Journal of clinical and diagnostic research

Management of Ocular Surface Squamous Neoplasia in Association with Fungal Keratitis in a HIV Positive Individual

Prabhakar Singh, Abhishek Gupta, Richa Gupta

Ocular Surface Squamous Neoplasia (OSSN) co-existent with fungal keratitis in an immunodeficient individual has rarely been talked about in literature. Risk factors for fungal keratitis are trauma with vegetative matter, topical steroid abuse, poor ocular surface, corneal anaesthesia, systemic immunosuppression, etc., and for OSSN a major risk factor is immunodeficiency. In current report, patient had multiple risk factors. This report highlights the management of HIV positive 42-year-old male with OSSN and fungal keratitis. A comprehensive evaluation helps clinician decide on treatment priority and achieve good clinical outcome.

Pseudomonas mendocina Wound Infection in a Farmer: A Rare Case

Varsha Gupta, Lipika Singhal, Kritika Pal, Ashok Attri, Jagdish Chander

The members of the family Pseudomonadaceae have been reorganised under various groups, each with several species and are known as opportunistic pathogens. Pseudomonas mendocina (P.mendocina) formerly known as CDC group Vb-2, belongs to stutzeri group (group II) and was first discovered in 1970 in Mendoza. The present case report is about an overwhelming leg ulcer in an asthmatic and diabetic 53-year-old, Indian farmer following a fall due to a multi-drug resistant strain of P.mendocina without any systemic spread due to timely intervention. Authors emphasise that P. mendocina may be an important emerging pseudomonad or alternatively an under-diagnosed pathogen in immunocompromised patients exposed to soil. The multidrug resistant nature of this organism is alarming and it may become a threat to people with weakened immune systems.

Tubercular Mediastinal Abscess in Nonimmunocompromised Patient: A Rare Case Presentation

Yash Rana, Vijendra Chouhan, Saket Kumar, Kusum V. Shah, Arti D.Shah

Mediastinal tuberculosis is a rare infection resulting from direct inoculation of organisms or through hematogenous spread. Infected lymph nodes may also transfer the bacilli through lymphatic route. Mediastinal tuberculosis may resemble a pyogenic abscess or tumour which might indicate tubercular aetiology and remains a clinical challenge. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. Authors hereby report a case of 60-year-old male with anterior mediastinal tubercular abscess.

Laser Excision of Large Peripheral Ossifying Fibroma, Histological and Radiographic Interpretation: A Case Report

Preeti Karhana, Vidushi Sheokand, Amit Bhardwaj, Neha Munjal

In oral cavity, the site for localised growth is usually gingiva which is considered as reactive in nature. Many of these lesions can be identified only on the basis of typical and consistent histomorphology and are difficult to identify clinically. One such reactive lesion which is clinically similar in presentation is Peripheral Ossifying Fibroma (POF). Females are affected more often than males. The presented case report is of a 45-year-old female with a significant growth of large POF in the anterior maxilla. The various clinical, radiological and histological features and diagnosis of POF with its treatment of choice are explained.

Use of Diode Lasers to Enhance Aesthetics of Anterior Implant Supported Prosthesis: A Report of Two Cases

Mohit Dhiman, Gunjan Pruthi, Tejomaya D Shastry, Sudhir Bhandari

Diode lasers have been used for multiple applications in dentistry; however, its use for soft tissue management around dental implants has not been reported much. The role of symmetrical gingival tissue with properly positioned zenith is paramount to achieving aesthetics. The gingival zenith can be described as the most apical point on the marginal gingiva; its ideal placement should be at the crest of the curvature of the gingival margin for the central incisors, canines, and premolars, this should be ideally located slightly distal to the middle of the long axis on these teeth. This produces a slight inclination of the distal root which plays a vital role in the foundation of a beautiful smile. If this gingival complex is malpositioned in maxillary anterior region, it may result in an unaesthetic appearance even if the artificial teeth are perfectly aligned. Here, authors are presenting two patients with missing anterior teeth, who were not satisfied with the final aesthetic outcome of their implant supported prostheses. Due to history of trauma and painful course of treatment, patients were not comfortable with one more exposure to injectable anaesthesia, use of scalpel, or long healing process when they were almost nearing completion of their treatment. So, Diode laser was used for soft tissue excision around implants followed by gingival contouring in pontic region to achieve the desired gingival zenith and contour. The procedure was painless, blood free, followed by quick healing and effective in achieving optimal aesthetic outcome for both the patients.

A Rare Case of Scapulothoracic Bursitis of the Chest Wall with Numerous Rice Grain like Loose Bodies- A Pathological Correlation

KR Chatura, CN Aarthy

Scapulothoracic bursitis is a rare disease which is caused from the inflammation of the bursa secondary to trauma or its overuse, owing to sports activities or work. It usually presents with pain, swelling without redness at the scapulothoracic interface. A 22-year-old male presented to the surgeon with the swelling in the left scapular region following a history of trauma. Ultrasound (USG) showed a large loculated fluid collection with internal debris outside the muscular plane. With the clinical diagnosis of haematoma surgical resection was done. It showed a cystic swelling containing haemorrhagic fluid attached to the chest wall. The specimen was sent for histopathological correlation. The thickened cystic structure had numerous rice grain like loose bodies on the inner surface. Microscopy showed fibrocollageneous wall with congested blood vessels, granulation tissue, fibrinoid bodies and macrophages. This case report describes a cystic lesion in left scapular region diagnosed as a case of scapulothoracic bursitis based on pathological correlation. Surgery was an effective treatment for this case with no complication and recurrence on follow-up.

Keratitis due to a Rare Fungus Colletotrichum dematium: A Case Report

Archana Bhimrao Wankhade, Vijaya Sahu, Pratibha Sharma, Padma Das

Keratitis is a very serious clinical condition caused by bacteria, fungi or parasites. It is associated with serious complications like blindness or endophthalmitis if remained undiagnosed. A 42-year-old male patient with the history of foreign body inoculation presented with mild pain and redness. After clinical examination, fungal keratitis was diagnosed. Corneal scrapping was sent for microbiological investigation. A very rare fungi Colletotrichum dematium was isolated and identified. Patient was managed with Natamycin tab fluconazole and atropin eye drops. To know the geographical distribution of the rare fungi, more and more cases should be studied and reported, which will help in management of rare fungi and standardisation of therapy.

Cholesteatoma Masquerading as Cerumen

S Prabakaran, RB Namasivaya Navin, R Guna Keerthana, S Rajasekaran, K Priya

Cerumen is composed of glandular secretions and desquamated epithelial cells. It protects and lubricates the external auditory canal. Impacted cerumen causes canal occlusion and pressure over the tympanic membrane, causing ear discomfort, conductive hearing loss, itching, etc. Up to 6% of the general population are affected with impacted cerumen, which includes 10% of children, more than 30% of the elderly and people with cognitive impairment. Persistent symptoms despite resolution of impaction and patient repeatedly should raise suspicion of alternative diagnosis and prompt for further evaluation. A 20-year-old female patient came with complaints of decreased hearing and ear discharge. On otoscopic examination of left ear, impacted cerumen was seen in the attic region. On removal of wax with the aid of oto-endoscopy, attic region was found to be filled with cholesteatoma debris. On pure tone audiometry, patient had mild conductive hearing loss of 30 db and computed tomography of left temporal bone revealed ill-defined soft tissue density in the middle ear (epitympanum) with erosion of head of malleus and short process of incus. Blunting of scutum was also seen. Attic reconstruction and type III tympanoplasty was performed. On histopathological examination, the section showed keratin flakes with bacterial colonies which were consistent with cholesteatoma. In conclusion, any case of impacted cerumen should not be ignored by otorhinolaryngologist. Further evaluation with thorough examination under otomicroscope/otoendoscope has to be done which can lead to different diagnosis and treatment plan.

Invasive Non-typhoidal Salmonella Sepsis in Top-up Fed Five-Month-Old Infant: Case Report

Non-typhoidal Salmonella (NTS) are generally associated with self-limiting gastrointestinal disease, often acquired through the ingestion of contaminated food and it seldom requires antimicrobial therapy for treatment. Extra-intestinal manifestations could be localised infection leading to septic arthritis, osteomyelitis. In complicated invasive disease, there could be bronchopneumonia with or without bacteraemia leading to mortality. Invasive NTS infections are infrequently reported in India. The S. Typhimurium is one of the common serovars associated with invasive disease and its virulence factors are responsible for causing the disease. S. enteridies, S. Dublin are the other serovars which are commonly responsible for invasive NTS infection. It is difficult to diagnose invasive disease without appropriate bacteriological culture based method. With emergence to resistance to antimicrobials the treatment of this condition is also becoming challenging. In this case report, a five-month-old infant presented with cough fever, stuffed nose dyspnoea and was diagnosed as bronchopneumonia. Mechanical ventilation was required for five days along with admission to intensive care unit. Invasive NTS infection was diagnosed using automated blood culture and the child responded to intravenous antimicrobial chemotherapy

Repair of Preduodenal Portal Vein Injury with Polytetrafluoroethylene Graft with Midgut Rotation and Left Sided Inferior Vena Cava

Zuber Ansari, Tuhin Subhra Mandal, Koustav Jana, Avik Sarkar

Preduodenal Portal Vein (PDPV) is a rare congenital anomaly. The presence of PDPV carries the risk of injury to Portal Vein (PV) during operations involving biliary duct, duodenum and pancreas. This report is about a 50-year-old female patient with PDPV associated with midgut malrotation and left sided Inferior Vena Cava (IVC). The patient was operated for Recurrent Pyogenic Cholangitis (RPC) and associated biliary stones. The patient sustained iatrogenic injury to PV during surgery which was subsequently repaired with Polytetrafluoroethylene (PTFE) graft doppler showed patent graft at three months of follow-up. This report highlights the fact that pre-existing inflammatory conditions of bile duct and hepatoduodenal ligament further increase the risk of injury to PDPV during surgery.

Subarachnoid Block in a Patient with Ebstein’s Anomaly Posted for Total Abdominal Hysterectomy

Jayshri Desai, Jayati Bhabutmal Jain, Venkata Suryanarayana Gopavajhula

Ebstein's anomaly is considered to be one of the rare congenital heart conditions which occur due to abnormal development of tricuspid valve and atrialisation of right ventricle and could be associated with either Atrial Septal Defect (ASD) or Patent foramen ovale through which shunting occurs. It might be associated with other cardiac malformations and rhythm disturbances. In such a patient, clinical presentation varies from congestive cardiac failure in childhood to incidental diagnosis in adulthood. If such a patient comes for surgery, it will be a challenging job for anaesthesiologist. Various cases have been reported of successful management either under general anaesthesia or epidural anaesthesia. In order to avoid complications of general anaesthesia, in a case report of 40-year-old female to provide some knowledge and information on the use of subarachnoid block in the case of Ebstein’s Anomaly posted for total abdominal hysterectomy

Fibular Aplasia, Tibial Campomelia, Oligo-Syndactyly Syndrome and Probable Femur Fibula Ulna Syndrome- Case Reports

S Prathyusha Kavipurapu, Madhuri Maganthi, LG Shyam Sundar, S Ramya

One in two thousand neonates suffer from congenital limb deficiencies. Fibular hemimelia, a birth defect, has an estimated incidence of 5.7 to 20 cases per 1 million births. Fibular Aplasia, Tibial Campomelia and Oligo-Syndactyly (FATCO) syndrome is one such which is a triad of fibular hemimelia (aplasia/hypoplasia of fibula), tibial campomelia (bending of tibial bone) and oligo syndactyly. It is a syndrome of unknown genetic basis and inheritance. Very few cases on this condition have been reported so far. This article reports two cases on this condition, wherein the babies had considerable variability of limb malformations. The first is a newborn with FATCO, and the second is a two-month-old male infant with FATCO associated with right focal femoral deficiency. In view of paucity of the cases, there is a need to report every case which may help in creating awareness and a standardised management approach.

Novel Presentation of Retroperitoneal Cyst-A Clinical Case Report

K Pranaya Theja, K Senthil Kumar, R Anantharama Krishnan, Vijayashree Raghavan

Cystic lesions of the adrenal gland are usually rare, seen in 1/5750 to 1/250,000 of the population. They may be true cysts, infectious cysts, malignancies with cystic degeneration, or pseudocysts. Adrenal cysts are rare in the differential diagnosis of Retroperitoneal Cysts (RPC) and may be treated. They can be correctly identified through pathological testing. Here, the author presents a case of giant adrenal cyst in a young 38-year-old female.

Anaesthetic Management of Patient with Atrial Septal Defect Posted for Abdominal Hysterectomy

Sara Mary Thomas, Pranav Kanabar, Dinesh Chauhan, Malini Mehta

Incidence of Atrial Septal Defect (ASD) in acyanotic congenital heart disease is about 10%. This condition is commonly diagnosed in childhood, although in some cases it is detected in later stages of life. Patients with ASD and Pulmonary Hypertension (PHT) pose a great challenge to anaesthetic management. Authors are presenting a case of general anaesthetic management of 39-year-old lady having ASD with mild to moderate PHT undergoing abdominal hysterectomy, a noncardiac surgery. The patient was induced with Inj. Propofol slow Intravenous (IV) and intubation was achieved with succinylcholine and maintenance was done with atracurium and isoflurane. The primary goal of general anaesthesia was to avoid increase in PHT and to maintain systemic vascular resistance.

Palliative Management of Sarcomatoid Buccal Carcinoma by Laser Ablation

Rusy S Bhalla, Seemantini Bhalla

Sarcomatoid change in buccal carcinoma is a rare and aggressive variant of Squamous Cell Carcinoma (SCC) and most often a diagnostic dilemma. There are some reports of second primary sarcomatous tumours in the oral cavity and nasopharynx post irradiation. Synchronous and metachronous lesions in this category in the oral cavity and neck have also been reported. Spindle cell neoplasms comprise a diverse collection of benign and malignant tumours. These tumours are uncommon in the oral cavity, accounting for <1% of all tumours of oral region. It is an unusual aggressive variant that frequently recurs and metastasises. Herein, the author present a case report of a 45-year-old Indian male with a sarcomatoid lesion according to his previous reports in the oral cavity of five months duration at presentation. The patient presented late as he was not willing for surgery and hence a very extensive 9×5 cm lesion was observed. In addition, he had trismus, multiple, firm, fixed lymph nodes in the ipsilateral neck. The biopsy of the oral cavity tumour showed a histological appearance of spindle shaped cells with penetration of basement membrane suggestive of sarcomatoid carcinoma. He was treated with repeated ablative laser technique for the primary and metastatic nodes in the neck disease and chemotherapy. The patient resumed normal activities 14 days after the laser ablation.

Rhupus Syndrome Presenting as Interstitial Lung Disease: A Case Report

Vishal Venugopal, Srujan Sriram Yelamanchi, Vrinda Vijayakumari, VR Mohan Rao

Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) are characterised by two distinct immunopathological activities, the T-helper 2 cells play a vital role in pathogenesis of SLE while T-helper 1 cells play an important role in RA. Organ involvement in Rhupus syndrome is relatively rare. Here, authors present a case of 59-year-old female who came with complaints of multiple joint pain (involving small and large joints) for a year and dyspnoea for 6 months without co-morbidities, on examination she had pallor, impaired percussion note and velcro crepitations in bilateral infrascapular region, her Pulmonary function test revealed a restrictive pattern and High-Resolution CT (HRCT) chest revealed sub-pleural reticulations involving lower lobes, she was diagnosed as RA with Interstitial Lung Disease (ILD) and started on hydroxycholoroquine, sulfasalazine and prednisolone. During follow-up after 6 months she developed a hyperpigmented rash over cheeks and bridge of nose, non-painful oral ulcers with Anti-Nuclear Antibodies (ANA) showing speckled positivity and Extractable Nuclear Antigen (ENA) panel showing positive anti-ds DNA and negative anti-histone, here with, we present a case of Rhupus syndrome presented with ILD. Recognising this condition is important as treatment varies between Rhupus syndrome and SLE or RA.

A Rare Case of Cervical Fibroid in a Young Woman Managed by Uterus Conserving Surgery

Chandana Galidevara, Dhivya Rajarajan

Cervical fibroid is a surgical challenge to the gynaecologist, more so when an attempt to conserve the uterus is made in young patients who want to preserve their fertility. The presenting complaint in cervical fibroids are mainly pressure symptoms due to compression on surrounding structures in the pelvis, which is an indication for surgical management. The mainstay of treatment in older patients who have completed family has been hysterectomy. Here authors report a case of 29-year-old young multiparous women, who underwent caesarean section in her second pregnancy because of cervical fibroid diagnosed antenatally elsewhere, presented to us postnatally with pain and pressure symptoms with abdominal distension due to that central cervical fibroid for 7 months in the postnatal period. She was managed by uterus conserving surgery with the involvement of a multi-disciplinary team.

Spontaneous Foetal Intracranial Haemorrhage: Scrutinising the Inscrutable

Manisha Jhirwal, Charu Sharma, Priyanka Kathuria, Shashank Shekhar

The incidence of major Intracranial Haemorrhage (ICH) is not the common finding in a post-mortem of stillborn. Subdural haemorrhage is mainly associated with obstetric trauma. Minor subarachnoid haemorrhage is observed in cases of intrapartum asphyxia and prematurity. It is very uncommon to find ICH in a foetus who has died before onset of labour. ICH is rare in low risk patient with no history of trauma, hypertensive disorder of pregnancy, coagulation disorder and drug abuse. Here, authors presents a case of 30-year-old female patient whohad uneventful pregnancy till term when she had sudden intrauterine foetal demise without any precipitating cause. Autopsy of the foetus revealed spontaneous ICH, which included subdural and subarachnoid haemorrhage along with scalp haematoma.

Lymphangioma Circumscriptum of the Vulva- A Case Series

Rashmi S Mahajan, Yogesh S Marfatia, Atmakalyani R Shah, Kishan R Ninama

Vulval dermatoses pose a diagnostic and therapeutic challenge for the dermatologists. Lymphangioma Circumscriptum (LC) is a form of lymphangioma affecting the skin and subcutaneous tissues that is characterised by benign dilation of lymphatic channels. This uncommon condition is known to occur over the chest, mouth, axilla, tongue, and rarely in the vulva. In this series, authors presented three cases of LC of vulva in women between the age group of 45 to 60 years with late-onset fluid-filled lesions over the vulva. The first case had history of hysterectomy prior to onset of lesions, the second case had a spontaneous onset of lesions while the third was a suspected case of pelvic tuberculosis with secondary lymphangioma.

Concomitant Mucormycosis with Aspergillosis in Patients with Uncontrolled Diabetes Mellitus: A Case Series

Arpana Singh, Aroop Mohanty, Shweta Jha, Pratima Gupta, Neelam Kaistha

Fungal infections are life threatening especially in presence of immunosuppression or uncontrolled diabetes mellitus mainly due to their invasive potential. Mucormycosis of the oculo-rhino-cerebral region is an opportunistic, aggressive, fatal and rapidly spreading infection caused by organisms belonging to Mucorales order and class Zygomycetes. The organisms associated are ubiquitous. Aspergillosis is a common clinical condition caused by the Aspergillus species, most often by Aspergillus fumigatus (A. fumigatus). Both fungi have a predilection for the immunosuppressive conditions, with uncontrolled diabetes and malignancy being the most common among them. Mucormycosis is caused by environmental spores which get access into the body through the lungs and cause various systemic manifestations like rhino-cerebral mucormycosis. Here, a case series of such concomitant infections of Aspergillus and Mucor spp from Rishikesh, Uttarakhand, India is reported.

Non-surgical Approach to Improve Prognosis of Ocular Prostheses for Grade III and IV Contracted Sockets

Neeti Solanki, Saumyendra Singh, Deeksha Arya

Patients with Grade III or IV contracted ocular sockets, most often due to Post Enucleation Socket Syndrome (PESS), suffer from loss of ocular volume along with a lax lower eyelid, which complicates prosthetic rehabilitation in terms of fit as well as aesthetics. Surgical correction is preferable, though not always feasible. A non-invasive approach for prosthetic rehabilitation of such difficult cases, using bandaging and progressively larger conformers is described here.

Pleomorphic Adenoma Arising from Heterotopic Salivary Gland Tissue in the Submandibular Region

Toshinori Iwai, Satomi Sugiyama, Hiroaki Kitajima, Makoto Hirota, Kenji Mitsudo

A 63-year-old male was referred to the Department of Oral and Maxillofacial Surgery becasue of left submandibular painless mass which has gradually grown for six years. The well-defined mass, measuring approximately 15×15 mm, was mobile and elastic hard. He was a nonsmoker and had no history of malignancy or tuberculosis. Clinical diagnosis was cervical lymphadenopathy. Computed Tomography (CT) revealed a well-circumscribed, round-shaped homogeneous mass (12×12×13 mm) was located below the left mandibular angle, anteriorly to the sternocleidomastoid muscle and posteroinferiorly to the submandibular gland [Table/Fig-1a,b]. Based on the clinical and radiological diagnosis of cervical lymphadenitis, he underwent removal of the lesion under general anesthesia. A 2 cm submandibular skin and the platysma muscle incision made, and the mass was removed easily without adhesion or connection of surrounding tissues including the submandibular or parotid gland [Table/Fig-2a,b]. Pathological diagnosis was pleomorphic adenoma without lymph node structure, and the tumour had myoepithelial and chondroid components [Table/ Fig-3]. The postoperative course was uneventful without facial nerve palsy, and there was no recurrence 9 years after surgery. Heterotopic salivary gland tissue is defined as the presence of normal salivary gland tissue occurring outside of the normal distribution of the major and minor salivary glands [1,2]. Cervical heterotopic salivary gland tissue is rare and manifests as a mass, cyst, or draining sinus [2,3]. Tumours arising from cervical heterotopic salivary gland tissue are even rarer [1-7]. For the rarity, the present case was misdiagnosed with cervical lymphadenitis. The embryological basis of heterotopic salivary gland tissue is unknown, but heterotopic salivary gland tissue may be caused by defective closure of the pre-cervical sinus (1). Heterotopic salivary gland tissue arises in a lymph node, external auditory canal, middle ear, thyroglossal duct, hypophysis, mandible, mastoid bone, tongue, tonsil, hypopharynx, sternoclavicular joint, pituitary gland, thyroid, parathyroid gland, and in the upper and lower neck regions [1,2,4,5]. Heterotopic islands of salivary gland tissue are recognised as incidental microscopic findings, and are common in the periparotid and upper cervical lymph nodes [2,5-7]. The incidence of heterotopic salivary gland tissue in cervical lymph nodes was reported as 12.1% (31 of 257 patients) (8). The mechanism of oncogenesis of salivary gland tumours in heterotopic sites is unclear, but the tumours may arise as a neoplastic transformation of heterotopic salivary gland tissue (6). About 80% of heterotopic salivary gland tumours are benign (2). Benign tumours arising from heterotopic salivary gland tissue are pleomorphic adenoma, Warthin’s tumour, and oncocytoma [1,2,4-7]. Warthin’s tumour is the most common benign tumour (2). Malignant salivary gland tumours are reported as mucoepidermoid carcinoma, adenocystic carcinoma, acinic cell carcinoma, adenocarcinoma, and carcinoma ex pleomorphic adenoma [2,4,5]. A tumour arising from heterotopic salivary gland tissue is generally unilateral, but multiple ipsilateral cases with pleomorphic adenomas or Warthin’s tumours in parotid or submandibular lymph nodes [2,6] or bilateral case with three Warthin’s tumours was also reported (7). Tumours arising from heterotopic salivary gland tissue are mainly adult, with a few pediatric cases (2). Pleomorphic adenoma in the present case (adult male) was considered to arise in submandibular heterotopic salivary gland tissue, because the specimen had no lymph node structure. For benign tumours arising from cervical heterotopic salivary gland tissue, local excision with close follow-up is appropriate management (2). For the low-grade malignancies, local excision with close followup is performed as treatment of the benign tumours (3), whereas the management of high-grade malignant tumours includes neck dissection with/without postoperative radiation (2). Concluding this, surgeons should take tumour arising from heterotopic salivary gland tissue into consideration in the clinical and radiological differential diagnosis of cervical mass.

The Challenges Faced by Allottees of Medical and Dental Postgraduate Programs during Admission: A Questionnaire-based Survey Study

Jayant Trimbakrao Patharkar, Manoj M Kulkarni, Maulin Dhiren Mehta

Introduction: The Postgraduate (PG) student admission scheme laid down by Medical Counselling Committee (MCC), Directorate General of Health Services, Government of India require the allottees to report to the allotted institute in online or offline mode in view of ongoing Coronavirus Disease (COVID19) pandemic. Aim: To identify the problems faced by Medical and Dental PG allottees during admission process. Materials and Methods: This was a cross-sectional, online questionnaire-based survey conducted among newly admitted students of Medical and Dental PG programs. The structured prevalidated questionnaire was filled by the students voluntarily and anonymously after giving consent. The detailed descriptive analysis was done using Statistical Package for the Social Sciences (SPSS) version 23 software. To study statistical significance, variables were tested using Chi-square test. Results: In the present study, 31(67.4%) Medical PG students and 15 (32.6%) Dentistry PG students participated. The students that reported to the allotted institute by both online and offline mode were 35 (76.1%), while only 8 (17.4%) reported by offline mode which was statistically significant (p<0.005). Maximum number of students {30 (65.2%)} found online mode convenient (statistically significant; p<0.005), while 12 (26.1%) said that offline mode was convenient. Conclusion: The online reporting for admission process is time saving. Continuous upgradation of system through feedback from stakeholders is desirable.

Tear Film Changes in Type II Diabetes Mellitus with and without Diabetic Retinopathy

Introduction: With the substantial progress in understanding of the ocular surface system in the past decade, Dry Eye Disease (DED) is the more commonly encountered condition in diabetes. Diabetes and DED have a common association. Aim: To estimate the prevalence of dry eye in diabetic patient and tear film changes with Diabetic Retinopathy (DR). Materials and Methods: It was an observational cross-sectional study, in which 103 type II diabetic patients attending the Department of Ophthalmology in a Tertiary Care Hospital were enrolled, out of which 43 patients had DR and 60 patients had no DR. Dry eye evaluation was done using Ocular Surface Disease Indexing (OSDI) questionnaire and was confirmed objectively using Schirmer’s I and II test and Tear film Break Up Time (TBUT). Statistical Package for the Social Sciences (SPSS) version 20 was used for statistical analysis of this study data. All quantitative data were analysed by using parametric test whereas all qualitative data were analysed by using non-parametric test to find significance level and the p-value <0.05 was considered significant. Results: In present study, 68 among 103 diabetics patients had DED with the prevalence of 66% based on OSDI scoring. Out of the 43 patients with DR and 60 without DR, DED was encountered in 38 and 30 patients, respectively. DED status was not influenced by gender, age and duration of diabetes. An increase in DED was seen with higher HbA1c (Glycated Haemoglobin) values but was not significant. DED in DR group yielded a significant association with OSDI (p=0.002), Schirmer’s I and II (p=0.001) and TBUT (p=0.046). Conclusion: On the basis of present study, it can be stated that the prevalence of dry eye was more in DR patients in comparison to those without retinopathy. Therefore, all diabetic patients should be screened for dry eye, in order to diagnose and treat it at the earliest.

Clinical and Biochemical Profile of COVID-19 Patients Admitted in a Tertiary Care Hospital of Kolkata

Avick Nag , Soumyadeep Ghosh , Anushree Pal , Ankan Saha , Sanjay Kumar Mandal

Introduction: The disease caused by Coronavirus (COVID19), is now pandemic all over the world including India. There are different manifestations of the disease from asymptomatic and mild to severe form. Clinical severity varies from country to country. This study was conducted to document different clinical and biochemical profiles in this Tertiary Care Hospital of Kolkata. Aim: The study was done to observe and to compare the clinical and biochemical profile in asymptomatic to mild and moderate to severe symptomatic patients. Materials and Methods: This was an observational study conducted in Medical College, Kolkata, West Bengal, India. The study was conducted from June 2019 to mid-August 2019. Total 573 Real Time Polymerase Chain Reaction (RT PCR) positive COVID patients were included in this study. All patients were examined and investigated with blood parameters. Patients were divided into two groups (Group A-asymptomatic and mild symptoms and Group B moderate and severe symptoms) clinically. Statistical calculators like Statistical Package for Social Sciences (SPSS) and Soccalculator were used and different biochemical parameters were analysed using Chisquare, unpaired T-test to find out significance among these two groups. Results: Among 573 patients, 222 were in group A and 351 were in group B. Fever was the most common presenting feature (69.6%) followed by dry cough and shortness of breath. Other features were malaise/fatigability, diarrhoea and anosmia. Among the co-morbidities hypertension and diabetes were significantly different between the two groups. Among the biochemical parameters Neutrophil-Lymphocyte Ratio (NLR), C-Reactive Protein (CPR), D-dimer, Prothrombin time, Serum Glutamic Oxaloacetic Transaminase (SGOT), Serum Glutamic Pyruvic Transaminase (SGPT) were significantly different between the two groups. Conclusion: In a tertiary care hospital of Kolkata, fever is the most common presentation followed by dry cough and fatigability in COVID patients. Diabetes and hypertension are the common co morbidities. CRP, NLR, D-dimer, prothrombin time, SGOT and SGPT should be monitored to differentiate between mild and severe cases.

Performance of Day 1 Paediatric Logistic Organ Dysfunction-2 Score in Children with Severe Sepsis: A Prospective Cohort Study

Mohd Kashif Ali, Rehanul Islam, Eeman Naim

Introduction: Judicious allocation of scarce resources in hospitals of developing countries is important. When a child is admitted to a hospital, it is important to judge the severity of illness and also to predict the mortality risk so that best available resources may be provided. The deranged clinical and laboratory parameters in sick children have been utilised to construct various scores to predict the mortality risk. One such score is Paediatric Logistic Organ Dysfunction-2 (PELOD-2) which is devised to predict mortality risk in children admitted to Paediatric Intensive Care Unit (PICU). The usefulness of PELOD-2 score needs to be tested in developing countries. Aim: To evaluate the performance of PELOD-2 scores in predicting the outcome in severe sepsis patients admitted to PICU of a Tertiary Care Centre. Materials and Methods: This prospective cohort study was done in a tertiary level PICU of a teaching Hospital in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India. PELOD-2 scores were calculated on day 1 of admission in PICU to predict the mortality risk patients of age between 1 month to 14 years admitted for severe sepsis. Results: Total 203 cases were enrolled in the study, with mean age of 37 (SD±46.97) months. The observed mortality was 52.21% (106), while PELOD-2 score predicted 57.63% (117) mortality. Mean PELOD-2 score in survivors was 5.95 (±2.47), while in non-survivors it was 12.87 (±4.73). Total 149 (73.4%) cases had 3 or more organ dysfunction. The area under Receiver Operating Characteristic (ROC) curve was 0.89, showing excellent discrimination. Sensitivity and specificity for predicting mortality at PELOD-2 score of 7.5 was 90.56% and 78.35%, respectively. Hosmer-lemeshow goodness for fit test showed good calibration at Chi-square of 2.44 and p-value of 0.11. Conclusion: Day 1 PELOD-2 scores can reliably assess the multiple Organ Dysfunctions (OD) and predict outcomes in severe sepsis patients admitted to PICU in a developing country.

Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy- A RCT

Usha Shukla, Pratima Kumari, Jay Brijesh Singh Yadav, Atit Kumar

Introduction: Abdominal Hysterectomy (AH) is one of the most common surgeries performed in gynaecology and is associated with a medium to high pain level. Newly discovered peripheral blocks such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum (QL) block have gained immense popularity as an adjunct to regional and general anaesthesia for postoperative pain management and reducing analgesic requirements. Aim: To compare the analgesic efficacy of QL block with TAP block in patients undergoing total AH. Materials and Methods: This was a double-blinded Randomised Clinical Trial (RCT). The study population comprised of 105 patients posted for elective total AH under spinal anaesthesia. They were randomly allocated into three groups of 35 patients each. Group Q received bilateral QL block with 40 mL of 0.25% bupivacaine divided on either side, Group T received bilateral TAP block with 40 mL of 0.25% bupivacaine divided on either side and in Group C no block was given. Patients were monitored for Visual Analogue Scale (VAS) scores at 0, 15 minutes, 30 minutes, 1st, 2nd, 6th, 12th and 24th hour postoperatively, time for first analgesic requirement, total analgesic requirement in 24 hours and patient satisfaction score after 24 hours and also adverse effects, if any. Data were analysed using Statistical Package For The Social Sciences (SPSS) version 16 (Chicago, IL, USA) with independent t-test and Chi-square test as appropriate. The p<0.05 was considered statistically significant. Results: There were significantly lower VAS scores in group Q than group T at 2nd and 6th hour with p-value of 0.003 and 0.001, respectively. The time for first analgesic was early in group C with mean value of 1.37±0.74 hours and it was 4.63±0.97 hours in group T and 7.77±1.51 hours in group Q. The total analgesic requirement was lesser in group Q when compared to group C and T. Patient satisfaction score was comparable between group Q and T (p=0.97). No significant difference in complications among the three groups was observed (p=0.51). Conclusion: QL block is a better postoperative analgesic technique than TAP block for postoperative analgesia in hysterectomy patients.

Deep Venous Thrombosis Prophylaxis Practices in Surgical Intensive Care Unit Patients: A Cross-sectional Study

Alisha Singh, Mary Samuel, Vijay Sundarsingh, Pratik Kabra, Anshu Kumari

Introduction: Deep Venous Thrombosis (DVT) is one of the critical complications which can occur in patients subsequent to surgeries. The patients in Surgical Intensive Care Units (SICU) have increased propensity to have DVT due to prolonged immobilisation, invasive interventions and other risk factors. It is important to prevent DVT as this can lead to catastrophic Pulmonary Embolism (PE) and balance the risk of haemorrhages due to pharmacotherapy. Aim: To observe the DVT prophylaxis methods and to compare the incidence of DVT in the different methods used in SICU. Materials and Methods: The present study was a prospective cross-sectional study in which 62 patients, aged between 18-70 years admitted in SICU for more than or equal to two days, were included in the study. Patients on drugs affecting cardiovascular system and having significant co-morbidities and coagulation abnormalities, that can impact the occurrence of DVT, were excluded. All patients were followed-up till 28 days or ICU discharge, whichever was later. Patients were evaluated for type of prophylaxis for DVT that included any of mechanical interventions {such as stockings or Sequential Compression Devices (SCD)} or pharmacotherapy (Low molecular weight heparin or Unfractionated heparin) or a combination of both. Statistical analysis was carried out using Student’s t-test and Chi-square test. Results: Thirty (48.39%) patients were given both mechanical and pharmacotherapy, 12 (19.35%) had used only mechanical interventions and 20 (32.26%) had used pharmacotherapy alone for DVT prophylaxis. The overall incidence of DVT was 3.33% (one patient) for patients receiving both mechanical and pharmacotherapy whereas it was 10% (two) for those receiving pharmacotherapy alone and 16.67% (two) for those using mechanical intervention alone. Incidence of haemorrhage was highest in pharmacotherapy alone {three patients (15%)}. The overall dose of drugs used as pharmacotherapy was the least in those receiving dual interventions compared to that of patients receiving pharmacotherapy alone. Conclusion: Pharmacotherapy and pressure stockings together are an ideal therapy for DVT prophylaxis.

Seroprevalence of Rubella Immunity in Rural Pregnant Women Attending Antenatal Clinics at a Tertiary Care Centre in Piparia, Gujarat, India

Introduction: Rubella viral infection in pregnant women is a Global Public Health concern as it has a devastating effect on developing foetus causing adverse foetal outcome or Congenital Rubella Syndrome (CRS). Aim: To recognise the proportion of pregnant women susceptible to Rubella infections so as to discern the risk of CRS. Materials and Methods: A prospective cross-sectional study was conducted on 90 rural pregnant women attending the Tertiary Care Centre, from September 2019-December 2019. Informed consent was obtained and a comprehensive structured questionnaire was noted regarding the sociodemographic details and reproductive history. Five mL of venous blood was tested for the presence of anti-rubella IgG using Enzyme-Linked Immunosorbent Assay (ELISA) kits. Data analysis were conducted using Statistical Package for Social Sciences version 15.0. Results: The mean age of the population was 23.26±5 years. Overall, seroprevalence was 88.9% (80/90). Immunity was higher (100%) in women of 30-35 years age, 100% in lower upper class, 93.3% with higher education, 90.9% with second trimester, 90.3% multigravida and 90.5% parity. It was also observed that in all the women with low immunity (11.1%) had a history of adverse foetal outcome. Conclusion: A significant proportion of pregnant females are still susceptible to rubella virus infection shows that rubella is endemic in the study area, so antenatal screening for rubella should be mandatory and rubella vaccination in adolescent girls and women of child bearing age is the only way to reduce the menace of CRS in India.

Effectiveness of Planned Teaching on Knowledge regarding First Aid for Burns and its Prevention among Parents of Children Under Five Years

Archana Lohave Taksande

Introduction: Naturally, the kids are curious. They begin exploring their environment and engaging with new objects as soon as they are mobile. But at the same time, while playing with fire or touching hot objects, they are likely to cause serious harm to themselves. Burn is characterised as damage to the skin or other organic tissue caused by thermal trauma, occurring when any or more of the skin cells or other tissue are killed by hot liquids, hot solids (contact burns), or flames (flame burns). Owing to radiation, radioactivity, strength, friction or chemical contact, burns are also considered to be skin or other organic tissue wounds. Aim: To determine the current awareness of parents of children under five years with respect to first aid for burns and prevention. Evaluating the efficacy of planned awareness teaching among parents and to associate the knowledge with the selected demographic variables. Materials and Methods: The present study was conducted in rural areas of Wardha, Maharashtra and 60 participants were recruited on the basis of inclusion criteria, using the purposeful technique of sampling. Structured questionnaires were the resources and the expected teaching was provided after the pre-test. Results: According to the findings of the analysis in the score of pre-test information, 30% of parents of under five years kids had poor awareness score level, 70% of the parents of under five kids had average awareness score level, mean knowledge score was 5.20±1.97, post-test 10% of the parents of under five years kids had average, 80% good and 10% with an outstanding degree of knowledge score, the mean knowledge score was 10.30±1.87. Mean percentage score, pre-test was 32.50±12.32 and post-test, it improved to 64.37±11.73, thus indicating improved understanding of first aid for burns and its prevention for most parents. Conclusion: It was statistically interpreted that the planned teaching program of the parents of children under five years on knowledge regarding emergency management and prevention of burns was very effective and has improved the knowledge significantly.

Perception of Saudi Mothers about Maxillary Midline Diastemas among Children with Mixed Dentition- A Cross-sectional Study

Introduction: Maxillary anterior spacing or midline diastema is the most frequently seen aesthetic concern among children, which can be quite challenging for the clinician to manage. There can be a significant disparity in the aesthetic perception from person to person and is greatly influenced by their personal experience and social environment. Aim: This study investigated the aesthetic perceptions of Saudi mothers to various Maxillary Midline Diastemas (MMDs) in mixed dentition. Materials and Methods: A cross-sectional study using structured questionnaire was employed for Saudi mothers chosen by stratified-cluster random sampling technique over a period of eight months (November 2016 to June 2017). The questionnaire assessed their perception about various MMDs using photographs and the source of information about MMDs. Data were statistical analysed (SPSS version 20) using the Chi-square test, with the level of significance set at p-value <0.05. Results: The sample consisted of 300 Saudi mothers with a response rate of 86.2%. The maximum mean score was 4.80±0.20 for the MMD photograph showing central incisor tooth discrepancy which the mothers perceived to be the most unpleasant (81%). The very unpleasant perception from the mothers’ perception for group D and B showing ugly duckling stage was (55%) and thumb sucking habit (33%), respectively. The MMD photograph showing high frenum attachment was perceived by 51% of the mothers to be unpleasant and 7% as very unpleasant. Moreover, on comparison it showed the least mean score of 3.65±0.41. Conclusion: The perception of Saudi mothers to various types of MMDs was found to be aesthetically unpleasant. Early detection of the MMDs by the Saudi mothers and intervention by the dental specialist can reduce the progression of the prevailing condition to a severe malocclusion.

Development of a Reliable and Valid Questionnaire to Identify Factors Affecting Health of Postmenopausal Women in Selected Areas of Gurugram India

Introduction: Postmenopause is the period when a woman misses her menstrual cycles for the entire year. A host of issues involving health, fitness and psychological problems come up in this phase which effect quality of a life of a woman significantly therefore a substantial degree of care is needed for them. There are various factors that affect the physical and psychological health of postmenopausal women. Aim: To develop a self-structured questionnaire that would identify and address various factors that affect health of postmenopausal women in Gurugram India. Materials and Methods: A thorough literature search related to the subject matter was done along with the interview of researchers working on the health status of postmenopausal women to arrive at a questionnaire, and a pilot study was conducted on 60 postmenopausal women (average age 52±3.44 years) from September 2019 to March 2020. Expert opinion was taken twice before preparing first draft of questionnaire. Questionnaire had 4 sections with questions related to demographic details, medical history, physical activity status and psychological health status. The scores were evaluated and subjected to reliability and validity tests. SPSS software version 20 was used to calculate Cronbach’s alpha value for ensuring reliability of the questionnaire. Results: The questionnaire possesses good content and face validity. Cronbach's alpha value was 0.772 which indicated acceptable degree of correlation between different items of questionnaire. The final questionnaire consists of 24 questions. Numerical coding of responses was done from 0-2. A score of 0-10, 11-20 and >21 indicated mild, moderate and severe effect respectively on health of postmenopausal women. Conclusion: The questionnaire can be utilised to evaluate factors affecting physical and mental health issues of postmenopausal women.

Topographic Distribution of Proximal Cavitated Lesions on Primary Mandibular Molars

Khyati Bagga, Sakshi Joshi, Anil Gupta, Shalini Garg, Shalu Bhardwaj

Introduction: Increased prevalence of proximal caries in primary teeth and its difficult diagnosis makes it necessary to develop newer diagnostic tools for accurate detection of these lesions. International Caries Detection and Assessment System (ICDAS) and its associated International Caries Classification and Management System (ICCMS) is a newer system that uses ICDAS for clinical staging of caries and ICDAS Radiographic score for radiographic staging of carious lesion. Aim: To the topographical distribution of proximal cavitated lesions on the mandibular arch and on primary mandibular molar tooth surface and to determine the extent of the agreement between clinical and radiographic examination in identifying proximal cavitated lesions involving primary mandibular molars. Materials and Methods: An observational study between July 2018-August 2019 in a total of 100 (60 first and 40 second primary molars) primary mandibular molars (D or E) was conducted. Proximal cavitation involving primary mandibular molars were examined both clinically (ICCMS caries merged category scores) and radiographically (ICDAS Radiographic scoring system) and the correlation between both scores were also analysed. Results: First primary molar was observed to have statistically significant prevalence of proximal cavitation (p-value =0.001) both clinically and radiographically as compared to second primary molar. Distal surface was observed to have more carious lesions as compared to mesial surface (p-value=0.003). Also, a statistically significant correlation was observed between the clinical and radiographic scores (p-value =0.001). Conclusion: Mandibular first primary molar is more prone to proximal cavitation along with chances of distal surface cavitations being higher.

End of Life Care: Healthcare Provider’s Mindset, Needs and Barriers

Sherry P Mathew, GB Kuldeep, Seema Ramesh Chawan

Introduction: In India, End of Life (EOL) care practice has gained momentum. EOL can have significant impact on physical, emotional and financial aspect. Care planning, coordination and good communication are important if the needs and preferences of people are to be met for their EOL care. There is very minimal information available on awareness, attitude, planning and provision of EOL care. Aim: To assess the Knowledge, Attitude and Practice (KAP) among hospital administrators, doctors and nurses on EOL care and to the decision-making aspects and possible barriers in the provision of EOL care. Materials and Methods: A descriptive survey-based study was conducted at the Department of Hospital Administration, Vydehi Institute of Medical Science and Research Centre Bengaluru, Karnataka. The questionnaire was distributed among 100 healthcare providers including hospital administrators, doctors and nurses involved in EOL care. A structured questionnaire containing 15 questions were used to gather data from the respondents wherein question no. 1 to 5 were based on the knowledge and question no. 6 to 13 were based on practice and question no. 14 and 15 were based on the attitude. All data were entered in MS Excel and statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Version 20. Results: Majority of respondents belonged to the group ranging from 25-35 years of age, wherein 58 were males and 42 were females. Ninety participants out of 100 were aware of the concept of "EOL care", 59 were aware about the current laws concerning EOL care and 17 participants had their medical staff in the hospital being educated and trained on EOL care (p>0.05). Around 29 participants have experienced lack of communication while giving EOL care to patients; 54 out of 100 participants have experienced fury from patient/attender during their practice and 66 participants felt that the hospital should take into consideration of spiritual, religious and cultural beliefs in dealing with EOL care patient. Furthermore, Chi-square test revealed significant (p<0.001) relation between the factors such as age of the patient, duration of disease, economic factors, health insurance, patient suffering, emotional distress among patient/attender and no hope of good quality of life in making decision during EOL. Conclusion: Along with improvements in rules and regulations, there is an urgent need for increasing in awareness among stakeholders who are involved in EOL care practice.

Remineralising Potential of Marine Skeletal Species-Perna viridis Powder Extract on Human Teeth Enamel: An In-vitro Study

Introduction: Biomineralisation is a dynamic, complex, constant mechanism by which living organisms manage precipitations of inorganic nanocrystals within organic matrices to form unique hybrid biological tissues, for example, enamel, dentin, cementum, and bone. Realising the mechanism of mineral deposition is crucial for the progress of treatments for mineralisation associated diseases and also for the innovation and development of scaffolds. Aim: To measure the remineralisation capacity of enamel surface lesion using marine skeletal species-Perna viridis (mussel shell) powder extract on human tooth enamel. Materials and Methods: The in vitro quantitative observational research study conducted from June 20^th, 2020 to July 20^th, 2020, included five freshly extracted un-erupted third molars decoronated at Cemento-Enamel Junction (CEJ). The coronal portion of single tooth was sectioned into 4 samples of enamel blocks in order to receive 20 blocks which were subjected to demineralisation process and divided as: Group A(Experimental group)-subsurface demineralisation + mussel shell powder extract and Group B(Control group)- subsurface demineralisation + clinpro application being placed in artificial saliva solution for thirty days. The specimens were tested for X-ray fluorescence spectroscopy analysis, microhardness testing and atomic analyses using Energy dispersive X-ray spectroscopy. Statistical analysis was done using unpaired t-test to check differences at the level of p≤0.05 between groups which were considered as statistically significant. Results: X-ray fluorescence spectroscopy showed calcium concentration in mussel shell of 95% and concentration of Phosphate as 0.31%. Group B (Clinpro) presented statistically significantly higher (p-value 0.028) potential in enhancing the remineralisation than Group A: Mussel Shell Powder Extract (MSPE). The results of atomic analyses exhibited that quantitative amounts of Ca weight % and P weight % is statistically insignificant between both the groups. Group B (Clinpro) showed greatest ability in promoting remineralisation than Group A (mussel shell extract). Conclusion: Marine shells with 95% of calcium concentration can remineralise enamel surface lesion.

To Check the Validity of Neoclassical Canon in Western MaharashtraAn Anthropometric Study

Laxmi Prashant Nivale, Achelshwar R Gandotra, Rohini Rajesh Karambalekar

Introduction: In ancient days, it was believed that attractive and harmonious faces were having certain fixed proportions known as neoclassical canons. These canons were used extensively by Leonardo Da Vinci, Durer in their art during renaissance. They served as guidelines for artists as well as for aesthetic surgeons for centuries and proved to be helpful till now. From ancient days to modern era, the exact formula of beauty is not yet calculated. The norms of beauty changes from country to country and race to race. A face is beautiful and shows harmonious features if the individual components are proportional, this is what is referred as facial balance. In ancient Greece, they calculated the formula for creation of art and these formulae are called as neoclassical canons. The classical Greek canons of facial balance are still foundation of modern reconstructive and aesthetic surgery. Aim: To check the validity of neoclassical canon in Western Maharashtrian population. Materials and Methods: This was an observational type of study carried out from March 2018 to January 2020. The validity of Naso-oral canon was checked in Western Maharashtrian population. According to this canon ideal mouth width (ch-ch) (mouth width (distance between right and left corners of mouth called chelion)) is 1.5 times of Nose width/alar width (al-al) (alar width (distance between right and left ala of nose)). Mouth width=1.5 times of Nose width. However, the mouth width can be less than 1.5 times of nose width or mouth width can be greater than 1.5 times of nose width. This study was carried out in the five cities Sangli, Kolhapur, Islampur, Karad and Satara of Western Maharashtra, India. Total 1500 male and female students, 300 from each city, between the age group of 18-20 years were selected. Measurements were taken with the help of digital Vernier caliper. The methodology adopted for the measurements was taken from the guidelines given by Farkas LG in his book- "Anthropometric facial proportions in Medicine". Results: In present study, total 68.33% subjects including males and females were having mouth width (ch-ch) lesser than one and half times of nose width/alar width (al-al) i.e., ch-ch <1.5 (al-al). Remaining 31.67% subjects were having mouth width greater than one and half times of nose width/alar width i.e., ch-ch >1.5 (al-al). Conclusion: Naso-oral neoclassical canon was not found valid in Western Maharashtrian young adults. In 78.32% male and 62.80% female population of Western Maharashtra, mouth width was found lesser than one and half times of nose width.

Management of Locally Advanced Breast Cancer: Challenges and Treatment Outcomes in an Emerging Tertiary Hospital in South-Western Nigeria

Introduction: Patients presenting with advanced breast cancer is a common phenomenon in Nigeria and many developing countries. At this stage, patients’ high expectations of survival conflict with the realities of the clinical outcome, thus creating enormous challenges to the attending surgeon practicing in a resource-poor setting. Aim: To evaluate patients who presented with Locally Advanced Breast Cancer (LABC), management challenges and treatment outcomes. Materials and Methods: This was a retrospective study of patients with LABC at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti between January 2016 and December 2018. The variables of interest were patients’ demographics, findings of triple assessment, presentation, diagnosis, treatment intervals, the treatment received and follow-up outcomes. Results were presented using descriptive statistics mean±SD, median and Interquartile Range (IQR). Results: Seventy-eight patients had LABC in the study period. ages ranged from 24-94 years (mean 50.1±14.0). Total 77 (98.7%) were females and patients had breast lump ranging in size from 3-22 cm (mean 8.7±3.3, median 8, IQR 6-10). A vast majority of patients (84.6%) had tumour >5 cm in size. More than two-thirds (69.2%) were clinical stage IIIB. The duration of symptoms was 2-42 months (mean 10.1±7.8). The duration between presentation and cancer confirmation ranged from 7-140 days (mean 40.1±32.1, median 28.5, IQR 16.5-60.0). There was no facility to determine the receptor status of the tumours. Forty-six (59.0%) patients were routinely placed on tamoxifen (hormone therapy). Fifty-six (71.8%) patients had Modified Radical Mastectomy (MRM). Only 30 (38.5%) completed the chemotherapy schedules while the rest had them haphazardly, mainly due to financial reasons. Five out of 22 (22.7%) referred for radiotherapy received it after an average of 5.2 months. Postmastectomy, 7 had loco-regional recurrence at one year and 15 within three years. Overall, 40 were alive, 16 were dead while 22 were lost to follow-up at three years. There was significant difference in 3-year survival among those who had chemotherapy and mastectomy compared to those who had just one of the two (Fisher’s-exact p=0.002). Conclusion: Delayed presentation, diagnostic and treatment inadequacies are the common challenges of management of LABC. Early diagnosis, adequate provision of diagnostic facilities and subsidisation of all aspects of care will be a reasonable panacea to some of the challenges.

A New Approach for Second-Tier Analysis of Methylmalonic Acid in Dried Blood Spots Using Liquid Chromatography Tandem Mass Spectrometry

Introduction: Inactivity or diminished activity of an enzyme Methylmalonyl-CoA mutase (a Cobalamin dependent) enzyme causes inborn error of metabolism named Methylmalonic Acidemia/Aciduria (MMA). Liquid Chromatography-tandem Mass Spectrometry (LC-MS/MS) based method for the diagnosis of MMA in Newborn Screening (NBS), is often challenging due to the nonspecificity of propionylcarnitine (C3), a primary marker in routine NBS. Aim: To develop a Flow Injection Analysis (FIA) method for the second-tier estimation of Methylmalonic acid in the Dried Blood Spots (DBS) of primary NBS. Materials and Methods: A retrospective NBS study was conducted for a period of two years i.e. (November 2015 to November 2017) at the Paediatrics Research and Genetic Lab of Maulana Azad Medical College associated Lok Nayak Hospital, a Tertiary Care Centre in New Delhi, India. DBS samples were collected by heel- prick method and a second tier detection, quantification of methylmalonic acid was performed by LC-MS/ MS on all samples with abnormal C3 levels in primary NBS. Multiple Reaction Monitoring (MRM) mode at m/z 117➔73 for MMA and m/z 120➔75 for MMA(IS) and isotopic dilution approach was followed for quantification. Results: Intra-assay and inter-assay precision and accuracy was determined at two different levels of MMA (LQC≅2.0 μmol/L & HQC≅10.0 μmol/L), respectively. The Coefficient of Variation (%) for intraday precision ranged between 5.27% to 8.9%. Similarly, for interday it ranged from 4.99% to 9.93%. The average accuracy (%) also falls within (105.4% and 106.1%) for interday and (105.9% and 106.7%) for intraday assay. Stability for samples during storage at different temperature i.e., (fresh, 2-8°C & -20°C) showed long term stability at -20°C storage. The assay was linear over a calibration range of (0.5 to 20.00 μmol/L). Conclusion: The outcome of the present data offers the confidence and reliability in the possible utility of this method for the definitive diagnosis and follows up of MMA patients.

Efficacy of D-Dimer Assay in Pulmonary Venous Thromboembolism: Study of 76 Cases

Shubhi Saxena, Nishant Saxena, Richa Jain, Jasmin Jasani

Introduction: Venous Thromboembolism (VTE) encompasses a wide spectrum consisting predominantly of deep venous thrombosis and pulmonary embolism. The value of Fibrin Degradation Product (FDP) of which, most common is D-dimer which is most commonly deployed to pre-diagnose venous thrombosis. Diagnosing it has always been a hard effort. It is produced when cross-linked fibrin is broken down; among patient who is suspected of having pulmonary embolism, blood D-dimer levels correlate with the probability of having pulmonary embolism. Aim: This study was done to analyse the sensitivity of plasma D-dimer for VTE. Materials and Methods: Retrospective case study of 76 patients with VTE in form of pulmonary embolism done at the Dhiraj Hospital, Sumandeep Vidyapeeth Deemed University, Vadodara from January 2019 to January 2020 for a period of one year. Prethrombolytic plasma was withdrawn and D-dimer quantification were measured using fully automatic stago coagulometer instruement (STA Compact Max). Sensitivity, Specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) was calculated and formulated in tables and graphs. Results: The sensitivity, NPV, specificity and PPV of the D-dimer was 95.65%, 76.92%, 66.66% and 92.95%, respectively. CT pulmonary angiography had a specificity of 80%, sensitivity of 92.75%, a NPV of 70.58% and a PPV of 95.52%. Conclusion: D-dimer is mostly the go to test for ruling out VTE especially pulmonary embolism, if the pre-test probability is intermediate. Rationale use of this test does help in prognostification and helps to achieve therapeutics faster and more effectively.

An Analysis of Drug-Drug Interactions in a Tertiary Care Hospital in Kerala: A Retrospective Study

Jihana Shajahan

Introduction: Concomitant use of several drugs for a patient is often necessary for achieving therapeutic response. Understanding the profile of Drug-Drug Interactions (DDI) will help health care providers to optimise therapy for better patient outcomes, reinforcing the concept of rational drug use. Aim: To analyse the frequency, mechanisms and severity of DDIs in a tertiary care hospital at Kerala. Materials and Methods: A retrospective cross-sectional study among 350 inpatients of a tertiary care hospital in Kerala from August 2020 to September 2020. Prescriptions containing ≥3 drugs were collected from inpatient medical records. A drug interaction check was performed using the Lexicomp drug interaction checker software. Results: DDIs were present in 74.6% of prescriptions and the average number of interactions was found to be 2.78. Most number for interactions was in the age group 61-80. Average number of DDI was significantly high among patients >60 years. Percentage of prescriptions with DDI and average number of DDI was found to be increasing with increase in number of drugs. Average number of interactions were maximum (5.01) in the group >10. Drug groups most commonly involved in interactions were antiplatelets, oral hypoglycaemic agents, bronchodilators, antibiotics, diuretics, insulin, statins, beta blockers, Proton Pump Inhibitors (PPI) and Non-Steroidal AntiInflammatory Drugs (NSAIDs). The most common interventions for minimising the impact of DDIs were changing the timing of drug administration, monitoring for symptoms/signs/lab values/ drug levels or both. There was a significant positive correlation between duration of hospital stay and number of DDI. Conclusion: This study threw light upon the pattern and profile of DDIs among inpatients of a tertiary care hospital in Kerala. Elderly people (>60 years) were most prone for DDIs. Percentage of prescriptions with DDI and average number of DDIs was found to be increasing with increase in number of drugs. There was a positive correlation between duration of hospital stay and number of DDI.

COVID-19 Lockdown Period: Perception of Doctors regarding Telemedicine Use for General Practice

Introduction: During this COVID-19 lockdown period, telemedicine is widely being used by doctors for continuing clinical care of patients so that physical distancing can be maintained and the risk of contracting the virus can be avoided. Aim: To assess perception of doctors regarding quality of healthcare by telemedicine as compared to traditional face to face consultation and, to assess the opinion of doctors on whether telemedicine could be an option for future practice after lockdown period. Materials and Methods: A questionnaire based cross-sectional study was conducted in which perception of doctors regarding their telemedicine usage for general practice during this lockdown period has been evaluated. The study was done during April to June 2020 among doctors working in a medical college attached to a tertiary care hospital in Chennai and using telemedicine for their practice during COVID-19 lockdown period. After collection of responses, data obtained were entered in excel sheet and analysed using SPSS version 23.0. Chi-square test was used to assess the association between different variables associated with perception regarding telemedicine usage for general practice. A p-value <0.05 was considered as statistically significant. Results: Easy access to healthcare services can be done with telemedicine practice according to 73.7% of doctors. Nearly 60.6% of doctors like to continue telemedicine for their practice even after COVID lockdown period. Conclusion: Telemedicine has helped doctors for continuing patient care during COVID-19 pandemic, but the quality of care delivered by telemedicine consultation was not good as compared to the quality of traditional healthcare. Telemedicine could be an option for future practice of doctors if awareness regarding proper usage of telemedicine is created among patients and if guidelines regarding legal concerns in telemedicine are properly framed.

Turn Around Time for Clinical Biochemistry Laboratory: A Vital and Effective Parameter for Patient Care

Introduction: Clinical laboratories are judged by its validity, reliability, genuineness or authenticity and its timeliness in reports generating. Repetitively, patients and physicians complain about the time taken by the laboratory for the investigation. The total Turn Around Time (TAT) for laboratory tests includes the entire interval from the order of the test to the awareness of the result by the clinicians. The evaluation and improvement of TAT is crucial for the management of laboratory quality and the satisfaction of patients. Aim: To observe the TAT of common biochemical investigations, to identify reasons for increased TAT and to formulate a plan to rectify increased TAT. Materials and Methods: A hospital based cross-sectional study was conducted at the Clinical Biochemistry Section of the Central Diagnostic Laboratory of Tertiary Care Hospital. TAT data from April 2014 to September 2015 were included in the study. The laboratory technicians and the resident doctors of biochemistry recorded the reasons for the delay of those specimens exceeding the TAT. Data were analysed with the help of statistical software Epi Info 7. Results: The total number of samples received in the biochemistry laboratory were 1,85,658. Out of this, Out Patient Department (OPD) samples were 1,35,022 and Intensive Care Unit (ICU) samples were 50,636. Pre-analytical errors were observed in 670 of ICU samples, which was 1.32% of total samples received and it was higher than the post-analytical errors. In the pre-analytical phase, the most common cause was inaccurate procedures of sample collection. Conclusion: This study demonstrates that the main culprit of increased TAT was delay in the sample transportation and Haemolysed samples. TAT minimisation is a constant procedure for any facility. Every laboratory needs to develop a decent approach for reducing the TAT.

Audiometry Analysis for the Assessment of Hearing Deficit in Patients with Oral Submucous Fibrosis

Introduction: Oral Submucous Fibrosis (OSMF) is a slowly progressive chronic fibrotic disease of the oral cavity extending to pharynx. Function and patency of eustachian tube gets altered when the palatal and paratubal muscles which regulate the patency of pharyngeal orifice gets affected. This leads to pain in ear along with mild to moderate conductive loss of hearing. Aim: To evaluate hearing deficit in OSMF patients and to correlate clinical stages of OSMF with degree of hearing deficits in patients. Materials and Methods: It was a cross-sectional study. The study comprised of a total of 50 subjects (100 ears). Forty patients diagnosed with OSMF who reported to Department of Oral Medicine and Radiology constituted the study group. Ten normal individuals with no deleterious habits and without any previously diagnosed ear disorders constituted the control group. Pure Tone Audiometry (PTA) was used for evaluating all the subjects for air conduction and bone conduction hearing loss. Values on qualitative characteristics were shown as n (% prevalence) across five study groups. Values on quantitative variables were shown as Mean±SD across five study groups. Inter group comparison for qualitative and quantitative variables was done using chi-square test and analysis of variance (ANOVA) test respectively with Post-Hoc Bonferroni's correction for multiple group comparisons. Results: The OSMF group showed a marked degree of hearing loss compared to the control group. The distribution of mean PTA in quantitative assessment was significantly higher in group D compared to group A and group B (p-value<0.05 for both) and also the distribution of qualitative hearing loss was significantly higher in group C and group D (p-value<0.05). Conclusion: There was a significant association between OSMF and hearing deficit in this study. Fibrosis of the oropharynx and palatal/paratubal muscles which are affected in OSMF and theses muscles are attached to eustachian tube, the patency of the eustachian tube gets affected. As a result, patients with mainly advanced cases of OSMF should be assessed for hearing deficit.

Short Term Outcome of Children with Antenatally Diagnosed Heart Disease: A Retrospective Single Centre Study

Dheeraj Deo Bhatt, Dinesh Kumar

Introduction: The aim of foetal echocardiography is to improve the outcome of foetuses with congenital heart diseases. Impact of foetal echocardiography on the foetuses with antenatally diagnosed heart disease is less studied in public sector hospitals in India. Aim: To evaluate the short term outcome of infants born with antenatally diagnosed heart disease. Materials and Methods: This was a retrospective observational study conducted from April 2016 to June 2019 in a tertiary care public hospital in Northern India. Data was tabulated as mean, frequency and percentages, analysis were done in Microsoft excel 2013. Study included total of 1013 patients who underwent foetal echocardiography during the study period. Results: Heart disease was found in 59 patients after excluding five cases of ductal constriction. Referral for foetal echocardiography was frequently late. Among the group with abnormal foetal echocardiography, the mean gestational age at the time of diagnosis was 28.4 weeks. Follow-up data was available for 45 patients. A 24.4% (11/45) of those diagnosed with heart disease did not survive till term. 50% (17/34) of those born died before three months of age. Only two neonates underwent surgery before three months of age. Overall, 62.2% did not survive beyond three months of age. Conclusion: It was found that referrals for foetal echocardiography in setting were frequently late. Despite antenatal diagnosis the outcome for foetuses with heart disease was less than optimal. This reflects both the complexity of heart disease as well as lack of paediatric cardiac care to young infants in the setting. Access to high quality cardiac care for infants and neonates are essential for foetal echocardiography to have a meaningful impact on foetuses with heart disease.

Association of Obesity with Peripheral Vascular Disease- A Case-control Study

Introduction: Peripheral Vascular Disease (PVD) is an important public health problem, due to its insidious course and the associated co-morbidities. Obesity has been implicated as one of the risk factor besides others. However, the reports on obesity are not consistent. Aim: To assess the association between central obesity and PVD along with other risk factors and the present study is undertaken to examine the correlation of central obesity as a risk factor for PVD. Further, the association between other risk factors and PVD was also ascertained. Materials and Methods: A total of 124 subjects were recruited in this case-control study. Ankle Brachial Index (ABI) was measured using peripheral Doppler studies. Patients with ABI <0.9 were taken as cases and with ABI >0.9 were taken as controls. Blood pressure was measured in the sitting position and the authors obtained anthropometric and demographic data. Chi-square test was used as the test of significance and p-value <0.05 to be considered as level of significance. Results: Of the total 124 participants in the study, 62 participants were the cases and 62 participants were controls. Body Mass Index (BMI) was higher in cases with PVD but Waist Circumference (WC) and hip circumference were significantly lower (p-value=0.003 and <0.001 respectively) and Waist-Hip Ratio (WHR) did not show any significant difference between cases and controls. Thus, fat mass is located elsewhere in these individuals, possibly it may be accumulated in the extremities. Other risk factors like history of smoking, history of alcoholism and history of diabetes mellitus had a positively significant association with PVD with p-values <0.001, 0.023 and <0.001 respectively. Conclusion: The results obtained from this data suggests that PVD is not associated with central obesity, instead it provides evidence that PVD correlates with peripheral fat mass. Subsequent studies separating central and peripheral obesity are required to get more clarity on the relationship between obesity and PVD.

Risk Factors for Carbapenem Resistance Section in Gram Negative Nosocomial Pneumonia: A Single Centre Prospective Cohort Study

Swayambhu Banerjee, Renoy Henry, Sandeep Surendran, Abhiram Pillai, Rema Pai

Introduction: Gram Negative Bacilli (GNB) account for about 70% of Hospital Acquired Pneumonia (HAP), Ventilator Acquired Pneumonia (VAP) and Healthcare Associated Pneumonia (HCAP). Increasing use of carbapenems lead to infections caused by GNBs with therapeutically challenging ExtendedSpectrum Beta-Lactamases (ESBLs). Aim: To assess the risk factors and clinical outcomes associated with HAP, VAP and HCAP caused by Carbapenem Resistant (CR) GNB at a Tertiary Care Centre. Materials and Methods: The present study was a prospective cohort study which was conducted from February 2015 to September 2016 that included 66 patients with Broncho Alveolar Lavage (BAL) cultures for GNB. Clinical, demographic and microbiological data (including antibiotic sensitivity) along with overall mortality, occurrence of sepsis and length of stay were collected for each patient. Data were analysed using OpenStat 30.0 along with relevant descriptive statistics. Comparison of outcomes between CR and Carbapenem Sensitive (CS) group were studied along with the concordance between initial antibiotics and BAL culture sensitivity. Results: Overall prevalence of CR in the cohort was 54.54%. The most common organism to be ESBL positive was Klebsiella pneumoniae (45.45%). Exposure to previous antibiotics was a risk factor for CR (p=0.017). Mortality was higher (50%) in CR group than in CS group (23.3%; p=0.026). There were 45.8% of the cases having lack of concordance of initial antibiotics that died in comparison to 16.7% who had an appropriate initial antibiotic therapy (p=0.030). Conclusion: There is a high prevalence of CR in nosocomial pneumonia. Judicious use of antibiotics is the need of the hour and can be implemented by an Antibiotic Stewardship program.

Effects of Different Doses of Dexmedetomidine on Intraocular Pressure after Suxamethonium in Non-ocular Surgeries: A Randomised Controlled Trial

Saswati Das, Mousumi Das, Lingaraj Sahu, Gayatree Mohanty, Akshya Kumar Parida

Introduction: Succinylcholine causes a rise in Intraocular Pressure (IOP) and is deleterious in patients with open globe injuries. Dexmedetomidine, by its virtue of central sympatholytic action can help prevent this rise in IOP. Aim: To find out the optimal dose of Dexmedetomidine in preventing the rise of IOP after administration of Suxamethonium. Materials and Methods: One hundred American Society of Anesthesiologists (ASA) I or II patients posted for non-ophthalmic surgery were included in this randomised, prospective, double blind study. Patients were randomly allocated to four groups. Group A (n=25) received Dexmedetomidine 0.6 μg/kg, Group B (n=25) received Dexmedetomidine 0.8 μg/kg, Group C (n=25) received Dexmedetomidine 1 μg/kg, Group D (n=25) received Normal Saline (NS) over a period of 10 minutes and IOP was measured at different points in time. Results: Premedication with Dexmedetomidine at doses of 0.6 µg/kg, 0.8 µg/kg and 1 µg/kg intravenous (IV) were equally effective in attenuation of the rise in IOP associated with Succinylcholine administration. The IOP recorded was 15.53±1.10 mm of Hg in Group A, 14.49±0.94 mm of Hg in Group B, 14.72±1.03 mm of Hg in Group C as compared to 20.12±1.40 mm of Hg in the control group (Group D) after 60 seconds of injecting Suxamethonium. It also significantly obtunded the sympathetic response to laryngoscopy and intubation. However, the incidence of side effects increased with incremental doses. Conclusion: Dexmedetomidine 0.6 μg/kg IV premedication is the optimum dose to be used for attenuating the rise in IOP associated with Succinylcholine administration in situations where rise of IOP may be detrimental.

An Association of Fasting C-Peptide Levels and Vascular Complications in Chronic Type 2 Diabetes Mellitus Patients

T Thippeswamy, Nirmal Nithin, Prathima Chikkegowda

Introduction: Numerous biochemical markers are being used in clinical practice for the prediction and prognostication of vascular complications among non diabetic individuals. Of late, fasting C-peptide levels is being investigated for its possible role in the prediction and protection of vascular complications of diabetes. It is also being explored for its protective role in prevention of vascular complications among patients with diabetes mellitus. Aim: The present study was undertaken with an objective to assess the strength of association of fasting C-peptide levels in the development of microvascular and macrovascular complications. Materials and Methods: An observational cross-sectional study involving 100 subjects with Type 2 Diabetes mellitus (T2DM) having an objective evidence of vascular complications were included into the study. The study period was 18 months from October 2017 to September 2019. After an overnight fasting of atleast 12 hours, C-peptide level estimation was done by Electro-Chemiluminescence Assay (ECLA) method. Results: The overall mean fasting C-peptide level among subjects with microvascular complications (0.73±0.55 ng/mL) was significantly decreased compared with subjects having macrovascular complications (2.44±0.72 ng/mL, with p-value being <0.001). Among microvascular complications, the mean fasting C-peptide level was least in subjects with diabetic retinopathy (0.64±0.35 ng/mL). Among patients with macrovascular complications, preserved C-peptide levels were observed in subjects with ischemic heart disease (2.35±0.75 ng/mL). Conclusion: Fasting serum C-peptide levels are significantly reduced among subjects with chronic T2DM having microvascular complications when compared to macrovascular complications. Also, with preserved serum levels, fasting C-peptide might have a protective role in the prevention of macrovascular complications among subjects with diabetes mellitus.

A Randomised Controlled Study of Two Different Doses of Bupivacaine in Ultrasound Guided Axillary Brachial Plexus Block

Introduction: The use of Ultrasound (USG) for needle precision aids in reduction of local anaesthetic volume needed for peripheral nerve blockade. Conventional dosages of 30 to 40 mL of local anaesthetic mixture have been used in peripheral nerve blockades but using a lesser volume will reduce the incidence of local anaesthesia associated systemic toxicity. Aim: To assess the efficacy of two different doses 20 mL and 25 mL of Bupivacaine in USG guided axillary plexus block. Materials and Methods: Sixty patients requiring forearm and hand surgeries were randomised into two groups. Group A received low volume (20 mL of 0.375% bupivacaine) and group B received intermediate volume (25 mL of 0.375% bupivacaine). The quality of anaesthesia in regards to sensory and motor blockade, duration of analgesia, haemodynamic variability and complications were evaluated. Successful block was defined by Vester Anderson’s criteria. Duration of analgesia was measured using Visual Analogue Scale (VAS). Statistical comparison of all continuous variables were assessed utilising Student’s t-test and Mann-Whitney U-test as applicable. Results: No significant difference in onset times were observed as far as sensory and motor blockade was concerned between the two groups A and B with p-values of 0.69 and 0.40, respectively. Group B had significantly longer duration of block in comparison with Group A (p<0.001). Two patients in group A and one patient in Group B required supplemental analgesia with fentanyl boluses. Haemodynamics were stable and no complications were seen in both the groups. Conclusion: Lower volume of Bupivacaine is convincingly prudent for regional blockade under USG guidance than suggested in literature.

Clinical and Microbiological Profile of Tracheal Aspirates in Chronic Kidney Disease Patients

N Shashikala, Mythri Shankar, NS Madhura, KM Mythri, R Kowsalya

Introduction: Chronic Kidney Disease (CKD) is a chronic inflammatory state, which inturn suppresses the immune system. CKD patients are hence at more risk for nosocomial infections. Ventilator Associated Pneumonia (VAP) is one of the major nosocomial infections. If not treated early and appropriately, it increases hospital stay and expenses in turn increasing morbidity and mortality. In recent times, due to irrational and rampant use of antibiotics, there is an emergence of multidrug resistant strains of organisms which are difficult to treat. Aim: To study the clinical and microbiological profile of tracheal aspirate samples in CKD patients. Materials and Methods: It was a retrospective cross sectional study conducted in the renal Intensive Care Unit (ICU) of a Tertiary Care Centre, Institute of Nephrourology, Bengaluru over a period of two years from July 2018 to July 2020. Clinical and demographic data of patients who fulfilled the inclusion criteria was recorded. Tracheal aspirates were obtained by convenient sampling technique. The samples were cultured on Blood Agar (BA), chocolate agar, MacConkey agar and Sabouraud’s Dextrose Agar (SDA). Antibiotic sensitivity profiling was done by using Mueller Hinton agar. Statistical analysis was done using Statistical Package For The Social Sciences (SPSS) V23.0 software. Results: Sixty-nine samples were analysed over a period of two years. Males (66.66%) were in majority. Diabetes Mellitus (64%) was the most common associated risk factor. Among the total samples obtained, around 70% showed bacterial growth. Gram negative bacteria (92.4%) were the most commonly isolated microorganism. Among the Gram-negative bacteria, Acinetobacter baumanni (45.3%) was the most common followed by Klebsiella pneumoniae. Majority of the gram negative organisms were sensitive to Polymyxin B, colistin, tigecycline. Acinetobacter and Klebsiella showed resistance to 3^rd generation cephalosporins, aminoglycosides and fluoroquinolones. Conclusion: There is emergence of extremely drug resistant gram negative organisms as the cause for VAP. They are dangerous and difficult to treat. They thus increase the hospital expenses by prolonging the hospital stay. Hence, the need of the hour is to formulate an appropriate antibiotic policy based on the population being treated and to follow strict infection control practices in ICU setup.

High Resolution Computed Tomography of Thorax- Is it an Early Predictor of Hypoxaemia in COVID-19 Patients?

Introduction: Novel Coronavirus-2019 (nCoV-2019) is capable of human-to-human transmission and can lead to acute respiratory distress syndrome similar to Middle East Respiratory Syndrome (MERS) due to lung parenchyma destruction. Some patients with COVID-19 consistently demonstrated no hypoxaemia, however, some patients develop sense of difficulty in breathing due to increased airway resistance. Aim: To assess the potential of High Resolution Computed Tomography (HRCT) thorax as an early predictor of hypoxaemia in COVID-19 patients. Materials and Methods: A prospective longitudinal cohort study of 1000 Reverse Transcription Polymerase Chain Reaction (RTPCR) confirmed COVID-19 and HRCT thorax positive patients, who were monitored simultaneously for SpO₂ levels, were undertaken. HRCT findings were graded into Computerised Tomography Severity Index (CTSI) and correlated with patient’s SpO2 levels, at the time of scan on admission. Patients, who had normal SpO2 levels (≥95%) at the time of initial scan, were monitored upto five days. Pearson's correlation test was used to find correlation between CTSI and SpO₂ levels. Results: In present study group there was male predominance (4:1). Fever was the most common clinical presentation followed by cough. HRCT thorax features were categorised as Typical 769 (76.9%), Indeterminate 176 (17.6%) and atypical 55 (5.5%). 371 (82.8%) patients with SpO₂ >95% were having CTSI between 0-7, similarly 189 (54.4%) patients with SpO₂ 90-94% were having CTSI between 8-15 and 133 (64.8%) patients with SpO₂ <90% were having CTSI between 16-25. So, the present study categorised the patients into three groupsCategory 1 (CTSI 0-7), Category 2 (CTSI 8-15) and Category 3 (CTSI 16-25) for better and prompt identification of clinical severity and their management. Majority of patients in CTSI category 1, 2 and 3 were having SpO₂ levels ≥95%, 90-94% and <90%, respectively. Statistical correlation between CTSI and SpO₂ levels at the time of initial scan was significant (Pearson’s correlation coefficient (r)=-0.261 and p-value <0.01). Number of patients who developed hypoxaemia (SpO₂ <95%) on follow-up in CTSI Category 1, 2 and 3 were 42 (11.32%), 10 15.87%) and 2 (14.28%), respectively. The association between CTSI and development of hypoxaemia based on follow-up SpO₂ levels was statistically found to be insignificant (chi-square value=1.21, degree of freedom (d.f.) 2 and p-value=0.570). Conclusion: In present study group, a negative correlation was established between CTSI and SpO₂ levels. The association between CTSI and development of hypoxaemia on follow-up SpO₂ monitoring was found to be non-significant statistically. So, HRCT thorax cannot be relied upon as an early predictor of hypoxaemia in COVID-19 patients.

Virtual Examination for Final Year Orthopaedics Postgraduate Residents during COVID-19: Is it a Viable Alternative?

Munir Farooq, Zubair Younis Ringshawl, Mubashir Maqbool Wani, Ibreez Rakshan

Introduction: Final year examinations for postgraduate residents of medical colleges in India were scheduled according to a defined protocol where doctor patient relationship was given utmost importance. Due to the currently prevailing pandemic, it has become extremely unsafe to conduct such an examination. So, an innovative method was devised by the Department of Orthopaedics, GMC Srinagar to ensure safety of the examiners and candidates as well as maintaining the required standard of the examination. This method was employed successfully in conducting exit examinations of final year postgraduate residents in this department. Aim: To evaluate the effectiveness by a preformed questionnaire (developed by the faculty of Department of Orthopaedics, GMC Srinagar), Jammu and Kashmir, India of virtual pattern for exit examinations of final year postgraduate residents of medical colleges in India. Materials and Methods:A total number of 10 candidates appeared in the final year (MS Orthopaedics) examination. The conventional format which consisted of assigning patients to the candidates was replaced by a digital presentation format. In this format, the cases were prepared by the faculty, in the form of individual digital presentations for long as well as short cases. Presentation format consisted of detailed history, clinical examination, photographs of any deformity, elicited clinical signs and radiological imaging. A mock test was conducted four weeks before the date of the exam so that the candidates were familiar with the new virtual pattern. A questionnaire was designed to assess the acceptability of the virtual examination. It comprised of 10 questions and each answer was graded on a three point Likert point scale, producing a maximum score of 2 and a minimum score of 0 for each question. Results: Mean total scores for both the groups (examiners and candidates) were 18.25 and 16.9, respectively. The overall outcome regarding the responses was satisfactory in both the groups. The scoring was highest for the safety of the examination in examiner as well as the candidate group. In addition, overall satisfaction also scored the highest among the examiner group. Conclusion: This virtual pattern of examination presents a viable interim alternative to the traditional face to face examination, though it may not replace the latter. The time frame of the pandemic and its trend is difficult to imagine at this point of time, so, the virtual pattern might have to be used for future examinations as well. In addition, this pattern may even be utilised by other departments to frame their examinations.

Exploratory Research on the Effectiveness of Lannea coromandelica in Streptozotocin Induced Diabetic Model: A Protocol for Systematic Review

Jacques Britto, Kesavi Durairaj, Sandhya Sundram, Usha Kumary, Uppu Praveen

Introduction: Diabetes mellitus is a metabolic disorder affecting human population since many centuries ago. To contend this disorder, effective alternative use of non-pharmacological approaches, particularly natural herbal plants, has become a subject of interest since the last decade. Aim: To evaluate the safety and effectiveness of Lannea coromandelica in the management of diabetes mellitus. Materials and Methods: A systematic review on randomised controlled trials will be carried out. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines will be followed. The search strategies will be conducted in PubMed/ MEDLINE, J-Gate, EMBASE, COCHRANE database and Google Scholar. The search period will be included from 1968 to December 2020. The screening process will be initiated by two authors for title and abstract followed by four authors for full-text articles. The extraction will be performed by using the following characteristicsStudy design, Animal model, Intervention of interest. Conclusion: This current review will provide evidence based on the available literature either to accept or reject the hypothesis that efficacy of Lannea coromandelica herbal plant may be beneficial for controlling glucose levels in diabetic model.

A Cross-sectional Study of Anatomical Variations of Coronary Ostia in the Adult Human Hearts and its Clinical Significance

Najma Mobin, H Basavanagowdappa, B Madhu

Introduction: The knowledge of anatomical variations of the coronary ostia is an important factor in the study of Coronary Heart Disease (CHD). With the adaptation of sedentary life style and increasing stress, CHD has become the major cause of death in many countries. Aim: To describe the location, size and shape of the coronary ostia in cadaveric hearts. Materials and Methods: Descriptive cross-sectional study was carried out in 110 adult human hearts, 90 males and 20 females with a mean age of 66 years, which were collected from the mortuary from March 2017 to March 2019. The aorta was dissected and the aortic sinuses were opened, the number, location, size, shape and anomalous presence of accessory coronary ostia was noted and the measurements were taken using vernier calipers. Results: The Right Coronary Artery (RCA) was seen taking origin from the anterior aortic sinus and the Left Coronary Artery (LCA) from the left posterior aortic sinus in all the 110 hearts. The mean diameter of the Left Coronary Ostia (LCO) was 3.66±0.40 mm and found to be greater than the Right Coronary Ostia (RCO) 3.43±0.38 mm. Variations in the location and shape of the RCO and LCO were noted, and presence of single accessory coronary ostia was observed in five cases. Presence of multiple accessory coronary ostia was observed in only one case and its presence was found to be very rare. Conclusion: The diameter of the LCO was found to be greater than the RCO and the shape was circular in most of the coronary ostia. The majority of the coronary ostia were found to be located within the aortic sinuses below the Sinutubular Junction (STJ). Anatomical knowledge of the coronary ostia in the ascending aorta is very important during cardiac interventions around the aortic root.

A Study of Correlation between Asthma Control Test and Lung Function Parameters

Introduction: Asthma control is the extent of observed asthma symptoms in patients and reduction in symptoms after treatment. Simple screening tools are available to assess asthma control. Asthma control test is a simple numerical scoring system that can be easily used on a routine basis. Latest Global Initiative for Asthma (GINA) guidelines stress that asthma control is the main objective of asthma treatment. In this COVID-19 pandemic situation, there is an hesitancy in performing and undergoing pulmonary function tests among physicians and the patients. Hence, in this study it was planned to correlate the asthma control test values with FEV1 and other parameters like Peak Expiratory Flow Rate (PEFR), Absolute Eosinophil Count (AEC) and serum magnesium. Aim: To study the correlation between asthma control test and FEV1; to study the correlation between asthma control test and other parameters like PEFR, AEC and Serum magnesium. Materials and Methods: This was a cross-sectional observational study done from February 2019 to January 2020 conducted at Department of Pulmonary Medicine. A total of 55 patients of Bronchial asthma in line with GINA Guidelines were included in the study. Asthma control test questionnaire was administered to all the patients. Routine blood investigations like Total Leucocyte Count (TLC), Differential Leucocyte Count (DLC), Absolute Eosinophil Count (AEC), serum magnesium levels were done. Pulmonary function parameters like FEV1 and PEFR were measured. Results: Asthma control test had positive correlation with FEV1 with a spearman’s correlation of 0.2758 and p-value of 0.0414 which was statistically significant. The spearman's correlation between asthma control test and AEC was -0.4583 with a p-value of <0.001, which was significant. The correlation of asthma control test with serum magnesium was 0.3414 with a p-value of 0.010. Conclusion: Asthma control test score had a significant positive correlation with FEV1 and serum magnesium levels. It also had significant negative correlation with AEC (inflammatory marker). Hence, asthma control test can be used as tool for treatment response in the current COVID-19 pandemic situation and also in resource limited settings.

Use of Ivermectin as a Potential Chemoprophylaxis for COVID-19 in Egypt: A Randomized Clinical Trial

Introduction: The rate of secondary attacks of SARS-COV-2 is high among household close contacts. Social distancing, isolation and infection control measures are important for preventing exposure to infection, but insufficient. Aim: The study aimed to evaluate possible role of oral ivermectin as a chemoprophylaxis in asymptomatic family close contacts with COVID-19 patients. Materials and Methods: A prospective interventional randomised open label-controlled study was conducted (registered at clinicaltrials.gov; NCT04422561) during June and July 2020. Two arms were designed according to use of ivermectin. In ivermectin arm, contacts received ivermectin according to Body Weight (BW) on day of the diagnosis of their index case. The non-intervention group received no treatment. Both groups were followed-up for two weeks for development of symptoms suggestive of COVID-19. Results: Ivermectin group included 203 contacts (to 52 index cases) aged 39.75±14.94 years; 52.2% were males. Non-intervention group included 101 contacts (to a total of 24 index cases) aged 37.69±16.96 years, 49.5% were males. Fifteen contacts (7.4%) developed COVID-19 in the ivermectin arm compared to 59 (58.4%) in the non-intervention arm (p<0.001). The protection rate for ivermectin was more prominent in contacts aged less than 60-year-old (6.2% infected compared to 58.7% if no treatment). Ivermectin in the protection against SARS-CoV-2 infection had an OR of 12.533 and 11.445 (compared to nontreatment) in both univariate and multivariate models, respectively. Side effects of ivermectin were reported in 5.4%; they were mild. Conclusion: Ivermectin is suggested to be a promising, effective and safe chemoprophylactic drug in management of COVID-19.

Oral Health of Autistic Children and Awareness of Care Providers towards their Oral Hygiene

Sanu Susan Sam, Vabitha Shetty, Vijayalekshmy Amma

Introduction: Autism is a lifelong neurodevelopmental disease characterised by qualitative abnormalities in reciprocal social interaction and patterns of communication. The incidence of autism has increased in recent years and therefore, the possibility of dentists encountering children with autism is higher. Knowledge about the prevalence of dental disease in these children and the awareness of their care providers towards oral health is crucial to provide quality dental healthcare. Aim: To evaluate the oral health status of children with Autism Spectrum Disorder (ASD) and to assess the awareness of the parents/care providers regarding their oral health. Materials and Methods: This study was a two-stage crosssectional study carried out in July, August 2015 at AB Shetty Memorial Institute of Dental Sciences, affiliated to NITTE Deemed to be University. Twenty children diagnosed with ASD formed the study group while 20 healthy children formed the control group. A clinical examination assessed dental caries (DMFT/dft). Gingival disease and oral hygiene of all children were evaluated using the Loe and Sillness gingival index and simplified oral hygiene index, respectively. Parents/care providers of the autistic children were asked to complete a questionnaire regarding the oral hygiene practices and oral health problems of the children. Descriptive statistics were performed for continuous variables, frequencies and percentages for categorical variables and comparisons were made using the Mann-Whitney U test, independent t-test and Chi-square test. Statistical analyses were conducted using EZR software (R version 3.6.3© 2020) and significance level was set at p<0.05. Results: The dft values in the children with autism were significantly lower than the control group (p=0.035). Children with autism had higher DMFT values, however this difference was not found to be significant (p=0.757). No statistically significant differences were found in the gingival and oral hygiene indices amongst the children with autism and their healthy controls, (p=0.811, 0.365, respectively). An 85% (n=17) of children were found to use tooth brush and paste for oral hygiene procedures. An 85% (n=17) of children with autism had supervised tooth brushing while only 20% (n=4) of the children with autism had previously visited a dentist. Most care providers of children with ASD seemed to be unaware of the causative factors of dental disease. Pouching of food was not seen in most of the autistic children. Conclusion: Caries experience in the permanent dentition in the autistic children and healthy children were comparable while autistic children had a lower caries experience in the primary dentition. Both autistic children and healthy children exhibited mild gingival inflammation. Whereas, the oral hygiene status was comparable amongst the two groups of children. Most of the autistic children had assisted tooth brushing (parental), however there were significant lacunae of knowledge in the oral health awareness of the parents/care providers.

Feasibility of Prophylactic Bilateral Salphingectomy during Vaginal Hysterectomy- A Prospective Longitudinal Cohort Study

Introduction: Fallopian tubes are not commonly removed during vaginal hysterectomy because of inadequate surgical training or fear of increased morbidity. Aim: The primary objective of this study was to estimate the proportion of planned bilateral salpingectomies successfully completed vaginally. Materials and Methods: This was a prospective, interventional longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at ESI, PGIMSR, Basaidarapur, New Delhi. From December 2018 to November 2019, all women undergoing vaginal hysterectomy for benign conditions were offered prophylactic salpingectomy. Operative time, blood loss and reason for non completion for salpingectomy were recorded. Patients were followed-up for six weeks. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 17.0. Continuous variables were described with mean and the categorical variables were described with frequencies and percentages. Results: Thirty-five patients were enrolled in the study. The most common indications for vaginal hysterectomy for benign conditions included uterovaginal prolapse in 21 (60%) patients and adenomyosis and fibroids in 10 (30%) and 4 (10%) patients respectively. Of the 35 patients, vaginal salpingectomy was successful in 31 (88.5%) patients. Factors which led to non completion of salpingectomy were pelvic adhesions and atrophic ovaries in 2 (5.7%) patients each. Mean operating time for bilateral vaginal salpingectomy was 14.05±2.75 minutes. Mean Estimated Blood Loss (EBL) for bilateral salpingectomy was 19.86±6.88 mL. Conclusion: Bilateral prophylactic salpingectomy with vaginal hysterectomy for benign conditions is feasible in most of the patients. Routine salpingectomy should be offered to women undergoing vaginal hysterectomy for benign conditions to prevent risk of ovarian carcinoma in future.

Awareness amongst Non-teaching Professionals Regarding COVID-19 in a Rural Teaching Hospital: A Cross-sectional Study

Ervilla Dass, Maulin D Mehta

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has enforced a huge burden on the primary health care systems around the world to deal with this global health challenge. The recent global threat of this pandemic is rapidly progressing and has placed a high priority on investigation of medicaments. The rapid rise in COVID-19 occurred during the first week of March 2020, wherein, cases of COVID-19 reached over 100 countries with more than 100,000 cases reported. Aim: To assess the knowledge and perception regarding COVID-19 amongst non-teaching professionals of a rural teaching hospital. Materials and Methods: This was a cross-sectional study and was conducted over a period of two months from start of May, 2020 to end of June, 2020. Total number of participants enrolled were 70. Each questionnaire had a total of 27 questions in their vernacular language, through which their knowledge (9 questions) and perception (18 questions) regarding COVID-19 were assessed. Moreover, one question related to five steps of the 20 second handwash technique was also included with pictorial graphics. Questionnaires filled by the participants were collected for statistical analysis and the results were expressed as percentage. Results: A total of 70 participants were included in the present study. Regarding questions related to knowledge of coronavirus, 91.43% of participants had heard about the recent coronavirus. However, 68.57% were not aware about coronavirus spread from person-to-person through small drops from the nose or mouth, that can be dispersed widely through an infected person when they cough or breathe. Nearly 44.29% participants knew that coronavirus can cause difficulty in breathing. Concerning questions related to prevention and safety, all the participants were aware of wearing face masks. Conclusion: Though majority of the participants were aware about coronavirus, they had lack of in-depth knowledge as seen in their perception of knowledge through detailed questions. Hence, there is a need for increased awareness regarding the symptoms, implementation of precautionary measures and guidelines laid down by the authorities from time to time.

A Randomised Control Trial on the Effects of Fentanyl vs Subanaesthetic Dose of Ketamine given along with Propofol on Anaesthetic Profile and Recovery Characteristics

Natham Hemanth, I Swami Devi Prasad, Aloka Samantaray, M Hanumantha Rao

Introduction: Total Intravenous Anaesthesia (TIVA) has been a subject of interest for all anaesthesiologists. TIVA was initially attempted with a single drug but no drug was found to give complete anaesthesia. So, the technique of co-induction using two or more agents to induce anaesthesia has been studied. With the invention of newer induction agents, opioids and amnestic agents having shorter half-life, with advents of infusion pumps and depth of anaesthesia monitors like Bispectral Index (BIS), TIVA is gaining popularity day by day. Aim: To compare the effects of fentanyl or subanaesthetic dose of ketamine given along with propofol in TIVA. Materials and Methods: A randomised double blind study was conducted in patients who underwent elective laparotomy under TIVA. Sixty-two ASA grade I and II patients were randomised to receive either subanaesthetic dose of ketamine or fentanyl along with propofol for induction. Infusion of one of the study drugs was continued during maintenance along with propofol infusion which was titrated to maintain BIS of 40-60. Vecuronium was used to provide muscle relaxation and bolus doses of fentanyl were given whenever additional analgesia was needed. Intraoperative propofol, vecuronium and additional fentanyl requirement, time for tracheal extubation and time for first postoperative analgesic request were recorded. Continuous data was analysed with Student’s t-test and categorical data was analysed with Chi-square test. A p-value less than 0.05 were considered statistically significant. Results: Immediately after induction, haemodynamics were more stable in the ketamine group when compared to the fentanyl group. There was also a significant decrease in propofol requirement (6.501±0.24 Vs 6.672±0.26 mg/kg/hr) and a delay in the request for first postoperative analgesia in ketamine group (57.50±38.20 vs 40.50±22.68 minutes). Conclusion: Pre-incisional bolus of subanaesthetic ketamine followed by an infusion intraoperatively maintains haemodynamic stability, provides analgesia, decreases propofol requirement and delays request for first postoperative analgesia.

Study of Prevalence of Neuropsychiatric Symptoms in Elderly Dementia Patients

Efficacy of Peptone Glycerol Broth in Long-term Storage of the Bacterial and Yeast Cultures

Introduction: Bacterial isolates and control strains stocking is an integral part of clinical microbiology laboratories. This is an essential step in maintaining quality. Preserving the strains without altering the character is an essentiality. There are different stock culture preparations studied in past showing varied level of performance. Aim: To evaluate the performance in terms of longevity and phenotypic character preservation of Peptone Glycerol Broth (PGB) in comparison to Brucella Glycerol Broth (BGB) and Skim Milk (SKM). Materials and Methods: The present study was a prospective analytical study. Three quality control strains and seven clinical isolates with different types of resistance were stocked in triplicates with cryobead based peptone broth with 15% glycerol, Brucella Broth (BB) with 15% glycerol and 10% SKM and stored at -80°C. Isolates were revived in monthly pattern, quarterly pattern and once after 10 months to assess the variations in viability and loss of phenotypic properties arising out of repeated freeze thaw and contaminations. Viability was assessed by time taken to produce observable confluent growth on revival. Metabolic characters and antibiotic susceptibility testing were compared before and after stock revival at intervals. Results: The phenotypic characters like metabolic features and antibiotic susceptibility were preserved with all three preparations both with repeated freeze thaw and single freeze thaw at the end of 10 months. PGB and BGB had a 100% revival rate of stored isolates with a confluent growth at 24 hours in comparison to 93.56% with SKM. Conclusion: Cryobead preparation of peptone broth-15% glycerol can be used as an effective preparation for stock culture maintenance of non-fastidious bacteria and yeast.

Motivational Factors and Training Aspects in Postgraduate Students of Anaesthesiology: A Survey

Rashmi Ravindran, Rekha Krishnankutty, MC Rajesh, Vineetha Prabhakaran

Introduction: Anaesthesiology is a fast growing branch of medicine. There is marked shortage of anaesthesiologists in India and this hinders the growth of surgical and interventional specialities which hinges on well-trained, enthusiastic anaesthesiology support. Exploring the perceptions about the speciality among Postgraduate (PG) students could help in planning strategies to make a career choice in anaesthesiology look more attractive. Aim: To explore the motivational factors for the choice of anaesthesiology for postgraduation, various aspects of PG training, stress among PGs and satisfaction with career choice in order to delineate the perceptions about the speciality among the medical graduates and to find out avenues for improvement to make the speciality more attractive. Materials and Methods: A cross-sectional questionnairebased survey was distributed among 300 PG students in anaesthesiology who attended various national level conferences in India and state level conferences in Kerala between November 2015 and March 2018. Data collected was statistically analysed using R software version 3.1. All the quantitative variables were summarised as mean±SD (Standard Deviation) or median with IQR (Inter Quartile Range) depending on the distribution. Qualitative variables were summarised as proportions. Association between factors was analysed using Chi-square test or Fisher’s-exact test. Results: Anaesthesiology was the first career preference for only 34.63% (n=88) of the participants. Predominant reasons for choosing anaesthesiology included unavailability of other specialities (32.8%, n=82) and good job opportunities without need of super specialisation (32%, n=80). After joining anaesthesiology, majority (68%, n=175) were satisfied with their career choice. Satisfaction with PG training, assessed by the Likert scale was high among the participants and majority suggested improvements especially in theory classes, case discussions and simulation. Stress was experienced by 60% (n=154) of participants ascribed mainly due to lack of time for academics due to high workload. Conclusion: Improving awareness among public health professionals and medical students and increasing Undergraduate (UG) exposure to the subject would increase the proportion of students joining anaesthesiology with genuine interest and improve the recruitment profile. Modifications in training and measures to reduce stress during training should also be considered.

Risk Factors of Diabetic Nephropathy Development in Type 2 Diabetic Patients: A Cross-sectional Retrospective Study

Introduction: Diabetic Nephropathy (DN) is one of the most serious long-term complications of patients with type 2 diabetes and the leading cause of end-stage kidney failure. Early detection and risk reduction measures can prevent DN. However, data showing the survival time and factors associated with DN development among Thai patients with type 2 diabetes is currently not available. Aim: This study aims to explore the survival time and examine the risk factors associated with the development of DN among Thai patients with type 2 diabetes. Materials and Methods: This cross-sectional retrospective study was conducted during 1st January, 2002 to 3rd December, 2017 to performed and to explore the survival time and examine the risk factors associated with the development of DN among 1,540 patients with type 2 diabetes who received treatment at the Diabetes Mellitus (DM) clinic in Mahachanachai Hospital, Yasothon Province, Thailand. Data was collected from the Hospital Experience (HOSxP) program and medical records from 2002 to 2017. Kaplan-Meier and Cox’s regressions were used for data analysis. Results: From those 15 years, out of 1,540 cases 306 eligible patients with type 2 DM were selected for survival analysis. The results showed that 274 patients met the criteria for DN (89.50%) and 32 patients (10.50%) did not meet the criteria for DN. The median of DN survival time was five years. Multivariate Cox’s regression analysis confirmed that systolic blood pressure had a statistically significant association with the development of DN among hospitalised type 2 diabetic patients. Conclusion: Duration of Diabetes and Systolic blood pressure are associated with the development of DN. The application of future prevention and control measures are highly recommended to control systolic blood pressure for DN protection.

Analgesic Efficacy of Perioperative Esmolol as an Adjunct to Morphine in Mastectomy- A Prospective Observational Study

Jose Tania, Vadakkoot Raghavan Hema, Prabhakaran Vineetha

Introduction: Multimodal analgesia with opioids as the prime component is the mainstay of postoperative analgesia for mastectomy, which can lead to many opioid related unwanted side-effects. Esmolol infusion has been found as a useful adjunct in reducing opioid requirements. Aim: To find the effect of perioperative esmolol infusion on postoperative pain and opioid requirements. Materials and Methods: This prospective observational study was done in 140 American Society of Anaesthesiologists (ASA) physical status l and ll patients, between 20-65 years of age posted for mastectomy under general anaesthesia. Esmolol group (group E) received 0.25 mg/kg of esmolol bolus ten minutes before induction followed by continuous infusion 5 μg/ kg/min till end of surgery while control group (group C) received equivalent volumes of saline. Primary outcome measures were Numerical Rating Scale (NRS) for pain, total postoperative opioid consumption and time to first rescue analgesic dosage till 24 hours. Intraoperative haemodynamics and other sideeffects were secondary outcomes. Descriptive statistics of numerical rating scores and analgesic requirements were analysed in terms of mean and standard deviation. Independent t-test was used to compare numerical rating scores and analgesic requirement of the two groups. A p-value of <0.05 was considered statistically significant. Results: The mean numerical pain scores were significantly lower in the esmolol group for the first 24 hour. The mean time to first rescue analgesic was 17.59±5.012 hour in the esmolol group and 8.21±2.22 hour in the control group which was statistically significant (p<0.001). The total tramadol consumption was also significantly lesser in the esmolol group (42.14±29.03 mg), compared to control group (102.86±22.3 mg), (p=0.0001). Mean heart rate was statistically lower in the esmolol group, but there was no incidence of bradycardia requiring treatment. Mean Arterial Pressures (MAP) were comparable. Conclusion: Perioperative esmolol infusion when used as an adjunct to morphine decreased postoperative pain and analgesic requirements for the first 24 hours without any haemodynamic disturbances.

The Tentorial Notch: Morphometric Analysis and its Clinical Relevance to Neurosurgery

Ashima Das, Sudha Chhabra, Sibadatta Das, Pinki Rai, Nishtha Saini

Introduction: The tentorial aperture is a complex space that varies considerably in size and shape. Although this space is defined by the free edges of the tentorium cerebelli, it has remained anatomically elusive. Modern neuroimaging methods routinely provide images of the tentorial notch but the literature so far available is remarkably devoid of extensive observations on the different types of tentorial notches. Dimensions of tentorial notch may determine the clinical sequelae and prognosis of many neurological conditions. Aim: To analyse the anatomical variations of tentorial notch, elucidating its clinical relevance in neurosurgery. Materials and Methods: A descriptive cross-sectional study was performed from August 2010-January 2012. The midbrain was sectioned in an axial plane following the contour of the tentorial edge during medico-legal autopsies in 40 adult human cadavers, age ranging from 20 to 65 years. The parameters measured were: 1) Anterior Notch Width (ANW), the width of tentorial notch through the posterior aspect of the dorsum sellae; 2) Maximum Notch Width (MNW), the maximum width of the tentorial notch in axial plane; 3) Notch Length (NL), the distance between posterosuperior edge of the dorsum sellae in the mid-plane and the apex of notch; 4) Interpedunculoclival (IC) distance, the distance from the interpeduncular fossa to the posterosuperior edge of the dorsum sellae; 5) Apicotectal (AT) distance, the distance between the tectum of midbrain in the mid-plane and the apex of tentorial notch. The data obtained was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The quartile groups defined by MNW (mean 29.77±2.26 mm) were labeled as narrow, midrange and wide. Quartile groups defined by NL (mean 57.98±4.52 mm) were labeled as short, midrange and long. By combining these six groups into matrix formation, tentorial notches were classified into eight types. Applying quartile distribution technique to IC (mean 21.21±3.72 mm), brainstem positions within the tentorial notch were labeled as prefixed, midposition and postfixed. Conclusion: Variations in the dimensions of tentorial aperture may be implicated in the different clinical presentations related to transtentorial herniation, concussion and accelerationdeceleration injuries. The results of the present study provide a baseline data about tentorial notch which may facilitate neurosurgical decision making.

Bone Mineral Status in Sub-clinical Hypothyroidism: A Case-control Study

M Vasanthan, VM Vinodhini

Introduction: Hypothyroidism is the most common thyroid disorder which results in various metabolic disturbances. The disturbance in the bone minerals, calcium and phosphorus contribute to the most common imbalance. This is commonly overlooked in sub-clinical hypothyroidism, based on the absence of symptoms in patients related to thyroid hormone imbalance. The diagnosis of sub-clinical hypothyroidism is generally incidental and is based on the Thyroid Stimulating Hormone (TSH) level. The concentration of the circulating thyroid hormones, T3 (Triiodothyronine) and T4 (Thyroxine) are not altered in this condition. Aim: To study the Ca/P ratio, an early indicator of osteoporotic marker among the patients with hypothyroidism. Materials and Methods: The present study was designed as a case-control study and involved 35 controls with normal thyroid function and 35 subjects with sub-clinical hypothyroidism, of age group 20-45 years. The serum samples were analysed for calcium and phosphorus by their respective methods. The samples were analysed on the same day to maintain the stability of the parameters. Calcium/Phosphorus ratio (Ca/P) was calculated. Results: Serum Calcium was found to be less (8.33±0.30) and serum phosphorus was more (6.61±0.88) in sub-clinical hypothyroidism when compared to control group. Therefore, a reversal of Ca/P ratio was (1.26±0.34) was noted. Conclusion: This study underlines the necessity for patients with sub-clinical hypothyroidism to be monitored for bone mineral status to avoid complications in bone health.

Appraisal of Inter-Rater Agreement among Assessment Scales and Retrospective Analysis of Validated Reports of Cutaneous Adverse Drug Reactions at Tertiary Care Hospital in Eastern India

Introduction: Cutaneous Adverse Drug Reactions (CADRs) share significantly to Adverse Drug Reactions (ADRs) comprising 10%-30% of all ADR reporting in India. Multi Drug Therapy for Leprosy (MDT-L) and antimicrobials contribute remarkably to the overall CADRs burden. Aim: To show distinctive pictures of CADRs profile and to assess inter-rater agreement of assessment scales among study populations. Materials and Methods:A retrospective analysis was done for 245 CADRs reported from March 2018 to March 2020. Cohen kappa statistics was applied for inter-rater agreement study for causality (World Health Organisation-Uppsala Monitoring Cente {WHO-UMC} Scale and Naranjo's Algorithm), severity (Hartwig and Siegel scale) and preventability assessment (Modified Schumock and Thornton scale). Results: CADRs contribute 45.54% of total ADRs reported during study period. Male (60.41%) and age group 21-40 years (22.45%) were predominant sex and age group, respectively. Multidrug therapy for leprosy (51.83%) was the most common offending agent and hyperpigmentation (20.82%), dryness (13.1%), and both (11%) were the most prevalent CADRs. Causality of WHO–UMC Scale was higher with 'Possible' than 'Probable'. Whereas, 'Probable' was maximally found with Naranjo's Algorithm. Severity assessment showed maximum 'mild' cases i.e., 66.53% (manual) and 69.8%% (app). Preventability assessment depicted mostly 'Definite', 66.53% (manual) and 85.71% (app). Inter-rater agreement study showed 'Substantial agreement' for WHO-UMC Scale (K=0.678) and Naranjo's algorithm (K=0.820), when manual vs app ratings were compared. 'Almost perfect' for severity assessment (K=0.893) and 'Moderate' for preventability assessment (K=0.434) were noticed. 'Fair' agreement was observed when manual (WHO-UMC scale) vs manual (Naranjo's algorithm) were compared with K=0.290 and also, in app (WHO-UMC scale) vs app (Naranjo's algorithm) with K=0.319. Conclusion: CADRs were most prevalent among ADRs which have a distinctive picture in eastern India. WHO- UMC scale and Naranjo's algorithm concluded significant differences in causality with only ‘fair’ agreement between them. Severity and preventability assessment done by manually little varied in their results with pharmvigill app and is still more reliable and popular.

Role of Repeat Transurethral Resection of Bladder Tumours after Primary Resection: A Retrospective Cross-sectional Study

Introduction: Bladder Cancer (BC) is the second most common cancer of the urinary tract. Initial treatment by Transurethral Resection of Bladder Tumour (TURBT) helps guide treatment. In High Grade (HG) and invasive cancers, improved staging is achieved by performing a repeat (rTURBT). Aim: To examine the outcome, residual disease, complications, outcomes and quality of procedure of repeat TURBTs at the study tertiary center. Materials and Methods: This was a retrospective study conducted at the Department of Urology in Government Medical College, Srinagar, Jammu and Kashmir, India between October 2018 and December 2019. A total of 123 TURBT’s were performed during the study period, of which 34 were repeat TURBT’s. Case records were examined for each of these patients. Student t-test and Chi-square tests were used to compare data sets. Results: Data was complete for 30 out of 34 patients. There was residual disease in 12 (40%) patients. Upstaging was seen in 2/12 (17%) of patients, down-staging in 0/12, and same stage in 10/12 patients (83%). No disease was seen in 18/30 (60%) of patients. No major surgical complications occurred. In 12 patients of non-invasive, High Grade (HG) tumours, who underwent rTURBTs, 6 (50%) were found to have residual disease. Conclusion: rTURBTs should be performed in all patients with high-grade or T1 tumours. Further studies are required to analyse risk-factors for residual disease which may narrow the indications of rTURBT, thus saving time and costs, and reducing need for an additional procedure.

Adolescent and Adult Hypospadias Repair: A Retrospective Study

Krishnendu Maiti, Bikram Haldar, Dilip Kumar Pal

Introduction: There is a general consensus that results of hypospadias repair surgery, done on children, seem to have a better outcome when compared to the adults. Hypospadias cases in adults can present as primary or with complications resulting from an attempted repair. Aim: To assess any difference in outcome of surgeries done among the adolescent and adult population and to evaluate the use of a Tunica Vaginalis (TV) second layer barrier flap in preventing complications such as urethrocutaneous fistula. Materials and Methods: This was a single centre retrospective observational assessment of the adolescent and adult hypospadias surgeries conducted at a Tertiary Care Hospital from January 2016 to July 2019. The assessment was based on the presentation, site of hypospadias meatus, previous surgery and development of any complications or recurrence. Routine surgeries as per the hospital protocol were done in these patients. Follow-up was done for the next 12 months. For data analysis tables, columns and pie charts were used. Fisher'sexact test was used to find the association and calculate the p-value with the help of SPSS 21.0 software. Results: Total 28 patients were assessed, of which 17 patients were adolescents (mean age 14.6 ±1.66 years) and 11 (mean age 22.7 ±3.51 years) were adult. There was no significant (p-value 0.581) difference in the final outcome of hypospadias repair surgery between the adolescent and adult population. Use of TV interposition barrier flap prevented development of complications. Urethrocutaneous fistula was the most common form of complication noted in both the groups overall rate of complication was 14.2%. Conclusion: When hypospadias repair in adolescents and adults is done in a systematic and meticulous fashion, the outcome was satisfactory and there was no significant difference in outcome among the two age groups. Use of TV flap as a second layer interposition can improve the outcome in such patients.

Association of Helicobacter pylori in Gastric Lesions with Emphasis on Immunohistochemistry

Introduction: Helicobacter pylori (H.pylori) is associated with many gastro-duodenal diseases like peptic ulcers and gastric adenocarcinoma. Hence, it is important to identify H.Pylori in the endoscopic gastric biopsies. Though Immunohistochemistry (IHC) is time-consuming and expensive, it has shown excellent results and is considered as gold standard method for detecting H.Pylori. Aim: To study the morphological patterns of gastric lesions, different histo-pathological gastric lesions with clinical presentation and the association of H.Pylori using Haematoxylin and Eosin (H&E), Giemsa and IHC staining techniques and their efficacy. Materials and Methods: The present study was an observational study conducted at a tertiary care hospital Kalaburagi for a period of 5 years (1 July 2014 to 30 June 2019). All patients were referred to endoscopic section for the biopsy. History was documented and clinical examination was performed. For the retrospective cases, clinical details were obtained from medical records section, blocks were retrieved, stained with H&E, Giemsa and IHC, studied, tabulated and results were analysed. Results: A total of 95 samples (mean age 49.74 years) were studied. Male: female ratio was 2.8:1. Most common histological benign lesions were Chronic Active Gastritis (CAG) 23 (24.21%) and Chronic Superficial Gastritis (CSG) 14 (14.73%). Malignant tumours were seen in 23 cases, among which moderately (39.13%) and poorly differentiated (39.13%) adenocarcinoma was the commonest. H pylori was identified by IHC in benign and malignant lesions in 20 (23.53%) and 01 (4.35%), respectively. Sensitivity and specificity of H&E and Giemsa was 57.14%, 66.67% and 100%, 100%, respectively. Positive Predictive Value (PPV) was 100% for both stains and Negative Predictive Value (NPV) was 89.16% and 91.36% for H&E and Giemsa. Conclusion: The present study highlights the utility of IHC in detecting H.Pylori in gastric lesions as inflammation and other factors are known to affect the detection rate by H&E and Giemsa staining methods. Hence, IHC can be considered as the best method in detecting H.pylori.

Evaluation of Diagnostic Value of Sediment Cytology in Oral Malignant and Oral Potentially Malignant Disorders

Shreyas N Shah, Falguni H Patel, Niraj Patil, Uday Patel

Introduction: Globally, highest prevalence of oral cancer has been observed in Indian subcontinent due to exposure to carcinogens such as betel nut extracts, smoking and chewing form of tobacco. Usually, cancer develops through rising grades of oral epithelial dysplasia which can arise from Oral Potentially Malignant Disorders (OPMD) and lead to fatal invasive malignancy. Being rapid, simple, cheaper and easy, sediment cytology may provide early diagnostic value in such cases. Aim: To estimate the role of sediment cytology from biopsy specimen fixatives in early diagnosis of OPMDs and oral malignant lesions. Materials and Methods: Cytological smears from total 30 cases, 15 subjects had Oral Potentially Malignant Disorders and 15 subjects each of Oral Potentially Malignant Disorders and Oral Malignant lesions were prepared by centrifuging fixatives of the biopsy specimens from February 2015 to January 2016. Analyses of prepared cytological smears were done and obtained results were compared with histological diagnosis. Results: The study results revealed that, out of 15 oral malignant lesions, 12 lesions were properly diagnosed with one inconclusive result and only three out of 15 OPMDs were properly diagnosed, where as three cases were inconclusive. Thus, in case of sediment cytology, the overall diagnostic accuracy was 50% and specifically 80% in case of oral malignant lesions. Conclusion: The Biopsy sediment cytology procedure is rapid, simple and inexpensive and can be applied with possible benefit in any laboratory for preliminary diagnosis. Thus, it is a good compliment for histopathological study of oral biopsies.

Evaluation of Routine Coagulation Parameter in Suspected Acute Myocardial Infarction Patients Attending Emergency Department of Tertiary Care Hospital

Mritunjay Kumar Mishra, DVSS Ramavataram, Tejas Shah

1. Ph.D. Scholar, Department of Biochemistry, SBKSMI & RC, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India. 2. Professor, Department of Biochemistry, SBKSMI & RC, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India. 3. Associate Professor, Department of Biochemistry, SBKSMI & RC, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India.

Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

Reetu Verma, Sasmita Panda, Rajeev Kumar Nishad

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. Conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

Association of Osteocalcin with Metabolic Syndrome and its Correlation with Insulin Resistance

Introduction: Metabolic Syndrome (MetS) is an important public health burden associated with five-fold risk of developing Type 2 Diabetes Mellitus (T2DM) and two fold risk of Cardio Vascular Disease (CVD). Recent studies described that osteoblasts produce osteocalcin which increases insulin secretion and adiponectin production resulting in insulin sensitivity. Aim: To determine the association of serum osteocalcin with MetS and to assess the correlation of insulin resistance Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) with osteocalcin. Materials and Methods: This case-control study was carried out in the Department of Biochemistry at MKCG Medical College, Brahmapur, Odisha, India. By observing the mean and standard deviation from previous studies, with 95% Confidence Interval (CI) and 80% power of study, the sample size was calculated to be 45. Forty eight cases between 20-45 years of age meeting the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria of MetS and 50 age and sex matched healthy individuals were taken as controls. Individuals with any systemic illness or on any kind of medications were excluded from the study. Fasting blood sugar, lipid profile were measured by standard procedures. Serum osteocalcin and serum insulin was estimated by Enzyme-linked Immunosorbent Assay (ELISA) LISA SCAN READER and ROCHE e COBAS 411 electrochemiluminiscence, respectively. Statistical analysis was done in Statistical Package for the Social Sciences (SPSS) 22.0 version software. Results: Serum osteocalcin was found to be lower in cases as compared to controls (7.74±4.62 ng/mL and 23.24±9.74 ng/mL) respectively. Osteocalcin was also found to be significantly negatively correlated with HOMA-IR, Waist Circumference (WC), triglyceride and fasting blood sugar in cases with (r=-0.322, p=0.025), (r=-0.519, p<0.001), (r=-0.401, p=0.005), (r=-0.539, p<0.001), respectively and also in controls with (r=-0.494, p<0.001), (r=-0.176, p=0.245), (r=-0.398, p<0.05), (r=-0.141, p<0.05), respectively. Conclusion: Serum osteocalcin being negatively correlated with insulin resistance may have therapeutic role in prevention of MetS which may be substantiated with further study.

Detection of Atypical Pathogens in Community Acquired Pneumonia by Indirect Immunofluorescence Assay

Introduction: In India, End of Life (EOL) care practice has gained momentum. EOL can have significant impact on physical, emotional and financial aspect. Care planning, coordination and good communication are important if the needs and preferences of people are to be met for their EOL care. There is very minimal information available on awareness, attitude, planning and provision of EOL care. Aim: To assess the Knowledge, Attitude and Practice (KAP) among hospital administrators, doctors and nurses on EOL care and to the decision-making aspects and possible barriers in the provision of EOL care. Materials and Methods: A descriptive survey-based study was conducted at the Department of Hospital Administration, Vydehi Institute of Medical Science and Research Centre Bengaluru, Karnataka. The questionnaire was distributed among 100 healthcare providers including hospital administrators, doctors and nurses involved in EOL care. A structured questionnaire containing 15 questions were used to gather data from the respondents wherein question no. 1 to 5 were based on the knowledge and question no. 6 to 13 were based on practice and question no. 14 and 15 were based on the attitude. All data were entered in MS Excel and statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Version 20.0. Results: Majority of respondents belonged to the group ranging from 25-35 years of age, wherein 58 were males and 42 were females. Ninety participants out of 100 were aware of the concept of “EOL care”, 59 were aware about the current laws concerning EOL care and 17 participants had their medical staff in the hospital being educated and trained on EOL care (p>0.05). Around 29 participants have experienced lack of communication while giving EOL care to patients; 54 out of 100 participants have experienced fury from patient/attender during their practice and 66 participants felt that the hospital should take into consideration of spiritual, religious and cultural beliefs in dealing with EOL care patient. Furthermore, Chi-square test revealed significant (p<0.001) relation between the factors such as age of the patient, duration of disease, economic factors, health insurance, patient suffering, emotional distress among patient/attender and no hope of good quality of life in making decision during EOL. Conclusion: Along with improvements in rules and regulations, there is an urgent need for increasing in awareness among stakeholders who are involved in EOL care practice.

Effectiveness and Safety of Ginkgo biloba, Vinpocetine and Piracetam as a Single Agent and Fixed Dose Combination in Patients with Subjective Tinnitus

Paul Mathai, Anu Chandran, Sourav Das

Introduction: Owing to the lack of any standard treatment, subjective tinnitus can be debilitating, manifesting a varied population response to tinnitus management. There is, therefore, an unmet need to optimise the existing treatment options and generate data to help physicians provide the best possible care for individual patients. Aim: To compare the effectiveness and safety of Ginkgo biloba, vinpocetine, and piracetam as a single agent and their Fixed Dose Combination (FDC) in patients with subjective tinnitus. Materials and Methods: Patients with complaints of subjective tinnitus were enrolled in this longitudinal cohort, single centre study which was conducted at Outpatient Clinic of the ENT Department of Justice KS Hegde Charitable Hospital, Karnataka, India. Patients received one of the five treatments, oral route, three times a day, {group 1: Ginkgo biloba (40 mg); group 2: vinpocetine (5 mg); group 3: piracetam (400 mg); group 4: FDC of Ginkgo biloba (60 mg) and piracetam (400 mg); group 5: FDC of Ginkgo biloba (60 mg), piracetam (800 mg) and vinpocetine (5 mg)} and were followed-up for six weeks using a modified version of Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS), before and after the treatment. Data for safety were also recorded. The association between each attribute and the presence of tinnitus was assessed through chi-square tests. Results: A total of 130 out of 149 enrolled patients completed the study. All the groups showed significant improvement in the severity of symptoms at the end of six weeks as assessed by the modified THI and VAS scores. The improvement was found to be better in group 5 than in other groups, which was evident from the percentage improvement at the end of the treatment compared to other groups. No adverse drug reactions were associated with any of the treatment groups. Conclusion: Though all the drugs were found to be effective and safe in reducing the intensity of subjective tinnitus, FDC of Ginkgo biloba-piracetam-vinpocetine may be considered a better alternative than Ginkgo biloba-piracetam combination and Ginkgo biloba, piracetam, or vinpocetine as single agents.

Lack of Excess Cardiovascular Risks among First Degree Relatives of Persons with Diabetes Mellitus: Is Lifestyle the Cause?

Taiwo H Raimi, Bolade Folasade Dele-Ojo, Samuel A Dada, Joseph O Fadare

Introduction: The prevalence of Diabetes Mellitus (DM) is rising worldwide with a projected increase of more than 50% in next three decades. Family History of Diabetes (FHD) is a recognised risk factor for DM, but development of DM in relatives of people with the disease, who carry susceptible genes, is dependent on interaction with other factors such as nutrition, physical activity and environment. Aim: To determine the prevalence of metabolic syndrome and impact of lifestyle on the CVD risk factors among adult Nigerian with FHD. Materials and Methods: This was a cross-sectional study among staff and students of Ekiti State University and Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Eighty-six participants with FHD were age and sex-matched with 86 participants who had no FHD. Relevant demographic and lifestyle information were obtained, and clinical measurements of Body Mass Index (BMI), waist and hip circumferences and blood pressures were obtained by standard protocols. Fasting plasma glucose and lipid panel were determined. Metabolic syndrome was defined according to the International Diabetes Federation criteria (IDF). The clinical, laboratory and other variables of the people with FHD and those without FHD were compared with Pearson’s Chi-Square and Student’s t-test. Results: The age, clinical, anthropometric and laboratory parameters were similar between the two groups. Participants with FHD consume more poultry (17.6% vs 3.5%) and less red meat (27.1% vs 37.2%) than those without FHD (p=0.036), but the level of physical activity and consumption of fruits/vegetables, and smoking did not differ between the two groups. Metabolic syndrome was equally prevalent between the people with or without FHD (p=0.846). There was no significant difference (p>0.05), in the prevalence of CVD risk factors, such as hypertension, hyperglycaemia, dyslipidaemia, and obesity between the two groups. Conclusion: The prevalence of metabolic syndrome was similar among people with or without FHD. Healthy lifestyle may explain the lack of excess CVD risk factors among people with FHD.

Comparison of Attendance of Patients Pre-Lockdown and During Lockdown in Gynaecology and Antenatal Outpatient Department in a Tertiary Care Hospital of Nadia, West Bengal, India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has brought about a paramount change in the life. This has lead to a reduction in the number of routine patients visiting the Outpatient Department (OPD) of various hospitals and this department was no exception. Aim: To compare the attendance of patient in Antenatal Care (ANC) and Gynaecology Out Patient Department (GOPD) between pre-lockdown and lockdown period due to COVID-19 pandemic. Materials and Methods: The study was conducted among patients attending the OPD in ANC and Gynaecology for 70 days lockdown from 23rd March to 31st May and 70 days immediate pre-lockdown period from 12th January to 22nd March 2020. Daily attendance was noted and types of patient attending in different sub clinics in Gynaecology OPD compared. Enrolment of new ANC patient and old booked cases was compared during both periods. Descriptive statistics were used and displayed as percentages. Results: There was a significant reduction in number of patients attending OPD in lockdown period. There was a total of 6088 (87.3%) reduction in number of patients in Gynaecology OPD and 2235 (69.6%) reduction of patients in ANC OPD which was found to be significant with p-value <0.001. Reduction of patient in lockdown days among new ANC was 574 while it was 1661 in case of old patients. The different sub clinics of GOPD like infertility (704), endocrine (1450), uro-gynaecology (656), STD/PID (732), postpartum (597), cancer detection (316), abortion and medical termination of pregnancy (MTP) (330), others (1303) also witnessed a diminution of attendance. Conclusion: COVID-19 caused a significant decrease in footfall of patients in outpatient department due to lockdown, though the percentage of types of patient attending Gynaecology OPD was almost same.

Prevalence of Abnormal Karyotypes among Males with Non-obstructive Azoospermia and Severe Oligozoospermia: A Retrospective Study

Priya Narayanan, PR Ashalatha

Introduction: Chromosomal abnormalities are one of the important causes of male infertility. Numerical and structural chromosomal abnormalities are seen frequently in men with azoospermia and severe oligospermia. Other abnormalities include Y Chromosome Microdeletions (YCMD), Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene mutations affecting the internal ductal system, genes affecting sperm function and other non-specific disorders. Upto 14% of the men with azoospermia and severe oligospermia have karyotypic abnormalities. Aim: To determine the prevalence of abnormal karyotypes among men with azoospermia and severe oligozoospermia (<5 million/mL). Materials and Methods: The present study was a retrospective observational study carried out at the Fertility Clinic, Institute of Maternal and Child Health, Calicut, Kerala, India, on patients who attended the Infertility Department between January 2016 to December 2019. Semen analysis was done on 232 patients with 100 patients of azoospermia and 132 patients of oligozoospermia. Karyotyping was done from the Cytogenetics Unit, Department of Anatomy. The data was entered in MS excel sheet and analysed and results were expressed in percentage. Results: Chromosomal abnormalities were detected in 35 (35%) of 100 azoospermia and 15 (11.3%) of 132 severe oligospermia cases analysed. Klinefelter syndrome was the most common abnormality detected in azoospermia (22/35). A 46XX was found in two cases. Structural abnormalities were detected in three case (46 X, der X, 46XY der Chr 1 and Chr 9 inversion). Small Y was found in three cases. Polymorphic variants were found in five patients (46XY 15pstk+, 46XY 15ps+, 46XY 1qh+, 46XY 9qh+). Small Y was found in one case. In oligozoospermia, autosomal translocations were found in four cases {46XY, t(11;13)(q21;q21.2), 46XY, t(1;9) (p13;p21), 46XY, t(13;15)(q34;q21), 46XY, t(7,14) (q34:q11)}, Derivative (46XY der 15) and Marker chromosome (47XY+mar) in one case each. Klinefelter syndrome was found in two cases and 48XXYY was found in one patient. Polymorphic variants were found in five cases (46XY 21pstk,46XY 15ps+, 46XY 1qh-, 48XY 9qh+). Small Y was found in one case. Conclusion: Sex chromosomal and autosomal abnormalities are found frequently in azoospermia and severe oligospermia and hence, genetic screening and counseling before Intracytoplasmic Sperm Injection (ICSI) is warranted.

Long COVID Syndrome Following Infection with SARS-CoV-2- A Devastating Influence on Health Status in Some Affected Individuals

Sarthak Nilang Soni, Somashekhar Marutirao Nimbalkar

Almost a year since the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) began causing COVID-19, our knowledge about its manifestations continues to expand. As more people become fatally ill with COVID-19, it is now clear that many patients who developed a mild illness, recovered from a serious illness, or had an asymptomatic infection are also beginning to suffer from a newly described entity called Long COVID. Studies show that show COVID-19 influences the cardiovascular framework, yet the general effects stay obscured. Impaired diffusion capacity, lower respiratory muscle strength, and lung imaging abnormalities are seen in COVID-19 patients in the early recovery stage. As compared to non-severe cases, severe patients had a higher incidence of Diffusion capacity of lung for carbon monoxide (DLCO) impairment and are more prone to total lung capacity decrease and 6-Minute Walk Test (6MWT) decline. The degree and seriousness of long-term well-being outcomes remain unclear, yet increasing information points in the direction of poorer physiological outcomes. Long-term sequelae of COVID-19 will have enduring implications on those afflicted's physical, mental, and social health while having a substantial monetary impact on society.

Ultrasound Diagnosed Disorders of Subacromial Shoulder Pain Patients: A Retrospective Study at a Tertiary Care Rural Hospital, Mewat, Haryana

Depinder Kaur, Harnam Madan, Surendra Kumar, Saurabh Anand, Manjeet Dhanda

Introduction: Shoulder pain is leading cause of disability and pain among musculoskeletal pain patients. Ultrasound is coming in a bigger way for diagnosis and management of subacromial pain due to its low cost, easy availability and accuracy in detecting soft tissues pathologies and for planning further treatment. Aim: To assess the role of diagnostic Ultrasound (US) in subacromial shoulder pathologies evaluation in shoulder pain patients. Materials and Methods: This was a retrospective observational study conducted on 98 patients who presented with subacromial shoulder pain. Diagnostic ultrasound examination was done and patients were categorised based upon underlying pathology and analysed in terms of frequency. Results: Most common ultrasound findings in subacromial shoulder pain patients were subacromial bursopathy 46 (46.93%) followed by Rotator cuff pathology including tear 38 (38.77%), mixed pathology 9 (9.18%) and Acromioclavicular (AC) joint pathology 5 (5.10%). Isolated biceps pathology was not seen in our study rather biceps pathology along with other tendon and joint involvement was observed. Conclusion: The findings in the present study imply that diagnostic ultrasound of shoulder pain patients helps to stratify them into different categories for better understanding of underlying pathology and targeted treatment approach. Ultrasound shall be used as an outpatient primary diagnostic modality for evaluation of subacromial shoulder pain patients.

Secondary Hyperparathyroidism in Patients with Chronic Renal Failure Attending a Tertiary Health Care Hospital- A Cross-sectional Study in Saurashtra Region of Gujarat, India

Jaiminkumar Naginbhai Parmar, Madhu Panjwani, Bhaveshbhai Rameshbhai Bariya

Introduction: Secondary hyperparathyroidism is a known and early complication of Chronic Renal Failure (CRF) patients. Renal hyperparathyroidism leads to a host of bone and cardiovascular problems that ultimately can cause fractures, decreased quality of life, and an increased risk of death. Aim: To determine the hospital-prevalence of secondary hyperparathyroidism in CRF patient and establish the correlation between Serum Parathyroid Hormone (PTH) level, Serum calcium and Serum phosphorus level. Materials and Methods: It was a cross-sectional study conducted on 50 patients with CRF at Government Hospital of Bhavnagar, Gujarat. Detailed medical history and blood investigations were done as a tool for data collection. The study variables were described by using statistical parameters like proportion, mean and standard deviation. Correlation coefficient was used for analysing relationship between Serum PTH, calcium and phosphorus. Results: Mean age of the patients was 42.57 (SD 15.19) years with almost equal representation of both genders. Hypertension was the most common aetiological morbidity (62%) among the study participants followed by diabetes (20%). The hospital prevalence of secondary hyperparathyroidism was 86% in Chronic Kidney Disease (CKD). Serum PTH negatively correlated with serum calcium and positively correlated with serum phosphorus with correlation coefficient value of -0.32 and 0.15, respectively. Conclusion: Parathyroid abnormalities and disorders of mineral metabolism are common among patients with CKD. Parathyroid abnormalities detected early may prevent future long term extra-renal complications.

Cross-sectional Survey on Parental Perception and Attitude on Measles Vaccine: Low Hospital Measles Case Presentation in Rural Area in Enugu, Nigeria

Introduction: The incidence of measles has spiked in recent times despite the efforts to its eradication using a highly effective measles vaccine. Vaccine coverage and underreporting of cases are the major challenges to this effort. Aim: This study was designed to assess the parental knowledge of measles, attitude to measles vaccine and practice of case notification in a rural area in Enugu Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out during a house to house campaign on measles in Ogwuagor (a rural area in Enugu, with frequent cases of measles like symptoms) between June to November 2019. A pre-tested self/interviewer’s administered questionnaire was used to assess the knowledge of measles while Parental Attitude on Childhood Vaccine (PACV) questions were adopted and used to assess the attitude of parents to the measles vaccine. The participants were parents of at least one child of above 12 months of age. The findings and scores were analysed using IBM SPSS Statistic software for windows (SPSS statistical software V.21 (IBM Corp. 2019). The age of the respondents was grouped, and the simple mean obtained. The associations of variables; number of children, level of education and last antenatal care with respect to knowledge and attitude were analysed using Chi-square and p<0.05 was regarded as statistically significant. Results: Out of 652 households in the area, 213 were assessed. One hundred and ninety three (90.6%) expressed knowledge above average about measles and measles vaccine. The score was higher among mothers who had at least three children in their household (p=0.518), tertiary education (p=0.706) and their last antenatal care in a hospital (p=0.774). Majority of the participants had good knowledge about symptoms, transmission and prevention of measles. Only about half, 114 (53.5%) knew the complication of measles. All the respondents had a positive attitude to the measles vaccine. Forty seven (22.1%) of the respondents delayed having their child get a measles shot while 31 (14.6) had concern on the efficacy of the vaccine. Forty-eight 22.5% were concerned about the side-effects of the measles vaccine. The delays having their child get a measles shot, concern on the efficacy of the vaccine, and concern about the side-effects of the measles vaccine observed were significant (p=0.0001, 0.0001, 0.0001, respectively) among parents of more than two children. Conclusion: There was adequate knowledge on measles symptoms, transmission and prevention but poor knowledge of the complication. Their attitudes on the measles vaccine were generally good however, the expression of delays having their child get a measles shot, concern on the efficacy of the vaccine, and concern about the side-effects of the measles vaccine were significant among parents of more than two children. Also, few measles cases were treated in hospital. There is a need to educate parents on the complication of measles and the importance of early hospital presentation of suspected cases for confirmation and prompt management. This will help to prevent complications and community transmission.

Does N-Carboxymethyl Lysine Serve as a Prognostic Biomarker of Diabetic Nephropathy?

Kishore Kondapi, Santhi Silambanan, Lakshmana Kumar, Swathy Moorthy

Introduction: The occurrence and progression of diabetic nephropathy to end stage disease mandates an early detection of kidney damage. Glycation and oxidation injury form an essential element in the evolution of diabetic complications both microvascular and macrovascular. Aim: To study the trends in the N-Carboxymethyl lysine levels in various stages of diabetic nephropathy and assess its efficacy as a prognostic marker for diabetic nephropathy. Materials and Methods: The study included 125 Type 2 diabetic individuals- 45 patients with normoalbuminuria, 40 patients having microalbuminuria and 40 with macroalbuminuria {based on the Albumin-Creatinine Ratio (ACR)}. Forty five nondiabetic healthy individuals were included as a control group. Serum N-carboxymethyl lysine quantification was done for all the study participants and compared and correlated with other parameters across various groups. Results: The fasting and postprandial sugar, glycosylated haemoglobin, triglycerides, duration of diabetes, systolic and diastolic blood pressure, Body Mass Index (BMI), all were strong risk factors for Diabetic Kidney Disease (DKD) progression which significantly correlated positively with microalbumin and urine ACR (uACR) and negatively with Glomerular Filtration Rate (GFR). The serum N-carboxymethyl lysine was observed to be significantly increased as the ACR increased and in comparison to the controls, respectively (p-value <0.001). The GFR showed significant negative correlation with levels of serum N-carboxymethyl lysine whereas positively correlated with fasting and postprandial sugar, glycosylated haemoglobin, triglyceride levels, duration of diabetes, systolic and diastolic blood pressure, BMI, microalbumin and uACR. Conclusion: N-carboxymethyl lysine in serum can serve as an early marker for diabetic nephropathy and its progression and severity.

Stress and Depressive Symptoms among Undergraduate Medical Students of Different Professional Years at a Medical College in Northern India- A Cross-sectional Study

Abhinav Pandey, Achyut Kumar Pandey, Pankaj Sureka, Amit Singh, Sanjay Gupta

Introduction: Medical students are exposed to tremendous pressure, leading to stress, depression and other psychiatric disorder at increasingly higher rates. The stress and depression can affect their learning and can lead to poor quality of life. The students of different professional year may have differing reasons for being under stress and in depression. Assessing stress and depression in students of different professional years may provide better insights, and help policy makers plan appropriate interventions. Aim: To measure and compare the prevalence and severity of stress, various aspects of life affected by stress and depressive symptoms among medical students of various professional years. Materials and Methods: A cross-sectional study was conducted from February 2018 to January 2019; on 150 undergraduate medical students (50 each from 1st, 2nd and 3rd professional year) of a medical institute in Northern part of India. Mini International Neuropsychiatric Interview (MINI version 5) was used to screen for depression, Student’s Stress Dimension Questionnaire (SSDQ) was used to assess for stress prevalence and severity and to find the various aspects of life affected by stress and Hamilton Depression Rating Scale (HAM-D) was used to measure the severity of depressive symptoms. Chi-square test and one-way Analysis of Variance (ANOVA) was used to make the group comparisons. Results: Overall stress and depressive symptoms were present in 66.67% and 52% of the participants, respectively. The three groups also differed significantly in the total score of SSDQ (H=13.664, p<0.05) and HAM-D (H=11.352, p<0.05) with first professional year students having higher scores than second and third professional year students. Domain wise comparison of SSDQ also showed higher prevalence and severity of impaired domains in first professional year students. Conclusion: Special care must be taken of the medical students. Interventions addressing stress and depression should be initiated from first professional year students itself.

Intelligence and Emotional Intelligence among Inmates of Orphanages: A Cross-sectional Study

Ganga G Kaimal

Introduction: Intelligence and Emotional Intelligence are the two psychological faculties that are closely related, both neurobiologically and conceptually and has significant influence in life outcome. Children living in orphanages are a group of unprivileged children with insufficient opportunities for both physical and psychological developments. Aim: To find out the intelligence, emotional intelligence and relationship between them among inmates of orphanages. Materials and Methods: The present study was a cross-sectional study which included 100 children living in orphanages. Personal data sheet developed by the investigator, Binet Kamat test of intelligence and Mangal Emotional Intelligence Inventory were the tools used for the study. Mann-Whitney U test and Spearman’s rank-order correlation was the statistical tests used. Results: The study subjects consisted of 58 girls and 42 boys. The mean score of intelligence in girls was 100.40 and the mean score of intelligence in boys was 99.12. The mean score emotional intelligence in girls was 61.45 and the mean score in boys was 59.95. No significant difference was found between girls and boys in intelligence and emotional intelligence. A positive correlation was found between intelligence and all the sub-scores and total score of emotional intelligence. Conclusion: Both nature and nurture are important in the development of psychological faculties like intelligence and emotional intelligence. There should be policies and programmes that focus on enhancing the intelligence and emotional intelligence of the underprivileged children living in child care institutions which in turn can decrease the deviant behaviours and increase the positive life outcomes.

Psychological Impact among COVID-19 Positive Patients in a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Coronavirus Disease (COVID-19) outbreak is one of the biggest medical challenges to humankind in recent times, started from China in December 2019, and had spread to almost all the countries of the world. The social, psychological and economic fissures exposed by the pandemic resulted in mass disruption in human behaviour population. This is pushing them towards more stress. Aim: To analyse the anxiety and depressive symptoms in COVID-19 positive patients. Materials and Methods: A cross-sectional study was conducted on 325 COVID positive patients who were admitted in isolation ward in Tertiary Care Centre and were enrolled in this study, out of which 18 subjects refused to give the consent and 5 were already taking psychiatric medications and were excluded. Telephonic contact was not established with rest of the 5 patients. After ethical clearance, the anxiety and depressive symptoms were assessed by using Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Results: Maximum patients belonged to age group of 21-40 years (54.9%). Maximum patients were males (70%). Almost 3/4th of the population 64% had depressive symptoms of different severity and 61% had anxiety symptoms. Significant association of anxiety symptoms was seen with gender (p=0.001) and marital status (p=0.002). No association with depressive symptoms was seen with gender (p=0.087) and marital status (p=0.399). Conclusion: COVID-19 had significant impact on the patients. More than half of the population had showed the psychological issues in the form of anxiety and depression. Males and married patients were affected more with both anxiety and depressive symptoms

Immunohistochemical Expression of HER2/neu, Ki-67 and MUC1 in Benign and Malignant Gall Bladder Lesions and its Association with Clinicopathological Parameters

Rania G Roshdy, Heba M Rashad, Enas Ibrahim

Introduction: Gall Bladder Carcinoma (GBC) is a diagnostic and a therapeutic challenge. Although it is increasing, chronic cholecystitis remains the most worldwide gall bladder lesions, harbouring many epithelial changes that may end in carcinoma. Aim: To investigate the expression of HER2/neu (Human Epidermal Growth Factor Receptor 2), Ki-67 and MUC1 (Mucin 1) in malignant and non-malignant gall bladder lesions, and to evaluate its relation with clinicopathologic parameters of GBC. Materials and Methods: This retrospective study included 40 cases of GBC, eight cases of gall bladder dysplasia, 10 cases of gall bladder metaplastic changes and 25 cases of chronic cholecystitis as a control group. The blocks were collected from the Department of Pathology of Benha University Hospital, from January 2012 to December 2019. Immunohistochemical staining results of HER2/neu, Ki-67 and MUC1 were analysed and correlated by Statistical Package for the Social Sciences (SPSS) version 16 and Chi-square test or Fisher’s-exact tests. Results: Positive HER2/neu expression (+2, +3) was detected in 47.5% (19/40) of malignant cases and 12.5% (1/8) of dyspastic group, at the same time it was completely absent in the metaplastic and cholecystitis cases (p<0.01). Similarly, Ki-67 Labeling Index (LI) (=20%) expression was found in 55% (22/40) of malignant group, while it was completely absent in the other three studied groups. All cases of malignant group 100% (40/40), 50% (4/8) of dysplastic one, one case of metaplastic (1/10) showed cytoplasmic expression of MUC1, at the same time it was completely absent in control group (0/25) (p<0.01). High MUC1 expression was found in 75% of both malignant (30/40) and dysplastic (6/8) studied cases and only one case (10%) of metaplastic group (p<0.01). There was a significant correlation between MUC1 expression and studied parameters of GBC. Conclusion: HER2/neu, and Ki-67 are overexpressed in GBC cases compared with control and dysplastic group. The study also highlights that MUC1 would be a better marker of malignant transformation of gall bladder epithelium and its depolarised expression would be reliable for detection of invasive carcinoma, so a new therapeutic agent can target these cell surface adhesion molecule (MUC1). HER2/neu can be considered as a candidate for targeted therapy in GBC treatment strategy.

Study on Correlation between Lipid Accumulation Product and Thyroid Stimulating Hormone Levels in Hypothyroidism

Sujatha Rajaragupathy, Jayagowri Karthikeyan, Egna Mahalekshmi

Introduction: Cardiovascular Disease (CVD) is one of the established causes of mortality and morbidity in hypothyroid patients. A predictor of cardiovascular risk in hypothyroid patients becomes essential to prevent the occurrence of cardiac event. One such prognosticator of CVD is the Lipid Accumulation Product (LAP). Aim: To compare the trend of LAP scores in hypothyroid patients with that of healthy controls. Materials and Methods: After obtaining approval from the Ethics Committee, this cross-sectional study was conducted. After obtaining written informed consent, details such as age, gender, waist circumference, serum Thyroid Stimulating Hormone (TSH), and serum triglyceride levels were collected. LAP was calculated among study participants as follows: LAP for men={Waist circumference (cm)-65}×{Triglyceride concentration (mmol/L)}. LAP for women={Waist circumference (cm)-58}×{Triglyceride concentration (mmol/L)}. Statistical analysis was performed with Microsoft excel and Statistical Package for the Social Sciences (SPSS) software version 24.0 for Windows. Results: The total number of participants were 118 among which 59 (50%) were hypothyroid cases and 59 (50%) were healthy controls. The two groups had statistically significant difference in their LAP scores. The mean LAP score among cases and controls was 38.6±15.6 cm.mmol/L and 30.9±13.2 cm.mmol/L, respectively with a p-value of 0.004. The LAP scores showed positive correlation with TSH levels with r-value of 0.784 and p-value <0.001 by Pearson’s correlation. Conclusion: The study concludes that there is a significant correlation between LAP score and TSH levels and LAP scores are significantly higher in hypothyroid patients.

Morphologic and Morphometric Study of Human Acetabulum and its Clinical Significance

KR Arunkumar, U Delhiraj, S Satish Kumar

Introduction: The acetabulum is a cup shaped hemispherical depression which is present on the hip bone, contributed by ilium, ischium and pubis. It has a central depressed nonarticular part called acetabular fossa, surrounded by a curved lunate articular surface which articulates with the head of femur to form hip joint. The knowledge of acetabular dimensions assists the radiologists in diagnosing acetabular dysplasia and aids the surgeon to determine the correct size of the acetabular cup during total hip arthroplasty and to realign the acetabulum back to normal position. Aim: To measure and analyse the relationship between the depth and diameter of acetabulum and also to study the variations in the morphology of anterior acetabular ridge. Materials and Methods: A cross-sectional study was done on 104 unpaired dry human adult hip bones from February 2017 to September 2019 after obtaining ethical clearance. The diameter and depth of acetabulum was measured using vernier calliper and a metallic strip and correlation between them were analysed using Pearson'’s test. Student's t-test was used to test the significance between the variables. The p-value <0.05 were considered as statistically significant. The different shapes of anterior acetabular ridge were noted. All the recorded data were analysed using Statistical Package for the Social Sciences (SPSS version 16.0). Results: The average measurements of acetabular diameter and depth were 48.98±2.91 mm and 24.12±2.54 mm, respectively. A positive and a significant correlation was found between diameter and depth of the acetabulum (r=0.388, p<0.001). The mean values of diameter and depth of acetabulum in right side were 48.76±2.94 mm and 23.6±2.48 mm, respectively. The average values of diameter and depth in left side were 49.2±2.92 mm and 24.6±2.59 mm, respectively. Though the measurements of acetabular dimensions on left side were slightly greater than right side, they were not statistically significant (p>0.05). Four different shapes of anterior acetabular ridges were noted: angular (23.08%), curved (63.46%), straight (2.88%) and irregular (10.58%). Conclusion: The present study showed weakly positive correlation between diameter and depth of the acetabulum and morphological variations in the shape of anterior acetabular ridge.

Diabetic Peripheral Neuropathy and its Association with Diabetes Self-care: A Clinic-based Study in an Urban Health Centre, Kolkata

Introduction: Diabetes mellitus is considered as silent epidemic worldwide including India. Peripheral neuropathy is one of the most common complications of diabetes mellitus. Diabetes Self-Management (DSM) is crucial in mitigating the afflictions of diabetes and it’s after effects. There was dearth of studies in view of Diabetic Peripheral Neuropathy (DPN) and diabetes self-management in Kolkata, West Bengal. Aim: To assess the associations between diabetes selfmanagement and DPN in Type 2 Diabetes Mellitus (T2DM) patients attending an urban health clinic in Kolkata. Materials and Methods: This study was conducted from December 2018 to March 2019 among known case of T2DM patients aged 30 years and above attending the NonCommunicable Disease (NCD) clinic at Chetla, under the purview of field practice areas of Urban Health Unit and Training centre (UHU and TC) of All India Institute of Hygiene and Public Health (AIIH and PH) Kolkata, West Bengal. A pre-designed and pretested schedule was used to collect data which were analysed using International Business Machines Statistical Product and Service Solutions (IBM SPSS) version 16.0 and represented using various tables. Results: The mean (SD) age of the participants was 54.89 (8.98) years. About 32.4% of the patients had DPN which was significantly associated with increased duration of T2DM {AOR (95% CI)}={1.52 (1.22-1.91)}, lower glucose management sub-scale score {AOR (95% CI)}={2.84 (1.42-5.67)} and lower healthcare use sub-scale score {AOR (95% CI)}={1.86 (1.05-3.31)}. Conclusion: Early screening and education regarding diabetes self-care would be helpful in glycaemic control and in prevention of DPN.

Olfactory and Gustatory Symptoms of Coronavirus Disease 2019: A Systematic Review and Meta-analysis

Introduction: There is increasing anecdotal evidence that olfactory and gustatory dysfunction may be associated with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Aim: The aim of this systematic review and meta-analysis was to find the association of olfactory and gustatory symptoms with Coronavirus Disease-19 (COVID-19) and estimate their pooled prevalence. Materials and Methods: PubMed, Embase, EBSCO and Cochrane databases were searched for cross-sectional, cohort and case-control studies evaluating olfactory and gustatory symptoms in patients with COVID-19. The search terms included COVID-19, severe acute respiratory syndrome coronavirus-2, coronavirus, olfaction disorders, anosmia, hyposmia, dysgeusia and ageusia. Random effects model was used to calculate a pooled Odds Ratio (OR) and pooled prevalence. Results: Total 14 studies were included in qualitative synthesis and 13 studies were incorporated in quantitative synthesis, involving 3,125 patients. The pooled OR was 15.59 reflecting that smell and taste disorders were strongly associated with COVID-19. The pooled prevalence of olfactory and gustatory dysfunction was 56% and 44%, respectively. Conclusion: It can be concluded that there is a significant association between olfactory and gustatory symptoms and COVID-19. Majority of the studies support the use of these symptoms as screening tools for COVID-19.

Sensitivity and Features of Computed Tomography in Diagnosis of COVID-19 Pneumonia: A Meta-analysis

Introduction: Early diagnosis of COVID-19 is important for disease treatment and management. Computed Tomography (CT) is a fast and easy modality for diagnosis and management plan of patients with COVID-19. In the literature, several studies were done to assess the sensitivity of CT for diagnosis of COVID-19 infection in comparison to Reverse Transcription Polymerase Chain Reaction (RT-PCR). Some studies stated that CT was more sensitive diagnostic modality for COVID-19 than RT-PCR. However, the sensitivity of CT for COVID-19 varies in these studies. Aim: This literature review and meta-analysis was designed to determine the CT features of COVID-19 pneumonia, to verify the pooled sensitivity of CT for the diagnosis of COVID-19 and to review the different reasons (e.g., the disease stage or severity and the negative or positive RT-PCR results) for the variations in CT sensitivity. Materials and Methods: This review analysed 31 articles selected from the Europe BMC, PubMed, Science Direct, and Scopus databases. Participant gender mean and median age, CT features of COVID-19 pneumonia were sought for and reviewed. The data was analysed using Microsoft excel version 10 and OpenMeta (Analyst) software (http://www.cebm. brown.edu/openmeta/) to verify the pooled sensitivity of CT in detection and diagnosis of COVID-19 pneumonia using meta-analyses forest plot, Receiver Operating Characteristic (ROC) curve, cumulative meta-analyses forest plot and leave one forest plot. Results: The most common CT findings of COVID-19 pneumonia were bilateral lung involvement, Ground Glass Opacity (GGO), and consolidation, and Crazy-paving pattern. The CT finding is more prominent in symptomatic and severe cases than in a symptomatic and mild cases specifically the presence of consolidation and peripherals lesion distribution. The pooled sensitivity of CT is 90% in diagnosis and detection of COVID-19 pneumonia (ranged 60-100%). Conclusion: Combination of CT chest and laboratory tests along with clinical manifestation and epidemiological features should be considered to confirm the final diagnosis of COVID-19 pneumonia.

Triple Therapy of Fluticasone Furoate, Umeclidinium, Vilanterol- A Compelling Choice in Severe Chronic Obstructive Pulmonary Disease

B Jagan Nathan, Melina I Sahay, AK Gautham, DK Sriram, Melvin George

Trelegy Ellipta (GlaxoSmithKlineTM) is the first single inhaler triple combination therapy comprising of umeclidinium, vilanterol and fluticasone approved by the United States Food and Drug Administration (US FDA) for patients with severe COPD in 2019. Clinical trials comparing this triple combination with dual therapy including a Long Acting β2-Agonist/Long Acting Muscarinic Antagonist (LABA/LAMA) or Long Acting β2-Agonist/Inhaled Corticosteroids (LABA/ICS) were evaluated. Triple combination did show improvement through the mean Forced Expiratory Volume per second (FEV1), St. George questionnaire, and reduced hospitalisation due to acute exacerbation of COPD. This medication should be prescribed cautiously for certain populations. Although this triple combination is used only in patients with the most advanced forms of disease who have frequent exacerbations and remain uncontrolled, there are certain additional indications that may be explored in future trials. The convenience associated with using a single device for three different classes of drugs could be its biggest trump card and it will not be surprising to see its preference among patients avoiding the need for multiple dosing. Nevertheless, it remains to be seen if this improved adherence would translate into improved outcomes such as reduced mortality in real world practice among patients with severe COPD. The availability of a single inhaler device for delivering a triple combination of LABA/LAMA/ICS is a small success story in the quest to identify better therapies for patients with severe COPD, who are so prone to repeat acute exacerbations which could eventually turn fatal.

Biomarker Signatures to Monitor Alcohol Consumption and Induced Organ Damage

Joy M Liji, PR Varghese, Susheela JacobInnah, Praveenlal Kuttichira

The difficulty to differentiate long duration alcoholic behaviours is a major obstacle in the diagnosis and its treatment. Biomarkers in alcoholism are indicative of recent alcohol consumption or alcohol-induced organ damage. They are broadly divided into two; state markers, which are tools indicative of acute or chronic alcohol consumption, and trait markers, which are markers indicative of a genetic predisposition responsible to develop alcohol dependence. This review aimed to sensitise the practitioners on different alcohol state markers available now-a-days. An electronic search in Google Scholar, MEDLINE, and PubMed was conducted by using following keywords: Alcohol biomarkers, State markers, Trait markers, Alcohol consumption test. Studies on alcohol biomarkers published in English language were included in this review. Reviews and studies with free access to only abstract have been excluded. The state markers mostly used to identify chronic alcohol exposure are the Gamma-Glutamyltransferase (GGT), Aspartate and Alanine Aminotransferase (AST and ALT) which are routine serum liver function panels and Mean Corpuscular Volume (MCV) which is a haematological marker. The available non-conventional state biomarkers are Phosphatidylethanol (PEth), Fatty Acid Ethyl Esters (FAEE) and 5-Hydroxytryptophol (5-HTOL). The novel state markers which have been developed in recent research context are still awaiting validation and possible introduction to commercial settings are Plasma Sialic Acid Index of Apolipoprotein J (SIJ), Total Serum Sialic Acid (TSA), Acetaldehyde, Acetaldehyde adducts, anti-adduct antibodies and β-Hexosaminidase. Conventional alcohol biomarkers are routinely used in clinical practice. Non-conventional biomarkers seem to be promising for its estimation. Novel biomarkers are at various stages of research and development.

Effect of Music Distraction in Managing Anxious Paediatric Dental Patients- A Review

Dental anxiety is one of the most commonly encountered problems seen in the dental clinic. Anxiety begins at a very young age, if not addressed at that point; it will result in more drastic consequences. As a dental clinician, there are various methods of behaviour management; one of them is music therapy. Music has always been one of the most commonly used methods to relieve anxiety. A lilting melody from a mother calms down the child in a few minutes. So, this review was performed to know the effect of music distraction in management of anxious dental patients. Music therapy is one of the most efficient forms of non-invasive therapy as the equipment used are musical instrument headsets, audio player among others. Various studies have shown that audio distraction causes a noticeable reduction in the anxiety level of the patient. While it may not have reduced the amount of pain the patient undergoes, it has been recorded that the music therapy shows a positive response in patients. Hence, music distraction proves to be an effective behaviour management tool in children during dental procedures and thus, instils a positive dental attitude.

Role of Early Childhood Adversity, Behaviour Problems and Academic Performance among Adolescents with ADHD: A Systematic Review

Apoorva Sharma , Waheeda Khan

Introduction: "Hyperactivity", is characterised by difficulties related to task, oriented behaviour in children particularly hyperactive children also tends to be socially intrusive and immature. Attention Deficit Hyperactivity Disorder (ADHD) children have great difficulty in compatibility with their parents and their peer group. This disorder occurs majorly in boys than girls and some residual effects, such as attention difficulties may persist into adolescence. Aim: Understanding of behavioural concerns among ADHD adolescents with their parents. Materials and Methods: A comprehensive search in the international databases of academic search complete, Psych articles, J GATE, Psychology and behavioural sciences collection, Proquest, Science Direct, and Google scholar was conducted. Studies included in this review were prospective studies, retrospective study, case-control study, cohort study, descriptive study, and review studies. The study consisted of 15 studies from review journals. Psycho social correlates were investigated in ADHD patients. The studies published from 2000 to 2016 were included in this review. Results: The present review revealed that there is significant role of early Childhood Adversity (CA), poor scholastic performance and behaviour problems in the formulation of ADHD among adolescents. Conclusion: It was concluded that there is a problem in ADHD patients related to their poor academic performances which also reflects in their adolescence, and behavioural problems with parents also. Parents with ADHD children faced more stress in comparison to parents of Non-ADHD children. There is a need to develop specific parent’s intervention training and early identification of ADHD children.

Diagnostic Efficacy of DNA Ploidy in Liquid Based Cervical Cytology using DNA Cytometry

Namrata P Awasthi, Sridhar Mishra, Akanksha Anand, Sarita Saxena, Nuzhat Husain

Worldwide cervical cancer is the fourth most common cancer in women and high incidence is reported from India. Liquid Based Cytology (LBC) provides good morphology for detection of cellular abnormalities. We, therefore, reviewed diagnostic efficacy of conventional Pap staining, flow cytometry and Human Papilloma Virus (HPV) testing in cervical pre cancer and cancer. Narrative review of cervical pre cancer and cancer candidate biomarkers including Pap staining, HPV and flow cytometry from cervical cytology fluids, is based on a detailed review of the literature. Based on the so far conducted studies, a promising conclusion can be drawn, that cytometry when coupled with HPV DNA typing or the conventional cytology gives better results as compared to that of conventional cytology or DNA cytometry alone. Liquid cytology provides a good and stable source of cervical cells to carry out ploidy studies using DNA cytometry. The procedure should be used in conjunction with LBC and HPV detection.

Pulmonary Adenofibroma in an Elderly Male with Recurrent Soft Tissue Sarcoma

Sandhya Devi Pasupathy, Archana Lakshmanan, S Annapurneswari

Pulmonary Adenofibroma (PAF) is a rare soft tissue tumour of the lung. It is a benign lesion, having a biphasic pattern with an admixture of epithelial and stromal components and has resemblance to fibroadenoma of the breast and adenofibroma of the female genital tract. The diagnosis can be challenging and it has to be delineated from other entities with biphasic pattern, like pulmonary hamartoma, pulmonary blastoma, intrapulmonary solitary fibrous tumour and metastases from soft tissue and visceral sarcomas, as each tumour has its own therapeutic and prognostic implications. Here, we report a case of a 73-year-old male, a known case of recurrent soft tissue sarcoma of the thigh, who presented with solitary pulmonary lesion. The patient was a non-smoker and did not have any specific respiratory complaints. On staging work-up with a Positron Emission Tomography and Computed Tomography (PET-CT), a hypermetabolic lesion was identified in the anterior segment of right upper lobe of the lung, following which he underwent right lobectomy. The tumour was a solitary lesion located near the hilum and on histology showed a biphasic pattern with scattered glandular spaces lined by columnar epithelium set in a hyalinised spindle cell stroma. The cells showed mild pleomorphism with oval to elongated nuclei and indistinct cytoplasm. On immunohistochemistry, the epithelial component showed positivity for Cytokeratin (CK), Epithelial Membrane Antigen (EMA), Thyroid Transcription Factor-1 (TTF-1) and Napsin-A and the stromal component showed positivity for Vimentin, Desmin, Smooth Muscle Actin (SMA) and H-Caldesmon (High molecular weight isoform-Caldesmon). With the given histological and immunohistochemistry findings, a diagnosis of PAF was rendered.

Giant Cell Tumour of Clivus: A Rare Case Report

Swapan Shantiram Goswami, Sonal Jain, Shalin Nagori

Giant Cell Tumours (GCT) of the skull is rare, being less than 0.05% of all skeletal tumours. They are usually located in the middle cranial fossa affecting the temporal, sphenoid, petrosal and occipital bone. Clival GCT is rarer and 15 cases are described in the literature. Authors report a case of a female patient aged 20 years, who complained of headache with decrease in vision of left eye. Neurological examination revealed left optic nerve palsy. Laboratory test of Vitamin B12, blood urea, Serum Creatinine, Serum Electrolytes were within normal range. Complete blood count showed mild anaemia. The serum calcium and parathyroid hormones were within normal range. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) were done, which demonstrated expansile destructive lytic lesion involving sphenoid bone and clivus, reaching upto sellar, parasellar regions, sphenoid sinus and left posterior ethmoid sinus, effacing left optic foramina and posteriorly effacing prepontine cistern. The left internal carotid artery was partially encased by the mass. The tumour was partially removed by endoscopic trans-nasal trans-sphenoidal approach. Histopathology confirmed it as a benign GCT. Surgical treatment of clival GCTs are fraught with complication because of its close proximity to vital structures. High vascularity, potential malignant behaviour, inaccessibility and very few published cases preclude a definite outcome of this lesion. Histopathology is necessary to differentiate various lytic lesion like chordoma, aneurysmal bone cyst, invasive pituitary adenoma, chondrosarcoma and brown tumour (parathyroidism).