Journal of clinical and diagnostic research

Management of Parastomal Hernia using Laparoscopic Keyhole Mesh Repair: A Case Report

Parastomal Hernia (PSH) is a frequent and challenging complication of stoma creation, with an incidence of up to 50% within two years postsurgery. This condition often presents with swelling, discomfort, or complications such as obstruction or strangulation. Surgical repair, particularly using minimally invasive techniques, is the definitive treatment for symptomatic or complicated hernias. This case report presents a 65-year-old female with a symptomatic PSH following anterior perineal resection and colostomy for rectal cancer. The hernia was successfully managed with a laparoscopic keyhole mesh repair. The procedure involved meticulous adhesiolysis and the placement of a composite mesh to reinforce the abdominal wall while maintaining stoma function. Postoperative recovery was uneventful, and the patient experienced complete symptom resolution with no recurrence at the one-month follow-up. This report underscores the efficacy and safety of laparoscopic keyhole mesh repair in the management of PSH and highlights the importance of individualised surgical planning and precision in achieving optimal outcomes.

Dermatofibrosarcoma Protuberans of Inguinal Region: A Case Report

Dermatofibrosarcoma is a rare tumour involving the skin. It is a low-grade soft-tissue sarcoma that is commonly seen in middle-aged individuals, usually in the third and fourth decades of life, with males showing a higher prevalence than females. The authors reported a case of a 48-year-old female patient who presented to the hospital with complaints of multiple right inguinal swellings for three months, along with a reported recent increase in size over the last month. On examination, multiple papulomatous lesions, approximately 5×3 cm in size, were observed in the right inguinal region. Ultrasonography (USG) revealed well-defined lesions with a relatively mixed pattern and a few cystic areas noted in the subcutaneous plane, measuring approximately 40×25 mm. These lesions exhibited raised vascularity on colour Doppler imaging. The histopathological examination revealed myxoid tissue showing spindle or satellite cells with oval elongated nuclei and indistinct cytoplasm, suggestive of dermatofibrosarcoma. Dermatofibrosarcoma protuberans is an unusual soft-tissue tumour of the skin, and ultrasonography can significantly help in its diagnosis and management.

Management of Postpartum Deep Vein Thrombosis with Inferior Vena Cava Filter Placement: A Case Report

Vidhi Jain, Neema Acharya

After caesarean sections, Deep Vein Thrombosis (DVT) is a serious complication that increases the risk of maternal morbidity and mortality. Immobility, obesity, thrombophilia and emergency caesarean sections are additional risk factors that can lead to the development of DVT. Symptoms of DVT include oedema, pelvic and lower limb pain and unilateral leg swelling. The primary purpose of Inferior Vena Cava (IVC) filters is to prevent blood clots from entering the lungs, where they can cause a potentially fatal pulmonary embolism. The placement of an IVC filter can be a crucial intervention to protect maternal health in the setting of postoperative DVT, where the risk of embolism is increased. In this case, a 27-year-old multiparous woman underwent an emergency caesarean section for foetal distress and developed unilateral pedal oedema postoperatively. A venous Doppler confirmed acute DVT in the right lower limb. She was managed with IVC filter placement, mechanical thrombectomy, thrombolysis and anticoagulation therapy. Comprehensive postoperative care included antibiotics, analgesics, physiotherapy and supervised mobilisation, ensuring safe breastfeeding under the guidance of neonatology. Regular wound care revealed healthy healing and the patient demonstrated complete recovery without complications. This case underscores the importance of early diagnosis, multidisciplinary management and vigilance in addressing postpartum DVT to prevent life-threatening complications.

Rectal Melanocarcinoma in an Elderly: A Case Report

Abhishek Ghose Biswas, Kishore M Hiwale

Rectal melanocarcinoma is a rare and aggressive malignancy often misdiagnosed due to non specific presentation. Hereby the authors present a case of a 71-year-old male who presented with mild anal pain and occasional bleeding, along with a 3 cm protruding mass from the anal canal. Clinical examination identified thrombosed external haemorrhoids and a suspicious 2 cm mass. Routine blood tests and Echocardiography (ECG) were unremarkable, but proctoscopic examination confirmed the presence of the mass, which was surgically excised. Histopathological analysis of the excised tissue revealed spindle and polygonal cells with prominent macronucleoli and melanin pigment in the cytoplasm, particularly at the squamocolumnar junction. Microscopic examination at various magnifications supported the diagnosis of rectal melanocarcinoma. Despite surgical intervention, the prognosis for rectal melanocarcinoma remains poor due to its aggressive nature and high potential for metastasis. The present case underscores the critical importance of early recognition and thorough histopathological evaluation of atypical anorectal lesions to avoid misdiagnosis.

Synergy of Ayurvedic and Modern Medicine for Improving Left Ventricular Ejection Fraction in Heart Failure Post Myocardial Infarction: A Case Report

Heart failure following a myocardial infarction presents a daunting challenge, with major implications for patient morbidity and mortality. The associated co-morbidities, such as diabetes and hypertension, complicate the treatment course. Managing such patients is challenging and is associated with numerous hurdles that call for an integrated approach for successful management. The present case of a 35-year-old male patient who had previously experienced a Myocardial Infarction (MI) and subsequently developed heart failure with reduced Left Ventricular Ejection Fraction (LVEF). He came to pursue Ayurvedic treatment. The patient was already taking allopathic drugs, which were continued and Ayurvedic interventions were provided alongside them. The Ayurvedic medications included an herbal decoction consisting of Terminalia arjuna (Arjuna), Withania somnifera (Ashwagandha), Terminalia chebula (Haritaki), Curcuma longa (Haridra) and Boerhavia diffusa (Punarnava), given as 40 mL decoction twice daily before meals. Prabhakar Vati (2 tablets of 250 mg each, twice daily before meals along with warm water), Arjunarishta (15 mL mixed with 20 mL of warm water twice daily after meals) and Sarak Vati (2 tablets of 500 mg each at bedtime along with warm water) were administered for 40 days. Further, external Ayurvedic therapeutic procedures were administered, including Sarvanga Snehana (therapeutic oleation of the whole body) with Bala oil (for 15 minutes in the morning), Sarvanga Bashpa Swedana (steam fomentation) with Dashamula Kwatha (for five minutes in the morning) and Hridaya Basti (therapeutic retention of oil over the cardiac region) with Bala oil (for 20 minutes in the morning) for 40 days. Matra Basti (enema with medicated oil) with Bala oil (60 mL/day immediately after lunch) was administered for 15 days. After the 40-day treatment regimen, 2D Echocardiography (2D Echo) reports showed a marked improvement in the ejection fraction from 30-35% to 45-50%. There was an improvement in other parameters such as the New York Heart Association (NYHA) classification (from Class III to Class II), the Fatigue Severity Scale (FSS) (score reduced from 56 to 28), the Modified Fatigue Impact Scale (MFIS) (score reduced from 64 to 25) and the pitting oedema grade (from Grade 3 to Grade 1). Thus, Ayurveda offers promising outcomes in enhancing ejection fraction in cases of heart failure following a myocardial infarction.

A Case of Unilateral Duplication of the Axillary Vein: A Rare Anatomical Variant

The axillary vein, being the principal vein of the axilla, is usually formed as a continuation of the basilic vein and drains the majority of the upper limb. Its duplication, as observed in this cadaver, is quite rare. Although many reports have emphasised the variations in the axillary artery, there are very few that have focused on the variant anatomy of the axillary veins. In this case report, a variant anomaly of the axillary veins was found while routinely dissecting the axilla in a formalin-fixed male cadaver. In this cadaver, the left axilla had two axillary veins. The thoracodorsal vein drained into the medial axillary vein, while the cephalic vein appeared to drain into the lateral axillary vein. Surgical implications regarding catheterisations are likely to arise as a result of these venous variants. A thorough understanding of the variant anatomy of these veins is essential for surgeons during operations in the axilla. A duplicated axillary vein may impede the route of catheters inserted into the heart and might also obstruct the laminar flow of blood into the subclavian vein. This case report serves as an indicator to encourage further typing and patterned studies on the numerical abnormalities pertaining to the angulations and number of axillary veins, in order to provide guidance for cardiovascular surgeons during their venous access procedures.

Integral Role of Physiotherapy Approach in Regaining Function following an Electrical Burn: A Case Report

Nikita Govind Zanwar, Subrat Samal, Gauri Bhutada

Electrical injuries frequently result in serious long-term problems because of their high rates of morbidity despite low death rates. Electrical injuries are when high-energy current travels through the body due to contact with an electrical source. A 45-year-old male electrician who, while troubleshooting a malfunctioning circuit, suffered a severe electrical burn to his right elbow. He was conservatively managed at a local hospital for a month following his injury, but after that, he needed additional care due to an ulcer over his anterolateral elbow joint. A clinical evaluation found a deep partial-thickness burn that covered 3.5% of his body’s surface. The burn was associated with skin pigmentation, ulceration, and redness. On the Numerical Pain Rating Scale (NPRS) patient-reported a score of 6/10 during activity and 3/10 at rest. Considering the extent of the burn and the emergence of problems, a thorough physiotherapy program was started to address joint mobility, control discomfort, and promote healing. The outcome measures were used to evaluate patients’ recovery before and after rehabilitation. A robust therapeutic regimen was planned, including reducing oedema and pain, improving joint mobility, preventing further contracture, enhancing strength and flexibility, quality of life, and managing depression. To enhance both physical and psychological outcomes, this case emphasises the significance of early and ongoing physiotherapy in rehabilitating electrical burn injuries. It also illustrates the necessity of a multidisciplinary approach.

Navigating the Complexities: A Case Report on Diagnostic and Management Challenges in Transverse Colon Cancer

The transverse colon is the least commonly impacted segment in Colorectal Cancer (CRC), contributing to only a fraction of cases. Its rarity can result in less clinical familiarity and significant diagnostic delays as compared to other CRC sites, such as the rectum or sigmoid colon. Because the transverse colon surrounds the upper abdomen, symptoms may overlap with those of other abdominal organs (for example, the stomach, liver, or pancreas). This frequently results in misdiagnosis or delayed recognition. Patients may present with non specific symptoms such as non specific abdominal pain, bloating, or changes in bowel habits, which are difficult to accurately attribute to cancer in this region. The mobility and location of the transverse colon might make visualisation difficult during colonoscopy, perhaps leading to undetected lesions. Hereby, we present a case study of a 70-year-old male with severe lower abdominal pain, intermittent watery stools, rectal bleeding, and significant weight loss. Examination identified an 8×5 cm palpable mass in the epigastric region extending into both hypochondria. Histopathological analysis revealed colonic mucosal ulceration, chronic inflammation, haemorrhage, and an infiltrating malignant tumour characterised by pleomorphic cells in sheets, nests, and glandular patterns. Magnetic Resonance Imaging (MRI) evidenced the diffuse circumferential wall thickening of the transverse colon, indicative of malignancy. The present case provides valuable insights and enhances the practice of early diagnostic procedures for detecting transverse CRC. By addressing the unique challenges of this rare condition, it deepens diagnostic precision and underscores the importance of timely intervention.

Colorectal Carcinoma in a Young Male Diagnosed as Lynch Syndrome with a Rare PMS2 Pathogenic Germline Variant: A Case Report

Colorectal cancers in young people can be due to inherited mutations in 5-10% of cases, among which Lynch syndrome is the most common. Lynch syndrome is defined as a genetic susceptibility to various types of cancer, with non polyposis colorectal cancer being one of the more common types. A man in his 20s presented with abdominal pain and haematochezia. Upon investigation, the transverse colon showed well-differentiated adenocarcinoma, accompanied by multiple tubulovillous adenomatous polyps of the sigmoid colon with high-grade dysplasia. He underwent surgery followed by chemotherapy, resulting in clinical improvement, resolution of symptoms and a decrease in tumour size and metastasis. Results of genomic testing identified a pathogenic variant located in intron 12 of the PMS2 gene (postmeiotic segregation increased 2), confirming Lynch syndrome. This syndrome, characterised by the PMS2 variant, is extremely rare compared to mutations in other DNA mismatch repair genes such as MLH1, MSH2, MSH6, and EPCAM. Lynch syndrome is thought to account for 2-3% of colorectal cancer cases worldwide and 10-15% of cases in India. The diagnosis of Lynch syndrome is complex and often necessitates a multifaceted approach that includes a thorough evaluation of the patient’s clinical history, clinical evaluation, laboratory testing, and histopathological reporting of biopsy specimens, followed by genetic counselling and genetic testing. His final diagnosis was colorectal cancer with adenomatous polyposis and Lynch syndrome associated with the PMS2 variant.

Takayasu Arteritis Masquerading as Acute Ischaemic Stroke in a Young Patient: A Case Report

Takayasu Arteritis (TA) is a form of vasculitis that involves large vessels. It is quite unusual for patients suffering from TA to present with an acute stroke as the initial symptom. This case involves a 40-year-old woman who presented with weakness of her limbs on the left-side and aphasia since the morning. There was no pulse in the left radial and brachial arteries; however, the left carotid and subclavian arteries had a bruit. Magnetic Resonance Imaging (MRI) and digital subtraction angiography were performed, and based on the results a diagnosis of TA was made. A multidisciplinary treatment approach was planned, and different drugs were administered to the patient, along with appropriate advice for follow-up after a month. The patient successfully underwent stenting for the lesion, and the treatment regimen included Ecospirin, Atorvastatin, methotrexate, and prednisone daily. Computed Tomography (CT) angiograms were conducted to monitor the progression of the vascular disease. The risks and benefits of potential complications in managing long-term care must be cautiously assessed. Early recognition and timely treatment are crucial for the patient’s survival. Hence, it is important to consider TA as a differential diagnosis in young patients and to remain alert to the nonspecific symptoms of TA.

Outcome of a Major ABO-incompatible Haematopoietic Stem Cell Transplantation: A Case Report

Dipshikhaa Ravi, A Ashwin, R Krishnamoorthy, Niranj Rathan, Sampat Kumar

The ABO determinants are not present on the cell surface of Haematopoietic Progenitor Cells (HPCs), which allows them to be transplanted into recipients regardless of their ABO type. The difficulties associated with an ABO-incompatible HPC transplant depends on the mismatch, which can be classified as major, minor, or bidirectional. In the present case report, the recipient’s (42-year old female) blood group was O Rh (D) positive, while the donor’s (47-year-old male) blood group was A Rh (D) positive, resulting in a major ABO-incompatible transplant. Investigation of the donor were within normal limits. Given the high anti-A titres in the recipient {O Rhesus D Rh (D) positive}, Fresh Frozen Plasma (FFP) from an A Rh (D) positive donor (the donor’s blood group) was transfused for four days. Once the levels were below the critical value, Peripheral Blood Stem Cell (PBSC) collection from the donor was done and later, the product was subsequently transfused to the recipient. On day 25 and day 29 post-PBSC infusion, the recipient achieved neutrophil and platelet engraftment, respectively. A delay in Red Blood Cell (RBC) engraftment Pure Red Cell Aplasia (PRCA) was noticed, and the recipient has been transfusion-dependent. Given mild Graft-versus-host Disease (GVHD) and molecular relapse, Donor lymphocyte was collected from the same donor and infused (DLI). A switch in the recipient’s blood group was later noted (5 months post-DLI infusion), and RBC engraftment was achieved. Here, the authors discussed the difficulties encountered when a significant ABO mismatch occurred after an allogeneic haematopoietic Stem Cell Transplant (SCT).

Type II Amplatzer Vascular Plug in Management of Proximal Splenic Artery Pseudoaneurysm causing Haemosuccus Pancreaticus: A Rare case report

The Amplatzer Vascular Plug device (AVP) Type II has been used for proximal Splenic Artery Embolisation (SAE) in settings of trauma and hypersplenism, but its application in the embolisation of proximal splenic pseudoaneurysms is not widespread, although it is very valid. It is particularly efficient in high-flow arteries, where there is a risk of migration and systemic embolisation compared to other traditional embolic materials. Due to shorter embolisation times, improved precision of deployment and a significantly decreased rate of recanalisation, AVP has been increasingly preferred over pushable coils. Haemosuccus pancreaticus is a rare and potentially lethal cause of upper gastrointestinal haemorrhage via the pancreatic duct. It is usually linked with pre-existing pancreatic inflammation that causes a pseudoaneurysm to rupture into the pancreatic duct, most commonly from the splenic artery. Establishing a diagnosis is difficult with endoscopy or imaging, as the presentation is insidious in nature and bleeding is intermittent at times. Authors report a rare case of a 40-year-old male, a chronic alcoholic, presenting with recurrent melena. Upon imaging, the patient was diagnosed with chronic calcific pancreatitis with a proximal splenic artery pseudoaneurysm, which was managed successfully with AVP Type II. Authors aim to popularise the use of the Amplatzer Vascular Plug Type II in achieving haemostasis of pseudoaneurysms in high-flow arteries.

Isolation of Ochrobactrum anthropi from Cerebrospinal Fluid: Insights from a Unique Case in an ICU Setting

Ochrobactrum anthropi (O. anthropi), previously classified as Achromobacter and designated by the Centers for Disease Control and Prevention (CDC) as group Vd, is known to cause severe infections even in immunocompetent individuals without underlying conditions. In index case, the patient presented with persistent symptoms for 5-6 months, including headaches, vertigo while walking, blurred vision in her right eye, hearing loss in her right ear and balance issues. Following a thorough diagnostic work-up, the patient underwent a Ventriculoperitoneal (VP) shunt procedure, during which Cerebrospinal Fluid (CSF) was collected and sent to the microbiology laboratory for culture. Microbiological investigation showed the growth of lactose non fermenting bacteria on MacConkey Agar (MA). Subsequent biochemical testing identified the organism as O. anthropi. This is notable as this bacterium is rarely found in CSF, marking this as potentially the third reported case. Most instances of infection stem from nosocomial or hospital-acquired sources, attributed to the organism’s ability to adhere to various surfaces. Recently, the pathogenicity of O. anthropi has increased due to its acquired resistance to multiple antibiotics. The patient was treated with a combination of fluoroquinolones, sulfonamides and beta-lactam antibiotics. Ensuring the appropriate use of antibiotics through susceptibility testing is essential for effective treatment and in preventing the development of resistance.

Periorbital Oedema as a Crucial Diagnostic Clue for Systemic Lupus Erythematosus in a Young Woman: A Case Report

Systemic Lupus Erythematosus (SLE) is a polygenic autoimmune disorder characterised by immune-mediated damage to various organs and tissues due to the formation of tissue-binding autoantibodies and immune complexes. This multifaceted disease results from complex interactions between genetic, environmental, and immunological factors, leading to diffuse inflammation and tissue injury.Among the hallmark features of SLE, serositis, a condition involving inflammation of serous membranes such as the pleura, pericardium, or peritoneum, is a key diagnostic criterion. Serositis indicates active inflammation and plays an important role with other diagnostic criteria in guiding the diagnosis and treatment of SLE. Serositis can be challenging to recognise despite its clinical importance, especially when overshadowed by other unusual manifestations. Our patient, a 19-year-old female, presented with persistent periorbital swelling, fatigue, breathlessness and progressive chest pain for the last two months. While, the periorbital oedema was an uncommon presentation of SLE, the identification of serositis was key in establishing the diagnosis. After comprehensive evaluation excluding other systemic causes of periorbital oedema and serositis, a diagnosis of SLE was made. This case showcases the cruciality of recognising serositis as a central feature of SLE, particularly in cases with unusual symptomatology. Prompt recognition and early diagnosis, along with timely intervention, can improve outcomes for patients with this complex autoimmune disease. Clinicians must remain vigilant for SLE in patients presenting with uncommon symptoms like periorbital oedema along with serositis.

Mediastinal Schistosomiasis in a Patient with HIV and Leprosy: A Case Report

Diksha Sabharwal, Asmita Samal, Kalyan Kumar Reddy, Sonali Agarwal

Schistosomiasis is a parasitic disease commonly affecting the urinary and gastrointestinal systems, caused by trematode worms of the genus Schistosoma. Mediastinal involvement is an exceedingly rare presentation, particularly in immunocompromised individuals such as those with Human Immunodeficiency Virus (HIV). Hereby, the authors present a case report of 51-year-old male, known to have HIV and on antiretroviral therapy, with a history of Borderline Tuberculoid (BT) leprosy, presented with sudden-onset breathlessness, chest pain, and dysphagia. Diagnostic imaging and bronchoscopy revealed the presence of Schistosoma haematobium in the mediastinum. The patient was treated with praziquantel and broad-spectrum antibiotics to manage the parasitic infection and prevent secondary bacterial complications. His condition required a multidisciplinary approach due to the complexity of his co-existing conditions. The patient responded well to a combination of praziquantel and broad-spectrum antibiotics. Praziquantel remains the treatment of choice for schistosomiasis, while antibiotics were necessary to prevent secondary infections in this immunocompromised patient. Close monitoring and follow-up were essential to ensure treatment success and to manage potential complications. This case illustrates the complexities of diagnosing and managing rare parasitic infections in patients with multiple chronic conditions. Early recognition, appropriate diagnostic work-up, and targeted therapy are critical to improving outcomes in such challenging cases. This report adds to the limited literature on mediastinal schistosomiasis and highlights the importance of a multidisciplinary approach in managing such patients.

Anaesthesia Management for High-risk Patients: A Case Study of Lower Limb Amputation on Anti-thrombolytic Therapy

Prachi Deshmukh, Vivek Chakole

Anaesthesia is associated with certain risks in patients on anticoagulant therapy, which need to be addressed according to clinical requirements. Regional anaesthesia is linked to venous thromboembolism, with increased chances of haematoma and bleeding risks. Various prophylactic measures are recommended to reduce the risk of postoperative complications for patients on anticoagulants and those with other co-morbidities. Risk assessment of the patient using different tools, such as the Caprini score, along with the type of anaesthetic technique applied, can help achieve better outcomes. Patients with a prolonged history of diabetes present an additional risk. Foot ulcers are a known complication in diabetic patients. Foot ulcerations can lead to various severe effects, such as infection and amputation, which negatively affect the quality of life. Debridement can be a viable option in the care and management of diabetic foot ulcers. Managing thromboprophylaxis in this group can be a major concern due to delayed healing and increased hospital stays. A prolonged anticoagulation regimen further raises the risk of spinal haematoma when undergoing regional anaesthesia, particularly due to the injection needle and catheter insertion. There is a constant rise in the number of patients on prolonged anticoagulants because of the increased incidence of individuals undergoing cardiac and orthopaedic procedures, highlighting the crucial need to address the associated risks. Hereby, the authors present a case of a 65-year-old male who presented with left lower limb gangrene requiring emergency amputation due to sepsis and septic shock, with a history of peripheral vascular disease, diabetes, hypertension, cardiovascular disease, and cardiac bypass surgery for myocardial infarction. Due to his high-risk profile, unilateral spinal anaesthesia (subarachnoid block) was performed using a 27-gauge Quincke needle, which was helpful in mitigating the risk. The procedure was uneventful, with successful haemostasis and good wound recovery.

Conservative Management of a Solitary Kidney in a Patient with Grade IV Renal Injury: A Case Report

The kidney is the most frequently injured organ in the genitourinary system, accounting for 1 to 5% of all trauma cases. The mechanism of injury can be either blunt or penetrating. Management strategies depend on the American Association for the Surgery of Trauma (AAST) grade of injury. For injuries upto AAST grade IV conservative management is employed, whereas grade 5 requires surgical exploration. The present case report discusses a rare and challenging case of traumatic injury to a solitary kidney in a 26-year-old male, resulting from a blunt horse kick. The patient presented with severe right-sided abdominal pain and anuria for eight hours, alongside haemodynamic instability and clinical signs of renal trauma. Initial imaging revealed a grade IV renal injury with haemoperitoneum and a solitary right kidney. Conservative management was prioritised to preserve the solitary kidney. Resuscitative measures, including volume expansion, blood transfusions, and dialysis sessions, were employed, while complications such as acute kidney injury and acute respiratory distress syndrome were managed by a multidisciplinary team. A retrograde pyelogram later revealed mild pelvicalyceal dilation and contrast leakage, leading to successful decompression with silicone double-J stenting (DJ) stenting. The patient’s condition improved, with the restoration of urine output and normalisation of serum creatinine levels. Follow-up demonstrated complete recovery without further complications. The present case emphasises the importance of a conservative approach, multidisciplinary collaboration, and close monitoring in managing high-grade renal trauma involving a solitary kidney, thereby avoiding the need for nephrectomy and lifelong renal replacement therapy.

Navigating the Diagnostic Dilemma: Thrombotic Thrombocytopenic Purpura Presenting with Rhabdomyolysis in an Adolescent

Thrombotic Thrombocytopenic Purpura (TTP) is a rare and potentially fatal disorder that causes the formation of small blood clots in the microvasculature, leading to symptoms such as low platelet count, Microangiopathic Haemolytic Anaemia (MAHA), fever, renal dysfunction and sometimes neurological issues. While the classic presentation includes a combination of five key symptoms, not every patient exhibits all of them, which can complicate diagnosis. TTP may be triggered by a range of factors, including infections, autoimmune conditions, or, in some cases, medications and vaccines. This case report details the clinical journey of a 17-year-old male who presented with a combination of symptoms, including rhabdomyolysis, Acute Kidney Injury (AKI) and haemolytic anaemia, which ultimately led to a diagnosis of TTP presenting with rhabdomyolysis. TTP along with rhabdomyolysis is not commonly seen. The complexity of the case was heightened by overlapping signs of infection, renal damage and haemolysis, which made it difficult to identify the underlying cause. This report emphasises the importance of considering TTP in patients with unexplained multiorgan failure and rhabdomyolysis and highlights the critical role of early treatment with plasmapheresis, steroids and supportive care in achieving a positive outcome, even in the face of a complex clinical presentation.

Thoracic Segmental Spinal Anaesthesia for Emergency Palliative Mastectomy with Moderate Pericardial Effusion: A Case Report

Archana Gautam, Vandna Bharti, Ruchi Saxena, Durgesh Kumar

Breast cancer may rarely present as Locally Advanced Breast Cancer (LABC) with acute severe bleeding. In some cases, breast haemorrhage can be a life-threatening condition for patients, and its treatment includes compressive dressing, the use of topical or intravascular haemostatic agents, radiotherapy, and surgery. Additionally, breast cancer patients in the geriatric population are commonly associated with coexisting major medical illnesses, which makes anaesthetic management challenging. In such cases, regional anaesthesia is a preferable option over General Anaesthesia (GA). Hereby, the authors present a case report in which Thoracic Segmental Spinal Anaesthesia (TSSA) is used as the sole anaesthetic plan for a palliative simple mastectomy in an elderly female patient (74-year-old) with a bleeding carcinoma of the breast, poor cardiopulmonary reserve, and moderate pericardial effusion. The present findings support that TSSA can be effectively utilised as the sole anaesthetic technique in a breast cancer patient with moderate pericardial effusion when breast haemorrhage is life-threatening.

Chondrosarcoma Arising from Bronchial Cartilage: A Rare Case report

Prabhat Nichkaode, Raghav Gupta, Varun Pudota

Primary pulmonary chondrosarcoma is an exceptionally rare malignancy, particularly originating from bronchial cartilage within the lung. Hereby, the authors present a case report of a 38-year-old non smoking male farmer who presented with persistent cough with expectoration and occasional streaks of haemoptysis, revealing a well-defined mass in the left lower lobe arising from bronchus and extending into the lung parenchyma. Radiographic and surgical findings confirmed a lobulated mass with dense pleural involvement. Chondrosarcoma, characterised by its cartilaginous origin, poses diagnostic challenges due to its unusual location and radiographic features resembling more common bronchial tumours. Surgical excision remains the cornerstone of treatment, offering favourable outcomes. The present report underscores the importance of early recognition and comprehensive management strategies for optimising patient outcomes in rare bronchial malignancies like chondrosarcoma.

Therapeutic Plasma Exchange in the Management of Postpartum HELLP Syndrome: A Case Report

Parul Jaiswal, Prashant Suryarao, Dipak Kolate

Haemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome is a serious obstetric complication occurring during pregnancy or postpartum. It often co-exists with other Thrombotic Microangiopathies (TMAs), including atypical Haemolytic Uraemic Syndrome (aHUS). Differentiating between these conditions is crucial due to varying treatment approaches. Postpartum aHUS, a rare but potentially fatal condition, involves unchecked complement activation leading to severe renal failure, hypertension and microangiopathic haemolysis. A multidisciplinary approach and early diagnosis are vital for optimal patient outcomes. A 29-year-old woman presented on postoperative day 1 after an emergency Lower Segment Caesarean Section (LSCS) with oedema, proteinuria, hypertension, sudden visual impairment and persistent abdominal pain. Laboratory findings suggested HELLP syndrome with concurrent postpartum aHUS (decreasing platelet count, increased liver enzymes, decreased renal function and microangiopathic haemolysis). Critical care management included intravenous fluids, antihypertensives, antibiotics and analgesics. Therapeutic Plasma Exchange (TPE), initiated due to TMA and severe renal impairment, significantly improved clinical outcomes. Haematological issues were addressed with corticosteroid therapy (initially intravenous methylprednisolone, gradually transitioned to oral prednisolone). Diuretics managed fluid control and close monitoring continued. The patient was discharged with supportive treatment, controlled hypertension and stable renal function. This case highlights the importance of early detection and a tailored multidisciplinary approach in managing postpartum HELLP syndrome with aHUS. Further research is needed to improve diagnostic algorithms and treatment plans due to overlapping clinical presentations.

A Rare Presentation of Whitmore’s Disease (Melioidosis) with Multisystem Abscess in a Diabetic Patient with Intractable Hiccups

Vuppala Rachana, Vignessh Raveekumaran

Whitmore’s disease (Melioidosis) is caused by Burkholderia pseudomallei (B. pseudomallei), a gram-negative bacterium with high pathogenicity. The disease manifests in various forms, ranging from pneumonia or localised abscesses to acute septicaemia or arthritis. Culture and sensitivity tests are the gold standards for diagnosis. For treatment, ceftazidime or meropenem is recommended during the intensive phase (10-14 days), while oral co-trimoxazole is the drug of choice for the eradication phase (3-6 months). Surgical drainage of abscesses plays an important role in the management of melioidosis. However, the occurrence of multisystem abscesses is very rare. Hereby, authors report a case of a 63-year-old female with a known history of diabetes who presented with fever and hiccups for 40 days, deranged liver function tests, and leukocytosis. A Computed Tomography (CT) scan revealed lung and liver abscesses, and the culture yielded B. pseudomallei. The patient was diagnosed with melioidosis, treated with antibiotics, and subsequently discharged.

A Perspective on Ear Malformations: A Case Series

Parindita Sarmah, Sagar Gaurkar, Prasad Deshmukh

Ear deformities, both congenital and acquired, can significantly impact aesthetics, hearing function and psychological well-being. The present case series presents a diverse range of auricular anomalies, discussing their clinical presentation, underlying causes and management strategies. Congenital deformities include microtia, characterised by underdeveloped external ear structures that may be associated with conductive hearing loss, as well as prominent ears, which can lead to self-esteem issues. Additionally, ear tags, which are small benign appendages of skin and cartilage and cupped ear deformity, where the helix and antihelix are malformed, are highlighted, emphasising the role of early intervention in improving cosmetic and functional outcomes. Acquired ear deformities arise due to trauma, chronic inflammation, or improper healing. This series discusses cases of ear keloids, which form due to excessive scar tissue following ear piercings or surgeries, requiring multimodal treatment that includes corticosteroid injections, surgical excision and pressure therapy. Cauliflower ear, which results from repeated trauma leading to haematoma formation and fibrosis, is examined in the context of preventive measures and surgical correction. Burn-related ear deformities, which lead to severe tissue loss and contracture formation, present reconstructive challenges that necessitate skin grafts or cartilage framework reconstruction. Early diagnosis and timely management, facilitated by a multidisciplinary approach involving plastic surgeons, dermatologists and otolaryngologists, are crucial for optimising patient outcomes. The present case series underscores the importance of addressing both functional impairments and aesthetic concerns to enhance the overall quality of life for patients.

Granulomatous Myocarditis as Rare Presentation of Mycobacterium tuberculosis: A Series of Four Autopsy Cases

Shalaka Anand Deshpande, Manisha Khare, Prashant V Kumavat, Sneha Janjal

Tuberculosis (TB) is a communicable disease caused by the organism Mycobacterium tuberculosis. It has been a leading cause of mortality and a global public health emergency for the last 25 years. Despite being a predominantly pulmonary infection, Mycobacterium tuberculosis can affect other organs, such as the nervous system, gastrointestinal system and, rarely, the cardiovascular system. This infection can sometimes present as Tuberculous Myocarditis (TM) in the cardiovascular system, an extremely unusual presentation that can be difficult to diagnose, especially in areas where TB is endemic, like India. Authors report four cases of Granulomatous Myocarditis (GM) across a wide range of age groups, who presented with non specific symptoms of giddiness followed by sudden unconsciousness and death. On gross examination of the hearts received after autopsy, two cases showed left ventricular focal white lesions, while one additionally showed Left Ventricular Hypertrophy (LVH). The hearts in the other two cases were grossly unremarkable. Microscopic examination of the cardiac tissue revealed multiple caseating granulomas composed of necrosis, epithelioid cells and lymphocytes. Three out of four cases also showed disseminated TB. Based on the histopathological examination of the granulomas, Mycobacterium tuberculosis aetiology was suspected in all cases. Herein, present series describe the pathological characteristics of this most unusual variant of Mycobacterium tuberculosis.

Correspondence: Iron Deficiency and Hypoferritinemia in Patients with Subclinical Hypothyroidism: A Retrospective Observational Study

Anita Deepak Deshmukh, Madhuri Abhay Jagtap

Dear Sir, We read the original article “Iron Deficiency and Hypoferritinemia in Patients with Subclinical Hypothyroidism (SH): A Retrospective Observational Study” by D. Shiva Krishna et al., published in June 2024 (1). This study concluded that there is a significant association between SH, hypoferritinemia, and iron deficiency, suggesting that before progressing to Overt Hypothyroidism (OH), it is crucial to assess the ferritin and iron status of patients with SH. This article is quite informative, and by assessing ferritin and iron levels, it could be helpful in monitoring the progression of the condition from SH to overt hypothyroidism. However, the article does not mention haemoglobin levels, which are a fundamental indicator of anaemia. Haemoglobin levels should be measured because individuals with thyroid dysfunction may have low iron levels that impact haemoglobin levels. Additionally, they may have decreased folate and vitamin B12 levels, which have been found in up to 25% of patients (2). The impact of the study would have been more promising if estimations of vitamin B12 and folic acid had been included, as deficiencies in vitamin B12 or folate also affect SH (3). Another key parameter required for thyroid synthesis is iodine, which was not estimated by the authors. Both iodine deficiency and excess intake may lead to thyroid dysfunction. Since 90% of ingested iodine is excreted in urine, it is considered a sensitive marker of current iodine intake (4). Iron deficiency may inhibit iodine incorporation into thyroglobulin and the coupling of iodothyronine to form thyroid hormone by reducing the activity of Thyroid Peroxidase (TPO), an iron-dependent enzyme (5). Author’s response: The present study is a retrospective observational study. Haemoglobin data was not available for all SH patients. Additionally, only a small number of SH patients have data on vitamin B12 and folic acid; thus, folic acid and vitamin B12 data are excluded from the results. None of the patients have had iodine measurements; hence, iodine measurement results were not included in the data. In this article’s discussion, under reference number 32, the study mentioned was conducted in pregnant women. Therefore, it cannot be compared with this study, as the subject age considered is between 48 and 52. Author’s response: Although the age groups are different, the prevalence of SH in pregnant women is 5-10%. Routine testing of ferritin and iron status may be helpful for the early detection and prevention of anaemia in pregnant women. Corrections are needed in some sentences, as they reflect inaccurate interpretations. 1) “Approximately, one-third of SH cases are not asymptomatic, but their TSH levels rise with a significant titer of thyroid autoantibodies.” Author’s response: Yes. It should be: “Approximately one-third of SH cases are asymptomatic, but their TSH levels rise with a significant titer of thyroid autoantibodies.” 2) “Consequently, certain types of anaemia, such as macrocytic and normocytic anaemia, stem from erythropoietin production, bone marrow suppression and simultaneous deficiencies in iron, vitamin B12, or folate that can result from thyroid dysfunction.” Author’s response: Yes, it should be: “Consequently, certain types of anaemia, such as macrocytic and normocytic anaemia, stem from erythropoietin production, bone marrow suppression, and simultaneous deficiencies of iron, vitamin B12, or folate that can result from thyroid dysfunction.” 3) “Hence, the present study was conducted to evaluate biochemical indicators of ferritin and iron in SH patients.” Author’s response: Yes, it should be: “Hence, the present study was conducted to evaluate biochemical parameters such as ferritin and iron status in SH patients.”

From India to Aruba: Insight into Teaching and Cultural Approaches in India and the Dutch Caribbeans Medical Education System

Arnaw Kishore

Dear Editor, As an academician, I recently transitioned from Assistant Professor of Microbiology and Molecular laboratory incharge in India to Assistant Professor of Microbiology and Immunology and Secretary Research at a medical school in the Dutch Caribbean. This provides a unique perspective on medical education in two distinctly different regions. I currently work at Xavier University School of Medicine (XUSOM), in Oranjestad, the capital of Aruba one of the ABC islands (Aruba, Bonaire and Curaçao) in the lesser Antilles (1). Cultural Context and Institutional Background From an Indian perspective, Aruba is often less known, yet it serves as a melting pot of diverse cultures reflected in the diverse backgrounds of the students enrolled in medical education at our institution. The diverse students are from different races and nationalities viz., Indian, Asian, North and South American, Afro-Caribbean, French, Filipino, Dutch and African heritage to name a few. The rich diversity creates a vibrant learning environment, fostering cross-cultural interaction. Established in 2008, XUSOM is a prominent leading institution in the Dutch Caribbeans and is the only medical school in Aruba among the five medical schools in the region. It has been accredited by the Accreditation Commission on Colleges of Medicine (ACCM) and listed in the World Directory of Medical Schools underscoring its global recognition (2). Additionally, XUSOM holds the prestigious New York State Education Department (NYSED) recognition, a distinction achieved by only a few selected Caribbean medical schools. Comparative Analysis of the Medical Education System 1. Educational Framework At XUSOM, students complete their basic science education on the island before moving to the United States (US) for their clinical rotation, a common path among offshore Caribbean medical schools. The US system places a strong emphasis on passing three major licensing examinations United States Medical Licencing Examination (USMLE) (3), before they can practice. In contrast, the Indian medical education system follows Competency-Based Medical Education (CBME) under National Medical Commission (NMC) guidelines (4), focusing on an integrated approach emphasising Early Clinical Exposure (ECE) and community-based learning. 2. Teaching Methods and Assessment A. Caribbean perspective- Faculty employ diverse teaching methodologies like Clinical Case Presentation (CCP), Team-Based Learning exercise (TBL), Objective Structured Clinical Examination (OSCE). Lectures are structured with two 45-minute sessions with breaks. The combination of digital toll with traditional chalk and talk teaching enhances understanding. Students are exposed to Standardised Patients (SPs) and ECE, from year one fostering patient-centred clinical skills despite limited population size and teaching hospitals. Assessment mainly relies on Multiple Choice Questions (MCQ) through examination software, with flexible scheduling and regular mentoring for struggling students. B. Indian perspective- The CBME curriculum in India, standardised by NMC as per VISION 2015 (4) has led to an even approach across all medical schools, which emphasises integration across disciplines through horizontal and vertical teaching methods, including ECE and community-based learning as key components leading to overall clinical development of students. Lecture follows a traditional one-hour format, with two-hour laboratory session emphasising skills. Indian system still values traditional assessment methods, combining essay questions, practical examination and viva voce and involvement of external examiner for non biased evaluation. Students engage in extensive laboratory work from first year along with real patient interaction during Outpatient Department (OPD) postings and bed side teaching. 3. Curriculum Design and Research A. Caribbean perspective- Caribbean schools operate independently, allowing curriculum flexibility and innovation. At XUSOM, curriculum is specifically aligned with USMLE requirement to maximise students’ success with strong emphasis on high yield topic and clinical relevance. Unlike many Caribbean schools where research is not given emphasis, XUSOM supports extramural and intramural funded projects. B. Indian perspective- Indian medical schools follow standardised curriculum under the NMC, ensuring consistency across institutions. Research has gained a prominence over the past two decades, with many institutions publishing their own journals. 4. Challenges and Key Difference Both systems face unique challenges while maintaining distinct approaches to train future doctors for a better healthcare. Caribbean school face challenge in geography and limited clinical exposure due to smaller population and fewer hospital facilities. SPs and local clinic partnership help address this. India, the seventh largest country in the world, is home to numerous medical colleges. After the formation of NMC, many institutions have made a significant technological advancement, becoming increasing resourceful. However, some college in the interior region still lag behind in technological process. Caribbean perspective: 1. Limited patient population for clinical exposures; 2. Fewer opportunities for hands on laboratory exposure; 3. Dependency on US for clinical rotation. Indian perspective: 1. Technological advancements are rapidly improving, but some interior colleges still lag behind; 2. National standardisation leads to a rigid curriculum structure; 3. Less emphasis on licensing exam preparation; 4. Limited exposure to SP interactions. Both Caribbean and Indian medical education systems have distinct strengths. Indian schools excel in practical experience and standardised education, while XUSOM leads in innovative digital learning, flexible student-centered approaches, strong research initiatives and high USMLE pass rates. Offshore schools like XUSOM show that quality education is achievable with blend of advanced technology, flexible learning and strong clinical training.

Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures

Hussein Harb, Sourya Acharya

Dear Editor, A 45-year-old male with a history of hypertension since eight years on tablet Amlodipine 10 mg once a day presented to Department of Medicine with complaints of exertional breathlessness. He reported experiencing NYHA grade 3 symptoms for the past two months, dizziness for one month, and an episode of syncope five days ago. Upon admission to the medical ward, a transthoracic echocardiogram was conducted, which revealed aortic jet velocity (Vmax) of 4.8 m/s, mean aortic Pressure Gradient (PG) of 45 mmHg, LV mass index (LVMi) 128 gm/m², and aortic valve area of 0.7 cm2 suggesting severe aortic stenosis. Pressure curves prior to Transcatheter Aortic Valve Replacement (TAVR) procedure were measured via two 6-French “pigtail” catheters from Cordis. Catheters were inserted through the stenotic valve to the left ventricle via a vascular access point assigned for the transcatheter heart valve. A second catheter was inserted to the aortic root through a second vascular access point. Both catheters were then connected and measured by a pressure line and transducer. Following careful calibration of the pressure transducer, Left Ventricular (LV) and ascending aortic pressures were recorded concurrently across multiple heartbeats. Left heart catheterisation demonstrated a higher LV pressure compared to aortic pressure (Table/Fig 1). The patient subsequently underwent TAVR with fluoroscopic procedural imaging (Table/Fig 2). Post-procedurally, left heart catheterisation showed alignment of LV and aortic pressures (Table/Fig 3). On follow up, after 30 days, the patient’s dyspnoea had significantly improved and the 2-D echocardiography revealed a decreasing LVMi to 115 gm/m². Aortic stenosis necessitates increased LV contractile effort to maintain adequate systemic perfusion. With a haemodynamically significant obstruction, this leads to a higher LV pressure than aortic pressure. TAVR effectively bypasses the dysfunctional aortic valve, reducing the LV afterload and allowing for the equalisation of LV and aortic pressures (1). Aortic valve replacement indications include asymptomatic patients with a cardiac ejection fraction <50% and symptomatic patients with severe aortic stenosis (2). Aortic valve replacement is done surgically and percutaneously. Since TAVR is done percutaneously, additional indications include patients with low to prohibitive surgical risks. TAVR is also indicated for failed prior bioprosthetic valves in valve-in-valve procedures (3). Following deployment of the artificial valve, there is relief from the pathological aortic stenotic obstruction, a significant decrease in myocardial oxygen demand, and an increase in cardiac efficiency. Clinically, this results in an improvement in typical aortic stenosis symptoms such as syncope, angina, and dyspnoea. Over time, the resolution of high LV afterload contributes to regression of LVMi, decreased rehospitalisation, and an improved patient prognosis irrespective of gender or age (4),(5). Patients who showed significant regression in LVMi within the first 30 days did not experience further regression throughout the year. In contrast, patients who did not show regression in the initial 30 days did experience regression over the year, albeit to a lesser extent (5). This haemodynamic correction post-TAVR is crucial for enhancing patient outcomes and quality of life.

REBA: A Comprehensive Scale for Workplace Posture and Ergonomic Analysis

Chaitanya Ajay Kulkarni, Manasi Pravin Metkar

Dear editor, The present study emphasises the practical application of the Rapid Entire Body Assessment (REBA) scale in workplace ergonomics, highlighting its effectiveness in identifying and mitigating Musculoskeletal Disorders (MSDs) among workers with physically demanding or static postures. Unlike previous literature that focuses solely on assessment, this paper provides a structured framework for using REBA as a predictive tool for ergonomic interventions, thus bridging the gap between theoretical knowledge and practical workplace solutions. REBA is a scale that is used to assess working posture, and the scoring is used to interpret the musculoskeletal risk. The present article emphasises the importance of the REBA scale in preventing workplace-related musculoskeletal issues caused by poor posture. The Long-Term Evaluation (LTE) of the REBA scale emphasises its sustained impact on workplace health and safety by guiding ergonomic interventions that reduce MSDs and improve productivity (1). Its long-term success depends on the consistent implementation of recommendations, adaptability to evolving work demands, and proper training to ensure scoring consistency (1). Integrating REBA with other assessment tools that address psychosocial factors and task duration enhances its effectiveness (1). Regular monitoring and data collection allow organisations to track trends and refine strategies, while periodic reassessments ensure that ergonomic interventions remain relevant and effective over time. These efforts solidify REBA’s role in fostering healthier and safer work environments in the long run. The REBA scale is a widely used ergonomic evaluation tool for assessing the risk of MSDs due to poor posture in various work environments. REBA was developed by Sue Hignett and Lynn McAtamney in 2000 (2). This scale is useful in identifying individuals or tasks at risk of MSDs, making it a crucial part of workplace health and safety assessments (3). The REBA scale serves as a versatile and efficient method for identifying harmful working postures that may contribute to musculoskeletal injuries. It stands out from other ergonomic tools due to its ability to evaluate postures in dynamic and complex work environments, where standard assessments may fall short (2). Designed to assess tasks involving a wide range of movements, such as reaching, lifting, and twisting, REBA captures the cumulative strain these actions place on the body (2). Its application is particularly beneficial in industries like manufacturing, healthcare, and construction, where workers are exposed to diverse physical demands. By identifying high-risk tasks, REBA supports the development of targeted ergonomic interventions, helping to prevent injuries, improve productivity, and foster safer working conditions. The scale is divided into two parts: the first part evaluates the posture of the trunk, neck, and legs, while the second evaluates the arms and wrists. Scores are assigned based on the observed positions of these parts during a specific task, with adjustments made for factors such as repetitions, load handling, and the presence of sudden movements. The scores from both parts are combined to generate a total score, which corresponds to a risk level. These scores are combined, and the final risk level is obtained, ranging from negligible to very high. A score of 1-2 indicates a negligible risk, where no immediate action is required. Scores of 3-4 suggest a low risk, warranting minor ergonomic adjustments or periodic monitoring. Medium risk, represented by scores of 5-7, highlights the need for further investigation and corrective measures within a reasonable timeframe. High-risk tasks, with scores of 8-10, require prompt action to implement significant ergonomic changes, while very high-risk tasks, scoring 11 or above, demand immediate intervention to mitigate critical hazards and prevent severe musculoskeletal issues. This scoring framework ensures that interventions are prioritised based on the severity of risks (4). Clinicians use REBA to evaluate and quantify the risk levels associated with patients’ work-related or daily activities. This helps in identifying potentially harmful postures that may contribute to musculoskeletal injuries. REBA aids in tailoring rehabilitation programmes by pinpointing specific postural or movement issues. For example, it helps in designing targeted interventions for patients recovering from workplace injuries. In clinical settings, REBA is applied to assess the ergonomic design of patients’ workstations or environments. This evaluation helps recommend modifications to minimise strain and improve comfort. REBA assists clinicians in developing preventive strategies for patients with a history of MSDs, ensuring that they avoid high-risk postures and movements in their daily lives or workplaces (5). REBA is a simple and versatile scale, which makes it a valuable tool for quickly identifying hazardous postures. It is easy to use, evaluating the entire body. It is designed to be adaptable, allowing professionals to use it in different work settings. It can be used as both a diagnostic and a prognostic scale, focusing on high-risk jobs. The scale provides immediate insights that can lead to interventions, such as altering the task, redesigning the workspace, or adjusting the posture through training or ergonomic aids, thereby reducing the likelihood of chronic injuries over time (1). In addition, REBA features a user-friendly design. It does not require complex equipment, allowing it to be used effectively by professionals involved in workplace health. Despite its advantages, the REBA scale has some limitations. It is subjective in nature; different assessors might interpret the same posture differently, leading to variability in scoring and making the scale less reliable in large-scale assessments. To overcome this issue, it is recommended that professionals using REBA undergo training to ensure consistency. The REBA scale assesses a specific moment in time, which may miss variations in posture or task demands. Additionally, REBA does not account for the frequency or duration of a posture, nor does it consider psychosocial factors that may contribute to the risk of injury. It only allows for the analysis of individual postures, meaning it is not possible to analyse a set or sequence of postures (1). Overall, the REBA scale is a valuable and effective tool for assessing the risk of MSDs in the workplace. Its user-friendly design, focus on whole-body posture, and broad applicability make it particularly useful in industries where workers are exposed to awkward or dynamic movements. While it has some limitations, particularly regarding subjectivity and the exclusion of time-related factors, it remains a critical component of ergonomic assessments. When used alongside other assessment tools and strategies, REBA can significantly contribute to reducing the risk of MSDs and improving workers’ health and safety.

Managing Sudden-onset Heart Block in a Neurofibromatosis Type 1 Patient undergoing Elective Caesarean Section

Sandip Baheti, Grace Mammen

Dear Editor, “A skilled physician is one who prevents illness.” This wisdom from the Sefer Hasidim, a collection of Jewish aphorisms from the early 13th century, underscores a core tenet of the medical profession: Prevention is better than cure. This principle is particularly relevant in the operating room, where heightened awareness and rigorous monitoring are crucial for preventing complications and managing unforeseen events. This case highlights the prompt identification and management of sudden-onset heart block during an elective Lower Segment Caesarean Section (LSCS) in a patient with Neurofibromatosis Type 1 (NF1) and hypothyroidism, and a bad obstetric history that includes three spontaneous abortions and an ectopic pregnancy. The patient, a 34-year-old female at 36 weeks of gestation, was a known case of NF1 since childhood and had been hypothyroid for six years, receiving regular treatment. Upon examination, the patient was vitally stable and exhibited characteristic café-au-lait lesions and neurofibromas all over her body (Table/Fig 1). No other significant neurological findings were observed. All routine investigations, including thyroid profile, electrocardiogram, and 2D echocardiography tests, were within normal limits (Table/Fig 2). Spinal anaesthesia was administered uneventfully for the surgery. Approximately 10 minutes after the delivery of the baby and the subsequent oxytocin infusion (20 IU slow intravenous drip), a Mobitz Type 1 heart block pattern (1) was observed on the intraoperative monitor (Table/Fig 3). A stat dose of Inj. Atropine 0.6 mg was administered, and a pacemaker was kept on standby in case of progression to complete heart block. Within 2-3 minutes, the ECG rhythm normalised, with no further arrhythmias observed (Table/Fig 4). The patient remained vitally stable throughout and was transferred to the Intensive Care Unit (ICU) for postoperative observation. NF1, also known as Von Recklinghausen’s disease, is an autosomal dominant genetic disorder caused by a mutation in the NF1 gene on chromosome 17. This mutation inhibits the production of the protein neurofibromin, which regulates cell growth. The disorder is characterised by multiple café-au-lait macules, axillary and inguinal freckling, neurofibromas, and Lisch nodules. High-grade Atrioventricular (AV) block, though rare, is a serious cardiovascular complication of NF1, potentially associated with neurofibromas impacting the cardiac conduction system. The development of arrhythmias in NF1 may also be linked to parasympathetic overactivity (1). A study using Holter monitoring in NF1 patients found arrhythmias in 76% of cases, which included bradycardia, ventricular and supraventricular tachycardia, and extrasystoles (2). Additionally, a case of biventricular failure with atrial fibrillation was linked to a neurofibroma in the interatrial septum (3). While third-degree AV block is rare in adults, there is a documented paediatric case that progressed from sinus bradycardia and second-degree AV block to complete heart block (4). More case reports are needed to further elucidate cardiac involvement in NF1 to help physicians provide effective treatment and prevent complications. Treatment to prevent the progression of second-degree to complete heart block often requires permanent pacemaker implantation. Immediate interventions may include atropine, isoproterenol, or temporary pacing for symptomatic patients (5). In this case of an NF patient, despite a normal preoperative evaluation, she still developed an unanticipated heart block. Prompt detection and treatment were key in preventing progression to complete block. Reinforcing this principle of intraoperative vigilance is paramount in ensuring patient safety. While technological advancements, like real-time monitoring systems and automated alerts, enhance safety, they should complement—not replace—continuous clinical observation and critical thinking. By fostering a culture of relentless vigilance and teamwork, one can transform patient care and ensure that every heartbeat counts.

Self-inflicted Traumatic Acute Epiglottitis due to Use of Tongue Scraper in Adults: A Retrospective Descriptive Study

Introduction: Acute Epiglottitis (AE) is an uncommon disease in healthy individuals but can be potentially life-threatening if left undiagnosed and untreated due to the risk of sudden airway obstruction. Aim: To identify the various characteristics, like demographics, clinical manifestations, and modes of management, in a series of adult patients with self-inflicted traumatic AE. Materials and Methods: This was a retrospective single-centre descriptive study conducted in the Department of Ear, Nose and Throat (ENT) in Al Azhar Medical College and Superspeciality Hospital in Thodupuzha, Idukki, Kerala, India and included all adult patients over the age of 18 years with self-inflicted traumatic AE due to the use of tongue scrapers from July 2022 to December 2023. The AE was diagnosed by flexible nasolaryngoscopy, which showed congested and oedematous epiglottis. Soft-tissue neck lateral view radiographs was used to confirm the diagnosis. Various demographic details-including age, gender, history of trauma, clinical symptoms, and signs-were evaluated along with treatment modalities. For descriptive statistics, the categorical variables were presented as ratios and proportions, while numerical data were presented as means and standard deviations. Results: A total of 16 patients were included, out of which five were males and 11 were females. All patients had a history of self-inflicted trauma while aggressively using metallic tongue scrapers. The mean age of presentation was 42.43 years. The most common symptom was sore throat (100%) and odynophagia (100%), followed by muffled voice (87.5%) and fever (75%). All patients were treated conservatively with broad-spectrum antibiotics and steroids. None of present patients had significant complications. Conclusion: The AE is a life-threatening condition which has to be diagnosed at the earliest. The use of tongue scrapers should not be advocated to avoid the potential side effects.

Histogram-based Sub-classification of Serum Triglycerides and Hypertriglyceridemia Prevalence Across Gender and Age Groups: A Cross-sectional Study

Chekkara Muthu Shaima, Jose Jacob

Introduction: The ICMR-Indiab study (2014) and National Centres for Environmental Prediction (NCEP) (2001) guidelines recommended a healthy cut-off for serum triglycerides of <150 mg/dL. The European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines (2019) proposed a cut-off between moderate hypertriglyceridemia and severe hypertriglyceridemia at 885 mg/dL. There are currently no studies addressing the cut-off values and prevalence of moderate and severe hypertriglyceridemia within the Indian population. These requirements are addressed through the use of the histogram method for calculating cut-off levels and prevalence of hypertriglyceridemia, which is unique to the present study. Aim: To sub-classify serum triglyceride concentrations using histogram regions and to calculate the percentage of hypertriglyceridemia from these histogram regions across gender and age groups for the upper cut-off level. Materials and Methods: The present study was an observational cross-sectional study conducted at the Department of Biochemistry, Amala Cancer Research Centre, Amala Institute of Medical Sciences, Amala Nagar, Thrissur, Kerala, India on healthy individuals and those with dyslipidemic conditions. Serum triglyceride data was collected from the clinical biochemistry laboratory from September 2018 to March 2022. Samples were partitioned according to gender and age groups of <18, 18 to 25, 26 to 50 and >50 years. Triglycerides were assayed using an enzymatic method. The histogram was divided into healthy (<150 mg/dL), positively skewed and outlier regions. Sample distribution before and after outlier removal was represented by the histogram and analysed using the Shapiro-Wilk and Jarque-Bera tests. Gender differences were analysed using the Mann-Whitney U test with Statistical Package for Social Sciences (SPSS) software. Results: The number of samples increased with age. In the histogram, the sample number decreased sequentially from the healthy region to the positively skewed and finally to the outlier region across all age groups. The p-value for distributions before the removal of outliers was <0.001. Males had higher mean triglyceride levels, with p-values ranging from <0.001 to 0.029 and exhibited a higher prevalence of hypertriglyceridemia in all groups. The histogram method allowed for the differentiation between the highly prevalent multifactorial moderate hypertriglyceridemia and the rare severe single-gene defects. Conclusion: The study partitioned triglyceride concentrations using a histogram into healthy, positively skewed and outlier regions. The histogram of hypertriglyceridemia can be clinically utilised to differentiate between the highly prevalent, multifactorial moderate hypertriglyceridemia and the rare, severe monogenic hypertriglyceridemia.

Postoperative Analgesia with Adductor Canal Block using Ropivacaine, Buprenorphine and Dexamethasone versus Ropivacaine and Dexamethasone in Knee Surgery Patients: A Randomised Controlled Trial

Introduction: The adductor canal nerve block has become contemporary, safe, highly effective and minimally invasive approach with faster sensory onset and greater success rate, without causing any quadriceps weakness, for postoperative pain management in knee surgery patients. The duration of block can be prolonged with addition of multiple perineural adjuvants, reducing the requirement of continuous catheters and other parenteral or oral analgesics. Aim: To compare postoperative analgesia provided by addition of Buprenorphine and Dexamethasone to Ropivacaine vs addition of Dexamethasone alone. Materials and Methods: A randomised controlled double-blind trial was conducted at a tertiary care rural teaching hospital in Gujarat, India. A total of 70 patients aged 18 to 75 years, planned for knee surgeries, were randomised in two groups using web-based program. Group A received 25 mL of 0.25% ropivacaine, 150 μg Buprenorphine, and 8 mg dexamethasone, whereas Group B received 25 mL of 0.25% ropivacaine with 8 mg dexamethasone in Adductor Canal Block (ACB) administered in immediate postoperative period. Visual Analogue Scale (VAS) score and Functional Activity Score (FAS) was recorded for next 24 hours. Duration of postoperative analgesia was determined based on time in hours at which rescue analgesia was required. The analysis was performed using STATA (14.2). Independent sample t-test was applied to contrast the mean rescue analgesia time in hours across groups. A p-value <0.05 was considered statistically significant. Results: Out of the 211 patients screened, 81 met the inclusion criteria. Eleven patients refused to participate, and 70 patients were finally randomised. The baseline parameters, viz., age, gender, and American Society of Anaesthesiologists (ASA) grade, was similar across groups. The mean±SD rescue analgesia time was significantly higher in Group A compared to Group B (12.91±2.13 vs 9.14±2.07, p-value<0.001). Similarly, the VAS and FAS profile was better in Group A compared to Group B. No side-effect was noted in either group. Conclusion: Addition of Buprenorphine as a perineural adjuvant significantly improved the duration of analgesia, as well as VAS and FAS profile in contrast to addition of only dexamethasone, without any notable side-effect/complication.

Effects of Ankle Proprioceptive Training on Ankle Functionality and Performance of Recreational Badminton Players with Pronated Feet: A Quasi-experimental Study

Shivani Vyas, S Sudhakar

Introduction: Excessive foot pronation is one of the most common functional foot abnormalities, with an average 13.6% prevalence rate in adults with bilateral affection. A 60% of the badminton gaming performance is dependent on the foot. In such a scenario, it can be widely accepted that any underlying abnormality in the foot will hamper the performance of the badminton players. Proprioceptive training involves exercises designed to improve the body’s ability to sense its position, movement, and orientation in space. It enhances balance, coordination, and stability, and is often used in rehabilitation, athletic training, and injury prevention programs. Elite sports immediately adopted it, mostly as an injury prevention measure. Aim: To determine the outcomes of ankle proprioceptive training on performance and functionality among recreational badminton players with pronated feet. Materials and Methods: This quasi-experimental study was conducted in the Department of Physiotherapy, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India and compared ankle proprioceptive training with game-specific warm-ups in badminton players for eight weeks from November 2022 to January 2023. Total 100 subjects were selected by random sampling and divided into two groups, i.e., the control group and the experimental group. The control group subjects received tailor-made warm-up protocol, while the experimental group received ankle proprioceptive training for 30 minutes before their usual game routine, three days a week for eight weeks. Agility was measured using the Badcamp Agility Test, the dynamic balance was assessed using the modified Star Excursion Balance Test (mSEBT), and ankle functionality was measured using the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS). The data analysis was done using Statistical Package of Social Sciences (SPSS) version 29.0 for Windows. Results: The experimental groups in present study showed considerable improvement in functionality and agility when compared to the control group (p<0.05). However, no significant improvement (p>0.05) was observed for the modified SEBT between the two groups. Greater improvement {in terms of Mean Difference (MD)} was observed in the experimental group in almost all the outcome measures. Conclusion: Proprioceptive training positively affects agility and ankle functionality in badminton players with pronated feet. The effect on balance still needs to be investigated, and further investigation is required.

Study of Drug Utilisation and Adverse Drug Reaction Pattern of Anti-glaucoma Drugs in Patients with Primary Open Angle Glaucoma Attending the Glaucoma Clinic at a Tertiary Care Institute in Bihar, India: A Cross-sectional Study

Nitu Pandey, Sachin Kumar, Vidya Bhushan Kumar, Rinky Thakur

Introduction: Primary Open Angle Glaucoma (POAG) is a leading cause of secondary blindness, with pharmacotherapy being the mainstay of treatment. As guidelines and recommendations have evolved, so have prescribing trends. The present study was carried out to assess the utilisation pattern and Adverse Drug Reactions (ADRs) of anti-glaucoma drugs in POAG patients to promote their rational and cost-effective use. Aim: To evaluate the drug utilisation pattern and ADRs associated with anti-glaucoma drugs in POAG patients. Materials and Methods: This observational cross-sectional study was conducted at the Department of Pharmacology and the Regional Institute of Ophthalmology (RIO) at IGIMS, Patna, Bihar, India, for a period of six months (December 2023 to May 2024) and included 87 outpatients over 18 years of age diagnosed with POAG. Their prescriptions were analysed for the number and types of drugs, Fixed Dose Combinations (FDCs) and costs {the costs were obtained from Drug Today (April-July 2024); for drugs not available in this source, the online platform (Tata 1 mg) was used). The ADR pattern was observed in 78 participants who were already on anti-glaucoma drugs through inquiry and examination; nine were newly diagnosed and thus their ADRs could not be evaluated. Descriptive statistics were used. Results: Of the 87 participants, 48 (55.17%) were males and the remaining were females, with a mean age of 53.75±14.83 years. Of the 147 drugs and FDCs prescribed, 145 (98.64%) were topical (eye drops). A single drug was prescribed in 24 (27.59%) instances, while a single FDC was prescribed in 10 (11.5%) of the prescriptions. A total of 50 FDCs were prescribed, with an average of 2.3 drugs per prescription. Prostaglandin (PG) analogues were the most frequently prescribed drugs, followed by beta-blockers (timolol), accounting for 60 (31.09%) and 51 (26.42%) prescriptions, respectively. Carbonic anhydrase inhibitors accounted for 49 (25.39%), α-adrenergic agonists for 29 (15.03%) and Rho-kinase inhibitors for 4 (2.07%) prescriptions. All medications were prescribed as branded generics with complete dosing information regarding dose, dosage form and dose frequency. Out of 78 patients, 23 experienced ADRs, the most common being dryness, burning and grittiness; timolol was the most commonly implicated drug. No significant systemic ADRs were observed except for frequent urination with oral acetazolamide. All data were entered into Microsoft Excel and statistically analysed. Conclusion: The present study highlights the current prescribing practices in POAG, with a shift from beta-blockers to PG analogues reflecting current guidelines. The increased use of FDCs offers cost-effectiveness and convenience. The choice of branded generics over generic drugs remains a topic for further investigation.

Comparison of Nurick Score and Modified Japanese Orthopaedic Association Score as Prognostic Indices for Surgical Outcome in Cervical Spondylotic Myelopathy Cases: A Prospective Observational Study

Ramis Abdul Aziz, Sarang Gotecha, Ashish Chugh, Prashant Punia

Introduction: Cervical Spondylotic Myelopathy (CSM) is a leading cause of spinal cord dysfunction, particularly in elderly populations. It presents with diverse motor, sensory and autonomic symptoms. Surgical decompression is the standard treatment, with prognostic tools such as the Nurick score and modified Japanese Orthopaedic Association (mJOA) score used to assess outcomes. Aim: To compare the Nurick and mJOA scores in predicting functional outcomes following surgical intervention for CSM. Materials and Methods: A prospective observational study was conducted over three years in the Neurosurgery Department of Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from December 2021 to December 2024, including 40 patients diagnosed with CSM. Pre- and postoperative evaluations were performed using the Nurick score, mJOA score and Odom’s criteria. Surgical interventions included anterior or posterior decompression. Statistical analyses included Wilcoxon signed-rank tests and Spearman’s correlation to assess changes in scores and relationships with Odom’s criteria. Results: The mean age of participants was 52.88±15.17 years.The median pre- and postoperative Nurick scores were 3 and 1, respectively (p-value<0.0001), while mJOA scores improved from 14 to 16 (p-value<0.0001). Both scores demonstrated a strong correlation with Odom’s criteria after surgery, with the mJOA score showing a greater association (ρ=-0.599 vs. ρ=0.502). Out of 40 cases, 35 patients (87.5%) showed improvement in their mJOA scores, while 29 patients (72.5%) demonstrated improvement in their Nurick scores at follow-up. Conclusion: The mJOA score provides a more comprehensive evaluation of functional recovery in CSM patients, while the Nurick score remains valuable for rapid assessments. A tailored use of these tools based on clinical context and healthcare settings is recommended.

Introduction of Question-making Sessions by Undergraduate Medical Students to Reinforce Learning in Pathology: A Cross-sectional Study

Introduction: Creating Multiple-Choice Questions (MCQs) requires extensive knowledge coupled with critical analytical thinking and enhances learning. This study was planned to make MBBS students equal stakeholders in framing Multiple-Choice Questions (MCQs) and, thereby, in the teaching-learning program. Aim: To evaluate whether involving medical students in framing quiz questions enhances learning in Pathology. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at the Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India from April 2022 to September 2022. A batch of 100 second-professional MBBS students were included in the study. Students were asked to prepare seven conceptual MCQs in a week after conventional didactic lectures. A total of nine quiz sessions were held on the topics flagged by the students and faculty. At the end of the study period of 24 weeks, the students were administered a feedback questionnaire. Responses from the students were graded on the Likert scale to assess the impact on learning, perception, analysis, communication and satisfaction. Results: A total of 88 (91.7%) of students felt that the question-making activity was useful for gaining a better understanding of the given topic, and 82 (85.4%) of students believed that the question-making exercise was a good and effective way of learning and would help them in exams. Additionally, 76 (79.2%) of students felt that the activity enabled in-depth knowledge of the topic, and 68 (70.8%) of students suggested that this type of learning method should be incorporated into other topics in the department. The satisfaction index ranged from 73.8% to 86.5% in this study. Conclusion: This study was an attempt to engage students actively in the teaching-learning process, and the feedback generated shows that it had the desired impact on the study participants. Including such sessions regularly will improve learning outcomes in the discipline of Pathology.

Case-based Learning as a Means of Reforming Pathology Teaching in Second Year Undergraduate Medical Students: An Interventional Study at a Medical College in Maharashtra, India

Vaishali B Nagose, Vipin Narendra Todase, Vilas M Sangole

Introduction: Case-based Learning (CBL) is a relatively recent Teaching and Learning (TL) method in medical subjects, including pathology, in India. It is learner-oriented, similar to problem-based learning and may enhance medical students’ analytical and problem-solving skills. Aim: To determine the effectiveness of CBL in increasing students’ interest in learning pathology and improving their analytical skills and to assess students’ perception of this method through feedback. Materials and Methods: This comparative interventional study was carried out at Dr. Ulhas Patil Medical College and Hospital, Maharashtra, India over two weeks in August 2020, involving 90 second year undergraduate medical students (II MBBS) studying pathology. The topics were ‘Megaloblastic anaemia’ and ‘Chronic Myeloid Leukaemia (CML)’. Students were divided into two groups (A and B, n=45 each). One group was taught using Didactic Lectures (DL); the other used CBL in small groups. A common Multiple-Choice Question (MCQ) post-test assessed analytical skills after each class. Student feedback on CBL was collected using a five-point Likert scale. Groups were interchanged for the CML session. Mean post-test scores and feedback scores were calculated. Statistical comparison was performed using Student’s t-test (Statistical Package for the Social Sciences (SPSS) version 16.0), with p-value <0.05 considered statistically significant. Results: CBL post-test scores were significantly higher than DL scores (p-value=0.03 and p-value=0.0138). The mean feedback score was excellent (4.4), with most students favouring CBL and reporting superior understanding. Conclusion: CBL promoted active learning, enhancing analytical skills and proving highly acceptable to II MBBS students as a TL method in pathology.

Effect of Instrument-assisted Soft-tissue Mobilisation of Iliotibial Band with Conventional Exercise Therapy versus Conventional Exercise Therapy Alone on Clinical Performance in Patients with Knee Osteoarthritis: A Prospective Interventional Study

Janhavi Balbir Gandotra, Pranita Dattatraya Ganjave, Riddhi Ashish Shroff

Introduction: Osteoarthritis (OA) of the knee is the second most prevalent rheumatological issue in India. Myofascial factors play a role in symptom presentation, challenging conventional perspectives on treatment. Instrument-assisted Soft-Tissue Mobilisation (IASTM) is used for treating soft-tissue injuries, but its impact on relieving the Iliotibial Band (ITB) and improving knee mobility in OA patients is still not well understood. Aim: To evaluate the impact of combining IASTM with conventional exercise therapy versus conventional exercise therapy alone on knee Range of Motion (ROM), pain, functional performance, and functional disability in patients with grade 1 and 2 knee OA. Materials and Methods: The present prospective interventional study was conducted in the Outpatient Department (OPD) of Physiotherapy, D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India from September 2023 to February 2024. Total 40 participants with grade 1 and 2 knee OA, aged 45-60 years, were randomly assigned to the conventional and experimental groups. Pain intensity was assessed using a numerical pain rating scale, and knee flexion ROM was measured with a universal goniometer. Functional performance and functional disability were evaluated using the 30-second sit-to-stand test and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Centre for Rheumatic Disease (CRD) Pune version 10, respectively. Participants underwent sessions three times a week over a two-week period. Data was analysed using the Statistical Package for Social Sciences (SPSS) software version 16.0. Intergroup comparisons were carried out using either independent t-tests or Mann-Whitney U tests. Intragroup comparisons were performed using dependent t-tests or Wilcoxon matched pairs tests. A significance level of 1% was utilised. Results: Intragroup analysis showed that both the conventional group (mean age 53.80±5.51 years) and the experimental group (mean age 50.22±4.61 years) had statistically significant improvements in knee flexion ROM, pain, functional performance, and functional disability (p-value<0.05). The experimental group demonstrated statistically significant superior improvements in pain (p-value=0.0077*), knee flexion ROM (p-value=0.0007*), and functional disability (p=0.0006*) compared to the conventional group. However, the functional performance showed statistically significant equal improvement in both groups. Conclusion: Combining IASTM with conventional exercise therapy led to superior improvements in knee flexion ROM, pain reduction, and functional disability compared to conventional exercise therapy alone in individuals with knee OA. However, both interventions were equally effective in enhancing functional performance.

Prevalence and Perception of Smoking among Medical Students: A Cross-sectional Survey-based Study from a Sudanese University

Anas Ibn Auf, Ahmed Ibrahim Fathelrahman

Introduction: Smoking among medical students is a public health concern, as these future healthcare providers play a crucial role in tobacco cessation. Aim: To examine the prevalence and perception of smoking among medical students in Sudan, with a focus on the socio-demographic factors influencing smoking behaviour. Materials and Methods: A cross-sectional study was conducted between June 2015 and July 2015 among medical students at Sudan International University located in Khartoum, Sudan. A total of 394 students were included in the study. Smoking behaviour and perceptions were analysed using a modified United Nations Office on Drugs and Crime (UNODC) survey, which included only the questions related to smoking. Statistical analysis was performed using descriptive statistics, and a Chi-square test was applied to identify associations, with a p-value of <0.05 considered statistically significant. Results: Of the 394 participants, 27 (6.9%) were current smokers, with smoking rates significantly higher among males 26 (17.2%) compared to females 1 (0.4%). Smoking prevalence was also higher among older students, with 5 (16.1%) of those aged ≥25 and 16 (10.7%) of clinical-stage students being current smokers. Strong disapproval of heavy smoking was noted among 234 (59.4%) of the students, especially among females (169, 70.1%). Students living with non relatives reported higher smoking rates, with 5 (50%) being ever smokers and 3 (30%) currently smoking, compared to those living with parents or relatives. Additionally, students living alone were less likely (n=4, 20%) to disapprove heavy smoking compared to their counterparts, with disapproval rates ranging between 50% and 65% for different categories. Conclusion: Smoking was more prevalent among males, older individuals and clinical-stage students, while perceptions of smoking vary by age and gender. These findings underline the need for targeted smoking prevention initiatives within medical schools that address gender- and age-related factors. Tailored interventions can better equip future healthcare providers in Sudan for effective tobacco cessation advocacy.

Comparing the Effectiveness of Aerobic Training, Isometric Handgrip Exercise and Yoga Therapy to Manage Primary Hypertension: A Randomised Controlled Trial

Introduction: Hypertension is the most avoidable cause of Cardiovascular Diseases (CVDs), with a prevalence of 22.4% among young adults. Lifestyle modifications, dietary changes and various non pharmacological therapies-including aerobic training, resistance training, handgrip exercises and yoga therapy-are effective in managing primary hypertension. However, non pharmacological treatments have shown contradicting results in earlier studies. Therefore, there is a need to identify better interventions for managing primary hypertension to lessen the considerable burden of hypertension on the public health system. Aim: To compare the effectiveness of aerobic training, isometric handgrip exercise and yoga therapy in managing blood pressure among individuals with primary hypertension. Materials and Methods: A randomised controlled trial was conducted at MM Super-Speciality Hospital, Mullana, Ambala, Haryana, India from February 2023 to May 2023. Forty hypertensive patients over 18 years of age were recruited based on the inclusion and exclusion criteria. Participants were divided into four groups: aerobic training, isometric handgrip exercise, yoga therapy and a control group, with 10 subjects in each group. Six weeks of intervention were provided four times a week and Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were measured at baseline and postintervention. For statistical analysis, Statistical Package for the Social Sciences (SPSS) version 20.0 was used. The Wilcoxon Signed Rank test and Kruskal-Wallis test were applied for intra- and intergroup comparisons. A p-value of <0.05 was considered statistically significant. Results: Aerobic training showed significant improvement (p-value <0.001) in SBP, with a median (IQR) reduction of 9.75 and in DBP, with a median (IQR) reduction of 9.50, along with regular pharmacotherapy. Conclusion: A supervised aerobic exercise training program, along with pharmacotherapy, was superior to other interventions in effectively managing primary hypertension.

Comparison of Haemodynamic Stability among Different Anaesthesia Techniques in Patients Undergoing Modified Radical Mastoidectomy: A Randomised Controlled Trial

Introduction: Traditionally, Modified Radical Mastoidectomy (MRM) is conducted under General Anaesthesia (GA) or Local Anaesthesia (LA) with sedation; however, the latter technique can cause patient discomfort and complications due to airway obstruction. The use of a supraglottic device not only secures the airway but also eliminates laryngoscopy-related risks. Aim: To compare the efficacy and safety of three different anaesthesia techniques: GA with endotracheal intubation, Laryngeal Mask Airway (LMA) and sedation with a Hudson mask. Materials and Methods: A single-blind, randomised control trial was conducted in the Department of Anaesthesia, GSVM Medical College (tertiary care centre), Kanpur, Uttar Pradesh, India, from October 2016 to September 2017. Ninety patients were randomly divided into three groups of 30 each: group A (GA with endotracheal intubation), group B (LMA with spontaneous respiration) and group C (sedation with Hudson mask). Haemodynamic parameters, intraoperative bleeding and surgeon satisfaction scores, were recorded and analysed. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 20.0 and using appropriate tests of significance. Results: The mean±Standard Deviation (SD) age in group A, group B and group C was 46.93±11.17 years, 46.85±11.25 years and 46.18±12.69 years, respectively. No statistical difference was found in the demographic profile among the groups. Both group A and group B showed a significant increase in Heart Rate (HR) at zero, one and three minutes compared to group C, which had consistently higher HR from five minutes onward throughout the surgery (p-value <0.001). Group C also displayed significantly higher Mean Arterial Pressure (MAP) starting from five minutes and throughout the procedure compared to the other groups (p-value <0.05). A significant drop in mean±SD Saturation of Peripheral Oxygen (SpO₂) levels was observed in group C (94.46%±1.47%) at one minute compared to the other groups (p-value <0.001). Group C had significantly higher mean±SD intraoperative bleeding (39.66±9.37 mL) compared to group A (17.33±4.49 mL) and group B (18.16±4.04 mL) (p-value <0.001). In groups A and B, the mean±SD surgeon satisfaction scores (6.46±0.50 and 6.48±0.50, respectively) were significantly higher compared to group C (4.66±0.84) (p-value <0.001). Conclusion: General anaesthesia with endotracheal intubation and LMA provide superior haemodynamic stability, reduced intraoperative bleeding and higher surgeon satisfaction compared to sedation with a Hudson mask in MRM. Additionally, the use of LMA omits the need for laryngoscopy, which limits the initial haemodynamic fluctuations at the time of device insertion.

Effect of Separated Instruments on Apical Seal of Root Canals Obturated with Different Techniques: An In-vitro Stereomicroscopic Study

Introduction: Practitioners often encounter challenges during root canal preparation, particularly with instrument separation. There is a need to understand how broken instruments interact with different obturation techniques. Aim: To evaluate the extent of apical microleakage in root canals containing fractured instruments obturated using three different materials and techniques, and to investigate the interaction between fractured instruments and these obturation methods. Materials and Methods: This in-vitro study was conducted at Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Pune, Maharashtra, India, over a duration of three months, from February 2024 to April 2024. Total 45 single-rooted premolars were decoronated and prepared with hand and rotary files upto size 20. A #25 rotary file was scratched and fractured 3 mm from the tip at the apex. Samples were randomly assigned to three obturation groups (n=15 each): Group A {Mineral Trioxide Aggregate (MTA)}, Group B (lateral compaction), and Group C (injectable gutta-percha). Roots were coated with nail varnish, sparing the apical 2 mm. The parameters studied included the degree of apical microleakage, which was measured by sectioning samples after 48 hours of immersion in methylene blue dye for observation under a stereomicroscope. Statistical analysis was performed using Statistical Package of Social Sciences (SPSS) version (IBM Corp, v.21.0). Intergroup comparison of apical microleakage (in mm) between different groups was conducted using One-way Analysis of Variance (ANOVA). Level of significance was set at p<0.05. Results: Intergroup comparison of apical microleakage (in mm) between different groups was performed using One-way ANOVA. This comparison showed statistically significant differences (p-value=0.047*) between the three groups. Pair-wise multiple Post-hoc comparison of apical microleakage (in mm) between different groups was performed using Tukey’s Post-hoc test. Group A (MTA) exhibited significantly lower microleakage (1.59 mm) compared to Group B (lateral compaction, 1.83 mm) and Group C (injectable gutta-percha, 2.25 mm). Groups A and B showed p-value of 0.047*, and Groups A and C showed p-value of 0.027*. No significant differences were found between Groups B and C (p=0.558). Conclusion: The MTA obturation demonstrated superior sealing capability compared to the other techniques, while comparable leakage was observed in the lateral compaction and injectable gutta-percha groups. These findings highlight the effectiveness of MTA in managing apical microleakage in the presence of fractured instruments.

Epidemiology of Respiratory Syncytial Virus in Hospitalised Adult Patients with Respiratory Tract Infections: A Cross-sectional Study from a Tertiary Care Institute, Amritsar, Punjab, India

Harsimrat Pal, Kanwardeep Singh, Shailpreet Kaur Sidhu, Harpreet Singh Thukral

Introduction: Respiratory Syncytial Virus (RSV) is increasingly recognised as an important cause of severe Respiratory Tract Infections (RTIs) in adults, especially those with underlying co morbidities, all over the world. However, the magnitude and nature of the effects of severe RSV infections are underestimated in our geographical area. Aim: To determine the prevalence of RSV among hospitalised adult patients with RTIs using Real-Time Polymerase Chain Reaction (RT-PCR), along with an assessment of the clinical profile and underlying co-morbidities associated with it. Materials and Methods: This cross-sectional study was conducted at the Virus Research and Diagnostic Laboratory (VRDL) in the Department of Virology at Government Medical College, Amritsar, Punjab, India. Nasopharyngeal swabs were taken from 158 adult patients with RTIs, belonging to different age groups, genders and localities. The study was conducted from December 2022 to April 2024. Nucleic acid was extracted using the magnetic bead extraction technique, and RT-PCR was performed to detect and differentiate between RSV-A and RSV-B. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 23.0, with a p-value considered significant. Results: Out of 158 nasopharyngeal swabs, 15 (9.5%) tested positive for RSV. Cough, dyspnoea and wheezing, along with normal haematological parameters, were significant clinical features in RSV-positive patients. Most of the RSV-positive patients required intensive care. Diabetes mellitus in 5 (14.3%), Coronary Artery Disease (CAD) in 2 (10.5%), and Chronic Obstructive Pulmonary Disease (COPD) in 10 (10.2%) were significant underlying co-morbidities among RSV patients. The disease exhibited a typical seasonal pattern, with a clear spike in all cases during the winter months. Present study reported that the dominant circulating subtype in the geographical area was RSV-B in all cases. Conclusion: The burden of RSV infections in adults is underestimated, but it is significant. Accurate estimation of the prevalence of RSV is important to understand its clinical and economic burden, which can guide policymakers in the development of RSV prophylaxis, including RSV vaccines.

Comparison of Smile Parameters, Maxillary Arch Changes and Perceived Smile Attractiveness in Patients Treated with Conventional and Self-ligating Bracket Systems: An Observational Study

Rieshy Vasudevan, Selvapriya Selvam, Shweta Nagesh

Introduction: The smile is an important determinant of facial attractiveness. Patients seek orthodontic treatment to enhance the aesthetics of their smiles. Passive Self-ligating (SL) appliances are promoted as a means to enhance smile aesthetics by widening the arch and thereby diminishing the buccal corridor area. Aim: To compare the transverse maxillary arch changes, smile parameters and their effect on smile aesthetics in patients treated with conventional and passive SL bracket systems. Materials and Methods: The present retrospective observational study, which spanned five months (May 2023 to September 2023) was conducted in the Department of Orthodontics, Saveetha Institute of Medical and Technical Sciences (tertiary care dental teaching hospital), Velappanchavadi, Chennai, Tamil Nadu, India, 30 records of patients who were treated between 2018 and 2023 were analysed-15 with conventional brackets (Group 1) and 15 with SL brackets (Group 2). Pre- and post-treatment digital models were used to assess changes in intermolar and intercanine widths. Pre- and post-treatment frontal smiling images were used to measure changes in smile parameters and ratios. The frontal smile photographs were sent to 30 raters, consisting of laypeople, general dentists and specialists like Orthodontists and aesthetic dentists, who scored the smile attractiveness on a 10-point Likert scale. Analysis of Variance (ANOVA) and the Bonferroni’s post-hoc test were used to compare the aesthetic scores, with p-value ≤0.05 considered statistically significant. Results: In Group 1, the average age was 17.5±4.7 years, while in Group 2 it was 16.5±5.6 years. Group 1 had ten females and five males. Group 2 had nine females and six males. The mean pre- and post-treatment inter-canine widths in Group 2 were 462.33±82.63 mm and 542.47±99.33 mm, respectively and the difference was statistically significant (p-value=0.004). The mean pre- and post-treatment visible dentition widths in Group 2 were 481.2±196.41 mm and 608.4±248.82 mm, respectively and the difference was statistically significant (p-value=0.049). There were no significant differences in other smile parameters, ratios, or maxillary arch changes between and within Groups 1 and 2. There was a statistically significant difference between the smile attractiveness scores given by the raters in the pre- and post-treatment stages of both groups (p-value ≤0.001). The smile aesthetic scores given by raters from the dental specialist groups were significantly lower compared to those from the general dentists and laypeople groups. Conclusion: The alteration in maxillary arch width, buccal corridor space and smile attractiveness showed no significant variation when treated with either SL or conventional brackets. The study did not find any advantages to support the use of the SL bracket system over conventional brackets for the purpose of smile enhancement and reduction of buccal corridor space. Regardless of the type of bracket, orthodontic therapy significantly enhances smile aesthetics.

Evaluation of Antibacterial Activity of Ethanolic Extract of Portulaca Oleracea against Periodontal Pathogens: An In-vitro Study

Introduction: The need of the hour is to search for new antimicrobial agents of herbal origin to combat the global problem of drug resistance. Portulaca oleracea (common purslane) is an agricultural weed with a long history of medicinal use. In the present study, the authors intend to test its antibacterial efficacy against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia, which are the main pathogens of periodontal disease in children and adults. Aim: To evaluate the antibacterial activity of the ethanolic extract of Portulaca oleracea. Materials and Methods: The in-vitro study was conducted in the Department of Paediatric and Preventive Dentistry and the Central Research Laboratory at Maratha Mandal’s NGHIDS and Research Centre, Belagavi, Karnataka, India, from November 2023 to January 2024. A crude extract from the aerial parts of Portulaca oleracea was prepared by the Soxhlet extraction method using ethanol as a solvent at KAHER’s Shri BM Kankanawadi Ayurveda Mahavidyalaya Post Graduate Studies and Research Centre, Belagavi, Karnataka. The extract’s Minimum Inhibitory Concentration (MIC) was assessed against the standard strains A. actinomycetemcomitans (ATCC 29523), P. gingivalis (ATCC 33277) and T. forsythia (ATCC 43037) and compared with that of chlorhexidine gluconate. A total of 10 serial dilutions of the extract were prepared using the double broth dilution method. After incubation, turbidity was noted at the lowest dilution. The procedure was performed three times and the mean value was calculated. Results: The MIC of the ethanolic extract of Portulaca oleracea for P. gingivalis, T. forsythia and A. actinomycetemcomitans was reported at 9.3, 0.5 and 4.7 μL/mL, respectively. Chlorhexidine showed consistent microbial resistance at 0.6 μL/mL for all the three periodontal pathogens. Conclusion: The ethanolic extract of Portulaca oleracea can be used as an effective antimicrobial agent against periodontal pathogens, since as it has been found to possess antibacterial properties.

Clinical Performance of Non Caries Excavation and Conventional Techniques of Caries Removal in Primary Molars: A Split-mouth Randomised Control Trial

Introduction: The minimally invasive, biological approaches are currently recommended for the management of active carious lesions extending into dentine in primary teeth. These treatments halt the progression of decay while preserving natural tooth structure and supporting the tooth’s ability to heal. Aim: This study aims to evaluate the clinical performance of Non Caries Excavation (NCE) and conventional Caries Removal Techniques (CT) for restoration in primary molars. Materials and Methods: In this split-mouth randomised control trial, a total of 56 children with cavitated primary molars showing an International Caries Detection and Assessment System (ICDAS) score of 5 were included. The teeth were randomly allocated into the NCE (Group I) and conventional caries removal (CT, Group II) groups. In the NCE group, 38% Silver Diamine Fluoride (SDF) was applied directly over carious dentine, whereas in the CT group, a round bur was used for caries removal, serving as the control group. Teeth were restored with Glass Ionomer Cement (GIC) in both groups. The clinical performance of the restorations was evaluated at 6 and 12 months. Among the 56 children, one child was lost to follow-up at six months, and two others at 12 months; they were excluded from the analysis. Descriptive analysis and the Chi-square test were used for statistical analysis of the obtained data. Results: Among the 53 children, 25 were male (47.16%) and 28 were female (52.84%). The mean age of the children was six years (6.12±0.94). On intragroup comparison, a statistically significant difference (p-value=0.001) in success rates was observed at six and 12-month intervals in both the NCE and CT groups. At six months, a 96% success rate was observed in both groups, and at 12 months, cumulative success rates of 92% and 91% were observed in the NCE and CT groups, respectively. However, no significant difference in success rates was observed in the intergroup comparison (p-value=1.00). In the CT group, failures were due to both partial dislodgement of restoration (60%) and secondary caries (40%), whereas no failures in the NCE group were due to secondary caries. Conclusion: Since both groups demonstrated similar success rates, the NCE technique emerges as an effective approach for restoring primary molars in children. This technique preserves tooth structure and promotes natural healing. As a result, it offers an effective alternative for managing decay in young and uncooperative children.

Gabapentin versus Clonidine Premedication for Haemodynamic Stability and Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomised Double-blind Control Study

Introduction: Laparoscopic cholecystectomy is associated with haemodynamic stress responses and significant postoperative pain due to CO₂ insufflation and peritoneal irritation. Effective premedication can improve intraoperative stability and postoperative recovery. Gabapentin, a calcium channel modulator and clonidine, an alpha-2 adrenergic agonist, have shown efficacy in addressing these challenges. Aim: To evaluate and compare gabapentin and clonidine as premedication for improving haemodynamic stability and reducing postoperative analgesic requirements in laparoscopic cholecystectomy. Materials and Methods: A prospective, randomised, double-blind control study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India on 150 American Society of Anaesthesiologists (ASA) Grade I/II patients undergoing elective laparoscopic cholecystectomy. Patients were divided into three groups: Group I (gabapentin 600 mg), Group II (clonidine 300 μg) and Group III (placebo). Haemodynamic parameters, Visual Analog Scale (VAS) scores and rescue analgesic requirements were recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Gabapentin significantly reduced postoperative VAS scores (e.g., at 4 hours: gabapentin 2.9±0.9, clonidine 3.7±1.2, placebo 4.8±1.3; p-value <0.001) and delayed rescue analgesia (gabapentin: 5.2±1.1 hours vs. clonidine: 4.1±0.9 hours and placebo: 3.7±0.8 hours). Clonidine provided superior intraoperative haemodynamic stability (e.g., Heart Rate (HR) at 15 minutes: gabapentin 100.28±9.11 bpm, clonidine 93.90±14.78 bpm, placebo 99.86±9.12 bpm; p-value=0.008). Both drugs demonstrated minimal and comparable adverse effects. Conclusion: Gabapentin and clonidine are effective premedications for laparoscopic cholecystectomy. Gabapentin is superior for postoperative pain control, while clonidine ensures better intraoperative haemodynamic stability. Both agents are safe and improve perioperative outcomes.

Knowledge, Attitude and Practices Regarding Antibiotic Usage and Resistance among Dental Postgraduate Students and Interns: A Cross-sectional Questionnaire-based Study

Introduction: Antimicrobial Resistance (AMR) is a critical and escalating global health issue. Educating healthcare providers and the public is essential to mitigating this threat. Early integration of antimicrobial stewardship into medical, dental, pharmacy, and nursing curricula is key, and baseline assessments of knowledge and practices are necessary for effective training programs. Aim: To evaluate the Knowledge, Attitudes, and Practices (KAP) related to antibiotic use and resistance among dental Postgraduate (PG) students and interns, with the goal of informing targeted educational interventions to promote responsible antibiotic usage and combat resistance. Materials and Methods: This cross-sectional, questionnaire-based study surveyed dental Postgraduate (PG) students and interns at the Government Dental College (GDC) and Hospital, Raipur, Chhattisgarh, India, from March 2024 to April 2024. A Google Forms questionnaire, validated for content and construct, was used, with questions addressing knowledge of antibiotic indications, resistance mechanisms, attitudes towards stewardship, and prescribing practices. A total of 142 participants were invited, with 112 complete responses (78.8% response rate). Ethical clearance was obtained. Data were analysed using Statistical Packages of Social Sciences (SPSS) version 20.0 for descriptive and inferential statistics, including p-values where applicable. Results: Out of 142 distributed questionnaires, 112 were completed (78.8% response rate), with 72 interns and 40 PG students responding; 72.3% were female. Overall, participants demonstrated acceptable knowledge of antibiotic use, with over 80% understanding factors contributing to resistance. Knowledge scores averaged 10.4±1.83 for interns and 11.3±1.31 for PG students. More than half expressed concerns about antibiotic safety and local misuse impacting global resistance. Most participants (89.93%) consulted a senior or specialist before taking antibiotics; though, 45.5% reported saving leftover antibiotics, and 27.7% had prescribed antibiotics to others without consultation. Statistical analysis revealed significant differences (p<0.05) in knowledge levels between interns and PG students. Conclusion: The present study concludes that dental students show varied levels of knowledge and attitudes towards antibiotic use and resistance, with significant gaps in understanding appropriate prescribing practices, emphasising the need for enhanced educational interventions tailored to their training and clinical responsibilities.

Comparative Evaluation of Typical Antipsychotic Haloperidol with Atypical Antipsychotics Olanzapine, Risperidone and Aripiprazole in the Treatment of Stable Schizophrenia in a Tertiary Care Teaching Hospital at Dehradun, Uttarakhand, India: A Randomised Clinical Trial

Introduction: Schizophrenia, a chronic psychiatric disorder, significantly impacts patients’ quality of life through positive symptoms (e.g., hallucinations, delusions), negative symptoms (e.g., social withdrawal, emotional blunting) and cognitive impairments. The pharmacological treatment landscape has evolved from First-Generation Antipsychotics (FGAs) like haloperidol to Second-Generation Antipsychotics (SGAs), such as olanzapine, risperidone and aripiprazole, which aim to improve therapeutic outcomes while minimising adverse effects. However, comparative evaluations of efficacy and safety among these agents remain critical, especially in the Indian context. Aim: To compare the therapeutic efficacy and safety of the FGA haloperidol with the SGAs olanzapine, risperidone and aripiprazole in the management of stable schizophrenia. Materials and Methods: This randomised, clinical open-label, prospective study was conducted for one year which included 98 stable schizophrenia patients diagnosed according to the International Classification of Diseases -10 criteria. Participants were divided into four groups receiving haloperidol (n=24), olanzapine (n=25), risperidone (n=25), or aripiprazole (n=24). Psychometric assessments were performed using the Brief Psychiatric Rating Scale (BPRS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI), and Calgary Depression Scale for Schizophrenia (CDSS) at baseline and follow-up visits over 16 weeks. Adverse Drug Reactions (ADRs) were monitored using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) Causality Assessment Scale. Statistical analysis included paired t-tests and Analysis of Variance (ANOVA), with significance set at p-value <0.05. Results: Olanzapine demonstrated the greatest efficacy, with significant improvements in BPRS and PANSS scores (p-value <0.0001), followed by risperidone and aripiprazole. Haloperidol showed efficacy in controlling positive symptoms but was less effective for negative and cognitive symptoms. ADRs were most frequent with haloperidol (57 events), primarily Extrapyramidal Symptoms (EPS), while SGAs exhibited better tolerability profiles with olanzapine showing the least ADRs (27 events). Weight gain and increased appetite were common among SGAs, whereas aripiprazole had the lowest metabolic disturbances. Conclusion: The study underscores the superior efficacy and safety profiles of SGAs, particularly olanzapine and risperidone, in managing stable schizophrenia. Haloperidol remains useful for acute symptom control but is less suitable for long-term therapy due to its adverse effects. These findings reinforce the importance of personalised treatment strategies to optimise schizophrenia management and improve patient outcomes.

Comparison of Actual Body Weight, Ideal Body Weight and Age for Selection of Appropriate I-gel Size in Paediatric Patients: A Randomised Controlled Study

Introduction: Manufacturer’s guidelines for I-gel advocate size selection of the device based on patient’s Actual Body Weight (ABW). However, this may not be suitable for children because of the wide range of weight for each device and the variation in individual anatomy due to difference in growth rate of paediatric patients. Aim: To compare ABW, Ideal Body Weight (IBW) and age for selection of I-gel size in paediatric patients. Materials and Methods: The present randomised controlled double-blinded study was carried out in the Department of Anaesthesiology and Critical care at Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. The study was conducted from February 2020 to November 2021. A total of 60 patients of age group 2 to 10 years (20 in each group) scheduled to undergo elective surgery under general anaesthesia using I-gel were enrolled and randomised into three groups: Group-I (IBW), Group-A (ABW) and Group-Ag (Age). A standard anaesthesia protocol was followed and I-gel size was selected as per the group criteria. The authors recorded the number of attempts, ease of insertion and Oropharyngeal Leak Pressures (OLP). The Wilcoxon’s signed-rank test and Kruskal-Wallis test were used for quantitative data, while, Chi-square test was used for qualitative data. Level of significance was set at p<0.05. Results: Demographic characteristics, i.e., age, gender, weight and height, were statistically similar in three groups. Mean age was 6.02±2.62, 5.40±3.23 and 6.65±2.43 years in groups Ag, A and I, respectively (p=0.37). First attempt success rate was highest in Group-I (90%), which was statistically significant between Group-Ag (55%) vs Group-I (p=0.01) and Group-A (75%) vs Group-I (p=0.02). I-gel insertion was easy in maximum patients (n=18) in Group-I, with difficulty in only two patients, leading to statistically significant difference between Group-Ag vs Group-I (p=0.04) and between Group-A vs Group-I (p=0.001). Mean OLPs (cmH₂O) were 21.6±7.46, 24.4±1.0 and 24.35±0.9 in Groups-Ag, Group-A and Group-I, respectively (p>0.05). Blood stains on I-gel after removal were observed in seven patients in Group-Ag, three patients in Group-A and only one patient in Group-I. Conclusion: The IBW can be a better predictor of I-gel size estimation as compared to ABW and age in paediatric patients. In our study, selection of I-gel size on the basis of IBW resulted in better first attempt success rate and easier insertion with fewer complications than ABW and age.

Pattern of Corneal Disorders at a Tertiary Care Centre in Amritsar, Punjab, India: A Cross-sectional Study

Introduction: Corneal disease is the fifth leading cause of blindness in the world. The burden of corneal blindness is higher in developing countries like India, where corneal opacity contributes to 8.2% of the blind population. It is estimated that approximately 25,000 new cases of corneal blindness arise each year in India. Aim: To determine the pattern of corneal disorders at a tertiary care centre in North India. Materials and Methods: This was a cross-sectional descriptive study conducted at the Regional Institute of Ophthalmology in Amritsar, Punjab, a tertiary care Institute in North India based on data from patients diagnosed with corneal pathology collected between July 2022 and June 2023. A standardised proforma was filled out for each patient. Information recorded included demographic characteristics, place of residence, presenting visual acuity, duration between the onset of symptoms and presentation at the clinic and final diagnosis. The data obtained were compiled in tabulated form using Microsoft Office Excel and the results were expressed as numbers and percentages. Results: A total of 2,535 patients (2,670 eyes) diagnosed with varying forms of corneal disorders were evaluated over a one-year period, accounting for 7.24% of the total 35,000 new patients seen. Males outnumbered females with a ratio of 2:1. The peak age of presentation was between 31 and 40 years, with a median age of 37 years. Patients engaged in agricultural activities constituted the largest group at about 49%. Pterygium (36.92%) and infectious keratitis (24.62%) were the major causes of corneal disorders among the patients. Approximately, 541 (20%) eyes presented with a visual acuity of less than 3/60. The majority of patients 1,747 (68.9%) were from rural areas. Conclusion: More than one-third of the eyes had severe visual impairment or blindness at presentation. Pterygium, infectious keratitis, corneal degeneration and foreign bodies were the main causes of corneal pathology found in the present study. A significant number of patients presented more than two weeks after the onset of symptoms, highlighting the importance of early referral to eye care facilities.

Effectiveness of Intralesional Triamcinolone Acetonide Injection in Uncomplicated Chalazion: A Prospective Observational Study at a Tertiary Care Hospital of Eastern India

Debajyoti Nanda, Nayanika Bose, Krittika Palchoudhury, Manisha Sarkar

Introduction: A chalazion is a self-limiting lipo-granuloma of the eyelid. Patients typically present with lid swelling, pain, and symptoms of local irritation. Larger lesions may cause disfigurement, depigmentation, ptosis, amblyopia, and secondary exotropia. For persistent lesions, Triamcinolone Acetonide (TA) injections and Incision and Curettage (I&C) are the most common procedures, with reported success rates of 87-89% and 62-92%, respectively, in previous studies. While I&C offers a more consistent success rate, intralesional steroid injection has potential advantages, including not requiring an additional anaesthetic injection, reduced bleeding, and lower risk of scarring. It can be performed in the Outpatient Department (OPD) and can be used for multiple chalazia. Despite the array of options for managing chalazion, the choice is not always clear, and there is a need for a method to clinically assess chalazion consistency before initiating invasive surgical treatment. Aim: To determine the efficacy of administering intralesional TA injection in patients with persistent uncomplicated chalazion. Materials and Methods: This prospective observational study was conducted in the Ophthalmology Outpatient Department (OPD) of R.G. Kar Medical College, Kolkata, India, over a period of two years, from April 2021 to March 2023. A total of 138 patients with uncomplicated chalazion measuring 2 mm to 10 mm were included. A volume of 0.05-0.15 mL of a 40 mg/mL aqueous suspension containing 2-6 mg of TA was injected into the center of the chalazion via the transconjunctival or transcutaneous route after administering topical anaesthesia (proparacaine 0.5% drops). The injection was repeated in the same dosage if the chalazion did not reduce by half its original size after the first injection, with a maximum of three additional repeat injections at two-week intervals. All data were tabulated, and statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 24.0 (IL, USA). The Chi-square test was used to assess size changes after TA injection, and p-values less than 0.05 were considered significant. Results: A total of 47 (34.1%) chalazia completely resolved within two weeks, and 70 (50.7%) showed a reduction in size at 2-4 weeks following the first dose of TA injection. After six weeks, a total of 111 (80.4%) patients showed complete resolution. There was recurrence in 9 (6.5%) patients, and 18 (13.1%) patients showed treatment failure. No major complications were noted in 130 (94.2%) patients; depigmentation was observed in 4 (2.9%) patients, an uneven scar was noted in 1 (0.7%) patient, and eyelid fat atrophy was seen in 3 (2.2%) patients after the first dose of injection. Conclusion: Intralesional injection of TA is a simple, fast, and less painful procedure for uncomplicated chalazia measuring 2 mm to 10 mm, with no major complications observed.

Comparison of Mammography Findings of Triple Negative Breast Cancer with Non Triple Negative Breast Cancer Subtypes: A Retrospective Observational Study

Sujata Panta, Pratiksha Yadav, Samir Gupta, Archana Buch, Saurabh Boralkar

Introduction: Different molecular subtypes of breast cancer demonstrate variations in their clinical course, treatment response, and prognosis, which are defined by the expression of biological markers Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor 2 (HER2). Aim: To analyse the spectrum of mammography findings in different Immunohistochemical (IHC) subtypes of breast cancer and to compare the findings of Triple negative Breast Cancer (TNBC) with other non TNBC subtypes. Materials and Methods: A retrospective observational study was conducted at the Department of Radiodiagnosis and Interventional Radiology, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from December 2023 to March 2024. A total of 65 histopathology-proven breast cancer patients with a known IHC profile were included. Mammography findings were analysed in four major IHC subtypes, namely Luminal A (HR+, HER2-), Luminal B (HR+, HER2+), HER2-enriched (HR-, HER2+), and triple negative (HR-, HER2-). Imaging findings of TNBC were also compared with those of other non TNBC subtypes. The association between different variables was compared using the Chi-square test. For all the tests, a p-value of <0.05 (two-tailed) was considered statistically significant. Results: The age of patients ranged from 30 to 83 years (Mean=53.7 years). The most common finding was a mass, which was present in 56 (86%) cases. Asymmetry was the least common finding, observed in 8 (12%) of cases. A total of 24 (36.9%) cases were classified as Luminal A, followed by 22 (33.8%) cases classified as TNBC. A total of 18.2% of TNBC cases demonstrated suspicious micro-calcifications, compared to 46.5% of non TNBC cases (p-value 0.031). The margins of the mass were circumscribed in 8 (40%) of TNBC cases, in comparison to other molecular subtypes (p-value 0.001). Conclusion: The characterisation of mammography findings in various IHC subtypes aids in diagnosis and management planning.

Exploring the Determinants of Physical and Mental Health among Patients with Non Specific Chronic Low Back Pain and Movement Control Impairment: A Cross-sectional Study

Manju Kaushik, Irshad Ahmad

Introduction: Movement Control Impairment (MCI) is a subgroup of Non Specific Chronic Low Back Pain (NSCLBP) which account for lower physical and mental Health-Related Quality of Life (HR-QoL). Subgroup-focused research is considered a way to improve management outcomes. Exploring factors linked to and potentially affecting the quality of life in the most common MCI subgroup is crucial. Aim: To investigate the pain intensity, functional disability and fear of movement relationship, as well as the univariate and multivariate impact on perceived physical and mental HR-QoL among NSCLBP patients with MCI. Materials and Methods: This cross-sectional study was conducted between August 2022 and July 2024 at a rehabilitation institute in India. A total of 66 NSCLBP patients aged 18-45 years with clinically confirmed MCI based on positive prone instability test and Luomajoki MCI tests battery were recruited. The dependent outcome measure of HR-QoL and determinants of pain intensity, functional disability and fear of movement were measured with the 36-item Short Form survey, Numeric Pain Rating Scale, Oswestry Disability Index (ODI), and Fear-Avoidance Beliefs Questionnaire (FABQ), respectively. The Pearson’s correlation test, univariate and multiple linear regression analysis were performed for the outcomes of physical and mental health domains at p-value of <0.05. Results: The mean scores for physical and mental health were 38.45±5.91 and 39.15±10.77, respectively. Physical health demonstrated a moderate inverse relationship with pain (r-value=-0.401, p-value=0.001), disability (r-value=-0.473, p-value <0.001) and fear (r-value=-0.516, p-value <0.001). Whereas, mental health has a low inverse relationship with pain intensity (r-value=-0.305, p-value=0.013), fear (r-value=-0.364, p-value=0.003) and moderate with disability (r-value=-0.520, p-value <0.001). The multivariate regression analysis indicated a significant change in physical (Adj. R²=32%, p-value <0.001) and mental health (Adj. R²=26%, p-value <0.001) collectively. Conclusion: Pain intensity, functional disability and fear of movement in NSCLBP patients with MCI are inversely related to physical and mental HR-QoL. Relatively, fear of movement had a significant impact on physical health and functional disability had an impact on mental health. Clinicians must be aware of these predictors’ which might improve the way NSCLBP patients with MCI are assessed and treated to optimise the overall QoL.

Association of Body Mass Index and Cholecystitis: A Retrospective Observational Study

Yasir Mehmood

Introduction: Cholecystitis is a medical condition characterized by the inflamation of gallbladder. In over 90% of cases, acute cholecystitis develops due to a gallstone obstructing the cystic duct. Understanding modifiable risk factors, such as obesity, is critical for developing effective prevention and management strategies. Aim: To study the association between Body Mass Index (BMI) and acute and chronic cholecystitis. Materials and Methods: This retrospective observational study was conducted out at Prince Abdulaziz Bin Musaad Hospital in Arar City, Saudi Arabia, between January 2024 and December 2024, involving 320 adult patients. Demographic data were collected from the medical records and BMI was calculated. Frequencies and percentages were utilised for gender and diagnosis, while the mean±standard deviation were calculated for age and BMI. A chi-square test was applied to evaluate the association between the variables, with a significance level of <0.05 considered significant. Results: Of the 320 patients, 228 (71.2%) were females. Of these, 167 (52.2%) patients were diagnosed with chronic cholecystitis, while 153 (47.8%) were diagnosed with acute cholecystitis. Only 52 patients (16.3% of the total) had an ideal BMI. The data were divided into two BMI groups: BMI <30 kg/m2 and BMI >30 kg/m2. A significant difference (p-value=0.042) was observed, with a higher proportion of acute cholecystitis cases in the BMI <30 kg/m2 group. Conclusion: There was a higher incidence of acute cholecystitis in patients with a BMI below 30 compared to those with a BMI above 30, indicating that BMI may influence the type of cholecystitis.

Insights into De Quervain’s Tenosynovitis as an Unintended Consequence of Problematic Smartphone Usage: A Cross-sectional Observational Study

Introduction: Smartphone use has been linked to Musculoskeletal Disorders (MSDs), particularly wrist and hand conditions like De Quervain’s Tenosynovitis (DQT), which causes inflammation of the tendons of the thumb, mainly the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB). In India, the rise in smartphone usage has led to a corresponding increase in such disorders. Aim: To investigate the association between problematic smartphone usage and the development of DQT and to assess its physical impact using the Visual Analogue Scale (VAS), Patient-rated Wrist/Hand Evaluation (PRWE) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scores. Materials and Methods: A cross-sectional observational study was conducted at the Department of Orthopaedics, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Chengalpattu, Tamil Nadu, India, from July 2024 to September 2024, with 300 participants aged 20-50 years. Participants were classified based on the results of Finkelstein’s Test and their smartphone usage patterns. Pain intensity was assessed using the VAS, while functional disability was measured using the quick DASH and PRWE questionnaires. Results: The DQT was more prevalent in younger individuals (20-30 years) and females, with prolonged smartphone use (>8 hours/day) and frequent horizontal screen orientation strongly linked to its occurrence. Specific hand gestures such as Horizontal screen Both Thumb-Both Hand Grip (HBT-BHG) were common in bilateral DQT, while Horizontal screen Unilateral thumb-Isolated Hand Grip (HUT-IHG) was more frequent in unilateral cases. Vertical screen Unilateral Index finger-Other Hand Grip (VUI-OHG) and Vertical screen Unilateral Thumb- Other Hand Grip (VUT-OHG) gestures showed a lower incidence of DQT. Group 1 experienced higher pain intensity (VAS score 5.43±1.34) and moderate disability scores (Quick DASH score 38.45±12.52; PRWE score 42.67±14.24), while Group 2 had minimal pain (VAS score 2.3±1.02) and minimal disability scores (Quick DASH score 11.96±6.68 and PRWE score 15.54±8.46). Conclusion: Problematic smartphone usage patterns (usage of phones for over 8 hours per day and horizontal screen orientation) were associated with the development of DQT, resulting in moderate disability scores that affected daily activities.

Translation and Psychometric Evaluation of the Gujarati Version of Participation Scale for Stroke Patients: A Cross-sectional Study

Surbala Lourembam, Dhruv Dave

Introduction: Social participation is increasingly recognised as fundamental to stroke rehabilitation outcomes and quality of life. However, existing participation measures for stroke often face cultural and linguistic challenges when used with the Gujarati population. The Participation Scale (PS) provides a culturally appropriate, comprehensive tool for evaluating participation restrictions across various conditions but has yet to be validated for Gujarati-speaking stroke patients. Aim: To estimate the reliability and validity of the Gujarati version of the PS-V6.0 among Gujarati-speaking stroke patients. Materials and Methods: This cross-sectional observational study was conducted between February 2022 and December 2022 at the Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology (CHARUSAT), Anand, Gujarat, India. The study involved a convenience sample of 86 stroke participants. The Gujarati version of the PS-V6.0, the Modified Rankin Scale (mRS), the Social Domain of Stroke Impact Scale (SIS-S), and the Barthel Index (BI) were administered during the initial visit. The Gujarati PS was administered again after one week. Psychometric testing of the scale included an investigation of internal consistency measured by Cronbach’s alpha, the Intraclass Correlation Coefficient (ICC) for test-retest reliability, and construct validity (known group and convergent validity). Result: The study included 86 stroke patients aged 50.47±14.13 years (59.3% males), with a mean stroke duration of 19.31±20.16 months. The Gujarati PS scale items demonstrated good internal consistency (Cronbach’s alpha=0.875). Test-retest reliability revealed a high correlation (ICC=0.998). Construct validity was confirmed by a moderate correlation with SIS-S (r-value=-0.507, p-value <0.001) and BI (r-value=-0.434, p-value <0.001). The scale differentiated patients with low and high disability severity (with a mean difference of 21.48, 95% CI=13.4 to 29.5). Conclusion: The Gujarati version of the PS is a reliable and valid patient-reported clinical instrument for the assessment of social participation in Gujarati-speaking stroke patients.

Comparison of CSF Flow Parameters between Clinically Diagnosed Normal Pressure Hydrocephalus with Age and Sex-matched Healthy Volunteers: A Cross-sectional Study

Saumya Ranjan, Vanda Maria Yasmin De Sequeria Fernandes

Introduction: Normal Pressure Hydrocephalus (NPH) is characterised by gait ataxia, cognitive impairment, and urinary incontinence, with enlarged lateral and third ventricles that are disproportionate to cortical sulcal enlargement, despite normal intracranial pressure. CSF flow studies have emerged as a non invasive method for diagnosing NPH by providing indications of abnormal CSF flow. Aim: To compare the parameters of CSF studies between clinically diagnosed NPH patients with age and sex-matched healthy volunteers. Materials and Methods: This cross-sectional, time-bound study was conducted in the Department of Radiodiagnosis at Goa Medical College and Hospital, Goa, India from January 2020 to July 2022. Patients referred to the Department of Radiodiagnosis with gait impairment, dementia, and urinary incontinence were included. A total of 100 patients {50 cases of clinically diagnosed NPH and 50 age and sex-matched healthy volunteers (controls)} were included in the study. Magnetic Resonance Imaging (MRI) was performed on a 1.5 Tesla (Magnetom Avanto, Siemens) unit using standard head coils in a neutral supine position. The Argus flow option on the Syngo Acquisition Workplace was used for quantitative flow analysis. The outcome variables evaluated were the Evans Index, Callosal Angle (CA), temporal horns of the lateral ventricle, and cerebrospinal flow parameters such as cross-sectional area, forward flow, backward flow, peak systolic velocity, aqueductal stroke volume, and mean systolic velocity. Data were presented as mean and standard deviation for continuous variables and as percentages for categorical variables. An unpaired t-test was used to compare the means of the two groups. Results: The mean age of the cases was 66.4±8.9 years, with a range of 45 to 85 years. The mean age of the controls was 69.41±9.02 years, with a range of 45 to 86 years. The CSF analysis showed that the mean stroke volume in controls was 15.93±1.5 microliters, the mean peak velocity was 4.3±1.8 cm/sec, and the mean systolic velocity was 1.2±0.73 cm/sec. In contrast, the stroke volume in the cases had a mean of 47.45±7.5 microliters, the mean peak velocity was 8.90±4.28 cm/sec, and the mean systolic velocity was 3.49±1.87 cm/sec. A significant increase in peak systolic velocity, aqueductal stroke volume, and mean systolic velocity was noted in NPH patients as compared to controls (p-value <0.001). Conclusion: A significant increase was noted in the parameters of CSF studies in clinically diagnosed NPH patients compared to age and sex-matched healthy volunteers.

Serial Estimation of IFN-γ and IP-10 as Biomarkers of Pulmonary Tuberculosis: A Longitudinal Study

Abha Shrivastava, Barnali Kakati, Dipak Kumar Dhar, Ashok Kumar Srivastava

Introduction: Tuberculosis is a chronic disease caused by the bacterium Mycobacterium tuberculosis, affecting the whole world, especially the South Asian region. Despite scientific advancements in its diagnosis and treatment, its incidence continues to be high. The treatment of TB usually requires a long course. Cell-mediated immunity is the mainstay of the host response in TB, and a number of cytokines are released in this process. Because these cytokines reflect the state of immune activation in the body, their estimation can be used for both screening and monitoring of patients once treatment has been initiated. The adequacy of treatment for active cases is an important determinant of the transmissibility of the disease in the community. Such a study has not been reported previously in Uttarakhand. These factors, along with the wide variations in literature, necessitated the study. Aim: To observe the changes in two biomarkers Interferon Gamma (IFN)-γ and Interferon Gamma-inducible Protein (IP-10) in tuberculosis patients during the course of their treatment. Materials and Methods: A longitudinal study was conducted on TB patients in the Department of Physiology, in collaboration with department of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India. October 2022 to September 2023 among 35 pulmonary Tuberculosis (TB) patients. IFN-γ and IP-10 levels in their serum were estimated using the sandwich Enzyme-linked Immunosorbent Assay (ELISA) technique. Baseline estimations were followed by two repeat estimations at two months and six months of treatment. Statistical analysis of the data obtained was performed using Statistical Package of Social Sciences (SPSS) version 17.0 with repeated measures Analysis of Variance (ANOVA), and a p-value <0.05 was considered statistically significant. Results: The subjects had a mean age of 40.11±20.32 years. The mean IFN-γ and IP-10 levels were 46.93±24.55 pg/mL and 39.68±51.20 pg/mL, respectively. Their levels reduced during the course of treatment, as revealed by serial measurements at two months (IFN-γ: 9.41 pg/mL, IP-10: 9.21 pg/mL) and six months (IFN-γ: 9.14 pg/mL, IP-10: 3.34 pg/mL). This pattern was statistically significant (p-value <0.001). The reduction was steeper in the first two months and was more marked for IFN-γ, as indicated by their effect size. The results were similar for both genders. Conclusion: Effective therapy led to reduced levels of IFN-γ and IP-10, suggesting that serial measurements of these biomarkers could be utilised to monitor the response to therapy in tuberculosis patients.

Correlation of Serum Homocysteine, Interleukin-6 and Cholesterol in Overweight Women of Reproductive Age Group with Type 2 Diabetes Mellitus: A Case-control Study

Zahir Hussain

Introduction: Overweight (OW) status and obesity increase the risk of a variety of diseases, including Diabetes Mellitus (DM), during childbearing age. There are conflicting outcomes regarding the contribution of various risk factors in Type 2 Diabetes Mellitus (T2DM) with or without being OW. The role of Homocysteine (Hcy) in association with Body Mass Index (BMI), Interleukin-6 (IL-6), Total Cholesterol (TC), and other factors in Normal Weight (NW) and OW women of reproductive age with T2DM is not clearly understood. Aim: To investigate the influence of BMI and T2DM on serum levels of Hcy in association with IL-6, TC, and other related factors, and vice-versa, in NW and OW female subjects of reproductive age. Materials and Methods: The present case-control study involved a group of menstruating women with T2DM (n: 166; age: 35-40 years), further divided into age-matched NW DM (NW-DM, n: 80) and OW DM (OW-DM, n: 86) subgroups, along with an age-matched control group of women (n: 168; age: 35-40 years) consisting of NW non diabetic (NW-ND, n: 80) and OW non diabetic (OW-ND, n: 88) subgroups. This study aimed to determine and correlate the levels of BMI, serum Hcy, IL-6, TC, and other variables. Enzyme-Linked Immunosorbent Assay (ELISA) kits and routine procedures were used to determine the levels of these variables. Results: Serum Hcy, IL-6, and TC varied significantly between OW-DM vs. OW-ND and OW-DM vs. NW-DM (p<0.05). The OW-DM group presented a significant correlation of age with IL-6 (p<0.023). Serum TC, Hcy, and IL-6 showed a highly significant correlation with BMI among OW-DM subjects. Hcy showed a significant positive linear correlation with IL-6 in OW-ND, NW-DM, and OW-DM women, as well as with TC in OW-ND and OW-DM women. Conclusion: The present study highlights the involvement of serum Hcy associated with BMI, IL-6, TC, and other related factors in OW women with T2DM of reproductive age.

Radiological and Clinical Presentation of Interstitial Lung Disease in Patients with Concomitant Psoriasis: A Cross-sectional Study

Introduction: Psoriasis is a chronic inflammatory, immune-mediated proliferative skin disorder that predominantly involves skin, nails, and joints. Pulmonary manifestations, Interstitial Lung Disease (ILD), are very uncommon in psoriasis. Aim: To evaluate the radiological and clinical presentations of ILD in patients with concomitant psoriasis. Materials and Methods: This was a cross-sectional study that included 3,012 patients with psoriasis treated in the psoriasis clinic at the Department of Dermatology in SMS Medical College, Jaipur, Rajasthan, India, from March 2021 to February 2022 and 144 patients were referred to the Department of Respiratory Medicine with complaints of respiratory symptoms for comprehensive radiological, immunological, and clinical evaluation. Detailed history regarding ongoing drug therapy and demographic profile were collected, and radiographic characteristics were evaluated. Categorical data was expressed as a percentage (%), on the other hand, the continuous data were presented as the means±SD and median with 25th and 75th percentiles (interquartile range). Pearson’s correlation test was used to determine statistical differences between the study groups. Results: Out of the total patients, ILD was detected in 10 patients. The median age was 51.5 years (range 25-65), males and females were equally affected. The median time for the development of respiratory symptoms from the diagnosis of psoriasis was 24.5 months (range 6-60). Psoriasis Area and Severity Index (PASI) scores and time of development of respiratory symptoms from diagnosis of psoriasis were strongly and inversely correlated (r=-0.906) (p<0.001) with each other. Seven out of 10 patients (70%) had an High Resolution Computed Tomography (HRCT) pattern consistent with Usual Interstitial Pneumonia (UIP), 2 (20%) had fibrotic Non-Specific Interstitial Pneumonia (NSIP), and 1 (10%) had Combined Pulmonary Fibrosis and Emphysema (CPFE). Out of the 10 ILD patients, five patients were on immunosuppressive therapy, while five were not exposed to any immunosuppressive therapy. Conclusion: According to the findings in the present study, the immunological cascade in lung parenchyma in psoriasis patients having high PASI scores may lead to lung fibrosis.

Impact of Tremor on Upper Limb Function in Parkinson’s Disease: An Cross-sectional Correlational Study

Nagarjuna Narayanasetti, Kshitija Bansal, Annie Thomas

Introduction: A common symptom of Parkinson’s Disease (PD) is tremor, which, in combination with motor block termed ‘freezing’, acts as a major disabling factor for Upper Extremity (UE) function in people with PD. Aim: To determine the correlation between tremor and upper limb function in PD patients. Materials and Methods: A hospital-based cross-sectional correlational study was conducted over one year at Sri Krishna Neuro and General Hospital, Kasibugga, Andhra Pradesh, India. Thirty primary PD patients aged 40-60 years were enrolled, following inclusion criteria. Tremors were evaluated using the Fahn-Tolosa-Marín tremor rating Scale (FTMS) and Bain and Findley Tremor (BFT) for Activities of Daily Living (ADL). Hand function was assessed using the 9-Hole Peg Test (9HPT) for the Dominant Side (DS) and Non Dominant Side (NDS). Spearman’s correlation, with p-value≤0.05 considered statistically significant, was used for analysis. Results: The mean age of the 30 patients was 56.5±3.83 years; 21 (70%) were males and 9 (30%) were females. The median FTMS total score was 109, with a median severity score of 75.7; the interquartile ranges (IQRs) were 4.75 and 3.30, respectively. Median 9HPT scores were 25.2 (DS) and 27.2 (NDS) and the median BFT score was 71; IQRs were 6.79, 6.87 and 2.75, respectively. Spearman’s correlation showed no significant correlation between FTMS and 9HPT scores, but a moderate correlation (r=0.46) was observed between FTMS and BFT scores (p-value<0.05). Conclusion: Tremor severity (FTMS) was not correlated with hand function. However, a link was identified between tremor and tremor-related ADLs. Further research exploring the relationship between non motor symptoms and motor or cognitive impairment and reduced quality of life associated with PD, is warranted.

Role of Diffusion Tensor Imaging in Early Detection of Cervical Spondylotic Myelopathy: An Observational Study

Introduction: Cervical Spondylotic Myelopathy (CSM) is a common degenerative spinal condition that can lead to significant neurological deficits if not detected early. Conventional Magnetic Resonance Imaging (MRI), while useful, has limited sensitivity in detecting early myelopathic changes. Diffusion Tensor Imaging (DTI), a novel MRI technique, offers quantitative parameters such as Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC), which may aid in the early detection and severity assessment of CSM. Aim: To estimate and compare DTI parameters (FA and ADC) at stenotic and non stenotic levels in patients with CSM and to correlate these parameters with clinical severity using the modified Japanese Orthopaedic Association (mJOA) score. Materials and Methods: An observational study was conducted at a Chettinad hospital and research institute involving 30 patients with CSM. Ethical clearance and informed consent were obtained. Patients underwent conventional MRI and DTI sequences using a 3T Philips MRI scanner. The FA and ADC values were measured at stenotic and non stenotic levels. Clinical severity was assessed using the mJOA score. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27, with paired sample t-tests and Pearson’s correlation (p<0.05 considered significant). Results: The mean FA value was significantly lower at stenotic levels (0.46) compared to non stenotic levels (0.61) (p=0.001). Conversely, the mean ADC value was significantly higher at stenotic levels (1.35) compared to non stenotic levels (1.02) (p=0.001). A strong positive correlation was observed between FA values at stenotic levels and mJOA scores (r=0.946, p=0.001), while a strong negative correlation was found between ADC values and mJOA scores (r=-0.920, p=0.001). Conclusion: DTI parameters (FA and ADC) demonstrated significant changes at stenotic levels in CSM patients and correlated strongly with clinical severity. DTI holds promise as a quantitative tool for early detection and severity assessment of CSM.

Efficacy of Curcumin and Spirulina in the Management of Oral Submucous Fibrosis: A Randomised Clinical Trial

Sanika Vaje, Manjushri Waingade, Raghavendra S Medikeri

Introduction: Oral Submucous Fibrosis (OSMF) is a chronic, potentially malignant oral disorder that is progressive in nature. Steroids are the mainstay in the treatment of OSMF; however, considering their side effects and contraindications, natural agents such as curcumin and spirulina are used as alternative therapies for OSMF. Aim: To assess and compare the efficacy of curcumin and spirulina in the management of OSMF. Materials and Methods: This randomised clinical trial was conducted in the Department of Oral Medicine and Radiology at Sinhgad Dental College and Hospital, Pune, Maharashtra, India from November 2023 to July 2024. The trial included 52 subjects clinically diagnosed with OSMF (Stage I and Stage II), who were equally divided into two groups: Group I (curcumin capsules 300 mg twice a day) and Group II (spirulina capsules 500 mg twice a day) for three months. Clinical parameters such as burning sensation, mouth opening, and tongue protrusion were evaluated at baseline and upto three months. The data were analysed using frequency and mean values. The paired t-test was used to compare study characteristics, and the unpaired t-test was used to compare the differences between the two groups. Results: The mean age of the study participants was 35.94±12.12 years (male: 35.58±12.19; female: 40.25±11.79). The burning sensation in Group I was 5.92±2.56 and in Group II was 6.42±1.793 at baseline, which reduced to 1.04±1.18 and 1.15±1.255, respectively, at the end of three months. The mouth opening in Group I was 33.46±8.38 and in Group II was 35.38±8.110 at baseline, which increased to 34.15±8.16 and 36.12±7.881, respectively, at the end of three months. The tongue protrusion in Group I was 42.81±8.40 and in Group II was 45.85±8.418 at baseline, which increased to 43.12±8.32 and 46.15±8.394, respectively, at the end of three months. There was improvement in all three parameters at subsequent visits, which was highly statistically significant in both groups when compared from baseline to three months (p-value <0.001). The comparison between Group I and Group II at three months revealed a non statistically significant difference in burning sensation (p-value=0.734), mouth opening (p-value=0.382), and tongue protrusion (p-value=0.196). Conclusion: The results suggest that both drugs are equally effective in reducing burning sensation and improving mouth opening and tongue protrusion. Therefore, natural agents, including spirulina and curcumin, can be effectively used in the management of OSMF.

Effect of the COVID-19 Outbreak on Patients with Oral Premalignant Lesions and Patients Requiring Maxillofacial Prosthesis in a Tertiary Dental Care Centre, Kerala, India: A Cross-sectional Study

Introduction: Oral cancer is one of the most prevalent cancers in India. The implementation of preventive programs by the government has played a crucial role in improving patient prognosis through early detection. However, the nationwide lockdown imposed due to the Coronavirus Disease 2019 (COVID-19) pandemic significantly affected patients with non COVID-19 illnesses and disrupted preventive healthcare services and clinics operated by various government agencies. Aim: To compare the proportion of patients diagnosed with oral premalignant lesions among those screened one year before and one year after the COVID-19 outbreak in a tertiary dental care centre in Kerala, India. Materials and Methods: The present cross-sectional study was in the Department of Prosthodontics, Government Dental College, Alappuzha, southern Kerala, India, from April 2019 to March 2021, based on medical records. The proportion of patients diagnosed with oral premalignant lesions before the COVID-19 outbreak (group 1) (April 1, 2019, to March 31, 2020) was compared with the proportion of similar cases after the outbreak (group 2) (April 1, 2020, to March 31, 2021). Additionally, the proportion of patients rehabilitated with maxillofacial prostheses during the same period was analysed. Statistical analysis was conducted using the Shapiro-Wilk and Kolmogorov-Smirnov tests to assess data normality. Chi-square tests were performed to compare proportions, while an independent t-test was used to compare patient data before and after the COVID-19 outbreak. A p-value of <0.005 was considered statistically significant. Results: In group 1, 6030 patients were screened, of which 81 (1.34%) had premalignant lesions and 14 (0.232%) required maxillofacial prosthetic rehabilitation. While in group 2, 19,963 patients were screened, of which 145 (0.72%) patients presented with premalignant lesions and 27 (0.135%) patients required maxillofacial prosthetic rehabilitation. The analysis revealed no significant differences in the proportion of patients diagnosed with oral premalignant lesions among the total screened population before and after the COVID-19 outbreak (p-value=0.8829). Similarly, there was no statistically significant change in the proportion of patients rehabilitated with maxillofacial prostheses between the two periods (p-value=0.9567). Conclusion: The proportions of patients diagnosed with premalignant lesions among the total screened population and those rehabilitated with maxillofacial prostheses did not differ significantly before and after the COVID-19 outbreak.

Inflammatory Biomarkers as Outcome Measures in Physiotherapy Interventions for Knee Osteoarthritis: A Systematic Review

Bhavna Anand, Pragya Kumar, Chitra Kataria

Introduction: Knee Osteoarthritis (OA) is a prevalent musculoskeletal disorder characterised by joint pain and reduced mobility. As a non pharmacological treatment option, physiotherapy interventions have gained attention for their potential to alleviate symptoms and improve function in patients with knee OA. Recent studies suggest that inflammatory biomarkers may play a significant role in assessing the effectiveness of these interventions. Aim: To explore the relationship between inflammatory biomarkers and physiotherapy outcomes in patients with knee OA. Specifically, it investigates how changes in biomarkers such as C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor-alpha (TNF-α) correlate with clinical improvements following physiotherapy treatments. Materials and Methods: In this systematic review, a comprehensive literature search was conducted across databases, including PubMed, Web of Science and the Cochrane Library, focusing on studies published between 2000 and 2022. The search targeted research examining the impact of physiotherapy interventions on inflammatory markers associated with knee OA. Specific attention was given to biomarkers such as CRP, IL-6, and TNF-α, alongside their relationship with treatment outcomes. The following keywords guided the search strategy: “OA of the knee,” “physical therapy,” “inflammatory markers,” “CRP,” “IL-6,” “TNF-α” and “treatment outcomes.” Studies were included if they reported biomarker levels (CRP, IL-6, TNF-α) before and after physiotherapy interventions and assessed the clinical outcomes of knee OA treatments. The search also focused on studies investigating the effects of specific physiotherapy modalities, such as exercise therapy or manual therapy, on inflammatory markers and knee OA symptoms. Exclusion criteria were applied to eliminate studies that focused solely on pharmacological treatments or that lacked sufficient reporting of pre- and postintervention biomarker levels. This search strategy aimed to gather robust evidence on the efficacy of physiotherapy in managing inflammatory processes and improving clinical outcomes for individuals with knee OA. Results: The review identified several studies indicating that physiotherapy interventions can significantly reduce levels of inflammatory biomarkers in knee OA patients. Notable findings included reductions in CRP, IL-6 and TNF-α levels, which were associated with improved clinical outcomes such as pain relief and enhanced functional mobility. However, variability in study designs, intervention types and biomarker measurement techniques posed challenges in establishing definitive conclusions. Conclusion: The evidence suggests that physiotherapy may effectively lower inflammatory biomarker levels and enhance clinical outcomes in individuals with knee OA. Nonetheless, the heterogeneity in methodologies underscores the necessity for standardised protocols in future research. Further investigations are essential to elucidate the precise mechanisms linking physiotherapy interventions to changes in inflammatory biomarkers and their implications for managing knee OA.

Study of NF-κB Gene Promoter Region {rs28362691 (-94 ins/del ATTG)} Polymorphism in Patients with Bipolar Disorder: A Case-control Study

Introduction: Bipolar Disorder (BD), a multifactorial disorder, is associated with increased proinflammatory cytokines due to chronic low-grade inflammation. It affects a relatively younger population. A transcription factor, Nuclear Factor Kappa-B (NF-κB) has an essential role in regulating the cascade of inflammatory responses to psychological stress that occurs in BD. Polymorphism of its promoter region has been a matter of discussion in recent years in schizophrenia but rarely any study has been done in BD. Aim: To evaluate the NF-κB promoter gene polymorphism in healthy subjects and in both types of BD patients, those with mania, and those with depression. Materials and Methods: The current case-control study was conducted at the Department of Biochemistry, SCB Medical College, Cuttack, Orissa, India from March 2020 to February 2022. Individuals aged 18-30 years with BD were included in the study group and age-matched healthy individuals in the control group. A total of 100 cases of newly diagnosed BD (61 BD patients with depressive phase and 39 BD patients with manic phase) and 100 controls were included in the study. Demographic variables such as age and Body Mass Index (BMI) were recorded. A sample of blood was collected from all the participants for genotyping of BD patients. DNA was extracted from Ethylene Diamine Tetraacetic Acid (EDTA) blood and NF-κB gene polymorphism was seen by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method in gel electrophoresis. The quantitative statistical analysis was conducted using SPSS. A p-value of ≤0.05 was considered statistically significant. Results: The common genotype found was del/del in patient groups. Among patients of depression, 32 out of 61 (52.46%) had del/del allele. Similarly in mania patients, 23 out of 39 (58.97%) had del/del allele. The odds of individuals developing BD with depression were the highest in the del/del {9.93 (4.36-22.4)} group. The odds of developing BD with mania were higher in the del/del group {12.94 (5.19-32.24)} than that in the ins/ins group {0.09 (0.04-0.23)}. The del/del type of genotype is higher in mild, moderate, and severe forms of depression as compared to ins/ins and ins/del. Conclusion: The presence of deletion allele in both phases of BD could throw some light on its pathophysiology in neuroinflammation. The findings of the study could lend scope to early genetic screening based on factors including family history to predict the course of BD based on the polymorphisms. This will help strategise the management and genetic counselling approach.

Evaluation of Oral Antidiabetes Drugs in Patients of Uncontrolled Type 2 Diabetes Mellitus: A Cohort Study

Introduction: The prevalence of uncontrolled Type 2 Diabetes Mellitus (T2DM) is higher due to non compliance to non pharmacological measures or pharmacotherapy, or due to disease progression, despite the availability of various oral antidiabetic drugs. Aim: To evaluate Oral Antidiabetic Drugs (OADs) in terms of treatment outcome as well as adherence. Materials and Methods: This was a single-centre cohort study, patients of uncontrolled T2DM on OAD(s) were enrolled for 12 months and followed-up monthly for six months. Details of blood sugar levels and antidiabetic treatment were recorded at each visit. Adherence to Antidiabetic Diet (ADD) and OAD(s) was studied using drug adherence diary, pill count method and Medication Adherence Report Scale (MARS-5) questionnaire. Data was presented in percentage, mean, standard deviation or as p-value (Z test of significance). Results: A total with 56 patients with uncontrolled T2DM were included in the study. There were 36 (64%) female patients, and mean age group and Body Mass Index (BMI) of patients was 57.14±10.3 years and 26.4±5.53 kg/m², respectively. Hypertension was present in 45 (80%) of patients. There was statistically significant reduction in mean HbA1c% to 6.85±0.83% compared to the baseline. Percentage patients prescribed single OAD decreased, and that described dual OADs regimen increased during study period. At time of enrollment, a total of 29 (52%) patients were adherent to ADD, and 44 (79%) were adherent to OAD(s). By the end of the study, 49 (94%, n=52) patients were adherent to ADD, and 51 (98%, n=52) patient were adherent to OAD(s). MARS-5 assessment showed that main reason for non adherence was that patients forgot to take the medicine; Adverse Drug Reactions (ADRs) was observed in seven patients, mainly belonged to gastrointestinal system organ class. Conclusion: Regular assessment of T2DM patients aids in monitoring of blood glucose levels and treatment modification. Increased number of OAD(s) and complexity of the regimen reduce drug adherence in the uncontrolled T2DM patients. Implementation of different tools for drug adherence evaluation in uncontrolled T2DM patients reinforces the importance of treatment adherence for better therapeutic outcome.

Clinical Profile and Outcome of High Flow Nasal Cannula Therapy in Children with Acute Respiratory Distress: A Single Centre Retrospective Cohort Study from Southern India

V Revathi, S Jagadeeswari, S Sundari

Introduction: High Flow Nasal Cannula (HFNC) therapy is being widely used as a treatment option for acute respiratory support prior to tracheal intubation or invasive ventilation. HFNC is a form of therapy in which high concentrations of oxygen, with adequate humidity and temperature, are administered non invasively via a nasal cannula. This approach has been shown to reduce airway resistance and improve lung compliance. While there are studies in Western literature regarding the efficacy of HFNC therapy in children in developed countries, there is still a paucity of data on the outcomes and efficacy of HFNC therapy in children in developing countries. Aim: To describe the clinical profile and outcomes of HFNC therapy in children admitted to a Paediatric Intensive Care Unit (PICU) with acute respiratory distress, as well as to identify the risk factors for failure of HFNC therapy in these children. Materials and Methods: This was a retrospective cohort study conducted by analysing the case records of children admitted with severe respiratory distress to the PICU of a tertiary care hospital in Southern India during the period from January 1, 2023, to December 31, 2023. The results were analysed over a three-month period from January 1, 2024, to March 31, 2024. In this study, 55 children aged between one month and 18 years were included if they had received HFNC therapy for acute respiratory distress during the study period. Clinical and demographic data were collected and analysed with regard to the aetiology of acute respiratory distress, the indication for HFNC therapy, and the outcome. Results: During the study period, 55 (23.6%) of the 233 children admitted to the PICU required HFNC oxygen therapy for acute distress. Of these, 24 (43.6%) were children less than one year of age. The most common indication for HFNC therapy was bronchiolitis in acute respiratory distress (58.2%). In this study, 43 (78.2%) of the 55 children improved with HFNC; however, 12 children (21.8%) required escalation to invasive mechanical ventilation, which was considered a treatment failure. The reasons for treatment failures were analysed and found to include desaturation with worsening of the primary pathology and discontinuation of HFNC due to nasal discomfort, particularly in older children. Conclusion: This study concluded that HFNC therapy is beneficial, offering favourable outcomes and alleviating the need for more invasive forms of ventilation.

Prevalence of Partial Edentulism and Awareness to Restore the Same among the Patients Visiting a Tertiary Dental Care Centre in Ambala, Haryana, India: A Cross-sectional Study

Satvika Prasad, Sandeep Garg

Introduction: Dental health is essential for overall well-being, affecting many aspects of an individual’s life, including physical health, social interactions and self-esteem. One significant issue in dental health is partial edentulism, which is the condition characterised by the loss of one or more natural teeth. A comprehensive understanding of partial edentulism necessitates a thorough exploration of its epidemiology. These studies not only shed light on the extent of the issue but also provide valuable insights into demographic patterns, contributing factors and disparities that may exist across different populations. Aim: To assess the prevalence of partial edentulism and the awareness of options for restoration among patients visiting a tertiary dental care centre in Haryana, India. Additionally, to evaluate the association of partial edentulism with socio-demographic factors, including age, gender, education level and total family income. Materials and Methods: This cross-sectional study was carried out at MM College of Dental Sciences and Research, Mullana, Ambala, Haryana, India. The duration of the study was six months (June 2022 to November 2022). A total of 507 patients were assessed. Questions regarding general information, economic status, reasons for the loss of teeth and the types of treatment taken for missing teeth were asked. Patients were also examined clinically for missing teeth and the type of prosthesis used. The collected data was then tabulated, analysed and subjected to a Chi-square test to evaluate the relationship of partial edentulism with socio-demographic factors. Results: The prevalence of partial edentulism among the study population was 72.90%. The major reason for tooth loss was caries, followed by caries coupled with periodontal problems. Most of the partially edentulous patients were not using any prosthesis and the major reasons for this were a lack of awareness, the cost of treatment, or the patients not feeling any requirement for a prosthesis. The association of partial edentulism with age, education level and total family income per month was found to be statistically significant (p<0.05), except for the gender of the patients. Conclusion: It can be concluded that the prevalence of partial edentulism was 72.9% and a significant association was found between partial edentulism and socio-demographic factors. However, no association was observed in relation to gender.

Hyponatremia in Cirrhosis: Clinical Outcomes and Comparative Analysis of Different Treatment Approaches

Introduction: Hyponatremia is a common electrolyte disturbance in cirrhotic patients, resulting from impaired renal water excretion due to elevated levels of Antidiuretic Hormone (ADH) and is strongly associated with morbidity and mortality. Despite its significance, optimal management strategies remain debatable. Aim: To evaluate the impact of varying levels of hyponatremia on the clinical outcomes of patients with liver cirrhosis and assesses the efficacy of different treatment modalities. Materials and Methods: A prospective interventional study was conducted on 120 cirrhotic patients with hyponatremia at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. Patients were categorised into five groups based on sodium levels: Group 1 (131-134 mEq/L), Group 2 (126-130 mEq/L), Group 3 (121-125 mEq/L), Group 4 (110-120 mEq/L), and Group 5 (<110 mEq/L). Treatment included albumin (20 g/day for the first three days, followed by 20 g/week), midodrine (5 mg three times daily), or a combination of both (albumin as above plus midodrine 5 mg three times daily). Patients were followed for six months, and sodium correction and mortality outcomes were analysed statistically. Results: Most patients presented with mild to moderate hyponatremia, with Groups 1 and 2 comprising 64.2% of the cohort. Sodium correction was most significant in Group 3 (121-125 mEq/L) with albumin plus midodrine (7.4-10.0 mEq/L at six months), while midodrine monotherapy showed the least improvement across all groups. Mortality was highest in Group 5 (<110 mEq/L; 100%) and among patients receiving midodrine alone in Group 4 (60%). Pairwise analysis in Group 2 revealed a significant advantage of combination therapy over midodrine alone (p-value=0.035). Conclusion: Hyponatremia significantly impacts survival. Combination therapy with albumin plus midodrine demonstrated superior sodium correction and trends toward better survival. Midodrine monotherapy was associated with the poorest outcomes.

Evaluation of Serum Cholesterol Level as a Risk Factor for Developing Surgical Site Infections following Clean Elective Surgery: A Prospective Cohort Study

Introduction: Surgical Site Infection (SSI) is defined as an infection occurring in an incisional wound within 30 days of the procedure or within one year if a prosthesis is implanted. SSIs increase hospital stays, expenditures, morbidity and significantly impact patients’ mental wellbeing, causing anxiety, stress and potential emotional distress. A multitude of patient-related, surgical and physiological variables contributes to the heightened risk of developing SSIs. Addressing patient-related risk factors for SSIs involves proactive measures such as optimising preoperative health, managing blood sugar and albumin levels and promoting healthy lifestyle choices such as smoking cessation. Aim: To evaluate serum cholesterol levels as a risk factor for developing SSI. Materials and Methods: A prospective cohort study was conducted at a tertiary healthcare centre from January 1st, 2023, to December 31st, 2023. It included 107 patients undergoing clean elective surgery. The relation of preoperative and postoperative serum cholesterol levels, serum High-Density Lipoproteins (HDL), serum Low-Density Lipoproteins (LDL), serum Very Low-Density Lipoproteins (VLDL) and serum triglycerides to SSI was studied. The data were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0 and the Student’s t-test was employed to obtain the results. Results: Out of 107 cases, SSI was observed in 23 patients (21.5%). Among these cases, there were 54 males and 53 females, with a mean age of 43.50±16.29 years. This study concluded that deranged HDL was associated with 65.22% of cases with SSI (p-value <0.001). Regarding preoperative cholesterol levels, 86.96% of patients without SSI had normal cholesterol, compared to 82.14% in those with SSI (p-value=0.585). For postoperative cholesterol levels, 91.3% of patients without SSI had normal cholesterol, versus 89.29% in those with SSI (p-value=0.778). Conclusion: The association of preoperative and postoperative serum cholesterol levels in the development of SSI could not be established in this study. However, serum HDL emerged as a good prognostic indicator for SSI after clean elective surgery. It should be checked and optimised in all cases prior to surgery.

A CBCT Analysis on Prevalence, Morphology, and Assessment of Lingual Wall Thickness of C-shaped Mandibular Second and Third Molars in an Eastern Indian Population: A Retrospective Observational Study

Introduction: Root canal anatomy can vary significantly across different ethnic groups, impacting treatment approaches. The presence of a thin lingual wall and a narrow isthmus in C-shaped canals poses a risk of strip perforation, making it challenging for clinicians to fully understand and manage their complex anatomy. A thorough understanding of the configuration of C-shaped canals, including morphologic variations and lingual wall thickness dimensions, is essential for preventing instrumentation errors and ensuring the success of root canal treatment. Aim: To evaluate the prevalence, morphology, and lingual wall thickness of C-shaped root canals in mandibular second and third molars among an Eastern Indian population using Cone Beam Computed Tomography (CBCT). Materials and Methods: This retrospective observational study was conducted in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India from February 2024 to July 2024. Out of the CBCT scans obtained from 426 patients, a total of 1,416 teeth were analysed, including mandibular second and third molars. The primary inclusion criteria were CBCT scans of fully erupted mandibular second and third molars. The methodology involved evaluating CBCT scans at three levels: coronal, middle, and apical. Additionally, the lingual wall thickness was measured at three zones (coronal, middle, and apical) for each C-shaped canal identified. Demographic parameters, including age and gender, were recorded for each patient to identify any potential associations with canal morphology and lingual wall thickness. For statistical analysis, the Chi-square test was used to analyse categorical variables, and the Kruskal-Wallis test was employed for continuous variables. The level of significance was set at p-value <0.05. Results: A total of 426 CBCT scans were screened, and 1,416 teeth (852 mandibular second molars and 564 mandibular third molars) in 237 males (55.63%) and 189 females (44.3%) were assessed for the presence of a C-shaped canals. The average age of participants was 29.3±8.78 years, with younger individuals having a higher incidence rate (p-value=0.0033). The incidence of C-shaped canals was 6.35% (n=90). Females had a higher proportion of C-shaped canals (71.1%) compared to males (26/90, 28.9%) (p-value <0.0001). Bilateral C-shaped canals were found in 36/54 cases (66.66%), with 29/44 (65.91%) and 7/10 (70%) significantly more prevalent than unilateral cases, which had 15/44 (34.09%) and 3/10 (30%) mandibular second and third molars, respectively (p-value=0.014). C-shaped canals were strongly linked to fused roots in 79 (87.8%) teeth (p-value <0.001). Type C1 was the most prevalent design, with 30 teeth (33.3%) at the coronal level and 36 teeth (40%) at the middle level, while Type C4 dominated the apical level with 43 teeth (47.8%) (p-value <0.001). Type C2 had thinner mesial lingual walls (p-value=0.02). Conclusion: The study identified a higher prevalence of C-shaped canals in mandibular second molars compared to third molars, with a significantly greater occurrence in females than in males. Type C1 configurations were predominant at the coronal and middle levels, while Type C4 was most frequent at the apical level. Lingual wall thickness was thinnest in Type C2 configurations at the mesial zone. These findings highlight the need for clinicians to account for the complex anatomy of C-shaped canals during root canal therapy.

Efficiency of Magnesium Sulphate as a Sole Muscle Relaxant for General Anaesthesia with Vecuronium Bromide for Tracheal Intubation: A Prospective Interventional Study

Bhupendra Singh, Praveen Kumar, D Harsha, Vikram Singh Rathore, Ram Murti Sharma

Introduction: Neuromuscular blocking drugs are the standard for tracheal intubation; however, misuse can cause allergies, intraoperative awareness and prolonged blockage. As a result, intubation without these drugs is being explored, with magnesium sulphate as an alternative. Aim: To assess the effect of magnesium sulphate on intubating conditions after the induction of anaesthesia without a neuromuscular blocking drug. Materials and Methods: This was a prospective interventional study at the Department of Anaesthesiology, Armed Forces Medical College and Hospital in Pune, Maharashtra, India from June 2012 to June 2014 involving 200 patients, divided into two groups of 100 each: Group M and Group V. The study included both male and female patients with an American Society of Anaesthesiologists (ASA) physical status of I or II, Mallampati Class I or II, aged between 18 and 50 years. All patients were scheduled for elective surgery under General Anaesthesia (GA) with endotracheal intubation. In Group M, patients received a 40 mg/kg magnesium infusion over five minutes, followed by a 2.5 mg/kg injection of propofol intravenously. Laryngoscopy was performed after two minutes and then a 0.5 mg/kg intravenous injection of atracurium was administered one minute after intubation. In Group V, patients were given 100 mL Normal Saline (NS) over five minutes, followed by induction with 2.5 mg/kg propofol intravenously and a 0.1 mg/kg intravenous injection of vecuronium, with laryngoscopy performed after three minutes. Intubation conditions were evaluated using the Copenhagen Consensus Conference and Mean Arterial Pressure (MAP) and pulse rates were also recorded during the study. Demographic data were compared using t-tests and Chi-square tests. Results: The mean ages for these groups were 39.78±8.42 years for Group V and 38.91±7.63 years for Group M. In terms of clinically acceptable intubation conditions, Group V had 100 patients (100%), while Group M had 78 patients (78%) (p>0.05). In the Copenhagen scoring system for intubating conditions, Group V (94 patients) scored significantly better than Group M (21 patients). Pulse rate and MAP were comparable until laryngoscopy, but were significantly higher in Group M after T5 (p<0.05). The duration of intubation was shorter in Group V, averaging 18.73±2.26 seconds, compared to 22.71±4.70 seconds in Group M (p<0.01). Conclusion: The administration of magnesium sulphate before the induction of anaesthesia significantly lowers intubating conditions without requiring neuromuscular blocking agents. Magnesium sulphate serves as an alternative to a non depolarising muscle relaxant to avoid the side-effects caused by muscle relaxants, but it is inferior to a non depolarising muscle relaxant.

Effect of Epidural Volume Extension with 10 mL versus No Saline on Combined Spinal Epidural Anaesthesia for Elective Lower Limb Surgeries: A Randomised Controlled Study

Utkarshini Kedia, Vaibhavi Singh

Introduction: Combined Spinal Epidural Anaesthesia (CSEA) is a regional anaesthetic technique that offers flexibility in prolonging anaesthesia and improving postoperative analgesia compared to spinal anaesthesia. Aim: To compare the effects of Epidural Volume Extension (EVE) with 0 mL and 10 mL of 0.9% normal saline on spinal anaesthesia in lower limb orthopaedic surgeries. Materials and Methods: A randomised controlled study was conducted at Deen Dayal Upadhyay Hospital, Delhi, India on 72 American Society of Anaesthesiologists (ASA) I and II patients undergoing elective orthopaedic surgeries under CSEA. Patients were assigned to two groups: S0 with 0 mL and S10 with10 mL of 0.9% normal saline on spinal anaesthesia using 12.5 mg (2.5 mL) of 0.5% hyperbaric bupivacaine in lower limb orthopaedic surgeries lasting less than three hours. Sensory block onset (pinprick method), motor block onset (Bromage scale), level of block, time to maximum sensory block, two-segment regression, and time to first epidural top-up were recorded. Haemodynamic parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and SpO₂} were monitored preoperatively, intraoperatively and postoperatively. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.1, with p-value <0.05 considered significant. Results: Both groups, group S0 (N=36) and group S10 (N=36), were comparable in terms of age, gender, ASA grade and surgery duration. A significantly higher sensory block level was achieved in S10, (58.33% reached T4 vs. T8–T10 in S0 (p-value <0.001). Time to maximum sensory blockade was shorter in S10 (8.75±1.13 minutes vs. 10.17±3.85 minutes; p-value=0.042), while two-segment regression was longer (100.61±6.02 minutes vs. 76.72±7.66 minutes; p-value=0.001). Epidural top-ups were required in 83.33% of S0 patients vs. 16.67% in S10, with a longer mean time to top-up in S10 (147.5±4.97 minutes vs. 111.87±7.56 minutes; p-value <0.001). Haemodynamic parameters were similar across groups (p-value>0.05). Conclusion: EVE with 10 mL of 0.9% normal saline enhances sensory block level, prolongs two-segment regression time and reduces the need for epidural top-ups in CSEA for lower limb surgeries. This technique maintains haemodynamic stability, making it a safe and effective modification of CSEA. Compared to no volume extension, EVE improves intraoperative conditions and enhances postoperative analgesia.

Comparative Evaluation of Fluoride-releasing Properties in Nano-formulated and Conventional Glass Ionomer Cements: An In-vitro Study

E Dhivyasri, Jessy Paulraj, Subhabrata Maiti

Introduction: Numerous efforts have been made to enhance the properties of Glass Ionomer Cements (GICs) using nanotechnology. One of the most advantageous properties of GICs is their ability to release fluoride. Aim: To compare and evaluate the fluoride release in nano-formulated and conventional GICs. Materials and Methods: This in-vitro study conducted at the Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, Tamil Nadu, India, assessed the influence of Chitosan-Titanium-Zirconia-Hydroxyapatite (Ch-Ti-Zr-HA) nanoparticles on the fluoride-releasing ability of GICs. A Ch-Ti-Zr-HA nano formulation was synthesised using a single-step, green-mediated process and was incorporated into GICs at concentrations of 3%, 5% and 10% (Groups I, II and III), with conventional GIC serving as the control (Group IV). Specimens from each group (n=30) were immersed in 10 mL of deionised water in sealed polyethylene vials. Fluoride release was measured using a fluoride Ion-Selective Electrode (ISE) in combination with Total Ionic Strength Adjuster Buffer (TISAB). Measurements were taken at 24 hours, on the third, seventh, 14th and 28th days, using an ion analyser (Orion Star™ A214 pH/ISE Meter). Statistical analysis was performed using One-way Analysis of Variance (ANOVA), followed by Tukey’s post-hoc test to determine significant differences between the groups. Results: The nano-formulated GICs demonstrated higher fluoride release compared to conventional GICs at all time points. All samples initially showed high fluoride release, which gradually decreased over time. The total fluoride release increased from day 1 to day 28 across all concentrations of the nano-formulated GICs. Among these, the 10% concentration released a significantly greater amount of fluoride at every time point: 170.03±0.512 on day 1, 164.83±0.427 on day 3, 155.10±0.275 on day 7, 126.20±0.309 on day 14 and 76.16±0.107 on day 28, compared to the other groups (p-value <0.05). Conclusion: In all the experimental groups, the addition of the nano formulation to the GICs had an accelerating effect on their fluoride-releasing property.

Association between the PaO₂/FiO₂ Ratio and Pneumonia Severity Index in Pneumonia Patients with ARDS: A Cross-sectional Study from a Critical Care Unit

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Trupti Jansari, Amit Chauhan

Introduction: Pneumonia is a major concern in patients in critical care units. Severe pneumonia can lead to hypoxaemia and Acute Respiratory Distress Syndrome (ARDS). The Partial pressure of arterial Oxygen (PaO₂), Fraction of inspired Oxygen (FiO₂) ratio and Pneumonia Severity Index (PSI) are helpful in assessing the severity of pneumonia and ARDS. Identifying the correlation between the PaO₂/FiO₂ ratio and PSI can improve patient management strategies and outcomes in cases of pneumonia. Aim: To analyse the PaO₂/FiO₂ ratio and the PSI in pneumonia patients with ARDS and examine their association. Materials and Methods: A cross-sectional study was conducted in the Critical Care Unit, Smt. B.K. Shah Medical Institute and Research Hospital, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Gujarat, India, from October 2024 to November 2024. Study involved 67 pneumonia patients with ARDS, aged over 18 years, who were admitted to the Critical Care Unit. Following informed consent, detailed history taking and clinical examinations were performed. Routine investigations, including Arterial Blood Gas (ABG), blood urea nitrogen, serum sodium, serum glucose, haematocrit and chest X-ray, were conducted. The PSI score and PaO₂/FiO₂ ratio were calculated at the time of pneumonia diagnosis. Statistical tests for prevalence and associations within the data were applied, with the Chi-square test used and a p-value of less than 0.05 considered statistically significant. Results: The mean±Standard Deviation (SD) age of the study participants was 49±9.79 years, with 34 (50.7%) females and 33 (49.3%) males. The majority of the study subjects resided in rural areas (83.6%). The mean±SD PaO₂/FiO₂ ratio among the study subjects was 218.55±60.98 and the mean±SD PSI score was 117.97±39.80. A PaO₂/FiO₂ ratio of 201-300 mmHg was observed in 39 (58.2%) patients, 101-200 mmHg in 24 (35.8%) patients and ≤100 mmHg in 4 (6%) patients. Patients classified in higher-risk categories included 32.84% in class IV and 35.82% in class V, reflecting an increased risk of mortality. Statistical analysis revealed a highly significant association between PSI class and the PaO₂/FiO₂ ratio (p-value <0.001), indicating that patients with higher PSI class severity are more likely to develop severe ARDS. Conclusion: The study emphasises the strong association between the PaO₂/FiO₂ ratio and the PSI in pneumonia patients with ARDS. A decline in the PaO₂/FiO₂ ratio is linked to higher PSI classes, reflecting greater disease severity and a higher risk of mortality. These findings highlight the value of both metrics in assessing patient risk and guiding clinical management. By incorporating the PaO₂/FiO₂ ratio and PSI into their evaluations, healthcare providers can better prioritise care and potentially reduce mortality in critical care settings.

Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals

Introduction: Guideline-Directed Medical Therapies (GDMT) are evidence-based treatments recommended by clinical practice guidelines for the management of Cardiovascular Diseases (CVDs). While GDMT is foundational for treating Heart Failure (HF), its adoption promotes uniform, evidence-driven practices across various cardiovascular conditions. This therapy includes drug classes such as Beta-Blockers (BB), Angiotensin-Converting Enzyme inhibitors, Angiotensin-Receptor Blockers, and Angiotensin Receptor-Neprilysin Inhibitors (ACEi/ARB/ARNI), Mineralocorticoid Receptor Antagonists (MRAs), and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i). Implementing GDMT can enhance cardiac function, improve quality of life and reduce hospitalisation and mortality risks. Aim: To understand the preferences of drug choice among Indian Healthcare Practitioners (HCPs) regarding the adaptation of GDMT in CVD management. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in India from December 2022 to March 2023. Participants (n=93) included cardiologists, electrophysiologists and cardiophysicians, who were actively involved in managing CVD. A predefined questionnaire consisting of seven questions, developed from existing literature, guidelines and expert opinions, was used. Responses were digitally analysed, with descriptive statistics presented as numbers and percentages. Results: For hypertension management in Acute Coronary Syndrome (ACS), telmisartan (60.22%) was the most preferred ARB, followed by metoprolol (48.39%; BB), amlodipine (39.78%; Calcium Channel Blockers [CCB]), and torsemide (32.26%; diuretics). For patients with diabetes and ACS, SGLT2i (89.29%) were favoured. Clopidogrel (56.99%) was the preferred oral antiplatelet drug alongside aspirin in ACS. In Acute Decompensated HF (ADHF), the preferred sequential addition of GDMT includes loop diuretics (44.74%) as the first choice, followed by ARB, SGLT2i, and MRAs as subsequent choices. One in four HF patients was on ARNI (37.36%) and SGLT2i (35.62%), while three in four HF patients were on BB (36.99%) and ACEi/ARBs (34.28%). In HF patients on loop diuretics and MRAs, the preferred doses were torsemide 10 mg with spironolactone 25 mg (57.32%) and torsemide 10 mg with spironolactone 50 mg (37.80%). In addition to symptomatic treatment with loop diuretics in HF patients, 72.50% of HCPs preferred ARNI, and 35.0% preferred ARBs as combination therapy. Conclusion: ARBs and BBs were preferred for hypertension in ACS, while SGLT2i were favoured for diabetes. Clopidogrel was the most popular P2Y12 inhibitor in ACS. For HF, HCPs favoured sequential therapy, with loop diuretics and ACEi/ARBs as the first and second choices and preferred combinations of ARNI or ARBs with loop diuretics for symptomatic HF.

Assessment of Signs of Anxiety and Depression Post Ilizarov Fixation: A Prospective Observational Study

Vishal Patil, Raj Pawar

Introduction: The management of various lower limb bones and in some cases upper limb bones, using the Ilizarov ring fixator is a well-known method of fixation. However, the psychological effects it has post-fixation on the mental health of patients are often overlooked. The authors conducted a study to assess signs of anxiety and depression following fixation to illuminate this aspect. Aim: To thoroughly investigate and highlight the signs of anxiety and depression that may emerge in patients after undergoing Ilizarov fixation surgery. Materials and Methods: This is a prospective observational study conducted from June 2023 to June 2024 in the Orthopaedics Department of Dr. D. Y. Patil Hostel, Pimpri, Chinchwad, Pune, Maharashtra, India. A total of 20 patients were selected for the study, which included cases of unilateral compound tibia fractures, tibia non union, femur non union and compound femur fractures in patients who underwent Ilizarov fixation. To evaluate signs of anxiety and depression, the used the Hospital Anxiety and Depression Scale (HADS). For each patient, the scale was administered during the hospital stay and three months following discharge. A paired t-test was used to compare the statistical values of the HADS system at the time of hospital stay and at the three-month follow-up following discharge. A p-value ≤0.05 was considered significant. Results: The results indicated a notable difference in anxiety and depression, with significantly lower p-values. Specifically, the p-value for anxiety was 0.008 when comparing hospital stay to three months post-discharge, whereas the p-value for depression was 0.005, which signifies active signs of anxiety and depression following the procedure. Conclusion: While the Ilizarov procedure has numerous benefits in improving the status of the affected limb over time, it also has debilitating effects on the mental status of patients, as demonstrated in the present study. Recommendations include counselling patients during follow-up to encourage psychological support and regular mental check-ups whenever possible.

The Burden and Menaces of Catheter associated Urinary Tract Infections in the Patients Admitted at the Critical Care Units: A Cross-sectional Study from a Tertiary Care Centre, Gujarat, India

Introduction: Catheter-associated Urinary Tract Infections (CAUTIs) represent a significant global health threat, leading to substantial morbidity and mortality, especially in Intensive Care Unit (ICU) settings. Aim: To evaluate the rate of CAUTIs and identify patient- and catheter-related risk factors contributing to UTIs and also to characterise the aetiological agents along with their antimicrobial resistance profiles. Materials and Methods: A cross-sectional study was conducted from October 2021 to September 2022, involving 85 patients with indwelling urinary catheters who had them in place for more than two consecutive days while admitted to the ICUs of a tertiary care centre. Urine samples were cultured and antibiotic susceptibility testing was performed using the Vitek-2 automated system. Data regarding patients’ demographic features, co-morbidities, catheterisation checklist and bundle care were collected via a questionnaire. Various patient- and healthcare worker-related risk factors were statistically analysed using p-values and odds ratios. Results: The CAUTI incidence rate was calculated to be 12.01 per 1000 urinary catheter days. Adherence to hand hygiene (p-value=0.02, OR=2.245), periurethral cleaning (p-value <0.0001, OR=3.675), use of sterile gloves (p-value <0.0001, OR=2.057) and maintenance of a closed drainage system (p-value=0.04, OR=2.057) were significantly associated with a reduced risk of CAUTI. Conversely, being older than 50 years (p-value=0.04, OR=1.650), residing in a rural community (p-value=0.003, OR=3.490), and having hospital stays exceeding seven days (p-value=0.006, OR=3.245) were identified as significant risk factors for the development of CAUTI. The most prevalent uropathogens were Escherichia coli (n=17/37, 46%) and Klebsiella pneumoniae (n=7/37, 19%), with a high proportion exhibiting Multidrug Resistance (MDR). Conclusion: To mitigate the burden of CAUTIs, it is essential to prioritise ongoing surveillance within ICUs, implement stringent infection control measures and promote antimicrobial stewardship.

Importance of Histological Pattern Recognition in Diagnosing Myeloproliferative Neoplasms in the Molecular Era: A Cross-sectional Study

Ramya Katta, Aparna Chinnam, Pasam Ramana Kumari

Introduction: Even after the inclusion of bone marrow features as major criterion in specific diagnosis of Myeloproliferative Neoplasms (MPNs), it is not given satisfactory importance in laboratory practice due to several reasons. Since bone marrow biopsy and histopathological examination is a simple procedure, proving its diagnostic utility in MPNs can be useful especially in resource-poor settings. Aim: To identify the importance and reproducibility of the histological pattern recognition in diagnosing MPNs within a blinded clinical scenario. Materials and Methods: This was a two-year cross-sectional analytical study done in the Department of Pathology at Guntur Medical College, Guntur, Andhra Pradesh, India from June 2021 to May 2023. Bone marrow biopsies from cases that were diagnosed as MPNs using a multidisciplinary comprehensive approach were included in the study. All the bone marrow biopsies were reviewed and re-evaluated by three experienced pathologists independently. The reviewers were blinded to clinical, laboratory and molecular data, excepting age and gender. Each pathologist gave an independent histological diagnosis based on his/her observations. Comprehensive multidisciplinary diagnosis was considered the gold standard to calculate diagnostic accuracy, sensitivity, specificity and degree of consensus of bone marrow histology. Data was analysed for kappa value to identify degree of agreement in all parameters between the different pathologists using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: A total of 47 cases of MPNs were included in the present. Highest diagnostic accuracy, specificity and sensitivity of bone marrow histology was obtained in Overt Myelofibrosis (OMF) (100%, 100%, and 100%, respectively), followed by Chronic Myeloid Leukaemia (CML) (80%, 85.7%, and 97%, respectively). Of all the morphological features tested for reproducibility, highest interobserver agreement was found in cellularity (kappa coefficient of 0.83), megakaryocytic hyperplasia (kappa coefficient of 0.88), and osteosclerosis (kappa coefficient of 0.82). Conclusion: There is a moderate level of agreement and reproducibility between different histological parameters and good accuracy, sensitivity and specificity of bone marrow histopathology in identifying various MPNs. This can be very useful in resource-poor settings and in the early stages of disease evolution.

Smart Phone Use and its Effect on Cognition: A Cross-sectional Study in Undergraduate Medical Students

Bageshree N Pande, Mitali Kumbhar

Introduction: Mobile smartphones have become an integral part of everyone’s life. However, concerns have been raised about the various health hazards associated with their use. The presence of smartphones among students reduces their attention span and acts as a distraction in their classes, which could lead to poor academic performance. Medical students, being an important element of society, need to be made aware of the health hazards of excessive smartphone use so that they can spread awareness among others, especially adolescents. Aim: This study aims to investigate the effect of smartphone use on academic performance and to associate the behavioural aspects of smartphone use with cognitive impairment in medical students. Materials and Methods: This observational cross-sectional study was conducted in the Physiology Department at Dr. DY Patil Medical College, Hospital and Research Centre, Pune, India, among first MBBS students from March to April 2024. Institute ethics committee clearance was obtained, and written informed consent was acquired from each participant. Participants were selected based on inclusion criteria that included a willingness to participate and a willingness to complete the questionnaire. They were provided with a validated questionnaire that included their personal details, followed by questions related to various aspects of mobile phone use. Their performance was assessed based on the marks (out of 100) in the Physiology theory paper of the first internal assessment examination. Out of a total of 250 first MBBS students, 72 were present on the day of the study. Out of these, eight were unwilling to participate, resulting in a total of 64 participants. The data was tabulated in an Excel sheet, and analysis was performed using SPSS 23. For analysis, participants were divided into three groups based on their theory marks (less than 50, 50-60, and 61 to 80). A chi-square test was used to find the association between theory marks and mobile phone use, with a p-value of less than 0.05 considered significant. Results: Eighteen students (28.12%) scored less than 50%, 26 students (40.62%) scored between 50% and 60%, while 20 students (31.25%) scored above 60%. Forty students (62.5%) use either glasses or contact lenses. Twenty-nine students (45.31%) started using mobile phones before 10th standard, 30 students (46.87%) began in 10th to 12th standard, and 5 students (7.81%) started after 12th. Thirty-five students (54.68%) use only 1-2 social media platforms, 27 students (42.18%) use 3-4, and only 2 students (3.12%) use more than 4. Eleven students (17.1%) use mobile phones for less than two hours daily, 37 students (57.81%) use them for 2-4 hours daily, and 16 students (25%) spend more than four hours on them. A total of 32 students, or 50%, use mobile phones just before going to sleep. Twenty-one students (32.81%) admitted that they use their mobiles as soon as they wake up in the morning. More than 50% of students use mobile phones or other electronic gadgets for studying and use them frequently between classes. Overall, mobile phone usage was reported to be higher among students who scored up to 60% compared to those who scored above 60%, although this difference was not statistically significant (p-value >0.05). Statistically, mobile phone use has not affected the academic performance of the students who scored less than 60%. Conclusion: Since the results of this study are not statistically significant, it can be concluded that mobile phone use has not affected the academic performance of undergraduate medical students. Future studies with a larger sample size and conducted across other professional year MBBS students can provide further insights.

Effects of Correction of Acidosis on Body Composition in Patients Suffering from Chronic Kidney Disease on Haemodialysis: A Prospective Interventional Study

Introduction: Metabolic acidosis is a common problem in patients with Chronic Kidney Disease (CKD) and those on maintenance haemodialysis. In resource-poor countries, financial constraints adversely affect the frequency of dialysis and compliance with medication. This leads to a worsening clinical condition for patients and an increased need for in-hospital care, often requiring intensive care, which further drives up treatment costs. Metabolic acidosis also has implications for bone and muscle health. Aim: To assess the changes in body composition (fat percentage and lean body mass), changes in third space fluid, biochemical parameters, the number of admissions and the requirement for blood transfusions before and after the correction of metabolic acidosis. Materials and Methods: This was a prospective, interventional study conducted in a tertiary care centre, Western India, in which 40 patients on maintenance haemodialysis were included. Bioelectrical Impedance Analysis (BIA) and biochemical parameters (Complete Blood Counts (CBC), renal function tests, serum calcium and phosphorus, liver function tests and blood gas analysis) were conducted at baseline before starting bicarbonate supplementation. The number of admissions and blood transfusions in the three months prior to the initiation of bicarbonate supplementation was noted. Oral bicarbonate supplementation was increased based on the baseline blood gas analysis. The same parameters were assessed after three months and analysed. Results: At the end of three months, a significant reduction (p-value <0.05) in creatinine, Extracellular Water (ECW) and lean body mass, along with an increased body fat percentage. There was a reduction in third space fluid and ECW, with no significant changes (p-value >0.1) in the weight and Body Mass Index (BMI) of patients was observed. Additionally, there was a significant improvement (p-value <0.05) in the serum protein and albumin levels of these patients. The number of hospitalisations decreased from 28 to 13 and the number of blood transfusions required also decreased from 31 to 13. Conclusion: The correction of acidosis improved metabolic parameters, resulting in an increase in fat percentage and a reduction in ECW and third space water without intracellular dehydration. There was a significant reduction in urea and creatinine values, as well as a significant decrease in hospitalisations and the number of blood transfusions required.

A Clinicoepidemiological Cross-sectional Study of Sexually Transmitted Diseases in Men who have Sex with Men Attending Tertiary Care Centre in Kerala, India

Prathyusha Prabhakar, S Darsan

Introduction: Men who have Sex with Men (MSM) is an umbrella term that describes a variety of men who engage in sexual activities with other men and thereby may transmit or acquire Human Immunodeficiency Virus (HIV) or other Sexually Transmitted Infections (STIs), but do not necessarily share the same sexual orientation, sexual identity or gender identity. MSM might be at increased risk for HIV and other STIs due to their sexual networks or behavioural or biological factors, including the number of concurrent partners, condomless sex, anal sex, or substance use. Conducting a detailed clinicoepidemiological study within the MSM population enables us to identify vulnerabilities and provide tailored counselling and care for them. Aim: To identify the trends of various STIs among the MSM population attending the Dermatology, Venereology and Leprosy Outpatient Department (DVL OPD). Materials and Methods: A hospital-based cross-sectional study was conducted at Karuna Medical College, Chittur, at DVL OPD, Kerala for one year, from March 2023 to February 2024. Those who were willing to provide consent and were aged between 15 to 45 years were included. The clinical and behavioural profile of each patient, along with the patterns of STIs, was recorded. Clinical examinations were supplemented with investigations performed wherever necessary. Results: This study included a total of 60 patients, of whom 30 (50%) were aged between 16 and 25 years. STIs were reported more commonly among patients involved in selling sex (Male Sex Workers, MSW) at a rate of 18 (30%). HIV was found in 6 (25%) patients and syphilis in 5 (21%), which are the major contributors, followed by Candidal Balanoposthitis (CBP), genital herpes and Non Gonococcal Urethritis (NGU). Among the affected group of 31 participants, 20 (64.5%) reported not using condoms, resulting in a p-value of 0.03, indicating a significant association with the acquisition of STIs. Conclusion: Unmarried young students and MSW represent relatively high-risk groups for STIs. An increasing trend of HIV and syphilis within the MSM population was observed. Awareness of sexual health should be promoted in schools and colleges. In the MSM population, it is crucial to enhance health education and condom use, along with appropriate management and follow-up of both patients and partners.

Comparison between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Repair for Unilateral Inguinal Hernia: A Prospective Interventional Study

Rajesh Kumar, Umesh Kumar Gupta, Anil Kumar, Shesh Kumar, Mohammad Yaseen

Introduction: Open and laparoscopic surgical methods are widely used for the treatment of inguinal hernias. Laparoscopic Transabdominal Preperitoneal (TAPP) repair is a minimally invasive approach and is one of the preferred methods for younger surgeons to treat inguinal hernias. Aim: To compare the intraoperative and postoperative complications, chronic pain, length of hospital stay and return to normal work associated with laparoscopic TAPP surgery and Lichtenstein open mesh repair for unilateral inguinal hernia in males. Materials and Methods: This prospective interventional study was conducted from January 2022 to December 2022 on 60 clinically diagnosed cases of primary unilateral direct and indirect inguinal hernias in the Department of Surgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India. Based on inclusion and exclusion criteria during, a total of 60 patients were included in the study and divided into two groups of 30 patients each using a random number table. In group A, patients underwent laparoscopic TAPP surgery, while in group B, Lichtenstein hernioplasty (open surgery) was performed. Patients were evaluated for intraoperative complications and postoperative pain using the Visual Analog Scale (VAS) for three consecutive days. They were followed-up one week postoperatively to monitor for common complications in both groups. Additionally, patients were followed-up at one month, three months and six months postoperatively for clinical recurrence of hernia and reports of pain in either group. The Chi-square test was used for comparison of categorical variables between the two groups and the Student’s t-test was used for continuous variables. Results: The overall mean age of the patients was 46.57±17.13 years, while the median age was 50 years. Vascular injury was present in one patient (2.33%) in group A (TAPP group). Intraoperative complications in group A and group B were statistically non significant for vas deferens injury, vascular injury, bladder injury and visceral injury. Postoperative complications during the first week of the postoperative period included stitch abscess and abdominal distension, which were statistically non significant. Seroma formation (c2=0.87, p-value=0.35), scrotal swelling (c2=0.27, p-value=0.61) and urinary symptoms (c2=0.00, p-value=1.00) were also non significant (p-value >0.05). Pain at one month, three months and six months follow-ups was not observed in group A, while in group B, pain was present in two patients (6.67%) at one month, one patient (3.33%) at three months and one patient (3.33%) at six months. Pain was statistically non significant in both groups. Recurrence of hernia at one month, three months and six months postoperatively was not observed in either group A or group B. The mean length of hospital stay in the TAPP group was 3±0.46 days, while in the Lichtenstein group it was 4±0.87 days. The mean time to return to normal work in the TAPP group was 6.6±1.22 days, while in the Lichtenstein group, the mean time was 14±3.37 days. Conclusion: In unilateral inguinal hernia, laparoscopic TAPP repair is safer and comparable to Lichtenstein repair in terms of complications. In the TAPP group, pain, length of hospital stay and time to return to normal work were lower compared to the Lichtenstein repair. In both groups, no hernia recurrence was observed at the six-month follow-up.

Flipped Classroom versus Traditional Lecture as a Teaching Learning Method for Undergraduate Medical Students: An Educational Interventional Study from Southern India

Introduction: The current competency-based undergraduate medical curriculum necessitates the cultivation of skills in self-directed learning, critical thinking and deep learning among learners. The flipped classroom is a teaching-learning method that can foster these skills. Aim: To compare the effectiveness of the flipped classroom versus traditional lectures as teaching-learning methods in final-year undergraduate students. Materials and Methods: An educational interventional crossover study was conducted in the Department of Paediatrics at Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India, from August 2023 to December 2023, involving 100 final-year MBBS students. They were randomly divided into two groups of 50 each. One group was taught using a flipped classroom approach, while the other received a traditional lecture for the first topic. The teaching-learning methods were interchanged for the second topic. Pretest and post-test scores were recorded and feedback was obtained from the students after the flipped classroom session. The Mann-Whitney U and Wilcoxon signed-rank tests were used for independent and paired samples, respectively. A p-value of <0.05 was considered significant. Results: There was no statistical significance in the post-test scores between the two teaching-learning methods for both topics 1 and 2 (p-value=0.194, p-value=0.493, respectively). Additionally, there was no statistical significance in the pretest to post-test score differences between the two teaching-learning methods for both topics (p-value=0.884, p-value=0.806). However, 97% of the students agreed that the flipped classroom was interactive and interesting and about 94% felt that their self-learning skills improved with the flipped classroom activity. Conclusion: The flipped classroom is not superior to traditional lectures as a teaching-learning method for undergraduate students. Nevertheless, most of the students preferred the flipped classroom due to its interesting and interactive nature.

Dental Ages of Children with Attention Deficit Hyperactivity Disorder versus Healthy Children Measured using Different Dental Age Estimation Methods: A Retrospective Observational Study

Melek Belevcikli, Deniz Sila Özdemir çelik

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioural disorder that is common in childhood and can lead to serious impairment in quality of life if, not treated. The dental development of children with ADHD may also be affected due to the effects of the medications they use or as a result of delayed growth and deficient development caused by the disorder. Aim: To evaluate the dental development of children with ADHD and healthy children using three different dental age estimation methods. Materials and Methods: A retrospective observational study was conducted at Bolu Abant Izzet Baysal University Paediatric Dentistry Clinic, Turkey for 6 months. The records of patients with ADHD and healthy subjects were retrospectively reviewed between January 2017 and January 2021. Two clinicians evaluated radiographs of ADHD and healthy patients using three different dental age estimation methods. The Analysis of Variance (ANOVA) test assessed the difference between three or more independent groups with normal distribution. The Post-hoc Bonferroni test determined the group or groups that created the difference. A p-value of less than 0.05 was considered statistically significant. Results: No statistically significant differences were obtained between the three different dental age calculation methods for the ADHD group and the control group (p>0.05). Conclusion: The dental ages of patients with ADHD were similar to their chronological ages and there was no delay due to the effect of the disease or the medications used in treatment. Although there was no statistically significant difference between all three methods in the Turkish population, Cameriere’s method underestimated chronological age, while Demirjian’s method tends to overestimate it.

Nail Features of Term Healthy Neonates: An Observational Study

Introduction: Nail disorders in neonates can be indicators of underlying dermatological or systemic disorders, such as Iso-Kikuchi syndrome, Y-shaped bifurcation of the distal phalanx and Nail Patella syndrome. However, there are very few studies describing the features of nails in newborns, especially in the Indian subcontinent. Aim: To study the morphological features of nails in term newborns. Materials and Methods: A descriptive observational study was conducted from November 2021 to July 2022 on term newborn babies born at and visiting Navodaya Medical College Hospital in Raichur, Karnataka, India. A total of 112 babies born to mothers without any co-morbidities were included in the study. Birth and antenatal history were recorded. Finger and toenails were systematically examined, photographed and data were collected regarding fingernail shape, toenail length, width, width ratio and pigmentation. Results: A total of 112 newborns were studied, of which 58 were males and 54 were females, with a mean age of 3±1.5 days. The mean fingernail length, width and width ratio were 4.70±0.53 mm, 3.41±0.11 mm and 0.55±1.95, respectively. Macronychia was observed in 39 newborns (34.8%). The most common fingernail shape was rectangular, observed in 91 (81.25%) cases. The lunula was present in 54 neonates (48.2%). The mean toenail length, width and width ratio were 2.7±0.17 mm, 3.23±0.73 mm and 0.56±1.78, respectively. Micronychia was noted in 65 neonates (58.0%) and macronychia in 8 (7.1%). Hyperpigmentation of the distal phalanx was noted in nine dark-skinned neonates, while 23 newborns (20.5%) exhibited pseudo-hypertrophy of fingernails and 38 newborns (33.9%) showed pseudo-hypertrophy of toenails. Conclusion: Macronychia is common in the fingernails of newborns, whereas micronychia is more common in toenails. Koilonychia can be a physiological finding at birth and the lunula is less common in toes compared to fingernails in newborns.

Effect of Duration of Bladder Catheterisation on Post Caesarean Recovery: A Prospective Observational Study

Shriya Attri, Divya Kanwar, Bharati Seth, Keya Kalra, Atul Kumar Sood

Introduction: The duration of bladder catheterisation plays a vital role in postoperative recovery after Caesarean Section (CS). Aim: To determine the association of the duration of the indwelling catheter on post Caesarean recovery. Materials and Methods: This was a prospective observational study conducted over six months in the Department of Obstetrics and Gynaecology of North DMC Medical College and Hindu Rao Hospital, a tertiary care hospital in Delhi, India. A total of 260 women undergoing CS were enrolled in the study and based on the duration of indwelling bladder catheterisation, they were divided into four groups: Group A, B, C and D, corresponding to postoperative catheter durations of ≤12 hours, 12-24 hours, 24-36 hours and >36 hours, respectively. The outcome measures analysed were time of first void, time to ambulate, time to pass wind, development of Urinary Tract Infection (UTI), duration of hospital stay and Surgical Site Infection (SSI). Continuous variables were presented as mean±standard deviation. Categorical variables were expressed as frequencies and percentages. Statistical tests like the Kruskal-Wallis test and Fisher’s exact test were used to assess various relationships. Results: The mean age of the study population was 26.07±3.53 years. Primigravida constituted 53.1% of the participants, whereas 46.9% of the women were multigravida. One hundred sixty-seven women (64.2%) underwent a primary CS, while 93 (35.8%) had a repeat CS. Group A had significantly shorter times for first voiding (p-value <0.001), ambulation (p-value <0.001) and passage of wind (p-value <0.001). There was no difference in the incidence of UTIs (p-value=0.888), duration of hospital stay (p-value=0.513), re-catheterisation (p-value=0.370) and SSI (p-value=0.379). Conclusion: Bladder catheterisation of ≤12 hours is associated with early post Caesarean recovery in terms of time for the first void, time to ambulate and passage of wind.

Evaluating the Utility of Mini-CEX as a Formative Assessment Tool for Paediatric Postgraduate Education: A Mixed-method Educational Interventional Study from Gujarat, India

Hemal Dave

Introduction: The Mini Clinical Evaluation Exercise (mini-CEX) assesses doctor-patient interactions and clinical skills. Its use in Indian Postgraduate (PG) programmes is limited despite its effectiveness. Aim: To evaluate the utility of the mini-CEX as a teaching, learning and formative assessment tool for paediatric PG education. Materials and Methods: This mixed-method educational interventional study was conducted in Department of Paediatrics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India from April to June 2024 which included nine residents and ten faculty members. The mini-CEX proforma from the American Board of Internal Medicine (ABIM) was used to assess seven domains of doctor-patient interactions. Mini-CEX encounters included residents from all three years in both Outpatient Departments (OPD) and Inpatient Departments (IPD) settings. Feedback on this tool was collected through a questionnaire to understand its educational utility and feasibility. The study analysed residents’ scores and satisfaction using statistical methods like Student’s paired t-tests, alongside qualitative insights from open-ended questions. Results: A total of 46 mini-CEX encounters were conducted, which showed significant improvements in both OPD and IPD settings. In the OPD, medical interviewing skills increased from 3.11 to 5.71 (p-value <0.001) and physical examination skills from 3.56 to 5.14 (p-value <0.001). In the IPD, medical interviewing skills rose from 3.67 to 4.86 (p-value=0.004) and counselling skills from 3.56 to 4.71 (p-value=0.002). Overall clinical competence improved from 4.44 to 5.29 (p-value=0.002). Residents’ satisfaction with this tool increased from 5.44 to 8.50 and faculty satisfaction rose from 5.56 to 8.86 on a 9-point Likert scale. Each encounter averaged 17.64 minutes, with 4.76 minutes allocated for feedback. All residents felt motivated to improve their learning, with 2 (22.2%) strongly agreeing and 7 (77.8%) agreeing. Faculty believed the tool could help identify knowledge gaps in their PG residents and improve teaching methods, with 5 (55.6%) strongly agreeing, 3 (33.3%) agreeing and 1 (11.1%) agreeing to some extent. Conclusion: Integrating the mini-CEX as a formative assessment tool could improve the Paediatric PG programme. While the mini-CEX proved feasible and acceptable, addressing time constraints and the need for greater commitment requires faculty development and effective change management strategies.

Standard versus Miniature Percutaneous Nephrolithotomy in the Treatment of Renal Stone sized between 1-2 cm: A Prospective Interventional Study

Introduction: Urinary tract stone disease affects 1-15% of the population. While Percutaneous Nephrolithotomy (PCNL) has replaced open surgery for kidney stones, it poses risks such as bleeding and renal damage. Mini-PCNL and Ultra-mini PCNL (UMP) reduce complications by using smaller tracts but face challenges, including limited visibility and longer operative times. Aim: To compare the efficacy and safety of standard, mini and UMP for stones measuring 1 to 2 cm, focusing on stone clearance, operative time and postoperative outcomes (pain, fever, haematuria and sepsis). Materials and Methods: In this prospective interventional study conducted between October 2022 and September 2024 at Dr. D. Y. Patil Medical College, 60 patients with 1 to 2 cm renal stones were grouped into Standard (group A), Mini (group B), or UMP (group C) groups. Preoperative assessments included medical history, imaging and anaesthesia evaluations. Standard PCNL utilised a 24 Fr sheath, mini-PCNL a 15/16 Fr sheath and UMP an 8.5 to 11 Fr sheath. The outcomes measured were operative time, stone clearance and postoperative outcomes (pain, fever, haematuria, sepsis and hospital stay). Statistical Package for the Social Sciences (SPSS) version 21.0 was used for statistical analysis. Results: In the present study, the average ages were 46.4 years (Group A), 53.25 years (Group B) and 48.1 years (Group C). Nephrostomy use was higher in group A (100%) compared to group B (75%) and group C (85%) groups. Group A had the shortest operative time (43.95 minutes, p-value <0.001). Hospital stays were shorter for group B (70%) and group C (90%) groups compared to group A (25%, p-value=0.0001). Stone-Free Rates (SFR) were similar across groups (90%, 95%, 95%). Complications were lowest in the group C (5%), while the group A showed the highest haemoglobin drop (p-value=0.027). No cases of sepsis occurred and the number of ancillary procedures was lower in group B (5%) and group C (5%) groups than in group A (10%). Conclusion: Standard PCNL had the shortest operative time but resulted in longer hospital stays and greater haemoglobin drops. Mini-PCNL and UMP reduced complications and hospital stays, with UMP offering the best overall outcomes.

Knowledge, Attitude and Practice towards Medical Research among Interns and Postgraduate Students of a Government Medical College: A Cross-sectional Study

Sukanya Badami, Vasundara S Gayakwad, Mahesh Baragundi, Srinivasa Arer

Introduction: Biomedical research is a tool which can improve healthcare. The latest information on skills of scientific principles and methods is essential for the conduct of research. Medical students should be aware of the research as they will be future doctors who will have to practice evidence-based medicine in patient care. Aim: To assess the Knowledge, Attitude and Practice (KAP) towards medical research of the Interns and Postgraduate (PG’s) students. Materials and Methods: A cross-sectional study was conducted at Gadag Institute of Medical Sciences, Gadag, Karnataka, India from July 2024 to September 2024. Data was collected using a self-designed, semistructured questionnaire (Cronbach’s alpha value 0.749) from 173 PGs and interns who gave consent to the study. Less than or equal to 50% correct answers were considered a poor knowledge score and more than 50% correct answers were considered a good knowledge score. Assessment of attitudes was done by using a 5-point Likert scale. Assessment of practice towards medical research was assessed using six questions. Statistical analysis was done using Epi Info software. The Chi-square test and Fisher’s exact test were applied for statistical evaluation. The p-value <0.05 was considered statistically significant. Results: The mean knowledge score was 7.8±2.9, out of 16 with a range of 2-14. The majority of students, about 102 (59%) had poor knowledge scores and 71 (41%) had good knowledge scores. About 104 (60.1%) students perceived that research increases their burden and 117 (67.6%) PG’s felt that separate time should be allotted for PG research in the curriculum these were students’ attitudes towards research. Only 66 (38.2%) students had done research work which shows poor practice towards research. Students with good knowledge were more involved in medical research than students with poor knowledge and the difference was statistically significant (p-value=0.017). In the present study, the reasons for not doing research were lack of time followed by lack of interest, etc. Conclusion: There exists a significant deficiency in knowledge and a predominance of negative or neutral attitudes among study participants regarding medical research. Despite most PGs, had participated in training workshops on research methodology, their engagement in research activities was insufficient. A robust understanding of research is correlated with increased research practice. Therefore, PG students must receive continuous training and encouragement to engage in research endeavours. Furthermore, the integration of workshops on research methodology into the curriculum for undergraduate and intern programs is essential for fostering a stronger research culture.

Urine Dipstick versus Urine Protein Creatinine Ratio for the Diagnosis of Preeclampsia: A Cross-sectional Study

Suhas Gaikwad, Vidya Gaikwad, Pragya Tiwari

Introduction: Preeclampsia is a condition related to pregnancy, manifesting after 20 weeks of gestation, characterised by hypertension and proteinuria, with potentially severe consequences for both the mother and the foetus. Aim: To evaluate the diagnostic performance of the urine dipstick test and the Urine Protein-Creatinine Ratio (UPCR) against the 24-hour urine protein test as a reference for detecting proteinuria and subsequently, preeclampsia. Materials and Methods: This was a cross-sectional study conducted at the Department of Obstetrics and Gynaecology at Dr. D.Y. Patil Medical College and Research Centre, Pune, Maharashtra, India, from October 2023 to October 2024. A total of 80 hypertensive pregnant women beyond 20 weeks of gestation were included. Participants were screened using the urine dipstick test and UPCR, followed by a 24-hour urine collection for protein estimation. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy and F1-score were calculated for both tests. Results: The mean age of the study population was 27±5 years. The study included 35 (44%) cases of preeclampsia and 45 (56%) cases of gestational hypertension. Preeclampsia was more prevalent in patients aged 25-35 years, accounting for 17 (49%) cases. The urine dipstick test showed a sensitivity of 43%, specificity of 40%, PPV of 36%, NPV of 47%, accuracy of 41% and F1-score of 39%. The UPCR demonstrated a sensitivity of 91%, specificity of 7%, PPV of 43%, NPV of 50%, accuracy of 44% and F1-score of 59%. Conclusion: The UPCR is more reliable for confirming proteinuria but has a low NPV, making it less effective at ruling out preeclampsia. These findings suggest that clinical assessment, combined with UPCR, should be used as an adjunct to improve early detection of proteinuria in preeclampsia.

Comparison of the Demonstration-Observation-Assistance-Performance Method and the Traditional Teaching Method for Endotracheal Intubation Skill Acquisition on a Simulator in Medical Students: An Educational Interventional Study

Seni Potsangbam, Jonan Puni Kay, Md Nushrat

Introduction: Endotracheal Intubation (ETI) is the insertion of a breathing tube into the trachea—a critical, life-saving skill in Cardiopulmonary Resuscitation (CPR), both inside and outside the hospital setting. Medical graduates often lack clinical skills such as ETI due to limited practical experience. Aim: To compare the methods of Demonstration-Observation-Assistance-Performance (DOAP) and Traditional Teaching (TT) for ETI skill acquisition, memory performance and skill retention in phase 3 part 1 MBBS students. Materials and Methods: This educational interventional crossover study was conducted at the Department of Anaesthesiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India from August 2023 to February 2024. The subjects (phase 3 part 1 MBBS students) were enrolled by universal sampling. They were given a pretest comprising Multiple Choice Questions (MCQs) followed by a lecture. Next, a post-test with the same MCQs was administered. Group I (DOAP) and Group II (TT) each comprised 22 students. ETI skills were taught using a simulator and assessed via Objective Structured Clinical Examinations (OSCE1 and OSCE2), with a recall test in between. On day 14, a crossover of the groups was conducted. Descriptive statistics, t-tests and Chi-square tests were used for statistical analysis. Results: The groups did not differ statistically significantly in terms of age, sex, or the number of attempts for the National Eligibility Entrance Test (NEET). The students’ post-test MCQ scores were significantly higher than pretest scores after the lecture (p-value=0.0001). The number of ETI attempts (1.77±0.685 for Group I and 1.82±1.006 for Group II) and intubation duration in seconds (62.50±20.061 for Group I and 59.55±19.576 for Group II) were comparable in OSCE1. In the recall test, Group I (8.77±0.428) and Group II (8.00±1.046) scores differed significantly (p-value=0.003). The number of ETI attempts (1.14±0.351 for Group I and 1.09±0.294 for Group II) and duration of intubations in seconds (65.23±12.626 for GroupI and 56.68±16.556 for Group II) were comparable in OSCE2. ETI attempts in independent groups decreased significantly, while ETI durations were comparable between OSCE1 and OSCE2. Conclusion: The DOAP and TT methods were equally effective for ETI skill acquisition and retention. However, the DOAP group demonstrated superior memory performance in the recall test.

Comparison of Intravenous Dexamethasone versus Perineural Dexamethasone as an Adjuvant to Local Anaesthesia in Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Randomised Clinical Study

Introduction: Dexamethasone is a potent adjuvant for prolonging analgesia in supraclavicular brachial plexus blocks. However, the optimal route of administration—perineural or intravenous—remains a subject of debate. Aim: To compare the effectiveness and safety of intravenous versus perineural dexamethasone as an adjuvant to local anaesthetics in supraclavicular brachial plexus blocks for upper limb surgeries. Materials and Methods: In this randomised clinical study, conducted in the Department of Anaesthesiology, Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India included 80 American Society of Anaesthesiologists (ASA) I and II patients undergoing elective upper limb surgeries were divided into two groups: Group I received intravenous dexamethasone, while Group P received perineural dexamethasone, along with a local anaesthetic mixture. The onset and duration of sensory and motor block, duration of analgesia, haemodynamic changes and complications were assessed. Statistical analysis was performed using the t-test and Chi-square test. Results: Group P exhibited a faster onset of sensory and motor block compared to Group I (p-value <0.05). The duration of sensory block, motor block and postoperative analgesia were significantly longer in Group P (p-value <0.05). Haemodynamic parameters showed significant differences at various time points, but no consistent trend favoured either group. No significant complications were observed. Conclusion: Perineural dexamethasone prolonged the duration of analgesia and sensory and motor block compared to intravenous dexamethasone, without significant side-effects.

Analysis of Quality Indicators of Preanalytical and Analytical Phases in Cervical Pap Smear Cytology: A Cross-sectional Study

Gracy Jeba Rani, S Sowmya, ES Keerthika Sri

Introduction: The Pap smear is a procedure used to collect cells from the cervix to screen for cancerous and dysplastic precancerous cells under a microscope. Internal quality control refers to the measures taken within a laboratory to ensure the accuracy, reliability and consistency of cytology results. It ensures that the technical quality of products in the preanalytical and analytical phases meets pre-established tolerance limits. Aim: To assess the quality indicators of the preanalytical and analytical phases of cervical Pap smear cytology in order to evaluate Non Conformity (NC) through root cause analysis for appropriate corrective and preventive measures. Materials and Methods: The cross-sectional study was conducted in the cytology section of the Department of Pathology at Mahatma Gandhi Medical College and Research Institute in Puducherry, India, planned and executed over a period of twelve months, starting in June 2023 and concluding in May 2024. The study cohort comprised 366 female patients who underwent Papanicolaou (Pap) smear testing as a routine screening test, systematically recruited from both the Outpatient (OP) clinics and the inpatient wards of the study Institute. Grading was performed for each parameter in the preanalytical and analytical phases using the Visual Analogue Scoring System (VASS). The grades used were: 3 - Good satisfactory smears; 2 - Extended time in fixative, average nuclear and cytoplasmic staining; 1 - Drying artefacts, air bubbles; and 0 - Inadequate smears, no clinicopathological correlation. Results: A total of 366 cases were studied and the study demonstrated strong adherence to quality standards, with 94.2% correct slide labelling and 98% excellence in fixation and transportation processes. Findings from the analytical phase revealed that 83% of smears were of excellent quality, with a swift Turnaround Time (TAT) of 90% processed within 24 hours and a clinicopathological correlation rate of 73.49%. Interobserver variation was minimal, with a 96.17% agreement among pathologists. The study identified significant preanalytical errors, primarily due to human factors. The quality indicators met grade 3 in the majority of the samples, indicating robust diagnostic reliability. Grades 0, 1 and 2 in all parameters were categorised as NC and were evaluated for root cause analysis, followed by appropriate corrective and preventive measures. Conclusion: Standardised protocols and continuous training can minimise variability and enhance the quality of smear preparation, fixation and staining, thereby ensuring that high standards are consistently met. The study proposes VASS as a validated benchmark system for evaluating the quality aspects of cytological smears. Additionally, focusing on value-added activities will optimise resource utilisation and enhance overall efficiency.

Influence of Thermocycling on the Bond Strength of Polyetheretherketone and Polymethyl Methacrylate to Indirect Composite: An In-vitro Analysis

Meghna Budati, Keerthi Sasanka

Introduction: Polymethyl Methacrylate (PMMA) has been used in dentistry for a long time due to its excellent aesthetics and ease of use. Polyether Ether Ketone (PEEK) has garnered attention for its potential in dental applications because of its remarkable mechanical properties and biocompatibility. Aim: To examine the Shear Bond Strength (SBS) of indirect composite resin when bonded to PEEK and PMMA, with assessments conducted before and after thermocycling. Materials and Methods: This in-vitro study was conducted at the Department of Prosthodontics and Implantology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from April 2023 to May 2023. The study included 44 samples, grouped into two: Group 1, consisting of 22 PMMA samples, and Group 2, comprising 22 PEEK samples. A total of 44 indirect composite samples were prepared using clear silicone moulds. The Ceresin Shofu bonding agent was used for bonding the PMMA and PEEK to the indirect composite and was light-cured. Subsequently, the two groups were further divided into four subgroups: Group 1A, with 11 PMMA samples subjected to the thermocycling process, and Group 1B, with 11 PMMA samples tested without thermocycling; Group 2A, consisting of 11 PEEK samples tested with the thermocycling process, and Group 2B, comprising 11 PEEK samples tested without thermocycling. The specimens underwent SBS testing after an immersion in distilled water for 24 hours at 37°C. SBS was measured using a universal testing machine, and statistical analysis was performed using parametric independent sample t-tests (α=0.05). Results: The study demonstrated a statistically significant difference in SBS for composites bonded to PMMA, which exhibited higher bond strength, with values of (7.922±0.285) MPa before thermocycling and (7.270±0.2694) MPa after thermocycling, revealing a significant difference (p<0.005). In contrast, the SBS for composite bonding to PEEK was slightly lower, with mean values of (5.520±0.341) MPa before thermocycling and (4.486±0.232) MPa afterwards (p<0.01). Conclusion: The SBS of PMMA bonded to indirect composite is higher than that of PEEK. Furthermore, it was noted that aging resulted in a reduction of bond strength for both PMMA and PEEK when bonded to indirect composite.

Pharmaceutico Analytical and Clinical Evaluation of Modified Dosage Forms (Lepa guti) of Varun Twak Lepa and Krushnatiladi Lepa in Vyanga (Melasma): A Research Protocol for Randomised Controlled Trial

Pratiksha Mahure, Bharat Rathi

Introduction: Vyanga, also referred to as melasma, is a prevalent disorder characterised by skin discoloration on the face. According to Ayurveda, Acharya Sushruta and Vagbhata described Vyanga as one of the Kshudra Rogas. Melasma is a related pigmentary disease characterised by symmetrical hyperpigmented macules on the face. Vyanga has been treated in Ayurveda through antah-parimarjana (internal therapy) and bahi-parimarjana chikitsa (external therapy), respectively. Need of the Study: Vyanga, also known as melasma, is not a life threatening condition, but it can significantly impact an individual’s appearance. Therefore, it is essential to explore effective management options. Modern treatments typically involve the use of topical steroids and antiseptics, which can lead to various side-effects such as irritation and rashes. In Ayurveda, several Shodhana (purification) and Shamana (alleviating) therapies are recommended for managing Vyanga. However, there are limitations regarding the use of Shodhana therapies in pregnant women, making Shamana therapies more preferable in such cases. Krushnatiladi Lepa, described in Raja Martanda, is noted for its properties, including Kusthaghna (antidermatological), Kandughna (anti-itch), Raktashodhaka (blood-purifying), Twak Prasadaka (skin-nourishing) and Varnyakara (skin-toning). Despite its potential benefits, no studies have assessed its efficacy in treating Vyanga. Aim: To conduct a pharmaceutical and analytical evaluation of modified dosage forms (Lepa guti) of Krushnatiladi Lepa and Varun Twak Lepa, as well as, to assess their clinical efficacy in managing Vyanga (melasma). Materials and Methods: A randomised double-blind, controlled clinical trial will be conducted Department of Rasa Shastra and Bhaishajya Kalpana, Mahatma Gandhi Ayurved College and Research Centre (MGACH and RC), Salod (H), Wardha, Maharashtra, India, from August 2024 to August 2025. A total of 62 patients aged between 18 years and 50 years with typical symptoms of Vyanga (melasma) will be selected from the Department of Kayachikitsa Outpatient Department (OPD) and Inpatient Department (IPD) and peripheral camps and divided equally into two groups. In group A (control group), Varun Twak Lepa guti will be administered for local application with cow’s milk once a day, whereas in group B (interventional group), Krushnatiladi Lepa guti for local application with cow’s milk once a day will be given. The parameters assessed will include Shyavata (discoloration), Parush Sparsha (dryness), Daha (burning sensation), Kandu (itching), Snigdhata (oiliness), size of patches, Von Luschan’s colour scale, and Melasma Severity Index (MSI) score. For statistical analysis, paired and unpaired t-tests will be applied for intragroup and intergroup comparison. A p-value of <0.05 will be considered statistically significant.

Effectiveness of Planned Teaching on Knowledge and Attitude towards Blood Pressure Control among Hypertensive Patients: A Research Protocol

Shiwani Padmakar Dandade, Arti Raut

Introduction: Arterial hypertension is a primary global public health concern, commonly called elevated or high Blood Pressure (BP). The term “hypertension” refers to elevated BP. Individuals’ knowledge and behaviours regarding hypertension are crucial in managing the condition and averting its chronic consequences. Need of the study: Hypertension is a modifiable and major risk factor for coronary artery disease, heart failure, cerebrovascular disease and chronic renal failure. The high prevalence of hypertension makes it a significant factor in mortality and morbidity. Hence, it is of utmost importance to assess the knowledge and attitude of hypertensive patients regarding hypertension. Aim: The present study aims to evaluate the effectiveness of planned teaching on knowledge and attitude regarding hypertension among hypertensive patients. Materials and Methods: A quasi-experimental one-group pre and post-test study will be conducted in Maharashtra’s community area of Wardha, India from June 2024-October 2024. Eighty five hypertensive patients will be included, and a structured questionnaire will be used for data collection in this study. The tools will consist of section I: Demographical data like age, gender, education, occupation, family income, and marital status. Section II: Structured knowledge questionnaire on hypertension among hypertensive patients. Section III: the respondent’s attitude toward hypertension, which will be premeditated using the Likert scale. To meet the study’s objectives, the data gathered from the participants will be categorised and analysed using descriptive and inferential statistics. One-way ANOVA will be applied to statistically evaluate the association of demographic variables with the level of knowledge and attitude and for pre and post-test evaluation of the participants, a paired t-test will be used. A p-value of <0.05 will be considered statistically significant.

Evaluation of Two Routes of Administration of Carthamus tinctorius as an Adjuvant Therapy with Standard Care and Physiotherapy in Thrombolytic Stroke (Pakshaghata) Management: Research Protocol for a Randomised Clinical Trial

Mahima Dubey, Punam Sawarkar, Shweta Parwe, Gaurav Sawarkar

Introduction: Stroke is characterised by rapidly appearing signs and symptoms of focal (or global, in the case of coma) disruption of cerebral function lasting longer than 24 hours or resulting in death, with no detectable cause other than vascular origin. When an artery supplying the brain becomes blocked or bursts, some brain cells die due to lack of oxygen, resulting in a stroke. In Ayurveda, this can be correlated with Pakshaghata, meaning immobility of one side of the body (Paksha meaning the right or left half of the body and Aghata, or paralysis, indicating deterioration of Karmendriya (organ of action), Gyanendriya (sense organ) and Manas (mind)). Need of the study: Sedentary lifestyles increase the risk of hypertension, dyslipidaemia, type 2 diabetes mellitus, etc., Vashti helps nourish, strengthen and stabilise the body’s overall function, aiding stroke recovery. Nasya karma aims to remove clots and replenish blood supply to the injured brain site; it is used in Urdhavjatrugata Roga and helps strengthen muscles and nerves, increasing blood supply. Aim: To assess the effectiveness of Kusumbhadya Taila Matra Vasti versus Kusumbhadya Taila Nasya as adjuvant therapy with standard care in treating thrombolytic stroke (Pakshaghata). Materials and Methods: A randomised, single (assessor) blind, three-arm superiority clinical trial will be conducted at Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Maharashtra, India from November 2024 to October 2025. Sixty patients will be divided into three groups: Group A (N=20) – standard care with physiotherapy for 11 days (control group); Group B (N=20) – Kusumbhadya Taila medicated enema + standard care with physiotherapy for 11 days; Group C (N=20) – Kusumbhadya Taila nasal administration + standard care with physiotherapy for 11 days (experimental group). The Dynamic Gait Index (DGI), Berg Balance Scale (BBS), Barthel Index and NIH Stroke Scale (NIHSS) will be assessed on days 3, 11 and 33. One-way Analysis of Variance (ANOVA) will be used to compare means; if significant, post-hoc tests (e.g., Tukey’s HSD) will be applied. A p-value <0.05 will be considered statistically significant.

Pharmaceutical Development and Analysis of Polyherbal Formulations as Ashmaghna Kwatha and Ashmaghna Ghana Vati and Comparative In-vitro Assessment of their Anti-urolithiatic Activity: A Research Protocol

Shubham Khanke, Mujahid Khan, Bharat Rathi, Anita Wanjari

Ayurveda, India’s oldest medical system has been practised for over 5000 years and effectively treats various ailments. The term “Ayurveda” combines “Ayu” (life) and “Ved” (knowledge), meaning “Science of Life.” It employs a holistic and analytical approach to health and longevity (1). Ayurveda’s medicine (bheshaja) is a natural solution from nature to combat harmful illnesses, processed under Pharmaceutical Science (Bhaishajya Kalpana) (2). The term medicine (bheshaja) means aushadh. By stabilising dosha, bheshaja or bhaishajya acts as a Chikitsa Chatushpada that removes disease fear and restores health. Illness management requires one of the Chikitsa Chatushpada. The use of multiple Dravyas is called Yojana (Planning), essential to Kalpana, which denotes transforming a chemical into a therapeutic form. Medication preparation involves processing, supported by the five components of “Panchavidha Kashaya Kalpana”: Swaras, Kalka, Kwath, Hima, and Phanta (3). One of five pharmaceutical procedures (Panchavidha Kashaya Kalpana), decoction (Kwatha Kalpana) is a well-known Ayurvedic pharmaceutical preparation. Decoction (Kwatha) is the liquid, created by roughly blending completely dry drugs with the correct amount of water, heating, and then reducing in quantity. Both mechanical pounding/pulverising equipment and manual pounding are employed in Khalva or Ulukhala Yantras. Filtering can be done mechanically with a sieve shaker or manually with a clean cloth and a selected sieve (4). The medications Virtaradi group (Gana) and Varunadi group (Gana), which are stated in the Ashmari rogadhikar chapter (adhyaya) of Bhaishajya Ratnawali in the form of a decoction for oral administration, were used to generate Ashmaghna decoction (Kwatha) and Ashmaghna tablet (Ghana vati). For the treatment of Urolithiasis (Mutrashmari), these formulations are prepared with carefully chosen ingredients such as Varun, Gokshura, Sahachara, Pashanbheda, Apamarga, Agnimantha, Kantakari, and Shatavari in equal parts. Ashmaghna decoction (Kwatha) and Ashmaghna tablet (Ghana vati) are prepared based on classical methods of preparation as mentioned in Sharangdhar Samhita (5). Urolithiasis, also known as Mutrashmari in Ayurveda, refers to the formation of stones anywhere in the urinary system, including the kidneys, ureters, bladder, and urethra. These stones can cause significant pain and discomfort. It is also known as Ashtamahagada (One of the eight fatal diseases), or Kapha Pradhan Tridoshaj Vyadhi (6). Kidney stone disease is a crystal concretion formed usually within the kidneys. It is an increasing urological disorder of human health, affecting about 12% of the world population. It has been associated with an increased risk of end-stage renal failure (7). National Commission for Indian System of Medicine (NCISM) has advised pharmaceutical standardisation for Ayurveda, Siddha, and Unani (ASU) drugs. Pharmaceutical standardisation is beneficial for the development of standard-quality medications, as well as for quality control, quality assessment, and determination of the quality and purity of manufactured formulations (8). It is vital to confirm the efficiency of Ayurvedic formulations in the modern day while adjusting drug doses without altering their original makeup (9). The present study has updated formulations of the drugs to reflect current needs without sacrificing the effectiveness or the benefits indicated above, but it is crucial to demonstrate their applicability in the modern period. Ashmaghna (decoction) Kwatha will be changed to a tablet (Ghana Vati) because decoction (Kwatha) has a very short shelf life and tablets (Ghana’s) form is easier to administer. Their relative efficacy will also be evaluated to determine whether the dosage form is more potent. No similar study has been conducted on these formulations in the past. Hence, the present study will be focused on the pharmaceutical development and analysis of polyherbal formulations, specifically Ashmaghna Kwatha and Ashmaghna Ghana Vati, along with a comparative in-vitro assessment of their anti-urolithiasis activity. Primary objectives: • To prepare Ashmaghna decoction (Kwatha) and Ashmaghna tablet (Ghana Vati) from Ashmaghna decoction as per the classical method of preparation of decoction. • To assess the quality control parameters of Ashmaghna decoction (Kwatha) and Ashmaghna tablet (Ghana Vati). Secondary objectives: • To evaluate and compare the in-vitro assessment of the anti-urolithiatic activity of Ashmaghna decoction (Kwatha) and Ashmaghna tablet (Ghana Vati) with standard drug. Null hypothesis (H₀): Ashmaghna Ghana Vati will be equally or less effective than the Ashmaghna Kwatha in treating urolithiasis. Alternate hypothesis (H₁): Ashmaghna Ghana Vati will be more effective than the Ashmaghna Kwatha as an in-vitro anti-urolithic. Review Of Literature Plants can synthesise almost an unlimited number of substances, and in many cases, these chemicals serve as plant defence mechanisms against microorganisms, insects, and herbivores. Generally, any part of a plant may contain various active ingredients. Qualitative analysis of crude extracts plays a very important role in identifying the purity and quality of drug likeliness. Traditional remedies have been used for a long time in treating kidney stone disease. Most of the remedies used in traditional medicine systems are taken from plants, although they do not have strong clinical evidence to support their causes. However, many remedies produced from plants have a positive effect on patients. The best method to prevent and treat urolithiasis is to control the crystallisation process, which is crucial for the production of stones. The extract included aggregation- and nucleation-preventing chemicals, as demonstrated by the nucleation assay results (10). Numerous investigations have offered insightful information about the application of calcium aggregation and nucleation in various pharmacological extracts that provide anti-urolithiasis activity. In 2010, Aggarwal A et al., investigated the activity of Tribulus terrestris on nucleation and the growth of the Calcium Oxalate (CaOx) crystals as well as on oxalate-induced cell injury of NRK 52E renal epithelial cells and concluded that Tribulus terrestris extract not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role (11). Similarly, Singh KG et al., study examined the impact of selected samples on kidney stone formation and dissolution capacity. They estimated the phytoconstituents of wood apple and apple cider vinegar to understand their relationship with kidney stone formation and degradation. Wood apple had a higher concentration of terpenoids, while apple cider vinegar had a smaller amount. The study found that wood apple pulp extracts showed better inhibition activity than apple cider vinegar, with 25% inhibition for nucleation and aggregation and 11.3% inhibition for calcium oxalate crystal growth (12). A study by Bandarapalle K et al., investigated the antiurolithiatic effect of Asparagus racemosus root extract on crystallisation methodology, revealing potential inhibition of calcium oxalate crystals, indicating a promising antiurolithiatic function (13). These findings suggest that natural extracts may have potential as antiurolithiatic agents. Further research is needed to explore their efficacy and safety for clinical applications in preventing kidney stone formation.

Effect of Airofit Pro Device on Lung Function, Capacity and Quality of Life in COPD: A Protocol for Randomised Controlled Trial

Pooja Ramesh Tiwari, Vishnu Vardhan

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease that causes difficulty breathing due to airflow blockage. Common causes of the condition include smoking cigarettes, air pollution, and exposure to irritants. Symptoms of COPD include coughing, wheezing, and shortness of breath. Chest physiotherapy is essential for managing COPD, utilising techniques such as chest percussion, vibrations, and breathing exercises to clear mucus from the lungs, enhance lung function, and facilitate easier breathing. This therapeutic approach can improve the Quality of Life (QoL) for COPD patients by alleviating symptoms and preventing complications. The Airofit Pro device shows potential for both evaluating and treating patients with COPD and merits further investigation. Need of the Study: The present study intends to examine the effects of the Airofit Pro device on Maximal Expiratory Pressure (MEP), pulmonary function, functional capacity, and QoL in individuals diagnosed with COPD. Participants with COPD will be recruited for this randomised controlled trial based on predetermined criteria, with caregiver consent obtained. Aim: To evaluate the effects of the Airofit Pro device on MEP, pulmonary functions, functional capacity, and QoL in patients with COPD. Materials and Methods: The present experimental study protocol for a randomised controlled trial will be conducted in the Department of Respiratory Medicine at Acharya Vinoba Bhave Rural Hospital, associated with Ravi Nair Physiotherapy College, Wardha, Maharashtra, India, from May 2024 to April 2025, following approval from the Ethical Committee DMIHER(DU)/IEC/2024/173. The study is registered with Clinical Trail Registry of India (CTRI) CTRI/2024/04/065110. Participants will be assigned to two groups: Group A will undergo conventional physiotherapy for COPD, while Group B will receive conventional physiotherapy along with the Airofit Pro device. Data will be collected and analysed statistically. Each participant will undergo a 2-week rehabilitation period after enrollment, with assessments conducted at the beginning and end of the rehabilitation period. Follow-up evaluations will occur after one week. Outcome variables will be analysed using descriptive statistics, which include measurements such as minimum, maximum, mean, standard deviation, standard error, and 95% confidence intervals for parametric data. The Kolmogorov-Smirnov test will be used to assess the normality of continuous outcome variables at a 5% significance level (p≤0.05). If the null hypothesis is rejected, indicating that the data is not normally distributed, non parametric tests will be used to evaluate significance. The t-test will be employed at a 5% significance level (p≤0.05) to compare the Control group (conventional chest physiotherapy for COPD) and the Intervention group (conventional chest physiotherapy paired with the Airofit Pro device for COPD). Non normally distributed data will be described using measures such as mean, median, lower quartile, and upper quartile, and significance will be assessed using the Mann-Whitney test.

Comparative Evaluation of Functional and Aesthetic Outcomes in Reconstruction of Commissure of Mouth with Radial Forearm Free Flap with and without Palmaris Longus Tendon in Patients being Operated for Squamous Cell Carcinoma of Buccal Mucosa and Lip: A Research Protocol

Imran Saleem Solanki, Rajanikanth Kambala, Nitin Bhola

Introduction: Previously conducted studies have demonstrated the effectiveness of the Radial Forearm Flap (RFF) in reconstructing lip and buccal mucosa deformities, both with and without the Palmaris Longus Tendon. The optimal therapy following large oncologic resections involves microvascular free flaps. The tissue produced by the Radial Forearm Free Flap (RFFF) is thin, malleable and well-vascularised, ensuring less morbidity at the donor site since it is harvested based on the radial artery. Successful vascularisation is facilitated by microvascular anastomosis. With a high success rate, RFFF provides good functional and cosmetic results for a range of intraoral reconstructions. Need of the study: This study aims to evaluate the functional and aesthetic results of reconstructing the lip and buccal mucosa in cases of Squamous Cell Carcinoma (SCC). The long-term preservation of vertical lip height and lip support is achieved by the Palmaris Longus Tendon, which functions as a sling over which the flap is elevated. Aim: To compare and evaluate functional and aesthetic outcomes in the reconstruction of the commissure of the mouth using RFFF, with and without the Palmaris Longus tendon, in patients undergoing surgery for SCC of the buccal mucosa and lip. Materials and Methods: This parallel group randomised trial will be conducted at the Department of Oral and Maxillofacial Surgery, Siddharth Gupta Memorial Cancer Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India from August 2024 to September 2025. The procedure will be performed on patients who have histopathologically confirmed Oral Squamous Cell Carcinoma (OSCC). Detailed case histories, clinical examinations, past medical and dental histories, general personal information and biopsy procedures will be conducted. Patients with biopsy-proven SCC will then undergo radiographic examinations (CT scans) to determine the extent of the lesion and lymph node metastasis. Patients with biopsy confirmation who meet the inclusion criteria will be included in the study after obtaining detailed informed consent. The study will consist of two groups of eight patients each: one group will receive RFFF with the Palmaris Longus tendon and the other will receive RFFF without the Palmaris Longus tendon. Functional outcomes such as drooling, swallowing and speech, along with aesthetic outcomes including smile, lip competence and commissural ends, will be assessed.

Effect of Vitamin D and Calcium Supplementation on Menstrual Abnormalities, Follicular Response and Metabolic Status in Polycystic Ovary Syndrome: A Systematic Review

Sangeetha V Joice, N Ananthi, G Lekshminath, Rebecca Abraham

Introduction: Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder affecting women. It presents with irregular periods, high levels of male hormones and multiple cysts on the ovaries. Metabolic disruptions related to PCOS consist of insulin resistance, obesity and dyslipidaemia. Recent studies show that supplementing with vitamin D and calcium could benefit metabolic health, menstrual cycle regularity and follicular growth in women with PCOS. Aim: To analyse the effectiveness of Vitamin D and Calcium on metabolic parameters, menstrual cycles and follicular response in patients with PCOS. Materials and Methods: The studies were reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A thorough literature search was conducted in databases including PubMed, Pub Med Central, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Evidence-based Medicine Reviews (EBMR), and Google Scholar. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) checklist for systematic reviews and research syntheses and the data were analysed using a narrative approach. Results: The systematic review of 12 experimental studies showed mixed results on the effects of vitamin D and calcium supplementation in women with PCOS. Some studies reported improved insulin sensitivity, lipid profiles and menstrual cycle regularity, while others found inconsistent outcomes in follicular development and ovarian morphology, with some showing improvement and others finding no significant changes compared to controls. Conclusion: The present systematic review suggests that vitamin D and calcium supplementation can potentially improve metabolic status in women with PCOS, but the effects on menstrual cycle abnormalities and follicular response are inconsistent. The variability in study outcomes highlights the need for personalised supplementation strategies and further research to determine the optimal treatment approach for improving both metabolic and reproductive health in women with PCOS.

Critical Contribution of Pharmacists in Optimising Medication Safety among Children: A Narrative Review

Pulkit Deswal, Mamta Farswan Singh, Sonal Setya

Paediatric patients are particularly vulnerable to medication errors and Adverse Drug Reactions (ADRs), with the incidence of adverse drug events being three times higher in children compared to adults. Given the complexity of paediatric care, it is essential that all healthcare professionals involved in paediatric medication management receive specialised training. Paediatric patients require individualised dosing, careful monitoring and age-appropriate formulations. The administration of the right drug to the right paediatric patient for the right indication, in the right amount, using the right route of administration, at the right time, and for the right duration forms the basis of rational therapeutics. The lack of availability of paediatric-appropriate medications necessitates urgent discussions among the health department, regulatory bodies, medical specialists and the pharmaceutical sector. The present review paper was aimed to identify the challenges associated with the development of paediatric formulations and Drug-related Problems (DRPs) faced by children, emphasising the critical role of pharmacists in addressing these issues, thus enhancing paediatric patient safety. Pharmacists, with their specialised knowledge and skills, are uniquely positioned to optimise medication therapy in paediatric care. They can significantly reduce medication errors by verifying dose calculations, identifying and mitigating potential drug interactions, and counselling caregivers on proper medication administration and storage. Additionally, pharmacists can serve as educators and communicators within the healthcare team, helping to minimise ADRs and improve their management and reporting. The present review study advocates for the increased involvement of pharmacists in paediatric care, recognising their potential to enhance therapeutic outcomes and safeguard paediatric patients from preventable medication-related harm.

Adhesive Removal Procedures in Orthodontics: A Literature Review

Anjusha Divakar, Ravindra Kumar Jain

The removal of residual adhesive after orthodontic bracket debonding is a critical step in restoring enamel surface integrity while minimising damage. Over the years, multiple techniques have been developed to remove orthodontic adhesive, including mechanical, chemical, and laser-based methods. While current methods are effective in removing adhesive residues, many are associated with enamel surface damage, time inefficiency, or patient discomfort. Given the widespread use of adhesive removal instruments by orthodontists, it is essential to have scientific knowledge about these techniques and their biological impact on tooth structure. Consequently, it is crucial to select effective removal methods that minimise damage to the patient at the end of treatment and, whenever possible, preserve the tooth’s original condition. Most authors prefer using a combination of abrasives and rotary speeds for effective appliance debonding, although the optimal choice of abrasive and speed remains unclear. Tungsten carbide burs receive the most favourable reviews in the literature, making them the recommended technique. Although the laser is more comfortable due to the lack of noise, vibration, or pressure, it creates a much rougher surface and is less effective compared to conventional methods. The present review aimed to summarise the available evidence on adhesive removal techniques reported in the literature and discuss their effects on the enamel surface and its integrity post-orthodontic treatment.

Spinal versus Epidural Anaesthesia for Obstetric Delivery: A Narrative Review of Outcome Impacts

Neeta Verma, Janhavi Dahake

As the most popular methods of pain management for women in labour, spinal and epidural anaesthesia are commonly used during normal vaginal deliveries. Epidural analgesia offers significant pain relief while maintaining maternal and foetal safety. This method involves the administration of anaesthetic agents into the epidural space, allowing for continuous pain management during labour. Spinal anaesthesia involves injecting a local anaesthetic, often combined with an opioid, into the cerebrospinal fluid in the spinal canal. Both techniques offer distinct advantages and considerations that can significantly impact the labour experience. The present review aims to evaluate all possible findings and outcomes of the comparison between spinal and epidural anaesthesia in normal delivery. Both spinal and epidural anaesthesia significantly impact maternal and foetal outcomes in obstetric care. Spinal anaesthesia provides rapid and profound analgesia, making it ideal for shorter procedures and urgent deliveries. However, its association with motor blockade and the potential prolongation of the second stage of labour requires careful consideration. Epidural anaesthesia, on the other hand, offers greater flexibility in dose adjustment and a more gradual onset, making it suitable for prolonged labour. The choice between spinal and epidural anaesthesia should be guided by factors such as the stage of labour, maternal co-morbidities, anticipated delivery duration and patient preference. Future research should focus on refining anaesthesia protocols to enhance maternal and neonatal outcomes while minimising complications.

Applications and Challenges of Advanced Molecular Diagnostics in Clinical Microbiology and Epidemiology: A Literature Review

Molecular biology techniques have revolutionised biomedical research and clinical practice, enabling the detailed examination of genetic information and cellular processes. In epidemiology and surveillance, molecular approaches have advanced more rapidly than in clinical use and are recognised for their superior discrimination. This review aimed to provide details on the clinical and epidemiological applications of molecular diagnostics, particularly Whole Genome Sequencing (WGS), in various bacterial and viral diseases and to discuss its future prospects. A comprehensive literature review was conducted using PubMed, Scopus and the Web of Science from January 2002 to December 2024. This review found that WGS offers advantages for antibiotic resistance surveillance and can be used as a standard to evaluate antibiotic susceptibility in pathogenic bacteria. In Tuberculosis (TB), WGS has transformed molecular epidemiology and effectively identifies transmission clusters. Next Generation Sequencing (NGS) exceeds traditional methods for detecting viral pathogens, including novel ones, and outperforms Sanger sequencing for detecting low-frequency antiviral resistance mutations. Metagenomics identifies all potential pathogens in a single test using NGS of DNA, surpassing traditional diagnostics. NGS provides a methodological foundation for investigating bacterial transmission in forensic microbiology. The implementation of WGS in clinical and epidemiological settings remains inconsistent, with varying applications across countries and contexts. Although WGS offers advancements in fastidious microbes, plasmid-mediated resistance detection, and comprehensive characterisation, its routine use depends on overcoming challenges, targeting diseases and demonstrating benefits. Challenges such as a lack of standardisation in bioinformatics analysis, incomplete mutation catalogs and technical complexities hinder its routine use. However, advancements in mutation catalogs and the optimised use of WGS may enable comprehensive and accurate diagnosis, leading to personalised treatment strategies. A significant shift is expected in developed countries within five years, driven by global sample preparation and result analysis approaches. Developing countries face challenges that complicate their efforts, while developed nations have made progress. Future improvements in mutation catalogs and the optimised use of WGS may enable comprehensive and accurate diagnosis, leading to personalised treatment strategies.

Omega-3 Fatty Acids as an Adjunct Therapy in Sepsis: Insights and Implications: A Narrative Review

Swati, Madhvi Awasthi, Nameet Jerath

Sepsis is a severe condition that affects a vast number of people globally, irrespective of their underlying health status. Sepsis arises from a disproportionate immune response to infection, leading to life-threatening organ dysfunction. This dysfunction is assessed using scoring systems like the Sequential Organ Failure Assessment (SOFA), where a score increase of two points or more signifies a high mortality risk in infected patients. Despite advances in critical care, mortality rates remain high, emphasising the need for novel therapeutic strategies. Inflammation, marked by mitochondrial dysfunction, oxidative stress and cytokine release, is central to sepsis, causing cellular damage and organ failure. Omega-3 Fatty Acids (FAs), Polyunsaturated Fatty Acids (PUFAs) essential for human health, have emerged as potential candidates due to their anti-inflammatory and immunomodulatory properties. Omega-3 FAs can positively influence SOFA scores. The mechanisms underlying the therapeutic effects of omega-3 FAs in sepsis are complex and multifaceted. These FAs may exert their beneficial effects by modulating the inflammatory response, attenuating oxidative stress, improving endothelial function. Neurological outcomes, such as improved Glasgow Coma Scale (GCS) scores, have also been reported. Importantly, it is associated with shorter hospital stays and reduced time on Mechanical Ventilation (MV). In conclusion, omega-3 FAs appear to be promising adjunct therapy for sepsis. While further research is needed to fully elucidate their mechanisms of action and to establish optimal dosing strategies, the available evidence suggests that these FAs may improve outcomes in patients with sepsis.

Exploring the Ophthalmic Features of Cornelia de Lange Syndrome: A Case Report

Radhika Paranjpe, Shikha Rai, Tushar Agrawal, Gufran Ali Kamdar

Cornelia de Lange Syndrome (CdLS) is a rare genetic disorder that affects growth, development and various body systems, with symptoms ranging from mild to severe. The condition is marked by distinctive facial features such as arched eyebrows, long eyelashes, a small nose and a thin upper lip. Growth delays are noticeable both before and after birth, leading to short stature. Affected individuals often have limb abnormalities, including missing or underdeveloped fingers and toes, as well as cognitive impairments that can vary from mild to severe. CdLS is caused by mutations in genes crucial for early development, particularly those involved in forming facial, limb and brain structures. The most common mutations occur in the NIPBL, SMC1A and SMC3 genes, although other genetic factors may also contribute. These mutations disrupt normal cellular functions, resulting in the physical and developmental challenges characteristic of the disorder. Effective management of CdLS requires a collaborative approach involving a team of medical professionals, therapists and educators who work together to address the diverse needs of affected individuals. This may include Physical Therapy (PT) for limb abnormalities, speech therapy and Occupational Therapy (OT) to support cognitive and developmental progress, as well as regular monitoring of growth and health. A seven-year-old child presented with involuntary eye movements (horizontal nystagmus) in both eyes since early childhood, along with global developmental delay, reduced psychomotor skills and intellectual disability. Clinical findings included a unibrow, hirsutism, long eyelashes and visual acuity of 6/60 in both eyes, improving to 6/36 with correction.

Panhypopituitarism Presenting with Non Specific Symptoms in a Geriatric Patient: A Case Report

S Hemadharshini, VM Vinodhini, P Renuka, KA Arul Senghor, B Gayathri

Panhypopituitarism is a rare condition in which there is a deficiency of all the hormones released by the pituitary gland. It can occur at any age, from infants and children to adults. The pituitary hormones are responsible for several important functions in the body, such as metabolism, growth and reproduction. A 71-year-old female presented with symptoms of nausea, aversion to food and significant weight loss over the past month. Her past medical history included spine surgery five years ago, a hysterectomy 35 years ago and she was a known case of systemic hypertension. Initial evaluations revealed normal vital signs and stable cardiovascular and respiratory functions, but laboratory tests showed markedly low levels of Thyroid Stimulating Hormone (TSH), free T4, cortisol, Adrenocorticotropic hormone (ACTH), Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH). A brain Magnetic Resonance Imaging (MRI) revealed pituitary hyperplasia without focal lesions, leading to a diagnosis of panhypopituitarism, characterised by central hypothyroidism, adrenal insufficiency and gonadotropin deficiency. The diagnosis of panhypopituitarism in this case was challenging due to the non specific nature of the presenting symptoms. The patient’s hormonal profile revealed deficiencies in multiple pituitary hormones, which aligned with the diagnosis of panhypopituitarism secondary to pituitary hyperplasia. Treatment with intravenous hydrocortisone and thyroid hormone replacement therapy was initiated, resulting in significant clinical improvement. Timely hormone replacement therapy led to favourable outcomes. Long-term follow-up is crucial to ensure continued hormone balance and prevent complications.

Hydroxychloroquine-induced Impetigo Herpetiformis Managed with Oral Cyclosporine: A Rare Case Report

Avinash Jadhav, Reshma Gupte, Asharbh Raman, Kirti Deo

Impetigo Herpetiformis (IH), or Generalised Pustular Psoriasis (GPP) of pregnancy, is a rare gestational dermatosis that lacks the usual triggers for pustular psoriasis and is often associated with adverse maternal and foetal outcomes. The onset typically occurs in the third trimester and hormonal fluctuations during pregnancy might play a role in the pathogenesis. Hypocalcaemia, hypoalbuminaemia and hypoparathyroidism are often associated with this condition. A characteristic resolution of symptoms typically occurs after delivery, with a tendency for recurrence in subsequent pregnancies. Genetic susceptibility and mutations in the gene encoding the interleukin 36 receptor antagonist may constitute significant underlying pathology. Acute Generalised Exanthematous Pustulosis (AGEP) closely resembles this condition both clinically and histopathologically and should be ruled out to ensure appropriate treatment. Drug-induced cases are seldom reported and those arising from Hydroxychloroquine (HCQ) are even rarer. The patient in the present case is a 33-year-old primiparous female in her second trimester, with a history of recurrent miscarriage for which she was prescribed HCQ prophylactically. However, 15 days later, she presented with itchy erythematous patches all over her body, which later evolved into a generalised pustular eruption. Histopathological examination revealed a large sub-corneal pustule filled with neutrophils and neutrophilic debris. A diagnosis of HCQ-induced IH was made and the patient was managed successfully with cyclosporine monotherapy. HCQ, a routinely used medication for a number of conditions, is considered safe in pregnancy; however, clinicians should be aware that it can cause IH. Early immunotherapy with cyclosporine is a safe and effective option to control the disease without the need to add glucocorticoids, thereby preventing the burden of additional adverse effects.

Elusive Nexus: A Case of Megaloblastic Anaemia Secondary to Jejunal Diverticulosis

Jejunal diverticulosis is a rare but often underdiagnosed condition that can lead to significant complications, including malabsorption and megaloblastic anaemia. Its non specific symptoms and the lack of routine small bowel imaging contribute to frequent diagnostic delays. This case report underscores the clinical importance of recognising jejunal diverticulosis as a potential cause of unexplained macrocytic anaemia and highlights the need for timely diagnosis and management. A 35-year-old male presented with progressive fatigue, pallor and abdominal discomfort for three months. Laboratory findings revealed macrocytic anaemia {Haemoglobin (Hb) 7.8 g/dL, Mean Corpuscular Volume (MCV) 108 fL} and severe vitamin B12 deficiency (120 pg/mL). Abdominal Computed Tomography (CT) imaging identified multiple jejunal diverticula and a barium meal follow-through confirmed the diagnosis. The patient’s anaemia was attributed to vitamin B12 malabsorption due to bacterial overgrowth in the diverticula. Treatment with intramuscular vitamin B12 led to complete symptomatic and haematological recovery over three months. This case highlights the necessity of considering small bowel diverticulosis in patients with persistent macrocytic anaemia when conventional causes have been ruled out. Early recognition through targeted imaging can prevent complications and guide appropriate management. Given the rarity of reported cases, particularly in younger patients, this case contributes valuable insight into the spectrum of presentations and reinforces the need for heightened clinical awareness.

Solitary Atypical Myocysticercosis in the Trapezius Muscle: A Case Report

One of the most dangerous parasitic infections found practically everywhere in the world is cysticercosis, which is also considered a neglected tropical disease. Cattle are the intermediate hosts in the life cycle of the parasite that causes cysticercosis, known as Cysticerci, which is the larval form of the beef tapeworm Taenia saginata. When raw or undercooked meat is consumed, human cysticercosis develops, turning the person into an unintentional intermediate host. In areas with inadequate sanitation, cysticercosis is endemic. Although human cysticercosis is becoming less common due to improved living and hygiene conditions, the primary locations of these cysts are in the skeletal muscles and subcutaneous tissues. Such cases are, however, sometimes observed. It is uncommon for a young male to exhibit involvement of the trapezius muscle. In this case report, we present an incidental diagnosis of myocysticercosis. The patient underwent radiological investigation, and surgical excision was successfully performed. We emphasize the importance of diagnostic work-up, management, and follow-up, as well as the need for a clinical suspicion of parasitic infestation in settings similar to ours for better management.