Journal of clinical and diagnostic research

Rheumatoid Myositis: A Rare Case Report

Satish Kumar, Santosh Kumar Singh, Yashas Saipangallu

Rheumatoid Arthritis (RA) and inflammatory myositis are distinct clinical syndromes. Muscle involvement in RA is frequently secondary to therapy with steroids or immune-modulators medication. However, the association of myositis in a treatment- naive patient with RA is rare. Myositis represents a distinct entity with specific clinical, biological, imaging, and histological patterns. Here, authors describe a case of RA presented with myositis. A 30-year-old female presented with insidious onset gradually progressive to paraparesis lasting for six months. This was preceded by a history of inflammatory arthritis involving small and large joints of the upper and lower extremities. Clinically, she exhibited pure motor weakness of the upper and lower limbs (proximal>distal) with hand, elbow, and knee deformities. Her Anti-Cyclic Citrullinated Peptide antibody (Anti-CCP) and inflammatory markers were elevated. Muscle-specific enzymes were also elevated, along with positive myositis-specific antibodies. Electromyography (EMG) and Magnetic Resonance Imaging (MRI) of the thigh revealed findings consistent with inflammatory myositis. The patient was managed as a case of Rheumatoid Myositis (RM) with steroids, conventional, and biological immune-modulators Disease-Modifying Antirheumatic Drugs (DMARDs). She experienced remarkable improvement in her symptoms and quality of life.

Surgical Excision of Hypertrophic Tissue and Retrieval of Orthodontic Mini-implant using Diode Laser- A Rare Case Report

Evangeline Ida, V Ramya, Anitha Balaji, Deepa Subramaniam, Dhivya Darshani

Orthodontic mini-implants or transient anchorage devices can be used to shift difficult teeth. There is substantial evidence showing the effectiveness of Temporary Anchorage Devices (TAD) and their anchorage requirements. However, there are also reports of failures and complications like soft tissue inflammation, tissue overgrowth, peri-implantitis and mini-implant fracture. The present case report of 22 years old female patient, discusses a rare occurrence of tissue overgrowth over the mini-implant on right buccal mucosa in relation to 45, 46 regions. A 1.3×9 mm stainless steel mini-implant was used as an interim anchorage device. The tissue overgrowth was attributed to soft tissue inflammation around the mini-implant. Under adequate anaesthesia, the tissue was removed using a laser, and the mini-implant was retrieved using tissue forceps. After achieving hemostasis, simple interrupted sutures were placed. It is recommended to administer antibiotics, analgesics, and along with postoperative instructions. When used correctly, mini-screws are valuable tools that enhance the effectiveness of orthodontic treatment. However, there is a scarcity of case studies discussing the complications and side-effects of mini-implants. Clinicians should carefully evaluate both general and unique side-effects and complications at the insertion site. This case report demonstrates the successful removal of an orthodontic mini-implant following diode laser ablation of hyperplastic tissue.

Hemisection for the Successful Preservation of Hopeless Teeth: A Case Report

Akansha Tilokani, Bidushi Ganguli, Prasanti Kumari Pradhan, Mohammad Jalaluddin

Hemisection is conservative way of preserving tooth , which is defined as the surgical procedure that involves removal of a weakened root and compromised crown portion which may be affected by periodontal, endodontic, or structural failures. It aims to efficacious atternative modality in the extraced to save multirooted teeth. This treatment option should be considered when caries, resorption, perforation, or periodontal damage is confined to one root, whereas the other root is healthier. As long as, Expected results can be achieved with this treatment by following the proper diagnostic, endodontic, surgical, prosthetic, and maintenance procedures are followed, this treatment can produce. Present study describes the successful treatment two patients with severely damaged mandibular molars through hemisection. The procedure was successfully and the remaining portion of the tooth was restored with a prosthesis. The patients were followed-up for several months, and the outcome was satisfactory, with no recurrence of symptoms. Hemisection can be an effective treatment option for preserving a damaged tooth, and this case report demonstrates its successful application in a clinical setting.

Orbital Apex Syndrome and Pituitary Metastasis in Lung Carcinoma: A Case Report

Sanjay M Khaladkar, Vanshita Gupta, Rahul Srichand Navani, Shreeya Goyal

Orbital Apex Syndrome (OAS) is a spectrum of Orbital Apex Disorder (OAD) in which progressive vision loss occurs due to the involvement of oculomotor nerve at the orbital apex, resulting in optic neuropathy and ophthalmoplegia. Generally patients represents with the associated symptoms related to the structures involved, specifically the orbital fissure, orbital appex or cavernous sinus, collectively known as OAD. The present study reports a case of in 38-year-old female patient, detected to have carcinoma bronchus on further evaluation. The patient presented with bilateral progressive blurring of vision, diplopia, and headache. The Magnetic Resonance Imaging (MRI) brain and orbits revealed thickening of the intracanalicular portion of the right optic nerve, thickening of the intracranial portion of bilateral bilateral optic nerves, a soft tissue intensity lesion at the planum sphenoidale, pituitary gland with out a bright spot, nodular thickening of infundibulum, and thickening of the bilateral cavernous sinus showing near homogeneous postcontrast enhancement. A Chest X-ray (CXR) followed by High Resolution Computed Tomography (HRCT) thorax confirmed a soft tissue density mass lesion with spiculated margins in the posterior segment of the right upper lobe, along with an abrupt termination of the posterior segmental bronchus. Fibreoptic bronchoscopy revealed narrowing of the right upper lobe segmental bronchus. Bronchial lavage fluid revealed features of adenocarcinoma. A whole-body Positron Emission Tomography (PET) scan performed elsewhere showed a well-defined hypermetabolic, heterogeneously enhancing soft tissue in the posterior segment of the right upper lobe and at the right orbital apex. Tissue diagnosis could not be confirmed as the patient’s health deteriorated. The MRI brain and orbits with contrast is the most important modality in evaluating OAD. The OAS is rarely reported as the first symptom of an occult lung carcinoma.

Skene’s Duct Cyst in an Elderly Female: A Case Report

Anji Reddy Kallam, Gudeli Vahini

Paraurethral glands and ducts are the rudimentary female homologues of the prostate, which empty into the vaginal vestibule near the urethral meatus. The two largest ducts are referred to as Skene’s ducts. Skene’s duct cysts are rare across all age groups and are only noticed when they cause complications such as dysuria. The causes of Skene’s duct cysts include duct obstruction due to infection, inflammation, or cystic degeneration of embryonic remnants of the paraurethral glands. In this case report, the authors present the findings of a 50-year-old female who had a painless swelling in the left labial region for a duration of three years. Upon local examination, a pedunculated swelling measuring 6×2.8 cm was observed in the left labia minora. The entire swelling, including the pedicle, was excised under regional anaesthesia through a vertical elliptical incision. Histopathological examination confirmed the diagnosis, and the patient experienced complete satisfaction and relief from her symptoms.

Multifocal Gingival Squamous Cell Papilloma: A Case Report and Literature Review

Ridhima Singhal, Anjali Yadav, Shikha Tewari, Nishi Tanwar, Anju Devi

Squamous Cell Papilloma (SCP) is a benign, asymptomatic, exophytic cauliflower-like growth of mucosal mass. It is mostly associated with Human Papilloma Virus (HPV) subtypes 6 and 11, and has a very low virulence and infectivity rate. The papillomas are commonly known as warts or verrucas when found on the skin. The typical lesion is a single mass with finger-like extensions, resembling a soft, pedunculated growth supported by a stem or stalk. If keratin, a skin protein, accumulates around the lesion, the projections can be long and pointed or short and rounded. Intraorally, the most common sites of occurrence are the tongue, lips, buccal mucosa, palate, and uvula. Hereby, the author present a case report of 25-year-old male patient with a 4×9 mm exophytic growth exhibiting a pebbled surface in the upper left first premolar region, with no signs of radiographic bone loss. Additionally, smaller pinpoint lesions were observed bilaterally in the interdental region of the first and second maxillary molars. A nevus on the right side of the face was also noted. Histological analysis confirmed the diagnosis of SCP. The presence of multifocal gingival squamous papilloma, along with an extraoral nevus, represents a novel finding that warrants reporting. The gingival lesion in the maxillary left first premolar region was surgically excised, along with 1 mm of healthy surrounding gingiva. This resulted in complete healing, and no recurrence was observed during the 12-month follow-up period.

The Effect of Siddha Medicine in Treating Autism Spectrum Disorder: A Case Report

The heterogeneity, complexity, co-occurring conditions, and lifelong impact are unique features of Autism Spectrum Disorder (ASD), making it a challenging disorder to diagnose and treat. The Siddha medicinal system offers a comprehensive approach to health that extends beyond the corporeal realm. It encompasses emotional, social, spiritual, and intellectual aspects of well-being. Siddha medicine is unique in its holistic approach to healthcare, emphasising the overall well-being of an individual rather than just treating symptoms. It focuses on balancing the body’s three humours, or doshas, to restore equilibrium. This case report describes a 10-year-old male with behavioural complications and Gastrointestinal (GI) symptoms diagnosed with Mantha sanni (ASD). The patient received specialised Siddha interventions, including Amukkara chooranam, Brahmi nei, Mantha ennai, and Varmam (a form of external manipulation). The study evaluated the treatment outcome over 90 days using the Indian Scale for Assessment of Autism (ISAA). The child showed significant improvement in all areas of the ISAA scale, including social relations, language and communication skills, behavioural patterns, emotional responsiveness, cognitive functions, and sensory perception. The overall score, previously indicating moderate autism at 159, improved to 100, indicating mild autism, after treatment. This case report contributes to the scientific literature by providing novel insights into alternative medicine treatments for individuals with ASD. These treatments can help them lead satisfying lives and enhance their quality of existence.

Recurrence of Ameloblastoma on the Right Side of the Mandible: A Case Report

KR Shakila, LP Raghupathy, RM Aravindh Swamy, J Sowmiya

Ameloblastoma is a benign, locally invasive epithelial odontogenic tumour occuring in the jaw. Among all types, multicystic ameloblastoma is a locally aggressive lesion and prone to recurrence. Hereby, the authors present a case report of a 23-year-old female with a chief complaint of painful swelling on the right lower third of the face for the past one month. History revealed a gradual increase in size of the swelling, along with intermittent and non radiating pain that worsened during mastication and improved with rest. Patient past history revealed similar swelling in the same region twice, with the first occurring five-years-ago and a recurrence after two years of treatment. Both the episodes were treated with laser ablative surgery and extraction of the affected tooth. The patient presented with recurrent swelling one month ago and underwent an incisional biopsy, which revealed a histopathological diagnosis of unicystic ameloblastoma. Additional investigations, including an occlusal radiograph, orthopantomogram, and Computed Tomography (CT), were performed. Based on the recurrence, clinical examination, and investigations, the present case was diagnosed as unicystic ameloblastoma. It was treated with segmental resection followed by reconstruction of the mandible using a free fibula graft was planned. The prognosis was good, and regular follow-up has been maintained for the last four months, with the patient still under review. The uniqueness of present case lies in the patient’s second decade of life, three episodes of recurrence within five years, and the treatment approach of segmental mandibulectomy with immediate free fibula graft reconstruction. This procedure reduces the risk of recurrence, allows for full rehabilitation within a short period, and minimises the number of surgical procedures.

Utility of Phlebotomy Tourniquet as a Cost-effective Adjuvant in Diabetic Wound Closure: A Case Report

Pravin Shinde, Aarsh Gajjar, Rajiv Karvande

Diabetes Mellitus (DM) is associated with numerous complications, including cardiovascular diseases, blindness, renal failure, and foot ulcers, which can result in morbidity, amputation, and increased mortality rates. Present case is of a 50-year-old patient with a Diabetic Foot Ulcer (DFU) who underwent amputation of the 2nd, 3rd, and 4th toes of the right foot and was managed on an outpatient basis. A phlebotomy tourniquet was tied across the wound and gradually tightened to approximate the wound edges, facilitating wound contraction. After 45 days of treatment, the wound had fully healed. This case suggests that using a phlebotomy tourniquet can effectively close wounds when other techniques, such as skin grafting, are not feasible.

Ovarian Brenner Tumour: A Case Report

Tanvi Bhardwaj, Kishor Hiwale, Yatharth Bhardwaj

Brenner’s tumour is a rare epithelial ovarian cancer, accounting for less than 5% of all cases. It is characterised by the presence of cells with transitional features between epithelial and mesenchymal cells. The diagnosis of Brenner’s tumour of the ovary has become more frequent in recent years. Accurate diagnosis is crucial since it exhibits distinct clinical behaviour and prognosis compared to other types of ovarian cancer. Studies have confirmed that this type of ovarian cancer shares unique characteristics similar to urothelial tissue and can be differentiated from non cancerous abnormal growths known as metaplastic and/or malignant Brenner’s tumours. Hereby, the authors present a case report of a 54-year-old woman, who presented with lumbar pain, abdominal discomfort, weight loss, abnormal uterine bleeding, and a persistent abdominal mass for a month. Abdominal and pelvic magnetic resonance imaging revealed an abnormal extensive, lobulated, and ill-defined lesion with solid and cystic components. The patient’s alpha-fetoprotein tumour marker was within the normal range (5.20 IU/mL), while beta-human chorionic gonadotropin (8.67 mIU/mL) and carcinoembryonic antigen (5.3 ng/mL) levels were slightly elevated. Serum Cancer Antigen (CA)-19-9 levels were within the normal range (9.0 U/mL). Following the surgical procedure, microscopic examination of the tissue confirmed the primary type of cancer in the ovary as Brenner’s tumour. Due to its rarity, favourable response to chemotherapy, and lower incidence compared to other tumour types, patients with Brenner’s tumours typically have a better prognosis.

Extensive Eccrine Squamous Syringometaplasia Mimicking Squamous Cell Carcinoma on Histopathology

Rakesh Rajiv Patkar, Shilpa Mishra, Amrita Neelakantan

Eccrine Squamous Syringometaplasia (ESSM) is a histologically distinctive skin eruption occurring predominantly in acral or intertriginous areas presenting as erythematous macules, papules or patches. It is a response of eccrine ducts and glands to any injury or inflammation. The cuboidal epithelium of eccrine ducts and glands undergoes metaplasia and transforms to keratinised squamous epithelium in ESSM. Other types of metaplastic changes encountered are squamous, mucinous and adenomatous. In squamous syringometaplasia, the metaplastic squamous cells form lobules and florid types can pose a diagnostic dilemma, which if not well understood may lead to an erroneous diagnosis of neoplasia. Literature suggests ESSM as a condition associated with another pathogenic stimuli or therapy; however florid ESSM is very rare. Hereby, the authors present a case report of a 43-year-old male who presented florid ESSM mimicking well-differentiated Squamous Cell Carcinoma (SCC). The present case presented with a non healing elevated lesion on anterior aspect of right leg with itching. Similar lesions were not present in any other part of the body. The patient did not have history of any systemic disease or drug intake. The lesion was excised and sent for histopathology. On gross examination the skin showed irregular thickening and foci of erosion. Microscopy showed acanthotic, hyperkeratotic epidermis and dermal ESSM. There were irregular clusters of metaplastic squamous cell in dermis, resembling invasive islands of SCC. Meticulous examination revealed lobulated architecture of ESSM, lack of individual cell keratinisation/significant atypia or mitosis. The present report highlights the significance of histopathological diagnosis of benign squamous proliferations which can mimic malignancy and cause undue stress to the patient.

Rehabilitation of Anterior Maxillectomy Patient with Dyna Magnets Retained Hollow Obturator: A Case Report

Prosthetic rehabilitation of midfacial defects has always been a challenging treatment plan in prosthodontics. These defects lead to functional and aesthetic deficiencies. These defects are less commonly rehabilitated by surgical construction alone. Typically, a prosthesis is required to restore both function and aesthetics. In the present study, the authors present the case of a 54-year-old male patient who had undergone partial maxillectomy for a verrucous lesion and complains of difficulty in mastication and speech. The objective of the treatment was to fabricate a 2-piece obturator with magnet attachments, facilitating easy insertion and removal. The final prosthesis demonstrated satisfactory retention, stability, and functional efficiency for the patient.

Cupriavidus gilardii Pneumonia in a Young Patient with Chronic Kidney Disease: A Case Report

Ashima Jamwal, Mitra Kar, Akanksha Dubey, Nidhi Tejan, Chinmoy Sahu

Cupriavidus gilardii (C. gilardii) is a Gram-negative, motile, non sporulating, non lactose fermenting bacterium. It was first identified by Coenye et al., and has a complex taxonomy, often being misidentified as Wausteria gilardii, Ralstonia gilardii. It is commonly found in ecosystems containing plants and heavy metal-contaminated soil and is rarely isolated from clinical samples with no clear evidence of its clinical significance. The pathogenic nature of C. gilardii in respiratory ailments, particularly in patients with cystic fibrosis, is still unclear. This case report presents a 19-year-old female with Chronic Kidney Disease (CKD) who developed pneumonia caused by C. gilardii. The report also includes the sensitivity pattern of the bacterium to guide physicians in treating these rare pathogens.

Silver Diamine Fluoride as Indirect Pulp Capping Agent in Primary Molars: A Case Series

According to the current recommendations of the American Academy of Paediatric Dentistry (AAPD), Indirect Pulp Capping or Indirect Pulp Treatment (IPT) is defined as a procedure that preserves the deepest cavities adjacent to the pulp to prevent pulp exposure. Preserving and protecting the vital pulp through remineralisation of hypomineralised carious dentin poses a significant challenge in restorative dentistry. Traditionally, managing deep caries often led to pulp exposure and subsequent root canal treatment. Selective or stepwise caries removal is based on the concept of halting the progression of carious destruction, allowing for biological repair of the pulp-dentin complex by promoting the formation of tertiary dentin between temporary and definitive restorations. Silver Diamine Fluoride (SDF) has gained popularity due to its unique combination of silver and fluoride, which provides antimicrobial and remineralising properties. In this case series of three cases, three-year-old preschool boy, five year old girl and five year old girl, in whom, deep carious lesions in primary molars were treated using selective caries removal techniques with SDF as an IPT agent, resulting in successful minimally invasive restorative procedures. This case series underscores the importance of employing selective caries removal techniques and the potential use of SDF as an IPT agent in such scenarios to preserve tooth vitality in a less invasive therapeutic approach suitable for the paediatric population.

Rare Diagnoses and Diagnostic Pitfalls in Female Genital Tract Neoplasms: A Case Series

Sanghamitra Mukherjee, Debajyoti Singha Roy, Vandana Maroo, Meghadipa Mandal

There is a wide spectrum of disorders that may originate from different parts of the female genital tract. They are often unique and rare, posing a diagnostic challenge for reporting pathologists. Their uniqueness lies in the rare histomorphologic picture and challenging clinical scenarios, accentuated by a paucity of available literature. Sometimes, histomorphology alone may not be sufficient for diagnosis, and ancillary studies like Immunohistochemistry (IHC) may help arrive at a definitive diagnosis. Present article represents a series of six unique cases. The first case presented with virilising features and menstrual irregularities. Gross examination of the adnexal neoplasm showed solid yellowish-orange areas, which were diagnosed as Steroid Cell Tumour (SCT), Not Otherwise Specified (NOS) based on histomorphology. This diagnosis was further substantiated by diffuse and strong Inhibin positivity on IHC. The second case presented with huge abdominal distention and markedly raised CA-125 levels. It was diagnosed as mucinous carcinoma with a focus of Benign Brenner Tumour. The third case presented with postmenopausal bleeding and underwent radical hysterectomy. Gross examination revealed simultaneous involvement of the unilateral adnexa, and it was finally diagnosed as endometrioid carcinoma with adnexal metastasis, International Federation of Gynaecology and Obstetrics (FIGO) stage IIIA. The fourth case was a cervical carcinoma with histomorphology suggestive of high-grade, but it did not fit into any of the known subtypes of adenocarcinoma. Therefore, it was reported as Adenocarcinoma NOS with focal mucinous differentiation. The fifth case was a rare cervical Adenosquamous Carcinoma (ASCC) with both malignant squamous and glandular components. The sixth case was of mesenchymal origin in the vulva, namely Aggressive Angiomyxoma (AA). All these cases highlight the fact that pathologists should be well aware of these entities to make an appropriate diagnosis.

Acute Mesenteric Ischaemia: A Case Series

C Arun Babu, T Jeyalaksmi, N Srividhya

Acute Mesenteric Ischaemia (AMI) is a group of disorders characterised by a sudden occlusion of blood supply to varing portions of the small intestine, eventually progressing to ischaemia and peritonitis. The present case series highlights a total of seven cases, three of which are classified as acute superior mesenteric artery thrombosis and four as acute superiormesenteric vein thrombosis. The typically symptoms reported were sudden onset of abdominal pain, distension, and melena (a late finding). Among the seven cases, four patients who received early intervention had favourable outcomes. All patients presented late with peritonitis symptoms, except for one patient. Emergency laparotomy was performed on all patients, except for one who underwent diagnostic laparoscopy. Therefore, although abdominal pain is an uncommon symptom, physicians need to exercise a high level of diligence. If left untreated, the overall mortality rate consistently exceeds 70-90%. This case series emphasises the importance of timely diagnosis, early intervention, and immediate postoperative heparinisation, which significantly decrease morbidity and mortality.

Varied Histomorphological Presentations of Appendiceal Neoplasms: A Case Series of Eight Cases

Dhivya Balaiya, Anithachellam Annadurai, Jayakarthiga Subbiah Rajendran

During routine histopathological study of appendicular specimens, we identified eight cases of appendiceal tumours, including five cases of Low-grade Appendiceal Mucinous Neoplasms (LAMN) and three cases of adenocarcinoma. Among the adenocarcinoma cases, one was a rare colorectal type adenocarcinoma in an older male and two were mucinous adenocarcinoma which includes a case of signet ring cell rich type. These tumours were classified and staged according to the recent WHO classification (5th edition) and the eighth edition of the American Joint Committee of Cancer (AJCC) staging manual. The median age in our series was 60 years. Serum markers were evaluated in two cases of Pseudomyxoma Peritonei (PMP), which showed elevated levels of CA-125 and CA 19.9 in each case. In this case series, three patients were initially diagnosed with acute appendicitis, one case as mucocele, two cases underwent surgery for ovarian malignancy, one patient was operated for an incisional hernia, and one patient was diagnosed with acute intestinal obstruction after clinical and radiological investigations. Histopathological examination confirmed the diagnosis of appendicular neoplasms in these eight cases. Meticulous histopathological examination of all appendectomy specimens is important for the proper diagnosis of appendicular neoplasms and to predict their severity. This will help surgeons plan further treatment to increase the patient’s survival rate.

Computed Tomographic findings in Patients with Craniofacial Fibrous Dysplasia: A Case Series

Roopa K Tandur, Revanasiddappa Kalyani, Ashok Kumar Kattimani, Santosh P Patil

Craniofacial Fibrous Dysplasia (CFD) is a rare developmental non inheritable, non neoplastic fibro-osseous disease of the bone, which can be monostotic or polyostotic. The term CFD is used to describe FD where the lesions are confined to contiguous bones of the craniofacial skeleton. This is a case series of 18 patients with features of FD in facial and skull bones on Computed Tomography (CT). CT findings of CFD in relation to lesion location, number, appearance, and gender of the patient were documented. Out of the 18 patients, 10 were males and eight were females. The mean age was 36.4 years with a range of 13 to 77 years. Single bone involvement was seen in 15 patients, and multiple bone involvement was seen in three patients. Among the cases with single bone involvement, the ethmoid bone was involved in the majority of the cases (n=5), while the sphenoid and temporal bones were equally involved in four patients. Two cases showed lesions in the frontal bone. Ground glass attenuation was seen in the majority (n=13) of the cases. Four cases showed mixed attenuation, and sclerosis was seen in one patient. CT is the investigation of choice for craniofacial dysplasia, which can help in the diagnosis and extent of the disease. Apart from diagnosis, CT is helpful in monitoring progression and treatment planning of the disease. CT is the first investigation of choice for craniofacial dysplasia since a plain radiograph of the skull can show a complex appearance due to overlapping structures.

CT Fistulogram: Demonstration of Vasocutaneous Fistula, a Rare Complication Following Orchidectomy

Harshika Mittal, Senthil Kumar Aiyappan, Aishwarya V Athani

A 65-year-old male patient presented with complaints of swelling and pain over the right inguinoscrotal region for the past two weeks. The patient had no significant previous medical history and no past surgical history. There was no history of vomiting or diarrhea. Local examination revealed a warm, tender swelling in the right inguinoscrotal region. Blood investigations showed neutrophilic leukocytosis with normal liver and renal function tests. An abdominal and scrotal ultrasound (USG) was performed, which revealed right epididymoorchitis with a multiloculated septated collection within the scrotal sac suggestive of pyocele. The spermatic cord structures were thickened, indicating funiculitis (Table/Fig 1). The patient underwent a right high orchidectomy, and the postoperative period was uneventful. Histopathology of the specimen showed features of acute inflammation. Seven months following the surgery, he noticed a serous discharge from the right inguinal region with mild swelling and pain at the postoperative site. No definite spermatozoa were identified in the discharge. He was referred for a plain Computerised Tomography (CT) abdomen to the radiology department. Since there was a small opening in the right inguinal region from which discharge was seen, non-ionic water-soluble iodinated contrast was injected through the opening, and a CT fistulogram was performed. The CT fistulogram demonstrated contrast opacification of a tubular structure reaching up to the right seminal vesicle, suggestive of the vas deferens. Hence, a diagnosis of vasocutaneous fistula was made (Table/Fig 2). Magnetic Resonance Imaging (MRI) screening was also performed, confirming the CT findings (Table/Fig 3). The prostate and the rest of the abdominal organs were normal. The patient was advised to undergo surgery, and sinus tract excision was performed. The patient is doing well with no evidence of discharge at the postoperative site. The fistulous communication between the vas deferens and skin is very rare. Only a few cases have been reported in the literature (1). The causes are usually trauma following surgeries such as vasectomy, prostatectomy, orchidectomy, neurogenic bladder, urinary tract infection, or rarely congenital (1). The first case was documented by Young in 1926 (1),(2). A case report published in 1992 by Thomas RB et al., describes only 16 cases of vasocutaneous fistulas, most of which occurred postoperatively, similar to this case (1). The most common surgeries associated with this condition were orchidectomy or vasectomy (3),(4). The fistula can develop in the immediate postoperative period or even 10 years after surgery (1). Yasumoto R et al., described a case of vasocutaneous fistula following scrotal injury; however, in this case, there was no history of injury (5). Only one of the previously reported cases was congenital, but in this case, it was not congenital (1). This case is unique as the CT fistulogram and MRI clearly demonstrated the fistula.

Subclavian Steal Syndrome (SSS)- A Rare Phenomenon

Anamika Giri, Sourya Acharya, Sandeep Kamat, Sunil Kumar

Dear Sir, Subclavian Steal Syndrome (SSS) occurs when the first part of the subclavian artery is stenosed, proximal to the origin of vertebral artery. The first part of subclavian artery usually supplies the arm. Whenever the pressure is put in arms, flow reversal from the vertebral artery to the arms occurs leading to vertebrobasilar insufficiency (steals flow from brain). Atherosclerosis is the usual culprit so these patients are also prone to coronary artery disease and stroke. A 72-year-old male came to the emergency department of the hospital with chief complaints of intermittent chest pain on exertion for the past three months, occasional presyncopal attacks and palpitations for the past two months. There was no history of orthopnoea, Paroxysmal Nocturnal Dyspnoea (PND), or oedema of feet. He was known to have systemic hypertension for eight years, though well controlled, and on Tablet Amlodipine 10 mg once a day. On examination, the pulse was 98 /min, regular, with diminished volume in left radial artery. Blood pressure in the right arm was 114/72 mm of Hg and left arm was 98/60 mmHg. There was no audible bruit in supraclavicular fossae. There were no digital ischaemic changes. Cardiovascular system examination revealed that the heart sound was soft, and there were no S3/S4 or murmurs. Electrocardiogram (ECG) revealed ischaemic ST segment depression. A coronary angiogram was planned and it showed 90% stenosis in Left Anterior Descending artery (LAD, single vessel disease). During angiography when the right brachiocephalic vessel was injected with dye to check for patency of right and left internal mammary arteries, it was observed that there was a 100% ostial stenosis of left subclavian artery and it was filling retrogradely from head, neck, and face collaterals; suggestive of SSS [Video-1]. The patient was advised stenting, of LAD and left subclavian artery. However, the patient declined angioplasty and was discharged with a prescription for- Tablet Aspirin 150 mg, Tablet Clopidogrel 75 mg, Tablet Rosuvastatin 40 mg, Tablet Metoprolol 12.5 mg, Tablet Amlodipine 5 mg. He was asked to follow-up every two months. Subclavian steal is a vascular phenomenon where there is an obstruction to the first part or prevertebral subclavian artery which is dedicated to blood supply of arms. The compensation of the blood flow is done by reversal of flow from the vertebral artery (1). Atherosclerosis is the leading cause of subclavian stenosis. Moderate stenosis (50%) usually causes flow reversal in the vertebral artery (2). Exercise induced arm pain and presyncope due to vertebral artery compensation is the classic clinical symptom though rarely encountered. This vertebral artery insufficiency can also present as drop attacks, syncope, dizziness (3),(4). The clinical examination may classically reveal decreased pulse volume (radio-radial delay) and blood pressure difference of more than 10 mmHg in upper extremities. Subclavian stenosis is associated with increased cardiovascular deaths and strokes. Medical management with antiplatelets, beta blockers and statins decrease long-term mortality (3). When diagnosed incidentally revascularisation therapy is usually not required irrespective of flow reversal. Mildly symptomatic patients are treated with medical therapy. Surgical or percutaneous intervention is required for patients with significant symptoms. The success of percutaneous approach is >90% (3). Surgical revascularisation done by carotid-subclavian bypass, axillo-axillary bypass surgeries or carotid transposition. The patency rate of such procedures is 80% at 5 years (5).

Asymptomatic Violaceous Nodules in a Young Female with Leukaemia Cutis

Aanchal Agarwal, Mohammad Hamza Ansari

Dear Editor, A 20-year-old female presented to the Department of Dermatology and Venereology of a tertiary care hospital with multiple asymptomatic, red, raised lesions over the trunk that had been present for two months. There were no other associated complaints, and her past and family history were not significant. During physical examination, multiple non tender erythematous to violaceous nodules were observed on the abdomen and back, ranging in size from 1.5 to 5 cm in diameter (Table/Fig 1). Systemic examination revealed no abnormalities. A provisional diagnosis of Leukaemia Cutis (LC) and cutaneous pseudolymphoma were considered. A skin biopsy was performed, which revolved an unremarkable epidermis. The dermis exhibited a moderately dense infiltrate of neutrophils and eosinophils, extending to the reticular dermis. Additionally, an interstitial infiltrate consisted of several large cells with abundant pale pink cytoplasm and irregular nuclei (Table/Fig 2). Complete Blood Count (CBC) revealed an elevated total leukocyte count (32,000 cells/μL) with neutrophilia (12,800 cells/μL). The general blood picture demonstrated marked leukocytosis with nearly 89% myeloblasts (Table/Fig 3). Bone marrow examination showed hypercellularity with approximately 90% blast cells, some of which exhibited cytoplasmic Auer rods (Table/Fig 4). Immunohistochemistry (IHC) results were positive for CD3 and CD20, equivocal for CD68, and negative for CD34 and CD117. Collectively all these findings from the investigations accularated in concluding the diagnosis as LC with acute myeloid leukaemia was made, and the patient was referred to a specialised cancer institute for further management. Leukaemia cutis is skin infiltration in patients with peripheral leukaemia which is relatively rare and typically signifies as advanced disease advances. LC refers to the specific cutaneous manifestation due to the infiltration of neoplastic leukocytes or their precursors into the epidermis, dermis, or subcutis. The non specific cutaneous manifestations occurring due to thrombocytopenia, inadequate granulocytosis, or paraneoplastic syndrome, and not necessarily because of leukaemic infiltration, are called leukaemids (1). They are more frequent than LC and are seen in upto 25-40% of cases of leukaemias (1). LC can occur in 3-30% of cases of leukaemia, depending on the type, with Acute Myeloid Leukaemia (AML) being the most common type and accounting for 5-10% of cases (2),(3). It usually follows the systemic disease but can also occur concomitantly, although rarely it precedes the diagnosis (aleukaemic LC). The exact pathophysiology of migration of leukaemic cells into the skin and the formation of LC lesions is unknown. However, recent molecular research has provided some information regarding the cell-cell interaction and the role of adhesion molecules in mediating the migration of leukaemic cells to the skin via skin-selective homing processes (3). The clinical presentation of LC varies, ranging from macules, papules, plaques, nodules, ulcers, or rarely, swellings or vesicles. However, it usually presents as red to violaceous papules and nodules (1), as seen in the present case. Other uncommon presentations that have been reported include LC presenting as lesions of erythema multiforme or mimicking urticaria pigmentosa (1),(4). LC is a local manifestation of systemic leukaemia; therefore, the treatment of choice is the management of the underlying malignancy. The prognosis of patients diagnosed with LC is poor, as most patients have extramedullary involvement at the time of diagnosis. Patients with AML, as well as LC, may have a median two-year survival rate of around 10%, which is lower than that seen in patients with AML without LC (5),(6). Present case study although represents the investigation which had abnormalities, the cutaneous lesions were the only presenting complaint, which ultimately led to the diagnosis of the malignancy. Prompt recognition of LC is important as it might be the sole indicator of the underlying haematological malignancy at times. Moreover, its presence indicates a poor prognosis, hence its detection also helps in deciding the management. Sincerely,

Quantitative and Qualitative Analysis of Food Consumption in Household Kitchen of Rural Haryana: A Community-based Cross-sectional Study

Tanvi Goel, Vijay Kumar Silan, Sanjay Kumar Jha, Pankaj Yadav

Introduction: Food availability is essential for addressing malnutrition. However, nutritional adequacy, which includes both the quantity and quality of food, is equally important. In India, the household serves as the fundamental unit of food consumption, and the health of all household members reflects the nutrient adequacy at this level. Aim: To assess the quantity and quality of food prepared in household kitchens in rural India. Materials and Methods: A community-based cross-sectional study was conducted from July 2021 to June 2022 in village Juan, Haryana, India. Ninety households were selected using systematic random sampling. A dietary assessment was conducted to evaluate the food consumed at the household level. Additionally, a general physical examination was performed on all household members (n=405). The data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the Chi-square test was applied to identify associations between micronutrients (iron, calcium, and folic acid) and socio-demographic variables (social caste, socio-economic status, and household size). Results: Out of the 90 households, the majority (52.2%) followed a lacto-vegetarian diet and had adequate calorie intake (more than the Recommended Daily Allowance (RDA)) (80%), protein intake (97.8%), and fat intake (86.7%). However, only 34.4% (n=31) and 20% (n=18) of households had sufficient iron and folic acid intake, respectively, resulting in over half (51.1%) of the household members being clinically anaemic. Approximately one-third (31%) of the household members were found to be overweight. Conclusion: Despite the majority of households having an adequate quantity of food, there was a high prevalence of anaemia and malnutrition. Therefore, it is not only the quantity of food that is crucial for an individual’s health but also the quality and source of food.

Impulsivity in Alcohol Dependence among Male Patients in Tamil Nadu: A Cross-sectional Study

Niaz Mohaideen, KS Arun Narayan Pradeep, R Arul Saravanan

Introduction: Alcohol is one of the major substances used in our country, affecting people of young age to old age. It has become a significant concern as a public health burden across all of India. Although the consequences of alcohol dependence in terms of impulsivity are widely assessed, the depth of the burden of alcohol dependence changes with respect to place, time, and socio-economic conditions. Aim: To understand the role of impulsivity and Adverse Childhood Events (ACE) in alcohol dependence among male patients. Materials and Methods: A hospital-based cross-sectional study was conducted between January 2020 and December 2020 among 190 male cases of alcohol dependence syndrome based on ICD-10 criteria. These patients visited the outpatient or inpatient psychiatry department at SRM Medical College Hospital and Research Centre, Potheri, Chengalpattu, Tamil Nadu, India. During the first visit, socio-demographic and clinical details were collected, along with the Barratt Impulsiveness Scale (BIS) and ACE Questionnaire. During the second visit, the Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Scale and Severity of Alcohol Dependence Questionnaire (SADQ) scales were used. Pearson’s correlation was used for analysis using statistical software Statistical Package for Social Sciences (SPSS) version 21.0. Results: Out of the 190 patients enrolled in the study, the majority had completed middle school level education (34.2%). Among the alcoholics, 63.7% were married, and approximately 73.2% were from the lower and middle socio-economic class. A family history of alcoholism was found in nearly 78% of the participants. The maximum number of participants had 1-3 months of abstinence. Pearson’s correlation showed a positive correlation between impulsivity and its subscales with alcohol dependence score and ACE (p<0.05). Conclusion: This study concludes that both impulsivity and alcohol dependence have a bidirectional relationship. ACE also has a positive relationship with impulsivity and alcohol use.

Impact of Dexmedetomidine Infusion during Functional Endoscopic Sinus Surgery: A Randomised Controlled Trial

Sarita Fernandes, Pooja Ramchandani, Minal Harde

Introduction: Functional Endoscopic Sinus Surgery (FESS) requires a surgical field with minimal bleeding, and numerous pharmacological agents have been used to achieve this. Dexmedetomidine has been widely used as a sedative, analgesic, and as a supplement to general anaesthesia. It has been found to decrease norepinephrine release, thereby decreasing Heart Rate (HR) and blood pressure. These properties, along with its opioid-sparing analgesic effects, make it an attractive drug to use during FESS. Aim: The aim of this study was to determine if dexmedetomidine infusion during FESS improves the visibility of the surgical field, provides stable haemodynamics, and alters the consumption of sevoflurane and other anaesthetic agents. Materials and Methods: This randomised, double-blinded controlled trial was conducted at the Otorhinolaryngology Operation Theatre, BYL Nair Charitable Hospital, Mumbai, India, from July 2018 to December 2019. The study included 100 patients of either sex, with American Society of Anaesthesiologists (ASA) I and II classification, aged 18-55 years, who were randomly divided into two groups. Group D received a dexmedetomidine infusion (0.5 mcg/kg/hour), while group C (control group) received a saline infusion. Haemodynamic parameters, Minimum Alveolar Concentration (MAC) of sevoflurane, surgeon’s grading of the operative field, and the requirement of additional hypotensive agents were compared. Statistical analysis was performed using Student’s unpaired t-test to evaluate the significance of normally distributed variables, Mann-Whitney U test and Chi-square test for ordinal data and categorical variables. Results: The groups were comparable with respect to age, weight, gender, and ASA grade. The average mean MAC of sevoflurane at various time intervals was 1.135±0.664635 in group D and 1.9675±0.438 in group C, which was statistically significant. The surgeon’s grading of the surgical field using the Fromme and Boezaart scale was significantly better in group D (1.53±0.45625 versus 2.907±0.5835 in the control group). Although not statistically significant, more number of patients in group C needed additional drugs to lower HR and blood pressure. Conclusion: Dexmedetomidine infusion during FESS is effective in maintaining stable haemodynamics with a lesser need for additional agents to lower HR and Mean Arterial Pressure (MAP). It improves the visibility of the surgical field and decreases the MAC of sevoflurane required to maintain anaesthesia.

Variation in Cost Among Anticancer Drugs Available in India: A Cross-sectional Study

Introduction: Cancer is an abnormal growth of cells, and it encompasses over 100 types of cancers that affect humans. Cancer management often involves a combination of radiation therapy, surgery, chemotherapy, and targeted therapy. Anticancer drugs, in general, tend to be more expensive compared to other categories of drugs, significantly contributing to the overall drug expenditure incurred by patients. Aim: To analyse the percentage variation in cost among different brands of anticancer drugs available in the Indian market. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Symbiosis Medical College, Symbiosis International University, in Pune, Maharashtra, India. The study duration was six months, from March 2021 to August 2021. Data on the prices of anticancer drugs were collected and analysed using the October 2020 to January 2021 edition of the Current Index of Medical Specialities (CIMS). A total of 29 anticancer drugs with different strengths were considered. The cost of a particular anticancer drug with the same dose and dosage form produced by different companies was compared. Drugs were selected based on their strength and dosage forms. The cost of one tablet, capsule, or injection was calculated in Indian Rupees (INR). The cost of a single unit was compared, and the difference between the maximum and minimum costs was calculated. Subsequently, cost ratios and the percentage of cost variation were determined. The study findings were recorded in both Microsoft Word 2016 and Excel 2016, and they were expressed as absolute numbers and percentages. Results: Bortezomib 3.5 mg was the costliest among anticancer drug which was priced at INR 18,988.00, while the cheapest was methotrexate 2.5 mg tablet, priced at INR 1.886. Among the anticancer drugs, pacilitaxel 260 mg injection had the highest cost ratio of 1 29.3055, whereas cisplatin 10 mg injection had the lowest cost ratio 1. Regarding cost variation, pacilitaxel 260 mg injection showed the highest percentage of cost variation at 2830.5555%, while cisplatin 10 mg injection showed the lowest at 0%. Conclusion: This study revealed a significant variation in prices, cost ratios, and cost variation among different anticancer drugs, providing insights into the price discrepancies observed in the market. The findings can help physicians and policymakers become aware of the cost variations among these drugs and make informed decisions regarding pricing.

Evaluation of Paste and Aqueous Lubricants on the Incidence of File Breakage, Quality of Obturation and Postoperative Pain in Children after Pulpectomy in Primary Teeth: A Randomised Clinical Trial

Janvi Manish Gandhi, Ganesh Jeevanandan, Lavanya Govindaraju

Introduction: Pulpectomy in primary teeth involves various steps, including tooth isolation, access opening, canal instrumentation, and obturation. Lubricants are commonly used in the biomechanical preparation of root canals to suspend and emulsify debris generated by the mechanical action of hand and rotary files. While paste-type lubricants (Prime Dental RC Help) and aqueous lubricants (17% aqueous Ethylenediaminetetraacetic acid [EDTA]) are available for use, there is a lack of studies in the literature documenting the effects of these lubricants on file fracture, obturation quality, and postoperative pain. Aim: To compare the effects of paste-type lubricants with aqueous lubricants on file breakage, quality of obturation, and postoperative pain in children treated with pulpectomy in primary teeth. Materials and Methods: This randomised clinical trial involved 40 primary teeth, evenly distributed for instrumentation using Kedo-S Plus pediatric rotary files. In Group 1 (n=20), paste-type lubricant was used during canal preparation, while in Group 2 (n=20), aqueous lubricant was used. The clinician recorded data on file fractures, evaluated the quality of obturation using immediate postoperative radiographs, and measured postoperative pain using the Four-point facial pain intensity rating scale. Descriptive statistics were performed once the data was tabulated. Results: Total of 40 primary teeth were included, participants aged 4-9 years, 22 girls and 18 boys. There was no incidence of file fracture in the group-2 treated with aqueous lubricants. Regarding the quality of obturation, the group-1 treated with paste-type lubricant had a higher number of under-fill and over-fill cases (p=0.002, 0.001), while no statistically significant difference was observed between the groups in terms of optimal fill (p=0.661). At 6, 12, 24, and 48 hours, there was no difference in pain experienced by the participants in both groups (p>0.05). Conclusion: During rotary instrumentation in primary teeth, aqueous lubricants were found to be more effective than paste-type lubricants in preventing file breakage, providing optimal obturation quality, and reducing postoperative pain.

Association Between Cycle Threshold Value of Cartridge-Based Nucleic Acid Amplification Test and Clinical Severity of Pulmonary Tuberculosis: A Cross-sectional Study

N Sahana, S Rajesh Kumar Jain, M Manjunath

Introduction: Tuberculosis (TB) is a major global health problem caused by Mycobacterium tuberculosis (MTB). The National Tuberculosis Elimination Programme (NTEP) emphasises early diagnosis and treatment of TB cases. The Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) is a semi-automated molecular assay that rapidly detects MTB Deoxyribonucleic Acid (DNA) and Rifampicin (RIF) resistance-associated mutations using Real-Time Polymerase Chain Reaction (RT-PCR). Aim: This cross-sectional study aims to assess the association between the Cycle Threshold (Ct) value of CBNAAT and the clinical severity of Pulmonary Tuberculosis (PTB). Materials and Methods: The study was conducted at the Department of Respiratory Medicine, Navodaya Medical College Hospital and Research Centre-Raichur, from January 2020 to July 2021. A sample size of 106 participants, aged ≥18 years and meeting the NTEP guidelines for presumptive PTB cases, were enrolled. Participants underwent chest radiography, sputum smear microscopy for Acid-Fast Bacilli (AFB), and CBNAAT testing. Clinical severity of PTB was categorised as mild, moderate, or severe using the Bandim TB score. Data was entered into Microsoft Excel 2017, and statistical analysis was performed using SPSS version 23. Descriptive statistics, frequencies, percentages, means, and standard deviations were calculated, and the chi-square test was utilised to assess associations between qualitative variables. Results: Among the participants, the majority (55.7%, n=59) had moderate clinical severity. Of these, 12.3% (n=13) had high CBNAAT Ct values, 20.8% (n=22) had medium Ct values, 11.3% (n=12) had low Ct values, and 11.3% (n=12) had very low Ct values. A total of 31.1% (n=33) had severe clinical severity, with 13.2% (n=6) having high Ct values, 12.3% (n=13) having medium Ct values, and 6.6% (n=7) each having low and very low Ct values. Additionally, 13.2% (n=14) had mild clinical severity, with 0.9% (n=1) having high Ct values, 3.8% (n=4) having medium Ct values, 5.7% (n=6) having low Ct values, and 2.8% (n=3) having very low Ct values. The chi-square value was 4.697, with a p-value of 0.58. Conclusion: There is no association between the Ct value of CBNAAT and the clinical severity of PTB.

Subjective Global Assessment of Nutritional Status among Chronic Kidney Disease Dialysis Patients: A Cross-sectional Study

Nagisetty Sindhura, Sreenivasulu J Naga, MSN Murty

Introduction: Nutritional status is compromised in End-Stage Renal Disease (ESRD) patients on dialysis. In order to predict the clinical outcomes of these patients, the diagnosis of nutritional status becomes extremely important. However, data related to parameters assessing nutritional status are limited. Aim: The aim of this study was to assess the nutritional status of dialysis patients with ESRD at the renal care unit of a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted at the renal care unit of a tertiary care hospital from January 2016 to July 2016. Fifty individuals were divided into two groups: 30 stable ESRD patients on Haemodialysis (HD) and 20 stable ESRD patients on Continuous Ambulatory Peritoneal Dialysis (CAPD). Data were collected using a questionnaire regarding nutritional assessment, which comprised medical history, food intake history, anthropometry, biochemical investigations, and Subjective Global Assessment (SGA). Based on the SGA analysis of nutritional status, the patients were divided into Categories A, B, and C. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22.0. Results: A total of 50 subjects were included in the final analysis - 30 patients in the renal dialysis group and 20 patients in the CAPD group. Body Mass Index (BMI) was significantly higher in the HD group (21.78±2.86 kg/m2) than in the CAPD group (20.87±2.63 kg/m2). In the HD group, the majority were in Category B (60%). In the CAPD group, the majority were in Category B (70%). The mean anthropometric measurements were significantly higher in Category A, followed by B and C (p<0.001). There was no significant difference across groups in biochemical parameters, except for serum albumin levels, which were significant. Serum albumin levels were highest in Category A, followed by Category B, and Category C in reverse for S. Prealbumin (mg/dL). Conclusion: There is a significant number of ESRD patients who have malnutrition as an additional burden. These results suggest that low BMI and low calorie intake are harmful to ESRD patients on HD, causing severe malnutrition. Optimal calorie intake could reduce malnutrition in these patients.

Prevalence and Characteristics of the Articular Tubercle on Cone Beam Computed Tomography: A Retrospective Study

Soundarya Ramesh, Poornima Govindraju, Balaji Pachipulusu

Introduction: Pneumatisation represents areas of minimal resistance, making it easier for the expansion of numerous pathological processes such as tumours, infections, or fractures into the joint. Detection of these air-filled cavities is necessary before planning surgical intervention in order to prevent complications. Aim: To assess the prevalence and characteristics of Pneumatisation of the Articular Eminence of the Temporal Bone (PAT) in the Bengaluru population. Materials and Methods: A retrospective study was conducted in the Department of Oral Medicine and Radiology at an esteemed Dental College and Hospital in Bengaluru, Karnataka, India. The study lasted for 13 months, from March 2019 to February 2020. The study included Cone Beam Computed Tomography (CBCT) images of 133 patients (84 males and 49 females) aged between 20-80 years. Based on age, the study group was divided into five groups with an age interval of 10 years, and the prevalence, laterality, and type of pneumatisation of the articular eminence were assessed. The obtained data were statistically analysed using the Chi-square test and McNemar’s test with a significance level of p-value <0.05. Results: Out of the 133 CBCT images evaluated, PAT was noticed in 62 subjects, with an overall prevalence of 46.6%. The highest prevalence of pneumatisation (62.5%) was present in the age group of 61-70 years, followed by 53.8% in the 31-40 years age group. A male predilection was noted with the maximum prevalence during the sixth decade, followed by the third decade of life. There was an equal distribution in terms of laterality, and the multilocular type of pneumatisation was more common than the unilocular type. Conclusion: The prevalence of PAT was 46.6% and was predominantly seen in males compared to females. Multilocular PAT was more commonly seen than unilocular PAT.

Factors Influencing the Prescription of Antibacterial Drugs in COVID-19 Patients: An Antibacterial Surveillance Study

Roopali Kedar Somani, Radhika Soanker, MVS Subbalaxmi, Padmaja Durga

Introduction: The empiric use of antibiotics in Coronavirus Disease-2019 (COVID-19) infection is not routinely recommended unless a secondary bacterial infection is suspected or confirmed. However, there have been reports of widespread antibiotic use in COVID-19 patients, despite a low rate of secondary bacterial co-infection. Therefore, this study aims to understand the factors influencing the empirical prescription of antibacterial drugs in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients in Indian settings, as the available data is sparse and conflicting. Aim: To determine the factors associated with antibacterial prescription in patients with proven COVID-19 infection at a tertiary care hospital. Materials and Methods: An antibacterial surveillance study was conducted at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. The study duration was two months, from September 2020 to October 2020. The study included COVID-19 patients admitted to critical and non-critical COVID-19 Care Units. Patient data, including demographics, general and systemic examination details, biochemistry, pathological and microbiological reports, and treatment details, were collected using a specially designed form. Patients who were prescribed antibacterial drugs (other than repurposed antibacterial drugs for COVID-19 treatment) were considered as cases, while the rest were classified as controls. The Hazard Ratio (HR) for factors associated with antibacterial prescription was estimated using Cox regression analysis with the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 200 patients, of whom 45 (22.5%) received antibacterial drugs and were classified as cases, while the remaining 155 (77.5%) received antibacterial drugs and were classified as controls. The median age of cases and controls was 59 and 46 years, respectively. Cox regression analysis showed that procalcitonin >1 ng/mL (HR: 1.074, 95% Confidence Interval [CI]: 1.009-1.142, p-value=0.02) and admission to the critical care unit were independent predictors of antibacterial prescription. Additionally, high-dose steroid use (>120 mg/day of Methylprednisolone [MPS]) was associated with a 20% higher risk of antibacterial prescription, although the values were statistically non-significant (HR: 1.203, 95% CI: 0.503-2.879, p=0.678). Conclusion: Admission to critical care units and procalcitonin levels >1 ng/mL were identified as independent predictors of antibacterial prescription in COVID-19 patients. Compliance with hospital-based standard treatment guidelines promotes the rational use of antibacterial drugs.

Association between Lip Prints and Skeletal Malocclusion using Digital Photography: A Cross-sectional Study

Introduction: Lip prints are the lines and furrows observed on the vermilion border of human lips. Several studies have found a connection between lip prints, skeletal malocclusion and gender. Establishing a direct relationship between lip prints and sagittal jaw relationships in different genders can aid clinicians in early prediction of malocclusion types. Aim: To identify the association between lip prints, skeletal class I and class II malocclusions in different genders using digital photographs. Materials and Methods: An analytical cross-sectional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics at Anil Neerukonda Institute of Dental Sciences, Vishakhapatnam, Andhra Pradesh, India. The duration of the study was two months, from June 2022 to July 2022. A total of 120, out of which 60 (30 males and 30 females) participants with Angles’s class I malocclusion and 60 (30 males and 30 females) with Angle’s class II malocclusion were included, based on angle formed by point A, nasion (N) and point B (ANB angle) aged between 18 to 30 years. Digital photographs were captured using an SLR digital camera. The lip print pattern in a 10 mm wide area in the middle of the lower lip was determined using Suzuki and Tsuchihashi’s method. Statistical analysis was performed using the Chi-square test. Results: The most prevalent lip pattern in skeletal class I malocclusion was the branched lip pattern (type-II) in 43.33% of 60 participants, while the intersected pattern (type-III) was most prevalent in skeletal class II malocclusion with 38.33% of 60 participants. Among males, the most prevalent lip pattern was the branched lip pattern (type-II) in 46.67% of 60 participants, while in females, the vertical groove across the lip pattern (type-I) was most prevalent in 46.67% of 60 participants. Statistical significance was observed between lip pattern, skeletal malocclusion and gender (p=0.0416 in males and p=0.01397 in females). When gender is not considered, statistically significant differences were observed between the two malocclusions in (type-II) branched lip pattern (type-II) (p=0.023) and the intersected lip pattern (type-III) (p=0.001). When skeletal malocclusion is not considered, statistically significant differences were observed between the two genders in the vertical lip pattern (type-I) (p=0.001) and the branched pattern (type-II) (p=0.04). When comparing the association of lip print pattern between skeletal class I and class II malocclusions in males and females significant differences were found between skeletal malocclusion and gender (males: p=0.008, females: p=0.004) only in (Type III) intersected lip pattern. Conclusion: In conclusion, lip prints can serve as a useful tool in identifying skeletal malocclusion. The (type-III) intersected lip pattern shows a higher likelihood of predicting class II malocclusion compared to the type-II branched lip pattern, which is more indicative of class I malocclusion.

Clinicopathological Study of Ovarian Germ Cell Tumours in Tertiary Care Hospital, Tamil Nadu, India: A cross-sectional Study

V Lokeshwari, PI Oshin, M Gomathi, V Eswari

Introduction: Ovarian germ cell tumours are a heterogeneous group of neoplasms derived from primitive germ cells of the embryonic gonad, either directly or indirectly. They can be classified as benign and malignant, with slow and rapid growth and spread, respectively. Benign ovarian germ cell tumours are common, while malignant tumours are rare and account for about 2.6% of all ovarian malignancies. They are more common in the second and third decades of life and typically present with abdominal mass, pain, and elevated serum tumour markers, which aid in primary diagnosis and follow-up. Aim: To analyse the distribution of germ cell tumours in the ovary in relation to age, parity, mode of presentation, biochemical markers, histomorphological patterns, and immunohistochemical markers. Materials and Methods: This cross-sectional study was conducted at Department of Pathology, Sree Balaji Medical College, Hospital and Research Institute, Chromepet, Chennai, Tamil Nadu, India. The study involved 86 ovarian specimens, of which 25 were germ cell tumours. Complete clinical history, radiological findings, and pre-operative laboratory test values were recorded. The ovarian specimens were carefully examined for gross appearances, fixed in 10% neutral buffered formalin for 24-48 hours, and subjected to histopathological processing, routine and special staining, and immunohistochemical study after observing the different morphological patterns of the ovarian specimens received. Results: The age range of presentation was between 14 years and 58 years. Seventeen patients were parous (14 benign and 3 malignant), and eight (5 benign and 3 malignant) were nulliparous. Abdominal mass and abdominal pain were the most common modes of presentation. Out of 25 germ cell tumours, 19 were benign cystic mature teratomas, 2 were immature teratomas, 1 was a yolk sac tumour, 2 were dysgerminomas, and 1 was a carcinoid tumour, with 6 being malignant and 19 being benign tumours. Among the 6 malignant ovarian tumours, 5 cases had raised serum tumour markers {cancer antigen-125 (CA-125), Alpha-Fetoprotein (AFP)} pre-operatively, and the levels reduced and became normal after surgery. Among the 2 cases of immature teratoma, one was Grade-II and the other was Grade-III. For one case with mixed tumour components, CD-30 and α-fetoprotein immunohistochemical markers were performed, showing negative and positive results, respectively. Conclusion: Among the histopathological subtypes, benign cystic teratomas were the most common ovarian germ cell tumours in this study. Both benign and malignant tumours presented with abdominal pain and abdominal mass. Most of the tumours were diagnosed between the ages of 21 and 40 years. In this study, α-fetoprotein immunohistochemical marker showed strong positivity, confirming a single tumour component.

Clinical Presentation and Categorisation of Chronic Low Back Pain: A Cross-sectional Analysis of 1000 Outpatients in Eastern India

Sanatan Behera, Tanmoy Mohanty, Chitrita Behera

Introduction: Low back pain is one of the most common presenting symptom among patients seeking medical help, accounting for approximately 85% of the cases. It affects individuals of all age groups and genders. Predominantly back pain is non specific, lacking identifiable patho-anatomy, while a lesser-known type, specific low back pain, demonstrates identifiable aetiology and pathology. This poses a challenge for physicians, as they must not only determine the underlying cause but also formulate categorical treatments for Chronic Low Back Pain (CLBP). Aim: To assess the prevalence of different types of CLBP based on clinical examination, past history, age, and gender in the overall population of the study. Materials and Methods: A cross-sectional study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, from August 2019 to July 2021. A total of 1,640 patients were examined in the orthopedics outpatient department, of which 1,000 patients aged between 20 and 60 years, with back pain lasting three months, were included in the study. All patients underwent a detailed clinical evaluation, including history and physical examination. The final type of CLBP was determined based on the predominant symptom. Data analysis was performed using Microsoft Excel software. Results: The male-to-female ratio was 1.23:1, and the average age was 43.1 years. The most common type of CLBP was neuropathic (n=473, 47.3%), followed by discogenic CLBP (n=255, 25.5%). The least common type was coccydynia (n=4, 0.4%). Facetogenic CLBP had the highest average age of presentation (57.3 years), while postural CLBP had the lowest average age (29.6 years). Conclusion: Neuropathic CLBP was the most common type, followed by discogenic CLBP, with sacroiliitis and coccydynia being less common. Detailed clinical evaluation aids in classifying different types of CLBP, which can help avoid unnecessary investigations, except for the neuropathic type and, to some extent, instability CLBP.

Mental Health of Foreign Medical Graduates in Tamil Nadu, India: A Mixed-methods Study

V Karthikeyan, Raghunath Elango

Introduction: Over the last five years in India, there has been a three-fold increase in the number of candidates taking the Foreign Medical Graduate Examination (FMGE). Foreign Medical Graduates (FMGs) have recently experienced the Coronavirus Disease-2019 (COVID-19) pandemic and wars/internal conflicts in the countries where they study. Aim: To assess the mental health status of FMGs and analyse the associated socio-demographic, economic, and academic factors, as well as the impact of COVID-19 on their mental health. Materials and Methods: This explanatory mixed-method study utilised a quantitative method (Phase 1- Self-administered questionnaire GHQ-12) followed by a qualitative method {Phase 2- Focus Group Discussion (FGD)}. The study included 169 FMGs doing their internship (academic year 2022-23) at Government Medical College Krishnagiri, Tamil Nadu, India, and their colleagues/batchmates who were willing to participate in the study. Descriptive statistics and student t-test were used to analyse the variables. Results: In the present study, 99 (58.6%) study participants were male, 130 (76.9%) were in the age group of 23-25 years, and 114 (67.5%) belonged to the upper socio-economic class. About 80 (47.3%) respondents scored higher than the overall mean GHQ-12 score, indicating mental distress. FMGs who had not yet joined the internship reported significant mental health issues compared to those currently in internship. FGD participants felt a lack of confidence in patient care, academic burden, financial burden, family bereavement, and personal health issues were the impacts of the COVID-19 pandemic on their mental health. Conclusion: Almost half of the FMGs in the present study were under stress, which could be attributed to the financial burden in the family, lack of academic confidence, and personal loss during the COVID-19 pandemic.

Histopathological Analysis of Lung Infections during Pre and Post COVID-19 Eras: Insights from a Four-Year Autopsy Study at a Tertiary Care Hospital in Tirunelveli, Tamil Nadu, India

Introduction: Autopsies are routinely useful in establishing the cause and time of death. The Coronavirus Disease-2019 (COVID-19), a pandemic viral infectious disease, has affected many countries worldwide. In developing countries like India, infectious lung pathology has been a significant cause of death even before the COVID-19 era. However, the emergence of COVID-19, there has been an increase in lung infections due to factors such as prolonged hospital stays, assisted ventilation, lung damage, and immune suppression, affecting both morbid patients and survivors. Aim: To describe the histopathological spectrum of infective lesions of lung in autopsy during Pre COVID-19 and COVID-19 era in a tertiary care hospital of Tirunelveli, Tamil Nadu, India. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, between January 2018 and December 2021. Data including age, sex, COVID-19 status, clinical history, histomorphological patterns, and identification of infectious agents, were collected from clinico-pathological and autopsy documents. A total of 627 lung specimens were available, with 41 specimens being autolyzed, leaving 586 specimens for inclusion in the study. Gross morphology and microscopic features were documented, and diagnoses were made based on these findings. Results: The study included a total of 586 specimens, of which 76 (12.9%) were reported as infective pathology. Among these cases, 29 (38.1%) cases were reported in the pre COVID-19 period, and 47 (61.9%) were reported during the COVID-19 period. Of the 76 cases, 41 (53.95%) were male, and 35 (46.05%) were female. The number of cases reported during the post COVID-19 period (47 cases, 61.84%) was higher than the number reported during the pre COVID-19 period (29 cases, 38.16%). In both periods, the majority of cases (10 cases, 13.1% in the pre COVID-19 period; 13 cases, (17.1%) in the post COVID-19 period) were observed in individuals aged 60 years and above, followed by those in the age group of 50 to 59 years (7 cases, 9.2%). Similarly, in the pre COVID-19 period; 10 cases, 13.2% in the post COVID-19 period). Among the 76 cases, interstitial pneumonia (9 cases, 11.8%) was the most common finding in the pre COVID-19 period, followed by bronchopneumonia (seven cases, 9.2%). In the COVID-19 period, Tuberculosis (TB) was the most common finding (17 cases, 22.4%), followed by pneumonia with consolidation (10 cases, 13.2%). Additionally, the number of cases diagnosed with pulmonary TB during the COVID-19 period (17 cases, 22.4%) was higher than that during the pre COVID-19 period (6 cases, 7.9%). During the post COVID-19 period, there has been a drastic increase in the number of pneumonia cases compared to the pre COVID-19 era, and this increase is statistically significant with a p-value of 0.04. Conclusion: Pneumonia (lobar pneumonia, interstitial pneumonia, and bronchopneumonia) is the most common histopathological lung lesion in the present study. Compare to pre COVID-19 era, there is increased number of infective lesions during COVID-19 era. There was a drastic increase in pathological findings of Kochs lesion during COVID-19 era.

High Sensitivity Cardiac Troponin-T STAT in Type 2 Diabetes Mellitus Patients and Healthy Individuals: A Comparative Study

AK Raseema, PA Geetha, Neethi R Krishnan, Arun Mathew Chacko, K Muhammed Ashraf

Introduction: Diabetes Mellitus (DM) is a metabolic disorder that shares the phenotype of hyperglycaemia, with several factors contributing to the disease, including decreased insulin secretion and glucose utilisation, as well as increased glucose production. There is a strong association between DM and Cardiovascular Disease (CVD). High-sensitivity cardiac troponin T (hs-cTnT), which is a marker of subclinical myocardial damage, is used in the risk stratification of asymptomatic individuals. Aim: To estimate and compare hs-cTnT Short Turn Around Time (STAT) levels in diabetic patients without Acute Myocardial Infarction (AMI) with age and sex matched controls and also to investigate the correlation between hs-cTnT STAT and Glycated Haemoglobin (HbA1c) levels. Materials and Methods: A comparative cross-sectional study was conducted in the Department of Biochemistry and Outpatient Clinic, Department of Medicine, Government Medical College, Kozhikode, Kerala, India, from April 2019 to April 2020. The study subjects were divided into two groups: Group 1 consisted of 58 patients with Type 2 Diabetes Mellitus (T2DM) without AMI, and Group 2 comprised 58 healthy individuals who were age and sex matched. No specific sampling technique was employed. After obtaining consent, T2DM patients who attended the outpatient clinic were evaluated with fasting blood glucose, HbA1c, Electrocardiogram (ECG), and hs-cTnT STAT estimation. Controls were selected and evaluated for the same from apparently healthy bystanders of other patients, medical and paramedical staff, and others willing to participate. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0 software. Results: The mean value of Fasting Blood Sugar (FBS) and HbA1c was higher in T2DM patients compared to healthy individuals. hs-cTnT showed a positive moderate correlation with HbA1c (rho=0.53), which was statistically significant (p-value <0.001). Simple linear regression analysis showed that in the case group, for a 1% increase in HbA1c levels, there was a 2.38 unit increase in hs-cTnT levels, which was statistically significant (p-value <0.001). Conclusion: hs-cTnT levels are significantly elevated in T2DM patients without overt CVD compared to age and sex matched healthy individuals. T2DM is a risk factor for increased levels of biomarkers for atherosclerotic CVD, and proper glycaemic control reduces the levels of hs-cTnT in T2DM patients.

Prevalence of Double Burden of Malnutrition among Young Children in Rishikesh, Uttarakhand, India: A Cross-sectional Study

Aakriti Jasrotia, Vartika Saxena, Yogesh Bahrupi

Introduction: The Double Burden of Malnutrition (DBM), which refers to the coexistence of obesity and stunting in children, is a newly emerging form of malnutrition and a significant issue in developing countries, including India. Many of these countries are in the third stage of the epidemiological transition and undergoing rapid urbanisation, leading to increased availability of processed food, mechanisation of work, and sedentary lifestyles. These factors present a unique challenge in combating DBM. Due to the lack of evidence on DBM in India, particularly among young children, the current study was conducted. Aim: The aim of this study was to estimate the prevalence of DBM among children under six years of age and identify its biosocial determinants. Materials and Methods: A cross-sectional study was conducted in the Urban Anganwadi Centres of Tehsil Rishikesh, Uttarakhand, India. The study spanned six months, from November 2021 to April 2022, and included a total of 310 children from 13 Anganwadi Centres. Data collection was performed using a validated and pretested semi-structured questionnaire through Epicollect 5.0. The collected data were analysed using the Statistical Package for Social Sciences (SPSS) version 23.0. Pearson’s Chi-square test was employed to examine the association between various biosocial determinants (sociodemographic factors, Infant and Young Child Feeding practices, and screen time) and DBM. Results: The study included 310 children under six years of age, among whom 11 (3.5%) exhibited DBM. The prevalence of DBM was higher in females, with 8 (5.2%) affected, compared to males, with 3 (2%) affected. Among the females, DBM was more prevalent in the age group of 2-5 years, with five cases. Six out of the 11 children with DBM belonged to the lower-middle class. Additionally, 7 (4%) of the DBM children were breastfed immediately, while 4 (3.5%) were breastfed after a few hours or days. The prevalence of DBM in urban areas of Rishikesh (3.5%) was higher than the national average of 2.8% reported in the Comprehensive National Nutrition Survey (CNNS) 2016-2018 report. Conclusion: Although, the present study had a small sample size, it offers valuable insights and fills the data gap regarding the estimation of DBM at the individual level and the association of various factors in this specific age group. DBM was more prevalent in females compared to males, suggesting a gender-related disparity in the occurrence of DBM among young children. However, further research is needed to understand the underlying factors contributing to this difference and to develop targeted interventions.

Ultrasound-guided versus Conventional Caudal Blocks in Children: A Randomised Clinical Study

Mythreyi Muthukrishnan, Nischala Dixit, Karthik Jain, Anjali TM Ollapally

Introduction: Caudal epidural block is a popular regional anaesthetic technique in children undergoing infraumbilical surgeries. Conventionally, a landmark-guided method is used to perform caudal epidural blocks. Although widely practiced, this method is associated with procedural difficulties such as multiple attempts, decreased success rates at the first puncture, as well as higher rates of complications including dural puncture, rectal injury, and intraosseous/intravenous (i.v.)/subcutaneous injections. In order to overcome the shortcomings of the conventional technique, various other methods have been described in clinical practice, including imaging-assisted techniques with fluoroscopy and Ultrasound (US). Aim: To compare the overall block success rates between the conventional and US-guided methods of caudal blocks in children. Materials and Methods: The present randomised clinical study was conducted in the Department of Anaesthesiology, St. John’s Medical College, Bengaluru, Karnataka, India, from November 2019 to September 2021. Sixty-four children, aged 1-8 years, belonging to the American Society of Anaesthesiologists (ASA) physical status grade I and II, and undergoing elective inguinal hernial surgery were included in the study. After induction of general anaesthesia, the children were administered caudal blocks based on the assigned groups: group A (conventional)- patients were given 0.5 mL/kg of 0.25% bupivacaine after the needle entered the sacral canal, and group B (USG)- patients were given 0.5 mL/kg of 0.25% bupivacaine immediately after the needle was visualised piercing the sacrococcygeal ligament in the longitudinal view. The parameters studied were overall block success rates, block performance times, and the number of attempts taken. Descriptive statistics were reported using mean±Standard Deviation (SD) for continuous variables and number or percentage for categorical variables. Independent t-test and Mann-Whitney U test were used for normally distributed and non-normally distributed variables, respectively. Chi-square test was used to analyse differences between categorical variables. Results: A total of 64 children of both genders, aged 1-8 years, belonging to ASA physical status I and II, were included in the study. Overall block success rates were comparable between the two groups, with 28 (87.5%) in group A and 30 (93.8%) in group B. The mean block performance time was longer in group B (2.781±1.2439 minutes) compared to group A (1.578±0.5835 minutes) (p-value <0.001). The number of attempts was lower in group B, with 100% success in the first attempt, as opposed to 68.8% in group A (p-value <0.05). Conclusion: Ultrasound-guided caudal block does not improve overall block success rates or block performance time, but it does improve success rates at the first attempt and thereby reduces the number of attempts.

Transversus Abdominis Plane Block with or without Intravenous Diclofenac Sodium as a Component of Multimodal Postoperative Analgesia Following Laparoscopic Cholecystectomy: A Randomised Clinical Study

Arunima Das, Shrawan Soni, Keka Pandey, Archana Roy

Introduction: Multimodal analgesia is the recommended approach for treating post-operative pain after laparoscopic cholecystectomy. The Transversus Abdominis Plane (TAP) block is a recently introduced technique showing promising results. To control visceral and somatic pain adequately and to avoid use of opioids intra-operative diclofenac sodium, combined with TAP block as part of a multimodal approach, may be beneficial. Aim: To evaluate the efficacy of TAP block with or without intra-operative diclofenac sodium aqueous injection for controlling post-operative pain following laparoscopic cholecystectomy. Materials and Methods: A randomised, double-blinded study was conducted from February 2022 to October 2022 at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Forty American Society of Anaesthesiology (ASA) physical status-I and II patients aged 20-50 years scheduled for elective laparoscopic cholecystectomy were divided into two groups of 20 patients each. Group A patients received bilateral Ultrasonography (USG) guided TAP block using 20 mL of 0.125% Bupivacaine on each side of the abdomen at the end of surgery. Group B patients received intravenous injection of diclofenac sodium aqueous 75 mg intravenous, intra-operatively, along with bilateral USG guided TAP block using 0.125% Bupivacaine. The primary outcome was the duration of post-operative analgesia (measured by the first request for rescue analgesia after the end of the operation at a VAS score of 4). Secondary outcomes included the total post-operative analgesic requirement (diclofenac sodium), pain score (VAS) over 24 hours in the post-operative period, and the incidence of complications such as nausea, vomiting, hypotension, and bradycardia. Patient Satisfaction Score (PSS) was recorded for each patient before discharge. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 24.0 software. Continuous variables were expressed as mean and standard deviation, and categorical variables were expressed as percentages. Independent t-tests and chi-square tests were used for between-group comparisons, with a p-value ≤0.05 considered statistically significant. Results: Amongst total 40 patients included, divided into group A (mean age: 32.95±8.74 years, 6 males and 14 females) and group B (31.90±9.16 years, 5 males and 15 females) with 20 patients each, the demographic characteristics such as age, gender, height, and weight were similar in both groups. The duration of post-operative analgesia was longer in group B (16.32±1.29 hours) than in group A (7.85±1.04 hours). The total post-operative analgesic requirement was lower in group B (32.95±20.9 mg) compared to group A (58.33±17.14 mg). Visual Analogue Scale (VAS) scores were lower in group B than in group A. PSS was significantly higher in group B patients (8.14±1.06) than in group A patients (6.16±1.38). Conclusion: TAP block, along with intra-operative intravenous diclofenac sodium aqueous, as part of a multimodal regimen, provides superior post-operative analgesia compared to TAP block alone. It is also associated with improved patient satisfaction.

Efficacy of Eyelid Taping with and without Ocular Lubricants in Patients Receiving General Anaesthesia: A Prospective Interventional Study

Joylin Stephany Dsouza, Apoorva Harish Shetty, Lobo Manuel Alexander

Introduction: Corneal Abrasion (CA) is the most common ophthalmic complication that occurs after General Anaesthesia (GA) in non ocular surgeries. GA results in reduced basal tear volume, loss of light reflex, and lack of pain perception, resulting in corneal drying. This makes the cornea susceptible to abrasion and keratitis. Research suggests that preventing corneal mechanical exposure and providing artificial tears can help mitigate these risks. Aim: The aim of this study was to assess the efficacy of eye taping with and without Hydroxypropyl Methylcellulose (HPMC) drops in preventing perioperative CA. Materials and Methods: This prospective comparative interventional study was conducted in the Department of Anaesthesia, Justice Hegde KS Charitable Hospital in Mangaluru, India, from June 2021 to November 2021. A total of 122 patients who underwent GA for non ocular surgeries lasting more than 45 minutes were grouped into group T or group D, depending on whether their eyes were only taped during GA (T) using hypoallergenic adhesive tape or had HPMC drops instilled in their eyes along with tape (D). Participants were evaluated 2 and 12 hours after the end of GA in the postanaesthesia care unit using a questionnaire to assess eye symptoms. Conjunctival hyperaemia and chemosis were evaluated using scoring systems. Other parameters noted included age, gender distribution, type, and duration of surgery. Statistical analysis using the chi-square test/likelihood ratio was performed to assess the association between the eye protection method used and postsurgical outcomes. Results: Out of the 122 patients who received either of the two eye protection methods under GA, 68 (55.7%) were females and 54 (44.3%) were males. A total of 85 (69.6%) were between the ages of 20-60 years, while 29 (23.8%) were above the age of 60 years. There was no statistically significant association found between the age or gender of the patients and the eye protection method used. No statistically significant difference was noted between the duration, type of surgeries, and the eye protection method used in this study. There was no statistical significance (p-value >0.05) noted with respect to the conjunctival hyperaemia and chemosis scoring in the two groups. However, 15 (24.6%) patients in group D were found to have adhesive lids two hours postsurgery. There was an association (p-value <0.05) between the occurrence of adhesive lids at two hours postsurgery and the eye protection method used. Conclusion: Eye protection is mandatory in all non ophthalmic cases under GA. Both eyelid taping alone and eyelid taping with HPMC drops are equally effective in preventing perioperative ocular injury.

Comparison of Intra-Articular Injection and Femoral Nerve Block Using a Combination of Levobupivacaine with Clonidine for Postoperative Analgesia after Arthroscopic Anterior Cruciate Ligament Reconstruction- A Randomised Double-Blind Clinical Trial

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee. Arthroscopic ACL reconstruction is the gold standard procedure for treating ACL tears. Good postoperative analgesia is the secret for immediate postoperative rehabilitation. Various techniques, such as Femoral Nerve Blocks (FNB), epidural blocks, adductor canal blocks, and Intra-Articular (IA) injections, are used to manage postoperative pain. Aim: To compare the quality of postoperative analgesia using a combination of levobupivacaine with clonidine via IA and FNB in patients undergoing ACL reconstruction under spinal anaesthesia. Materials and Methods: This randomised, double-blinded trial was conducted at Pondicherry Institute of Medical Sciences, Puducherry, India, from August 2016 to May 2018. Forty patients with American Society of Anaesthesiologists (ASA) physical status I and II, aged between 18-60 years, undergoing arthroscopic ACL repair under spinal anaesthesia were randomly assigned to two groups, with 20 patients in each group. After the surgery, patients in group 1 received FNB with 15 mL of 0.25% levobupivacaine and 30 mcg clonidine, while patients in group 2 received IA with 15 mL of 0.25% levobupivacaine and 30 mcg clonidine. Parameters such as the total duration of sensory block, the need for rescue analgesia, and total analgesic consumption within 24 hours were recorded postoperatively. The data were analysed using Student’s unpaired t-test, Analysis of Variance (ANOVA), Chi-square test, and Fisher’s-exact test. Statistical analysis was performed using Statistical package for the Social Science (SPSS) software (version 20.0 and info version 3.5.1) for Windows, with a p-value <0.05 considered significant. Results: The quality of postoperative analgesia, including the total duration of block, the need for rescue analgesia, and total analgesic consumption within 24 hours, was similar in both groups. The total duration of block was 216±36.041 minutes for the FNB group and 224±47.395 minutes for the intra-articular group, with a p-value of 0.552. The time for rescue analgesia was 307±87.666 minutes for the FNB group and 305±82.00 minutes for the intra-articular group, with a p-value of 0.963. There were no significant differences between the groups in terms of sex, age, weight, or ASA physical status classification. Conclusion: The present study showed that the postoperative analgesia following arthroscopic ACL reconstruction was equally effective in both groups. Both combinations reduced postoperative pain, expedited the return of postoperative function, maintained vital parameters, and had no apparent side-effects. However, IA may be considered as the preferred option since it is easier to perform than a femoral block.

Analysis of Variation in Blood Donor Deferral Statistics as per Drugs and Cosmetics (Second Amendment) Rules, 2020: An Institutional Experience

Anshul Gupta, Nidhi Bansal, Ram Niwas Maharishi, Arnav KR Roychoudhury

Introduction: The safety of donated blood is of utmost importance for the well-being of the recipient, which requires proper adherence to donor acceptance criteria. In March 2020, new amendments were introduced in the Drugs and Cosmetics Act, which included several new criteria. It is important to explore these changes and their impact on the donor pool to ensure adequate maintenance of whole blood/component inventory in our blood centre. Aim: To study the variation in deferral statistics of blood donors after the introduction of new donor criteria as per the Drugs and Cosmetics (Second Amendment) Rules, 2020. Materials and Methods: The present study was conducted from October 1, 2022, to June 30, 2023, in the Department of Immunohaematology and Blood Transfusion (Blood Centre) of a tertiary care hospital in Punjab, India. Retrospective data for three years was collected from blood donor records and deferral records, divided into two groups: group 1 (October 1, 2018, to March 31, 2020) for the old criteria, and group 2 (April 1, 2020, to September 30, 2021) for the new criteria. Reasons for deferral of donors were categorised into four stages: clinical history, medical examination, investigations (haemoglobin levels), and inadequate collection for both male and female donors. The collected data was entered into a Microsoft Excel sheet. Variables in different categories were represented as frequencies and percentages. Chi-square test was used for comparison between the data of the two groups. Results: In group I, 332 out of 6,588 donors (5.04%) were deferred, and in group II, 345 out of 6,143 donors (5.61%) were deferred. The deferral rate was comparatively higher in females in both groups, with 17.98% (41/228) in group I and 21.65% (21/97) in group II. The percentage of deferred donors was higher in the age group of 18-30 years in both groups, with 50.60% (168/332) in group I and 47.25% (163/345) in group II. The maximum number of donors were deferred at stage I (clinical history), with 270/332 (81.33%) in group I and 296/345 (85.8%) in group II, followed by stage III (investigations), with 34/332 (10.24%) in group I and 33/345 (9.56%) in group II. COVID-19 related history was the third most common cause of deferral in group II, accounting for 43 (12.46%) of the total deferred cases, which was not present in group I. Conclusion: The new guidelines, although comprehensive, only minimally increased the deferral rate and did not have a significant impact on the donor pool of our blood centre. Knowledge about the latest deferral guidelines and donor deferral rates is of utmost significance for the maintenance of inventory and to reduce the loss of a significant donor pool.

Learning Curve of Ophthalmic Postgraduate Students During Training in Manual Small Incision Cataract Surgery (MSICS): A Cross-sectional Study

Introduction: Ophthalmology residency programs play a critical role in training surgeons to perform cataract surgery. A fundamental component for developing competency in cataract surgery is undergoing a structured surgical training program. There is an inverse relationship between the number of surgeries performed by a resident and adverse surgical outcomes. Aim: To assess the learning curve of Manual Small Incision Cataract Surgery (MSICS) performed by postgraduate students during their residency tenure by estimating the difficulties encountered and intraoperative and postoperative complications during surgical training. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology, Hassan Institute of Medical Sciences (HIMS) Teaching Hospital, Hassan, Karnataka, India, from July 1st 2020 to January 1st 2023. Study included 249 patients undergoing MSICS by three postgraduates, who enrolled in the Master of Surgery (MS) Ophthalmology course and received hands-on training in a wet lab were selected. They performed MSICS in a stepwise manner under the supervision of a trained ophthalmologist. Surgeries were recorded and discussed in surgical audits, and intraoperative and postoperative complications were analysed. The collected data was statistically analysed using descriptive statistics such as frequency and percentage. Results: A total of 249 patients, including 135 (54.2%) females and 114 (45.7%) males, with a mean age of 68.4 years, were included in the study. The majority (47%) of cases were senile immature nuclear sclerotic cataracts grade 3-4. Difficulties encountered during the surgeries were tunnel formation (24.6%), capsulotomy (4.5%), nucleus delivery (21.5%), cortical wash (34.3%), and Intraocular Lens (IOL) insertion (14.8%). Intraoperative complications observed were premature entry (46.3%), roof tear (16.1%), Descemet’s membrane detachment (7.3%), iridodialysis (7.3%) and Posterior Capsular Rent (PCR) (22.1%). Postoperative complications included wound gaping (0.4%), anterior chamber reaction (10.8%), corneal oedema (25.4%), striate keratopathy (58%) and raised intraocular pressure (5.1%). Conclusion: The most common difficulty encountered during the first year of residency was tunnel formation, while the most common difficulty encountered during the second and third years was cortical wash. The most common intraoperative complication was premature entry, and the most common postoperative complication was striate keratopathy. Stepwise learning by the resident under continuous monitoring by a consultant lowers complications and gives confidence to postgraduate students.

Pulmonary Manifestations of Dengue Fever at a Tertiary Care Centre in Northern India: A Cross-sectional Study

Introduction: Dengue Fever (DF) is associated with systemic inflammation, clinically manifesting as involvement of different organ systems, including the pulmonary system. Pulmonary involvement is characterised by pleural effusion, pneumonia, haemoptysis, pulmonary haemorrhage, secondary bacterial infections with Acute Respiratory Distress Syndrome (ARDS), and Dengue Haemorrhagic Shock Syndrome (DHSS), which are the leading causes of mortality and morbidity. Aim: This study aims to analyse the pleuropulmonary manifestations associated with DF. Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in northern India from June 2018 to November 2018. A total of 140 patients diagnosed with DF using Non-Structural protein 1 (NS1), Immunoglobulin (Ig)M, (Ig)G rapid card tests and confirmed by Enzyme-Linked Immunosorbent Assay (ELISA) were included. Patients were examined for pleuropulmonary manifestations and other systemic features. Baseline investigations, including Complete Blood Count (CBC), Haematocrit (Hct), Liver Function Test (LFT), Renal Function Test (RFT), chest X-ray (PA view), and High-Resolution Computed Tomography (HRCT) of the chest when required, were performed. Data analysis was carried out by using Statistical Package for Social Sciences (SPSS) version 25.0. Results: A total of 140 patients (108 males and 32 females) aged between 18 and 35 years were included and analysed. Among them, 113 (81%) were diagnosed with uncomplicated febrile illness, 17 (12%) with Dengue Haemorrhagic Fever (DHF), and 10 (7%) as Dengue Shock Syndrome (DSS). Patients with co-morbidities, particularly respiratory system illnesses, and young patients were found to be at increased risk of morbidity. Pleuropulmonary manifestations observed in the study included pleural effusion, pneumonia, pulmonary haemorrhage, ARDS, and pneumothorax. Conclusion: DF is associated with the involvement of the pulmonary system, and its incidence is increased in cases of moderate to severe disease. Therefore, pleuropulmonary manifestations can be useful in evaluating the severity of DF cases.

Effect of a Social Skills Intervention Programme on the Emotional Intelligence of Children with Limited Social Skills: An Experimental Study

Rahul Gandhi, Manmohan Kaur

Introduction: The present study investigated the effect of a social skills intervention programme on the emotional intelligence of children with limited social skills. While many intervention programmes have been studied for the development of social skills and emotional intelligence, most of them were conducted in foreign countries. However, the present study was conducted due to the limited availability of such programmes in India. Aim: The aim of this study was to develop an intervention programme on social skills for children with limited social skills and to determine the effect of the programme on intra and interpersonal awareness and management of these children. Materials and Methods: An experimental study was conducted at the Department of Education, Kurukshetra University, Kurukshetra, Haryana, India. The study lasted for six weeks, from December 2013 to January 2014. A total of 40 ninth-grade students, aged between 13-15 years, selected from two schools in Kurukshetra, Haryana (Arya Public School and Mata Rukmini Rai School). The experimental group (n=20) received the intervention programme related to social skills, while the control group (n=20) received no intervention. The students were pre-tested and post-tested using a scale on social skills and the ‘Mangal Emotional Intelligence Inventory’ 2005 (MEII) emotional intelligence inventory. Statistical analysis “t-test” was applied for to measuring significance of the difference between the performance of the experimental and control groups. Results: The present study showed a significant change in intrapersonal and interpersonal awareness and management of children with limited social skills after the implementation of the intervention programme designed by the researcher. The calculated t-ratio for the pre-test scores of the experimental and control groups (0.19) was not significant at the prescribed levels of significance (0.05 and 0.01). This suggests that no significant difference was found between the pre-test scores of the experimental and control groups in terms of emotional intelligence. The mean score of the experimental group students (85.65) was higher than the mean score of the control group students (59.40). Conclusion: The social skills intervention programme proved to be effective in influencing the emotional intelligence of students with limited social skills. Students should be encouraged to develop social skills such as conversation skills, friendship skills, leadership skills, honesty, and teamwork, as these contribute to emotional intelligence and overall success. Co-curricular activities should be considered as important as the curriculum. Students should be observed for peer relations, lack of interest, friendship skills, and cooperative skills, as schools can be considered a miniature society where children with limited social skills can be identified early on.

Comparison of Bolus Ephedrine vs Mephentermine in the Management of Hypotension during Spinal Anaesthesia for Caesarean Section: A Randomised Clinical Trial

Richi Goyal, Ram Gopal Maurya, Sudhir Kumar Rai

Introduction: Ephedrine and mephentermine are synthetic sympathomimetic drugs used as vasopressors. Ephedrine has direct and indirect effects on α, b1, and b2 receptors, and it also releases endogenous norepinephrine from synaptic storage sites. This leads to an elevation in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). On the other hand, mephentermine indirectly stimulates beta-adrenergic receptors and to some extent alpha-adrenergic receptors as well. Its primary effect is cardiac stimulation, which increases peripheral vascular resistance and contributes to an increase in blood pressure. Aim: The aim of this study is to examine the efficacy of ephedrine and mephentermine in the treatment of hypotension during Lower Segment Caesarean Section (LSCS). Materials and Methods: This double-blinded randomised clinical trial was conducted in the Department of Anaesthesiology among 90 pregnant females scheduled for caesarean delivery at Hind Institute of Medical Sciences, Sitapur, India from January 2021 to December 2022. Patients who developed hypotension (SBP <90 mmHg or <20% of the baseline) after receiving spinal anaesthesia were included in the study and divided into two groups. Group A received an intravenous bolus of 6 mg of ephedrine, and group B received an intravenous bolus of 6 mg of mephentermine. The variables studied included age, height, weight, Mean Arterial Pressure (MAP), Heart Rate (HR), SBP, DBP, bolus doses, and any side effects that occurred. HR, SBP, and DBP were recorded at baseline and then monitored every two minutes for a total of 10 minutes, and then every five minutes until the end of surgery. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 21.0 for Windows, and the results were represented as numbers (%) and mean±Standard Deviation (SD). Results: The mean age of patients in group A and group B was 24.35 years and 24.72 years, respectively. All vital parameters were comparable. The need for bolus doses after hypotension was significantly higher in group B (1.68±0.81) than in group A (mean 1.28). The statistically significant complications identified were tachycardia, nausea, and vomiting, which were more prevalent in group B with 13 and 16 patients, respectively. Conclusion: In this study, the authors found that ephedrine was more effective than mephentermine in terms of the requirement for bolus doses and the occurrence of intraoperative side effects. The requirement for bolus doses and occurrence of significant complications were higher in the group that received mephentermine. Therefore, ephedrine bolus immediately following spinal anaesthesia would be a safe and effective technique for preventing hypotension in females scheduled for LSCS.

Comparison of Ultrasound-Guided Anterior and Posterior Approaches to Sciatic Nerve Block for Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Sciatic nerve block is used for anaesthesia and analgesia in lower limb surgeries. The anterior approach to the sciatic nerve is rarely performed due to unreliable anatomical surface markings. Aim: To compare the anterior and posterior approaches to sciatic nerve block in terms of patient comfort and technical difficulty. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. A total of 84 patients who underwent lower limb surgeries from November 2020 to August 2022 were included. Informed consent was obtained, and patients were randomised into two groups- Group A and Group P using the card method. Ultrasound-guided sciatic nerve block was performed using the anterior approach in Group A and the posterior approach in Group P. Sensory and motor blockade, time to perform the block, number of attempts, duration of analgesia, and patient satisfaction were recorded. Statistical analysis was performed using the Chi-square test, Analysis of Variance (ANOVA), student t-test, and the results were represented in tables. Results: The median age in Group A was 42.95±12.69 years, and in Group P was 43.95±8.68 years. Males were higher in number with 26 (31%) in Group A and 23 (27%) in Group P, respectively. Patient satisfaction, duration of analgesia (10.3±3.5 years Group P and 10.5±4.0 years Group A), onset of sensory (11.85±7.35 years Group P and 9.53±5.40 years Group A), and motor blockade (18.67±7.05 years Group P years and 17.82±5.70 years Group A) were similar in both groups. The number of attempts (2.85±0.90 years Group P and 3.05±0.91 years Group A) and time taken for performing the sciatic nerve block (6.75±1.10 years Group P and 7.44±1.00 years Group A) was higher in the anterior approach compared to the posterior approach. Conclusion: Although both approaches to sciatic nerve block are equally effective, this study concludes that the posterior approach is simpler to perform, requires less time, and provides better patient comfort and satisfaction. Ultrasound-guided posterior sciatic nerve block offers effective anaesthesia and excellent post-operative analgesia.

Outcomes and Associated Factors of Pregnancy Related Acute Kidney Injury: A Retrospective Longitudinal Study

Introduction: In developing countries, the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) has significantly decreased over the past three decades. However, it remains a major contributor to maternal and foetal morbidity and mortality. Aim: This retrospective longitudinal study aims to determine the aetiology, outcomes, and factors associated with maternal-foetal outcomes of PRAKI. Materials and Methods: The study was conducted at a tertiary care Medical College Hospital in Dharwad district, Karnataka, India. It included patients with AKI during pregnancy and the peripartum period, admitted between January 2014 and December 2021. A total of 156 subjects at risk of PRAKI were identified. Data was collected from the Medical Records Department (MRD), and three months of patient follow-up data were also collected. PRAKI diagnosis and staging were done using the Acute Kidney Injury Network (AKIN) criteria. Primary outcomes included the need for dialysis, renal recovery, renal biopsy findings, and development of CKD. Secondary outcomes were maternal and foetal mortality and birth weight. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the participants was 26.34±4.67 years. The most common cause of PRAKI was Pregnancy Induced Hypertension (PIH) (75 cases, 48.1%), followed by sepsis (67 cases, 42.90%), and Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome (32 cases, 20.50%). Out of the 156 PRAKI patients, one-fourth (42 cases, 26.92%) required haemodialysis, 126 (93%) achieved complete renal recovery, 12 (7.6%) required renal biopsy, 9 (6.6%) developed chronic kidney disease, and 3 (2.2%) developed End-Stage Renal Disease (ESRD). Maternal mortality was observed in 21 patients (13.46%), and foetal mortality occurred in 47 patients (31%) out of 156 perinatal outcomes. Conclusion: PRAKI was associated with poor maternal and neonatal outcomes. PIH, followed by sepsis, remained the leading cause of PRAKI. Immediate referral of patients to a higher centre and comprehensive antenatal care in peripheral areas can reduce the overall health and economic burden.

Knowledge of Emergency Colour Codes among Healthcare Workers in a Tertiary Care Hospital of Wardha, Maharashtra, India: A Cross-sectional Study

Bhushan Vidyadhar Wandile, Deepika Kanyal

Introduction: An emergency refers to any crisis caused by humans or natural disasters that requires prompt and effective action to protect life and property. Consequently, a well-coordinated and carefully planned emergency response is crucial. Medical emergency codes are utilised globally to alert hospital staff about various emergencies. Aim: To assess the knowledge of healthcare workers regarding emergency colour codes in a tertiary care hospital. Additionally, it aims to develop standardised operating procedures and policies based on these codes and provide guidance on their implementation in hospitals for different emergency situations. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, from December 2021 to May 2022. A total of 100 healthcare workers aged >18 years, employed at a tertiary care hospital, were included in the study. A survey was conducted using a structured questionnaire to assess the knowledge of the participants. The questionnaire consisted of two sections: the first section collected demographic information such as age, gender, qualifications, and profession, while the second section consisted of nine items to evaluate knowledge related to the role of emergency response codes in managing hospital emergencies. Descriptive statistics, including percentages and frequencies, were used to present the results. Results: In the present study, out of 100 study subjects, the maximum percentage (40%) belonged to the age group of 36-55 years, while the minimum percentage (18%) belonged to the age group of 18-25 years. Among the participants, 25% were male and 75% were female. A significant proportion (92.7%) of the population demonstrated knowledge of the codes for handling hospital emergencies. Specifically, 98% of participants were familiar with the use of code red for fire emergencies, and 88% understood the process of activating code red. All participants had a basic understanding that code blue is used for cardiac arrest, and 85% had knowledge of paediatric emergency codes. Additionally, 96% were aware of the indications for Cardiopulmonary Resuscitation (CPR), and 100% knew the abbreviation for CPR. Conclusion: The present study revealed that 96% of the population had good knowledge, while 4% had average knowledge regarding the codes for handling hospital emergencies. Implementing standardised operating procedures and ensuring staff awareness of all emergency response codes used in the hospital are recommended.

Plasminogen Activator Inhibitor-1 as a Marker of Thrombosis among Prehypertensive Patients: A Cross-sectional Study

B Umadevi, OR Anitha, N Nalina, R Lavanya

Introduction: Impaired endogenous fibrinolysis has been shown to play a role in the pathogenesis and complications of hypertension. Plasminogen Activator Inhibitor-1 (PAI-1) is said to be a predictor of impaired fibrinolysis and thrombosis. Prehypertension is a common worldwide condition and is known to be an independent risk factor for Cardiovascular Disease (CVD). Aim: Present study aimed to measure plasma PAI-1 levels in prehypertensive patients and normal subjects and to find the correlation between elevated PAI-1 levels with Blood Pressure (BP), triglycerides, total cholesterol, Low-Density Lipoproteins (LDL) cholesterol, High-Density Lipoproteins (HDL) cholesterol, and urine albumin. Materials and Methods: This cross-sectional analytical study included 100 patients, comprising 50 prehypertensive individuals and 50 controls, aged between 35 and 50 years. The study was conducted at Sapthagiri Institute of Medical Sciences and Research Centre in Bangalore, India. Anthropometric measurements, PAI-1 levels, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and urine albumin were measured using standard procedures. The data were statistically analysed using the Statistical Package for Social Sciences (SPSS) version 10.0, applying Student t-test and Chi-square test. Correlation analysis was performed to assess the relationship between PAI-1 and various parameters. Results: A total of 100 patients were included in the study which had 64 men and 36 women with a mean age of 46±7 years. PAI-1 levels were significantly higher in the prehypertensive group compared to the control group (p-value=0.013). Participants with higher plasma PAI-1 levels had significantly elevated BP (p-value=0.001) compared to those with lower PAI-1 levels. Total cholesterol, triglycerides, and LDL cholesterol were significantly increased in prehypertensive individuals (p-value=0.001), whereas HDL cholesterol was significantly lower (p-value=0.001). The study also observed a significant increase in urine albumin in the prehypertensive group with elevated PAI-1 levels compared to the controls (p-value=0.001). The study revealed that elevated plasma PAI-1 levels did not show a significant positive correlation with SBP and DBP (r=0.138 and 0.660, p-value of 0.338 and 0.648, respectively). Plasma PAI-1 levels were weakly correlated with total cholesterol (r=0.145, p-value 0.315), LDL cholesterol (r=-0.068, p-value 0.640), HDL cholesterol (r=0.21, p-value 0.882), and triglycerides (r=0.207, p-value 0.150). There was no significant correlation between increased PAI-1 levels and urine albumin (r=-0.225, p-value of 0.117). Conclusion: Present study demonstrated that plasma PAI-1, total cholesterol, triglycerides, LDL cholesterol, and urine albumin were significantly elevated in prehypertensive individuals, suggesting vascular damage and inflammation. As prehypertension is often asymptomatic, patients with prehypertension should be considered to have an increased risk for CVD.

Comparison of the Effectiveness of Pre-procedural Rinse and Ultrasonic Coolant using Chlorhexidine Gluconate and Povidone-iodine in Reducing Aerosol Contamination: A Randomised Clinical Trial

Introduction: The production of airborne particles with embedded microorganisms poses a high risk to dental professionals. Antimicrobials, when used in various forms such as pre-procedural rinse or ultrasonic coolant agents, could reduce the aerosol load. Aim: To compare the effectiveness of ultrasonic coolant, pre-procedural rinse using 0.2% Chlorhexidine (CHX) gluconate, and 2% Povidone-iodine (PVI) in reducing aerosol contamination. Materials and Methods: A prospective single-centre, triple-blind, randomised clinical trial was conducted in the Department of Periodontology at Sree Sai Dental College and Research Institute, Srikakulam, India. The study duration was four months, from November 2021 to February 2022. A total of 75 patients diagnosed with gingivitis, aged 20 to 30 years, systemically healthy, with probing depths of <3 mm were included and randomly assigned to one of two groups: pre-procedural rinse or ultrasonic cooling agent. They were then divided into five subgroups: Subgroup I- CHX pre-procedural rinse, Subgroup II- PVI pre-procedural rinse, Subgroup III- ultrasonic cooling agent CHX, Subgroup IV- ultrasonic cooling agent PVI, and Subgroup V- control (distilled water). Agar plates were placed at three different locations, followed by a 20-minute ultrasonic scaling procedure. The agar plates were then incubated at 37°C for 48 hours, and the Colony Forming Units (CFU) were counted using a digital colony counter. Multiple measures Analysis of Variance (ANOVA) was performed for group-wise comparisons, and Tukey’s post-hoc test was performed for intergroup comparison of CFU. Results: All the groups reported statistically significant differences. The control group had higher CFU (616.85, 871.77, 342.23 for the operator, patient, and back of the patient’s head, respectively) compared to the rinse and coolant groups. However, the CHX coolant group showed lower CFU (186.31±41.508 at the operator’s chest area, 415.38±59.219 at the patient’s chest area, 71.69±10.323 at the back of the patient’s head) compared to the other subgroups. The patient’s chest area had higher CFUs (415.38±59.219 for CHX coolant, 545.85±38.105 for PVI coolant group, 580.38±48.290 for CHX rinse group, 752.46±41.667 for PVI rinse group, 871.77±98.826 for the control group) compared to the blood agar plates placed at other locations. Conclusion: The results of the study clearly indicate that CHX coolant can be considered a promising alternative in reducing aerosol contamination produced during ultrasonic scaling procedures.

Measurement and Morphology of Corneal Endothelial Cell Density in Myopic Eyes of Adult Females Using a Non Contact Specular Microscope: A Cross-Sectional Study

Farah Maqsood, Menwah Almatrafi, Noura Alhassan

Introduction: A non contact specular microscope has been used to acquire the morphology of the corneal endothelial cell layer. This analysis provides measurements of the Coefficient of Variation (CV), the hexagonal appearance of the cells, and the mean corneal Endothelial Cell Density (ECD). These parameters are used to assess the function of the corneal endothelial layer. Aim: To evaluate the average corneal ECD, Hexagonality (HEX), CV, and their relationship with myopia in young females. Materials and Methods: The present cross-sectional study was conducted over a period of five months, from November 2016 to March 2017 at the clinics of the Department of Optometry and Vision Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia and involved 107 eyes of healthy subjects aged 18-25 years. The participants’ refraction was estimated using an automatic refractor. Non contact specular microscopy was performed on emmetropic and myopic subjects. The average of three successive estimations of ECD, hexagonal appearance, and CV in cell size were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) program (version 22.0), and the independent student’s t-test was used to compare the means of various variables between low and moderate myopia. Results: The study included the right eyes of 107 healthy Saudi female subjects aged 18-25 years, who were divided into three groups based on their refractive errors. Non contact specular microscopy was performed on emmetropic (n=36, 20.58±1.20 years and mean Spherical Equivalent (SE) of -0.01±0.23 D), low myopic (n=49, 20.63±1.51 years and SE of -1.19±0.68 D), and moderate myopic (n=22, 20.64±1.26 years with mean SE of -4.15±0.90 D) subjects. The mean ECD in low myopic eyes was 2799.59±184.39 per square millimetre, the mean CV was 26.67±4.03 percent, and the mean hexagonal appearance of the cells was 67.69±4.82%. The average ECD, mean CV, and hexagonal appearance in moderate myopic eyes were found to be 2722.36±143/mm2, 26.68±3.57%, and 68.73±5.87%, respectively. The results showed no statistically significant differences in ECD (p>0.05) and hexagonal appearance (p>0.05) in the cells of moderate and low myopic eyes. Conclusion: The present study found no significant relationship between corneal endothelial parameters and mild to moderate myopic eyes.

Knowledge, Attitude, and Practices on the Use of Cross-Linkers During Dentin Bonding among Practitioners Specialised in Conservative Dentistry

Introduction: Biomodification involves the application of exogenous cross-linkers to stabilise collagen molecules through the formation of inter- and intramolecular cross-links. This approach shows potential for improving bonding performance in adhesive restorations. Aim: To assess the Knowledge, Attitude, and Practices (KAP) regarding the use of cross-linkers during dentin bonding among practitioners specialising in conservative dentistry. Materials and Methods: An online survey was conducted among dentists practicing conservative dentistry across India from September 2022 to November 2022. The survey consisted of a semi-validated questionnaire with 24 questions and was distributed through personal email and social media. Data was collected over a period of three months and analysed using statistical evaluation in the Statistical Package for the Social Sciences (SPSS) via chi-square test. Results: A total of 181 responses were received. Of the study population, 68.2 percent became aware of biomodification through articles in various journals. According to the study, 85 individuals (47%) acknowledged that using cross-linkers could enhance the mechanical properties of dentin by stabilising collagen. However, it is interesting to note that only 33 individuals (18.2%) actually incorporated biomodification techniques in their dental practice. Conclusion: Nearly half of the study population were aware of the use of cross-linkers to enhance dentin strength, prevent degradation and preserve resin-dentin bonds, inhibit demineralisation, and prevent root caries. However, only 18.2% of the participants reported practicing biomodification procedures in their dental practice.

Application of Clock Drawing Test in Evaluating Different Types of Dementias (AlzheimerÂ's Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study

Introduction: The Clock Drawing Test (CDT) is a highly effective screening tool for assessing cognitive function. It complements the Mental State Examination (MSE) in the early detection of various types of dementia and the evaluation of cognitive functions. Documenting the specific type of error in clock drawing significantly enhances the clinical evaluation of dementia patients in an economical manner. The CDT can effectively detect errors in execution and visuospatial functions associated with different types of dementia, including Alzheimer’s Disease (AD), Vascular Dementia (VD), and Frontotemporal Dementia (FTD). Additionally, it allows for a comparative analysis of the CDT with the severity of dementia assessed by the Bengal Mental Status Examination (BMSE) Scale. Aim: Present study aims to determine the ability of the CDT to scriminate these three disorders AD, VD, and FTD by analysing patterns of error in clock drawing. Materials and Methods: This cross-sectional observational study was conducted at the Department of Neuromedicine, Memory Clinic, Medical College, Kolkata, West Bengal, India, from March 2019 to February 2020. The diagnosis of dementia was made based on the Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-V) criteria for AD and VD, and the Rascovsky Criteria for FTD. A total of 80 patients were included in the study, with 40 in the AD group, 30 in the VD group, and 10 in the FTD group, considering 80% power and a 5% probability of error. Dementia severity was assessed using the BMSE [Annexure-III]. The subjects were provided with an 8.5×11-inch blank sheet of paper and a pencil, and were asked to draw a clock, including all the numbers, and set the hands to 10 minutes past 11. They were also requested to copy a clock as accurately as possible from a model. The resulting drawings were then analysed quantitatively by revised scale score and qualitatively using Rouleau’s qualitative analysis of clock drawing. Numerical variables were compared between groups using the Analysis of Variance (ANOVA) test and the Wilcoxon test, depending on the distribution’s normalcy. All analyses were two-tailed, and p<0.05 was considered statistically significant. Results: When comparing the revised quantitative scale, the CDT score showed a significant difference between the three groups (AD, VD, and FTD) with mean scores of 2.91, 2.9, and 0.7, respectively (p=0.01). The size of the drawn clocks also showed a significant difference (p=0.006) among the AD, VD, and FTD groups, with sizes of 21.27, 18.63, and 16.7, respectively. The BMSE score also showed a significant difference between AD and FTD (p<0.05), as well as between AD and VD (p<0.05). Clock size was significantly different between AD and VD (p<0.05). There were no significant differences observed regarding graphical difficulty, stimulus-bound response, conceptual deficits, spatial and/or planning deficits, and perseveration among the three groups. Conclusion: Qualitative analysis of the CDT contributes to the identification of different types of dementia by enabling the description of specific errors. A significant inter-group difference was found in the BMSE score, but it could not pinpoint the domains of cognitive deficits, whereas the CDT can detect those.

Preterm Labour Management with Glyceryl Trinitrate Patch and Isoxsuprine: A Longitudinal Study

Introduction: Nitric oxide donors in the form of nitroglycerine and β-mimetic drugs (Isoxsuprine hydrochloride) are commonly used in managing preterm labour. It is one of the most challenging obstetric complications encountered by obstetricians, as well as preterm neonates for paediatricians. Preterm labour refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of the cervix between 20 and 37 weeks of gestation. Aim: To compare the effects of transdermal Glyceryl Trinitrate (GTN) with Isoxsuprine in terms of maternal complications, perinatal outcomes, and their tocolytic effectiveness. Materials and Methods: A hospital-based longitudinal study was conducted in the Department of Obstetrics and Gynaecology at JNU Medical College and Research Centre, Jaipur, Rajasthan, India. The study duration of the study was one year, from March 2022 to February 2023. A total number of 100 cases of preterm labour were enrolled and equally divided into two groups: Groups A (GTN patch) and group B (Isoxsuprine) with a defined dosing schedule. Singleton pregnancies with intact membranes and gestational age of 26-36 weeks were included in the study, metting the diagnostic criteria for preterm labour. Both the groups received pharmacological intervention, and outcome measures such as success rate of treatment (i.e., prolongation of labour), maternal side effects, and foetal outcomes {Neonatal Intensive Care Unit (NICU) admission and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score) were measured and evaluated. Predefined parameters and other data were tabulated in Microsoft Excel and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test was applied to identify significant differences. Results: The incidence of preterm labour was highest in the age group of 21-30 years (76% in Group A and 70% in Group B) among patients treated with nitroglycerine and isoxsuprine, respectively. The mean prolongation of pregnancy in the nitroglycerine group was 21.42 days, and in the isoxsuprine group, it was 16.22 days (p=0.042). The most common side effect in the nitroglycerine group was headache (60%), while in the isoxsuprine group, it was maternal hypotension (24%). The mean APGAR score in Group A and Group B was 8.18 and 8.06, respectively. It was observed that 24% of newborns in the nitroglycerine group and 36% in the isoxsuprine group required NICU admission. The success rate was 90% in the nitroglycerine group and 80% in the isoxsuprine group. Conclusion: Both drugs were effective in prolonging pregnancy for the first 48 hours, but nitroglycerine was found to be slightly better in terms of success rate. Nitroglycerin was more acceptable to patients with preterm labour, as it did not have to be administered through painful injections.

Efficacy of Celecoxib and Diclofenac Sodium in the Management of Postoperative Pain, Swelling and Mouth Opening after Surgical Removal of Impacted Third Molars: A Split-mouth Randomised Clinical Study

Introduction: The surgical removal of mandibular third molars is generally followed by complaints of pain, trismus, and swelling. The duration of surgery and the reflection of a mucoperiosteal flap have been shown to affect the intensity and frequency of postoperative complaints. Pain from third molar surgery typically begins within one to three hours after surgery and ranges in intensity from moderate to severe. Numerous analgesics have been used to minimise pain and discomfort following the surgical removal of impacted third molars. Commonly used agents include ibuprofen, diclofenac sodium, paracetamol, or their combinations. Newer drugs, such as selective COX inhibitors, have not been extensively used for minor oral surgical procedures. Aim: To compare the clinical efficacy of celecoxib and diclofenac sodium on pain, swelling, and mouth opening after the surgical removal of impacted mandibular third molars. Materials and Methods: A split-mouth randomised controlled clinical trial was conducted in the Department of Oral and Maxillofacial Surgery at BharatiVidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India. The study duration was six months, from August 2022 to January 2023. A total of 21 subjects (11 males and 10 females) who required surgical extraction of an impacted mandibular third molar were selected. All subjects were randomly allocated to receive one of the following treatments twice a day for five days after surgery: celecoxib 200 mg (n=11) or diclofenac sodium 75 mg (n=10). Pain scores were evaluated using the Visual Analogue Scale (VAS) on postoperative day one, two, and three. Swelling and mouth opening were evaluated on Postoperative Day (POD) two and seven. Intergroup comparison was done using Student’s t-test. Results: The mean age of the study participants was 28±1.5 years, and the mean VAS score for pain evaluation with celecoxib was 6.61, 5.38, and 5.00 on day 1 (p=0.027), 2 (p=0.972), and 3 (p=0.809), respectively. The difference in swelling values for the celecoxib group was significant, while there were no significant differences in the values of mouth opening. Conclusion: It was concluded that celecoxib 200 mg is a better analgesic and anti-inflammatory compared to diclofenac sodium 75 mg. Celecoxib was easily tolerable and comfortable for the patients. There was no significant difference in the values of mouth opening.

Effectiveness of Ankle Stretching and Strengthening Exercises to Improve Rounded Shoulder Posture: A Pilot Study

Jasmine Kaur Chawla, Darshita Kulkarni, Roshani Sharma, Pragya Kumar

Introduction: Incorrect posture habits and reduced physical activity can predispose individuals to various changes in the muscular and skeletal structures. Rounded Shoulder Posture (RSP) is one such clinical manifestation that deforms the normal relationship of various structures. Different treatment protocols have been devised for correcting RSP; however, postural changes in the musculoskeletal system can also be addressed by focusing on muscular imbalances elsewhere in the biomechanical kinetic chain. Aim: To analyse and investigate the efficacy of ankle muscle stretching and strengthening exercises in enhancing the correction of RSP in young adults. Materials and Methods: The present pilot study was conducted at Amity Institute of Physiotherapy in Noida, Uttar Pradesh, and Prime Hospital and Ortho Centre in Faridabad, Haryana, India, from January 2021 to July 2021. A total of 30 young adults with RSP were randomly allocated into two groups of 15 each. Group 1 (control group) received six weeks of conventional exercises consisting of scapular stabilisation and stretching of the pectoralis minor muscle. Group 2 (experimental group) received ankle plantar flexor stretching and ankle dorsiflexor strengthening in addition to the conventional exercises, three times per week for six weeks, with each session lasting between 30 to 45 minutes. RSP and ankle Dorsi-Flexion (DF) were assessed using the posterior Acromion to Table Distance (ATD) in a supine lying position and a universal goniometer, respectively, pre-intervention and post-intervention for the dominant and non-dominant sides. For statistical analysis, after determining the normality of the data, either a Paired-test or Wilcoxon rank sum test was used to compare the data within each group. Further, either a two-sample Independent t-test or Wilcoxon-Mann-Whitney U test was used to find statistical differences between the two groups at a 5% level of significance. Results: The subjects had an average age of 24.8±4.07 years and a Body Mass Index (BMI) of 24.10±4.39 kg/m2, with 11 male and 19 female participants (p-value=0.70), with the right side being the dominant side for all. At baseline, there was no significant difference in the variables between the two groups (p-value >0.05). After the six-week intervention, a significant difference was found in the ATD (dominant pre: 6.17±1.02, dominant post: 3.47±1.05, p-value <0.0001; non-dominant pre: 6.07±1.05, non-dominant post: 3.32±0.92, MD=-2.75; p-value <0.0001) and DF (dominant pre: 16.23±1.37, dominant post: 19.27±1.33, MD=3.03; non-dominant pre: 15.67±1.05, non-dominant post: 19.53±0.74, MD=3.87; p-value <0.0001) in the experimental group. However, the control group revealed a significant difference only for ATD (dominant pre: 6.51±0.89, dominant post: 4.47±0.84, MD=-2.05; non-dominant pre: 6.23±1.00, non-dominant post: 4.41±0.90, MD=-1.82; p-value <0.0001). Additionally, when compared to the control group, the experimental group showed statistically significant results for ATD and DF (p-value <0.05). Conclusion: The incorporation of ankle muscle strengthening and stretching exercises was found to be more effective compared to the conventional treatment used for correcting RSP.

Prevalence of Psychosocial Problems among School-going Children aged 4-10 Years: A Cross-sectional Study

Shikha Garg, Jaikrishan Mittal, Rakesh Kumar

Introduction: A substantial proportion of the Indian population comprises children under 15 years of age. The prevalence of psychosocial disorders in children is increasing, coinciding with a decrease in infection-related morbidities. Psychosocial disorders may not only have short-term effects but also have long-lasting effects on the child’s well-being. Aim: To assess the prevalence of psychosocial disorders in children aged 4-10 years and compare it before and after the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted as an online survey originating from Rukmani Birla Hospital, a tertiary care centre in Jaipur, Rajasthan, India. A total of 171 children aged between 4-10 years were included in the study, from February 2021 to June 2021. A structured survey questionnaire was distributed using Google Forms. The Childhood Psychopathological Measurement Schedule (CPMS) was used to assess psychosocial problems in children. CPMS scoring was performed for both the pre-pandemic period (before March 2020) and the post-pandemic period (from March 2020 until the form was filled out) for the same children. The Chi-square test was used to compare the association of demographic variables with the CPMS score. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: The mean age of the children was 6.82±2.06 years, with 47.4% (81/171) being females. A majority of the children, 158 (92.4%), were from an urban setting. The average CPMS score significantly increased from 6.66±7.46 to 11.9±10.8 (p-value <0.05) after one year of the COVID-19 pandemic. Before the pandemic, 28 (16.37%) children had an abnormal CPMS score, while after the pandemic, 73 (42.69%) had an abnormal score. Prior to the pandemic, 96 (56.14%) children had a screen time of 1-2 hours per day, but after the pandemic, 94 (55%) had a screen time of more than four hours. Psychosocial problems were significantly higher in nuclear families before the pandemic (p-value <0.05) and significantly higher in children with increased screen time after the pandemic (p-value <0.01). Conclusion: The COVID-19 pandemic has led to an increase in psychosocial disorders among children. There is an urgent need to address these issues in children at an early stage so that early interventions can be implemented.

Maternal and Perinatal Outcomes in Planned Labour: A Prospective Interventional Study

Introduction: Labour, especially in primiparas, is associated with intense pain. Patients labouring without analgesia may experience longer durations in all stages, along with the suffering associated with labour pains. The study was conducted to determine whether a programmed labour regime provided adequate pain relief and accelerated the labour process. Aim: To compare the maternal and perinatal outcomes in patients who underwent conventional labour with those who received programmed labour analgesia. Materials and Methods: This prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Netaji Subhash Chandra Bose Medical College and Hospital in Jabalpur, Madhya Pradesh, India. The study duration was one year and five months, from March 2021 to August 2022. A total of 100 patients, including 50 low-risk primiparas in each group with cervical dilatation of 3 to 4 cm, were randomly allocated to the case and control groups. The case group received a programmed labour regime, which involved administering small doses of various drugs such as pentazocine, drotaverine, diazepam, and tramadol. No analgesia was given to the control group. Pain relief assessment was conducted using a Visual Analogue Scale (VAS). The duration of the various stages of labour and the rate of cervical dilatation were assessed in both groups. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study subjects in the control group was 24.14±2.39 years, and in the case group, it was 24.26±2.49 years. Compared to the control group, 29 (58%) cases experienced mild pain, and 21 (42%) experienced moderate pain. The rate of cervical dilatation was 2.57±1.41 cm/hour in the case group compared to 1.41±0.36 cm/hour in the control group (p-value <0.001). The mean duration of the first (cervical dilatation from 3-4 cm onwards), second, and third stages of labour was 140.2±35.06 minutes, 25.22±9.41 minutes, and 3.56±0.91 minutes, respectively, in the case group. The duration of all stages of labour was significantly reduced in the case group (p-value <0.001). Minimal side effects were observed, with nausea being the most common side effect in 16% of cases. Conclusion: Programmed labour resulted in shorter and more comfortable labour with minimal adverse effects. This method does not require a trained anaesthetist; thus, it can be easily administered in low-resource settings.

Functional Outcome of Management of Isolated Supraspinatus Tendon Tear by Mini-open repair Technique- A Prospective Interventional Study

Introduction: Rotator Cuff Injuries (RCIs) are common shoulder injuries, and the supraspinatus muscle, which is part of the rotator cuff, plays a crucial role in shoulder abduction. The mini-open repair technique offers several advantages, including being less invasive, leading to reduced postoperative morbidity, and shorter operative times. Aim: The aim of this prospective interventional study was to assess the functional consequences of open microscopic repair and the functional implications of supraspinatus tendon repair following the procedure and during the postoperative healing period. Materials and Methods: The study was conducted at the Department of Orthopaedics at Great Eastern Medical School and Hospital in Srikakulam, Andhra Pradesh, India. The study duration was one year, from July 2020 to July 2022. A total of 120 patients aged between 20 and 60 years were included, and all surgeries were performed by the same surgeon. Patients were followed-up for one year and evaluated with Constant-Murley Score (CMS) system. Patient data were analysed based on gender, age, degree of tears, clinical test results, and postoperative scores. Levene’s test was used to determine variance homogeneity, and the Student’s t-test (two-tailed, dependent) was used to determine the statistical significance of study parameters on a continuous scale within each group. Results: The study included 120 patients (84 males and 36 females), and the majority of them had traumatic tears. When data was analysed based on patient age, the majority were between 46 and 50 years (33 patients, 27%), followed by the age group of 41-45 years. At the end of one year, the outcomes were excellent in 68 patients, good in 24 patients, satisfactory in 16 patients, and poor in 12 patients. Conclusion: Based on the results of the mini-open technique, the authors concluded that mini-open rotator cuff repair resulted in superior repair integrity and shoulder function.

Comparative Evaluation of Tramadol and Butorphanol as an Adjuvant to Bupivacaine for Supraclavicular Block: A Randomised Clinical Study

Introduction: Brachial plexus blocks have become useful alternatives to general anaesthesia for forearm surgeries. When used as a sole agent, Local Anaesthetics (LA) do not provide adequate pain relief. Tramadol and Butorphanol are synthetic opioid analogues that, when added to Bupivacaine, improve the quality of the block and reduce the need for supplementary postoperative opioids. Aim: To evaluate the effect of Tramadol and Butorphanol as adjuvants to Bupivacaine for supraclavicular brachial plexus block on sensory and motor block characteristics. Materials and Methods: This double-blinded randomised clinical study was conducted in the Department of Anaesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from January 2021 to June 2022. The patients were randomly allocated into two groups of 30 each: group T received 0.5% Bupivacaine 25 mL with 50 mg Tramadol, and group B received 0.5% Bupivacaine 25 mL with 1 mg Butorphanol. The primary objective was to study the onset and duration of sensory and motor blockade. The secondary objectives were to study the duration of postoperative analgesia, requirements of rescue analgesia, and drug-related adverse effects in supraclavicular brachial plexus block. Fisher’s exact test and the Chi-square tests were used to compare categorical variables. Results: Demographic data were comparable in both groups. A faster onset of sensory block and motor block was seen with Tramadol than with Butorphanol (p-value <0.001). The duration of sensory and motor block was longer with Butorphanol than with Tramadol (p-value <0.001 and p-value=0.01, respectively). The time to first rescue analgesia was longer with Butorphanol (p-value <0.001). Beyond six hours, the Visual Analog Scale (VAS) score was significantly lower in group B, except at the 12th hour. Very few incidents of adverse events were recorded in both groups. Conclusion: The authors concluded that adding Butorphanol in a dose of 1 mg to Bupivacaine showed a delayed onset for sensory and motor block but prolonged duration of sensory and motor block, as well as the duration of postoperative analgesia, compared to the addition of 50 mg Tramadol, without producing any significant adverse effects.

Impact of Different Types of Bikes on Post-ride Pain and Insights into Strategies Adopted by Recreational Cyclists from Gurugram to Alleviate Pain: A Cross-sectional Survey

Aparna Gupta, Sheetal Kalra

Introduction: Non-traumatic injuries are prevalent among long-distance cyclists. However, there is a lack of studies analysing the impact of different types of bikes on the pain experienced by cyclists or the physiotherapy measures commonly adopted by cyclists post-ride. Aim: To understand the impact of different types of bikes on the pain experienced by cyclists and to identify the physiotherapeutic measures commonly adopted by Indian cyclists. Materials and Methods: A cross-sectional survey was conducted on 120 cyclists (94 males and 26 females) from three different cycling groups in Gurugram, Haryana, India. Data was collected from August 2022 to September 2022. A self-structured questionnaire was used to collect information on sociodemographic profile, type of bike used, duration of cycling, average distance and speed covered, areas and types of pain experienced, and measures taken to address pain. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. The level of significance was set at p≤0.05. Data was presented as frequencies and percentages, and comparisons were made using Kruskal-Wallis and Chi-square tests. Results: The mean age of the study participants was 39.36±11.88 years. The average speed and distance covered in one ride were 22.52±4.73 km/hour and 43.50±15.32 km, respectively. A statistically significant association between the type of bike used and pain status (p<0.05) was observed. 65% of riders reported experiencing pain in some part of their body in the last six months. Pain was more prevalent among hybrid bike users compared to mountain and road bike users. Male cyclists had a faster average speed compared to female cyclists by 5 km/hour. The average distance covered by male and female cyclists was similar, with just a 1 km difference. Cyclists commonly experienced pain in the wrists, legs, back, and neck. 19.1% of riders did nothing or only rested to address pain, while 21.66% opted for muscle stretching, 9.16% engaged in exercises, and 3.33% used cycling gloves for wrist and hand pain. Other measures included Transcutaneous Electrical Nerve Stimulation (TENS), dry needling, icing, refitting or changing the bike, and taking supplements. Conclusion: Among different types of bikes, hybrid bike users showed a higher incidence of pain. Cyclists in Gurugram tend to utilise limited physiotherapy measures to alleviate pain and enhance performance.

Over-the-Counter Use of Medical Abortion Pills: A Prospective Cohort Study

Reema Kumari, Sarita Tirkey, Archana Kumari

Introduction: Medical abortion is a safe intervention in the first trimester that requires access to accurate information and the support of a trained healthcare provider. However, women often use medical abortion pills on their own or with guidance from friends, relatives, quacks, or pharmacists due to the easy availability of these drugs over-the-counter without a medical prescription. Aim: To study the effects of over-the-counter use of medical abortion pills on maternal health and to explore the possible reasons for it. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. The study duration was one year and five months, from June 2020 to October 2021. A total of 98 women who reported unsupervised consumption of medical abortion pills over a period of 17 months were included in the study. Demographic and obstetric profiles, clinical presentation, diagnosis, outcomes, and complications were analysed. Reasons for unsupervised intake were also explored. The data were analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 98 women, with the majority (54.08%) belonging to the 25-31 years age group. Out of these, 49 (50%) women took the abortion pills between 7-12 weeks, 32 (32.65%) before seven weeks, and 17 (17.35%) between 13-20 weeks. Pregnancy was confirmed with a Urine Pregnancy Test (UPT) kit in 64 (65.30%) women, with Ultrasonography (USG) in 22 (22.45%) women, while 12 (12.25%) took pills based solely on missed periods. The most common clinical presentation was excessive vaginal bleeding in 70 (71.42%) cases. Incomplete abortions were observed in 77 (78.56%) women, missed abortions in 10 (11.22%) women, and septic abortions in 4 (4.08%) women. Laparotomy was needed in six women with ectopic pregnancy. Two women required hysterectomy, one due to uterine perforation after suction evacuation in a private hospital, and the other due to intractable haemorrhage. Blood transfusion was needed in 25 (25.5%) women, and Intensive Care Unit (ICU) care in 15 (15.3%) women. However, none experienced acute kidney injury, Disseminated Intravascular Coagulation (DIC), or mortality. The main reasons for over-the-counter use of abortion pills were privacy or non-disclosure of pregnancy in 48 (48.9%) cases, opposition from the husband in 31 (31.6%) cases, avoiding a hospital visit in 25 (25.51%) cases, and easy availability of the pills in 27 (27.55%) cases. Conclusion: Unsupervised intake of pills increases the risk of complications like incomplete or missed abortion, sepsis, and ectopic pregnancy, which may require blood transfusion, ICU admission, and major surgeries like laparotomy or hysterectomy in a few cases. Therefore, there is a need for supervised intake of pills to reduce maternal morbidities.

Continuous Dienogest vs Cyclical Dienogest with Ethinyl Estradiol in the Management of Pelvic Endometriosis- A Prospective Interventional Study

Introduction: Endometriosis is a disease of adolescents and women of reproductive age group characterised by the presence of endometrial tissue outside the uterine cavity. It is a typical gynaecological condition that causes symptoms such as dysmenorrhoea, dyspareunia, dyschezia, chronic pelvic pain, irregular uterine bleeding, and infertility. Being a prevalent disease primarily affecting women of reproductive age, this condition significantly reduces the Quality of Life (QoL) with frequent recurrence of symptoms after discontinuation of conservative therapy. Aim: The aim of this study was to investigate the alleviation of Endometriosis-associated Pelvic Pain (EAPP), effective cycle control, and to compare the side effects of continuous dienogest and cyclical dienogest with ethinylestradiol, as well as the improvement in QoL in the two study groups. Materials and Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynaecology, Medical College Kolkata, West Bengal, India. The study duration was 12 months, from June 2020 to May 2021. Patients attending the Gynaecology Outpatient Department (GOPD) with clinical, sonological, and/or surgical diagnosis of endometriosis were enrolled in the study and divided into two groups of 30 patients each. Group 1 was treated with Dienogest (D) 2 mg, and group 2 received a combination of dienogest 2 mg and Ethinyl Estradiol 30 mcg (D+EE) combination. The Visual Analogue Scale (VAS) was used to define endometriosis-related symptoms. Patient satisfaction in terms of improvement in QoL was measured using a free online calculator based on the 12-item Short Form Health Survey (SF-12), which includes both physical and mental components. Follow-ups were conducted at one, three, and six months. Data were summarised as mean and Standard Deviation (SD) for numerical variables and count and percentages for categorical variables. A p-value <0.05 was considered statistically significant. Results: A total of 60 patients were enrolled in the study and divided into two groups of 30 patients each. At three and six months, endometriosis-associated pelvic pain significantly decreased in patients receiving Dienogest+Ethinylestradiol (D+EE) compared to patients receiving dienogest alone (p<0.001). The effectiveness in cycle control at three and six months was also higher in the D+EE group (p=0.0098 and 0.0443, respectively). The safety profile was similar in both groups during follow-ups. QoL, as assessed by the Physical Component Score (PCS-12), showed a significant decrease at one, three, and six months with D+EE compared to Dienogest alone (p=0.0135, p=0.0058, and p<0.0001, respectively). The Mental Component Score (MCS-12) at three and six months significantly improved in patients on D+EE (p=0.0101, p<0.0001, respectively). Conclusion: Cyclical D+EE was found to be more effective in the management of pelvic endometriosis compared to continuous dienogest alone, resulting in reduced EAPP, improved cycle control, and enhanced QoL.

Hepatitis B Viral Load Patterns in HBsAg-Positive Antenatal Women and their Correlation with Stages of Pregnancy: A Cross-sectional Study

Introduction: Screening for Hepatitis B Surface Antigen (HBsAg) during pregnancy is essential, as maternal viremia is directly proportional to perinatal transmission. However, there is insufficient literature available on the viral load pattern of Hepatitis B Virus (HBV) in different trimesters of pregnancy. Aim: The aim of this study was to investigate the seroprevalence and estimate the viral load of HBsAg among antenatal women in different trimesters of pregnancy. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Microbiology at Jorhat Medical College and Hospital in Jorhat, Assam, India, from June 2017 to May 2018. A total of 7833 samples were collected from antenatal cases attending the Outpatient Department of Obstetrics and Gynaecology. HBsAg positive cases were screened using a rapid diagnostic kit and Enzyme-linked Immunosorbent Assay (ELISA). Viral load was estimated using Reverse Transcription Polymerase Chain Reaction (RT-PCR) after obtaining written consent. Positive patients were followed-up, and viral load estimation was repeated in each trimester. Statistical analysis was performed using Epi Info software and the Mann-Whitney U test. Results: The mean age of the HBsAg positive antenatal women who participated in the study was 25.97±3.72 years. Out of the 7833 patients screened, 32 antenatal patients were found to be positive for HBsAg. The highest viral load was found to be 1 log10 (25%) and 6 log10 (25%) IU/mL. The median viral load was highest in the second trimester at 1.434×106 IU/mL, followed by the third trimester at 7.003×105 IU/mL, and the first trimester at 43.6482 IU/mL. Conclusion: The pattern of HBV viral load indicates that patients in the first trimester either had borderline or low levels compared to those in the second and third trimesters. Since the viral load pattern varies in different trimesters of pregnancy, viral load estimation is crucial for the treatment of positive patients and to reduce HBV vertical transmissions.

Association between Q192R Polymorphism of Paraoxonase-1 Gene and Risk of Coronary Artery Disease: A Case-control Study

Harleen Kaur, Jaskiran Kaur, Gurinder Mohan, Nishant Sharma, Sahiba Kukreja

Introduction: Coronary Artery Disease (CAD) is a complex metabolic disorder in which lifestyle and genetic factors are known to play key roles in pathogenesis. Extensive studies have examined the role of Paraoxonase 1 (PON1) polymorphisms as genetic markers of CAD. However, the evidence regarding their role in the aetiology of CAD remains contradictory. Aim: The aim of this study was to determine the genotypic/allelic frequency of the Q192R polymorphism of the PON1 gene and its association with the risk of CAD. Materials and Methods: A case-control study was conducted at the Department of Biochemistry in collaboration with the Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, from November 2019 to December 2022. A total of 100 participants were divided into two groups: group I (CAD patients) and group II (healthy controls) to investigate the association between the Q192R polymorphism and CAD risk. The genotypic and allelic frequencies of the Q192R polymorphism of the PON1 gene and its association with CAD were determined using Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP), followed by 2% agarose gel electrophoresis. The data were statistically analysed using the Chi-square test. Results: There were a total of 50 participants in each group (29 males and 21 females), with a mean age of 47.02±8.79 years in group I and 37.70±7.29 years in group II (p-value <0.001). The present study confirmed that individuals with QR+RR genotype compared to QQ genotype (OR: 2.47; 95% CI: 1.10-5.55; p-value=0.03) of the Q192R polymorphism were associated with an increased risk of CAD. A higher frequency of the RR genotype of the Q192R polymorphism was detected in CAD patients, and it was associated with a 3-fold increased risk of developing CAD (p-value <0.05). However, the difference between QR versus QQ genotypes {Odds Ratio (OR): 2.13; 95% CI: 0.89-5.12, p-value=0.09} was found to be statistically insignificant. Furthermore, a significantly higher frequency of the R allele was observed in CAD patients compared to controls (OR 2.12, 95% CI: 1.18-3.84, p-value=0.01). Conclusion: In conclusion, the Q192R polymorphism of the PON1 gene was associated with an increased risk of CAD in the Punjabi population. The results confirmed that the presence of the R allele was associated with an increased risk of CAD.

Comparison of Haematological Variables in Helicobacter Pylori-Infected Patients with Ulcer and without Ulcer: A Cross-sectional Study

Introduction: Helicobacter pylori (H. pylori) is predominantly responsible for acute and chronic progressive gastroduodenal inflammation. Symptoms of gastric diseases vary from dyspepsia to altered bowel movements, leading to ulcers and potential gastrointestinal bleeding. Consequently, H. pylori can have a variable effect on the gastrointestinal tract and other organs. Ongoing research has shown associations between H. pylori and haematological manifestations. Recent studies have reported a 90% incidence of duodenal ulcers and an 80% incidence of gastric ulcers in patients with H. pylori infection. Aim: To investigate haematological manifestations in H. pylori-infected patients with and without ulcers, and to compare the haematological variables. Materials and Methods: This cross-sectional study was conducted in the Department of Gastroenterology at King George’s Medical University in Lucknow, India, from October 2021 to October 2022. One hundred patients diagnosed with H. pylori-positive biopsy through endoscopy were enrolled in the study. Among these patients, 51% had ulcers with H. pylori infection (enrolled as cases), while 49% were H. pylori infected but without ulcers (enrolled as controls). Samples were analysed for Haemoglobin (Hb) levels, Red Blood Cell (RBC) count, Reticulocyte Count (RetC), serum iron, serum ferritin, Total Iron Binding Capacity (TIBC), serum vitamin B12, and Homocysteine (HCy) levels. Statistical analysis involved independent sample t-tests to compare continuous data and chi-square tests to compare categorical data. Results: The majority of patients included in the study, both with ulcers (70.6%) and without ulcers (59.2%), were males with mean±Standard Deviation (SD) ages of 32.39±7.25 years and 29.86±7.66 years, respectively. In the present study, low reticulocyte count, anaemia, deranged RBC count, low serum iron, high TIBC, and low ferritin were observed in 9%, 22%, 61%, 11%, 12%, and 8% of the patients, respectively. Vitamin B12 deficiency and hyperhomocysteinemia were observed in 6% and 1% of the cases, respectively. Among patients with ulcers, the strongest correlation was found between serum iron and serum ferritin (r-value=0.901), while the weakest correlation was found between vitamin B12 and RetC (r-value=0.206). Among patients without ulcers, the strongest correlation was found between serum iron and Hb (r-value=0.884), while the weakest correlation was found between TIBC and HCy (r-value=0.270). Conclusion: The present study demonstrates a significant association between H. pylori infection-induced ulcers and decreased mean reticulocyte count, serum iron, and serum ferritin levels. Recognising these haematological derangements and including them as indications for H. pylori eradication may lead to a remarkable improvement in the management regime.

Role of B-scan in Blunt Ocular Trauma: A Cross-sectional Study

Anshi Gupta, Avaneesh Singh, Preeti Gupta

Introduction: Ocular trauma is a significant cause of unilateral vision loss, especially in developing countries. Proper assessment of ocular damage and prompt treatment initiation after the injury have a crucial impact on the final outcome. B-scan Ultrasonography (USG) plays an important role in detecting findings that may not be evident during clinical examination. Aim: To assess the role of B-scan in blunt ocular trauma and to determine if B-scan provides any additional advantages over clinical examination. Materials and Methods: A cross-sectional study was conducted from May 1, 2021 to April 30, 2022, at Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India. Fifty consecutive patients with blunt ocular trauma, presenting with hazy or opaque ocular media or unexplained visual loss during clinical examination, were evaluated in the casualty and ophthalmology Outpatient Department (OPD). The frequency of lesions such as traumatic cataract, vitreous degeneration, and retinal detachment was assessed clinically and using B-scan USG. Anterior and posterior segment manifestations of blunt trauma, including traumatic cataract, vitreous haemorrhage, and retinal detachment, were evaluated clinically and with B-scan imaging. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0, including frequency counts, percentage calculations, and Kappa’s statistical analysis to correlate B-scan USG and clinical findings. Results: Majority of patients (28%) were in the age group of 21-30 years. Workplace-related injuries, particularly agricultural injuries, were the most common cause of blunt ocular trauma (30%). Traumatic cataract (44%), vitreous degeneration (8%), vitreous haemorrhage (6%), and retinal detachment (4%) were the common clinical posterior segment findings. On B-scan USG, the most frequent findings were retinal detachment (30%) and vitreous haemorrhage (28%). Choroidal detachment was noted in 2% of cases. B-scan USG was more helpful in accurately diagnosing vitreous lesions and retinal lesions (52%, 30%) compared to clinical examination (16%, 6%). Conclusion: B-scan USG emerged as a superior diagnostic tool for identifying posterior segment lesions, including vitreous, retinal, and choroidal lesions. Lesions such as retinal detachment and vitreous haemorrhage were more easily identified using USG, especially in the presence of hazy or opaque media. Therefore, B-scan USG should be considered an integral part of all ophthalmic set-ups dealing with trauma to avoid missing significant posterior segment pathologies.

Clinical Spectrum of Neonatal Encephalopathy and the Role of CK-MB Assay in Transient Myocardial Ischaemia in Neonates with Hypoxic Ischaemic Encephalopathy: A Prospective Cohort Study

MK Senthil Kumar, Nallamuthu Soundararajan, Muthukumar Geethanjali

Introduction: Significant advancements have been made in the field of perinatal medicine through the use of newer monitoring technologies. However, birth asphyxia continues to cause prolonged hospitalisation due to multiple organ dysfunction and unfortunately, sometimes results in death. An elevation of the serum Creatine Kinase Myocardial Bound (CK-MB) fraction in myocardial ischaemia could indicate exposure to asphyxia and shock in neonates. Aim: The aim of this study was to examine the clinical spectrum of Neonatal Encephalopathy (NE) and investigate Transient Myocardial Ischaemia (TMI) in neonates with Hypoxic Ischaemic Encephalopathy (HIE) using CK-MB assay at birth, 24 hours, and 72 hours. Materials and Methods: A prospective clinical study was conducted in the Neonatal Intensive Care Unit (NICU) at a Tertiary Care Hospital in Tamil Nadu, India. The study duration was eight months, from January 2014 to August 2014. A total of 70 term neonates admitted with NE symptoms were included. Among them, 65 babies with evidence of asphyxia, such as an Appearance, Pulse, Grimace,Activity and respiration (APGAR) score less than 3 at five minutes, heart rate less than 60 Beats Per Minute (bpm), meconium-stained amniotic fluid, or the need for positive pressure ventilation for more than one minute, were evaluated for TMI. Myocardial involvement was assessed through clinical evaluation, chest X-ray (CXR), Electrocardiogram (ECG), Echocardiography (ECHO), and CK-MB assay at birth, 24 hours, and 72 hours. Statistical analysis was performed using Epi Info software version 7.0. Results: The mean Gestational Age (GA) of the study participants was 38.97±1.31 weeks. During the study period, 70 babies were admitted with NE symptoms, and HIE was the cause of encephalopathy in 65 babies. Other causes included hypoglycaemia, intraventricular haemorrhage, and bilirubin encephalopathy. Meconium staining of amniotic fluid was the most common intrapartum event in HIE babies. The survival rate in encephalopathy cases was 28.57%. Shock and respiratory failure were common complications in HIE, representing 46.15% and 44.61% respectively. Cardiomegaly in CXR, ST depression in ECG, Tricuspid Regurgitation (TR) in ECHO, and elevated CK-MB were commonly detected in babies with TMI associated with HIE. Conclusion: NE caused by HIE has a high mortality and morbidity rate. 83.3% of asphyxiated babies with shock had elevated CK-MB levels at birth, but the CK-MB values at 24 hours and 72 hours were not significantly elevated.

Type and Screen Method versus Antihuman Globulin Crossmatch in Pretransfusion Testing: A Cross-sectional Study

D Umesh, A Sivaramakrishnan, V Naveen Kumar, Arumugam Pothipillai

Introduction: Blood transfusion remains the primary modality of treatment for many serious and common diseases. According to the International Society of Blood Transfusion (ISBT), there are about 349 blood group antigens, out of which only about 25-28 antigens are known to cause acute or delayed type of haemolytic transfusion reactions which could be prevented by Pretransfusion Testing (PTT). Regulated pretransfusion tests include ABO blood grouping, Rh typing, antibody detection, antibody identification and compatibility testing. The purpose of compatibility tests is to demonstrate in-vitro red cell antigen-antibody reaction. The Antihuman Globulin (AHG) crossmatch testing can assure ABO compatibility between donor and patient blood as well as detect most clinically significant antibodies. Type and Screen (T&S) is a procedure carried out as part of PTT in which the recipient’s blood sample is tested for ABO group, RhD T&S for unexpected antibodies. Aim: To compare T&S method of PTT with AHG crossmatch. Materials and Methods: This cross-sectional study was conducted in the Department of Transfusion Medicine at Government Royapettah Hospital, Chennai and The Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India from June 2012 to December 2013. T&S was performed on 1,040 recipients’ (510 males and 530 females) samples. All these samples were subjected to AHG crossmatch with ABO group and RhD type matched donor samples to assess the compatibility between donor and recipient by using column agglutination technology. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 11.0. Results: The prevalence of unexpected antibodies in the recipient population was 1.06%. Among the 1,040 recipients’ blood samples, 11 samples were found to have unexpected antibodies. Out of these 11 samples, 10 showed exact antibodies and the remaining one sample with negative antibody screening was found to be incompatible with AHG crossmatch. The sensitivity and specificity of T&S method in comparison to AHG crossmatch was 87.50% and 99.71%, respectively. Conclusion: The sensitivity and specificity of T&S is as acceptable as AHG crossmatch. However, in view of one sample with false negative antibody screening in the study population, it is imperative to know the phenotyping of Red Blood Cells (RBC) antigens of the native population before getting away with AHG crossmatch.

Functional Outcomes of Quadriceps Tendon versus Hamstring Tendon Autograft using Suspensory Fixation at Femoral and Tibial Sites for Primary Anterior Cruciate Ligament Reconstruction: A Randomised Controlled Study

Introduction: Arthroscopic Anterior Cruciate Ligament (ACL) reconstruction using hamstring tendon autografts is commonly used in day-to-day practice. Recently, the quadriceps tendon has been considered as a graft choice for primary ACL reconstruction due to its reliable graft size and resistance to rupture. The available literature comparing Quadriceps and Hamstring autografts in ACL reconstruction is limited. Therefore, the present study was conducted to compare the functional outcomes of these autografts using suspensory fixation at the femoral and tibial sites. Aim: To compare the functional outcomes of quadriceps tendon versus hamstring tendon autografts for primary ACL reconstruction. Materials and Methods: A randomised controlled study was conducted at Department of Orthopaedics, BLDE’s Shri BM Patil Medical College and Research Centre, Vijayapur, Karnataka, India, from January 2021 to April 2023. Thirty-four patients were included in the study and randomised into two groups: one group was operated with a quadriceps tendon graft, and the other group used a hamstring tendon autograft. Both groups underwent surgery using suspensory fixation, and postoperative rehabilitation was similar. Functional outcomes (assessed using Lysholm and International Knee Documentation Committee (IKDC) scores), return to preinjury activity, and complications were evaluated. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Mann-Whitney U test was applied to compare pre- and postoperative functional outcomes (Lysholm and IKDC scores) at 6, 12, and 24 months, with a significance level of p<0.05. Results: Out of 34 patients, 27 (79%) were male and 7 (21%) were female. The follow-up period ranged from a minimum of 24 months to a maximum of 26 months. The mean Lysholm score in the hamstring group increased from 47 preoperatively to 92 at six months postoperatively, while in the quadriceps group, it increased from 46 preoperatively to 90 at six months postoperatively. The reliability and validity of the IKDC score for the hamstring group also increased from 46 preoperatively to 79 at six months, and for the quadriceps group, it increased from 44 preoperatively to 78 at six months. A total 31 of the cases (91%) returned to their preinjury activity, while 3 patients (9%) (2 from the hamstring group and 1 from the quadriceps group) experienced knee stiffness, which restricted their ability to squat and sit cross-legged. There were no significant differences in Lysholm and IKDC scores between the hamstring and quadriceps tendon autografts at 6, 12, and 24 months postoperatively. Conclusion: Patients undergoing single bundle ACL reconstruction have comparable functional outcomes with either hamstring or quadriceps grafts at the end of the 2-year follow-up period, with no specific graft site complications. The soft tissue quadriceps tendon autograft can be considered as an equally viable option for graft selection.

Differential Expression and Utilisation of CD34, EMA, PR, and Inhibin in Differentiating Meningioma, Haemangioblastoma, and Solitary Fibrous Tumour: A Cross-sectional Study

Introduction: Mesenchymal tumours of the Central Nervous System (CNS) include meningioma, haemangioblastoma, and Solitary Fibrous Tumour (SFT). Although conventional histopathological examination remains the mainstay in diagnosis, Immunohistochemistry (IHC) plays an important role in CNS tumours, owing to its diagnostic significance and prognostic implications. Aim: To evaluate whether combined use of inhibin, Epithelial Membrane Antigen (EMA,) Progesterone Receptor (PR) and CD34 improves diagnostic accuracy in meningeal and non meningeal mesenchymal tumours of CNS. Materials and Methods: This was a cross-sectional retrospective observational study conducted in the Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, October 2022 to December 2022 in which all brain tumour specimens diagnosed as meningeal or non meningeal mesenchymal tumours from January 2022 to August 2022 were included in the present study. Sections were immunostained with an IHC panel of EMA, PR, inhibin, CD34, and Ki67. The immunohistochemical expression of EMA, PR, inhibin, and CD34 was expressed as frequencies and percentages, along with sensitivity and diagnostic accuracy evaluation. Ki67 was assessed in the hotspots and expressed as a percentage. The data were presented as frequencies and percentages. Results: A total of 60 patients were included, with an age range from 12 to 73 years and a mean age of 48.2 years. Female predominance, constituted 40 (67.5%) of the study population. Out of the total cases, 49 (81.7%), 9 (15%), and 2 (3.3%) cases were of meningioma, haemangioblastoma, and SFTs, respectively. Among the 49 cases of meningioma, the majority 47 (96%) showed diffuse and strong staining for EMA with a cytoplasmic staining pattern±membranous accentuation. PR was expressed in 45 (92%) of the meningiomas. Inhibin was diffusely expressed in stromal cells of haemangioblastoma 9 (100%). A characteristic cytoplasmic positivity of CD34 was observed in both cases 2 (100%) of SFT. The Ki67 index of anaplastic and atypical meningiomas was 15%, while all other tumours had a very low proliferation index of 2%. Conclusion: The IHC panel comprising CD34, EMA, and inhibin was useful in the differential diagnosis of both meningeal and non meningeal mesenchymal tumours in the CNS, even in cases with overlapping histomorphological features. Inhibin had a very high sensitivity and diagnostic accuracy for the diagnosis of haemangioblastomas. EMA and PR also had fairly good sensitivity and diagnostic accuracy for the diagnosis of meningiomas. CD34 had good sensitivity but very poor diagnostic accuracy for the diagnosis of SFT.

An Audit of the Length of Bone Marrow Trephine Biopsy in Adult Patients: A Cross-sectional Study

Vandana Bhatti, Ashima, Gagandeep Deval, Roma Isaacs

Introduction: A bone marrow trephine biopsy is a minor surgical procedure used to diagnose various haematological and non haematological diseases, such as leukaemia, multiple myeloma, and parasitic disorders like histoplasmosis and leishmaniasis. It is often performed alongside bone marrow aspiration to gather additional information about cellularity, the arrangement of marrow components, and the presence of focal diseases. According to the World Health Organisation (WHO), the recommended minimum adequate length for a trephine biopsy is ≥1.5 cm (before processing). Aim: To conduct an audit of trephine biopsy lengths and assess their diagnostic utility among adult patients. Materials and Methods: This cross-sectional study analysed all bone marrow biopsies from adult patients received at the Department of Pathology, Christian Medical College and Hospital in Ludhiana, Punjab, India, over a three-year period (January 2019 to December 2021). The biopsies were categorised into three groups based on their length at the time of grossing: Group A (≥1.5 cm), Group B (1-1.4 cm), and Group C (0.5-0.9 cm). The length of each trephine biopsy was recorded and its diagnostic usefulness was evaluated. Results: The study included 1,155 trephine biopsies performed over the three-year period. Out of these, 1042, 97, and 16 biopsies were allocated to Groups A, B, and C, respectively. Biopsies meeting the recommended length (>1.5 cm) accounted for 90.2% of the cases. Longer biopsies were associated with a higher rate of conclusive diagnosis compared to shorter biopsies (p-value=0.02). However, when comparing Groups A and B individually, no significant difference was observed in terms of the conclusive diagnosis (p-value=0.9). Conclusion: Trephine biopsy is a vital tool for diagnosing haematological disorders, particularly focal lesions. Obtaining longer trephine biopsies should be emphasised, as they contribute to a more definitive diagnosis.

Dexmedetomidine versus Clonidine for Improved Quality of Emergence from General Anaesthesia: A Randomised Placebo-Controlled Study

Vikram Bedi, Suman Goyet, Chanchel Mary Thomas, Anjuna Velloth

Introduction: Extubation of the trachea upon emergence from General Anaesthesia (GA) is often accompanied by potentially dangerous events, like coughing, hypertension, tachycardia, and agitation. The centrally acting a-2 agonist, dexmedetomidine, has been evaluated to attenuate the emergence/extubation response. However, there is insufficient evidence regarding the effectiveness of clonidine for the same purpose. Aim: This study aimed to evaluate the quality of emergence from GA in patients receiving clonidine infusion versus dexmedetomidine infusion. Materials and Methods: In this randomised, double-blinded trial conducted over a period of 5 months, 105 patients aged 18-70 years, of either sex, with American Society of Anaesthesiologists (ASA) grade I-III, scheduled for elective laparotomies with an estimated duration of 1-4 hours, were randomly assigned to groups D, C, and P. Group D received inj. dexmedetomidine 1 μg/kg, group C received clonidine 3 μg/kg, and group P received placebo (normal saline) via Intravenous (i.v.) route over 10 minutes using a syringe pump, 10 minutes prior to the anticipated end of surgery. Haemodynamic parameters, cough, agitation, shivering, time to extubation, sedation, Visual Analogue Score (VAS), and Postoperative Nausea and Vomiting (PONV) scores were recorded before, during, and after extubation. The incidence of complications (hypotension, bradycardia, or others) was also recorded. Categorical data were expressed as proportions, while numerical data were presented as mean±Standard Deviation (SD) or median±Interquartile Range (IQR). Appropriate data were compared using Statistical Package for Social Sciences (SPSS) version 16.0. Results: A total of 105 patients were included, with 53 males and 52 females. There was no difference in the demographic characteristics, such as age, gender, and Body Mass Index (BMI), amongst the three groups. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)) were significantly lower in patients of group D and group C compared to the placebo group at 5, 10, 10, and 15 minutes, respectively, after the beginning of drug infusion (p-value <0.05). Patients in groups D and C had significantly lower median cough scores at 20-25 minutes compared to the placebo group (p-value at 20 and 25 minutes was 0.012 and <0.001, respectively). There was a significant reduction in postoperative pain, as measured by VAS score, and an increase in sedation, as measured by Ramsay sedation score, in groups D and C compared to the placebo group. There was no statistical difference in agitation score, shivering score, PONV score, time to extubation, and incidence of complications among the three groups (p-value >0.05). Conclusion: Administration of 1 μg/kg of dexmedetomidine or 3 μg/kg of clonidine over 10 minutes prior to recovery from General Endotracheal Tube Anaesthesia (GETA) results in a better quality of recovery, as evidenced by a statistically significant reduction in cough scores in patients undergoing elective laparotomies when compared to patients of placebo group.

Laser Application in Remineralisation of Enamel after Interproximal Reduction: An In-vitro Scanning Electron Microscopic Study

Preethi Rajamanickam, Ashwin Mathew George

Introduction: Interproximal Reduction (IPR) or reproximation of enamel is of prime importance in orthodontics for correcting arch length-tooth size discrepancies. Despite its widespread application, IPR has been associated with adverse effects on the enamel surface. Aim: The aim of this study was to investigate whether laser application, when combined with fluoride application, enhances the remineralisation potential of enamel. Materials and Methods: This in-vitro study was conducted at Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India, from December 2021 to July 2022. It involved 54 extracted teeth, divided into three groups of 18 samples each. Reproximation of 0.25 mm was performed on the proximal enamel surface of each tooth. Group 1 served as the control, group 2 was subjected to Fluor Protector, and group 3 received low-level laser therapy (Er,Cr:YSGG) after Fluor Protector application. Fluor Protector (Ivoclar Vivadent) was applied for seven days. Following the seven-day fluoride administration, a laser treatment using 0.75 W of power and 8.5 J/cm2 of energy was applied for 20 seconds. Microhardness testing was conducted on the samples using a Vickers Hardness Tester. All specimens underwent surface topographic analysis with Scanning Electron Microscopy (SEM) and were evaluated for mineral content (% weight) using SEM-Energy Dispersive X-Ray analysis (EDX). Paired t-tests were performed to compare the pre- and post-microhardness values, while one-way Analysis Of Variance (ANOVA) test and Tukey’s Post-hoc test were used to compare the microhardness values between the groups. Results: The mean microhardness values recorded for group 1, group 2, and group 3 were 209.4±18.4 N/mm2, 215.16±21.0 N/mm2, and 233±18.05 N/mm2, respectively. ANOVA test revealed a significant difference in microhardness values between group 1 and group 2 (p-value=0.004), as well as between group 1 and group 3 (p-value=0.001). The microhardness value was highest for group 3, followed by group 2 post-intervention. SEM analysis showed that laser-treated enamel surfaces were smoother, with well-coalesced enamel rods. The porous structure of enamel was lost due to fluoride deposition in group 2 and group 3, resulting in a smooth surface. Conclusion: The combined application of fluoride and laser therapy demonstrated synergistic effects in remineralising the slenderised enamel. This simple, non-invasive technique may benefit patients undergoing IPR procedures by reducing the occurrence of dental caries.

Assessment of Arterial Stiffness in Patients Recovered from Mild COVID-19 Disease using Pulse Wave Velocity: A Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) may manifest with different grades, such as mild, moderate, or severe. COVID-19 has many post-viral implications on different organ systems, including the vascular system. As the pandemic load increases, it is vital to identify any post-recovery complications and functional impairments of the arteries in patients who have recovered from mild COVID-19 disease. Aim: Present study aimed to evaluate the functional impairment of the arteries, specifically arterial stiffness, in patients recovered from mild COVID-19 disease by assessing Pulse Wave Velocity (PWV). Materials and Methods: The present cross-sectional study was conducted at Shri BM Patil Medical College and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India, from April 2021 to June 2021. A total of 18 patients who had recovered from mild COVID-19 disease (Group 1: n=18) and age- and sex-matched healthy participants (Group 2: n=18) accessing health services at the hospital were included in the study. Data were collected for physiological parameters such as height, weight, Body Mass Index (BMI), Pulse Rate (PR), Blood Pressure (BP), and arterial stiffness parameters like PWV. The data were statistically analysed using the Mann-Whitney U test and Spearman’s correlation. Results: The study included 36 participants aged between 18 and 65 years. In the present study, patients recovered from mild COVID-19 disease showed a statistically significant increase in brachial-ankle Pulse Wave Velocity (b-a PWV) (p=0.001) and carotid-femoral Pulse Wave Velocity (c-f PWV) (p<0.01) compared to the controls and positively correlated with Mean Arterial Pressure (MAP). Conclusion: The present study concluded that even a mild degree of COVID-19 enhanced PWV, reflecting an increase in arterial stiffness. This study may assist clinicians in follow-up visits and rehabilitation to reduce the burden of the disease.

Awareness of Medicolegal Issues among Interns and Resident Doctors at a Tertiary Care Hospital in Kolar, Karnataka, India: A Cross-sectional Study

P Srinivasa Reddy, R Abhinandana

Introduction: Medicolegal issues are handled by every doctor in their day-to-day medical practice. However, if they are not well versed in the rules of managing such cases and the law behind them, they often land into criticism and distress in court while dealing with evidence in Medicolegal Cases (MLCs). Aim: To assess the awareness of interns and resident doctors, who are working at RL Jalappa Hospital and Research Centre, regarding the management of MLCs in their day-to-day practices. Materials and Methods: A cross-sectional questionnaire-based study was conducted to determine the awareness of medicolegal issues among 107 participants, including interns and resident doctors in the Department of Forensic Medicine and Toxicology at a tertiary care hospital, Sri Devaraj Urs Medical College, Tamaka Kolar, Karnataka, India, from January 2022 to October 2022. A prevalidated list of 21 questionnaires, obtained through a pilot study with Cronbach’s alpha=0.78, was used. Numerical data were summarised using mean and standard deviation, while categorical data were expressed using percentages. Results: The mean age of the study participants was 28.6 years. Most of the participants were from Surgery and allied fields (61%), and the majority of the participants (51.4%) had one to two years of experience in the medical field. Among the findings, it was observed that 67.28% of participants had insufficient knowledge about the minimum age requirement for informed consent, 60% of residents had insufficient knowledge of maintaining meticulous medical records, 57% of the participants responded incorrectly regarding the desired way of handling brought dead cases in hospitals, and 63.8% of the participants had poor knowledge of the Karnataka Private Medical Establishment (KPME) act and organ transplantation act. Conclusion: The study concluded that while interns and postgraduates showed some level of awareness regarding certain aspects of medicolegal issues, like need for consent, they still lack comprehensive knowledge on subjects like legal requirements of consent, medical records, the KPME act, and organ transplantation act. Therefore, it is necessary to modify the curriculum for students and provide orientation programs, continued medical education, and guest lectures to interns and residents to build fiduciary character in Indian medical graduates.

Effectiveness of Drainless versus Drained Onlay Mesh Hernioplasty in Patients Undergoing Elective Open Ventral Hernia Repair: A Prospective Interventional Study

Lejeune Ramot Mahalakshmi, Sivamarieswaran Ramalingam, Manimaran Pethuraj

Introduction: Ventral Hernia Repair (VHR) is one of the most frequently performed surgical procedures worldwide. The two commonly used surgical techniques for ventral hernia are onlay and sublay repairs. The use of drains in hernioplasty is controversial, as some studies suggest an increased incidence of surgical site infections. Aim: This study aims to compare the postoperative outcomes between patients who had drains placed and those who did not, undergoing elective open VHR. Materials and Methods: A prospective interventional study was conducted at the Department of General Surgery, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India. The study duration was one year, from September 2020 to September 2021. A total of 50 hernia patients participated, with 25 undergoing drainless and 25 undergoing drain onlay mesh hernioplasty. Surgical complications such as surgical site infection, seroma formation, and duration of hospital stay were observed and compared between the two groups. Independent t-tests and Chi-square tests were used to compare continuous and categorical variables, respectively. Results: Out of 50 patients, 15 (60%) in the drain group were aged between 11 to 60 years, while 11 (44%) in the drainless group were aged between 18 to 40 years. Postoperative seroma was present in 6 (12%) patients, with an equal distribution in both groups (p-value >0.05). Surgical site infection was present in 3 (60%) and 2 (40%) patients in group A and group B, respectively (p-value >0.05). The mean duration of hospital stay was 6.36±1.89 and 4.92±1.91 days in group A and group B, respectively (p-value=0.010). Conclusion: The presence or absence of a drain did not significantly affect the formation of seroma among the participants. The incidence of infection did not vary significantly with or without the use of a drain.

Intravenous Low Dose (4 mg) Dexamethasone as an Adjunct to Epidural Labour Analgesia with 0.125% Ropivacaine in Parturients: A Randomised Controlled Study

Jagdish Kumar, Garima Choudhary, Gayatri Tanwar, Shobha Ujwal

Introduction: Labour pain is one of the most severe pains, and the mother’s demand is reason enough for the induction of labour analgesia, provided that no contraindications exist. Labour analgesia must be safe for both the mother and the child. Aim: To assess the impact of a low dose (4 mg) of Intravenous (IV) dexamethasone used in conjunction with neuraxial labour analgesia with 0.125% Ropivacaine. Materials and Methods: The present study was a double-blinded randomised controlled study conducted at tertiary care hospital on 80 parturients classified as American Society of Anaesthesiologists (ASA) II. The parturients were over 18 years old, in their third trimester, carrying a single live foetus that was cephalic at 36 weeks of gestation, and whose cervical dilation was greater than 3 cm and who requested epidural analgesia. All parturients were randomly divided into two equal groups. Before receiving epidural analgesia, the dexamethasone group received 4 mg of IV dexamethasone in 50 mL of normal saline. Patients in the control group received only 50 mL of normal saline. After an initial bolus of 0.125% ropivacaine (8 mL given gradually over 5 minutes), all expectant mothers received a continuous background infusion of 0.125% ropivacaine at a rate of 5 mL/h, along with patient-controlled boluses of 5 mL of the same medication given with a lockout interval of 12 minutes using a Patient Controlled Epidural labour Analgesia (PCEA) pump through the epidural route. Yates continuity correction test (Chi-square test), Fisher’s exact test, and Fisher Freeman Halton were used to compare qualitative data. For categorical data, numbers and percentages were used to summarise all continuous variables as mean±SD. Results: Demographics such as age, height, weight, and pre-procedure obstetric-related details were comparable in both groups. There was no statistically significant difference in the average hourly medication intake between the dexamethasone group and the control group (Group D-7.64±0.88 mL/hr and Group C-8.04±1.24 mL/hr, p-value=0.09). Other factors, including pain scores, haemodynamics, administration method, and side effects, did not differ significantly between the two groups. Conclusion: Despite having modest analgesic properties, IV dexamethasone could not significantly reduce the hourly average medication consumption of ropivacaine during epidural labour analgesia.

Outcome of Anterior Wall Acetabulum and Pelvis Fracture through a Modified Stoppa Approach: A Prospective Cohort Study

Introduction: Acetabular fractures are becoming more common these days. The treatment of complicated acetabular fractures is challenging due to their location and associated injuries. Since the development of the Stoppa approach, it has been used as an alternative to the conventional ilioinguinal strategy. Aim: To assess the postoperative outcomes based on clinical and radiographic results in patients with fractures of the pelvis and acetabulum treated using the Modified Stoppa method. Materials and Methods: This prospective cohort study was conducted at Shri BM Patil Medical College, Hospital and Research Centre in Vijayapura, Karnataka, India, from January 2021 to May 2022. The study included 30 patients with acetabular fractures. Fracture reduction was achieved using a modified Stoppa technique. The patients were followed-up for six months, and postoperative function was assessed using the Merle D’Aubigne Score and postoperative X-rays. Frequency distribution was used to analyse the frequency and percentage of study variables. The Chi-square test was used to determine the association between outcomes and radiographic results. Pearson’s correlation coefficient test was used to compare the follow-up time of the patients and the Merle D score. Results: Out of the 30 cases operated on using the modified Stoppa approach, 86.67% achieved anatomical reduction, with 53.33% showing a good outcome and 33.33% achieving an excellent outcome post-surgery. The results were subjected to statistical analysis. Frequency distribution was used to analyse the frequency and percentage of study variables. The Chi-square test was used to determine the association between outcomes and radiographic results. Pearson’s correlation coefficient test was used to compare the follow-up time of the patients and the Merle D score. There was a statistically significant correlation (r-value of 0.007) between the patient’s outcome and the radiographic results post-surgery. Conclusion: The use of less invasive techniques has simplified surgery and reduced complications in the treatment of difficult acetabular fractures. With improved surgical skills and early intervention, this innovative technique for anterior exposure of the acetabulum can be used effectively.

Clinical Evaluation of Pro-Argin and Low Level Laser Therapy in the Treatment of Dentinal Hypersensitivity: A Split-mouth Randomised Clinical Trial

Introduction: Dentinal Hypersensitivity (DH) is the most prevalent condition that causes patients discomfort for patients, leading them to frequently visit dental offices. A wide range of methods and therapeutic procedures have evolved for pain alleviation have evolved. In recent decades, desensitising therapy has been coupled with newer therapies such as Pro-Argin and Low-Level Laser Therapy (LLLT). Pro-Argin therapy occludes the openings of dentinal tubules, while Diode Lasers (DL) cause a melting effect, crystallisation of dentine inorganic components, and coagulation of fluids trapped inside the dentinal tubules, thereby reducing the hypersensitivity. Aim: To compare the efficacy of Pro-Argin and LLLT -475 nm (Bluelase) in providing immediate relief in the treatment of dentinal hypersensitivity. Materials and Methods: This was a double-blind randomised split-mouth clinical trial involving from December 2021 to March 2022, including 12 patients (120 teeth) with bilateral hypersensitivity. They were divided into Group A (Pro-Argin) and Group B (LLLT-475 nm) both with 12 patients and 60 teeth each. Hypersensitivity was recorded using the Schiff cold air sensitivity scale and the Visual Analog Pain Scale (VAS) at baseline and at 15 minutes after desensitising therapy. Results: The study included 12 subjects with bilateral dentinal hypersensitivity, categorised into Group A (Pro-Argin) (Colgate Sensitive Pro-relief) and Group B (LLLT at 475 nm), with 60 teeth each. The Results were assessed using the independent t-test for inter-group comparison and the t-test for intra-group comparison. On inter-group comparison of the Schiff cold air sensitivity score, there was a statistically significant reduction in dentinal hypersensitivity in both the groups (p<0.001) with no statistical significance in VAS scores. However, on intra-group comparison; there was a statistically significant reduction in VAS scores in Group B (p≤0.001). Conclusion: LLLT has provided a significant reduction in dentinal hypersensitivity when compared with Pro-Argin.

Genetic Polymorphism in Patients with Diabetic Nephropathy and Retinopathy: A Cross-sectional Study

Parul Gupta, Sri Venkata Madhu, Parvesh Bubber

Introduction: The chronic persistence of diabetes leads to microvascular complications, such as Diabetic Nephropathy (DN) and Diabetic Retinopathy (DR). Both of these are progressive disorders involving pathological changes in capillaries. A few biochemical pathways have been suggested to link hyperglycaemia and microvascular complications. The probability of developing and progressing DN and DR is associated with the duration of diabetes. These complex disorders are strongly influenced by both genetics and environmental factors. Several candidate genes have been reported to be associated with DN and DR in different populations. Aim: To determine the co-existence of DN and DR in relation to gene polymorphisms of Angiotensin-Converting Enzyme (ACE), Angiotensinogen (AGT), Receptor for Advanced Glycation End-products (RAGE), Aldose reductase (ALR2), and Vascular Endothelial Growth Factor (VEGF). Materials and Methods: The present DN and DR cross-sectional study was conducted at the Department of Endocrinology, University College of Medical Sciences, University of Delhi and GTB, New Delhi, India, and the Discipline of Biochemistry, Indira Gandhi National Open University, New Delhi, India. The study was conducted from October 2019 to August 2022. All the participants under uniform diabetes management were divided into two groups (100 in each group): Group 1 included Type-II diabetic patients with DN and DR, and Group 2 comprised Type-II diabetic patients with DN only. Polymorphisms in all genes were determined using Polymerase Chain Reaction (PCR), followed by digestion with restriction enzymes and visualisation through an ultraviolet transilluminator. The analysis of biochemical parameters and association of gene polymorphisms was performed using Statistical Package for Social Sciences (SPSS) version 26.0 software. Results: There were 57 males and 43 females in the DN+DR group, and 51 males and 49 females in the DN-DR group. The mean age of study subjects in the DN+DR group was 52.60±9.08 years, compared to the DN-DR group (47.33±10.68 years). The DN+DR group had a significantly higher mean duration of diabetes (11.78±6.86 vs. 5.13±4.78, p≤0.001) and a significantly lower mean waist circumference (91.30±13.99 vs. 95.11±9.95 cm, p≤0.02). The DN+DR group also had significantly higher urea (34.34±16.32 vs. 26.43±12.34 cm, p≤0.001), creatinine (1.34±0.90 vs. 0.89±0.25 cm, p≤0.03) and significantly lower estimated Glomerular Filtration Rate (eGFR) levels compared to the DN-DR group. The distribution of genotypes of ALR2 (p≤0.04) and VEGF genes (p≤0.001) showed a significant difference between both DN+DR and DN-DR groups. The frequency of the D allele of the VEGF gene (p≤0.02) (OR=1.94, 95% Confidence Interval (CI)=1.10-3.40) was higher in the DN+DR group. The DN+DR group also had a significantly lower frequency of the CT+TT dominant model of the ALR2 gene (p≤0.04) as well as an increased frequency of the ID+DD dominant model of the VEGF gene (p≤0.002). No significant differences were found in genotypic as well as allelic frequencies of ACE, AGT, and RAGE gene polymorphisms between the two groups. Conclusion: The D allele of the VEGF (I/D) gene polymorphism is significantly associated with DR in patients with DN. It can be concluded that the VEGF gene plays an important role in the development of retinopathy in DN patients.

Estimation of Waiting Time and Consultation Duration for Patients in the Outpatient Department of Radiation Oncology at a Tertiary Care Teaching Hospital in Uttarakhand, India: A Cross-sectional Study

Dinesh Chandra Joshi, Ravinder Singh Saini, Shweta Samant, Sangeeta Bijlwan

Introduction: The Outpatient Department (OPD) holds significant relevance in modern medical care and serves as the “Shop Window” of the hospital. Waiting time serves as a crucial indicator of the quality of OPD services provided by the hospital, as it greatly affects patient satisfaction. Radiation oncology is a clinical specialty that focuses on administering radiation therapy to cancer patients, who seek consultation in the radiation oncology OPD. Aim: To estimate the waiting time and consultation duration for patients in the OPD of radiation oncology at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was conducted from August 1 to August 31, 2022, at the Cancer Research Institute of Himalayan Hospital, which is the affiliated hospital of the Himalayan Institute of Medical Sciences under the aegis of Swami Rama Himalayan University, Dehradun, Uttarakhand, India. A total sample size of 300 patients was selected using the simple random sampling technique. Data was collected through direct observation using a data collection sheet. Statistical analysis was performed using the data analysis tool in Microsoft Excel and Statistical Package for Social Sciences version 23.0. Pearson coefficient of correlation (r) and p-value were calculated. Results: The results were analysed based on demographic details, days of the week, patients seen per consultation room, new and follow-up patients, and patient arrival time in the OPD. The majority of patients attending the OPD were in the age group of 50-69 years (60.6%). A total of 256 patients (85%) were follow-up patients. Analysis of the patient arrival pattern revealed that the highest number of patients, 200 (66.7%), arrived between 8:30 AM and 10:30 AM. The overall mean waiting time was estimated to be 50.43±0.030 minutes, and the mean consultation time was estimated to be 9.53±0.004 minutes. The Pearson coefficient of correlation between the two variables was calculated, revealing a positive correlation with ‘r’ value=0.14 and a statistically significant p-value=0.014 (<0.05). Conclusion: This study provides valuable insights for waiting time and consultation duration in the radiation oncology department’s OPD. On average, patients spend approximately 59.96 minutes in the OPD premises. Out of this time, 84.1% is spent waiting, while 15.9% is spent with the consultant. The primary reason for delays in the waiting area is the delayed availability of consultants due to ongoing ward rounds or other academic activities.

Comparison of Nolla’s Method, Cameriere’s Indian-specific Method, and Acharya’s Indian-specific Regression Formula for Estimation of Dental Age in Puducherry and Cuddalore Population, Southern India

R S Priya, RC Jagat Reddy, S Vandana, T Sivasankari, A Vani Anusha

Introduction: Forensic dental age estimation plays a vital role in determining the identity of a deceased individual. There are numerous dental age estimation methods available to estimate dental age using radiographs based on tooth maturation. Aim: To compare Nolla’s method, Cameriere’s Indian-specific method, and Acharya’s Indian-specific regression formula in estimating dental age in the Puducherry and Cuddalore populations of South India. Materials and Methods: This retrospective study was conducted in the Department of Oral Medicine and Radiology at the Indira Gandhi Institute of Dental Sciences, Puducherry, India, between January 2021 and October 2022. The study included 448 panoramic radiographs (202 males and 246 females) of individuals aged between six and 17 years. Chronological age was recorded based on the subject’s date of birth. Dental age was estimated using Nolla’s method, Acharya’s Indian-specific regression formula, and Cameriere’s Indian-specific method. Two qualified and experienced oral radiologists evaluated all the samples to assess their reliability. Data were analysed using descriptive statistics, the Pearson’s correlation coefficient, and Student’s t-test. Results: Nolla’s method (excluding the third molar) revealed a mean age of 13.52±3.15 years, while Nolla’s method (including the third molar) revealed a mean age of 12.81±2.84 years. Acharya’s Indian-specific method revealed a mean age of 15.08±2.92 years, and Cameriere’s Indian-specific regression formula revealed a mean age of 11.51±2.19 years. The results showed that the age estimated by Nolla’s method (including the third molar) had a p-value of 0.93 (>0.05), indicating no significant differences between the estimated dental age and chronological age. The r-values for Acharya’s Indian-specific regression formula, Nolla’s method (excluding the third molar), Nolla’s method (including the third molar), and Cameriere’s Indian-specific method were found to be 0.682, 0.885, 0.847, and 0.849, respectively, indicating a strong positive correlation among the age estimation methods. Conclusion: Nolla’s method (including the third molar) was found to be the most accurate method for dental age estimation when compared with the other three methods in the Puducherry and Cuddalore populations.

Computer-Assisted Learning versus Conventional Methods for Pathology Tutorials: A Longitudinal Interventional Study

Introduction: One of the important objectives of undergraduate pathology teaching is to enable the student to correlate the normal and altered morphology of different organ systems in common diseases. The conventional chalk and board method of tutorials for imparting this training is not free of disadvantages. Computer-Assisted Learning (CAL) is the trend of the day worldwide. Aim: The present study aimed to compare the effectiveness of CAL with the conventional method for pathology tutorials, with special emphasis on the retention of knowledge in students. Materials and Methods: The present study was a longitudinal interventional study involving 110 students of the second Professional MBBS batch of the Department of Pathology at North Bengal Medical College, Darjeeling, a rural area Medical College, for a period of six months from December 2017 to June 2018. The students were divided into an intervention group taught by the CAL method and a control group taught by the chalk and board method. On the day of teaching and one month after that, assessment was done by histopathology slide spotting. Focus Group Discussion (FGD) and a pre-tested and validated questionnaire completion were also undertaken. Paired t-test was used for comparison in both groups. Results: Those instructed by the CAL Method scored significantly higher than the control group students in both Spotting-1 and Spotting-2. In Spotting-1, the average score of group A (interventional group) and group B (control group) students was 71.11±27.67 (SD) and 38.89±24.75, respectively (p-value 0.01). In Spotting-2, the average score of group A and group B students was 67.78±28.52 (SD) and 29.44±28.85 (SD), respectively (p-value-0.01). Conclusion: The present study concluded that the CAL method is acceptable to both students and facilitators. It resulted in a significantly improved performance of students in the diagnosis of histopathology slides assessed immediately after teaching and one month after teaching. Hence, CAL also assists in the retention and recall of information.

Incidence of Acute Renal Failure in Preterm Babies in a Tertiary Care Centre from Southern India: A Cross-sectional Study

Nithya Jayaraman Ponmudi, Indira Agarwal, Vijaykumar S Theophilus

Introduction: Preterm babies are a vulnerable population group who are more susceptible to multiple end-organ damage due to an immature immune system and incomplete organogenesis/organ function. There is scanty data on preterm Acute Kidney Injury (AKI) in India. Aim: To investigate the incidence of acute renal failure and the risk factors predisposing preterm babies to renal failure in an inborn at a tertiary care centre in Southern India. Additionally, we aimed to evaluate the usefulness of a biomarker, Neutrophil Gelatinase Associated Lipocalin (NGAL), as both a marker of renal function and a predictor of AKI in preterm babies. Materials and Methods: A cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Christian Medical College, Vellore, Tamil Nadu, India, between May 2014 and August 2014. The study included babies born <33 weeks of gestation, while those with abnormal antenatal renal scans, major systemic congenital anomalies, and chromosomal anomalies were excluded. Demographic details and clinical features were noted. Weekly monitoring included urine output, assessment of clinical deterioration, details of interventions, unexpected events, and the use of nephrotoxic drugs. Blood samples for serum creatinine and urine samples for NGAL were collected once a week starting from 72 hours of age. The data was statistically analysed using Statistical Package for the Social Sciences (SPSS) software, version 16.0. Descriptive statistics were reported using mean±SD for continuous variables. Repeated measures Analysis of Variance (ANOVA) and Chi-square test/Fisher’s-exact test were used for categorical variables. Risk factor analysis was done using log binomial to estimate the Relative Risks (RR), considering values greater than 1 as significant. Results: During the study period, a total of 4823 live births were recorded. Among them, 80 babies had a gestational age <33 weeks (10.14%). One baby was not recruited as the parents did not provide consent, leaving a total of 79 babies included in the study. Five babies did not complete the study (three died and two were discharged against medical advice). The incidence of AKI in babies <32±6 weeks in this study was 10 out of 79 (12.6%). It was higher in babies <28 weeks, with 4 out of 10 (40%) affected, and all 10 babies (100%) weighed less than 1500 gm at birth. Risk factors for AKI included oliguria, Patent Ductus Arteriosus (PDA), nephrotoxic drugs, low APGAR score, mechanical ventilation, Continuous Positive Airway Pressure (CPAP), and abnormal antenatal scans. Urine NGAL was estimated in 30 babies, and it was found that NGAL levels were high in week 1 or rose by week 2 in those with AKI, while creatinine levels increased in week 2 or 3. NGAL was inversely proportional to gestational age and birth weight. Both NGAL rise and creatinine levels were observed in babies with AKI associated with Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), umbilical lines, and asphyxia. Conclusion: The incidence of AKI was found to be 10%. Although NGAL levels were noted to rise earlier than creatinine levels in those with AKI, a definitive cutoff value for NGAL to define AKI could not be calculated. Due to the small study population, the sensitivity and specificity of NGAL could not be determined.

Effect of Preoperative Preconditioning of Patients with External Nasal Compression for Different Time Intervals on Emergence Agitation After Nasal Surgeries: A Randomised Controlled Trial

Anupama Kumari, Anuja Agrawal

Introduction: Emergence agitation is a commonly experienced phenomenon in the waking period of general anaesthesia, which can adversely affect the recovery of patients in the postoperative period. Patients undergoing nasal surgeries under general anaesthesia, involving postoperative nasal packing, tend to have a higher rate of emergence agitation after extubation. Non pharmacological methods like nasal clips, can be safe and cost-effective alternatives to pharmacological agents for controlling emergence agitation. Aim: To evaluate the efficacy of preoperatively applying nasal clips for various durations in patients scheduled for nasal surgeries under general anaesthesia, which require nasal packing in the postoperative period, in reducing emergence agitation after extubation. Materials and Methods: The present randomised controlled trial was conducted at department of Anaesthesia, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS MIRC) in Piparia, Vadodara, Gujarat, India. A total of 75 patients with ASA I and II, aged 18-65 years, posted for elective nasal surgeries under general anaesthesia with postoperative bilateral nasal packing, were randomly divided into three groups. Group A (25 patients) wore nasal clips for 30 minutes preoperatively, Group B (25 patients) wore the clip for 40 minutes preoperatively, and Group C (25 patients) served as the control group without nasal clips. At the time of extubation, the emergence agitation score, ability to cough, time to verbal response, respiratory rate, incidences of desaturation, laryngospasm, or any other complications were observed and noted by an anaesthetist who was unaware of the application of nasal clips preoperatively. All data statistically analysis were performed using Statistical Package for Social Sciences (SPSS) for Windows (version 21.0; IBM Corporation). Results: All three groups were comparable (p>0.05) in terms of demographic profile, type and duration of surgery, and baseline haemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Oxygen Saturation (SpO₂), and baseline Electrocardiography (ECG). Emergence agitation was significantly lower in Group A and B as compared to Group C (p-value=0.02). On comparing Groups A and B, Group B had a significantly lower incidence of emergence agitation (p-value=0.02). There were two cases of dangerous emergence agitation in the control group and one case in Group A while no cases were reported in Group B. Other parameters at extubation were comparable among all groups. Patient satisfaction was significantly higher in Groups A and B in comparison to Group C. Conclusion: The present study suggests that preoperative preconditioning with nasal clips for 40 minutes in patients undergoing elective nasal surgeries can be a useful and safe method to reduce postoperative emergence agitation.

Correlation of Acute Inflammatory Markers with Oxidative Stress Markers in Patients with Chronic Pancreatitis: A Cross-sectional Study

Abhina Mohanan, BIJU Pottakkat, Balasubramaniyan Vairappan, V Gladwin

Introduction: Chronic Pancreatitis (CP) is a long-standing inflammation of the pancreas that presents as episodes of acute inflammation or chronic damage, leading to alterations in the organ’s normal structure and function. Numerous studies have focused on inflammatory and oxidative stress markers in Acute Pancreatitis (AP), but similar studies in CP are rare. Aim: The aim of this study was to compare the serum levels of acute inflammatory and oxidative stress markers in CP patients with healthy controls, and to investigate the correlation between acute inflammatory markers and oxidative stress markers. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Institute of Postgraduate Medical Education Research (JIPMER), Puducherry, India, from January 2018 to December 2021. Forty-five patients diagnosed with CP, based on clinical manifestations, Contrast-Enhanced Computed Tomography (CECT) of the abdomen, and histopathology reports, were enrolled along with 45 healthy controls. Serum biochemical parameters, including inflammatory markers such as high-sensitive C-Reactive Protein (hs-CRP), Interleukin-6 (IL-6), and Tumour Necrosis Factor-alpha (TNF-α), as well as oxidative stress parameters such as Malondialdehyde (MDA), Total Antioxidant Status (TAO), and Total Oxidant Status (TOS), were measured. The Oxidative Status Index (OSI) was calculated. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Results: There were no significant differences in age and gender between the two groups. None of the individuals in the control group had diabetes, and their Body Mass Index (BMI) was within normal limits. Patients exhibited leukocytosis, hypoproteinemia, and hypoalbuminemia. Although all patients presented with pain, none had recent acute pain episodes or elevated serum amylase levels. Compared to healthy individuals, CP patients showed significantly elevated serum concentrations of inflammatory and oxidative stress markers, as well as OSI. Serum antioxidant (TAO) levels were significantly reduced in patients compared to controls. Inflammatory and oxidative stress markers were positively correlated with age, smoking and alcohol intake. There was a positive correlation between acute inflammatory markers and oxidative stress markers in patients with CP. Conclusion: Serum inflammatory and oxidative stress markers were significantly elevated in patients with CP as compared to controls, indicating key roles in patients with CP.

Comparison of Preoperative Acupressure, Incentive Spirometry, and Nebulisation with Lignocaine in Reducing Fentany-induced Cough: A Randomised Controlled Study

Nidhi Kumar, Parul Jindal, Anupama Pandey, Ajay Dubey

Introduction: Fentanyl bolus during induction often leads to cough. It is usually benign, but in some cases, it can be explosive and life-threatening. The incidence of Fentany-induced Cough (FIC) varies from 18% to 65%. Aim: To compare the effect of acupressure, incentive spirometry, and nebulisation with lignocaine on the incidence and severity of FIC. Materials and Methods: This single blind randomised controlled study was conducted in Department of Anaesthesia, Himalayan Institute of Medical Sciences, HIMS, Dehradun, Uttarakhand, India over a period of nine months from May 2019 to February 2020. Four hundred patients, aged 18-60 years, of either sex, scheduled for elective surgery, were randomly assigned to four groups: acupressure group (A), incentive spirometry group (S), nebulisation with lignocaine group (N), and control group (C). All patients received undiluted fentanyl at a dose of 2 mcg/kg over five seconds. Episodes of cough within 60 seconds of fentanyl administration were classified as FIC, and the severity was graded based on the number of coughs (mild: 1-2, moderate: 3-4, severe: 5 or more). The time of onset of FIC was recorded. Hemodynamic changes and adverse effects due to fentanyl injection and the procedure were noted. The Kruskal-Wallis test, Mann-Whitney U test, and Chi-square test were used for statistical analysis. Results: There were no differences among the four groups in terms of patients’ characteristics and a American Society of Anaesthesiologist (ASA) status. The incidence of FIC was higher in Group C (37%) compared to Group A (8%), S (12%), and N (10%), which was statistically significant (p-value <0.001). There was no significant difference in the incidence of FIC between Groups A, S, and N. Severe cough were observed in nine patients in the control group, one patient in the nebulisation and spirometry group, and none in the acupressure group. Conclusion: Non pharmacological methods such as acupressure and incentive spirometry were equally effective in reducing the incidence of FIC as the pharmacological methods and are more cost effective.

Effect of Chair Suryanamaskar with Strength Training on Functional Fitness in Frail Older Adults: A Research Protocol for a Randomised Controlled Trial

Nitin Suhas Nikhade, Vaishali Deepak Phalke

Introduction: Physical frailty is a syndrome characterised by deterioration in multiple physiological domains, including muscle mass and strength, flexibility, balance, neuromuscular coordination, and cardiovascular function. Evidence suggests that regular exercise provides substantial health benefits, reducing the risk of many chronic diseases and medical costs, especially for frail older adults. However, the effect of exercise on functional status in this population is not well explored. Need of the study: Population aging in India is rapidly accelerating, and frailty is a significant clinical condition associated with aging. Frailty increases the risk of institutionalisation, morbidity, and mortality. Regular exercise has been shown to improve functional fitness in older adults, but exercises performed while standing unaided can be challenging for individuals with compromised balance and mobility. Chair Suryanamaskar, a form of exercise performed while seated, may be an alternative mode of exercise for this population. Although aerobic and resistance exercises have shown benefits, there is growing interest in exploring the potential benefits of a multicomponent intervention for frail older adults. Aim: The aim of this study is to investigate the effect of chair Suryanamaskar with strength training on functional fitness in community-dwelling frail older adults. Materials and Methods: The study will be conducted from March 2021 to March 2024. This two-group parallel single-blind randomised controlled trial will take place at MAEER’s Physiotherapy College in TalegaonDabhade, Maharashtra, India. Approximately 400 older adults will be screened for frailty using the Short Physical Performance Battery (SPPB) test. Participants with an SPPB score ≤7 will be considered frail and a total of 108 participants aged 65-84 years will be recruited based on inclusion and exclusion criteria. The participants will be equally divided into two groups (54 participants in each group) using computer-generated random tables. The experimental group (group A) will receive a 45-minute Chair Suryanamaskar with strength training protocol three times a week for 12 weeks. Before the study begins, participants will have two practice sessions of 20 minutes each to become familiar with Chair Suryanamaskar. The control group (group B) will participate in two 20-minute health education program sessions and receive weekly telephonic follow-ups to monitor for adverse events. Additionally, a health education program booklet will be provided. The primary outcome of the study is the Senior Fitness Test (SFT). Assessments will be conducted at baseline (0 weeks) and post-intervention (12 weeks). Intention-to-treat analyses with mixed linear modeling will be used for statistical analysis.

Immunoprofiling of BRAF^V600E in Precancerous and Cancerous Lesions of Breast by Immunohistochemistry and its Association with Clinicopathological Features

Simran Khan, Arvind Bhake, Sunita Vagha

Introduction: Breast carcinoma in women is one of the few causes of morbidity and mortality which concerns the health providers. The molecular basis of breast carcinoma in recent years has provided the insight for the genesis of carcinoma, the prognostic, and predictive utility for targeted therapies. Aim: A study has been planned with the aim to know immunoprofiling of BRAF^V600E in precancerous and cancerous lesions of the breast by Immunohistochemistry (IHC) and its association with clinicopathological features. Materials and Methods: The subjects will be divided in two groups of 45 cases each: Precancerous breast lesions; and Invasive ductal carcinoma. The tissue of these cases will undergo IHC of BRAF^V600E. The comparison of expression is to be brought out and the clinicopathological association of immunoexpression of BRAF^V600E will also be studied.

Influence of Biological Dentin Post on Fracture Resistance of Endodontically Treated Anterior Teeth: A Systematic Review

Introduction: A biological dentin post is recommended when more support for the restoration is needed and there is a severe loss of tooth structure. However, whether the use of biological dentin post affects the fracture resistance of the restored anterior teeth is not impervious. Aim: This systematic review aimed to evaluate the fracture resistance of endodontically treated and restored anterior teeth and to answer the research question, “Does the use of biological dentin post influence fracture resistance of endodontically treated anterior teeth?” Materials and Methods: In the present systematic review, the initial search was performed on PubMed, Scopus, Web of Science, EBSCO, and Cochrane. According to inclusion criteria, additional records from all other resources like the citation database of related articles were also performed. The articles were searched between January 2000 to December 2021. The risk of bias was evaluated by using the Cochrane risk of bias assessment tool. The keywords for search strategy were “Biological Dentin Post” OR “Dentin Post” OR “Biological Post” OR “Experimental Dentin Post” AND “Fracture Resistance” OR “Dentin Post Failure” OR “Biological Post Failure.” Results: After removal of duplicates and title and abstract screening, five studies met the inclusion criteria. Three studies were considered having/showing high-risk of bias and two studies were considered having/showing medium risk. The data concluded that the biological dentin post exhibited higher fracture resistance in three studies. However, one study concluded that both dentin post and glass fibre post may be preferred for additional reinforcement of immature teeth. Another study disclosed that human dentin, bovine dentin and prefabricated glass fibre posts presented similar values of fracture resistance. Conclusion: The use of biological dentin post increases the fracture resistance of endodontically treated and restored teeth. Also, future studies should follow a standardised approach to implementation and reporting of data.

Bone Anchored Hearing Aid: A Narrative Review

Sonaakshi Kushwaha, Prasad Deshmukh

Bone Anchored Hearing Aid (BAHA) is a small vibrator that can be reversibly attached to a Titanium (Ti) screw and implanted behind the ear. It uses the bone conduction channel to activate the cochleae by converting sound into the vibration of the screw. The two main indications are conductive hearing loss and unilateral deafness when using traditional hearing aids is not possible, as a rehabilitative or mixed hearing loss with a moderate perceptual component. For patients with canal atresia, Single-sided Deafness (SSD), and chronically discharged ears despite treatment, the BAHA implant is an option. Combination hearing loss is a crucial indicator for implanted hearing implants. Various options are accessible based on the bone conduction threshold. Patients with modest sensorineural impairment usually benefit from transcutaneous Bone Conduction Implants (BCI), while those with intermediate hearing loss may also benefit from percutaneous BCI devices. For combined, active middle ear implants are advised for hearing deficits with moderate and severe cochlear hearing loss. For individuals who need middle ear surgery or who are incompatible with other options for therapy, implants are a helpful and successful addition. Skin-drive Bone Conduction Devices (BCDs) are BCDs that vibrate the bone via the skin can also be separated into passive subcutaneous devices and traditional devices that are coupled, for instance, with soft bands with implanted magnets. BCDs that directly stimulate the bone, percutaneous devices, and dynamic transcutaneous devices are examples of direct-drive devices. The latter kind of apparatus uses embedded transducers to stimulate bone effectively via healthy skin. The BAHA, also known as the percutaneous direct-drive device (BCD), now rules the market. More direct-drive and skin-drive transcutaneous solutions are now being studied, partly due to problems with the transdermal implant and partly for aesthetic reasons.

Pharmacological Properties of the Plant Aerva lanata-A Narrative Review

B Preeja, D Bindu, A Jamuna Rani

Aerva lanata (Linn.) Juss.ex Schult is a woody, succulent, perennial herb belonging to the family Amaranthaceae commonly found in Asia and Africa. It is a common weed that grows everywhere in the plains of Asia. It is locally called ‘bui’ or ‘polpala’. It is familiar in the name of knot grass. These are branching shrubs. This plant is included in Dasapushpam, the ten sacred flowers of Kerala. The different parts of the plant have different functions. It belongs to the group Pashanabheda used to cure urinary stone. This is a traditional plant in India used for many purposes including antibacterial, antiparasitic, antiasthmatic, antioxidant, anti-infertility, antihypoglycaemic, antidiabetic, antilipidemic, antitumour, hepatoprotective, diuretic and anti urolithiatic, and immunomodulatory. Aerva lanata plant comprises of many phytochemicals including alkaloid, flavanoid, phenol, tannin, protein, amino acid and carbohydrate, which are responsible for the pharmacological activity. This review focuses on the general information regarding the pharmacological value of the plant Aerva lanata.

Recent Strategies for Cardiac Rehabilitation in Post-Myocardial Infarction Patients: A Narrative Review

Leksha Patel, Purva Gulrandhe, Moli Jain, Vishnu Vardhan

Myocardial Infarction (MI) is a severe cardiac crisis that can result in significant morbidity and death. ST segment Elevated Myocardial Infarction (STEMI) is irreparable myocardial damage caused by persistent ischaemia, and while the adage “time is muscle” remains true, rapid and prompt detection of MI continues to be a key concern. Cardiac Rehabilitation (CR) is the most significant evidence-based intervention for secondary prevention following STEMI. However, only a small proportion of patients have access to a cardiovascular recovery programme. Recent research implies that exercise-based CR provides significant benefits to patients with cardiovascular disease, including a lower risk of MI, a likely slight decline in all causes of mortality, a massive reduction in all-cause hospitalisation, along with associated medical costs, and enhanced Health-Related Quality of Life (HRQoL) upto a year of follow-up. Adapting rehabilitation programmes to existing abilities based on experience in the field of activity is becoming a major solution in the current CR training programme selection. The effectiveness of both centre-based and home-based therapy is proven. Telerehabilitation and home-based rehabilitation strategies have gained much importance during the Coronavirus Disease-2019 (COVID-19) pandemic. Further research is needed to standardise the treatment quality for patients with home-based CR.

A Narrative Review on Emergency Management of Poisoning

Rajiv Ratan Singh, Pradeep Kumar Yadav, Sachin Kumar Tripathi

Poisoning cases are coming to the Emergency Department (ED) and cases are increasing day by day due to their easy and vast availability. Clinicians are frequently dealt with to manage critically ill poisoning patients. With the swing of prominence in managing poisoning from in-patient care to early decontamination and early stabilisation, ED physicians are playing a more dynamic role in the care of poisoned patients. The clinical effects encountered by them are dependent on numerous variables, such as the dose, the duration of exposure, the health history of the patient, to provide thorough supportive care, recognition of patients requiring treatment with a specific antidote, and to use the appropriate methods to restrict poison absorption or to increase its elimination, which is the foundation of management. If poisoning in the patient is documented early and appropriate compassionate care is commenced hastily, maximum of patients recover soon. This article is aimed to focus on the more specific issues of emergency management of the poisoned patient.

Significance of Internal Nasal Valve and Nasal Septal Swell Body in Improving the Outcome of Septoplasty: A Literature Review

Senu Sunnychan, Prasad Deshmukh, Sagar Gaurkar

Nasal obstruction is a common presenting symptom for both primary care physicians and otolaryngologists, and it can be caused by various anatomic, physiologic, and pathophysiologic factors. Structural nasal obstruction may result from a Deviated Nasal Septum (DNS), Internal Nasal Valve (INV) obstruction, External Nasal Valve (ENV) obstruction, inferior turbinate hypertrophy, Nasal Septal Swell Body (NSB) etc. Combined causes occasionally go unnoticed, and postoperative symptom relief may not always be satisfactory. Revision surgeries in cases where septoplasty fails due to misdiagnosed multicausative factors can increase the complexity of the procedure, further affecting its success. In this review, our objective is to examine the significance of the NSB and the INV, which are often overlooked nasal structures, in improving the outcomes of septoplasty. Upon reviewing the findings, it can be confirmed that diagnosing these overlooked structures has led to improved outcomes in septoplasty and, consequently, the quality of life for patients with nasal obstruction.

Effect and Impact of Obesity on Outcome and Complications of COVID-19: A Narrative Review

N Damodharan, A Priyadharshini, P Arunshankar, R Varsha, Aleen Ann Thomas

Coronavirus Disease 2019 (COVID-19) is a viral disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that triggered a global pandemic back in 2019 and was primarily found to affect the respiratory system which continues its devastating effect across nations. Obesity is already a pre-existing modern-day complication, the root causes for which are largely attributed to the contemporary lifestyle. Many severe cases of COVID-19 in obese patients were reported globally which sparked many theories relating the two as some of their clinical manifestations are closely related. This review aims at providing the possible links between the two providing an idea based on which future research could be carried out since both these diseases tend to affect multiple organs, thus producing profound detrimental effects.

Long COVID-19 Syndrome and its Effects on Various Systems: A Narrative Review

Naved Bhurani, Roshan Umate, Seema Umate

Since December 2019, the Coronavirus Disease-2019 (COVID-19) outbreak has led to a pandemic, causing suffering worldwide. Among the survivors of COVID-19, a second type of pandemic is observed in individuals experiencing long-term effects, known as long COVID-19 or post COVID-19 syndrome. This condition occurs when people who have recovered from COVID-19 continue to experience symptoms or develop new ones after a month or more. The exacerbation of symptoms can be attributed to various factors, including psychological, social, or biological causes, all of which contribute to the development of this condition. Although COVID-19 was first discovered a few years ago, its impact on a large population is still not fully understood. As the disease affects multiple organ systems, its effects persist even after the virus is cleared from the body, resulting in a significant number of individuals who continue to suffer from it. Therefore, this review focuses on the long-term effects of COVID-19 as post COVID-19 syndrome.

Idiopathic Condylar Resorption: How to Diagnose and When to Treat it?

Rishika Agarwal, Shailesh V Deshmukh, Amol S Patil, Veera Bhosale

Idiopathic Condylar Resorption (ICR) has been frequently reported in patients undergoing orthodontic treatment especially in young adolescent females, so as dentists we could be the first ones to diagnose this condition. This condition represents an aggressive and fast-moving form of degenerative disease of the Temporomandibular Joint (TMJ) and the pathognomonic features of this condition include a deficit of condylar volume, furthermore reducing the ramus height and length of mandible and causing a clockwise rotation of the mandible leading to absence of anterior bite. The accurate cause of this condition is not known, however, there are multiple aetiological factors that could be contributing to this disease. ICR is a poorly understood disease and it could be a very difficult condition to treat because of its various expression and the large number of treatment options that are available. Over the past years a number of cases with ICR have been reported in the orthodontic literature. The aim of this review article is to present a compiled data to better understand the pathophysiology and aetiological factors contributing to ICR and provide an insight about the various clinical features and radiographic findings of this condition which will help us diagnose this condition better in our day-to-day practice. Various treatment modalities like splint therapy, orthognathic surgery, joint replacement have also been mentioned and discussed. A case of ICR that reported to our department with a chief complaint of progressive opening of the bite has also been included in this review article.

Secondary Effects of Yoga and Pranayama in Dentistry: A Narrative Review

Neelam Desai, Mona Somani, Aashray Patel, Sweety Thumar, Chintan Joshi

Yoga is an art that includes physical, mental, and spiritual activities for a healthy mind and body. Nowadays, because of modern dentistry, we dentists face many occupational health issues related to the neck, shoulder, and back. The “asana” and the “pranayama” are part of the yoga activity. Asana helps dental professionals to recover from posture-related problems like musculoskeletal pain. Daily practice of yoga does not just help to decrease the stress and anxiety of the dentist and dental patient but also improves the immunity of the body. The people who are more stressed give less care to their teeth, gums, and oral health. Yoga reduces stress, improves the oxidative status of the body, increases immunity, and reduces gingival inflammation. Yoga improves the lifestyle of the person toward nature. Yoga helps dentists to give good posture and flexibility to relieve musculoskeletal pain. Yoga and pranayama help in the maintenance of oral hygiene, reduction of gingival inflammation, and prevention of dental diseases. Yoga and pranayama help us with our day-to-day muscular discomfort and pain. Yoga is easy and more comfortable than other muscle-strengthening exercises. Yoga helps to get the best from our personal and professional life. This review article focuses on the importance of yoga and pranayama for the dentist, dental diseases, and oral health.

Evidence-based Dentistry: A Potential Tool for Best Dental Practice

Tried and tested methods exist that are taught throughout the training and course of study for dental students in patient examination and clinical diagnosis. It is impractical to change the entire field of dentistry and abandon the commonly followed techniques that have proved highly efficient and accurate in the past years. However, with the ever-growing advances in the clinical community, it would be prudent to improve our current practices to ensure that clinicians stay up to date with the demands of the dental world, as well as those of the patients, whose awareness is constantly evolving. This can be achieved by using Evidence-Based Dentistry (EBD) as a diagnostic tool and incorporating it into everyday dental treatments and patient interactions. By following the necessary steps and incorporating EBD into dental practices, clinicians can meet patient expectations satisfactorily while maintaining their competency. Practices and dental education establishments can review existing guidelines and become more familiar with the EBD process, paving the way for further improvements in a dentist’s skill set and the method itself. EBD has the capacity to bridge the gap between evidence, knowledge, and practical application, thereby attracting more attention in the scientific and clinical arenas. It has the potential to be a game changer, creating a smoother and well-organised workflow. The use of EBD will enhance the world of dentistry, taking it a step further from its current state.

Management Strategies for Overcrowding in Emergency Medicine Department: A Narrative Review

Rajiv Ratan Singh, Pradeep Kumar Yadav, Shobhna Yadav

Emergency Medicine Departments (EMDs) are one of the busiest hospital departments in the world, as they are typically the first point of contact for health emergencies and are designed and resourced to manage them. However, due to their potential overflow, EMDs contribute to overcrowding. Overcrowding in the Emergency Department (ED) of hospitals can harm hospitals financially and have negative impacts on patient care, such as lengthening waiting times, diverting ambulances, increasing length of stays, raising medical errors, and elevating patient mortality rates. The COVID-19 pandemic has exacerbated the critical situation for EMDs, making it imperative to reduce overcrowding and improve EMD efficiency for patient welfare and safety during this pandemic. Controlling overcrowding should be carried out by the authorities responsible for regulations. This review discusses the effects of EMD crowding on patients’ health status and explores potential solutions through strategic management, including executive leadership involvement, hospital-wide coordination strategies, data-driven management, and performance accountability.

Impression of the Clock Genes on Oral Health and Diseases: A Narrative Review

Amol Dhokar, Heena Golani, Latisha Prashant Hadkar

The circadian clock helps organisms adapt their physiological processes to changing environmental conditions, including the adaptation of the 24-hour sleep-wake cycle in day and night. Circadian rhythms regulate the proper timing and synchronisation of various physiological and metabolic processes in our body by supporting 24-hour oscillations of master genes. At the molecular level, a family of transcription factors known as “clock genes” controls circadian oscillations in gene expression. Through this complex regulatory network, our brain communicates with several peripheral organs and tissues receive communication from our brain via this complex regulatory network. Dysregulation of the circadian rhythm can lead to multiple diseases, including cancer and autoimmune disorders. The circadian clock appears to significantly affect saliva production, salivary glands, oral epithelium, and tooth development. Therefore, the goal of this review is to provide a systematic and integrated perspective on the role and effects of the circadian clock and its genes on oral health and diseases, while briefly discussing their relation to systemic health and conditions.

First Responders: The Critics of the Critical

Daksh Manish Kedia, Rajesh Ashok Kshirsagar

Newer developments in the field of medical technology have significantly changed hospital-based medical emergency services. However, the “out-of-hospital management” of the most emergent situations, such as cardiac arrest and stroke, remains poorly addressed. Basic Life Support (BLS) is a great tool if used in time by a trained service provider. The critical determinant of survival remains the availability of good quality Cardiopulmonary Resuscitation (CPR) as soon as possible. Most emergencies happen unexpectedly outside the hospital setting, making it difficult for the Emergency Medical Service (EMS) team to locate and reach the spot in a short time. The protocol for out-of-hospital emergency services has more or less remained the same over the years. The strategies should be planned by the government and private associations to reach the site of an emergency faster and provide timelier BLS by a trained provider. This will increase the chance of patient survival. The various strategies that can be planned are discussed below. 1. Primary prevention- It is done with population-based interventions, such as smoking cessation, healthier diets, and improved lifestyles, should be of the highest priority. The key to preventing sudden death in the general population is to prevent coronary attacks by avoiding or correcting the risk factors (1). 2. Second strategy- To improve the medical response system infrastructure in developing countries should be considered. Presently, many congested urban cities have high traffic congestion, which does not allow emergency medical response teams to reach the site of a Sudden Cardiac Arrest (SCA) in a short time. The value of infrastructural changes to facilitate the arrival of the first responder to the site is just being appreciated. In a handful of developed cities, emergency medical response is beginning to provide appropriate timely care. 3. Third strategy- The use of home-based Automatic External Defibrillators (AEDs) by patients at high risk of SCA. It is believed that almost 80% of SCAs occur at home and 20% in a public place (2). Although the effectiveness needs to be evaluated with prospective studies, the cost is low and can be accepted by a much larger community (3). In the near future, a significant research focus will be on risk stratification, which involves defining patient groups with or without cardiovascular disease who are at the highest risk of Sudden Cardiac Arrests (SCAs). This will enable the delivery of appropriate treatment technologies to these individuals in a more cost-effective manner, thereby lowering healthcare costs in developed and developing economies. Simultaneously, the efficacy and cost-effectiveness of Automatic External Defibrillators (AEDs) for SCA management need to be prospectively evaluated. This evaluation could have a significant impact on reducing SCA mortality in developing economies, where 80% of SCAs occur (4). The value of Emergency Medical Services (EMS) is also gaining recognition, and with improvements in road infrastructure, it could become an important component of the overall strategy for preventing SCAs (5). According to the limited data available in the literature, formal training of CPR teams greatly improves survival rates and survival to hospital discharge rates following resuscitation of cardiac arrest victims. Formal certified Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training courses, including hands-on practice and periodic renewal, are crucial for improving CPR outcomes (6). Therefore, educating medical undergraduates about BLS may prove to be an excellent strategy to reach the broader community if students share their acquired knowledge with their families and friends (7). In India, very limited data have been published on the outcome of CPR in Out-Of-Hospital Cardiac Arrests (OHCA). One of the key reasons for low survival rates in OHCA events is the lack of a comprehensive Emergency Medical Services (EMS), which is a crucial component of the overall healthcare system (8). Despite considerable advancements in the healthcare industry, India has yet to establish a single, comprehensive EMS that is accessible from anywhere in the nation. This is why survival rates have not significantly improved over the past several decades. In the early 1990s, the Indian government established centralised accidents and trauma services in an attempt to address this issue. However, it failed to achieve the same level of acceptance as Western EMS, despite having a centralised “108” number for medical emergencies and a national extension of medical services (9). Furthermore, neither ambulances nor emergency medical staff are required to adhere to predetermined EMS protocols for patient assessment, triage, transfer, or disposition to a medical facility. Focused strategies should be developed to establish a centralised medical emergency body that can provide guidelines for setting up an Emergency Medical Services (EMS), preparing emergency protocols, and disseminating technical assistance and training to improve the effectiveness of CPR and the low survival rates following an Out-Of-Hospital Cardiac Arrest (OHCA) event in India. Additionally, there is an urgent need for a national campaign to increase bystander CPR rates and educate the general public on basic CPR, which is essential for enhancing the survivability of OHCA episodes (9). Developed countries have multiple facilities, such as dispatcher telephone CPR, helicopter teams, and pre-hospital resuscitative endovascular balloons for aortic occlusion (10). However, developing countries like India still struggle to ensure the timely availability of EMS teams at the site of an emergency. Apart from the strategies discussed above, we propose a novel idea that has not been discussed yet. In the case of India, all locations in a town or city are well connected through a strong online network of various food delivery agents and cab drivers who provide mobile application-based services to every part of the city. This makes them familiar with the shortest/quickest routes to reach a particular destination. They typically use motorcycles for food deliveries, which can navigate road traffic better than an ambulance with a blaring siren. Moreover, these applications are widely used by all sections of society. We suggest that all food delivery agents and cab drivers be trained in Basic Life Support (BLS). The training should be imparted by a competent authority such as the American Heart Association (AHA), the Indian Society of Anaesthesiologists, or the Indian Medical Association. Delivery agencies and taxi providers should promote such training processes as part of their corporate social responsibility, allocating adequate funding for the training fees. Some incentives can be granted as rewards to the providers who assist people during emergencies. The government or local bodies may formulate and regulate policies and also provide additional funding for training and equipment expenses. A separate option for the applications of these food delivery and cab services could be installed for use in a medical emergency. If used, the call would directly connect to the nearest available food delivery/cab service agent, who would then arrive at the site of the emergency as quickly as possible. If the applications permit or evolve, a second call should be immediately directed to the nearest EMS location. If this is not possible, a relative or bystander should now place a second call to the desired EMS location or “108,” the free telephone number for emergency services in India. However, if the patient or bystander calls 108, the EMS should not only arrange to reach the desired location as soon as possible but also initiate the movement of a food delivery agent or cab driver to arrive ahead of them and initiate the chain of survival. It is important to note that no matter how soon an agent reaches the emergency location, a fully trained EMS team from the hospital would be required to provide the most appropriate services. These agents would only serve as the very first primary responders who would reach the site of the emergency earlier and provide the initial steps of the chain of survival, briefing the EMS team about the situation upon their arrival (Table/Fig 1). In addition to this, BLS certification can be made mandatory for all drivers of public transportation, such as buses, taxis, auto-rickshaws, and police officials (traffic as well as civil). They should also have a compulsory Automated External Defibrillator (AED) in their stations. The major challenges faced would be the hesitation of providers to leave their core job and learn something entirely new. The responsibility for engaging a suitable organisation dealing with EMS to motivate and encourage cab drivers and food delivery agents to promote this socially rewarding activity would lie with the parent company. Technological or mobile application glitches, server problems, or any breaks in the schematic chain may complicate the workflow. Reluctance to respond in an emergency situation as a non medico is another major issue that needs to be addressed with proper counseling and practice during the training program itself. Some repetition of face-to-face training will be required after two years, but online videos and trainings can be provided every six months.

Roles and Responsibility of the Retriever Renalogist: An Insight

Chandan Bala R Kataria

Unequivocally, the term “retriever” is the pertinent description for the dialysis technologists since they consecrate themselves to retrieving the quality of life of the dialysis patients. These professionals commit their lives to their patients; they are so dedicated that even natural disasters can’t derail their work. Apart from just assembling the extracorporeal circuit and terminating the case, technologists play a predominant role during renal replacement therapy. HAEMODIALYSIS: ROLE AND RESPONSIBILITY Dialysis Zone Infrastructure The technologist is accountable for maintaining the facility in an aseptic environment with an ambient temperature of 70-72°F and a humidity of 55-60%. The area must be well-organised to curb patients from converting from negative to positive serology (sero-conversion). As a consequence, the spectrum is divided into negative and positive bays, and patients are dialysed in their respective bays based on their serology. The dialysis facility also features an emergency evacuation tunnel that connects to Intensive Care Unit (ICU) in case of a medical emergency (1). Dialysis Zone Necessities in an Emergency The defibrillator and the crash cart are required equipment components for the unit. These are crucial in circumstances where saving lives is vital. The oxygen cylinder or colour-coded oxygen supply pipelines, along with vacuum pump lines next to them, make up the other significant pieces of equipment. Primitive Medical Care Technologists render significant contributions to patient care through their knowledge and experience. These professionals supervise patients from the time they arrive at the facility until they depart. When a patient arrives at the department, their weight and vascular access are assessed. Technologists ought to be acquainted with sphygmomanometers, thermometers, and glucometers to evaluate blood pressure, temperature, and plasma glucose. In addition to these, they have the requisite skills to analyse vital indicators, including heart rate, respiration rate, pulse rate, and Electrocardiogram (ECG) waves. Typically, these parameters are detected in monitors with the use of leads positioned on the patient’s skin (2). Assessment of Vascular Access The viability of the fistula is assessed by bruit or thrill sound, which benchmarks the patency of the access. The technologist also ensures if there is any lack of sensation to rule out the steal syndrome (ischaemia of the limb bearing a permanent access). The access is intended to be sterile during cannulation to prevent infection, and the ideal techniques are the rope ladder method with sharp needles and the buttonhole approach with blunt needles. These professionals indeed have the responsibility of guiding and training patients to perform ball exercises for prominent matured veins. The therapist examines for inflammation at the exit site before scrubbing with a povidone-iodine solution in the case of temporary access. Medical professionals advise patients to take preventative measures and administer catheter antibiotics locks as per the nephrologist’s orders when there is inflammation. The permanent access is inaccessible for drawing blood and recording blood pressure. These safety measures are educated by the therapist. To improve the longevity of access, patients are recommended to undrape the tourniquet after 4 hours postdialysis. To prevent vascular complications such as stenosis or thrombosis, thrombolytic agents or ice pack application is suggested (3). Intradialytic Roles While the patient is on dialysis mode with the extracorporeal circuit intact with the machine circumference, the technologist monitors both the living and non living sectors of the dialysis. The sole purpose of monitoring the patient during dialysis is to avert intradialytic complications. The therapist’s key role is to use sodium modeling and ultrafiltration profiling to reduce predominant complications such as hypotension and muscle cramps. Other vitals that are monitored include venous pressure, transmembrane pressure, and conductivity. These pressures indicate any complications, such as swelling at the cannulation site, dislocation of needles, clotting of the dialyser, and increased sodium and bicarbonate levels due to high conductivity. Air bubbles invading the circuit must be monitored meticulously as they can cause circuit clotting or an air embolism. If not addressed, it can jeopardise the situation and put the patient’s life at stake. The therapist must be proactive during the procedure. Haemodialysis Equipment Dialyser-the artificial kidney: The dialyser, or artificial kidney, is the central component of the procedure. Professionals predetermine the dialyser based on the patient’s body surface area. Ethylene trioxide (ETO) or steam is used for sterilising these dialysers. Since this sterilisation technique is perilous, a priming step is performed to prevent complications such as first-use syndrome or activation of the complementing system. After completing the step, a test factor helps in ruling out the presence of residual substances. Storage and reuse of the dialyser: Dialysers are typically reprocessed and reused before being stored in an aseptic environment. Before storing and priming the dialyser, professionals ensure that the sterilising agents bare atleast 90% full. They also provide specific details on each dialyser, such as the patient’s name, age, and distinctive hospital Identification (ID) number. If the dialyser is stored for an extended period (more than a month), it is not reused. Blood circuit: These circuits are sterilised using agents similar to those used for dialysers. Therefore, these agents must be removed before the procedure. After the priming process, technologists ensure that the circuit is free of contaminants by performing a litmus paper test. The volume of these circuits varies depending on the group of patients undergoing haemodialysis; adult circuits are typically around 150 mL, while paediatric circuits are 10% less. Anticoagulant: Low molecular weight heparin is the preferred drug during haemodialysis to prevent blood clotting. The dosage of the drug is determined based on laboratory data of Partial Prothrombin Time (PTT) and clotting time. Technologists find it easy to prevent circuit clots during heparin-free dialysis. They also ensure that anticoagulants are avoided in cases of active bleeding or completed/planned surgery. Dialysate: The fluid part used during the procedure, known as the dialysate or bath, contains a specific concentration of electrolytes and an acid-base component (Table/Fig 1). It interacts with the blood to aid diffusion. There are two types of buffer systems: acetate-based and bicarbonate-based. Each type has its advantages and disadvantages. Acetate dialysate is not ideal for patients with liver failure because acetate cannot be converted into bicarbonate. The Reverse Osmosis (RO) standards for dialysate include a requirement of <100 μs/cm3 colony forming units and endotoxin levels should be <0.03 μs/cm3. It is important to remove trace metals as they can lead to toxicity (4). For patients with hyperkalemia, potassium-free baths are highly recommended. There are several options available, including a zero-potassium bath, 2 K bath and 4 K bath (5). The volumetric portable device facilitates the precise elimination of ultrafiltration volume from the patient’s body. The ultrafiltration volume is determined by the difference between dry weight and prehaemodialysis weight. This advanced device also allows for online clearance monitoring of urea/sodium, as well as measurements of blood temperature and pressure. It is user-friendly, practical, and offers assistance in case of any issues. Haemodialysis standards: Professionals adhere to haemodialysis standards to enhance the quality of life and prevent complications in haemodialysis patients. Regulatory bodies provide guidelines for determining the quality of dialysis, with the adequacy cut-off value typically set at 1.4-1.6 (6). To achieve this goal, technologists must consider specific criteria for adequacy, such as dialyser surface area based on body surface area, cannulation technique to prevent recirculation, dialysis duration and frequency, effective blood flow rate, and dialysate flow rate. Post haemodilaysis role: Technologists assess vital signs and the patency of vascular access. If the blood pressure exceeds 160/90 mmHg, they do not administer erythropoitein (EPO) (7). They also educate the patient on vascular access maintenance and restrictions on salt and water intake. They evaluate the postdialysis weight to ensure accurate removal by the machine. If complications arise during subsequent dialysis sessions, they may reassess the dry weight. PERITONEAL DIALYSIS: ROLES AND RESPONSIBILITIES When it comes to peritoneal dialysis, it may seem like the technologist’s role is simple and concise. However, it requires great care as the entire procedure is manual, and there are no pressure pods to monitor inflow and outflow pressure. Technologists follow aseptic procedures throughout the dialysis process to prevent the risk of developing peritonitis. In addition to manually conducting the procedure, technologists play a pivotal role in determining the type of transporter through Peritoneal Equilibration Test (PET). Non compliance with aseptic process increases the risk of peritonitis and may require the patient to transition to chronic haemodialysis. Therefore, the role may sound effortless, but it is not as easy as it may seem. The therapist primarily assesses the effectiveness of the dialysis, which helps improve the therapy. Furthermore, educating patients and caregivers on the aseptic process of manual exchange in peritoneal dialysis is one of the most crucial responsibilities. CONTINUOUS RENAL REPLACEMENT THERAPY: ROLES AND RESPONSIBILITIES The technologist plays a crucial role in continuous renal replacement therapy, which is often indicated for patients with haemodynamically unstable renal failure or septic shock. The technologist monitors the Arterial Blood Gas (ABG) report and vital signs to assess pH levels, lactate and bicarbonate levels, potassium, and other electrolytes. When these parameters are altered, the technologist seeks instructions from the nephrologists and executes them. They also provide continuous monitoring of the patients throughout the treatment, being available around the clock. AdditionalResponsibilities Vaccinations Patients with Chronic Kidney Disease (CKD) should receive vaccinations for Hepatitis B, diphtheria, tetanus, influenza A and B, and Pneumococcus. The technician maintains records of the patients’ immunisation status (3). Renal Diet The technologist also serves as a nutritionist, being aware of each patient’s eating habits and tailoring their diet to meet their nutritional needs. They calculate the Body Mass Index (BMI) and assess it using nutritional methods such as Subjective Global Assessment (SGA), anthropometry, and bioimpedance. These patients are advised to avoid potassium-rich meals and processed foods (8). Minor Procedures The technologist assists the nephrologist in minor procedures such as temporary access catheterisation (Internal Jugular Vein (IJV), subclavian, femoral) and renal biopsy. They also handle catheter removal and control bleeding from the exit site. In cases where doctors are unavailable, the technologists are authorised to approve x-rays taken after catheterisation. Renal Psychologist The technologists also address the psychological needs of the patients. Renal psychologists work with all patients who have chronic renal failure or any renal condition. They provide encouragement, support, and strive to build a friendly relationship with the patients.

An Aberrant Case of Squamous Cell Carcinoma of Trachea in Female Patient: A Case Report

Nabha Mahajan, Suresh Phatak, Avinash Dhok, Yash Jakhotia

Tracheal tumours can be either benign or malignant. Benign tumours grow slowly and may mimic the clinical presentation of chronic lung diseases, resulting in delayed diagnosis. Conversely, rapidly growing malignant tumours present early with locally advanced disease. Hereby, the authors present a case of a 54-year-old female who presented with complaints of breathlessness at rest and cough with expectoration for one year, with a background history of chronic bidi smoking for 20 years. Multidetector Computed Tomography (MDCT) showed an ill-defined soft tissue mass lesion above the carina, partially obstructing its lumen with heterogeneous post-contrast enhancement. During bronchoscopy, an endotracheal pedunculated mass was observed in the proximal one-third of the trachea, occluding the distal airway. The excised mass was confirmed as Squamous Cell Carcinoma (SCC) on histopathological examination {Haematoxylin and Eosin (H&E)}. The presence of co-morbid conditions in the patient, the site of the tumour, and the availability of treatment options are some of the factors that influence the survival rate of this rare airway tumour.

Correction: 2014 Jan,Vol-8(1): 26-30

Parisa Vali, Fereshteh Shahcheraghi, Maryam Seyfipour, Maryam Alsadat Zamani, Mohammadreza Allahyartorkaman, Mohammad Mehdi Feizabadi Phenotypic and Genetic Characterization of Carbapenemase and ESBLs Producing Gram-negative Bacteria (GNB) Isolated from Patients with Cystic Fibrosis (CF) in Tehran Hospitals (Published in Journal of Clinical and Diagnostic Research. 2014 Jan,Vol-8(1): 26-30 ) There was a correction in the fifth author's name.

Delusional Content in Patients with Schizophrenia- A Case Series

Arti Tyagi, Vivek Kumar, Zebaish Rehman

Schizophrenia is a chronic and severe mental disorder that affects more than 21 million people worldwide. It is characterised by distortions in thinking, perception, emotions, language, sense of self, and behaviour. Common experiences include hallucinations, mostly involving hearing voices or seeing things that are not there, and delusions, which involve having fixed, false beliefs. This case series presents three patients with schizophrenia who came to the Department of Psychiatry with peculiar delusions. One patient, a 65-year-old, complained of an inability to walk due to the fear of being electrocuted. The second patient, a 25-year-old female, reported the ability to communicate with people in America without the use of any technology. The third patient, aged 20 years, presented with nihilistic delusions. These patients were managed with psychotropics, along with symptomatic treatment for their physical problems. They improved with the interventions and rehabilitation provided to them.

Dermatofibrosarcoma Protuberans at Unusual Sites: A Case Series

Subrat Burma, Gayatri Rath

Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive malignant subcutaneous soft tissue tumour that often goes undiagnosed due to its indolent nature and non protuberant growth. Recurrences after surgical excision are a common issue. While the trunk and extremities are commonly affected sites, rarer locations such as the genitalia and breast have been reported. The rarity of the lesion, its occasional unusual presentation sites, the indolent yet locally aggressive nature, and the diagnostic and therapeutic challenges are the distinctive features of this tumour. This study presents three unusual sites of DFSP: scrotum, vulva, and pubic region, one of which is an uncommon variant known as pigmented DFSP (Bednar tumour).

Endometrial Stromal Tumour: Clinicopathological Series of Seven Cases

Srimoyee Sen, Manisha Sarkar, Moumita Sengupta, Uttara Chatterjee

Endometrial Stromal Tumour (EST) mimics other neoplasms and is difficult to diagnose due to its wide range of morphologies. This is a clinicopathological study of seven cases of EST, which includes Endometrial Stromal Nodule (ESN), Low-grade Endometrial Stromal Sarcoma (LGESS), and High-grade Endometrial Stromal Sarcoma (HGESS). The age ranges from 34 to 75 years. Five out of seven cases presented with abnormal uterine bleeding, abdominal pain, and were radiologically suspected to be leiomyomas. After histopathological and Immunohistochemical (IHC) examination, one was diagnosed as ESN, three as LGESS, and the remaining three cases as HGESS. One case was initially diagnosed as a cellular leiomyoma and experienced multiple recurrences, eventually being diagnosed as HGESS with a fatal outcome within 36 months of the onset of the first symptoms. ESN and LGESS should be differentiated from leiomyoma and leiomyosarcoma. IHC plays an important role in distinguishing these tumours from the more common smooth muscle counterparts.