baseline, 3 months and 6 months. Also, inflammatory marker i.e., Myeloperoxidase (MPO) was estimated from Gingival Crevicular Fluid (GCF) and Total Antioxidant Capacity (TAOC) were recorded at baseline, 3 months and 6 months. Statistical Package for the Social Sciences (SPSS) version 16 was used for all statistical analysis. Intergroup and intragroup comparisons for both test and control group were analysed by paired t-test and independent t-test, respectively. A p-value =0.05 was considered as statistically significant. Results: Intergroup comparison showed that there was no significant difference in PI, Sulcular Bleeding Index (SBI), CAL, PD between the test and control group at baseline, 3 months and 6 months except SBI scores at 3 months with p-value=0.017 and PI scores with p-value=0.014. The test group (SRP+GSE) as well as control group (SRP+placebo) showed statistically significant improvement from baseline to 3 months and baseline to 6 months in PI, SBI, CAL and PD (p≤0.05). FBS showed significant improvement from baseline to 3 months in both test and the control group. At 3 months statistically significant results was seen in SBI, FBS, TAOC, MPO and PI scores between the test and the control group (p≤0.05). Conclusion: This study shows a promising result in using grape seed formulation as an adjunct to scaling and root planing to reduce the oxidative stress, decreasing the inflammation and achieving the glycaemic control in diabetic patients with chronic periodontitis. Further studies are needed to prove its efficacy as an adjunct to conventional therapy.

Subclinical Hypothyroidism: A Modifiable Risk Factor for Retinal Vein Occlusion

Amit Kumar Gupta, Kapil Deb Lahiri

Introduction: It is well established that overt hypothyroidism, itself was a risk factor for atherosclerosis. Retinal Venous Occlusion (RVO) is caused by localised atherosclerosis. Subclinical Hypothyroidism (SCH) also cause arteriosclerosis thereby could be an important causative factor for RVO. But no study on SCH in RVO has taken place in Indian population. Aim: To find the prevalence of SCH in RVO in Indian Population. Materials and Methods: Thyroid hormones and Anti-Tissue Peroxidise (TPO) antibody was measured in 479 RVO cases in this two year prospective cross-sectional study in ESIC medical college. Data was entered into Microsoft Excel and presented in tables. Results: In this study, 312 males (aged 52±7.2 years) and 167 females (aged 47±7.7 years) with RVO were screened for thyroid hormones and anti-TPO antibody. Thyroid disorders were found in 162 patients out of 479 participants in this study (33.8%). Moreover, 52 cases were found to have SCH (10.8%) which is 32.1% of total thyroid disorder among RVO cases. Total of 118 patients had high anti-TPO antibody among 162 RVO cases with thyroid disorders (72.8%) and only 67 had high anti-TPO antibody among 317 euthyroid RVO cases (21.1%). Conclusion: This study has shown that SCH was a modifiable risk factor of RVO. Therefore, understanding the prevalence of SCH in this population might help in the prevention of RVO by secondary preventive intervention. Moreover, all SCH cases should be referred to ophthalmologist for evaluation of retinal vasculature.

Health Beliefs on Chronic Disease Management and Changes in Daily Routine among Thai Pilgrims during the Haj: A Qualitative Study

Muhammadfahmee Talek, Charnchai Chaisukkosol, Wit Wichaidit

Introduction: Serious illnesses and fatalities occur among Haj pilgrims each year, and chronic diseases appear to be the most common causes. However, there appears to be a lack of in-depth information on lifestyle adaptation and behavioural determinants of Haj pilgrims regarding management of chronic diseases during the pilgrimage. Aim: To describe health beliefs regarding management of chronic conditions and adaptation in daily routines among Thai Haj pilgrims who had chronic diseases. Materials and Methods: In this qualitative study, 19 pilgrims and one guide (in Mecca and Medina) were selected by purposive sampling and invited to participate in in-depth interviews after they finished the Haj rituals. Patients 18 years or above being able to communicate in either Thai or Malay languages and history of diagnosis with at least one non-communicable disease were included. Interview recordings were transcribed by a trained transcription writer. The transcriptions were analysed using content analysis. Results: Study participants deemed that they were susceptible to chronic diseases, and symptoms could become severe. However, participants regarded maintenance of good health as a way to follow religious principles, and the Haj was to be performed without assistance from others, when feasible. Participants also reported adapting daily routines according to medical and physical limitations, and strict adherence to prescribed medications. Conclusion: The findings offered insights on health beliefs among Haj pilgrims as reported during the pilgrimage. However, the investigators adapted the interview questions according to the flow of the conversation, which did not allow for standardisation of the questions and responses.

Laboratory Diagnosis of SARS-CoV-2 Infection: Single Centre Experience of First 12,000 Samples

Introduction: First spotted in Wuhan, China, World Health Organisation declared the deadly outbreak caused by novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) as global pandemic on March 11, 2020. With over 72 million cases globally till December 2020, countries need to gear up to detect, isolate and treat Corona Virus Disease-2019 (COVID-19) cases. Laboratories play a crucial role in diagnosis thereby instituting early contact tracing and quarantine measures. The laboratory based COVID-19 diagnostic testing data may help in formulating strategies to contain the spread of infection. Aim: To describe key patient variables of the respiratory samples processed for SARS-CoV-2 by Real Time Polymerase Chain Reaction (RT-PCR) at a diagnostic laboratory. Materials and Methods: In this descriptive, single centre study carried out at ICMR approved COVID-19 diagnostic laboratory, nasopharyngeal swabs received in Viral Transport Medium (VTM) were tested for SARS-CoV-2 infection by RTPCR. Key patient variables, like age, gender, symptoms and sample positivity rate were tabulated. The demographic and clinical data of samples tested were summarised by medians and Interquartile Range (IQR) for continuous variables and by proportions for categorical variables. Results: A total of 12,187 samples were received between 21st March to 8th July 2020. The data from 11,196 individuals were complete and were included in the analysis. Overall, 2,053 samples were tested positive for SARS-CoV-2 indicating positivity rate of 18.33%. Sample positivity was highest (63.91%) among high-risk contacts of a laboratory confirmed case. The maximum number of samples tested belonged to age group of 21-40 years and male predominance was observed. Conclusion: Although social distancing, mask usage, hand hygiene and respiratory etiquettes are important measures for containment of COVID-19, strengthening and capacity building of laboratory network is crucial for mitigating the pandemic.

Management of Liver Abscesses at a Teaching Hospital in Rural Haryana- A Prospective Study

Introduction: With the rise of change in imaging modalities like Computed Tomography (CT) scan or Ultrasonography (USG) the treatment of liver abscess has changed leading to reduction in morbidity and mortality. Liver abscess is more common in developing countries like India. Aim: To determine the methods for aetiological diagnosis of liver abscesses and to evaluate various methods for treatment of liver abscesses and select appropriate treatment modality on the basis of clinicomicrobiological findings. Materials and Methods: The present prospective study included 60 diagnosed cases of liver abscesses both amoebic and pyogenic which were managed in rural tertiary care centre between the period of November 2018 to April 2020. A preformed protocol was made for the management of all patients diagnosed with liver abscess and various parameters contributing to the illness like age, gender, associated conditions and clinical features. The prognosis was evaluated and assessed by using laboratory investigations and radiological findings to check the response to treatment by selecting appropriate treatment modality. Statistical analysis was done with the help of Statistical Package for the Social Sciences (SPSS) 20.0 for windows; Chicago, USA. Results: Amoebic liver abscess was more common as compared to pyogenic liver abscess {42 (70%) and 18 (30%)}. Liver abscess was more common in males as compared to females (4:1). History of alcohol consumption was strongly associated with the aetiology of liver abscess. Abdominal pain was the most common symptom in these patients. Conclusion: Proper clinical evaluation along with radiological imaging modalities has led to the early diagnosis of liver abscess. Microbiological investigations like blood antibody Enzyme Linked Immuno Sorbent Assay (ELISA) for Entamoeba histolytica is not in favour of diagnosing amoebic liver abscess. Conservative management is effective for minor abscesses.

Perception of Students and Faculties towards Implementation of Concept Mapping in Pharmacology: A Cross-sectional Interventional Study

Sarmila Nath, Swati Bhattacharyya, Pallavi Preetinanda

Introduction: Medical Council of India (MCI) in the current competency based on the undergraduate curriculum for the Indian medical graduate has focussed on the development of critical thinking, reasoning and communicating abilities of the undergraduate students. This would enable them to apply their knowledge effectively and provide better patient care. In this context, concept mapping has proved to be a simple yet powerful tool. Aim: To assess the feasibility of implementing concept mapping module and perception of the students and faculty about use of concept mapping as complementary teaching aid in pharmacology using peer validated questionnaires and Focus Group Discussion (FGD). Materials and Methods: This cross-sectional interventional study was conducted in the Department of Pharmacology of a tertiary hospital in Eastern India. Study duration was six months, from September 2019 to February 2020. After obtaining permission from Institutional Ethics Committee (IEC), 64 consenting students of 2nd year professional Bachelors of Medicine and Bachelors of Surgery (MBBS), Dean of student affairs, Medical Education Unit (MEU) Co-ordinator and 10 faculties of the Department of Pharmacology were sensitised about the concept mapping. A module for implementation and assessment rubric was decided. Participating students were randomly divided into eight groups (Group A, B, C, D, E, F, G, H), each group comprising eight students. Each group had to prepare one concept map on an allotted topic from General Pharmacology. They had to submit the maps within seven days. Students could use pen and paper or they could utilise computer software to prepare the maps. After submission, faculties other than the researcher assessed and gave feedback to the students. After one month, the second set of assignments was allotted on topics from autonomic nervous system. As before, submission had to be done in seven days. This set was also assessed and feedback given. At the end of second submission, perception of the students and faculties about implementation of the module was assessed through peer validated open as well as closed ended questionnaires. A FGD was also held among participating faculties. Open ended questions were analysed using verbatim and closed ended questions were analysed as percentage using Microsoft Excel. FGD was analysed using content analysis method. Results: Among the 64 participating students, 63 (98.43%) preferred concept mapping as complementary teaching tool in addition to traditional tutorial format and 62 (96.9%) students enjoyed making the concept maps. On analysis of students’ feedback, 56 (87.5%) students opined that this module could be included in Pharmacology curriculum. Out of 12 faculties, 7 (58.33%) graded feasibility of the module as 4 out of a maximum of 5. Conclusion: This study concludes that with proper selection of topics, concept mapping may be included as complementary teaching learning tool in Pharmacology curriculum for undergraduate students.

Hearing-impaired Children and Adults in Need of Cochlear Implant: A Hospital Based Cross-sectional Study

Malik MD Islahuddin, Rajeev Kumar Nishad, Mangal Singh

Introduction: Hearing is essential to learn language and speech and to develop cognitive skills. According to World Health Organisation (WHO), world-wide approximately 350 million people have hearing disorder. The performance of some moderately severe hearing-impaired adults and children using hearing aids is poorer than that of even profoundly hearingimpaired individuals using cochlear implants with advanced speech processing strategies. Aim: To find out the appropriate candidates in need of cochlear implantation in Prayagraj district of Uttar Pradesh, India. Materials and Methods: This cross-sectional study was conducted on hearing-impaired patients attending Ear Nose Throat (ENT) Out Patient Department (OPD) of tertiary health care center in Prayagraj, Uttar Pradesh from August 2011 to July 2012. The study population consisted of 95 patients categorised into four groups (pre-lingual children and adults, post-lingual children and adults) who presented with the chief complaints of impaired hearing and delayed speech. A detailed history, clinical and other relevant systemic examination and investigations were done. Patients were subjected to free field audiometry, pure tone audiometry and Brainstem-Evoked Response Audiometry (BERA) for assessment of hearing threshold level. Patients used hearing aid for six months and after hearing aid use, their hearing threshold and speech discrimination scores were estimated. Patients, whose aided score on open-set sentence test was less than 50%, were selected as candidate for cochlear implants, as they were not significantly benefited by hearing aids. Results: Out of the 95 cases, 48 cases were found to be suitable for cochlear implantation, which formed 50.5% of the study group. Pre-lingual hearing-impaired adults had the highest percentage i.e., 86.7%, fulfilling the criteria for cochlear implantation followed by pre-lingual children, in whom 46.7% fell in this category. A 26.7% of post-lingual children and 20% of post-lingual adults were found suitable for cochlear implantation. Conclusion: The pre-lingual hearing-impaired children and adults are more in need for cochlear implantation than the post-lingual hearing-impaired children and adults. Approximately, 134,501 cases were estimated to be, in need of cochlear implantation in Prayagraj district based on the census estimate of 2011.

Study on Synergistic Effect of Bromocriptine and Sitagliptin in Streptozotocin-induced Diabetic Rats

Introduction: Diabetes mellitus is a potentially morbid condition with high prevalence worldwide. Restoration of euglycemia in type 2 diabetes mellitus is difficult to achieve due to its multifactorial pathogenesis and frequently requires multiple anti-diabetic medications with different mechanism of action. This study is based on the possible synergistic effect of Sitagliptin and Bromocriptine in reducing blood sugar in diabetic animal models. Aim: To evaluate the effect of Sitagliptin and Bromocriptine monotherapy and their combination in three different doses on blood sugar, Lipid profile, Liver and renal parameters in diabetic albino Wistar rats. Materials and Methods: An experimental animal study was conducted on 48 adult male albino wistar rats for a period of one month (August 2014). Streptozotocin induced (40 mg/kg IP) diabetic rats were divided into six groups of eight animals each weighing 150-200 gms. Group I- Vehicle (distilled water), Group IISitagliptin (100 mg/kg), Group III- Bromocriptine (10 mg/kg), Group IV- Sitagliptin (75 mg/kg)+Bromocriptine (7.5 mg/kg), Group V- Sitagliptin (100 mg/kg)+Bromocriptine (10 mg/kg), Group VI- Sitagliptin (125 mg/kg)+Bromocriptine (12.5 mg/kg). All drugs were given once daily (per oral) for four weeks. Body weight, fasting blood sugar, fasting lipid profile, liver parameters and renal parameters were estimated before and after administration of the drugs. Results were analysed with Statistical Package for the Social Science (SPSS) software version 16.0 using one-way ANOVA followed by post-hoc Dunnett t test, p-value <0.05 was considered statistically significant. Results: The low dose combination therapy [Sitagliptin (75 mg/ kg)+Bromocriptine (7.5 mg/kg)] showed a significant decrease in body weight (p<0.05), fasting blood sugar (p<0.001) compared with the vehicle group. It also showed a favorable lipid profile, renal and liver parameters compared with the vehicle, monotherapy and other combination regimens. Conclusion: The low dose combination therapy of Sitagliptin and Bromocriptine showed a better control over fasting blood sugar along with a beneficial effect on lipid profile, liver parameters and renal parameters than compared to other groups.

Estimation of Serum Ferritin Levels in Blood Donors and its Association with Frequency of Blood Donation and Blood Indices

Amrita S Kumar, A Geetha, Jim Joe, Arun Mathew Chacko

Introduction: Blood donation is one of the most significant contributions that a person can make towards the society. A donor generally donates maximum 450 mL of blood at the time of donation. If 450 mL of blood is taken in a donation, men lose 242±17 mg and women lose 217±11 mg of iron. Hence, adequate iron stores are very important in maintenance of the donor’s health. Aim: To assess the influence of frequency of blood donation on iron levels of blood donors by estimating Haemoglobin (Hb) and other blood indices which reflect iron status of blood and serum ferritin which reflects body iron stores. Materials and Methods: The present study was a crosssectional analytical study, conducted on 150 blood donors, 18- 40 years of age presenting to the Blood Bank in Government Medical College, Kottayam, Kerala, India, between December 2016 to December 2017. Total of 150 donors were divided into four groups according to the number of donations per year. Group I were the first time donors with no previous history of blood donation, Group II- included those with history of donation once in the previous year, Group III- those donors with history of donation twice in the previous year and Group IV- those having history of donation thrice in the previous year. Six ml of whole blood collected from each donor, two ml was used for estimating Haemoglobin (Hb), Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hb (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC) in haematology analyser. Serum separated from remaining four mL of blood underwent ferritin analysis by Chemiluminescence Immunoassay (CLIA) method. Iron stores were considered normal at serum ferritin value from 23.9-336ng/mL in males and 11-307ng/mL in females. Statistical analysis was performed in Statistical Package for the Social Sciences (SPSS) version 16.0. Analysis of Variance (ANOVA) test and Pearson’s correlation test were used to find association between various parameters and collected data. The p-value <0.05 was considered as statistically significant. Results: There was no significant correlation between serum ferritin level and frequency of blood donation. MCH, MCHC showed significant association (p-value=0.039 and 0.007, respectively) with frequency of blood donation. Low positive correlation was seen between Hb and PCV with serum ferritin levels (r=0.381, p-value <0.001 and r=0.354, p-value <0.001, respectively). Conclusion: There is no significant association between frequency of blood donation and serum ferritin levels.

Comparison of Clinical, Haematological, Biochemical Findings and Significance of Co-morbidities amongst COVID-19 Positive Survivors and Nonsurvivors

Vinay Bharat, Mitali Singhal, Ankita Varma, Sonal Jindal

Introduction: Coronavirus Disease 2019 was first isolated in 1960. Middle East Respiratory Syndrome virus (MERS) and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) also belongs to Corona viridae family. Human Coronavirus causes fever, cough, fatigue, respiratory infection and abdominal symptoms. This virus has a strong affinity to human respiratory receptors and transmits rapidly. Since, the virus has spread around the world and has acquired features of emergency, World Health Organisation (WHO) declared it as a pandemic in March 2020. Aim: To study the clinical, haematological, biochemical findings and significance of co-morbidities amongst COVID-19 positive survivors and non survivors. Materials and Methods: A retrospective cohort study was done at Chattrapati Shivaji Subharti Hospital (CSSH), Meerut, Uttar Pradesh, a level 3 COVID-19 Hospital from mid-June 2020 to end of August 2020 including 140 COVID-19 positive patients selected randomly. Patients were categorised into asymptomatic and symptomatic. Symptomatic were further divided into survivors and non survivors. Haematological and biochemical parameters were analysed amongst survivors and non survivors, with calculation of significant p-value (<0.01). Results: Out of total 140 patients, 37/140 patients (26%) were asymptomatic and 103/140 (74%) symptomatic. Amongst symptomatic, survivors were 78/140 (56%) and non survivors were 25/140 (18%) of total positive patients. Out of 37/140 (26%) asymptomatic patients, majority were in the age group 21- 30 years 14/140 (10%) with female preponderance 10/140 (7.1%). Out of 78/140 (56%) survivors, majority were in 51 to 60 years age group, with male predominance17/140 (12.1%). Amongst 25/140 (18%) non survivors most common affected age group was 51 to 60 years 10/140 (7.1%). Most common symptoms in survivors was cough (51/78 patients; 65.4%) and fever (35/78 patients; 44.9%). In Non survivors, pneumonia was seen in 100% (25/25) patients. Out of 23/25 (92%) patients presented with fever, 19/25 (76%) had breathlessness, 16/25 (64%) had myalgia, 9/25 (36%) had cough, 5/25 (20%) presented with vomiting or pain in abdomen. Amongst non survivors, Total Leucocyte Count (TLC), Absolute Neutrophil Count (ANC), Neutrophil Lymphocyte Ratio (NLR), urea, serum creatinine, serum bilirubin, Aspartate Amino Transferase (AST) and Alanine Amino Transferase (ALT) were significantly raised as compared to survivors (p<0.01); meanwhile platelet count and Platelet Lymphocyte Ratio (PLR) in non survivors was significantly lower than survivors (p<0.01). Most common co-morbidity was diabetes in 12/25 (48%) and hypertension in 6/25 (24%) among non survivors. Conclusion: COVID-19 infection more likely affects older men with co-morbidities like diabetes mellitus and hypertension and can rapidly progress to pneumonia, Acute Respiratory Distress Syndrome (ARDS) and septic shock. Certain haematological and biological parameters have been found to be in concordance with increased mortality which can be reduced by early identification of these parameters.

Communication Challenges and Implementation of Telepractice for Children with Hearing Impairment during Lockdown- A Parental Perspective

MN Anusha, KS Sathveeka, J Maria, G Sangeetha, G Saranyaa

Introduction: The global Coronavirus Disease-2019 (COVID-19) outbreak has resulted in numerous difficulties and drawbacks in our daily life. Despite causing mortality, it has halted the therapeutic facilities because of the in-person interaction involved in it. Communication difficulties have been aggravated which seeks for immediate attention as it can lead to a lack of improvement in communication delays observed in children with Hearing Impairment (HI). Aim: To highlight the communication challenges faced by children with hearing impairment and consequently investigate the effectiveness and need for telepractice during the Lockdown. It also aims to improve the service delivery models. Materials and Methods: A cross-sectional descriptive study was conducted in MERF Institute of Speech and Hearing, Chennai from July 2020 to August 2020. A convenience sampling was opted for enrolling the participants in the study. The questionnaire was administered to the parents in two modalities- telephonic survey and electronic format. The data analysis was done by frequency counting and percentage calculation. Results: The findings of the current study suggest that the speech and language performances have worsened for 35% (due to lack of formal stimulation, device malfunction, etc.,), improved for 35% (due to intensive home training, adequate stimulation, etc.,) and no difference has been noted for 30% of children with HI during the lockdown. Total of 23 (57.5%) parents were aware of the Telepractice services, and those unaware were oriented. Twelve 12 (40%) respondents opted for other modalities of assistance instead of Telepractice services. Conclusion: The communication challenges faced, calls for seamless intervention during the lockdown. The introduction of Teletherapy proves to be beneficial and hence, the ultimate goal is to integrate telerehabilitation services into clinical facilities. Alternatives of service delivery models should be utilised optimally.

Circadian Variation of Ocular Perfusion Pressure in Primary Open Angle Glaucoma: A Cross-sectional Study

Raheeba Pakeer Muhammed, Neeta Sidhan, Beena Thankappan
Introduction: Various haemodynamic factors have been implicated as pathophysiological mechanisms in Primary Open Angle Glaucoma (POAG) other than raised Intraocular Pressure (IOP). However, the exact relationship still remains unclear. Aim: To examine the circadian pattern of Blood Pressure (BP), IOP and Ocular Perfusion Pressure (OPP) with the aim of understanding their relationships in a cohort of patients with POAG. Materials and Methods: A cross-sectional study was conducted in which 44 cases of newly diagnosed, non-hypertensive patients with POAG were enrolled and categorised based on the severity of glaucoma. Recording of BP and IOP were done every 4th hourly during a 24 hour hospital stay. The Mean OPP (MOPP) was calculated as 2/3×Mean Arterial Pressure (MAP)- IOP. Systolic OPP (SOPP) was calculated as Systolic BP-IOP and Diastolic OPP (DOPP) was calculated as Diastolic BP-IOP. The diurnal, nocturnal and 24 hour fluctuations were derived from the difference between the highest and lowest values within each period. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Univariate and multivariate regression analysis of the variables with age and severity of POAG were performed. Results: Significant positive correlation of the nocturnal fluctuations in MAP (r=0.533), SOPP (r=0.835), DOPP (r =0.768), MOPP (r=0.685) and 24 hour fluctuation in MOPP (r=0.636) were noted with severity of glaucoma on multivariate analysis. No significant correlation of these parameters with age was noted on multivariate analyses. Conclusion: Nocturnal dip in OPP was an important observation among patients with POAG, potentially contributing to its pathophysiology

Aesthetic Conflict and Eating Behaviour in Adolescent Girls of Urban Slum-A Community Based Mixed Method Design

Lopamudra Debasish, Kariarath Cheriath Premarajan, Vignesh Murugan
Introduction: Body image is correlated to self-esteem and eating behaviour and is often skewed in adolescence. The social pressure to be thin and the stigma of obesity lead to unhealthy eating practices. Dieting could be a corollary to body dissatisfaction reflecting skewed perception. Aim: To study the perception of body image among the adolescent girls of the study area and to explore if it affected their eating behaviour. Materials and Methods: An explanatory mixed method design (Quantitative Descriptive - Qualitative) was conducted in a sample of 250 adolescent girls after obtaining ethical clearance. The adolescents' 'Self perceptions of body shape' (compared with their actual body weight, Body Mass Index (BMI), World Health Organisation (WHO) Asian standards), their 'perceptions of a healthy body shape' and their practices were collected quantitatively. Qualitative exploration {Focus Group Discussions (FGD)} of their beliefs and practices pertaining to their perceptions of body image were summarised and the data was analysed by Statistical Package for the Social Sciences (SPSS) (version 13.0) and N Vivo 8 (Demo version). Results: The 'self-perception of body shape' in adolescent girls was compared with their BMI. Of those who felt that they were normal, 57.3% were underweight (BMI ≤18.5) and among those who perceived their self-image as fat, about 29.4% were normal and even about 33.3% were underweight (kappa 0.116, p<0.001). About 7% of the adolescent girls did dieting for maintaining body shape. The respondent's various perspectives of a fatty body shape were related to dietary factors and few beliefs predominant in their community. Those who were 'very thin' wanted to be ‘normal’ but never 'fat' at any cost (Qualitative). Additionally, those who perceived themselves as 'thin' did not diet. For those who were on diet, being 'thin' was considered healthy (91%) but for none (0%), being 'fat' was healthy. Conclusion: Body image dissatisfaction and negative selfperception is observed in adolescent girls and impacts their eating behaviour. They should be positively counselled and their food habits must be shaped with sustained motivation as these tend to persist till adulthood.

Axiograph and Panoramic Radiographic Imaging Technique, an Alternative to Conventional Technique to Record Condylar Guidance

Naresh Shetty, Ganaraj Shetty, Manoj Shetty
Introduction: The documentation of the maxillomandibular relationship and the recording values of condylar guidance is the most critical, yet essential step in fabrication of complete denture prosthesis and it also helps in diagnosing, treatment planning, and fabrication of the balanced complete denture prosthesis that aids in enhancing the aesthetics, and maintenance of the stomatognathic system. Various techniques are available to record the condylar guidance; These are axiographic technique and panoramic radiograph followed by programming the semi adjustable articulators. Aim: The aim of the present study was to evaluate and compare the condylar guidance using the conventional technique the gothic arch tracing with that of axiographic technique and the panoramic radiographs. Materials and Methods: The observational study with the clinical set up was carried out over a period between October 2018-March 2019. Twenty completely edentulous patients were selected for the study. The comparative evaluation of Axiographic tracing technique, Panoramic radiographic technique and the Extraoral gothic arch tracing technique was conducted. The horizontal condylar guidance values obtained with these techniques were assessed. The data obtained was statistically analysed using Karl Pearson correlation test to determine the correlation between the values obtained from all the three techniques on the right side and the left side of the subjects. Paired t-test and Bonferroni Post-Hoc test were used to compare the Extraoral gothic arch tracing values and Orthopantomogram values and axiographic tracing values on right side and left side of the subjects. Results: A statistically significant correlation was observed between the extraoral Gothic arch tracing technique and the Panoramic radiographic technique on right (r=0.047, p-value 0.04) and left sides (r=0.55, p-value 0.01) of the subjects. The axiographic tracing showed lower values when compared with gothic arch tracing technique and the Panoramic radiographic technique (95%CI of difference was -0.49 lower). Significant differences were obtained on comparison between all three techniques on right (p-value <0.001) and left sides (p-value 0.008). On pairwise comparison of right sides between Extraoral gothic arch Tracing and Axiographic tracing (p-value <0.001) and between axiographic tracing and Orthopantomographic tracing (p-value <0.001) were significant, while pairwise comparison on left side between Orthopantomogram and Axiographic tracings (p-value 0.01) were significant. Conclusion: The panoramic radiographic images can be used as an alternative method to that of conventional gothic arch tracing technique to obtain the condylar guidance values. The values obtained using axiographic tracings method was comparatively lower. Thus, the values obtained from axiographic technique should be used with caution or the values needs to be compared to gold standard techniques to further analyse the accuracy of the values that can be used as a valuable aid in setting the condylar guidance in semi-adjustable articulators.

Comparative Evaluation of Efficacy between Topical Calcipotriol used along with Topical Clobetasol and Topical Clobetasol Monotherapy in Treatment of Alopecia Areata: A Randomised Clinical Trial

Mohan Lal Gupta , Shivangna Singh , Bushra Hasan Khan
Introduction: Alopecia Areata (AA) is a hair disorder characterised by non-scarring, patchy loss of hair from scalp and other parts of the body. For the treatment of AA, topical steroid is one of the first line therapeutic options. Topical vitamin D analogue Calcipotriol has immunomodulatory action. Vitamin D Receptors (VDR) are present in the hair follicles, therefore for treatment of AA topical vitamin D analogue Calcipotriol can be considered. Aim: To comparatively evaluate the role in terms of efficacy of topical vitamin D analogue Calcipotriol when used along with topical Clobetasol in comparison to topical Clobetasol used alone for AA treatment. Materials and Methods: In this randomised, open label, clinical study, sixty patients (age 20-32 years) diagnosed with AA were randomly assigned into two groups, thirty patients in each from September 2019 to February 2020. Topical Clobetasol (0.05%) was applied on the affected area twice a day for 24 weeks by Group A patients. While both topical Clobetasol (0.05%) and topical Calcipotriol (0.005%) was applied on the affected area twice daily for 24 weeks by Group B patients. Parametery like Age, Serum Hydroxy Vitamin D (25(OH)D) and Severity of Alopecia Tool (SALT) Score were mesured at baseline. At regular intervals of time (i.e baseline, 6,12,24 weeks), SALT score was evaluated. Mean values of the data were evaluated using student’s t-test and chi-square test based on whether the data was quantitative or qualitative in nature respectively. A p<0.05 was considered statistically significant. Results: With respect to age and gender distribution both the groups were comparable (p>0.05). For patients of group A and group B the mean values of SALT score at baseline were 10.45±5.25 and 9.85±4.95, respectively (p=0.65). In patients of Group A and Group B towards the end of 24 weeks the mean values of SALT score decreased to 5.98±4.32 (p=0.0007) and 3.66±3.53 (p=0.0001), with a greater decrease in SALT score seen in Group B (p=0.05) i.e., the group in which patients were treated with topical calcipotriol 0.005% along with topical Clobetasol 0.05%. Conclusion: Topical calcipotriol 0.005% lotion used along with topical Clobetasol 0.05% lotion had higher efficacy than topical Clobetasol 0.05% lotion used alone, in the treatment of AA.

Group B Streptococcus Colonising the Genital Tract of Pregnant Women from Dibrugarh, Assam: Circulating Serotypes, Susceptibility Pattern and Phylogenetic Analysis
Introduction: Maternal genitalia colonising bacteria i.e., Group B Streptococcus (GBS) well known as Streptococcus agalactiae is responsible for serious health complications in newborns like sepsis, meningitis and pneumonitis. Centre for Disease Control and Prevention (CDC) recommends a thorough culture based screening in 35-37 weeks gestation mothers for further therapeutic steps. Previously no study was carried out on the occurrence of GBS among pregnant mothers in Assam with phylogenetic analysis. Aim: To bring the scenario of GBS infection in antepartum women by targeting the capsular serotypes with their antibiogram profile and to bring the phylogenetic relationship of the prevailing GBS isolates found in Dibrugarh district, Assam, India. Materials and Methods: This was a hospital based observational study which was carried out in District Urban Health Centre, Assam, India. Lower vaginal swabs without using speculum were collected from the enrolled late trimester pregnant women. Socio-demographic data were collected with their consent. Out of the total enrolled participants (n=345), GBS was isolated in 52 samples. These were inspected by culture techniques and further confirmed using molecular methods. Serotyping was carried out by employing multiplex PCR. Antibiotic susceptibility test was conducted as per Clinical and Laboratory Standards Institute (CLSI) guidelines and phylogenetic tree was reconstructed. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0. Results: This study showed a GBS carriage rate of 15.1% in the colonising participating women. No significant association with any of the demographic and clinical factors was found. Serotype Ia (42.1%) was the ruling one followed by VI (31.6%), II (15.8%) and VII (10.5%). While 36.7% of the GBS isolates were grouped into not typeable. Serotypes Ia showed resistant towards cefotaxime, erythromycin and clindamycin and serotype II towards vancomycin. Phylogenetic evaluation showed the presence of four distinct clusters viz., I, II, III and IV with unique evolutionary trends in human GBS population in the study site. Conclusion: So far in Assam, this study reports for the first time on GBS prevailing rate in late trimester mothers which may be helpful in declining the rate of adverse neonatal outcomes with on time maternal therapeutic administration by real time monitoring of antibiogram profiling. This study also paves a way of designing Capsular Polysaccharide (CPS) based vaccines for immunising the expectant mothers to prevent adverse outcomes of the newborns.

Efficacy of Injection Histaglobulin in Treatment of Chronic Urticaria

Usha Naraindas Khemani, Avinash Aba Sajgane
Introduction: Patients of Chronic Urticaria (CU) suffer from the morbidity that arise from irritable itch and wheals and it also shows a poor response to drug treatment. Treatment options which increase the duration of remission and those which address the key factors involved in the disease pathogenesis are the need of the hour. Aim: To assess the efficacy of injection histaglobulin a complex of histamine and human immunoglobulin in producing relief in patients with CU and to compare effect of histaglobulin in between Autologous Serum Skin Test (ASST) positive and ASST negative group of CU patients. Materials and Methods: This was a single centre, open label, non-randomised prospective clinical study in which 40 patients with CU were enrolled. Patients were administered injection histaglobulin as a weekly dose of 1 mL subcutaneously for eight consecutive weeks. Patients were permitted to take tab. levocetirizine 5 mg as and when required not exceeding the recommended permitted dose. The efficacy of the drug was assessed using Urticaria Activity Score (UAS 7) a unified, validated and simple scoring system. The assessment was done at every weekly visit and the final assessment was done after 24 weeks. Results: Out of 40 patients enrolled, 32 patients had completed the entire schedule of dosage of eight weeks and final followup at 24th week. The mean basal UAS 7 was 12.6 at the time of enrolment to the study and it reduced to 2.57 at the end of 8th week which marginally increased to 2.8 at the end of 24 weeks, the antihistamine pill burden also reduced. No adverse effects were observed in the study group. Conclusion: Histaglobulin was found to be effective in producing long term remission and it reduced the antihistamine need as well. Thus, it can be an effective alternative to existing treatment modalities.

Evaluation of Saline as Potential Alternative to Viral Transport Media for COVID-19 Samples Stored at Different Temperatures
Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS CoV 2) virus, a causative agent of COVID-19 has led to universal pandemic. During this pandemic there has been an acute shortage of good quality Viral Transport Medium (VTM) because of increase in number of infected people worldwide. It is also difficult to maintain the transport and storing conditions in line with the guidelines in pandemics. Aim: To assess the feasibility of Oropharyngeal Swab (OP)/Nasal swabs in 0.9% normal saline in place of VTM and to analyse the effect of temperature on nucleic acid detection by rRT PCR on saline samples stored at 4°C, ambient and at higher temperature (37°C). Materials and Methods: The present study was an observational analytical study which included 94 positive and 5 negative samples. Patients' nasal or OP samples were collected as dry swabs and in VTM. Normal saline was added once the samples were received in the laboratory. PCR was done with saline and VTM samples both on day 1. Samples were aliquotted in 3 sets and one set was kept at 4°-8° C and other two at 25°C and 37°C, respectively. All positive samples were further tested on day 3, day 4 and day 6. Results were analysed and compared. Results: Samples in normal saline showed very good sensitivity at all temperatures (4°-8°C, 25°C and 37°C) till day 6. Both the swab samples (in saline and in VTM) showed nearly 100% agreement in rRT-PCR results. Ct value variation was also ≤±2. Conclusion: Looking into the cost and logistics issues especially during pandemics, saline is a good and cheaper alternative to VTM and with its use, testing capacity can be expanded.

Retrospective Audit of Phacomorphic Glaucoma in Last 12 Years in a Tertiary Eye Care Centre, New Delhi, India

Shanu Kumar, Julie Pegu, Safeena Tabassum, Suneeta Dubey, Umang Mathur
Introduction: Phacomorphic glaucoma is a type of secondary glaucoma caused by lens swelling in eyes with mature or intumescent cataract. It is encountered more commonly in developing countries. Its management includes initial lowering of Intraocular Pressure (IOP) followed by definitive treatment of removal of lens by cataract surgeries. The visual prognosis remains unpredictable due to the irreversible optic nerve damage that may have incurred in a matter of few days. It is equally pertinent to know the postoperative IOP values and whether these patients would require long term Anti-Glaucoma Medications (AGM). The role of Laser Peripheral Iridotomy (LPI) in IOP control preoperatively in such patients also needs to be evaluated. Aim: To assess the visual outcome, IOP control and the requirement of AGM after cataract surgery in phacomorphic glaucoma. Materials and Methods: This was a retrospective, observational study conducted from March 2019 to January 2020 on all patients diagnosed with phacomorphic glaucoma at the tertiary eye care centre. The primary variables were IOP and visual acuity. All patients underwent a complete ophthalmic examination. Cataract surgery was done after instituting treatment for IOP control. Preoperative LPI was done according to consulting doctors’ discretion. Trabeculectomy was combined with cataract surgery based on surgeons’ decision. Patients were followed for 6 weeks postoperatively. Fisher-test and paired t-test were used for statistical analysis. Results: A total of 118 patients (25 males and 93 females, mean age 64.55±6.35 years) were recruited in the study and 94 patients followed-up till last visit at 6 weeks. The mean presenting IOP was 39.55±12.55 mmHg. The mean IOP at day 1 postoperatively was 14.66±4.55 mmHg, the difference was statistically significant (p-value <0.001). There was a significant drop in IOP seen postoperatively at day 1 and 6 weeks (p<0.001). At 6 weeks, the mean IOP was 13.19±3.83 mmHg. A combined cataract extraction and trabeculectomy did not result in statistically significant difference in the final IOP values. At 6 weeks follow-up, 87.23% patients did not require any AGMs; 63.83% patients gained good vision, 26.59% gained borderline vision and 9.58% had poor vision. LPI resulted in a better IOP control preoperatively (p=0.003). Conclusion: Cataract surgery alone results in good IOP control in phacomorphic glaucoma without a need for long term AGMs. However, to prevent permanent angle damage and disc changes an early surgical intervention is required. LPI appears to have a beneficial role in controlling the preoperative IOP in these eyes.

Risk Factors for Reverse Transcriptase Polymerase Chain Reaction Positivity for SARS-CoV-2 among Healthcare Workers in a Group of Tertiary Care Hospitals in Mumbai: A Cross-sectional Study
Introduction: Healthcare Workers (HCWs) can acquire or transmit Coronavirus Disease 2019 (COVID-19) from and to patients respectively. There is limited data on risk factors for Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) infection among HCWs. Aim: To evaluate the risk factors for SARS-CoV-2 infection amongst HCWs of tertiary care hospitals in Mumbai, Maharashtra, India. Materials and Methods: A questionnaire based crosssectional study was conducted among 801 HCWs from three tertiary care hospitals. Data regarding demography, comorbidities (hypertension, diabetes, heart disease, cancer, immunosuppressive therapy, asthma), symptoms, contact with confirmed cases of COVID-19 and protective precautions at the work place was collected. Infection diagnosed by Respiratory Tract samples- Reverse Trancriptase Polymerase Chain Reaction (RT-PCR) test was correlated with the above factors. Results: Of the participants, 50.1% were working in designated COVID-19 area; 85.1% had no co-morbidity. A total of 62 of the 801 (7.75%) HCWs had a history of positive RT-PCR for SARSCoV-2. Only asthma was associated with a significant higher in infection rate. Loss of taste/smell (30%), acute febrile illness (46.4%), acute respiratory illness (18.5%) were more common in persons with RT-PCR positivity (p<0.05). Visit to fever clinic, positive household member, and a definite history of exposure to a COVID-19 positive patient, were significantly associated with higher risk of infection. Working in designated COVID-19 hospital was not a significant risk factor (8.5% vs 5.6%). HCWs on Hydroxychloroquine (HCQ) prophylaxis had significantly lower rate of infection. Conclusion: Rate of SARS-CoV-2 positivity among HCWs was 7.7%. Presence of symptoms, especially, loss of taste/ smell, fever and respiratory symptoms are associated with high positive rates. Working in a designated COVID hospital was not a risk factor for increased rate of infection. HCQ prophylaxis is associated with reduced rate of COVID-19 among HCWs.

Matrix Metalloproteinase-2 Expression as a Prognostic Marker in Breast Carcinomas

B Jayashree, Priyathersini Nagarajan, Thanka Johnson
Introduction: Matrix Metalloproteinase-2 (MMP-2) is over expressed in a variety of malignant tumours and their expression and activity are often associated with tumour aggressiveness and a poor prognosis. It serves as a prognostic marker in breast carcinoma regardless of patient age, disease stage, malignancy grade, or hormone receptor status and modulation of MMP-2 expression and activation provides a new mechanism for breast cancer treatment. Aim: To evaluate the expression of MMP-2 in breast carcinoma tumour cells and peritumoural stroma and also to analyse the findings with the existing other prognostic markers of mammary carcinoma. Materials and Methods: The present study was a retrospective study conducted on paraffin blocks of 90 cases of invasive breast carcinoma specimens received in the Department of Pathology, Sri Raamachandra Institute of Higher Education and Research a tertiary care centre in Chennai, Tamil Nadu, India, from January 2012 to June 2017. Immunohistochemical staining for MMP-2, Oestrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor 2 (HER2) was done. Statistical analysis was done on the data collected by using the software GNU-PSPP version 0.10.1. Pearson Chi-square test was used to determine significant clinicopathological differences between MMP-2 expression in positive and negative tumours. Differences were considered statistically significant when p-value was <0.05. Results: The study included 90 cases of histological proven invasive breast carcinoma. The study parameters include age, clinical staging, histopathological grade, lymphnode status, molecular subtype and MMP-2 expression in invasive breast carcinoma. Out of 90 cases, 62 cases were positive for MMP-2 and 18 cases were positive for peritumoural stroma, 30 cases were negative for MMP-2 in tumoural cells and 72 cases were negative surrounding the peritumoural stroma. Conclusion: Present study showed high MMP-2 immunohistochemical expression in breast carcinomas. There was a statistically significant association of increased MMP-2 expression with tumour stage. There was also a statistically significant association of MMP-2 in the tumour and stroma with High Grade Ductal Carcinoma In Situ (HGDCIS). There was an increased expression of MMP-2 in Luminal A subtype. Low expression was seen in the other molecular subtypes. In view of these findings and association with other studies in the literature, the present study demonstrates that the expression of MMP-2 in tumour and stromal cells could serve as a parameter of poor prognosis in breast cancer.

A Cross-sectional Study on Electrophysiological Evaluation of Neuropathy in Rheumatoid Arthritis-RETRACTED ARTICLE
This article has been retracted as it was bought to the editorial notice that the electrophysiological prerequisites of maintaining ambient temperature, correction for height and utilization of a single machine for all recordings were not uniformly executed leading to inaccuracies in data interpretation and statistical analysis.

Development of a Yoga Module for Hypothyroidism

T Venkatesh, Itagi Ravikumar, TL Alaka Mani
Introduction: Prevalence of hypothyroidism is found high in India in the recent years and is more commonly seen in women. While treating the condition with pharmacological intervention, importance of exercise, diet and lifestyle modifications plays a significant role in managing the condition. Yoga based techniques have shown positive impact in managing hypothyroid related symptoms. Yoga when considered as a therapeutically approach needs to be customised by considering specific yogic techniques for the targeted health condition and it is also essential to validate the yoga module for a given health condition. While there are a few validated yoga modules for managing obesity, backpain etc., there are no validated yoga modules for treating/managing hypothyroid condition. Aim: To develop an integrated yoga module for hypothyroidism. Materials and Methods: Integrated yoga module has been designed based on traditional yoga literature and expert opinion. Based on the pancha kosha model (five layered existence), 53 yogic techniques were compiled and sent to 36 experts for content and face validation. Experts validated each technique by rating the relevance on a five point likert scale. Validated techniques were administered to a group of 35 women having hypothyroidism to assertain acceptance and the possibility of practice of said techniques. Content Validity Ratio (CVR) and the average of mean, mode and median of scores were calculated. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 23. Results: Out of the 53 yogic techniques, 41 techniques scored either CVR more than 0.5 or average of mean, median and mode more than 4. Conclusion: The developed integrated yoga module for hypothyroidism enjoys good face and content validity. Initial feasibility test confirms that the techniques are accepted and could be practiced by the hypothyroid patients. Further validation of the module using a pre-post study is warranted to confirm its efficacy.

Evaluation of a New Rapid Antigen Detection Test for the Diagnosis of Influenza Virus Infection in a Tertiary Care Hospital of Southern India
Introduction: Rapid antigen testing can help in early diagnosis of Influenza in resource limited settings in patients presenting with Influenza Like Illness (ILI). Aim: To evaluate the usefulness of Rapid Influenza Direct antigen Testing (RIDT) in comparison to Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) for diagnosis of Influenza virus infection in clinically suspected patients with ILI in a tertiary care hospital. Materials and Methods: A prospective observational independent study was done to evaluate RIDT for Influenza virus infection, considering RT-PCR as gold standard. Throat swabs and nasal swabs from patients meeting Category 3 definition of ILI by Ministry of Health and Family Welfare (MoHFW) were collected from 20th July, 2019 to 20th October, 2019 from hospitals in and around the study area. Onsite Rapid test (Biogenix, China) was used as per manufactures instructions for rapid detection of Influenza antigen. Ribonucleic Acid (RNA) extraction was done using Qiagen kit followed by RT-PCR using primer, probes recommended by National Institute of Virology (NIV, Pune) as per their protocols. Data was recorded on a predesigned proforma and managed using Microsoft Excel 2018 (Microsoft Corp, Redmond, WA). The Statistical software MedCalc version 9.1 for Windows was used for data analysis. Results: The overall sensitivity of the RIDT was 37.9% and specificity was 94.4%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 73.3% and 78.8%, respectively. Kappa was calculated to be 0.37 that suggested a fair agreement between RIDT and RT-PCR. When the Cycle threshold (Ct) values were compared to the results of RIDT, there were more false positives at low Ct value and more false negatives at high Ct values. Conclusion: The RIDT is not useful in screening during an outbreak in acute care settings. The negative result of RIDT should be followed up with RT-PCR. With a strong clinical suspicion, it is better to start antivirals than wait for laboratory report in severely ill patients with ILI.

Fenugreek Seeds as a Therapeutic Supplement for Patients with Non Insulin Dependent Diabetes Mellitus: A Cross-sectional Study

Shailendra Singh Bhadauria, Archana Kushwah
Introduction: Diabetes mellitus is a metabolic disorder, for which there is no known cure except in very specific situations. Management of diabetes is based on keeping blood sugar levels as close to normal as possible, without causing hypoglycaemia. Usually, this can be accomplished with diet, exercise and use of appropriate medications. In India, herbs are used in treatment to maintain normal blood glucose and lipid levels. In any form of management of diabetes with drug or insulin, diet is a common factor. Besides diet, many plants and foods of medicinal value have proved to be very useful in which one of them is fenugreek seed. Aim: To evaluate the blood glucose modulating effect of Fenugreek Seed Powder (FSP) in patients of Non Insulin Dependent Diabetes Mellitus (NIDDM). Materials and Methods: A cross-sectional study was conducted on 25 patients of NIDDM of age group between 40 to 50 years. A 5 gm Fenugreek seed powder was given to the patients on empty stomach early in the morning every day. Before beginning the study and at the end of every month, the blood glucose level (fasting and postprandial) was measured consecutively for three months. Statistical Package for Social Sciences (SPSS, version 17.0) computer software package was used for statistical analysis of the data. Results: Administration of FSP lowered the blood glucose levels in patients of NIDDM and a significant reduction in blood glucose level (fasting and postprandial) was observed in the study. Conclusion: Present study suggested that FSP might have potential to modulate blood glucose level which can serve as an effective supportive therapy in the prevention and management of long-term complications of diabetes.

Manual Therapy Combined with Therapeutic Exercise Vs Therapeutic Exercise Alone for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis

Saurabh Sharma, Mohammed Ejaz Hussain, Shalini Sharma
Introduction: Shoulder complaints are the third most common musculoskeletal presentation, after back and neck disorders, in primary care. Among people with shoulder pain, Shoulder Impingement Syndrome (SIS) has the highest prevalence and accounts for 27% of shoulder disorders. Various treatment options are available for SIS. However, literature suggests the need of a review regarding the addition of Manual Therapy (MT) to the Therapeutic Exercise (TE) program. Aim: To investigate the effectiveness of MT combined with TEs versus TEs alone for the management of SIS. Materials and Methods: The study examined published randomised controlled trials and quasi-experimental studies. A comprehensive search of two electronic databases (PubMed and Physiotherapy Evidence Database (PEDro)) was performed from inception till the last week of August, 2020. The selected studies were assessed on methodological quality rating using the PEDro scale and the modified downs and black scale for experimental and quasi-experimental studies, respectively. The extracted outcomes were pain levels, strength, Range of Motion (ROM) and Shoulder Pain and Disability Index (SPADI) scale score. The meta-analysis was done on continuous data and the data were summarised qualitatively and quantitatively. Results: Seven trials were included (n=437) after evaluation. Standard Mean Difference (SMD) with 95% CI was used to denote summary effects of the outcome measures. Pain {SMD: -1.07; 95%CI: -1.85, -0.28; p<0.01} showed positive effect when managed with MT combined with TE while external rotation strength {SMD: 0.55; 95%CI 0.27, 0.84; p<0.01} improved with TE alone. The majority of the studies (six out of seven) had low risk of bias. Conclusion: The results indicate that evidence exists for improvement in pain level and muscle strength with MT combined with TE and TE alone respectively. The qualitative evidence suggests that glenohumeral mobilisation and exercises are associated with best outcomes for SIS management.

Retinopathy of Prematurity: Nursing Perspective

Bindu K Sankar, Hrishikesh Amin, KM Riaz, P Pappa, Shalu Varghese
Retinopathy of Prematurity (ROP) is the leading cause of childhood blindness. India and other middle income countries are currently facing the third ‘epidemic’ of this disease which is mainly due to increased survival of preterm babies, suboptimal neonatal care and lack of proper screening and management of ROP. This is a disorder of the immature retina of preterm babies in which abnormal vascularisation occurs after birth. ROP is multifactorial, and is sensitive to the quality of neonatal inpatient care received during early postnatal life. Nurses, being the primary care givers in Neonatal Intensive Care Units (NICUs), plays a vital role in prevention and management of ROP.

Musculoskeletal Physiotherapy Strategies in Post COVID-19 Infection: A Narrative Review

Nityal Kumar Alagingi
In 2019, COVID-19, a disease associated with Novel Corona-virus was initially reported from Wuhan, China. Since then, infection rates have gone out of control. World Health Organisation (WHO) has declared COVID-19 as a pandemic. Many government and nonprofit organisations are working to control this situation and norms like lockdown, social distancing, and restricting gatherings have been implemented to control the spread of the virus. Despite following these policies, the infection rate is high and people with COVID-19 infection are experiencing a lot of complications. Cardiac and pulmonary complications like shortness of breath, oxygen saturation etc., were documented, but recent reports mentioned musculoskeletal symptoms like Myalgia, Arthralgia, and Fatigue are also prevalent in people with post-COVID-19 infection. Due to the reoccurrence of symptoms and vulnerability of people, post-Covid-19 has made healthcare workers and hospitals to adopt alternative strategies in treating people. Of those strategies telerehabilitation, patient education, self-management and pain management are the most used rehabilitation options in treating post-COVID-19 infection. In this literature review, the strategies for treating people with post-COVID-19 infection are summarised.

Influence of Stress and Anxiety on Sports Injuries in Athletes

Sajjan Pal, Sheetal kalra, Supriya Awasthi
An athlete does not only require to be fit physically but also requires to be fit psychologically for their successful performance in sports activities. Hence, it is essential to understand the psychological risk factors which contribute to sport injuries in athletes. For this review, literature search in the international databases of PubMed, MEDLINE and Google Scholar was done by using following keywords: ‘sports injury’, ‘stress’, ‘anxiety’, ‘athletic injury’, ‘psychology’, ‘predictors’ and ‘athletes’. The studies published from 1992 to March 2020 and in the English language were included in this review. Of 120 articles obtained by the end of this search process, 18 full text articles were finally selected. Most of the study designs were cross-sectional studies or surveys, cohort studies and descriptive studies. The results indicated that stress and anxiety are two notable psychological variables which are associated with predicting injury in different sports and found to be significant with the incidence of sports injuries among athletes of different sports. It was found that stress and anxiety can influence the risk of injuries, injury frequency, and injury severity in athletes.

Guided Bone Regeneration- A Comprehensive Review
Successful implant treatment requires prosthetically driven placement of an implant, primary stability at placement, and careful living bone management. The resorptive changes of alveolar bone are an inevitable process following tooth loss, periodontal disease or trauma which causes bone defects. This results in various aesthetic and functional complications such as soft tissue recession, infection and inflammation. Various methods have been tried and advocated for augmenting these bone deficiencies. Guided Bone Regeneration (GBR) is a successful modality for bone augmentation with a wide range of indications and helps restore the alveolar ridge dimensions. It utilises the principle of Guided Tissue Regeneration (GTR) for space maintenance within a bony defect. Different types of barrier membranes are being utilised along with various bone grafts in GBR. Thorough knowledge regarding the biology of bone is required before the initiation of any bone augmentation procedure. A combination of Collagen Membrane (CM) and graft material was found successful for GBR. Hence, this review focuses on presentation of best available evidence for various aspects of GBR.

Pathology of COVID-19: A Review of Emerging Evidences from Autopsy Studies

Seetu Palo, Debadutta Mishra
Coronavirus Disease 2019 (COVID-19) is caused by novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The disease was first reported from Wuhan, China, in December 2019 and since then it continues to spread worldwide. Although, there are rapidly increasing number of studies on epidemiologic characteristics and clinical aspects of COVID-19, its pathology still remains a largely unexplored territory, mainly due to limited autopsy studies. Autopsy studies are essential to demonstrate the spectrum of COVID-19-associated organ changes. This article reviews and highlights the important histopathological findings observed in different organ systems as evident from various published and anecdotal reports from across the world. Major histopathological findings in the lungs include different stages of Diffuse Alveolar Damage (DAD) and microthrombi along with variable degree of inflammation. Microscopic analysis of renal parenchyma may show acute tubular injury and fibrin thrombi in the glomerular capillaries. Heart, liver and brain show no significant inflammatory changes.

COVID-19 Prevention Protocol for an Organised Mass Gathering-An Essential Requisite in Pandemic and Post-pandemic Phase

Sheen Job, Mayank Kapoor, Prasan Kumar Panda, Latika Mohan, Ravikant
Coronavirus Disease 2019 (COVID-19) pandemic has stirred up chaos in the whole world. After prolonged lockdowns, finally, society is opening again for business and day-to-day life. Mass gatherings are undoubtedly again expected to start, but carry additional risks for transmission of the virus. We designed a concept model that was validated in about 1000 people gathering in a convocation ceremony at the beginning of the COVID-19 outbreak. A protocol was made, a risk assessment was done, and attendees followed-up. The emphasis on thermal screening, hand hygiene, physical distancing, open-air ventilation, refusing attendees having Influenza-Like Illnesses (ILI), and other preventive measures were the means to contain the potential transmission in an organised mass gathering of this magnitude. The dictum "prevention is better than cure" held amidst this outbreak. As a result of this well-structured mass gathering, the event was quite successfully conducted. Further event planning in the COVID-19 scenario or other outbreaks of similar infections must be managed in this way for the prevention of spread.

Second Metacarpal Base Avulsion Fracture Due to the Extensor Carpi Radialis Longus Tendon: A Case Report

Tanvi Rao, Jonathan Victor
Fracture avulsion injuries of the extensors of the wrist are not common. The most common mode of injury is forced flexion of the hand and wrist with Extensor Carpi Radialis Longus (ECRL) contraction at the same time. These fractures are generally managed by Open Reduction and Internal Fixation (ORIF) along with repair of the ECRL tendon. This modality of management is associated with less chance of complications, makes the joint more stable and has an overall positive result.

Enchondromatosis Affecting the Foot: A Case Report

Steven R Edwards, Mark F Gilheany
Enchondromatosis is characterised by asymmetrical cartilage lesions of variable distribution that cause pain, deformity, changes to limb length, and potential malignancy. The cause is unknown. The pain associated with enchondromatosis is due to the increasing pressure of the lesions on the surrounding bone. A 16-year-old male with suspected enchondromatosis affecting his left foot was referred to our surgical practice. Physical examination revealed swelling and disfigurement with moderate pain upon palpation of the second and third toes. X-rays and Magnetic Resonance Imaging (MRI) displayed lesions within the proximal and middle phalanx of the second and proximal phalanx of the third toe. Management involved curettage with insertion of tibial bone graft with percutaneous Kirschner wire stabilisation. Success was defined as the resolution of symptoms, successful take of the graft and normal alignment of the tires. At eight-weeks postoperatively the patient reported no pain and his toes were in normal alignment and not deformed. Enchondromatosis is an uncommon disorder that may respond well to surgical curettage with bone graft.

Customised Ball Attachment Retained Cheek Plumpers to Enhance Facial Aesthetics: A Case Report

Priyanka Pavankumar Patil , VNV Madhav
Facial aesthetics plays a very important role in dentistry. Loss of teeth leads to the resorption of alveolar ridges, loss of support to the facial musculature resulting in diminished facial muscle tone, all of which lead to the slumping of the cheek. Authors here by present a case of a 59-year-old male patient who reported with the complaint of missing upper and lower teeth. Intraoral examination revealed completely edentulous maxillary and mandibular arches. Extraoral examination revealed sunken cheek and wrinkling of the skin. The patient was more concerned about his hollow cheek, so the treatment option advised for him was complete denture with detachable cheek plumpers. The technique used here precisely determines available space for cheek plumpers. But, despite of providing the maxillary cheek plumper, appearance of hollow cheek remained in lower third of face. So, the mandibular cheek plumper was also planned. This case report a novel, simple, straightforward, cost-effective and noninvasive technique of fabricating detachable cheek plumpers for maxillary and mandibular denture using customised ball attachment.

Atypical and Severe Manifestations of Scrub Typhus in Children: Hiding without the Rash

Ashish Marwah , Poonam Mehta Nee Marwah
Scrub typhus has rarely been reported as a cause of acute febrile illness with Acute Kidney Injury (AKI) and Acute Respiratory Distress Syndrome (ARDS) among children from northern India plains. The diagnostic dilemma is further enhanced when the children do not present with any rash or an eschar. Three such children (12-year-old female girl, three-year-old female child and two-year-old male child) with severe scrub typhus presenting with AKI, ARDS and multi-organ dysfunction respectively are described in this case series. All were successfully managed with doxycycline and supportive management. This series highlights the importance of early diagnosis and treatment with a low-cost drug like doxycycline based on high index of clinical suspicion and appropriate investigations in a case of paediatric scrub typhus.