Journal of clinical and diagnostic research

Unilateral Carotid Body Tumour: A Case Report

The carotid body, which is located bilaterally on the medial side of the carotid bifurcation, is the largest group of paraganglia in the head and neck. Chemoreceptor cells in the carotid bulb give rise to uncommon tumours known as Carotid Body Tumours (CBTs). The authors describe a case of a CBT in a 40-year-old woman who had a painful, pulsatile, lateral neck enlargement on the right side that had been developing over time. Due to the numerous difficulties and problems brought on by their high vascularity and close proximity to cranial nerves in the neck near the carotid bifurcation, they pose a surgical challenge. Based on the patient’s medical history, the results of clinical and radiological examinations, and the successful surgical removal of the tumour, the diagnosis was suspected. The results of histological analysis supported the diagnosis of a CBT.

Collagenous Enterocolitis: A Rare Condition with Simultaneous Involvement of the Upper and Lower Gastrointestinal Tract

Collagenous colitis is a form of microscopic colitis, while Collagenous Sprue (CS) is a malabsorptive disorder that mimics celiac disease. Both conditions show increased Intraepithelial Lymphocytes (IELs) and basement membrane thickening due to collagen deposition. The simultaneous occurrence of both disorders is rare, and only a few such cases have been reported in the literature. A 60-year-old female presented with chronic, non bloody diarrhoea persisting for two years. Investigations revealed megaloblastic anaemia and hypoalbuminaemia. Gastroenteroscopy showed flattening and atrophy of the small intestinal mucosa. Biopsy results showed increased IELs, normal crypt architecture, and stripping of the epithelium. There was also patchy deposition of hyalinised band subepithelially, confirmed to be collagen through Masson’s stain. As both the upper and lower Gastrointestinal (GI) tracts were involved, a diagnosis of collagenous enterocolitis was made. A 70-year-old female presented with intermittent watery diarrhoea for the past 10 days, accompanied by urgency and tenesmus. She had a history of colicky abdominal pain four years ago, which improved with steroids, but the symptoms recurred. Clinically, she was considered to have inflammatory bowel disease, with recurrent anaemia. Both gastroduodenoscopy and colonoscopy were normal. Mapping biopsy showed increased IELs and focal atrophy in the duodenum, while the colon exhibited mild mononuclear inflammation with occasional minimal activity. Focal, irregular deposition of subepithelial collagen was also observed and confirmed through Masson’s stain. A diagnosis of collagenous enterocolitis was made. She is currently being monitored for any recurrence of symptoms, after which steroid treatment will be initiated. Collagenous colitis, CS, and collagenous duodenitis share similar histological features and can rarely co-exist. Further studies are needed to better understand their aetiology and association.

Impact of Oral Metronomic Chemotherapy in Locally Advanced Carcinoma of the Laryngopharynx: A Case Report

Anmol Mahani, Vipul Nautiyal, Meenu Gupta, Viney Kumar

Oral cancer continues to be a significant health concern in Southeast Asia. The primary treatment involves surgical resection with or without reconstruction, along with adjuvant therapy. However, the survival rates for patients with stage I-II oral cancer range from 70% to 80%, whereas in more advanced stage III-IV cancers, these rates drop significantly to 40%-50%. Unresectable oral cancers are primarily managed with palliative intent, utilising systemic therapy and/or radiotherapy. Unfortunately, a substantial portion of these cases (around 60%-80%) are diagnosed at an advanced stage due to delayed diagnosis, limited access to definitive treatment, and financial constraints. These challenges underscore the critical need for therapies that can effectively halt cancer progression, promote regression, and maintain the disease in an operable state while awaiting definitive treatment, typically involving surgery. In this context, Oral Metronomic Chemotherapy (OMCT) emerges as a promising alternative. OMCT offers cost-effectiveness and involves the regular administration of chemotherapeutic drugs at low doses without interruption. The concept of “metronomic” chemotherapy draws inspiration from a metronome, which produces regular ticks representing a constant pulse. Herein, the authors presented case report of a 55-year-old male patient to compile evidence-based data on the use of OMCT in treating locally advanced carcinoma of the laryngopharynx. It explores the mechanism of action, utility, and potential future directions of OMCT. By analysing a real-world case, it seeks to highlight the effectiveness and advantages of OMCT as a treatment option for oral squamous cell carcinoma.

Emphasis on Temporal Association between Oral Verruciform Xanthoma and Candidal Infection: A Case Report

Reshma Poothakulath Krishnan, Deepak Pandiar

Oral Verruciform Xanthoma (VX) is a verrucopapillary lesion seen as a cauliflower-like/papillary growth in the oral cavity. The aetiopathophysiology of VX is explained by several pathogenic processes. The presence of xanthoma cells or foamy macrophages is considered a characteristic feature of this lesion however there is disagreement about the origin of these cells. In this case report, the authors described a case of VX with concomitant candidal infection in a 31 years old male patient. Although not fully explored, a hypothesis is constructed to understand the relationship between Candida albicans and VX, combining the current literature and present findings. Presumably, an initiation event varies from patient to patient and site to site, additionally, the candidal infection may also play an important role in the pathogenesis of VX.

Upper Labial Mucosa Schwannoma: A Rare Case Report

Roopa Yadahalli

An upper lip swelling, asymptomatic, and benign-looking lesion may be attributed to numerous aetiologies. About 25% to 45% of Schwannomas/Neurilemmomas occur in the head and neck region and are seldom seen in oral sites, accounting form only 1% of cases. Herein, the authors presented a case report of a 36-year-old female patient with a clinical appearance of upper labial mucosa swelling is mentioned, which mimicked a mucocele. It was a single, smooth, oval, fluctuant, and non tender swelling. Complete surgical excision was performed following proper protocol, and histological diagnosis revealed a well-outlined lesion enclosed within a fibrous capsule. The connective tissue mass of the tumour consisted predominantly of neural tissue arranged in Antoni A structures, characterised by a palisaded nuclear arrangement and the presence of distinctive eosinophilic Verocay bodies. Another area with a myxoid appearance, representing Antoni B structure, was also present, suggesting a Schwannoma/Neurilemmoma. During follow-up, complete healing with no recurrence of swelling was observed. Schwannomas/Neurilemmomas in the head and neck region are less common, particularly in the oral cavity. According to various studies, the occurrence of neurilemmomas in the intraoral aspect accounts for only 19.24% of cases, specifically involving the mucosa of the lip. Practitioners should consider this rare entity of Schwannoma/Neurilemmoma when evaluating an upper lip swelling routinely.

Hemiagenesis of the Thyroid in a Seven-year-old Child: A Case Report

Anshuta Abhijit Ramteke, Swati Maldhure, Vaishali Dhawan

Thyroid Hemiagenesis (TH) is a rare condition characterised by developmental abnormalities of the thyroid, often observed on the left-side, with a higher prevalence in females. It is commonly associated with a lack of the isthmus. A seven-year-old boy presented to the Ear Nose Throat (ENT) Department with chief complaints of bilateral ear block sensation and dull aching earache persisting for two months, for which syringing was performed. No family history of TH or any past surgeries related to the neck, thyroid, or parathyroid were reported. In recent laboratory tests, his Thyroid Stimulating Hormone (TSH) level was 7.23 μIU/mL, free tetraiodothyronine was 8.91 mcg/dL, free triiodothyronine was 75.06 ng/dL, and Antithyroid Peroxidase (TPO) was 2.0 IU/mL. The neck ultrasound revealed the absence of the left thyroid lobe and isthmus. He was diagnosed with congenital TH and hypothyroidism and was treated with a dosage of 25 mcg of levothyroxine. TH can be incidentally discovered and may manifest in later stages of life. Patients with TH are more prone to developing hypothyroidism compared to individuals with a complete thyroid, as they have lower reserves of thyroid hormones.

Monckeberg’s Calcification as a Clinical Mimicker of Temporal Arteritis: A Case Report

Reeta Mohan, Manjiri Dilip Phansalkar, Ramesh Kannan

Temporal arteritis usually presents in patients above 50 years and is characterised by granulomatous inflammation in all layers of the arterial wall. On the other hand, Monckeberg medial calcification is a disease condition limited to the tunica media of the affected vessels. In this report, authors present the case of a 68-year-old man who presented to the casualty with facial pain. He also had a runny nose, cough, and sleep disturbance. A Computed Tomography (CT) scan was performed and reported as normal. The patient underwent Ear, Nose and Throat (ENT) and Ophthalmology evaluations. Neurology opinion revealed tenderness and thickening of the right superficial temporal artery. Based on clinical suspicion, the patient was started on oral corticosteroids, suspecting temporal arteritis. A temporal artery biopsy was performed for histopathological examination, which surprisingly revealed no evidence of arteritis but only calcification of the tunica media. Unfortunately, the patient was lost to follow-up after the biopsy. This case highlights the importance of recognising Monckeberg medial calcification in clinically suspected cases of temporal arteritis, as there are only a few reported cases in the literature.

A Unique Tripod Suspension and Stabilisation Technique for the Treatment of Nasal Bone Fracture: A Case Report

Nasal bone fracture is more common because it is a prominent structure on the face. It can occur as an isolated injury or in combination with other soft tissue and bony facial injuries. While isolated fractures are more common, they can also be associated with fractures of the zygomatic-orbital-maxillary complex and the skull base. Typically, nasal bone fractures are treated with closed reduction or open reduction and fixation. This involves internal fixation using nasal packing and external fixation using plaster splinting. However, in this technique, we utilised an internal teflon splint and an external thermoplastic splint for the fixation of comminuted nasal bone fractures. One advantage of this technique is that it keeps the nostrils open, allowing for unobstructed breathing. Additionally, the internal splint helps lift the nasal bone back into its anatomical position. The present case report presents the management of a 40-year-old male patient who sustained nasal and maxillary dentoalveolar fractures as a result of a road traffic accident. The fractures were further managed using intranasal teflon splints, an external thermoplastic splint, and Kirschner’s wires. This splint pattern prevents displacement and promotes healing in the desired alignment. This technique employs a logical tripod arrangement of a rigid support system that incorporates all these elements into one interconnected unit, providing support, stability, and tension for optimal results. It focuses on the keystone area of the nose, which requires the most support.

Isolated Unilateral Ulnar Motor Neuropathy at Wrist- A Case Report

Anasuya Ghosh, Tandra Ghosh, Charu Bansal, Amit Kumar

The ulnar nerve compression neuropathy commonly occurs around the elbow; however, focal compression or injury can also occur at the wrist, axilla, or neck involving the roots of the brachial plexus. Ulnar neuropathy at the wrist is caused by the compression of the ulnar nerve within Guyon’s canal or distal to it, often referred to as ‘ulnar tunnel syndrome.’ It can manifest as mixed, pure sensory, or pure motor neuropathy depending on the specific site of compression and the branches involved. This case report of 21 years old male patient, a college student, discusses the clinical and electrodiagnostic features of a case involving unilateral isolated pure motor neuropathy of the ulnar nerve. The onset of the case was insidious and subacute, characterised by painless and non-progressive symptoms with no history of trauma or injury to the affected limb. The Nerve Conduction Studies (NCS) were conducted, indicating probable compression of the deep motor branch of the ulnar nerve distal to the wrist. The patient was subsequently referred for high-resolution Ultrasonography (USG) or Magnetic Resonance Imaging (MRI). Cases of ulnar neuropathy at the wrist are quite rare, and there is limited literature available on this topic.

Is Estimation of HbA2 Alone Sufficient for Screening Beta Thalassaemia Carriers: A Case in Perspective

Beena Suresh, Umarani Ravichandran, Sujatha Jagadeesh

Beta thalassaemia is one of the most common inherited haemoglobinopathies, characterised by reduced or absent production of the beta globin chain. In India, the carrier frequency of thalassaemia is estimated to be 3-4%. The prevention of Beta thalassaemia is the best strategy, and this can be achieved through carrier screening and prenatal diagnosis. Carriers of beta thalassaemia can be easily identified using haematological parameters such as complete blood count and High Performance Liquid Chromatography (HPLC) for haemoglobin analysis. The characteristic findings observed in thalassaemia carriers include microcytosis, hypochromia, with a Mean Corpuscular Volume (MCV) of less than 80 fL and Mean Corpuscular Haemoglobin (MCH) of less than 28 pg. They also present with elevated levels of HBA2 (α2δ2) ≥3.5%. Carrier screening for beta thalassaemia primarily relies on the observation of elevated HbA2 levels. However, in rare cases, some carriers can have normal HbA2 levels, leading to false-negative screening results. In a case involving a married couple who underwent routine preconceptional screening by complete blood count and HPLC for thalassaemia screening, the male partner had elevated HbA2 levels (5.2%), while the female partner had normal HbA2 levels (1.6%). Molecular testing revealed that the male partner was heterozygous for the Intervening Sequence (IVS) 1-5 (G>C) mutation, while the female partner was found to be heterozygous for the CD41-42 (-CTTT) mutation. It is important to consider molecular testing of the HBB gene in couples, even if one partner is a carrier and the other partner has normal or borderline HbA2 levels.

Hepatoid Adenocarcinoma of the Stomach: A Rare Tumour in an Unusual Subserosal Location

Kasimsetty Ramakantha Chatura, Archana Muniswamyreddy

Hepatoid Adenocarcinoma (HAC) is a special type of adenocarcinoma of extrahepatic origin that has overlapping features with Hepatocellular Carcinoma (HCC). Herein, present case is of a 75-year-old man who presented with abdominal pain, bilious vomiting, and constipation for four days, along with a palpable mass in the abdomen for five months. Imaging studies revealed a mass in the subserosal region of the greater curvature of the stomach. Intraoperative findings showed a mass involving the stomach, liver, and omentum, initially suggesting a diagnosis of malignant Gastrointestinal Stromal Tumour (GIST). However, histopathological examination revealed lobules of polygonal cells with abundant eosinophilic to vacuolated cytoplasm and enlarged, moderately pleomorphic nuclei, indicating hepatoid differentiation. The aggressive nature of the lesion, invading the liver and omentum, the absence of risk factors for HCC, negative staining for CD 117 and polyclonal Carcinoembryonic Antigen (pCEA), and positive staining for glypican 3 and CK 19 on immunohistochemistry, confirmed the diagnosis of HAC of the stomach rather than HCC. After surgery, the patient was referred to an Oncology centre. An accurate diagnosis of HAC is crucial due to its aggressive nature and poor prognosis.

Liver Transplant in an Unusual Case of Acute Fulminant Hepatic Failure: A Case Report

Pradnya Mukund Diggikar, Mayank Mundada, Raju Hansini Reddy, Tushar Pancholi

Yellow phosphorus ingestion causing acute fulminant hepatic failure is a serious condition. The establishment of health measures to monitor and prevent yellow phosphorus poisoning is of utmost importance because there is no known cure for the condition. To prevent phosphorus poisoning, it is crucial to raise awareness among the general population about its potential fatality, educate primary care physicians about the delayed onset toxidrome, and take precautions to ensure careful monitoring and reporting. Herein, we present a case of a 33-year-old male who consumed 30 grams of rat poison {Yellow Phosphorus (YP)} while under the influence of alcohol. He presented to us on day 5 with icterus and bilateral subconjunctival haemorrhage. Laboratory investigations revealed severely deranged liver function tests and raised Prothrombin Time (PT)/International Normalised Ratio (INR), indicating acute fulminant hepatic failure. The patient was started on N-acetyl cysteine, vitamin K, and received fresh frozen plasma transfusion. Despite treatment, on day 3, the patient developed grade 4 Hepatic Encephalopathy (HE) and the laboratory parameters worsened. Close monitoring revealed further deterioration, leading to the decision for emergency orthotopic Liver Transplantation (LT) on day 7. Following the transplant, the patient’s liver function tests showed improvement. The subconjunctival haemorrhage and icterus resolved completely on day 3 post-transplantation. The patient was extubated on day 3 and discharged on day 5 post-transplantation. Regular follow-up appointments were uneventful. In conclusion, the present case report highlights the successful management of a patient with acute fulminant hepatic failure through early hepatic transplantation. It emphasises the importance of prompt recognition, appropriate treatment, and timely transplantation in improving patient outcomes.

Management of Adverse Effects of Chemotherapy in Ovarian Cancer through Ayurveda: A Case Report

Pankaj Yadav, Vaishali Kuchewar, Tanika Yadav

Cancer is a condition where abnormal cells multiply uncontrollably and can invade nearby tissues. Only 30% of women with ovarian cancer can expect to live for more than 5 years, as 70% of cases are diagnosed at an advanced stage. Ovarian malignancies account for about 15 to 20% of genital malignancies. Surgical intervention and chemotherapy are conventional measures used to treat these conditions. However, due to the specific side effects of chemotherapy, there is a high demand for safer ayurvedic interventions. Hereby, the authors present, a 54-year-old female patient who was diagnosed with ovarian cancer and advised to undergo chemotherapy. After completing six cycles of chemotherapy, administered once every four weeks for six months, the patient experienced complaints of anorexia, nausea, vomiting, epigastric pain, and a burning sensation in the stomach and lower limbs. Despite taking antacids and other suggested medications by the oncologist, the symptoms did not subside. Therefore, the patient sought ayurvedic treatment. Shaman Ayurvedic Chikitsa (Jawahar Mohra Pisti, Keharva Pisti, Swarna Makshik, Mukta Pisti), Shatavari Ghrita, Turmeric Kwath, and Pathya Vihar were prescribed for three consecutive months. After 5-7 days, the patient noticed significant relief in the aforementioned symptoms and felt better. The frequency of vomiting, complaints of anorexia, and burning sensation were also significantly reduced. After three months of ayurvedic treatment, the functions of Apana Vayu, Samana Vayu, and Pachaka Pitta were normalised through appropriate treatment. The selected combination of ayurvedic medicines provided relief due to their Vata-Pitta Shamak, Sheeta guna, and Pittahara properties, which alleviated the burning sensation. In present case report, the aforementioned ayurvedic prescription significantly reduced the adverse effects of chemotherapy and radiotherapy due to its Vata-Pitta Shamak and Pittahara properties.

Aneurysmal Bone Cyst with Ossifying Fibroma of the Mandible: A Case Report and Review of the Literature

Aneurysmal Bone Cysts (ABCs) are uncommon benign bone lesions primarily affecting children and adolescents. They are distinguished by severe bone breakdown and expansive tissue growth, resulting in clinical symptoms and potential complications. ABCs typically occur in long bones, but reports have also documented their presence in the jaws, particularly the mandible. These lesions are commonly considered non-cancerous and are characterised by cystic or blood-filled chambers. There are two clinicopathological variations of ABC: primary ABC and secondary ABC. Primary ABC originates independently, while secondary ABC develops as a result of a pre-existing lesion such as a cyst, tumor, or Fibro-Osseous Lesions (FOL) like solitary bone cyst, ossifying fibroma, or giant cell granuloma. When ABC coexists with another bone lesion believed to be its precursor, it is referred to as an “ABC plus lesion”. In this case report, a 75-year-old patient, presented with a painful growth in the lower anterior region of the jaw for the past 18 months. The diagnosis was established through clinical, radiological, and histopathological examinations. A complete surgical resection was performed, followed by uneventful reconstruction. Histopathological examination confirmed the presence of ABC with ossifying fibroma (ABC plus lesion). It is important to address ABC plus lesions as they can cause significant pain, deformity, and discomfort. Although non-cancerous, they can still disrupt normal bone structure and function. This case report emphasises the clinical, radiographic, and histopathological features of ABC plus lesions, aiding in disease identification.

Tardy Aschner-Dagnini Reflex following Topical Pterygium Surgery: A Rare Case Report

The Aschner-Dagnini reflex, also known as the Oculocardiac Reflex (OCR) or Trigeminovagal Reflex (TVR), is characterised by a reduction in heart rate due to direct pressure on the globe or traction on the Extraocular Muscles (EOM). It was first described in 1908 and is observed during strabismus surgery. However, it has also been reported following other ophthalmic procedures such as pterygium surgery or gonioscopy, as well as after facial trauma or regional anaesthesia. Sinus bradycardia is the most common presentation, accompanied by nausea and dizziness in conscious patients. In severe cases, it may also result in reduced blood pressure and life-threatening emergencies, including cardiac arrhythmias and arrest. Hereby, the authors present a rare case report of a 34-year-old male with delayed onset OCR following pterygium surgery under topical anaesthesia. The case was managed conservatively, as described in the case report, and the patient had a good recovery. To the best of authors’ knowledge, the present is the first reported case of OCR in the early postoperative period, following pterygium surgery.

Neuroendocrine Carcinoma with Bone Marrow Metastasis: A Case Series

Namrata N Rajakumar, Teena D Murthy, Raghavendra H Vijay, Girish Balikai

Neuroendocrine Neoplasms (NENs) account for 0.5% of all malignancies. Skeletal colonisation is often regarded as a rare event, and metastasis to the bone marrow occurs in the advanced stage of the disease, carrying a poor prognosis. In this report, the authors present three rare cases of Neuroendocrine Carcinomas (NEC) of the lung, diagnosed among 6766 bone marrow aspirations and biopsies performed at our institution between January 2019 and December 2022, highlighting the rarity of these cases. All three cases (63 years, 56 years and 73 years old male patients) presented to our institute at an advanced stage of the disease, with bone marrow involvement at the time of presentation. They exhibited nonspecific symptoms and had normal haematological parameters. Bone marrow aspiration and biopsy confirmed metastatic NEC. The aim of this case series was to investigate bone marrow involvement in NECs, along with their clinical and radiographic features, treatment, and follow-up. Bone marrow biopsy plays a crucial role not only in diagnosing haematological diseases but also in diagnosing and staging solid tumours. Future prospectives include adopting a multimodal approach for early diagnosis and treatment of NECs.

FLAG Regimen and Bortezomib: A Study of Eight Cases with Relapsed Leukaemia

Historically, relapsed and refractory Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML) have been associated with a dismal prognosis. Relapse-refractory ALL is associated with cure rates of <10% in adults and 30% in the paediatric population. Similarly, the five-year survival rates for relapsed and refractory AML are only 10%. This case series describes eight patients with relapsed/refractory leukaemia (6 with ALL and 2 with AML) who received the FLAG-Bortezomib protocol from January 2021 to August 2022. In this case series, the authors investigated the remission rate and toxicity of the regimen, including Intensive Care Unit (ICU) admissions and the incidence of neutropenic sepsis. In the present study, the rates of culture-positive sepsis and High Dependency Unit (HDU) admission were 50% (4/8) and 37.5% (3/8), respectively, with no post-chemotherapy mortality in this cohort. Morphologic remission was documented in 87.5% (7/8) of cases, and negative minimal residual disease was achieved in 62.5% (5/8), with 100% (2/2) remission in those with AML. One patient with ALL experienced disease progression during treatment. The FLAG with Bortezomib protocol induces remission in relapsed and refractory ALL and AML patients with an acceptable toxicity profile. This protocol requires rigorous blood product support in the form of packed red blood cells, platelet-rich plasma, and single-donor platelet apheresis. It serves as a bridge to stem cell transplant.

Extraintestinal Salmonella Infections- An Underdiagnosed Clinical Entity: A Case Series

M Jane Esther, Ronald J Bosco, Jeevaraj Giridharan, Pradhap Lenin

Extraintestinal salmonellosis can occur as a complication of enteric fever. In this case series, five clinically suspected cases of pyogenic meningitis and arthritis, a case of pyelonephritis suspected to be pyogenic or tubercular, a case of vertebral osteomyelitis suspected to be tuberculosis or malignancy, and a case of pyomyositis that clinically presented as a tumour were discussed. Although none of these cases were clinically suspected to be due to Salmonella, all were confirmed as extraintestinal salmonellosis based on microbiological evaluation. Salmonella should be suspected in acute inflammatory lesions that are unresponsive to empirical treatment. Instead of empirical antibiotics, culture and sensitivity-based antibiotics for the recommended duration are the only way to cure extraintestinal salmonellosis and prevent morbidity. Effective communication and correlation between the laboratory, clinician, and radiologist are essential for a definitive diagnosis. Histopathological and microbiological investigations should be done simultaneously to identify the definitive aetiology in all localised lesions presenting with necrosis/inflammatory response. This case series presents five cases of extraintestinal salmonellosis with serious complications, including meningitis, pyelonephritis, osteomyelitis, septic arthritis, and pyomyositis, each with varied clinical presentations.

Iron Overload Combined with Islet Autoimmunity Causes ‘Ferro-immune’ Hybrid Diabetes: A Case Series

Iron’s role in diabetes pathophysiology is underrecognised. Authors describe three cases (two females and one male) with evidence of ‘ferro-immune’ hybrid diabetes, HFE C282Y homozygosity with islet autoimmunity. Case one describes iron overload followed by classical autoimmune diabetes. A 20-year-old female presented with non transfusion-dependent hereditary spherocytosis, contributing to hepatic iron overload. At the age of 26 years, the patient presented with diabetic ketoacidosis and elevated Glutamic Acid Decarboxylase (GAD) (50.5 U/mL) and Islet Antigen 2 (IA-2) (>4,000 U/mL) autoantibodies, and commenced insulin therapy. Two months after her diabetes diagnosis, she began iron chelation therapy. Case two describes haemochromatosis followed by adult-onset diabetes. A fit 78-year-old woman was diagnosed with haemochromatosis at the age of 58 years and presumed to have Type 2 Diabetes (T2D) at the age of 66 years. However, subsequent testing revealed GAD autoantibody positivity (24 U/mL) with normal C-peptide levels (0.55 nmol/L). Her diabetes was diet-controlled, and her transferrin saturation normalised while GAD seropositivity resolved spontaneously. Case three describes slowly-progressive autoimmune diabetes preceding haemochromatosis. A lean man was diagnosed with latent autoimmune diabetes in adulthood with elevated GAD autoantibodies (11 U/mL). At the age of 81 years, he was diagnosed with haemochromatosis (transferrin saturation 61%), which was followed by a decline in glycaemic control (HbA1c 8.3% to 9.0%). A paired fasting glucose (10.8 mmol/L) and C-peptide (0.15 nmol/L) indicated insulin deficiency, and he remains dependent on insulin therapy. Reducing iron levels through venesection or iron chelation may help decrease islet inflammation and potentially, autoimmunity. A family history of haemochromatosis or an atypical diabetes presentation should prompt an investigation into iron status. Additionally, a low C-peptide level in the presence of haemochromatosis should prompt an investigation into islet autoantibody status.

Acute Fatty Liver of Pregnancy- A Case Series from a Tertiary Hospital of Kolkata, India: A Case Series

Madhulima Saha, Raju Agarwal, Sharad Srivastava, Aditya Joshi

Acute Fatty Liver of Pregnancy (AFLP) is a rare, life-threatening complication of pregnancy that affects women in the third trimester or immediate postpartum period. Although the exact pathogenesis is poorly understood, it has been linked to a deficiency in Long Chain 3-hydroxyacyl-CoA Dehydrogenase (LCHAD) in foetal fatty acid metabolism. The early diagnosis of AFLP can sometimes be challenging due to overlapping features with severe preeclampsia, Haemolysis Elevated Liver Enzymes, Low Platelet (HELLP) syndrome, viral hepatitis, and cholestasis of pregnancy. It is a diagnosis of exclusion when no other known liver diseases are present in the mother. Herein, the authors presented a case series of four cases of AFLP, including their chief complaints, clinicopathological findings, management, and outcomes. Early diagnosis, termination of pregnancy, and multidisciplinary management in the post-delivery period are crucial for improving foetomaternal prognosis.

Importance of the Levothyroxine Absorption Test in an Adolescent Girl

Asish Mondal, Pradip Kumar Sinha, Dipu Roy, Basudeb Ghosh, MD Arif

Hypothyroidism is a commonly encountered problem in daily clinical practice. Although the management of hypothyroidism may seem straightforward, it can become challenging when patients’ Thyroid-Stimulating Hormone (TSH) values remain elevated despite treatment. Various factors, including non-adherence and malabsorption, can contribute to this issue. Consequently, it is crucial to identify the underlying cause of increased levothyroxine demand, as this will prevent unnecessary dosage adjustments of levothyroxine tablets. In this case, a 13-year-old girl patient, presented with a TSH level greater than 200 and an fT4 level of 0.34, along with absent secondary sexual characteristics, impaired memory, delayed puberty, easy susceptibility to anxiety, difficulty with memorisation, and poor academic performance. Despite repeated inquiries, neither she nor her mother reported any instances of non-compliance. Additionally, there were no signs suggestive of malabsorption, such as diarrhoea or oedema. Therefore, a levothyroxine absorption test was conducted to rule out pseudo-malabsorption. This test aids in distinguishing patients with non-compliance from those with true malabsorption, thereby avoiding unnecessary dosage adjustments of levothyroxine supplementation, a problem frequently encountered in day-to-day clinical practice.

Lingua Plicata: A Precursor of Pemphigus Vegetans

C Balakumaran, S Sivaramakrishnan, S Gayathri, R Mahadhi

A 45-year-old female presented to the Dermatology outpatient department with complaints of painful oral erosions on the lips and a burning sensation on the tongue for two weeks. Oral cavity examination showed a tongue with multiple fissures (resembling sulci) with a few erosions on the lips. Regarding the erosions on the lips, cheilitis and nutritional deficiencies were considered. She was treated conservatively with multivitamin supplements, topical analgesics, and emollients. Complete dermatological examination was normal, and she was kept under regular monthly follow-up. Four months after the onset of oral lesions, she presented with raw areas over the trunk, bilateral upper and lower limbs, raised lesions over the bilateral axillae, and gluteal region (Table/Fig 1)a. On examination, vegetative plaques with oozing and crusting were present over the bilateral axillae and gluteal region. Multiple erosions were present on the trunk, groin, bilateral upper and lower limbs. The classical oral presentation of a fissured tongue (Table/Fig 1)b with cutaneous erosions and vegetative plaques pointed towards a provisional diagnosis of pemphigus vegetans with drug reaction and other bullous dermatoses like pemphigus vulgaris, pemphigus foliaceous, bullous pemphigoid, and paraneoplastic pemphigus as differentials. A skin biopsy was done and sent for histopathological examination, which showed suprabasal clefts containing abundant eosinophils and acantholytic cells (Table/Fig 1)c. Based on the clinical findings of vegetative plaques and cerebriform tongue (Premalatha’s Sign) (1), along with the histopathological findings, the diagnosis of pemphigus vegetans was confirmed. The tongue can serve as an indicator of systemic disease and, as such, can herald the onset of several systemic and cutaneous diseases. A benign disorder known as lingua plicata (also referred to as scrotal tongue, fissured tongue, furrowed tongue, plicated tongue, cerebriform tongue, or grooved tongue) affects the tongue, with deep fissures appearing on the lateral and dorsal surfaces as its defining feature. Fissured tongue usually remains asymptomatic, but in certain cases, it can be associated with a constant burning sensation that prompts the patient to seek medical attention. While the exact aetiology of the condition is unknown, there is evidence that lingua plicata may be an inherited condition and may represent a polygenic trait or an autosomal-dominant trait with partial penetrance (2). The most frequently observed fissuring pattern in the above-mentioned study was the central longitudinal pattern, while the lateral longitudinal pattern was infrequently observed (3). There are various disorders associated with lingua plicata, including pemphigus vegetans, pustular psoriasis, geographic tongue, Melkersson-Rosenthal syndrome, Sjogren’s syndrome, Down syndrome, chronic granulomatous disease, pachyonychia congenita, Cowden syndrome, and acromegaly, to name a few. A study by Vörös-Balog T et al., showed evidence of the coexistence of diabetes mellitus and hypertension with fissured tongue, while studies by Jahanbani J et al., and Ebrahimi H et al., suggested a relationship between fissured tongue and geographic tongue (4),(5),(6). While there is no effective treatment for the complete clearance of fissured tongue, implementing general measures such as avoiding hot and acidic foods, chewing betel nuts, smoking, and using tobacco can provide symptomatic relief. Utilising a specific tongue scraper and practicing good dental hygiene may also help prevent issues (7). Pemphigus vegetans belongs to a group of immunobullous disorders and is characterised by vegetative plaques over the flexures and involvement of the oral mucosa. This variant of pemphigus vulgaris accounts for about 1 to 2% of all cases of pemphigus (8). The two major subtypes are the Hallopeau and Neumann types, and of the two, the Neumann type is considered a severe form and more commonly associated with oral mucosal involvement, such as the cerebriform tongue described by Premalatha S et al., (1). Premalatha S et al., reported that this eponymous sign can precede, occur simultaneously, or follow the cutaneous lesions of pemphigus vegetans and is usually refractory to treatment (1). The present paper aimed to shed light on oral manifestations such as fissured tongue, which can herald the onset of several cutaneous and systemic conditions, as seen in the current case where oral lesions manifested months before the onset of the cutaneous lesions of pemphigus vegetans.

Ayurvedic Management in a Case of Plaque Psoriasis

Khushhali Balpande, Sadhana Misar

Psoriasis is a papulosquamous skin disorder characterised by erythematous squamous lesions that are clearly defined and have reddish scaly regions on the skin. In classical texts, all forms of skin conditions are mentioned under the Kushtha topic, and in this condition, it is mainly correlated with Ekakushtha, which is one among the Kshudrakushtha (1). A 45-year-old male patient came with the main complaint of reddish erythematous plaques over both upper and lower limbs with dryness and itching for the past three years. He had previously consulted an allopathic dermatologist and was clinically diagnosed with plaque psoriasis. He was prescribed immunosuppressive agents, systemic and topical corticosteroids, which he took for two years. However, there was no relief, so he came to an Ayurvedic hospital for treatment. No significant family history was present regarding any dermatological disorders or major illnesses such as hypertension, diabetes, and bronchial asthma. This condition can be differentially diagnosed with dry eczema due to dry blackish-brown patches associated with itching and oozing, as well as Tinea corporis with circular ring patches, dryness, and itching (2). In the present case, the blackish-brown patch was widespread over a larger surface area, associated with itching, dryness, and white powdery discharge, which is specific to plaque psoriasis (Table/Fig 1), (Table/Fig 2). Plaque psoriasis was diagnosed based on the clinical appearance of silvery-white scales and the Auspitz sign, which exhibits pinpoint bleeding patches. In ayurvedic literature, all skin conditions are categorised into seven Mahakushthas and 11 Kshudrakushthas, discussed under the Kushtharogaadhikar. Ekakushtha is one of the 11 Kshudrakushthas. Symptoms observed in Ekakushtha include Mahavastu (spread over a larger surface area), Matsayashakalopama (resembling fish skin), and Kandu (itching) (3). It is considered a Tridoshajvyadhi with Vata kapha Pradhan. The Samprapti (pathogenesis) involves the involvement of Rasa (plasma), Rakta (blood), Mamsa (muscle), and Lasika (lymph) leading to Dosha-Dushya Samurchana in the Twak (skin), resulting in Ekakushtha. The literature describes both Shodhan (purification treatment) and Shaman Chikitsa (palliative care) for the treatment of Ekakushtha (4). In this case, purification treatment such as Vaman (emesis) is administered along with palliative care and topical application (Table/Fig 3). Purification Procedure-Vaman (emesis): In the pre-procedure (Purvakarma), Tab Chitrakadi is given, which acts as a digestant and appetizer. Internal oleation with Mahatiktaghritam is administered to alleviate the vitiated Vata in the body. Marichyadi Tail (external oleation) improves blood circulation, reduces dryness and itching, and provides moisture to the body. Hot fomentation with Dashmool decoction is given to liquefy the vitiated Doshas from Shakha (tissues) to Koshtha (Gastrointestinal tract) and remove Srotorodha (obstruction in blood vessels). Vaman (emesis) eliminates vitiated Kapha and Pitta from the Gastrointestinal (GI) tract. The properties of Vamanopaga Dravyas, such as being hot, penetrating, diffusing, and dispersing, help enhance absorption and remove toxins from the upper GI tract (5). Excessive elimination of Doshas leads to a decrease in digestive strength, so a light diet is initiated, progressing to a semi-solid diet in a sequential pattern to gradually increase the patient’s digestive strength (6). Palliative care: Tab Arogyavardhini contains Katuki (Picrorhizia kurroa) as the main ingredient, which has antioxidant and anti-pruritic properties and promotes tissue nourishment. It pacifies all the Tridoshas, acts as an appetiser, and aids digestion (7). Tab Gandhak rasayan includes refined sulfur, which is used to treat many skin conditions (8). It has antimicrobial, antiviral, and antibacterial properties that help reduce the signs and symptoms of psoriasis. Syp Patolkaturohinyadi contains Chandan (sandalwood), Patol (Trichosanthes dioica), Guduchi (Tinospora cordifolia), and Murva (Marsdenia tenacissima), which possess Tridosha-shamak (balancing) properties. Hence, it is useful in treating Kapha Pradhanta (predominant Kapha) skin disorders such as Ekakustha (9). Topical application: Vetapallai lubricant and Psoralin ointment have antibacterial, antiviral, anti-inflammatory, antifungal, antioxidant, anti-psoriatic, anti-pruritic, and antimicrobial properties. All the ingredients are Twachya (skin-friendly) and Tridosha-shamak (balancing). They moisturise and soothe the skin (10). Thus, the purification procedure, palliative care, and topical applications help reduce itching, dryness, and erythematous lesions on the lower and upper limbs [Table/Fig- 4,5] by pacifying the vitiated Vata and Kapha Doshas. Hence, it can be concluded that psoriasis (Ekakustha) can be successfully managed with Ayurvedic modalities.

Radiological Findings in a Patient Presenting with Chronic Abdominal Pain as a Secondary Manifestation of Pulmonary Tuberculosis

A 32-year-old female patient presented with complaints of loss of appetite, weight loss (8-9 kg), and generalised weakness for three months. The patient also had a history of cough with expectoration for two months accompanied by abdominal pain, particularly on the left-side, and low-grade, intermittent fever for the last two weeks. The Erythrocyte Sedimentation Rate (ESR) was deranged, measuring 25 mm/hr. The Mantoux test was positive with an induration of 17 mm. The sputum study confirmed the diagnosis of tuberculosis by detecting acid-fast bacilli. On ultrasound, multiple hypoechoic lesions were noted scattered throughout the splenic parenchyma (Table/Fig 1),(Table/Fig 2). They showed no vascularity on colour Doppler and no evidence of calcification (Table/Fig 3). Multiple enlarged lymph nodes were found in the preaortic, para-aortic, peripancreatic, and splenic hilum regions. Computed Tomography (CT) scan demonstrated a tree-in-bud appearance and patchy areas of consolidation in the left lung parenchyma along with multiple subcentimeter lymph nodes. Multiple variable sized hypodense areas (HU +25 to +35) were noted scattered throughout the splenic parenchyma (Table/Fig 4).

Detection of Biofilm Formation among Drug-resistant Acinetobacter spp. Isolated from ICUs at a Tertiary Care Hospital: A Cross-sectional Study

Shweta R Sharma, Amit Mishra, Imran Ahamad, Sudhir Singh

Introduction: Acinetobacter spp. has emerged as an important hospital-acquired and opportunistic agent due to its survival capability in adverse conditions, saprophytic presence, and increasing resistance to antimicrobials. The irrational use of antibiotics, along with biofilm formation, plays an important role in producing Extensively Drug-resistant (XDR) and Multidrug- Resistant (MDR) Acinetobacter species, especially Acinetobacter calcoaceticus-baumannii complex (Acb complex), in the hospital environment, contributing to morbidity and mortality. Aim: To detect biofilm production among Acinetobacter species isolated from various clinical samples received from Intensive Care Units (ICUs) as well as their antibiotic sensitivity pattern. Materials and Methods: A cross-sectional study was conducted in the Microbiology Department at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India from January 2022 to April 2023. Patients of all age groups and both genders were included in the study after obtaining informed consent. Clinical specimens, including endotracheal secretions, endotracheal tips, pus, urine, sputum, tissue, and other body fluids, were collected from ICUs where Acinetobacter spp. was detected. A total of 223 cases were included. The specimens were collected using clean, leak-proof, sterile containers with proper aseptic precautions. Antimicrobial susceptibility testing was performed according to the guidelines set by the Clinical and Laboratory Standards Institute (CLSI) in 2022 and identifies MDR and XDR strains. The biofilm production of isolates was determined using a quantitative adherence assay. The data generated was entered into Microsoft excel, and statistical analysis was conducted using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) statistical software version 28.0. The results were then presented as descriptive statistics. Results: Among the 223 Acinetobacter spp. isolates, 159 (71.3%) were identified as Acb complex (Acinetobacter calcoaceticus-baumannii complex), followed by A.lwofi with 39 (17.5%) isolates and A. haemolyticus with 16 (7.2%) isolates. Acinetobacter showed resistance, in descending order of frequency, to amoxicillin+clavulanic acid (211 isolates, 94.6%), ciprofloxacin (211 isolates, 94.6%), trimethoprim-sulfamethoxazole (208 isolates, 93.3%), cefotaxime (198 isolates, 88.8%), cefepime (187 isolates, 83.8%), gentamycin (178 isolates, 79.8%), amikacin (152 isolates, 68.2%), piperacillin-tazobactam (68 isolates, 30.5%), imipenem (72 isolates, 32.3%), meropenem (71 isolates, 31.8%), polymyxin B (12 isolates, 5.4%), and colistin (2 isolates, 0.9%). The maximum antibiotic resistance was observed in Acb complex, with 208 (93.3%) strains being MDR producers and 32 (14.3%) strains being XDR producers. Biofilm production was observed in 214 isolates (95.9%), with 127 (56.9%) exhibiting strong biofilm production 63 (28.2%) showing moderate biofilm production, and 24 (10.8%) showing weak biofilm production. All MDR strains were found to produce biofilm, and out of those, 127 (61.1%) exhibited strong biofilm production. Among the XDR strains, all 32 (100%) were found to produce strong biofilm. Conclusion: In conclusion, Acinetobacter spp. has a high propensity for developing MDR, and the formation of biofilms further aids the organism in surviving under strenuous conditions, making it difficult to treat. Therefore, regular surveillance of Hospital-acquired Infections (HAI), the prevention of misuse and overuse of antibiotics, prescribing antibiotics based on antibiogram patterns, formulating antibiotic policies, and implementing bundle care approaches for the prevention of HAI are crucial in preventing antibiotic resistance.

Disease Burden of Hepatitis B Infection and Vaccination Trends in Healthcare Workers: A Prospective Cohort Study

Sandeep Goyal, Banoth Sridhar, Manjri Garg

Introduction: Hepatitis B Virus (HBV) infection is an important occupational hazard for Healthcare Workers (HCWs), with an approximately four-fold increased risk of acquiring this infection compared to the normal population. The horizontal mode of transmission is the predominant mode among HCWs. Additionally, vaccination trends among HCWs have been disappointing, with paramedics reported to have a higher risk of HBV transmission and receiving HBV vaccination less often than doctors. Aim: To determine the burden of hepatitis B infection and vaccination trends among HCWs. Materials and Methods: This cross-sectional study was conducted at Pandit Bhagwat Dayal Sharma PGIMS, Rohtak Haryana, India, from March 2019 to January 2020, enrolling 250 HCWs. The study included 80 junior residents, 17 house surgeons, 123 nursing staff, 18 Laboratory Technicians (LTs), and 12 Operation Theatre Assistants (OTAs). The subjects were divided into two groups: medical workers (Group-1; House Surgeons and Junior Residents) and paramedical workers (Group-2; Nursing staff, LTs, OTAs). The sample size was calculated using Probability Proportion to Size (PPS) of HCWs. Descriptive statistics were performed. Results: None of the subjects tested positive for Hepatitis B surface Antigen (HBsAg) during the study period. A total of 196 (78.4%) subjects were vaccinated, while 54 (21.6%) subjects remained Non-Vaccinated (NV). Out of the 196 vaccinated subjects, 140 (71.4%) were Completely Vaccinated (CV), and 56 (28.6%) were Incompletely Vaccinated (IV). The vaccination rate was highest among junior residents (95%) and lowest among LTs and OTAs (50%). Among the 80 junior residents, 76 (95%) were vaccinated, and 4 (5%) were NV. Among the 123 nursing staff, 89 (72.3%) were vaccinated, and 34 (27.7%) were CV. Among the 18 LTs, 6 (33.3%) were CV, 9 (50%) were NV and 3 were in category of IV. None of the 12 OTAs were CV, with 6 (50%) being NV. Conclusion: HCWs are at a potential risk of contracting HBV infection as an occupational hazard. There is need to strengthen efforts towards vaccination and prevention of HBV infection.

Prevalence of Depression, Anxiety, and Stress among Medical Students before their Final Examinations at a Private Medical College of Tamil Nadu, India: A Cross-sectional Study

Gautam Babu, Dhanasekar Gurupatham, Rajsri Thutikadu Rajasekaran

Introduction: Due to their susceptibility to mental health problems, medical students should have their prevalence of stress, anxiety, and depression checked before their final examinations. Aim: To assess the prevalence of stress, anxiety, and depression among medical students at a private medical college in Tamil Nadu, India, four weeks before their final examinations. Materials and Methods: A cross-sectional study was conducted at a private medical college, Tamil Nadu, India, including 297 Bachelor of Medicine and Bachelor of Surgery (MBBS) students, using Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire in December 2022 The survey was completed independently by the students with verbal agreement obtained; the response rate was 68.2%. The short form and history of usage of the DASS-21 in comparable medical student research led to its selection. Results: The mean age of the study participants was 20.48±1.23 years. The DASS-21 revealed prevalence rates of 60.9% for depression, 72.7% for anxiety, and 40.4% for stress among 297 first- to third-year medical students. There was no discernible effect of gender on these rates. With a depression frequency of 69% and significantly higher rates of severe depression (18.6%), first-year students demonstrated the highest scores, which were statistically significant (p<0.05). Conclusion: The study highlights the need for preventative actions, such as professional counselling, early detection of mental health problems, and educational programs on healthy coping mechanisms. To support medical students from the start of their academic journey and ultimately promote their resilience and mental health, these interventions should be specially designed.

Significance of Haematological Variates in Determining Risk of Cardiovascular Complications Post SARS-CoV-2 Infection: A Prospective Cohort Study

Introduction: Coronavirus Disease-2019 (COVID-19) is an ongoing global pandemic. Changes in haematological variables in patients with COVID-19 are emerging as important features of the disease. These changes in haematological variables may provide significant clues in the prognosis post Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. Aim: To determine the significance of various haematological variables in cardiac outcomes post SARS-CoV-2 infection. Materials and Methods: This was a prospective cohort study conducted at Prince Faisal bin Khalid Cardiac Centre, Abha, Kingdom of Saudi between March 2021 and October 2021. A total of 59 patients who were infected with SARS-CoV-2 with or without cardiac complaints were involved. Demographic, clinical, and laboratory data were recorded. Leukocyte counts, Neutrophil Counts, Lymphocyte counts, Neutrophil to Lymphocyte Ratio (NLR), platelet counts, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), and D-Dimer were assessed and compared between subjects who developed Cardiovascular Complications (CVC+ group) and the subjects who did not develop CVC post SARS-CoV-2 infection (CVC-group). Statistical analyses were performed using R scripting language and R Studio (version 1.2.5033, Orange Blossom). For continuous variables, t-test (for normally distributed) and Mann-Witney U test (for non normally distributed) were employed. For categorical data, Chi-square test (c2) was used. A p-value <0.05 was considered significant. Results: Among all the haematological variables assessed, Neutrophil counts (p<0.0001), NLR (p<0.0001), and PT (p<0.0001) were highly significant for developing CVC post SARS-CoV-2 infection. Additionally, Leukocyte counts (p=0.028), Lymphocyte counts (p=0.0002), APTT (p=0.036), and D-dimer (p=0.022) also showed statistical significance for developing CVC post-SARS-CoV-2 infection. Conclusion: Haematological testing is easily available, inexpensive, and provides almost instant results. Therefore, assessing haematological variables like Leukocyte counts, Neutrophil counts, Lymphocyte counts, NLR, PT, APTT, and D-Dimer values post SARS-CoV-2 infection can help doctors identify patients at higher risk of developing CVC and guide their interventions accordingly. This can potentially help in reducing the occurrence of cardiovascular complications.

Comparison of Nalbuphine Hydrochloride and Fentanyl Citrate for Total Intravenous Anaesthesia in Short Surgical Procedures: A Randomised Control Study

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p>0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value <0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value <0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value <0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group.

Diagnostic Value of Routine Biomarkers in Predicting Septicaemia in Hospitalised Patients: A Cross-sectional Study

Bhagwati Chundawat, Sakshee Gupta, Alka Meena

Introduction: Sepsis is a potentially fatal condition that leads to alterations in coagulation, immunosuppression, and multiorgan failure. Predicting the risk of septicaemia before the onset of organ dysfunction poses a challenge. Prompt diagnosis, coupled with triaged management, is crucial in determining disease outcomes. Aim: To assess the role of routinely employed biomarkers in the early identification of septicaemia in patients. Materials and Methods: A cross-sectional study was conducted on 564 blood samples from Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC) in Jaipur, Rajasthan, India, over a period of six months (July 2019-December 2019). Blood culture, identification, and antimicrobial sensitivity testing were performed for all the samples following the Clinical and Laboratory Standards Institute (CLSI- M100) guidelines. Standard septic markers, such as Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Serum Glutamic Pyruvic Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT), serum urea, serum creatinine, Haemoglobin (Hb), and Total Lymphocyte Count (TLC), were studied. The culture-positive patients were compared with a negative control group. The t-test and logistic regression were used for analysis. Results: Out of 564 patients suspected of sepsis, 135 (23.94%) were culture positive, with a male-to-female ratio of 1.41. No significant differences were found in septic markers {TLC (p-value=0.261), ESR (p-value=0.186), SGPT (p-value=0.336), SGOT (p-value=0.264), Hb (p-value=0.179), serum urea (p-value=0.350), and serum creatinine (p-value=0.155)} between the culture-positive group (135/564, 23.93%) and the culture-negative group (429/564, 76.06%), except for CRP (p-value=0.006). The results of logistic regression also showed that CRP was a significant predictor of septicaemia (p-value=0.009). Amikacin, doxycycline, and piperacillin-tazobactam were found to be sensitive. Conclusion: Currently used blood markers do not provide sufficient evidence for the prediction of septicaemia, although CRP may be preliminarily useful. There is an urgent need to combine them with novel markers for the early detection of septicaemia.

Assessment of Xerostomia or Hyposalivation among Smokers Using the Modified Schirmer Test in the Saudi Population: A Cross-sectional Study

Saeed Abdullah Arem

Introduction: Saliva is essential for maintaining homeostasis in the oral cavity through its various components. A decrease in Salivary Flow Rate (SFR) has various deleterious effects on the oral tissues. Several factors can alter salivary flow, and one such factor is smoking. Therefore, this study aims to evaluate the effect of smoking on salivary flow. Aim: To assess xerostomia and hyposalivation using the Modified Schirmer Test (MST) and the spitting method among smokers and compare the results with non-smokers in the Saudi population. Materials and Methods: A cross-sectional study was conducted at the Institutional Diagnostic Clinic at the College of Dentistry, King Khalid University in the Aseer region of Saudi Arabia from February 2023 to March 2023. A total of 200 subjects were divided into two groups of 100 each. Group-I consisted of individuals with a smoking habit history for 10 years, while Group-II comprised healthy subjects with no smoking history. All subjects underwent screening for xerostomia and hyposalivation using the spitting method and MST. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20.0, and a p-value of <0.05 was considered statistically significant. Mean SFRs by the spitting method and MST were calculated, and the means were compared using an unpaired t-test. Pearson correlation analysis was used to assess the correlation between the two methods. Results: A statistically significant decrease in SFR was observed in smokers compared to healthy subjects using both methods (p<0.001). There was an excellent correlation between the two estimation methods (p<0.001). The prevalence of xerostomia in Group-I was 45 (45%), and in Group-II, it was 14 (14%), while the prevalence of hyposalivation in Group-I was 73 (73%) and in Group-II, it was 10 (10%). Conclusion: Salivary flow was lower in smokers compared to non-smokers in the Saudi population. There is an excellent correlation between the two assessment methods, and based on the study experience, the MST can be considered a reliable, objective, inexpensive, easy-to-perform, and well-tolerated test for assessing hyposalivation.

Evaluation of the Role of Neck Dissection in Patients with Verrucous Squamous Cell Carcinoma of the Oral Cavity: A Cohort Study

Introduction: Verrucous Carcinoma (VC), a well-differentiated Squamous Cell Carcinoma (SCC), commonly presents in the oral cavity, accounting for 2-16% of oral carcinomas. Though rare, it poses a challenge in establishing a pathological diagnosis, even in adequate biopsies, as 20% of Oral Cavity Verrucous Carcinoma (OVC) contains concomitant SCC. VC is primarily treated by surgery, similar to oral SCC. The role of neck dissection in oral SCC is well-established, but there is limited data on VC. Aim: To evaluate the role of neck dissection in the management of OVC. It also aimed to evaluate the clinicopathological demographics of OVC and identify predictors for survival outcomes. Materials and Methods: A retrospective cohort study was conducted using medical records of 2312 patients with oral carcinoma treated from January 2010 to December 2020 at Department of Surgical Oncology, Malabar Cancer Centre, Kannur, Thalassery, Kerala, India, a tertiary cancer centre under the Government of Kerala. Among 116 patients identified with VC, 49 patients met the inclusion criteria. The collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. The primary outcomes were overall survival rate and disease-free survival rate. Kaplan-Meier curves were constructed based on the survival data and compared using the log-rank test. Results: The mean age of the entire population was 62.8 years, with an age range of 40-90 years. Among the 2312 patients who underwent surgery for oral carcinoma, 49 (2.11%) patients were diagnosed with VC based on the final histopathology report. The majority of patients were diagnosed with early-stage disease on histopathological examination 36/49 (73.5%). A total of 34 patients received neck dissections, of which 13 patients (38.3%) had palpable nodes on presentation. All patients were node negative (PN0). On univariate analysis, neck dissection was not found to be a predictor of mortality or locoregional recurrence. There was no significant difference in overall survival rate (p=0.160) or disease-free survival rate (p=0.67) when comparing patients who underwent primary resection with neck dissection to those whose necks were kept under observation. Conclusion: The OVC has an excellent prognosis, and surgery remains the mainstay of treatment. The decision on neck dissection and the extent of neck dissection should be judiciously made based on the surgical approach and the procedure’s morbidity.

The Association of Thyroid Autoimmunity and Lipid Profile in Hypothyroidism: A Cross-sectional Study

Itisha Katha, Nivedita Priya

Introduction: Thyroid disorders, particularly hypothyroidism, are the most common thyroid disorders in India, affecting one in ten adults. Autoimmunity may play a significant role in the progression of hyperlipidaemia, which is one of the recurrent issues associated with thyroid disorders. Although serum lipids have been proven to control immunological and inflammatory responses, little is known about their relationship to thyroid autoimmunity. Aim: To investigate the association between Thyroid Peroxidase Antibody (anti-TPO) and serum lipid parameters among patients diagnosed with hypothyroidism. Materials and Methods: A hospital-based cross-sectional study was conducted at Parul Sevashram Hospital in Vadodara, Gujarat from November 2022 to May 2023. A total of 103 patients with hypothyroidism were included in the study. All patients underwent estimation of thyroid function parameters such as triiodothyronine (T3), thyroxine (T4), and Thyroid-Stimulating Hormone (TSH), as well as anti-TPO levels and selected lipid profile parameters such as Total Cholesterol (TC), Triglycerides (TG), High-Density Lipoproteins (HDL), and Low-Density Lipoproteins (LDL). The association between anti-TPO and lipid levels was further analysed. Statistical analysis was performed using the Chi-square test. Results: Among the 103 hypothyroid patients, 83 (80.6%) were females, while only 20 (19.4%) were males. Positive serum anti-TPO antibodies were found in 79 (76.7%) patients, whereas negative Anti-TPO cases accounted for 24 (23.3%). The total serum cholesterol, with a mean of 226.88±37.44 mg/dL, and serum LDL, with 145.31±34.60 mg/dL, were significantly increased (p-value <0.01), whereas the serum TG with a mean of 181.06±52.13 mg/dL, and serum HDL, with 44.61±7.87 mg/dL, were found to be non significant (p-value >0.05). Conclusion: Hypothyroid patients positive for anti-TPO antibodies are at risk of experiencing disrupted lipid levels. There was a significant association between positive anti-TPO status and TC and LDL in the present study.

Clinicopathological Features of Cutaneous Vasculitis: A Cross-sectional Study from a Tertiary Care Centre in Karnataka, In

Kanthilatha Pai, Sadaf Khan, Sathish Pai, Raghavendra Rao

Introduction: Cutaneous vasculitis is an inflammatory disease of the dermal blood vessels with varying clinical presentations. It is not a single disease but a spectrum of entities that present as cutaneous vasculitis. Hence, histopathological evaluation is essential to confirm the diagnosis and determine the type of vasculitis. Direct Immunofluorescence (DIF) studies add credibility to the diagnosis. Aim: To investigate the spectrum of cutaneous vasculitis, its aetiological factors, and the clinicopathological features. Materials and Methods: This cross-sectional study was conducted over a three-year period (February 2015-January 2018). All cases of biopsy-proven cutaneous vasculitis diagnosed in the Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India were included in the study. The clinical data, along with laboratory investigations including skin biopsy and DIF, were analysed. Results: A total of 137 cases of cutaneous vasculitis were diagnosed during the study period. The age of the patients ranged from 1-73 years. The peak incidence of cutaneous vasculitis was observed in the fourth decade 31 (22.6%), with no significant gender preponderance. Palpable purpura over the lower extremities was the most common skin lesion at the time of presentation seen in 47 (34.3%). Most cases of vasculitis were primary cutaneous vasculitis, while 11 cases showed evidence of systemic vasculitis such as Wegener’s granulomatosis, Polyarteritis Nodosa (PAN), and Churg-Strauss syndrome. No underlying aetiology was identified in the majority of cases 82 (59.9%), while a possible underlying aetiology like connective tissue disorder, drug intake, infections, etc., could be identified in 55 (40.1%) cases. Small vessel vasculitis was the most frequent, with leukocytoclastic vasculitis being the predominant type seen in 89 (65%) cases. DIF positivity was sensitive, with positivity around the blood vessel wall observed in89 (87.3%) of cases (N=102). Conclusion: Vasculitis is a broad, poorly defined category of diseases and can manifest with a variety of clinical presentations. Therefore, compiling clinical, laboratory, and pathological findings is essential for formulating the diagnosis.

Prevalence of Gastrointestinal Sequelae among Previously Hospitalised Patients due to COVID-19 and its Association with Computed Tomography Chest Severity: A Cross-sectional Study

Sri Vengadesh Gopal, Ray Ganapathy, Saravanan Pandian, Renuka Srisai Peddireddi

Introduction: Coronavirus Disease 2019 (COVID-19) is a highly infectious disease primarily characterised by respiratory symptoms. While respiratory symptoms initially predominated during the pandemic, there has been an increase in Gastrointestinal (GI) manifestations in the later phase. Moreover, reports have highlighted the presence of chronic GI symptoms following COVID-19 infection. Aim: To determine the prevalence of GI sequelae after COVID-19 hospitalisation and its association with Computed Tomography (CT) chest severity scores. Materials and Methods: The present cross-sectional study was conducted at a COVID-19 designated tertiary care hospital, Indira Gandhi Medical College and Research Institute, Puducherry, India, from April 2022 to December 2022. Patients admitted with COVID-19 illness between January 2021 and June 2021 were included in the study. Socio-demographic details, CT chest severity scores, and chronic GI symptoms (nausea, vomiting, diarrhoea, abdominal pain, etc.) were collected from patients’ medical records and through telephonic interviews. The data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0 Qualitative variables were expressed as frequencies and percentages. The association of CT severity with GI symptoms was assessed using the Chi-square test, with a p-value of <0.05 considered significant. Results: A total of 1,903 patients who met the inclusion criteria were included in the study. Among the participants, 1142 (60%) were males and 761 (40%) were females. The majority of patients belonged to the age group of 41-60 years, followed by 21-40 years. The mean age of the patients was 48.88±1.72 years. The prevalence of chronic GI symptoms was observed in 26% of patients, with 36.6% experiencing abdominal pain and 19.6% having gastroesophageal reflux. Diarrhoea was reported by 15.8% of patients. Patients with severe CT severity scores showed a lower prevalence of GI symptoms. Conclusion: Chronic GI symptoms were observed in nearly one-fourth of the patients hospitalised for COVID-19. Interestingly, patients with severe CT chest severity scores exhibited a lower prevalence of GI symptoms. Further experimental studies are needed to understand the pathogenesis of GI symptoms and their association with CT severity, which could contribute to the development of effective treatment strategies.

Histopathological Patterns of Testicular Biopsy in Male Infertile Patients: A Cross-sectional Study

Introduction: The management of male infertility has undergone rapid changes with advancements in assisted reproductive techniques such as testicular sperm aspiration and microdissection, testicular sperm extraction (MicroTESE). However, testicular biopsy remains an important tool for diagnosing and managing male infertility, as well as assessing spermatogenesis levels. Aim: To examine the histological patterns of testicular biopsies in male patients with infertility. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, ESIC Super Specialty Hospital, Hyderabad, Telangana, India from May 2012 to May 2023. A total of 141 Tru-Cut biopsies from patients with male infertility were included based on predefined inclusion and exclusion criteria. Histopathologists labeled and reported the slides, noting the pattern of histopathology and level of spermatogenesis according to Johnson’s criteria. The data was analysed for percentages and mean values. Results: The majority of patients 43 (30.5%) exhibited normal histopathology, followed by Sertoli cell-only syndrome in 37 (26.24%) patients, and complete spermatogenic arrest in 14 (9.93%) patients. The least common pattern observed was incomplete spermatogenic arrest. Testicular atrophy was observed in 13 (9.22%) patients. Conclusion: This study highlights the importance of understanding the histological patterns observed in testicular biopsies, as it provides valuable insights to clinicians regarding the likelihood of obtaining spermatozoa for testicular sperm extraction in infertile males.

Assessment of Medical Practitioners’ Knowledge Regarding the Relationship Between Periodontal Disease and Diabetes Mellitus: A Questionnaire-based Cross-sectional Study

Shubhangi Behl, Vishakha Patil, Vidya Dodwad, Pooja Pharne

Introduction: Periodontal disease is a chronic inflammatory infectious disease that increases the host’s overall inflammatory burden by inducing a persistent systemic inflammation. This burden has been linked to insulin resistance, the development of diabetes, and its complications. Periodontal therapy plays a vital role in controlling diabetes and its potentially fatal complications. Medical and dental professionals should be aware of this inter-relationship between the two diseases to facilitate proper diagnosis and predict better treatment outcomes. Aim: To assess the knowledge of medical practitioners regarding periodontal disease and its inter-relationship with diabetes mellitus. Materials and Methods: This was a questionnaire-based cross-sectional study conducted by using google forms between May 2022 and October 2022 among 150 medical practitioners. The questionnaire consisted of 15 questions divided into two parts. The first part gathered personal data, while the second part focused on their knowledge about disease awareness. The collected data were analysed using percentages. Results: Out of 149 participants, who sent completed questionnaires, only 8 practitioners (5.4%) referred all while 99 (66.4%) referred only a few of their patients for dental check-ups. Among them, only 39 participants (26.2%) referred patients for regular general dental check-ups without any complaints or findings. Although 112 (75.2%) had knowledge about the association, only 59 participants (39.6%) knew that it is bidirectional. A total of 80 (53.7%) responses understood that periodontal bacterial load and associated inflammation caused alterations in sugar levels. However, 68 (45.6%) were unaware that periodontal treatment can help improve glycaemic status. Conclusion: It can be inferred that medical practitioners were not aware of the connection between periodontal disease and diabetes mellitus.

Association between Frontal QRS-T Angle and Major Adverse Cardiovascular Events among Patients with Acute Myocardial Infarction: A Cross-sectional Study

Jatin Praveen Panchal, Sharan Badiger

Introduction: Acute myocardial infarction has reached epidemic proportions in the Indian population. The premature onset of acute myocardial infarction has shifted the focus of research. An abnormal frontal QRS-T angle can be used as a marker of acute myocardial infarction and can also predict Major Adverse Cardiac Events (MACE) such as heart failure, complex ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation), early post-infarction angina, mechanical complications, and cardiac death resulting from acute myocardial infarction. Predicting the likelihood of serious adverse cardiovascular events and mortality in patients who have experienced an acute myocardial infarction aids in developing immediate and short-term treatment plans. Aim: To assess the association between the Frontal QRS-T angle and MACE among patients with Acute Myocardial Infarction (MI). Materials and Methods: A cross-sectional study was conducted on adult patients admitted with a diagnosis of acute MI at the Department of Medicine, BLDE (Deemed to be University) Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 95 patients were enrolled in the study and classified into two groups: Group A (n=68) with a frontal QRS-T angle of <100 degrees, and Group B (n=27) with a frontal QRS-T angle of >100 degrees. The patients were monitored for the emergence of serious MACE such as heart failure, pulmonary oedema, cardiogenic shock, arrhythmias, and death while they were in the hospital. Statistical analysis was performed using the Chi-square test, Independent t-test, and Mann-Whitney U test as applicable. A p-value of <0.05 was considered statistically significant. Results: The most common age group in Group A was 60-70 years, while in Group B it was 50-60 years. A total of 95 patients with acute MI were enrolled and divided into two groups. Out of 95 patients, 68 patients with a frontal QRS-T angle <100 degrees were in Group A, and 27 patients with a frontal QRS-T angle >100 degrees were in Group B. There was a significant difference between the two groups with respect to MACE, including heart failure (Group A=8.8%, Group B=77.8%, p=0.00), pulmonary oedema (Group A=10.3%, Group B=77.8%, p=0.00), and cardiogenic shock (Group A=7.4%, Group B=40.7%, p=0.00). Conclusion: A frontal QRS-T angle of >100 degrees was a reliable factor for assessing in-hospital major adverse cardiac outcomes such as heart failure, pulmonary oedema, and cardiogenic shock. Hence, a frontal QRS-T angle of >100 degrees on a 12-lead ECG is a cost-effective, reliable, and non-invasive parameter of MACE in patients with acute MI.

Evaluation of Comfort Levels of Patient and Ergonomics of the Dental Surgeon during Manual Scaling under Both Proprioceptive Derivative Concept and Conventional Approach: A Cross-sectional Study

Introduction: The important components that contribute to successful dental care are maximum accessibility, visibility, comfort, and control over clinical processes. Dental practitioners are more prone to developing musculoskeletal disorders due to awkward working postures. To minimise all these risk factors, a new concept called Proprioceptive Derivative (PD) has come into existence. Aim: The main aim of this study was to evaluate the comfort levels of the patient and ergonomics of the dental professional in the PD approach and conventional approach. Materials and Methods: A cross-sectional study was conducted in which manual scaling was performed by 20 dentists on 120 patients using the PD concept and conventional concept. A 13-item questionnaire was distributed among the patients and clinicians to record their perceptions of comfort levels, clinicians’ treatment satisfaction levels, and the time needed to complete the procedure after mastering the PD concept. In indepedent sample t-test was use to compare the responses among the two groups. p≤0.05 was considered statistically significant. Results: The comfort levels of the clinician (q1) during treatment in the conventional approach, with a mean value of 2.96±0.69, were significantly lower than in the PD approach, with a mean value of 3.46±0.85 (p<0.001). However, from the perspective of the patients, the mean comfort levels using the conventional strategy were 2.61±1.03, while using the PD approach, it was 2.85±1.11, which was not statistically significant (p>0.05). Conclusion: The clinicians had more ergonomic benefits and improved time factors under the PD concept. By following the work postures according to the PD concept, clinicians can avoid musculoskeletal discomfort, which is beneficial to all clinicians and can increase the longevity of their clinical practice.

Efficacy of Single-site versus Two-site Phacotrabeculectomy in Primary Open-angle Glaucoma: A Prospective Cohort Study

Introduction: The prevalence of co-existing cataract and glaucoma is increasing in the adult population. Combined surgeries have become more popular. However, there is a conflict over which technique provides the best Intraocular Pressure (IOP) control with good postoperative outcomes. Aim: To compare the efficacy of single-site versus two-site phacotrabeculectomy with mitomycin-C in patients with Primary Open-angle Glaucoma (POAG) and cataract. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology, S.V. Medical College, Tirupati, Andhra Pradesh, India, over a period of one year from January 2019 to January 2020. A total of 50 cases of POAG co-existing with cataract were analysed in the present study. Twenty-five cases were included in each group (Group-1 and Group-2). Phacoemulsification and trabeculectomy were both performed through a superior scleral tunnel in the single-site approach. The two-site method combines a superior trabeculectomy with a temporal clear corneal phacoemulsification. A concentration of 0.2 mg/mL of MMC was applied in both groups for three minutes. Patients were followed-up for three months after surgery to evaluate Intraocular Pressure (IOP), the need for antiglaucoma medication, and postoperative best-corrected Visual Acuity (VA). Comparative analysis was done using the Student’s t-test, and a p-value <0.05 was considered statistically significant. Results: Throughout the three-month duration, the patients were monitored. In the single-site group, the average preoperative IOP was 21.880±8.4079 mmHg, which significantly decreased to 11.16±9.95 mmHg after three months (p<0.001). In the two-site group, the corresponding figures were 22.640±6.3040 and 10.8±1.19 mmHg, respectively (p<0.001), with no discernible statistical distinction between the two groups (p=0.486). At the final follow-up, the number of antiglaucoma medications was 0.24±0.5 in the single-site group compared to 0.16±0.24 in the two-site group. The mean postoperative Best Corrected Visual Acuity (BCVA) did not exhibit any significant variation between the two groups. Furthermore, there was no disparity in the occurrence rate of complications between the two groups. Conclusion: Both single and two-site phacotrabeculectomy led to a significant reduction in IOP and improvement in BCVA. The final IOP was similar in the two procedures, although the two-site group needed less glaucoma medication. As both surgical procedures are equally effective, the choice of procedure remains at the discretion of the surgeon.

Oral Health Complaints in Pregnant Women Visiting a Tertiary Care Hospital in Mumbai, India: A Retrospective Observational Study

Introduction: Pregnancy results in a lot of changes within the oral cavity, and recent reports have suggested an association between dental issues and poor pregnancy outcomes. Although many studies indicate that dental procedures can be carried out safely on pregnant patients to alleviate pain and promote better oral health, dental health is not given importance in pregnancy mainly due to fear and misconceptions that dental care can adversely affect the foetus. Aim: To summarise the dental presenting complaints and clinical examination findings of pregnant women and to evaluate the proportion of those compliant with the respective dental treatment services recommended by the dentist. Materials and Methods: It was a retrospective observational study analysing data pertaining to all pregnant patients who reported to the Department of Dentistry at Seth G.S. Medical College and King Edward Memorial Hospital in Maharashtra, India between December 2017 and September 2018. There was no formal sample size estimation, and all eligible patients’ data available in the department registry, which was maintained as part of routine clinical care, were analysed. A structured Case Record Form (CRF) was used to collect demographic and clinical data from these registers, and descriptive statistics were used to summarise the data. Results: The mean±Standard Deviation (SD) age of study sample was 27.69±4.584 years. A total of 81 patients’ data were included for the analysis. The most common presenting complaint and examination finding were pain and dental caries, respectively. The most common treatment plan suggested and performed was medication, followed by extraction. The number of patients who followed-up was 37 (45.67%). Conclusion: Pain and carious tooth were the most common presenting complaint and examination finding, respectively. The proportion of patients who came for follow-up was not adequate, warranting enhanced awareness activities to reduce stigma over dental care during pregnancy.

Severity of Ventriculomegaly and its Associated Finding using Antenatal Ultrasound Scan at a Tertiary Care Hospital: A Retrospective Descriptive Study

Surekha Balaji, Kirtan Krishna

Introduction: Foetal Ventriculomegaly (VM) is defined as the enlargement of the lateral ventricles in the developing foetal brain. The measurement of foetal cerebral lateral ventricles’ size is routinely recommended as part of the second-trimester foetal scan to screen for anomalies. VM can occur due to obstruction of the Cerebrospinal Fluid (CSF) tract, absorption disorders, inadequate brain development, or excessive CSF production. Aim: To classify VM based on severity to differentiate between isolated and non isolated VM. Materials and Methods: A retrospective descriptive study was conducted in the Department of Radiology at PESIMSR, Andhra Pradesh, India., a tertiary medical hospital, from April 2018 to April 2021. Cases were selected from computer records showing a diagnosis of hydrocephalus or foetal VM in patients who underwent the Ultrasound (US) anomaly scan. VM was defined as a lateral ventricle width of ≥10 mm. Foetal VM was classified, and associated CNS and extracranial abnormalities and their details were collected. Descriptive statistics were used, and results were expressed in terms of frequency and percentage. Results: The VM was observed in 91 foetuses, with mild VM in 59 foetuses (64%), moderate VM in 14 foetuses (15.2%), and severe VM in 18 foetuses (19.5%). The median age at diagnosis was 26.5 weeks. Isolated mild VM was seen in 26 cases (44%), and it was associated with other abnormalities in 33 cases (56%). Isolated moderate VM was observed in four cases (28.5%), while 10 cases (71.4%) were associated with other abnormalities. Isolated severe VM was seen in (33.3%) 6, and it was associated with abnormalities in 12 cases (66.6%). The most common associated abnormalities were foetal growth restriction (15 cases), absent cavum septum pellucidum (eight cases), and open spina bifida, Arnold-Chiari malformation (eight cases). Conclusion: Ultrasound is a sensitive tool for detecting VM. Once VM is diagnosed, a detailed examination of the fetus should be conducted to evaluate other CNS and non CNS anomalies, thereby differentiating isolated from non-isolated VM, as the prognosis may vary. This information will be valuable for counseling patients.

Surgipler Skin Stapler versus Trulon Polyamide Suture in Post-surgical Open Abdominal Wound Closure: A Randomised Clinical Trial

Seraj Ahmed, Soham Patra, Nabarun Manna, Tirna Halder

Introduction: Surgical wound closure is the process of closing incised skin to facilitate rapid wound healing with a low risk of complications and an appealing cosmetic outcome. The method and material for wound closure are influenced by the type of surgery, the anatomical site of the wound, and the length of the incision. It must serve both functional and aesthetic purposes with fewer complications. Aim: To compare the rate of Surgical Site Infection (SSI) between skin staplers and polyamide sutures among patients undergoing open abdominal surgeries. Materials and Methods: The present study was a single-centre, prospective, two-arm, parallel-group, randomised (1:1) clinical study conducted at the Department of General Surgery, IPGMER-SSKM Hospital, Kolkata, West Bengal, India, between July 19, 2022, and January 31, 2023. A total of 134 eligible adult patients (18-70 years) undergoing open abdominal surgeries were screened, enrolled, and randomised to the Surgipler skin stapler (n=67) and Trulon polyamide suture (n=67). Patients were followed-up for 84 days. The primary objective was to compare the rate of SSI between the two groups. The secondary objectives were evaluation of wound complications, postoperative pain, patient satisfaction, cosmetic appearance of the wound, time taken for skin closure, ease of use, and safety of the two interventions. The statistical analysis was performed using the Analysis of Variance (ANOVA) test for continuous variables. A p-value <0.05 was considered significant. Results: The Surgipler skin stapler performed better than the Trulon polyamide suture in postoperative wound closure of open abdominal surgeries, based on the percentage of SSI (2.98% vs. 4.47%), skin closure time (387.99±116.40 vs. 578.57±139.22 seconds), patient satisfaction score (4.20±0.53 vs. 2.69±0.57), the overall Patient and Observers Scar Assessment Scale (POSAS) observers score (1.17±0.39 vs. 2.44±0.69), and the overall POSAS patient score (1.24±0.47 vs. 2.50±0.76) at the end of the study. All parameters had a statistically significant p-value <0.0001. Conclusion: The present study concludes that the Surgipler skin stapler performed better than the Trulon polyamide suture in postoperative wound closure in open abdominal surgeries.

Frequency of Preneoplastic and Neoplastic Lesions in Cholecystectomy Specimen from a Tertiary Care Hospital in Uttar Pradesh, India: A Cross-sectional Study

Umika, Afreen Fatima, Kanchan Garg, Vijai Singh

Introduction: Cholelithiasis is known to cause a spectrum of changes, including inflammation in the gallbladder wall, cholesterolosis, atrophy, metaplasia, dysplasia, polyps, and eventually cancer. Gallbladder Carcinoma (GBC) is a rare and highly fatal malignancy. Aim: To determine the frequency of preneoplastic and neoplastic lesions, along with demographic and clinical aspects of different gallbladder lesions. Materials and Methods: This cross-sectional study was performed on 788 patients who underwent elective cholecystectomy for gallbladder disease at Hind Medical College, Sitapur, Uttar Pradesh, India, from August 2017 to October 2021. All patients underwent a history and physical examination, followed by routine laboratory tests and other investigations, including full abdominal ultrasound. Histopathologic evaluation of the gallbladder specimen was also performed after surgical resection. Categorical variables were presented as numbers and percentages (%), while continuous variables were presented as mean±Standard Deviation (SD). Results: A total of 788 cholecystectomy specimens were analysed. The mean age of the patients was 42.49±1.39 years with female predominance 640 (82.05%). The majority of cases were between 40-49 269 (34.13%) and 60-69 399 (50.63) years of age. Preneoplastic changes were found in 764 (96.96%) cases, while neoplastic pathology was evident in 24 (3.04%) cholecystectomy specimens. The most commonly observed preneoplastic change was chronic cholecystitis in 532 (67.54%) cases. Other lesions associated with chronic cholecystitis were cholesterolosis in 76 cases (9.64%), xanthogranulomatous cholecystitis in 34 cases (4.31%), follicular cholecystitis in 30 cases (3.80%), and GBC in 24 cases (3.04%). Conclusion: This study observed that chronic cholecystitis and cholesterolosis, followed by xanthogranulomatous cholecystitis, were associated with metaplastic changes in gallbladder pathologies. It is believed that metaplasia-dysplasia could be linked to GBC. Therefore, routine microscopic examination is required for all cholecystectomies. However, further studies on gallbladder carcinogenesis are needed.

Head and Neck Malignancies and Neck Dissection Complications: A Cohort Study from a Tertiary Care Centre in Telangana, India

M Mallikarjun Rao, Shubranshu Jena, Rudra Prakash Panigrahi, S Kumar Vashist

Introduction: Complications after major surgery are a significant cause of morbidity and mortality, and they have been shown to harm long-term quality of life. Lymph node status is the chief prognostic indicator. In the head and neck, complications from oncosurgeries can also delay adjuvant treatment, which is known to adversely affect survival. Neck dissection is a standard procedure for head and neck cancer following resections of the primary tumour. The invasive nature of neck dissection predisposes patients to a variety of intraoperative and postoperative complications. Aim: To analyse the complications in patients with head and neck malignancies following neck dissections. Materials and Methods: This was a single-centre cohort study conducted at the Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. All patients diagnosed with head and neck malignancies who underwent neck dissections from July 2022 to December 2022 were included in the study. Complications such as bleeding, haematoma, infection, seroma, wound dehiscence, flap necrosis, fistula, chyle leak, shoulder dysfunction, and nerve and vascular injuries following various neck dissections were observed until discharge. The data was entered in Microsoft excel and results were expressed in terms of frequency and percentage. Results: A total of 67 patients were analysed in this study. Among them, 42 (62.7%) were males and 25 (37.3%) were females, with a mean age of 48 years and an age range of 25-84 years. Three patients underwent bilateral neck dissection, and a total of 70 neck sides were studied. Among the patients who received prior radiotherapy (20, 29.8%), 6 (30.0%) experienced complications, and there were no deaths. Conclusion: Head and neck surgery carries the potential for many complications due to the presence of major vessels and nerves. Carefully performed surgery is the cornerstone of success. Thorough preoperative assessment, proper surgical technique, and postoperative care are essential in preventing and managing complications. A step-by-step approach to studying details and conducting a complete check-up of the patient after the procedure ensures optimal results with minimal late side-effects and complications.

Impact of Certain Socio-clinical Factors on COVID-19 Preventive Measures among Patients with Chronic Respiratory Diseases: A Cross-sectional Study at a Tertiary Care Centre in Southern India

Anil Kumar Kodavala, Surekha Tadisetti

Introduction: Chronic respiratory diseases are known risk factors for Coronavirus Disease-2019 (COVID-19) associated morbidity and mortality. With the fourth wave of COVID-19 looming in India, it is crucial to prioritise preventive measures at both individual and community levels. However, following the third wave of COVID-19, adherence to preventive measures has declined. Aim: To assess the socio-clinical factors affecting COVID-19 preventive behaviour among patients with chronic respiratory diseases. Materials and Methods: This cross-sectional observational study was conducted at the outpatient department of Respiratory Medicine, Narayana Medical College Hospital, Nellore, a tertiary care centre in Andhra Pradesh, India from March to April 2022. The estimated sample size was 600 patients. Data was collected using a validated questionnaire, and analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 28.1 {International Business Machines (IBM) Corporation}. The association between independent and dependent variables was assessed using binary logistic regression. Results: A total of 671 patients’ data were analysed. The mean age was 51.45 (±14.397) years, with 390 (58.1%) being male. Among the participants, the prevalence of wearing face masks in workplaces was 47.8%, wearing face masks in public places was 43.6%, frequent hand sanitisation was 39.9%, and maintaining physical distance in public areas was 35.2%. The main factors associated with non adherence were women, rural dwellers, non smokers, patients with co-morbidities, those who had not experienced a detrimental impact of COVID-19 on themselves, and the perception that COVID-19 was a mild disease. Conclusion: Among patients with chronic respiratory diseases, the practice of COVID-19 preventive measures was inadequate. Factors that positively influenced COVID-19 behaviour were being married, having a high school education level or above, and being a smoker. The impact of age varied depending on the type of preventive measure. Socio-economic status had no significant impact.

The Post-treatment Impact on Quality of Life, Body Image, and Occupational Concerns among Head and Neck Cancer Patients

Aneri Shah, Ritu Sharma, Dushyant Mandlik, Kaustubh Patel

Introduction: Head and Neck Cancer (HNC) is the sixth most common cancer across globe, more common in Asian countries. HNC patients are at a significant risk of developing body image and functionality-related concerns, which in turn impact their overall Quality of Life (QoL). This study provides factual insights into the QoL of Indian male HNC patients three months after completing their treatment. Aim: To assess patients’ perceptions of self and overall QoL in context of body image and occupation. Materials and Methods: This mixed-method study included 32 male HNC patients and was conducted at a tertiary cancer centre in Ahmedabad, India, from March 2022 to April 2022. Patients who underwent surgery, with or without radiation therapy or chemotherapy, were included. The Functional Assessment of Chronic Illness Therapy-Head and Neck version (FACT-HN) and the Body Image Scale (BIS) were used as assessment tools. Qualitative responses were also recorded by the interviewer. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0, including both parametric and non parametric tests. Results: The mean age was 45.50 years. The overall QoL of the HNC population was found to be positive, with a mean score of 117.88±12.72. Higher scores indicated better QoL (total score range: 0-148). Similar trends were observed across all domains. Analysis of variance was conducted for three groups: ‘3-11 months’, ‘1-3 years’, and ‘more than three years’. A significant difference in mean HNC scores between these groups (p-value=0.004) was observed, with ‘3-12 months’ (mean=108) and ‘more than three years’ (mean=124.6) showing notable differences. QoL between these two groups was compared using the Kruskal-Wallis test, revealing significant differences in their physical, social, and HNC-specific index (HNCS). Approximately 43% of patients reported returning to work within 3-4 months post-treatment, while 46% experienced reduced work hours due to concerns related to functionality and appearance. Conclusion: This data highlights the subjective impact of physical, social, and head and neck-specific QoL issues on patients, particularly in the immediate post-treatment phase, which may persist for upto three years in some cases. Over time, patients’ overall QoL improves post-treatment.

Stromal CD10 Expression in Breast Carcinoma and its Association with ER, PR, and HER2/neu Using Immunohistochemistry: A Cross-sectional Study

Introduction: Breast cancer is a common and deadly malignancy affecting women worldwide. Various immune markers, such as Estrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal growth factor Receptor 2 (HER2/neu), are commonly used to assess prognosis. Currently, ongoing research aims to evaluate molecular pathways that contribute to invasion and metastasis. One important immunomarker under investigation is CD10, a zinc-dependent Matrix Metalloproteinase (MMP) that degrades bioactive peptides. CD10 expression in the tumour stroma has been associated with the biological aggressiveness of several epithelial malignancies, including breast carcinoma. Aim: To analyse the association between stromal CD10 expression and different prognostic factors, such as age, histological grade, and status of ER, PR, and HER2/neu markers, in patients with breast cancer. Materials and Methods: This institutional-based, cross-sectional study was conducted at the Department of Pathology, Nil Ratan Sircar Medical College and Hospital (NRSMC) in Kolkata, West Bengal, India over a period of one and a half years (February 2021 to July 2022). It included 120 cases of breast carcinoma diagnosed through histopathological examination of formalin fixed paraffin embedded sections, which were prepared from trucut biopsies and resection specimens referred from the Department of General Surgery, NRSMC. CD10 expression was assessed by Immunohistochemistry (IHC) in all cases and scored as negative, weak, or strong. The study examined the association between CD10 expression and the following parameters: age, histopathological grade, and the status of ER, PR, and HER2/neu markers. Data were entered into Microsoft Excel (MS) for statistical analysis. The significance of the study was determined using the Chi-square test, and data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Illinois, US). A p-value of <0.05 was considered statistically significant. Results: The study included a total of 120 cases, with 119 cases of female breast cancer (99.16%) and one case of male breast cancer (0.84%). The mean±SD age of the patients was 54±5.038 years (range 44 to 67 years). The majority of cases 102 (85.00%) were diagnosed as Invasive Ductal Carcinoma (IDC), Not Otherwise Specified (NOS), followed by IDC-special types 18 (15.00%). CD10 expression was evaluated in all cases, and stromal CD10 positivity was observed in 79 out of 120 cases (65.80%), with 39 individuals (49.40%) showing weak positivity and 40 cases (50.60%) showing strong positivity. The remaining 41 cases (34.16%) were CD10 negative. Grade 3 cancers were predominant in this study 62 (51.66%). It was noted that CD10 stromal positivity increased with higher grade. Most of the cancers in this study were negative for ER, PR, and HER2/Neu (78, 65.00%; 84, 70.00%; and 67, 55.83%, respectively). Stromal CD10 expression showed a significant association with ER (p-value=0.00001), HER2/neu (p-value=0.000089), tumour grade (p-value=0.0012), and an insignificant association with age (p-value=0.264) and PR (p-value=0.256). Conclusion: Therefore, CD10 expression is strongly associated with well-established prognostic markers, namely higher tumour grade, HER2/neu negativity, and ER negativity. This indicates that CD10 can not only be used as an independent marker of poor prognosis but also as a target for the development of novel therapies.

Clinical Profile and Outcome of Acute Myocardial Infarction among Young Adults at a Tertiary Care Centre in Manipur, India: A Cohort Study

KR Sarath Chandran, Salam Kenny Singh, Sunil Kumar Singh Leishangthem

Introduction: The incidence of Acute Myocardial Infarction (AMI) is rising in young adults. Timely control of cardiovascular risk factors is important to prevent the increasing incidence of AMI in young adults. Aim: To analyse the clinical profile, risk factors, and outcomes of AMI among the young adult population in Manipur, India. Materials and Methods: A hospital-based cohort study was conducted in a tertiary care centre at Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India from January 1, 2021, to December 31, 2022, among patients aged 45 years or younger attending the medicine Outpatient Department (OPD), admitted to the Intensive Care Unit (ICU) and Intensive Coronary Care Unit (ICCU) with the first attack of AMI. Cases involving pregnancy, known cases of pericarditis, and Congenital Heart Disease (CHD) were excluded. Data were collected using a performa regarding demographic profile, clinical presentation, risk factors, and treatment outcomes. The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0 and expressed as descriptive statistics. Results: A total of 39 cases were reported with a mean age of 40.2±4.6 years, with a male-to-female ratio of 9:1. The majority of cases presented with chest pain (74.3%), followed by shortness of breath (40%), nausea (13%), and collapse (10%). 75% of cases presented with multiple clinical features. The most common risk factors in young adults were smoking (84.6%), alcohol consumption (56.4%), family history of heart disease (25.6%), hypertension (20.5%), substance abuse (20.5%), diabetes (17.9%), and dyslipidemia (25.6%). Cases showed elevated cardiac enzymes - Creatine Kinase-Myocardial Band (CK-MB) (92.3%) and Troponin I (94.9%). Electrocardiogram (ECG) changes revealed ST segment elevation MI (89.7%). Only one case resulted in death during the hospital stay. Conclusion: The incidence of AMI among young adult populations is increasing, emphasising the need to raise awareness regarding cardiovascular risk factors and lifestyle modifications. However, the cases have shown good clinical outcomes among young adults with the disease.

Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study

Pankaj Kumar Verma, Surendra Kumar, Avinash Singh, Mohammad Vaseem, HS Shrishma

Introduction: The tibia, the second largest bone in the human body, is largely enveloped by subcutaneous fat and skin, rendering it vulnerable to fractures and soft tissue injuries. This unique anatomical configuration contributes to a heightened susceptibility to open fractures. Notably, an aggressive treatment protocol involving radical debridement, internal fixation, and immediate or early soft tissue coverage with muscle flaps has demonstrated improved rates of bony union and reduced incidences of infection. Aim: To assess the clinical outcomes of early bony fixation and soft tissue coverage in Type IIIB open proximal tibia fractures. Materials and Methods: This cross-sectional observational study was conducted at the Department of Orthopaedics, BRD Medical College, in Gorakhpur, Uttar Pradesh, India. Total of 30 cases were enrolled between August 2021 and November 2022. The parameters assessed in the study encompassed patient demographics, including age and gender distribution, the aetiology of fractures, soft tissue coverage outcomes, time to bone union, knee joint movement postsurgery, and the incidence of complications such as superficial infections and chronic osteomyelitis. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26.0, primarily employing descriptive statistics to present the results, with percentages and frequencies serving as the primary modes of representation. Results: All cases of Gustilo-Anderson Type IIIB high-grade open tibial fractures were included in this study, with the majority of patients being males 26 (87%) aged between 20 to 40 years. Road traffic accidents accounted for 25 (83.3%), while falls from height were responsible in 5 (16.7%) cases. Assessment of soft tissue coverage revealed 73.33% with good healing, 20% with fair healing, and 6.67% with poor healing. The time to bone union varied, with 10% of cases showing non union. Postsurgery, most cases demonstrated knee joint movement of over 120° (86.67%) and a few cases with movement ranging between 90-120° (13.33%). The incidence of complications was relatively low, with 3 (10%) cases presenting superficial infections and 2 (6.7%) suffering from chronic osteomyelitis. Conclusion: Early bony fixation and soft tissue coverage utilising the medial gastrocnemius flap, along with Split-Thickness Skin Grafting (STSG), demonstrate efficacy in treating high-grade open proximal tibia fractures (Gustilo-Anderson Type IIIB). This approach facilitates expedited bony union and contributes to a reduction in postoperative complications.

Comparison of Postoperative Analgesic Effect of Ultrasound-guided Erector Spinae Plane Block and Local Anaesthetic Infiltration with 0.375% Ropivacaine in Percutaneous Nephrolithotomy Patients: A Randomised Clinical Study

S Renganathan, SC Ganesh Prabhu, Naveen Raj

Introduction: The Erector Spinae Plane Block (ESPB) is a novel procedure that has shown benefits in postoperative pain management for various surgeries. It involves the systemic infiltration of anaesthesia into the surrounding tissues, which helps to suppress local pain responses. Aim: To compare the efficacy of Ultrasound-guided (USG) ESPB with local anaesthetic infiltration in postoperative pain management for patients undergoing Percutaneous Nephrolithotomy (PCNL). The comparison was based on the Numeric Rating Scale (NRS) score and the time taken for the first rescue analgesic requirement, along with its total consumption within 24 hours. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesia at Velammal Medical College and Hospital, Madurai, Tamil Nadu, India. The duration of the study was two months, from September 2022 to October 2022. A total of 70 patients were randomly assigned to either group L (n=35) (local anaesthetic infiltration) or group E (n=35) (USG-guided ESPB). Demographic details, NRS pain scores, time taken for the first rescue analgaesia, and total consumption within 24 hours were noted and analysed. Descriptive analysis was performed, and a comparison between the groups was made using the Mann-Whitney U test or Chi-square test. Analysis was conducted using coGuide V1.0.3. Results: The mean age (mean±SD) of the study participants in group L and group E was found to be 49.31±13.96 years and 46.37±13.72 years, respectively. A total of 35 patients were included in each group, consisting of 16 (45.71%) females and 19 (54.29%) males in both groups. The difference in NRS scores was significant at 30 minutes, one hour (p-value <0.001), and six hours (p-value <0.011). The median time required for the first rescue analgesic was found to be 480 and 30 minutes in group E and group L, respectively (p-value <0.001). The median total consumption within 24 hours was 50 mg in both groups. Conclusion: The USG-guided ESPB provided a longer-lasting analgesic effect in postoperative pain management for PCNL patients, as evidenced by the NRS pain scale, postoperative opioid consumption, and time for the first rescue analgesia.

An Innovative Laboratory Technique Showcasing the Synergy among Ceftazidime- Avibactam and Aztreonam in Combating Infections caused by Enterobacterales producing Metallo-beta-lactamases: A Prospective Study

Shital Shrikant Ghogale, Ketaki Niranjan Pathak

Introduction: Combination therapy with Ceftazidime-Avibactam (CAZ-AVI) and Aztreonam (ATM) has been studied in the context of infections caused by Enterobacterales that produce Metallo-Beta-Lactamases (MBL). The development of combination therapy is a crucial factor in combating MBL-producing Enterobacterales. As most isolates from Intensive Care Unit (ICU) patients produce a variety of beta-lactamases, offering resistance to a broad range of antibiotics, they need to be treated with the CAZ-AVI and ATM combination. This study addresses a pressing public health issue-the rise of multidrug-resistant bacteria, particularly MBL-producing Enterobacterales. By investigating the synergy between CAZ-AVI and ATM, the study aims to provide valuable insights to guide clinical practice, improve patient outcomes, and contribute to the global effort to combat antibiotic resistance. Aim: To demonstrate the synergy between CAZ-AVI and ATM in patients with infections caused by MBL-producing Enterobacterales. Materials and Methods: A prospective study was conducted in the Department of Microbiology at Symbiosis Medical College for Women (SMCW) and Symbiosis University Hospital and Research Centre (SUHRC), Symbiosis International (Deemed University), Lavale, Pune, Maharashtra, India. The study duration was six months, from January 2023 to June 2023. All isolates meeting the inclusion criteria were processed to demonstrate synergy between CAZ-AVI and ATM. Isolates from the Enterobacteriaceae family with resistant breakpoints for carbapenemase, ceftazidime-avibactam, and aztreonem, as determined by the Phoenix automated system, were included in the study. Restoration of the ATM breakpoint was observed following the addition of CAZ/AVI to ATM. Breakpoints provided by the BD Phoenix system were compared to the results obtained from CAZ/AVI and ATM disc diffusion/stacking, E-strip/disc methods, in terms of susceptibility and resistance. Results were simultaneously compared with the broth disc elution test, considered the gold standard. Results: Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated for the E-test/disc and disc stacking methods. The disc stacking synergy test demonstrated a PPV of 96.88% and an NPV of 62.5%. By using the E-test/disc, the ATM/CAZ-AV synergy test revealed a PPV of 97.22% and an NPV of 83.33% when CAZ/AVI was added to ATM. Comparatively, disc stacking was less sensitive than the broth disc elution. Conclusion: In the majority of MBL-producing Enterobacterales that are ATM-resistant, the CAZ/AVI+ATM combination showed strong synergy. In the microbiology laboratory, the E-test/disc and disc stacking approaches are rapid, repeatable, and reliable methods for checking clinically significant synergy.

Haematological, Clinical and Radiological Prognostic Markers in Young COVID-19 Patients during the Second Wave: A Prospective Cohort Study

Ankit Pandey, Priyadharshini Bargunam, Christina Goveas, S Sridhara

Introduction: The devastating outbreak of the second wave of Coronavirus Disease-2019 (COVID-19), resulting in numerous deaths among young individuals, has been the deadliest pandemic witnessed in this century. It caught us off guard by affecting young people and those without any underlying health conditions, leaving profound psychological and economic scars. Aim: To investigate various prognostic markers (haematological and clinicoradiological) in young COVID-19 patients during the second wave. Materials and Methods: This prospective, cohort study was conducted at a tertiary care centre in Karnataka, India from May 1st, 2021, to June 30th, 2021. All COVID-19 patients between the ages of 18 and 45, regardless of their pre-existing health status, who tested positive on Real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR)/Rapid Antigen Test (RAT) or showed typical Computed Tomography (CT) changes, were included. Patients with COVID-19 symptoms but negative RT-PCR/RAT results and without typical CT changes were excluded. Clinical, haematological, and radiological parameters were compared between the survivor group and non survivor group, and the results were analysed using measures of central tendency (mean, median, and mode), Chi-square test, and Independent t-test Statistical Package for Social Sciences (SPSS) version 21.0. Results: A total of 624 cases aged between 18 and 45 were included in the study. Among them, 481 (77.08%) patients survived, while 143 (22.92%) patients were dead. Of the 624 cases, 376 (60.26%) were males, 247 (39.58%) were females, and 1 (0.16%) was transgender. Factors associated with increased mortality included older age (>40 years), presentation with cough (119 patients, 83.2%) and dyspnoea (120 patients, 83.9%), asthma (7 patients, 1.1%), clinical classification based on respiratory rate, oxygen saturation, CT changes, and requirement for mechanical ventilation (78 patients, 54.5% in the Severe category and 54 patients, 37.8% in the Critical category), increased white blood cell count (mean μ=9685.8±5470.9), increased neutrophils (μ=8216±4986.9), elevated levels of CRP (μ=96.7±65.84 mg/dL), serum ferritin (μ=571.4±353.15 ng/mL), LDH (μ=1268.7±835 U/L), D-dimer (μ=74.87±527), serum globulin, ALT (μ=67.6±58.5 U/L), AST (μ=76.4±62 U/L), ALP (μ=120±89 U/L), urea, creatinine, decreased levels of albumin, total protein, haemoglobin, and lymphopenia (μ=1096.1±795.9). Additionally, a CT score >15 was associated with increased mortality. Conclusion: The aforementioned clinical, haematological, and radiological predictive biomarkers were associated with poor outcomes in young COVID-19 patients. Therefore, prompt and intensive management should be implemented to improve the prognosis of these patients.

Comparison of Two Different Continuous Wave Compaction Gutta-percha Obturation Techniques for Filling Oval-shaped Root Canals: An In-vitro Study

Introduction: The quality of Gutta-percha (GP) filling techniques depends on canal dimensions and anatomy. Thermoplasticised GP obturation techniques need to be modified in accordance to the root canal space anatomy. Aim: To evaluate the efficacy of continuous wave and modified continuous-wave compaction GP techniques in obturating ovoid canals. Materials and Methods: The present in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics in MGMDCH, Navi Mumbai, Maharashtra, India, from October 2019 to December 2019 on 45 single rooted human teeth were selected and mounted in Eppendorf tubes. The canals were cleaned and shaped using the Protaper Next rotary system. The specimens were divided into three groups based on the obturation technique: Group 1-Lateral Compaction (LC), Group 2-Continuous Wave Compaction (CWC), and Group 3-modified continuous-wave compaction. After obturation, the specimens were radiographed in labial and distal views. Subsequently, the specimens were removed from the Eppendorf tubes, and the extrusion of filling materials was assessed. The radiographic images were analysed using image analysis software, and the void area was measured. The obtained data was tabulated and statistically analysed using the Kruskal-Wallis test, followed by Post-hoc Dunn’s test. Results: The warm compaction techniques showed denser obturations compared to LC and were statistically significant (p<0.0001) by the Kruskal-Wallis test in the distal view. Post-Hoc analysis using Dunn’s test for the density of obturation in the distal view showed a statistically significant difference between Group 1 compared to Group 2 (p=0.000002*) and Group 3 (p=0.000204*). Extrusion in Group 3 was comparable to Group 1, while the highest extrusion was observed in Group 2. Conclusion: The modified continuous warm compaction technique showed dense and homogenous obturation comparable to the continuous wave technique and outperformed the LC technique. Additionally, the modified continuous warm compaction technique exhibited less extrusion compared to the continuous warm compaction technique.

Frequency and Patterns of Unintentional Injuries among Children Aged Less than 14 Years in Chengalpattu, Tamil Nadu, India: A Cross-sectional Study

V Sivagamasundari, S Appandraj, T Parvathy Devi

Introduction: Unintentional injuries occur very frequently in the paediatric age group. The major causes leading to unintentional injuries, such as poisoning, fires, drowning, and accidents, can vary according to age. Most of these injuries are preventable by modifying the child’s environment or providing adult supervision. Aim: To study the frequency and patterns of unintentional injuries in the paediatric age group under 14 years in Chengalpattu, Tamil Nadu. Materials and Methods: A hospital-based, cross-sectional study was conducted in the paediatric Outpatient Department (OPD) and emergency Department of Karpaga Vinayaga Institute of Medical Sciences, Chengalpattu, Tamil Nadu, India from June to November 2019. A total of 220 paediatric patients aged less than 14 years, who were admitted to the emergency Department with a history of unintentional injury, were included in the study. Data were collected using a semi-structured proforma containing details of age, education of the mother and father, type and place of injury, and other socio-demographic parameters. The nature of the injury was considered as the primary outcome variable. Statistical analysis was performed using coGuide. Results: In the present study, 220 children were included with a mean age of 6.12±3.74 years. The majority were male children 130 (59.09). The majority of the children (93.64%) were taken care of by their parents, and falls were the most commonly reported injury (55.00%), followed by falls of objects, poisoning, and Road Traffic Accidents (RTA). There was a statistically significant difference in mean age across the groups classified by the nature of their injury (p<0.05). Conclusion: In the present study, the prevalence of falls was 55%. Other common unintentional injuries among children under 14 years of age included falls of objects, poisoning, RTAs, bites/stings, foreign bodies, burns, and drowning or near drowning. These injuries can be prevented by adult supervision and providing a safe, child-friendly environment for play.

Role of Nebulised Heparin as an Adjunct in Critically-ill COVID-19 Patients: A Randomised Controlled Trial

Arun Nagalingareddy, Peram Srividya, KC Shivakumara, SP Raghu

Introduction: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of Venous Thromboembolism (VTE) and coagulopathy. The available studies have shown the anticoagulant and mucolytic effects of nebulised heparin in non COVID-19 patients. Hence it was decided to conducted to study the efficacy of nebulised heparin in patients suffering from COVID-19 pneumonia requiring mechanical ventilation. Aim: To evaluate the safety and efficacy of nebulised heparin administered to patients with COVID-19. Materials and Methods: A double-blinded randomised controlled trial was conducted at Basaveshwara Medical College and Hospital in Chitradurga, Karnataka, India among 100 patients with COVID-19 who required mechanical ventilation from February 2021 to May 2021. They were randomly assigned to two equal groups of 50 patients each. One group received nebulised heparin, and the other group received a placebo. The patients were compared for baseline characteristics, coagulation characteristics, and Oxygen Saturation (SpO₂). Data were analysed using Statistical Package for Social Sciences (SPSS) version 22.0, expressed as frequency and percentages, and displayed in tables and figures. The association between two variables was determined using the Chi-square test and paired t-test. Results: The two groups did not differ significantly in terms of age, sex, respiratory failure, vasopressin use, and severity score. Respiratory failure was present in 54% of the heparin group and 38% of the placebo group. Vasopressin was used in 64% of the heparin group and 56% of the placebo group. The severity score was 4.44 in the heparin group and 4.42 in the placebo group. Activated Partial Thromboplastin Time (APTT) levels did not differ significantly between the groups. None of these parameters showed significant differences between the heparin and placebo groups. However, both groups showed a significant difference in Thrombin Antithrombin (TAT) complex levels from baseline to follow-up (p<0.05). D-Dimer levels decreased during follow-up, and SpO₂ improved significantly in the nebulised heparin group compared to the placebo group. Conclusion: Nebulised heparin used as an adjunct in critically ill COVID-19 patients was shown to decrease TAT and D-Dimer levels. Nebulised heparin also significantly improved oxygenation levels. Importantly, heparin nebulisation was not associated with any adverse events, even when administered with systemic heparin.

Efficacy of Locoregional Perforator Flaps for Resurfacing of Peri-ankle Soft Tissue Defects: A Single Centre Prospective Cohort Study

Priti Upadhyay, Sandip Basu

Introduction: The foot and ankle serve as vital components in supporting mobility. When afflicted by trauma, infections, burns, or tumours, they often present challenging defects that expose tendons, bones, joints, and nerves. Managing soft-tissue reconstruction in this area is complex, primarily due to limited local tissue resources and inadequate muscle coverage. A range of reconstructive options exists, encompassing local, locoregional, and distant flaps, with microvascular free flaps as the gold standard. Recent studies have explored newer pedicled and perforator-based flaps as promising alternatives for lower extremity soft-tissue defects. Aim: To explore the efficacy of perforator-based local and locoregional flaps for resurfacing peri-ankle defects. Materials and Methods: This prospective cohort study was conducted at the Department of Plastic Surgery, SSKM Hospital, and IPGME&R, Kolkata, West Bengal, India, from April 2019 to March 2022. A total of 49 patients with soft-tissue defects around the ankle were included. The reconstructive approach primarily involved perforator-based flaps from various arterial sources. Outcomes were categorised as complete defect coverage, minor flap necrosis without intervention, or major necrosis necessitating additional surgical intervention. For this descriptive study, proportion was used to compare categorical variables such as the number of cases with different aetiology, and the number of different flaps used were compared. For the continuous variable like age, mean has been used as a measure of central tendency. Results: The mean age of the study population was 39.6±4.1 years. Thirty-four out of 49 patients (69.38%) presented with defects stemming from Road Traffic Accidents (RTA), and the posterior aspect of the ankle was the most common defect location (14 out of 49 patients, 28.57%). Peroneal Artery Perforator Flaps (PAPF) exhibited the highest success rate, with 18 out of 20 cases where this flap was used (90%), closely followed by Lateral Supramalleolar Flaps (LSF), with 13 out of 15 cases (86.7%). Overall, in 42 out of 49 cases (85.7%), the perforator-based flaps effectively resurfaced the defects. Conclusion: Pedicled perforator-based flaps, including those based on the peroneal artery and lateral supramalleolar, have emerged as valuable options for the reconstruction of soft-tissue defects around the ankle.

Comparison of Laboratory Parameters and Outcomes in Perforation Peritonitis Patients before and after Peritoneal Drain Placement: A Prospective Cohort Study

Introduction: Patients with perforation peritonitis present in the Emergency Department with various causes, but bowel perforation is the most frequent cause. These patients often arrive late at tertiary centres, resulting in severe peritoneal contamination and septic shock. Therefore, preoperative peritoneal drain placement provides adequate drainage and better outcomes in such cases. Aim: To compare various clinical and laboratory parameters in patients with perforation peritonitis before and after the placement of a peritoneal drain, prior to any definitive surgical treatment. Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery at Kalpana Chawla Government Medical College in Karnal, Haryana, India, from October 2022 to June 2023. All cases of perforation peritonitis that were critically-ill or in shock upon presentation in the emergency department were planned for intraperitoneal drain placement before definitive surgery. A total of 140 patients were enrolled in the study, and their clinical parameters (temperature, pulse rate, SpO2, and urine output) and laboratory parameters (such as leucocyte count, electrolytes (Na+, K+, Ca++), pH, base excess, bicarbonate values, lactate, Random Blood Sugar (RBS), and haematocrit) were compared before and 24 hours after drain placement. Statistical analysis was performed using paired t-test. Results: The mean age of the patients was 46.03±18.06 years, and 116 (82.85%) of the cases were male. The most common co-morbid condition was pulmonary disease {Chronic Obstructive Pulmonary Disese (COPD)/Asthma}, diagnosed in 96 (86.57%) cases. The most common perforation site was duodenal, followed by gastric and ileal, observed in 65 cases (46.42%), 23 (16.34%) cases, and 21 (15%) cases, respectively. There was a significant improvement in clinical parameters such as temperature, pulse rate, Saturation of Peripheral Oxygen (SpO₂), and urine output after drain placement (p-value <0.001). There was also an improvement in laboratory parameters including leucocyte count, electrolytes (Na+, K+, Ca++), pH, base excess, and bicarbonate values (p-value <0.001). The mortality rate was 20%, with 28 cases resulting in death. Conclusion: Although preoperative intraperitoneal drain placement is not a standard surgical procedure for patients with perforation peritonitis, it resuscitates and stabilises the patient, thereby helping in reducing morbidity and mortality postoperatively.

Acoustic Changes in Patients with Laryngopharyngeal Reflux Disease without Voice Complaints: A Cross-sectional Study

Introduction: In Laryngopharyngeal Reflux (LPR), refluxate rich in acid, pepsin, and bile regurgitates above the upper oesophageal sphincter onto the laryngeal mucosa. However, not all patients with LPR present with subjective voice changes. This may be due to a gradual change in voice that remains unnoticed. The clinical subtlety is important for diagnosis or at least awareness for better treatment and care. Aim: To objectively determine preclinical acoustic changes in patients with LPR who have not reported any voice complaints. Materials and Methods: This cross-sectional study was conducted on adult patients visiting the Out-patient department of a Tertiary Care Teaching Institute in Northern India, from September 2022 to October 2022. Patients with LPR but without voice changes were included in the study. They underwent multidimensional voice analysis during the phonation of the vowel /a/. Mean fundamental frequency (MF0), absolute jitter, absolute shimmer, and Soft Phonation Index (SPI) were analysed for the sample and compared to the gender-specific mean values provided by the software used. Statistical significance was determined using the one-sample t-test. Results: A total of 27 participants (20 females, 7 males) completed the study. In the female group, the mean MF0 (204.30±32.49 Hz) was significantly lower, absolute jitter (92.41±87.93 μs), absolute shimmer (0.38±0.31 dB), and SPI (25.62±15.24) were significantly higher than the reference mean. In the male group, the mean MF0 (138.03 Hz), absolute jitter (104.01±84.28 μs), and absolute shimmer (0.34±0.16 dB) were not significantly different from the reference mean. However, SPI (25.09±16.95) remained significantly higher than the reference mean. Conclusion: Increased jitter, shimmer, and SPI are primary acoustic changes observed in patients with LPR. These changes appear even before patients experience any voice changes.

Morphological Changes in Paraspinal Muscles on MR Imaging in Chronic Low Back Pain Patients with Unilateral Lumbar Disc Herniation: A Cross-sectional Study

Introduction: Low Back Pain (LBP) caused by Lumbar Disc Herniation (LDH) is a major cause of chronic disability worldwide. The management of LDH depends on clinical assessment and Magnetic Resonance Imaging (MRI) findings. Atrophy or fatty replacement of paraspinous muscles has a negative impact on the outcomes of both conservative and surgical treatment for LBP due to LDH. Aim: To analyse the morphological changes in paraspinous muscles using MRI in patients with chronic LBP and unilateral LDH. Materials and Methods: A cross-sectional study was conducted at Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, India, from December 2020 to May 2022. A total of 59 patients, aged 21-65 years, with chronic LBP and unilateral LDH on MRI, were included in the study. The morphological changes in the Multifidus Muscle (MM) and Erector Spinae Muscle (EM) were analysed. The Cross-Sectional Area (CSA) of MM and EM, as well as the Signal Intensity (SI) of MM on the herniated side of the lumbar disc, were recorded and compared to the contralateral side at the same level. Continuous variables were expressed as mean±SD, median, and interquartile range, while categorical variables were presented as numbers and percentages. The Mann-Whitney test was used to compare continuous variables, and a p-value of <0.05 was considered statistically significant. Results: The mean age of the study participants was 39.17±12.82 years, with 59.3% male and 40.7% female participants. The CSA of MM on the side of disc herniation was 5.84±1.53 cm2, compared to 6.52±1.69 cm2 on the unaffected side (p=0.02). The CSA of EM on the side of unilateral disc herniation was 13.08±3.04 cm2, compared to 14.29±3.22 cm2 on the unaffected side (p=0.01). The SI of MM on the affected side was 175.84±100.99, compared to 147.70±83.50 on the unaffected side (p=0.02). Conclusion: Chronic LBP due to unilateral LDH resulted in a reduction in the Cross-Sectional Area (CSA) and fatty infiltration of the ipsilateral paraspinous muscles.

Inter-observer Reliability in Reporting Complications of Transurethral Resection of the Prostate with Clavien-Dindo Classification: A Retrospective Observational Study

Introduction: Transurethral Resection of the Prostate (TURP) is a gold standard treatment for Benign Prostatic Hyperplasia (BPH). The Clavien classification system was proposed in 1992 to grade complications of general surgery, which was then modified in 2004 by Dindo. In 2017, the European Association of Urology (EAU) endorsed its use for reporting complications in urological procedures. However, the system relies on observers to grade complications, and different observers may assign different grades to the same negative outcome, highlighting the need for uniformity. Aim: To assess the inter-observer reliability and uniformity among urologists in reporting complications of TURP using the modified Clavien-Dindo classification system. Materials and Methods: A retrospective observational study was conducted at Department of Urology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from January 2018 to May 2023. The study included symptomatic patients with BPH and prostate gland sizes greater than 40 cc. Negative outcomes were evaluated and complications were rated by nine different raters. Inter-observer reliability was tested using weighted kappa with Statistical Package for Social Sciences (SPSS) version 21.0 (Fleiss’s kappa test). Results: A total of 523 men with BPH who underwent TURP were evaluated, with a mean age of 66.7±5.2 years and a mean prostate volume of 62 cc. Adverse events occurred in 96 patients (18.36%), and these complications were classified according to the Clavien-Dindo System (CDS) by nine different blinded observers. The rating of these complications was then assessed for concordance. A concordance rate using weighted kappa of 0.847 was observed, indicating high inter-observer reliability for TURP. Conclusion: Clavien-Dindo’s system demonstrated good inter-observer concordance and reliability. Some modifications to the grading system are needed, taking into account the impact of pre-existing co-morbidities and auxiliary procedures. Large-scale prospective studies are recommended to further validate these findings.

Effect of Bilateral Salpingectomy versus Bilateral Tubal Ligation on Ovarian Reserve for Patients Seeking Permanent Sterilisation: A Prospective Cohort Study

Robin Medhi, Rumen Chandra Boro, Kafiluddin Ahmed, Gautami Dhar, Neha Singh

Introduction: Ovarian cancer is a common malignancy in women with a high mortality rate, necessitating effective preventive measures. The American Cancer Society and the American College of Obstetricians and Gynaecologists, in their newer guidelines, suggest that patients undergoing tubectomy have an opportunity for the prevention of ovarian carcinoma by undergoing Prophylactic Bilateral Salpingectomy (PBS) instead of tubectomy in average-risk women. However, salpingectomy is not widely accepted as a method of sterilisation over tubectomy during caesarean section due to concerns about its potentially detrimental effect on ovarian reserve. Aim: To determine the effect of Bilateral Salpingectomy (BLS) and Bilateral Tubectomy (BLT) on ovarian reserve over a period of six months from surgery and to compare salpingectomy and tubectomy for their intraoperative and postoperative complications. Materials and Methods: The study is a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam, India, from Sept 2020 to Aug 2021, over a period of one year, involving women between 32-35 years undergoing sterilisation during caesarean section. Mean Antimullerian Hormone estimation was done preoperatively, at the 3rd month, and at the 6th month to assess changes in ovarian reserve following salpingectomy and tubectomy. Intraoperative blood loss, surgery time, surgical complications, postoperative complications, recovery period, histopathological study of the fallopian tube, etc., were analysed and compared between the two groups. All data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value <0.05 was considered statistically significant at a 5% confidence level. Results: A total of 114 patients were enrolled in the study, of which 9.64% dropped out midway, while the remaining 103 (90.36%) patients were part of the study until its completion. The mean age of the participants was 33 years and six months. There was no significant intergroup variation in preoperative, 3rd month, and 6th month mean Antimullerian Hormone (AMH) values (p>0.05). However, in each group, the preoperative mean AMH was lower than its 3rd month and 6th month values, which were in the normal range. This was attributed to ovarian suppression during pregnancy, which normalised following delivery and showed an increasing trend thereafter. However, on average, salpingectomy required approximately 10 minutes more than tubectomy. Conclusion: Salpingectomy does not affect ovarian reserve in the short-term of six months. Other than being more time-consuming compared to tubectomy, salpingectomy is on par with traditional tubectomy. Therefore, it may be adopted as a routine sterilisation method considering its role in the prevention of ovarian cancers.

Factors Affecting Blood Donations among COVID-19 Plasma Donors at a Tertiary Care Hospital in Mandya, Karnataka, India

P Yogendra, MU Mythreyi, BG Malathi, Ayshath Shumaisa

Introduction: Blood group antibodies are associated with susceptibility to Coronavirus Disease 2019 (COVID-19) infection among different blood groups. Factors such as age and male sex have been identified as risk factors for COVID-19 and disease severity. Aim: Determination of blood groups of COVID-19 positive plasma donors and examine the association of blood groups with different sexes and age groups. Additionally, the study aims to investigate the factors that either prevent or motivate COVID-19 positive individuals to donate plasma. Materials and Methods: This retrospective cross-sectional study analysed records from July 2020 to June 2021 at the Blood Bank of Mandya Institute of Medical Sciences, Mandya, Karnataka, India. The sample size included 115 COVID-19 plasma donors, selected using inclusion and exclusion criteria. Data on blood group, age, sex, and factors influencing plasma donation were recorded. The collected data was entered into a Microsoft Excel sheet and analysed using Statistical Package for Social Sciences (SPSS) version 20.0 statistical software, applying the Chi-square test. Results: Among the 115 COVID-19 positive patients, 113 were males and two were females. The most commonly affected age group was between 31-40 years (44 donors), and the most commonly observed blood group was O+ve (44 cases). There was no significant association between gender and age group (p-value-0.299). Similarly, there was no significant association between blood group and age groups (p-value-0.730). When evaluating the reasons for donating blood, the majority of people (33 out of 115) mentioned that their family member required blood. The provision of transport facilities by the blood bank did not significantly increase the number of blood donations, as most people preferred using their own vehicles (44 out of 115) due to the fear of COVID-19 infection. Among their friends, the main reason for not donating blood was the fear of infection (63 out of 115). Conclusion: Individual with blood group ‘O’ were more affected by COVID-19 compared to other blood groups. The pandemic has impacted blood transfusion services as fewer donors are visiting hospitals for blood donation. It is important to thoroughly assess and address the various reasons that prevent individuals from donating plasma through mass awareness campaigns.

Association of Lipid Accumulation Product with Insulin Resistance in Type 2 Diabetes Mellitus: A Cross-sectional Study

P Vijayalakshmi, HS Manjula, SMR Usha

Introduction: The increased incidence of diabetes and Cardiovascular Disease (CVD) is attributed to the rising obesity rates, which is one of the major factors contributing to Insulin Resistance (IR). Although there is a close relationship between obesity and IR, not all cases of obesity lead to cardiometabolic complications. Visceral fat is considered to be the primary cause of IR. Lipid Accumulation Product (LAP) is postulated as a new continuous biomarker of visceral adiposity. Aim: To determine the association between LAP and IR in T2DM. Materials and Methods: This institution-based cross-sectional study was conducted over a period of three months at the Department of Biochemistry, Rajarajeswari Medical College and Hospital in Bengaluru, Karnataka, India. A total of 60 Type 2 diabetic patients (including newly diagnosed and known cases) were recruited as cases, along with 30 healthy controls. Height, weight, and Waist Circumference (WC) were measured. Fasting blood samples were collected for laboratory biochemical estimation of glucose, Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and fasting insulin. Statistical analysis for continuous variables was performed using unpaired Student’s t-test, and Analysis of Variance (ANOVA) test was used for group comparisons. Results: Fasting serum insulin (p-value=0.007), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p-value=0.001), and LAP index (p-value <0.001) were significantly higher in the case group. LAP index was divided into quartiles, Insulin and HOMA-IR showed statistical significance across the quartiles (p-value=0.005). The lipid profile analysis across LAP quartiles revealed a progressive increase in TG levels (p<0.001) and a decrease in HDL levels from Q1 to Q4 quartiles. Conclusion: The study concludes that increased LAP levels are associated with IR in T2DM. LAP can serve as a useful marker for cardiometabolic risk in early-stage T2DM, enabling better disease stratification for improved prognosis.

Biochemical Analysis of Liver Function in Individuals Affected and Unaffected by Dental Fluorosis in Endemic Fluoride Rural Areas of YSR Kadapa District, AP, India: A Cross-sectional Study

Sirigala Lavanya, Prathiba Ramani

Introduction: Fluoride is known to affect the nervous system, kidneys, liver, and gastrointestinal system, in addition to teeth and bones, when consumed in amounts exceeding 1 ppm per day over a prolonged period. YSR Kadapa district has been identified as one of the districts with endemic fluoride areas in Andhra Pradesh, India, by the Central Groundwater Board of India. Aim: To assess the toxic effects of fluoride on liver function in individuals affected and unaffected by dental fluorosis, who consume high levels of fluoride in water, in the endemic fluoride rural areas of YSR Kadapa district. Materials and Methods: A cross-sectional study was conducted in six villages of YSR Kadapa district, where the drinking water has elevated fluoride content. A total of 320 subjects were selected as study participants. The subjects were divided into two groups based on age and dental fluorosis: Group A, aged between 21 and 40 years, and Group B, aged between 41 and 60 years. Subjects of each group were further sub-grouped according to presence or absence of fluorosis. The selected subjects were screened for dental fluorosis, and Groups A and B were further divided into subgroups based on the presence or absence of dental fluorosis. Blood samples were collected from the participants to assess liver function using serum levels of liver function markers such as total bilirubin (direct and indirect), Serum Glutamic Oxaloacetic Transaminase (SGOT), Serum Glutamate Pyruvate Transaminase (SGPT), and Alkaline Phosphatase (ALP). Water and urine samples were also tested for fluoride levels using a fluoride ion meter. Statistical significance was determined using the t-test. Results: The mean fluoride levels in the water samples from the study areas ranged from 1.55±0.30 mg/L to 4.10±0.20 mg/L, and the urinary fluoride levels in the urine samples ranged from 0.54±0.46 mg/L to 2.13±0.845 mg/L. Among the study subjects, 60.6% (194) were affected by dental fluorosis, with 58.66% (88) belonging to Group A and 62.35% (106) belonging to Group B. There was no statistically significant difference in liver function markers in the serum between subjects with dental fluorosis and those without dental fluorosis in both groups (p>0.05), and the levels were within the normal reference range. Conclusion: This study found no impaired or altered liver function in adults affected by dental fluorosis and adults unaffected by dental fluorosis who consumed water with high levels of fluoride in the YSR Kadapa district.

Plasma Interleukin-6 Levels in Relation to the Severity of Pain in Cancer Patients: A Case-control Study from a Tertiary Care Centre in North East India

Firdushi Begum, Sumi Deka, Arun Deka, Archita Boiragi

Introduction: With increased levels of ferritin, C-Reactive Protein (CRP), and the proinflammatory cytokine Intrleukin-6 (IL-6) frequently seen in cancer patients, inflammation is acknowledged as a critical component in the context of cancer. For medical professionals, managing pain in cancer patients, whether from the illness or its treatment, remains a constant struggle. Aim: To compare the markers of inflammation between controls and cancer patients with pain and to correlate the degree of pain and IL-6 levels in this group of patients. Materials and Methods: The present case-control study was conducted from January 2022 to December 2022 on 45 age-matched controls and 40 cancer patients with varied levels of pain who were included in the Palliative Care Unit of a State Cancer Hospital, Guwahati, Assam, India. The intensity of pain was measured using a Numerical Rating Scale (NRS). Blood samples were taken to assess the levels of IL-6, ferritin, and CRP. The data were analysed statistically using one-way Analysis of Variance (ANOVA) and linear regression, and were presented as mean±Standard Deviation (SD). Results: Compared to controls, cancer patients had significantly higher levels of IL-6, CRP, and ferritin (p-value <0.001). Spearman’s correlation analysis revealed a positive link between pain intensity and IL-6 (p-value <0.001, r-value=0.516) and between pain and CRP (p-value=0.002, r-value=0.474) was found using Spearman’s correlation analysis. Conclusion: The study results suggest a possible role for IL-6 in cancer-related pain by indicating a clear correlation between elevated IL-6 levels and the severity of pain experienced by cancer patients. This lays the foundation for investigating IL-6 antagonists as potential painkillers for cancer patients.

Comparison of Linear Dimensional Stability among Three Different Types of Interocclusal Recording Materials: An In-vitro Study

Introduction: In routine dental practice, clinicians often face difficulty in selecting accurate interocclusal recording materials due to the introduction of numerous options in the market. Therefore, it is crucial to choose the appropriate material and use it correctly for the success of any prosthesis. Aim: To evaluate and compare the linear dimensional stability of three different types of interocclusal recording materials: polyvinyl siloxane bite registration paste (orangebite), polyether bite registration paste (ramitec), and bite registration wax (aluminium filled). Materials and Methods: An in-vitro study was conducted in the Department of Prosthodontics and Crown and Bridge, with microscopic evaluation performed at the Department of Oral and Maxillofacial Pathology and Microbiology at Maratha Mandal’s NGH Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India in September 2020 for a period of four days. A stainless steel die was used to make impressions, and materials were manipulated according to the manufacturer’s instructions. A total of 30 samples (10 for each material) were created. Three minutes after the respective setting time of each material, discs were separated from the die. The distance between two parallel lines was measured using a stereomicroscope at different time intervals: one hour, 24 hours, 48 hours, and 72 hours. Statistical analysis was performed using Analysis of Variance (ANOVA) and the Mann-Whitney test. Results: In the intragroup comparison of dimensional changes at different time intervals, all three materials showed statistically insignificant results (p>0.05). However, statistically significant results (p≤0.05) were found when comparing the materials at different time points. Polyether bite registration material exhibited better dimensional stability than polyvinyl siloxane and bite registration wax at one hour, 24 hours, 48 hours, and 72 hours. Conclusion: Polyether demonstrated superior dimensional stability compared to polyvinyl siloxane and bite registration wax. The dimensional stability was influenced by both the material used and the duration of time.

Exploring Canine Anomalies: Patterns, Prevalence, and their Relationship to Skeletal Malocclusion among Orthodontic Patients at Bhimavaram, Andhra Pradesh, India

Introduction: Canines are crucial for biting and tearing food, as well as guiding the jaw into proper orientation. Anomalies of the canines can result in a loss of these functions, leading to low self-esteem and overall poor health and quality of life. Understanding these dental anomalies and their varying occurrence among different racial populations can assist dental practitioners in providing vigilant treatment for specific communities. Aim: To assess the prevalence and patterns of impacted canines and other canine anomalies, and to investigate potential relationships between impacted teeth and malocclusions in an orthodontic patient population. Materials and Methods: A cross-sectional study was conducted in Department of Oral Medicine and Radiology, Vishu Dental College, Bhimavaram, Andhra Pradesh, India using 530 orthopantomographic and cephalometric records obtained from orthodontic patients as part of their diagnostic and therapeutic modalities. Radiographs with identified canine impactions during the screening process were assessed for skeletal relationships on lateral cephalograms using tracing techniques. Skeletal malocclusions were categorised based on the Point A, Nasion, Point B angle and Wits appraisal, and the data underwent analysis using the one-way Analysis of Variance (ANOVA) test and Fisher’s-exact test. Results: The study found a prevalence of 3.2% for impacted canines in the orthodontic population. Unilateral impactions were more prevalent than bilateral impactions, and the majority of impactions were associated with class- skeletal malocclusion. The grouping of skeletal relationships using ANB and WITS appraisal showed that ANB was significant in categorisation (p<0.001). Conclusion: These findings provide insights into the prevalence and distribution of impacted canines, which were more prevalent in females and predominantly Unilateral impacted were unilateral. Majority of impacted canines were associated with Class-I skeletal malocclusion, followed by Class-II and III, among the study population.

Evaluation of Dental and Periodontal Health Status in Leprosy Patients during Three Different Stages of Drug Regimen: A Cross-sectional Study

Madhumita Choudhari, Pavan Bajaj

Introduction: The prevalence of oral lesions in leprosy patients and the risk of developing them with the disease are considerably high. Multidrug Therapy (MDT) can effectively treat leprosy, but its effectiveness is heavily dependent on early detection, when chronic disability might be avoided. Poor oral hygiene combined with weakened immunity increases the risk of developing oral lesions in leprosy patients and impacts their overall health. Aim: To evaluate the oral, dental and periodontal findings in patients during three different stages of drug regimen. Materials and Methods: A cross-sectional study was conducted on 150 known leprosy patients from four leprosy facilities in the Vidarbha area, Maharashtra, India. Comprehensive oral examination was performed from July 2022 to September 2022, including the Decayed, Missing, Filled Teeth (DMFT) index, assessment of Non-Carious Cervical Lesions (NCCLs), Plaque Index (PI), Papillary bleeding Index (PBI) and complete periodontal examination by measuring Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL). Descriptive statistics were done utilising SPSS version 23. The Analysis of Variance (ANOVA) test was used to check the mean difference between the three groups. The statistical significance established was p<0.05. Results: The evaluation revealed the prevalence of decayed teeth as 103 out of 150 (68%), that of a missing tooth was 93 out of 150 (62%). NCCLs were found in 80 out of 150 with the prevalence of abrasion as seen in 51 (63.7%) patients and 38 patients (47.5%) for abfraction, and 18 out of 80 patients (22.5%) for erosion. Comparing the PI and PBI between the groups, significantly higher scores were observed in patients who had not undergone treatment (p-value <0.01). CAL was found to be statistically significant with higher scores in patients who had completed their treatment (p-value <0.001). Conclusion: The findings of the present study indicate that the NCCLS and the DMFT scores were higher in the untreated group. However, there was increased attachment loss in treated patients, which can be supplemented to the drug therapy prescribed for leprosy.

Correlation between Skeletal Malocclusion and the Dimensions of Maxillary and Frontal Sinuses using Lateral Cephalograms: A Cross-sectional Study

Shiladitya Sil, Kerthna Selvan, Nilanjana Saha, Subhankar Ghosh

Introduction: Lateral cephalograms are routinely used in orthodontics for accurate assessment and treatment planning of malocclusion. Paranasal air sinuses, such as the maxillary and frontal sinuses, are visible in the lateral cephalogram. However, a direct correlation between the area of these sinuses and the tendency to develop skeletal discrepancies has not been studied in the literature. Aim: To determine the cephalometric correlation between different skeletal malocclusions and the dimensions of the frontal and maxillary sinuses. Materials and Methods: A cross-sectional cephalometric study was conducted at a Tertiary Care Centre in Siliguri district of West Bengal, India. The duration of the study was two years, from August 2019 to September 2021. A total of 150 patients were included and they were divided into three equal groups: skeletal class I (n=50), skeletal class II (n=50), and skeletal class III (n=50). Multiple cephalometric parameters were traced on the radiographs using Dolphin and AutoCAD software, and they were compared among the three groups. The data were analysed using Pearson’s correlation test. Results: The results showed a statistically significant correlation between Maxillary Sinus Area (MSA) and Gonial angle (r=0.468, p=0.001) in skeletal class I malocclusion. In skeletal class II malocclusion, a significant negative correlation was found between Frontal Sinus Area (FSA) and total mandibular length (r=-0.30, p=0.009). However, no significant negative correlation was found between MSA and any cephalometric parameter in skeletal class II malocclusion. Conclusion: The present study highlights there was an increase in the size of the maxillary and frontal sinuses was observed in skeletal class II and skeletal class III malocclusion. However, no correlation could be found between skeletal class I malocclusion and the areas of the frontal sinus.

Efficacy and Safety of Nitrous Oxide Inhalation Sedation in Paediatric Dental Patients: A Comparison of Different Concentrations

M Nandini Devi, Ganesh Jeevanandan

Introduction: In order to effectively treat children, managing terrified and nervous paediatric dental patients is crucial. The choice of a specific behaviour control strategy is at the operator’s discretion, but it may be influenced by parental approval. Clinically beneficial pharmacological therapies, such as Nitrous Oxide-oxygen Inhalation Sedation (NOIS), have been demonstrated. However, prolonged exposure to specific amounts of these therapies could pose health hazards for medical personnel. Aim: To evaluate the clinical efficacy and safety of utilising N₂O inhalation sedation at a 70% concentration in a paediatric dental setting, compared to administering it at 50% and 60% concentrations. Materials and Methods: A non randomised clinical trial was conducted in the Department of Paediatric and Preventive Dentistry at Saveetha Dental College, Chennai, India. The duration of the study was three months, from June 2022 to August 2022. A total of 42 young patients between the ages of 4 and 10 who required mandibular pulpectomy and crown were selected. During the study, the researchers recorded each patient’s levels of sedation and cooperation at four specific time points while administering a fixed concentration of N₂O. The concentrations at these time points were 50% at the 10th minute, 60% at the 20th minute, 70% at the 30th minute, and 70% at the 40th minute. The study compared the primary outcomes of sedation and cooperation levels, along with the secondary outcome of adverse effects, between the different time intervals using the Kruskal-Wallis test followed by post-hoc tests for pair-wise comparison. The level of significance was set at p<0.05. Results: The mean age of the children included in the present study was 7.4±1.324 years. At the end of 40 minutes at a 70% concentration, a deep sedation score of six was achieved by 7 (16.7%) of the patients, while none of the patients achieved this sedation level at concentrations of 50%, 60%, or 70% at the end of 30 minutes. The mean sedation score of patients at the end of 40 minutes at a 70% concentration (4.86±0.683) was higher than the sedation score of patients at the end of 30 minutes at a 70% concentration (4.36±0.656). Cooperation at a 70% concentration was better at the end of 40 minutes (5.83±0.377) than at the end of 30 minutes (5.40±0.497). At 50% and 60% concentrations, no adverse effects were observed. Conclusion: Sedation at a 60% concentration was more effective than 50% in achieving satisfactory cooperation to complete dental treatment without any adverse effects. Additionally, at a 70% concentration, sedation and cooperation were higher, but adverse effects were noted, warranting caution when considering its use for extended periods.

Variations in Sleep Architecture among Different Subtypes of Schizophrenia: A Cross-sectional Study

Sagarika Ray, Partha Sarathi Kundu, Amit Kumar Bhattacharya, Amit Kumar Pal

Introduction: Schizophrenia is a severe mental disorder characterised by positive symptoms such as delusions and hallucinations, as well as negative symptoms including anhedonia, asociality, avolition, and affective blunting. It may also be associated with cognitive deficits. Sleep disturbances are commonly encountered in schizophrenia, and there may be variations in sleep patterns among its different subtypes. These differences in sleep patterns could have prognostic implications for the various subtypes of schizophrenia. Effective management of sleep disturbances could contribute to the recovery and well-being of individuals diagnosed with schizophrenia. Aim: To compare the differences in sleep architecture between the various subtypes of schizophrenia and to compare them with socio-demographically matched healthy volunteers. Materials and Methods: A cross-sectional study was conducted at the Institute of Psychiatry-Centre of Excellence, Kolkata, West Bengal, India over a duration of one year (May 2016 to June 2017). The study included 60 medication-naïve patients diagnosed with schizophrenia according to International Classification of Diseases (ICD)-10 criteria, and a control group of 30 demographically matched healthy volunteers. All study participants were aged between 18 and 60 years and free from any co-morbid illnesses. Patients with schizophrenia were further classified into four groups based on the ICD-10 subtypes: paranoid, hebephrenic, catatonic, and undifferentiated. Overnight polysomnography was performed to assess sleep parameters, including total record time, total sleep time, sleep onset latency, Rapid Eye Movement (REM), sleep latency, sleep efficiency, durations of Total Non Rapid Eye Movement (NREM) Sleep, Total REM sleep, and the different phases of NREM sleep. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Analysis of Variance (ANOVA), Chi-square, and t-test were used as applicable, with a p-value <0.05 considered statistically significant. Results: The results showed a decrease in sleep efficiency, total sleep time, and shorter duration of mean N1, N2, and N3 sleep in schizophrenia patients compared to the control group. There was a significant difference in N3 sleep duration, reduced duration of total NREM and REM sleep, reduced REM latency, increased sleep onset latency, and the number of awakenings during sleep in schizophrenia patients. Statistically significant differences (p-values <0.05) were also noted in some sleep parameters among the various subtypes of schizophrenia. The paranoid subtype had the shortest REM latency, while the catatonic subtype had the longest. The hebephrenic subtype had the lowest percentage of REM sleep and sleep efficiency, while the catatonic subtype had the highest. The duration of Slow Wave Sleep (SWS) was lowest in the undifferentiated subtype and highest in the catatonic subtype. Conclusion: This study reveals significant differences in sleep patterns between patients with schizophrenia and the control group, as well as among the various subtypes of schizophrenia. These distinctions provide insight into the relationship between schizophrenia subtypes, sleep irregularities, and clinical consequences. Further investigation is necessary to explore differences in sleep architecture among the various subtypes of schizophrenia and yield clinically meaningful results.

Mental Health Effects of Online Education among Medical Students during the COVID-19 Pandemic in Kalaburagi, Karnataka, India: A Cross-sectional Study

Insha Arshad, Linah Maryam, Roopa R Mendagudali, Nitish Agarwal

Introduction: Globally, the Coronavirus Disease-2019 (COVID-19) pandemic has had a significant impact on the mental health of the general population, including medical students. As part of the control measures, the Government of India implemented a nationwide lockdown, resulting in the closure of medical institutes. However, medical education continued through online teaching platforms, which was a new experience for students and caused them significant stress. Aim: To assess the mental health effects, specifically anxiety and depression disorders, among medical students in Kalaburagi city during the COVID-19 pandemic. Materials and Methods: A cross-sectional online survey was conducted between June 1st and June 30th, 2021, involving four medical colleges in Kalaburagi city: Khaja Banda Nawaz Institute of Medical Sciences (KBNIMS), Mahadevappa Rampure Medical College (MRMC), Government Institute of Medical Sciences (GIMS), and Employees State Insurance Corporation Medical College (ESICMC). A total of 261 students were surveyed using prestructured questionnaires that included socio-demographic information, the Generalised Anxiety Disorder (GAD-7) scale for anxiety assessment, and the Patient Health Questionnaire (PHQ-9) scale for depression assessment. The questionnaires were prepared using Google Forms and distributed through WhatsApp groups. The data was collected and analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software. Results: Out of the 261 students, 99 (37.9%) reported moderate anxiety symptoms, and 72 (27.6%) reported severe anxiety symptoms. The depression score indicated that 119 (45%) students had moderately severe to severe depression symptoms. Conclusion: The study revealed that online teaching and learning methods had a significant impact on students, leading to a higher prevalence of moderate to severe anxiety and depression symptoms during the COVID-19 pandemic. These mental health issues may adversely affect learning abilities and preparedness for the future. It is crucial for medical colleges to address these concerns and develop effective interventions to support students during pandemic situations and continuous online teaching.

Accuracy of Nasopharyngeal Temperature in Comparison to Oesophageal Temperature for Core Body Temperature Measurement: A Cross-sectional Observational Study

MN Pooja, Sagar S Majigoudar

Introduction: Temperature monitoring intraoperatively is standard of care for almost all surgical cases and is necessary due to the important role that temperature plays in maintaining body homeostasis, anaesthetic drug metabolism, and recovery. However, invasive and user-unfriendly methods like measuring temperature in the oesophagus, tympanic membrane, or rectum have limitations. An alternative site for measuring core body temperature could be the nasopharynx, as its mucosa is supplied by branches of the internal carotid artery. Aim: To determine the accuracy of the nasopharyngeal probe in comparison to oesophageal temperature probe and to identify appropriate insertion depths for measuring core body temperature. Materials and Methods: Sixty patients scheduled for elective non-cardiac surgery under general anaesthesia lasting 60 minutes or more. A nasopharyngeal probe was inserted past the nares to a depth of 20 cm, and an oesophageal temperature probe was inserted to a depth of 40 cm past the incisors. The nasopharyngeal probe was gradually pulled out after induction, and temperatures at various depths were recorded at regular intervals. The observed depths of the nasopharyngeal probe that correlated with the oesophageal temperature were considered as the endpoints. Data was entered into Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The study population consisted of 60 patients, with 31 males and 29 females, a mean age of 50 years, mean body mass index of 26 kg/m2, American Society of Anaesthesiologists (ASA) (physical status) of 1 (n=27) and 2 (n=33). The insertion depths of 10 to 20 cm for the nasopharyngeal probe showed a mean temperature difference of ±0.3°C compared to the reference oesophageal temperature. This difference fell within the clinically acceptable accuracy range of 0 to 0.3°C (temperature mean difference ±1.96 SD) for both probes. Conclusion: The nasopharyngeal probe offers a minimally invasive method for measuring body temperature and is easily accessible for probe placement. However, the optimal depth of insertion past the nares has not been well established. Based on the results, which showed that the mean temperature difference between the two probes fell within the specified accuracy range when the nasopharyngeal probe was inserted to a depth range of 10 to 20 cm from the nares, it is advisable to use this depth range for core body temperature measurement in non cardiac surgeries.

Efficacy of Bilateral Uterine Artery Ligation versus B-lynch Suture in Primary Postpartum Haemorrhage due to Uterine Atony in Lower Segment Caesarean Section: An Interventional Study

Abhijeeth Sudhir Jadhav, Sowmya Gopinath, Manitha Madar, Rekha Gurumurthy

Introduction: Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in both developing and developed countries. PPH is a severe obstetric emergency that often occurs unexpectedly, leaving birth attendants unprepared to handle it on a regular basis. Aim: To evaluate the efficacy and complications of the Bilateral Uterine Artery Ligation (BUAL) technique and B-lynch sutures in Lower Segment Caesarean Section (LSCS) for primary PPH caused by uterine atony. Materials and Methods: A hospital-based prospective, interventional study was conducted at a secondary care centre in the inpatient Department of Obstetrics and Gynaecology at District Hospital, Tumkur, Karnataka, India. The duration of the study was one year from August 1, 2019, to August 1, 2020. A total of 100 patients with atonic PPH were randomly assigned to receive either BUAL (group BUAL-50 patients) or B-lynch sutures (group B-lynch-50 patients). Age, parity, gravidity, socioeconomic status, and risk factors were compared. The mean drop in Haemoglobin (Hb) percentage, the need for blood transfusion, and complications were studied and analysed. The success of the method was defined as avoiding obstetric hysterectomy and major complications. The z-test was used to calculate the difference between the means of the two groups. Results: The mean age of the patients was 25.22±4.33 years in the BUAL group and 26.02±4.32 years in the B-lynch group. During the one-year study period, the total number of deliveries in the Institution was 4,658, with 1,864 vaginal deliveries and 2,794 LSCS performed. Among the 2,794 LSCS cases, 268 women (9.58%) developed primary PPH. Out of these 268 women, 134 (50%) were managed with primary medical treatment for atonic PPH. For those who did not respond to primary medical management and met the inclusion and exclusion criteria, 50 women underwent BUAL and were assigned to the BUAL group. Another 50 cases were treated with B-lynch sutures and assigned to the B-lynch group. The patients in both groups were matched in terms of age, socio-economic status, booking status, gestational age at delivery, induction of labour, and high-risk factors for PPH. Maternal outcomes were analysed. The mean preoperative Hb level was 9.65±1.16 g/dL, which significantly decreased to 8.54±1.27 g/dL post-procedure in the BUAL group (p-value <0.001). In the B-lynch group, the mean preoperative Hb level was 9.68±0.85 g/dL, which significantly decreased to 8.52±0.95 g/dL post-procedure (p-value <0.001). The mean blood loss among patients was 1312.14±227.65 mL in the BUAL group and 1359.22±259.07 mL in the B-lynch group, but the difference was not statistically significant (p-value=0.33). In the present study, 17 patients (34%) in the BUAL group and 21 patients (42%) in the B-lynch group did not require blood transfusion. The Intensive Care Unit (ICU) care was necessary for 6 (12%) patients in the BUAL group and 8 (16%) in the B-lynch group. Postoperative fever was a common complication in both groups. The success rate of BUAL was 94%, while the B-lynch procedure was successful in 96% of cases. Conclusion: The PPH a significant concern for obstetricians, and effective and meticulous management is crucial in reducing maternal mortality. Both BUAL and B-lynch sutures are simple, safe, and effective methods for controlling PPH during caesarean section by uterine devascularisation.

Factors Affecting Pulmonary Artery Catheterisation in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding cost-effectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value <0.05 was considered statistically significant. Results: A total of 138 patients were analysed during the entire study. There was a predominance of male patients (82.6%) with a male-to-female ratio of 114:24. The first attempt failure rate of successful PAC was 13 out of 138, i.e., 9.42% (95% confidence interval 4.55% to 14.29%). The cut-off time for the procedure as the 75th percentile of the first 30 successful cases is 269 seconds. The number of cases in which it was done within this time was 109 cases, i.e., 78.99%. There was a significant difference (p<0.05) in terms of body weight, body surface area, and neck length between the two groups. Conclusion: Increased body weight and increased body surface area are significant factors associated with difficult PAC placement. On the other hand, short neck length is a significant factor for taking more time in the placement of the catheter.

Assessment of Knowledge, Attitude, and Practices Regarding Self-medication among Patients Attending the Rheumatology Outpatient Clinic at a Tertiary Care Hospital in West Bengal, India

Introduction: Self-medication is an important health issue. The rising tendency of self-medication has been a cause for concern. Rheumatic patients, being vulnerable to various symptoms like pain and fever, may resort to self-medication. Although several studies have been conducted among different populations, there is a lack of literature focusing on rheumatic disease patients in India. Aim: To investigate the knowledge, attitude, and practice of self-medication among patients attending the Rheumatology Outpatient clinic at a tertiary care centre in eastern India. Materials and Methods: This descriptive cross-sectional study was conducted at the Rheumatology Outpatient Clinic in Medical College Kolkata, a tertiary hospital in West Bengal, India, from July 21, 2021, to September 20, 2021. A total of 105 patients attending the rheumatology outpatient clinic were included in the study. Data were collected by conducting interviews with the patients using prestructured and prevalidated questionnaire after obtaining informed consent. The Knowledge, Attitude, and Practice (KAP) of self-medication were assessed, and the data were statistically analysed using Chi-square tests. Results: The mean age of the study population was 38.77 years±12.56 years. Among the 105 subjects, 61 (58.1%) were suffering from arthritis, 26 (24.8%) from Systemic Lupus Erythematosus (SLE), and 6 (5.7%) from kidney disease. A total of 75 (71.4%) study subjects reported that they knew what self-medication was. The majority of the patients (86.7%) were unaware of the common adverse effects. However, 90 (85.7%) stated that self-medication was generally not beneficial, whereas 9 (8.6%) held the opposite view. A total of 64 (61%) reported having practiced self-medication in the past year. Conclusion: The present study reported a self-medication rate of 61%. Self-medication was found to be more frequent among the younger age group, females, and individuals with higher educational qualifications.

Seroprevalence of Human Parvovirus B19 in Haematological and Extra-haematological Disorders: A Retrospective Observational Study

Tasneem Siddiqui, Chinmoy Sahu, Sangram Singh Patel

Introduction: Human parvovirus B19 (B19V) has an affinity for multiple organs and causes a myriad of clinical diseases depending on the host’s immunological and haematological status. The seroprevalence of human parvovirus B19 has mostly been studied in haematological disorders, but there is still a lack of data on B19V seroprevalence in extra-haematological disorders. Aim: To study the seroprevalence of B19V in haematological and extra-haematological disorders. Materials and Methods: This retrospective observational study was conducted at the Microbiology Laboratory of Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India. Data was collected from September 2017 to September 2020, and data analysis was done from October 2020 to January 2021. A total of 702 serum samples from patients suspected of B19V infection were received over a three-year duration for parvovirus B19 antibody testing. Of these, 674 serum samples were included in the study as per the inclusion and exclusion criteria. The prevalence of B19V antibodies in different clinical disorders was investigated by collecting patient details like age, gender, underlying clinical disorder, and B19V-specific Immunoglobulin M (IgM) and IgG antibodies detected by quantitative enzyme immunoassay on all serum samples suspected of B19V infection using Statistical Package for Social Sciences (SPSS) version 25.0 software. The Chi-square test was used to analyse statistically significant variables. Results: B19V-specific IgM and IgG antibodies were detected in 35.7% (241/674) of the serum samples received over a three-year duration. The positivity rate was 94 (13.9%) for IgG, 108 (16%) for IgM, and 39 (5.8%) for both IgG and IgM. The positivity in adults aged 18 years and over (39.6% or 160/404) was statistically significantly higher compared to children aged 17 years and younger (30% or 81/270) (p=0.0109). Among the 241 B19V-positive patients, 126 (52.3%) had haematological disorders, and 115 (47.7%) had extra-haematological disorders. The total positivity of IgG plus IgM antibodies was highest in musculoskeletal and connective tissue disorders (33 (54.1%) and haematological disorders 126 (48.3%). Conclusion: The B19V seroprevalence was relatively low in the present study compared to most serological studies conducted in other regions. The present study provides information on the seroprevalence of B19V in both haematological and extra-haematological disorders simultaneously.

Intrathecal Buprenorphine versus Intrathecal Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Segment Caesarean Sections: A Randomised Clinical Study

Nelka Mukeshkumar Patel, Mridul Madhav Panditrao

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, side-effects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher’s-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value <0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value <0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects.

Evaluation of Functional Capacity and Rate of Perceived Exertion through Six-minute Walk Test in Pre and Post-haemodialysis Patients with Chronic Kidney Disease: A Prospective Cohort Study

Zoha Badiuzzama Alvi, Manish Prannath Shukla

Introduction: Chronic Kidney Disease (CKD) is a condition that affects multiple organs, including the respiratory system. Haemodialysis is a commonly used treatment for End-stage Renal Disease (ESRD), but it can lead to respiratory issues, reduced muscle strength, decreased functional capacity, and lower quality of life. The Six-minute Walk Test (6MWT) is widely accepted for assessing functional capacity in CKD patients. Aim: To evaluate the impact of haemodialysis on the functional capacity and Rate of Perceived Exertion (RPE) in patients with CKD by employing the 6MWT as a comprehensive measure. Materials and Methods: A prospective cohort study was conducted in the Department of Nephrology and Dialysis ward at MGM Hospital, Aurangabad, Maharashtra, India, from April 2020 to December 2021. A total of 73 patients were included in the present study. The primary outcome measure was the walked distance assessed using the 6MWT, and secondary outcomes are the RPE were evaluated using the Modified Borg Scale (MBS). Gait speed was also measured. Baseline demographic data, laboratory investigations, and associated co-morbidities were collected. The tests were performed before and immediately after the haemodialysis session. Data were analysed using the Student’s t-test and one-way Analysis of Variance (ANOVA), and the statistical significance level was set-up at p<0.05. Results: The mean age of the study participants was 44±8.25 years. The study found a significant reduction in walking distance (mean of 85 meters) after the haemodialysis session compared to the pre-session. The post-haemodialysis session showed a significant increase in RPE and fatigue levels (p=0.0001). Additionally, a significant difference in gait speed (p=0.0001) was observed between the pre and post-haemodialysis sessions. Conclusion: The present study findings indicate a significant decrease in walking distance and noteworthy increase in RPE and fatigue levels following haemodialysis sessions in CKD patients. These results emphasise the impact of haemodialysis on functional capacity and perceived exertion among individuals with this condition.

Diagnostic Performance of Streptococcus pneumoniae Urinary Antigen Assay: A Cross-sectional Study on Comparative Analysis of Bacterial Culture and Molecular Detection in Pneumococcal Infections

Introduction: Pneumonia is the most prevalent infection worldwide, leading to hospitalisation and contributing to mortality rates. Among the bacterial agents associated with Community-Acquired Pneumonia (CAP), Streptococcus pneumoniae remains the most common. Conventional microbiological diagnostic tests have various limitations, including issues with sample collection, prior antibiotic administration, and delayed specimen transport. Urinary Antigen Testing (UAT) shows promise in rapidly identifying the causative agent of CAP, allowing for targeted therapy. Aim: To evaluate the diagnostic accuracy of the pneumococcal UAT in identifying CAP. Materials and Methods: A cross-sectional analytical study was conducted over a period of one year from June 2022 to May 2023 at SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India. A total of 38 patients (>18 years of age) with clinically suspected CAP and who satisfied the clinical criteria for CAP were recruited for the study. Respiratory specimens were subjected to bacterial culture, real-time Polymerase Chain Reaction (PCR), and UAT using the Fluorescent Immunoassay (FIA) to detect Streptococcus pneumoniae. The sensitivity, specificity, positive and negative predictive values, and accuracy of the pneumococcal UAT for detecting CAP were assessed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Results: The study revealed a female predominance 22 (57.89%). Bacterial culture and real-time PCR identified 7 (18.42%) of patients with S. pneumoniae, while the UAT only detected 1 (2.63%). The pneumococcal UAT showed low sensitivity (14.29%), high specificity (100%), and satisfactory accuracy (84.21%). Conclusion: The pneumococcal UAT, with its straightforward technology, ease of use, rapid results, non invasive approach, cost-effectiveness, and high specificity and accuracy, could be favoured over bacterial culture and molecular techniques for ruling out CAP.

Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study

Introduction: The clinical manifestations of Coronavirus Disease-2019 (COVID-19) range from asymptomatic cases to severe respiratory failure. It is unclear whether disease severity is determined by an excess viral load or a dysregulated immune response. It is also unclear whether the severe immune response is successful in rapid viral clearance. Aim: To understand the relationship between immune response, viral clearance, and the severity of illness in unvaccinated patients suffering from COVID-19. Materials and Methods: This was a cross-sectional observational study of 65 unvaccinated patients suffering from Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19, conducted at a dedicated COVID-19 centre, Dr. D.Y. Patil Hospital, Pimpri, Pune, Maharashtra, India. from September 2020 to April 2021. The subjects were enrolled between day 10 and day 14 of the onset of symptoms and from two distinct clinical groups. Group A consisted of 34 mild cases, and Group B consisted of 31 severe cases, classified according to the national guidelines issued by the Indian Council of Medical Research (ICMR). The clinical progress of the illness and laboratory test records were carefully reviewed. A repeat throat swab for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) RT-PCR, blood levels of COVID-19 specific antibodies Immunoglobin G (IgG) and IgM, C-reactive protein (CRP), and D-dimer levels were measured on day 14 of the illness. The data were analysed using MedCalc and Epi Info software. Chi-square and Fisher’s-Exact tests were used to assess variables such as viral detection, antibody response, and inflammatory markers. Results: In Group A, 2/34 (5.88%) patients tested RT-PCR negative {Cycle threshold (Ct) value cut-off above 35} compared to 5/31 (16.13%) in Group B (p=0.0829). In Groups A and B, respectively, the mean antibody titers were 35390.47 and 36426.11 (p=0.7469), the mean CRP values were 4.91 (p<0.001) and 31.01 mg/dL, and the mean D-dimer levels were 895 and 2896 ng/mL (p<0.001). Conclusion: Both mild and severe COVID-19 cases had a significant antibody response which, however, did not help in viral clearance. Most patients remained RT-PCR positive on day 14 regardless of the disease severity.

Comparison of Functional Communication Training, Sensory Integration Therapy, and Behaviour Intervention for Challenging Behaviours in Children with Autism: A Pilot Study

Redkar Simran Sandeep, Ganapathy U Sankar, Monisha Ravikumar

Introduction: Challenging behaviours are frequently observed in children diagnosed with Autism Spectrum Disorder (ASD), potentially hindering their daily functioning. As the prevalence of autism continues to rise, the array of challenging behaviours, including repetitive patterns, stereotypes, and self-harm, emphasises the importance of developing effective interventions in occupational therapy. These interventions aim to manage these challenging behaviours and enhance the overall well-being and functionality of these children. Aim: To compare the effectiveness of Functional Communication Training (FCT), Sensory Integration Therapy (SIT), and Behavioural Interventions (BI) on challenging behaviours in children with ASD. Materials and Methods: An experimental study with pre-post test design was conducted in the Paediatric Unit of the Department of Occupational Therapy, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India. The duration of the study was nine months, from September 2020 to May 2021. A total of six (N=6) children selected through convenience sampling. The SIT took place at the paediatric unit of the occupational therapy department at SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India. Due to Coronavirus Disaese-2019 (COVID-19) restrictions, FCT and BI were conducted simultaneously at the participants’ homes. Outcomes were measured using Functional Behavioural Assessment (FBA) and the Repetitive Behaviour Scale-Revised (RBS-R). Within-group analysis involved utilising the Wilcoxon signed-rank test, while between-group analysis entailed the application of the Kruskal-Wallis and one way Analysis of Variance (ANOVA) test. Results: The mean age of the study participants was 7.83±1.83 years. A significant reduction in challenging behaviours was seen in all six children in the three intervention groups when outcomes were measured using FBA (p<0.05). Among these interventions, BI proved to be the most effective in reducing the frequency of challenging behaviours in children with ASD, as evidenced by a mean post-test score of RBS-R (19.50±12.02 for BI, compared to 20±1.41 for SI and 23±11.31 for FCT, p=0.047). Conclusion: The results of the study indicated that all three interventions - SIT, FCT, and BI successfully decreased the occurrence of challenging behaviours in children with ASD.

Antimicrobial Usage during COVID-19 Pandemic in Intensive Care Unit at a Tertiary Care Hospital in Eastern India: A Retrospective Study

Aniket Kashyap, Sarmila Nath

Introduction: Antimicrobials, one of the greatest contributions of the 20th century to the field of therapeutics, appear to be crucial defense in severely ill Coronavirus Disease-2019 (COVID-19) patients. However, a major concern is the excessive and, in a few cases, irrational use of antimicrobials, leading to the global crisis of the emergence of multidrug- resistant microbial strains. Thus, prompt action is needed to optimise antimicrobial therapy. In this context, a situation analysis, such as the present study, focusing on medication management in COVID-19 patients, can help identify key gaps so that appropriate measures may be undertaken to ensure rational antimicrobial therapy in the future. Aim: To analyse the antimicrobial use pattern during the COVID-19 pandemic in the Medical Intensive Care Unit (MICU) of a tertiary care hospital and assess the existing hospital antimicrobial policy. Materials and Methods: A hospital-based, retrospective observational study was conducted in the Department of Pharmacology at a Tertiary Care Hospital (Government Medical College Kolkata), West Bengal, India. The study duration was two months, September and October, 2022. Data were extracted from the standard clinical records of all diagnosed COVID-19 adult patients (≥18 years) admitted for atleast 24 hours in the MICU between April 2021 and June 2021 {positive result on a Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) assay of a specimen collected with a nasopharyngeal swab indicated a positive diagnosis}. Records containing incomplete data were excluded. A total of 128 records were analysed. Group A included data on patients who expired (n=100), and group B contained data on patients who survived (n=28) during these two months. For the hospital antimicrobial policy, a personal interview was conducted with the Intensive Care Unit (ICU) incharge. Categorical variables were expressed as frequencies (n), percentages (%), and continuous variables were expressed as mean±Standard Deviation (SD). Pearson’s Chi-square test and Mann-Whitney U test were used to assess the significance level for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant. Results: The mean age of the study participants in group A was 58.31±15.22 years and in group B was 51.93±18.33 years. Out of the 128 records collected, 100 patients (78.12%) had succumbed in the ICU during the particular period. Each patient had received an average of 18 drugs and 4.27 Antimicrobial Agents (AMAs) during their stay in the ICU. More than 80% of patients had received concurrent AMAs. Meropenem was the most frequently prescribed AMA (93 patients, 72.65%), followed by piperacillin/tazobactam (88 patients, 68.75%) and doxycycline (79 patients, 61.71%). More than 80% of patients received antimicrobials in the MICU, and an average of 4 AMAs were used per patient. The choice of AMA was empirical. There was no significant relationship between the number and type of AMAs received by the patients and the final clinical outcome. There was no antibiogram or Institutional antimicrobial policy. Conclusion: The study indicates extensive, empirical use of antimicrobials in the MICU, often in combination, without an available antibiogram and without any impact on the clinical outcome of the admitted patients. The findings thus warrant the urgent establishment of a hospital antimicrobial policy to encourage rational antimicrobial therapy in the future.

Development and Evaluation of Novel Alginate-based Photocrosslinkable Tissue Adhesive: An In-vitro Study

Devika Bajpai, Arvina Rajasekar

Introduction: In clinical practice, traditional methods like sutures and staples are employed to halt bleeding and expedite wound healing. However, these techniques, which involve piercing tissue, come with drawbacks including the risk of inflammation, infections, and the formation of scars. Surgical sealants and tissue adhesives offer a way to mitigate some of these disadvantages associated with conventional sutures and staples. Tissue adhesives have emerged as a newer alternative for non invasive wound closure. Aim: To develop and analyse the properties of alginate-based photocrosslinkable tissue adhesive. Materials and Methods: This in-vitro analysis was done at the Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India from April 2022 to May 2022. The tissue adhesive was prepared by mixing Alginate, N-Hydroxysuccinamide (NHS) and 1-Ethyl, 3- Dimethylaminopropyl Carbodiimide (EDC) and methacrylate which was used as photo initiator. The preparation was followed by characterisation of the material, strength test and evaluation of biocompatibility. Results: Surface characteristics test showed homogeneous slices in Scanning Electron Microscope (SEM) analysis. Mechanical test compressive strain was found to be 3% for both the specimens whereas tensile strain was 211.40% and 269.50% for specimen 1 and 2, respectively. Biocompatibility test of the newly developed adhesive showed that adhesive caused the L929 cells to multiply less than the fibrin glue. Conclusion: All these results suggested that the developed material is a promising soft tissue adhesive for various applications in dentistry.

Association of Mean Arterial Pressure and Outcome in Children with Acute Non Traumatic Neurological Illnesses in Paediatric Intensive Care Unit: A Prospective Cohort Study

Sweta Jain, Umesh Pandwar, Bhavesh Motwani, Jyotsna Shrivastava, Naina Rose

Introduction: The course of outcome in non traumatic neurological illnesses, such as acute encephalitis syndrome, meningitis, paediatric stroke, metabolic encephalopathy, etc., can be affected by various risk factors. While there have been many studies evaluating the effects of blood pressure on outcomes in traumatic brain injury, there is a dearth of studies assessing Mean Arterial Pressure (MAP) in non traumatic injury, particularly in the paediatric age group. Aim: To examine the association between MAP and outcomes in children with acute non traumatic neurological illnesses in the Paediatric Intensive Care Unit (PICU), focusing on mortality and length of PICU stay. Materials and Methods: This prospective cohort study was conducted at Gandhi Medical College, Bhopal, Madhya Pradesh, India from September 2021 to August 2022. A total of 249 children aged between 1 to 14 years with acute non traumatic neurological illnesses were included, and their mean blood pressure was recorded. Associated co-morbidities (severe anaemia, respiratory failure, sepsis, and acute kidney injury), mean length of hospital stay, and outcome were also assessed. Categorical variables were analysed using either the Chi-squared (c2) test or Fisher’s exact test, while continuous variables were assessed using the Analysis of Variance (ANOVA) test for mean length of stay. Results: Out of the 249 subjects, 157 (63.1%) were male, and 143 (57.4%) belonged to the age group of 1-5 years. Among them, 36 (14.5%) experienced hypotension, and 17 (6.8%) had hypertension during their PICU stay, while 196 (78.7%) had normal blood pressure. Abnormal MAP was significantly associated with a higher mortality rate among the study subjects (p-value <0.001), and the mean length of PICU stay was significantly longer (p-value <0.001) in study subjects with abnormal MAP. Conclusion: Both high and low MAP were significantly associated with higher mortality and longer duration of stay in children with acute non traumatic neurological illnesses.

Linezolid-associated Hyponatremia in Guillain-Barré Syndrome Patients in Intensive Care unit: A Retrospective Analysis

Shweta Suresh Naik, Mathangi Krishnakumar, S Mouleeswaran, VJ Ramesh

Introduction: Guillain-Barré Syndrome (GBS) is a neurological disorder associated with ascending paralysis due to damage to the peripheral nerves by the immune system. Hyponatremia is the most common electrolyte disorder encountered in patients with GBS admitted to the Neurointensive Care Unit (NICU). Hyponatremia is associated with a poor outcome, prolonged hospital stay, and increased hospital cost. Linezolid is an oxazolidinone antibiotic used against gram-positive bacteria. The main adverse effect limiting its use is the development of myelo suppression; however, it can also cause hyponatremia. Aim: To investigate the incidence of hyponatremia in GBS patients treated with linezolid. Materials and Methods: This was a retrospective study conducted in a 14-bedded NICU at the National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India, over a period from January 2017 to January 2018. All patients with GBS who received linezolid therapy were included in the study. Out of 46 admitted patients, 16 received linezolid therapy. Final data were available for 12 patients. Hyponatremia was defined as sodium <134 mmol/L, and severe hyponatremia was defined as sodium <128 mmol/L. Descriptive statistics were used to characterise the data. The Wilcoxon signed-rank test was used to compare sodium levels before and after linezolid therapy. A p-value <0.05 was considered significant. Results: The incidence of hyponatremia was 9 out of 12 (75%). Five out of 12 patients had severe hyponatremia. There was a significant decrease of 11 (7-12) mmol/L in sodium level before and after linezolid therapy (p<0.001). The median days to develop hyponatremia were 3 (2-4) days after initiation of therapy. No mortality was observed in the study population. Conclusion: The incidence of hyponatremia is high in GBS patients treated with linezolid in the NICU. It is imperative to monitor sodium levels at frequent intervals in patients treated with linezolid to recognise and treat hyponatremia.

Comparison of Biochemical Parameters in Cord Blood versus Venous Blood among Premature and Term Neonates: A Cross-sectional Study

Introduction: Premature and low birth weight neonates are more prone to develop various disorders. These neonates undergo various investigations to confirm diagnosis. Cord blood samples are obtained without any intervention on the neonate, making them a useful source for analysing biomarkers and predicting disorders in premature and low birth weight neonates. Aim: To compare the biochemical parameters among premature neonates (low birth weight) versus matured term neonates (normal birth weight) in cord blood and venous samples. Materials and Methods: This analytical cross-sectional study was conducted at SRM Medical College Hospital and Research Centre in Kattankulathur, Kancheepuram, Tamil Nadu, India from July 2022 to September 2022. The study included two groups: Group 1 consisted of premature and low birth weight neonates, and Group 2 consisted of normal birth weight term neonates, with 53 participants in each group. Biochemical parameters like creatinine, sodium, potassium, calcium, magnesium, phosphorus, High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), Albumin, Alkaline Phosphatase (ALP), Gamma-Glutamyl Transferase (GGT), iron, and Creatine Kinase (CK) were analysed in cord blood and venous samples of these groups. Student’s t-test was used to compare between groups, and Pearson’s correlation was used to assess the association of biochemical parameters in cord blood and venous blood samples. Results: The mean age of the mothers and gestational age in group 1 were 24±4 years and 33±2.3 weeks, respectively. The mean weight of the neonates was 2135±241 grams. When cord blood samples were compared between the study groups, sodium, phosphorus and albumin were found to be significantly decreased and LDL-C was significantly increased in group 1, whereas GGT was significantly decreased in group 2 for venous blood. When cord blood samples were compared between the study groups, magnesium (r-value=0.2) was found to be significantly decreased in group 1. Conclusion: It was observed that biochemical parameters were significantly correlated, except for sodium, HDL-C, LDL-C, and GGT, between cord blood and venous blood samples. Hence, cord blood samples collected through non invasive methods can be used for sample analysis in neonates.

Assessment of Knowledge, Attitudes, and Practices of Rubber Dam Usage among Dental Practitioners in Tamil Nadu after COVID-19: A Questionnaire-based Cross-sectional Study

Introduction: The rubber dam plays an important role in isolation of teeth during dental procedures and helps prevent contamination risks. The usage of rubber dam in day-to-day clinical practice has become crucial during the pandemic. Aim: To assess the knowledge, attitudes, and practices of rubber dam usage among dental practitioners in India during and after the Coronavirus Disease 2019 (COVID-19) pandemic. Materials and Methods: This was a cross-sectional survey-based examination. A pretested 15-item questionnaire was administered to 300 dental practitioners in Tamil Nadu, India, using Google Forms. The questions were categorised into three parameters: knowledge, attitude, and practice. The study population included dentists of all types who were performing restorative and endodontic procedures. Information was collected regarding age, gender, educational qualification, and the use of rubber dam. The questionnaire contained leading questions designed to assess the opinions and attitudes of dentists toward the use of rubber dam. The responses received were statistically analysed using the Chi-square test. Results: Out of the respondents, 257 (85.66%) reported being taught about rubber dam placement, while 43 (14.33%) were unaware of its usage. Prior to the pandemic, 181 (61.35%) of respondents were utilising rubber dam for conservative and endodontic procedures. Only 151 (50.84%) of practitioners believed that rubber dam placement prevents aerosol transmission. Additionally, 266 (89.26%) of respondents expressed willingness to learn and gain knowledge about rubber dam. Conclusion: The study concluded that dental practitioners exhibited a positive attitude towards incorporating rubber dam usage in their practice and showed willingness to update their knowledge about rubber dam, regardless of age, due to the pandemic.

Comparison of Intrathecal Nalbuphine and Magnesium Sulphate for Prevention of Shivering in Caesarean Section: A Randomised Clinical Study

Introduction: Nalbuphine and magnesium sulfate are commonly used drugs for the treatment of Perioperative Shivering (POS), but there is a paucity of comparative studies on their intrathecal use in Lower Segment Caesarean Section (LSCS) patients. LSCS is the most commonly performed obstetric surgery, and Spinal Anaesthesia (SA) is advantageous in LSCS. However, shivering has been found to be the most common side-effect of SA. Aim: To compare the effect of intrathecal injection of nalbuphine and magnesium sulfate on the prevention of postspinal anaesthesia shivering during LSCS. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, Government Medical College, Kathua, Jammu and Kashmir, India on 60 parturients between the ages of 20-40 years from September 2021 to January 2023. The participants had full-term gestation and an American Society of Anaesthesiologists (ASA) status of I or II, and were scheduled for LSCS under SA. The total sample was divided into two groups of 30 patients each. Group N (n=30) received 0.7 mg nalbuphine intrathecally, while Group M (n=30) received 25 mg of magnesium sulfate intrathecally, both with 0.5% bupivacaine (10 mg). Characteristics of spinal blockade, time to onset of shivering, severity of shivering, and side-effects such as nausea, vomiting, sedation, and hypotension were noted. Student’s t-test, Chi-square test, and Fisher’s exact test were used for data analysis. A p-value of <0.05 was considered statistically significant. Results: Both study groups were comparable in terms of age (p-value=0.081), height, weight (p-value=0.079), ASA grade (p-value=0.072), and duration of surgery (p-value=0.077). In group N, 5 patients (16.67%) had POS, while in Group M, 6 patients (20%) had POS, but the difference was not statistically significant. In Group N, 3 patients (10%) had a shivering score of 3 and 2 patients (6.67%) had a shivering score of 4, while in group M, 3 patients (10%) had a shivering score of 3 and 3 patients (10%) had a shivering score of 4. The difference was statistically insignificant. Perioperative complications (sedation, hypotension, nausea, and vomiting) were comparable in both groups with no statistically significant difference. Conclusion: Intrathecal injection of preservative-free 0.7 mg nalbuphine and 25 mg magnesium sulfate were both effective in reducing the incidence of postspinal shivering. Both drugs had comparable minimum perioperative complications. The intrathecal use of nalbuphine and magnesium sulfate for the prevention of postspinal shivering is encouraged, as both drugs are less expensive and readily available in the operation theaters.

Metabolic Derangements with Anticonvulsants in Children with Generalised Tonic-clonic Epilepsy: A Cross-sectional Study

Jyoti Sharma, Savita Verma, Himani Deswal, Jayashankar Kaushik

Introduction: Epilepsy is one of the most prevalent non-communicable neurologic conditions, accounting for significant disability and mortality. The effects of Antiepileptic Drugs (AEDs) on total cholesterol, triglycerides, High-Density Lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and apolipoprotein levels have been demonstrated in many studies, mainly conducted with adults. However, there have been very few studies in children. Derangement of lipid profile and other metabolic abnormalities could lead to the development of metabolic syndrome in children. The adverse metabolic effects of anti-epileptics are underestimated, as only a few studies have been done in this area, which is a legitimate concern. Aim: To assess the impact of AEDs on metabolic parameters in children with epilepsy. Materials and Methods: This was a descriptive, cross-sectional study conducted in the Department of Paediatrics and Pharmacology at Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. The study included 100 children with epilepsy from May 2022 to October 2022. A predefined case record form, including demographic and clinical characteristics, was filled for each participant. The parameters recorded were age, gender, outpatient number, type of epilepsy, history of duration of epilepsy, current AED history, and seizure frequency over the preceding six months, as per the case record form. Guidelines from the International Diabetes Federation were used for diagnosing metabolic syndrome in children. The data was entered into Microsoft excel and presented using descriptive statistics. The chi-square test was used to differentiate between categorical variables. Results: The mean age of the study participants was 10.2±2.97 years. There were more males (62%) than females (38%). A 48% of the patients received monotherapy, while 52% received polytherapy. A total of 24% of the patients had derangement in lipid profile (increased triglycerides and decreased HDL), with 14% of patients on monotherapy and 10% on polytherapy. The difference in metabolic derangements between monotherapy and polytherapy was not statistically significant (p=0.25). Out of 100 participants, 3% fulfilled the criteria for metabolic syndrome, with a predominance in males. Conclusion: Metabolic derangements are known with 1st generation AEDs, but 2nd generation AEDs can also lead to significant metabolic abnormalities.

Correlation Between Axial Length and Peripapillary Retinal Nerve Fiber Layer Thickness Determined by Spectral Domain Optical Coherence Tomography: A Cross-sectional Study

Nikhil Parashar, Tejaswini Prashant Khandgave, Sanjiv Agrawal, Murti Vimawala

Introduction: Peripapillary retinal nerve fiber layer (pRNFL) thickness is an important indicator for the diagnosis and monitoring of glaucoma. Optical Coherence Tomography (OCT) allows for accurate assessment of pRNFL thickness, but previous studies have shown that axial length can affect pRNFL thickness. Hence, this study aimed to confirm this hypothesis. Aim: To determine the correlation between axial length and pRNFL thickness in healthy adults. Materials and Methods: This was a cross-sectional study conducted on 200 eyes of healthy adults aged 18-30 years. All subjects underwent a complete ophthalmic evaluation. Average pRNFL thickness and quadrant pRNFL thickness were recorded using Topcon Spectral Domain OCT (SD-OCT) in all subjects. Axial length measurements were performed using optical biometry with the Topcon IOL Master, and subjects were divided into three groups according to axial length: Group 1 (<23.5 mm), Group 2 (23.5-25.5 mm), and Group 3 (>25.5 mm). pRNFL thickness values were subjected to Littmann’s correction for ocular magnification. Data was analysed using a one-way ANOVA test, and the correlation between pRNFL thickness and axial length, before and after correction for ocular magnification, was determined using the Pearson correlation coefficient. Results: There was a significant negative correlation between uncorrected pRNFL thickness and axial length in the average pRNFL (r=-0.05, p<0.001), superior quadrant (r=-0.26, p<0.001), nasal quadrant (r=-0.44, p<0.001), and inferior quadrant (r=-0.48, p<0.001). Uncorrected temporal quadrant pRNFL thickness showed a positive correlation with axial length (r=0.17, p=0.015). After applying Littmann’s formula, the negative correlation between uncorrected pRNFL thickness and axial length disappeared in the average, superior quadrant, and inferior quadrant. Conclusion: A negative correlation was established between pRNFL thickness and axial length, but this correlation disappeared after applying correction for ocular magnification. Thus, to avoid misdiagnosis of glaucoma in individuals with varying axial lengths, the authors recommend using correction methods for the effects of ocular magnification induced by axial length when considering pRNFL thickness values obtained from OCT.

Clinicoepidemiological Profile of Patients with Chronic Urticaria and its Association with D-dimer Levels at a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Chronic urticaria is a commonly encountered, long-standing skin condition that typically lasts for more than six weeks and has various underlying aetiologies, including chronic infections, infestations, immunological and non immunological causes, and physical factors. In some cases, it may be idiopathic. Recent studies have shown that the activation of the coagulation cascade is involved in the development of chronic urticaria. This involvement is reflected in plasma D-dimer levels, which are explored in the current study. Aim: To assess the epidemiological and clinical characteristics of urticaria and their association with D-dimer levels in a tertiary care centre. Materials and Methods: This prospective cohort study was conducted at Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India, from August 2022 to July 2023. The study included 100 chronic urticaria patients attending the dermatology Outpatient Department (OPD) to investigate various clinical types and their epidemiological factors. D-dimer levels were estimated using the latex-enhanced immunoturbidimetry assay method. The mean and range were calculated, and statistical analysis of various clinic-epidemiological characteristics was performed using Pearson’s Chi-square test. A p-value <0.05 was considered statistically significant. Results: Among the 100 patients with chronic urticaria, 40 (40%) were males and 60 (60%) were females. The mean age of presentation was 30 years, and the mean duration was 20.5 months. Elevated plasma D-dimer levels were noted in 40 (40%) of the study population. Chronic Spontaneous Urticaria (CSU) constituted 92 (92%) of the cases, followed by Chronic Inducible Urticaria (CIU) with 4 (4%) cases and 4 (4%) cases with CSU+CIU. Angioedema was noted in 20 (20%) of the cases in the present study. Thyroid disorder was seen in 12 (12%) of the study population. The majority of patients (44%) had mild urticaria. The mean Urticaria Activity Score (UAS) score before treatment was 21.08. A statistically significant association was found between elevated plasma D-dimer levels and age range, duration of chronic urticaria, disease severity, angioedema, and response to antihistamines. The response to antihistamines was graded based on the UAS7 score calculated before and after treatment. Conclusion: The present study provides additional evidence to the existing literature by establishing an association between D-dimer levels and factors such as severity and angioedema. It also provides important insights into the relationship between age range, duration of chronic urticaria, and elevated plasma D-dimer levels by establishing statistical significance between these factors.

Breast Cancer Risk Stratification and Screening Practices of Women in South Kerala, India: A Cross-sectional Study

Susanna John, Regi Jose, Anil Bindu Sukumaran, Manju Leelavathy, PV Benny

Introduction: The incidence of breast cancer is increasing in India, making it the most common cancer among women. Early detection of breast cancer is crucial for reducing morbidity, mortality, and improving the quality of life for patients. However, breast cancer mortality rates are higher in India compared to other parts of the world, possibly due to late-stage diagnosis. Regular screening is key to early detection, but population screening is not feasible in India due to limited resources. Therefore, high-risk screening is a more practical approach. Assessing individual risk using a breast cancer risk calculator can help identify asymptomatic women at high-risk and motivate them to undergo regular screening, leading to early detection. Aim: To assess the risk of developing breast cancer among women in Kerala using a breast cancer risk calculator and to describe their screening practices. Materials and Methods: A cross-sectional survey was conducted among 1861 women aged over 30 years in Thiruvananthapuram, Kerala, India. Personal details of the participants, major known risk factors of breast cancer, and information about breast cancer screening practices were collected using a questionnaire. Breast cancer risk stratification was performed using the Snehita breast cancer risk calculator. Results: According to the breast cancer risk calculator, 12.74% of the women were classified as high-risk and 65.18% had a normal risk of developing breast cancer. Among the participants, 82.64% stated that they had never undergone any breast cancer screening procedures. Conclusion: Despite Kerala being a state with high female literacy rate, the screening practices for breast cancer were found to be very low (17.36%). Additionally, 12.74% of the women were identified as being at high-risk of developing breast cancer. Breast cancer risk calculators can serve as a motivational tool to encourage women to undergo regular screening.

An Epidemiological Analysis of Severe Acute Repiratory Syndrome Coronavirus 2 Genome Sequencing: A Hospital-based Retrospective Study

Pratiti Datta, Reena Ray Ghosh

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a positive-sense enveloped single-stranded Ribonucleic Acid (RNA) virus. Structural proteins help the virus package its RNA, while other proteins enable viral replication by facilitating host entry. Through constant mutation, the virus changes its emergence profile, and combinations of mutations can lead to increased transmissibility and receptor binding capacity, altering its surface structure. Whole genome sequencing is an important tool for studying these changes. In this study, the authors report on the genome sequencing of patients who tested positive for SARS-CoV-2 using real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) tests. Aim: To identify the different lineages circulating in specific districts of West Bengal, India, and perform an epidemiological analysis of the patients to control disease severity during the second wave of Coronavirus Disease-2019 (COVID-19). Materials and Methods: This retrospective hospital-based study was conducted at the Virus Research and Diagnostic Laboratory (VRDL) at RG Kar Medical College and Hospital, West Bengal, India from January 2021 to October 2021. Data collection started in January 2021 and was analysed in October 2021. Nasopharyngeal and oropharyngeal swabs were taken from patients with SARS-CoV-2, and the samples were tested using RT-PCR. Positive samples were sent to the Regional Virus Research and Diagnostic Laboratory-National Institute of Cholera and Enteric Diseases (NICED) for sequencing. Samples were collected from patients in different districts of West Bengal who were reported to the VRDL of RG Kar Medical College and Hospital. A total of 172,550 samples were tested for SARS-CoV-2, and out of 13,764 positive samples, 230 were sent for genome sequencing. The primary inclusion criteria were SARS-CoV-2 positive patients with CT values between 25 and 30 who were vaccinated. Patient information, address, gene variant, and gene mutation of the samples were analysed. Statistical analysis was performed using t-test with Statistical Package for Social Sciences (SPSS) software. Results: Whole-genome sequencing helped identify new trends and their prevalence in specific areas, aiding in prevention efforts. The most common type of mutation observed after double vaccination was the delta variant (B.1.617.2), followed by the kappa variant (B.1.617.1) and the alpha variant (B.1.1.7). Conclusion: Epidemiological genome sequencing studies help to identify emerging and changing viral trends, contributing to the mitigation of the spread of new variants. The delta, kappa, and alpha variants were the three primary sequences discovered in this study. The identification of these lineages facilitates the design of novel vaccines and diagnostic medications. Continuous monitoring and analysis of sequences from new cases in India and other affected countries are crucial for understanding the genetic evolution and substitution rates of SARS-CoV-2.

Effect of Tactile and Kinaesthetic Stimulation in Preterm Neonates with Hyperbilirubinaemia: A Study Protocol

Saumya Kothiyal, Asir John Samuel, Aksh Chahal

Introduction: Elevated Total Serum/Plasma Bilirubin (TSB) levels in the blood manifest as hyperbilirubinaemia, which is commonly observed among newborns and can result in significant long-term consequences. Need for the study: Long-term phototherapy may have negative effects on newborns. These effects can potentially be mitigated if tactile and kinaesthetic stimulation are proven to be effective as adjuvants to phototherapy, thereby reducing its duration. Aim: The study aims to investigate the effect of tactile and kinaesthetic stimulation among preterm neonates with hyperbilirubinaemia. Materials and Methods: Eighty two neonates with hyperbilirubinaemia admitted to a Neonatal Intensive Care Unit (NICU) will be recruited and allocated through block randomisation into two groups: the experimental group (massage therapy+tactile stimulation+phototherapy) and the control group (only phototherapy). TSB levels, Transcutaneous Bilirubin (TcB) levels, and weight gain in neonates will be measured as outcomes at baseline and each day for two days following treatment.

Unraveling the Intricacies: Pioneering Insights into the Interplay of the Gut and Oral Microbiome in Diabetes and Periodontal Disease

J Bhuvaneswarri, Julius Amaldas, Snophia Rani Rajamani, S Parthiban, V Ramya

Exploring the intricate interplay between two prevalent chronic conditions, diabetes mellitus and periodontal disease, reveals a bidirectional relationship. Recent evidence underscores the pivotal influence of the microbiome, particularly the gut and oral microbiome, in shaping the pathogenesis of both diabetes and periodontal disease. The present comprehensive review aimed to elucidate the current understanding of how these microbial communities contribute to the development and progression of diabetes, especially when compounded by periodontal disease. However, emerging evidence suggests a complex bidirectional relationship between these two conditions. The microbiome’s involvement in these conditions unfolds through multifaceted mechanisms, with microbial dysbiosis influencing systemic inflammation, insulin resistance, and periodontal tissue degradation. The authors explored the dynamic crosstalk between the gut and oral microbiome, shedding light on how alterations in these microbial ecosystems may exacerbate the interconnected manifestations of diabetes and periodontal disease. Furthermore, present review unraveled the potential therapeutic implications for targeted interventions. By dissecting the microbiome-driven pathways, authors identified the promising avenues for precision medicine and tailored therapies. This exploration opens new vistas for developing strategies that leverage the microbiome to mitigate the impact of diabetes with periodontal disease. As the authors navigated this complex terrain, the manuscript underscores the urgency of a holistic understanding and targeted modulation of the microbiome to revolutionise treatment paradigms for these intertwined chronic conditions. The present manuscript aimed to review the current understanding of the role of the gut and oral microbiome in the development and progression of diabetes with periodontal disease.

A Scoping Review on the Ethical Issues in the Use of CRISPR-Cas9 in the Creation of Human Disease Models

Russell Franco D’Souza, Mary Mathew, Krishna Mohan Surapaneni

Introduction: The remarkable advances in molecular science and technology have dramatically changed the landscape of Deoxyribonucleic Acid (DNA). With the rapid pace of new gene editing technologies like Clustered Regularly Interspaced Short Palindromic Repeats and CRISPR-associated protein 9 (CRISPR-Cas9), human disease models can be created to reduce the burden of morbidity and mortality caused by genetic defects and congenital malformations. However, despite its potential to advance human health and well-being, the use of CRISPR-Cas9 technology raises numerous ethical concerns, including the lack of a well-defined regulatory framework. Aim: To outline the ethical concerns that arise in the creation of human disease models using CRISPR-Cas9 technology and to design a conceptual framework to identify the ethical challenges and address these concerns. Materials and Methods: The data on ethical issues in the use of CRISPR-Cas9 in the creation of human disease models were obtained by reviewing 530 articles retrieved from scientific databases such as Google Scholar, PubMed, Scopus, and Excerpte Medica dataBASE (EMBASE) from the year 2015. Based on the eligibility criteria, 24 publications from 56 full-text articles that were screened were included in this study. The selection process was conducted in three phases-screening of the title, abstract, and full text. The articles selected after full-text screening were analysed, and the data was scrutinised independently. Tables, charts, figures, and graphs were used to organise and illustrate the obtained data. The entire paper was drafted using the Preferred Repoting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping review reporting criteria. Results: The present study included 24 articles for review after the screening process. The articles emphasised the bioethical issues related to CRISPR-Cas9 technology and gene editing while also shedding light on the current level of research in the field. The studies included different countries, with the maximum number of papers from the United States of America (USA), followed by the United Kingdom (UK), China, Turkey, Spain, Canada, Pakistan, Australia, Italy, France, Korea, and Sri Lanka. These articles were published between 2015 and 2021. The disease for which models were created was not mentioned in the majority of articles, while a few investigated the application of CRISPR-Cas9 in genetic disorders, cardiovascular diseases, neurodegenerative diseases, and eye disorders. The major ethical concerns identified included safety, efficacy, unintended consequences, harm to the environment, off-target effects, obtaining informed consent, and the risk of misuse. Conclusion: The use of CRISPR-Cas9 technology in creating human disease models has raised many ethical concerns. One of the primary ethical issues is the potential for unintended consequences, which could have serious long-term effects on individuals and their offspring. To address these ethical issues, it is important to develop ethical guidelines and best practices, as well as to support ongoing research to investigate the long-term effects of gene modifications.

Revolutionising Precision and Efficiency of Dental Implant Placement through Digital Planning Software: A Narrative Review

KR Segin Chandran, Neeti Mittal, Manoj Goyal

Advancements have transformed dentistry, and digital planning software has emerged as a revolutionary tool in implantology. The present review explores the capabilities, benefits, and limitations of digital planning software in implantology, emphasising its impact on clinical practice and patient outcomes. Traditional implant planning relied on Two-dimensional (2D) radiographs and physical study models, limiting accuracy and predictability. Digital planning software utilises advanced imaging technologies to generate precise Three-dimensional (3D) models of the patient’s dentition, enabling comprehensive treatment planning. Key features include 3D visualisation, virtual implant placement, prosthetic-driven planning, and simulations. These features enhance accuracy, enable collaborative decision-making, and streamline the treatment process. Commercially available digital planning software options offer similar advantages but also have unique features. Studies support the clinical efficacy of digital planning in implant placement, showing improved accuracy, patient satisfaction, and reduced complications. However, more randomised controlled trials are needed to evaluate the clinical outcomes of digitally guided implant placement. Considerations include the need for high-quality input data, a learning curve for software proficiency, and cost considerations. Nevertheless, digital planning software has become an indispensable tool in implantology, enhancing treatment outcomes and patient satisfaction. The future of digital planning software in implantology lies in Artificial Intelligence (AI) integration, automation, and personalised recommendations. With ongoing advancements, digital planning software will continue to revolutionise implantology, optimising treatment planning and execution for improved patient care.

Evaluating the Efficacy of Chewable Toothbrushes: A Scoping Review

Bandar Shukr

Introduction: The Chewable Toothbrush (CB) is a recent innovation in mechanical plaque removal methods. With its unique design, this tiny compressible brush can be used in both chewing and brushing actions without the need for toothpaste or water. Aim: To provide an overview of the indications, contraindications, advantages, and disadvantages of CBs. Furthermore, the present study aims to summarise the current evidence on the efficacy of plaque removal compared to powered or manual toothbrushes in all age groups and in both orthodontic and non orthodontic patients. It also aims to report the evidence on the ability of CBs to prevent dental caries. Materials and Methods: The electronic databases of ‘Google Scholar,’ ‘PubMed,’ ‘Cochrane Database,’ and ‘Science Direct’ were searched for all studies that evaluated the efficacy of CBs in removing dental plaque or controlling dental caries. The eligibility criteria included any study written in English, involving all types of populations without any restrictions. A total of 14 articles were identified and included in the present review. A data-charting form was utilised to extract relevant information from eligible studies. Results: A review of the current published studies revealed inferior efficacy for CB compared to the powered brush, with inconsistent findings compared to the manual brush. Additionally, CB has demonstrated promising caries prevention capabilities in most studies. Conclusion: Based on its indications, CB might be an appropriate oral hygiene tool in situations where manual toothbrushing is difficult to perform, such as in individuals with physical disabilities, reduced manual dexterity, and those who lack brushing motivation or the appropriate brushing technique. The use of CB could be beneficial in individuals with a high-risk of caries due to its unique anticaries properties. However, more research is required to confirm these findings.

Artificial Intelligence: An Innovative Approach in Orthodontics: A Narrative Review

Mansi S Sharma, Vikrant Jadhav, Kushal Prakash Bhuskute, Amit Reche

The present article aims to describe how Artificial Intelligence (AI) assists orthodontics with its potent algorithms for identification and prediction, aiding medical professionals in making better treatment choices. AI is a valuable tool for helping orthodontists determine the best approach for moving teeth with orthodontic appliances to predetermined positions. Symbolic AI, an expertise system based on human comprehension of a problem, organises knowledge into algorithmic structures. While it remains applicable for problem-solving with limited potential outcomes and the need for human explainability, building rule-based models in complex healthcare scenarios with multiple explanatory variables proves exceptionally challenging, if not impossible. However, modern AI often overlooks oral disorders, fails to fully incorporate facial analysis into its models, and neglects functional issues when developing remedies. Nonetheless, AI does improve imaging, diagnosis, specificity, and more in various situations, from identifying syndromes to detecting caries. Orthodontic diagnosis is complex, involving the simultaneous assessment of multiple facial features from different perspectives. Digital dentistry tools and AI-driven automation solutions have streamlined the process by digitally recording patient history and reducing diagnostic variations, benefiting both diagnosis and treatment. With its problem-solving capabilities, AI is starting to provide orthodontists with more powerful resources to deliver higher standards of care. AI-based technology can be utilised to gain new insights from various types of medical data. The present article aims to provide a concise overview of the use of AI in orthodontic care. The literature review is divided into six categories: extraction or non extraction therapy in orthodontic treatment, orthognathic surgery, segmentation and landmark identification, growth prediction, cleft-related studies, and Temporomandibular Disorders (TMD) classification.

Role of Selenium in the Body: A Narrative Review

Urvashi Mohanlal Saini, Suraiya Ferdous

The maintenance of required levels of essential micronutrients and macronutrients is necessary for the smooth and proper functioning of the body. Any increase or decrease in the levels of these required micronutrients will have an adverse effect on the metabolic activities carried out in the body. The intake of micronutrients differs from region to region, and many micronutrients do not function in their natural form. Selenium is one of the most vital micronutrients required by the body. Numerous organs and systems, such as the cardiovascular system and reproductive system, are affected by selenium deficiency, which is characterised by diminished activity. Consuming selenium in physiologically suitable doses is necessary for maintaining reproductive and general health. Selenium levels that are beyond the permissible range have been associated with infertility. Prolonged exposure to selenium in the environment has been shown to pose a significant danger to human health. It is still unknown how different dietary selenium sources are processed in human bodies, as well as the ideal type or quantity of dietary selenium to maintain metabolic homeostasis and enhance reproductive health. Throughout the world, selenium deficiency is a relatively prevalent cause of various diseases. It is possible to take supplements for selenium deficiency; however, increased levels of selenium, which are toxic, are very close to normal levels. Therefore, it is important to rule out the toxicity brought on by elevated selenium levels when determining the normal selenium concentration.

Factors Causing Cardiovascular Diseases in Young Adults: A Narrative Review

Anushka Bandawar, Trupti Balwir, Ujwal Gajbe, Brijraj Singh, Yugeshwari Tiwade

Cardiovascular Diseases (CVD) are a major public health problem worldwide. They continue to be one of the leading causes of death worldwide, and it is alarming that these diseases are becoming more common in people of the young age group. Although various risk factors have been proposed, smoking, dyslipidemia, and hypertension are prominent emerging risk factors in the young. The primary pathogenic mechanism for most cardiovascular disorders, such as coronary artery disease, peripheral vascular disease, heart failure, and Myocardial Infarction (MI), is atherosclerosis. Plaque rupture is the most common cause of MI, although distinctive symptoms such as plaque erosion, coronary microvascular dysfunction, spontaneous coronary artery dissection, and drug-related coronary spasm are more common in this age range. Various lifestyle factors, including, but not limited to, physical inactivity, tobacco use, alcohol consumption, poor eating habits, and drug abuse, contribute to the development of comorbid conditions such as hypertension, hypercholesterolemia, obesity, and diabetes, increasing the likelihood of having heart disease. To mitigate the societal impact of CVD and promote a healthier future for the next generation, proactive measures, such as regular physical activity and a balanced diet, are essential. This will be addressed in terms of lifestyle, environmental, physiological, pathological, and psychological aspects.

Scope of Bioaggregate in Paediatric Dentistry: A Narrative Review

Yatika Saraswat, Eswari Ramassamy, Prathima Gajula Shivashankarappa

Paediatric Dentistry has witnessed significant changes in the materials used in pulp therapy in recent years. Bioceramic materials have been considered as the dawn of a new era in dentistry. The introduction of these materials into pulp therapy as mineralising materials has brought about enormous productive changes. Bioaggregate (BA) is a newly introduced nanoparticle-sized bioceramic material produced as an alternative to Mineral Trioxide Aggregate (MTA), aiming to overcome the disadvantages of the material. In-vitro studies and a few clinical studies have demonstrated its biocompatibility and other properties, establishing it as an alternative to MTA and expanding its clinical applications. The aim of the present narrative review is to provide insight into the properties of BA, considering its scope in Paediatric dentistry.

Unveiling the Hidden Agony: Exploring Neuropathic Pain in the Younger Generation: A Narrative Review

Nithya Raju, Roja Murugesan, Samyuktha Villavan, Saranya Ravi

Pain is described as “an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage.” Neuropathic Pain (NP), a common condition, is characterised by subjective negative and positive sensations that range from numbness to debilitating agony. The prevalence of chronic pain and nerve pain in young individuals is estimated to be around 30%-50% and 6%-11%, respectively. The exact cause of NP is unknown, but research suggests that factors such as allodynia, external sensitisation, neuronal swelling, free radical damage, activation of microglia, and physiological state play a significant role in its development and progression. While there have been recent suggestions for medications, neurostimulation techniques, and interventional management, comprehensive guidelines covering all these treatments are yet to be released. Both peripheral and Central Nervous System (CNS) mechanisms contribute to the persistence of most NP types. The initial approach to treating NP in young individuals often involves pharmacotherapy. The types of drugs prescribed for general and specific types of NP in young individuals, including antidepressants and anticonvulsants, align with guidelines and consensus statements from various organisations worldwide. However, many individuals may not experience complete relief from their pain despite using these first-line treatments. Neuralgia, affecting 7 to 10% of the general population, is caused by dysfunction in the sensory organs of the body, which comprise A, A, and C fibers, as well as the brainstem and spinal cord.

Serum Biochemical Changes among Chronic Kidney Disease Patients in a Rural Cohort of Odisha, India: A Cross-sectional Study

Introduction: Chronic Kidney Disease (CKD) is one of the fastest-growing causes of death worldwide. Monitoring biochemical parameters such as liver function tests, kidney function tests, and lipid profiles is crucial for early identification of health complications, prevention, and prompt management in CKD patients. Aim: To investigate the association of sociodemographic factors and serum biochemical indicators with Glomerular Filtration Rate (GFR) among CKD patients in rural Odisha, India. Materials and Methods: A cross-sectional study was conducted in a rural cohort of the Model Rural Health Research Unit (MRHRU) established in Cuttack district, Odisha, India, from March 2021 to April 2021. A total of 530 registered CKD patients were enrolled in the study. Sociodemographic data and blood samples were collected for lipid profile, kidney function, and liver function analysis. The data were analysed using STATA 15.1 and RStudio 2021.09.0+351. Results: The mean age of the study participants was 51.2±14.1 years, with 330 (62.26%) being male. A total of 74% of the participants showed abnormal Estimated Glomerular Filtration Rate (eGFR). Abnormal eGFR was found to be more common among the older age group (>45 years), those who were literate, and those in private jobs, compared to their counterparts. Both lipid profile and liver function abnormalities were significantly associated with individuals having normal eGFR. Conclusion: The positive association of eGFR with lipid profile and liver function enzymes highlights the importance of regular screening of these parameters among CKD patients for early prevention and control of future complications.

Polyglandular Syndrome with Complications and a Rare Co-existence of Hypercortisolism in a Young Girl: An Internist Approach

K Vidhya, P Ananth Krishnan, Prasan Kumar Panda

Patients diagnosed with Type 1 Diabetes Mellitus (T1DM) can sometimes manifest as part of broader clinical presentations known as Autoimmune Polyglandular Syndromes (APS). APS refers to a group of rare autoimmune disorders in which multiple endocrine glands are affected by autoimmune attacks. There are four types of APS described so far, including APS1, APS2, APS3 and APS4. In contrast to APS1 and APS2, APS3 does not involve the adrenal cortex. In APS3, autoimmune thyroiditis occurs with other organ-specific autoimmune diseases, excluding Addison’s disease. A 20-year-old female with a known case of T1DM, Chronic Kidney Disease (CKD), hypothyroidism, and hypertension recently presented with a hypertensive emergency. On further evaluation, she was also diagnosed as a possible case of APS3 with a rare presentation of hypercortisolism instead of Addison’s disease. Various challenges were faced while managing her diabetes due to the brittle diabetes pattern she showed, and also there was a dilemma in the conclusive diagnosis of hypercortisolism in this patient due to the co-existing CKD.

Orthodontic Marvel: Correction of Class II Malocclusion with the Churro Jumper Appliance

Nishu Agarwal, Pallavi Daigavane, Nikhil Kumar, Dhwani Suchak

Class II malocclusion is a common orthodontic issue characterised by an excessive overjet, where the upper front teeth are significantly ahead of the lower ones. It often leads to aesthetic concerns and functional problems. Orthodontic treatment is the preferred solution to correct Class II malocclusion, and among the diverse range of appliances available, the Churro Jumper Appliance has emerged as a groundbreaking innovation. The present case report is about a 15-year-old male patient with Class II division 1 malocclusion and a retrognathic mandible. The MBT 0.022” prescription was used for bonding. After levelling and aligning both the upper and lower arches, and closing the anterior spacing, the Churro Jumper was used as a fixed functional appliance for mandibular repositioning. The required results were achieved using the appliance, and the patient’s occlusion was brought to a Class I molar and canine relationship, while also improving the profile. The treatment was completed in 17 months. Although several fixed functional appliances are available in the market for Class II correction, the Churro Jumper appliance was used in the present case.

Invasive Aspergillosis and Candidiasis in a Patient with Supraglottic Carcinoma undergoing Chemoradiotherapy: A Case Report

Neethu Babu, Chitralekha Saikumar, Jomon Raphael Chalissery

The incidence of Invasive Aspergillosis (IA) is increasing. Early diagnosis and treatment are very important to improve patient survival, especially in immunocompromised patients. The diagnosis of IA is challenging as clinical indicators are limited, and early microbiological confirmation of the infection is infrequent. Here, the authors present the case of a 43-year-old male who was undergoing radiotherapy along with concurrent chemotherapy for carcinoma supraglottis. He developed Invasive Pulmonary Aspergillosis (IPA) along with candidiasis within two weeks of therapy. Voriconazole remains the recommended therapy for patients with IA, which also acts against fluconazole-resistant Candida species.

Metagenomics and Whole Genome Sequencing in Clinical Microbiology: A Narrative Review

Preeti Thakur, Indira Verma

The role of Whole Genome Sequencing (WGS) in clinical microbiology is increasing and is not restricted to molecular epidemiology alone. With the advent of third-generation sequencing technologies, its applications in infectious disease diagnostics have further expanded to include the direct identification of microorganisms from primary clinical samples, prediction of antimicrobial resistance (including antiviral resistance) by detecting resistance genes, and detection of virulence genes. Untargeted metagenomic sequencing of clinical samples can provide a promising platform for the comprehensive diagnosis of infections. This article outlines the applications and scope of WGS and metagenomic sequencing in routine clinical microbiology, along with the challenges and practical issues in their implementation.