Journal of clinical and diagnostic research

Obsessive Compulsive Disorder as a Rare Manifestation of Wilson’s Disease

Ishani Roy, Debasish Sanyal

Wilson’s disease is a rare autosomal recessive disorder of copper metabolism, that causes an impairment of cellular copper transport. An individual’s inability to excrete excess copper in bile leads to accumulation of copper in organs like the brain, liver and cornea. It can manifest with symptoms of hepatic impairment and liver failure. It can also present with neurological symptoms like rigidity, gait disturbances, dystonia, dysarthria and chorea. Frequently certain psychiatric manifestations have been reported like mood changes, personality changes, cognitive impairment, phobias, psychosis, anxiety, impulsive and compulsive behaviours . It’s rare for a Wilson’s disease patient to present with only Obsessive Compulsive Disorder (OCD). In the present case report, a 15-year-old male presented in the Outpatient Department with complaints of repetitive intrusive thoughts that he was unable to voluntarily control and compulsions of washing and preoccupation with checking and symmetrical organising with a deteriorating scholastic performance. The only positive findings were Kayser-Fleischer rings, low serum ceruloplasmin and mild cerebellar atrophy. The patient started showing symptomatic improvement with pharmacological treatment comprising of zinc, D-penicillamine, and fluoxetine and diet modification.

Eventration of Diaphragm: A Rare Cadaveric Case Report

MV Ravishankar, Prasanna K Santhekadur, S Hemamalini, K Pushpalatha

The respiratory diaphragm is a barrier between the thoracic and abdominal cavities. It is a chief skeletal muscle of respiration that plays a critical role in the process of inspiration. The defective diaphragm may be clinically present with or without obvious symptoms. Depending on the severity of its defects, it can lead to mild to severe fatal consequences. Protrusion of abdominal contents into the thoracic cavity through the weakened or defective part of the diaphragm is known as a diaphragmatic hernia. Such herniations will exist either in the form of congenital birth defects or acquired defects in the diaphragm. An acquired hernia may be due to spontaneous or iatrogenic causative factors. Congenital Diaphragmatic Hernia (CDH) can occur due to the disruption of various cellular mechanisms involved in organogenesis during the gestation period. Such herniations may exist with or without content protrusions into the cavity of the thorax, later referred to as Eventration of the Diaphragm (ED). In the Department of Anatomy at JSS Medical College, Mysuru, Karnataka, India, a rare case of diaphragmatic eventration was noticed in a male cadaver aged about 70 years, during the routine dissection class of preclinical medical students. In this rare case report, diaphragmatic eventration along with various factors involved in its presentation would be considered holistically.

Bronchoscopic Management of Bronchopleural Fistula using Cyanoacrylate Glue

Bhanushree Ramanna, Chandramouli Mandya Thimmaiah, Giridhar Belur Hosmane

Bronchopleural Fistula (BPF) is a potential complication following pulmonary surgeries, lung infections, chest trauma, chemoradiotherapy, and inappropriate mechanical ventilation with significant morbidity and mortality. Surgical repair of BPF is a definitive treatment, particularly in those who develop BPF following lung resection. However, bronchoscopic management is an excellent treatment option for BPF for causes other than pulmonary resection. The present case report describes about a 50-year-old male patient who presented with a left-sided pneumothorax. He was immediately managed with Intercostal Drainage (ICD) but there was a persistent pneumothorax due to BPF. Video bronchoscopy was done, and at the site of the air leak, cyanoacrylate glue was injected. The resolution of pneumothorax was confirmed with a radiograph, the ICD tube was removed and he was discharged. He was on regular follow-up for the next six months, and there was no recurrence of pneumothorax.

A Rare Index Presentation of Hodgkin’s Lymphoma

Nikita Srivastava, Raghav Upneja

Hodgkin’s lymphoma almost invariably presents as generalised lymphadenopathy. Neurological involvement in Hodgkin’s is such a rare occurrence that not many case reports are available highlighting its importance. Also, cord compression more commonly occurs in non Hodgkin’s lymphoma rather than Hodgkin’s and is a manifestation of advanced disease. Refuting these common perceptions, the present case report discusses a 28-year-old male patient with complaints of low grade fever since three months followed by motor weakness of both lower limbs along with bladder involvement. Systemic examination revealed multiple lymph nodes in right cervical region along with features of extramedullary cord compression with spinal level at D4. Magnetic Resonance Imaging (MRI) revealed an epidural mass in the spinal canal extending from D2-D4, causing cord compression. Histological examination with immunohistochemical analysis of cervical lymph nodes demonstrated a mixed cellularity type Hodgkin’s lymphoma. With appropriate imaging and prompt pathology guided chemotherapeutic regimen, the neurological function were restored without the need for any surgical intervention. Hence, it is important to also consider Hodgkin’s lymphoma in the setting of spinal cord compression along with other causes especially in Indian scenarios where tuberculosis is the closest differential bias encountered. Also, early diagnosis and evidence-based prompt treatment is crucial in preventing further neurological worsening and may curb the need for surgery.

Influence of Physiotherapy in the Vigilant Revitalisation of Decubitus Ulcer: A Case Report

Neha Nilesh Bhagdewani, Anam R Sasun, Shubhangi Patil

Decubitus ulcer seems to be the most typical side-effects seen in chronic patients due to postspinal cord injury, various neurological conditions and prolonged periods of immobilisation. This is a type of skin and soft tissue lesion that develops as a result of prolonged or continuous skin pressure. All of the pressure sensitive sites are the occiput, trochanters, sacrum, malleoli and heel. A 43-year-old male patient experienced road traffic accident that resulted in cervical spinal cord injury and was bed ridden for the past five months, developing grade 4 bed sores over bilateral buttocks and sacral region. Magnetic Resonance Imaging (MRI) of the dorsal spine revealed cervical canal stenosis with neural forminal stenosis and neural impairment at C3-C4 to C6-C7 disc levels. Braden score and functional independence measures were the outcome measures used to evaluate patient condition. Physiotherapy was initiated to deal with symptoms such as lower limb weakness, bed sores in the bilateral buttock and sacral region and hand activities. It entailed a variety of therapeutic approaches aimed at teaching patient transfers and bed mobility as well as making the patient functionally independent. Laser therapy had been used to speed wound healing and to explore if it is beneficial in combating massive, chronic pressure sores. In this case, it was also demonstrated that advanced physiotherapy rehabilitation, which included laser therapy, was advantageous to the patient and led to significant outcomes after a spinal cord injury.

Recurrent Right-side Pleural Effusion Mimicking Malignancy: Pseudo-Meig’s Syndrome

Bhavesh Patel, Princee Patel, Arti Shah, Chirag Chakravarti

Pseudo-Meig’s syndrome is an unusual presentation in which a benign ovarian tumour develops with ascites and pleural effusion. Diagnosis of exclusion is made only after ovarian fibroma has been ruled out and confirmed by disappearance of pleural effusion. The present case report is of a 55-year-old female, who presented with progressive shortness of breath, on and off right chest pain, and abdominal distension, over a period of 2-3 months. Clinical examination and a chest radiograph confirmed pleural effusion as the cause of progressive dyspnea. Presence of a pelvic mass and an elevated serum Cancer Antigen-125 (CA-125) increased the probability of malignancy. After complete tumour resection, a pathological report confirmed a benign ovarian tumour. The authors highlight the importance of suspicion, careful general examination, radiological evaluation, and histologic examination to confirm the diagnosis of pseudo-Meig’s syndrome.

A Case of Sepsis by a Rare Pathogen Delftia acidovorans in a Patient Undergoing Chemotherapy

Romya Singh, Radhika Chaudhary, Chinmoy Sahu, Sangram Singh Patel

Patients undergoing chemotherapy for any malignant disease are at a higher risk of developing central line related blood stream infection, as a result of lack of proper care of the central line used for giving chemotherapy. Here, a case of sepsis by an unusual pathogen Delftia acidovorans is shown in a 29-year-old female patient undergoing chemotherapy for breast cancer with no other related co-morbidities and family history. On investigation, elevated procalcitonin showed presence of bacterial sepsis. Despite of empirical antimicrobial therapy, the patient showed features of continued sepsis. Blood specimens were taken and sent as paired sets of BACTEC blood culture bottles. This was identified as Delftia acidovorans which is rarely known to cause central line related blood stream infection and has a ubiquitous presence and cause infection mostly in immunocompromised patients. Empirical therapy was continued in the patient but could not be revived because of sudden episode of bradycardia. This report highlights the significance of appropriate diagnosis and treatment of such rare pathogen as a causative pathogen for sepsis. In this report, authors also emphasise the need of education of patients and healthcare providers for proper care of any chemoport inserted to avoid incidence of central line associated blood stream infection.

Oligopleiodontia with Impacted Permanent Canine: A Rare Entity with Multidisciplinary Management

The congenitally missing tooth is elucidated as the one not erupted in the oral cavity, and also not eye-catching in a radiograph. The absence of one to six teeth is coined as hypodontia (excluding the third molars). Oliogodontia entitlement is used when more than six teeth are absent, and anodontia is the complete absence of teeth. Supernumerary teeth, also designated as hyperdontia, may happen in twain dentitions, unilaterally or bilaterally, and in both arches. The concurrent happening of tooth agenesis (hypodontia) and supernumerary or supplemental teeth (hyperdontia) in the same sole is one of the infrequent anomalies of number in human dentition. Hypohyperdontia may affect the primary and/or permanent dentition and may necessitate in both arches. The presence of this hypohyperdontia in the same piece of an arch is an even rarer occurrence. Various terms were used to designate this environment among them oligo-pleiodontia- ‘Oligos’ meaning few; ‘Pleion’ meaning more or extra in Greek. A new implementation of Computed Tomography (CT) that bring about three-dimensional (3D) data at lower cost and engross lower doses than conventional CT found in the practice of medical radiology is termed as Cone Beam Computed Tomography (CBCT). They fit into most dental practices as they do not require more space. The present case report discusses a complete multidisciplinary management case of nonsyndromic oligopleiodontia in a 14-year-old female with missing bilateral permanent central incisors and supernumerary teeth with an impacted permanent canine.

Nocardia farcinica as a Cause of Complicated Chronic Suppurative Otitis Media: A Case Report

SG Lijitha, V Abarna, V Pradha, P Dhanaleha, G Vaishnavadevi

Nocardia belongs to the order Actinomycetales suborder Corynebacteriaceae, family Nocardiaceae. It causes infections mostly in immunocompromised individuals. It primarily causes pulmonary infections, followed by central nervous system infections, cutaneous and disseminated infections. Cutaneous infections are reported in immunocompetent individuals also. Because of the growth characteristics, it is difficult to recover the organisms in culture. The recent advanced molecular technology has made identification of the organism to species level possible. Chronic Suppurative Otitis Media (CSOM) due to Nocardia spp is rarely reported. Here, authors report a case of CSOM caused by Nocardia farcinica in a 47-year-old female. The patient was on steroid therapy for bronchial asthma. Culture of ear discharge isolated Nocardia spp, identified as Nocardia farcinica by mass spectrometry. Appropriate antibiotic treatment was administered and good treatment response was obtained. Early diagnosis and appropriate antibiotic treatment is critical for nocardial infections. Difficulty in recovering and identifying the organism, with delay in initiating appropriate treatment can result in poor prognosis and treatment failure.

Rare Case of Caesarean Scar Pregnancy with Soaring β-hCG Levels: A Therapeutic Challenge

Nishtha Jaiswal, Reena Yadav, Apurwa Bardhan, Manisha Kumar

Caesarean Scar Pregnancy (CSP) is a life-threatening form of ectopic pregnancy characterised by abnormal implantation of embryo within the myometrium and fibrous tissues of a previous scar on the uterus. This is the case report of a 24-year-old pregnant lady who underwent previous caesarean section presented at eight weeks gestation with bleeding per-vaginum. Ultrasound of pelvis revealed an intrauterine gestational sac with a live foetus at the site of previous caesarean scar with very high levels of serum beta-human Chorionic Gonadotropin (β-hCG) of 88789 mIU/mL. To prevent surgical complications, a conservative approach was employed, involving injection methotrexate and uterine artery embolisation. Serial measurements of serum β-hCG and transvaginal sonography were used for monitoring. Treatment was successful and the β-hCG levels returned to normal on day 48. This case report highlights that conservative management is successful even with extremely high serum β-hCG levels, and an early recognition and timely intervention is the key to prevent poor outcomes.

MRI Findings in Osmotic Demyelination Syndrome- A Report of Two Cases

Vaishali Bodhraj Dhawan, Bhushita Nilesh Guru

Osmotic Demyelination Syndrome (ODS) is a condition seen due to the loss of normal myelin in the central nervous system. Multiple etiologies have been identified as causing this condition, however, the most reported cause is the rapid correction of hyponatraemia. Different levels of the central nervous system are involved in the condition. Despite variable etiologies and clinical outcomes of the disease, the Magnetic Resonance Imaging (MRI) findings are well-established and characteristic. Hereby, two cases (45 years and 25 years old males) of ODS are described, to demonstrate the characteristic magnetic resonance imaging findings of the brain. Both cases were chronic alcoholics with a history of few episodes of vomiting, who later developed neurological symptoms. Their biochemical investigations showed severe hyponatraemia. The hyponatraemia was corrected rapidly, following which they developed neurological symptoms. Non contrast MRI brain was done for both patients, which showed abnormal hyperintense T2/Fluid-attenuated Inversion Recovery (FLAIR) signals in central Pons. Both cases showed variable, however characteristics findings of ODS on MRI. Despite, multiple causative factors and clinical outcomes of ODS, MRI with its characteristic findings plays a key role in diagnosis.

Primary Pancreatic Squamous Cell Carcinoma: An Incidental Diagnosis of a Rare Entity

Primary Squamous Cell Carcinoma (SCC) of pancreas is a non endocrine tumour showing ductal origin which accounts for approximately 0.5-2% of all malignant pancreatic tumours. Diagnosis is usually made by tissue sampling followed by comprehensive search for primary SCC elsewhere. Hereby, authors report a rare case of primary pancreatic SCC in a young female. A 46-year-old female with history of type 2 diabetes mellitus presented with abdominal pain radiating to back associated with biliary vomiting since five months. Laboratory investigations revealed mild anaemia, neutrophilic leucocytosis and elevated blood glucose. Carcinoembryonic Antigen (CEA) and Cancer Antigen 19-9 (CA 19-9) were within normal limits. Contrast-Enhanced Computed Tomography (CECT) (abdomen and pelvis) showed pancreatic atrophy, multiple stones in head and body along with a pseudocyst in tail of pancreas. Patient underwent triple phase Magnetic Resonance Imaging (MRI) with Magnetic Resonance Cholangiopancreatography (MRCP) which showed chronic pancreatitis with intraductal calculi in the head and distal body region with pseudocyst at tail region. Frey’s procedure was done and tissue sent in multiple pieces. Histopathology revealed features of infiltrating SCC in a background of atrophic pancreas. Immunohistochemistry for CK5/6, P63 and CEA was done for confirmation. It showed strong positivity for CK5/6 and P63, while CEA was negative. Final diagnosis of SCC of pancreas in a background of atrophic pancreas was rendered. Though pancreas is devoid of squamous cells, it is not uncommon to find squamous metaplasia of ductal epithelial cells secondary to chronic inflammation. In the present case, though clinical and radiological features points towards benign lesion, definite diagnosis as SCC is justified by histopathology and immunohistochemistry. Because of the rarity, diagnosis and treatment still remains a challenge.

Detection of Anti-Rod and Anti-Ring Autoantibodies in a Patient with Seronegative Rheumatoid Arthritis and Cirrhosis of Liver: A Case Report

Present case (53-year-old female) relates to results of diagnostic autoantibodies reactive against various antigens. Autoantibodies reactive against 16 nuclear antigens (Mi-2, ku, nRNP/Sm, S5-A (nativ), RO-52, SS-B, Scl-70, PM-Scl100, jo-1, CENPB, PCNA, DsDNA, nucleosomes, histones, ribosomal P-protein) and antigen Anti-Mitochondrial M2 Antibody (AMA-M2) were tested by indirect enzyme-linked immunosolvent assay, using a membrane as the solid phase; no colour reaction developed, suggesting absence of antibodies against above antigens. However, autoantibodies against rod and ring-like structures Inosine Monophosphate Dehydrogenase (IMPD) were detected. Presence of high titer autoantibodies against Double stranded (Ds) Deoxyribonucleic Acid (DNA) and Sm nuclear antigens might be diagnostic of Systemic Lupus Erythematosus (SLE). However, low titer antibodies against other nuclear antigens might increase the risk to develop SLE in an asymptomatic patient. Immune complexes might develop and get deposited in synovium. Later, chronic synovitis might develop. In addition, the test for rheumatoid factor was negative with serum of the current patient. Patient was diagnosed as a case of seronegative rheumatoid arthritis. The patient also had cirrhosis of the liver. Rarely, anti-rod and anti-ring autoantibodies might develop in a patient with Hepatitis C Virus (HCV) infection. Further, these antibodies might also be detected in sera of patients with SLE or Hashimoto’s thyroiditis or during treatment with interferon-α/Ribavirin. However, the significance of these autoantibodies in pathogenesis of a autoimmune disease or HCV infection is unknown. High titer antibodies against double stranded (Ds) DNA and Sm antigens might be diagnostic of SLE.

High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation

Sayan Bhowmik, J Thanka, Rajendran Shanmugasundaram

Adenomatous polyps can be found throughout the colon, most commonly in right colon. Microscopically, they are classified as tubular, villous or tubulovillous subtypes. Tubular adenomas are the most common subtype with villous component less than 25%. Tubulovillous adenomas have a villous component that accounts for 25-75%, while villous adenomas have a villous component, that accounts for more than 75% of the polyp. Peutz-Jeghers syndrome which is an autosomal dominant condition is characterised by gastrointestinal hamartomatous polyp with distinctive arborisation of smooth muscle within the lamina propria. Peutz-Jeghers type polyp is a hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. In the present case study, a 82-year-old male presented with the chief complaint of constipation and abdominal distension since six months. A polypoidal rectal growth was identified on sigmoidoscopy. The clinical diagnosis of mid-rectal growth with acute colonic obstruction was made. Positron Emission Tomography and Computed Tomography (PET CT) was done which was suggestive of malignancy and therefore, Hartmann’s procedure was performed and lesion was excised. On gross examination, a portion of large intestine including sigmoid colon and rectum was received and a pedunculated polypoidal lesion measuring 4.5×3.5×3 cm along with stalk measuring 2.5 cm was seen. On microscopy, the polyp with extensive arborisation of muscularis mucosa into the lamina propria was seen with one area showing features of villous adenoma with high-grade dysplasia. Hence, a final diagnosis was given as villous adenoma with high grade dysplasia arising from a hamartomatous polyp consistent with Peutz-Jeghers polyp. The identification of a villous adenoma with high-grade dysplasia in a Peutz-Jeghers type polyp is essential in such situations, since it is a precursor of invasive malignancy.

A Rare Presentation of Controlled Chaos: Spontaneous Pneumothorax Under General Anaesthesia

Perioperative pneumothorax is a potentially dangerous and rare complication during general anaesthesia. Hereby, the authors report a case of 25-year-old female, who was posted for a dental procedure, and developed spontaneous pneumothorax under general anaesthesia. The patient had no co-morbidities or risk factors during the perioperative period and classified as American Society of Anaesthesiologist’s (ASA) class I. She was planned under general anaesthesia with an orotracheal intubation with controlled positive pressure ventilation. At the end of the surgery, she developed significant respiratory changes, which rose the suspicion of pneumothorax and later, it was confirmed radiologically. This early suspicion and early intervention by tube thoracostomy in Postanaesthesia Care Unit (PACU) stabilised the patient and resolved eventually. Early recognition and appropriate intervention can mitigate the perioperative outcome and reduce morbidity. Positive pressure ventilation, Positive End Expiratory Pressure (PEEP) and airway handling being the major predisposing factors for the development of pneumothorax. This further reiterates the need for keen perioperative vigilance for early recognition and appropriate management. Although rare, pneumothorax should be considered as differential diagnosis in crisis scenarios like tight bag.

Pilomatricoma of Pinna- A Maze that may Misdirects

D Senthilkumaran, Sankappa P Sinhasan, Simon Dasiah

Pilomatricoma is a rare cutaneous epidermal appendageal tumour having differentiation in the direction of hair cortex cells. It usually presents as single, less than 3 cm size, subcutaneous lesion, commonly seen in children, more commonly in head, neck and upper extremities. It can mimic a variety of other lesions clinically, as well as, cytologically, thereby, posing a diagnostic challenge. The ear lobe is a very rare site for it to occur. The authors report a case of a 61-year-old female presented with history of non tender nodule on left ear lobe for six months. The lesion was clinically suspected as keloid, sebaceous cyst and chondroma, later diagnosed as pilomatricoma on fine needle aspiration cytology, confirmed further on histopathological examination. Sebaceous cyst has been ruled out, due to the presence of characteristic findings in both cytology and histopathology. However, due to the inherent disadvantage of cytology, predominance of one component over the other would have mislead the diagnosis. It is being reported for its rare location, unusual age of presentation and to report its mimics, on cytology.

Vascular Invasion of Papillary Thyroid Carcinoma into Neck Veins and Superior Vena Cava: A Case Report

Gaurav Satish Pawar, Rohini Avantsa

Papillary thyroid cancer is the most common thyroid malignancy in women which spreads through lymphatic. Even though microscopic vascular invasion has been published in the recent past, direct venous extension is rare. This case report is about a rare presentation of a Fine Needle Aspiration Cytology (FNAC) proven papillary thyroid carcinoma in a 45-year-old female patient, who presented with a swelling in the neck. The Contrast Enhanced Computed Tomography (CECT) of the neck showed multiple nodular lesions of both lobes of thyroid extending to the retrosternal region and direct tumour thrombus extension to thyroid veins, External Jugular Vein (EJV), Superior Vena Cava (SVC) and subcutaneous veins of neck with lung metastases.

Meckel-Gruber Syndrome with Multiple Congenital Anomalies- A Rare Lethal Case

Roli Joshi, Deepa Deopa, Pankaj Singh

Meckel-Gruber Syndrome (MGS), a rare autosomal recessive malformation syndrome with incidence of one per 13,250-140,000 live birth. It is a classical triad of occipital encephalocele, infantile polycystic kidneys and postaxial polydactyly with associated multiple congenital anomalies. It leads to the death of foetus in utero or shortly after birth. Most important diagnostic tools for MGS are antenatal ultrasonography and chromosomal study. A 3.14 kg dead female foetus was delivered from 19-year-old primigravida on the first visit to hospital with full term pregnancy. Sonography revealed no cardiac activity of the foetus in utero. Termination of pregnancy was done by the decision of obstetrician and consent of patient. Gross multiple anomalies along with microanatomical changes were noticed in foetus. Typical triad of polycystic kidney resulted to oligohydramnios, protrusion of meninges with brain tissue resulted to occipital encephalocele and limb anomalies might be hereditary or due to mutational changes. Histological changes were supportive of gross anatomical changes and ultrasound scan findings. Major changes as multiple cystic lesions in kidney, non functional alveoli in lungs and fibrous tissues with deranged hepatocytes in foetal liver were noticed. Concluding through all investigations and family history might confirm the diagnosis and help in further treatment or termination of pregnancy timely and directs for further genetic and chromosomal counselling.

Spontaneous Passage of Stensen’s Duct Calculus following Gland Massage: A Case Report

Obstructive parotitis usually occurs as a painful, unilateral swelling of the cheek with a decreased salivary flow and pus discharge, when secondarily infected. The known causes for this condition include commonly, sialoliths, strictures, and/or stenosis of the duct. Imaging in patients with obstructive parotitis has multifactorial benefits ranging from diagnosis to localisation thus, enabling preoperative planning. A 43-year-old female patient presented with features suggestive of obstructive parotitis with secondary infection. The diagnosis was confirmed by Ultrasonography (USG) and a Radiovisiograph (RVG) was performed to localise the sialolith. The patient was admitted and treated with supportive therapy in the form of intravenous antibiotics, milking of the gland, and adequate hydration. Sialolithotomy was scheduled following the resolution of the acute phase of infection. Repeat USG and RVG were performed on the day of surgery to confirm the position of the sialolith but the sialolith could not be located. A panoramic radiograph was performed to confirm the absence of the sialolith. The planned procedure was cancelled, and the patient was continued on systemic antibiotic therapy and anti-inflammatory medication for three more days. On follow-up, copious serous saliva could be expressed from the duct. This highlights the importance of repeating preoperative imaging in patients who have received supportive therapy including gland massage.

Histopathological and Immunohistochemical Analysis of Rare Parotid Tumours: A Case Series

Sayantan Dey, Piyali Kundu, Sona Das, Madhumita Mondal

Malignant salivary gland tumours are rare representing only 2% of all head and neck malignancies. The most common malignant salivary gland tumour is mucoepidermoid carcinoma followed by adenoid cystic carcinoma while parotid is the most common site. But there are presence of other rare variants with diverse biological feature of malignancy including Salivary Duct Carcinoma (SDC), basal cell adenocarcinoma, Carcinoma ex Pleomorphic Adenoma (CXPA), polymorphous adenocarcinoma which represent 1-5% of all salivary gland neoplasm. They typically are high-grade carcinomas with presence of lymph nodal metastases. Hereby, author report five rare cases of parotid gland malignancy detected by histopathological examination along with confirmation by immunohistochemical examination. A 60-year-old and 65-year-old male diagnosed with salivary duct carcinoma of left parotid and right parotid, respectively with ipsilateral cervical lymph node involvement but peripheral resection margins were free from tumour invasion. A 50-year-old female diagnosed with basal cell adenocarcinoma of left parotid with lymph node metastasis and resection margin was involved by the tumour. A 60-year-old male presented with recurrent swelling in left parotid region, diagnosed as carcinoma ex pleomorphic adenoma with lymph node involvement in a case of pleomorphic adenoma of parotid, reported previously. A 52-year-old male presented with right-sided parotid region swelling for last six months having Fine Needle Aspiration Cytology (FNAC) report of pleomorphic adenoma. Parotidectomy revealed diagnosis of polymorphous adenocarcinoma while surgical resection margins were free. Surgery is the main mode of treatment in these tumours. Involvement of resection margins, extraparotid extension, lymphovascular and perineural invasion along with lymph node metastasis are the common indicator for postoperative radiation therapy.

Unusual Findings and Outcomes of Balloon Mitral Valvotomy

Balloon mitral valvotomy is a common procedure done for rheumatic mitral stenosis. However, certain cases may pose challenges and rarely may be life-threatening. Here, three unusual cases of balloon mitral valvotomy are presented. Case 1, a 42-year-old male, had procedural challenge in terms of Interatrial Septal (IAS) fibrotic thickening and calcification, posing difficulty in trans-septal puncture and crossing IAS with valvotomy balloon. Case 2, a 38-year-old female, had bidirectional Ventricular Tachycardia (VT) with a single dose of intravenous digoxin, and stress cardiomyopathy. Case 3, a 49-year-old male, had difficulty in negotiating valvotomy balloon towards apex and in the process, there was left ventricular free wall perforation.

Dermatosis Neglecta Involving Different Age Groups- A Series of Four Cases

Dermatosis neglecta is a benign cutaneous condition which is often misdiagnosed. It occurs due to poor local hygiene or inadequate washing of a part of the body resulting in progressive accumulation of sebum, sweat, keratin and other debris which form an adherent crust of dirt. It mainly occurs in individuals who are unable to take care of themselves, like those with physical disability or psychosis. It is usually asymptomatic and is characterised by localised hyperpigmented patch or verrucous papules and plaques. Rubbing the affected area with alcohol-soaked gauze results in complete clearance of the lesion which is both diagnostic and therapeutic. The present case series describes four patients of different age groups. The first patient was a 65-year-old female, who underwent amputation of the gangrenous toes of right foot. She did not wash that leg for several weeks following surgery and developed cornflakes-like scaly lesions. Later lesions were diagnosed as dermatosis neglecta. Second case was an 18-year-old male, who presented with lesions on neck, which was misdiagnosed initially as Pityriasis vesicolor. The third patient was a 20-year-old female, who presented with lesions on neck and was earlier diagnosed and treated as acanthosis nigricans. The fourth patient was a two-year-old female who developed lesions on neck due to accumulation of dirt and debris. In all these patients, lesions resolved on rubbing with alcohol-soaked swab. Very little data is available in medical literature about this condition. Therefore this case series is being reported to bring awareness among dermatologists. This would enable prompt clinical recognition and obviate the need for expensive investigations and treatment strategies.

Variable Presentations of Enteric Fever, beyond Fever and Pain Abdomen: A Case Series

Somnath Maitra, Kaushik Hazra, Sunetra Roy

Enteric Fever (Typhoid and Paratyphoid fever) is an illness that presents with marked pyrexia, abdominal pain and other gastrointestinal symptoms. Symptoms and complications primarily involve gut. But sometimes it involves other organ systems like heart, and brain. It thus poses a great diagnostic challenge in diagnosing these extraintestinal manifestations. The three cases depicted in this case series had unusual presentations in the form of dilated cardiomyopathy, non haemophagocytic lymphohistiocytosis (HLH) dyslipidaemia and encephalopathy. The first case is a case of reversible cardiomyopathy in a 26-year-old male patient presenting with fever for seven days with headache, loose motions and vomiting with audible third heart sound (S3) and bibasal crepitations without oedema. The patient responded to ceftriaxone and azithromycin. On echocardiography, dilated cardiomyopathy was diagnosed after which treatment with Ramipril and Metoprolol was started. The second case was of a 30-year-old female patient presenting with fever, vomiting, and abdominal pain. There was hypertriglyceridaemia with normal ferritin levels. The patient responded to ceftriaxone. High Density Lipoprotein (HDL) level was low. Statin and fenofibrates were added after which the triglyceride levels came down. This was an interesting case of non-HLH dyslipidaemia which responded to therapy. The third case was of a 40-year-old female patient presenting with fever for six days with impairment of consciousness. Bilateral plantar responses were extensor and there was no papilloedema or any cranial nerve palsy. Magnetic Resonance Imaging (MRI) Brain and Cerebrospinal Fluid (CSF) study were normal. The patient responded to ceftriaxone and dexamethasone proving beneficial effects of steroids in enteric encephalopathy. The purpose of the case series was to make clinicians aware of these uncommon presentations of a common disease so that early diagnosis and treatment with anti-salmonella antibiotics can be initiated quickly to prevent complications.

Symptomatic COVID-19 Positive Parturients Posted for Lower Segment Caesarean Section

M Jisha, M Mohan David

Since the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic many elective cases were postponed worldwide. But emergency Lower Segment Caesarean Sections (LSCS) is one surgery which can’t be postponed at any cause, since two lives are at risk. The present case series reports 16 symptomatic COVID-19 patients in whom emergency LSCS was performed. The aim of presenting the series was to analyse how far the clinical and laboratory findings were deranged in such patients and to find out whether the current anaesthetic techniques were safe in these patients. Out of a total of 157 COVID-19 positive patients who had undergone LSCS in the study, 16 presented with symptoms such as fever, cough, dyspnoea, rhinitis, headache and palpitation. Six (37.5%) were preterm. Seven patients had elevated C-Reactive Protein (CRP) (>5 mg/L). Liver function tests abnormalities were seen in 5 (31.25%). Most of the patients had elevated D-dimer of which (>1500 ng/mL) were seen in seven. The most common indication was foetal distress. COVID pneumonia was an indication for LSCS in 3 (18.75%). All the surgeries were performed under subarachnoid block. Of the four patients who had fall in oxygen saturation two were admitted in Intensive Care Unit (ICU) and one required Non Invasive Ventilation (NIV). There were no mortalities. Thus, LSCS can be done safely under subarachnoid block even in symptomatic COVID-19 parturients. Elevation of D-dimer is common in pregnancy and it does not always indicate severe COVID-19 disease.

Onychomadesis- A Late Manifestation of Hand, Foot and Mouth Disease: A Case Series

MG Ravanagomagan, M Senthil Kumar, AP Krithika

Hand Foot Mouth Disease (HFMD) is one of the most common viral illness that is characterised by fever below 38.3°C, painful oral lesions on the tongue and buccal mucosa and macular, maculopapular or vesicular skin lesions on the soles and palms. Many viruses are implicated in HFMD, such as Coxsackievirus A5, A6, A7, A9, A10, A16 (most common), B1, B2, B3, B5, Echoviruses E3, E4, E9 and Enterovirus 71. The illness is usually mild and self-limiting. HFMD due to enterovirus 71, is associated with a severe illness complicated by aseptic meningitis, acute flaccid paralysis, pulmonary oedema and heart failure. Onychomadesis is a very rare complication of HFMD, typically occurring third to eight week of onset of illness. This is characterised by the detachment of the nail plate from the proximal nail fold by a full thickness sulcus. It is postulated that viral infection causes inflammation around the nail matrix either due to direct effect or due to the deposition of immune complexes secondary to distal thromboembolism. Here, authors report six children of different age groups, who were affected with onychomadesis during an outbreak of HFMD in the month of February to May 2022 in Chennai, Tamil Nadu, India. All these six children developed onychomadesis following HFMD, after a couple of weeks. Both upper and lower limb nails were involved. Other causes of onychomadesis like chronic illness, nutritional deficiencies, drug ingestion, periungual dermatitis, trauma were ruled out. Children were given supportive care and were followed-up. The changes in nails spontaneously regressed after a couple of weeks.

Atrial Fibrillation Masquerading as Wolff-Parkinson-White Syndrome

Sourya Acharya, Sandeep Kamat, Samarth Shukla, Sunil Kumar

Atrial Fibrillation (AF) can complicate Wolff-Parkinson-White (WPW) syndrome. The characteristic feature of AF associated with pre-excitation is the irregular Wide Complex Tachycardia (WCT) with varying morphology of QRS complexes, with a rate more than 200 beats per minute. Delta waves may be obscured when atria discharge at a rate of more than 300 bpm. This case describes rare ECG features of AF that may resemble AF with pre-excitation. Organised atrial activity may masquerade as short PR interval and delta patterns. QRS morphology does not change in AF.

Infected Pseudoaneurysm with Necrotising Fasciitis Following Femoral Artery Catheterisation

Femoral pseudoaneurysm is the most common complication of femoral artery catheterisation usually diagnosed by colour doppler ultrasound. Ultrasound-guided compression has replaced surgery to be the mainstay of therapy due to its high success rate and low complications. The present case is about a 63-year-old female, who presented with pain and swelling in the right groin. She had undergone coronary angioplasty two weeks back. She developed fever, chills, wound induration and necrosis at the puncture site. A laboratory study revealed leucocytosis, elevated Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP). Ultrasound doppler showed a 4×2.8×2.7 cm pseudoaneurysm of the right superficial femoral artery with a to-and-fro flow pattern. Computed Tomography (CT) angiogram showed a large narrow neck pseudoaneurysm arising from the anterior wall of the proximal superficial femoral artery just distal to its origin. The right superficial femoral angiogram showed a pseudoaneurysm draining into a large cavity. She underwent an ultrasound-guided thrombin injection of the pseudoaneurysm. A thrombus was formed in the superficial femoral artery after thrombin injection and thrombosuction was done. The necrotic tissue was excised and skin grafting was done after the wound healed.

Early versus Delayed Initiation of Oral Feeds among Mothers after Caesarean Delivery: A Comparative Study

Rajiv Kumar Saxena, Chaitanya Indrani, P Roshini, Aritra Maji

Introduction: It is a common practice to keep a patient ‘nil’ per oral, till the return of bowel sounds, after any laparotomy. Enhanced Recovery After Surgery (ERAS) society, now recommends evidenced-based guidelines for postoperative early oral feeding after an uncomplicated Caesarean Delivery (CD), as opposed to the delayed (conventional) initiation of oral feeds. Aim: To compare the effects of early feeding versus delayed oral feeding in women undergoing CD. Materials and Methods: This prospective comparative study was conducted in Department of Obstetrics and Gynaecology at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from November 2020 to October 2021. Total of 148 women with uncomplicated singleton pregnancy undergoing CD, under spinal anaesthesia, were allocated into two groups. Early Feeding group (n=70) (EF) where feeding was started within 2-8 hours of surgery and Delayed Feeding group (n=78) (DF) where feeding was started between 18-24 hours of CD. The outcome measures were maternal satisfaction, and the effect on gastrointestinal function (return of bowel sounds, passage of flatus and stool), mobilisation of patient and complications in postoperative period. Student’s t-test and Chi-square test were used as appropriate, and p-value <0.05 was determined to be statistically significant. Results: The mean age of women in DF was 24.79±4.37 years and in EF group was 25.09±3.86 years. Overall, the maternal satisfaction was high in both the groups; DF (80%) and in EF (98.6%). There was an early return of bowel sounds in EF group 4.71±1.83 hours versus 13.72±3.08 hours in DF group. Participants in EF group recorded. early passage of flatus (9.89±3.00 hours versus 13.72±3.08 hours), and early ambulation (9.57±1.62 versus 14.95±3.9 hours) when compared to DF group participants. Conclusion: The ERAS strategy is a safe and effective approach for postoperative care for women undergoing caesarean delivery and results in overall high patient satisfaction.

Prevalence of Ocular Manifestations and Visual Impairment among Pre-employment Screening Candidates at a Tertiary Care Hospital, Tamil Nadu, India

Ajay Venkat Ananthan, P Dinesh, Ashwini Sonkamble, K Meena Devi

Introduction: The importance of pre-employment check-ups cannot be understated. Every year visual impairment causes an enormous loss of productivity running in billions worldwide. One of the major reasons for this is lack of comprehensive data on national and international levels about the prevalence of visual impairment in the working sector. Aim: To assess the prevalence of ocular manifestations and visual impairment among the pre-employment screening candidates at a tertiary care hospital, Tamil Nadu, India. Materials and Methods: This cross-sectional prospective study was conducted, from March 2022 to July 2022, at Trichy SRM Medical College Hospital and Research Centre, Tiruchirappalli, Tamil Nadu, India. All the pre-employment candidates who attended the Ophthalmology Outpatient Department were included in the study. A comprehensive ophthalmic evaluation was done to all the pre-employment candidates. The Statistical Package for Social Sciences (SPSS) version 2.0 was used for the data analysis. Results: A total of 530 candidates were screened during this period, which included 325 (61.3%) males and 205 (38.6%) females. The mean age was 33.75±11.52 years. The most common ocular manifestation was refractive errors in 52 (9.81%), senile cataract in 43 (8.11%), presbyopia in 32 (5.66%) and amblyopia in 20 (3.77%) patients. Conclusion: The overall prevalence of ocular manifestations and visual impairment among visual impairment was 43.39%. This helps in early detection of ocular morbidities among pre-employment candidates and appropriate and timely intervention will improve the productivity of the candidate.

Intrarater and Inter-rater Reliability of Pinch Dynamometer for Toe Grip Strength: A Cross-sectional Study

Shreya Vinodara Poojari, Saumya Srivastava

Introduction: Reduced Toe Grip Strength (TGS) is associated with an increased risk of knee pain. In India, toe grip is rarely examined and examination of TGS lacks quantifiable values. The pinch gauge dynamometer is an instrument/tool which is apposite in the assessment of grip strength. The present study is a first of its kind to establish the reliability of pinch gauge dynamometer in assessing TGS. Aim: To evaluate intrarater and inter-rater reliability of pinch gauge dynamometer in measuring TGS. Materials and Methods: This cross-sectional study was conducted at the Department of Physiotherapy, Deemed to be the University of Mangalore, Karnataka, India during the 1st week of August 2022. Out of 30 individuals, 15 were males and 15 were females. TGS was assessed using a pinch gauge dynamometer. For data analysis, the mean of the three trials was used and the reliability test was calculated using the Intraclass Correlation Coefficient (ICC). The level of significance was set at 5%. Results: Intrarater reliability showed ICC scores of 0.991 and 0.985 for both right and left feet, and inter-rater reliability showed scores of 0.985 and 0.977, respectively. In the female group inter-rater agreement on right side pinch strength was 0.923 and left side was 0.924. Among males inter-rater agreement, right side ICC score was 0.983 and left side was 0.967 between the raters. Conclusion: The pinch gauge dynamometer is reliable for measuring TGS with excellent intra and inter-rater reliability values.

Resilience of Healthcare Providers during COVID-19 Pandemic: A Rapid Assessment using Digital Platform

Anirban Ray, Debjani Sen Gupta, Jayasree Sar Choudhury, Pramit Ghosh

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic exposed the health workforce to an unprecedented occupational hazard. While taking care of patients they always had to be conscious simultaneously for safeguarding themselves and their family members against the highly infectious virus. In West Bengal, cases were first reported in the last week of March-2020 and reached the peak around October-2020 in the first wave, once the lockdown was lifted. During the initial months, the staggering number of cases, prevailing uncertainty over case management, and untimely demise of colleagues and relatives, took their toll on the physical and mental health of doctors, paramedics, or support staff, both in the government and private sectors. Aim: To measure perceived stress, resilience and psychological well-being of healthcare providers using standard psychometric tools. Materials and Methods: This was a cross-sectional observational study carried out among healthcare workers in hospitals located in West Bengal, India. A self-administered questionnaire was circulated through a digital platform between June-November 2020. The questionnaire was designed using Perceived Stress Scale (PSS-10), Kessler-6 (K6), and Brief Resilient Coping Scale (BRCS) to assess perceived stress, psychiatric morbidity, and resilience of the person. It had three parts, one to capture socio-demographic details of the participants including age, sex, marital status, occupation, family history of psychiatric morbidity, place of stay etc. Second part consisted of psychometric scales and third was designed to capture the views of participants on the coping strategies. Calculated sample size was 189. Results: Based on standard cut-off values, it was found that 65.6% subjects were under moderate or severe stress; 56.6% had compromised mental well-being and 64% were not coping well with the pandemic situation. PSS were significantly poor for females (p-value <0.001), single (p-value <0.001) and those without history of psychiatric morbidity (p-value <0.001) and low resilient copers (p<0.0001). Mental well-being was compromised more among married (p-value=0.01), doctors (p-value=0.008), aged <40 years (p-value=0.003), high resilient copers (p-value=0.02). Popular means of stress reliever were music and yoga/exercise. Correct and updated knowledge on disease transmission, availability of personal protective equipment, pursuing hobbies like music and gardening were few suggested measures to improve coping with stress associated with patient care. Conclusion: The study revealed that majority of the health workers experienced moderate to heavy degree of stress and compromised psychological well-being during the first wave of pandemic. Relationship of stress and psychological well-being with resilience and socio-demographic variables was not always linear.

Analysis of Factors Hindering the Measles Elimination among Children at a Tertiary Care Hospital in South India

Nirmala Cherukuri, Srividya Yeruva, Usha Rani Thota, Karunya Karnabathula

Introduction: Measles is a highly infectious acute viral disease that can lead to serious complications and death. Effective immunisation coverage for measles will play a pivotal role in its elimination strategy. So, the global commitment, strengthening of health infrastructure and effective vaccine coverage are essential to achieve a world that will be free of measles. Aim: To assess the factors associated with the occurrence of measles and to determine the factors responsible for non compliance to measles vaccination. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Niloufer Hospital, Hyderabad, India, during the period from October 2019 to March 2020 among the children clinical diagnosed with measles. The patients were evaluated for fever, rash, respiratory and other clinical symptoms associated with measles. History of measles vaccination and vitamin A administration were taken. Blood samples of patients were collected and measles specific IgM antibody detection test was done by Enzyme-linked Immunosorbent Assay (ELISA). Data was statistically analysed and presented as numbers and percentages were calculated. Results: Among 129 children, clinically diagnosed with measles, the predominant age group of children affected was 1-6 years 68 (52.71%). Overall, 38 (29.5%) were vaccinated and 85 (65.9%) were unvaccinated during routine immunisation schedule. Measles-Containing Vaccine (MCV) coverage during Supplementary Immunisation Activities (SIAs) was also very limited (19.3%). Out of 129 cases, 121 (93.7%) were confirmed positive by measles IgM ELISA, 5 (3.8%) samples gave equivocal results and 3 (2.3%) were negative for the test. Conclusion: Inspite of the availability of effective and inexpensive measles vaccine for decades, vaccination coverage remains inadequate across the globe. So, effective implementation of vaccine services and monitoring of its surveillance system are needed for eradication of measles.

Intramedullary Nail Supplemented with Poller Screws for Proximal and Distal 1/3^rd Shaft Tibial Fracture: A Prospective Interventional Study from North India

Introduction: The fracture of shaft of the tibia is the most common long bone fracture. The treatment goal for shaft tibial fracture is to achieve union with correction of both axial and rotational alignment and, maintain initial fracture length. Higher malunion rates are seen in fractures of the proximal and distal 1/3^rd of the shaft of the tibia. However, Intramedullary (IM) nailing is the preferred choice of operative management of diaphyseal fractures of the lower limb. Aim: To evaluate the functional and radiological outcomes of IM nail supplemented with Poller screws for proximal and distal 1/3^rd shaft tibial fractures. Materials and Methods: A prospective, interventional study was conducted in the Government Medical College, Patiala, Punjab, India from May 2020 to November 2021. A total of 30 fracture patients in the age group of 18 to 60 years were included in the study. All the subjects were treated with IM nail supplemented with Poller screws for proximal and distal 1/3^rd shaft tibial fractures. Twenty cases were closed fractures and 10 were open (grade I or II according to Gustilo Anderson’s classification of compound tibia fracture). Patients were followed-up at 3 weeks, then 6 weekly till union. Patients were evaluated by Karlstro¨m-Olerud’s functional evaluation criteria.The data was statistically analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: The mean time of fracture union was 17.33±2.59 weeks with a maximum (n=19) patients in ≤15 weeks, followed by 15-20 weeks (n=10) and only one patient had delayed union (>20 weeks). According to Karlström-Olerud’s functional evaluation scale 18 (60%) patients had excellent outcome followed by good outcome in 8 (26.7%) patients, while 2 (6.7%) patients had satisfactory and 2 (6.7%) patients moderate outcomes. The total mean varus/valgus deformity preoperatively was 10.17±4.15° while postoperatively it was 1.63±2.3°. The total mean antecurvatum/recurvatum deformity preoperatively was 6.47±5.906° while postoperatively it was 0.20±0.61°. Postoperative complications were observed such as shortening of the leg (n=2), movement loss in the ankle (n=4), movement loss in the knees (n=3), muscle wasting (n=6) and subtalar movement loss (n=6). One patient had a superficial skin infection (oozing of purulent discharge from distal locking skin suture site), which was treated with prolonged antibiotics. Conclusion: Poller screws were found to be effective in achieving fracture alignment and hence, serve as a effective fracture reduction tool. Also helps to maintain the fracture aligned until it healed, preventing the loss of the initial reduction.

Assessment of Cell-mediated Immunity to Trichophyton Antigen in Patients with Dermatophytosis: A Case-control Study

Shubham Chopra, Sudhir Singh, Bhushan Madke

Introduction: Dermatophytosis are presenting for longer durations and at atypical sites and are quite persistent. If changes in the Cell-Mediated Immunity (CMI) will be studied then, it will help to set treatment guidelines for the management of dermatophytosis to certain extent, considering the current changes in the resistance to dermatophytosis. There is paucity in literature regarding the CMI to Trichophyton antigen in dermatophytosis patients in the geographical region of Vidarbha, Maharashtra, India. Aim: To assess the CMI to intradermal Trichophyton antigen in dermatophytosis patients and to study its adverse reaction in these patients. Materials and Methods: The present prospective cross-sectional case-control study will be conducted on patients of dermatophytosis attending Skin Outpatient Department (OPD) in Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, Maharashtra, India, during January 2022 to January 2023 (13 months). Patients will be enrolled following fulfillment of study’s eligibility criteria. Clearance has been acquired from the Institutional Ethical Committee (IEC). Participants will be required to sign a written informed consent form in their native language. A detailed history will be collected and cutaneous examination will be done before conducting the study. The area for intradermal injection will be marked. For the study 0.1 mL, Intradermal Trichophyton antigen will be injected in the patient’s forearm. Patient will be called after 48 hours to check for the CMI response (delayed response).

Correlation of Dermatology Life Quality Index and Vitiligo Extent Tensity Index: A Cross-sectional Study

Naveen Netaji Rao, Rahul Ashok Thombre, Aijaz Ahmad

Introduction: Vitiligo is a chronic depigmentary disorder having an autoimmune aetiology. Vitiligo has a severe impact on the quality of life of the individual in our country. Considering the changing socio-economic trend and the arrival of new medicines in the therapeutic armamentarium of dermatologists, there is a need to know whether vitiligo, which had high social stigmata in the past, still continues to have the same impact on Quality of Life (QOL). Aim: To find out the correlation of Dermatology Life Quality Index (DLQI) in cases of vitiligo using Vitiligo Extent Tensity Index (VETI) score Materials and Methods: A questionnaire-based cross-sectional study was conducted in Department of Dermatology at Military Hospital, Bareilly, Uttar Pradesh, India, from January 2021 to March 2022. The study involved all patients with vitiligo, aged between 15-60 years including both sexes. The patients were given the DLQI questionnaire and DLQI scores were calculated. The DLQI score was correlated with the VETI score established clinically. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 108 patients were recruited which included 41 males and 67 females. The VETI score ranged from 0.5 to 25.7 (5.8±4.187) whereas DLQI score ranged from 1 to 19 (6.73±3.751). Patients with high VETI score (8.84±7.74) had high DLQI score (11-20), thereby correlating the extent of the quality of life compromised. The VETI positively correlated with the DLQI (r-value=0.476; p-value=0.001). Conclusion: Patients with a high VETI have a severely compromised quality of life. Proper counseling should be done for vitiligo patients apart from conventional medicines being used for treatment.

Formulation of In-situ Thermoreversible Gel with Moringa oleifera Lam Extract as a Local Drug Delivery System for Adjunct Periodontal Treatment

Introduction: Periodontal disease is an outcome of a plethora of molecular mechanisms associated with oxidative stress, inflammation and oral microorganisms is managed by surgical or non surgical therapies with systemic antibiotics. However, local drug delivery system is known to augment the currently available therapies and improves prognosis. Although, there are several local drug delivery systems available, the search for an ideal agent with antioxidant, antimicrobial and anti-inflammatory properties continues. Moringa oleifera Lam extracts is one such wonder plant with all the above mentioned effects. Aim: To formulate an in-situ thermoreversible gel with Moringa oleifera Lam extract that could be used as a local drug delivery system as an adjunct to periodontal treatment. Materials and Methods: This in-vitro study was conducted in Nanotechnology Laboratory, Department of Pharmacology at Saveetha Dental College, from May 2022 to June 2022. For preparation of thermoreversible gel the 19% of thermogelling polymer poloxamer 407 (15% to 30%w/v) which the least concentration that demonstrates thermoreverisibility at 36°C and 0.2% which is the least concentration of mucoadhesive polymer carbapol 934 (0.2% to 0.5% w/v) which forms sol-gel transition and 5% aqueous extract of Moringa oleifera and cold deionised water were used. Surface pH, gelation temperature, syringeability, in-vitro drug release, stability, gelation time and Fourier Transform Infrared Spectroscopy (FTIR) analysis was done. Results: The surface pH of the gel was 6.94±0.091 with a gelation temperature of 34°C±0.5. The gel was flowable with good stability and fast release of eight hours. The chemical components compatability study of Moringa oleifera Lam powder, thermoreversible gel without extract and thermoreversible gel with extract were subjected to FITR analysis. The spectral analysis showed no significant chemical interaction between the Moringa oleifera and thermoreversible gel. Conclusion: The study concluded that the thermoreversible gel with Moringa oleifera Lam extracts could be used as an adjunct for the management of periodontal disease with good bioavailability. However, future clinical studies have to be conducted to validate the results of the present study.

Cognitive Evoked Potentials in Anaemic Women: A Cross-sectional Study

Umme Kulsoom Sheema, Alka Rawekar

Introduction: Iron Deficiency Anaemia (IDA) is a globally prevalent nutritional disorder and an important risk factor for the development of Mild Cognitive Impairment (MCI). A manifestation of IDA is altered electrogenesis in the central nervous system. As women of reproductive age are more susceptible to this form of anaemia, it is important to assess their cognitive function. Auditory cognitive evoked potentials/P300 are sensitive in detecting MCI which is indicated by prolonged latency and reduced amplitude. Aim: To investigate the effect of IDA on cognitive function using cognitive evoked potentials/P300 in neurologically intact women. Materials and Methods: A cross-sectional study was conducted at the Central Neurophysiology Laboratory, Acharya Vinobha Bhave Rural hospital (AVBRH) attached to Jawaharlal Nehru Medical College (JNMC), Wardha, Maharashtra, India, from January 2018 to February 2022. A total of 260 women were recruited for the study. Based on their blood haemoglobin and serum ferritin levels, 130 women were grouped as anaemic and 130 as non anaemic. The P300 was used as an objective tool to assess cognitive function. Haematological parameters like blood haemoglobin and serum ferritin levels were compared (‘t’-test) and correlated (Spearman’s correlation) with the latency and amplitude of the P300 wave in the two groups. Results: The mean age (years) and Body Mass Index (BMI) (kg/m²) of anaemic women were 23.88±3.67 and 20.98±1.45, respectively; and that of non anaemic women were 24.09±3.41, and 21.25±1.27 (p>0.05) respectively. The blood haemoglobin (mg/dL) and serum ferritin (ng/mL) were significantly (p<0.001) lower in anaemic group (10.37±0.95, 8.55±3.78) compared to non anaemic group (13.02±0.70, 27.61±10.52). The latency of P300 wave (ms) was significantly prolonged (p<0.001) in anaemic women (317.75±7.34) in comparison to non anaemic women (311.71±9.02), while the P300 amplitude did not differ between the two groups (p>0.05). A highly significant low negative correlation of P300 latency with haemoglobin (r=-0.48, p<0.001) and highly significant moderate negative correlation with serum ferritin (r=-0.55, p<0.001) was observed. And a negligible positive correlation of P300 amplitude with haemoglobin (r=0.26, p<0.05) and serum ferritin (r=0.24, p<0.05) was observed. Conclusion: Cognitive evoked potential is an objective method that aids in the early detection of cognitive impairment. Evaluating the cognitive function in anaemic women and ensuring adequate iron treatment can prevent MCI from progressing to severe forms like dementia and other neuropsychological disorders.

Utility of Mini-Clinical Evaluation Exercise in the Assessment of Medical Interns in Simulation based Medical Education: A Pilot Study

Gajanan Chavan, Tejavenu Yedla, Shradha Patel

Introduction: Medical graduates skill assessment in simulation is underdeveloped and needs due attention in making them proficient. The mini-Clinical Evaluation Exercise (mini-CEX) could be an important tool in assessing and making them perfect, through Competency-Based Medical Education (CBME). Aim: To determine utility of mini-CEX as a definitive and reliable assessment tool in high fidelity medical simulation. Materials and Methods: This pilot study was conducted at School of Virtual Learning (SVL) affiliated with JNMC, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (M), Wardha, Maharashtra, India between 1st November 2021-31st December 2021, on 50 medical interns. The learners were taught of basic clinical examination on SimMan simulator along with training in mini-CEX. The case scenarios on Hypertensive, Valvular, Acute Coronary artery disorders and dysrhythmias cardiac medical emergencies were allotted and the performance of administrators and learners were assessed by mini-CEX. The mini-CEX rating form was used to evaluate the competence and student satisfaction score form was sent to learners for their feedback. The data was collected on online Google form and was tabulated and analysed, descriptive statistics, mean with standard deviation was calculated. Results: The mean age of participants was 22.5±0.53 years. There were 15 males (30%) and 35 females (70%). Average satisfaction score for the assessors was 7.4±1.2 and for the interns was 8.2±0.2. Conclusion: Excellent level of satisfaction was observed in the learners, as well as, the administrators by use of mini-CEX format. Hence, this exercise can be applied in accessing high fidelity simulation.

Vaccination Status and Outcome of Patients at a Dedicated COVID-19 Centre, Delhi, India: A Retrospective Study

Anshuman Srivastava, Abha Sharma, Rajat Jhamb, Subhash Giri, Nikunj Aggarwal

Introduction: Coronavirus Disease-2019 (COVID-19) vaccine provides strong protection against transmission, serious illness, hospitalisation, and death. As India carried out robust vaccination drive covering more than two third of its population, the study was aimed to highlight the effects of vaccination status of patient on the outcome of COVID-19 infection. Aim: To describe the relation of vaccination with disease severity and its outcome during the third wave of COVID-19. Materials and Methods: It was a single-centre retrospective, cross-sectional study conducted in a dedicated COVID-19 Hospital (Guru Tegh Bahadur Hospital) in Delhi, India. A total of 257 patients were admitted between 10th January 2022 to 9th February 2022, and 246 were included in the study. For each individual, demographic, and clinical data was collected. Vaccination data was extracted via the CoWin platform which included vaccine type, as well as date of administration. The profile of patients was established based on clinical examination, laboratory data, nursing record and radiological record during the course of hospitalisation. The clinical outcome was described as discharge, length of hospital stays, and in-hospital death in relation to the vaccination status. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS), version 22.0. Results: Total of 246 patients were divided into three groups- 97 were fully vaccinated, 46 were partially vaccinated and 103 were unvaccinated. Both vaccinated and unvaccinated groups had similar percentage of co-morbidities i.e. 61.3% vs 63.5%. Those who were fully vaccinated were more likely to maintain saturation at room air 30.9% vs 26.1% vs 3.9%, had lesser requirements of mechanical ventilation (6.2% vs 15.2% vs 21.4%), shorter duration of hospital stay (4.2 vs 5.3 vs 7.2 days), and lesser mortality (9.3% vs 21.7% vs 33%) as compared to the partially vaccinated and unvaccinated patients respectively. Conclusion: The beneficial effect of the vaccination was observed in severity, mortality, morbidity, and lesser number of hospitalisations. Hence, vaccination coverage was critical in reducing the severity in reducing the and the hospitalisation in third wave of COVID-19.

Aetiopathological Spectrum of Unilateral Nasal Mass: A Hospital-based Cross-sectional Study

S Prathiba, Ajay Kumar Neeli, SB Amarnath, Mahesh Kumar Revoori

Introduction: The presence of unilateral symptoms or pathology should be regarded with extreme caution as sinonasal neoplasms in their early stages with subtle symptoms may mimic inflammatory pathology. It is always the otolaryngologist’s endeavour to diagnose a neoplastic pathology in the early stage to prevent further complications. Aim: To study the aetiopathological profile, age, and sex distribution of unilateral nasal masses presented at a tertiary care centre, Telangana, India. Materials and Methods: The present study was a hospital-based cross-sectional study consisting of 53 patients of all age groups, of both sexes, with unilateral nasal mass presenting to the Ear, Nose and Throat (ENT) Outpatient Department (OPD) at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India from December 2020 to June 2021. A detailed history was recorded and the patient underwent a complete ENT check-up, and head-neck examination followed by Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and biopsy. Results: The mean age of the study population was 44 years and there were 47 males and six females. Nose block was the most common presenting symptom in 43 (81.1%). Middle meatus was the common site seen in 12 patients (22.6%). Inflammatory lesions was the most common observed in 24 (45.3%), followed by fungal sinusitis in 6 (11.3%), granulomatous lesions in 2 (3.8%), benign lesions in 15 (28.3%), and malignant lesions in 6 (11.3%). Conclusion: Unilateral nasal masses were found common in males than females, with a peak incidence in the 5th to 6th decades of life. Histopathologically inflammatory lesions are the most common followed by benign and then malignant lesions.Any unilateral nasal mass should be viewed with a high index of suspicion for malignant lesions and should be subjected to diagnostic nasal endoscopy, imaging, and histopathological examination after surgical excision of the mass.

Effect of Antiretroviral Therapy on Circulating Lipid Levels in Human Immunodeficiency Virus Infected Patients: A Cross-sectional Study

RN Devaki, Hasit Kumar D Lad, Rana Neetaben Maheshchandra, N Chandrika

Introduction: The antiretroviral drugs have improved the quality and extent of life of Human Immunodeficiency Virus (HIV) infected patients, yet like any other long-term medication, these are known to cause several adverse effects. One such adverse effect is on the lipid metabolism in individuals on Antiretroviral Therapy (ART). Aim: To analyse the effect of ART on the circulating lipid levels in HIV patients. The secondary aim was to compare the lipid changes in patients treated with ZLN (Zidovudine+Lamivudine+Nevirapine) drug regimen against those, with TLE (Tenofovir+Lamivudine+Efavirenz). Materials and Methods: This cross-sectional study was conducted from December 2019 to March 2021 at the District Hospital, Chamarajanagar Karnataka, India. A total of 200 HIV positive patients between 18-55 years of age with no associated co-morbidities and who have been on ART were recruited into this study. Of the total 91 patients were on TLE (Tenofovir+ Lamivudine+ Efavirenz) and 109 were on ZLN (Zidovudine+ Lamivudine+Nevirapine) regimen. Blood samples were collected from all the patients and lipid profile analysis was done. Results: Statistically significant increase was observed in all lipid parameters in the ZLN group compared to TLE group. Serum Total Cholesterol (TC) {ZLN 190.92±43.57 vs 164.23±40.7 in TLE group (p-value <0.0001)} serum Low Density Lipoprotein Cholesterol (LDL-C) {ZLN 120.44±35.46 vs 100.81±26.84 in TLE group (p-value <0.0001)}, Triglyceride (TG) {ZLN 245.68±132.42 vs 171.56±77.30 in TLE group (p-value <0.0001)} and High Density Lipoprotein Cholesterol (HDL-C) {ZLN 60.71±17.51 vs 53.31±13.8 in TLE group (p-value=0.0012)}. Also the non HDL-C levels {ZLN 130.2±39.51 vs 110.91±36.87 in TLE group (p-value <0.0005)} were higher in patients receiving ZLN drug regimen than those who were on TLE. Of the 200 HIV patients, 53 were taking ART for less than five years (mean 2.51±1.12 years), 109 were receiving ART between 5-10 years (mean 7.78±1.50 years), 38 patients were on ART treatment for more than 10 years (mean 11.73±0.76 years). A positive significant association between lipid derangement and disease/ART duration was observed. Conclusion: Lipid abnormalities were more in HIV patients on ZLN drug regimen, than those on TLE regimen. The longer course of disease/ART is associated with imminent lipoprotein derangement. Periodic monitoring of lipid levels are recommended in these patients.

Gliosarcoma in a Paediatric Patient: A Rare Entity and Review of Literature

Meenakshi Shankar, Sachin Kolte, KB Shankar, Vivek Yadav

Primary Gliosarcoma is a rare malignant tumour of central nervous system in adults. It is usually a variant of Isocitrate Dehydrogenase (IDH) wild type glioblastoma. Its incidence is approximately 2% of glioblastomas and has a dismal prognosis. Most common age group is between 40-60 years of age is commonly seen in males. Paediatric gliosarcoma is even rarer than adults ones. Most common location is temporal and frontal lobes (cerebral hemisphere). Histologically, it shows biphasic pattern and is composed of both glial and mesenchymal components. Both these components has monoclonal proliferations. Here, a 20-month-old boy resident of Gorakhpur, presented with persistent crying for short duration in neurosurgery emergency. On magnetic resonance studies a frontotemporal lesion was found, for which he underwent tumour excision. The tumour proved to be a primary gliosarcoma. Due to malignant nature of tumour patient did not survive. Gliosacrcoma is rare adult tumour, but can rarely occur in children. A differential diagnosis of gliosarcoma should be kept in mind, while dealing with congenital tumours in children, due its aggressive nature with poor survival outcome.

Effectiveness of 0.125% Bupivacaine versus 0.125% Ropivacaine in Epidural Labour Analgesia- A Randomised Clinical Study

K Udaya Bhaskar, MS Anusha, Jagannath, KC Arun, Jagadeesan, Mohan Koyee

Introduction: Epidurally administered local anaesthetics provide most effective analgesia during labour process. Among the available local anaesthetics, bupivacaine and ropivacaine are the most commonly used drugs in concentrations ranging from 0.0625% to 0.125% and 0.08% to 0.125%, respectively. Both these drugs are weak bases, highly protein-bound, highly lipid soluble, and have a pKa of 8.1, low unionised fraction, thus, having a slightly longer time for onset of action but with a longer duration of action and have less transfer across the placenta. Hence, they are ideal drugs for use in labour analgesia. Aim: To compare the effectiveness of programmed intermittent bolus of 0.125% bupivacaine vs 0.125% ropivacaine in low volumes in full term primigravidas for epidural labour analgesia. Materials and Methods: This randomised clinical study was conducetd at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, between June 2020 and December 2021 among 80 full-term primi parturients requiring normal vaginal delivery. They were randomly divided into two groups of 40 each. Group B received 10 mL of 0.125% bupivacaine and group R received 10 mL of 0.125% ropivacaine as initial bolus dose. Repeat doses of 5 mL was given every 60 minutes or when the patient had Visual Analogue Score (VAS) score >4 with a maximum dose of 10 mL/hr with a 20 minute interval between two doses. Parameters assessed were onset, duration, level and quality of analgesia, motor blockade, number of epidural top ups, total volume of drug consumed, mode of delivery, duration of labour, APGAR score, haemodynamics, patient satisfaction and complications. Data was entered in Microsoft Excel 2010 version and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Both drugs were equally effective in terms of analgesia, maternal and foetal outcomes. Bupivacaine had a faster onset of action (7.075±0.916 min) compared to ropivacaine (8.225±0.891 min) (p-value=0.001). Ropivacaine had a shorter duration of action (43.1±2.30 min vs 47.9±4.16 min in group B) (p-value=0.0001), requiring more top-up doses (5.2±0.46 vs 4.77±0.61 in group B) (p-value=0.0007), and more total volume of drug (38.5±3.08 mL vs 35.5±4 mL in group B) (p-value=0.002). It also caused lesser motor blockade (Bromage score of 1 in 1 parturient vs 8 parturients in group B) (p-value=0.0129) and better overall maternal satisfaction score (excellent) in 30 parturients vs 25 parturients in group B. APGAR scores at 1 minute and 5 minutes were comparable between the two groups. Mean heart rates, mean blood pressures were also comparable between the two groups. There were no significant adverse effects in either groups. Conclusion: By providing minimal motor blockade and adequate analgesia 0.125% ropivacaine allows parturients to go through the labour process with excellent maternal satisfaction and minimal adverse effects compared to 0.125% bupivacaine.

Consequence and Prevention of Haemodynamic Stress Response during Laryngoscopy and Endotracheal Intubation with Oral Ivabradine- A Multicentric Randomised Controlled Study

Introduction: Laryngoscopy and intubation cause lots of haemodynamic changes which adversely affects the patient during the perioperative period. Various methods have been applied to reduce stress response in high risk patients. Ivabradine is a unique cardiotonic drug which reduces the heart rate without compromising blood pressure, specially in debilitating and severely ill patients. Aim: To evaluate role of oral ivabradine in attenuating the haemodynamic stress response to laryngoscopy, intubation and extubation in patients undergoing surgical procedure under General Anaesthesia (GA) and to note the side-effects and its complications, if any. Materials and Methods: A randomised controlled multicentric study was conducted in 200 American Society of Anaesthesiologists’ (ASA)-I and II patients undergoing various surgery under general anaesthesia. The patients were randomly divided into two groups: group A (Test group, n=100) received 5 mg oral ivabradine one hour before intubation, group B (Control group, n=100) received placebo. The pulse rate, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded at intubation and 10 minutes postintubation along with at extubation and postintubation period till 10 minutes. Patients were monitored for haemodynamic changes as per the protocol. Statistics analysis was done using Statistical Package of Social Science (SPSS) software version 21.0. Results: Demographic findings were comparable in both groups. Heart rate (84.36±4.11 versus 114.19±12.4), SBP (120±10.5 versus 150±17.5), DBP (76.08±4.29 versus 113.2±10.6), MAP (91.3±6.7 versus 124.4±12.8) at 10 minutes postintubation decreased more in test group as compared to control group from baseline (p-value <0.005). Similarly, heart rate (84.13±2.06 versus 110.58±8.92), SBP (123.4±10.06 versus 150.8±13.1), DBP (84.08±2.02 versus 107±10.2), MAP (97.8±6.47 versus 122.06±9.7) at 10 minutes postintubation decreased significantly in test group as compared to control group from baseline (p-value <0.005). Conclusion: Oral ivabradine is a very useful cardiotonic drug which facilitates the fluctuation in heart rate during laryngoscopy and endotracheal intubation.

Immunohistochemical Expression of Anaplastic Lymphoma Kinase in Invasive Breast Carcinomas- A Retrospective Study

B Gouthami, B Ravi Chandra, P Priyanka, SVR Raja Sekhar, VL Mounika, V Sasi Sri

Introduction: Breast carcinoma remains one of the most common causes of mortality among female cancer patients inspite of improvements in treatment modalities. Increased survival rate can be achieved by identification of new targeted therapies. Anaplastic Lymphoma Kinase (ALK) alterations are present in many solid and haematological tumours indicating its role in pathogenesis and treatment. There are studies regarding the expression of ALK in few breast cancers but its importance was not clearly mentioned. Hence, identification of ALK overexpression in breast cancers, particularly in Triple Negative Breast Cancers (TNBC) might play a role in their chemotherapy with the help of ALK inhibitors. Aim: To study the ALK expression in different subtypes of invasive carcinomas of breast. Materials and Methods: This was a retrospective cross-sectional study conducted in the Department of Pathology at Great Eastern Medical School (GEMS) and Hospital, Srikakulam, Andhra Pradesh, India, from January 2022 to July 2022. The data of 60 patients, from January 2021 to December 2021 was retrieved using Hospital Information Management System (HIMS) and the Haematoxylin and Eosin (H&E)-stained slides and formalin fixed paraffin embedded tissue blocks of breast tumour were retrieved and reviewed. Estrogen receptor (ER), Progesterone receptor (PR) and Human Epidermal growth factor Receptor 2 (HER2) immunostains were performed and categorised based on molecular classification as Luminal, Her2 and Triple negative. ALK Staining was performed on all cases and its expression was studied. Statistical Package for Social Sciences (SPSS) software version 2.0 was used for analysis of data. Mean with standard deviation is used for quantitative variables and prevalence, ratio is used for quantitative variables. Chi-square test and Fischer exact test were used for detecting significance. The p-value <0.05 was considered as significant. Results: Out of 60 cases, majority (N=22; 36.66%) of patients were in the age group of 51-60 years. The mean tumour size was 3.2±0.5 cm. The most common histological type was invasive breast carcinoma, No Special Type (N=44; 73.34%). Majority of the tumours showed grade 1 and 2 with 24 (40%) and 25 (41.67%) cases, respectively. A total of 30 cases (50%) of tumours belonged to stage T2. Luminal molecular subtype was the most common 31 (51.67%) cases followed by TNBC, 16 (26.67%) cases and Her2neu 13 (21.67%) cases. Among all the cases, ALK overexpression was seen in 17 (28.33%) cases and among different molecular subtypes, its expression was seen in 5 (8.33%) cases of Luminal type, 3 (5.0%) cases of HER2 type and in 9 (15.0%) cases of TNBC cases. Conclusion: Immunohistochemical analysis showed ALK over expression in a substantial proportion of cases and possibly plays a significant role in aggressive behaviour of breast cancer. ALK inhibitors offer an opportunity to treat aggressive subtypes of breast cancer.

Evaluation of Outcome of Pregnancy Complicated with Thrombocytopaenia- A Prospective Observational Study

Rao Bahadur Badugu, Prabhadevi Kodey, Sowjanya Pappala

Introduction: Thrombocytopaenia occurs in 7-12% of pregnancies at the time of delivery. Knowledge, regarding the causes and effects of thrombocytopaenia on mother and newborn, facilitates proper diagnosis and management of thrombocytopaenia in pregnant women for better maternal and foetal outcomes. Aim: To determine the incidence, causes and outcome of pregnancy with thrombocytopaenia. Materials and Methods: A prospective observational study was conducted among women attending Outpatient Department for an antenatal checkup at NRI Medical College and General Hospital, Chinnakakani, Guntur, Andhra Pradesh, India, from October 2017 to October 2019. A total of 44 antenatal women with platelet count less than 1,50,000/cumm were included in the study. They were followed-up throughout the antenatal period until delivery to record any complications that developed due to low platelet counts in the mother and neonate. A neonatal platelet count was done on day one of life. Data was subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 22.0, all qualitative variables were expressed in terms of proportion. Results: A total of 500 cases were studied of which 50 cases had thrombocytopaenia with an incidence of 10%. Out of 50 cases, six were lost for follow-up and the remaining 44 cases were included in the study. Out of 44 patients, 23 (52.27%) had mild thrombocytopaenia, 12 (27.27%) had moderate and 9 (20.46%) had severe thrombocytopaenia at the time of diagnosis. Common causes seen were Gestational Thrombocytopaenia (GT) 17 (38.6%), Preeclampsia (PE) 8 (18.18%), Gestational hypertension 4 (9.09%). A total of 5 (11.36%) required intensive care unit care, 3 (6.81%) had multiorgan dysfunction syndrome (MODS), 2 (4.54%) underwent hysterectomy, 2 (4.54%) had postpartum haemorrhage (PPH), 2 (4.54%) had secondary suturing done for wound infection, 1 patient (2.27%) underwent laparotomy (for rectus sheath haematoma), and mortality was seen in two cases. A total of 14 cases (31.8%) required blood and blood product transfusions. Eight neonates were admitted to the neonatal intensive care unit. There was no case of neonatal thrombocytopaenia. Conclusion: Thrombocytopaenia is a significant problem in pregnancy; hence, the routine antenatal platelet count should be done for a timely diagnosis of thrombocytopenia.

Association between Serum Sialic Acid Levels and Disease Severity in Psoriasis: A Case-control Study

UG Bhavyashree, Laddha Vedant, B Vishal, Malcolm Pinto, Manjunath Shenoy

Introduction: Psoriasis is a chronic inflammatory disease distributed worldwide with varying prevalence among different geographical areas and ethnic groups. It has been recently found that oxidative stress is one of the important factors in the pathogenesis of psoriasis. The varied effects of oxidative stress include changes in cellular uptake, altered enzymatic activity of proteins, increased predisposition to aggregation and proteolysis, which subsequently alter their immunogenicity. Sialic Acid (SA) is an acetylated derivative of neuramic acid. It is a marker for acute phase inflammatory response, with increased levels observed in inflammatory diseases. Aim: To estimate the levels of SA in psoriasis patients and to correlate with the severity of the disease. Materials and Methods: This case-control study was conducted among 50 patients, diagnosed with psoriasis, and 50 age and sex-matched subjects without psoriasis. General, systemic and dermatological examination was carried out. The severity of psoriasis was assessed according to Psoriasis Area Severity Index (PASI). The serum was treated with ethanol and centrifugation to precipitate proteins. The SA of both the precipitate and supernatant was estimated based on the reaction of SA with the ninhydrin reagent. Calculation of sialic acid was done by the formula: OD of test/OD of standard×concentration of the standard. To establish a correlation student’s t-test was used. Results: There were 39 males and 11 females in each case and control group. The mean±SD age of cases and controls was 44.04±10.9 years and 44.10±9.996, respectively. The mean PASI value was 23.1666±18.47. Mean SA in cases and controls were 35.792±2.124 and 28.556±3.854 (p-values <0.001). A positive correlation was observed between the free SA and psoriasis severity (p-value <0.001, r=0.460). Conclusion: Higher levels of free serum SA were significantly associated with more severe forms of psoriasis.

Clinical Profile and Serotyping of Rotavirus Diarrhoea in the Postvaccination Period: A Single-centre Cross-sectional Study

Gunasekaran Sabharritha, Krishnaswami Devi Meenakshi, Dhandapani Prabu

Introduction: Rotavirus is the leading cause of severe, life threatening gastroenteritis in infants and young children. As rotavirus strains vary between geographic areas, region specific genotyping information is highly vital to study rotavirus epidemiology and to monitor strain variation after vaccine introduction. Aim: To estimate the prevalence of rotavirus diarrhoea and strains causing the infection among children younger than five years of age and to study the clinical profile of rotavirus diarrhoea to ascertain factors associated with rotavirus infection in them. Materials and Methods: This hospital-based cross-sectional study was carried out on 150 children under five years with diarrhoea in the Department of Paediatrics, Government Medical College, Chennai, Tamil Nadu, India from November 2017 to August 2018. The clinical severity was assessed by using Vesikari score. By using PremierTM Rotaclone ELISA Kit rotavirus antigen was detected. Positive samples were tested for RNA identification by Reverese Transcriptase-Polymerase Chain Reaction (RT-PCR). The IBM Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical analysis. Results: The prevalence of rotavirus diarrhoea was 17.3% and positive samples belonged to G3 type. Prevalence of rotavirus diarrhoea among the vaccinated children was less when compared to unvaccinated children (p-value 0.034). Clinical severity score (Vesikari score) indicated that patients infected with rotavirus had severe disease as compared to rotavirus non infected patients (p-value 0.011). The duration of hospital stay was longer in rotavirus-positive children as compared to rotavirus-negative children (p-value <0.001). Conclusion: This study highlights the serotype specific prevalence of rotavirus diarrhoea in under five children. Rotavirus has been found to have more severe and prolonged illness among unimmunised under five children; thereby, reinforcing the need for routine rotavirus vaccination.

Assessment of Oxidative Stress Indicators among Patients with Sickle Cell Anaemia versus Non Sickle Cell Iron Deficiency Anaemia: A Case-control Study

Introduction: In sickle cell anaemia, haemolysed iron is reutilised, moreover, iron stores are increased owing to the blood transfusions, hence, iron deficiency is less common in sickle cell anaemia. But iron decompartmentalisation, due to unstable haemoglobin, is thought to be the cause for oxidative stress. Hence, iron deficiency anaemia and sickle cell anaemia need to be compared and studied to provide better treatment and awareness. Aim: To compare the oxidative stress, antioxidants and iron indices among patients with Sickle Cell Anaemia (SCA) and Iron Deficiency Anaemia (IDA). Materials and Methods: A case-control study was conducted at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, from January 2016 to December 2018. Total 240 SCA patients {120 SS (homozygous disease) and 120 AS (heterozygous trait)}, 120 patients with IDA and 120 age-matched and sex-matched controls were included in present study. Oxidative stress markers Malondialdehyde (MDA), Catalase, Superoxide Dismutase (SOD), vitamin C and vitamin E, zinc and iron indices {Iron, Total Iron Binding Capacity (TIBC) and serum ferritin} were analysed. Data was analysed using descriptive and inferential statistics using Analysis of Variance (ANOVA). Results: The mean age of SS patients was 19.01±11.43, AS was 22.01±11.78 years, control was 22.63±12.17 years, and IDA was 18.50±11.46. There was an equal distribution of both males and females in all groups. The mean of haemoglobin in SS was 7.40 g/dL, AS was 10.31 g/dL, IDA was 8.63 g/dL, and control was 14.81 g/dL. The mean value of mean corpuscular volume for SS was 65.71 fL, AS was 65.64 fL, IDA was 72.38 fL, and control was 87.68 fL. Zinc for SS was 82.65 μg/dL, AS was 82.13 μg/dL, IDA was 43.33 μg/dL, and control was 103.99 μg/dL. Conclusion: There is impairment in the oxidant and antioxidant status among patients with sickle cell anaemia with and without IDA.

Association of Gonial Angle with Hand Grip Strength in Vertical, Horizontal and Average Growers: A Cross-sectional Study

Introduction: The orthodontic treatment focuses on improving facial aesthetics and functional occlusion by improving the masticatory function, including masticatory chewing pattern, masticatory muscle activity, maximum occlusal force, and occlusal contact area. In orthodontics, every decision is based on the patient’s growth pattern and muscle strength. Aim: To evaluate the gonial angle, hand grip strength and association of the gonial angle with Hand Grip Strength (HGS) in vertical, horizontal and average growers. Materials and Methods: This cross-sectional study was conducted from 24^th June 2021 to 24^th July 2022 in the Department of Orthodontics at Sharad Pawar Dental College and Hospital in Sawangi, Wardha District, Maharashtra, India on a total of 196 patients. Data were categorised according to the growth pattern. For the vertical growth pattern, 49 patients were selected, 49 for the horizontal growth pattern, and 98 for the average growth pattern. A Jamar hand dynamometer was used to measure HGS and gonial angle using a lateral cephalogram. Study compared the results using inferential and descriptive statistics with a Analysis of Variance (ANOVA) (one-way) and multiple comparisons with the Tukey’s test. Also, p-value <0.05 was considered as a level of significance. Results: The data of total of 49 patients in vertical growth pattern, 49 for the horizontal growth pattern, and 98 for the average growth pattern was collected and analysed. Grip strength and gonial angle were compared between horizontal, average, and vertical growers. The gonial angle ranged from 101°to 124° in the average growth pattern, 81° to 99° in the horizontal growth pattern and 121° to 156° in the vertical growth pattern. The HGS in the horizontal growth pattern patients ranged from 27.2 kg to 57.5 kg. The HGS in the vertical growth pattern ranged from 14.7 kg to 37.7 kg. In the vertical growth pattern, the HGS was decreased compared to the horizontal growth pattern group. To determine the factor of HGS, gonial angle is the most prominent one. The assessment of growth patterns is vital in diagnosis and treatment planning. Conclusion: The study concluded that, due to weak muscle strength, vertical group cases should be treated more carefully.

Burden of Hepatitis B Virus at a Tertiary Care Hospital, Doda, Jammu and Kashmir, India: A Cross-sectional Study

Sameera Akhtar, Sufhia Akhtar, Shoket Ali, Nazia Tabassum

Introduction: Hepatitis B Virus (HBV) causes most frequent chronic liver disease of infectious origin in human beings worldwide, with more than 600,000 deaths caused by end-stage liver disease complications per year. The most used test for identifying acute HBV infections and carriers is the detection of HBsAg. Immunochromatography assays have been suggested for routine use in clinical microbiology laboratories for the detection of HBsAg since they are easy to use, affordable, don’t need specialised equipment, and are straightforward to run. Compared to commercially available HEPA card kit for the detection of the same markers, Enzyme Linked Immunosorbent Assay (ELISA) was shown to be more sensitive for the detection of HBsAg. This study is first of its kind in District Doda, Jammu and Kashmir, India. Aim: To know the burden of HBV in a Tertiary Care Hospital, Government Medical College, Doda using HEPA card kit and ELISA method. Materials and Methods: The present hospital-based cross-sectional study was carried out in the Department of Microbiology, Government Medical College and Hospital, Doda Jammu and Kashmir, India during the period from January 2020 to December 2020. The study comprised blood samples from all age groups referred by clinical departments for testing HBsAg. Tests were performed using an immunochromatographic technique (HEPA card Diagnostic enterprises) for the qualitative detection of HBsAg, and results were interpreted in accordance with the manufacturer’s guidelines. The collected data was analysed in Microsoft excel sheet using Chi-square test to know the burden of HBV infection. Results: Among total number of 5,448 samples tested, 50 (0.92%) were positive for HBsAg which comes under low epidemicity (<2%) as per World Health Organisation (WHO) guidelines. The number of positive females and males were 30 (0.84%) and 20 (1.07%), respectively. Females were predominate over males and majority of the positive patients (N=29) were younger than 40 years though prevalance (2.1%) was higher in age group above 40 years. All samples which shows positive by rapid test were also shown positive by ELISA test. Conclusion: Overall prevalence of HBV was 0.92% which comes under low epidemicity (<2%) as per WHO guidelines. It can be an alternate option for community based studies and also helps to improve the public health and to prevent the spreading of disease in the local population.

Reasons and Barriers of Breast Self-examination among Affluent Women: A Cross-sectional Study

Sheldon Thompson, N Pragathi Kumar, Tagaram Ramchandra, S Priyanka

Introduction: Breast Self-examination (BSE) is the simplest and easiest way to look for abnormalities. It’s an inexpensive and easy procedure that needs to be implemented from a young age. BSE will help in early diagnosis and treatment of benign and malignant tumours. Inadequate knowledge about BSE was seen usually in non affluent women. Though, affluent individuals have access to good and better healthcare, still there seems to be a lack. Aim: To understand the reasons and barriers among affluent women concerning BSE. Materials and Methods: This descriptive cross-sectional study was conducted in the field area of Ayaan Institute of Medical Sciences, Hyderabad, Telangana, India, from March 2021 to February 2022. A total of 250 women were included in the study between the ages of 21-49 years. Data was collected using a predesigned pretested questionnaire to evaluate socio-demographic, reasons and barriers to BSE. Data were presented in numbers and percentages. Results: The mean age of the study population was 34.60±8.31 years. All 250 women were educated and with the majority being graduates 176 (70.4%), only 140 (56%) had a working occupation and 205 (82%) were married. The feeling of mass in either of the breast 123 (49.2%), followed by family history of breast cancer 99 (39.6%) and breast pain 92 (36.8%) were the common reasons for performing SBE. The barriers to self-examination were majorly due to lack of knowledge 164 (65.6%), lack of breast complaints 164 (65.6%), absence of lump 130 (52%), followed by 115 (46%) who did not like to touch their breast. Forgetfulness was seen in 93 (37.2%) subjects. Conclusion: Poor awareness of the BSE practice exists even among affluent women. There is an urgent need for awareness about screening techniques, including BSE, in media and health facilities.

Low Interscalene Brachial Plexus Block with Dexmedetomidine and Clonidine as Adjuvants to Local Anaesthetic Mixture: A Double-blind Randomised Clinical Study

Introduction: For routine and emergency upper limb surgeries, brachial plexus block is better alternative to general anaesthesia. As compared to classic Interscalene brachial plexus Block (ISB), Low Interscalene Block (LISB) deposit Local Anaesthetic (LA) more caudad causing sensory-motor blockade of upper limb. It acts as bridge between supraclavicular and classic ISB. Local anaesthetic mixture are used to shorten the onset of sensory-motor blockade. Alongside, various adjuvants are mixed with LA to further improve quality of block. Aim: To compare the efficacy of dexmedetomidine and clonidine as adjuvants to LA mixture in LISB for upper limb surgeries to assess onset and duration of sensory-motor block and to observe any complication associated with block. Materials and Methods: This double-blind, randomised prospective clinical study was conducted on 90 patients, aged 18-60 years, posted for upper limb surgeries with American Society of Anaesthesiologists (ASA) grade I, II at a tertiary care centre of Government Medical College, Patiala, Punjab, India from February 2021 to November 2021. The patients were randomly divided into three groups. Group I: levo-bupivacaine 0.5% (20 mL)+lignocaine 2% (10 mL)+Normal Saline (NS) (1 mL), group II: levo-bupivacaine 0.5% (20 mL)+lignocaine 2% (10 mL)+dexmedetomidine 50 mcg (1 mL), group III: levo-bupivacaine 0.5% (20 mL)+lignocaine 2% (10 mL)+clonidine 50 mcg (1 mL). The parameters observed were: onset and duration of sensory and motor block, any intraoperative complication. Data was compiled with the help of MS-Excel and analysis done with IBM Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean onset time of sensory and motor block was faster in group II (4.20±0.62, 5.25±0.89 min) as compared to group III (5.24±0.99, 6.23±0.96 min) and group I (6.48±0.87, 7.03±1.02 min). The mean duration of sensory and motor block was prolonged in group II (743.38±12.55, 673.21±22.29 min) as compared to group III (480.65±14.72, 433.03±7.28 min) and group I (311.28±5.75, 272.03±6.09 min). No adverse effect was observed during this study. Conclusion: Dexmedetomidine was more effective than clonidine as an adjuvant to LA mixture (0.5% levobupivaciane+2% lignocaine) in low interscalene brachial plexus block and no episode of pneumothorax and phrenic nerve palsy was seen.

Reliability and Validation of a Newly Proposed Score-based Criterion for Minimal Invasive Pulpal Diagnosis and Treatment Planning

Ajay Singh Rao, Unnati Shah, Suwidhi Ranka, Dikshit Solanki

Introduction: A thorough case history aids in proper diagnosis and treatment planning. Since many years various case history formats or questionnaires have been followed, which are too long as well as they lack any numerical support for the responses. Hence, it makes all of them less precise and less accurate. Aim: To develop and validate a newly proposed score-based criterion for minimal invasive pulpal diagnosis and treatment planning. Materials and Methods: The present cross-sectional study was conducted at the Department of Conservative Dentistry and Endodontics, K.M. Shah Dental College, Vadodara, India, from December 2021 to April 2022. Study included 200 subjects with pain in maxillary or mandibular teeth due to primary carious lesion participated. This study included two groups of experts: group I had two experienced endodontists, who examined the patients based on their knowledge and experience using traditional diagnostic methods and a standard treatment plan was advised and group II had two calibrated experts endodontist (primary investigator) and a general dentist (co-investigator) using this newly proposed score-based evaluation criterion and a minimal invasive treatment plan was suggested. Each patient was examined by both the groups. The statistical analysis for the agreement between standard treatment plan (group I) and suggested treatment plan (group II) was done via Cohen Kappa test. Results: Of total participants, 108 (54%) were females and 92 (46%) were males and the mean age of participants was 36.26±12.72 years. The mean age of females and males was 34.26±12.17 years and 38.61±13.01 years, respectively. The result of the study showed almost perfect agreement (kappa=0.918, p-value <0.001) between both the groups indicating high accuracy of the newly proposed score-based criterion. Conclusion: This newly proposed score-based criterion offers a minimal invasive diagnosis and treatment planning with a strong numerical support that can be efficiently used by the general practitioners and the endodontists in their routine clinical practices as well as by the academicians/researchers for case selection for clinical trials/studies in field of endodontics.

Prevalence of Abnormal Uterine Bleeding and its Associated Risk Factors in Women of Perimenopausal Age Group- A Retrospective Study

Introduction: Abnormal Uterine Bleeding (AUB) is defined as any deviation from the normal menstrual cycle that is abnormal in regularity, duration, volume and frequency. AUB may be accompanied by pain and discomfort which presents a substantial burden on patient’s health, quality of life, society and healthcare system. There is also an increased incidence of associated co-morbidities like thyroid disease, diabetes and hypertension in AUB cases. Aim: To estimate the prevalence of AUB according to the PALM-COEIN classification and its associated risk factors in the perimenopausal age group. Materials and Methods: This retrospective study was conducted in the Gynaecology Department of Malabar Medical College, Kozhikode, Kerela, India. The data was collected from the medical records and computerised system of the hospital for a period of one year from January 2021 to December 2021. A total of 225 patients in the perimenopausal age group (40 years and above) attending Gynaecology Outpatient Department (OPD) and admitted with complaints of AUB was included. Patient’s information such as age, menstrual history, obstetric history, medical and surgical history, laboratory tests, imaging findings, endometrial biopsy results was obtained and analysed. Data was entered in Microsoft excel and analysed by using Statistical Package for the Social Science (SPSS) version 24.0. Results: The total number of patients attending the Gynaecology OPD during the study period was 11765. The total number of AUB cases during the study period were 2154, so the prevalence for AUB was 18.3%. For the associated risk factors, 255 patients were considered, where maximum number of patients 103 (45.3%) were in the age group of 45-49 years. Structural causes accounts for 175 (77.6%) cases. Hypertension was the most common risk factor associated with AUB 68 (30.2%), followed by diabetes 32 (14.2%) and thyroid disorders 15 (6.6%). Conclusion: The prevalence of AUB was 18.3% in present study. Abnormal Uterine Bleeding-Ovulatory dysfunction and Abnormal Uterine Bleeding- Endometrial had statistically significant association with thyroid disease.

Magnesium Sulphate as an Adjuvant to Ropivacaine in Bilateral Transversus Abdominis Plane Block for Laparoscopic Cholecystectomy: A Randomised Double-blind Clinical Study

Wasim Mohammad Bhat, Masrat Jan, Mubashar Ul Islam, Basharat Ahad

Introduction: Magnesium sulphate has the potential to treat and prevent pain by acting as an antagonist at N-methyl-D-Aspartate (NMDA) receptors. Many researchers found that magnesium sulphate as adjuvant to local anaesthetics reduces analgesic requirements in the postoperative period. Aim: To evaluate magnesium sulphate as an adjuvant to ropivacaine in ultrasound guided bilateral Transversus Abdominis Plane (TAP) block with respect to postlaparoscopic cholecystectomy pain. Materials and Methods: The present randomised double-blind clinical study was conducted in the Department of Anaesthesiology, SKIMS Medical College, Srinagar, Jammu and Kashmir, between January 2022 and June 2022. Total 80 patients of American Society of Anesthesiologists (ASA) grade I and II were divided into two groups. Group A (n=40) patients received ropivacaine with magnesium and group B (n=40) patients received ropivacaine only. Pain was measured using the Visual Analogue Scale (VAS). Total rescue analgesia consumption during 24 hours, time to first request of rescue analgesia, postoperative nausea vomiting, sedation score and patient satisfaction score were recorded. Mann-Whitney U test was used for VAS score and patient satisfaction score. Results: Mean age of patients was higher in group A (47.95±13.853 years) than group B (46.45±11.940 years). Group A had 12 males and 28 females while in group B, there were 11 males and 29 females in group B. Group A showed better analgesic profile in the form of lower mean VAS, which were statistically significant (p-value <0.05). However, time to first request of rescue analgesia (743.5±58.214 minutes in group A vs 668.50±214.375 minutes in group B; p-value=0.162) and total dose of rescue analgesia consumption were comparable in both groups (p-value >0.05). Also the sedation score (2.325±0.2529 in group A vs 2.295±0.2562 in group B; p-value=0.600) and patient satisfaction score (PSS) between the two groups (81.05±8.638 in group A vs 80.53±7.517 in group B; p-value=0.665) were statistically not significant. Incidence of postoperative nausea and vomiting was comparable in both groups (p-value=0.924). Conclusion: Addition of magnesium sulphate to ropivacaine in ultrasound guided bilateral TAP block significantly reduced pain scores in patients undergoing laparoscopic cholecystectomy.

Quality Audit Towards Improvement of Transfusion Services: An Institutional Assessment

Nikhil, Subhashish Das, R Kalyani

Introduction: Maintaining quality in transfusion services is a vital cogwheel of Quality Management System (QMS) in a hospital to impart safe blood to the patients. Quality Indicators (QI) play a pivotal role in quality management as they dispense imminent information regarding the execution of transfusion services and could help in utilising QI as a benchmark for safe quality of blood. Less is known about the authentic utilisation of QI in hospitals. Aim: To assess the comprehensive quality performance of the blood centre and evaluating the five obligatory QIs as per National Accreditation Board for Hospitals and Healthcare Providers (NABH) and make necessary suggestions for refinement of the same. Materials and Methods: The cross-sectional study was conducted at the blood bank attached to RL Jalappa Hospital, Tamaka, Kolar, Karnataka, India. The five compulsory QIs, as defined by NABH, were noted and monitored on monthly basis, from December 2019 to December 2020. The particulars were collected in a methodical outline and root causes for any deviation were assessed. Accordingly, particular corrective and preventive measures were taken. Data was entered in Microsoft excel spreadsheets and analysed using Statistical Package for Social Sciences (SPSS) v22 software. Results: The mean transfusion reaction rate was 0.18 in patients, with a highest value of 0.9 noted in the month of March-2020; there was no transfusion reaction at all in the month of February, April, June, July, October, November and December-2020. The mean wastage rate was 12.9. The maximum wastage was noted in August-2020 (21.7%) and was least in October 2020 (7.2%). Turnaround Time (TAT) was <30 minute for emergency cases with a mean of 27.11 minutes. For routine cases mean TAT was 140.9 minutes. Conclusion: Stringent enforcement of quality indicators, as mandated by NABH, can help in preventing errors in transfusion services. This, in turn, helps in maintaining a better quality and performance of the blood bank.

Response of Antipsychotic Drugs in Late-onset and Early-onset Schizophrenia in the Vindhya Region, Central India: A Prospective Cohort Study

Suneel Singh Kushwah, Prashant Maravi, Akshat Varma, Daisy Rure

Introduction: Previous studies were predominantly on early-onset schizophrenia with little emphasis on clinical profile, therapeutic responsiveness and various investigational, biochemical and neuroimaging variables in Late-onset Schizophrenia (LOS), which is an emerging concern in elderly morbidity, and differs significantly from Early-onset Schizophrenia (EOS). Aim: To study the clinical profile, and response to various antipsychotic drugs in LOS and compare it with EOS. Materials and Methods: A clinical prospective cohort study was conducted in Shyam Shah Medical College, Rewa Madhya Pradesh, India, from January 2020 to June 2021, with baseline and follow-up assessment of psychotic and cognitive symptoms after four weeks using PANSS (Positive and Negative Syndrome Scale), MoCA (Montreal Cognitive Assessment) and BPRS (Brief Psychiatric Rating Scale) scales. A total of 51 patients were included in the study, divided into two groups of early and late-onset, attending the outpatient and inpatient services during the period at the centre and concomitant treatment with antipsychotics for four weeks. Statistical analysis was done in Statistical Package for Social Sciences (SPSS) version 21.0 with p-value of 0.05 as significant. Results: A total of 51 patients, 27 in EOS group and 24 in LOS were included and analysed in the present study. The demographic profile of late and EOS varied in mean age with EOS at 30.11 years and LOS at 57.66 years), gender distribution predominantly males (n=19) in EOS and predominantly females (n=20) in LOS) and the average age of onset of EOS was 22.05 years and LOS was 55.54 years. The duration of illness in EOS 7.98 years and LOS was 2.12 years. The mean PANSS score at baseline for EOS was 1.92±1.07 and LOS was 2.83±0.56 and four weeks for EOS was 1.70±0.91 and LOS was 2.83±0.56. The response in PANSS at four weeks as well as individual domain scale score such as hallucinations, suspiciousness, blunted effect, emotional withdrawal, active social avoidance showed significant results in both EOS and LOS. Conclusion: Schizophrenia can manifest for the first time in late life and manifestations of stringently defined schizophrenia is by no means confined to onset at younger ages. Although there are undoubted similarities between the symptoms of EOS and LOS, there are also clear differences, especially demographic and clinical characteristics, early identification of which will help in adequate intervention and prevention of further morbidity in the elderly.

Comparing Propofol-Ketamine and Propofol-Fentanyl as Procedural Sedation and Postoperative Analgesia for Total Intravenous Anaesthesia in Adult Patients Undergoing Short Surgical Procedures- A Randomised Clinical Study

Ayesha Khatun, Saikat Majumdar, Tapobrata Mitra, Swapnadeep Sengupta

Introduction: Total Intravenous Anaesthesia (TIVA), an immensely popular procedure of recent times is most often conducted using propofol as the main anaesthetic agent. Ketamine or fentanyl has also been regularly used to compliment with their analgesic action, which propofol lacks. Aim: To compare the induction characteristics, maintenance of anaesthesia, awakening and recovery characteristics while performing TIVA with either propofol-ketamine or propofol-fentanyl combinations. Materials and Methods: This randomised, single blinded study was conducted, from March 2020 to August 2021, in a tertiary care centre of Kolkata, India. Total of 76 patients of either sex, aged between 18-45 years with an American Society of Anaesthesiologist (ASA) physical status I and II, who were posted for short surgical procedures, with a duration of surgery less than 30 mins were equally divided into two groups. Group A received propofol ketamine (1:1), prepared by mixing 4 mL ketamine (50 mg/mL) with 20 mL of 1% Propofol (10 mL/kg), while group B received propofol-fentanyl solution (1:1) was prepared by mixing 4 mL (50 μg/mL) of fentanyl with 20 mL of 1% propofol (10 mg/mL). Induction was done with ketamine 10 mg/kg+propofol 1 mg/kg in group A and fentanyl 1.5 μg/kg+propofol 1.5 mg/kg while maintenance of anaesthesia was achieved with continuous infusion of the prepared solutions for either group, respectively at a rate of around 20 mL/hour or more, as per required to maintain the Ramsay Sedation Scale (RSS) score of 6. Intraoperative haemodynamic parameters, including respiratory rates, awakening time, recovery time and the possible the side-effects were recorded at regular intervals. Student’s t-test was used for quantitative data and Chi-square test for qualitative data. A p-value of less than 0.05 was considered statistically significant. Results: Patients of group B developed significantly more incidents of bradycardia (20 in group B and 3 in group A) and hypotension (28 in group B and 2 in group A). Respiratory depression was also significantly more in group B (p-value <0.005). However, recovery, awakening, VAS score and other side-effect profiles were all comparable in the two groups. Conclusion: Propofol-ketamine provides equipotent analgesia with better haemodynamic control and minimal side-effects in comparison to propofol-fentanyl while used in TIVA for adult patients undergoing short surgical procedures.

Role of Ovarian Artery to Uterine Artery Anastomosis in Uterine Artery Embolisation: A Retrospective Study

Introduction: Uterine Artery Embolisation (UAE) is now extensively recognised as a treatment for uterine fibroids, uterine artery pseudoaneurysms, and Uterine Arterio-Venous Malformations. The occurrence of collateral circulation from the ovarian artery to the uterine artery is one of the reasons for the failure of the process. The occurrence of ovarian failure and premature menopause after the UAE is high in patients with Utero-ovarian Artery (UOA) anastomosis. Aim: To classify UOA as per Razavi MK et al., angiographic classification and to determine the presence of such anastomosis in UAE procedure failure cases. Materials and Methods: A retrospective study was done for a period of two years from November 2017 to October 2019 in the Department of Radiodiagnosis, Government Kilpauk Medical College, Chennai, Tamil Nadu, India and Department of Interventional Radiology, Govt. Omandurar Multispeciality, Chennai, Tamil Nadu. UAE was performed with Poly Vinyl Alcohol (PVA) microparticles (300 to 500 μm in size) followed by capping with a gelatin sponge in all 25 cases and coils were used in three cases. The presence or absence of UOA and four different types as per Razavi MK et al., angiographic classification were noted. Results: Among 25 cases who underwent UAE, 14 had UOA. The majority (six cases) were type Ib, five cases were type Ia, two cases were type II and one case was type III. The bilateral anastomosis was noted in one case with type Ia and Ib on either side. Eight cases with UOA had successful embolisation. The UAE was successful in 16 cases, and failed in nine cases. Among various causes for failure, six out of nine were due to UOA. Among six failure cases of UOA, two cases were Type Ia, two cases were Type Ib, one case was Type II and one case was Type III anastomosis. Conclusion: The UOA is one of the major risk factors in the procedural failures of the UAE. Identification avoids non target ovarian embolisation.

A Cadaveric Study of Variations of Renal Artery from Nashik, Maharashtra, India

Introduction: Renal vascular anatomy is well known in the literature about its variations. The data of cadaveric study performed by different authors in different populations is suggestive of variable nature of existence of renal artery variations. A thorough knowledge of accessory renal arteries is important for planning and performing endovascular, laparoscopic, urological and radiological procedures and renal transplants. Aim: To study the variations of renal arteries in cadavers and to compare it based on laterality, sex and symmetry in Nashik region, Maharashtra, India. Materials and Methods: The present cross-sectional study was conducted at SMBT Institute of Medical Sciences and Research Centre, Dhamangaon, Nashik, Maharashtra, India, from May 2019 to June 2020 during routine abdominal dissection for medical undergraduate students. Total 25 cadavers (21 males and four females) were dissected to expose kidneys along with its arteries. The morphological variations (early branching renal artery and accessory renal artery) of renal arteries were noted and the data gathered were compared with respect to laterality, sex and symmetry. Statistical analysis was done using Chi-square test. Results: Out of 24 cadavers, six {5 (25%) males and 1 (25%) female} were found to have variations in renal arteries. The renal artery variations were present bilaterally in 2 (8.3%) cadavers. The variations in the renal artery were in the form of accessory renal artery in 6 (12.5%) kidneys and early branching renal artery in 2 (4.2%) kidneys. The variation based on sex were found in 5 (25%) males, while based on laterality were found in five (20.8%) right and three (12.5%) left kidneys. Conclusion: In the present study, 25% were found to have variations in renal arteries This finding will provide anatomical knowledge of variations in the renal arteries amongst the donor for kidney transplantation surgeries in the Nashik region of Maharashtra.

Prevalence of Oral Precancerous Lesions in Tobacco and Areca Nut Habituated Patients in Barpeta District, Assam, India: A Cross-sectional Study

Debojyoti Roy, Balmiki Datta, Bahnisikha Pathak

Introduction: Oral cancer has become one of the leading causes of death and disease globally as well as in India. Tobacco consumption is responsible for nearly half of all cancers in men and nearly one-fourth of cancers in women in India and more than two-third of oral cancers are directly attributable to tobacco use. Early detection of precancerous lesions and tobacco cessation activities, if conducted together can have high impact on reducing incidence of oral cancer. Aim: To study prevalence of oral precancerous lesions in tobacco and areca nut habituated patients in Barpeta district, Assam, India. Materials and Methods: The present observational, cross-sectional, hospital-based study was conducted on Outpatient Department (OPD) patients of Dentistry Department of Fakhruddin Ali Ahmed Government Medical College. College, Barpeta, Assam, India, from June 2021 to June 2022. Patients with tobacco and areca nut chewing habits were selected as study participants. Total number of study participants were 404. Oral cavity screening was done to detect oral precancerous lesion. History of tobacco and areca nut chewing habits were recorded in terms of gender, age, form of tobacco, duration and frequency. Chi-square test was used for statistical analysis. Results: Prevalence of oral precancerous lesions in tobacco consuming patients was 3.46% in smoke form and 9.9% in smokeless form. Premalignant lesions had been seen predominantly in male. Among the premalignant lesions prevalence of oral leukoplakia was highest (22.27%) followed by erythroplakia (4.46%). Overall, prevalence of precancerous lesions in tobacco and areca nut habituated patient in the present study was 37.62%. The association between prevalence of oral precancerous lesion with frequency and duration of habits was statistically insignificant (χ²=7.167, p-value=1.000). Conclusion: In the present study, prevalence of oral precancerous lesion in tobacco and areca nut consuming patients in Barpeta district was quite high. The findings from this present study can be used to design cohort study to further understand the relation between precancerous lesions in tobacco and areca nut habituated patients.

Quality of Life among Postmenopausal Women with Osteoporosis in Southern India: A Cross-sectional Study

Introduction: Osteoporosis is characterised by reduced bone mass and structural destruction of bone tissue which increases the brittleness of bone that leads to increased fracture risk. It is very common among postmenopausal women. Since osteoporosis is closely related to oestrogen deficiency, postmenopausal women are predisposed to it. The decrease in oestrogen during the menopausal transition period causes more bone resorption than formation, resulting in osteoporosis. Aim: To assess the quality of life of among the postmenopausal osteoporotic women without fracture and to find out the association of quality of life with selected demographic variables. Materials and Methods: The present cross-sectional survey was conducted at the Osteoporosis Clinic of Orthopaedic Outpatient Department of Kasturba Medical College Hospital, Manipal, India, between June 2019 and September 2021, after obtaining the permission from concerned authorities. The sample was 120 postmenopausal osteoporotic women who belong to the age group 45-65 years. Postmenopausal women with uncomplicated osteoporosis without fractures were included in the study. The independent variable was of quality of life of the postmenopausal women and the dependent variables were the age, religion, education, occupation, and Bone Mineral Density (BMD). After obtaining the informed consent, the participants were interviewed using Short Form-36 (SF-36) quality of life questionnaire. The questionnaire consisted of 36 items and eight subscales which are summarised in two domains: Physical Component Summary (PCS) and Mental Component Summary (MCS). The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) software version 22.0. The collected data was analysed using descriptive and inferential statistical measures. One way Analysis of Variance (ANOVA) and the Pearson correlation coefficient test was used to find out the association. Results: The mean±Standard Deviation (SD) age of the participants was 56.8±2.5 years, 99 (82.5%) participants were Hindus and n=52 (43.34) belonged to general category. Higher proportions of the women were housewives i.e., n=85 (70.83%). Higher scores show a better quality of life. The results of this study showed that participants scored less (29.99±9.56) in role limitations due to emotional problems. Also, the participants scored less (43.39±4.57) in the domain of MCS in comparison to PCS (47.78±4.53). Further, association of PCS and MCS scores of quality of life were tested (p-value <0.05) with selected demographic variables such as age, religion, education, occupation and BMD. The results showed that there was no significant association found between PCS scores and age (p-value=0.84), religion (p-value=0.94), occupation (p-value=0.805) and BMD (r=-0.058, p-value >0.05). Also, there was no significant association between MCS scores and age (p-value=0.69), religion (p-value=0.86), occupation (p-value=0.70) and BMD (r-value=-0.0604, p-value >0.05). Conclusion: The participants scored less in the subscale of role limitations due to emotional problems of the SF-36 questionnaire. The quality of life was less in the mental component subscore. This indicated that osteoporosis make the postmenopausal women anxious and affects their daily activities.

Foetomaternal Outcome in Pregnancy with Burn Injury: A Prospective Cohort Study

Diksha Ambedkar, Vijay Kumar, Yogesh Kumar Yadav, Rina Sharma, Charu Mishra

Introduction: Pregnancy is a state of an altered physiological process, and a burn injury during pregnancy, serves as an additive factor to this stressful state, such that it can directly or indirectly affect the faetomaternal outcome. Aim: To find out the effects of burn injury in pregnant females, in terms of maternal and foetal outcomes. Materials and Methods: This was a prospective cohort study, done in collaboration with the Department of Surgery at Rajashri Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, India, from September 2019 to November 2021, on 22 pregnant patients. All 22 confirmed cases of pregnancy with burn injury were included. Cases were evaluated in terms of age-wise distribution, parity, gestational age/trimester of pregnancy, cause of burn injury, Total Body Surface Area (TBSA) distribution, the relation of TBSA distribution with foetal and maternal mortality, and events associated with the burn injury. Data was analysed using trial version of Statistical Package for Social Sciences (SPSS) version 22.0. Results: Mean age of pregnant patients with burns was 25.22±2.3 years. Thirteen (59.09%) patients with burn injuries were married for one to three years, incidence was more in primigravidae 14 (63.63%). Domestic violence and suicide attempts accounted for 12 (54.54%) cases. Kerosene and gas explosions were a major cause of burn injury, that is 16 (72.72%) and 5 (22.72%), respectively. Sixteen (72.72%) patients had burns with TBSA between 31-50%. Foetal mortality was 15 (68.18%) and maternal mortality was 14 (63.63%). Conclusion: Faetomaternal outcome was directly related to TBSA involved in burns. Illiteracy, and cultural practices like the use of earthen lamps, wood, and charcoal used for cooking, were some of the important causes of burn injury.

Prevalence of Depression and Anxiety among Students Preparing for National Eligibility Cum Entrance Test- Undergraduate Exam in Chennai, Tamil Nadu, India

Introduction: Indian students are subjected to enormous stress to compete and perform since competitive exams have been made mandatory to enter professional courses. Inability to handle performance pressure, meet parental expectations, and achieve aspirations may lead to psychological distress and subsequent depression. Aim: To estimate the prevalence of depression and anxiety and identify the associated factors among National Eligibility cum Entrance Test (NEET) aspirants in the Chennai, India. Materials and Methods: The present community-based, cross-sectional analytical study was conducted at various NEET coaching centres in Chennai, Tamil Nadu, India, among 250 NEET aspirants between July and August 2021. A pretested, semi-structured, self-administered online questionnaire with 45 questions, consisting of the Beck Depression Inventory-II and Beck Anxiety Inventory, in the English language was used. Categorical data were presented as frequency and proportions. Pearson’s Chi-square test was used to evaluate differences between groups for categorised variables. Results: Out of the total 250 students, 147 (58.8%) were males and mean age of the participants was 19.38±1.146 years. Overall, 112 (45%) participants had attempted NEET-Undergraduate (UG) exam once and 94 (38%) participants had two attempts. The overall prevalence of depressive symptoms was 148 (59.2%) and anxiety symptoms were seen in all 250 (100%) participants. Symptoms of severe depression were high among those with three previous attempts (44) and those awaiting their first NEET attempt. The number of previous attempts had a statistically significant (p-value <0.001) association with the severity of anxiety symptoms. Conclusion: This high morbidity of depressive and anxiety symptoms highlights the need for access to preventive and curative mental health services for students preparing for highly competitive exams like NEET.

Prior Incubation as a Tool to Overcome Understaining of Leishman Stain: A Cross-sectional Study

Sneha Tata, Chethana Mannem

Introduction: A well stained peripheral smear is an integral part in the diagnosis and management of many clinicohaematologic conditions. Leishman stain is recommended universally by the International Committee for Standardisation in Haematology (ICSH). However, a commonly encountered problem in tropical countries, especially during the rainy season, is under staining by Leishman stain as a result of interference by the atmospheric moisture. Hence, incubation of slides and/or buffer prior to standard Leishman staining protocol could bring out best staining qualities. Aim: To assess the effects of prior incubation of slides and/or buffer on standard Leishman staining technique. Materials and Methods: The cross-sectional study was conducted over a period of eight weeks in the Central Laboratory, Kempegowda Institute of Medical Sciences, Bangalore, India, in the months of October to November 2020. Blood samples were received in the central laboratory for routine haematological investigations. Total of 100 samples of left over non haemolysed Dipotassium Ethylenediaminetetraacetic Acid (K2-EDTA) anticoagulated blood irrespective of age, gender and cell counts were included in the study. Slides were stained following prior incubation of slides and/or buffer at 37°C and compared with the standard staining technique. The staining characteristics of nucleus, cytoplasm and granules of White Blood Cells (WBCs), platelets and erythrocytes were observed. One-way Analysis of Variance (ANOVA) test and p-value of <0.05 was considered statistically significant and higher f value (>104.35152) rejected the null hypothesis. Results: Prior incubation of slides and/or buffer resulted in better stained smears which were found to be statistically significant (p-value <0.05) as compared to standard Leishman staining technique. Conclusion: Minor modifications when applied to standard Leishman staining technique such as prior incubation of slides and/or buffer at 37°C produced best staining characteristics to overcome the effects of humidity which normally interfere with staining of slides.

Reliability and Validity of Gujarati Version of WHO-5 Well-being Index in Community-dwelling Older Individuals: A Cross-sectional Study

Vipra Dalal, Subhash Khatri

Introduction: Major mental health issues like depression are not yet acknowledged as considerable public health challenges. The World Health Organisation (WHO-5) well-being index is a simple concise questionnaire consisting of five basic questions that evaluate respondents’ subjective well-being. The scale’s internal and external validity are good for assessing depression in older individuals. This scale serves as an essential tool to evaluate various mental health-related issues as part of regular health check-ups. Thus, there was a need to translate and validate the WHO-5 well-being index in the Gujarati language. Aim: To find out the validity and reliability of the Gujarati version of the WHO-5 well-being index in the community-dwelling older individuals. Materials and Methods: This cross-sectional study was conducted among various community-dwelling older individuals in Ahmedabad, Gujarat, India, from March to August 2022. Permission was taken from the developer of the original scale and translation and validation of the scale were done according to suggestions given by the developer. A total of 60 participants and eight professionals with a mean experience of 13.5 years in the field of psychology, physiotherapy and healthcare area were involved in the examination of each item of the Gujarati version of WHO-5. The Statistical Package for the Social Sciences (SPSS) version 26.0 was used for the statistical analysis. Results: The mean age of the participants was 67.02±4.77 years. The content validity ratio of all items of the Gujarati WHO-5 well-being scale was 1. Internal consistency of the Gujarati WHO-5 well-being scale was calculated through Cronbach’s alpha (α=0.89) suggesting high internal consistency. Test-retest reliability of the Gujarati WHO-5 well-being scale was calculated through the Interclass Correlation Coefficient (ICC=0.89) suggesting excellent test-retest reliability. Conclusion: Gujarati WHO-5 well-being scale is a simple, accurate and reliable measure for evaluating psychological well-being and mental health status.

Relationship of Hearing Impairment in Patients with Lamivudine Therapy: A Systematic Review and Meta-analysis

Mahesh Namdeo Belhekar, Kalpesh K Joshi

Introduction: Lifelong Antiretroviral Therapy (ARVT) in patients with Human Immunodeficiency Virus (HIV) infection damages cochlea. Hearing Loss (HL) has been reported with lamivudine therapy in both HIV and/or Hepatitis B Virus (HBV) infections. Hence, the benefit of lamivudine therapy in individuals affected by these infections and risk of development of HL needs to be studied to make an adequate benefit-risk assessment. Aim: To evaluate the relationship of hearing impairment in patients treated with lamivudine and diagnosed with either HIV or HBV infection. Materials and Methods: The present study is a systematic review in which English-language publications that assessed HL in patients who are on lamivudine drug therapy were included. The types of studies included were: prospective studies, retrospective studies, case reports and case series. A comprehensive database search (PubMed, PubMed Central, Cochrane review, Google scholar and Embase) was conducted to identify the relevant literature published on HL and were searched for keywords related to lamivudine and HL- ‘lamivudine and hearing loss’, ‘lamivudine and deafness’, ‘lamivudine and hypoacusis’, ‘lamivudine and hearing impairment’ and ‘lamivudine and ototoxicity’ for searching the data. The publications were independently reviewed and assessed for study quality and the data (title, author, year of publication, study design, study setting, population characteristics) extraction was done. Results: Out of 1,778 publications found at the initial stage, nine were included in the systematic review and quantitative meta-analysis. The majority (4/9) were cross-sectional studies. The prevalence of hearing impairment defined as per the protocol was 41% (total population 1,548). The I2 statistic was used to test statistical heterogeneity, with values of >50% representing important heterogeneity, then a random-effects model was used to perform the meta-analysis. A subgroup analysis was performed for the age group ≤18 years and >18 years. All analyses were conducted using the R software version 4.1.0. It was found that most of the studies (8/9) suffered moderate-serious overall risk across all the domains of ROBINS-1 tool. Conclusion: This study showed a positive association of HL with lamivudine in patients with HIV infection.

Association of Serum Beta-Trace Protein Levels in Patients with Chronic Kidney Disease: A Case-control Study

Mohit Thalquotra, Gundeep Kaur Brar, Rajinderjit Singh Ahi

Introduction: Chronic Kidney Disease (CKD) is common disorder showing decreased Glomerular Filtration Rate (GFR) value (<60 mL/min/1.73 m²). Because of limitations of creatinine as a biomarker of GFR, new alternative biomarkers are being investigated, such as Beta-Trace Protein (BTP) is low molecular weight proteins that are filtered by the glomeruli. Serum BTP have been shown to be more helpful for estimating GFR. Aim: To assess the role of Beta-Trace Protein (BTP) as a potential biomarker of Chronic Kidney Disease (CKD) in comparison to serum urea, serum creatinine, fasting blood sugar and Creatinine Clearance Rate (CCR). Materials and Methods: This case-control study was conducted at Government Medical College, Rajouri, Jammu and Kashmir, India, from February 2021 to December 2021. Total 50 known patients of kidney diseases and 50 healthy individuals above the age of 18 years were enrolled in the study. Blood samples were collected from all individuals and serum BTP, serum urea level, serum creatinine level, fasting blood sugar were measured. Correlation of BTP with serum urea level, serum creatinine level, Fasting Blood Glucose (FBG) level, and CCR was calculated by Pearson Correlation test. Results: In present study, 50 patients in case groups (33 male and 17 females) and 50 healthy controls (25 males and 25 females) were included. Among controls, the mean age of patients was 52.12±5.66 years and among cases 55.94±10.51 years. BTP level was increased two times (from 32.06±11.25 μg/mL to 66.36±27.80 μg/mL) in CKD patients than controls individuals. BTP level was positively correlated with serum urea level, serum creatinine level, and FBG level while negatively correlated with CCR. Conclusion: The BTP may be a useful and reliable serum marker for identifying the magnitude of renal dysfunction in patients with CKD and may have its place beside serum creatinine as an alternative endogenous GFR marker.

Effectiveness of Seminar Based Approach on the Level of Financial Literacy among Dental Students of Central Gujarat

Mital Thakkar, Mohit Verma, Medha Wadhwa, Subhasish Chatterjee

Introduction: Financial literacy refers to knowledge and skills related to effective and informed money management decisions. Healthcare professionals graduate with some of the highest student loan debt level. They complete their graduation with minimal unbiased financial planning guidance. Aim: To assess the effectiveness of seminar based approach on the level of financial literacy among dental students of Vadodara, Gujarat, India. Materials and Methods: This prospective interventional study was conducted in Vadodara, Gujarat, India from May 2021 to October 2021. The data was collected from 332 participants through a closed-ended questionnaire which included 83 statements related to banking, alternate banking, investment and income and expenditure. The data was assessed using Paired t-test to assess the effectiveness of financial education seminar at 95% confidence level. The software used was IBM Statistical Package for the Social Science (SPSS) Version 21.0 for Windows. Results: This study included 332 interns and postgraduate students, of which 209 participants were female while 123 participants were male. There was a significant difference in the knowledge of students on various financial aspects covered in the study before and after the seminar with respect to gender, age and category of students (p-value <0.05). There was a significant difference in the knowledge of participants before and after the seminar on financial literacy (p-value <0.001) Conclusion: The result shows that the score of the participants improved after the 90 minutes seminar which would be helpful to them for their future long-term investment decisions.

Efficacy of Stroke Volume Variation-guided Fluid Management of Patients undergoing Off-pump Coronary Artery Bypass Grafting: An Observational Comparative Study between Open and Closed Chest

Shilpa Durge, Nazmeen Imranali Sayed, Shakuntala Basantwani

Introduction: Functional haemodynamic monitoring using dynamic parameter such as Stroke Volume Variation (SVV), based on pulse contour analysis, helps in predicting fluid responsiveness in off-pump Coronary Artery Bypass Grafting (CABG) surgery. This allows adequate volume replacement to achieve optimal cardiac performance. Aim: To evaluate the efficacy of SVV in predicting volume responsiveness and effect on haemodynamic variable in patients undergoing off-pump CABG in both closed and open chest. Materials and Methods: This single-centre, non randomised observational study was conducted at a tertiary medical college and hospital (LokmanyaTilak Municipal Medical College and General Hospital) Mumbai, Maharashtra, India, from December 2016 to December 2018. A total of 34 patients undergoing elective off-pump CABG were included. Haemodynamic measurements Stroke Volume (SV), Cardiac Output (CO), Cardiac Index (CI), and SVV, were recorded with the transducer positioned at the level of midaxillary line. If the SVV was equal to or higher than 12, 100 mL fluid aliquot was given to patients. Endpoints for fluid aliquots was increase in CO by 15%, decrease in SVV of less than 12 or an increase Central Venous Pressure (CVP) upto 15 millimetre of mercury (mmHg). Number of times SVV above 12 during the procedure was recorded. SVV was considered as fluid responsive “if there was an increase in SV by 5%”. Statistical analysis was done using Student’s t-test (two tailed, dependent) on continuous parameters. The p-value <0.05, was considered significant. Results: Out of 103 events of rise in SVV, 65 (63.1%) occurred when chest was open and 38 (36.9%) while chest was closed. The SVV-guided fluid response was 76.3% in closed chest and 75.4% in open chest and there was no significant difference. (p-value=0.91). There was a significant increase in SV (p-value <0.01), CO (p-value=0.04), and significant decrease in SVV (p-value <0.01) and heart rate (p-value <0.01) after fluid loading in the responsive group when compared with non responsive group. There was no statistically significant difference between percentage change in SV, CO, CI, SBP, DBP, MAP and CVP between closed and open chest conditions after fluid replacement. Conclusion: The SVV is not affected by open or closed chest conditions in mechanically ventilated patients undergoing CABG and can be used as a guide for fluid replacement. Weather open or closed chest conditions, few patients do not respond to fluid replacement when SVV are more than 12 by an increase in SV, cardiac output or CI, the cause of which remains to be determined.

Assessment of Macro and Micronutrient Levels Associated with Gallbladder Cancer among Women of Eastern Uttar Pradesh and Western Bihar: A Case-control Study

Introduction: Gallbladder Cancer (GBC) is highly fatal due to late-stage diagnosis and poor prognosis. Women are more prone to GBC than men. Imbalanced nutrient intake is cited as a risk factor for GBC. Association of nutrients with GBC incidence assessed using 24-hour recall method may mislead as food intake is altered in disease condition. The Food Frequency Questionnaire (FFQ) method that assesses usual nutrient intake pattern would be a better approach. Aim: To evaluate the association of macro and micronutrients in women with GBC using the FFQ method. Materials and Methods: This case-control study was carried out at a tertiary care hospital of Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from September 2018 to August 2019. A total of 82 women with GBC, aged 40 years and above, considered as cases and 164 healthy controls were included in the study. Data was collected regarding food intake, following the FFQ method, which included breakfast, lunch, dinner, and other extra intakes. Macro and micronutrients were computed using a raw database of food. A multivariate statistical approach was adopted as the nutrients were correlated. Results: The mean age of the controls (45.7±10.1 years) was significantly lower than the GBC cases (55.2±11.0 years). Preponderance in both cases and controls was of Hindus, rural and Other Backward Class (OBC) women. Illiterate patients were more than twice than the controls. Intake of 12 nutrients i.e., protein, fat, phosphorus, zinc, manganese, and carotene were higher and of calcium, potassium, selenium, vitamin-C, vitamin-E, and fibre were lower in cases than the controls. These 12 nutrients completely separated cases and controls. However, zinc, manganese, potassium, and fibre whose contributions were lowest when ignored, the separation ability to cases and controls remained the same as of 12 nutrients. Conclusion: Protein, fat, phosphorus, carotene, calcium, selenium, vitamin-C and vitamin-E, were found to be associated with GBC risk. Therefore, further understanding the role of nutrients in bringing about the right intervention to reduce the incidence of GBC is needed.

Knowledge and Attitude about Emergency Management of Avulsed Tooth Amongst Paramedical Students of Visnagar, Gujarat: A Questionnaire-based Cross-sectional Study

Shoba Fernandes, Heli Shah, Yash Bafna, Dharati Patel, Harsh Mistry, Kavya Shah

Introduction: Dental trauma has emerged as a significant aspect of dental public health. Traumatised teeth require early and appropriate treatment, which frequently relies on the competence of the dentists, doctors and nurses, who provide the primary care. Aim: To assess the knowledge and attitude of paramedical students about the emergency management of avulsed tooth. Materials and Methods: A cross-sectional questionnaire survey consisting of 17 questions was designed and circulated among 365 paramedical students (nursing, pharmacy and physiotherapy) of Sankalchand Patel University, Visnagar, Gujarat, India, to assess their knowledge and attitude about the emergency management of avulsed tooth. Descriptive statistics were applied by Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Total 260 (71.23%, mean age of 23 years) students responded, with 71 students from Physiotherapy, 106 from Nursing and 83 from Pharmacy. A total of 178 (68.46%) students comprehend the meaning of avulsion. While 193 (74.23%) students had knowledge that tooth re-implantation is possible. Of all the respondents, 192 students (73.84%) were familiar about the benefit of mouth guards for prevention of sports injury and 125 students (48.07%) had the opinion, that it is very important to be acquainted with emergency management of dental trauma. Conclusion: Though the paramedical students had good understanding about tooth avulsion, they were unaware about the emergency management of the situation. This warrants the need of incorporating training programmes, dedicated to the subject in their curriculum.

Comparative Estimation of Arginine Content in Peanuts: An Analytical Study

Archana Voleti, Narasinga Rao Bandaru, K Sethumadhavan

Introduction: Arginine is an amino acid that has several positive effects on human health and peanut seeds are the richest source of it. Peanuts are the store houses loaded with proteins, fatty acids, vitamins, fiber and other phytochemicals. It has been shown that the intake of arginine at the concentration of 3-6 g/day has been found to improve the cardiovascular system, reduce intestinal permeability and activate the immune system that aids in early recovery of tuberculosis patients. Aim: To evaluate the variation of arginine content in raw, boiled, soaked, soaked and boiled type of peeled and unpeeled peanuts Materials and Methods: The analytical study on various groups of peanuts (raw, boiled, soaked, soaked and boiled peanuts of both peeled and unpeeled varieties) was conducted at Gayatri Vidya Parishad Institute of Health Care and Medical Technology at Visakhapatnam, Andhra Pradesh, India, in December 2019. The arginine content was estimated in peanut seeds using the Sakaguchi method by Spectrophotometry at wavelength of 520 nm. Descriptive statistics were done for all 12 groups and were represented with mean, standard deviation and standard error. Analysis of Variance (ANOVA), Post-hoc Tukey’s tests were applied to find statistical significance. The p-value <0.05 was considered as statistically significant. Statistical Package for Social Sciences (SPSS) version 25.0 was used for analysis. Results: Concentration of arginine was recorded for each type in triplicate considering the mean. The raw soaked peeled peanuts had the lowest concentration of arginine (31.82 μg/g) and the soaked boiled for 15 minutes, unpeeled peanuts had the highest amount of arginine (1438.18 μg/g). Significant difference was found among the twelve groups by using ANOVA test p<0.001. Soaked and boiled 15 min peeled peanuts, soaked unpeeled, soaked and boiled 15 min unpeeled and soaked and boiled 30 min unpeeled were significantly different when compared to the remaining groups using Post-hoc Tukey’s test p<0.05. Conclusion: Soaked, boiled and unpeeled peanuts were the best types with the highest amounts of arginine which could be chosen as adjuvant nutritional therapeutic supplement to aid in the recovery of certain diseases.

Prevalence and Morphological Pattern of Haematopoietic Malignancy Involving Oral Cavity at a Tertiary Care Hospital, Chengalpattu District, Tamil Nadu, India

Anitha Murali, N Sangeetha, Saumya Gaur, P Viswanathan

Introduction: Lymphomas, a cancer of lymphoid tissue (either B or T-lymphocytes) are the second most common malignant tumour in the head and neck after squamous cell carcinoma. Extranodal Non-Hodgkin’s Lymphoma (NHL) in the oral cavity is thought to be rather uncommon. Aim: To study the prevalence and morphology of oral cavity-related haematopoietic malignancies. Materials and Methods: A descriptive cross-sectional study on 1089 cases of oral lesions at a Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India, was undertaken in the Pathology Department from July 2012 to July 2022. Demographic information including age, sex, clinical information, histopathological diagnosis, and investigational details were recorded. Morphology of oral cavity lesion was considered as primary outcome variable and the data was represented in frequency and percentage and the descriptive analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. Results: A total of 1089 patients, age distribution range from 10-70 years were analysed in this study. Majority were noted among 41-50 years 423 (38.8%), followed by 51-60 years 257 (23.5%). Buccal mucosa was the commonest site for lymphomas constituting 510 (46.8%), gingiva occupied 132 (12.2%). All NHL (N=3) cases were reported as B cell lymphoma constituting 03 (100%). Conclusion: Non-Hodgkins Lymphoma in oral cavity is very rare in occurrence and amongst them B-cell form of oral NHL was more frequent. It should always be considered in the differential diagnosis of intraoral malignant diseases.

Severity of Menopausal Symptoms in Women Posthysterectomy at a Tertiary Care Hospital, Tamil Nadu, India: A Cross-sectional Study

Sahasra Reddy, Vijayalakshmi Kandasamy, Ranoji V Shinde

Introduction: Menopause, a natural occurrence in women’s lives, is characterised by a drop in ovarian hormones, oestrogen, and progesterone levels. Sudden hypoestrogenic state, that is caused by hysterectomy leads to the development of menopausal symptoms. Aim: To assess the occurrence and severity of menopausal symptoms in women, who underwent hysterectomy for benign gynaecologic conditions. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, over a period of three months. The study included 100 women in the age group of 35-55 years who had undergone hysterectomy for benign conditions were invited to participate in the study. Those who agreed to the study and completed the questionnaire after six weeks and three months postoperatively were included in the present study. Menopausal symptoms and severity were assessed using modified Menopause Rating Scale (MRS) scale. Posthysterectomy menopausal symptoms at six weeks and three months, were compared using Chi-square test. Results: The mean age of the study participants was 45.85±6.24 years. Most of them, 52 (52%) had heavy menstrual bleeding, 28 (28%) of the study participants had no associated co-morbidities. A total of 54 (54%) of the women of this study was diagnosed as Abnormal Uterine Bleeding-Leiomyomas (AUB-L). Majority 76 (76%) of them had undergone total abdominal hysterectomy with or without bilateral salphingoopherectomy. Mean duration of hospital stay 7.48±2.02 days. Postoperative diet of these women included calcium containing foods 57 (57%), iron containing foods 68 (68%). There was a statistically significant difference in majority of menopausal symptoms like hot flushes, palpitations, night sweats, reduced duration of sleep, anxiety, lack of interest in sex, forgetfulness and joint and muscle pains between six weeks and three months postoperatively. Conclusion: The present study concluded that the symptoms of hot flushes, difficulty in urinating, anxiety, joint and muscle pain was significantly higher at six weeks when compared to three months.

Comparison of the Efficacy of Ivalon^® Nasal Pack and Ribbon Gauze Pack Following Nasal Surgeries- A Randomised Clinical Trial

K Gowthame, S Prabakaran, RB Namasivaya Navin, Karthika Ranganathan

Introduction: Nasal bleeding is one of the Ear, Nose and Throat (ENT) emergencies which are usually managed by the Hippocratic manoeuvre. Anterior nasal packing is unavoidable after nasal surgeries and refractory anterior nasal bleeding. There are wide variety of newer nasal packs available and easily acceptable by the patients. The most commonly used nasal packs in day to day practices are Ivalon^® and vaseline soaked ribbon gauze pack. Aim: To compare the difference between Ivalon^® nasal pack with a traditional ribbon gauze pack in terms of efficacy, feasibility, patient comfort, cost and need for repacking postremoval in patients undergoing nasal surgeries. Materials and Methods: This randomised clinical trial involved 144 patients who required nasal packing after nasal surgeries, like septoplasty, Functional Endoscopic Sinus Surgery (FESS) and nasal bone fracture reduction in the Department of ENT, Head and Neck surgery at a Tertiary Care Centre, Chennai, India. Patients were categorised into two groups- Ribbon gauze group and Ivalon^® group. The patient’s comfort was quantified based on nasal discharge, pain on removing the pack, stuffiness of the nose, and irritability were compared. After pack removal, mucosal oedema, congestion, and synechiae formation were assessed by using a diagnostic nasal endoscopy after 1 week. Results: Out of 144 patients, in Ivalon^® group, 37 (51.4%) were males and 35 (48.6%) were females. The incidence of nasal symptoms with nasal surgery i.e nasal discharge was significantly higher in the ribbon gauze packing group (68.1%) compared to Ivalon^® pack (31.9%) (p-value=0.044). Pain on pack removal was also more in the former (76.4%) compared to Ivalon^® group (23.6%) which were statistically significant (p-value=0.005). Pain on pack removal was significantly more in the former (76.4%) compared to Ivalon^® group (23.6%). Other symptoms like anxiety, discomfort, stuffiness, local irritation, and congestion were lesser in the Ivalon^® group. Mucosal oedema was higher in ribbon gauze group (59.7%) compared to Ivalon^® pack (40.3%) which was statistically significant (p-value=0.019). Conclusion: As a postnasal surgery pack, Ivalon^® pack is a better option due to less pain, anxiety, stuffiness, local irritation, congestion, synechiae formation and gives better comfort when compared to the ribbon gauze packs.

Tibial Guidewire Insertion Timing- Does it Affect the Functional Outcome in Arthroscopic Anterior Cruciate Ligament Reconstruction? A Prospective Longitudinal Study

TS Nidhin, R Shibu, AS Shyam Roy

Introduction: Tibial fixation site of graft in arthroscopic Anterior Cruciate Ligament (ACL) reconstruction has an effect on anterior displacement and internal rotation of the tibia. The position of the interference screw determines the final orientation of the graft. The screw position in turn depends on the position of the tibial guidewire. The tibial guidewire can be placed, before introducing the graft or after the graft placement. There are no studies in the literature comparing the outcome of tibial guidewire placement timing in arthroscopic ACL reconstruction. Aim: To compare the functional outcome of arthroscopic ACL reconstruction, with placing the tibial guidewire before and after graft passage. Materials and Methods: This prospective longitudinal study was conducted at Government Medical College, Thiruvananthapuram, India, from February 2020 to January 2021, among patients undergoing arthroscopic ACL reconstruction. A total of 84 patients with an isolated ACL tear, who underwent arthroscopic ACL reconstruction were followed-up for a minimum period of nine months. Two groups were studied, each with 42 patients. In group 1, the tibial guidewire was placed posterolaterally in the tibial tunnel and then, the graft was pulled through femoral and tibial tunnels. In group 2, the guidewire was placed after the graft was passed through femoral and tibial tunnels. Functional outcomes were evaluated with International Knee Documentation Committee (IKDC) and Lysholm knee scores after nine months. Statistical analyses were carried out using Statistical Package for Social Sciences (SPSS) statistics version 22.0. Results: The median age of the study subjects were 27 (22;35) years. Fifty nine (70.2%) patients were males. Forty eight (57.1%) patients had left-sided injuries. The majority of injuries (n=58, 69%) were due to sports injuries. In 14 patients (16.7%), the mode of injury was due to road traffic accidents and in 12 patients (14.3%) it was due to a fall. In the majority of the cases (n=50, 59.5%), the duration between injury and ACL reconstruction was three months. The mean IKDC subjective score of group 1 was 86±5.51 and that of group 2 was 81.9±6.64; (p-value=0.003). The mean Lysholm score of group 1 was 84.9±8.73 and that of group 2 was 79.6±9.56; (p-value=0.009). Conclusion: Arthroscopic ACL reconstruction placing the tibial guidewire posterolaterally prior to graft passage has got a better functional outcome compared to placing the guidewire, after passing the graft. Prior placement of guidewire, before graft ensures the posterolateral position of the interference screw at the tibial tunnel and increases the graft obliquity.

Morphometric Measurements of Posterior Cruciate Ligament and its Clinical Implications: A Cadaveric Cross-sectional Study

Abhinav Kumar Mishra, Hetal Vaishnani

Introduction: Posterior Cruciate Ligament (PCL) is a band like structure which tightly adheres to femur and tibia with collagen fibres. It is considered as an active and primary stabiliser of the knee joint and it acts as the principal restraint against posterior tibial translation. Its anatomical knowledge is necessary for practicing surgeons. Aim: To study the morphometric parameters of total length and width of Posterior Cruciate Ligaments (PCL) at three points (proximal, central and distal) on both knee joints and their clinical correlation. Materials and Methods: The cross-sectional study was conducted at Smt. Bikhiben Kinjal Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, from August 2021 to May 2022. This cadaveric study was conducted over 40 knee joints of 20 formalin-fixed cadavers of unknown sex and measured the length and width of PCL with the help of digital caliper. Total length and width (proximal, central and distal) of PCL were measured and Mean±Standard Deviation (Mean±SD) were recorded. Independent t-test and Karl Pearson’s correlation coefficient were used to find out any possible association and correlation for various morphometric measures of right and left knee at 5% and 1% level of significance, respectively. Statistical analysis was done by the trial version of Statistical Package for Social Sciences (SPSS) version 21.0. Results: Total length of PCL of right and left knee was 33.19±3.09 mm and 33.12±3.40 mm, and range between 23.4-37.9 mm and 23.8-38.0 mm, respectively. The measurements of the width of PCL at different levels (proximal, central and distal) of right knee were 9.07±1.24 mm, 10.44±1.75 mm and 9.10±1.46 mm respectively, while in left knee they were 9.33±1.67 mm, 10.32±1.99 mm and 9.29±1.70 mm, respectively. T-test showed that there was no association for considered morphometric measures between right and left knee at α=5%. The correlation assessment showed strong positive correlations between left and right sides for both knees at different levels, which were significant p-value <0.001. However, no correlation was found between length and width (proximal, central and distal) for both knees. Conclusion: This study gives the valuable result of parameters of length and width of PCL, which helps for orthopaedic surgeons in the surgery and grafting of ligament in the case of trauma.

Angiogenic Index as a Measure of Angiogenesis in Prostate Cancer and Its Correlation with Gleason Grade and Score

Introduction: Microvessel density, as a measure of angiogenesis, predicts prognosis in prostate cancer. Angiogenic Index (AI, numerical value of angiogenesis) minimises the possible variation concerning the width of the microscopic field, stromal epithelial relations and cellular tumour size. Aim: To study AI in prostate cancer and its correlation with Gleason Grade (GG) and Gleason Score (GS). Materials and Methods: The present cross-sectional, study was done at Postgraduate Department of Pathology, Sarojini Naidu Medical College, Agra, India, from September 2019 to December 2020. Twenty five histopathologically confirmed prostate adenocarcinoma specimens from radical prostatectomy, Transurethral Resection of Prostate (TURP), and needle biopsy were included in the study. These cases were categorised according to Gleason Grade (GG); Gleason Score (GS) was assigned to each case. The GSs were simplified into three groups: low (GS 2-6), intermediate (GS 7) and high-grade (GS 8-10). Immunohistochemical {Cluster Differentiation (CD) 31} blood vessel staining was done to calculate AI. Statistical significance was determined by Unpaired t-test. Results: All the cases were males with age range from 55-76 years (mean age was 65.48±5.62 years). Mean AI was 13.74, 83.76, 163.27, 299.12 for the GG1, GG3, GG4, GG5, respectively. Mean AI was 29.72, 82.67, 129.15, 190.31, 206.71, 307.34 for GS 2, 6, 7, 8, 9, 10, respectively. Comparing GG among themselves, statistically significant difference in AI was found between GG3 vs GG4 (p-value=0.0056, r-value=0.5269). Difference was also statistically significant between GG3 vs GG5 (p-value=0.000011, r-value=0.8030) and GG4 vs GG5 (p-value=0.0036, r-value=0.5806). In all scores combined, the mean AI was 56.20 for low-grade (GS 2-6), 129.15 for intermediate-grade (GS 7), 247.35 for high-grade (GS 8-10). Statistically significant difference was found in between AI (p-value <0.05) in all Gleason scores. Conclusion: Positive correlation was observed between AI, GG and GS in prostatic adenocarcinoma. AI may be of immense value to predict prognosis of prostatic adenocarcinoma.

Intermittent Fasting Modulates the Glycogen Level in Zebrafish (Danio rerio) and their Next Generation

Shanmugasundaram Tamilarasan, Uthirakumar Devaraj, Balamurugan Elumalai

Introduction: Zebrafish (Danio rerio) has become the best model organism to study the evolutionary biological process and human developmental studies. The liver glycogen plays a vital role in maintaining cellular metabolism, accumulation of glycogen in liver affects the enzymes related to glycogen metabolism. Aim: Impact of intermittent fasting, refeed and overfeeding in glycogen homeostasis on Zebrafish (Danio rerio) and their F₁ generation. Materials and Methods: The present in-vivo study demonstrates the effect of intermittent fasting on glycogen storage in zebrafish and their F₁ generation. The study was conducted at Department of Biochemistry and Biotechnology, Annamalai University, Chidambaram, Tamil Nadu, India. The duration of study was carried out for one month (December, 2021) for both parental and their F₁ generation (April, 2022) groups. The F₁ generation fishes involved after its matured (three months). The zebrafish (AB strain) were randomised and split into five experimental groups such as control, overfed, 12 hours, 24 hours, and 48 hours intermittent fasting. The F₁ generation from each group was treated as same as parenting groups. The physiological and histological changes were observed in the study group. Significant results were evaluated as p<0.05 values turkey’s method was used. Results: The fasting and overfeeding significantly affects the physiological condition like body weight, length and Body Mass Index (BMI). The parental control and their F₁ have a BMI of 0.042±0.04 g/cm² and 0.041±0.04 g/cm². The maximum fasting treated groups (48 hours) of both parent and their F₁ generation shows reduced BMI such as 0.032±0.03 g/cm² and 0.030±0.04 g/cm². The over feed group shows a BMI of 0.053±0.05 g/cm² and 0.052±0.05 g/cm². The result demonstrates that the food-deprived groups and their F₁ generation showed less glycogen storage in histological observation. The refeed and overfed groups and their F₁ generation exhibit more glycogen accumulation in the liver. The result confers normal regulation of glycogen synthase and glycogen synthase kinase 3 in normally in control and fasting groups as well as in their F₁ generation. Conversely, the overfeeding and refeed groups show modulated glycogen activity in both parent and their F₁ generation. Conclusion: Glycogen accumulation leads too many diseases and it also affects the generations. The frequent fasting may help to minimise glycogen accumulation and BMI level reduces the complications of disorders related to glycogen homeostasis.

Histopathological Spectrum of Neoplastic and Non Neoplastic Brain Lesions at a Tertiary Care Centre in South India- A Retrospective Observational Study

Introduction: Brain lesions can be caused by varied etiological factors like neoplastic, infectious, inflammatory and vascular diseases. Accurate diagnosis in very important for correct neurosurgical treatment. A retrospective histopathological study of brain lesions is of utmost importance because as it can demonstrate the changes in the spectrum of brain lesions, burden of disease in the community, can reveal the possible risk factors and can suggest probable treatment methods for various neoplastic and non neoplastic brain lesions. Aim: To evaluate the incidence, age distribution, gender distribution, and histopathological spectrum of neoplastic and non neoplastic lesions of brain. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology at Narayana Medical College, Nellore, Andhra Pradesh, India, from January 2019 to December 2021. Total 216 cases were studied. The tumours were classified under World Health Organisation (WHO) classification. To test the mean difference between the groups, Independent sample t-test was done. Results: Out of 216 cases, 180 (83%) were neoplastic and 36 (17%) were non neoplastic lesions. The male:female ratio was 1.03:1. Non neoplastic lesions were common in males (22, 61.11%), while neoplastic lesions were common in females (92, 51.11%). The most common age group affected was 41-50 years (55, 25.46%). Astrocytoma (41, 22.77%) followed by meningioma (40, 22.22%) were the common neoplastic tumours and haematoma (7, 19.44%) was the most common non neoplastic lesion in adults. Common tumour in children (<18 years) was diffuse fibrillary astrocytoma (3/11, 27.27%) and chronic inflammatory pathology was the common non neoplastic lesion (2/11, 18.18%). Conclusion: Majority of cases were seen in 41-50 years age group. Astrocytoma was the common neoplastic tumour and haematoma was the common non neoplastic lesion in adults. Diffuse fibrillary astrocytoma was the common tumour and chronic inflammatory pathology was the common non neoplastic lesion in children.

Knowledge, Attitude and Practice regarding COVID-19 Vaccination in a Tertiary Care Centre of Tiruvannamalai, Tamil Nadu: A Cross-sectional Study

DP Punitha, DP Sudhagar

Introduction: Coronavirus Disease 2019 (COVID-19) is one of the worst pandemics witnessed across the globe. COVID-19 vaccination is one of the best available strategies to minimise the severity of the infection and reduce mortality rates. Active participation and involvement of the stakeholders in taking the COVID-19 vaccine are key aspects of the vaccination’s success. Lack of knowledge, negative attitude, and willingness to vaccinate may pose a significant challenge for the health authorities to complete the vaccination drives. Aim: To assess the Knowledge, Attitude, and Practice (KAP) about COVID-19 vaccination among people of Tiruvannamalai, Tamil Nadu, India. Materials and Methods: The present cross-sectional study was conducted in a tertiary care centre of Tiruvannamalai district, Tamil Nadu, India, in November 2021. Overall, 478 respondents aged above 18 years were included in the survey using a structured questionnaire. The questionnaire was administered to assess the KAP regarding the COVID-19 vaccine among study subjects. The study used descriptive statistics such as frequency, percentage, and sentiment analysis. Results: Out of total sample, 99% of the study participants had taken the COVID-19 vaccine, 81% had taken the second dose, predominately 51% of the participants had taken the COVID-19 vaccine at a Government hospital, 74% of the participants mentioned that it was their responsibility to take COVID-19 vaccine. Regarding KAP, the knowledge score was 10 out of a total score of 14, the attitude score was 8 out of 10, and the total score of the COVID-19 related practice was 10 out of 10. Conclusion: The findings of the study indicate that the vaccination drive in the population will be highly effective since the vaccine acceptance among the stakeholders was good due to sound knowledge, positive attitude, and safe COVID-19 practice.

Effect of FIFA 11+, Dynamic and Regular Warm-up Protocols on Speed, Agility, and Lower Limb Explosive Power in Badminton Players: A Quasi-experimental Study

Sudesh Chettri, Abhishta Sehdev, Nitin Kumar Indora, Vipin Indora, Pooja Anand

Introduction: FIFA 11+ (Federation International Le De Football Association), has already shown a positive response to the various physical parameters and reduced injury rates in football players, similar studies were not performed on badminton players. With this background, the present study was conducted. Aim: To compare the effects of FIFA 11+, dynamic warm-up, and regular badminton warm-up on speed, agility, and lower limb explosive power. Materials and Methods: A quasi-experimental study was conducted in different badminton academies located in Faridabad, Haryana, India, from September 2017 to March 2019 with the implementation of the programme for four weeks with a sample size of 48 players (both male and female) aged between 14-18 years participated in the study. The participants were divided randomly into group A; following FIFA 11+ protocol (11+ is a multifaceted warm-up program with four components- sprinting, strength, plyometric and balance), group B followed dynamic warm-up and group C followed their regular warm-up. The players followed the protocols for four weeks (12 sessions with FIFA 11+ for 15-20 minutes and dynamic warm-up of 15 minutes). A pre and postassessment was done for agility using a T-test, speed was assessed by a 10 m sprint, and Lower limb explosive power was assessed using the vertical jump test. The statistical tests used for analysis was the Post-Hoc Tukey test for between-group analysis and Analysis of Variance (ANOVA) paired t-test for within-group analysis using Statistical Package for Social Sciences (SPSS) version 21.0 software. Results: There was no statistical difference between the three groups when the Post-Hoc Tukey test was done. However, when within the group analysis was done using paired t-test there was statistically significant difference for agility in group A (p-value=0.030) and speed in group B (p-value=0.021). Conclusion: This study concludes that none of the three groups out performed the other for all the parameters.

Trushield NXT Non Adherent Wound Dressing versus Standard of Care Dressing among Women Undergoing Obstetric and Gynaecological Surgeries: A Randomised Clinical Study

Rathindranath Ray, Rehana Sarkar, Subhalaxmi Gupta, Tirna Halder

Introduction: Surgical Site Infection (SSI) is the most frequently reported postsurgical wound complication worldwide. Trushield NXT is a non adherent dressing with a unique non leaching physical mechanism of action antimicrobial property, whereas the Standard of Care (SOC) dressing is made with cotton, povidone, and leucoplast which is primarily used as a barrier dressing. Aim: To compare the effectiveness of Trushield NXT non adherent wound dressing over SOC dressing (cotton+povidone+leucoplast) in postoperative wound management of obstetric and gynaecological surgeries. Materials and Methods: This was an investigator-initiated, single-centre, prospective, two-arm, parallel-group, randomised (1:1) clinical study conducted in the Department of Obstetrics and Gynaecology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India, between 7th February 2022 and 18th May 2022. A total of 114 patients were screened but finally 111 were selected for the study and randomised to Trushield NXT non adherent wound dressing (n=56) and SOC (n=55) groups. Women in the age group of 18-65 years, undergoing obstetric and/or gynaecological surgeries at the site were enrolled in the study after fulfilling the inclusion and exclusion criteria. Patients underwent surgery (caesarean section/hysterectomy) as per the standard institutional practice and were followed-up on day 3±1, day 8±1, day 42±7. The primary endpoint was the evaluation of SSI using the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria and Stay (ASEPSIS) scoring system, along with dressing time and the number of dressing changes. The secondary endpoints include assessment of pain using a Visual Analog Scale (VAS), and pain during dressing removal, evaluation of ease of application/usage/removal of the dressing, modified Hollander wound score scale, wound healing score, and patient satisfaction of wound dressing and wound healing. Statistical analysis was done using Student’s t-test or Mann-Whitney U test for continuous variables or Moses’ test for extreme reaction. A p-value of ≤0.05 was considered significant. Results: The mean age of participants in the Trushield NXT and SOC group was 28.38±4.97 and 27.28±6.03, respectively. Statistically significant difference favouring Trushield NXT was observed between the two groups of Trushield NXT and SOC in terms of ASEPSIS scoring (6.97±0.63 vs. 7.04±0.61; p-value <0.0001), dressing time (39.16 vs 101.07 secs; p-value <0.0001), pain score (3.28 vs 3.82; day 8), pain during dressing removal (30.63 vs 59.2; p-value <0.0001) and patient satisfaction (3.71 vs 3.24; p-value <0.0001). Conclusion: Trushield NXT was found to be superior to SOC for postoperative wound management in obstetric and gynaecological surgeries.

Cardiac Dysfunction in Early Stages of Diabetic Kidney Disease- Fact or Fiction: A Case-control Study

Richard Bruno Michael, V Joseph

Introduction: The occurrence of kidney dysfunction in diabetics promotes early cardiac dysfunction. The timing of Diabetic Kidney Disease (DKD) and the impact of the stage of DKD on cardiac dysfunction is far from elucidated in current literature. Aim: To evaluate the association between the early stages of DKD and cardiac dysfunction by echocardiography. Materials and Methods: The present descriptive, case-control study was conducted in the Pondicherry Institute of Medical Sciences (PIMS), Kalapet, Puducherry, India, from November 2018 to November 2020. All diabetic patients between 25-60 years, who attended the Medicine Outpatient Department (OPD) or were admitted into the medical wards, were screened, among which 280 subjects were selected for the study. Patients with Estimated Glomerular Filtration Rate (eGFR) of more than 45 mL/min/1.73m2 were characterised as cases and those with eGFR of more than 90 mL/min/1.73m2 were controls. Echocardiographic parameters were recorded. Chi-square test, Mann-Whitney U test, and unpaired t-test were used for statistical analysis. Multivariate logistic regression analysis was done using an odd’s ratio to assess the association between early DKD and cardiac dysfunction. Results: The number of diabetics with early kidney disease (cases) were 139 and without kidney disease (controls) were 141. The mean age of the cases was 54.63±4.84 years and the controls were 52.61±7.916 years. The number of males among the cases and controls were 68 (48.92%) out of 139 and 96 (68.08%) out of 141, respectively. The prevalence of systolic dysfunction among diabetic patients with early kidney disease was 12.23% (17/139) and diastolic dysfunction was prevalent in 99.28% (138/139). Systolic dysfunction was 9.68 times more common in cases (n=139) than in controls (n=141). Women had a 2.6 times higher likelihood, and hypertension had (an independent association which was) a 2.6 times higher likelihood of developing cardiac dysfunction in the early stages of DKD. Conclusion: Systolic cardiac dysfunction is significantly higher (9.68 times more common) in those with early DKD when compared to those without kidney disease; with female gender and systemic hypertension as independent and significant risk factors.

Significance of Ki67, BCL 2 Immunoexpression in Urothelial Carcinoma and their Association with Grading and Staging: A Descriptive Cross-sectional Study

Prithwish Ray, Sanjayay Sarkar, Seema Mondal, Anadi Roy Chowdhury

Introduction: Urinary bladder is the most common site of malignancy in the urinary tract and the most common type of cancer of urothelial origin is urothelial cell carcinoma. This subtype constitutes more than 90% of bladder cancer. Histological grade of tumour is one of the most important predictive parameter for prognosis and biological behavior of urothelial carcinoma. As some crucial discordances may arise between pathologists because of subjectivity, so immunohistochemistry can be used for accurate diagnosis and prediction of prognosis. Aim: To study the immununohistochemical expression of B-Cell Lymphoma 2 (BCL 2) and Ki (Kiel)-67 markers and their association with tumour grade and stage in urothelial carcinomas. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Pathology of a tertiary care R G Kar Medical College and Hospital, Kolkata, West Bengal, India. West Bengal, India, on a total of 75 cases from January 2018 to June 2019. The study population comprised of cases of urothelial lesions as diagnosed by cystoscopy, who underwent standardised operative procedures. Relevant sections were taken from different parts of the fixed specimens. Histopathological Examination (HPE) was done to confirm the presence or absence of non-invasive and invasive carcinoma, and the depth of invasive tumour cells for pathological staging. Evaluation of the level of cytological and architectural disorder at low and medium magnification (100X and 200X) were done for grading. Cytological disorder were defined as abnormalities in nuclear size, shape, and chromatin, while architectural disorder were defined as abnormalities in the orientation of the cells in relation to each other and to the basement membrane of the papillae. Immunohistochemical analysis was done for Ki67 and BCL 2 expression in paraffin embedded sections in all the cases. In this study, chi-square test was done with International Business Management(IBM) Statistical Package for Social Sciences (SPSS), as per which, the association between two variables is statistically significant if p value is <0.05. Results: Out of total 75 cases (mean age: 67.3 years) analysed, 58 cases (77.3%) had Invasive type of bladder neoplasm, followed by low grade papillary urothelial carcinoma 10 (13.3%), and papillary urothelial neoplasm of low malignant potential 07 (9.3%). Ki67 expression in urothelial carcinoma has more significance because 59 cases (78.7%) showed high level expression (>20%) out of 75 cases, whereas only 12 (16%) cases show high level expression (4+) of BCL 2 marker. Conclusion: Ki67 overexpression is seen more commonly, than BCL 2, in high grade tumours as well as in advanced stage. So Ki67 may be used as a marker to predict aggressive behavior and to differentiate low grade and high grade tumours also.

Diagnostic Utility of Proposed Sydney System of Lymph Node By Fine Needle Aspiration Cytology: A Cross-sectional Study

Dhwani Pandya, Bharat Bhetariya, Prakhar Gupta

Introduction: Fine needle aspiration cytology is the basic and simple technique for diagnosis and evaluation of lymphadenopathies. Although large numbers of conditions and cytomorphological overlapping may cause a challenging task in diagnosis. In 2020, an expert panel proposed the Sydney system for classification and reporting of lymph node based on cytology. Aim: To evaluate the diagnostic utility of the recently proposed Sydney system of reporting for lymph node aspirations. Materials and Methods: This retrospective cross-sectional study was conducted at M. P. Shah Government Medical College, Jamnagar, Gujarat, India, from January 2020 to January 2022. Total of 194 fine needle aspirations (FNA) of lymph node lesions performed were reviewed and cytologically re-evaluated and classified according to the Sydney system and were compared with its clinical and histopathological details. The statistical analysis was done with the help Statistical Package for Social Sciences (SPSS) version 26.0. Results: Out of 194 FNA, 8 (4.12%) were inconclusive, 119 (61.34%) benign, 6 (3.09%) atypical lymphocytic lesions, 26 (13.4%) suspicious for malignancy and 35 (18.04%) were malignant including metastasis and lymphomas. Data of 82 cases of histopathological follow-up was available. The sensitivity was 95.2% and the specificity was 94.1%. The positive and negative predictive values were 98.3% and 84.21%, respectively. The Risk of Malignancy (ROM) in category L2 was 0.5%, in category L3 was 50% and in category L4 and L5 were 100%. Conclusion: The proposed Sydney system for reporting lymph node cytology would be helpful in the improvement of quality of reports, better understanding and communication between clinician and pathologist and thereby improving patient care.

Correlation of Alcohol Dependence and Delusions of Infidelity: A Cross-sectional Study

Mrinalini Reddy, Arun Narayan Pradeep, Vadivumbal, Sivabalan

Introduction: Delusions of infidelity are harmful malfunctioning beliefs that can bear significant impact on an individual’s interpersonal, social and occupational functioning. The exact prevalence is not known, due to the lack of community surveys but is not uncommonly seen by practicing physicians. However, they are more common in male alcoholics, morbid jealousy is encountered mostly in old age psychiatry and clinicians should be familiar with its recognition and management. Aim: To identify the correlation of delusion of infidelity in patients with alcohol dependence syndrome. Materials and Methods: A cross-sectional study was conducted at Psychiatry Outpatient Department (OPD), SRM Medical College, Hospital and Research Centre, Chennai, Tamil Nadu, India, for duration of one month in March 2020. Male patients attending the Psychiatric OPD, diagnosed with alcohol dependence syndrome as per International Classification of Diseases-10 (ICD-10) guidelines were selected. A total of 30 patients who attended the OPD in one month were screened by Mini-International Neuropsychiatric Inventory (MINI). Alcohol Dependence Scale (ADS) for alcohol dependence as well as Browns Assessment of Beliefs Scale (BABS) to assess their delusion was applied. Statistical analysis using regression analysis and correlation coefficient was done. Results: The mean of age of study group was 32.47 years with a standard deviation of 5.05 years. Out of the 30 male alcoholic patients, 13 patients had delusions of infidelity. The mean alcohol dependence score of study population was 27.6±11.51 and the mean BABS of study population was 9±10.77. Conclusion: There was a weak positive correlation between alcohol dependence and the delusions of infidelity. Physicians must have sufficient knowledge in identifying alcohol dependence syndrome.

A Cross-sectional Study on Knowledge, Attitude, and Practice Regarding Notification of Tuberculosis Patients by Private Practitioners of Urban Chennai, India

Introduction: India accounts for one-fourth of global incidence of Tuberculosis (TB) with 2.79 million estimated cases, annually. To improve and intensify case finding, the Government of India declared TB a notifiable disease in May 2012. It is now mandatory that, all public and private health providers notify TB cases to the designated public health authorities. To facilitate notification, the central government has created a web-based, case-based notification system called Nikshay. Notification also provides support to the private sector in adherence to standards of TB care which helps in the monitoring of the patients, contact screening and adherence to the treatment. Aim: To assess the knowledge, opinion and barriers regarding TB notification and its processes amongst private practitioners offering TB services. Materials and Methods: This was a cross-sectional study with both analytical and descriptive components, which was conducted on the private practitioners of urban Chennai for a period of three months from April 2021 to June 2021. Study was done on a convenient sample of 150 private practitioners in urban Chennai. Any registered medical practitioner with a bachelor degree in medicine (MBBS) with private practice in urban Chennai with a minimum of one year practice was included in the study. The knowledge, attitude and practice of notification of TB among private practitioners and other proportions were summarised into percentages and 95% Confidence Intervals (CI) were calculated. The categorical data was analysed by Chi-square (χ²) test. Strength of associations was assessed through odds ratio and 95% CI. Tha analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 28.0.1.1. Results: Amongst the total sample of 150 study participants, 90% had said that TB notification was mandatory, of whom 80% said that, they had prior sensitisation on the notification procedures. Only 46% were aware of the honorarium given after notification. Attitude of the study participants towards notification, though 100% of the study participants agreed that TB notification was necessary, while 56.7% said that, government should do more towards the sensitisation of the notification procedures. Only 5.3% of the study participants, had initiated treatment on their own and 4% had started treatment based on clinical suspicion Nikshay registration was more among those whose duration of practice was more than or equal to five years (p-value=0.03), those who had prior sensitisation on TB notification procedures (p-value <0.001), those who had TB patients in their Outpatient Department (OPD) (p-value <0.001), and among those who were aware of the honorarium given for notification (p-value <0.001). Conclusion: Nikshay registration was significantly more among those, who had prior sensitisation and those, who were aware about the honorarium that, they will receive after notifying. This shows that simple awareness creation can significantly increase the Nikshay registration, thereby, increasing the TB notification.

Prescription Pattern and Cost Analysis of Nutraceuticals among Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: Type 2 Diabetes Mellitus (T2DM) is a disorder related to the relative lack of insulin secretion leading to abnormal metabolism. In addition to insulin, various micronutrients takes part in the metabolic processes. The imbalance between these vital micronutrients might be one reason for the progression of chronic diseases. There is a need to understand the utilisation pattern of these nutraceuticals in treating chronic conditions like DM. Aim: To study the prescribing patterns of various types of nutraceuticals and the cost of nutraceuticals per prescription in T2DM patients. Materials and Methods: This cross-sectional study was conducted in a tertiary care teaching hospital of Dakshin Karnataka, India, from September 2021 to April 2022. Total 150 T2DM patients, who were prescribed atleast one nutraceutical, were included in the study. Collected data was assessed by descriptive analysis (quantitative data; age, height, weight, Body Mass Index (BMI), number of drug prescribed, number of prescriptions, cost of nutraceuticals) whereas qualitative data (gender, social classes, qualification, occupation, domiciliary status, marital status, duration of diseases, family history, social history, personal history) was documented using frequency/percentage. Results: Out of total 150 subjects, 92 (61.33%) were males, and 58 (38.67%) were females. At the same time, the mean age of the patients was found to be 58.1 years. Among all the prescribed nutraceuticals, vitamins were found to be the most frequently prescribed 97 (64.66%), followed by proteins 45 (30%) and vitamins+minerals 42 (28%). The average number of nutraceuticals per prescription was 1.57±0.76. The average cost of nutraceuticals was 440.55 (Indian rupee) INR per prescription. Conclusion: The most commonly prescribed nutraceuticals were vitamins in 97 (64.66%) patients. The average additional cost for the nutraceuticals was found to be 440.55 INR.

Comparison between Dexmedetomidine, Ketamine and Tramadol for Prevention of Perioperative Shivering under Spinal Anaesthesia: A Randomised Clinical Trial

Tanwin Khan, Monu Yadav, Singam Geetha, R Gopinath, Padmaja Durga, Hima Chowdary

Introduction: Perioperative shivering after spinal anaesthesia is a common complication. Ketamine and tramadol are routinely used to prevent perioperative spinal shivering. Ketamine has the side-effect of delirium while tramadol causes nausea and vomiting. Dexmedetomidine an alpha2 agonist is superior to tramadol and ketamine in view of better central vasoconstrictor tone regulation and less sympathetic activity. Aim: To compare the efficacy, effect on haemodynamics, and any adverse effects of tramadol, ketamine and dexmedetomidine when used prophylactically to prevent perioperative shivering after spinal anaesthesia. Materials and Methods: This, randomised, clinical study recruited adult patients aged 18-65 years, of American Society of Anaesthesiologists (ASA) I and II, of both genders undergoing surgery under spinal anaesthesia between February 2018 and August 2018. A total of 120 patients were assigned to four groups: T, D, K, and N, to receive Tramadol 0.5 mg/kg or Dexmedetomidine 0.5 μg/kg or Ketamine 0.25 mg/kg or normal saline 5 mL, respectively. Each study drug was diluted to 5 mL using normal saline and administered as a slow intravenous (i.v.) bolus injection five minutes before spinal anaesthesia. Patients received subarachnoid block in L3-4 or L4-5 space in sitting position with 0.5% hyperbaric bupivacaine 15 mg. Patients were monitored for shivering, (using a four-point scale), level of consciousness, heart rate, SpO₂, respiratory rate, non invasive blood pressure, nausea and vomiting, at intervals of every five minutes for the first 30 minutes and every 15 minutes for the remaining observation period. Results: Dexmedetomidine (n=0) offered lower incidence of shivering prevention after spinal anaesthesia than ketamine (n=2, 6.6%), tramadol (n=10,33%) and normal saline groups (n=11, 36.6%). Dexmedetomidine also provided the advantages of maintaining haemodynamics, respiratory rate, and consciousness, similar to ketamine or tramadol (p-value >0.05). Conclusion: Dexmedetomidine is superior to ketamine and tramadol for the prevention of shivering after spinal anaesthesia.

Thyroid Function Status in Nephrotic Syndrome in Paediatric Age Group: A Hospital-based Cross-sectional Study

Introduction: Nephrotic syndrome, being one of the common glomerular diseases in the paediatric population, is characterised by massive proteinuria and has a negative impact on thyroid function, necessitating investigation. Aim: To assess the status of thyroid function in nephrotic syndrome in the paediatric age group. Materials and Methods: This descriptive cross-sectional study was carried out at Bankura Sammilani Medical College and Hospital (BSMCH) in Bankura, West Bengal, India. The study included 100 children of both sexes, aged one to eight-year-old who had nephrotic syndrome, either newly diagnosed or relapsed, and who were either hospitalised to the Paediatric Department or visited an Outpatient Department (OPD), between April 2020 and September 2021. Thyroid hormone profiles, as well as, other relevant investigations, were estimated in all children. Data was analysed using the Epi-Info (version 3.5.1) software. Results: Out of 100 children, 64% were males and the rest, 36%, were females. The mean age of presentation was 4.31±1.90 years. A total of 62% of them had a higher serum level of Thyroid Stimulating Hormone (TSH). Low levels of thyroxine (T4) and triiodothyronine (T3) were observed in 56% and 54% of cases, respectively. The serum albumin and serum TSH levels showed a significant negative correlation (r=-0.249, p=0.013). While T3 had a significant positive correlation (r=0.221, p=0.027), serum levels of T4 had a positive correlation (r=0.187), but turned out to be statistically insignificant (p=0.063). Conclusion: It was found that, 62% of the children having nephrotic syndrome, also had increased levels of TSH. Serum T4 and T3 levels were low in 54% and 56% of the study population, respectively, necessitating further investigation.

Catalase Test and Gram Staining of Uncentrifuged Urine for the Diagnosis of Urinary Tract Infection: A Cross-sectional Study

Amit Padmakar Khekade, Dhruba Hari Chandi, Nandkishor J Bankar

Introduction: Urinary Tract Infection (UTI) is caused by the abnormal growth of the pathogen in the urinary tract. Urine Microscopy and culture is still the gold standard for the isolation of bacteria. However, screening tests are cost-effective and more practical in managing UTIs. Aim: To determine rapid screening tests (Gram Staining and Catalase test) for detection of UTI keeping culture as a gold standard. Materials and Methods: The cross-sectional study was done in the Department of Microbiology, Jawaharlal Nehru Medical College; Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe, Wardha, Maharashtra, India, for a period of one year from August 2019 to September 2020. In this study, 100 urine samples were processed by screening tests such as the Catalase test and Gram stain, followed by culture. Results: Of total 100 urine samples 51 were from males and 49 from females. Positive predictive value of the catalase test was 55.31% and Gram’s stain was 78.26%. In contrast, the negative predictive value of catalase was 69.81%, and Gram stain was 88.88%. The sensitivity and specificity of the catalase test was 61.90% and 63.79%, respectively and the sensitivity and specificity of Gram stain was 85.71% and 82.75%, respectively. Conclusion: Gram stain had the highest sensitivity, 85.71%, and specificity of 82.75% compared to the catalase test. Candida spp. was the most frequently isolated from a urine culture, followed by Enterococcus spp. E. coli, and Klebsiella spp. were also commonly isolated from people.

Evaluation of Serum Vitamin B12 and Vitamin D Levels in Infertile Males with Suboptimal Semen Parameters- A Pilot Study from Eastern India

Introduction: According to World Health Organisation (WHO), infertility is a disease defined by the inability to conceive a child after one year or more of unprotected and regular sexual intercourse. Not only female partner is responsible but male partner related factors play a crucial role in infertility. A key role of vitamin D in male reproductive organs has been suggested. Role of vitamin B12 in spermatogenesis has also been emphasised. Aim: To delineate if there is any significant association between serum vitamin B12 and vitamin D levels with semen parameters among infertile males belonging to the Eastern India. Materials and Methods: This cross-sectional study was conducted in Department of Biochemistry at Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India, from May 2020 to July 2021. Fifty two infertile males of 25-40 years of age, with suboptimal semen parameters (semen volume, sperm count, sperm motility and sperm morphology were considered) were selected. Fasting (12 hours) blood samples were collected for estimation of serum vitamin B12 and vitamin D levels. Significance of association between each parameter with serum vitamin B12 and vitamin D levels was determined using Chi-square test and Fisher’s-exact test. Results were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. A p-value less than 0.05 was considered as statistically significant. Results: Low serum vitamin D levels (<20 ng/mL) were detected in 10 (83.33% ) subjects with low semen volume and in 15 (65.21%) With low sperm count. No significant statistical association was found for vitamin D levels with semen volume and sperm count. Among subjects with abnormal sperm motility and morphology, low vitamin D levels were found in 37 (75.51%) and 16 (69.56%), respectively. A significant statistical association was found between vitamin D level and sperm motility (p-value=0.005) but not with sperm morphology. Amongst subjects with low semen volume and low sperm count, low vitamin B12 levels (<200 pg/mL) were seen in 5 (41.6%) and 15 (65.21%), respectively. A significant statistical association was found between vitamin B12 level and sperm count (p-value=0.003). Among subjects with abnormal sperm motility and morphology, low vitamin B12 levels were present in 19 (38.77%) and 13 (56.52%) and there was a significant association between low vitamin B12 level and sperm morphology (p-value=0.049). Conclusion: It can be concluded that vitamin B12 and vitamin D levels in infertile male subjects disturb normal physiological mechanisms required for being fertile. Hence, vitamin B12 and vitamin D supplementation may be suggested for improvement of semen quality.

Impact and Perception of Virtual Team-based Learning in Comparison to Online Lectures in Pharmacology- A Randomised Crossover Interventional Study

M Lakshmi Prabha, A Geetha Rani, Y Nisha Maheswari, J Ezhil Ramya

Introduction: Competency-based Medical Education (CBME) emphasises small group teaching; henceforth, more innovative educational strategies are needed to stimulate student learning. Team-based Learning (TBL) is structured small-group teaching featuring student preparation out of class to acquire critical concepts. In the current study, TBL was carried out on a virtual platform using commonly available web applications. Aim: To evaluate the impact and perception of virtual TBL compared to online lectures in Pharmacology. Materials and Methods: The randomised crossover study was conducted from September 2021 to January 2022, in the Pharmacology department of Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. The students were assigned into two groups in the ratio of 1:1 by simple random sampling. Students in group A attended TBL sessions, whereas group B attended lectures on the same topic via Google classroom for the first session. A crossover of groups was done for the second session. At the end of both sessions, a questionnaire with Multiple Choice Questions (MCQs) to assess knowledge recall and Short Answer Questions (SAQs) to assess critical analysis was sent to both groups in Google forms, and responses were collected and evaluated. A validated 33 item TBL Student Assessment Instrument (TBL-SAI) was used to determine the student perceptions. An unpaired t-test was used to compare the scores of both groups to assess performance. Mann-Whitney U test was used to compare the student accountability, preference, and satisfaction scales of TBL-SAI. Results: Out of 130 students, 125 were taken up for analysis as five failed to attend the sessions or complete the questionnaire. TBL group scored significantly better than the lecture group in MCQs {(15.8±2.2 vs 12±2.6) and (12.7±3.5 vs 6.4±2.2)} and SAQs {(5.4±2.1 vs 2.3±1.4) and (6.1±2.0 vs 3.3±1.9)} in sessions 1 and 2, respectively. TBL-SAI subscale and total scores were higher than neutral scores in both groups, indicating a positive attitude toward virtual TBL. Conclusion: Implementation of virtual TBL in synchronous setting in Pharmacology course established proof of high student accountability and satisfaction. Students preferred online TBL to online lectures. Virtual TBL sessions were more effective than online lectures.

Evaluation of Expulsion and Continuation Rate of Immediate Postpartum Intrauterine Contraceptive Devices: A Prospective Hospital-based Study

Monika Yadav, Archana Bharti, Gagandeep Kour

Introduction: Family planning can avert nearly one-third of maternal deaths and 10% of child mortality, when couples space their pregnancies more than two years apart. With increased institutional deliveries, Postpartum Intrauterine Contraceptive Devices (PPIUCD) can play an important role in addressing the unmet needs of spacing methods in India. Moreover, in this digital age, generalised awareness of the female population about contraception has increased considerably, so the acceptance and continuation rate might be high. Aim: To evaluate expulsion and continuation rate of immediate PPIUCDs at a tertiary care hospital in Haryana, India. Materials and Methods: The prospective, hospital-based study was conducted from October 2020 to September 2021 in the Department of Obstetrics and Gynaecology at Kalpana Chawla Government Medical College, Karnal, Haryana, India. Ninety women, who underwent IUCD insertion within 10 minutes of delivery of the placenta were enrolled, irrespective of the mode of delivery. Patients were followed-up at six weeks, three months, and six months. The expulsion and continuation rate of immediate PPIUCD and reasons for removal were studied. Descriptive variables were expressed in percentages. The Chi-square test was used to determine the continuation rate and expulsion/removal rates in vaginal versus cesarean deliveries and a p-value less than 0.05 was taken as statistically significant. Results: A continuation rate of 84.4% was observed at six months. A statistically significant difference was observed in the continuation rate of participants of vaginal delivery vs caesarean section (82.67% vs 93.33%, p-value <0.01). Overall, the expulsion rate was 6.66%. Conclusion: Immediate PPIUCD insertion has high continuation rates and can play an important role in family planning.

Barriers in the Implementation of Clinical Guidelines in Diabetes Management: Physicians’ Experiences in Bisha, Saudi Arabia

Abdullah M Al-Shahrani

Introduction: Currently, the number of people living with diabetes in Saudi Arabia is less than one in every ten individuals and this number is expected to double in the next 20 years, which entails frequent and thorough investigation of implementation and effectiveness of the disease management guidelines. Aim: To explore the knowledge and barriers in implementation of the clinical guidelines in diabetes management among the physicians in Bisha, Saudi Arabia. Materials and Methods: In this cross-sectional study, data were collected using structured questionnaire, from a convenient sample of 149 physicians working at several health centres in Bisha, Saudi Arabia from May 2021 to July 2021. The implementation of clinical guidelines according to physician’s gender, years of experience, speciality, workplace, and professional status was statistically assessed using Mann-Whitney test, Chi-square test, Kruskal-Wallis test and Spearman test. The data was imported to an Excel sheet, coded and analysed using Statistical Package for Social Sciences (SPSS) (IBM version 20). Results: The results showed no significant relationship between guideline use and assessed variables except for years of experience, indicating that work experience influences practitioners’ impressions and attitudes towards clinical guidelines (0.001). The study also disclosed some barriers to implementing the clinical guidelines, including lack of familiarity (mean=3.483; median=4) and awareness (mean=3.637; median=4). The results also showed that the minor challenges included a lack of confidence in guideline developers (mean=2.557; median=2), lack of outcome expectancy in patient care (mean=2.7114; median=2) and a lack of agreement with guidelines because they were not up to date (mean=2.591; median=2). Conclusion: The findings concluded that physicians were well aware of the American Diabetes Association standards, demonstrating their popularity and ease of use in Saudi Arabia.

Ultrasound-guided Percutaneous Drainage of Intra-abdominal Collection and its Clinical Outcome: A Prospective Interventional Study

Sushant Agarwal, Bijit Kumar Duara, Rajib Ahmed, Bhaskar Das

Introduction: Intra-abdominal collections are abscesses that occur within the peritoneal cavity, the pelvis or behind the peritoneum (retroperitoneum) or intra-parenchymal. They are common complications of colorectal disease, particularly inflammatory bowel disease, malignancy and trauma. Ultrasound is very useful in establishing the diagnosis, quantification and localisation of intra-abdominal abscesses. Open Surgical Drainage (SD) used to be the traditional treatment protocol. Recently however, percutaneous drainage procedures are becoming an essential therapeutic strategy in the treatment of this condition. Aim: To study the therapeutic efficacy of ultrasound-guided drainage of abdominal abscess and to compare it with open SD. Materials and Methods: A prospective interventional study was conducted in 94 patients with intra-abdominal abscess at Gauhati Medical College and Hospital, Guwahati, Assam, India, in between July 2019 to June 2020 who were randomly allocated into two groups and underwent respective procedures. The first group was Percutaneous Catheter Drainage (PCD) and second group was open Surgical Drainage (SD) group. Patient demographics, symptoms, aetiologies and locations of the collections as well as duration of hospital stay, success rate, and complications were analysed. Results of radiological findings were tabulated, evaluated and collated between both the groups. Statistical Package for Social Sciences (SPSS) software 21.0 version was used for analysing data and p-value <0.05 was considered significant. Results: For abdominal collections and abscesses, ultrasound guided percutaneous drainage was successful in 96.8% of the patients whereas it was successful in 80% cases in the SD group. Complications were more frequently encountered in patients who underwent open SD (16.70%) compared to percutaneous drainage (12.40%) which was significant (p-value 0.0136). The average duration of stay for the group undergoing percutaneous drainage was 9.13±1.62 days which was shorter than for the group undergoing SD was 11.10±1.75 days (p-value <0.001). The overall rate of failed percutaneous drainage was 3.2% as compared to SD where it was 20%. Conclusion: The presesnt study concluded that, image-guided percutaneous drainage has lesser complications and higher success rate for abdominal collections/abscesses as compared to SD. Due to lower mortality rates as well as shorter duration of hospitalisation than open SD, it can replace the traditional open or laparoscopic approach of drainage in most cases.

Diagnostic Utility of Immunohistochemistry Markers Galectin-3, CK19 and CD56 in Thyroid Neoplasms: A Descriptive Study

Jayasree Raman, Febby K Philip, Unnikrishnan Govind

Introduction: The spectrum of follicular patterned thyroid lesions vary from benign to malignant, their categorisation based solely on morphology can often be equivocal. Diagnostic value of immunohistochemistry as a useful ancillary technique is researched in detail, but there is no consensus for use of a marker of diagnostic utility in differentiated thyroid carcinoma. Aim: To evaluate the differential immunohistochemical expression of galectin-3, CK19 and CD56 in benign and malignant thyroid neoplasms. Materials and Methods: The present descriptive cross-sectional study was carried out in the Department of Pathology of a tertiary care centre, Government Medical College, Ernakulam, Kerala, India, from January 2018 to January 2019. Immunohistochemistry staining of galectin-3, Cytokeratin 19 (CK19) and Cluster Differentiation 56 (CD56) was done in 47 thyroid neoplasms. Cytoplasmic and nuclear staining of galectin-3, cytoplasmic or membranous staining of CK19 and loss of membranous expression of CD56 in more than 10% neoplastic cells were taken as positive expression. The data was analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 22.0. Diagnostic test evaluation for markers done by calculating sensitivity and specificity. Results: Out of total 47 neoplasms, 26 were malignant and 21 were benign neoplasms. Of these, galectin-3 positivity was seen in 22 (84.61%) malignant neoplasms and in 2 (9.52%) benign neoplasms. Cytokeratin 19 positivity was seen in 26 (100%) malignant neoplasms and in 7 (33.33%) benign neoplasms. Loss of CD56 expression was observed in 24 (92.3%) malignant neoplasms and in 4 (19.04%) benign neoplasms. Considering histopathology as the gold standard, the sensitivity for detecting malignancy for the three markers, galectin-3, CK19 and CD56 was 84.62%, 100%, 92.3% and specificity was 90.48%, 66.67%, 80.95%, respectively. The diagnostic accuracy of galectin-3, CK19 and CD56 was 87.23%, 85.10%, 87.23%, respectively. Diagnostic Odd’s ratio for Galectin-3 was 2.3% in the present study. Conclusion: Galectin-3 was found to be a reliable marker for thyroid papillary carcinoma and for differentiating malignancy. The panel consisting of galectin-3 and CD56, is valuable and complementary when used in two marker combination. CK19 was found to be the least specific diagnostic marker of thyroid malignancy.

Evaluation of Shade Matching Accuracy of Smartphone Application compared to Conventional Visual Method: An Observational Pilot Study

Introduction: Shade selection has been always a challenging step for a dentist by using a shade guide in manual visual selection. “Colour Grab” application of the smartphone simplifies the procedure of shade selection by providing L a* b* values. Aim: To evaluate the accuracy of the Smartphone application in shade selection compared to the visual method of shade selection. Materials and Methods: This observational pilot study was conducted at Maratha Mandal Dental College, Belagavi, Karnataka, India, from January 2022 to March 2022. A total of 30 subjects were examined by five observers for shade selection using two methods- 1. Conventional visual method, 2. Smartphone application. A total of 300 samples were collected by the both methods. Colour grab application was used to determine L a* b* values of Vita Classic Shade tabs at a distance of 25 cm on neutral grey background and tabulated. Data was collected and subjected to statistical analysis. Cronbach’s alpha test for interobserver reliability analysis, intraclass correlation test and Spearman rho correlation tests were used to determine the inter-observer and intra-observer shade selection accuracy respectively. Results: A total of 30 subjects (Females-16, Males-14) of age between 18-40 years were observed and analysed. For observers 1, 2, 3, 4, and 5, the correlation coefficients were 0.962, 0.849, 0.824, 0.930 and 0.793, respectively at p-value <0.01 for all observers which was highly significant. This test showed that there was strong correlation between the two techniques for each observer which had excellent consistency. Conclusion: Colour Grab smartphone application can be used as an alternative method to conventional visual method in shade selection.

Efficacy of Maternal Magnesium Sulfate Administration on the Neurodevelopmental Outcome of Preterm Babies: A Randomised Controlled Trial

Lakshmi Mohanan Sheeba, Aparna Namboodiripad, Manoj C Varanattu

Introduction: Cerebral Palsy (CP) is a disability which shows an increased incidence with prematurity and Low Birth Weight (LBW). Many studies suggest that Magnesium Sulfate (MgSO₄) given to mothers expected to deliver preterm improves their neurodevelopmental outcome. Aim: To assess the role of administration of MgSO₄ in improving neurodevelopmental outcome in preterm babies. Materials and Methods: This was a hospital-based, prospective interventional study open label, randomised controlled trial conducted from December 2015 to May 2016 in the Department of Neonatology at Jubilee Mission Medical College in Central Kerala, India. Randomisation was done in deliveries expected to occur at or below 34 weeks. The mothers were then divided into two groups, those who would receive either MgSO₄ or a placebo (normal saline). A total of 83 babies were compared for their baseline characteristics, and the association of MgSO₄ administration on neonatal mortality, and on Amiel-Tison angle abnormalities and developmental delay at six months was studied. Either Chi-square test or Fisher’s exact test was used to compare the percentages. Microsoft excel was used to enter data. IBM Statistical Package for the Social Science (SPSS) version 21.0 was used for analysis. Statistical significance was considered for p-value <0.05. Results: Both groups were comparable on baseline characteristics. MgSO₄ use in mothers was not significantly associated with reduction in neonatal mortality (p-value=0.205). At six months of age, use of MgSO₄ was associated with significant reduction in Amiel-Tison angle abnormalities (p-value <0.001), and reduction in developmental delay as assessed by Trivandrum Development Screening Chart (TDSC) (p-value <0.001), showing that MgSO₄ has a neuroprotective role. Conclusion: Although the percentage of neonatal deaths in the MgSO₄ group were less, it was not statistically significant. Amiel-Tison angle abnormalities were significantly less in the group which received MgSO₄. Neurodevelopmental outcome as assessed by TDSC was also significantly less in the group which received MgSO₄. This suggests that antenatal MgSO₄ protects preterm babies from cerebral palsy and neurodevelopmental disabilities. A larger study with a longer follow-up is suggested to confirm these findings.

Evidence-based Analysis of Primary Caesarean Section Techniques Amongst Obstetricians: A Questionnaire-based Cross-sectional Study

Priya Sharma, Vartika Tripathi, Aditya Vikram, Swati Dubey, Uma Gupta

Introduction: Caesarean Section (CS) despite being one of the most commonly performed surgeries in the world has a wide variation in its techniques. To improve the outcomes of CS through rectification of the surgical techniques, it is imperative to assess the current practices amongst the obstetricians and analyse the rationale behind their surgical preferences. Aim: To assess the surgical techniques used for primary CS by obstetricians and review them with respect to the current evidence. Materials and Methods: The present descriptive, questionnaire-based, cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Mayo Institute of Medical Sciences, Barabanki, Lucknow, Uttar Pradesh, India, in the month of May 2020. A total of 400 Obstetricians possessing diploma or degree in the speciality performing CS and willing to participate in the study were included. A pretested questionnaire majorly focused on the various surgical techniques of primary CS, performed by the obstetricians, was distributed online. A total 203 respondents completed the questionnaire and their response was recorded. Analysis of Variance (ANOVA), Independent samples t-test and Chi-square test were used to analyse the data. Results: Majority (n=140, 68.96%) of the respondents were between 25-40 years of age. In the study population, 8 (3.94%) were male respondents and 195 (96.06%) were female respondents with experience of <5 years. The most consistently used technique was the creation of bladder flap (187, 92.11%), while the least common was use of vertical incision (6, 2.9%) for opening the abdomen. There was a huge variation in the method of opening of the abdomen with 117 (57.6%) of obstetricians using blunt versus 86 (42.36%) using sharp dissection. The blunt extension of uterine incision was significantly associated with the increasing years of practice, whereas the preference to use Pfannensteil incision was significantly associated with the younger obstetricians. Conclusion: There was heterogeneity and variation in the CS techniques being practiced by the obstetricians. These varied practices were the result of surgeon preferences, their training and difficulty in unlearning the long used surgical techniques. These are bound to continue until strong evidence-based guidelines for the techniques of CS are formulated.

Sinapis arvensis-Wild Mustard as an Anti-inflammatory Agent: An In-vitro Study

Introduction: Inflammation is body’s immune response to harmful stimulus. Commonly used conventional anti-inflammatory agents are Non-Steroidal Anti-inflammatory Drugs (NSAIDs). But on prolonged long-term use, it causes serious adverse events. So, the search towards natural agents which have anti-inflammatory property are increasing nowadays. Sinapis arvensis is an annual flowering plant which has proven multipurpose medicinal phytoconstituents. Aim: To evaluate in-vitro anti-inflammatory effects of flower extracts of Sinapis arvensis with diclofenac as standard. Materials and Methods: This in-vitro study assessed the laboratory based anti-inflammatory activity, performed using Bovine Serum Albumin (BSA) assay in December 2021 at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. BSA at pH of 6.8 generated denatured proteins. The anti-inflammatory activity of the sample (flower extracts of Sinapis arvensis) and standard (Diclofenac) was assessed by adding to BSA and percentage of inhibition of denaturation were calculated using the formula based on the absorbance measured. Descriptive statistics was used for analysis of collected data. Results: The concentration-dependent inhibition of protein denaturation was observed for both Sinapis arvensis and Diclofenac. At 100 μg concentration, percentage of inhibition reached up to 81.8% and 100% for Sinapis arvensis and Diclofenac, respectively. Conclusion: The present study showed that flower extracts of Sinapis arvensis exhibited concentration dependent anti-inflammatory property in-vitro which proves to be nearly equivalent with that of the standard Diclofenac.

Attitude of Doctors Towards Homosexuality at a Medical College, West Bengal, India: A Cross-sectional Study

Ashis Debnath, Shuvankar Mukherjee, Ranjan Das, Sudipa Mandal

Introduction: Attitude towards homosexuality varies differently in different parts of the world. But, almost everywhere social stigma and marginalisation make them vulnerable to poor health and social outcomes. So, physicians should be made aware and sensitive about this issue in order to provide optimal care without any prejudices and discrimination. Aim: To assess the attitude of the doctors towards the homosexuality at a Medical College, West Bengal, India. Materials and Methods: A cross-sectional study was conducted for three months from August 2021 and October 2021 at Raiganj Government Medical College and Hospital, West Bengal, India. A predesigned, pretested, structured questionnaire was distributed to each of the faculty members of this medical college. The questionnaire was kept anonymous for name, religion, department or academic qualification and began with asking questions on age and sex. It consisted of 18 statements, nine substatements of relevant attitude along with additional specific comments on the subject. The faculty members were requested to put the filled up questionnaires in a drop box placed at a designated area in the Department of Psychiatry. In this way responses were finally obtained from 56 out of total 69 faculty members. All of them were postgraduate degree holders. The attitude scores were compared on the basis of age and sex using Kruskal-Wallis and Mann-Whitney U tests. A p-value was calculated to find the association of attitude score with age and gender groups. Results: Among the study participants 21 (37.5%) were in ≥50 years age group, 18 (32.1%) in 40-49 years age group and 17 (30.4%) in ≤40 years age group. Males were 41 (73.2%) and females were 15 (26.8%). Forty six (82.2%) participants agreed that homosexuality is “constitutionally determined” (an inherent fundamental right as per Indian constitution). However 34 (60.7%) did not believe it to be a “sexual orientation”. Half of the participants are of the opinion that “homosexuals are easily recognisable”. Forty three (76.8%) respondents are of the opinion that “homosexuals should not be employed in school”. Also 41 (73.2%) believed that “homosexuals are danger to children”. Only 23 (41.1%) generally agreed that they “did not feel embarrassed while talking about homosexuality”. Just above half of the participants agreed that they “really did not understand homosexuality”. The attitude scores did not however vary according to age (p-value=0.25) or sex (p-value=0.09) groups. Conclusion: Majority of the study participants had inadequate knowledge on the issues of homosexuality with a more or less neutral stance in their attitude.

Intermittent Manually Controlled versus Continuous Infusion of Propofol for Procedural Sedation during Interventional Endoscopic Procedures: A Single-blinded Randomised Study

Ramandeep Kaur Haher, Bhupinderjeet Singh Heera, Harjinder Kohli, Ritul Mehta

Introduction: Sedation with propofol during interventional gastrointestinal endoscopy is usually accomplished with two main modes-intermittent manually controlled using a syringe, and continuous infusion using an infusion device. Aim: To compare the effect of bolus administration and infusion of propofol on recovery profile during sedation in patients undergoing interventional endoscopy procedures. Materials and Methods: The present study was a single-blinded randomised study in which 120 patients, belonging to American Society of Anaesthesiologists (ASA) grade I and II, of either gender, and age 18-70 years, were randomly assigned to receive intermittent bolus (Bolus Group, BG) or continuous infusion (Infusion Group, IG) of propofol sedation after induction with 2 mg Midazolam for deep sedation. BG patients received an initial dose of propofol, 1%, according to body weight (<60 kg: 40 mg, >60 kg: 60 mg), followed by boluses of 10-20 mg adjusted to maintain a Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) of 0 or 1. In the IG, continuous propofol infusion (4-6 mg/kg/hr) via Graseby 2000 (Smiths Medical) was administered after a bolus of 1 mg/kg of propofol. Vital signs, recovery time, quality of recovery, total dose of propofol, side-effects as well as patient and endoscopist satisfaction score were evaluated. The data was compiled systematically and analysed using unpaired Student’s t-test and Chi-square test. The p-value <0.05 was considered significant. Results: The demographic profile of patients was comparable in both the groups. The recovery time (6.30±2.06 minutes in BG versus 5.71±2.19 minutes in IG) and total propofol dose (327.74±45.52 mg in BG versus 314.46±64.52 mg in IG) were comparable. Similarly, the quality of recovery was identical in both groups. At 10 and 15 minutes after induction, arterial blood pressure was significantly lower in group BG as compared to group IG (114±16.96 in BG versus 120.34±8.78 in IG; p-value=0.031). The endoscopist’s satisfaction score was better in IG (p-value=0.001), whereas, the patient satisfaction score was comparable in both the groups (p-value=0.162). Conclusion: Both regimes allowed good controllability of propofol sedation. However, endoscopist satisfaction score was significantly better and haemodynamic fluctuations were less in infusion group.

Comparative Efficacy between Streptokinase, Tenecteplase and Reteplase in ST Elevated Myocardial Infarction among Patients Attending Tertiary Care Hospital of Odisha

Lorika Sahu, Nirmal Kumar Mohanty, Siddhartha Goutam, Trupti Rekha Swain

Introduction: ST Elevation Myocardial Infarction (STEMI) is one of the most fatal emergencies contributing to significant morbidity and mortality due to coronary artery disease. Fibrinolytic agents are most effective agents used for the management of STEMI. However, there is a relative paucity of data comparing the effectiveness of thrombolytic agents that can provide insight for proper selection of this class of drugs. Aim: To compare the efficacy of streptokinase, tenecteplase, and reteplase in patients of STEMI in terms of post-thrombolytic resolution by observing reduction of ST-segment elevation at 90 minutes of thrombolytic and assessing for mortality within 30 days of therapy. Materials and Methods: This prospective, single-centre, observational, hospital-based study was conducted in the Department of Cardiology in collaboration with the Department of Pharmacology at Srirama Chandra Bhanja Medical College and Hospital, Odisha, India, from February 2020 to January 2022. The study involved 300 patients (100 patients in each group) being treated with streptokinase, or tenecteplase,or reteplase. A reduction of ≥50% of the initial ST elevation was considered as successful thrombolysis. The efficacy of the thrombolysis with these agents was assessed based on the extent of ST resolution in Electrocardiogram (ECG) at 90 minutes and observing 30 day mortality thereafter. Categorical data were evaluated using Chi-square test and the means were evaluated using Analysis of Variance (ANOVA). Results: There was no statistically significant difference between the three groups with respect to ST segment reduction. At 90 minutes of thrombolysis, 75%, 76%, 72% patients showed reduction in the ST segment in the Streptokinase, Tenecteplase and Reteplase group, respectively (p-value=0.79). A total of nine, five and eight deaths were seen in the streptokinase, tenecteplase and reteplase group, respectively within a span 30 days (p-value=0.52). Conclusion: Streptokinase, tenecteplase and reteplase were equally efficacious for thrombolysis in terms of thrombus resolution and preventing mortality, when started early.

Comparative Evaluation of Serum Interleukin-6 Expression with Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio in Pre and Post Surgery Oral Squamous Cell Carcinoma Patients: A Research Protocol

Pragati A Bhargava, Rahul R Bhowate

Introduction: Oral Squamous Cell Carcinoma (OSCC) is the 3rd most common malignancy. In Indian scenario, oral submucous fibrosis is the most common condition associated with OSCC. Pre and postsurgical evaluation of serum Interleukin-6 (IL-6), Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) will help in predicting the prognosis, along with planning of postsurgical treatment protocol. The NLR and PLR are easily available and cost-effective biomarkers from peripheral smear. Need of Study: The IL-6 and NLR are convenient and inexpensive prognostic markers, they could be widely available in routine clinical practice, which might serve as a valuable marker for predicting the prognosis of OSCC and assessing the magnitude of systemic inflammation. Aim: To compare the serum IL-6 with NLR and PLR in pre and postsurgical OSCC patients. Materials and Methods: A prospective analytical study, for duration of two years from December 2020 to October 2022 will be conducted at Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, in which total 40 patients from lower and middle socio-economic status and histological confirmed cases of OSCC will be included, after obtaining an informed written consent. A detailed clinical, radiological and histological evaluation of all cases will be recorded in the structured format. Presurgical and postsurgical 5 mL venous blood will be collected for evaluation of IL-6, NLR, Platelet–Lymphocyte ratio. Data analysis will be done using unpaired‘t’ test. For categorical data, Chi-square test will be used to compare the proportions. Conclusion: The present study results are expected to provide evidence for the role of serum IL-6 alongwith NLR and PLR as adjuvant biomarkers for OSCC.

Immunoexpression of Podoplanin in Leukoplakia and Oral Squamous Cell Carcinoma and its Correlation with Survival: A Research Protocol

Introduction: Podoplanin (PDPN) is a well-conserved mucin-type transmembrane glycoprotein. According to various studies, podoplanin expression is seen in various human cancers and it also encourages the progression of the tumour. A high PDPN expression, specifically in oral cancers, shows a significant relation to the metastasis of lymph nodes and poor patient survival, suggesting its substantial role in identifying the malignant transformation of a lesion by its expression in initial oral tumourigenesis. Only few studies have mentioned the use of podoplanin marker in detection of malignant transformation of Oral Potentially Malignant Disorders (OPMDs). Most malignant transformations are seen in cases of oral leukoplakia. The present study will help in early diagnosis of malignant transformation of leukoplakia by showing an increased expression of podoplanin, thereby, resulting in better treatment and prognosis of the disease. Aim: To evaluate immunoexpression of podoplanin in leukoplakia and oral squamous cell carcinoma and also to correlate it with the clinicopathological characteristics of leukoplakia and Oral Squamous Cell Carcinoma (OSCC) and the survival of OSCC patients. Materials and Methods: This retrospective study will be conducted in the Department of Oral Pathology at Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India. Surgically operated OSCC cases from year 2005-2019 in this Institute will be retrieved from the archival of the department. Ninety samples in total will be taken for the study, which will be further divided into three groups, consisting of 30 samples in each group as follows: leukoplakia, OSCC and normal oral mucosa (control). Immunohistochemical staining will be carried out, and podoplanin (PDPN) immunoexpression with different clinical characteristics of leukoplakia and oral squamous cell carcinoma will be assessed. Broder’s grading system will be used for histopathological grading of all cases of OSCC. The Chi-square test, Kaplan-Meier method, and the log-rank test will be used to statistically analyse the data.

Assessment of a New Regression Equation for Mixed Dentition Space Analysis in Paediatric Population of Wardha, Maharashtra, India- A Research Protocol

Rutuja Purushottam Ragit, Punit Ratnakar Fulzele, Nilima Thosar

Introduction: Prediction of the mesiodistal crown width of unerupted canines and premolars in mixed dentition analysis is crucial. When Tanaka-Johnston’s equations, the most popular approach, are applied to diverse ethnic groups, their accuracy is questioned. Aim: To derive a new regression equation of mixed dentition space analysis for predicting the size of unerupted canines and premolars teeth among paediatric population of Wardha, Maharashtra, India. Materials and Methods: The study will be conducted in two phases. The study design for First phase is observational and second phase is interventional. Dental study casts of 400 patients aged 11-18 years will be selected in the first phase. A Digital Vernier Caliper (DVC) will be used to measure the mesiodistal crown dimension of all erupted permanent teeth up to first molar. Between four mandibular incisors and the canine-premolar segments of both arches, correlation and linear regression equations will be created. In the second phase, 30 children aged 6-11 years will be randomly selected. Analysis of Tanaka-Johnston’s equations, Huckaba GW equation and the proposed equation will be compared and further statistical analysis will be carried out. Results: New derived regression equation will allow the closer prediction of the size of unerupted canines and premolars in the paediatric population of Wardha. Conclusion: This new equation will allow an accurate prediction of the width of unerupted canines and premolars at an earlier age in the said population.

Mandibular Ramus as a Tool For Sexual Determination: A Systematic Review

Kishore Chandra Thakur, Tarang Srivastava

Introduction: Mandible being one of the sturdy bone resists damage and therefore its fragments are mostly available after mass disasters like explosions. After the pelvis, the mandible of the skull has significant sexual dimorphism. Many parameters of the mandible altogether make it suitable to identify sex from a given bone. Aim: To determine sex with the help of parameters of the ramus of human mandible. Materials and Methods: This systematic review included the articles from 2000 to 2020 and took one year duration. All studies were categorised under dry bone and radiological study. Only original articles of a cross-sectional study, cohort study and case-control study related to ramus and sex determinations were selected online by using available databases like Medline, Embase, and Google Scholar. All selected articles were then analysed for different types of ramus parameters studied. Studies that considered more than one parameter of ramus were included or otherwise rejected. Research articles that mentioned the efficacy of gender identification of bone by considering parameters of the ramus of the mandible, were tabulated. Results: Commonly used ramus parameters by different researchers were maximum ramus breadth/width, minimum ramus breadth/width, ramus flexure and ramus height. In addition, coronoid height and projection height was also used by some. In most of the studies, parameters in males were higher than in females whereas gender predictive value was seen higher i.e, 70-83% when a combination of all ramus parameters was taken. In the case of consideration of a single parameter, gender predictive values ranged from 45-79%, and a higher sex predictive value was seen for males. Conclusion: Only when the fragment of the mandible ramus is available, then it can be utilised for gender identification by using ramus width, ramus height along with other parameters based on availability. Ramus alone is a good tool for sex determination in the mandible.

Altered Biomechanics of the Normal Side and the Impact on Rehabilitation of the Affected Side in Patients with Hemiplegia: A Mini Review

Altered biomechanics is defined as the acquired alteration in the mechanics of the musculoskeletal system that leads to improper movement patterns. Hemiplegia is the reduction in strength or paralysis of one side of the body due to a stroke. The amount of involvement poststroke depends on the site of the lesion. There are various other neurological complications and associated symptoms, but the effect on biomechanics is due to alterations in the muscle strength of the unaffected side of stroke along with hemiplegia or paresis of the affected side. The unaffected side of stroke is considered to be the normal side and is thus, not considered in the treatment session, allowing it to lose its competencies, thus, the gait pattern is altered in poststroke survivors. To find the pertinent literature, electronic databases were searched using the terms “biomechanics” and “hemiplegia”. The resulting articles were reviewed, the bibliography was double-checked, and pertinent literature was added. The present review article discusses the alterations in the biomechanics of the normal side and the impact on rehabilitation of patients with hemiplegia. It also provides a newer outlook to focus also, on the normal side while rehabilitation, thus, enhancing early recovery.

Effect of Intrathecal Dexmedetomidine as an Adjuvant for Labour Analgesia

Monika Sharma, Aruna Chandak

Opioids analgesics have been used commonly among several patients in labour in various studies but side effects associated with use of opioids during painless delivery are the main factors that affect rapid postpartum recovery. Opioid use can result in risk of respiratory depression in the patient and can also disrupt the baby’s breathing and heart rate. So, the non opioid analgesic dexmedetomidine, a new alpha-2-adrenergic agonist came into existence, was evaluated and used intrathecally among parturients as an alternative adjuvant. The aim of the present review article was to establish the effect of non opioid analgesic dexmedetomidine, to assess the potency and the safety of dexmedetomidine when given intrathecally as an adjuvant to neuraxial block among patients in labour. Studies report that addition of dexmedetomidine improves the quality of the block, causes an early onset and better length of the sensory block, enhances the onset and duration of the motor block, as well as the onset of analgesia. Additionally, this lengthens the time needed to restore analgesia. Use of dexmedetomidine in combination with bupivacaine significantly prolonges the sensory block time in pregnant women.

MRI and MR Arthrography Imaging of the Pathologies of the Wrist: A Pictorial Essay

Magnetic Resonance Imaging (MRI) has a special advantage over radiographs and Computed Tomography (CT) in evaluating an anatomically complex structure like wrist, owing to its excellent soft-tissue resolution and multiplanar imaging functionality. MR arthrography further improves the diagnostic value of MRI by virtue of its meticulous depiction of even small tears involving the Triangular Fibrocartilage Complex (TFCC), intrinsic and extrinsic ligaments of the wrist. This article focuses on the MRI and MR arthrography illustration of various traumatic as well as non traumatic pathologies affecting the wrist region and is mainly intended to educate the residents by comprehensively reviewing the imaging features of the major afflictions of this complex joint in a systematic fashion using checklists.

Youth and Zero Incidence, Zero Prevalence of Cancer in India- An Achievable Goal?

HS Sreeshyla, HP Jaishankar, R Shashidara, Usha Hegde, Priyanka Nitin

Cancer is one of the main leading causes of high mortality and morbidity. It is also one of the preventable diseases with known risk factors in many of the cases. Youth are like double edged sword, by being the highly vulnerable group as well as the group with strong potential for disease prevention. Health education, creating strong awareness on the known avoidable risk factors among the young adults can prevent the occurrence of cancer. Simultaneously, using the educated young group to dissipate their knowledge to curb the cancer is the need of hour. Thought of zero incidence and prevalence of cancer in India looks unachievable. However, with the youth centred programmes, by the youth, for the youth and to the general public, such goals can be achieved.