Journal of clinical and diagnostic research

Methicillin-resistant Staphylococcus aureus Intraepiphyseal Osteomyelitis of Distal Femur: A Rare Case Report

Epiphyseal osteomyelitis caused by Methicillin-resistant Staphylococcus aureus (MRSA) is a rare bone infection, usually occurring secondary to metaphyseal bone involvement due to a separate system of epiphyseal arteries that penetrate the epiphysis near the capsular insertion close to the growth plate. We report a unique case of a two-year-old girl who presented with a history of fever for one week, followed by pain and swelling in the left knee. She had a flexion deformity of 20 degrees. Laboratory findings showed elevated inflammatory markers, while blood cultures showed no growth. Magnetic Resonance Imaging (MRI) revealed epiphyseal osteomyelitis of the distal femur. Bone marrow biopsy confirmed MRSA infection. The patient underwent debridement of the epiphyseal lesion, taking care not to injure the growth plate, and STIMULAN® local antibiotic-impregnated dissolvable synthetic calcium sulphate beads were placed in and around the bone and knee joint. Postoperative purulent material and tissue cultures showed no growth. All inflammatory markers trended downward, and there were no further fever spikes. The patient recovered well without complications. High clinical suspicion is necessary for early diagnosis, and follow-up is important to detect any limb length discrepancy or deformities at an early stage.

Atypical Presentation of Nephrotic Syndrome and Cerebral Venous Sinus Thrombosis in Minimal Change Disease: A Case Report

Minimal Change Disease (MCD) is a major cause of nephrotic syndrome in children and a minority in adults. MCD and primary Focal Segmental Glomerulosclerosis (FSGS) are both examples of pathogenic mechanisms that predominantly affect the podocytes. MCD has also been linked to thrombotic consequences. The term Cerebral Sino-Venous Thrombosis (CSVT) refers to a group of conditions that involve thrombosis of the cerebral venous system. The patient presented with a severe headache for seven days, accompanied by vomiting and he was diagnosed with Cerebral Sino-Venous Thrombosis (CSVT) with underlying MCD. There was no associated medical or surgical history. Laboratory examination showed serum hypoalbuminaemia, low protein levels, and an altered urine-protein creatine ratio. A follow-up magnetic resonance imaging showed chronic occlusion of the right transverse and sigmoid sinus with multiple flow voids adjacent to the right transverse and sigmoid sinus. The patient was managed with low molecular weight intravenous corticosteroids, which led to symptomatic relief, followed by a switch to oral steroids. This index case highlights that while MCD is typically a kidney disease, it can lead to severe and potentially overlooked thrombotic events in adults. The case underscores the link between nephrotic syndrome and a hypercoagulable state, which, although not definitively proven as a direct cause of thrombosis, is associated with profound clotting factor abnormalities.

A Case Report of Traumatic Neuroma in the Buccal Mucosa: Role of Histopathology in Unravelling Clinical and Diagnostic Hurdle

Neha Shah, Shreya Batabyal, Mehebuba Sultana, Sangeeta Sinha, Mousumi Pal

Traumatic neuroma, also known as amputation neuroma, is a benign, non-neoplastic proliferation of nerve tissue that occurs in response to long-standing nerve injury or trauma. While this condition is mostly associated with peripheral nerves, it can also manifest in the oral cavity, particularly following surgical procedures, accidental injury, or chronic irritation. Although traumatic neuromas are relatively rare in the paediatric population, their occurrence in the oral cavity warrants attention due to potential diagnostic challenges and the impact on the patient’s quality of life. Traumatic neuromas can be easily overlooked or misdiagnosed, as there is no consensus on their clinical presentation due to their rarity. This article presents a case report of a 14-year-old female patient complaining of excruciating pain in the left side of her face. The case highlights the unusual and obscure clinical presentation of traumatic neuroma, posing a diagnostic dilemma and the importance of histopathology for definitive diagnosis and proper treatment and management.

Co-existence of Multifocal Ductal Carcinoma in Situ with Microinvasion and Benign Phyllodes Tumour in the Same Breast: A Rare Case Report

Khushi Soni, Kishor Hiwale, Bhagyesh Sapkale

The presented case is a rare instance of multifocal Ductal Carcinoma In Situ (DCIS) with microinvasion in the presence of a benign phyllodes tumour in a 60-year-old postmenopausal woman. The patient reported that she had painless right breast lumps for four months and no previous trauma, hormonal treatment or family history of breast/ovarian carcinoma. A physical examination showed four discrete, mobile and non-tender masses without any skin changes or lymphadenopathy. Biochemical and haematological investigations were unremarkable. Mammography and targeted ultrasound imaging showed several heterogeneous nodules, one of which was lobulated fibroepithelial with the rest being segmental calcifications, which led to suspicion of multifocal DCIS with microinvasion. Wide local excision of all nodules was done. Histopathology also confirmed DCIS with microinvasion in three nodules and one benign phyllodes tumour, without having epithelial malignancy. This case underlines diagnostic challenge in coexisting DCIS and phyllodes tumours, emphasising the importance of proper imaging, surgical excision and histopathology for diagnosis and management of such rare cases.

Intranasal Lobular Capillary Haemangioma of the Anterior Inferior Turbinate: A Case Report

PM Raghuraman, Karthika Rajendran, CRK Balaji, S Anand

Intranasal Lobular Capillary Haemangioma (LCH), also known as pyogenic granuloma, is a rare benign vascular lesion of the nasal cavity, typically presenting with recurrent epistaxis and nasal obstruction, predominantly in females. It arises from the nasal septum or turbinates and is characterised by rapid growth with a tendency to bleed easily. Although benign, its presentation often mimics more aggressive conditions, making an accurate diagnosis essential. This is a case report of a 23-year-old female who presented with intermittent left-sided epistaxis for two months and progressive nasal blockage for six weeks. Nasal endoscopy revealed a reddish-yellow, polypoidal mass arising from the anterior inferior turbinate, which bled upon contact. Computed Tomography (CT) revealed a well-defined, hypodense, non-enhancing lesion without bony erosion or sinus involvement. The patient underwent complete endoscopic excision with bipolar cauterisation of the pedicle under general anaesthesia. Intraoperative bleeding was minimal, and the recovery was uneventful. Histopathological examination confirmed LCH, revealing lobular proliferation of capillary-sized vessels lined with plump endothelial cells without atypia or malignancy. The patient remained symptom-free during the six-month follow-up period. This case highlights the importance of considering LCH in young females presenting with recurrent unilateral epistaxis and nasal obstruction. Early diagnosis, imaging, histopathological confirmation, and complete endoscopic excision with pedicle cauterisation are crucial for effective management and prevention of recurrence.

Lingual Lipoma: An Atypical Case Presentation of a Common Tumour in an Uncommon Site

Lipomas are common benign mesenchymal tumours composed of mature adipose tissue, but they are rare in the oral cavity, particularly on the tongue. This report describes the case of a 53-year-old female who presented with a slowly enlarging, painless swelling on the right lateral border of the tongue for four years, causing difficulty in speech and eating. Clinical and radiological evaluations, including Magnetic Resonance Imaging (MRI), revealed a well-defined, fat-containing lesion without invasion. Fine Needle Aspiration Cytology (FNAC) suggested a lipoma, and complete surgical excision was performed under general anaesthesia. Histopathological examination confirmed a simple lipoma with no signs of malignancy. The postoperative course was uneventful, and the patient remained symptom-free with no recurrence at the one-year follow-up. Although they are rare, lingual lipomas should be included in the differential diagnosis of asymptomatic oral swellings, and their surgical removal provides excellent outcomes.

Dentigerous Cyst Associated with Impacted Supernumerary Tooth in Anterior Palatal Region: A Case Report

The dentigerous cyst is the most common developmental odontogenic cyst, originating from the accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted or impacted tooth. It is most frequently associated with the mandibular third molars and maxillary canines, followed by the maxillary third molars. Occurrence in the anterior maxillary region is exceptionally rare; however, when present in this location, it is typically associated with a supernumerary tooth. Supernumerary teeth are additional teeth that develop beyond the normal dentition and can be found in any region of the maxilla or mandible. The most common type is the mesiodens, typically located in the anterior maxilla, followed by the distomolar, situated distal to the third molars. Although most supernumerary teeth erupt normally into the oral cavity, a subset remains impacted. Of these, only a small proportion are associated with clinical complications such as crowding, delayed eruption of adjacent teeth, or the development of an odontogenic cyst or tumour. This article presents a rare case of a dentigerous cyst associated with an impacted supernumerary tooth in the anterior maxilla of a 40-year-old male, who presented with pain and mild swelling in the anterior palatal region. The case highlights the diagnostic process, radiographic evaluation, and surgical management of this uncommon presentation.

Transverse Mesocolon Volvulus: A Case Report

Ruchika Prabhu, Saumya Ranjan

Volvulus is described as the axial twisting or rotation of a part of the colon around its mesentery. It constitutes approximately 5% of all cases of bowel obstruction, making it an extremely rare pathology. We report a case of transverse colon volvulus in a 38-year-old female who presented with a sudden onset of right upper abdominal pain, distension, constipation, and emesis. An erect X-ray of the abdomen revealed two air-fluid levels in the right lumbar region. Preliminary ultrasonography showed the presence of a mesenteric twist in the right hypochondriac region and a dilated fluid-filled ascending colon and caecum. Contrast-enhanced Computed Tomography (CT) imaging demonstrated the presence of a twisted transverse mesocolon with a vascular pedicle in its centre, consisting of branches of the superior mesenteric artery and dilated, tortuous collaterals arising from inferior mesenteric vessels. These findings were later confirmed with histopathological correlation.

Undetected Hepatocellular Carcinoma Initially Manifesting as Pathologic Fracture of Femur: A Case Report

Sarojini Raman, Prajna Das, Urmila Senapati, Bhabani Shankar Mahapatra

Hepatocellular Carcinoma (HCC) is the most common primary liver malignancy and its global incidence and mortality have shown an upward trend recently. According to GLOBOCAN 2020, it is the 4th most frequent cause of death worldwide. Despite advances in diagnostic and therapeutic modalities, many patients present at an advanced stage with a dismal prognosis. HCC often metastasises to the lungs, lymph nodes and abdominal organs. Bone metastasis is reported in only 5-7% of primary HCCs. The long bones, such as the femur, are rare sites for distant metastasis compared with the axial skeleton. HCC typically presents as a large space-occupying lytic lesion with systemic symptoms. Extrahepatic isolated bone metastasis without clinical signs or symptoms of liver injury as the sole initial manifestation in HCC is very uncommon. Present case is of primary HCC in a non cirrhotic liver metastasising to the femur in a patient with no known co-morbidities. This case highlights the fact that metastatic HCC should be included in the differential diagnosis in cases presenting with lytic bone lesions of unknown primary in older males, even in the absence of liver cirrhosis. Early radiological intervention and aggressive management policies should be adopted to extend survival.

A Case Report on Gas Gangrene with a Fatal Outcome

Gas gangrene, a life-threatening illness caused by Clostridium perfringens, progresses rapidly, resulting in systemic toxicity, multiorgan failure and ultimately death. This case report describes a 19-year-old male patient presenting with dyspnoea, limb oedema, and severe pain following an intramuscular injection. Examination revealed significant oedema, palpable crepitus, absent peripheral pulses, metabolic acidosis and septic shock. The patient underwent emergency surgical debridement under general anaesthesia with inotropic support. Despite aggressive resuscitation, he died seven hours after arrival. Posthumous tissue cultures confirmed Clostridium perfringens infection. This case underscores the critical importance of prompt diagnosis, aggressive intervention and the challenges of perioperative management in gas gangrene.

Malignant Transformation in Tailgut Cyst Presenting as Retrorectal Adenosquamous Carcinoma: A Case Report

Dipkana Das, Raya Banerjee, Durgaprasad Nanda, Namrata Maity

Tailgut cysts are rare congenital retrorectal lesions that can rarely undergo malignant transformation. Occurring predominantly in middle-aged females, these lesions are mostly asymptomatic, with rare symptoms arising mostly in association with malignant transformation. The mainstay of therapy is surgical excision with adequate clear margins. Postoperative radiotherapy is indicated in cases with involved or close margins postoperatively, high histologic grade of malignancy, presence of perineural or lymphovascular invasion or high proliferative index of tumour, in order to prevent local site recurrence. In this study, we present a case of adenosquamous carcinoma arising from a retrorectal tailgut cyst. The patient was treated with surgical excision followed by adjuvant chemoradiotherapy. Patient is currently doing well and is on routine follow-up as per institutional protocol.

Psoas Abscess as an Atypical Presentation of Acute Necrotising Pancreatitis in a Diabetic Patient: A Case Report

Gowtham Ganesan, Velvizi Raveendran, S Jayakanthan

Psoas abscess can be challenging to diagnose due to non specific symptoms. It is commonly noted to have tuberculous or pyogenic aetiologies. Acute necrotising pancreatitis can be defined as pancreatitis with necrosis. This can cause the formation of a psoas pseudocyst, which may be misdiagnosed as a psoas abscess. The likelihood of misdiagnosis is higher in diabetic patients due to the associated increased risk of infection. This is a case report of a 37-year-old male presenting with fever, swelling and left lumbar region pain, with a history of long-standing diabetes and alcohol consumption. The patient was diagnosed with a pancreatic pseudocyst with left psoas abscess by Computed Tomography (CT) imaging. The abscess was treated with percutaneous drainage, culture and drug-sensitivity analysis, followed by intravenous antibiotics tailored to the results. This case highlights the need to consider necrotising pancreatitis as a potential differential diagnosis in cases of psoas abscess, particularly in cases with retroperitoneal involvement.

Malakoplakia of Bone Presenting as Bilateral Septic Arthritis: A Case Report

S Supriya, B Krishnamoorthi Adiga

Malakoplakia is an uncommon chronic inflammatory disorder that usually involves an abnormal immunological response to underlying infection. Though it is reported in almost every organ system, involvement of bone is extremely rare, where it usually presents as a solitary lytic lesion. We report a case of bilateral knee swelling in a 58-year-old woman yielding pus on aspirate due to Proteus and Citrobacter infection with osteolytic lesions of adjacent bones. As the disease was refractory to antibiotics, a biopsy was taken, which revealed malakoplakia. The aim of this article is to present a unique first case of malakoplakia involving joints. The patient was diabetic and had recently recovered from nephrotic syndrome. Detailed discussion of the case along with characteristic histopathological features, challenge in diagnosis and management with review of the literature of bony malakoplakia is presented.

Delayed Diagnosis of Atypical Neuroleptic Malignant Syndrome Precipitated by Olanzapine: A Case Report

Jiang Cao, Na-Hua Yuan, Yan Zhang

Neuroleptic Malignant Syndrome (NMS) is a life-threatening and idiosyncratic adverse reaction to common antipsychotic medication. The diagnosis of NMS remains controversial and unclear, as most criteria used in practice fail to correspond to empirical diagnoses. Here, we present a case of NMS diagnosis and management. A 48-year-old man with bipolar disorder was frequently admitted to a psychiatric ward with recurrent episodes. He had been stable for six months since his last hospitalisation and was being treated with oxcarbazepine and olanzapine. Oxcarbazepine was discontinued, and olanzapine (20 mg/d) was continued because of hyponatraemia and hypochloraemia. Clinical manifestations after olanzapine intake comprised confusion, agitation, fever, urinary retention, and increased Creatine Kinase (CK). A urinary tract infection was considered because of absent muscle rigidity in the first five days. Furthermore, the patient had an increased body temperature, frequent urination, urgency, and pain. Upon muscle rigidity and pulmonary infection development, the patient was medically treated. Following quetiapine monotherapy (administered at 25 mg and gradually increased to 600 mg in two oral doses) at week 3 post-NMS recovery, the mental state of the patient improved. He maintained a rational conversation with no evidence of autonomic instability or disorientation. He was discharged from the psychiatric ward 3.5 months after admission. NMS is a rare neurological disorder with a potential atypical presentation and requires emergency medical treatment rather than psychiatric care. Clinicians must carefully distinguish between medical and mental illnesses, prioritising multiple illnesses promptly in case of identification difficulties.

Elevated NT-proBNP in a Patient with Grade 1 Renal Cell Carcinoma undergoing Axitinib Therapy:A Case Report

Abhijit Pratap, Pradnya Phalak, Anjali Garg, Deepali Jain

The N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) elevation in oncology patients underscores the importance of considering paraneoplastic syndromes, specific drug toxicities, and tumour-related vascular complications alongside primary cardiac. A 58-year-old male with Grade 1 clear cell Renal Cell Carcinoma (RCC) on Axitinib therapy presented with a three-week history of progressive fatigue, significant weight loss (5 kg), and anaemia. Despite normal renal function and preserved cardiac ejection fraction (60%), his NT-proBNP level was persistently elevated above 35,000 pg/mL. Comprehensive cardiac workup, including troponin, Electrocardiogram (ECG), and echocardiography, revealed no evidence of heart failure. Diagnosis was confirmed via Positron Emission Tomography (PET)-Computed Tomography (CT), which identified a right renal mass with an Inferior Vena Cava (IVC) thrombus and bilateral lung lesions, and biopsy with immunohistochemistry. This case highlights an extreme elevation of NT-proBNP in low-grade RCC, potentially mediated by paraneoplastic activity, Axitinib-related cardiotoxicity, anaemia, or tumour thrombus effects, suggesting its role as a biomarker beyond cardiac dysfunction. Monitoring NT-proBNP in such patients may offer insights into tumour behaviour and treatment-related stress.

Accidental finding of Strongyloides stercoralis Hyperinfection in an Immunocompetent Patient: A Case Report

Shahin Vishani, Dhruba Hari Chandi, Dipika Shaw, Supriya Meshram, Gargi Mudey

Soil-transmitted helminths commonly present as asymptomatic gastrointestinal discomfort, abdominal pain, diarrhoea, anaemia, and decreased work productivity. They are rarely fatal. Strongyloides stercoralis is a soil-transmitted intestinal nematode that can remain asymptomatic for a very long time. Hyperinfection and disseminated infection, commonly associated with immunocompromised patients, can have a grievous outcome. In this case, the patient was admitted to the hospital with an electric burn wound and was treated with partial amputation of the right hand, along with other wounds. During hospitalisation, it was found that he was anaemic with a haemoglobin of 8.3 g/dL, for which he was evaluated. Stool examination revealed multiple larvae of S. stercoralis, suggestive of hyperinfection. The patient was treated to prevent further complications and was discharged later. This implies the importance of having a high index of suspicion, while evaluating patients in tropical and subtropical climates for parasitic infections.

Multimodal Imaging in the Diagnosis of Juvenile Retinoschisis: A Case Report

Gufran Ali Kamdar, Shikha Rai, Sumit Navneet Toshniwal, (Col) OK Radhkrishnan

Retinoschisis is a retinal disorder characterised by splitting within the neurosensory retina, which leads to structural disorganisation and varying degrees of visual loss. Among hereditary forms, X-Linked Juvenile Retinoschisis (XLRS) is the most common subtype. It arises due to mutations in the RS1 gene encoding retinoschisin, a protein vital for cellular adhesion and synaptic integrity within the retina. Because of its X-linked recessive inheritance, XLRS predominantly affects males and typically manifests in the first decade of life. In this case report, a 20-year-old male, born to a consanguineous marriage, presented with gradual, painless, bilateral diminution of vision for one year. There was no history of trauma, systemic illness, surgery, or family history. Best-corrected visual acuity was 6/24p in the right eye and 6/18p in the left eye, with normal anterior segment and trichromatic colour vision. Fundus revealed spoke-wheel foveal schisis, suggestive of XLRS. Optical Coherence Tomography (OCT) confirmed intraretinal splitting, and Electroretinography (ERG) demonstrated a negative waveform with reduced b-wave, characteristic of XLRS. The prevalence of XLRS varies globally but is often higher in populations with frequent consanguineous marriages, which increase the likelihood of transmitting recessive mutations. Early diagnosis with careful clinical and imaging evaluation is important for monitoring progression and identifying complications. Management remains largely supportive, including low-vision rehabilitation and treatment of associated complications. Although no curative therapy is currently available, gene therapy targeting RS1 mutations is under active investigation and holds promise as a future treatment option for preserving vision.

Management of Plummer-vinson Syndrome: A Report of Two Cases

S Aravind Warrier, Arnesh Garg, M Vaishnavi, Preethi Ramesh, CV Divyambika

Plummer-Vinson Syndrome (PVS), also referred to as Paterson-Kelly syndrome, is a complication of Iron Deficiency Anaemia (IDA) that is associated with the formation of oesophageal webs and dysphagia. The oesophageal webs are thin, membranous structures that partially obstruct the upper oesophagus, hindering the passage of food. PVS occurs more frequently in middle-aged women and is linked to an increased risk of squamous cell carcinoma of the pharynx and oesophagus. Due to the high risk of malignant transformation, PVS has been grouped under the category of Oral Potentially Malignant Disorders (OPMD). Identification of the disease, early intervention, and long-term follow-up are essential to prevent complications associated with PVS. A thorough history and clinical examination to evaluate possible etiologic causes, haematological evaluation of the blood count and erythrocyte morphology, along with evaluation of the oesophagus using barium swallow or endoscopy, are needed to diagnose the severity of the case and plan appropriate treatment. Treatment with iron supplementation can lead to the improvement of symptoms and regression of oesophageal webs, emphasising the importance of timely intervention and long-term surveillance. This case report aims to highlight the various oral and systemic manifestations, investigations, treatment, and follow-up of PVS in two female patients. The highlight of the cases is timely medical intervention leading to the disappearance of webs, eliminating the need for mechanical dilatation. Thus, early diagnosis and prompt management of such cases can improve the overall quality of life of such patients.

Nasal Septal Schwannoma: A Rare Tumour at an Atypical Site

Vaibhavi Patil, Prasad Deshmukh, Sagar Gaurkar

Schwannomas are benign tumours originating from Schwann cells of peripheral nerves. Although common in the head and neck region, their occurrence in the nasal cavity is rare, and involvement of the nasal septum is exceptionally uncommon. Due to their non-specific symptoms and rarity, nasal schwannomas often pose a diagnostic challenge. In this report, we present a case of a schwannoma arising from the right side of the nasal septum in a 50-year-old male, who presented with a slowly enlarging nasal mass and progressive nasal obstruction. The mass was excised surgically, and histopathological evaluation confirmed the diagnosis. This case highlights the diagnostic challenges and therapeutic considerations in managing nasal septal schwannomas, a seldom-seen entity.

Anaesthetic Considerations for Neurosurgery in a Patient with Large Atrial Septal Defect and Left Parietal Cystic Glioma: A Case Report

Kavya Kalluri, Teena Tanaji Desai, Narendra Patil

Atrial Septal Defect (ASD) can pose unique anaesthetic challenges for patients undergoing non-cardiac surgeries, such as craniotomy. The presence of a shunt can affect haemodynamic stability, oxygenation, and anaesthetic management. The current case report detailing the anaesthetic considerations and management strategies employed for a patient with ASD undergoing craniotomy highlights the importance of careful perioperative planning and monitoring to ensure optimal outcomes. A rare case of a 60-year-old female patient with a large ASD and severe Pulmonary Arterial Hypertension (PAH) who underwent left frontotemporoparietal craniotomy and excision of a left-sided parietal cystic glioma. The patient’s medical history included palpitations, exertional dyspnoea, slurring of speech, and right-sided upper and lower limb weakness. Echocardiography (ECHO) revealed a large ostium secundum ASD (3.7 cm) with left-to-right shunt, moderate tricuspid regurgitation, severe PAH, and a left ventricular ejection fraction of 50%. The patient was carefully managed perioperatively by a multidisciplinary team approach. Anaesthetic techniques and medications were selected to minimise haemodynamic instability and Pulmonary Vascular Resistance (PVR). Intraoperative monitoring included monitoring of cardiac function, oxygenation, and ventilation. The patient underwent successful surgery without major complications. This case report highlights the anaesthetic complexities of managing patients with large ASDs and severe PAH undergoing non-cardiac surgery. Careful perioperative planning, multidisciplinary collaboration, and close monitoring are essential to ensure optimal outcomes. Our experience demonstrates that with careful management, patients with complex cardiac and neurological conditions can undergo successful surgery. This case report provides valuable insights into the perioperative management of patients with large ASDs and severe PAH, highlighting the importance of a multidisciplinary approach and careful anaesthetic planning.

Parkinsonism as a Rare Manifestation of Hashimoto Encephalopathy Associated with Autoimmune Polyendocrine Syndrome: A Case Report

Diksha Samsukha, Rohidas T Borse, Meenal Chandanwale

Hashimoto’s encephalopathy is a rare manifestation of a common autoimmune disease, characterised classically by its association with autoimmune thyroid disease and responsiveness to steroids. Usual clinical manifestations include a relapsing-remitting course of seizures, stroke-like episodes, cognitive decline, neuropsychiatric symptoms and myoclonus. Diagnosis requires raised Thyroid Peroxidase (TPO) antibody titre and exclusion of other encephalopathies, including neuronal surface and paraneoplastic antibodies. Here, we delve into a case of Hashimoto’s encephalopathy for: 1) its rare linkage to an Autoimmune Polyendocrine Syndrome (APS); and 2) an uncommon manifestation in the form of Parkinsonism. We report a case of a 45-year-old male with previously diagnosed hypothyroidism, vitiligo and likely adrenal tuberculosis. The current presentation included a fluctuating sensorium with gradually declining mobility and all classical features of Parkinsonism. Investigations revealed hyponatraemia owing to decreased morning serum cortisol levels, normal thyroid profile, and a normal Cerebrospinal Fluid (CSF) analysis. The Electroencephalogram (EEG) showed generalised slowing. The autoimmune and paraneoplastic encephalitis panel was negative. A raised anti-TPO antibody level clinched the diagnosis of Hashimoto encephalopathy associated with APS (Autoimmune thyroid disease, vitiligo and autoimmune adrenalitis). He showed remarkable improvement with steroids, thyroxine and levodopa-carbidopa. On follow-up, the patient showed marked improvement in bradykinesia, tremors and rigidity. This rare case underscores the importance of suspicion of rare manifestations in relatively common and potentially reversible disorders.

Rare Presentation of Early Gastric Carcinoma with Bone and Bone Marrow Metastases: A Case Report

Gastric carcinoma has emerged as a global health problem in recent decades. Bone and bone-marrow metastases are common findings in the diagnostic work-up for malignancies; however, they are rarely seen in early gastric carcinoma. This case report describes a 60-year-old male patient who presented with severe back pain for three weeks. The patient underwent blood tests and radiologic imaging, including abdominal ultrasonography and Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the brain and spine, upper Gastrointestinal (GI) endoscopy, gastric biopsy, and bone marrow biopsy. The MRI of the lumbar spine revealed patchy heterogeneous T2 hyperintense signals in multiple vertebrae along with a focal defect at the L2 vertebra. A differential diagnosis of multiple myeloma and bone metastases was initially contemplated. The Histopathological Examination (HPE) of the stomach biopsy indicated poorly differentiated adenocarcinoma exhibiting localised signet-ring cell characteristics. Bone marrow biopsy revealed a similar histopathological picture, confirming metastasis to the bone marrow. A diagnosis of gastric adenocarcinoma with bone and bone-marrow metastases was made. Chemotherapy was deferred due to the patient’s poor performance status and, in part, because of worsening cytopenia and Disseminated Intravascular Coagulation (DIC). During the patient’s hospital stay, managing the patient’s pain, cytopenia, and ongoing DIC became difficult, and the patient succumbed on day 21 of hospitalisation. This case presents an unusual instance of early gastric carcinoma with extensive bone and bone-marrow metastases without visceral or peritoneal involvement.

Rasmussen Encephalitis Closely Mimicking Infantile Spasms: A Case Report

Touheer Pasha, Shilpi Agrawal, MG Ravanagomagan

Rasmussen Encephalitis (RE) is a rare, progressive neurological disorder primarily affecting children, with early-onset cases posing significant diagnostic challenges. In infants, RE may closely resemble more common conditions such as infantile spasms, often leading to delayed diagnosis and suboptimal treatment. The present case reported a six-month-old male who presented to the paediatric neurology department with the chief complaint of repeated jerky movements of the left hand for the past three weeks. His seizure semiology mimicked infantile spasms. Initial Electroencephalography (EEG) and Magnetic Resonance Imaging (MRI) findings were unremarkable, contributing to diagnostic uncertainty. However, over subsequent weeks, the child developed progressive left hemispheric atrophy on neuroimaging, along with persistent, treatment-resistant seizures. These evolving features guided the diagnosis towards RE. Management included oxcarbazepine, levetiracetam, and corticosteroids, which resulted in only partial seizure control. This case underscores the importance of maintaining a high index of suspicion for RE in infants with refractory spasm-like seizures and emphasises the diagnostic value of serial imaging. Early recognition and initiation of immunotherapy may potentially alter disease progression and improve outcomes. Multidisciplinary collaboration remains essential for optimising long-term neurological function and quality of life in affected patients.

Inflammation-induced Giant Retroperitoneal Lymphangioma in an Adult: An Unusual Case Report

Saurabh Boralkar, Samir Gupta, N Santhosh

Cystic lymphangiomas belong to the group of tumours arising from the lymphatic system. In adults, they are less commonly seen, with the abdomen being the least common site. Here, the present case study included a 32-year-old female who had a history of tube drainage of an abdominal cystic mass six years ago at the same hospital. Following that procedure, she developed tachycardia clinically, along with fever and rigors. The patient now presented with abdominal pain and distension for five months. She was evaluated with an ultrasound and a Computed Tomography (CT) scan of the abdomen and pelvis, which revealed a similar retroperitoneal cystic lesion. The patient underwent complete excision of the cystic lesion, and her postoperative course was uneventful. We are reporting this case of a lymphangioma that became iatrogenically infected and resulted in a giant lymphangioma within six years. According to the literature, only three cases of retroperitoneal lymphangioma in adults with a size greater than 20 cm have been reported. Compared to these, this cystic lymphangioma represents the fourth largest reported case.

Regional Hyperhidrosis as an Unusual Presentation of Juvenile Amyotrophic Lateral Sclerosis: A Case Report

S Indulekha, Raj Kumar Yadav, Hrishikesh Das, Paras Yadav

Juvenile Amyotrophic Lateral Sclerosis (JALS) is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord, which occurs before the age of 25 years. A 21-year-old man without a family history of neurological diseases started having increased sweating in his right hand and slippage of a pen 5 and a half years back. Within two years of the symptoms first appearing, progressive weakness in the right hand and forearm muscles, leading to difficulty in writing, grasping and lifting heavy objects, was noticed. This weakness gradually progressed to the left upper limb also. There was no history of dysphagia or dysarthria. Physical examination revealed spasticity and exaggerated deep tendon reflexes in all four limbs, along with wasting and fasciculations, with normal cranial nerves, sensory and cerebellar examinations. Blood investigations were normal. Needle Electromyography (EMG) denervation changes were noted in the upper and lower limbs and thoracic paravertebral muscles. He was diagnosed with JALS according to the modified El-Escorial criteria and age of the patient. After counselling, Riluzole was started along with non-pharmacological management. The purpose of this case is to highlight an unusual initial autonomic presentation of JALS. Here, the patient initially had increased sweating, i.e., hyperhidrosis, as the only complaint. The reason might be the increased autonomous neural firing rate.

Reviving Knee Function with Panchakarma Therapy: Case Report of a Meniscal Tear

Kavita B Sutagatti, Pradeep L Gramapurohit

The knee is the largest weight-bearing compound synovial joint, important for activities like sitting, walking, and running. Knee injuries significantly impact the quality of life regardless of age, gender, or occupation. This case report evaluates the effect of panchakarma therapies on the medial meniscal tear of the left knee. A 41-year-old female experienced left knee trauma, resulting in acute pain, swelling and tenderness after a sudden twist of the left leg while walking. Magnetic Resonance Imaging (MRI) revealed a grade III medial meniscus tear of the left knee. The patient had on-and-off episodes of knee pain and instability while walking, even after repeated sessions of physiotherapy treatment and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). After three years, patient opted for panchakarma for complete recovery of the condition. She was treated with panchakarma therapies for the period of four months, which included Godhuma Upanaha, Sthanika Parisheka with Ashwagandha Balalakshadi Taila and Murivenna Taila, Janu Basti with Murchita Tila taila and Nirgundi Taila, Erandmoola Niruha Basti, and Anuvasana Basti with Guggulu Tikthaka Ghrita in a Yoga Basti schedule and oral ayurvedic medication. After the panchakarma therapies, left knee pain reduced from Visual Analogue Scale (VAS) 5 to 0 along with improved range of movements, knee flexion from 60 degrees to 110 degrees and the MRI report showed normal medial meniscus. This case report highlights the efficacy of Panchakarma therapies by addressing doshic imbalances, reducing inflammation, and supporting tissue repair, thus providing comprehensive relief and complete recovery for a grade III meniscus tear.

Delayed Suture Granuloma Imitating Tumour Recurrence following Hemithyroidectomy: A Case Report

Suture granulomas are rare benign inflammatory reactions to retained non absorbable suture materials that may clinically and radiologically mimic neoplastic recurrence. Present case is of a 48-year-old female who developed multiple anterior neck swellings 18 months after undergoing hemithyroidectomy for a biopsy-proven follicular adenoma. Imaging and cytology raised suspicion of recurrence. However, histopathological examination of excised tissue confirmed the diagnosis of a suture granuloma. This case highlights the diagnostic challenge posed by this entity and underscores the importance of considering benign postoperative complications in the differential diagnosis of new neck masses in previously operated patients.

A Case of Bilateral Antrochoanal Polyp: Breaking the Unilateral Norm

Antrochoanal Polyps (ACPs) are benign lesions arising from the maxillary sinus mucosa, typically unilateral, with bilateral presentation being exceedingly rare. We present the case of a 53-year-old female with progressive bilateral nasal obstruction for three years and recent onset of right-sided facial pain. Endoscopic examination revealed large polypoidal masses originating from both middle meati, with the right-sided lesion extending into the choana. Imaging confirmed bilateral maxillary sinus opacification. The patient underwent successful endoscopic sinus surgery with bilateral uncinectomy and middle meatal antrostomy. Histopathology confirmed inflammatory polyps with side-specific differences- right-sided specimen showing eosinophilic infiltration and cholesterol clefts, and left-sided specimen exhibiting pigment-laden macrophages. Postoperative recovery was uneventful, with complete symptomatic relief. However, at the 12-month follow-up, bilateral recurrent ACPs were noted. This case adds to the limited reports of bilateral ACPs and highlights the importance of high clinical suspicion and tailored surgical management in such presentations.

Management of Partial Hanging Accompanied with Acute Onset Decreased Left Ventricular Systolic Function: A Case Report

Aishwarya Ramanathan, Meenal Muthiah, Ragavendra Chanthanamuthu, Keerthiga Mohan

Hanging can lead to cardiovascular complications like negative pressure pulmonary oedema, ventricular tachycardia and fibrillation, hypotension, shock, myocardial infarction, heart blocks, carotid dissection and even cardiac arrest. Stress cardiomyopathy after attempted hanging is an unusual and rarely encountered complication, particularly in young patients. It is usually a transient and reversible condition. Routinely, patients have no antecedent cardiac history or symptoms. It is precipitated by extreme physical and emotional stress. The presenting symptoms can mimic those of myocardial infarction, leading to a misdiagnosis of cardiac pathology. Extreme vigilance and awareness are paramount for the diagnosis and management. The blood investigations and electrocardiogram can be normal in the initial stages, but with careful monitoring, this complication can be successfully treated. In the current case, the patient was a young female with no significant cardiac history who presented with an alleged history of attempted hanging. Echocardiography revealed severe left ventricular dysfunction with an ejection fraction of 30%. She was intubated and managed for cardiac failure. Coronary angiography was done to rule out any organic lesions, which came out negative. She was discharged after seven days in stable condition with improvement in cardiac function to near normal with an ejection fraction of 55%. We report this as a case of stress-induced cardiomyopathy precipitated by acute stress of hanging to ensure that clinicians have a high index of suspicion while dealing with a patient with hanging.

Endoscopic Excision of Glomus Tympanicum: A Case Report

Vinod Shinde, Mohak Kumar, Mayur Ingale

Navigating the delicate anatomy of the middle ear demands precision, especially when confronting rare vascular tumours such as glomus tympanicum. This report highlights the successful endoscopic excision of a glomus tympanicum tumour in a 44-year-old female presenting with persistent tinnitus, hearing loss, and aural fullness. Diagnostic imaging confirmed a Grade 2 glomus tympanicum tumour localised to the middle ear. The patient underwent a successful endoscopic transcanal excision, achieving complete tumour removal without compromising adjacent structures. Postoperative recovery was uneventful, with complete resolution of symptoms. This case underscores the efficacy, safety, and favourable outcomes of minimally invasive endoscopic techniques for treating localised glomus tympanicum tumours.

Comprehensive Multimodal Imaging in Tuberous Sclerosis Complex: A Case Report

Tuberous Sclerosis Complex (TSC) is an autosomal dominant disorder caused by mutations in the TSC1 (hamartin) or TSC2 (tuberin) genes, affecting multiple organ systems. A 23-year-old female presented with cosmetic concerns due to malodorous facial plaques and oral papules. Clinical examination revealed characteristic skin manifestations such as facial angiofibromas and hypomelanotic macules. Magnetic Resonance Imaging (MRI) of the brain showed subependymal and subcortical tubers with radial bands, while abdominal ultrasound and Computed Tomography (CT) scans demonstrated bilateral renal angiomyolipomas and pulmonary cystic lesions, suggesting Lymphangioleiomyomatosis (LAM). TSC impacts both children and adults, with significant variability in clinical features, even within families. Early recognition of imaging findings such as radial migration lines and renal angiomyolipomas can significantly improve outcomes. Multimodal imaging is crucial in assessing disease severity and planning appropriate management.

Perioperative Management of Hypernatraemia: An Anaesthetic Perspective

Sandeep Veer, Pragya Pramanik

Preoperative hypernatraemia remains a rare yet formidable challenge in anaesthetic practice, especially in emergency surgical situations where time constraints often limit full preoperative optimisation. Severe hypernatraemia is associated with increased perioperative morbidity and the risk of significant neurological complications if corrected too rapidly. Present case is a unique case of a 68-year-old male with type 2 diabetes mellitus who presented for emergency hepatic jejunostomy due to suspected bowel obstruction. The patient had a one-month history of recurrent vomiting, jaundice, and generalised weakness. Preoperative investigations revealed marked hypernatraemia, with a serum sodium level of 158 mEq/L, raising serious concerns about intraoperative and postoperative management. Given the urgency of the procedure, gradual preoperative correction of sodium was initiated with hypotonic saline while proceeding to surgery. Anaesthetic management involved rapid sequence induction with close airway protection, maintenance with sevoflurane and remifentanil, and intraoperative haemodynamic monitoring. The patient experienced transient intraoperative hypotension, requiring norepinephrine support. A major focus of care was the controlled correction of hypernatraemia, which was achieved over 72 hours postoperatively, avoiding rapid osmotic shifts. The patient was extubated on postoperative day 2, transferred to the surgical ward on day 4, and discharged home on day 10 without neurological sequelae. This case underscores the importance of vigilant perioperative care, multidisciplinary coordination, and a tailored anaesthetic approach in managing patients with severe hypernatraemia. It also adds to the limited body of literature addressing anaesthetic considerations in such high-risk, time-sensitive cases, where both fluid and electrolyte management play a pivotal role in patient outcomes.

Dengue Fever Associated Secondary Haemophagocytic Lymphohistiocytosis in an Adolescent with Beta Thalassaemia Trait: A Case Report

Prema Lakshmi, Touheer Pasha

Dengue-associated Haemophagocytic Lymphohistiocytosis (HLH) is a rare but life-threatening hyperinflammatory complication. It arises when an exaggerated immune response is triggered by viral infection, leading to multi-organ involvement and high morbidity. Early identification and judicious management are critical for favourable outcomes. A 14-year-old boy presented with the dengue-associated secondary HLH, confirmed by fulfilling five of the eight HLH 2004 diagnostic criteria, including fever, splenomegaly, cytopenia, hyperferritinaemia, and hypofibrinogenaemia. The patient also carried beta thalassaemia trait, contributing to his anaemia, though it was incidental to the acute presentation. Management with broad-spectrum antibiotics (cephalosporin, followed by piperacillin-tazobactam) and supportive care led to prompt resolution, without immunosuppressive or HLH-specific therapy. Clinical improvement occurred within 48 hours, and sustained resolution was confirmed at one-week follow-up. This case supports the notion that, in selected dengue-associated HLH patients, especially those showing early clinical improvement, aggressive immunosuppressive therapy may be deferred. It emphasises the need for early suspicion, exclusion of differential diagnoses, and careful monitoring. The incidental beta thalassaemia trait, while unrelated to HLH pathogenesis, underscores the importance of genetic counselling. An extended follow-up validated complete recovery without complications. In dengue-associated HLH, prompt supportive and antibiotic therapy may suffice in certain cases, avoiding unnecessary immunosuppression. Clinicians should consider case-by-case management, guided by response trajectory and diagnostic completeness.

Redefining Smiles by Malo Bridge: A Case Report on Digitally Fabricated Fixed Prosthetic Solution for Anterior Mandible

Ritul Jain, Sweta Kale Pisulkar, Surekha Godbole, Shruti Deshmukh

The rehabilitation of edentulous spaces with implant-supported fixed prostheses has evolved significantly, with digital workflows enhancing precision and predictability. This case report details the prosthetic rehabilitation of a 50-year-old male patient presenting with missing teeth in the anterior mandibular region. The patient reported difficulty with mastication and aesthetic concerns due to a long-standing edentulous space. Clinical and radiographic evaluation revealed moderate to severe alveolar ridge resorption and a high crown height space, posing a challenge for conventional prosthetic options. To address the functional and aesthetic demands of the case, a digitally planned implant-supported Malo bridge was selected as the optimal restorative solution. The prosthetic workflow incorporated customised abutments, a screw-retained substructure, and cement-retained individual crowns, all designed using Computer-Aided Design (CAD)-Computer-Aided Manufacturing (CAM) technology and fabricated via Direct Metal Laser Sintering (DMLS) Three-Dimensional (3D) printing. This case highlights the advantages of integrating advanced digital techniques for the fabrication of complex implant-supported prostheses, offering a predictable and durable solution for high crown height space restorations.

Oral and Clinical Manifestations of DiGeorge Syndrome with Primary Hypoparathyroidism: A Case Report

Nayantara Menon, BB Shahala, MP Uthkal, Shahana P Sulaiman, Amjad Ali

DiGeorge syndrome is an autosomal dominant inherited disorder caused by a deletion of chromosome 22q11.2. It is a multisystem condition, classically presenting with a triad of congenital heart defects, hypoplasia of the parathyroid glands and thymus, and congenital immunodeficiency. The present article reports a 24-year-old female with a DiGeorge syndrome with primary hypoparathyroidism, with emphasis on craniofacial and extraoral features, which included a hypoplastic mandible, flattened forehead, bulbous nose, and flattened nasal bridge. Radiographic findings revealed a thickened calvarium, frontal calcifications, and sutural diastasis. Early diagnosis and intervention, including genetic testing, can significantly improve patient outcomes.

Central Mucoepidermoid Carcinoma of Maxilla: A Case Report with Immunohistochemical Analysis

Mucoepidermoid Carcinoma (MEC), which accounts for 3-4% of all cancers of the maxillofacial region, is the most common type of salivary carcinoma. It most commonly occurs in the major salivary glands. The palate, retromolar region, buccal mucosa, tongue, and lips are common sites for tumors arising in minor salivary glands. Central MEC (CMEC) is an infrequent neoplasm of the jaw bones, accounting for 2-4% of MECs and showing varied biological behaviour. The aetiology of this tumour is uncertain, but several concepts have been proposed based on neoplastic transformation of the odontogenic cyst epithelium or ectopic salivary tissue. Most of these lesions occur in the third to fifth decades with a female predilection and are common in the mandible but rare in the maxilla. Radiographically and clinically, CMEC is often misinterpreted as an odontogenic lesion. To confirm the diagnosis, identifying the origin with the aid of immunohistochemistry is crucial. Hereby, the authors present a rare instance of low-grade CMEC in the maxilla of a 51-year-old male patient, which posed a diagnostic challenge and is accompanied by a review of the literature.

From Misdiagnosis to Precision: Genetic Testing Reveals MODY in Adolescents Initially Treated as Type 1 Diabetes

Kumar Ajith, Varalakshmi Sureka, J Jayannan, Purushothaman Indu

Maturity-Onset Diabetes of the Young (MODY) is a heterogeneous form of clinical monogenic diabetes caused by genetic abnormalities resulting in an autosomal dominant mode of inheritance. MODY accounts for approximately 4.8-10.9% of diabetes cases worldwide; its clinical characteristics often resemble those of Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM), causing underdiagnosis. In this study, we have presented three cases, initially diagnosed with T1DM but later identified as Monogenic Diabetes (MODY) caused by mutations in the HNF1A and HNF4A genes. All patients, despite insulin therapy, suffered from recurrent Diabetic Ketoacidosis (DKA) and poor glycaemic control, prompting further investigation. Genetic analysis revealed two instances of HNF1A (MODY3) mutations and one case of HNF4A (MODY1) mutation. These findings were pivotal in reclassifying the patients’ conditions from T1DM to MODY. Understanding the genetic mutations, the patients were switched to a minimal sulfonylurea regimen, resulting in significant improvement in blood glucose control and a reduction in DKA episodes. The studies emphasise the significance of genetic testing in accurately diagnosing MODY and tailoring a personalised treatment with oral sulfonylureas.

Tolosa-hunt Syndrome following COVID-19 Pandemic: A Case Series Describing the Clinical Presentations and Response to Steroids

Nimmy Jimmichan, Surya Dinesh

Tolosa-Hunt Syndrome is a rare condition characterised by unilateral periorbital headache with ophthalmoplegia caused by inflammation of the superior orbital fissure or cavernous sinus. There has been an increase in cases of Tolosa-Hunt Syndrome following the Coranavirus Disease-19 (COVID-19) pandemic. This case series describes the clinical details of three such patients and their response to steroid therapy. The first patient was a 61-year-old woman with a history of post COVID infection who had received two doses of the COVID vaccine. She presented with second, third, fifth, and sixth cranial nerve palsies of the left eye. She received steroid therapy, following which there was recovery of extraocular movements and improvement in vision. The second patient was a 43-year-old male who had received two doses of the COVID vaccine. He presented with multiple cranial nerve palsies affecting the second, partial third, and fifth cranial nerves of the left eye. He reported symptomatic relief and improvement in ptosis after steroid therapy. The third patient was a 40-year-old male who had received two doses of the COVID vaccine. He presented with painful external ophthalmoplegia involving the second, third, fourth, and sixth cranial nerves of the right eye. Following steroid therapy, he experienced symptomatic relief and recovery of extraocular movements.

Isolated Oculo-auricular Manifestations in Goldenhar Syndrome: A Case Series of Three Paediatric Patients

Vishakha Vatkar, Pradipta Potdar, Shreya Gandhi, Rutuja Patil, Lokisha Chandwani

Goldenhar Syndrome (GS), also known as the Oculo-Auriculo-Vertebral Spectrum (OAVS), is a rare congenital disorder characterised by variable craniofacial and ocular anomalies due to aberrant development of the first and second branchial arches. This case series describes three paediatric patients who exhibited diverse phenotypic features of the syndrome, highlighting its clinical heterogeneity and the importance of individualised management. All three patients presented with epibulbar dermoids since birth, an ocular hallmark of GS. The first patient, a 12-year-old female, had a limbal dermoid, medial canthal swelling suggestive of nasolacrimal duct obstruction, a symblepharon, and microtia with preauricular tags. She was advised dacryocystorhinostomy and excision of the dermoid but was lost to follow-up. The second patient, a 15-year-old had a reddish limbal mass extending to the lateral canthus and preauricular tags, and a cosmetic symblepharon release was advised. The third patient, a 15-year-old had a non-progressive limbal dermoid with no significant adnexal involvement and was managed conservatively. None of the patients had associated spinal, cardiac, or neurological anomalies on systemic evaluation. This case series reinforces the phenotypic variability of GS and underscores the importance of early ophthalmic diagnosis, systemic screening, and a multidisciplinary approach to optimise functional and cosmetic outcomes in affected children.

Emerging and Unusual Gram-positive Coccal Infections: A Case Series

Gram-Positive Cocci (GPC), like coagulase-negative staphylococci and a few beta-haemolytic streptococci, are usually found as a part of the normal flora of the human body. Opportunistic infections, caused by these cocci, are increasingly being reported. Worldwide, there are a few reports of infections caused by these commensal GPC in immunocompetent patients, too. Kocuria kristinae is a coagulase-negative coccus. K. kristinae has been isolated in paired blood culture of a 54-year-old patient on haemodialysis, who presented with fever. His Echocardiography (ECHO) revealed endocarditis with vegetations on the mitral and pulmonary valves. Staphylococcus warneri is also a coagulase-negative Staphylococcus. S. warneri was reported as a pathogen in paired blood culture of a three-year-old kid with fever who was being investigated for pyrexia of unknown origin. Gemella sanguinis and Globicatella sanguinis are beta-haemolytic streptococci. G. sanguinis was isolated from a 46-year-old man with recurrent sebaceous cyst on the left lumbar region and G. sanguinis from the sputum of a 54-year-old lady with fever and cough with expectoration. All four isolates are commensals of the human body. In this case series, they have been reported as pathogens due to standard techniques of sample collection and processing, growth of no other pathogen in the culture and clinical evidence.

Genitourinary Tuberculosis with Co-existing Transitional Cell Carcinoma of the Urinary Bladder: Imaging findings and Diagnostic Challenges

Varsha Reddy, Yatham Rama Rao, Senthil Kumar Aiyappan

A 56-year-old male presented with gross haematuria, increased frequency of micturition, dysuria for two months and passage of clots in urine for one week. There was no history of fever, nausea, vomiting, or weight loss. The patient had been evaluated at an outside hospital for haematuria six months earlier, during which Genitourinary Tuberculosis (GUTB) was suspected. Consequently, empirical Anti-Tuberculosis Therapy (ATT) was initiated and continued for six months. The patient had a 30-year history of smoking. He did not have a known history of hypertension. No other relevant medical or surgical history could be elicited. Urine analysis revealed reddish-brown discolouration with a turbid appearance. Microscopic examination demonstrated numerous red blood cells and occasional urothelial epithelial cells, with no significant presence of white blood cells, casts, or crystals. Plain and Contrast-Enhanced Computed Tomography (CECT) abdomen showed an atrophic and calcified right kidney (Table/Fig 1)a, (Table/Fig 2)a. The bladder showed diffuse and irregular wall thickening with a polypoid lesion along its right lateral wall (Table/Fig 1)b and multiple left ureteric strictures (Table/Fig 2)b. Radiological diagnosis of GUTB sequelae was made, as the patient exhibited imaging signs of a shrunken kidney, reduced bladder volume (thimble bladder) and multiple left ureteric strictures. These imaging signs were characteristic of GUTB. Given the associated polypoid soft tissue in the right lateral wall of the urinary bladder (Table/Fig 1)b, transitional cell carcinoma of the urinary bladder was suspected. The patient underwent Transurethral Resection of Bladder Tumour (TURBT) and histopathology confirmed muscle-invasive high-grade urothelial carcinoma. The patient was referred to a higher cancer centre for further management with chemotherapy. GUTB is the third most common form of extrapulmonary tuberculosis, constituting approximately 3-5% of all tuberculosis cases (1). It typically leads to granulomatous inflammation, caseating necrosis and eventual fibrosis of the renal and lower urinary tract structures, resulting in anatomical distortion such as ureteral strictures and bladder wall thickening (2). Chronic inflammation caused by Mycobacterium tuberculosis may predispose the urothelium to dysplastic changes through prolonged epithelial injury, oxidative stress and impaired immune surveillance (3). Furthermore, M. tuberculosis may create a local immunosuppressive microenvironment that facilitates malignant transformation (4),(5). In a study conducted in Taiwan by Lien YC et al., 1.2% of urinary tuberculosis cases had an association with urothelial carcinoma, but there was no association with renal cell carcinoma (4). In the present case, a 56-year-old male with a long history of smoking presented with persistent lower urinary tract symptoms and haematuria, initially misattributed to tuberculosis. Empirical ATT was administered without histological confirmation, leading to a delay in cancer diagnosis. Xiang Y et al., reported a case of renal tuberculosis combined with bladder cancer in a 57-year-old man who presented with haematuria and signs of urinary tract irritation (3). Tsai YC et al., reported a patient with fever, persistent haematuria and pyuria who had both GUTB and urothelial carcinoma of the urinary bladder (2). Treatment strategies for coexisting renal TB and Muscle-Invasive Bladder Cancer (MIBC) require a multidisciplinary approach. Simultaneous nephrectomy and radical cystectomy may be considered in selected patients, but carry increased perioperative risk due to anaemia, malnutrition and infection-related morbidity (3). An alternative approach includes staged management: initial TB nephrectomy, followed by neoadjuvant chemotherapy to reduce tumour burden and finally radical cystectomy (2). In resource-constrained settings, concurrent ATT and chemotherapy may be initiated, with surgery deferred until patient stabilisation (5). The present case highlights the importance of not anchoring solely on a single diagnosis, particularly in high TB-burden areas where symptoms like haematuria may be misleadingly attributed to infection. Cystoscopic biopsy remains the gold standard for confirming bladder pathology and should not be delayed when malignancy is suspected (6). This underscores the need for vigilant cancer screening in patients with chronic or recurrent GUTB, especially in TB-endemic regions.

Imaging findings in Klippel-Feil Syndrome with Unilateral Renal Agenesis and Ectopic Pelvic Kidney

A 22-year-old male presented with a five-day history of insidious-onset neck pain, rated 5/10 on the numeric rating scale, aggravated by neck turning and relieved by rest. The pain was localised to the neck, non radiating, with no history of trauma, bowel or bladder incontinence, weakness, numbness, neurogenic claudication, or morning stiffness. The patient’s past medical history was unremarkable, with no known co-morbidities. On examination, there was no gross deformity, scar, or sinus over the cervical spine. Palpation revealed no warmth, no local rise in temperature, or tenderness. Range of motion of the neck in side-to-side movement was painful. Neurological examination showed full power (5/5) in all cervical myotomes (C2-C7) and normal sensation. Provisional diagnosis was neck muscle spasm. Differential diagnoses included cervical spondylosis, congenital vertebral anomaly, inflammatory and neoplastic aetiology. Plain radiographs of the cervical spine showed mild scoliosis with convexity to the left and fusion of the C3-C4 and C6-C7 vertebral bodies, suggestive of block vertebra (Table/Fig 1)a,b. Computed Tomography (CT) of the cervical spine confirmed the radiographic findings (Table/Fig 2)a. Cervical spine MRI revealed mild basilar invagination, with the tip of the odontoid process approximately 7 mm above Chamberlain’s line (Table/Fig 2)b. A well-defined linear T2 hyperintensity was seen within the centre of the spinal cord at the C6-C7 vertebral level, suggestive of syrinx (Table/Fig 2)b. Dorsal-spine screening also showed a well-defined linear T2 hyperintensity within the centre of the spinal cord at D5-D10 vertebral levels, suggestive of syrinx (Table/Fig 3)a. Lumbar spine screening showed mild disc desiccation at L5-S1 and suggestion of pelvic kidney (Table/Fig 3)b. Further investigation with CT abdomen revealed that bilateral kidneys were not visualised in the renal fossae (Table/Fig 4)a. A single kidney, measuring approximately 9.7×5 cm, was noted in the pelvis, above the urinary bladder, with its convexity towards the right side (Table/Fig 4)b. This finding confirmed unilateral renal agenesis with an ectopic pelvic kidney. Based on the constellation of imaging findings, including multiple cervical vertebral fusions (C3-C4, C6-C7), cervical scoliosis, basilar invagination, along with the presence of syrinx, the possibility of Klippel-Feil Syndrome (KFS) was considered. The co-occurrence of unilateral renal agenesis with an ectopic pelvic kidney further supported this diagnosis, given the known association of KFS with genitourinary anomalies. The KFS, first described in 1912 by Klippel and Feil, is a developmental anomaly resulting from failure of segmentation of the cervical somites during weeks 3-8 of gestation, leading to congenital fusion of the cervical vertebrae. The classic triad of a short neck, a low posterior hairline, and restricted neck movement is present in less than 50% of cases (1). In the present case, the triad was not evident. Various classification systems have been proposed to categorise the diverse presentations of KFS, aiding in understanding its clinical significance. The condition is often associated with a wide spectrum of extra-skeletal abnormalities, with renal anomalies being among the most common (2),(3). These can range from agenesis, ectopia, and malrotation to duplication and hydronephrosis. Early detection of these associated anomalies is crucial for appropriate management and prevention of complications (3). KFS is a complex disorder with varied clinical presentations, often due to associated systemic anomalies. The presence of cervical spine fusions, while the hallmark, necessitates thorough evaluation for other malformations. Renal anomalies are among the most frequent associated conditions, with agenesis representing a severe manifestation. The embryological basis for this association lies in the fact that vertebral column and renal development occur during similar periods of gestation and are influenced by common genetic pathways (2),(3),(4). Unilateral renal agenesis, as seen in this patient, can often be asymptomatic if the contralateral kidney is healthy and functions adequately; however, it increases the risk of complications such as hypertension, proteinuria, and renal insufficiency later in life, especially if the solitary kidney is subjected to increased physiological demands or develops abnormalities (2). The ectopic pelvic kidney in this case further emphasises the broad spectrum of renal malformations that can occur. The syrinx noted at multiple levels in the spinal cord is another significant neurological complication associated with KFS, often resulting from altered CSF dynamics due to underlying bony abnormalities such as basilar invagination and cervical fusions. This can lead to progressive neurological deficits if left unmanaged. Similar to the present case, a report by Kelekçi S et al., described a 10-year-old girl with KFS and unilateral renal agenesis, emphasising the strong association between these developmental anomalies (4). Another notable case by Eroz R et al., described a seven-year-old girl with KFS, bilateral Sprengel deformity, and congenital unilateral renal agenesis, with a unique association to an MEFV gene mutation, suggesting broader genetic and systemic implications that can accompany this syndrome (5). This case underscores the critical need for a comprehensive diagnostic approach in patients suspected of having KFS. Imaging of the entire spine is essential to identify all vertebral anomalies and associated neurological complications such as syrinx (2). Furthermore, routine renal ultrasonography or CT abdomen is highly recommended to detect any associated genitourinary malformations, even in asymptomatic patients, to facilitate early intervention and long-term follow-up (2). Multidisciplinary management involving orthopaedic surgeons, neurologists, nephrologists, and geneticists is often required for optimal patient care (3),(4),(5).

Exploring the Scope of the Jigsaw Classroom: An Innovative Teaching-learning Method for Ayurveda Undergraduates

Seema Thakare, Sumant Pande

Dear Editor, Various innovative teaching-learning methods have been incorporated into medical education to enhance skills such as communication, critical thinking, and attitude development among students. However, the challenge lies in selecting and implementing strategies that are both feasible and impactful for learners. Didactic lectures are often teacher-centred and monotonous, which ultimately reduces students’ interest in the classroom. The Jigsaw teaching method is a unique cooperative learning strategy introduced in 1971 by Professor Elliot Aronson. It is a student-centred teaching-learning approach that enhances student participation and active learning by creating a supportive and motivating environment. This method helps students grasp complex concepts more easily through collaborative group work. Consequently, it encourages active participation, teamwork, group interaction, and mutual learning among students from diverse backgrounds (1),(2). In this method, two types of groups are formed — the parent group (primary group) and the expert group (temporary group). The steps involved in the Jigsaw method are shown in (Table/Fig 1) (3),(4). In the traditional system of medicine, Ayurveda, a unique teaching method known as the Gurukul system was used to transfer knowledge from teachers to students. Although the principles of Ayurveda are eternal, there is a growing need to modernise Ayurveda education by incorporating emerging technologies and innovative teaching tools. Recognising this need, the National Commission for Indian System of Medicine (NCISM) has introduced various innovative teaching-learning methods in Ayurveda education (5). Implementing the Jigsaw Classroom in Ayurveda teaching has the potential to offer significant benefits to students. This method can be effectively applied to achieve learning objectives across a wide range of topics. For the first professional year, it can be used for topics such as Peshi (muscles), Asthi (bones), Dhatu (major structural components of the body), Prakruti (body constitution), Trividha Nyaya, and Tantrayukti etc. For the second professional year, it is suitable for topics such as various Vyadhi (diseases), Herbal drugs, Rasapanchak, Dincharya, Rutucharya, Ashtang Yoga, Rasashastra formulations, and different Visha Dravyas (poisonous substances). In the third professional year, the Jigsaw method can be used for topics such as parasurgical procedures in Shalya (surgery), parasurgical procedures in Shalakya (ENT), and Panchakarma (detoxification therapy). Teachers can also adopt this method for many other subjects and topics to further enrich the learning experience. An example of the Jigsaw method is illustrated using the topic of Rasapanchak, as shown in (Table/Fig 2).

Clinical Outcome of Extended Total Extraperitoneal Rives-stoppa versus Intraperitoneal Onlay Mesh Repair in Ventral Hernia: A Prospective Interventional Study

Introduction: Umbilical hernias are a common anterior abdominal wall defect, often necessitating surgical intervention to prevent complications such as incarceration and recurrence. Among minimally invasive approaches, the extended Total Extraperitoneal Rives-Stoppa (eTEP-RS) and Intraperitoneal Onlay Mesh (IPOM) techniques are widely used. Aim: To compare the clinical outcomes of two laparoscopic techniques, the eTEP-RS and IPOM techniques, in patients undergoing umbilical hernia repair. Materials and Methods: A prospective interventional study was conducted over 16 months (March 2023 to July 2024) in the Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, involving 60 patients diagnosed with primary umbilical hernia. Participants were equally divided into two groups: eTEP-RS group (n=30) and IPOM group (n=30). Parameters assessed included operative time, postoperative pain by Visual Analogue Scale (VAS) score, Surgical Site Infection (SSI), hospital stay and recurrence rates. Continuous variables such as operative time, VAS scores, and duration of hospital stay were first assessed for normality. Non normally distributed data were expressed as median with interquartile range and compared using the Mann-Whitney U test. Categorical variables, including SSI and recurrence, were presented as frequencies and percentages, and compared using the Chi-square test or Fisher’s-exact test where appropriate. A p-value of less than 0.05 was considered statistically significant. Results: Patients in the eTEP-RS group had significantly lower postoperative pain scores at 6 hours, 24 hours, and one week postoperatively (p-value <0.001). The eTEP-RS group also showed a shorter mean hospital stay (4.6±3.17 days) compared to the IPOM group (5.9±2.19 days) (p-value=0.02). The operative time was significantly longer in the eTEP-RS group (p-value <0.001). SSIs were absent in the eTEP-RS group but occurred in one patient in the IPOM group. No recurrences were reported in either group during the follow-up period. Conclusion: The eTEP-RS technique offers significant benefits in terms of reduced postoperative pain and shorter hospital stay, with comparable safety and recurrence rates. It represents a promising alternative to IPOM, particularly in resource-optimised laparoscopic settings.

Clinicopathological Features of Malignant Melanoma with Emphasis on S-100,HMB-45 , and BRAF Expression: A Cross-sectional Study

Sayantan De, Mamata Guha Mallick Sinha

Introduction: Malignant melanoma is one of the most lethal forms of skin cancer. While it predominantly originates from the skin, it can also develop in extracutaneous sites, including ocular, mucosal, and leptomeningeal regions. S-100 and HMB-45 immunohistochemical markers are widely used for melanoma detection. Additionally, the V600E missense mutation, which changes valine to glutamic acid, is a common BRAF alteration in melanoma and serves as a target for therapeutic interventions. Aim: To evaluate the clinico-epidemiological and histopathological features of malignant melanoma, with emphasis on the immunohistochemical expression of S-100, HMB-45, and BRAF. Materials and Methods: The present prospective cross-sectional study was conducted in the Department of Pathology, IPGME&R, Kolkata, West Bengal, India, from January 2020 to June 2023. A total of 26 specimens diagnosed as malignant melanoma were analysed. Only excision specimens were included in this study. Histopathological parameters, including type, pigmentation, Breslow thickness, lymph node status were recorded. Subsequent immunohistochemical testing of paraffin-embedded blocks was performed using S-100, HMB45, and BRAF markers. Collected detailed epidemiological and histopathological and immunohistochemical data were entered into Microsoft excel sheet. From that tabulated descriptive measures obtained including percentages and frequencies. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Statistics software (version 25). A Chi-square test of independence was used to assess the association between melanoma type, pigmentation, subtype, lymph node involvement and BRAF expression levels. A p-value of less than 0.05 was considered statistically significant. Results: Among the 26 cases, nineteen were of cutaneous origin, six were mucosal, and one was congenital. All cutaneous melanomas were located on the lower extremities. Superficial Spreading Melanoma (SSM) was the most common type (13/19 cases), followed by Nodular Melanoma (NM) (5/19 cases). Lymph node involvement was observed in six cases, all from the cutaneous group, with inguinal lymph nodes being the primary site. All cases showed diffuse S-100 and HMB-45 positivity. BRAF positivity was detected in 26.92% of cases (7/26 cases). Conclusion: A thorough assessment of histopathological parameters, supplemented by immunohistochemical analysis of markers such as S-100 and HMB-45, is essential for precise diagnosis, prognostication, and the formulation of effective therapeutic strategies. Although BRAF immunoexpression was identified in approximately one-fourth of the cases, its detection holds significant therapeutic relevance by facilitating the implementation of targeted molecular therapies, thereby potentially improving overall patient survival.

Association of Fasting Blood Sugar to High-density Lipoprotein Ratio with Short Term Outcome in Patients of Acute Coronary Syndrome: A Cohort Study

Donisri Morampudi, Sethuraj Selvaraj, Vignessh Raveekumaran, KS Chenthil

Introduction: Acute Coronary Syndrome (ACS), which includes Unstable Angina (UA) and Myocardial Infarction (MI) both ST-elevated and non-ST-elevated (STEMI and NSTEMI), is a critical condition with high morbidity and mortality, emphasising the need for early identification of prognostic markers. Although biomarkers like Fasting Blood Sugar (FBS) and High-Density Lipoprotein cholesterol (HDL-c) have been individually linked to Cardiovascular (CV) health, the combined FBS/HDL-c ratio’s (F:H) potential as a prognostic marker for short-term outcomes in ACS patients is not well understood. Aim: To investigate the association of F:H ratio Major Adverse Cardiovascular Events (MACE) and CV mortality within 30 days of discharge in ACS patients. Materials and Methods: The present hospital-based analytical cohort study was conducted from June 2023 to May 2025 at the tertiary care teaching hospital, in Pondicherry, India. The study included 95 patients, of age >18 years and both genders, newly diagnosed with ACS. On admission, FBS and HDL-c levels were measured, and outcomes were evaluated 30-day post-discharge. Analysis was done in Statistical Package for Social Sciences (SPSS) software (ver_24.0) and inferential statistics was done based on the normality of the variables and p-value <0.05 was considered statistically significant. Results: Among 95 ACS patients, majority were males (70.5%), with the mean age of 59.89±13.31 years. About 64.2% had diabetes and the ACS types included NSTEMI (36.8%), UA (30.5%), and STEMI (32.6%). Mean FBS and HDL-c was 141.67±57.80 mg/dL and 38.69±12.96 mg/dL, and the F:H was 4.075±2.42. Within 30-day post-discharge, 24.2% experienced MACE, and 10.5% suffered CV death, with F:H significantly associated with MACE (p<0.001) and CV death (p 0.030). The diagnostic level was found to be at ≥3.26 by Receiver Operating Characteristics (ROC) curve and the sensitivity and negative predictive value was 73.91% and 83.78%, respectively. At ≥3.26 found to be statistically significant with MACE (p 0.019). Conclusion: Elevated F:H strongly associate with adverse outcomes in ACS, suggesting their usefulness as a prognostic marker for targeted therapies, requiring further studies with larger populations.

Role of First Trimester Screening Test Results (Beta-hCG, PAPP-A, Nuchal Translucency) in Predicting Fetal Growth Restriction: A Retrospective Study

Aziz Kindan, Can Ozan Ulusoy, Sinem Ece Kindan, Ahmet Kurt, Salim Erkaya

Introduction: Foetal Growth Restriction (FGR) is defined as the rate of foetal weight that is smaller compared to the week of gestation below 10 percentile. The increased prenatal mortality and morbidity associated with FGR make its detection all the more important. It can lead to serious perinatal complications, including prematurity, cerebral palsy, intrauterine foetal death, and neonatal mortality. Given the burden of FGR and the lack of reliable early screening tools, further studies are warranted to evaluate the predictive value of these widely used biomarkers. Aim: The present study aimed to investigate the effectiveness of first trimester screening test results {Pregnancy-Associated Plasma Protein A (PAPP-A) and free β Human Chorionic Gonadotropin (free β-hCG), and foetal Nuchal Translucency thickness (NT)} in predicting patients with FGR. Materials and Methods: The present retrospective study was carried out to assess 659 pregnant women diagnosed with FGR and an equal number of women with normal foetal development, all of whom delivered at the Health Sciences University Ankara Etlik Zübeyde Hanim Gynaecology Training and Research Hospital between February 2016 and June 2020. The investigation focused on comparing first trimester serum levels of PAPP-A, free β-hCG, and NT measurements to explore their potential link with FGR. Statistical analysis involved the use of an independent samples t-test or Mann-Whitney U test for continuous variables, based on their distribution, and the Chi-square test for categorical data. To determine the predictive value of PAPP-A, free β-hCG, and NT, Receiver Operating Characteristic (ROC) curve analysis was utilised. A p-value of less than 0.05 was considered indicative of statistical significance. Results: The median age of pregnant women in the FGR group was 26 (18-43) years, and in the control group was 26 (18-42) years (p=0.206). Demographic data of both groups were similar. The mean free βhCG value was 46.53±36.28 ng/mL in the FGR group and 41.24±34.26 ng/mL in the control group (p=0.006). The mean PAPP-A value was 2.89±2.47 mIU/mL in the FGR group and 3.38±2.57 in the control group (p<0.001). In the FGR group, the mean value of Nuchal Translusens was 1.16±0.38 mm, the mean value of NT (MoM) was 0.75±0.24, and in the control group, the mean value of nuchal translusens was 1.23±0.36 mm, NT (MoM) mean value was 0.78±0.21 (p<0.001). Low PAPP-A (AUC=0.576, p<0.001) and NT values (AUC=0.570, p<0.001) and high free βhCG (AUC 0.576, p<0.001) levels were found to be associated with FGR. Conclusion: The present study shows that FGR is associated with low PAPP-A, high free β-hCG, and low NT values in the first trimester. However, none of these parameters alone demonstrated sufficient predictive value for the early detection of FGR. These findings suggest that while early screening markers may reflect placental dysfunction, they should not be solely relied upon for FGR prediction in clinical practice.

Epidemiological Investigation of an Outbreak of Acute Diarrhoeal Disease in a Coastal Area in Central Kerala, India: A Cross-sectional Study

Carol Pinheiro, Priyanka Shibu, TS Sudhiraj, VG Anupama

Introduction: A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. Early detection and reporting of such events is crucial in limiting the spread of the disease and minimising its negative social and economic impact. Aim: To explore the clinico-epidemiological features of the diarrhoeal disease outbreak in a municipal area in a coastal region of Central Kerala and to identify the factors associated with the diarrhoeal disease outbreak. Materials and Methods: This was an epidemiological investigation conducted as a cross-sectional analytical study done in December 2022 in the coastal wards, namely ward no. 41, 42 and 43 of Alappuzha Municipality, Alappuzha, Kerala, India from where an increased number of ADD cases were reported in November 2022-December 2022. An investigator administered questionnaire was used to collect information from 191 residents. Water samples were taken from four points in the community to check the coliform count, and stool and rectal swabs for microbiological examination. Continuous variables were summarised as Mean±Standard Deviation (SD), and categorical variables as proportions. Associations were tested with the Chi-square test, and a p-value of less than 0.05 was considered statistically significant. Results: The prevalence of ADD among children in the under-five age group in the coastal wards was 0.020 (2.1%) 95% Confidence Interval (CI): 1.2-3.4 and in the age group above five years in the coastal wards was 0.0041 (0.42%), 95% CI: 0.31-0.55 The median age of the 66 cases with ADD was 9 years, majority of the cases were below or equal to the age of 20 years. There was an almost equal distribution of gender. The majority of the cases had watery diarrhoea, followed by fever. About one-half of the cases used a public pipe water supply for drinking and washing utensils.There is significant statistical association between the practice of drinking unboiled water (p-value=0.036) and lack of hand hygiene practices (p-value=0.011) with the diarrhoeal cases. Conclusion: The outbreaks of diarrhoeal diseases provide information to understand the factors associated with food and waterborne diseases and to identify ongoing and emerging threats. The practice of consuming unboiled water, lack of hand hygiene practices, water used for washing utensils and consuming food from places other than home were the significant transmission factors resulting in the current outbreak.

Distinct Radiological and Clinical Characteristics of Intestinal Perforation caused by Jujube Pits and Fishbones: A Retrospective Observational Study

Yi-Zhi Zhao, Xue-Xia Sheng, Long Xu, Yu-Cheng Qian, Zhi-Gang Min

Introduction: Jujube pits and fishbones are common ingested foreign bodies leading to intestinal perforation. Their clinical presentation is often atypical, with patients frequently lacking a history of ingestion and less than 50% showing pneumoperitoneum on plain films. Accurate diagnosis is challenging, emphasising the critical role of radiologists and Computed Tomography (CT) imaging. Aim: To compare the clinical and imaging characteristics of intestinal perforations caused by jujube pits and fishbones. Materials and Methods: The present retrospective analysis was conducted on patients with surgically or endoscopically confirmed perforations caused by jujube pits (n=17) and fishbones (n=15) in the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China, between January 2016 to September 2024. All patients underwent conventional or contrast-enhanced CT scans using dual-source 64-slice scanners. Imaging parameters included Multiplanar Reconstructions (MPRs), Maximum Intensity Projection (MIP), and Volume Rendering (VR). Clinical and imaging features, including foreign body type, location, intestinal wall thickening, and pneumoperitoneum, were analysed. Numerical data and categorical variables were compared using student’s t-test and Chi-square test, respectively. Results: Patients in the jujube pit group were older than those in the fishbone group (77.3±17.0 vs. 66.9±14.7 years). A marked female predominance was observed in the jujube pit group (male: female ratio 3:14), contrasting with the relatively balanced gender distribution in the fishbone group (7:8). However, neither age nor gender distribution showed statistically significant differences between the groups. The jujube pit group exhibited significantly higher White Blood Cell (WBC) counts (13.8±4.3×109/L vs. 10.5±3.9×109/L, p=0.033) and more frequent bowel oedema (15/17 vs. 6/15, p=0.008) and fatty infiltration (16/17 vs. 9/15, p=0.027) compared to the fishbone group. The ileum was the most common perforation site (66%). Surgical management was required in 29 cases (72% primary repair, 28% resection), with three fishbone cases treated endoscopically. The jujube pit group had significantly longer hospital stays (p<0.05). Conclusion: Jujube pits cause more severe inflammatory responses and tissue damage than fishbones, often necessitating surgical intervention. Recognising these differences can guide appropriate treatment strategies for intestinal perforations caused by these foreign bodies.

Evaluation of Colour Stability of Conventional versus 3D-printed Crown and Bridge Resins after Surface Treatment and Artificial Tooth Brushing: An In-vitro Study

J Jesima, R Kamala Kannan, Y Sameera, P Kabilan, A Balamurugan, J Raghunathan

Introduction: Three-Dimensional (3D)-printing is becoming increasingly popular, especially for Interim Fixed Dental Prostheses (IFDPs). However, there is limited evidence regarding the colour stability of 3D-printed IFDPs and the combined effects of advanced surface treatment along with good oral hygiene practices. Aim: To evaluate the effect of surface treatment and artificial tooth brushing on the colour stability of conventional and 3D-printed crown and bridge resin after immersion in a colouring medium. Materials and Methods: An in-vitro study was conducted in the Prosthodontics and Crown and Bridge Department at Karpaga Vinayaga Institute of Dental Sciences, Chennai, Tamil Nadu, India, between December 2023 and May 2024. A total of 30 specimens were divided into three groups: Group 1 - Polymethyl Methacrylate (PMMA), Group 2 - 3D-printed polished, and Group 3 - 3D-printed glazed, with 10 specimens in each group. All specimens were immersed in coffee and subjected to artificial tooth brushing for 12 days, equivalent to three months of oral exposure to coffee and tooth brushing. Colour stability was assessed using Vita EasyShade spectrophotometer at baseline (T0), on the 4th day (T1), the 8th day (T2), and the 12th day (T3) for all groups. The data were analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0. Repeated measures Analysis of Variance (ANOVA) was used for intragroup comparisons, and an independent Student’s t-test was employed for intergroup comparisons to interpret the results. A p-value of <0.05 was considered significant. Results: The mean and Standard Deviation (SD) of colour change (ΔE - Delta E) for the three groups were 6.6, 4.8, and 11.2 at T1, showing decreased colour change at T3. A statistically significant difference was found between groups (p<0.001). The highest colour change was observed for Group 2 (mean=4.5), followed by Group 3 (mean=2.8). Conclusion: The results conclude that the glazed 3D-printed group showed better colour stability than the polished 3D-printed group and was comparable to the conventional group. A 3D-printed sample can be glazed to reduce the adhesion of stains to its surface.

Precision of Working Length Determination of Two Different Apex Locators in Teeth with Periapical Lesion: An In-vivo Study

Introduction: Accurate working length determination is critical for the success of root canal treatment. While Electronic Apex Locators (EALs) have improved accuracy compared to radiographs, their performance can be affected by presence of periapical lesion. Aim: To evaluate and compare the precision of a fifth generation Integrated apex locator (CanalPro CL2i) with a third generation apex locator (Root ZX Mini) in determining the working length in single-rooted teeth with and without periapical lesion. Materials and Methods: In the present in-vivo study, 30 single-rooted teeth indicated for root canal treatment, were assigned into two groups. Teeth with absence of periapical lesion (Group 1) consisted of 15 teeth and the periapical lesion group (Group 2) included 15 teeth with presence of radiographic periapical lesion of size 5 mm, approximately. In each canal, CanalPro CL2i and Root ZX mini were used to determine working length. Under local anaesthesia and rubber dam isolation, an access cavity was prepared for each tooth. Electronic working length measurements were determined with a #15k file in the presence of 2.5% Sodium hypochlorite (NaOCl) irrigant. The mean value of working length of both EALs was recorded and evaluated by the independent sample t-test. A p-value of <0.05 was considered significant. Results: A total of 30 patients were included with mean age of 41.2 years. Out of 30, 18 were female and 12 male patients. Intragroup analyses of mean working length measurements did not show significant differences within both the groups, Group 1 (p=0.987) and Group 2 (p=0.663), when using either Canal Pro CL2i or Root ZX mini. Conclusion: Presence of periapical lesion had no influence on the precision of both EALs. Both Root Zx Mini and Integrated apex locator Canal Pro Cl2i were comparable in precision in determining working length in cases with and without periapical lesion.

Evaluation of Dulaglutide in Acute and Subacute Inflammation Models of Male Wistar Rats: An Experimental Study

Aarti Gulabrao Bhosale, Nayana Kamalnayan Hashilkar, Sunita Y Patil

Introduction: Dulaglutide, a Glucagon-Like Peptide-Receptor Agonist (GLP-1 RA) commonly used for the treatment of Type 2 Diabetes Mellitus (T2DM), is known for its glycaemic and cardiovascular benefits. However, its anti-inflammatory effects remain uncertain. Aim: The present study aimed to assess dulaglutide’s anti-inflammatory potential in acute and subacute inflammatory models using male rats of Wistar strain. Materials and Methods: The present experimental study included healthy adult male Wistar rats that received treatment with either dulaglutide or aspirin (as a benchmark) and subjected to carrageenan-induced paw oedema (acute) or foreign body-induced granuloma (subacute). Paw oedema volume, granuloma weight, inflammatory cytokine levels in the serum (IL-1β, CRP, TNF-α), and histopathological changes were evaluated. Results: A total of 36 healthy adult male Wistar rats were used in this study. The acute model, dulaglutide did not significantly reduce paw oedema compared to the control, while aspirin significantly reduced oedema at 2, 4, and 5 hr (p<0.05). In the subacute model, dulaglutide failed to reduce granuloma weight or significantly alter serum inflammatory markers. Histopathological examination revealed abundant granulation tissue, fibroblasts, and collagen in the dulaglutide-treated group, similar to that in the control. In contrast, aspirin-treated rats showed reduced granulation tissue, fibroblasts, and collagen. Conclusion: Dulaglutide showed no significant independent anti-inflammatory effects in both acute and subacute animal models of inflammation. Thus, GLP-1 receptor agonists like dulaglutide may exert beneficial effects on inflammation associated with metabolic diseases; however, their direct anti-inflammatory actions appear to be limited. Further research is required to explore dulaglutide’s role in inflammation and its broader therapeutic implications in inflammatory diseases.

Occupational Health Problems and Co-morbidities among Food Handlers in Kozhikode District, Kerala, India: A Cross-sectional Study

Introduction: Over the past five years, India’s food service market has grown at 10.3%, with many people consuming food from outside. Food handlers can passively transmit infections to consumers, and occupational health problems contribute to this transmission. Therefore, it is essential to identify the morbidity and occupational health problems among food handlers. Aim: To assess the prevalence of morbidity and occupational health problems among food handlers in the Kozhikode district, Kerala. Materials and Methods: The present cross-sectional study was conducted among food handlers in Kozhikode district, Kerala, India, during January to December 2024. A multistage sampling was done and data were collected from 1132 participants by expert team through direct interviews using a pretested semi structured questionnaire. Questionnaire consisted of demographic parameters like age, gender, education and native place, occupational parameters, general examination and laboratory tests. Descriptive and inferential statics were analysed using Statistical Package for Social Sciences (SPSS)Ver.25. Chi-square test was used to find the association between qualitative variable and p-value <0.05 was considered as statistically significant. Results: The study participants were predominantly male 998 (88.2%), with mean age of 39.92±13.39 years. In acute morbidity, 22 (1.9%) had a fever. Other morbidities such as diarrhoea, vomiting and boils were less than 1%. Out of the total tested 35 (7.51%) were positive for S.Typhi O,10 (0.88%) were positive for S.Typhi H and 4 (0.35%) were positive for S.Paratyphi AH but only few had acute morbidities. During examination, one-fourth of the participants were found to be hypertensive according to Joint National Committee-8 criteria. The prevalence of occupational health problems was 125 (11.04%), with paronychia being most common 59 (5.21%). Cooking was significantly associated with cut injuries (OR=3.64, p<0.001). No participants were dewormed in the last six months. Conclusion: The prevalence of morbidities and occupational health problems among food handlers was low, but the public health implications are significant. Occupational health issues, particularly paronychia and contact dermatitis were common among participants involved in washing and cut injuries were prevalent among participants engaged in cooking. To prevent food-borne disease transmission, regular health screening, awareness classes, and the promotion of hand washing and safe food handling practices should be implemented. Additionally, exempting ill workers from duty can enhance public health.

Role of Blood Ketone Levels in the Diagnosis and Management of Patients with Diabetes Ketoacidosis: A Cross-sectional Study

Gnanasa Kalapala, Vignessh Raveekumaran

Introduction: Diabetic Ketoacidosis (DKA), a potentially fatal complication of diabetes, is characterised by accumulation of ketone bodies, metabolic acidosis, and hyperglycaemia. Blood ketone levels serve as key indicators for the diagnosis and management of DKA. The clinical significance of blood ketone cut-off values remains underexplored, necessitating further research to improve patient outcomes. Aim: To determine the role of blood ketone levels in the diagnosis and management of patients with DKA. Materials and Methods: The present cross-sectional, hospital-based study was conducted over two years among patients presenting with signs and symptoms of DKA or elevated blood glucose (>250 mg/dL, or ≤250 mg/dL in suspected euglycaemic DKA) were included. Blood ketone levels were measured at baseline, at the time to half reduction (t1/2), and at resolution, and their diagnostic characteristics were evaluated. Data were analysed using Statistical Package for Social Sciences (SPSS) (v_24.0) software, diagnostic performance of blood ketone measurements was assessed by Receiver Operating Characteristic (ROC) curve analysis. Results: Among 45 patients, 23 (51.1%) were female. Age distribution was 35.6% (31-50 years) and 31.1% (51-70 years). Urine ketone testing was positive in 53.3% and negative in 46.7%. Mean blood ketone levels were 2.231±1.91 mmol/L at presentation, decreasing to 0.982±1.06 mmol/L after two hours, and 0.253±0.23 mmol/L at resolution. Sensitivity of blood ketone measurement was 100%, specificity 42.9%, Positive Predictive Value (PPV) 66.7%, and Negative Predictive Value (NPV) 100%. Conclusion: Serum ketone measurement is more reliable than urine dipstick testing for DKA diagnosis. The ketometer is less accurate than conventional clinical assessments and should be used as an adjunctive diagnostic tool in emergencies rather than as a standalone modality.

Influence of Two Forms of Chlorhexidine on the Accuracy of Working Length Determination using Different Generation Apex Locators: An Experimental Study

Introduction: Variations are observed in working-length measurements of root canals in the presence of different irrigants due to differences in electrical conductivity. Chlorhexidine is commonly used as an irrigant in endodontics, primarily in concentrations of 0.2%, 1% and 2%. These solutions are favoured for their broad-spectrum antimicrobial properties, with higher concentrations being particularly effective against a wide range of bacteria, including resistant strains like Enterococcus faecalis. Additionally, chlorhexidine gel formulations have been introduced, which offer enhanced lubricating properties and improved retention within the root canal system compared with traditional liquid solutions. Aim: To determine the influence of 2% chlorhexidine gel, 2% chlorhexidine solution and 2.5% sodium hypochlorite on the accuracy of the 4^th-generation Root ZX Mini (J Morita Corp, Tokyo, Japan) and the 6^th-generation Canal Pro™ (Coltene/Whaledent, Switzerland) Electronic Apex Locators (EALs). Materials and Methods: This experimental study was conducted at the Department of Conservative Dentistry and Endodontics, Vokkaligara Sangha (VS) Dental College, Bengaluru, Karnataka, India over six months (January 2021-June 2021). A total of 48 single-rooted premolar teeth were selected. After obtaining ethical clearance, the teeth were randomly divided into three groups based on the irrigant used: Group 1 (G1)—2% chlorhexidine gel; Group 2 (G3)—2% chlorhexidine solution; Group 3 (G3)—2.5% sodium hypochlorite solution. A sample size of 16 teeth per group was used. Under local anaesthesia with rubber dam isolation, access cavities were prepared. Working length measurements were performed using the 4^th- and 6^th-generation EALs. The coronal access was sealed and the tooth was extracted atraumatically. Actual Working Length (AWL) was determined using Cone- Beam Computed Tomography (CBCT). Inferential statistics were performed using Fisher’s-exact test. Statistical analysis was conducted with Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Accuracy of the Root ZX Mini and Canal Pro™ EALs in the presence of chlorhexidine gel was 81.25% and 93.0%, respectively; in the presence of chlorhexidine solution, the accuracy was 81.25% and 87.5%, respectively; and in the presence of sodium hypochlorite solution, the accuracy was 68.75% and 81.25%, respectively. Conclusion: The EALs Root ZX Mini and Canal Pro™ showed the highest accuracy in working-length measurements with chlorhexidine gel, followed by chlorhexidine solution and then sodium hypochlorite solution.

Efficacy of Chelating Agents on Calcium Hydroxide Removal from the Root Canals and their Influence on the Penetration of a Bioceramic Sealer: An In-vitro Evaluation

Introduction: Eliminating Calcium Hydroxide {Ca(OH)₂} remnants from root canal walls presents a significant challenge. Nevertheless, its complete removal enhances the deeper penetration of a sealer, which improves the three-dimensional (3D) seal against the canal walls. Aim: To analyse the intracanal Ca(OH)₂ removal efficacy of different chelators and evaluate their influence on the depth of penetration of a bioceramic sealer. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India, from October 2024 to April 2025. In this study, 120 extracted mandibular premolars were selected. After biomechanical preparation, Ca(OH)₂ was placed in all root canals, except those assigned to the control group, and the teeth were incubated for 7 days. Intracanal medicament removal was carried out using various chelating agents: 17% Ethylenediaminetetraacetic Acid (EDTA), 9% etidronic acid, 7% maleic acid, or 0.7% fumaric acid (n=24 each), irrigation in combination with ultrasonic activation. A total of 60 teeth were sectioned longitudinally to calculate the number of open dentinal tubules and assess canal cleanliness with Scanning Electron Microscopy (SEM). In the remaining 60 teeth, following Ca(OH)₂ removal, the canals were obturated with gutta-percha using CeraSeal. Sealer penetration depth was evaluated utilising Confocal Laser Scanning Microscopy (CLSM). The data obtained were subjected to statistical analysis using one-way Analysis of Variance (ANOVA) followed by Tukey’s post hoc test, with a significance threshold of p-value <0.05. Results: The use of 7% maleic and 0.7% fumaric acids resulted in significantly cleaner canals and enhanced sealer penetration compared to 17% EDTA and 9% etidronic acid (p-value <0.05). The coronal third of the canal demonstrated the greatest efficiency in both medicament removal and sealer penetration, whereas the apical third showed the lowest effectiveness (p-value=0.0001). Conclusion: Compared to 17% EDTA and 9% etidronic acid, increased dentinal tubule patency and superior penetration of sealer were observed with 7% maleic and 0.7% fumaric acids.

Assessment of Salivary CD26/DPP-IV Levels and their Association with a Ketogenic Gluten-free Diet in Autism Spectrum Disorder: A Cross-sectional Study

Kavya Soundararajan, Sham S Bhat, Devika Jayarajan, A Fahizah, Riaz Abdulla

Introduction: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterised by challenges in social interaction, communication, and the presence of repetitive behaviours. Gastrointestinal (GI) problems are frequently observed in patients with ASD, and dietary interventions, such as the Ketogenic Gluten-Free (KGF) diet, have been employed to manage these symptoms. Dipeptidyl-peptidase IV/CD26 (CD26/DPP IV), an enzyme expressed in the small intestine, plays an important role in protein digestion. Low levels of CD26/DPP IV have previously been reported to have implications in ASD. Aim: To evaluate salivary CD26/DPP IV levels in children with ASD and compare them with healthy controls, considering KGF diet adherence. Materials and Methods: The present cross-sectional study was conducted on children with ASD at the Arivu Early Intervention Centre for Special Children, Mangalore, Karnataka, India over one year (April 2021 to March 2022). The study group included children aged 3-14 years diagnosed with autism, selected using the Childhood Autism Rating Scale (CARS) criteria. The control group consisted of age- and sex-matched healthy children. Unstimulated saliva samples were collected from 42 participants (21 children with ASD and 21 healthy controls). CD26/DPP IV expression levels were estimated using Enzyme-Linked Immunosorbent Assay (ELISA). Information on GI symptoms and KGF diet adherence was obtained through a questionnaire completed by caregivers. Statistical analysis was performed using the Mann-Whitney U test to compare and correlate salivary CD26/DPP IV levels between groups. A p-value <0.05 was considered statistically significant. Results: A total of 21 children with ASD and 21 age-matched neurotypical controls were included. The mean salivary CD26/DPP IV level was significantly lower in children with ASD (0.61±0.16 ng/L) compared to controls (0.88±0.25 ng/L; p<0.001). Within the ASD group, children adhering to a KGF diet showed slightly higher CD26 levels (0.56±0.17 ng/L) than those not on the diet (0.47±0.16 ng/L), and this difference was statistically significant (p=0.0113). Conclusion: Salivary CD26/DPP IV levels were lower in children with ASD compared to healthy controls. Although children with ASD on a KGF diet showed slightly higher CD26/DPP IV levels, this difference was not statistically significant. Further studies are needed to establish the sensitivity and specificity of CD26/DPP IV and its potential role in early intervention for ASD.

Comparison of the Linear and Angular Mandibular Measurements in Asthmatic and Non-asthmatic Children: A Cross-sectional Study

Introduction: Chronic asthma, often associated with increased airway resistance and thoracic gas-trapping, can significantly impact respiratory biomechanics. This may result in adaptive shortening of cervical respiratory muscles, subsequently influencing head and cervical spine alignment resulting in structural changes in craniofacial development. Aim: To assess and compare the linear and angular mandibular measurements in asthmatic and non-asthmatic children using Orthopantomographic (OPG) imaging. Materials and Methods: The present cross-sectional study performed with a sample of 50 patients grouped into Group-A (Asthmatic children) and Group-B (Non-Asthmatic children). Standardised OPG imaging was performed for all participants. The radiographs from both groups were carefully traced and evaluated. The obtained data was subjected to statistical analysis by an expert statistician using Statistical Package for Social Sciences (SPSS) software v26.0. Independent t-test was used to analyse the linear and angular measurements between right and left-side in each group and also compare the linear and angular measurements between asthmatic breathing subjects and normal subjects. The Chi-square test was employed to assess differences in the cant of the occlusal plane and the Ag-Go-M relationship between the asthmatic and non-asthmatic groups. The p-value <0.05 was considered to be statistically significant. Results: Statistical analysis revealed that asthmatic individuals exhibited no significant bilateral differences in most linear and angular measurements, except for a notably greater mandibular corpus height on the right-side (p=0.05). Similarly, normal-breathing subjects showed no significant asymmetries (p>0.05), apart from the Co-Go-Me angle. When comparing the two groups, asthmatic subjects demonstrated significantly increased condylar length (p=0.001) and mandibular corpus height (p=0.006). Conversely, they presented significantly reduced coronoid process length (p=0.002), the angle between the condyle and coronoid process (p=0.016), and the Co-Go-Me angle (p=0.023), relative to normal-breathing counterparts. Conclusion: The present study demonstrated that asthmatic children exhibit distinct mandibular alterations, including increased condylar length and corpus height, along with reduced coronoid process length and angular measurements, when compared with non-asthmatic counterparts. These findings suggest that chronic asthma, through its impact on breathing patterns and head posture, may influence mandibular development during critical growth phases.

Changing Epidemiology of Influenza in Post COVID-19 Era: A Retrospective Observational Study

Introduction: Coronavirus Disease (COVID-19) is a highly transmissible viral infection and has challenged the world’s healthcare systems. COVID-19 co-infections with other respiratory pathogens may complicate the diagnosis, treatment and prognosis. Despite Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) high transmissibility and dominance, influenza circulation persisted throughout the COVID-19 pandemic. Due to their evolving nature and capability to evade the immune system, the available vaccines for these viruses protect from severe disease but not infection. There are varying strains of influenza and SARS-CoV-2 viruses and also their transmission is dynamic over time, thus emphasising the need to continue and expand surveillance across countries for improved decision-making. Aim: The present study was conducted with a aim to study Severe Acute Respiratory Infections (SARI) and Influenza-like Illness (ILI) with reference to COVID-19 and influenza. Materials and Methods: The present retrospective observational study was carried out at the tertiary health care centre at Department of Microbiology of Rajiv Gandhi Medical College and Hospital, Kalwa, Thane, Maharashtra, India, from August 2022 to September 2024. The study population includes all patients presenting with ILI and SARI whose samples have been tested for COVID-19 and influenza at the RT-PCR Laboratory during the above-mentioned period. Since it was a retrospective study, the sampling method was consecutive sampling. A total of 1170 patients presenting with ILI and SARI were studied in the given period. Patients of all age groups, presenting at Outpatient Department and hospitalised patients were included in the study. Retrospective analysis of Influenza and SARS-CoV-2 positive cases was carried out. Different clinical and epidemiological parameters were noted. As the data is quantitative in nature, the proportions and percentages were computed accordingly. To study the association of meteorological seasons with that of surge of the Influenza cases, Chi-square test was performed and p-value was noted. Results: A total of 1170 patients were tested in the given period. Among these 893 presented with SARI and 277 presented with ILI. SARS-CoV-2 infection was found in 61 (6.83%) of SARI and 35 (12.64%) of ILI patients, respectively. The total Influenza positive cases were 62 (6.94%) in SARI and 61 (22.02%) in ILI patients. SARS-CoV-2 variant was predominant in the year 2022 and Omicron and recombinant XBB variant were predominant in 2023. Significant surge in Influenza cases was seen in monsoon season in 2023. COVID-19 and Influenza co-infection was seen in 2 (0.17%) of 1170 cases. In ILI, 5 (20%) patients having co-morbidities while in SARI 15 (10.34%) patients having co-morbidities were positive for either SARS-CoV-2 or Influenza. Mortality was seen in 2 (3.23%) SARI influenza patients. Conclusion: Due to the varying circulating strains, seasonal variations of SARS-CoV-2 and influenza viruses, continuous surveillance is essential for management and prevention of SARI and ILI cases.

Clinical Outcomes of Single Lateral versus Dual Plating in Isolated Comminuted Intra-articular Distal Femur Fractures among Adults: A Retrospective Study

Tanmay Datta, Manik Roy, Pritam Rahaman

Introduction: Distal femur fractures are relatively rare compared to hip fractures. Distal femur fractures, particularly Arbeitsgemeinschaft für Osteosynthesefragen (AO) 33-C2 and C3 types with multiple fragments, pose significant treatment challenges. Complex comminution and articular extension markedly increase the difficulty of achieving stable fixation. Aim: To compare the effectiveness of Single Lateral Plating (SLP) and Dual Plating (DP) techniques in treating comminuted distal femur fractures, with a focus on clinical improvement and complication rates. Materials and Methods: The present hospital-based retrospective study was conducted on 50 cases of comminuted intra-articular distal femur fractures managed surgically at a tertiary care medical institute in eastern India between January 2020 and December 2022. Patients were divided into two groups: Group A (n=25) received SLP, while Group B (n=25) underwent DP. Key outcomes were evaluated at the level of functional recovery and union time, with additional data collected on the intraoperative blood loss, surgical time and frequency of complications. Clinical outcomes were assessed based on functional recovery, as measured by the Knee Society Scores (KSS). Statistical analyses were conducted using unpaired t-tests and Chi-square tests. A p-value of <0.05 was considered statistically significant. Results: Fifty adults were analysed (SLP, n=25; 16 men/9 women; 53.2±9.8 years) and (DP, n=25; 15 men/10 women; 50.0±10.9 years). The DP cohort showed higher KSSs at every follow-up- one month: 64.5±5.0 vs 54.0±6.0 (p<0.001); three months: 75.4±5.6 vs 62.5±6.8 (p<0.001); six months: 82.1±6.1 vs 66.3±6.2 (p=0.003); 12 months: 87.3±4.9 vs 69.0±5.7 (p=0.021); 15 months: 89.0±4.5 vs 70.2±5.1 (p=0.047). Radiographic union occurred earlier with DP (p<0.0001). No significant between-group differences were observed in intraoperative blood loss (p=0.21) or operative time (p=0.12), while implant failure and non-union were less frequent with DP; surgical-site infection occurred in one patient per group. Conclusion: The DP group showed superior functional outcomes, faster healing, and fewer complications, with no significant increase in blood loss or operative duration.

Perception, Attitude and Practice of Doctors towards Complementary and Alternative Medicine in a Tertiary Care Teaching Hospital: A Cross-sectional Questionnaire-based Study

Smitha Rai, Padma Gopinath

Introduction: The use of Complementary and Alternative Medicine (CAM) is increasing worldwide, including in India. People who are not satisfied with conventional medicine often turn to CAM. The World Health Organisation (WHO) also encourages the integration of CAM into modern medicine, which is possible only with the right perception and attitude of modern practitioners toward CAM. Aim: To assess the perception, attitude, and practice of modern practitioners toward CAM. Materials and Methods: A cross-sectional, non interventional, questionnaire-based study was conducted at Sapthagiri Institute of Medical Sciences and Research Centre (SIMS & RC), Chikkabanawara, Bengaluru, Karnataka, India, from August 2024 to December 2024. A total of 107 consultants, including senior residents, assistant professors, associate professors, and professors working at SIMS and RC and willing to participate, were enrolled in the study. The final sample size considered for analysis was 98. Participants were provided with an offline questionnaire related to the perception, attitude, and practice of CAM. Their responses were recorded using a five-point Likert scale ranging from “strongly agree” to “strongly disagree” and analysed using descriptive statistics. Statistical analyses were conducted using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 26.0. Results: A total of 107 questionnaires were analysed. The demographic parameters included name, gender, designation, and department of the consultants. Males (71, 66.4%) outnumbered females (36, 33.6%), and most participants were professors (50, 46.7%). The majority belonged to the departments of Surgery (20, 18.7%), Orthopaedics (19, 17.8%), Medicine (13, 12.1%), and Anaesthesiology (13, 12.1%). A total of 82 out of 107 (76.6%) practitioners believed that CAM is not reliable in acute conditions. Only 26 (24.3%) doctors believed that CAM is quite safe. Sixty-seven (62.6%) believed that the therapeutic response in CAM is slow to develop, and 76 (71%) agreed that a change in the patient’s lifestyle is necessary to obtain maximum benefit from CAM. Fifty-five (51.4%) doctors believed that CAM mainly focuses on disease prevention rather than cure. The majority (93, 87%) agreed that more scientific studies are required to substantiate the use of CAM. Almost half of the participants (52, 48.6%) reported using or considering the use of CAM in their clinical practice, with Yoga being the most commonly practiced branch (51, 47.7%). Additionally, 45 (42%) expressed willingness to undergo training in CAM. Conclusion: Modern practitioners’ perception and attitude toward CAM are generally positive. Nearly half (52, 48.6%) are open to incorporating CAM into their clinical practice. The most commonly used branch was Yoga (51, 47.7%), followed by Ayurveda (19, 17.8%). Many participants (45, 42.1%) also expressed willingness to undergo future training in CAM.

Prevalence of Dental Implant Positioning Errors among the Saudi Arabian Population: A Retrospective Observational Study

Introduction: Despite being an established procedure with a success rate exceeding 90%, dental implant therapy can be associated with certain complications, such as peri-implantitis and mechanical failures. Among the factors contributing to implant failure, implant placement-related factors may play a crucial role; however, their prevalence has been less frequently reported in the scientific literature. Aim: To assess the prevalence of errors in dental implant placement using Orthopantomogram (OPG) records of patients. Materials and Methods: A retrospective observational study was conducted in the Dental Clinics at Al Zulfi, College of Dentistry, Majmaah University, Al-Majmaah, Riyadh Province, Saudi Arabia from August 2013 to June 2023. Approximately 500 records of patients who had received atleast one dental implant were reviewed. Data regarding gender, type of implant, and implant position (anterior vs posterior; maxilla vs mandible) were collected. Implant placement errors, such as violation of the minimum distance between two implants (<3 mm) or between a tooth and an implant (<1.5 mm), as well as thread exposure, were assessed on OPGs by three independent investigators. Other factors associated with implant positioning errors were also evaluated. The Chi-square test was used to determine significant differences between implant positioning errors and implant location. Results: The study included 147 participants with a total of 500 dental implants, of whom 116 (78%) were male and 31 (22%) were female. A total of 348 implants (69.6%) exhibited placement errors. Implants placed in the maxillary arch showed a significantly higher prevalence of violation of the minimum distance between the implant and the tooth compared to those placed in the mandibular arch (p<0.05). Conversely, implants placed in the mandibular arch had a higher incidence of thread exposure compared to those in the maxillary arch (p<0.05). Conclusion: Successful dental implant therapy depends on multiple factors, including patient selection, meticulous treatment planning, precise surgical technique, prosthetic design, and long-term maintenance.

Analgesic Efficacy of Perineural versus Intravenous Dexamethasone and Paracetamol in Supraclavicular Block for Forearm Surgeries: A Randomised Control Trial

Chhaya Suryawanshi, Rashmi Kelkar

Introduction: Supraclavicular brachial plexus block is commonly employed for forearm surgeries, but its duration of analgesia with local anaesthetics alone is limited. Enhancing adjuvants in regional anaesthesia can lead to better analgesia, decreased opioid consumption, and improved recovery and patient satisfaction. Aim: To compare the onset and duration of sensory and motor blockade, time to rescue analgesia, and overall pain-relief effectiveness of perineural versus intravenous dexamethasone administered with paracetamol following supraclavicular block in forearm surgeries. Materials and Methods: The present double-blind randomised control trial was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, where 60 patients scheduled for forearm surgeries under supraclavicular block were randomly divided into two groups. In Group A, patients received 20 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 8 mg of dexamethasone. Group B received the same local anaesthetic with the addition of 2 mL of 0.9% normal saline, followed by intravenous administration of 8 mg dexamethasone and 1 gm paracetamol after the block. Parameters evaluated were sensory and motor block onset and duration. Postoperative pain relief duration and time to first rescue analgesia were assessed using the Visual Analogue Scale (VAS), and any adverse effects were documented. Data were analysed with student’s t-test and Chi-square test; p<0.05 was significant, p<0.001 highly significant. Results: The two groups were comparable with respect to demographic characteristics. The mean age was 43.07±11.6 years in Group A and 42.33±10.42 years in Group B (p=0.79). Both groups had a similar gender distribution, with no statistically significant difference. Group A had a faster onset of sensory block (4.93±0.82 min) compared to Group B (7.87±0.97 min) and a longer sensory block duration (511.4±31.4 min vs. 432.3±19.5 min). Motor block onset was also quicker in Group A (9.93±0.82 min) than in Group B (13.2±1.04 min), with a longer duration (401.4±30.3 min vs. 366.4±26.7 min). Group A experienced more extended analgesia (527.9±30.9 min vs. 447.4±19 min). Haemodynamic variables were stable in both groups, with no significant complications. Conclusion: Perineural dexamethasone significantly prolonged the duration of sensory and motor blockade and delayed the requirement for rescue analgesia compared to intravenous dexamethasone with paracetamol. Both routes were safe and well-tolerated, making perineural dexamethasone a more effective adjuvant for enhancing postoperative analgesia in supraclavicular block for forearm surgeries.

Short-term Effects of Non Surgical Periodontal Therapy on Oral Fluid Calprotectin Levels in Stages III or IV Periodontitis: A Longitudinal Observational Study

Introduction: Periodontal diseases cause destruction of the tooth supporting structures and contribute to low-grade systemic inflammation. Calprotectin is a major cytosolic protein of immune cells; it is highly expressed in sites of inflammation and has been explored as a biomarker in many inflammatory conditions including periodontitis. Cross-sectional studies have reported elevated calprotectin levels in oral fluids of periodontitis patients, but evidence regarding the impact of periodontal therapy on Gingival Crevicular Fluid (GCF) and salivary levels of calprotectin is inconclusive. Present study was conducted to assess whether calprotectin levels in oral fluids would be altered by Non Surgical Periodontal Therapy (NSPT). Aim: To observe the short-term impact of NSPT on the GCF and salivary levels of calprotectin. Materials and Methods: The present longitudinal observational study was carried out in the Department of Periodontology Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, over a period of four months from January to April 2023. A total of 11 patients clinically diagnosed with stages III or IV periodontitis and who met inclusion and exclusion criteria were enrolled in the study. Gingival Index (GI), mean Probing Pocket Depth (PPD), mean Clinical Attachment Loss (CAL), percentage of sites with PPD ≥5 mm and sites with CAL ≥5 mm were recorded. GCF and salivary samples were collected to measure calprotectin levels by Enzyme Linked Immunosorbent Assay (ELISA). Professionally administered oral hygiene instructions, mechanical supragingival plaque removal (PMPR) and sub gingival instrumentation were performed for these patients. They were recalled for their first follow-up visit after a period of six weeks. Re-evaluation of periodontal parameters was done and GCF and salivary samples were collected to estimate calprotectin levels. Mean and standard deviation was used to summarise the variables. The comparison between baseline and follow-up periodontal parameters were done using non parametric Wilcoxon signed rank tests. Oral fluid calprotectin levels were compared using paired t-test. The p-values less than 0.05 were considered statistically significant. Results: A total of 11 participants were recruited for the study. Only 10 participants returned for the first follow-up visit at six weeks. Statistically significant differences were seen in pre and post-treatment values for GI, mean PPD, mean CAL, percentage of sites with PPD ≥5 mm and sites with CAL ≥5 mm. Salivary calprotectin was 1160.17±596.18 at baseline and was lowered to 1100.46±604.75 pg/μL at follow-up. (p=0.74) GCF calprotectin was 1605.11±79.29 before NSPT and decreased to 1556.24±37.56 pg/μL post therapy (0.092). Conclusion: This study observed a significant improvement in all clinical periodontal parameters at six weeks after NSPT. Calprotectin levels in both saliva and GCF decreased but the differences were not statistically significant. Calprotectin levels in oral fluids of stages III or IV periodontitis patients was not significantly altered at six weeks after NSPT.

Assessment of Surface Roughness and Wettability of Hafnium Oxide Coated Titanium Discs: An In-vitro Analysis

Meghan Ranjan Singh, Vaishnavi Rajaraman, Padma Ariga, Saravanan Sekaran

Introduction: Surface modifications of titanium implants play a crucial role in enhancing their performance, particularly in terms of surface roughness and wettability, which directly influence osseointegration and biological responses. Hafnium Oxide (HfO₂) coatings are emerging as potential surface modifiers due to their unique physicochemical properties. Aim: The aim of the present study was to evaluate and compare the surface roughness and wettability of uncoated titanium discs and hafnium oxide coated titanium discs using Atomic Force Microscopy (AFM) and contact angle goniometry. Materials and Methods: The present in-vitro study was conducted in the Department of Prosthodontics, Saveetha Dental College and Hospitals, Chennai, India, between March 2024 and June 2024. Twenty titanium discs were divided into two groups: uncoated Ti (Group A) and hafnium oxide coated Ti (Group B). Surface roughness parameters (Ra, Rq, Rm) were evaluated using AFM and wettability was assessed by static contact angle goniometry. Data were analysed with the Shapiro-Wilk test for normality and independent samples t-tests for intergroup comparison. Results: AFM analysis revealed that the hafnium oxide coated titanium discs (group B) exhibited significantly higher surface roughness (Ra: 62.19 nm; Rq: 78.123 nm) compared to the uncoated titanium discs (group A) (Ra: 37.762 nm; Rq: 49.261 nm) (p<0.05). Contact angle measurements indicated that group B had substantially higher contact angles (average: 86.56°) compared to group A (average: 41.42°) (p=0.018), suggesting reduced surface wettability following HfO₂ coating. Conclusion: Hafnium oxide coating on titanium discs significantly increases surface roughness while decreasing surface wettability. These surface modifications could potentially influence the biological behaviour of titanium-based implants.

Biochemical Correlation of FGF23 with other Biomarkers in Patients with Endstage Renal Disease on Haemodialysis: A Cross-sectional Study

Barat Yusubov, Mirkhalig Javadov, Khanbaba Huseynov, Muradali Bakhshiyev

Introduction: In patients with End-Stage Renal Disease (ESRD) undergoing Haemodialysis (HD), Fibroblast Growth Factor 23 (FGF23), intact Parathyroid Hormone (iPTH), and Homocysteine (Hcy) are frequently elevated and have each been associated with disordered mineral metabolism and increased cardiovascular risk. In addition to FGF23, both iPTH and Hcy play important roles in Chronic Kidney Disease (CKD)-related Mineral Bone Disorder (MBD) and Cardiovascular Disease (CVD) risk. Aim: To evaluate the correlation of FGF23 with iPTH, Hcy, and routine biochemical parameters in patients with ESRD. Understanding these correlations may help identify new prognostic markers and inform treatment strategies in HD patients. Materials and Methods: This cross-sectional study was conducted in the Department of Nephrology at Yeni Klinika Hospital, Baku, Azerbaijan between February 2024 and November 2024. ESRD patients who had been on dialysis for atleast three months were recruited. Data were collected from 103 patients who consented to participate. Patients were divided into two groups: the main group (n=75) with elevated FGF23 and Hcy levels, and the control group (n=28) with normal FGF23 and Hcy levels. Baseline laboratory parameters included Haemogram (Hg), C-reactive Protein (CRP), Glucose (Gluc), Creatinine (Crea), estimated Glomerular Filtration Rate (eGFR), Potassium (K), Sodium (Na), Calcium (Ca), Phosphorus (P), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), iPTH, Hcy, and FGF23. Descriptive statistics and frequency analysis were used to summarise demographic and clinical characteristics. The Chi-square (χ2) test was used to compare categorical variables between groups, and the Mann-Whitney U test was applied to compare clinical parameters. Statistical significance was set at p<0.05. Analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 25.0. Results: The sample included 65 (63.1%) males and 38 (36.9%) females, with a mean age of 64±13.64 years, mean height of 170±6.9 cm, and mean weight of 79±13.04 kg. In the main group, FGF23 levels showed positive correlations with phosphorus (r=0.72, p=0.01), creatinine (r=0.78, p=0.01), iPTH (r=0.61, p=0.01), and Hcy (r=0.74, p=0.01). FGF23 was negatively correlated with eGFR (r=-0.64, p=0.01). No statistically significant correlation was observed with calcium levels (r=-0.12, p=0.29). Conclusion: Changes in FGF23, iPTH, and Hcy levels, particularly when assessed alongside other biochemical parameters, may serve as early prognostic markers in HD patients. Monitoring these parameters could help guide prognosis and support timely treatment management in patients with ESRD.

Rapid Characterisation of Carbapenem-resistant Klebsiella pneumoniae using the OKNVI RESIST-5 Multiplex Lateral Flow Assay and Evaluation of the Synergistic Activity between Aztreonam and Ceftazidime-avibactam: A Cross-sectional Study

Madhumati Jagadish Patil, Meera Rajeev, Anjali Patil

Introduction: Carbapenemase-Producing Klebsiella pneumoniae (CP-KP) is a major public health concern, since such isolates are inherently resistant to most available antibiotics. A newer therapeutic option, namely Ceftazidime-Avibactam (CAZ-AVI), is effective against Extended-Spectrum Beta-Lactamase (ESBL) producers and carbapenemase-producing organisms. However, CAZ-AVI is not active against strains bearing class B Metallo-Beta-Lactamases (MBLs) such as NDM, VIM, and IMP. The monobactam antibiotic Aztreonam (ATM) is stable against all MBLs (NDM, VIM, IMP) and hence serves as a good therapeutic choice for MBL-producing Enterobacterales. There are no established standards (CLS I/EUCAST) for evaluating synergy of CAZ-AVI and ATM. The RESIST-5 OKNVI (O-Oxacillinase (OXA)-48, K-Klebsiella pneumoniae Carbapenemase (KPC), N-New Delhi Metallobetalactamase (NDM, V-Verona Integron-encoded Metallobetalactamase (VIM), I-Imipenemase (IMP) assay enables rapid and accurate detection of five major carbapenemases, supporting timely and appropriate antimicrobial treatment. Aim: To detect carbapenemases using the RESIST-5 (OKNVI) test and to determine the in vitro activity of CAZ-AVI alone or in combination with ATM against carbapenemase-producing Klebsiella pneumoniae isolates. Materials and Methods: A cross-sectional study was conducted over four months (February 2024-May 2024) in the Department of Microbiology, KLE’s Prabhakar Kore Hospital, Belagavi, Karnataka, India. A total of 123 nonduplicate Klebsiella pneumoniae isolates from various clinical specimens, identified using standard biochemical methods during the study period, were included. The most common clinical samples were wound swabs, urine, and blood. Antibiotic susceptibility was tested by the disc diffusion method, with an ertapenem disc (10 μg) used to screen for carbapenem resistance. Carbapenem-resistant Klebsiella pneumoniae were subjected to the Modified Carbapenemase Inactivation Method (mCIM) to confirm carbapenemase production. Klebsiella pneumoniae isolates were further tested using the OKNVI RESIST-5 test for rapid detection of carbapenemases and were also evaluated for synergy between CAZ-AVI and ATM using modified disc diffusion and E-test methods. Statistical significance was assessed using the Chi-square test, with a p-value <0.05 considered significant. Results: Ceftazidime-avibactam (CAZ-AVI) and Aztreonam (ATM) synergy testing showed that synergy between CAZ-AVI and ATM was observed in 24 out of 30 Klebsiella spp. isolates (80%) using both the E-test and ATM disc diffusion methods. Fifteen isolates (50%) were resistant to CAZ-AVI and 18 (60%) to ATM, while 6 (20%) isolates were resistant to CAZ-AVI plus ATM by disc diffusion and E-test methods. Among 33 CP-KP isolates, 94% showed one or more carbapenemases, with 42% coproducing NDM and OXA-48. NDM and OXA-48 were detected in 26% and 32%, respectively, while 6% were negative for all five carbapenemases. Conclusion: CAZ-AVI in combination with ATM is effective against carbapenemase-producing Klebsiella pneumoniae. This study suggests that further commercialisation of ATM-AVI as a pharmaceutical preparation could be an attractive option to treat infections caused by MBL producers.

Efficacy of 6% Hydroxy Ethyl Starch Pre Administration to Alleviate Pain following Propofol Injection: A Randomised Control Study

Jigisha Bharatbhai Mehta, S Sreya Sri, Sara Mary Thomas

Introduction: Propofol is widely used intravenous induction agent owing to its rapid onset and short duration of action; however, Pain on Propofol Injection (POPI) remains a common adverse effect, with reported incidence between 28-90%. Despite the evaluation of multiple preventive strategies, including lignocaine, opioids, and formulation modifications, none have achieved complete effectiveness in eliminating POPI. Colloids, particularly Hydroxyethyl Starch (HES), may reduce pain through their effects on endothelial permeability and inhibition of contact activation. Aim: To evaluate the efficacy of pre-administration of 50 mL of 6% HES 130/0.4 compared with 0.9% Normal Saline (NS) in alleviating POPI. Materials and Methods: This double-blinded randomised control study was conducted at Dhiraj General Hospital, Sumandeep Vidyapeeth, Waghodia, Vadodara, Gujarat, India, from March 2025 to July 2025. A total of 84 patients of either gender belonging to the American Society of Anaesthesiology (ASA) physical status grade I or II were randomised into two groups. Group HES received 50 mL 6% HES, and group NS received 50 mL 0.9% normal saline via 20-G intravenous cannula over 3-5 min before propofol. Pain during propofol injection was assessed every 10 seconds before loss of verbal contact. Data were analysed with the Unpaired t-test. A p-value <0.05 was considered significant, and a p-value <0.001 was considered highly significant. Results: Both groups were comparable with respect to demographic variables, including age, weight, gender distribution and ASA physical status. The dose of propofol required for induction was also comparable between the HES and NS groups (136.10±21.25 vs. 131.67±16.22 mg; p-value=0.28). The incidence of pain on propofol injection was significantly lower in the HES group, with 78.57% of patients reporting no pain compared to 28.57% in the NS group (p-value <0.001). Pain grade 1 (14.29% vs. 38.09%; p-value=0.01), grade 2 (4.76% vs. 19.05%; p-value=0.04), and grade 3 (2.38% vs. 14.29%; p-value=0.04) were significantly more frequent in the NS group. Haemodynamic parameters showed no significant difference between groups. Conclusion: Administration of 50 mL 6% HES before propofol injection results in significantly less incidence of pain compared to 0.9% NS. Thus, authors conclude that it is effective to alleviate POPI.

Clinical Outcomes in Acute Stroke: A Cohort Comparison of Dysnatraemia and Normonatraemia

Sureshkumar Vellingiri, Bhargav Kiran Gaddam, K Suganya

Introduction: Stroke is the leading cause of mortality throughout the world, with significant economic and social implications.Electrolyte disturbances especially dysnatraemia is common in acute stroke patients and may affect clinical outcomes though its prognostic impact remains unclear. Aim: To compare clinical outcomes between acute stroke patients with dysnatraemia and those with normonatraemia. Materials and Methods: In the present prospective cohort study, 130 neuroimaging-confirmed acute stroke patients admitted to a tertiary care hospital in India were enrolled. Serum sodium was measured at admission and during hospitalisation and was categorised into dysnatraemia (both hyponatremia or hypernatremia) as group I and normonatraemia as group II. Primary outcomes were Intensive Care Unit (ICU), and hospital stay lengths, National Institutes of Health Stroke Scale (NIHSS) scores at admission and discharge, and in-hospital mortality. Secondary outcomes included the need for interventions such as intubation, Central Line Placement (CLP) and tracheostomy. Statistical Package for Social Sciences (SPSS) (ver_20) was used for analysis and appropriate tests of significance i.e., Chi-square test or Fisher exact test, Student t-test, Mann-Whitney test and multivariate logistic regression was used to test the significance. Values of p<0.05 was statistically significance. Results: The mean age of group I was 61.2±15.1 years versus 57.6±13.2 years in group II, with approximately 71% of males in both groups. Of 130 patients, 70 (53.8%) had dysnatraemia and 60 (46.2%) had normonatraemia. Group I experienced longer ICU stays (Median 2.5 days versus 2 days, p=0.002) and higher NIHSS scores at discharge (mean 6.35±6.33 vs. 4.36±5.46, p=0.043) than group I. They also had increased rates of CLP (21.4% vs. 6.7%, p=0.018) and requires intubation (31.4% vs. 10%, p=0.003) compared to group II. Conclusion: Dysnatraemia in acute stroke patients is linked to prolonged ICU stays, more interventions, and poorer neurological outcomes at discharge. Early identification and management of dysnatraemia may improve outcomes in acute stroke patients.

Effectiveness of Mulligan’s Spinal Mobilisation with Leg Movement Technique and Specific Exercise Therapy in Improving Clinical Outcome in Individuals with Lumbar Radiculopathy: A Randomised Controlled Study

Pratap Ravi, Subbiah Kanthanathan, Antony Leo Aseer Peter

Introduction: Low Back Pain (LBP) is a common musculoskeletal problem affecting the general population and involvement of Sciatic nerve is the common cause for leg Pain dominance. Mulligan’s Spinal Mobilisation With Leg Movement (SMWLM) technique is recommended as management. Limited data is available regarding the combined effect of SMWLM and specific exercises. Aim: The aim of the study was to find the effectiveness of Mulligan’s SMWLM technique with self GATE mobilisation and sustained lumbar rotation exercise on the clinical outcome compared to conventional care in individuals with Lumbar Radiculopathy (LR). Materials and Methods: The present randomised controlled study was conducted in a tertiary care hospital during March to August 2024, around 69 participants were included after receiving the informed consent and are divided into three groups. The leg pain intensity using Visual Analogue Scale (VAS), Numerical Pain Rating Scale (NPRS), disability using Oswestry Disability Index (ODI), Abdominal core muscle strength, passive Straight Leg Raise (SLR) range self-perceived improvement were measured before and after treatment. group 1 received Neural Mobilisation (NM), lumbar spine range of motion exercises. group 2 received SMWLM, NM and lumbar spine range of motion exercises. Group 3 SMWLM, NM, self GATE mobilisation and sustained lumbar rotation exercise. All participants received electrotherapy for pain modulation. The treatment was given to all three groups for one week, and the Global Rating of Change (GROC) scale was evaluated after 1st treatment and end of therapy. The outcomes were analysed using paired t-test, and ANOVA with a significance set at <0.05. Results: The mean age of the participants in group 1, group 2, group 3 were 44.21, 47.78, 46.52 respectively. The findings reveal that group 3 had greater improvement in leg pain (p<0.001), back pain (p<0.001), disability (p<0.001), core muscle strength (p<0.001), SLR range (p<0.0042) and GROC (p<0.0001) post-treatment. Conclusion: Mulligan’s SMWLM self GATE mobilisation and lumbar rotational exercises improved the clinical outcomes when compared to SMWLM alone and general exercises in individuals with LR. Mulligan’s SMWLM can be combined with technique specific exercise for maximum clinical improvement.

Role of Candida in the Pathogenesis of Oral Squamous Cell Carcinoma: A Systematic Review

Suganya Panneer Selvam, Deepak Pandiar

Introduction: Oral Squamous Cell Carcinoma (OSCC) is the sixteenth most prevalent cancer globally, with a significant proportion of cases originating in India. The progression from healthy oral mucosa to OSCC often involves Oral Potentially Malignant Disorders (OPMDs). However, recent classification updates have excluded chronic candidiasis from the list of OPMDs. Despite this, Candida species are frequently associated with cases of severe dysplasia and OSCC, suggesting a potential role in the pathogenesis of OSCC. By exploring specific pathways through which Candida may promote carcinogenesis, this review highlights the importance of recognising chronic candidiasis as an OPMD for early diagnosis and improved patient outcomes. Aim: The present systematic review aimed to consolidate evidence on the potential association between chronic Candida infections and the pathogenesis of OSCC. Materials and Methods: The present systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original studies involving tumour tissues or archival blocks from patients with oral cancer and those addressing OSCC pathogenesis were included; case reports, case series, and studies using only saliva samples or oral swabs were excluded. A comprehensive search across PubMed, Scopus, and Web of Science was performed up to December 10, 2023. Study quality was assessed using the Newcastle-Ottawa Scale, with modifications to fit the review’s objectives. Data extraction included information on Candida species and diagnostic approaches, with results synthesised narratively due to variability among studies. Results: The search strategy yielded 624 articles from multiple databases (PubMed: 263; Scopus: 204; Web of Science: 157). After applying the inclusion and exclusion criteria, only 13 studies were selected for the review. Candida prevalence in Oral Leukoplakia (OL) ranged from 6.8 to 100%, with three studies reporting malignant transformation rates of 2.5%, 6.5%, and 28.7%. C. albicans was the most frequently detected species, followed by C. dubliniensis, C. glabrata, C. guilliermondii, and C. krusei. Some studies identified additional fungal species, though they were considered potential contaminants. Histological analysis revealed Candida hyphae penetrating deep into OSCC tissues, suggesting a role in tumour progression. Conclusion: The review highlights the importance of recognising chronic candidiasis as an OPMD due to its potential role in the pathogenesis of OSCC. Early identification and management of chronic Candida infections could serve as a preventive strategy in high-risk populations. The findings advocate for the inclusion of chronic candidiasis in future classifications of OPMDs to enhance early diagnosis and improve patient outcomes.

Early Detection of Fluconazole Resistance Targeting Y132F Mutation in ERG11 Gene among Candida tropicalis Clinical Isolates using Polymerase Chain Reaction: A Cross-sectional Study

Introduction: Candida tropicalis is the most prevalent yeast associated with high mortality rates in candidaemia patients. The extensive use of fluconazole for prophylaxis has led to the emergence of resistance. The Y132F mutation occurs in the active site of the enzyme, making the organism resistant to fluconazole, and may serve as a significant marker. Aim: To detect the presence of the Y132F mutation in the ERG11 gene for early identification of fluconazole-resistant C. tropicalis isolates. Materials and Methods: This cross-sectional study was carried out in the Department of Microbiology at Sri Ramachandra Institute of Higher Education and Research, Chennai Tamil Nadu, India, over a period of 19 months from May 2018 to December 2019. Blood samples received in the Microbiology laboratory that grew Candida during the study period were included. A total of 92 Candida isolates from candidaemia patients were studied. Among these, isolates identified as C. tropicalis by phenotypic and genotypic methods were subjected to Antifungal Susceptibility Testing (AFST) by the broth microdilution method, according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (M27-A3). Subsequently, Polymerase Chain Reaction (PCR) assays were performed on fluconazole-resistant C. tropicalis isolates, targeting the Y132F mutation in the ERG11 gene using in-house primers. Additionally, sequencing of the C. tropicalis ERG11 gene was performed to confirm the presence or absence of the Y132F mutation in both resistant and susceptible isolates. Results: Among the 92 candidaemia patients, 37 (40.2%) cases were caused by C. tropicalis, of which 10 (27%) were resistant to fluconazole. The PCR assay accurately detected all 10 fluconazole-resistant C. tropicalis isolates and also produced bands for control strains with the Y132F mutation. DNA sequencing further confirmed that the Y132F mutation was present in fluconazole-resistant isolates, with results consistent with the PCR assay. Conclusion: This PCR-based detection of the Y132F mutation highlights the importance of molecular diagnostics in identifying fluconazole resistance in C. tropicalis. Such early detection enables healthcare providers to initiate appropriate treatment, reducing the risk of treatment failure and improving patient outcomes. Moreover, this assay could be a valuable screening tool to detect potentially resistant strains and monitor their spread.

Radiological Assessment of Supratubal Recess and Sinus Tympani Dimensions: A Retrospective Descriptive Study

Introduction: The hidden recesses of the temporal bone, particularly the Supratubal Recess (STR) and the Sinus Tympani (ST), play a crucial role in the presence and recurrence of cholesteatoma. Due to their complex anatomy and limited surgical visibility, these areas pose significant challenges in otologic surgery, often leading to residual disease. High-Resolution Computed Tomography (HRCT) provides a non invasive method for preoperative assessment, enabling better surgical planning and improved patient outcomes. Aim: To determine the mean length, height, and width of the STR and to classify the ST and STR. Materials and Methods: This retrospective descriptive study analysed 110 HRCT temporal bone scans from patients referred between June 2019 and June 2020 at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. Patients with a history of ear surgery, trauma, or those in the paediatric age group were excluded. Scans were performed on a PHILIPS MX-16 (16-slice) CT scanner with a slice thickness of 0.67 mm and multiplanar reconstruction. STR grading and ST classification were assessed based on studies conducted by El-Anwar MW et al., and Marchioni D et al. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 24.0, with continuous variables expressed as mean±standard deviation, and categorical variables as frequencies and proportions. Results: HRCT analysis of 110 patients revealed a mean STR length (STR-L) of 4.78 mm (SD: 2.45-6.94 mm), width of 2.67 mm (SD: 1.09-4.71 mm), and height of 3.39 mm (SD: 2.07-5.69 mm). STRs were classified into three grades, with Grade 2 (n=141; 64.09%) being the most common, followed by Grade 3 (n=77; 35%). The STs were categorised into three types, with Type B (n=171) being the most prevalent. Conclusion: Grade 3 STR is associated with a higher risk of residual cholesteatoma; therefore, preoperative evaluation of the STR is essential to aid surgeons in its prevention. The likelihood of residual disease due to partial removal, as well as the risks of ossicular discontinuity and hearing loss, can be effectively assessed before surgery.

Effect of Ursodeoxycholic Acid on Unconjugated Hyperbilirubinemia in the Term Neonates Treated with Phototherapy: A Prospective Interventional Study

Introduction: Neonatal hyperbilirubinemia affects 60–80% of term neonates in the first week of life. Phototherapy (PT) is the standard treatment; however, prolonged PT has limitations. Ursodeoxycholic Acid (UDCA) is a potential adjuvant therapy to enhance bilirubin clearance. Aim: To evaluate UDCA as a safe and useful adjuvant to PT in term neonates with Unconjugated Hyperbilirubinemia (UCHB) by comparing bilirubin reduction, PT duration, and length of hospital stay. Materials and Methods: A prospective interventional study was conducted at the Level 3 Neonatal Intensive Care Unit (NICU) of Shri BM Patil Medical College, Hospital and Research Institute, Vijayapura, Karnataka, India, from January 2024 to January 2025. Total 100 term neonates were allocated into two groups: Group 1 (n=50) received oral UDCA (10-15 mg/kg/day) with PT, and Group 2 (n=50) received standard PT alone. Total Serum Bilirubin (TSB) levels were measured at admission, 24 hours, and 48 hours. PT duration, NICU stay, and adverse effects were assessed. The independent samples t-test or the Mann–Whitney U test was used to compare continuous variables, and the Chi-square test or Fisher’s-exact’s test was used to assess categorical variables. A p-value <0.05 was considered significant. Results: Baseline characteristics such as gestational age (38.4±1.2 vs 38.2±1.3 weeks), birth weight (2.79±0.43 vs 2.76±0.40 kg), and gender distribution were comparable between groups. The decline in TSB at 48 hours was 9.3±1.75 mg/dL in the UDCA+PT group versus 9.8±1.90 mg/dL in the PT-only group (p=0.175). The mean PT duration was 47.84±2.50 hours in the UDCA group and 48.22±5.50 hours in the control group (p=0.66). UDCA was well tolerated, with only mild vomiting observed in three neonates. Conclusion: The UDCA may modestly enhance bilirubin clearance, but differences in bilirubin reduction, PT duration, and NICU stay were not statistically significant. Larger randomised controlled trials are needed.

Effects of Anaesthetic Techniques on Cancer Recurrence and Survival: A Systematic Review and Meta-analysis

Hemlata, Aparna Shukla, Reetu Verma

Introduction: Many anaesthetic agents and techniques are used in surgical oncology, yet their effects on cancer cells remain inconclusive. Some studies suggest that propofol-based Total Intravenous Anaesthesia (TIVA) and regional anaesthetic techniques may protect against cancer progression, while volatile anaesthetics and high-dose opioids could increase recurrence. Other research indicates that anaesthetics may have no effect. Aim: To evaluate the impact of General Anaesthesia (GA) supplemented with Regional Analgesia (RA) on Overall Survival (OS) in adult cancer surgery patients, as well as the effects of TIVA versus Inhalational Anaesthesia (INHA) on OS. Materials and Methods: The present systematic review and meta-analysis was conducted at King George’s Medical University, Lucknow, Uttar Pradesh, India, PUBMED/MEDLINE, EMBASE/Emtree, Google Scholar, and ResearchGate were searched. Original retrospective studies from 2005 to 2020 on adult cancer surgeries were included. Eligible studies involved primary cancer surgeries under general anaesthesia (TIVA or volatile) alone or with regional anaesthesia. Only studies published in English and providing numeric Hazard Ratios (HR) were considered. The selected studies were divided into two groups: 10 studies comparing GA with or without RA, and 13 studies comparing TIVA versus INHA. Forest plots were generated to analyse pooled data, and Begg’s funnel plots were used to assess publication bias. The Risk Ratio (RR) was used to measure dichotomous outcomes with 95% Confidence Intervals (CI). Heterogeneity was assessed using the τ² statistic, and a fixed-effects model was applied. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale (NOS). The GRADE system was applied to ascertain the level of evidence. Results: A total of 23 retrospective studies involving 67,550 patients were included. In the GA+RA versus GA comparison (10 studies, 46,425 patients), GA+RA was associated with improved overall survival (RR=0.91, 95% CI: 0.89-0.92) but showed no significant difference in recurrence-free survival (RR=1.01, 95% CI: 1.00-1.02). In the TIVA versus INHA comparison (13 studies, 21,125 patients), TIVA was associated with modestly better overall survival (RR=1.11, 95% CI: 1.09-1.13) and recurrence-free survival (RR=1.06, 95% CI: 1.04-1.08). Heterogeneity was low to moderate, and the quality of evidence was graded as low to moderate due to the retrospective design. All 23 studies were evaluated using NOS, with scores ranging from 6 to 9. Most studies scored 7 or higher, indicating moderate to high quality. Evidence certainty was rated as low to moderate for both OS and RFS outcomes across comparisons due to the retrospective nature of the studies. Conclusion: This study provides evidence that anaesthetic technique may impact long-term outcomes in patients undergoing cancer surgery. General anaesthesia combined with regional analgesia (GA+RA) was associated with improved OS, although no significant difference was observed in Recurrence-Free Survival (RFS). Additionally, TIVA showed a survival benefit over INHA, with improvements in both OS and RFS. Despite these findings, the overall certainty of evidence is limited by the retrospective design of the included studies.

Impact of Nursing Resignations on Annual Recruitment Strategies in Sudair Region Hospitals, Saudi Arabia: A Cross-sectional Study

Introduction: Many healthcare organisations are grappling with a critical issue of having critically low nurse staff levels. This leads to high workload stress, job dissatisfaction, and frustration among nurses and triggers a disruptive cycle of high turnover. This turnover, in turn, disrupts the workforce, creating an urgent need for action. The negative impact on patient care is significant, compromising the quality of service and the well-being of patients. Nurses’ resignations have become a global issue that has been researched over the last decade. Aim: The present study aimed to evaluate the impact of nursing resignations on annual recruitment plans in hospitals in the Sudair region, Saudi Arabia. Materials and Methods: The present cross-sectional study was conducted in Sudair area hospitals from November 2023 to January 2024. A total of 403 nurses completed a questionnaire about their experiences. Statistical analysis was done using the Chi-square test and ANOVA, and a p-value less than 0.05 was considered statistically significant. Results: A total of 403 nurses participated of which 135 (33.5%) of participants were aged 36-45 years, 118 (29.3%) aged 26-35 years, 82(20.3%) aged 20-25 years, and 68(16.9%) aged 46 years and above, most participants were Saudi nationals 388 (96.3%). The majority had a bachelor’s degree, 123 (30.5%) had a diploma, and 54 (13.4%) were postgraduates. Nearly 97 (24.1%) had 10-15 years of experience. Participants’ responses to motivation, effective leadership, and human resources strategies to reduce turnover ranged from 3.14 to 3.43, 2.93 to 3.3, and 3.1 to 3.28. Conclusion: The present study highlights the need to understand workforce dynamics to create effective recruitment strategies for hospitals in the Sudair region, promoting staffing solutions and healthcare growth. Understanding workforce dynamics is vital for effective recruitment strategies in Sudair hospitals, helping address staffing challenges and promote growth.

Morphometric Analysis of Dry Typical Thoracic Vertebrae: A Cross sectional Study from Telangana, India

BH Shiny Vinila, Masooma Begum, K Ephraim Vikram Rao, E Rajshekhar Reddy

Introduction: Morphometric measurements of dry typical thoracic vertebrae play an important role clinically in managing scoliosis, performing laminectomies, guiding pedicle screw fixation, and in designing spinal implants or prostheses for traumatic injuries. A precise understanding of typical thoracic vertebral dimensions is essential when planning thoracic spine surgery. Most of the screw and implant sizes are derived from Caucasian data, and hence may not be appropriate for all populations. Therefore, developing region specific morphometric data for typical thoracic vertebrae is crucial. Aim: To establish the normative morphometry of typical thoracic vertebrae in the population of Telangana region to guide spinal instrumentation. Materials and Methods: The present cross sectional study involved 80 adult dry typical thoracic vertebrae collected from the Department of Anatomy, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India. The study was conducted from October 2024 to February 2025. Various parameters including dimensions of the vertebral body, diameter of the vertebral foramen, pedicle dimensions and angles, laminae dimensions and length of spinous process were measured using vernier callipers. The statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. Range, Mean and standard deviations were calculated for all the parameters and Student’s t-test was performed to compare the right and the left-sides. Results: The mean transverse and anteroposterior diameters of the bodies were 31.49±3.35 mm and 22.05±3.53 mm, respectively. The vertebral foramen transverse and anteroposterior diameters were 15.61±1.34 mm and 13.75±1.26 mm, respectively. The transverse angle of the pedicle was 14.55±3.72° on the right side and 14.95±3.95° on the left-side. The sagittal angle of the pedicle was on the right-side 10.54±2.74° and 10.36±2.90° on the left-side. The mean laminar height and the thickness on the right-side were 21.03±2.42 mm and 06.18±1.06 mm, respectively and on the left-side were 20.96±2.09 mm and 06.35±1.03 mm, respectively. There was no statistically significant difference observed between the right and left-sides of the pedicle and laminar dimensions and also chord length as the p-value was more than 0.05. Hence, bilateral symmetry was observed. Conclusion: There were few variations observed in Telangana regional data collected in the current study namely transverse diameter of vertebral bodies, pedicle chord lengths, and sagittal and transverse angles were greater than in previous studies. These parameters are crucial for spinal surgeries and also the current study provides baseline data for the Telangana population that could help in improving instruments accuracy, reducing the risk of misplaced pedicle screws and neural injury.

Evaluating DMARDs Adherence in Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis: A Quasi-experimental Study

Introduction: Psoriasis (Ps), Psoriatic Arthritis (PsA), and Rheumatoid Arthritis (RA) are chronic autoimmune conditions requiring long-term pharmacological management. Medication adherence is crucial for effective disease control and improved patient outcomes. Drug-Related Problems (DRPs) and non-adherence significantly impact treatment efficacy. Disease-Modifying Antirheumatic Drugs (DMARDs) improve long-term outcomes and slow disease progression in Ps, PsA, and RA. Understanding adherence patterns helps healthcare providers address barriers to effective therapy. Aim: This study aimed to assess medication adherence and identifies factors influencing adherence in patients suffering from Ps, PsA, and RA. Materials and Methods: The present quasi-experimental study was conducted in KLE’s Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India. The study was conducted for a period of seven months from September 2023 to April 2024) on 124 patients diagnosed with Ps, PsA, and RA. Medication adherence was measured using the Medication Adherence Rating Scale (MARS) across baseline, first follow-up (second week), and second follow-up (fourth week). Factors affecting adherence, such as demographic variables, forgetfulness, carelessness, Adverse Drug Reactions (ADRs), and polypharmacy, were analysed. Clinical pharmacists provided targeted interventions, including patient education and counselling via Patient Information Leaflet (PIL). Data were analysed using Statistical Package for Social Sciences (SPSS) v23 with Friedman and McNemar tests to assess adherence changes, using a 5% significance level (α=0.05). Results: Of the 124 patients, 57.26% were females, and the most affected age group was 41-60 years. Methotrexate was the most commonly prescribed DMARD. Adherence improved from 54.03% at the baseline to 75.00% at second follow-up (p<0.001**). Forgetfulness (32.25%) and carelessness (50.80%) were major barriers to adherence. Pharmacist-led interventions significantly enhanced adherence rates over time. Conclusion: Clinical pharmacists play a crucial role in improving medication adherence through patient education and counselling. Enhancing adherence to conventional DMARDs leads to better disease management and reduced complications. Ongoing interventions, including regular follow-ups and personalised support, are essential for sustaining adherence in chronic autoimmune diseases. Improving adherence to DMARDs is vital for effective management of chronic autoimmune diseases. Clinical pharmacists play a key role through education, counselling, and ongoing patient support.

International Classification of Functioning as a Framework for Understanding Activity Limitation and Participation Restriction in Elderly Adults with Knee Osteoarthritis in Rural and Urban Community: A Cross-sectional Observational Study

Megha Desai, Prashant Naik, Gayathri

Introduction: Knee OA is the most common joint degeneration disorder which can lead to inactivity with ageing, secondary to pain and reduced function thus ultimately impairing the Quality of Life (QoL). International Classification of Functioning Disability and Health is a universal language that can be used across all professions for an easy communication. Aim: To assess the activity limitations and participation restriction in elderly adults with knee Osteoarthritis (OA) using ICF functional profile. Materials and Methods: The present cross-sectional observational study was conducted in affiliation to KLE Institute of Physiotherapy at the rural and urban community of Belagavi, Karnataka, India, April 2020 to March 2021. A total of 386 adults from both rural and urban community above the age of 60 years with knee pain were included for the study. A door to door survey for activity limitations and participation restrictions was done using ICF and the data was later statistically analysed using Statistical Package for Social Sciences (SPSS) 20. Results: A 52.85% (n=193) of the urban population used western toilets and showed greater amount of difficulty in activities of daily living. The study included 69.95% (n=386) of the population who were females and 71.24% were under the age group of 60-70 years. The comparison of rural and urban communities showed that both communities faced the similar limitations and restrictions in functional activities whereas the type of toilet used had a major impact over the urban population where 37.31% (n=193) of the individuals in urban community showed the need of external support during toileting activities. Conclusion: The ICF functional profile was helpful in understanding the framework for activity limitation and participation restriction in elderly adults with knee OA. It can also be used as a clinical tool to evaluate activities of daily living and also provides a detailed frame work of understanding the interaction of personal environmental and medical factors.

Evaluation of Platelet Count, Anti-microbial Efficacy, and Fibrin Network Pattern for Advanced Platelet Rich Fibrin versus Titanium Platelet Rich Fibrin Prepared from Blood Samples of Young Adults: An Ex-vivo Study

Introduction: Platelet concentrates have gained popularity in periodontal regenerative therapy owing to their autologous nature. Platelet Rich Fibrin (PRF) can be classified into various types based on the centrifugation protocol. Among these, Advanced PRF (A-PRF) and Titanium-prepared PRF (T-PRF) have gained recognition because of their regenerative potential. Aim: To evaluate platelet count, antimicrobial efficacy, and fibrin network pattern for A-PRF and T-PRF in young adults. Materials and Methods: This ex-vivo study was conducted at the department of Periodontology and Oral Implantology, Sree Sai Dental College and Research Institute, Andhra Pradesh, India, over a period of six months from January to June 2024 and it included a 15 systemically healthy subjects. From each subject, 10 mL of blood was collected, of which 5 mL was centrifuged to obtain A-PRF (1400 RPM, 15 minutes) and 5 mL for T-PRF (3000 RPM, 10 minutes in titanium tubes). The obtained PRF membranes were analysed for platelet count, antimicrobial activity, and changes in the fibrin network. Data were analysed using Statistical Package for the Social Sciences (SPSS) 20 with an independent t-test. Results: A total of 15 patients (7 females and 8 males) were included in this study, with a mean age of 23.8±2.54 years. The T-PRF had greater antimicrobial efficacy than A-PRF, with statistical significance (p<0.001), whereas the platelet count and fibrin network pattern did not show any statistical significance (p>0.05). Conclusion: According to finding of the present study result it was observed that T-PRF exhibited superior antimicrobial efficacy when compared to A-PRF.

Diagnostic Utility of the Absent Cremasteric Reflex and Prehn’s Sign in Testicular Torsion: A Multicentre Retrospective Observational Study Comparing Clinical Examination with USG and Colour Doppler Imaging

G Raghavendra Prasad, Abdullah Umayr Khan

Introduction: Testicular torsion is a urological emergency requiring timely diagnosis and surgical intervention to prevent ischaemia and testicular loss. Clinical signs such as the absent cremasteric reflex and Prehn’s sign are traditionally used, but their accuracy compared to Ultrasonography (USG) and colour doppler imaging needs validation. Aim: To validate the diagnostic utility of the absent cremasteric reflex and Prehn’s sign in identifying testicular torsion and compare them with USG and colour doppler imaging. Materials and Methods: The present multicentre retrospective observational study was conducted at Princess Esra Hospital and Deccan College of Medical Sciences, Hyderabad, India. The study reviewed records of 332 male patients presenting with acute scrotum over a five-year period (January 2015 to December 2019). The study was planned, executed, and data analysed between January 2020 and March 2021. Patients were divided into pre USG era (n=229) and USG era (n=103) based on the availability of imaging at the time of presentation. However, only 93 cases with complete clinical and imaging documentation met the inclusion criteria and were used for detailed statistical analysis. Clinical signs (absent cremasteric reflex and Prehn’s sign) and imaging findings (USG and colour doppler) were compared against surgical exploration outcomes. Diagnostic performance was evaluated using sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy. Statistical comparison between clinical signs and imaging modalities was performed using the McNemar test with significance set at p<0.05. Results: The absent cremasteric reflex showed sensitivity of 82.43% and accuracy of 74.19%, comparable to USG and colour Doppler, which demonstrated sensitivity of 81.08% and accuracy of 81.72%, as confirmed by the study results. Prehn’s sign had lower reliability, with sensitivity of 63.51% and accuracy of 59.14%, consistent with the original data. Conclusion: The absent cremasteric reflex is a reliable clinical sign for diagnosing testicular torsion, with sensitivity comparable to USG and Doppler. Prehn’s sign is less reliable. In ambiguous cases, immediate surgical exploration remains crucial.

Om (Aum) Chanting as a Physiological Approach for Managing Type D Personality: A Narrative Review of Cognitive, Autonomic, Psychological, and Biochemical Outcomes in Adults

Introduction: Type D personality includes negative emotions and social withdrawal with constant stress activation and different biological regulation. This leads to autonomic dysfunction, hormonal imbalance, and immune activation thus increasing the vulnerability to cardiovascular and mental health problems. Aim: To examine the psychobiological features of Type D personality and assess the role of “OM” chanting in improving vagal tone, reducing stress reactivity in individuals. Materials and Methods: A comprehensive search strategy was conducted in PubMed, Scopus, Web of Science, and Google Scholar (1990–2025) using keywords related to Type D personality. vagal tone, and OM chanting. A total of 1,287 records were identified, 1,019 were screened after the removal of duplicates, 80 full-text reports were sought for retrieval and assessed for eligibility, with 30 studies finally included in the review. Studies were narratively synthesised, focussing on Type D’s psychobiological impact and OM chanting’s effects on autonomic and psychological parameters. Results: Type D personality showed exact signs of stress system overactivity, with higher cortisol levels, lower heart rate variability, and increased inflammatory markers. These patterns show the chronic stress, poor autonomic control, and higher risk for cardiovascular problems. OM chanting had measurable calming effects which increases parasympathetic activity, improves heart rate variability, and lowers blood pressure. Type D individuals showed better memory and coordination after regular practice, and group chanting helped lower cortisol and strengthen social bonding. Overall, OM supports both mental and physical relaxation. Conclusion: “OM” chanting is a non-invasive, accessible intervention that can reduce the physiological and psychological burden of Type D personality, complementing care, easing stress, and lowering cardiovascular risk in preventive and therapeutic settings.

PhysioConnect 5 International Conference

Sarvotam Chauhan (PT)

PhysioConnect 5 International Conference, a prestigious two-day Physiotherapy-focused academic and cultural platform bringing together clinicians, academicians, researchers, and students from across institutions.

Chest Clearance Technique on Dyspnoea Management in Community-Acquired Pneumonia: A Study Protocol

RUPAL BHARDWAJ, NEHA GUPTA, RITIKA KUMAR, ANUJ MISHRA

Introduction: Dyspnoea is a common feature of Community Acquired Pneumonia (CAP) which affects the functional activity and Quality of Life (QOL) of patients. Airway Clearance Techniques (ACTs), in addition to antimicrobial and supportive therapies, are essential in the management of dyspnoea. ACTs reduce respiratory exertion by facilitating of movement of mucus from the lower respiratory tract. Aim: To compare the effect of the Active Cycle of Breathing Technique (ACBT) and Postural Drainage (PD) on dyspnoea in CAP by using a modifi ed Borg scale, MRC scale, oxygen saturation and chest expansion. Materials and Methods: This experimental, randomised, parallelgroup trial include 32 participants (CAP patients aged between 40-70 years) allocated into two groups, Group A (ACBT) and Group B (PD with percussion and vibration), as airway clearance technique. Both groups will receive 4 weeks of baseline treatment, diaphragmatic and segmental breathing exercises (10 repetitions, 3 sets, with one-minute rest between sets, tailored to individual chest radiograph results), and Range of Motion (ROM) exercise for both the upper extremity and lower extremity (10 repetitions, 3 sets) with ambulation. PhysioConnect 5 International Conference Abstract 1

Barriers To Smoking Cessation: Exploring Factors That Hinder Quitting Efforts-A Systematic Review

Raveena Lodhi, Meena Gupta

Introduction: Smoking remains one of the leading causes of preventable diseases and premature deaths worldwide, contributing to conditions such as heart disease, stroke, respiratory disorders, and cancer. Smoking cessation is complex, as numerous factors contribute to the difficulty of quitting. A systematic understanding of these barriers can inform more effective cessation strategies. Aim: To systematically review and analyse the barriers to smoking cessation that make quitting difficult. An extensive literature search was conducted using the Scopus, PubMed, and Web of Science databases. The keywords included smoking cessation. Methods: A systematic review of qualitative studies was conducted. An extensive literature search was conducted using the Scopus, PubMed, and Web of Science databases. Relevant studies on adult smokers’ experiences and barriers to cessation were identified through databases. Articles were included if they explored the multifaceted obstacles to smoking cessation. Results: The review identified psychological barriers, with stress and emotional dependence more prominent, environmental triggers, such as social cues, failed assisted smoking cessation, sociocultural norms, including the role of societal pressures and stigmas; and barriers related to access and awareness of cessation resources. Both genders emphasised the need for supportive, non-judgmental interventions tailored to individual needs. Conclusion: Factors that significantly influence barriers to smoking cessation include nicotine addiction, ingrained cultural norms, and limited knowledge of cessation resources. Women benefit more from emotionally supportive, group-based interventions, whereas men may respond better to structured, incentive-based approaches. Further research is needed to explore long-term effectiveness and sustainability of current cessation programmes. Implications: The findings underscore the need to create supportive, non judgmental environments to reduce stigma and encourage individuals to seek help. Taxation and smoke-free laws should be implemented to support quitting efforts. PhysioConnect 5 International Conference Abstract 2

Efficacy of Universal Exercise Unit on Trunk Control in Children with Spastic Cerebral Palsy: Study Protocol

Imtisenla Tzudir, Neha Gupta, Ruchika Kalra, Himandri Kapil

Introduction: Universal Exercise Unit (UEU), a form of spastic cerebral palsy treatment, has potential in enhancing the strength of muscles, motor control, and postural alignment of patients. However, the scientific literature available on its efficacy, outcomes, and standardised protocols is scarce. Need of the Study: The scarcity in literature is limiting its integration in clinical practice. Evidence to validate this potential and optimise therapeutic strategies in Spastic Diplegic Cerebral Palsy (SDCP). Aim: To study the effectiveness of UEU on trunk control in SDCP children. Materials and Methods: This randomised controlled trial will include 24 patients divided into two groups using computer generated randomisation. Physiotherapeutic intervention following stretching and strengthening wil be provided in Group A and followed with addition of UEU unit with the same regime in Group B. This study will include diagnosed Spastic Diplegic Cerebral Palsy (SDCP), both male and female ,GMFCS III and IV, aged 4 to 10 years, and Trunk Control Measurement Scale (TCMS) score of 9. Severe disability exceeding GMFCS level IV, history of seizures, hearing deficits, any cardiac anomalies, usage of botulinum toxin A injection within three months prior will be included in the exclusion criteria. Implications: Study will benefit in management of trunk control and balance. PhysioConnect 5 International Conference Abstract 3

Impacts of Occupational Head Loading on Cervical Degeneration: A Systematic Review

Introduction: Occupational head loading is prevalent among porters and agricultural workers in many developing regions, posing risks to cervical spine health. This systematic review investigates the effects of habitual head loading on cervical spine degeneration and identifi es the magnitude of associated health risks. Materials and Methods: PubMed, Scopus, and Google Scholar were systematically searched for studies published between 1968 and 2023. Inclusion criteria encompassed studies analysing cervical degeneration in head-loading workers compared to controls. The risk of bias was assessed using the Cochrane tool, and results were synthesised qualitatively and quantitatively. Results: A total of 16 studies involving 1,080 participants were included. Cervical degeneration prevalence was signifi cantly higher in head-loading workers (76.89%) compared to non-load carriers (9.90%) p-value. Key fi ndings included reduced cervical lordosis, disc height reduction, and early onset of osteophytes. Conclusions: Habitual head loading is strongly associated with accelerated cervical spine degeneration. Preventive measures, ergonomic interventions, and alternative load-carrying techniques are essential to mitigate health risks. Future longitudinal studies are warranted to explore the progression of these changes. PhysioConnect 5 International Conference Abstract 04

Impact of Using Wearable Devices in Rehabilitation of Knee Joint

Introduction: Knee joint injuries and degenerative conditions are becoming increasingly prevalent, leading to significant physical disabilities and socio-economic burdens. Effective rehabilitation is essential for restoring function and improving quality of life. However, traditional methods face challenges, including limited healthcare provider availability, inconsistent patient monitoring, and varying adherence to treatment protocols. Aim: This study aims to critically evaluate the evidence on wearable devices for knee joint conditions, examining their effectiveness, limitations, and potential to enhance rehabilitation outcomes. Materials and Methods: Peer-reviewed articles in English language published between 2013 and 2024 and focussing on using wearable devices for knee joint rehabilitation were included. A computer based search on google scholar, PubMed, research gate was done to retrieve relevant articles. The keywords used for research were knee joint, rehabilitation, wearable devices. A review of existing literature was conducted, focusing on studies that utilised wearable devices such as Inertial Measurement Units (IMUs), accelerometers, and goniometers. Key parameters analyzed included Range of Motion (ROM), joint kinematics, and physical activity levels. Results: Wearable devices have demonstrated significant potential in postoperative rehabilitation, especially after Total Knee Arthroplasty (TKA). They improve functional outcomes, pain management, and patient satisfaction while reducing rehabilitation costs. These devices enable remote monitoring and personalised treatment plans, facilitating better recovery. However, challenges such as sensor miscalibration, limited real-world applications, and gaps in research on patient self-treatment remain. Conclusion: Wearable devices represent a transformative approach to knee joint rehabilitation, providing accessible, cost-effective, and efficient care. Addressing existing barriers and advancing research can further enhance their integration into clinical practice, improving patient outcomes globally. PhysioConnect 5 International Conference Abstract 5

Effectiveness of Vestibular Rehabilitation In Vertigo – A Review

Balance and quality of life are severely hampered by vertigo, which is frequently brought on by vestibular dysfunctions as Benign Paraoxysmal Positional Vertigo (BPPV). Exercises for Vestibular Rehabilitation Exercises (VRE) provide a non-pharmacological method of managing symptoms. This review aimed to assess how well VRE works to manage vertigo symptoms and enhance patient outcomes, both on its own and in conjunction with other therapies. VRE increased quality of life, decreased vertigo symptoms, and improved balance. When VRE was used with yoga or medication, the results were better than when it was used alone. Yoga also provided accessibility and relaxation benefi ts. VRE works well for treating vertigo, and its effects are amplifi ed when paired with other treatments. To confi rm these results, larger, multicentric trials should be conducted in future. PhysioConnect 5 International Conference Abstract 6

Triangular Fibrocartilage Complex Injuries in Athletes: Management Strategies, Impact On Performance, and Return-to-Play Considerations – A Narrative Review

Introduction: The Triangular Fibrocartilage Complex (TFCC) supports Distal Radioulnar Joint (DRUJ) stability, dissipates axial loads, and integrates with radioulnar ligaments. Its limited vascular supply and complex structure make it prone to recurrent injuries, especially in athletes. Understanding TFCC tears is crucial, as 3% to 9% of athletic injuries involve the hand and wrist, with a growing focus on pediatric and adolescent management and recovery. Aim: This article compares conservative management to surgical procedures for treating TFCC injuries in athletes. It examines the impact on wrist function, athletic performance, and return-to-play outcomes. Materials and Methods: A comprehensive search was conducted using PubMed and Google Scholar for studies from 2000 to 2024. Keywords included “TFCC injury,” “athletes,” “conservative management,” “surgical control,” “wrist function,” and “return to play.” Results: Both conservative and surgical treatments offer similar longterm benefi ts in pain relief and improved grip strength. However, TFCC injuries signifi cantly affect athletic performance. Inadequately managed injuries can lead to persistent instability and faster osteoarthritis development. Conservative management allows for a quicker return to play (6-12 weeks), while surgery often requires 3-6 months. Athletes undergoing surgery typically have higher chances of returning to preinjury performance levels. Effective rehabilitation and gradual return-toplay are crucial for optimal outcomes. Conclusion: The choice between conservative and surgical management should consider injury severity, sport-specifi c needs, and individual athlete characteristics. While conservative management may enable a faster return to activity, surgery might offer better long-term outcomes for complex injuries. Proper treatment and rehabilitation are essential for a successful return to play and maintaining performance. PhysioConnect 5 International Conference Abstract 7

Variability, Diffi culties and Expertise among Cardiopulmonary Physiotherapists in India’s Cardiopulmonary Rehabilitation Practices: A Nationwide Survey

Gayatri Goel, Jyoti Ganai

Introduction: Pulmonary Rehabilitation (PR), a cornerstone in managing chronic respiratory diseases and Cardiac Rehabilitation CR) for managing patients with heart conditions necessitates strict adherence to quality standards. Evidence-based Practice (EBP) is integral to cardiopulmonary physical therapy worldwide, requiring suffi cient knowledge, skills and resources for effective implementation. This study investigates Cardiopulmonary Rehabilitation (CPR) practices in India, assessing service quality, provider affi liations, available offerings and structural components. Aim: The purpose of this evaluation seeks to identifying gaps, highlight strengths and areas of improvement for offering actionable insights, contributing to enhanced CPR delivery and better outcomes for management of individuals with cardiac or pulmonary diseases in India and improving patient outcomes. Materials and Methods: An electronic questionnaire was circulated for survey among ~90 licensed cardiopulmonary phy sical therapists via WhatsApp and Gmail, covering demographics, structural process and outcome quality indicators and CPR delivery challenges. Results: The study found that 70% of therapists adhered to evidence-based guidelines, but gaps in follow-ups and resources persisted. Key challenges included limited equipment (70%), patient awareness (80%) and funding (50%) with 90% calling for standardised protocols and 75% advocating for professional training. Conclusion: The study found that while most cardiopulmonary physical therapists in India adhere to evidence-based guidelines, challenges such as limited resources, low patient awareness and funding constraints hinder effective CPR delivery. Therapists emphasised the need for standardised protocols, regular audits and continuous training to improve service quality and patient outcomes. Addressing these gaps can enhance CPR practices and their impact on managing patients. PhysioConnect 5 International Conference Abstract 8

Effectiveness of Kinesio Taping in Basketball Athletes with Chronic Ankle Sprains Undergoing Rehabilitation: A Narrative Review

Shaurya Gupta, Pooja Sharma, Nitesh Malhotra, Divya Aggarwal

Introduction: Basketball is a dynamic sport that demands athletes to maintain high levels of stability, strength, and fl exibility in both the lower and upper limb. Ankle injuries, particularly sprains, are prevalent among basketball players, signifi cantly impacting their performance and recovery due to the sport’s high demands for agility and explosive movements. Kinesio taping (KT) method is a relatively new taping technique. Kinesiology tape can support tissues and joints without restricting the movements of structures around the joint. Aim: To assess the existing literature on the effectiveness of KT in Basketball athletes with chronic ankle sprains undergoing rehabilitation, identify the limitation of previous studies, and justify the need for further research. Materials and Methods: A literature search was performed using Google Scholar, PubMed, and Scopus database. A total of more than 60 articles showed up in which 10 is mentioned in the review on the basis of eligibility criteria. The search terms used were “Kinesio Taping”, “chronic ankle sprain”, and “rehabilitation”. In this review we have included various parameters such as recurrent ankle sprain, in the past 1 year. Previous history of ankle fracture, ligament injury or recent sprain under 1 month were excluded. The articles were checked thoroughly and only full text articles were included for this review. These articles were reviewed in a narrative way. The duration of intervention varied across studies, ranging from 3 to 6 weeks, depending on the rehabilitation protocol used. Results: As a result, this review appears to show significant improvement in the pain, ROM , functional performance, agility, functional mobility. Conclusion: In basketball athletes with chronic ankle sprains undergoing rehabilitation, KT has demonstrated signifi cant effectiveness in improving rehabilitation outcomes. The incorporation of KT into rehabilitation programmes should be prioritised, as it enhances functional performance, reduces pain, and supports recovery. Recommendations should focus on designing comprehensive rehabilitation protocols that integrate KT to optimise clinical outcomes and ensure athlete satisfaction. PhysioConnect 5 International Conference Abstract 9

Effectiveness of Spencer Technique versus Capsular Stretching Along with Tens in Patients with Adhesive Capsulitis: A Narrative Review

Annu Tanwar, Pooja Sharma, Divya Aggarwal, Nitesh Malhotra

Introduction: Frozen shoulder also known as adhesive capsulitis is a common shoulder condition marked by pain and a gradual loss of shoulder movement. Three overlapping stages are seen by frozen shoulder patients: Stage I is infl ammation, Stage II is frozen, and Stage III is thawing. The Spencer approach is a widely used set of standardised shoulder treatments that can be applied to diagnosis, prognosis, and treatment. Capsular stretching can ease intraarticular pressure and promote articular surface separation, while Transcutaneous Electrical Nerve Stimulation (TENS) therapy involves electrical stimulation to relieve pain and tension in muscles. This study aims to compare the effi cacy of the Spencer technique with capsular stretching in combination with TENS therapy in treating patients with adhesive capsulitis. Aim: To assess the existing literature on the effectiveness of Spencer technique versus Capsular stretching along with TENS in patients with adhesive capsulitis, identify the limitation of previous studies, and justify the need for further research. Materials and Methods: All the related literature were incorporated that was published from the year 2010 to 2024 and collected from various search databases like Google Scholar, PubMed, Scopus, etc., by using keywords “Adhesive Capsulitis”, “TENS”, “Capsular Stretching”. In this review we have included various parameters such as clinical diagnosis of adhesive capsulitis (frozen shoulder) stage 1 & stage 2, duration of symptoms for at least three months, and no previous shoulder surgery or recent trauma. Systemic conditions affecting the shoulder & recent fractures were excluded.The articles were checked thoroughly and only full text articles were included for this review.These articles were reviewed in a narrative way. Results: As a result, this review appears to show signifi cant improvement in the pain, Range of Motion (ROM), functional mobility,and Quality of Life (QOL). Conclusion: In patients with adhesive capsulitis, Spencer technique and capsular stretching did signifi cantly improve rehabilitation results. Recommendations should be directed towards the development of rehabilitation programmes that encompass these interventions to achieve superior clinical outcomes and patient satisfaction. Implications: This research highlights a novel approach to physiotherapy that is effective, economical and has a positive impact on saving recovery time and increasing satisfaction rates. PhysioConnect 5 International Conference Abstract 10

Advancements in Dysmenorrhoea Management: Comprehensive Narrative Review of Perineometer-Assisted Pelvic Floor Rehabilitation

Vindhya Vijikumar, Pooja Sharma, Divya Aggarwal, Nitesh Malhotra

Introduction: Primary Dysmenorrhoea (PD) is defi ned by painful menstrual cycles in the absence of pelvic disease. It is characterised by recurrent cramps and lower abdomen discomfort during menstruation, affecting 50% to 90% of women. Adolescents with dysmenorrhoea had higher levels of anxiety and depression, and lower perception of their Quality of Life (QOL). Dysmenorrhoea among female students adversely impacted academic performance leading to absentism (Amza et al., 2024). Non-pharmacological therapies provide positive effective in reducing menstrual cramps in people with PD. Aim: To assess the existing literature on the effectiveness of Perineometer assisted pelvic fl oor rehabilitation and Progressive Relaxation Technique (PRT) in managing dysmenorrhoea severity and associated psychological symptoms such as anxiety and depression in young women, identify the limitations of previous studies, and justify the need for further research. Materials and Methods: A thorough search was done in PubMed, Scopus, and Google Scholar Library using keywords such as “pelvic fl oor rehabilitation,” “biofeedback,” “Perineometer,” “Progressive Relaxation Technique,” and “dysmenorrhoea.” Studies published between 2014 and 2024 that focussed on women with PD, reported outcomes of PFMT with biofeedback, PRT, or combined interventions, and used validated measures such as the PERFECT score, Visual Analogue Scale (VAS), and psychological assessment tools were included, with only full-text articles. Results: Evidence suggests that PFMT with biofeedback signifi cantly enhances pelvic fl oor strength, as indicated by improved PERFECT scores and reductions in VAS pain scores. PRT consistently reduces anxiety and depression, improving psychological wellbeing. Combined interventions demonstrated superior outcomes, emphasising the synergistic effects of physical and psychological therapies. Conclusion: Perineometer-assisted PFMT is more effective to traditional training due to precise feedback, enabling better adherence and outcomes. Combining with PRT addressees psychological distress, providing a holistic approach to managing Dysmenorrhoea. PhysioConnect 5 International Conference Abstract 11

Effect of Physiotherapy Rehabilitation on Luxatio Erecta and Brachial Plexus Injury:A Case Study

Bhawana Mangla, Bhawna Sharma

Introduction: The shoulder joint, comprising the Glenohumeral Joint (GHJ), scapulothoracic, sternoclavicular, and acromio clavicular joints, is highly mobile but vulnerable to injuries like luxatio erecta. These dislocations often involve soft tissue and bony damage, including brachial plexus injuries. With the help of this study we are focussing on restoring strength, stability, and mobility, with scapular stabilisation and nerve recovery with the help of conservative management. Case Report: A 28-year-old male presented with a traumatic shoulder dislocation, exhibiting an adducted and internally rotated shoulder. Patient presented with pain, altered sensations, and impaired ability to perform Activities of Daily Living (ADLs). Magnetic Resonance Imaging (MRI) revealed a partial supraspinatus tendon tear, subacromial impingement, bursitis, glenohumeral effusion, and a Superior Labrum Anterior to Posterior (SLAP) tear. Nerve Conduction Velocity (NCV) studies confi rmed brachial plexus neuritis affecting the C5-C6 trunk. Initial assessment included restricted Range of Motion (ROM) (10°-20°), weak muscle strength [Manual Muscle Training (MMT) 1/5], absent refl exes, altered sensation, severe pain [Visual Analogue Scale (VAS) 10], and limited functional independence (SPADI 93%, [Disabilities of the Arm, Shoulder and Hand (DASH) 95%] 95%). A 4-month physiotherapy programme comprised: Stage 1: Pain management, ROM exercises, and electrical stimulation. Stage 2: Strength training and functional independence via isometric and Proprioceptive Neuromuscular Facilitation (PNF) exercises with electrotherapy. Stage 3: Resistance training to enhance and maintain strength. Stage 4: Scapular stabilisation and functional strength development. Significant improvements included pain resolution (VAS 0), intact sensations, improved strength (MMT 4/5), reduced SPADI (40%) and DASH (32.5%) scores, better sleep, and enhanced quality of life. Conclusion: Conservative physiotherapy effectively managed the shoulder dislocation, SLAP lesion, and brachial plexus injury, restoring mobility, strength, and function without surgical intervention. PhysioConnect 5 International Conference Abstract 12

Inspiratory Muscle Training for Respiratory Muscle Strength and Pulmonary Function in Female Breast Cancer Patients:A Systematic Review

Aaliya Javed, Neha Reyalch, Aditi, Upasna, Lakshya

Introduction: Breast cancer, common among women, weakens respiratory muscles and impairs lung function due to chemotherapy,radiotherapy, and surgery. Inspiratory Muscle Training (IMT),combined with aerobic exercise, improves respiratory muscle strength, and reduces dyspnoea. IMT can enhance quality of life for breast cancer patients dealing with fatigue, stress, and posttreatment symptoms. Aim: The study aims to assess the impact of IMT on respiratory mechanics and pulmonary function in breast cancer patients to address treatment-related respiratory diffi culties. Materials and Methods: The review included Randomised Controlled Trials (RCTs) and clinical trials following the PICO method, involving women with stable breast cancer post-adjuvant treatment and reduced inspiratory muscle strength or dyspnoea. Interventions combined IMT with aerobic or other exercises, while control groups received low-intensity IMT. Primary outcomes were respiratory muscle strength and pulmonary function. Study characteristics, participant details, interventions, and trial quality were assessed using the 11-point PEDro scale. Conclusion: The research supports using IMT for post mastectomy breast cancer survivors, combined with therapy or aerobic exercise, to strengthen respiratory muscles, improve performance, and reduce stress and fatigue. While the results are promising, further largescale, multicentre studies are needed to enhance the effectiveness of IMT in breast cancer rehabilitation. PhysioConnect 5 International Conference Abstract 13

Effect of Active Release Technique to Improve Flexibility in Patients with Piriformis Syndrome: A Review

Rasleen Kour, Rita Sharma

Introduction: The present review of literature has been undertaken to discover the “effect of Active Release Technique (ART) in improving the fl exibility in patients with piriformis syndrome”. Piriformis syndrome is a musculoskeletal ailment that causes discomfort. The piriformis muscle spasms and becomes infl ammed as a result of long sitting positions, causing a persistent mechanical defect that eventually compresses the sciatic nerve and causes aches that radiate down the leg. Aim: To identify the effect of active release technique to improve flexibility in patients with piriformis syndrome. Materials and Methods: Using PubMed, Google Scholar, Research Gate, and Scopus, database searches were performed. The keywords: Piriformis, piriformis syndrome, pain, ART in piriformis syndrome, prevention and intervention of piriformis syndrome, range of motion, fl exibility were searched. Articles released within the year 2019-2025 were selected. Languages apart than English were not included. The study encompassed both male and female sexual groups. Data is extracted from proportion of clients in various systematic review and randomised controlled trials. Result: Numerous studies have been conducted individually and on comparison to see the effect of active release technique in reducing pain and improving fl exibility in piriformis syndrome. This technique plays a signifi cant role in reducing pain, improving fl exibility, increasing the functional range of motion and promoting long term relief. However, it is often recommended to combine the use of ART with other physical therapy techniques such as stretching,strengthening, and posture correction. Conclusion: ART has proven to be signifi cantly better when compared to other techniques in reducing pain, improving the fl exibility and range of motion. PhysioConnect 5 International Conference Abstract 14

Compare the Effect of Theragun and Myofascial Release in Patients with Trapezius Myalgia

Abhishek Choudhary, Kriti Sachan

Introduction: The complaint of upper trapezius muscle dis comfort, stiffness, and tightness is known as trapezius myalgia. characterised by sudden or ongoing shoulder and neck discomfort. Various physiotherapy techniques have shown to be effective in trapezius myalgia but myofascial release technique and use of theragun is also proven to be effective. The goal of the current literature review is to compare the effects of theragun and myofascial release technique on trapezius myalgia. Aim: Comparing the effects myofascial release technique and theragun in patients having trapezius myalgia. Materials and Methods: Relevant literature was reviewed using databases like Google Scholar, Pubmed and ReseachGate focussing on studies from the last fi ve years discussing theragun, myofascial release and other techniques in trapezius myalgia management. Data on pain relief, Range of Motion (ROM) improvement and functional outcomes were extracted from the selected studies to find out the effects of techniques such as theragun and myofascial release in trapezius myalgia. Result: Numerous studies have been conducted individually on effects of myofascial release in comparison to other modalities or techniques for treatment of trapezius myalgia. Myofascial release improves the range of motion, increases the fl exibility and reduces the pain. On the other hand, theragun has also shown more signifi cant effect in patients with trapezius myalgia. It also increases ROM by reducing the tension on the muscle and causing pain relief. Conclusion: Myofascial release technique and theragun has proved being signifi cantly better when compared to other techniques or modalities in term of reducing pain, increasing fl exibility, improving ROM in trapezius myalgia. PhysioConnect 5 International Conference Abstract 15

Combined Therapeutic Strategies with Lumbar Stabilisation Training for Mechanical Low Back Pain: A Systematic Review

Dheeraj Kumar Rai, Kriti Sachan

Introduction: Mechanical Low Back Pain (MLBP) is a prevalent condition, often caused by overuse or repetitive strain on the lumbar spine, leading to signifi cant functional impairments. Lumbar Stabilisation Training (LST) has been a key therapeutic approach, focusing on core strengthening to enhance spinal stability. Recent studies suggest that combining LST with other therapeutic strategies may provide superior outcomes in terms of pain reduction, functional improvement, and long-term management. Aim: This review aims to evaluate the effectiveness of combined therapeutic strategies with LST for managing MLBP, by examining the outcomes of comparative and adjunctive studies. Materials and Methods: A systematic search of PubMed, Google Scholar, and Research Gate was conducted using relevant keywords. Randomised controlled trials published on or after 2017 were included in this review. After screening 61 articles, 23 studies focussing on combined therapies with LST for MLBP were selected for the review. Subjects in the study were at-least 18 years old, with pain for more than 12 weeks and site of pain was T12 to gluteal fold, with or without leg involvement. Results: LST is highly effective in managing mechanical low back pain, especially when combined with adjunctive therapies. Studies show LST improves pain, disability, spinal alignment, and range of motion, with enhanced outcomes when paired with treatments like thoracic mobilisation, cervical posture correction, or Muscle Energy Technique (MET). Combinations with walking protocols or respiratory resistance training offer superior functional benefits. LST also performs as well or better than conventional therapies, highlighting its versatility in personalised treatment plans. Conclusion: This review underscores the potential benefi ts of combining LST with other therapeutic strategies for managing MLBP. It suggests that personalised treatment plans, tailored to individual patient needs, are critical for optimal outcomes. PhysioConnect 5 International Conference Abstract 16

Motion, Activities of Daily Livings, and Quality of Life in Patients with Non-Specific Low Back Pain - A Review

Chahina Sharma, Kriti Sachan

Introduction: Non-specifi c low back pain has been found to limit activity, to reduce the productivity at work place and increased medical expenses. Muscle Energy Technique (MET) uses isometric and isotonic contraction that aids to improve musculoskeletal function and also helps in reduction of pain. Aim: To analyse the effect of MET on range of motion, disability,activity of daily living and quality of life of a patient. Materials and Methods: Different search engines were used such as Research gate, Google Scholar, and PubMed to extract relevant studies on MET and its effect on Range of Motion (ROM), disability and activities of daily livings. Studies like experimental studies, randomised controlled trials, and pilot studies were preferred.Studies between 2014-2024 were included to collect the data. Keywords like, nonspecifi c low back pain, MET, functional ability, quality of life, and activities of daily livings were used to find the relevant studies. Results: Subjects introduced with MET along with with other conventional treatment protocol was helpful in improving ROM and disability. It not only improved ROM but also improved the functional ability that would help in improving the quality of life and activities of daily livings. Conclusion: MET can be benefi cial to improve ROM, disability and can also help the subjects to effi ciently participate at their workplace and day to day life and can lead a better life. PhysioConnect 5 International Conference Abstract 17

Effect of Postural Corrective Exercises in Forward Head Posture: A Systematic Review

Hitaishi Tyagi , Rita Sharma

Introduction: Forward head posture is the most common misalignment of the neck. It can lead to headaches, unusual neck pain, and stiffness in muscles. Posture corrective exercises were used to correct this misalignment hence improving the quality of life of the patient. Aim: To identify the effect of postural corrective exercises in forward head posture. Materials and Methods: The articles included were randomised controlled trials and systematic reviews. The databases included were Google Scholar and PubMed. The systematic reviews were taken from 2015-2023. Researchers have used the English language. The studies included were about posture corrective exercises that were used to correct forward head posture. Data were extracted from the proportion of clients in various systematic reviews and randomised controlled trials. Results: Several studies show that postural corrective exercises were effective in correcting forward head posture and improving the craniovertebral angle. These exercises help to improve posture, muscle strength and fl exibility. Conclusion: Forward head posture can be due to poor sitting posture, low height sitting or long hours of use of a laptop. Posture corrective exercises were benefi cial for improving forward head posture and decreasing the craniovertebral angle, which decreases neck pain and enhances the quality of life of patients.Keywords: Forward head posture, exercises, posture, cranio vertebral angle (CVA). PhysioConnect 5 International Conference Abstract 18

Effects of Treadmill-Based Perturbation Training on Balance Impairments in Chronic Obstructive Pulmonary Disease Patients and Older Adults at Risk of Falls : A Literature Review

Riya Sarkar, Sumedha Rabra

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a illness characterised by persistent respiratory symptoms and airflow restriction due to airway abnormalities caused by harmful particles or gases. The main cause is smoking tobacco, but other factors include air pollution and occupational exposures. Diagnostic criteria include a ratio of less than 0.70 between FVC and FEV1. COPD is expected to become a major health issue by 2030. Pulmonary rehabilitation is a multidisciplinary therapy programme that includes quitting smoking, taking prescribed corticosteroids and bronchodilators, and participating in exercise training. It is most effective for COPD patients with reduced quality of life, anxiety, dyspnoea, and those willing to commit to a rigorous education and exercise regimen. Aim: This study is being performed to assess the effectiveness of treadmill based perturbation training on balance in people suffering from COPD, while drawing insights from studies on its application in older adults with balance impairments. Materials and Methods: PubMed, Google Scholar and Research Gate were searched using phrases such as COPD, chronic obstructive pulmonary disease, balance training, perturbation, treadmill, and related topics. Out of the 63 articles that were retrieved, 20 were found to be pertinent following careful examination. Articles published on or after 2018 and randomised controlled trials were included. Systematic reviews, case control studies, articles without abstracts or full English text, articles published on or before 2017 and articles with subjects having a history or risk of dizziness and loss of consciousness were excluded. Results: This review of the literature on perturbation-based balance training in older individuals encompasses a diverse range of research analysing different treatments and their impacts on fall risk, balance, and associated outcomes. Studies conducted by Jens Eg Nørgaard et al. (2023), Leon Brüll et al. (2023), and Natalie Hezel et al. (2023) shed light on the effectiveness of various PBT paradigms, demonstrating reductions in laboratory falls and improvements in fall-risk-related indicators. Investigations by Jacqueline Nestico et al. (2021) provide insights into the mechanisms underlying reactive stability and gait variability as markers of balance control. Additionally, studies by Jon D. Lurie et al. (2020), Yiru Wang et al. (2020), illustrate the ability of PBT to enhance proactive and reactive adaptation, reduce fall-related injuries, and improve voluntary step execution. Moreover, research such as that by Marissa H. G. Gerards et al. (2021) delves into the acceptance of PBT procedures among the elderly population, offering valuable insights for practical application. Conclusion: Perturbation-based training (PBT) shows significant promise in improving balance and reducing fall risk, particularly in older adults. While specific evidence for its application in COPD patients remains limited, the potential benefits suggest PBT could be effective for this population as well. The reviewed literature consistently highlights the efficacy of PBT interventions—whether treadmill-based or stability-focused—in enhancing balance, improving reactive stability, and reducing fall risk. Key factors, such as optimal dose, progression, and training duration, have been identified as crucial for maximising outcomes. Furthermore, the importance of tailoring PBT protocols to individual needs and preferences has been emphasised, with an ongoing need for research to identify the most responsive subgroups. Future studies should focus on long-term effects and further refinement of PBT techniques to ensure broader applicability and effectiveness across diverse patient groups. PhysioConnect 5 International Conference Abstract 19

Effect of Telerehabilitation in Patients with Plantar Fasciitis

Swati Sharma , Kriti Sachan

Introduction: Plantar Fasciitis (PF) is a common musculoskeletal condition. It is a infl ammation of a PF caused by repetitive strain which is characterised by a pain and tenderness in the bottom of the foot which is usually worst in the morning triggered by long periods of standing. Various researches have shown to be effective in various musculoskeletal conditions. The present review of literature have been undertaken to know the effi cacy of telerehabilitation in patients with PF. Aim: To determine the effi cacy of telerehabilitation in patients with PF. Materials and Methods: These articles are collected from databases such as PubMed, Google Scholar, and Research Gate.They are from year 2017-2024. Results: Telerehabilitation appears to be effective in reducing pain and improving physical function in a number of musculoskeletal conditions. Conclusion: Telerehabilitation has shown promising results when compared with other conventional methods in terms of pain relief,improve range of motion. PhysioConnect 5 International Conference Abstract 20

Analysing the Effect of Suboccipital Myofascial Release in Patients with Cervicogenic Headache

Rishika Gurung , Apoorva Tiwari

Introduction: A cervicogenic headache is characterised by unilateral neck pain that originates in the neck and is referred from the neck’s soft tissues or bones. It is a frequent, recurring, persistent headache that typically begins with neck movement. It typically comes with a decreased neck range of motion. People between the ages of 30 and 44 are most likely to experience a cervicogenic headache. Its incidence among headache sufferers ranges from 0.4 to 4%. It could be mistaken for another main headache condition, such as a tension headache or migraine. Cervicogenic headaches can be effectively treated with manipulative therapy and therapeutic activity programs. Aim: To elicit evidence for the effect of the sub occipital release technique in reducing cervicogenic headaches. Materials and Methods: A systematic search was conducted across databases such as PubMed, Scopus and Google Scholar. Keywords such as suboccipital release, physiotherapy, cranial base release, myofascial release, cervicogenic headache, secondary headache, treatment were used. Six free full text articles were identifi ed through PubMed and Google Scholar adhering to objective and inclusion criteria. Results: Patients with cervicogenic headache showed a better improvement after going through suboccipital myofascial release technique than the conventional therapy. The result of this review provides evidence that suboccipital myofascial release has a signifi cant positive effect on the improvement of cervicogenic headaches. Conclusion: The result of this review provides evidence that the suboccipital myofascial release technique is helpful in releasing cervicogenic headaches. PhysioConnect 5 International Conference Abstract 21

Comparing the Effects of Indoor versus Outdoor Exercises on the VO2 Max Amongst the Young Healthy Adults: A Narrative Review

Rajnish Mishra, Baldev Negi

Introduction: Indoor and outdoor exercises both positively impacted VO2 max in young healthy adults. Enhanced VO2 max a key indicator of cardiovascular fi tness, higher intensity workouts yield greater improved VO2 max compared to moderate or low intensity workouts. Outdoor aerobic exercises provided psychological benefi ts such as increased motivation and reduced perceived exertion potentially led betterment in their performance and high heart rates in contrast indoor controlled environment helped in maintaining consistent training intensity . VO2 max is gold standard measure of cardiorespiratory fi tness strongly predicts cardiovascular health. Aim: This narrative review study summarises the effect of indoor and outdoor exercises on VO2 max level of young healthy adults in intense or moderate low intensity workouts . Materials and Methods: The studies included were randomised controlled trials and were published in peer-reviewed journals between 2011-2024. The data was searched in databases like PubMed, Google Scholar and Scopus using the following keywords– indoor versus outdoor, aerobic exercises intense and moderate VO2 max with the help of Boolean operators like AND,OR. Inclusion criteria were studies involving healthy adults aged 18-30 years, with no history of cardiovascular or respiratory diseases, and not currently engaged in regular exercise. Result: This narrative review found that exercises could be joyful in outdoor and indoor environment depending upon performing intense or less intense exercise which can improve psychological condition of the person. Conclusion: This narrative review concluded that outdoor intense exercises not only boost up VO2 max but also developed athletic strength of endurance who ever taken participation in this randomised controlled trial indoor versus outdoor condition. PhysioConnect 5 International Conference Abstract 22

Effectiveness of Postural Training with Self-Management Exercises on Pain and Range of Motion in Patients with Text Neck Syndrome

Avinash Kumar, Rita Sharma

Introduction: Text Neck Syndrome (TNS) is a prevalent musculoskeletal condition caused by repetitive forward head fl exion during prolonged use of mobile devices. This condition can result in chronic pain, reduced cervical Range of Motion (ROM), and poor posture, impacting daily life and productivity. Aim: The study reviews the combined effectiveness of postural training and self-management exercises in reducing pain and improving ROM in patients with TNS. Materials and Methods: Randomised controlled trials in English language, published between 2020 and 2024, related to postural training and self-management exercises in TNS were included. A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and Research Gate, focussing on studies published between 2020 and 2024. After searching the databases, 10 free full text articles that fulfi lled the objective and inclusion criteria were included in the review. Results: Findings from the reviewed studies suggest that integrated postural training is more benefi cial compared to conventional exercise programmes in treating TNS as a whole. Correcting awkward neck postures while using mobile devices is an important strategy to reduce or prevent neck pain among users of mobile devices. Postural Retraining Exercise Programme (PREP) can improve the movement patterns and the alignment of the head,shoulder & thoracic spine in people with TNS. Conclusion: The study concludes that postural training combined with self-management exercises is an effective strategy to alleviate pain, improve ROM, and enhance functional posture in patients with TNS. This integrated approach offers promising applications for physiotherapists and clinicians. PhysioConnect 5 International Conference Abstract 23

Effect of Tissue Flossing for Improving Hamstring Tightness in University Going Students: A Review

Simren Parihar, Kriti Sachan

Introduction: Muscle tightness is the state of activity or tension of a muscle beyond that related to its physical properties, which is its active resistance to stretch. The typical pattern of tightness in striated muscles is responsible for the postural function. Tightness in hamstring muscle causes posterior pelvic tilt which lead to decrease in lumbar lordosis result in low back pain. There are many things that may cause hamstring tightness. Sitting for prolong period of time shortens the hamstring muscle. Prevalence is about 58.33% of males and 95.85% of females have hamstring muscle tightness. Tissue flossing was first proposed by Starrett and Cordoza(2015), who suggested that flossing can increase the range of motion and/or performance (e.g., strength or jumping performance), speed up recovery, and decrease pain caused by various disease or injurie’s. Materials and Methods: Various research articles was searched using the database such as PubMed, Research Gate, Google Scholar, and Scopus. Randomised controlled trials that studied both short and long term effects of tissue flossing were selected. Randomized controlled trial, interventional studies, crosssectional studies, and surveys between 2018 to 2025. Results: Majority of the reviewed studies indicated that tissue flossing improves the range of motion, increase the flexibility, muscle activation and reduce the pain. This technique have been proven to be effective in comparison with various other technique Conclusion: Tissue flossing when given individually and in combination has proven to be effective in reducing pain, enhancing functional and improving the range of motion. PhysioConnect 5 International Conference Abstract 24

To Evaluate the Effect of Incentive Spirometer and Autogenic Drainage in Postoperative Recovery Following CABG for Triple Vessel Disease: A Case Study

Sakshi Tiwar, Sumedha Rabra

Background: One crucial therapy for triple vascular illness is Coronary Artery Bypass Grafting (CABG), which aims to restore heart blood fl ow. Atelectasis, pneumonia, and decreased lung volumes are examples of pulmonary dysfunction that can impair postoperative recovery and prolong hospital stays. With procedures like autogenic drainage and incentive spirometer being frequently suggested to enhance pulmonary function and lower complications, physiotherapy is essential for improving postoperative recovery. In order to speed up recovery, these methods seek to increase lung expansion, mobilise secretions, and promote oxygenation. This case study aims to investigate these elements in further detail because, despite their widespread usage, there are gaps in the information about the comparative effi ciency of various therapies in CABG patients with triple vessel disease. Purpose: The aim of this case study was to evaluate the effect of incentive spirometer and autogenic drainage in postoperative recovery following CABG for triple vessel diseases. This case study provide a summary of the available data on the benefi ts of autogenic drainage and incentive spirometry for postoperative recovery after coronary artery bypass grafting (CABG) for triple vascular disease. To fi nd the the effects of these interventions on pulmonary function, postoperative complications, and reduce the length of hospital stay. Result: Both incentive spirometer and autogenic drainage were found to signifi cantly improve pulmonary function, reduce respiratory complication and enhance the strength of the muscle, reduction in the hospital stay. Conclusion: The Incentive Spirometer and autogenic drainage were very effective in postoperative coronary artery bypass grafting. There length of hospital stay was reduce & pulmonary function get enhanced. PhysioConnect 5 International Conference Abstract 25

The Role of Sensory Re-Education Exercises in Diabetic Peripheral Neuropathy Management:A Narrative Review

Somya Sharma, Apoorva Tiwari

Diabetic neuropathy is a heterogeneous group of disorders with extremely complex pathophysiology and affects both somatic and autonomic components of the nervous system. The pathology of diabetic neuropathy is characterised by progressive nerve fi bre loss that gives rise to positive and negative clinical sign and symptoms such as pain, paresthesia and loss of sensation. Neuropathy is the most common chronic complication of diabetes mellitus, resulting from long term high blood sugar levels that damage peripheral nerves, particularly in the limbs. This condition can lead to sensory loss, affecting somatosensation and balance. Articles published in peer-reviewed journals between 2015 to 2024 focussing on diabetic peripheral neuropathy and sensory re-education. The main outcome measures were semmes-weinstein, monofi laments neuropathic pain questionnaire, Cumulative Sensory Impairment Scale (CSIS), sensory and nerve conduction parameters, BBS, SF-36. The review was conducted across databases such as PubMed, Scopus and Google Scholar. Keywords included “sSomatosensory,” “diabetic population,” “sensory re-education exercises,” and “neuropathy”. Six free full-text articles were identifi ed through PubMed and Google Scholar, adhering to objectives and inclusion criteria. Numerous studies have been conducted to analyse the role of sensory reeducation exercises in diabetic population and signifi cant changes were found, and improvement was noted in somatosensory component, post sensory re-education exercises. The study concluded that sensory re-education and interventions improve sensory and motor function in individuals with Diabetic Peripheral Neuropathy (DPN). Innovative tools like the diabetic exercise mat also enhance outcomes, reducing fall risk and improving quality of life for patients with type 2 diabetes. PhysioConnect 5 International Conference Abstract 26

Anthropometric Analysis in Recreational Runners: A Narrative Review

Isha Kroliya , Baldev Negi

Recreational runners are a diverse group whose performance is infl uenced by multiple factors, including biomechanical, physiological, and anthropometric variables. Recent studies have explored how training modalities like running-specifi c strength training, endurance training, and concurrent training affect both performance and anthropometric parameters in this population. Understanding these predictors is crucial for optimizing performance and preventing injuries among recreational endurance athletes. This review aims to evaluate the role of anthropometric variables in predicting performance in recreational runners, summarising fi ndings from studies on various training methods and their imparts on these parameters. Thus study focussed on recreational runner, assessed anthropometric variables related to performance, and discussed training modalities such as strength, endurance, or concurrent training. The studies were published as full-text articles in English. PubMed and Google Scholar were searched using terms like “anthropometric analysis,” “recreational runners,” “performance predictors,” and “training effects”. Relevant data on anthropometric variables, training methods, and performance outcomes were extracted from selected studies. A total of 5 studies were included. Studies from Brazil, Spain and Greece. Anthropometric variables such as body composition, limb proportions, and muscle mass were signifi cant predictors of performance. Training methods had varying effects on these variables, infl uencing endurance and overall performance. Anthropometric analysis provides valuable insights into recreational runners’ performance. Tailored training strategies can enhance outcomes and reduce injury risks. PhysioConnect 5 International Conference Abstract 27

Effectiveness of Janda’s Approach in Managing Upper Crossed Syndrome:A Systematic Review

Prerona Krishna , Mayank Shukla

Introduction: Upper Crossed Syndrome (UCS) is a common neuromotor disorder causing postural imbalance affecting the neck, shoulders, and postural asymmetries in sagittal plane as well as multiple planes frequently causing pain, thoracic kyphosis, myofascial disorder, load transfer, sensory and kinetic chain function and movement dysfunction. Janda’s approach - emphasising muscle imbalance correction, motor control, and therapeutic exercises, provides a holistic framework for physiotherapy interventions. This study contributes to evidencebased practice by exploring the potential benefi ts of Janda’s approach in managing UCS in multiple planes, thereby enhancing clinical management, physiotherapy education, and development in addressing postural asymmetry, myofascial disorder and postural disorders. Aim: The primary objective of this study was to evaluate the effects of Janda’s approach on individuals with neck and upper back pain due to UCS. Secondary objectives included assessing its impact on muscle imbalance, posture correction, range of motion, and flexibility improvement. Materials and Methods: The study data bases were searched from PubMed, Google Scholar, and Research Gate. The systematic reviews were taken from 2015-2024. The papers articles investigating the effect of Janda’s approach on neck pain, upper crossed syndrome and forward head posture were included. Results: This approach is highly effective in reducing pain, improving range of motion and fl exibility, and restoring proper movement patterns. It has been shown to be more effective compared to other approaches. Janda’s approach for UCS focusses on strengthening weak muscles and stretching tight ones to correct muscle imbalances, posture, range of motion, and fl exibility may vary based on individual factors and any underlying health conditions. Conclusion: Janda’s approach demonstrates substantial therapeutic benefi ts in managing UCS by addressing muscle imbalances and promoting proper postural alignment. Strengthening weak muscles while lengthening tight ones leads to improved posture, reduced pain, enhanced fascia and enhanced functional movement. However, its effectiveness may vary based on localized trigger point and tender points, individual and contextual factors. PhysioConnect 5 International Conference Abstract 28

Efficacy of Physiotherapeutic Intervention in Pneumonia Patients: A Narrative Review

Nayuma Rai, Shivpriya Sharma

Pneumonia is an acute respiratory infection of the lower respiratory tract. It is actually an umbrella term for a group of symptoms caused by organisms which maybe bacteria, viral or fungal, manifesting a variety of clinical features. Chest physiotherapy has gained popularity for resolving pneumonia in the recent years. This review aimed to analyse the effect of physiotherapy interventions on pneumonia patients. Keywords like pneumonia, airway clearance, chest physiotherapy, and respiratory physiotherapy wereemployed to identify relevant studies. A comprehensive literature search was conducted across various reputable sources, including Google Scholar, PubMed, Scopus, and Web of Science. Relevant literature was systematically identifi ed and analysed. A thorough evaluation of 20 articles was undertaken to draw a relevant result. A comprehensive review of several studies was conducted to assess the effi cacy of chest physiotherapy in pneumonia patients. Out of the identifi ed studies, 20 full-text articles were included in this analysis. These studies demonstrated that chest physiotherapy effectively improved functional ability, muscle strength, and SpO2 levels, ultimately enhancing the quality of life for pneumonia patients Chest physiotherapy is a simple yet effective therapeutic intervention employed in the management of pneumonia patients. PhysioConnect 5 International Conference Abstract 29

Effect of Retro-Walking on Low Back Pain in Basketball Players: A Review

Mohit Kumar Singh, Archana Khanna

Introduction: Basketball is a high-intensity, semi-contact sport characterised by rapid multidirectional movements that place signifi cant strain on players’ musculoskeletal system, particularly the lower back. Retro walking or backward walking has recently emerged as a new concept in rehabilitation that has different pattern of muscle activation. It improves balance, posture, and muscle activity simultaneously reducing stress on the joint. Aim: To review the effect of retro walking on Low Back Pain (LBP) in basketball players. Materials and Methods: Randomised controlled trials published from 2018 to 2024 that explored retro walking’s impact on LBP and were openly accessible were included. A comprehensive literature review was conducted using various databases such as PubMed, Google Scholar, and Research Gate, using the following keywords:Retro Walking, Low Back Pain, Basketball Players, Performance Measures, Agility, Dynamic Balance, and Flexibility. After screening 10 free-full text articles were included in the review that fulfilled the requirements of inclusion criteria. Results: Retro walking has a positive impact on both LBP and performance measures among basketball players. Participants who engaged in retro walking interventions experienced improved scores on pain assessment tools such as the numerical pain rating scale and Oswestry Disability Index. Additionally, retro walking contributed to enhanced dynamic balance, agility, and overall performance. Conclusion: The fi ndings from this review suggest that retro walking may offer a unique and effective intervention for managing low back pain and enhancing performance measures among basketball players. Further research is needed to validate these effects and establish retro walking as a standard part of rehabilitation and training regimens for athletes. PhysioConnect 5 International Conference Abstract 30

Blood Flow Restriction Training on Chronic Stoke Patient: A Review

Neha Singh Shishodia, Vishal Sharma

Introduction: Stroke is a leading cause of long term disabilities characterised by muscle weakness, motor dysfunction and reduced physical activity. Conventional treatment approach consists of improving motor functions using stretching, strengthening and functional training. Blood fl ow restriction training is a newer form of strength training for stroke rehabilitation. Blood fl ow restriction training combines low intensity exercises with partial vascular occlusion, using a cuff or band that restricts venous blood flow while maintaining arterial infl ow. This method allow patients to gain muscle strength & hypertrophy, thus improving functional mobility. Aim: To review the effect of blood fl ow restriction training on chronic stroke patient for improving muscle strength and functional mobility. Materials and Methods: Articles in English, published between 2018 to 2024, inluding chronic stroke patients were included. The review was conducted using databases like PubMed, Google Scholar, and Research Gate. After searching the databases, 25 fulltext articles that fullfi llied the inclusion criteria and objectives were included in this review. Qualitative analysis of data was done. The major trends found were muscle hypertrophy, increased muscle strength and functional mobility. Results: The search identifi ed 40 studies, after the screening of titles, abstract and full text, 25 studies were included in the fi nal analysis out of 25 studies,16 studies showed signifi cant improvement of blood fl ow restriction training on chronic stroke patients. Nine studies suggested no signifi cant improvement. However no side effects were noted in any study. Conclusion: The key conclusion of the review is that blood flow restriction training is benefi cial for chronic stroke patients and that should be included in clinical practice. However, blood flow restriction training is a new method and should be more explored in order to provide greater evidence to be recommended for patient usage. PhysioConnect 5 International Conference Abstract 31

Comparative Effects of Kinesiology Taping and Mcconnell Taping on Chronic Ankle Instability in Recreational Runners

Amrita Kapoor, Adil Ali Ansari

Introduction: Running is one of the numerous activities that has grown in popularity as it can be done anywhere and anytime. A common ailment happens during running is ankle instability, which is linked to anomalies in postural stability. In recent times, there has been a growing interest in Kinesiology Taping (KT) and McConnell Taping (MT) as tools for injury prevention, rehabilitation, and stability enhancement. Aim: To bring forth a comprehensive review of the present position in the literature about the study. The study included randomised controlled trials, experimental studies, and case studies and all studies published between 2018–2024.Various databases like Google scholar, PubMed, ResearchGate were searched and articles from 2018-2024 and were reviewed in this study, total 20 articles were reviewed. Result: MT seems to provide more stability as compared to KT,whereas KT provides better proprioception. Conclusion: It can be concluded that, there were signifi cant improvement in postural stability by using KT. Further, it was seen that MT improves stability more than KT and it also improves functional performance and dynamic balance. The limitation to this study was lack of research on effects of MT, hence further studies can consider studying the same. PhysioConnect 5 International Conference Abstract 32

Effect of Virtual Reality (VR) on Gait and Balance in Chronic Stroke Patients:

Omary Mussa Karata, Vishal Sharma

Background: Stroke causes sudden, focal (or global) cerebral function disturbance lasting over 24 hours. It is the second leading cause of death globally and a major cause of disability. Stroke rehabilitation often includes conventional therapies for lower limb impairments, but motivation remains a challenge. Virtual Reality (VR) technologies, such as immersive, non-immersive, augmented, gamifi ed, and mobile VR, enhance patient engagement and feedback compared to traditional methods. Objective: To evaluate the effects of VR on gait and balance in chronic stroke patients. Inclusion Criteria: Reviews published from 2019-2025, involving adults (18-85 years) diagnosed with chronic stroke and treated with VR (immersive, semi-immersive, or non-immersive), alone or combined with conventional therapy. The primary outcome was gait and balance. Methods: Articles (2019-2025) were sourced from PubMed, Google Scholar, Scopus, PEDro, HINARI, and Cochrane Library using keywords like VR, rehabilitation, gait, and balance. Of 36 initial articles, 15 met inclusion criteria. Results: Studies showed signifi cant improvement in balance and leg strength using VR. Stroke patients with immersive head-mounted displays demonstrated slower cadence, altered stance, and swing times. VR training, being intensive, engaging, and varied, provided realistic and safe simulations for daily activities. Conclusion: VR, alongside conventional therapy, signifi cantly improves gait, balance, trunk control, and functional mobility in chronic stroke patients, though it lacks real-life applications compared to game-based simulations. PhysioConnect 5 International Conference Abstract 33

Effect of Kinesio Taping in Shoulder Impingement Syndrome in Volley Ball Players: A Review

Aman Kumar, Archana Khanna

Introduction: Volleyball requires extensive use of the shoulder joint, with repetitive overhead activities that may result in Shoulder Impingement Syndrome (SIS). SIS involves compression and abrasion of the rotator cuff structures, leading to pain, reduced range of motion, and diminished sports performance. Kinesio Taping (KT) is known for its potential to reduce pain, improve joint stability, and promoting muscle function among players. Aim: To review the effectiveness of KT in addressing SIS and enhancing performance measures among volleyball players. Materials and Methods: Randomised controlled trials in English language, published between 2010 and 2023, related to KT on volleyball players were included. A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and Research Gate, focussing on studies published between 2010 and 2023. After searching the databases, 10 free full text articles that fulfi lled the objective and inclusion criteria were included. Results: Findings from the reviewed studies suggest that KT can signifi cantly reduce pain and improve scapular kinematics in athletes with SIS. However, its effi cacy compared to conventional physiotherapy modalities or other interventions, such as subacromial corticosteroid injections, remains inconclusive. Conclusion: KT offers a viable alternative for managing shoulder impingement syndrome among volleyball players, especially for short-term pain relief and functional improvement. However, more robust and controlled studies are required to establish its efficacy as a standalone treatment or in combination with conventional therapies. PhysioConnect 5 International Conference Abstract 34

Effects of Hold-Relax Technique on Pain, Range of Motion in Patients with Knee Osteoarthritis

Shwarya Mahajan, Rita Sharma

Introduction: Knee osteoarthritis (OA) is a chronic condition that leads to signifi cant pain and reduced mobility, impacting quality of life. Physical therapy, including manual techniques like mobilisation and stretching, plays a crucial role in managing OA symptoms. Aim: This study aims to fi nd out the effects of hold-relax technique on pain, Range of Motion (ROM) in patients with knee osteoarthritis Materials and Methods: Patients diagnosed with knee OA, aged 40 years and above, experiencing pain and mobility limitations. were included. Relevant literature was reviewed using databases like PubMed, Google Scholar, and Cochrane Library, focusing on studies from the last 10 years discussing hold-relax techniques in OA management. Data on pain relief, ROM improvement, and functional outcomes were extracted from the selected studies and to fi nd out the effects of hold relax technique in knee OA. The review presents the effects of hold-relax technique in knee OA patients, focussing on the effect on pain reduction, joint function,and overall quality of life improvement. Results: Hold-relax technique showed significant improve ments in pain relief and ROM. Conclusion: According to the studies, hold-relax technique appears effective in enhancing functional outcomes in knee OA patients. Further research with larger sample sizes is recommended to confirm these findings and optimise treatment protocols. PhysioConnect 5 International Conference Abstract 35

Evaluating the Effectiveness of Motor Re-Learning with Task-oriented Approach versus Traditional Methods in Upper Extremity Rehabilitation for Post-Stroke Patients

Shaonli Das, Meenakshi Verma

Introduction: Stroke accounts for the second leading cause of death in the western world. Upper limb disability is common & severely affects everyday activities. Muscle weakness, spasticity, decreased motor function as well as reduction in quality of life which highlights the need for effective rehabilitation to restore function. Aim: The aim of the study is to analyse the effectiveness of motor relearning with task-oriented approach in upper extremity rehabilitation for post-stroke patients. Materials and Methods: A systematic search was performed across several electronic databases, including Google Scholar, Research-Gate, PubMed, and Scopus, using relevant scientific terms. Articles published between 2013 to 2024 assessing the effects of a task-oriented approach, motor re-learning on stroke patients were included in the review. Initially 81 articles were identified , after removing 10 duplicates, excluding 28 for non-eligibility, 13 for inaccessibility, 4 for inconsistent results, and 6 during data extraction, 20 relevant articles were included in this review. Selected studies were extracted, including study design, sample size, intervention methods (task-oriented approach, and motor re-learning), outcome measures (Box and Block Test, Fugl-Meyer Assessment, FIM, Nine-Hole Peg Test) and key findings. Results: The results depicted that there has been marked increase in gross motor and fi ne motor skills, hand dexterity whereas decrease in tone when compared pre and post-test results. The combination of motor relearning with the task-oriented approach demonstrated superior outcomes compared to conventional therapy. Conclusions: The study indicates that combining the motor relearning program with a task-oriented approach in stroke patients has been more effective than traditional training. For future physiotherapy applications, it can be explored as a standard practice to enhance functional recovery in stroke patients. PhysioConnect 5 International Conference Abstract 36

A Comparative Analysis of Electrical Stimulation with Kabat and Proprioceptive Neuromuscular Facilitation Technique on Bell’s Palsy Patients

Manisha Kumari, Meenakshi Verma

Introduction: Bell’s palsy is a neurological condition infl uenced by immune, infective, and ischaemic mechanisms, though its exact cause remains unclear.This study aims to evaluate the effectiveness of electrical stimulation compared with Kabat and proprioceptive neuromuscular facilitation techniques in treating Bell’s palsy patients. Aim: This study aims to compares the effi cacy of electricalstimulation and Kabat-techniques and proprioceptive-neuromuscular- facilitation in Bell’s palsy rehabilitation, aiming to identify the most effective approach for improving muscle function, facial symmetry, and recovery. Materials and Methods: In this study review was conducted using databases like PubMed and Scopus, focussing on studies published between 2014-2024. Inclusion criteria covered clinicaltrials and studies comparing electrical stimulation with Kabat and proprioceptive neuromuscular facilitation techniques. Data on outcomes such as muscle function and facial symmetry were analysed to assess efficacy. Result: The 21 articles-used various outcome measures, including the House-Brackman Scale, Sunnybrook Scale, and Facial Disability Index (FDI). Results show that therapeutic methods, especially the Kabat technique and electrical stimulation, are highly effective in treating Bell’s palsy. Conclusion: The therapeutic methods are very helpful in treating patients with Bell’s palsy, specially according to our topic the Kabat technique and electrical stimulation shows great result. PhysioConnect 5 International Conference Abstract 37

Effectiveness of Tailormade Physiotherapy Protocol in 42-years Old Female Patient Suffering from Ankylosing Spondylitis: A Case Study

Kanchan Goyal, Smati Sambyal, Sandeep Kumar

Ankylosing Spondylitis (AS) is a chronic infl ammatory arthritis that primarily affects the axial skeleton and is often underdiagnosed in females due to atypical presentations, such as peripheral joint involvement. Early intervention, especially through physiotherapy, is crucial for symptom management and preventing disease progression. This case study evaluates the effectiveness of a tailored physiotherapy protocol in improving pain, stiffness, functional ability, and mobility in a 42-year-old female patient with AS. A 42-year-old overweight female (body mass index: 26.5) with a 10-year history of hip pain, stiffness, and reduced spinal mobility, along with a family history of HLA-B27 positivity and arthritis, underwent an 8-week physiotherapy programme. The 60-minute sessions included hot packs, Transcuataneous Electrical Nerve Stimulation (TENS), Ultrasound Therapy (UST), resistance and spinal mobility exercises, ergonomic training, and a home exercise plan. Outcomes were assessed using Numeric Pain Rating Scale (NPRS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Modifi ed Schober Test, and lateral spinal fl exion test. The physiotherapy intervention signifi cantly improved the patient’s condition, reducing pain (NPRS: 8 to 2), functional impairment (BASFI: 5.4 to 2.1), and disease activity (BASDAI: 6.3 to 2.3). Spinal mobility also improved, with the Modifi ed Schober Test increasing from 3 cm to 4.5 cm and Lateral Spinal Flexion improving bilaterally (right: 10 cm to 12 cm, left: 9 cm to 11 cm). These results highlight the program’s effectiveness in reducing pain, enhancing mobility, and improving function. The tailored physiotherapy programme effectively reduced pain and stiffness, enhanced mobility, and improved functional ability in a female AS patient. This case highlights the need for individualised physiotherapy regimens to address gender-specifi c challenges in managing AS. PhysioConnect 5 International Conference Abstract 38

Two-Dimensional Analysis for Comparison of Biomechanical and Gait Parameters between Male and Female Young Adults with Obesity

Karina Choudhary, Manibhadra Panda

Objective: To compare the gait and biomechanical parameters among obese adult males and femalesusing two-dimensional analysis. Materials and Methods: This observational study included 42 obese young adults (21 males, 21 females) from Department of Sports Physiotherapy, MGM School of Physiotherapy, Aurangabad, Maharashtra, India, with age between 18 to 25. Participants were chosen based on the inclusion and exclusion criteria, and test method was explained to them. Informed consent was taken. Each subject was asked to walk on treadmill at a speed of 0.50 to 1.75 m/s. The videos and pictures of lower extremity were taken from three views i.e. anterior, posterior and lateral. The videos and pictures were then uploaded on the Two-Dimensional (2D) motion analysis software “Kinovea”. All the parameters were analysed further. Results: The normality test using the Shapiro-Wilk test revealed that the data for most variables were not normally distributed, as indicated by p-values less than 0.05 for several variables, suggesting the use of non-parametric tests for further analysis. In gender distribution, both males and females were equally represented (50% each), with 21 participants per group. Q-angle (p = 0.001) and Heel strike (p = 0.044) showed signifi cant differences between both the populations, with males showing lower values compared to females. No signifi cant differences were found for Tibial torsion and Leg heel alignment. Sagittal plane gait parameters showed signifi cant differences in the maximum hip fl exion (p = 0.002), maximum knee flexion (p = 0.008), and maximum knee extension (p = 0.009), with males demonstrating lower values for hip fl exion and higher values for knee extension compared to females. However, no signifi cant differences were observed in the maximum hip extension, maximum ankle dorsifl exion, and maximum ankle plantarfl exion. Spatiotemporal gait parameters revealed signifi cant differences in swing time (p = 0.049), toe-out angle (p = 0.001), and pelvic inclination (p = 0.004), with males showing shorter swing times, lower toeout angles, and lower pelvic inclination compared to females. No signifi cant differences were found in stance time, step length, or cadence. Conclusion: Differences in Body Mass Index (BMI), Q-angle, joint movements, and pelvic inclination indicate distinct anatomical and biomechanical profi les between males and females. These variations have clinical implications, emphasising the importance of genderspecific treatment and rehabilitation strategies. The study highlights how understanding these differences can improve management of musculoskeletal conditions and optimise movement patterns based on gender. PhysioConnect 5 International Conference Abstract 39

Exploring the Role of Neuromodulation in Enhancing Creative Thinking: A Narrative Review

Jyoti James, Sidharth Bansal

Cognition comprises mental operations including reasoning, problem-solving, and decision-making. In this context, creative thinking would be an important function to be considered.Neuromodulation, through electrical or magnetic stimulation of specifi c areas in the brain, can be employed to modulate such processes by boosting cognitive performance as well as boosting creativity. This review aimed to cover all the existing evidence on the impacts of neuromodulation methods on creative thinking. This review focussed on experimental studies on neuromodulation for enhancing creativity among healthy adults, including students and professionals. The literature was narrowed down to studies published in the last 10 years, focussing on divergent and convergent thinking, verbal creativity, and intelligence tests, in order to make the literature relevant and rigorous. A literature search was conducted using PubMed, PEDro, and Google Scholar using the combined terms related to “neuromodulation” and “creative thinking.” Thematic and qualitative analysis of the studies was conducted to analyse the impact on creative thinking, verbal creativity, and task-specifi c outcomes infl uenced by modulating parameters. The fi ndings of the study indicate that neuromodulation techniques, specifi cally tDCS, improve creative thinking. Other techniques also exhibited positive effects but dearth of literature available on longitudinal and omparative studies involving other forms of neuromodulation such results are very encouraging. Neuromodulation enhances creativity through task-specifi c and modality-dependent effects. Long-term effects should be observed in future studies, and the standardisation of protocols with the optimisation of stimulation parameters would be essential. PhysioConnect 5 International Conference Abstract 40

Immediate Effects of Fartlek Training on Blood Lactate Levels – Post-exercise in a Recreational Runner: A Case Study

Avneet Kaur Saini, Aditi Upmanyu, Amit Kumar

Fartlek training, a form of unstructured interval training, involves alternating between periods of high and low intensity during a single workout session. It is widely adopted by recreational and competitive athletes for enhancing both aerobic and anaerobic capacity. Blood lactate concentration is a key biomarker used to assess metabolic stress and performance adaptation following high-intensity exercise. While traditional interval training’s impact on lactate dynamics is well-documented, there is limited research on the immediate effects of Fartlek training on blood lactate levels, particularly in recreational runners. Oxygen saturation (using pulse oximeter), pulse rate (breaths per minute),physical activity (6-minute walk distance) and perceived levels of exertion (RPE) using modified Borg scale corresponding to pre and post levels of blood lactate were measured in 19-year-old recreational runner. Before investigating the levels of blood lactate, participant performed 6-minute walk distance to quantify the physical exertion. The distance covered by participant was 690 metres. Pre and post blood lactate levels in participant were 11.40 mg/dL and 12.50 mg/dL respectively. According to the reports, participant maintained the normal limits of blood lactate levels. With this we can conclude that there is no or minimal effects of Fartlek training. PhysioConnect 5 International Conference Abstract 41

Evaluating the Effectiveness of Virtual Reality and Conventional Therapy for Improving Balance and Fall Prevention in Geriatric Population: A Systematic Review

RIYA JAIN, SUNITA KUMARI, POOJA SHARMA, DIVYA AGGARWAL, KANGANA JUNEJA KANSAL

Background: Elderly people are more susceptible to balance impairments and associated injuries. Innovative interventions including Virtual Reality (VR), Motor Imagery (MI) training have the potential to enhancing balance, mobility & functional outcomes. Through visual and auditory feedback, VR improves motor learning and MI stimulates brain pathways to strengthen motor patterns. This review evaluates evidence from studies comparing VR, MI & conventional exercises for enhancing balance and lowering fall risks among older adults. Purpose: To evaluate the comparative effectiveness of VR-based and conventional therapies in enhancing balance and preventing falls in older adults. Inclusion Criteria: All the articles included in this review involved interventions using VR and conventional exercises. The article has to be written in English language. Methods: A comprehensive literature search will be conducted across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar focused on VR and conventional approaches. 20 articles included in the review. Results: VR interventions demonstrated signifi cant improvements in balance and fall risk metrics, comparable to conventional therapies. Common assessment tools including Time Up and Go Test and Berg Balance Scale demonstrated improvements across interventions. Participants in VR programs showed higher adherence and motivation, highlighting its practicality and acceptability among elderly. Combined interventions including VR and motor imagery, enhanced both physical and cognitive outcomes. Conclusion: VR-based therapy is a promising alternative to conventional exercises for improving balance and reducing fall risks in older adults. However, further research is needed to optimize protocols and explore long-term effects. Implications: These fi ndings support integrating VR-based interventions into geriatric rehabilitation to promote independence and reduce fall-related injuries. PhysioConnect 5 International Conference Abstract 42

Revolutionising Muscular Dystrophy Rehabilitation: The Role of Cutting-Edge Physiotherapy Technologies

Introduction: Muscular dystrophy encompasses a group of genetic disorders characterised by progressive muscle weakness and wasting. Although it is currently incurable, physiotherapy plays a vital role in managing the condition and enhancing quality of life. Traditional physiotherapy techniques include stretching, strengthening exercises, and electrical stimulation, while contemporary approaches have expanded to incorporate virtual reality, tele-rehabilitation, and Artifi cial Intelligence (AI) technology. This review aims to evaluate and synthesise available evidence on the effectiveness of both conventional and modern physiotherapy interventions in managing muscular dystrophy. Aim: The purpose of this study helps in understanding the evolution of physiotherapy approaches and evaluating which among them is more effectively managed to get a sound informed decision for the practioner to support more evidence based practice. Materials and Methods: The articles in English language, and articles relating to the usage of both the treatment approaches were used for the current review. A comprehensive literature search across PubMed Central, Google Scholar, Scopus, and Web of Science focussed on conventional exercise-based and technologydriven contemporary approaches. Of 35 articles reviewed, 20 met the inclusion criteria for this study. Results: Telerehabilitation, Virtual Reality (VR) and AI based technologies are emerged in managing with multiple goals whereas aqua therapy, electrical stimulation and exercises are also support evidence based practices. Hence, treatment protocol are tailored to individual patient needs. Conclusion: The current review provides a comprehensive overview that both conventional and contemporary approaches managing effectively as per the need and requirement of the patient population. PhysioConnect 5 International Conference Abstract 43

Efficacy of Muscle Energy Technique versus Conventional Treatment on Pain, Range of Motion, Functional Disability and Quality of Sleep in Patients with Idiopathic Adhesive Capsulitis

SHAGUN BHARDWAJ, NITI PRAKASH

Introduction: Adhesive capsulitis is a common musculoskeletal disorder and is defined as a condition in which inflammation of the joint capsule that preserves the glenohumeral joint give rise to pain, stiffness, along with tightness during movement of glenohumeral joint. Aim: To evaluate the efficacy of Muscle Energy Technique (MET) along with conventional treatment and conventional treatment alone on pain, range of motion, functional disability and quality of sleep in patients with adhesive capsulitis. Materials and Methods: A total of 26 participants were included. Patients were divided into 2 groups Group A and Group B. Both male and females were included of 40-60 years of age, 2nd and 3rd stage of idiopathic adhesive capsulitis, unilateral involvement, having painful stiff shoulder for at least 3 months. Group A received MET along with conventional treatment and Group B received conventional treatment. Pre intervention measurements was taken on day 1 before treatment and post treatment measurements was taken on day 21 after treatment for pain, range of motion, functional disability and quality of sleep. The study protocol has been approved by the Institutional Ethics Committee of Saket College of Physiotherapy, Chandimandir, Panchkula. The study is registered under Clinical Trials Registry - India with Registration No. CTRI/2024/02/062932. Results: Within group analysis was done using t-test and for between group t-test and non parametric test were used. There is a significant reduction in pain, increase in shoulder fl exion, extension, abduction, external and internal rotation, reduces functional disability and improves quality of sleep (p<0.05). Conclusion: The study finding demonstrated that both MET along with conventional and conventional treatment alone were effective but MET along with conventional treatment was more effective for reducing pain, improving range of motion, reducing functional disability and improving quality of sleep. PhysioConnect 5 International Conference Abstract 44

Testing the Immediate Effectiveness of Myofascial Release of Gastrocnemius on Pain and Dorsiflexion Range of Motion in Plantar Fasciitis : A Protocol

RAMA, DIMPLE BHANKAR

Introduction: Plantar fasciitis or plantar heel pain is a commonly reported condition which causes inferior heel pain. Previous studies have shown significant association between the degrees of heel pain with the tightness of the gastrocnemius in cases of plantar fasciitis. Myofascial Release (MFR) is an effective handson approach of soft tissue mobilisation, can be used to reduce pressure in the fibrous bands of the connective tissue. We hypothesize that there will be an immediate effect of MFR on pain and dorsiflexion Range of Motion (ROM). Need of the Study: This study will work towards finding the immediate effectiveness of myofascial release of gastrocnemius on pain and dorsiflexion range of motion, if found effective it can then be used as an immediate pain-reducing and activity enhancing treatment in plantar fasciitis. Aim: To test the immediate effectiveness of MFR of gastrocnemius on pain and dorsiflexion ROM in plantar fasciitis. Materials and Methods: Convenient sampling method will be used. Participants will be screened using the patient screening form. Forty participants who meet the inclusion criteria (male/female, 40-60 years, diagnosed with plantar fasciitis, gastrocnemius tightness) will be included. The purpose, procedure and advantage of the study will be explained to the participants prior to participation. Group A (experimental group) will receive MFR and Group B (control group) will receive sham MFR for 15 minutes. Data will be collected before and after the intervention, followed by conventional treatment in both groups. The study protocol has been approved by the Institutional Ethics Committee of Saket College of Physiotherapy, Chandimandir, Panchkula. The study is registered under CTRI (The Clinical Trials Registry - India) with registration number CTRI/2024/06/068693. PhysioConnect 5 International Conference Abstract 45

Effectiveness of Kinesiology Taping in Chronic Low Back Pain

DARAKHSHA MAHJABIN, ADIL ALI ANSARI

Background: Low back pain (LBP) is the most common musculoskeletal disorder and work-related health problem affecting millions of People. Kinesiology taping(KT) is acommonly used intervention for patients with chronic low back pain. Although it has been used as an additional treatment to conventional physiotherapy interventions the current evidence does not support this intervention. Purpose: The primary goal of this study is to determine the effi cacy of KT in relieving pain improving the disability of patients and increasing the range of motion in this patient with chronic low back pain. Methodology: After carefully looking through many articles published on different databases such as Google Scholar, PubMed, Research Gate, etc. The articles researched and included in this paper are not older than 2018. Data Extraction: Extracted data included participant demo graphics, baseline pain, VAS, NDI, intervention details (KT techniques, duration), and outcomes at 4 weeks. Result: After carefully reviewing the above studies majority of the cases reviewed have shown a positive effect of KT in many cases of chronic lower back pain while improving movement and function of the lower back. KT combined with physical therapy provided better therapeutic effects regarding pain reduction and disability improvement compared with physical therapy alone in individuals with chronic low back pain. Conclusion: Kinesiology taping effectively reduces pain and improves functional disability in CLBP patients. Implication: Kinesiology taping results in decrease in CLBP and improve ROM. PhysioConnect 5 International Conference Abstract 46

Effectiveness of Mckenzie Technique Along with Spinal Manipulation in Mechanical Low Back Pain: A Narrative Review

NIDHI, RAMSHA AHMED

Mechanical Low Back Pain (MLBP) is a common musculoskeletal complaint, signifi cantly impacting quality of life and daily functioning. As one of the leading causes of disability globally, MLBP often requires effective therapeutic strategies to alleviate pain and improve mobility. The McKenzie method is a wellregarded approach for managing MLBP, focussing on patient- led exercises that centralise and reduce pain. Spinal manipulation is used to restore spinal alignment and relieve pain through manual adjustments. This review was done to evaluate the combined effectiveness of the McKenzie method and spinal manipulation in reducing pain and disability among patients with MLBP. The literature search was done from 2015-2023 using the databases Cochrane Library, Google Scholar and PubMed. Studies on McKenzie technique and spinal manipulation for low back pain were reviewed, focussing on treatment methods, pain relief, and functional outcomes. After carefully reviewing the above studies, majority of the cases reviewed have shown a positive effect of Mckenzie technique and spinal manipulation in treating low back pain while reducing pain, disability and improving lumbar Range of Motion (ROM). Above studies have shown that the effect of Mckenzie in reducing pain, disability and improving lumbar ROM is positive but Mckenzie in combination with other techniques such as manipulation has better therapeutic effects. PhysioConnect 5 International Conference Abstract 47

Effects of Dual Task Training on Geriatric Patients with Balance Impairment: A Narrative Review

SHIVANGI GUPTA, APOORVA TIWARI

Dual Task (DT) training a promising approach that helps in improving gait and balance of especially geriatric patients. It includes simultaneous training of motor or cognitive dual tasks with conventional training. Examining and evaluating the effects of DT training on older adults with balance issues is the driving force for this research. In order to identify the best course of action for patients, this study will examine numerous well-established methods. Many databases were searched such as Research Gate, PubMed, and many more. The articles researched and included were not any older than 2013. Extracted data on participant characteristics (age, gender, baseline balance status), dual-task training specifi cs (type, duration, frequency), and outcomes (balance improvement, gait performance, and fall reduction) to assess its effectiveness in geriatric populations. Outcome of this examination reveals positive changes after introducing DT training in the treatment protocol of patients. This introduction also helped in improving both static and dynamic balance especially with patients having a history of tumbling. Outcome of this study further proves the scenario that dual task training is a promising approach and should be used in combination with other protocols for geriatric patients with balance impairment for better results. PhysioConnect 5 International Conference Abstract 48

Effect of Neuromuscular Training on Strength, Agility and Balance in Football Players

MANPREET BHARAJ, SHAILJA, DEEPANSHI SHARMA

Introduction: Football demands high level of physical conditioning including agility, strength, and balance apart from technical, tactical, and mental skills. It has been demonstrated that neuromuscular training techniques improve these elements, enhancing performance and lowering the risk of injury. This review consolidates evidence on the impact of these training methods on football players’ agility, strength, and balance. Aim: To evaluate how well neuromuscular and proprioceptive training affects football players’ strength, agility, and balance. Materials and Methods: The studies published in last 10 years, between 2015 to 2023 were examined for this narrative review. Search engines like PubMed and Google scholar were used to fi nd relevant publications using keywords like “proprioception,” “neuromuscular training,” and “football players.” Only English language publications that satisfi ed certain inclusion requirements were taken into account. Ten studies meeting the inclusion criteria highlighted the benefi ts of these training methods. While neuromuscular training improved strength, agility, and injury prevention, proprioceptive training on unstable surfaces improved balance, joint stability, and technical skills. For instance, tests of agility revealed notable gains of 0.3 to 0.5 seconds and increases of 5 to 10% in lower limb strength. In certain strategies, the incidence of injuries decreased by as much as 67%. Integrative neuromuscular training demonstrated improvements in dynamic stability, coordination, and sport-specifi c performance. In conclusion, football players can improve their physical performance and lower their risk of injury by using proprioceptive and neuromuscular training. To maximise performance and guarantee injury prevention, these techniques should be incorporated into athletic and rehabilitation regimens. PhysioConnect 5 International Conference Abstract 49

A Comprehensive Rehabilitation Protocol for a Patient with Left Hemiparesis and Cerebellar Ataxia: A Case Report

ANTAR DAS, SIDHARTH BANSAL, HIMANI MEHTA, JYOTI JAMES

Stroke is a prevalent condition leading to balance and coordination disorders such as cerebellar ataxia making daily activities increasingly challenging. Additionally, preexisting age-related conditions such as degenerative knee arthritis and cervicooccipital hump can further complicate the rehabilitation process for the therapists. Therefore, it becomes crucial to develop a comprehensive rehabilitation protocol tailored to such patient’s needs. A 62-years old male was assessed in his home setting and clinical Outpatient Department (OPD) sitting, comprehensively for higher mental functions, sensory, and motor systems. A tailored rehabilitation protocol was implemented four times weekly, with three follow-up assessments after 45 days to adjust exercises. Interventions included balance and coordination exercises, physical conditioning, mobility training, postural correction, gait training, and electrotherapy modalities. The outcome measures used in this case were Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS) for balance and Functional Independence Scale (FIM) for functional improvement. The follow up assessment demonstrated significant improvement in balance and functional independence. Improvement in SARA score: from 29 to 8, BBS score: from 9 to 43 and FIM score: from 62 to 106. The patient was walking independently and shifting without any help. The multidimensional approach towards patient’s need has shown significant improvement in term of functional independence, balance and overall quality of life. PhysioConnect 5 International Conference Abstract 50

Effect of High Intensity Laser on Pain, Joint Range of Motion, and Functional Ability of Patients with Post-operative Rotator Cuff Tears: A Study Protocol

MIRZA NAUMAN BAIG, JASOBANTA SETHI, VIMAL SHARMA

Introduction: Rotator cuff tear is a common shoulder injury, often requiring surgical intervention to restore function and alleviate pain. Post-operative rehabilitation is critical for recovery, and various modalities are utilised to enhance healing. High-Intensity LASER Therapy (HILT) is an advanced treatment modality that uses LASER to promote tissue repair and reduce pain. Need of the Study: This research explores the effects of HILT on pain, joint Range of Motion (ROM), and functional ability in patients recovering from rotator cuff repair. Aim: To fi nd out the effect of high intensity LASER on pain, joint ROM, and functional ability of patients with post-operative rotator cuff tear. Materials and Methods: The present study will be a single blind, parallel group, randomised control trial recruiting 90 patients having severe partial thickness (>50%) and full thickness tear, undergone post operative rotator cuff repair and will be allocated through computerised randomisation into two groups as per the inclusion and exclusion criteria. The experimental group will be treated with HILT (Power 750 Joules, frequency 10 Hz, pulses width 50 ms, 5 minutes) along with conventional therapy (3 sets of 10 repetitions of wand exercises for shoulder ROM and shoulder isometrics for muscle strength followed by cold therapy for pain relief) whereas the control group will be treated with placebo HILT along with conventional therapy. The outcome measures; pain, joint ROM, and functional ability will be assessed using Numeric Pain Rating Scale, Goniometer, and Shoulder Pain And Disability Index (SPADI) score, respectively, at baseline and the fourth week of post intervention. PhysioConnect 5 International Conference Abstract 51

Effect of Neuromuscular Electrical Stimulation on Balance and Gait Recovery in Post Concussion Combat Sports Athletes: A Study Protocol

K K SHRAVAN, JASOBANTA SETHI, VIMAL SHARMA

Introduction: Combat sports athletes often suffer from Postconcussion Syndrome (PCS) due to repeated head trauma, leading to symptoms such as dizziness, balance issues, and gait abnormalities. Vestibular rehabilitation improves balance, while Neuromuscular Electrical Stimulation (NMES) enhances muscle activation making a combination of both therapies promising for PCS recovery. Need of the Study: To fi nd out the effectiveness of NMES on balance and gait recovery in post concussion combat sports athlete. Materials and Methods: The present study will be single blinded, parallel group, randomised controlled trial recruiting 74 athletes with post-concussion and will be allocated through computerised randomisation into two groups as per inclusion and exclusion criteria. The experimental group will be treated with NMES (Pulse duration of 200 microseconds, frequency of 50 pps, ON time of 5.0 seconds, OFF time of 5.0 seconds, RISE time of 2.0 seconds, FALL time of 2.0 seconds & will be applied for 20 minutes per session) along with vestibular exercise whereas the control group will be treated with placebo NMES along with vestibular exercise protocol based on Herdman’s guidelines. The outcome measures such as balance and gait parameters will be assessed using Balance Error Scoring System (BESS) score and stride time, step length, and gait speed. The data will be collected and analysed post fourth week intervention. The experimental group is might show signifi cantly improved balance and gait parameters compared to the control group. PhysioConnect 5 International Conference Abstract 52

Effects of Kinesio Taping on Patellofemoral Pain Syndrome: A Narrative Review

HARIOM CHOUDHARY, ARCHANA KHANNA

Patellofemoral Pain Syndrome (PFPS) is a common muscu loskeletal condition affecting the knee joint, often characterized by anterior knee pain during activities such as running, squatting, or ascending/ descending stairs. As a non-invasive therapeutic intervention, Kinesio Taping (KT) has gained attention for its potential to alleviate symptoms and enhance functional outcomes in individuals with PFPS. Open access randomised controlled trials related to KT on PFPS among young adults and athletes, published from 2018-24 and in English language were included. Databases like PubMed, Google Scholar were searched using the following keywords- Kinesio tape, taping, patellofemoral pain, pain, muscle strength, range of motion and athletes. After searching the databases, 10 free full-text articles that fulfi lled the objective and inclusion criteria were included in the review. It was found that KT is effective in reducing pain, improving range of motion, improve function, and enhance muscle activity around the knee joint in individuals with PFPS. The effect of KT on PFPS suggests that KT can be a benefi cial intervention for managing this condition. Studies have shown effective results in terms of reducing pain levels, improving functional outcomes, and enhancing muscle activity in individuals with PFPS. PhysioConnect 5 International Conference Abstract 53

The Impact of Proprioceptive Based Exercise Programme on Agility, Muscle Strength and Dynamic Balance Among Athletes with Post Knee ACL Reconstruction: A Study Protocol

ABDUL GAYAS, JASOBANTA SETHI, SADHANA MEENA

Introduction: Anterior Cruciate Ligament (ACL) injury common among athletes often result from high-impact movements and lead to reduced knee stability and proprioceptive defi cits. They are prevalent in males and females aged 18-25 years. Despite treatment advancements, many athletes face challenges in regaining pre-injury performance. Proprioceptive training plays a vital role in enhancing neuromuscular control, balance, joint stability, supporting recovery and reducing re-injury risk. Need of the Study: To examine the impact of proprioceptive based exercise programme on agility, muscle strength and dynamic balance among athletes with post knee ACL reconstruction. Materials and Methods: This study will be randomised, single blinded, parallel-group prospective study evaluate the effects of proprioceptive-based exercises on muscle strength, agility, and dynamic balance in 80 young athletes from 18 to 25 years of age with post knee ACL reconstruction which are actively involved in sports prior to injury and completed basic rehabilitation protocol (acute phase) and cleared for advanced exercises by the physiotherapist with no additional injuries, chronic illnesses, or surgical complications and non-compliance risk or pregnancy. Participants will be randomly assigned to experimental and control groups using computer-based randomisation. Experimental group will be on proprioceptive-based exercises for 4 times per week, progressing in intensity from stable to unstable surfaces, for each session 4 sets, 2 exercises per set with 3 repetitions each for 60 seconds per repetition including 5 min rest between sets. The outcome measure such as agility, muscle strength and dynamic balance will be assessed by using hexagon agility test, isokinetic dynamometer and Huber 360 score at baseline, 2nd and 6th week respectively. PhysioConnect 5 International Conference Abstract 54

Effects of Instrument Assisted Soft Tissue Mobilisation on Calf Muscle Tightness Among Basketball Players: A Review

ANURAG BORDOLOI, ARCHANA KHANNA

Calf tightness is a common problem among athletes, especially in sports like basketball where players require sprinting, jumping, and change in directions frequently. It often leads to pain, discomfort and decreased performance in physical activities. Instrument- assisted Soft Tissue Mobilisation (IASTM) is a form of manual therapy that uses specialised tools in order to treat soft tissue dysfunction. It has emerged as a useful intervention in alleviating calf tightness. To find out the effectiveness of IASTM on calf muscle tightness. Open access randomised controlled trials related to IASTM on calf muscle tightness among young adults and athletes, published from 2018-24 and in English language were included. Databases like PUBMED, Google Scholar were searched using the following keywords: Instrument Assisted Soft Tissue Mobilization”, “Calf Tightness”, “Plantar Flexors”, “Basketball players”, ‘Calf Pain.’ After searching the databases, 11 free full text articles that fulfilled the objective and inclusion criteria were included in the review. IASTM was found to be effective in decreasing the pain, increasing the range of motion, flexibility and overall performance of the individual. IASTM has shown positive trends in reducing calf tightness. The intervention not only effectively reduces pain but also contributes to a significant increase in range of motion. PhysioConnect 5 International Conference Abstract 55

Efficacy of Core Stability Exercises with Kinesio ‘I’ And ‘Y’ Taping on Pain and Quality of Life in Individuals with Chronic Non-Specific Low Back Pain: A Case Series

DEEPANNITA AWASTHI, DIGVIJAY SHARMA

Chronic Non-specifi c Low Back Pain (CNSLBP) is among the most common musculoskeletal disorders reported worldwide. It is a principal factor contributing to pain, disability, and impairment globally. Acute or chronic lumbar diseases can also infl uence the structure and functioning of the body, directly leading to reduced muscle strength, endurance capacity, and ability to perform all daily activities (ADL). Core stability exercises enhance pain management, muscular strength, and spinal stability while substantially aiding neuromuscular control in the lumbar region. Kinesio taping, a therapeutic modality, alleviates pain and enhances muscle function by carefully aligning the tissue. This study aims to investigate and determine pre-post improvement in Kinesio ‘I’ and ‘Y’ taping with core stability exercise and determine the better signifi cant difference in the treatment. The study evaluates the combined effect of core stability exercise with Kinesio ‘I’ and ‘Y’ taping on pain and quality of life in patients experiencing CNSLBP. Four elderly patients, as per the inclusion criteria were selected for treatment, three females and one male with CNSLBP underwent treatment core stability exercises with Kinesio taping, which were regularly given three times a week till a 4-week allergic test was done prior to the treatment, and then taping was applied to the patient. The pain and quality of life were assessed by 11-point Numerical Pain Rating Scale (NPRS) and Short Form 36 (SF-36) respectively. The intervention leads to a considerable pain reduction from the baseline score (pre-treatment), from 5.50±1 to 2.75± 1.50 with a (p-value <0.05), indicating statistical signifi cance. T-test score = 11 of this case series demonstrates signifi cant improvement in pain intensity, and signifi cant improvements were seen in the SF-36 score post-treatment (p< 0.05) in quality of life. This case series indicates that taping with core stability exercise may effectively manage CNSLBP. Nevertheless, additional research with a larger sample size must determine effectiveness conclusively. PhysioConnect 5 International Conference Abstract 56

Correlation between Fatigue and Insomnia Severity Among Women with Polycystic Ovarian Syndrome: Preliminary Findings

AAKANKSHA BAJPAI, DIGVIJAY SHARMA

Introduction: Polycystic Ovarian Syndrome (PCOS) is a common endocrine condition that affects reproductive, metabolic, and psychological health. Women with PCOS often report fatigue and insomnia, but limited research has examined their severity. This association must be studied to improve PCOS treatment and management for women. Aim: To investigate the relationship between fatigue and insomnia severity in women with PCOS, providing a foundation for future integrated management strategies in this population. Methods: Women diagnosed with PCOS (n=30) based on established clinical criteria and reporting fatigue or sleep complaints were recruited. Eligibility required completion of relevant questionnaires, excluding those with comorbidities, recent physical activity, pregnancy, lactation, or abnormal weight status. Fatigue and insomnia were assessed using the Fatigue Severity Scale (FSS) and Insomnia Severity Index (ISI). Participants provided informed consent and completed demographic forms and questionnaires. Ethical approval was secured, and data confidentiality was ensured. Results: Descriptive analyses showed a median age of 26 years {Interquartile Range (IQR) 22-30}. Spearman’s rank correlation indicated a strong positive relationship between insomnia severity and fatigue severity (ρ = 0.698, p = 0.002), suggesting that women with more severe insomnia also report higher levels of fatigue. These findings highlight the importance of integrated clinical strategies targeting both insomnia and fatigue in PCOS. Conclusion: The findings of this study reported association between fatigue and insomnia severity in women with PCOS. These fi nding highlights the importance of addressing both insomnia and fatigue together in PCOS to optimise treatment plans. PhysioConnect 5 International Conference Abstract 57

Neurology and Neuropsychiatry of COVID-19 in Post-Stroke Patients: A Systematic Review of Early Central Nervous System Manifestations Among Elderly Stroke Patients

Introduction: Post-stroke patients, particularly the elderly, have an increased risk of neurological and neuropsychiatric complications post COVID-19 infection. The interplay between stroke-related vulnerabilities and COVID-19’s impact on Central Nervous System (CNS) requires a systematic exploration. Aim: Systematically review the early CNS manifestations of COVID- 19 among elderly post-stroke patients, and also identify its effect on neurology and neuropsychiatry outcomes. Materials and Methods: A systematic search was conducted across PubMed, Scopus and Web of Science databases for related studies published from 2020 to 2024. The inclusion criteria focussed on elderly stroke patients with COVID-19, presenting early CNS manifestations and associated co-morbidities. Data were extracted and synthesised for neurological outcomes, functional impairments, and treatment strategies. Results: Eleven studies with post-stroke elderly patients were included in this review. Common CNS manifestations included non-specifi c white matter microangiopathy (55.4%) associated with higher 2-week mortality, chronic infarcts (19.4%), and acute onset haemorrhages (4.5%). Severe COVID-19 cases were seen to be associated with acute cerebrovascular diseases (5.7%) and neuropsychiatric symptoms, including impairment of consciousness (14.8%), alongside fewer typical respiratory symptoms. These conditions were linked to worsened functional outcomes, increased dependency, and heightened mortality. Multimodal therapies, including neurorehabilitation and pharmacological management, showed potential in mitigating complications. Conclusion: COVID-19 exacerbates CNS vulnerabilities in elderly post-stroke patients, necessitating targeted neuro rehabilitation and integrated care approaches to improve neurological and functional outcomes. Further research should focus on optimizing therapeutic strategies for this high-risk population. This study highlights the need for tailored physiotherapy strategies addressing post-stroke and COVID-19 neuropsychiatric effects to improve elderly rehabilitation outcomes. PhysioConnect 5 International Conference Abstract 58

Comparing the Effect of Dry Cupping to the Traditional Manual Therapy for Planter Fasciitis: A Randomised Controlled Trial

JIBRAN AHMED KHAN, MD.QAIS, SAMAD FAROOQUI

Aim: The purpose of this research was to investigate how Dry Cupping (DC) impacts the pain and functionality of individuals suffering from plantar fasciitis. Materials and Methods: Thirty subjects (age 20 to 40 years old, 19 females and 11 males), randomly assigned into the two groups (Manual Therapy [MT] and DC with MT groups), participated in this study. The study was conducted using a randomised controlled trial design. Treatments were provided to the subjects thrice a week for 3 weeks. Outcome measurements included the Visual Analogue Pain Scale (VAS), the Foot and Ankle Ability Measure (FAAM), the Lower Extremity Functional Scale (LEFS). Results: The data showed that both manual therapy and dry cupping with manual therapy were effective in reducing pain and improving function in the group studied. Clinical outcomes at baseline and 3 weeks were compared in both groups utilising paired sample t-test. The results suggest that for all the outcomes – VAS (MT = 2.13; DC+MT = 2.80), FAAM (MT = -13.93; DC+MT = -17.40), and LEFS (MT = -15.93; DC+MT = -17.87), the difference was statistically significant across both the groups (p < 0.05). There was no significant difference between the DC therapy and DC with MT groups outcome measurements when assessed by independent t- test. Conclusion: These results support that DC therapy combined with traditional MT could reduce pain and increase function in the population tested as compared to treating the patient with MT only. PhysioConnect 5 International Conference Abstract 59

Maximising Functional Recovery in Cervical Hemivertebra through Physiotherapy: A Case Report

NANDINI KUSHWAHA, ANCHIT GUGNANI, KRITIKA SINGH

Hemivertebra is a congenital failure in the formation and fusion of vertebral body ossifi cation nuclei, resulting in the development of one side of the vertebral body. Its incidence is estimated at ~0.3 per 1000 live births. Hemivertebra of the cervical spine is even rarer and has been associated with cervical scoliosis and instability, neck pain, and torticollis. Congenital cervical hemivertebrae often remain asymptomatic unless triggered by a traumatic event or an increase in biomechanical stress. Physiotherapy interventions can play a vital role in helping patients recover from the mechanical strain on the cervical neuromuscular structure. The present case involves a 19-year-old student who was referred for physiotherapy with complaints of neck pain (nonradiating) lasting for one week. The intensity of the pain had been fl uctuating, with periods of increase and decrease, over the past year, occurring in 2–3 episodes per month. An X-ray revealed the presence of a right congenital cervical hemivertebra at the C5-C6 level. Physiotherapy protocol focused on reducing pain, improving mobility, and enhancing spinal stability. Treatment includes manual therapy, stretching exercises and strengthening exercises, Postural correction and ergonomic advice were provided. Physiotherapy plays a crucial role in managing congenital cervical hemivertebrae by alleviating pain, improving range of motion, and enhancing spinal stability. Through targeted exercises, physiotherapy helps reduce symptoms and prevent further complications, signifi cantly improving the patient’s quality of life. PhysioConnect 5 International Conference Abstract 60

Effects of Blood Flow Restriction Training on Knee Injury Rehabilitation in Athletes: A Systematic Review

SATAKSHI AJOY TRIVEDI, DIVYA KARKI, ANKITA SHARMA

Introduction: Blood Flow Restriction (BFR) training, when combined with low-intensity resistance exercises, has been shown to induce physiological adaptations comparable to high-intensity training. BFR creates a localized hypoxic environment, facilitating the release of growth hormone, activation of myogenic stem cells, and suppression of myostatin, thereby promoting muscle hypertrophy. Knee injuries in athletes range from ligamentous and meniscal injuries to patellofemoral pain syndrome. BFR is emerging as a promising adjunct in knee injury rehabilitation, offering a potential alternative to traditional high-intensity strength training. Aim: To evaluate the effects of BFR training in combination with low-intensity resistance exercises compared to conventional highintensity strength training in the rehabilitation of knee injuries in athletes. Materials and Methods: A systematic review was conducted using databases such as PubMed, MEDLINE, Embase, CINAHL Plus, pedro, and ERIC, covering the period from January 1, 2014, to January 1, 2025. The search focussed on studies investigating the effi cacy of BFR in individuals unable to perform high-intensity exercises, particularly within the context of knee injury rehabilitation. Of the 85 initially identifi ed studies, 11 met the inclusion criteria based on relevance, language, and study duplication. Primary outcomes included “Blood Flow Restriction Training in Clinical Musculoskeletal Rehabilitation,” while secondary outcomes focussed on “The Role of Blood Flow Restriction Therapy Following Knee Surgery.” Results: The fi ndings suggest that BFR training, when combined with low-intensity resistance exercises, provides physiological benefi ts similar to high-intensity strength training. This approach facilitates early-stage rehabilitation, muscle hypertrophy, and strength development, enabling a faster return to sports for athletes recovering from knee injuries. Conclusion: BFR training presents a viable and effective rehabilitation strategy for knee-injured athletes, particularly when high-intensity training is not feasible. It accelerates muscle adaptation and functional recovery, making it a valuable adjunct to conventional rehabilitation protocols. Further research with larger sample sizes and randomised controlled trials is warranted to optimize BFR applications in clinical settings. PhysioConnect 5 International Conference Abstract 61

Effect of Exercise on Pain and Depression in Mobile Gaming Addiction: A Randomised Controlled Trial

PIYUSH KUMAR, RABAB KAUR, VRANDA AGARWAL

Introduction: There is a growing behavioural issue among youth population that is addiction to mobile gaming. The youth have to suffer several signifi cant psychological and physical consequences due to excessive gaming such as musculoskeletal pain that often results from prolonged static posture and repetitive strain and depression that often results from social isolation and disturbances in sleep. Keeping them little bit apart from mobile gaming and inclusion of aerobic and anaerobic exercises in their schedule can be helpful in reducing pain and improving mental health by triggering release of endorphins, by promoting blood circulation and enhancing muscle strength. Aim: The purpose of this study is to fi nd out the effect of structured aerobic and anaerobic exercises on pain intensity and the severity of depression in individuals with mobile gaming addiction with the help of Numeric Pain Rating Scale (NPRS) and Hamilton Depression Rating Scale (HDRS) as our assessment tool. Materials and Methods: A total of 20 participants of age ranging from 21– 26 years (11 males and 9 females) had participated in the study out of which 10 candidates (6 males and 4 females) were categorised under control group and rest of the 10 candidates (5 males and 5 females) were categorised under exercise group. Randomised Controlled Trials (RCT) with 20 participants was conducted for 5 weeks in which the exercise group was getting the structured exercise programme comprising of aerobic and anaerobic activities whereas the control group was not getting any such intervention. The scores of NPRS and HDRS were then recorded before and after intervention. Results: This study supports the fact that structured exercise programmes effectively reduces pain and depressive symptoms in the population as the exercise group shows a signifi cant reduction in pain intensity and depression severity as found in NPRS and HDRS scores (p < 0.0001) whereas the control group shows no signifi cant or notable changes. Conclusion: The potential of the structured exercise programmes intervention for the management of pain and depression in individuals with mobile gaming addiction is clearly highlighted in this study. Intervention of aerobic and anaerobic exercises into rehabilitation programmes can be proven as one of the signifi cant approach towards addressing these modern life health challenges. PhysioConnect 5 International Conference Abstract 62

Effect of Myofascial Release on Pain and Quality of Life in Patients with Flexible Flat Foot: A Randomised Controlled Trial

VRANDA AGARWAL, RABAB KAUR, PIYUSH KUMAR

Introduction: Flexible flatfoot is a common musculoskeletal condition characterised by the loss of the foot arch during weight-bearing, leading to altered gait biomechanics, increased stress on soft tissues, and pain. Chronic foot pain can impair mobility, elevate the risk of falls, and negatively impact daily activities and quality of life. Myofascial Release (MFR) therapy has gained attention for its potential to alleviate pain and improve musculoskeletal function. This study aims to evaluate the effectiveness of MFR therapy in comparison to conventional exercise therapy for pain reduction and quality of life improvement in individuals with flexible flatfoot. Aim: To assess the potential of MFR on reduction of pain in patients with fexible flat foot patients. It also aimed to evaluate the impact of MFR on addressing enhancement in quality of life in patients with flexible flat foot patients. Methods: A randomised controlled trial with 30 participants (aged 20–50 years) diagnosed with flexible flatfoot pain was conducted. Participants were randomly allocated into: • Experimental group (n=15): Received MFR therapy along with exercise intervention. • Control group (n=15): Received exercise intervention only. The intervention lasted four weeks (fi ve sessions per week). Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), while quality of life was measured using the Short Form (SF) 36 questionnaire. Statistical analysis included paired t-tests for intragroup and unpaired t-tests for intergroup comparisons. Results: Both groups showed significant improvements (p < 0.05) in pain reduction and quality of life. However, the experimental group demonstrated superior improvements, emphasising the efficacy of MFR therapy over conventional physiotherapy. Conclusion: MFR therapy, combined with exercise, provides greater pain relief and functional benefits in patients with flexible flatfoot compared to exercise alone. Future research with larger sample sizes and longer follow-up periods is recommended to establish long-term efficacy. PhysioConnect 5 International Conference Abstract 63

Impact of Cardiac Rehabilitation on Autonomic Function: A Systematic Review

PIYUSH KUMAR, RABAB KAUR, VRANDA AGARWAL

Introduction: The rise in number of cardiac patients has signifi - cantly increased the demand for cardiac rehabilitation practises. Cardiac rehabilitation is the sum of activities and interventions required to ensure best possible conditions for patients with chronic or post-acute cardiovascular disease to resume an active life. This study sheds light on its contribution in maintaining autonomic homeostasis. Aim: To identify and highlight the impact of cardiac rehabilitation on autonomic functioning, and its ability to achieve Sym pathovagal balance in terms of parameters like Heart Rate Variability (HRV) and Barorefl ex Sensitivity (BRS). Materials and Methods: This study optimises the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method for conducting a systematic literature review. Due to their reliability, google scholar, PubMed, Science Direct and Research Gate were used to obtain data. Results: Upon interpreting physiological parameters such as HRV and BRS closely, it was seen that cardiac patients who had undergone cardiac rehabilitation achieved an improved sympathovagal balance and autonomic homeostasis, contributing to more smooth and effective autonomic functioning. Conclusion: Parameters like HRV and BRS demonstrate signifi cant improvement following cardiac rehabilitation. It is reasonable to state that incorporating cardiac rehabilitation into patients’ treatment regimen is bene fi cial in maintaining autonomic harmony and facilitating smooth autonomic functioning. PhysioConnect 5 International Conference Abstract 64

Role of Assistive Devices in Different Neurological Conditions: A Systematic Review

KSHITIJ JAISWAL, MEENA GUPTA, MIHIKA SHARMA

Introduction: Assistive technology refers to a broad range of products, systems, and services designed to assist individuals to perform a particular task. These assistive devices aid neurologically impaired individuals in carrying out their activities within the community. Some examples of assistive technologies are mobility aids such as wheel chairs, walkers, canes,crutches, prosthetic and orthotic devices. Aim: To identify and highlight the role of assistive devices in enhancing mobility, Quality of Life (QOL) and functional independence in neurological conditions. Materials and Methods: In this study, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was used. Because of their credibility and reliability, databases such as Google Scholar, Science Direct, PubMed, and Research Gate were utilised. Nevertheless, none of the databases, such as Science Direct and Research Gate, are comprehensive or entirely thorough. Result: Assistive devices are frequently utilised in the rehab ilitation process for neurological conditions. For stroke patients, wheelchairs, walkers, and crutches are mainly utilized for mobility and everyday activities. Individuals with cerebral palsy also utilize wheelchairs, walkers, and crutches to enhance quality of life. Certain assistive devices serve both therapeutic functions and modifi cations for activities of daily living, potentially enhancing and sustaining quality of life. Conclusion: Assistive devices aid a physiotherapist in reaching optimal objectives during rehabilitation for various neurological conditions. Various assistive devices were utilized for both treatment purposes and modifi cations to activities of daily living, enhancing and preserving their quality of life. However, understanding the correct usage of these devices is crucial, along with addressing the signifi cant concerns regarding their overuse and inappropriate application. Such misuse can result in increased dependency among neurological patients, ultimately hindering their rehabilitation progress. PhysioConnect 5 International Conference Abstract 65

Role of Physiotherapy in Diastasis Recti: A Systematic Review

BHAVYA GARG, MEENA GUPTA

Introduction: Diastasis Recti Abdominis is characterized by separation of the rectus abdominal muscle along the linea alba during pregnancy or postpartum period, impacting quality of life well beyond childbirth. This review emphasizes tailored management programs and encourages data driven decision making in physiotherapy practice to improve quality of life. This review was prompted by a lack of standardized assessment and training protocols, and hence aims to identify effective management strategies, and address gaps and limitations in the existing literature. Objective: Objective of the study is to consolidate existing evidence and explore potential areas for future research. Inclusion Criteria: Selection criteria included randomized controlled studies and experimental studies investigating exercise therapy interventions both with and without adjunct modalities for Diastasis Recti Abdominis. Methods: Search strategy: electronic search conducted on databases such as Google scholar, pubmed, Scopus, sciencedirect. Keywords included “diastasis recti abdominis”, “postpartum”, “core rehabilitation”, “abdominal strengthening”. Data extraction: experimental studies or observational studies published in English were selected. Characteristics of the study (sample, diagnostic criteria, program design and outcome measures) were recorded from the articles fulfi lling eligibility. Data analysis: Guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. Studies had varying sample sizes, different cut-off points for Diastasis Recti diagnosis and varying program duration. Results: Exercises like abdominal and pelvic fl oor muscle training, functional exercises and adjuncts showed significant reduction in inter- rectus distance and dysfunction, with transverse abdominis training as a key component of most protocols. Apart from exercises, other interventions like abdominal binding, yoga etc have also contributed to the favourable results. Conclusion: Reviewed studies provide valuable insights into the effectiveness of rehabilitation in correction of Diastasis Recti. It is evidently highlighted that a focused exercise program might be a potent approach for treating Diastasis Recti. Implications: Diastasis Recti Abdominis being often underdiagnosed and considered a mere cosmetic problem underestimates its functional impact. This study aims to improve awareness and encourage use of evidence- based rehabilitation by therapists. PhysioConnect 5 International Conference Abstract 66

Unravelling the Evidence: Epley Manoeuver in Managing Benign Paroxysmal Positional Vertigo: A Review

SIMRAN, SAMEER CHHIKARA

Introduction: Vertigo is the perception of motion without movement, which may be described as persuading, tipping, spinning, or feeling unstable. Benign paroxysmal positional vertigo ( BPPV) is the most common cause of peripheral vertigo, counting for over half of all cases. According to multihued estimates, a minimum of 20 of cases presenting to the provider with vertigo have BPPV. This is associated with the threat of falling and is compounded in senior persons with other neurologic defi ciencies and chronic medical problems. The aim of Epley’s manoeuver, which is noninvasive, affordable, and fl uently administered, is to move the canaliths out of the canal to the utricle where they no longer affect the canal dynamics. Aim: To emphasise the effect of Epley Manoeuver in managing dizziness in BPPV patients. Methods: Relevant articles were identifi ed by searching major databases (PubMed, Physiotherapy Evidence Database, Cochrane Library, Google Scholar) published between 2015 and 2025 on adult participants who received Epley Manoeuver with a history of BPPV. The focus was to fi nd whether effectiveness of Epley Manoeuver is superior to conventional interventions with vertigo. Results: The present search identifi ed 39 studies, of which only 10 trials met the strict criteria for inclusion in this review. These studies consistently showed that Epley Manoeuver was more effective than conventional treatments in repositioning the otoconia. Additionally, the results suggested that it not only decreases dizziness but also improves overall quality of life. Conclusion: Epley Manoeuver is a gentle and effective approach and is a valuable complementary approach that helps to reduce both the frequency and intensity of vertigo episodes. PhysioConnect 5 International Conference Abstract 67

Long-Term Efficacy of a Home-Based Intervention for Toddlers with Developmental Delays

HRITIKA MEHTA, KANIKA MARKAN

Background: Developmental delays in toddlers require early and consistent intervention. A ten weeks home-based intervention program was designed to improve adaptive functioning in children with developmental delays. Purpose: The purpose is to compare children diagnosed with delayed milestones who have undergone intervention training with those who have not received it. Materials and Methods: Fourteen children with developmental delays, aged 1-4 years were randomly selected and assigned to either a control group or a home-based intervention group of seven children each. The control group received standard physiotherapy, while the intervention group had core stability training with strength and motor skill development. Both groups were evaluated preand post-treatment using Bayley Scales of Infant and Toddler Development (BSID), Peabody Developmental Motor Scales– Second Edition (PDMS-2), and Alberta Infant Motor Scale (AIMS). Results: We observed a statistically signifi cant improvement in strength and motor skills among children who underwent the 10- week intervention compared to those in the control group receiving regular physiotherapy. Conclusion: The home based intervention program demonstrated improved effi cacy in enhancing motor skills in children. Caregivers played a pivotal role in sustaining these gains. PhysioConnect 5 International Conference Abstract 68

Effectiveness of Kinesio Taping and Extracorporeal Shock Wave Therapy in Plantar Fasciitis: A Systematic Review

JASLEEN KAUR GROVER, SIMRANJEET KAUR, NITIN BHARDWAJ

Introduction: Plantar fasciitis impacts one’s quality of life and necessitates appropriate, safe remedies. Extracorporeal Shockwave Therapy (ESWT) aids healing by lowering infl ammation, regenerating tissue, and increasing blood fl ow. Kinesio taping (KT) provides temporary pain alleviation and support. This review evaluates the effectiveness of ESWT and KT for treating plantar fasciitis. A limited study explicitly compares their effi cacy for pain and function. Randomised Controlled Trials (RCTs) included adults (18–70 years) with plantar fasciitis. Pain and foot function was assessed using Visual Analogue Scale (VAS), Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), and Heel Tenderness Index (HTI). Aim: This systematic review aims to determine the effectiveness of ESWT in comparison to KT in plantar fasciitis focussing on pain reduction and foot function improvement for the long term. Materials and Methods: Database and search engines including PubMed, Cochrane Library, PEDro, and Google Scholar were searched using keywords related to “plantar fasciitis,” “ESWT”, “extracorporeal shockwave therapy” and “kinesio taping” from 2017 till date. PROSPERO registration with ID CRD42024594806. Data from all databases were compiled 3378 articles were found, 2856 were duplicates,132 titles/abstracts were screened, and 11 were sought for retrieval by two researchers. Nine were screened for methodological details, participant data, outcome measures, results, and dropouts, and were reviewed, and 5 articles were included. Following PRISMA guidelines, study quality was evaluated using CONSORT, PEDro, and ROB 2. Result: Five rcts (373 participants) were included. ESWT showed better long-term pain reduction (VAS, p<0.001; FAOS, p=0.003), while KT demonstrated improved foot function (FFI, p=0.027, p=0.001). One study found no significant difference. Conclusion: ESWT is more effective for pain relief, while KT enhances foot function and support. Treatment is determined by the individual’s needs and the severity of their ailment. Recognizing the benefi ts of ESWT and KT helps clinicians customize treatments for ideal outcomes. PhysioConnect 5 International Conference Abstract 69

Impact of Physiotherapy Interventions on Post-Mastectomy Lymphoedema: A Systematic Review

HARMANPREET KAUR, SIDHARTH BANSAL

Introduction: Post-mastectomy Lymphoedema (PML) is a chronic condition caused by lymphatic disruption from mastectomy, lymph node dissection, or radiotherapy, leading to limb swelling, pain, and reduced range of motion. It affects up to 60% of patients a year post-surgery. With 2.3 million new breast cancer cases in 2020, effective PML management is essential. Physiotherapy interventions show promise, but their comparative effectiveness needs further investigation. Aim: To assess the effectiveness of physiotherapy interventions in reducing lymphodema, alleviating symptoms, and improving quality of life for PML patients. Materials and Methods: The review includes peer-reviewed articles from 2000 to 2024, focussing on Randomised Controlled Trials (RCTs) and pilot studies evaluating physiotherapy interventions. The review excludes non-physiotherapy interventions (pharmacological or surgical treatments), studies with insuffi cient data, and non-English publications or those not focused on PML. A systematic search of PubMed and Google Scholar using keywords like “post-mastectomy lymphoedema” and “physiotherapy interventions” extracted data on population, interventions, outcomes, and follow-up. Screening followed PRISMA guidelines, with quality and bias assessed using the PEDro scale and Cochrane risk-of-bias tool. Results: The systematic review evaluates physiotherapy interventions for PML, fi nding Low-Level Laser Therapy (LLLT) and acupuncture as most effective for reducing limb volume and pain, while Shockwave Therapy (SWT) improves tissue elasticity. Education supports prevention and adherence. Personalized multidisciplinary care is recommended for optimal outcomes. Conclusion: Physiotherapy techniques like LLLT, SWT, MFR, acupuncture, and education improve post-mastectomy lymphoedema management by reducing symptoms and enhancing quality of life. Personalised, multidisciplinary approaches, consistent protocols, and further research are essential to optimise long-term outcomes for breast cancer survivors. PhysioConnect 5 International Conference Abstract 70

A Study to Detect Effectiveness of Therapeutic Laser on Trigeminal Neuralgia: A Literature Review

JYOTI PRIYA, NISHCHINT BANGA, SUPRIYA AWASTHI, PALLAVI PRAKASH, DIKSHA

Introduction: Trigeminal neuralgia (TN) is a prevalent and debilitating neuralgia affecting the craniofacial region. Due to the limited effi cacy of traditional treatments, there is growing interest in alternative therapies like laser therapy for TN management. Purpose: This study aimed to investigate the effects of laser therapy on trigeminal neuralgia through a comprehensive literature review. Participants: Adult patients diagnosed with chronic trigeminal neuralgia unresponsive to conventional treatments were included, with sample sizes ranging from 17 to 45, categorized by the type of laser therapy administered. Methods: A systematic search was performed across pubmed, Scopus, Web of Science, Science Direct, and Google Scholar from 1980 to 2024 using the keywords “trigeminal neuralgia” and “laser.” The inclusion criteria focused on experimental studies, including randomized clinical trials utilizing laser therapy for TN treatment. Out of 6,472 identified records, 20 were relevant after title and abstract reviews, with 15 articles ultimately meeting eligibility criteria for inclusion. Results: The review indicated that low-level laser therapy is a potent and safe intervention for trigeminal neuralgia, particularly for patients resistant to standard treatments. It consistently demonstrated significant pain reduction, with some studies reporting up to 85% pain relief. Conclusion: Laser therapy effectively alleviates pain associated with trigeminal neuralgia and enhances overall quality of life by reducing pain intensity and interference in daily activities. Implications: These fi ndings emphasize the need for clinicians to consider laser therapy as a viable treatment option for TN, especially in patients who have not responded to conventional therapies. Accurate diagnosis is crucial for optimizing treatment outcomes and improving patient quality of life. PhysioConnect 5 International Conference Abstract 71

Effectiveness of Physical Therapy Along with PEMF Therapy on Disability, Function and Balance in Knee Osteoarthritis Patients

SANYA KAPOOR, ANU BANSAL

Introduction: Osteoarthritis (OA) is a degenerative joint disease affecting synovial joints, particularly the knee, leading to pain, stiffness, and functional limitations. It impairs mobility, balance, and quality of life, increasing the risk of falls. While physical therapy is a standard approach for OA management, Pulsed Electromagnetic Field (PEMF) therapy has shown potential in reducing pain, inflammation, and improving joint function. Objective: The objective of this study was to evaluate the combined effect of physical therapy and PEMF therapy on disability, functional performance, and balance in knee OA patients. Methodology: This experimental study included 30 knee OA patients (aged 40-75 years), randomly assigned to two groups. Group 1 (n=15) received physical exercises and hot pack treatment, while Group 2 (n=15) received the same treatment plus PEMF therapy. Both groups underwent a 4-week intervention (fi ve sessions per week, 55 minutes each). Pain, functional ability, and balance were assessed using the WOMAC Scale, Lysholm Scale, and Tandem Stance Test. Result: Group1 has base value for womac scale, lysholm scale and tandem stance test (20±2.60,64.06±9.98 ,21.5±3.85 )as compared to after the 4 week protocol post treatment values are for respective groups ( 16.98±4.02, 82.26±10.76,24.2±3.38) & Group 2 has base value (29.06±4.71,66.86±4.88,20.6±3.5) and the result are (15.46±4.77,79.46±7.52, 25.8±3.04) thus it indicates the treatment has shown the improvement. Both groups showed significant improvements (p < 0.05) in all measured outcomes, with Group 2 demonstrating greater enhancements. WOMAC scores signifi cantly decreased, and Lysholm scores increased, indicating reduced pain and improved function. The Tandem Stance test also improved significantly, highlighting better balance in Group 2. Conclusion: Integrating PEMF therapy with physical therapy enhances pain reduction, functional recovery, and balance in knee OA patients. Future studies with larger samples and longer followups are recommended. PhysioConnect 5 International Conference Abstract 72

Comparitive Study to Find out Effects of High-grade Maitland Mobilization Technique with Scapular Mobilization versus Capsular Stretching with Hold Relax PNF Technique in the Management of Adhesive Capsulitis

SAURABH SHARMA, MUKUL TANWAR, RENUKA GULIA

Introduction: Adhesive Capsulitis, or frozen shoulder, is characterized by pain and restricted range of motion (ROM). Physiotherapy techniques such as high-grade Maitland mobilization (HGM) with scapular mobilization and capsular stretching combined with hold relax proprioceptive neuromuscular facilitation (PNF) aim to alleviate these symptoms. Background: Adhesive Capsulitis affects 3-5% of the general population, with higher prevalence in diabetic individuals. This condition involves thickening and fibrosis of the shoulder capsule, leading to progressive stiffness and pain. Aim: This study compares the effectiveness of HGM with scapular mobilization and capsular stretching combined with hold relax PNF in reducing pain and improving ROM and shoulder function. Methodology: A randomized controlled trial included 30 participants (ages 40-70) with Adhesive Capsulitis. Group A (n=15) received HGM and scapular mobilization, while Group B (n=15) underwent capsular stretching and hold relax PNF technique. Interventions were provided five days weekly for four weeks. Outcomes were assessed using SPADI, VAS, and ROM measures for abduction, flexion, internal rotation, and external rotation. Results: Group A demonstrated significant improvements: SPADI reduced from 65.79±7.51 to 31.17±5.62, VAS decreased from 8.27±0.70 to 4±0.93, and abduction improved from 73.73°±13.65 to 140°±12.42. In Group B, SPADI reduced from 65.84±7.20 to 34.46±6.11, VAS decreased from 8.40±0.74 to 4.20±0.68, and abduction improved from 69°±13.13 to 118.8°±12.67. Conclusion: HGM with scapular mobilization showed superior efficacy in improving ROM and reducing pain compared to capsular stretching with hold relax PNF technique, making it a preferred approach for managing Adhesive Capsulitis. PhysioConnect 5 International Conference Abstract 73

Efficacy of HABIT-ILE Approach for Children with Spastic Cerebral Palsy: A Systematic Review

HIMANI CHAUHAN, AVI CHOUDHARY, HIMANI KAUSHIK

Introduction: Spastic cerebral palsy is the type of cerebral palsy characterized by spasticity or high muscle tone often resulting in stiff, jerky movements. HABIT-ILE is an intensive therapy that focuses on improving bimanual coordination of hand-arm and lower extremities. Aim: The study aims to systematically review the efficacy of HABITILE approach for children with spastic cerebral palsy and to evaluate the scientific evidence endorsing the benefits of this therapeutic approach. Materials and Methods: This review includes articles encompassing children patients aged 6-12 years with cerebral palsy, including both males and females. Using keywords such as, cerebral palsy, spasticity, hand-arm coordination, physiotherapy and rehabilitation, a comprehensive analysis of research on the role of HABIT-ILE approach in spastic cerebral palsy was conducted. Electronic databases such as PubMed, Research Gate, Web of Science and Google Scholar were searched to identify the literature. A total of 121 articles from the last 10 years (2013-2025) were identifi ed according to inclusion and exclusion criteria, out of which 12 articles were included in the study using the PRISMA guidelines. Data was obtained from the included articles and summarised in PICO format. Results: Finally 12 articles were analysed for the literature review providing evidence supporting the use of HABIT-ILE approach to manage symptoms of cerebral palsy patients in combination with exercise therapy. It significantly improves posture, gross motor functions, walking endurance, mobility, physical independence, and functional capacity. No adverse effect was observed after the therapy. Conclusion: HABIT-ILE approach helps improve the overall quality of life of patients with cerebral palsy. More randomised control trials are needed to provide good-quality evidence of the extent to which HABIT-ILE approach can improve the function and quality of life of children with cerebral palsy. PhysioConnect 5 International Conference Abstract 74

Empowering Patients: Transforming Physiotherapy Outcomes through Innovative Educational Strategies

KRITIKA PURI, ARCHITA RAO, DRISHTI JOSHI

This abstract explains that patient engagement is essential for achieving successful outcomes in Physiotherapy, as it signifi cantly impacts adherence to treatment and recovery and it discusses how evidence-based educational interventions can enhance patient engagement by improving their understanding of their condition and treatment plan and allow them to make decisions. The lack of patient engagement in physiotherapy often leads to struggle and with a limited understanding of the importance and benefi ts of physiotherapy, which can lead to a lack of motivation to adhere to prescribed exercises and treatments. Enhancing patient engagement in physiotherapy is to improve adherence and outcomes by increasing patient understanding of treatment benefi ts, personalising therapy plans offering fl exible scheduling. This approach aims to boost motivation, accountability, and overall effectiveness of the therapy. Key strategies include the use of multimodal educational tools, such as video games, apps, interactive sessions combined with ongoing feedback from Physiotherapists. These interventions help patients overcome barriers like anxiety, misinformation, and low confi dence in their ability to manage their health, leading to better adherence to prescribed exercises and more consistent attendance at therapy sessions. The result is a more empowered patient who is actively involved in their care, leading to faster recovery and improved clinical outcomes. According to many researchers and their studies, we reach to a conclusion that decision making done by patients increase their interest and one can also introduce games and interesting apps with motivational feedbacks For their effective engagement, optimising patient engagement through targeted educational interventions is a promising approach to enhancing the effectiveness of Physiotherapy. PhysioConnect 5 International Conference Abstract 75

Effectiveness of Chin Tuck Exercises in Cervical Spondylosis

ABDUL MAAZ, RABAB KAUR

Introduction: Cervical spondylosis, also known as cervical osteoarthritis, is a degenerative condition affecting the cervical spine, primarily due to age-related wear and tear of the intervertebral discs and vertebrae. This condition is prevalent in individuals over the age of 40, Modern sedentary lifestyles, prolonged use of digital devices, and poor posture have signifi cantly increased the incidence of cervical spondylosis, even among younger populations. Chin tuck exercises are designed to strengthen deep cervical fl exor muscles, improve posture, and reduce stress on the posterior cervical structures. They help restore the natural curvature of the cervical spine, thereby reducing nerve impingement and alleviating pain. Aim: The primary objective of this research is to evaluate the ‘effectiveness of chin tuck exercises’ in the management of cervical spondylosis in sitting/standing vs supine lying position. And comparing their pre-post data with Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Also to determine whether chin tuck exercises signifi cantly reduce neck pain and discomfort & to study the role of chin tuck exercises in strengthening the deep cervical fl exor muscles and to evaluate the infl uence of chin tuck exercises on daily activities and quality of life in affected individuals. Materials and Methods: Following up the randomised controlled trial, the sample size will consist of 10 subjects with pre-diagnosed cases of cervical spondylosis having neck pain from the age group of 40- 60 years old, which will further be randomly allocated for the study. Ten subjects with pre-diagnosed cervical spondylosis who will be fulfi lling inclusion and exclusion criteria will be selected for the study. Ten subjects with pre- diagnosed cervical spondylosis with neck pain. There will be two groups, group A (study group, n= 5) and group B (control group, n =5). Result: 1. Standard Deviation (Pre vs. Post): • For NPRS in Group A, variability slightly increased after the exercise, while Group B maintained a constant variability pre- and post-test. • For NDI, Group A showed a noticeable increase in variability post-test, while Group B showed reduced variability, suggesting more consistent outcomes for sitting/standing. 2. T-Statistic and p-Value: • The t-statistics and p-values indicate signifi cant improvements (p < 0.05) in both NPRS and NDI scores across groups. Group B (sitting/standing) exhibited a much stronger statistical signifi cance than Group A (supine), particularly for the NDI. • For NPRS in Group B, the high t-statistic and zero p-values suggest exceptionally consistent pain reduction outcomes. The significant reduction in NDI scores for both groups (with Group B showing a more pronounced improvement) indicates that chin tuck exercises positively influence neck function, which directly impacts daily activities and quality of life. Chin tuck exercises improve neck mobility, reduce pain, and enhance muscle strength, enabling individuals to perform everyday tasks with greater ease and less discomfort. Conclusion: The effectiveness of the chin tuck exercise in Group B (sitting/standing position) showed more consistent and statistically significant improvements in reducing neck pain and disability compared to Group A (supine position). This suggests that performing chin tuck exercises in a sitting/ standing position might be more effective for managing cervical spondylosis. However, Group A still demonstrated substantial improvements. While both positions are effective, the sitting/standing position is recommended for better outcomes in managing cervical spondylosis. Chin tuck exercises significantly reduce neck pain and discomfort, strengthen deep cervical fl exor muscles, and improve neck function, positively influencing daily activities and overall quality of life in individuals affected by cervical spondylosis. The sitting/standing position is particularly effective for achieving these outcomes, making it the recommended position for chin tuck exercises. PhysioConnect 5 International Conference Abstract 76

Role of Physiotherapy Management in Post-Fracture RSD Complications: A Case Study

SANJANA KHANNA, ANKITA SHARMA

Refl ex Sympathetic Dystrophy (RSD) is a neuropathic pain disorder characterised by ongoing pain disproportionate to the degree of tissue injury and persists beyond the usual expected time for tissue healing. Pain is accompanied by sensory, motor, trophic, and autonomic abnormalities. Pain does not follow a particular dermatome or myotome but is rather regional. This disabling condition often develops after a trauma, fracture, or surgery. Three stages are recognised, with clinical and radiographic features are- Stage 1: Acute which is up to 6 months with burning pain; Stage 2: Dystrophic which is from 6-12 months with continuing pain, atrophy of the skin and tissues and contracture of the joint; Stage 3: Atrophic which is after 1 year and the pain is less prominent, and as there is little active movement, the pain is most marked during passive movement. The objectives of physiotherapy management in RSD post-fracture complications include managing pain, reducing swelling, and restoring mobility. The goal is to improve function, prevent complications, and enhance the patient’s overall quality of life. This case study involved a 62 years female with a history of a right-hand metacarpal fracture that healed in a malunion position, leading to refl ex sympathetic dystrophy at grade 1. The pain was burning and chronic, and exacerbated during physical activity and Inability to initiate movement of the right hand due to stiffness and reduced range of motion, dystonia and tremors. The patient reported the pain scale of 9 on Numeric Pain Rating Scale (NPRS) with, 30° wrist fl exion; 20° wrist extension; 25° MCP fl exion; 30° MCP extension. The physiotherapeutic intervention included moist heat therapy and gripping exercises to reduce the swelling and to increase the joint range of motion. Compression gloves were advised to control the oedema and for progression active range of exercises with joint mobilization techniques to improve the mobility. The treatment continued for 2.5 months and the patient responded well and the symptoms for RSD were not seen. The patient progressed with the treatment and started regaining her mobility. The range of motion was improved signifi cantly with continued precision exercises and strengthening. The pain score was also reduced to 6 on NPRS and no signs of visible swelling and oedema were seen. In conclusion, this case highlights the diffi culties faced by a 62-yearold woman living with RSD caused by a poorly healed metacarpal fracture. The persistent pain, hypersensitivity, swelling, and limited movement have deeply affected her daily life and independence. Her recovery journey requires a thoughtful, personalized approach, focusing on pain relief, restoring movement, building strength, and regaining her ability to perform everyday tasks. Considering her age and emotional well-being is just as crucial as physical treatment. With ongoing physiotherapy, guidance, and emotional support, the aim is to help her reclaim her functionality and improve her quality of life. PhysioConnect 5 International Conference Abstract 77

Effect of Therapeutic Ultrasound on Pain, Range of Motion and Functional Ability in Patients with Adhesive Capsulitis: An Experimental Study

SHIKHA TIWARI, JASOBANTA SETHI

Introduction: Adhesive capsulitis is a condition that affects shoulder joints and causes pain, stiffness, and limited range of motion. The condition develops slowly over time and is caused by injury, surgery and medical conditions. Aim: To assess the effect of therapeutic ultrasound on pain, range of motion and functional ability in patients with adhesive capsulitis. Materials and Methods: Sixty-two participants between the ages of 30-60 years with low back pain following selection criteria were randomly assigned to the control and experimental group with 31 participants each. This is an experimental study with pre and posttest analysis in which the control group received conventional treatment and study group received conventional treatment with the addition of continuous therapeutic ultrasound of 1 MHz, intensity of 1.5 W/ cm² for 8 minutes. The duration of treatment for both the groups was 14 days. Pain, range of motion and functional ability were assessed using Numerical Pain Rating Scale (NPRS), goniometer and Shoulder Pain and Disability Index (SPADI) score respectively. Pre and post data was gathered and analysed. Result: Independent t test was performed between the groups. We observed that the study group showed significant improvement in pain (p=0.0004), increase in range of motion with external rotation (p=0.1876), abduction (p=0.0572), internal rotation (p=0.0095) and decrease in SPADI score (p=0.0001) as compared to the control group. Conclusion: The study provides evidence supporting the effi cacy of therapeutic ultrasound as management of adhesive capsulitis. PhysioConnect 5 International Conference Abstract 78

Effect of Therapeutic Ultrasound on Pain, Range of Motion and Functional Ability in Patients with Frozen Shoulder

SHAILVI JOSHI, JASOBANTA SETHI, KRISHNA MOHAN

Introduction: Frozen shoulder is a condition characterized by painful, progressive, and disabling loss of active and passive glenohumeral joint range of motion in multiple planes. Aim: To assess the effect of therapeutic ultrasound on pain, range of motion and functional ability in patients with frozen shoulder. Materials and Methods: Sixty-four participants between the ages of 40-60 years with frozen shoulder following selection criteria were randomly assigned to the control and experimental group with 32 participants each. This is an experimental study with pre and posttest analysis in which the control group received conventional treatment and study group received conventional treatment with the addition of continuous therapeutic ultrasound of 1 mHz, intensity of 1 W/cm² for 8 minutes. The duration of treatment for both the groups was 14 days. Pain, range of motion and functional ability were assessed using NPRS, goniometer and SPADI score respectively. Pre and post data was gathered and analysed. Result: Independent t test was performed between the groups. It was observed that the study group showed significant improvement in pain (p=0.0003), range of motion with abduction (p=0.0257), flexion (p=0.0049) and external rotation (p=0.0463), decrease in SPADI scores (p=0.0007) as compared to the control group. Conclusion: The study provides evidence supporting the efficacy of therapeutic ultrasound as management of frozen shoulder. PhysioConnect 5 International Conference Abstract 79

Effect of TENS on Pain, Range of Motion and Function Ability Among People with Low Back Pain: An Experimental Study

SAKSHI SINHA, JASOBANTA SETHI, NALINI SHRIVASTAVA

Introduction: Low back pain is often seen in patients above 30 years of age and is characterised by limitation of range of motion and pain in the joint along with stiffness. It presents a challenging scenario in musculoskeletal health and demands effective therapeutic strategies to alleviate symptoms and improve functional outcomes. Aim: To assess the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on pain, range of motion, and functional ability in patients with low back pain. Materials and Methods: Sixty-two participants between the ages of 30-60 years with low back pain following selection criteria were randomly assigned to the control and experimental group with 31 participants each. This is an experimental study with pre and post-test analysis in which the control group received conventional treatment, while the experimental group received the conventional treatment along with TENS with 10 Hz frequency, 50 ms pulse width and 40 ma intensity for 20 minutes. The duration of treatment for both groups was 14 days. Pain, range of motion, and functional ability were assessed using Numerical Pain Rating Scale (NPRS), goniometer, and Oswestry Disability Index (ODI) respectively. Pre and post treatment data were collected and analysed. Results: Independent t test was performed between the groups. Both groups showed improvement however, the experimental group showed a significant decrease in NPRS (p=0.0020), increase in range of motion with flexion (p=0.0065), extension (p=0.0055), left lateral flexion (p=0.0006), right lateral flexion (p=0.0218) and decrease in ODI scores (p=0.0161) compared to the control group. Conclusion: These results provide substantial evidence supporting the efficacy of incorporating TENS into treatment plans for low back pain, which could offer more efficient and holistic care. PhysioConnect 5 International Conference Abstract 80

Comparison of Gait Parameters in Typically Developing Children with Down Syndrome Children: A Literature Review

NUSRAT JAHAN, NITESH MALHOTRA

Introduction: Down syndrome is a nonhereditary genetic condition, characterized by an extra abnormal chromosome set which is placed on the 21st chromosome and so it is also called trisomy 21 due to one extra chromosome which makes 47 chromosomes in total instead of normal 46. All the Down syndrome children may show some degree of motor delay, postural issues, gait impairment, balance issue, sensory and cognition impairment on the basis of their severity level. Due to generalized hypotonia and fl accid posture which is the major characteristics of Down syndrome condition, children often seen with delay in walking, abnormal gait patterns specially at spatiotemporal area. When compared with typically developing children, it has been noticed that some difference is seen in stride length, step length, cadence and base width which may vary on severity of the condition of particular individual. Aim and Relevance: The purpose of this review is to provide a vision into how Down syndrome children have different gait patterns for spatiotemporal area in age-matched typically developed children. Material & Methodology: This literature includes those studies involving gait analysis on Down syndrome children and typical children for comparison purpose. Inclusion Criteria: Primarily 30 articles were retrieved on the basis of topic gait in typically and down syndrome children from Google Scholar, education Source, and PubMed were the primary medical databases for this review. We shortlisted 15 studies after using keywords like “Down syndrome, gait, spatiotemporal, cadence, stride length” used one & alternatively. Result: Typically developed children and Down syndrome children have different gait patterns. When gait of Down syndrome children compared with typically developing children, it has been observed that stride length and step length in Down syndrome children found to be 65-75cm (centimetre) and 30-40cm subsequently, velocity around 0.6-0.8 m/sec which is much lesser than in typical children. Cadence found to be approximate 120 steps/min and base width around 10-14cm which is much larger when compared to agematched typically developing children. Conclusion: Down Syndrome children have different and unique gait patterns because of their physiology of the body structure and so this type of study for therapeutic intervention is needed to examine and work with the children with Down syndrome to obtain objective data to implicate in therapy to get better balance and improve gait patterns. PhysioConnect 5 International Conference Abstract 81

Antimicrobial Efficacy of Methanolic Extracts of Tinospora cordifolia and Cinnamomum zeylanicum against Enterococcus faecalis Biofilm Production: An In-vitro Study

Introduction: The robust nature of Enterococcus faecalis (E. faecalis) biofilms poses substantial challenges during endodontic therapy. Conventional irrigants, such as Sodium Hypochlorite (NaOCl) and Chlorhexidine (CHX), are effective but are cytotoxic and have deleterious effects on fracture resistance. Natural alternatives like Tinospora cordifolia (TC) and Cinnamomum zeylanicum (CZ) offer promising antimicrobial properties against biofilms. Aim: To evaluate the antimicrobial efficacy of TC and CZ against 21-day-old E. faecalis biofilms, compared to conventional irrigants. Materials and Methods: This an in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Chennai, India, between February 2024 and May 2024. Methanolic extracts of TC and CZ were prepared, and Minimum Inhibitory Concentrations (MICs) were determined using an agar diffusion test. Thirty-one single-rooted teeth were vertically sectioned (N=62) and incubated in an E. faecalis suspension for 21 days to establish biofilms, confirmed via Scanning Electron Microscopy (SEM). Samples were categorised into five groups (n=12): TC, CZ, NaOCl, CHX, and saline (control) and each group was treated with 2 mL of the respective solution for 10 minutes. Microbial load was assessed quantitatively via Colony-forming Unit (CFU) counts/mL and qualitatively. CFU data were expressed as mean±SD. One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test was used for intergroup comparison. Results: The findings revealed a statistically significant variation among the tested irrigants. MIC was 7 mg/L for TC extract and 7.5 mg/L for CZ extract. CFU counts/mL (mean±SD) were lowest for 5.25% NaOCl (0) and 2% CHX (0), followed by TC (15.430±4.320×107), CZ (20.564±2.234×107), and saline (34.45±5.653×107). Conclusion: Both methanolic extracts of TC and CZ show considerable antimicrobial efficacies against E. faecalis biofilm as compared to the negative control, suggesting their potential as alternative or adjunctive endodontic irrigants.

Impact of Food Insecurity on Oral Health Related Quality of Life among Brick Kiln Workers of Rayagada District, Odisha, India: A Cross-sectional Study

Payal Dash, Anandamoy Bagchi, Ipseeta Menon, Gunjan Kumar

Introduction: Food insecurity is a pressing public health issue that adversely affects both general and oral health, particularly among marginalised groups. Brick kiln workers, who are part of the informal labour sector, often lack access to adequate healthcare and nutrition. However, limited data exist on how food insecurity influences their Oral Health-Related Quality of Life (OHRQoL). Aim: To assess the impact of food insecurity on OHRQoL among brick kiln workers in Derigaon Gram Panchayat, Rayagada District, Odisha, India. Materials and Methods: A community-based cross-sectional study was conducted among 1,240 adult brick kiln workers selected through multi-stage stratified random sampling. A structured, pretested, and Odia-translated questionnaire was utilised, incorporating the Food Insecurity Experience Scale (FIES), Oral Health Impact Profile-14 (OHIP), and sociodemographic details. Descriptive statistics, Analysis of Variance (ANOVA), and Pearson’s correlation were applied for data analysis, with a significance threshold of p<0.05. Results: A high prevalence of food insecurity was observed in the study population. ANOVA revealed significant differences across FIES categories in OHIP domains such as psychosocial discomfort, physical disability, and psychological disability (p<0.05). Pearson’s correlation showed weak but significant associations between food insecurity and functional limitation (r=0.057, p=0.045), physical pain (r=0.075, p=0.008), and psychological disability (r=-0.084, p=0.003). The overall OHIP score did not significantly correlate with FIES. Conclusion: Food insecurity significantly influenced several aspects of OHRQoL among brick kiln workers. Integrated strategies targeting both nutrition and oral health are essential for improving outcomes in these vulnerable labour populations.

Ocular Manifestations in Children with Developmental Delay: A Cross-sectional Study

Renu Magdum, Arpit Gupta, Priyanka Aher, Gufran Ali Kamdar, Preethi Abraham

Introduction: Children with Developmental Delay (DD) are at increased risk for ocular abnormalities, which may further hinder their overall growth and neurodevelopment. Understanding the spectrum of these manifestations is essential for early intervention. Aim: To investigate the prevalence and types of ocular manifestations in children with DD milestones, and to study antenatal, natal and postnatal factors present in these children with ocular manifestations. Materials and Methods: The present cross-sectional study was conducted at a tertiary care centre in Western Maharashtra from September 2023 to March 2025. A total of 201 children aged six months to 15 years with a clinical diagnosis of DD were included. Each child underwent a comprehensive ophthalmic examination, including visual acuity assessment, cycloplegic refraction, squint evaluation and anterior and posterior segment examination. Relevant antenatal, natal, and postnatal histories were also recorded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27. Descriptive statistics were used to summarise the data. A 95% confidence level was maintained, and a p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 5.73±4.07 years, with 120 (59.7%) males and 81 (40.3%) females. Ocular abnormalities were present in 166 (82.6%) children with DD, while 35 (17.4%) had normal ocular findings. Refractive errors were the most common, found in 119 (59.2%) children, including hypermetropia {55 (27.4%)}, astigmatism in {42 (20.9%)}, and myopia in {22 (10.9%)}. Other common ocular conditions included strabismus {59 (29.4%)}, Cortical Visual Impairment (CVI) {13 (6.5%)}, cataract {12 (6%)} Only round off done, The values are matching with the values given in table 5 and 6, amblyopia {7 (3.5%)}, keratoconus {8 (4%)}, and optic atrophy {7 (3.5%)}. Ocular abnormalities were slightly more frequent in children with Isolated Developmental Delay (IDD) {37 (18.4%)} than those with Global Developmental Delay (GDD) {129 (64.1%)}, though this difference was not statistically significant (p=0.942). No significant associations were observed between ocular abnormalities other than refractive errors and age group, sex, or consanguinity. However, preterm birth showed a statistically significant association with ocular abnormalities (p=0.016). Conclusion: Children with DD, especially those with global delay, are at high-risk for ocular abnormalities. Early diagnosis and intervention for conditions such as refractive errors, strabismus, and CVI are essential to improve visual outcomes and support overall development. Routine vision screening and multidisciplinary collaboration are vital for ensuring timely care and preventing long-term visual impairment.

Effect of Pelvic Proprioceptive Neuromuscular Facilitation on Balance, Postural Sway and Quality of Life in Chronic Stroke Patients: A Case Series

Introduction: Among long-term stroke survivors who are also chronic stroke patients, balance impairments are common, leading to increased postural sway and reduced Quality of Life (QOL). Pelvic Proprioceptive Neuromuscular Facilitation (PNF) is a targeted treatment approach focused on the pelvic region to improve coordination, mobility, and stability, thereby enhancing daily functioning and well-being. Aim: To determine the effect of pelvic PNF on balance, postural sway, and QOL in chronic stroke patients. Materials and Methods: The present case series included five patients (4 males and 1 female) aged 40-65 years with chronic stroke. Baseline data for balance, postural sway, and QOL were collected pre and post intervention. Balance was assessed with the Berg Balance Scale (BBS); postural sway was measured with a sway meter; QOL was evaluated with the Stroke-Specific Quality of Life (SS-QoL) scale. The effectiveness of pelvic PNF was determined by comparing pre and post intervention data. Results: A paired t-test showed significant differences between pre and post intervention scores (p<0.05). The BBS score increased from a preintervention mean of 30.8 to a post intervention mean of 38.2, indicating improved balance. Postural sway decreased in all directions: anterior sway from 6.9 cm preintervention to 5.3 cm post intervention, and posterior sway from 8.6 cm to 7.2 cm. Similarly, right lateral sway improved from 8.1 cm to 6.9 cm, and left lateral sway decreased from 7.1 cm to 5.9 cm, reflecting better stability. The SS-QoL score rose from 92.4 preintervention to 109.2 post intervention, indicating improved quality of life. Conclusion: Pelvic PNF improves balance, reduces postural sway, and enhances quality of life in chronic stroke patients.

App-based Assessment of Hearing Impairment among Undergraduate Medical Students in Chengalpattu District, Southern India: A Cross-sectional Study

Introduction: Hearing loss is a significant global health issue, affecting over 430 million people worldwide, including 6.3% of the Indian population. Risk factors include excessive use of audio devices, high volume levels, and prolonged noise exposure. Early identification through accessible and cost-effective screening methods is essential, and mobile applications offer a promising approach for hearing assessment. Aim: To determine the prevalence of hearing loss among medical students and identify associated risk factors using the World Health Organisation (WHO)’s hearWHO app. Materials and Methods: A cross-sectional study was conducted between May 2024 and October 2024 among 250 undergraduate students from two medical colleges in the Chengalpattu district, Tamil Nadu, India. A pretested semi-structured questionnaire was used to collect sociodemographic details and information on various risk factors associated with hearing impairment among students aged above 18 years. The hearWHO app was used to assess hearing loss through a digits-in-noise test, categorising scores as >75, 50-75, and <50. Participants with scores <50 were classified as having hearing loss. Data analysis was performed using SPSS version 22. Statistical analysis included Chi-square tests, bivariate analysis, and multivariate logistic regression, with a significance threshold of p<0.05. Results: The prevalence of hearing loss among participants was 69 (27.6%). Significant associated factors were age >22 years (AOR=2.372, p=0.007), female gender (AOR=4.011, p<0.001), prolonged audio device usage >4 hours/day (AOR=4.216, p<0.001), listening at volumes >50% (AOR=2.866, p=0.006), and media usage during sleep (AOR=3.055, p=0.022). Symptoms such as ear discomfort or fullness and a history of ear infection were also associated with hearing loss. Conclusion: This study highlights a high prevalence of hearing loss among medical students, emphasising the need for early screening, education, and interventions. Addressing modifiable risk factors such as device usage habits and listening volume is crucial in mitigating hearing loss and promoting auditory health among young adults.

Morphological and Morphometric Characterisation of Lateral Ankle Ligament Complex in Human Cadavers: A Descriptive Cross-sectional Study

Reba Babu Alex, Smitha Sasidharan Nair, Sreekumar Rajasekharan

Introduction: The lateral ankle ligaments are the most common to get involved in ankle sprains and problems related to ankle instability, and a precise knowledge of the morphological features of these ligaments would be highly beneficial for diagnosis and treatment. Aim: To describe the attachments, and mean dimensions of the lateral ankle ligament complex. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Anatomy, Government Medical College, Thiruvananthapuram, Kerala, India, from March 2022 to 2023. A total of 56 embalmed cadavers donated for teaching purposes were dissected to evaluate the lateral ankle ligaments. The three lateral ankle ligaments, namely Anterior Talofibular (ATFL), Calcaneofibular (CFL), and Posterior Talofibular (PTFL) were identified. Their positions with respect to external bony landmarks were defined. The morphology of the ligaments, their site of attachments, length, and width were documented. The stretching of the ligaments and their orientation with the long-axis of the fibula with dorsiflexion and plantarflexion of the foot was noted. The morphological observations were presented in percentages. Assuming the numeric measurements of the morphometric analysis to be normally distributed, the data were summarised in mean and standard deviation. Results: The ATFL was found to consist of two bands in 32 (57.14%) ankles and a single band in 24 (42.86%) ankles. The CFL was cord like in 38 (67.9%) ankles and was single banded in 18 (32.1%) ankles. The lateral talocalcaneal ligament was observed to reinforce CFL in four ankles. The mean length of ATFL, CFL and PTFL were 19.24±2.31 mm, 28.16±3.56 mm, 25.03±3.53 mm, respectively and the mean width were 8.21±1.52 mm, 5.25±1.10 mm, 7.56±1.25 mm, respectively. Conclusion: The detailed anatomical knowledge would be vital in diagnosis and arthroscopic reconstruction of the injured ankle ligaments In the era of minimally invasive surgeries, the study findings would be promising for clinical practice and research.

Pattern of Cardiac Autonomic Modulation Assessed by Heart Rate Variability in Normal Pregnancy: A Longitudinal Cohort Study

Deepali Khatri, Priya Rajeev Mardikar, Ketaki Junnare, Leena Sanjay Phadke

Introduction: Normal pregnancy is associated with adaptive maternal haemodynamics, viz., increase in blood volume, Heart Rate (HR), cardiac output, and fall in blood pressure. Alterations in hormones and plausible autonomic modulation may regulate these haemodynamic changes and failure of such alterations could have clinical consequences like pregnancy-induced hypertension and preeclampsia. Heart Rate Variability (HRV), a non-invasive measure of cardiac autonomic activity may provide insights in pattern of cardiac autonomic modulation during pregnancy, and tracking it may be useful clinically. Aim: To evaluate the pattern of cardiac autonomic modulation assessed by HRV during the course of healthy pregnancy. Materials and Methods: The present longitudinal cohort study was conducted from August 2019 to April 2021 in SKNMC and GH, Pune, Maharashtra, India. A total of 31 pregnant females who underwent repeated HRV assessment between 11th-13th, 18th to 20th, and 24th to 26th weeks of gestation and tracked for pregnancy outcome till delivery, were included. High sampled Electrocardiogram (ECG) (1 Kz) for 15 minutes was recorded in supine left lateral position and HRV indices from last five minutes were measured. Multiple group comparisons and between-group comparisons were done using non parametric tests and p<0.05 was considered significant. Results: The mean age of 31 pregnant females was 24.1±3.4 years. Significant increase in average HR (p=0.002) was observed from first to third trimester significant decrease in overall HRV (p=0.01), total power (ms²) (p=0.008), High Frequency (HF) (ms²) (p=0.03) and Low Frequency (LH) (ms²) (p=0.001) was also observed. A trend in HFnu decrement was observed. Conclusion: As pregnancy advances, (till 26 weeks) a pattern of parasympathetic withdrawal (decreased overall variability and HF (ms²) along with increase in average HR and reduced baroreflex sensitivity (decrease in LF power) was observed with healthy pregnancy.

Efficacy of Chlorhexidine Alcohol versus Povidone Iodine Alcohol in Reducing Peripheral Venous Catheter Colonisation in Paediatric Patients: A Randomised Controlled Trial

Introduction: Peripheral Venous Catheters (PVCs) are routinely used in paediatric patients but are associated with catheter-related infections. Adequate skin antisepsis prior to catheter insertion is critical in preventing these infections. Aim: To compare the efficacy of 2% chlorhexidine in alcohol (CHA) with 10% povidone-iodine in alcohol (PI) in reducing catheter-tip colonisation in paediatric patients. Materials and Methods: A double-blind randomised controlled trial was conducted at the Paediatric Ward of Acharya Vinoba Bhave Rural Hospital, Maharashtra, India, from May 2024 to December 2024. A total of 102 paediatric patients aged 1 month to 16 years, admitted to the paediatric ward with an indication for intravenous catheterisation, were randomly assigned to two groups: Group A received 2% CHA and Group B received 10% PI in alcohol before PVC insertion. Upon catheter removal, the distal tips were cultured for microbial colonisation. Parameters assessed included gender, age group, mean age, incidence of catheter-tip colonisation, and type of organism isolated. Statistical tests applied included Chi-square test, Independent t-test, and Fisher’s exact test. Results: Demographic data showed comparable gender distribution (M:F=31:20 in Group A, 30:21 in Group B) and mean age (6.6±3.05 years vs 7.14±3.42 years) between the two groups. Catheter-tip colonisation occurred in 1 (1.96%) patient in Group A and 6 (11.76%) in Group B (p-value=0.112). Staphylococcus was the predominant organism in both groups, while Klebsiella and Gram-positive Cocci (GPC) were additionally isolated in the PI group. Conclusion: Catheter-tip colonisation was higher in the PI-alcohol group (6/51) compared with the CHA group (1/51); however, this difference did not reach statistical significance (p-value=0.112). A larger study is warranted to provide more definitive evidence.

Students’ Perception on Problem-based and Limerick-based Learning Methods: A Mixed-method Study

Introduction: Medical education continuously explores innovative teaching methods to enhance student engagement, critical thinking, and knowledge retention. Problem-based Learning (PBL) and Limerick-based Learning (LBL) are two distinctive approaches aimed at fostering these skills. PBL emphasises real-world problem solving and critical thinking, while LBL uses creative mnemonic techniques to improve memory retention. Aim: To assess medical students’ perceptions of both PBL and LBL approaches after undergoing sessions of both methods. Materials and Methods: The present mixed-method study was conducted at Mata Gujri Memorial Medical College, Kishanganj, Bihar, India, from June 2024 to September 2024. The study included 66 medical students who participated in three PBL and three LBL sessions. The students provided feedback on various aspects of the sessions using a Likert-scale questionnaire and in open-ended feedback. Since the data were non parametric, the Mann–Whitney U test was applied to compare the two samples. Alongside, a thematic analysis of student feedback was performed to identify common themes and insights. Results: There were 66 medical students: 39 males and 27 females, with a mean age of 21.75±1.49 years. PBL was found to be more effective in improving critical thinking skills and applying theoretical knowledge to practical scenarios (p<0.0001). Students found LBL to be more enjoyable and creative, fostering better memory retention of medical concepts (p<0.0001). Both methods were perceived as equally beneficial in enhancing collaboration (p=0.09), but LBL received higher satisfaction in terms of time and resource adequacy (p<0.0001). Qualitative feedback highlighted PBL’s strength in critical thinking, while LBL was appreciated for simplifying difficult concepts and making learning more enjoyable. Conclusion: Both PBL and LBL provide valuable learning experiences. A blended approach that combines the strengths of both methods may optimise medical education by fostering deep, critical thinking and efficient recall of essential medical concepts. Further research is needed to explore how these methods can be integrated effectively into medical curricula.

Comparative Outcomes of Thoracic Endovascular Aortic Repair versus Open Surgical Repair for Descending Thoracic Aortic Aneurysms:A Retrospective Cohort Analysis

Nishant Bhargava, Zakir Hussain, Jayesh Dholakiya, Prarabdh Saxena

Introduction: Descending Thoracic Aortic Aneurysms (DTAAs) pose significant management challenges, with Thoracic Endovascular Aortic Repair (TEVAR) increasingly replacing Open Surgical Repair (OSR) due to its minimally invasive nature. However, debates persist regarding long-term outcomes, durability, and optimal patient selection between these approaches. Aim: The present study aimed to compare perioperative and long-term outcomes of TEVAR versus OSR for DTAAs over a 10-year period focusing on mortality, complications, reinterventions and survival. Materials and Methods: The present retrospective cohort analysis was conducted on 133 consecutive patients (TEVAR: n=91; OSR: n=42) treated at a tertiary aortic center in Central India (2015-2025). Data collection included preoperative demographics, procedural details, and outcomes (30-day mortality, complications, reinterventions, and survival). Statistical analyses employed Kaplan-Meier survival analysis, Cox regression, and propensity score matching to adjust for confounders. Results: TEVAR demonstrated superior perioperative outcomes, with significantly lower rates of respiratory failure (p<0.01) and Acute Kidney Injury (AKI) (p=0.02), along with a trend toward reduced 30-day mortality (3.3% vs 9.5%, p=0.18). At 5-year follow-up, TEVAR showed better overall survival (80.1% vs 58.3%, p=0.042) but required more reinterventions (34.7% vs 0%, p<0.01). Multivariable analysis identified age {Hazard Ratio (HR) 1.05/year} and renal insufficiency (HR 2.12) as independent mortality predictors, while treatment modality showed no significant association (p=0.39). Conclusion: TEVAR provides superior early safety and intermediate-term survival, making it ideal for high-risk patients, while OSR offers greater durability for younger patients. Treatment selection should be individualised based on patient risk profile and anatomic suitability.

Comparison of Intravenous Ibuprofen and Paracetamol for Postoperative Pain Relief in Functional Endoscopic Sinus Surgeries: A Randomised Controlled Study

Geetha Ramalakshmi, Karthik Kanthan, Sujina Hermin, Ramamurthy Balaji

Introduction: Functional Endoscopic Sinus Surgery (FESS) is widely performed for chronic rhinosinusitis and sinonasal disorders. Despite being minimally invasive, it can cause moderate to severe postoperative pain, necessitating effective analgesia with minimal opioid use. Aim: To compare the efficacy of intravenous (i.v.) ibuprofen and i.v. paracetamol for postoperative pain management in patients undergoing FESS. Materials and Methods: This double-blind, randomise, controlled study was conducted at SRM Medical College Hospital and Research Centre in Chennai, Tamil Nadu, India done from 15th November 2024 and 2nd February 2025. It included 100 adult patients undergoing elective FESS under general anaesthesia. Patients were divided into two groups (n=50 each) to receive either i.v. ibuprofen (400 mg) (group I) or i.v. paracetamol (1 g) (group P), 30 minutes before the end of surgery. Postoperative pain intensity was assessed using the Visual Analogue Scale (VAS) score at 0, 4, 8, 12, 16, 20, and 24 hours. Secondary outcomes included total rescue opioid (i.v. tramadol) consumption, rescue analgesia requirement. Results were considered significant if ‘p’ was less than 0.05 (two-tailed). The analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 21.0. Results: The baseline characteristics of groups I and P were comparable, with no significant differences observed across age (p-value=0.956), gender distribution (p-value=0.229), and weight (p-value=0.651). The ibuprofen group had significantly lower Non Steroidal Anti-Inflammatory Drugs (NSAIDs) requirements at 4, 8, 16, and 20 hours postoperatively (p-value <0.0001). Only 8% of patients in the ibuprofen group required rescue analgesia compared with 36% in the paracetamol group (p-value=0.001). Conclusion: The i.v. ibuprofen provides superior early postoperative analgesia compared to i.v. paracetamol in FESS patients, with reduced need for rescue opioids and better patient satisfaction, makes it a valuable choice in opioid-sparing pain management protocols.

Pattern of Abdominal Organ Injuries in Road Traffic Accidents: An Autopsy Based Cross-sectional Study from Central Kerala, India

Joseph Ajin, Baby Neeraja, Rajan Boney, Neeratty Asokan Balaram, Babu Boban

Introduction: The abdominal wall usually avoids severe damage by transferring stress to the abdominal organs. Analysing the pattern of abdominal injuries in Road Traffic Accidents (RTAs) may help clinicians in providing more targeted treatment to trauma victims at the earliest. Aim: The present study aimed to analyse the pattern of abdominal organ injuries in RTAs based on medicolegal autopsies. Materials and Methods: The present cross-sectional study included data from medicolegal autopsies of RTA victims conducted between December 2019 and September 2021 at a Government Medical College hospital in Thrissur, Central Kerala, South India. All cases in which death occurred as a result of RTA-related injuries were included. Postmortem examinations were performed, and injuries were recorded. Data were statistically analysed using the chi-square test and Cramer’s V effect size value Statistical Package for Social Sciences (SPSS), version 16.0, Illinois, CA, USA). Results: A total of 70 cases were included. Males accounted for 57 (81.42%) (p=0.022). The majority of victims 55 (78.57%) were brought dead to the hospital, most of whom were between 40-59 years of age. Among single-organ injuries, the liver was most commonly involved 38 (54.28%), followed by the mesentery 23 (32.85%). The most common type of injury was liver laceration (35/67, 52.22%), followed by mesenteric contusion (20/31, 64.51%) and splenic laceration (17/67, 25.37%). Multiple-organ injuries were also observed, most commonly involving two organs. Conclusion: Liver and mesenteric injuries were the most frequently observed, highlighting the severity and complexity of abdominal trauma. These findings emphasise the need for early diagnosis, efficient trauma care systems, and preventive strategies to reduce mortality associated with such injuries.

Comparison of Two-handed Mask Ventilation using C-E versus V-E Techniques for Induction of General Anaesthesia: A Randomised Clinical Trial

Richa Tailor, Jigisha Mehta, Sara Mary Thomas

Introduction: Mask ventilation is a fundamental skill in airway management, requiring optimal hand positioning for effective ventilation. Two-handed techniques are preferred for challenging mask ventilation scenarios. Aim: To compare the effectiveness of the C-E versus the V-E techniques of two-handed mask ventilation during the induction of general anaesthesia. Materials and Methods: This randomised clinical trial was conducted in the Department of Anaesthesiology at Dhiraj General Hospital, Vadodara, Gujarat, India from August 2024 to July 2025. Seventy adult patients (American Society of Anaesthesiologists (ASA) I-III, aged 18-60 years) undergoing elective surgery were randomly allocated into two groups: Group A (C-E technique, n=35) and Group B (V-E technique, n=35). The primary outcome measured was expired Tidal Volume (TVe). Secondary outcomes included peak airway pressure (Pmax), ease of ventilation score, haemodynamic parameters, and ventilation failure rates. Data were analysed using unpaired t-tests for continuous variables and the Chi-square test for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The groups were comparable in demographics (mean age: Group A-42.3±8.7 years vs. Group B-41.8±9.2 years, p-value=0.832; weight: 84.2±12.1 kg vs. 85.1±11.8 kg, p=0.751; BMI: 26.8±2.4 kg/m² vs. 27.2±2.6 kg/m², p-value=0.513). The mean TVe was significantly higher in the V-E group (677.9±76.8 mL) compared to the C-E group (450.7±71.2 mL; p-value <0.001). Peak airway pressures were similar between groups (C-E: 21.5±1.8 cmH₂O vs. V-E: 20.3±1.6 cmH₂O; p-value=0.074). The ease of ventilation score was significantly better with the V-E technique (4.2±0.6 vs. 2.7±0.8; p-value <0.001). Ventilation failure occurred in five patients (14.3%) with the C-E technique and none with the V-E technique. Conclusion: The V-E technique provides superior ventilation with higher tidal volumes, better ease of ventilation, and lower failure rates compared to the C-E technique during mask ventilation. The V-E technique achieved 50% higher tidal volumes without requiring increased airway pressures, demonstrating superior ventilation efficiency. This technique should be preferentially used for two-handed mask ventilation in clinical practice.

Adhatoda vasica and Tetracycline Coated Type I Collagen Membrane for Periodontal Regeneration: An In-vitro Study

Bawatharani Maharavi, Jaideep Mahendra, Balaji Ganesh, Aisvarya Naagendran

Introduction: Periodontitis is a chronic inflammatory disease that leads to the destruction of periodontal tissues and alveolar bone loss. The lost periodontium has been restored using regenerative materials such as collagen membrane. Enhancing these membranes with antibiotics or bioactive agents can improve their antimicrobial and physiochemical properties. Aim: This in-vitro study aimed to analyse the antibacterial and physiochemical properties of herbal agent Adhatoda vasica and tetracycline coated type I collagen membrane. Materials and Methods: The present in-vitro study was conducted at Central Research Laboratory Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India. The study was carried out over a period of four months, from December 2024 to March 2025. Type I collagen membranes devoid of pre-existing antimicrobial agents and exhibiting no structural defects were included for analysis. A total 40 membrane samples were used and divided equally into four groups (n=10 per group) to ensure uniform distribution for analysis. Adhatoda vasica extract was prepared using ethanol and coated onto Type I collagen membranes via dip coating, alone and in combination with tetracycline. The study comprised four groups: Group 1: Type I collagen membrane, (CM), Group 2: Adhatoda vasica (Av) coated CM (Av+CM), Group 3: Tetracycline coated CM, (T+CM) and Group 4: Av and T coated CM (Av+T+CM). Antibacterial efficacy was assessed through culture tests, while physicochemical properties such as membrane integrity was checked using Fourier-Transform Infrared Spectroscopy (FTIR), hydrophilicity via Ossila goniometer, surface roughness via Atomic Force Microscopy (AFM), drug release was measured via a plate reader and degradation rate was determined by electronic weighing balance machine. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. One-way Analysis of Variance (ANOVA) was used for intergroup comparisons. A p-value <0.05 was considered statistically significant. Results: Group 4 (Av+T+CM) showed the highest antibacterial activity with zone of inhibition significantly greater than other groups (p<0.001). Surface roughness was significantly increased in Group 2 (Av+CM) and Group 4 (p<0.01) indicating enhanced topography. Hydrophilicity varied significantly with Group 2 showing the lowest contact angle (p<0.01). FTIR analysis showed no significant spectral shifts confirming structural integrity. Group 4 exhibited burst release during the initial three hours followed by sustained release upto 48 hours and exhibited slow rate of degradation. Conclusion: The present in-vitro study suggested that Adhatoda vasica and tetracycline when used synergically as a coating on Type I collagen membrane, provides excellent antibacterial and physiochemical properties and hence can be used as a therapeutic material for preventing infections and promoting periodontal regeneration after periodontal surgery.

Insights from Histogram and Flag Analysis in Pseudothrombocytopenia Cases: A Single-centre Cross-sectional Study

Rajeswari Thivya Dhanabalan, Aarthi Kannan

Introduction: Pseudothrombocytopenia (PTCP), also known as Spurious Thrombocytopenia (TCP), is a common problem encountered in many laboratories. When stable patients are evaluated for thrombocytopenia, the first step is to exclude PTCP. Most haematology analysers are equipped with software-generated flagging algorithms that identify abnormal platelet distributions, indicating the presence of giant platelets or platelet clumping, which is reflected in the histogram. Aim: To analyse the White Blood Cell (WBC) and platelet histograms in cases showing falsely low platelet counts. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Chettinad Hospital and Research institute, Tamil Nadu, over a period of six months from January 2021 to June 2021. Haemogram samples were analysed using the Beckman Coulter LH 750 analyser within two hours of sample collection. Samples showing platelet counts of less than one lakh (1,00,000/μL) on the analyser were further evaluated using Leishman-stained peripheral smears to confirm platelet counts. All cases that showed low platelet counts on the analyser but adequate platelet counts on the peripheral smear were included in the study. Demographic details such as age and sex were recorded. Platelet and WBC histograms, along with platelet parameters such as Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW), were analysed. The results were tabulated using Microsoft Excel, and mean and median values were calculated. Results: In this study, PTCP cases constituted 0.32% of the total cases (18,654) and 1.96% of thrombocytopenic cases (3,060). Among the 60 identified PTCP cases, 44 were males (73%) and 16 were females (27%), giving a male-to-female ratio of 2.75:1. The study population ranged from 19 to 73 years of age, with a mean age of 45±15.11 years. MPV was within normal limits in 40 cases, increased in 15 cases, and decreased in five cases. PDW was increased in 43 cases and normal in 17 cases. Platelet histograms showed changes such as the presence of Multiple Peaks (MP flag) in 41 cases (68.3%). In WBC histograms, platelet clumping was identified by an abnormal curve in front of the lower discriminator in 53 cases (88.3%). Conclusion: Microscopic blood smear examination in cases of PTCP along with analysis of histogram can prove to be valuable tool to provide the details of the etiology and pathogenesis of PTCP.

Assessment of Central Corneal Thickness and Corneal Curvature in Patients with Pseudoexfoliation: A Cross-sectional Study

Rekha Mudhol, Nitheesha Vaddeboina

Introduction: Pseudoexfoliation Syndrome (PEX) is the most frequently reported cause of secondary open-angle glaucoma, accounting for approximately 25-30% of global cases. PXG is typically more aggressive than Primary Open-Angle Glaucoma (POAG), as evidenced by higher Intraocular Pressures (IOP), greater pressure fluctuations, and faster progression of visual field loss. Central Corneal Thickness (CCT) is a key parameter in ocular assessment for PEX patients. However, current literature offers conflicting findings regarding CCT in PEX patients. Aim: The present study compared CCT and corneal curvature between individuals with and without PXF to evaluate the IOP readings in PXF patients, thereby aiding in the early detection and management of glaucoma. Materials and Methods: The present hospital-based, cross-sectional, study included 53 patients with unilateral or bilateral PXF (study group) and 53 age-matched control patients without corneal pathology. CCT was measured using Anterior Segment-Optical Coherence Tomography (AS-OCT), and corneal curvature was measured using an auto refractometer. Independent sample t-tests and paired sample t-tests were used for statistical comparisons between groups. Results: The mean CCT was 506.15±36 μm in the study group and 501.4±34.74 μm in the control group (p=0.626). The mean corneal curvature (K1) in the right eye (OD) was 44.2±2.0 D in the study group and 45.11±2.03 D in the controls (p=0.024). K2 in OD was 46.1±1.3 D in the study group and 46.9±1.2 D in controls (p=0.005). In the left eye (OS), the mean K1 was 44.06±1.7 D in the study group and 45.04±1.5 D in controls (p=0.002), while the mean K2 was 46.5±1.2 D in the study group and 47.2±1.3 D in controls (p=0.009). There was no statistically significant difference in CCT between PXF and control eyes (p=0.626). However, keratometry values (K1 and K2) were significantly lower in PXF eyes compared to controls in both OD and OS. Conclusion: There was no significant difference in mean CCT between the PXF and control groups, nor between PXF eyes and fellow eyes in unilateral PXF cases. However, the mean corneal curvature was significantly lower in individuals with PXF than those without, suggesting possible implications for accurate IOP measurement and early glaucoma management.

Intranasal Vacha Taila Nasya as Add-on Therapy for Postdural Puncture Headache: A Pilot Randomised Controlled Trial

Amit Ashok Paliwal, Sanjay Babar, Rutuja Bhosale, Shital Rasane, Vasudha Asutkar

Introduction: Postdural Puncture Headache (PDPH) is a common complication of spinal anaesthesia, typically managed with conservative measures or invasive epidural blood patch. Vacha (Acorus calamus) Taila Nasya, described in Ayurveda for head disorders, offers potential as a safe, non invasive adjunct therapy. Aim: To evaluate the efficacy and safety of Vacha Taila Nasya as an add-on therapy in routine postoperative care for PDPH. Materials and Methods: This single-centre, pilot, randomised controlled trial was conducted at the Inpatient Departments of Shalyatantra and Stree Prasuti, Dr. D. Y. Patil College of Ayurved and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India over a period of 1 year and 6 months. A total of 40 patients diagnosed with PDPH following spinal anaesthesia were enrolled. Participants were randomised into two groups: Group A (control: routine postoperative care including hydration, bed rest, analgesics, and caffeine as required) and Group B (intervention: routine postoperative care plus Vacha Taila Nasya, 2 drops per nostril, twice daily for 3 days). The study was conducted in an open-label design; however, outcome assessment was performed by a blinded investigator. The primary outcome was change in Visual Analogue Scale (VAS) pain score. Secondary outcomes included resolution of associated symptoms (neck stiffness, tinnitus, hypoacusis, photophobia, nausea) and incidence of adverse events. Data analysis was carried out using the Mann–Whitney U test with Statistical Package for the Social Sciences (SPSS) software, version 26.0 (IBM Corp., Armonk, NY, USA). Results: Patients in the Vacha Taila Nasya group (Group B) demonstrated significantly greater pain reduction compared to the control group (mean VAS score reduction was 5.6±1.2 in Group B compared to 3.1±1.4 in Group A (p-value=0.004). Associated symptoms such as nausea, neck stiffness, and photophobia also improved significantly (p-value <0.05 for all). No major adverse events were observed; only 2 patients (10%) reported mild nasal irritation, which resolved spontaneously without intervention. Conclusion: Vacha Taila Nasya was safe, feasible, and demonstrated promising efficacy as an adjunct therapy in the management of PDPH. As part of an integrative approach, it may reduce symptom burden, minimise reliance on conventional analgesics, and enhance patient comfort in the postoperative setting. Early adoption in selected cases could provide a simple, non invasive supportive therapy alongside routine care.

Prevalence and Patterns of Musculoskeletal Injuries among Female Karate Athletes: A Cross-sectional Study

Suma Patil, Pushparaj Kulal, Brinda Dcosta

Introduction: Karate is a high-intensity combat sport that subjects athletes to repeated biomechanical stress, often resulting in Musculoskeletal Injuries (MSIs), particularly among female athletes. Despite the increasing participation of females in this sport, there remains a paucity of gender-specific injury data. Aim: To determine the prevalence and patterns of MSIs among female karate athletes in the Hubli-Dharwad region. Materials and Methods: This cross-sectional observational study was conducted from January 2025 to April 2025, involving 70 female karate practitioners aged 18-35 years across six registered karate academies in the Hubli-Dharwad region, Karnataka, India. Participants had a minimum of two years of consistent training. The Nordic Musculoskeletal Questionnaire (sport-adapted) was used to document symptoms over the past 12 months. Injury prevalence across anatomical regions was calculated, and correlations between injury sites were assessed using Spearman’s coefficient. A p-value of <0.001 was considered statistically significant. Results: The overall prevalence of MSIs was observed in 51 participants (72.9%). The most commonly affected areas were the lower back (24 participants, 34.3%), knees (21 participants, 30.0%), shoulders (20 participants, 28.6%), and wrists/hands (18 participants, 25.7%). Statistically significant correlations were observed between several adjacent or functionally linked areas, including the shoulders and upper back (r-value=0.467; p-value <0.001) and knees and ankles/feet (r-value=0.540; p-value <0.001), suggesting biomechanical interdependence. The Sport-adapted Nordic Musculoskeletal Questionnaire (SNMQ) demonstrated acceptable internal consistency, with a Cronbach’s α of 0.761. Conclusion: Female karate athletes exhibit a high burden of MSIs, predominantly affecting the lower back and lower extremities, followed by the shoulder and upper back. These findings emphasise the need for gender-specific preventive strategies and biomechanically informed training modifications to safeguard athlete health and performance.

Prevalence of Post COVID-19 Pulmonary Arterial Hypertension and its Clinical Association with CT Severity Score among COVID-19 Pneumonia Survivors in a Tertiary Care Hospital of Western Odisha, India

Panda Sibaram, Panda Mayadhar, S Nanda, Sharma Sunil Kumar

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus targets the Angiotensin Converting Enzyme 2 (ACE2) receptor, which is abundantly present in two vital organs of the body, namely the lungs and the heart, making the pathogen devastating. Because these organs are closely linked in their pathophysiology, disease in one organ can affect the other. It has been observed that patients recovering from Coronavirus Disease 2019 (COVID-19) pneumonia can later develop fatal cardiac complications such as Pulmonary Arterial Hypertension (PAH) as a result of multiple and complex pathophysiological phenomena. PAH leads to right ventricular failure and death due to increased pulmonary vascular resistance. However, early diagnosis with appropriate medical management can increase survival and quality of life. The chest Computed Tomography (CT) severity score on High Resolution Computed Tomography (HRCT) of the lungs is a standard index for estimating the severity of pneumonia in hospitalised COVID-19 patients. Aim: To estimate the prevalence of post COVID-19 PAH and to assess the association between chest CT severity score and post COVID-19 PAH among survivors of COVID-19 pneumonia. Materials and Methods: A cross-sectional study was conducted in the Department of Cardiology, VIMSAR, Burla, Odisha, India, from October 2020 to October 2023, enrolling 854 patients with cardiac complaints in the post COVID-19 period. Severity of COVID-19 pneumonia was graded as mild, moderate, or severe according to the semiquantitative chest CT severity score method, based on the CT reports from the COVID-19 period. The enrolled patients were thoroughly examined; those with abnormal cardiac signs and Electrocardiography (ECG) or chest X-ray suggestive of underlying PAH underwent echocardiography. Diagnosis of PAH was performed according to the 2022 European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Nonparametric statistical methods, such as the Chi-square test, were used to analyse qualitative data, whereas quantitative variables were expressed as means with standard deviations, and an unpaired t-test was used to compare means between two groups. Results: The prevalence of PAH in the post COVID-19 period among pneumonia survivors was 12.1%. A total of 104 patients were diagnosed with PAH: 35 (33.7%) had severe pneumonia, 26 (25.0%) had mild pneumonia, and 43 (41.3%) had moderate pneumonia. The chest CT severity score was significantly associated with the development of post COVID-19 PAH. Conclusion: Higher chest CT severity scores during acute COVID-19 pneumonia are associated with a greater risk of developing PAH in the post COVID-19 period. Proper screening of these patients can enable earlier detection of post COVID-19 PAH.

Efficacy of Oral Ketamine and Midazolam Combination versus Oral Midazolam alone as Premedicants in Paediatric Surgical Patients: An Interventional Study

Introduction: In paediatric patients midazolam and ketamine are commonly used as premedicants, intended to reduce emotional trauma and ensure smooth induction. Hence, we undertook a study to evaluate if addition of oral ketamine 3 mg/kg to oral midazolam 0.5 mg/kg resulted in better premedication than oral midazolam 0.5 mg/kg alone. Aim: To evaluate whether the addition of oral ketamine 3 mg/kg to oral midazolam 0.5 mg/kg results in more effective premedication compared to oral midazolam 0.5 mg/kg alone in paediatric surgical patients. Materials and Methods: The present interventional study was conducted on 100 children who were assigned equally to the two groups (n=50 each) aged eight months to six years belonging to ASA grade I and II undergoing elective surgeries. Group KM received oral ketamine 3 mg/kg with midazolam 0.5 mg/kg and group M received oral midazolam 0.5 mg/kg 30 minutes prior to proposed surgery. Sedation score, anxiolysis score, parental separation and mask tolerance was assessed in all patients 30 minutes after the drug administration. The data was analysed by using statistical Statistical Package for Social Sciences (SPSS) software. The p-values <0.05 were considered statistically significant, and 95% confidence intervals are reported where applicable. Results: A total of 100 children were randomly divided equally into two groups. The mean age was 3.42±1.48 years in group KM and 3.81±1.69 years in group M, while the mean weight was 12.24±3.59 kg and 13.64±3.77 kg, respectively. Gender and ASA status were comparable between the groups. Satisfactory sedation was achieved in 72% of children in group KM compared to 54% in group M. Anxiolysis was significantly better in group KM (80% score IV) than in group M (24% score IV). Parental separation was smoother in group KM (96% calm separation) compared to 78% in group M. Mask tolerance was also superior in the KM group. All differences were statistically significant (p<0.05). Conclusion: Oral ketamine 3 mg/kg with midazolam 0.5 mg/kg produces significantly better sedation, anxiolysis, parental separation and mask acceptance without significant side effects when compared to oral midazolam 0.5 mg/kg alone. The quality of sedation, anxiolysis and separation parameters are significantly better in midazolam and ketamine combination group.

Efficacy of Gambhari Phala Granules versus Haridra Khanda in the Management of Sheetapitta (Urticaria): A Randomised Controlled Clinical Trial

Tanika Yadav, Vaishali Kuchewar

Introduction: Large wheals or erythematous, pruritic rashes on the skin are characteristic of urticaria. It is characterised by raised, itchy lesions that may last longer than six weeks in chronic cases and resemble a nettle sting. About 20% of people experience it at some point in their lives. Conventional medicine mainly addresses symptoms and often requires long-term medications, which may cause undesirable side-effects. The hallmark of Sheetapitta (urticaria) is itchy red rashes that may appear nearly everywhere on the body. In Ayurveda, repeated Shodhana (detoxification) and Shaman Chikitsa (internal medication) are recommended for Sheetapitta. Various Acharyas have described different herbal and herbo-mineral treatments for Sheetapitta. Yogratanakara mentions Gambhari phala (Gmelina arborea fruit) with milk. Aim: To determine whether Gambhari phala (Gmelina arborea fruit) granules and Haridra Khanda (Curcuma longa granules) are effective in reducing wheal appearance, intensity and the duration of itching in Sheetapitta. Materials and Methods: This randomised controlled trial was conducted for 30 days at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, Maharashtra, India. Two equal groups of 60 patients were enrolled. In Group H, Haridra Khanda (Curcuma longa granules) was administered as an adjuvant, while Gambhari Phala (Gmelina arborea fruit) granules were administered to Group G, at a dose of 3 g twice daily for 30 days. The effectiveness of the intervention was evaluated using baseline subjective and objective measures and the data were compared. Results: There was no statistically significant difference between the groups (p-value=0.67), with the mean age of Group G (Gambhari Phala granules) 38.53±13.18 years and Group H (Haridra Khanda) 39.43±12.51 years. Comparable distributions were found for gender, diet, Koshtha and Prakruti (p-value >0.05 for all). Absolute Eosinophil Count (AEC) values decreased significantly in Group G from 217.20±74.63 to 184.48±50.25 (p-value=0.012); however, Group H did not show a significant change (p-value=0.32). By Day 15 (p-value=0.0056) and day 30 (p-value=0.0001), Group G showed significant improvement from baseline Urticaria Activity Score (UAS) scores, which were similar between groups (p=0.26). According to the 5D Pruritus Scale, 100% of patients in Group G reported less than 6 hours of itching per day by Day 30, compared with 57.1% in Group H. Group G showed a substantial reduction in itching duration across all time points (p-value <0.01). On day 30, 86.2% of patients reported no irritation, compared with 57.1% in Group H (p-value=0.026), indicating a considerable improvement in itching in Group G. During the 30-day treatment period, neither group experienced adverse events. Conclusion: Gambhari Phala granules in patients with Sheetapitta significantly improved clinical outcomes, including reductions in pruritus intensity and wheal severity, without notable adverse effects. Gambhari Phala appears to be a safe and effective Ayurvedic alternative and was more effective than Haridra Khanda in terms of UAS and 5D Pruritus Scale scores. Regarding urticaria symptoms, Haridra Khanda was less effective than Gambhari Phala.

Intraoral Nitroglycerine Spray versus Intraoral Lignocaine Spray to Suppress the Haemodynamic Response to Endotracheal Intubation in Patients undergoing Elective Surgeries under General Anaesthesia: A Randomised Clinical Trial

Introduction: General Anaesthesia (GA) is the keystone in the management of complicated and specialised surgeries, enabling the safe and effective performance of procedures that would otherwise be intolerable or unsuccessful for patients. Airway manipulation during GA, especially laryngoscopy and endotracheal intubation, leads to acute haemodynamic changes that may pose risks in susceptible individuals. Aim: To compare the effect of intraoral Nitroglycerine (NTG) spray versus the intraoral lignocaine spray before laryngoscopy and endotracheal intubation. Materials and Methods: A single-centre, double-blinded, randomised clinical trial was conducted in the Department of Anaesthesia, Sree Balaji Medical College/BIHER, Chennai, Tamil Nadu, India over 18 months from January 2021 to June 2023. Total of 60, American Society of Anaesthesiologists (ASA) grade I and II patients undergoing elective surgery under GA were randomised into two groups: group A received an intraoral spray of nitroglycerin 400 mcg, and group B received an intraoral spray of 10% lignocaine 20 mg. Haemodynamic parameters were recorded at multiple time points during induction, intubation and at various time intervals post-intubation. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 23.0 via independent two-tailed t-test and One-way Analysis of Variance (ANOVA) for parametric data and via Chi-square test for non parametric data. A p-value <0.05 was considered statistically significant. Results: Among total of 60 participants, 33 (55%) belonged to the age group 20-29 years, and 37 (61.67%) were males. The data showed significant attenuation of Blood Pressure (BP) and Heart Rate (HR) changes during laryngoscopy, intubation and post-intubation in both groups (Mean HR: 85.42 vs 77.22 bpm) {Mean Systolic Blood Pressure (SBP): 124.1 vs 128.53 mmHg} {(Mean Diastolic Blood Pressure (DBP): 78.16 vs 81.27 mmHg} and {Mean Arterial Pressure (MAP): 93.47 vs 97.04 mmHg}, with comparative analysis suggesting that NTG exhibited superior control over blood pressure and the results were statistically significant (p-value <0.05). Conclusion: Both intraoral lignocaine and nitroglycerin sprays effectively attenuate intubation-induced haemodynamic responses, with nitroglycerin providing superior blood pressure control during laryngoscopy and intubation. Nitroglycerin spray may be preferred for patients requiring enhanced haemodynamic stability, especially those with hypertension or coronary artery disease, pending further large-scale studies.

Impact of Prolonged Tourniquet Time on Wound Healing in Orthopaedic Surgeries: A Retrospective Cohort Study

V Venkataram, Karthik Prakash, Gayatri R Nair

Introduction: Tourniquet application is routinely used in orthopaedic surgeries to reduce intraoperative blood loss and enhance surgical field visualisation. However, prolonged use of it may adversely affect tissue perfusion and delay wound healing. Aim: To evaluate the association between tourniquet duration and wound healing in patients undergoing orthopaedic surgeries. Materials and Methods: The present retrospective cohort study was conducted at Mahatma Gandhi Medical College and Research Institute, Pondicherry, India, over a period of six months involving 40 patients who underwent orthopaedic procedures involving tourniquet use. Participants were categorised into two groups based on tourniquet time: less than 120 minutes (n=23) and 120 minutes or more (n=17). Delayed wound healing was defined as wound dehiscence requiring clinical intervention, delayed suture removal beyond postoperative day 12, or the presence of a surgical site infection confirmed clinically or microbiologically. Delayed wound healing incidences were compared between groups using Fisher’s-exact test. Results: A total of 40 patients were included in the study, of whom 7 were females and 33 were males. Delayed wound healing occurred in 4 out of 17 patients (23.5%) with tourniquet time ≥120 minutes, while none of the patients in the <120-minute group experienced delayed healing. The difference was statistically significant (p=0.026). Conclusion: Prolonged tourniquet application of 120 minutes or more is significantly associated with delayed wound healing in orthopaedic surgeries. Careful consideration of tourniquet duration is warranted to minimise postoperative complications and support optimal healing.

Comparison of Efficacy and Durability of Three Desensitising Agents in Non Carious Non Restorable Lesions: A Randomised Clinical Study

Introduction: Dentin hypersensitivity arises from stimulus transmission across exposed dentin, leading to pain through a hydrodynamic mechanism. The primary goal in treating this condition is to provide immediate and lasting pain relief while restoring the impermeability of dentinal tubules. However, an ideal desensitising agent has yet to be identified. Aim: To compare the efficacy of Admira Protect, Gluma Desensitiser, and Seal&Protect as an antihypersensitive agent in non carious, non restorable lesions and the durability of the bond for one, three and six months. Materials and Methods: This randomised clinical study was carried out in the Department of Conservative Dentistry and Endodontics at K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2016 to July 2017, with 90 teeth from 27 patients randomly assigned to one of three groups, each containing at least 30 teeth with a Visual Analogue Scale (VAS) score of 4 or higher. Admira Protect-group A (n=30); Seal&Protect-group B (n=30), and Gluma Desensitiser-group C (n=30). Dentin hypersensitivity was evaluated using tactile, thermal (cold), and evaporative stimuli at four time points: baseline, immediately after treatment, and at one, three, and six months post-treatment. Sensitivity levels were recorded using a VAS. The experimental agents were applied by a co-investigator per the manufacturer’s instructions, while the principal investigator assessed sensitivity at all time points. Data were analysed using One-way Analysis of Variance (ANOVA) and post-hoc Tukey tests. Results: All three treatment groups demonstrated significant differences (p-value <0.05) at baseline, immediately after treatment, and during the 3 months and 6 months follow-ups. A statistically significant difference was observed between Admira Protect (A) and Gluma Desensitiser (C). However, no significant differences were found between Admira Protect (A) and Seal&Protect (B), or between Seal&Protect (B) and Gluma Desensitiser (C). Overall, all three agents proved effective for approximately six months. Conclusion: Admira Protect demonstrated a statistically significantly greater reduction in dentin hypersensitivity compared to Gluma Desensitiser, particularly at immediate, 1-month, and 3-month assessments.

Correlation of an Emerging Inflammatory Marker Neutrophil Lymphocyte Ratio with Obesity Markers among Medical Students: A Cross-sectional Study

Divyashree, Anand Kachigere Siddeshwara Siddegowda

Introduction: Obesity contributes to chronic low-grade systemic inflammation and increases the risk of non-communicable diseases such as cardiovascular disease, diabetes, and hypertension. The Neutrophil-to-Lymphocyte Ratio (NLR) is a simple and accessible marker that reflects the balance between innate and adaptive immunity, thereby serving as an indicator of early systemic inflammation. Although elevated NLR has been associated with metabolic and cardiovascular disorders, limited evidence is available on its significance in healthy young adults, particularly among medical students. This highlights the need to explore its relationship with obesity markers in this population. Aim: To assess the relationship between obesity markers and NLR among first-year medical students. Materials and Methods: The present cross-sectional study was conducted at a rural medical college in southern India and included 202 first-year undergraduate medical students who provided written informed consent. Demographic details and medical history were recorded. Anthropometric measurements, including height, weight, and waist circumference, were taken using standardised methods. Body Mass Index (BMI) was calculated and classified according to World Health Organisation (WHO) Asian criteria. Venous blood samples were collected for complete blood count, and NLR was calculated by dividing the absolute neutrophil count by the lymphocyte count. Associations were analysed using Pearson correlation in GraphPad Prism version 10.60. Results: Mean NLR values increased across BMI categories: 1.98 in normal weight, 2.2 in overweight, and 2.5 in obese participants (p<0.0001). BMI showed a strong positive correlation with NLR (r=0.604, p<0.0001), while waist circumference also demonstrated a significant correlation (r=0.542, p<0.0001). Total leukocyte count did not differ significantly between BMI groups. Conclusion: NLR increases with rising BMI and waist circumference, indicating subclinical inflammatory changes in healthy young adults. Monitoring NLR may serve as a practical and early marker of systemic inflammation, helping to guide timely preventive interventions for at-risk young individuals. Screening for NLR in obese individuals can aid in the early identification of inflammatory risk.

Comparison of Wilson’s Score and Intubation Prediction Score for Prediction of Difficult Endotracheal Intubation: A Prospective Observational Analytical Study

Jigisha Bharatbhai Mehta, Apoorva Tarafdar, Sara Mary Thomas, Arpan Patel

Introduction: Prediction of a difficult airway is of utmost importance, as an unanticipated difficult airway can lead to severe adverse events. Clinically, prediction is done using independent bedside tests; however, these often lack accuracy. Moreover, most airway assessment scores are cumbersome and subject to interobserver variability because of subjective parameters. Wilson’s Score and the Intubation Prediction Score (IPS) are commonly used scoring systems for preoperative airway evaluation. Aim: To determine the diagnostic accuracy of the Wilson Score and IPS in predicting difficult airways. Materials and Methods: This prospective, observational, analytical, single-blind study was conducted among 120 patients aged 18 to 70 years who underwent surgeries requiring endotracheal intubation. All patients underwent airway assessment using both the Wilson Score and IPS. General anaesthesia with endotracheal intubation was performed by an anaesthesiologist who was unaware of the patients’ scores. The ease of laryngoscopy and intubation was assessed using the Intubation Difficulty Scale (IDS), where an IDS score greater than 5 indicated a difficult airway. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and overall accuracy of both scoring systems were calculated. McNemar’s test was used to compare diagnostic performance, with p-value <0.05 considered statistically significant. Results: A total of 120 patients were assessed, of whom 58 (48.33%) were male and 62 (51.67%) were female. The mean age and weight of the patients were 40.47±12.14 years and 70.53±13.76 kg, respectively. Sixty-six (55%) patients belonged to American Society of Anaesthesiologists (ASA) Grade I, and 54 (45%) to ASA Grade II. The actual incidence of difficult airway was 11.67%. Wilson’s Score showed a sensitivity of 21.43%, specificity of 93.40%, PPV of 30.00%, NPV of 90.00%, and accuracy of 85.00%. IPS demonstrated significantly better sensitivity (71.43%; p-value=0.014), PPV (83.33%; p-value=0.023), and overall accuracy (95.00%; p-value=0.012). Both systems showed high specificity (IPS: 98.11%; Wilson’s: 93.40%; p-value=0.172), while NPV was higher for IPS (96.30% vs. 90.00%; p-value=0.057). Conclusion: The IPS outperforms Wilson’s Score in predicting difficult endotracheal intubation, particularly in terms of sensitivity, PPV, and overall accuracy. Incorporating IPS into routine preoperative assessment may enhance patient safety. Therefore, it can be preferred as a simple and accurate bedside tool for predicting difficult airways in patients undergoing endotracheal intubation under general anaesthesia.

Correlation between Cognition, Functional Ability and Quality of Life in Older Adults having Subjective Cognitive Decline: A Cross-sectional Study

Madhuchhanda Mohanty, Jasobanta Sethi, Prakash Kumar, Meenakshi Batra

Introduction: Subjective Cognitive Decline (SCD) represents self-perceived cognitive impairment that may precede objective signs of cognitive decline. Exploring the association between cognition, functional ability, and Quality of Life (QoL) among older adults having SCD, will help in identification of at-risk population and tailor interventions. Aim: To investigate the association between cognition, functional ability and QoL among older adults having SCD across different Socioeconomic Status (SES) and gender. Materials and Methods: The present a cross-sectional study included data collected from the Outpatient Department (OPD) of a Rehabilitation Institution in Delhi,India between July 2023 to October 2023. Data from 130 older adults with SCD was taken by random sampling for cognition, functional ability, QoL and SES. Cognition was assessed using Montreal Cognitive Assessment (MOCA) and Addenbrooke’s Cognitive Examination III (ACE-III). Functional ability was measured by Lawton Instrumental Activities of Daily Living (L-IADL) Scale, QoL {Health Related Quality of Life (HRQoL)} by SF-36 Health Survey and Kuppuswamy socioeconomic scale was used to measure SES. Descriptive statistics, Pearson product-moment correlations, and chi-square tests were used to explore the association between the variables. Results: SES was not significantly correlated with IADL (r=-0.098, p=0.267), SF-36 scores (r=0.131, p=0.138), or ACE-III scores (r=0.145, p=0.099). In males, a statistically significant moderate positive correlation was found between MOCA and ACE-III scores (r=0.521, p<0.001), indicating consistency in cognitive assessment tools and no significant correlations were found between SES and MOCA (r=0.137, p=0.221), IADL (r=-0.076, p=0.502), or SF-36 scores (r=0.072, p=0.520). Among females, a statistically significant moderate-to-strong correlation was also observed between MOCA and ACE-III scores (r=0.546, p<0.001). Additionally, a weak but positive, nearly significant correlation was observed between SES and MOCA scores (r=0.255, p=0.078), indicating a possible trend. The correlation between SES and SF-36 was also weak and non-significant (r=0.212, p=0.143). Conclusion: A statistically significant moderate positive correlation was observed between MOCA scores and ACE-III scores. This indicates that participants who scored higher on the MOCA also tended to have higher ACE-III scores. The correlation between SES and MOCA score was weak and not statistically significant. Other variables did not show strong or statistically significant relationships.

An In-vitro Evaluation of Fracture Resistance of Pulpotomised Permanent Teeth Restored with Different Aesthetic Restorative Materials

Introduction: One of the fundamental goals of modern dentistry, centered around the ideology of minimally invasive dentistry, is to maintain tooth pulp viability. The dental pulp has the capacity for repair, depending on the intensity of damage and the level of pulp inflammation. All attempts are made to preserve the vitality of the radicular pulp. Pulpotomy has been reinvestigated as a definitive therapeutic option for mature permanent teeth with extensive carious lesions. Furthermore, Class II Mesio-Occluso-Distal (MOD) cavity preparation undergoing pulpotomy reduces the teeth’s fracture resistance. Aim: To evaluate and compare the fracture resistance of pulpotomised premolars treated with calcium silicate materials, such as Mineral Trioxide Aggregate (MTA) or Biodentine (BD), in Class II MOD cavities restored using Cention-N and nanohybrid composite. Materials and Methods: An in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India, from November 2023 to December 2023. A total of 55 extracted maxillary premolars were collected, embedded in acrylic resin molds, and divided into five groups of 11 teeth each. Group 1: Intact teeth, Group 2: Standardised Class II MOD cavities were prepared, coronal pulpotomy was performed, and teeth were restored with MTA. After the complete setting of MTA, a Glass Ionomer Cement (GIC) base was placed, followed by restoration with a nanohybrid composite, Group 3: Similar procedure as Group 2, but with MTA as the capping material and restored with Cention-N, Group 4: Similar procedure as Group 2, but with BD as the capping material and restored with a nanohybrid composite, Group 5: Similar procedure as Group 2, but with BD as the capping material and restored with Cention-N. Specimens were subjected to a fracture resistance test using a Universal Testing Machine (UTM). The load at which restorations fractured was recorded in Newtons (N), and the obtained data were statistically analysed using One-way Analysis of Variance (ANOVA) and post-hoc tests. Data were considered significant if p≤0.05. Results: Intact teeth (1273.64 N) had the highest mean fracture resistance compared to other groups. Group 5 (973.64 N) showed the highest mean fracture resistance, followed by Group 3 (895.45 N), Group 4 (700 N), and Group 2 (633.64 N). The differences in fracture resistance were statistically significant (p<0.05). Conclusion: The present in-vitro study found that intact teeth had the highest fracture resistance. Among the experimental groups, pulpotomised premolars restored with BD and Cention-N showed significantly greater fracture resistance. In contrast, restorations using MTA and nanohybrid composites exhibited lower resistance. BD and Cention-N outperformed the MTA-Cention-N, BD-Nanohybrid, and MTA-Nanohybrid combinations. Therefore, BD and Cention-N can be considered preferred materials for restoring pulpotomised maxillary premolars with Class II MOD cavities.

Ultrasound and Fluoroscopy-assisted Central Venous Catheterisation: A Retrospective Evaluation of Device Survival and Complications in a Tertiary Care Setting

Vishal Nandkishor Bakare, Ritesh Kumar Sahu

Introduction: Central Venous Access Devices (CVADs) are indispensable in tertiary care for administering chemotherapy, parenteral nutrition, and haemodialysis. Image-guided insertion, particularly under Ultrasonography (USG) and fluoroscopy, has significantly reduced complications compared to landmark-based techniques. However, data on outcomes and complications in diverse patient populations remain limited. Aim: To evaluate the technical success, device survival, and complications associated with image-guided CVAD insertions, focusing on patient demographics, catheter types, and risk factors. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent CVAD placement in the Department of Interventional Radiology of a tertiary care setting, Pune, India, from January 2015 to June 2016. Data were collected using a structured case record form, including demographics, catheter types (tunneled, non-tunneled, Peripherally Inserted Central Catheters (PICC), ports), access sites (internal jugular, femoral, basilic veins), and complications (early: <24 hours; intermediate: 24 hours-30 days; late: >30 days). Technical success was defined as successful catheter placement with tip confirmation at the cavoatrial junction and functional patency. Statistical analysis included descriptive statistics (mean, SD, percentages) and device survival analysis (from insertion to removal or patient death). Results: The study comprised 60 males and 40 females (mean age: 37.13±16.61 years). Tunneled catheters (Permacath) were most common (41%), followed by PICCs (36%). The right internal jugular vein was the preferred access site (61%). Technical success was achieved in 100% of cases. Device survival averaged 146.32±98.9 days (median: 135.5 days). Complications included infection (4%), catheter occlusion (2%), and tip migration (1%). Seven patients died during follow-up, none from catheter-related causes. Conclusion: Image-guided Central Venous Catheter (CVC) insertion demonstrated excellent technical success rates. The right internal jugular vein was the safest access site, while infectious complications remained the most common adverse outcome despite relatively low occurrence rates. These findings support current practice standards while identifying areas for continued quality improvement.

Effect of Sensor Monitored Upright Sitting on Core Muscle Thickness, Contractibility and Spinal Posture among Asymptomatic University Students: A Study Protocol for RCT

Varsha Huddar, Sanjiv Kumar, Ashwin Patil

Introduction: Prolonged sitting in classrooms predisposes students to poor posture, muscle imbalance, and low back pain. Tonic activation of the core muscles that stabilise the spine increases when seated upright, and this may have positive effects on pulmonary function and overall wellbeing. Need of the study: Although there is extensive literature on upright sitting activating the core, little is known about upright sitting as an intervention for core strengthening compared with conventional exercises in asymptomatic students with core weakness. Hence, this study aims to determine and compare the effect of four weeks of upright sitting as an intervention. Aim: To compare the effects of four weeks of sensor-monitored upright sitting, conventional exercises, and a combination of upright sitting and conventional exercises on core strength, as measured by the plank test, surface Electromyography (EMG), and ultrasonography, in asymptomatic university students with core weakness. Materials and Methods: This is a randomised three-arm, assessor-blinded controlled trial that will be conducted in the physiotherapy department of a tertiary-care hospital in North Karnataka, India. A total of 120 university students with core weakness, aged 18 to 25 years, will be randomly assigned to one of three groups: upright sitting group; conventional exercises group; or combined upright sitting and conventional exercises group. Ethical clearance for the study was obtained from the KAHER Ethics Committee (KAHER/EC/24-25/417). The outcome include plank hold test to evaluate the core endurance, surface EMG to assess muscle contractability and ultrasonography to assess muscle thickness, Forced Vital Capacity (FVC), and Forced Expiratory Volume in one second (FEV1) ratio by portable spirometer and posture by Artificial Intelligence Posture Evaluation and Correction System (APCES) application, will be assessed at pre, post 4th week. Follow-up assessment of core endurance by plank hold test will be done at the end of 8th week. Data will be analysed using Statistical Package for the Social Sciences (SPSS) version 28.0. Descriptive statistics will include frequency, percentage, mean, and standard deviation. Chi-square test will be used for association. Repeated-measures Analysis of Variance (ANOVA) (or mixed-design ANOVA) will be used to assess differences over time, followed by appropriate post hoc procedures. For normally distributed data, independent t-tests (between groups) and paired t-tests (within groups) will be used; for non normally distributed data, Mann-Whitney U tests (between groups) and Wilcoxon signed-rank tests (within groups) will be used. A significance level of 0.05 will be used.

Effect of Transdermal Magnesium and Moderate Intensity Theraband Training on Pressure Pain Threshold, Disability and Quality of Life among Adults with Sciatic Pain: A Research Protocol

Sakshi Vats, Mohammad Sidiq

Introduction: Sciatic pain, commonly known as sciatica, is a prevalent condition characterised by radiating pain along the sciatic nerve pathway, significantly affecting an individual’s quality of life due to discomfort, numbness, and muscle weakness. Need of the study: Cost-effective, non-invasive methods of treating sciatic pain are increasingly necessary. Investigating the synergistic effects of TM and MIT training may provide an innovative approach to promoting integrative pain management techniques by enhancing quality of life, reducing disability, and improving pressure pain threshold in affected individuals. Aim: To study the effect of Transdermal Magnesium (TM) and moderate-intensity Theraband (MIT) training on quality of life among adults with sciatic pain. Materials and Methods: A two-group, randomised, pretest-post-test clinical trial will be conducted in recognised hospitals in Delhi, India using simple random sampling from February 2025 to February 2026. Two groups will be formed, each consisting of 56 participants. Group A will be the experimental group and will receive a TM spray and MIT training using Theraband exercises. Group B, the control group, will receive sham TM spray and MIT training with Theraband exercises. Both groups will undergo the intervention three days per week for eight weeks. The paired t-test will be employed to assess within-group changes, while the unpaired t-test will be used for intergroup comparisons, with a significance level of p<0.05. This integrated approach addresses both biochemical and functional aspects, offering comprehensive rehabilitation benefits.

Comparing the Effect of Preoxygenation using High-flow Nasal Oxygen and the Tight Facemask Technique during Rapid Sequence Induction in Abdominal Surgeries: A Research Protocol

Dara Lakshmi Harshitha, Vivek Chakole

Introduction: Preoxygenation is a critical step during Rapid Sequence Induction (RSI) to prevent hypoxemia during the apnoeic phase, particularly in patients undergoing abdominal surgeries who are at higher risk due to full stomachs, elevated intra-abdominal pressure, and compromised respiratory mechanics. Need of the study: Tight-fitting facemasks have traditionally been used for oxygen delivery in high-risk patients, but they can cause discomfort and may lead to inadequate oxygenation. High-flow Nasal Oxygen (HFNO) has emerged as an effective alternative, offering warmed, humidified oxygen and continuous apnoeic oxygenation, which enhances patient comfort. Despite these benefits, there is limited research on the efficacy of HFNO in abdominal surgeries. Investigating its impact on oxygenation, recovery times, and overall patient satisfaction during these procedures is essential for improving clinical outcomes. Aim: To compare the effectiveness of preoxygenation using HFNO versus a tight facemask during RSI in patients undergoing abdominal surgeries. Materials and Methods: This randomised interventional study will be conducted at Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India, from February 2025 to July 2026. The study will include 76 adult patients (38 per group) undergoing abdominal surgeries under general anaesthesia. After obtaining informed consent and ethical approval, eligible patients will be randomised into two groups: the HFNO group or the tight-fitting facemask group. Standard monitoring and premedication will be administered. The primary outcome will be oxygen saturation during preoxygenation and one minute after intubation. Secondary outcomes include End-tidal CO₂ (EtCO₂), haemodynamic responses, and complications. Data will be analysed using an Independent t-test to find the significant difference between the two groups. A p-value <0.05 will be considered statistically significant.

Comparative Evaluation of Sesame Oil Massage, Epsom Salt Hot Water Application, and their Combination for Managing Knee Joint Pain in Homemakers: A Research Protocol

Jaya Khandar, Abhay Mudey, Deeplata Mendhe, Achita Sawarkar

Introduction: Knee pain is a common musculoskeletal disorder, particularly observed among homemakers who engage in prolonged standing and repetitive activities. The burden of knee pain significantly affects mobility, Quality of Life (QOL), and daily functioning. Osteoarthritis (OA) remains the leading cause of knee pain, and non-pharmacological interventions are increasingly being recognised as safe and effective alternatives to conventional treatments. Need of the study: Homemakers, due to their daily household activities, have a higher tendency to develop knee pain, which often goes unaddressed because of financial constraints and limited access to healthcare. Prolonged use of pharmacological management for knee pain is associated with adverse effects, thereby necessitating alternative, cost-effective, and community-based interventions. Sesame oil is known for its anti-inflammatory and antioxidant properties, while Epsom salt, rich in magnesium sulphate, promotes muscle relaxation and circulation. Despite these potential benefits, limited research has compared their effectiveness when used individually and in combination. This study aims to fill this gap and provide evidence-based recommendations for the management of knee pain in homemakers. Aim: To compare and evaluate the effectiveness of Epsom salt hot water application, sesame oil massage, and their combination for knee pain management among homemakers. Materials and Methods: A three-arm parallel Randomised Controlled Trial (RCT) will be conducted from May 2024 to May 2026 in selected rural areas of the Wardha district, India. A total of 126 homemakers aged 40-60 years with mild to moderate knee pain will be randomly assigned to three groups of 42 participants each. Group A will receive sesame oil massage, Group B will receive hot water fomentation with Epsom salt, and Group C will receive a combination of both interventions. Outcome measures will include pain severity and functional status, assessed at baseline (Day 0) and after three weeks of intervention. Pain severity will be evaluated using the Visual Analogue Scale (VAS), and functional status will be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For intergroup and intragroup comparisons, one-way ANOVA and paired t-tests, respectively, will be applied. Additionally, for pairwise comparisons, post-hoc Tukey’s test will be used. Associations between demographic variables and intervention outcomes will be analysed using Pearson’s Chi-square test. Statistical significance will be set at p<0.05.

Assessment of Add-on Effect of Satvavajaya Chikitsa (Counselling), Bhramari Pranayama versus Brahmi Ghrita in Vishada (Depression): A Three-arm Randomised Control Trial Protocol

Vikas Chaurasiya, Dnyanesh Joshi, Sushil Kumar Dubey

Introduction: Depression (Vishada) has emerged as a significant mental health concern worldwide, affecting over 300 million individuals globally, with a particular rise in young people in India. Traditional Ayurvedic approaches offer alternative and holistic treatments, emphasising the balance of mind (Mana) and body (Sharira). Vishada, as described in classical texts like Charaka Samhita and Sushruta Samhita, represents a state of persistent sadness, loss of self-confidence, and mental incapacity, often leading to disturbances in daily functioning. Traditional Ayurvedic treatments such as Satvavajaya Chikitsa (Counselling), Bhramari Pranayama, and Brahmi Ghrita have been suggested for managing Vishada. The current study aims to evaluate the efficacy of these interventions in comparison. Need of the study: Over 300 million people globally suffer from depression, projected to be the leading cause of disability by 2030. In India, 31-57% of youth are affected, yet 75% in low and middle-income countries lack access to treatment. Conventional antidepressants often have side effects, highlighting the need for affordable, holistic alternatives. This study evaluates the effectiveness of three Ayurvedic therapies - Satvavajaya Chikitsa (counselling), Bhramari Pranayama (breathing exercise), and Brahmi Ghrita (herbal formulation)-in managing depression. Aim: To assess the add-on effect of Satvavajaya Chikitsa (Counselling), Bhramari Pranayama versus Brahmi Ghrita in Vishada (Depression). Materials and Methods: The present study will adopt a randomised controlled trial design. The study will start from June 2025 and be conducted over 21 days for all groups, with measurements recorded on the 0th, 7th, 14th, and 21st days. Patients will be enrolled for treatment at the Mahatma Gandhi Ayurved College, Hospital, and Research Centre in Wardha Maharashtra, India, covering both Outpatient Department (OPD) and Inpatient Department (IPD) services under the Kayachikitsa Department. The sample consists of 123 patients diagnosed with depression, aged 16-40 years, both male and female, with a Beck Depression Inventory (BDI) score between 21-30 and a Hamilton Depression Rating Scale (HDRS) score between 17-23. Participants are randomly assigned to three groups: Satvavajaya Chikitsa (Counselling) and Brahmi Ghrita, Bhramari Pranayama, Brahmi Ghrita, and Brahmi Ghrita alone. Each group undergoes a 24 day treatment period. The primary outcome was the reduction in depression symptoms measured by the BDI and HDRS scales. Secondary outcomes include improved psychological well-being, reduced anxiety and stress, and overall patient satisfaction.

Evaluation of Ozonated Water and Ozonated Olive Oil as an Adjunct to Non Surgical Periodontal Therapy in Chronic Periodontitis: A Research Protocol

Sakshi Vishal Kotecha, Priyanka Jaiswal, Shweta Bhagat

Introduction: Periodontitis is characterised by inflammation of the supporting tissues of the teeth, leading to progressive destruction of the periodontal ligament and alveolar bone, which results in the formation of periodontal pockets and gingival recession. The primary goal of periodontal therapy is to eliminate these pathological features. While Scaling and Root Planing (SRP) is a widely accepted treatment, it has limitations, such as difficulty accessing deeper pockets and root concavities. Need of the study: Ozone therapy, known for its antimicrobial and anti-inflammatory properties, has gained attention as a potential adjunctive treatment in the management of Chronic Periodontitis (CP). Despite growing interest in these treatments, limited research has directly compared the effectiveness of ozonated water and ozonated olive oil in combination with SRP for treating CP. The present study seeks to fill the gap in the literature by assessing and comparing the clinical outcomes when ozonated water or ozonated olive oil is applied as an adjunct to SRP. Aim: This study aims to assess the efficacy of ozonated water and ozonated olive oil as adjuncts to non surgical periodontal therapy, specifically SRP, in treating CP. Materials and Methods: A double-blind, randomised controlled clinical trial will be conducted in the Outpatient Department of Periodontics at Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. from June 2025 to June 2026. A total of 30 participants will be divided into two groups: Group 1 will receive SRP followed by ozonated water application, while Group 2 will receive SRP followed by ozonated olive oil application. The participants will be assigned to each group by coin-flip randomisation. Pocket probing depth, plaque index, papillary bleeding index, and Clinical Attachment Level (CAL) will be assessed at each follow-up interval. Unpaired and paired t-tests will be used to evaluate data from baseline, 1-month, and 3-months for each group. A p-value of less than 0.05 will be deemed significant.

A Comparative Analysis of Vidarikand Vati (Pueraria tuberosa DC) and Ashwagandha Vati (Withania somnifera Linn.) for Karshya (Underweight): A Randomised Controlled Trial Research Protocol

Nikita Maroti Rathod, Vaishali Kuchewar, Ashvini Pardhekar

Introduction: The term “karshya” refers to a person who is thin, weak, or malnourished. It originates from the root word “Tanukarane dhatu,” which translates to “Alpa, Suskshma” (small, subtle). According to Dalhanacharya, Karshya is characterised by a deficiency in Upachaya (growth), Bala (stamina), and Rupa (appearance). In Ayurveda, Ahara (food) is considered the most crucial of the three pillars of health, known as Tryopasthambha. Ayurvedic medicine emphasises the concept of Agni, the digestive fire, which transforms food into nourishment. Malnutrition occurs due to Mandagni, or weak digestive fire, leading to malabsorption and poor digestion. Karshya (underweight) is classified into aetiology, prodrome, signs and symptoms, complications, and chronic diseases, and is considered a poor predictor of overall health outcomes. Need of the study: There are numerous research articles on weight gain. However, many nutritional and bulk-promoting products in the market are expensive and are known to have significant side-effects. Charaka Samhita mentions Vidarikanda as balya (strengthening) and bruhaniya (growth-promoting). It is a cost-effective and readily available bruhaniya herb for weight gain. Despite this, only a few individuals are aware of herbal medications to gain weight. Hence, this study is planned. Aim: To evaluate the comparative efficacy of Ashwagandha vati (Withania somnifera) versus Vidarikand vati (Pueraria tuberosa DC) in the management of Karshya (underweight). Materials and Methods: A double-blind, controlled trial will be conducted at the Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India from April 2025 to February 2026. Sixty patients (30 in each group) who are underweight will be included in this study. Group A (the control group) and Group B (the experimental group) will be treated with Ashwagandha vati (Withania somnifera Linn) and Vidarikand vati (Pueraria tuberosa DC), respectively, for 90 days. Patients will be assessed based on Body Mass Index (BMI), body weight, and body circumference (arm and waist) on Day 0, Day 30, Day 60, and Day 90. Statistical analyses will be performed using paired and unpaired t-tests. A p-value <0.05 will be considered statistically significant.

Managing Neuraxial Anaesthesia in Patients undergoing Anticoagulation Therapy: A Narrative Review

Prachi Siddharth Kamble, Neeta Verma, Amreesh Paul

Neuraxial anaesthesia in patients taking antithrombotic medications, including anticoagulants and antiplatelet agents, poses considerable challenges due to the increased risk of bleeding complications such as spinal or epidural haematomas. The use of both conventional anticoagulants like warfarin and newer drugs like Direct Oral Anticoagulants (DOACs) has made the decision-making process for anaesthesiologists more complex because these drugs affect the coagulation system differently. This review covers the mechanisms of action of antiplatelet and anticoagulant medications, and their impact on bleeding risk and complications during neuraxial anaesthesia. Preoperative considerations of relevance, e.g., drug cessation timing and coagulation monitoring, also receive mention as key to avoiding patient harm. Bleeding risks are minimised with appropriate drug regimen adjustment, selective anaesthetic practice, and case-by-case assessment of patients, all of which are discussed here. The review examines the influence of antithrombotic therapy on anaesthetic practice. It emphasises the necessity of meticulous planning to weigh the advantages of neuraxial anaesthesia against the risk of poor outcomes. In spite of the availability of some guidelines, there are a lot of controversies in the management of patients on dual or multiple antithrombotic therapy, particularly in light of the recent trend of the usage of novel anticoagulants. The review brings into focus the need for further studies to formulate evidence-based guidelines to perform neuraxial anaesthesia safely in such patients. Ultimately, better comprehension of the coagulation management, testing, and safety profile of such therapies will come to bear as improved outcomes and more precise clinical practice guidelines in this high-risk population.

Management of Paediatric Traumatic Brain Injury: A Comprehensive Review of Current Evidence and Emerging Strategies

Nayakawadi Akhil, Amar Taksande, Revat J Meshram

Paediatric Traumatic Brain Injury (TBI) is a significant health concern, contributing to morbidity and mortality. Epidemiology shows variations influenced by demographics, age and injury severity. Status Epilepticus (SE) is a common complication of seizure activity, negatively affecting clinical outcomes. Secondary TBI increases neuronal damage, underscoring the necessity of effectively managing Intracranial Pressure (ICP) and Cerebral Perfusion Pressure (CPP). Assessing strategies such as direct ICP measurement and brain tissue oxygen monitoring is pivotal for informing interventions. Pharmacological agents, including osmotic therapies and antiepileptic medications, are crucial for managing TBI symptoms and preventing complications. Temperature monitoring is essential for reducing metabolic demand. Individuals surviving severe TBI (sTBI) face functional disabilities, cognitive impairments and mental health issues, impacting their quality of life. Despite diagnostic advancements, the pathophysiology and optimal management of paediatric TBI remain controversial. Nevertheless, global perspectives exist to enhance knowledge and optimise clinical management guidelines to improve outcomes. The present study aimed to provide a comprehensive review of the epidemiology, pathophysiology and management strategies for paediatric TBI, emphasising current approaches and emerging modalities.

Potential of Yoga Therapy in Modulating Neurotransmitters for Treatment and Prevention of Autism Spectrum Disorder: A Narrative Review

Soccalingam Artchoudane

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterised by impairments in communication, social interaction, and behaviour. Increasing evidence suggests that maternal psychological stress during pregnancy can lead to neuroinflammation and disruption of neurotransmitter systems. This review aims to critically evaluate the potential role of yoga therapy in regulating neurotransmitter systems to mitigate ASD symptoms in children and reduce maternal psychological stress during pregnancy. A comprehensive literature review was conducted using PubMed and Google Scholar. The keywords used for the search included “Yoga,” “pregnancy,” “maternal psychological stress,” “ASD,” and “foetal neurodevelopment” in various permutations and combinations with “neurotransmitters.” The focus was on neurotransmitters, including serotonin, dopamine, and Gamma-Aminobutyric Acid (GABA), emphasising their roles in mood regulation, behaviour, and cognitive functions. The review found that yoga therapy modulates neurotransmitter systems by reducing stress and enhancing emotional regulation and cognitive function in the treatment of ASD. It also helps prevent the adverse effects of maternal psychological stress on foetal neurodevelopment during pregnancy

Role of Terahertz Radiation in the Detection and Treatment of Cancer: A Narrative Review

Sayali Satish Chodankar, Nimmi Puthan Veedu, Omkar Uttam Gaonkar

Terahertz (THz) waves occupy a distinctive position in the electromagnetic spectrum, between the long-wavelength far-infrared and the high-frequency microwave ranges. THz imaging and spectroscopy have proven useful in identifying tumour margins, assessing biochemical changes, and distinguishing between cancerous and normal tissues in breast, skin, and brain cancers. Experimental studies suggest that THz radiation may also affect cellular structures, offering potential as a treatment method through selective heating and alterations in Deoxyribo Nucleic Acid (DNA) and Ribonucleic Acid (RNA) structures. Advancements in source technology, detector sensitivity, and the application of Artificial Intelligence (AI) are driving progress in this field, while hybrid imaging strategies may further enhance diagnostic accuracy. This review highlights the potential of THz technology as a novel technique for the early diagnosis and treatment of cancer. However, additional research is required to enable its application in medical imaging so that it can compete with conventional techniques such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), and further develop its potential in cancer therapy.

Role of Physiotherapy in the Outcome of High-risk Neonates in the NICU: A Narrative Review

In India, the role of physiotherapy in the Neonatal Intensive Care Unit (NICU) is crucial for effective outcomes. Early intervention measures have a positive impact on premature babies. One of the main causes of neonatal death is premature birth. It is believed that prolonged immobilisation or inactivity is the cause of growth retardation and demineralisation of the bones in newborns. This, in fact, prompted us to analyse the beneficial impact of early physiotherapy intervention on premature infants with Low Birth Weight (LBW), decreased irritability, increased parent-infant bonding, sucking, improved respiratory and developmental outcomes, improved motor skills, and enhancement in neurodevelopment and medical conditions in terms of optimal improvement. Early physiotherapy intervention is a useful and successful tactic for encouraging optimal growth and enhancing outcomes in high-risk newborns in the NICU. More investigation is required to enhance the provision of physiotherapy treatments to optimise Physiotherapy services for high risk neonates to analyse the impact of an early physiotherapy intervention, specifically in those who are less than 28-week-old, moderately preterm neonates (32-37 weeks), and very premature neonates (28-32 weeks), and to gain a deeper understanding of the precise mechanisms of action. The study examines the growing physiotherapy services provided to high-risk newborns admitted to the NICU.

Advancements in Orthodontic Bonding to Non Conventional Surfaces: A Comprehensive Review

Orthodontic bonding traditionally relies on composite resin to adhere brackets to enamel surfaces. However, the emergence of non conventional surfaces, such as ceramic, zirconia and composite materials, presents new challenges due to the increasing demand for aesthetically pleasing orthodontic options and the widespread use of these materials in dental restorations. This review explores recent advancements in orthodontic bonding for non conventional surfaces, evaluating innovative techniques and materials while analysing their effectiveness, reliability and longevity through a critical analysis of bonding protocols. Relevant information was gathered using databases and search engines including PubMed, Scopus and Google Scholar. The present article reviews the materials and techniques used for bonding orthodontic brackets to restorative material surfaces termed non conventional surfaces in contrast to conventional bonding to tooth enamel.

A Narrative Review on Comprehensive Approaches to Chronic Pain Management: Integrating Medical, Psychological, Lifestyle, and Emerging Therapies

Chronic pain, defined as pain lasting longer than three months, profoundly affects physical, emotional, and social wellbeing and cannot be understood through a single disciplinary lens. This narrative review synthesises traditional and emerging strategies for chronic pain management, emphasising a multimodal, patient-centred approach. Pharmacologic therapies—including Non Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, antidepressants, and anticonvulsants—remain central and may be used alone or in combination with interventional methods such as nerve blocks or spinal cord stimulation, depending on pain phenotype and risk–benefit considerations. Psychological strategies, notably Cognitive-Behavioural Therapy (CBT), mindfulness, and guided imagery, are integrated to modulate pain perception and enhance coping. Concurrent lifestyle modifications—regular physical activity, anti-inflammatory nutrition, weight management, and adequate hydration—are highlighted for improving function and quality of life. The review also discusses barriers to implementation, the varying quality of evidence across conditions, and the need for individualised, patient-centred care. Gaps in long-term outcomes and safety are acknowledged, with future directions pointing toward precision medicine and digital health tools to optimise multimodal pain management.