Journal of clinical and diagnostic research

Scrofula Presenting as Tubercular Meningitis: A Neglected Sequelae

Tuberculosis (TB) is a multiorgan disease that can affect any part of the body. Though it is thought to be affecting mainly the pulmonary system, genitourinary TB is a rare but important manifestation of TB. It has been reported in <0.5% of Extrapulmonary Tuberculosis (EPTB). Amongst instances of genitourinary TB, glandular TB is even scarcer. Maximum patients seek medical intervention later in the progression of ailment due to the attached stigma linked with tuberculosis and in view of affected site and part of the body and the reluctance on the patient’s side. In the present case report, a 58-year-old male presented to Department of Medicine, with the complaint of a non healing wound on the scrotal region with excoriation since one month and irritability with altered sensorium since a week. Ultimately, it turned out to be a case of tubercular meningitis resulting from a neglected scrofula with neck rigidity, Kernig’s and Brudzinski’s sign positive. Though many case reports involving tubercular meningitis have been reported, a neglected scrofula remains a rare manifestation of tubercular meningitis.

Supervised Structured Exercise Program on Adolescents with Polycystic Ovary Syndrome: Two Case Reports

Anu Bansal, Jasobanta Sethi, Raju K Parasher, Manisha Tomar

Healthy lifestyle intervention has been incorporated as first line of management when treating adolescents with Polycystic Ovary Syndrome (PCOS) but benefits of structured therapeutic programs with defined dosimetry on psychological parameters is poorly understood. Here, authors present two adolescent girls (15-year-old and 13-year-old) who presented with irregular menstrual cycle and polycystic ovarian morphology on ultrasonography. Both the girls were anxious and concerned about irregular menses. Both the girls had weight gain, anxiety and mild stress. Oral contraceptives were prescribed to one adolescent girl to regulate her menses. Supervised exercise program with combination of exercises and dietary counselling proved effective in managing adolescents with PCOS and improving their physiological and psychological health. Thus, clinicians must consider incorporating supervised exercise regime in managing adolescents with PCOS.

A Serviceable Treatment Option for Partially Edentulous Cases- From Traditional to Technological

Malika Jagannath Sehgal, Surekha Anil Dubey

Rehabilitating patients with partial edentulism always pose countless challenges to the clinicians. Despite of the popularity of fixed options, many individuals opt for removable prosthesis as an alternative due to monetary constraints, local anatomic factors and several medical conditions contradicting the use of fixed prosthesis. This case report describes the oral rehabilitation of two patients exhibiting Kennedy’s class 1 and class 2 conditions, respectively. In the first case, the patient was already a cast partial denture wearer and reported to the Department of Prosthodontics for the replacement of the same due to broken mandibular partial denture. However, in the second case, the patient sought replacement of the missing mandibular teeth in the form of a removable partial denture. In both the cases, the cast partial dentures were fabricated using Computer Aided Designing and Computer Aided Manufacturing (CAD-CAM). The patients have shown enhancement in the fit of the prosthesis and at the same time shriveled the human handling faults, indistinctness, and surplus time period as well as the cost.

Scleral Necrosis in Porphyria Cutanea Tarda: A Case Report

Ruchi Shukla, Ashutosh Kumar Mishra, Prasoon Pandey

Scleral necrosis is a rare but well documented ocular manifestation of Porphyria Cutanea Tarda (PCT). The PCT is caused by a deficiency of Uroporphyrinogen Decarboxylase (Uro-D). The typical clinical manifestations of PCT in the form of cutaneous photosensitivity are due to the accumulation of fluorescent polycarboxylated porphyrins. Here, a case of 30-year-old male patient who was referred to the cornea services department for scleral thinning in right eye has been presented. Slit lamp biomicroscopy revealed focal area (5×5 mm²) of punched out scleral thinning (>80%) with uveal show in the interpalpebral area, 2 mm temporal to the limbus in right eye and a partial thickness scleral melt in nasal area. The left eye was phthisical. Patient had multiple blisters and pigmented, slightly depressed scars on the skin, especially in the sun exposed parts such as face, hands and legs. Digital shortening, atrophy and contractures were seen in hands and legs. Based on the clinical, biochemical and dermatological evaluation, the diagnosis of PCT was made. A rare case of scleral necrosis with uveal show in a patient with PCT which was successfully treated with allogenic scleral patch graft has been reported. On follow-up visits scleral patch graft was well taken up.

Novel Pathognomonic Variant of Atypical Type IV Usher Syndrome with Retinitis Pigmentosa- A Case Report

K Ezhil Vendhan, S Harshitha, Arun Kumar, Aprajitha Gautam, R Rajesh Kannan

Retinitis Pigmentosa (RP) is a genetically heterogeneous group of inherited retinal disorders causing progressive dysfunction of rod photoreceptor and retinal pigment epithelium, may be seen in isolation or in association with systemic disease. This paper focuses on RP in an atypical type IV usher’s patient. Usher’s syndrome is a rare disorder and is the most common hereditary form of deaf-blindness. The management of these patients is multidisciplinary, involving specialists from different fields. Hereby, author present a case of 47-year-old male patient presented with chief complaints of defective vision in both eyes and defective vision in dim light for past six months. On fundus examination of both the eyes, he was diagnosed to have bilateral RP and on pure tone audiometry, he was diagnosed to have bilateral sensorineural deafness. Molecular gene analysis was done and it revealed Arylsulfatase G (ARSG) gene mutation. The patient was prescribed spectacles for his visual improvement.

Thrombocytopenia in an Apparently Healthy Neonate: An Unusual Report of Postnatally Acquired Dengue Infection

Shradha Zutshi, Namita Gwasikoti, Kapil Bhalla, Poonam Dalal

Dengue is one of the commonest viral infections affecting general population in endemic zones every year. However, dengue is usually not reported in newborn period as it is widely believed that infants are protected from serious viral infections in the first six months of life by presence of maternal antibodies. Here, a unique case of an apparently healthy newborn with dengue fever is reported where transmission of the infection occurred postnatally. A 10-day-old male child, born to a primigravida mother with normal antenatal history, presented with complaints of fever for four days along with full body macular rash. Examination findings revealed red coloured, pin-point macular rash while rest of general and systemic examination were unremarkable. Routine Sepsis work-up was negative except presence of thrombocytopenia. Keeping in mind the endemicity and season of dengue, NS1 antigen of the baby was tested by a rapid antigen test which was positive, which was further confirmed by IgM ELISA for dengue. However, the mother was asymptomatic and platelet count as well as NS1 antigen and IgM, IgG ELISA for dengue of the mother was negative.

An Unusual Case of Rectal Bleed in an Adolescent: Solitary Rectal Ulcer Syndrome Mimicking Rectosigmoid Malignancy

S Rajeevan, I Shubha, K Premkumar, S Caroline, A Chezhian

Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon rectal disorder. Severe rectal bleeding, anaemia and a mass on evaluation are a rare presentation of SRUS, and can pose as an endoscopic challenge in differentiating from other causes of rectal bleeding. The incidence of SRUS is 1 in 100,000 people per year. Hence, a high degree of suspicion and timely diagnosis is necessary. The present case is about a 17-year-old female who presented with rectal bleeding. Physical evaluation revealed a large polypoidal rectal mass mimicking malignancy which later turned out to be SRUS. The patient improved with medical management. On outpatient follow-up, she had no complaints after a month and follow-up lower endoscopy and imaging later revealed complete healing within three months. Although uncommon, SRUS should be considered as a potential cause of lower gastrointestinal bleeding after sinister causes have been ruled out.

Embryonal Rhabdomyosarcoma: A Tale of Two Cases with Unusual Presentation

Paridhi, Varsha Kumar, Kachnar Varma, Ritu Verma, Vatsala Misra

Rhabdomyosarcoma (RMS) is a rare soft tissue tumour, accounting for 3% of all childhood cancers. RMS can arise virtually anywhere in the body, as it originates in embryonal mesenchyme. Embryonal Rhabdomyosarcoma (ERMS) and Alveolar Rhabdomyosarcoma (ARMS) are the most prevalent subtypes of RMS but arise through diverse biological mechanisms. RMS generally presents as an expanding mass that tends to be very painful and causes symptoms related to the compression of structures present nearby. Metastases of such tumours are common and can occur in bone, lungs and other organs leading to pain, difficulty with respiration, pleural effusion, anaemia, thrombocytopenia, and neutropenia. In the present report, two unusual presentations of ERMS have been reported. First case is of a 28-year-old adult male who presented in surgical Outpatient Department (OPD) with recurrent episodes of painful acute urinary retention since one year. Another case was of a six-year-old girl presenting with aural fullness and serosanginous discharge from right ear, ear pain and decreased hearing since two years. Since five year survival rate of such tumour is less than 30%, therefore, an awareness of the typical signs and symptoms, radiological features, histomorphological features in a case of paediatric and adult ERMS can help a pathologist to consider this tumour in the differential diagnoses, even at unusual sites.

Botulinum Neurotoxin Injection as a Therapeutic Option in Thoracic Outlet Syndrome Caused by a Supernumerary Scalenus Muscle: A Case Report

Margarida Mota Freitas, Alexandre Camões Barbosa

Thoracic Outlet Syndrome (TOS) is a neurovascular syndrome and may occur as a result of compression of brachial plexus elements and/or subclavian vessels as they traverse the cervicoaxillary canal. One of the causes of TOS is the existence of a supernumerary scalene muscle, usually denominated as scalenus minimus. Botulinum Toxin Type A (BoNT-A) acts by binding presynaptically to high-affinity recognition sites on the cholinergic nerve terminals and decreases the release of acetylcholine, suppressing muscle overactivity. BoNT-A reduces contraction in injected muscles, causing focal chemodenervation and has been described as a non surgical effective treatment in selected cases of TOS. Here, is the case of a 44-year-old woman diagnosed with refractory TOS, who presented with paresthesia in the fourth and fifth fingers of her right hand, associated with a feeling of lack of coordination in the same hand. On Magnetic Resonance Imaging (MRI), a supernumerary scalene muscle was identified as a probable cause of TOS. She was treated with chemodenervation of the scalenus anterior muscle (30 Units) and scalenus medius muscle (30 Units), using incobotulinumtoxin A. The patient had a very significant clinical improvement after Anterior Scalene (AS) and Middle Scalene (MS) muscle BoNT-A injections. Incobotulinumtoxin A neurotoxin injection is a therapeutic option in TOS.

An Extremely Rare Case of Granular Cell Tumour of Right Nasal Vestibule

Pooja Agarwal, Nupur Kaushik, Lalit Kumar, Akhil Pratap Singh

Granular Cell Tumour (GCT) of nasal and paranasal area is an extremely rare entity, while the most common site is the tongue in oral cavity. GCT was first time described by Abrikossoff in 1926, which occurs in 3^rd to 5^th decades of life and most frequently involving the head and neck region. Abrikossoff in 1926, first time described GCT, to be derived from smooth muscle and gave the term myoblastomas, also known as Abrikossoff’s tumours. Schwann cell origin of GCT was demonstrated on immunohistochemistry through positive S100 protein identification. Herein, the authors report a case of GCT arising from right nasal vestibule in a 28-year-old female who presented with swelling since three months. On gross examination, the specimen revealed firm red and white pieces of tissue measuring 0.8x0.8x0.5 cm. Diagnosis was made by histopathological examination which was confirmed by PAS special stain and S100 immunohistochemistry. Author also abridged the clinical information, microscopic features, treatment and patient status after follow-up. This case is believed to be the 7^th reported case of GCT as primary lesion at this location.

Dorsal Cord Herniation with Diastematomyelia- A Rare Case

Saad Shaikh, Sneha Sirigireddy, Vishal Walasangikar, Viraj Shah, Rahul Navani

Transdural spinal cord herniation is rare and under reported. Ventral or ventro-lateral cord herniation is relatively more common and a well described entity. Dorsal or posterior spinal cord herniation is very rare, only five cases in the cervical spine have been reported, as per authors' knowledge. It is nonetheless a recognised cause of myelopathy, either acquired postsurgery or post-trauma or idiopathic in cause and congenital. The authors are reporting a rare case of a 47-year-old male patient who underwent Magnetic Resonance Imaging (MRI) spine. The MRI showed cord with diastematomyelia from C3 to C5 levels with kinking of cord at this level attached to the posterior dura. Posterior subarachnoid space at this level is completely effaced with no evidence of Cerebrospinal Fluid (CSF) posterior to the cord and hence, the patient was subsequently diagnosed as postoperative dorsal spinal cord herniation and myelomalacia in the cervical spine associated with diastematomyelia. Patient is being managed conservatively till date.

Chronic Indolent Community-acquired Pneumonia due to Pseudomonas Infection in an Immunocompetent Patient- A Case Report

Gaurav Karna, Shridhar Pattar, Prasan Kumar Panda, Ramit Shah

Pseudomonas is an uncommon cause of community-acquired pneumonia in immunocompetent patients. It is an opportunistic pathogen resulting in serious infection in patients who are hospitalised, mechanically ventilated, or immunocompromised. Here, authors reported a case of 47-year-old male, forest worker without any co-morbidities presented with a history of chronic cough, fever, and shortness of breath complicated with pseudohaemoptysis for 45 days. This patient was admitted and treated as a lower respiratory tract infection. Work-up for tuberculosis, invasive fungal balls was negative but sputum culture revealed Pseudomonas aeruginosa growth. This case report demonstrates a rare Pseudomonas infection which can also cause chronic indolent respiratory illness in immunocompetent.

Intravesical Migration of the Longest Forgotten Intrauterine Contraceptive Device with Secondary Vesicolithiasis in a 70-Year-Old Female: A Rare Case Report

Abhay Dinkar Mahajan, Sumeeta Abhay Mahajan

Intrauterine Contraceptive Device (IUCD) is the most common method of contraception due to its low cost and reversibility. Longstanding IUCD’s can cause complications like menorrhagia, chronic pelvic pain, perforation of uterus and migration into adjacent structures as pouch of douglas, rectum or bladder. The Copper T acts as a foreign body and its presence for a long time causes secondary stone formation in bladder. Most of the cases in literature have been managed with open surgery. The author reports a case of a 70-year-old female presenting with transmigration of a forgotten Copper T into bladder with secondary calculus formation. The unique features of the presented case were the age of the patient, the longest duration of the forgotten Copper T (31 years) and the successful removal of both the calculi and Copper T device using an endoscopic approach.

A Rare Case of Purple Urine Bag Syndrome Presenting with Delirium and Associated with Acidic Urine and UTI due to Serratia marcescens: But do we Still know Enough?

Subrata Bhattacharya, Rajeeb Dey, Ratnadeep Nath

Purple Urine Bag Syndrome (PUBS) is a rare occurrence characterised by a striking purple to blue/violet discolouration of the urine bag and its tubing after long-term indwelling urinary catheterisation while the urine inside remain clear. This phenomenon is a warning sign of Urinary Tract Infection (UTI). However, unlike traditional UTIs, such patients can be non verbal and asymptomatic with purple/blue urine bag being the only signal for UTI. Tryptophan-Indigo hypothesis is advanced to explain the mystery behind this phenomenon. A rare case of PUBS in acidic urine in an octagenarian (80 years old) female patient, with right sided hemiparesis, hypertension, Post Stroke Aphasia (PSA) and delirium is presented here. Moreover, her urine culture yielded an opportunistic bacteria Serratia marcescens which is not a typical organism responsible for this condition. The bluish colour of urine bag disappeared after hydration, change of the catheter along with urine bag and antibiotic therapy. To the best of the author’s knowledge, this is the first case of PUBS reported from the state of Assam. It is hoped that this case report will be valuable in raising awareness and educating healthcare providers about this rather unknown esoteric syndrome in this region.

Stenotrophomonas maltophilia: Threat of a Multidrug Resistant Infection in Hosts with Co-morbidities- A Case Series

Stenotrophomonas maltophilia (S.maltophilia) was first identified in the year 1943. Since the discovery, the organism has been classified into multiple genus. Finally, Stenotrophomonas genus was created in 1993 and has steadily been growing in prevalence since then. S.maltophilia is an organism of low virulence but owing to its inherent resistance to commonly used antibiotics and some peculiar resistance mechanism, the organism is poising challenge as a nosocomial infection, hence high index of suspicion is essential in part of physicians for early intervention and better prognosis. Five cases (35 years old male, 18 years old female, 55 years old female,82 years old male and 60 years old male patients) of S. maltophilia infection, diagnosed by various diagnostic modalities like chest x-ray and relevant blood investigations, in hosts with co-morbidities (like diabetes, hypertension, sickle cell disease, psychiatric illness etc.) are presented here along with a brief review. The patients were treated by antibiotic therapy according to culture sensitivity report and were discharged at time range of 10-21 days of hospitalisation after improvement of clinical condition and laboratory reports of the patients.

Clinicopathological Parameters of Haemolytic Anaemia in COVID-19 Infection: A Series of Three Cases

Rabish Kumar, Sarika Singh, Mradul Kumar Daga, Urmila Jhamb

Coronavirus Disease 2019 (COVID-19) patients show various haematological abnormalities like cytopenia and coagulation disorders. Coronavirus can induce an inflammatory state, leading to extensive coagulation manifestations. Association between COVID-19, Autoimmune Haemolytic Anaemia (AIHA) and thrombotic state is still the subject of extensive research. In this study, three cases of haemolytic anaemia are discussed. First case was a 28-year-old female with a history of abruptio placentae who presented with complaints of generalised weakness and oliguria for five days. She was diagnosed as thrombotic microangiopathy based on peripheral smear finding of schistocytes and spherocytes and few polychromatophils and normal prothrombin time (International Normalised Ratio (INR)) with very high D-dimer levels on coagulation profile. Second case was of a 25-year-old female who presented with complaints of fatigue, rashes, dark urine, nausea and abdominal pain. She was diagnosed as a case of AIHA based on peripheral smear finding of Red Blood Cells (RBC) clumping and positive direct coomb test. Third case was of a two-month-old child who presented with respiratory distress and pallor. He was diagnosed as a case of haemolytic anaemia either due to direct effect of COVID-19 infection or Cytomegalovirus (CMV) and mycoplasma infection. Thus, COVID-19 infection can directly or indirectly lead to a wide spectrum of haemolytic manifestations and every patient with anaemia should be thoroughly investigated for early detection and treatment.

Management of Closed Tendoachilles Rupture- A Case Series

R Anil, Avinash Prabhu, Niranjan Kumar

Tendoachilles is the most commonly ruptured tendon of lower limb. Forced eccentric loading on plantar flexed foot is the common cause for the rupture. Even though the frequency of this tendon rupture is high, the mode of treatment is still debatable. Here the authors describe case series of operative management of closed acute tendoachilles ruptures. Eleven cases are hereby presented who underwent this technique of surgery from January 2018 to December 2020. Mean age of patients was 36.54 years. All patients were operated electively under spinal anaesthesia. Postoperative period was uneventful with no complications observed. Physiotherapy was started after removal of cast and independent full weight bearing walking was observed between 8^th to 11^th postoperative weeks. This is a simple technique of repair of ruptured tendoachilles. Meticulous dissection is the requirement to avoid wound complication. Planned immobilisation followed by physiotherapy helps in early recovery of the patient.

Adrenal Myelolipoma: A Series of Three Cases

Kumari Sunita Bharati, Ashish Ranjan Singh, Rashmi Rani Bharti, Reecha Singh

Adrenal myelolipomas are rare benign adrenal tumour composed of mature adipocytes intermixed with myeloid tissue. They are second most common cause after adrenal adenomas and comprise of 6-16% of all the adrenal incidentalomas. They are often asymptomatic and therefore, rarely detected but in recent times due to radiological advancements, these cases are increasingly being detected and therefore, treated. Extra-adrenal myelolipoma are the myelolipomas, detected outside the adrenal gland but occur rarely. Three cases (53 years old male patient, 60 years old male patient and 46 years old female patient) of clinically and radiologically suspected cases of symptomatic adrenal myelolipoma are discussed here. The first case described, presented with right flank pain radiating to back which was suspected as adrenal mass by Computed Tomography (CT) evaluation. The second case presented with right flank pain, haematuria and weight loss which was suspected on Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) as an adrenal mass. The third patient presented with bilateral pedal oedema and suspected adrenal mass was found on USG. All three cases were histopathologically confirmed as adrenal myelolipoma and managed by surgical excision. The uniqueness of the case lies in its early detection due to technological advancements and hence, proper management of the patients.

Laparoscopic Pyeloplasty in Paediatric Age Group with Standard Adult Sized Laparoscopic Instruments

Sandeep Gupta, Eeshansh Khare, Dilip Kumar Pal

Most paediatric patients attend Urology Outpatient Department with diagnosis of pelviureteric junction obstruction. Nowadays laparoscopic pyeloplasty is increasingly been used for the pelviureteric junction obstruction in paediatric patients. In the present case series, four paediatric patients of pelviureteric junction obstruction with age group of six, seven, eight and 12 years underwent laparoscopic pyeloplasty with adult sized laparoscopic instruments with ports size of 5 mm and 10 mm. Outcomes were measured in terms of mean operative duration, mean hospital stay and complications and improvement in Glomerular Filtration Rate (GFR). Mean operative duration was 211 minutes, mean blood loss of 96.25 mL and mean hospital stay was 5.75 days. Mean preoperative and mean postoperative GFR (at three months) were 53.19 mL/min and 55.35 mL/min respectively. In postoperative period one patient had increased drain output of more than 250 mL up to postoperative day three. All four patients had minor complications like postoperative fever on postoperative ileus which were managed conservatively. Mean postoperative follow-up duration was six weeks when Double-J (DJ) stent was removed. All patients had good outcome in terms of being asymptomatic and decreased hydronephrosis on follow-up renal ultrasonography and increased function of operated kidney on renal scan at three months. Based on intraoperative and postoperative observations, adult sized laparoscopic instruments can be used with ease with changes in port position and length of instrument inserted , adult sized laparoscopic instruments can be a useful armamentarium for paediatric laparoscopic pyeloplasty in cases of unavailability or intraoperative instrumental damage.

Morphological Study of Left Ventricular False Tendons in Human Cadaveric Heart Specimens

Shalom Elsy Philip, KR Dakshayani

Introduction: Left Ventricular False Tendons (LVFT) are normal and common anatomical variants of the left ventricle. They may be associated with findings of cardiac pathology or they may be an isolated finding from 2D echocardiogram. These structures may mimic pathologic structures, such as intraventricular chorda rupture, vegetation or thrombus, but considered as false tendon. Aim: To study the morphology, age and gender specific proportions of false tendons in cadaveric heart specimens. Materials and Methods: A descriptive cross-sectional study was conducted in Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from October 2015 to March 2017. A total of 100 human cadaveric heart specimens of both males (n=50) and females (n=50) aged 18-76 years were collected from Department of Anatomy and postmortem specimens from Department of Forensic Medicine. The morphology of tendons was studied regarding its location, gross appearance and parameters such as its length and width. The statistical analysis was done using Chi-square test and Analysis of Variance (ANOVA) test appropriately using the software Statistical Package for Social Service (SPSS), version 20.0 for windows. Results: False tendons were seen in 49 of heart specimens. Total 40 of the specimens showed one LVFT and nine showed two LVFT. Out of total 44 (58.67%) specimens aged 50 years or less had false tendons, while in older specimens, only 5 (20%) were found to have false tendon (p-value <0.05). The common location of false tendons was Posteromedial Papillary Muscle (PMPM) to mid interventricular septum 11 (18.9%), followed by PMPM to free wall 9 (15.5%). The tendons were fibrous in 53 (91.4%), fibromuscular in 4 (6.9%) and 1 (1.7%) was muscular in nature. Out of 50 female and 50 male heart specimens, 24 and 25 had LVFT, respectively (p-value=0.891). Conclusion: Sound knowledge of heart morphology can avoid false diagnosis in patients with false tendon, as it can simulate other pathological murmurs and structural heart disease in echocardiography.

Lost Opportunities for Cornea Retrieval: A Cross-sectional Study from District Hospital, Tumakuru, Karnataka

Roopa Bharamshetter Siddalingamurthy

Introduction: Corneal blindness in developing countries mainly affects the younger population. About 95% of corneal blindness can be avoided. The economic burden to society is much higher with corneal blindness compared to cataracts. Corneal transplant (Keratoplasty) is the primary vision restoring procedure to rehabilitate patients with corneal blindness. The procedure requires viable corneal tissue. The corneal tissues are procured either by voluntary eye donations or through the Hospital Cornea Retrieval Programme (HCRP). The objective of HCRP is to encourage potential eye donations from hospital deaths by utilising a combined method of motivation and grief counselling. Aim: To find the possibility of cornea retrieval in the district hospital of Tumakuru, Karnataka, India. Materials and Methods: This cross-sectional study analysed the number of hospital deaths at district hospital, Tumakuru, Karnataka, India, between January 2016 and December 2016. The study was conducted at the same hospital from May 2017 to July 2017. Patient demographics, systemic illnesses, treatment received, and cause of death were obtained from the 757 medical records. Analysis was done for potential corneal donors as per the National Programme for Control of Blindness (NPCB) guidelines. Results: The total number of deaths were 679, which included 375 (55.23%) males and 304 (44.77%) females with maximum death in age group 71-80 years. Of the total deaths, those between 3 and 40 years of age were 196 (28.86%). After excluding the contraindications of cornea retrieval as per NPCB guidelines, 1016 corneas could have been retrieved out of 508 (74.8%) deceased. Conclusion: Hospital cornea retrieval programme can immensely contribute to fill the deficiency of donor corneal tissue. The present study concluded that upto 74.8% of corneas could have been potentially retrieved and indicates a vast potential to reduce the deficit of corneal tissues.

Knowledge, Attitude and Perception about Neurodevelopmental Disorders among Pregnant Women: A Cross-sectional Study

Introduction: Neurological Developmental Disorders (NDD) reflect disruptions of neuroanatomic structure or psychophysiological function and place a child at-risk for developmental, cognitive, emotional, behavioural, psychosocial and adaptive challenges. The common NDD are Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), tics disorder, intellectual disabilities, Specific Learning Disorders (SLD), motor disorders and communication disorders. The purpose of the study was in agreement with the literature overviewed, which suggests, the prevalence of NDD is high in children. Complications that happen during the antenatal or perinatal period, and the awareness of the same in pregnant women is significantly low. Aim: To know about the knowledge, attitude and perception of NDD among pregnant women. Materials and Methods: This cross-sectional study was conducted at Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune from September 2020 to February 2021 on pregnant women with informed and voluntary consent. A total of 200 primigravida women were included and women with complicated pregnancy were excluded. A self-constructed questionnaire was prepared and administered. It had three domains of total 21 items- the knowledge domain with eight questions, the attitude domain with seven questions and the perception domain with six questions. Descriptive statistics were used to analyse the results. Results: b>Total 200 women were included, mean age was 25.6±2 years. A 24% of the women had heard about the term NDD and only 13% of them knew its meaning. Attitude of pregnant women, where 79.5% were aware about infections, use of drugs and alcohol and smoking during pregnancy can lead to harmful effects on the foetus. Perception of NDD, where 84% women believed that good health of the mother during pregnancy can prevent NDD, 91.5% believed that a proper diet and nutrition during pregnancy plays a role in prevention. Conclusion: The study concluded that, only 24% have ever heard of the term NDD and only 13% were aware of the meaning of it. While 79% of the pregnant women knew about the importance of antenatal care, significantly less pregnant women had knowledge about NDD and only few of them were aware about the possible signs of NDD.

Effect of Non Incentivised and Incentivised Free COVID-19 Vaccination Camps in Augmentation of State’s Efforts in Achieving Vaccination Targets Necessary for Herd Immunity

Meghna Gupta, Vitull Kumar Gupta, Navjot Kaur, Pranav Singla, Meenakshi Singla
Introduction: Most effective way to defeat the Coronavirus Disease-2019 (COVID-19) pandemic is mass vaccination to achieve herd immunity which requires vaccination of about 80% of the population. Aim: To compare the effect of non incentivised and incentivised free COVID-19 vaccination camps on augmentation of state’s efforts in achieving vaccination targets of covering 80% of population. Materials and Methods: The present retrospective observational study included free COVID-19 vaccination camps, both non incentivised (8 days) and incentivised (8 days), were organised in month of June and July, 2021 at a hospital in association with an NGO under the supervision of District Immunisation Officer. Data of all vaccinations done was compared to document the effect of incentivised free vaccination camp as compared to non incentivised camps. Data was represented as frequency, percentage and Chi-square test was used. Results: Total of 4111 vaccinations were done during the free vaccination camps, including 1406 during non incentivised and 2705 during incentivised camps. During non incentivised camps 1114 people were given 1^st dose and 292 were given 2^nd dose, while during incentivised camps 2334 people were given 1^st dose and 371 were given 2^nd dose. Analysis of the data showed that the difference in number of 1^st dose and 2^nd dose vaccinations done during the incentivised vaccination camps was statistically significantly higher as compared to the number of 1^st dose and 2^nd dose vaccinations done during non incentivised vaccination camps. Similar results showed that the difference in number of vaccination done among the age groups of 18-44 years and >44 years during the incentivised vaccination camps was statistically significantly higher as compared to the number of vaccination among the age groups of 18-44 years and >44 years done during the non incentivised vaccination camps. Conclusion: The present study documented statistically significantly higher number of 1^st dose of vaccinations, 2^nd dose of vaccinations, vaccinations among 18-44 years age group and >44 years age group done during incentivised vaccination camps as compared to non incentivised vaccination camps. Results of the present study suggest that incentivised vaccination campaigns should be incorporated as an important component of COVID-19 vaccination campaign strategy to vaccinate enough Indian population and achieve herd immunity for protection from COVID-19 pandemic.

Comparison of Oral Labetolol and Oral Pregabalin in Attenuating Pressor Response to Endotracheal Intubation in Patients undergoing Mastoidectomy under General Anaesthesia- A Randomised Control Study
Introduction: Direct laryngoscopy and tracheal intubation provoke stress response side-effects in the form of hypertension, tachycardia, and dysrhythmia which are long-standing concerns for anaesthetists. Various drugs and techniques have been tried over the last few decades to avoid these side-effects but none are ideal. Oral labetalol through years of study has proven its efficacy in attenuation of these haemodynamic responses. Oral pregabalin is also effective in this regard, however, there are no studies comparing their relative efficacies. In the present study, we have compared these two drugs i.e., oral pregabalin and oral labetalol with satisfactory results. Aim: To compare the efficacy of preoperative oral pregabalin with that of oral labetalol in controlling the haemodynamic responses to laryngoscopy and intubation in patients undergoing mastoidectomy under general anaesthesia. Materials and Methods: This randomised control study was conducted in Era Medical College and Hospital, Lucknow, Uttar Pradesh, India, over the period of 18 months from June 2019 to December 2020. Total 90 American Society of Anesthesiologists (ASA) Grade I and II patients aged 18-50 years of either gender scheduled to undergo elective mastoidectomy surgery under general anaesthesia were enrolled in this study. Thirty patients received tablet oral pregabalin 150 mg, 30 received oral labetalol tablet 200 mg while the remaining 30 received placebo in form of a multivitamin tablet. Drugs were given one hour before propofol induction. Heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded preoperatively, 60 minutes after administration of study drug, during laryngoscopy and intubation, and at 1, 2, 5, and 10 minutes after intubation. At the end of the study, results were represented as (mean±SD) and percentage changes and compared using the student’s t-test. Results: Mean age of group I was 25.53±8.51 years, group II was 24.80±8.19 years and group III was 26.03±9.10 years. While conducting an intergroup comparison of the two study drugs oral pregabalin showed a greater control in haemodynamic parameters like SBP (at t=2 min, p-value <0.001, t=5 min, p-value 0.003), DBP {at t=Induction (p-value <0.001), 1 min (p-value=0.010), 2 min (p-value <0.001), 5 min (p-value <0.001)} and MAP {at t=Induction (p-value <0.001), 1 min (p-value=0.006), 2 min (p-value <0.004), 5 min (p-value=0.033)} than oral labetalol. Intergroup difference in heart rate was not appreciable between the two drugs except at 60 minutes and baseline after administration (p-value <0.001). Conclusion: The study showed that though both pregabalin and labetalol were effective in controlling postintubation haemodynamic changes, attenuation of all immediate postintubation haemodyn-amic changes except heart rate was more effective with pregabalin as compared to labetalol. The difference in attenuation of heart rate was not significant between pregabalin and labetalol.

Lipid Abnormalities in Tuberculosis Patients with Diabetes Mellitus: A Hospital-based Cross-sectional Study

Jyothi, G Chandana, BA Praveen Kumar
Introduction:Tuberculosis (TB) is a chronic infectious disease that also causes lipid abnormalities. Limited studies are focusing on metabolic abnormalities in TB patients with Diabetes Mellitus (DM). While studying lipid abnormalities in pulmonary TB patients, there were no marked differences between serum levels of cholesterol, triglycerides, Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). However, it was suggested that increased levels of lipoprotein (a) in patients with pulmonary TB may be a risk for atherosclerosis. Aim: To study the lipid abnormalities in TB patients with DM. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine at a tertiary care teaching Institute {PES Institute of Medical Sciences and Research (PESIMSR} Andhra Pradesh, India, between October 2015 to March 2016 (six months). Four groups were made, Group I included 30 patients with TB and no DM, Group II included 25 patients with TB with DM, Group III had 30 patients with DM only and Group IV was control group with 30 healthy individuals. Lipid profile testing was done for all the participants and the values obtained were compared. Analysis of Variance (ANOVA) test was used to compare the means between the groups and KruskalWallis test when data did not follow the normal distribution. The p-value <0.05 was considered statistically significant. Results: Total 25 patients in group II had 18 males and seven females with mean age of 48.5±11.12 years. The total cholesterol, triglycerides, Very Low Density Lipoprotein (VLDL) was high in group III (176.33±43.35 mg/dL, 221.733±39.2 mg/dL, 34.8±17.81 mg/dL respectively). The HDL was lowest in group II (27.88±8.03 mg/dL). However, the LDL values showed no significant difference between the groups (p-value=0.162). group I had Low Body Mass Index (BMI) (18.61±3.6 kg/m2 ). The atherogenic index was high in group II especially in males. Conclusion: In patients with TB and DM, screening of lipid profile can provide markers of atherogenicity which may help to predict and prevent cardiovascular events. A good nutritious diet is recommended alongside chemotherapeutics in the treatment for TB patient’s management and their lipid profile status should be monitored while managing the patients.

Three Dimensional Morphological Grading of Ankylosed TMJ for Surgical Planning: A Retrospective Observational Study

Rabin Chacko, Saurabh Kumar, Arun Paul
Introduction: Temporomandibular Joint (TMJ) ankylosis remains an enigma in craniofacial surgery due to the challenges encountered while restoring mouth opening, facial form and airway to normalcy. Though TMJ ankylosis is a relatively simple diagnosis to make, the specific surgical plan depends on the nature and extent of the fusion of the mandible with the cranial base. Aim: To classify the pattern of bone deformity found in TMJ ankylosis using three Dimensional (3D) Computed Tomography (CT) imaging and its role in determining the type of procedures required for effective gap arthroplasty. Materials and Methods: This retrospective study was done to evaluate the 3D CT reconstructed images of 66 consecutive patients having 82 ankylosed joints treated from January 2007 to December 2019 with a standardised protocol. A grading system was used with the following criteria: coronoid hyperplasia, sigmoid notch to skull-base fusion and loss of residual joint space. The gap arthroplasty required for each grade of ankylosis was also analysed. The complete data in the present study was tabulated in Microsoft Excel sheet and frequency (n) analysis was done for all variables. Results: Out of 66 patients (82 ankylotic joints) 37 males and 29 females), age range 2.5-51 years, average age 18.2 years) 27% of the total joints surveyed belonged to grade 1 type of ankylosis. None of these joints had complete bony fusion (absence of the radiolucent zone between the cranium and condyle). A 10% of the joints had moderate ankylosis (grade 2). None of them revealed complete bony fusion (absence of the radiolucent zone) or fusion of the sigmoid with the cranial base. Grade 3 ankylosis was the most widely seen pattern of ankylosis (63% of the present study subjects) and 92% had a history of childhood onset. A 90% of the joints in this group had ipsilateral coronoid hyperplasia. A 48% of the joints with severe ankylosis (grade 3) showed bony fusion with the cranial base, with loss or absence of the radiolucent zone {Fusion Line (FL)} between the cranial base and the condyle. Conclusion: The extent and severity of TMJ ankylosis needs to be ascertained prior to planning TM Joint ankylosis surgery. A 3D CT assessment and subsequent radiologic grading provides a reliable guide for ankylosis release.

Factors Determining the Functional and Radiological Outcome after Secondary Nailing in Open Fractures of Lower Extremity- A Prospective Cohort Study

Siva Swaminathan Santhanam, Prince Solomon, Gopi Kumarasamy, Ajay Saravanan
Introduction: Open long bone fractures of lower limb are cumbersome to treat. Because of the increased chances of infection, wound debridement and external fixation is the primary procedure followed by a secondary intramedullary nailing when the wound improves. Pin tract infection, loss of fixation, non union is the most frequently encountered complications of external fixation. These complications have discouraged surgeons all over the world in accepting external fixation as a definitive method of fracture treatment. Secondary intramedullary interlocking nailing provides intramedullary input of cancellous tissue at the fracture site due to reaming and nailing. Aim: To evaluate the factors determining the outcome after secondary nailing in open fractures of lower extremity. Materials and Methods: The prospective cohort study was conducted from October 2017 to April 2020 at Pondicherry Institute of Medical Sciences, Puducherry, India, with 33 patients who had open long bone fractures of lower limb and underwent secondary nailing following external fixation, were evaluated. The patients were followed-up for a period of six months. Factors such as age, bone involved, grade of injury, timing of debridement, time interval between external fixation and secondary nailing were analysed to see whether they affect the outcome of secondary nailing of open fractures of long bones. All patients underwent an initial thorough wound debridement and external fixation application. A secondary nailing was done once wound had settled down. Age, gender, bone involved, grade of injury, timing of debridement and timing of secondary nailing were noted for all the patients and patients were followed-up at six weeks, three months and six months. Final functional outcome (end of six months) was calculated using Lower Extremity Functional Scale (LEFS) and radiological union (end of six months) was calculated using Radiological Union Scale in Tibial fractures score (RUST). Results: There were no statistically significant differences in RUST/LEFS score at the end of six months, with respect to age (p-value=0.825/0.847), gender (p-value=0.235/0.348), bone involvement (p-value=0.726/0.757), grade of injury (p-value=0.107/0.546) and timing of debridement (p-value=0.117/0.374). The mean RUST scores at six weeks, three months and six months were 4.39, 6.57 and 9.28, respectively. The mean LEFS scores at six weeks, three months and six months were 20.96, 34.92, 49.5, respectively. The radiological union rate in this study was 60.61% at the final follow-up. But patients who underwent secondary nailing with 10 days of primary debridement and external fixation had a statistically significant (p-value) better outcome in terms of RUST (p-value at 3 months=0.045)/LEFS (p-value at 6 months=0.030). Conclusion: The interval between external fixation and secondary nailing was found to be a significant determinant of radiological outcome at three months (p-value at 3 months=0.045) and better functional outcome at six months (p-value at 6 months=0.030) with patients undergoing secondary nailing within 10 days of external fixation having a good final outcome. However, the radiological outcome between the two groups was comparable at six months follow-up.

Association of Serum Lactate Dehydrogenase and Qualitative C-Reactive Protein with the Severity of COVID-19 Disease

Barnali Thakur, Keshab Bora, Manidip Chakraborty
Introduction: After December 2019, the word “COVID” became the nightmare to the civilisation. As per the nomenclature laid by World Health Organisation (WHO), the disease is called Coronavirus Disease-2019 (COVID-19) and the causative virus is Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). By August 11^th 2021, the virus caused around 43 lac deaths with an infection burden of approximately 20.3 crore cases worldwide. Many studies are published from most of the corners of the world regarding clinical features, laboratory parameters and radiological features of the disease to identify the infection at an early stage. Serum Lactate Dehydrogenase (LDH) and C-Reactive Protein (CRP) are among the most commonly studied parameters in COVID-19, though in India, a smaller number of studies were done in this regard. As the disease itself is new to the medical fraternity, maximum studies were done with small sample size which requires more studies to confirm the findings. Aim: To find out the association of on-admission serum LDH and qualitative CRP with the severity of COVID-19 disease. Materials and Methods: The present study was a retrospective observational study conducted for three months from May to July 2021. A 114 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) positive COVID-19 patients were included as per the inclusion-exclusion criteria of which 57 were from Intensive Care Unit (ICU), considered as ‘severe’ patients and 57 from ward, taken as ‘non severe’ patients. Required blood parameters including LDH and CRP values were obtained from Laboratory Information System (LIS) and clinical data was obtained from hospital database. The values were analysed using statistical software. Results: Present study showed significant difference in values of LDH among ICU and ward patients (p=0.0001), also significant difference of CRP positive percentage between these two groups (p=0.0003) was observed. Conclusion: On the basis of the findings of the present study, it can be concluded that on-admission LDH and CRP can be used as a marker of severity in COVID-19 disease.

Evaluation of Efficacy and Safety of Clevira as an Add on Drug in Mild to Moderate COVID-19 Positive Patients: A Randomised Control Trial
Introduction: Coronavirus Disease-2019 (COVID-19) has caused a devastating pandemic. Despite the worldwide efforts to find a therapeutic strategy and prophylaxis, we have not attained a complete success. Hence, there exists an urgent need for development of alternative solutions from Ayurveda system of medicine for COVID-19. Aim: To evaluate clevira, a polyherbal ayurvedic formulation, for its efficacy and safety in treatment of mild to moderate COVID-19 patients as an add on drug. Materials and Methods: This randomised control trial was carried out from May 2020 to July 2020, in 100 patients (50 in test group and 50 in control group) confirmed with COVID-19 infection (mild to moderate cases) by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) at a tertiary care Government Medical College and Hospital in Chennai, India. The test group received tablet clevira orally twice daily after food, in the morning and night for 14 days, as an add on, in addition to standard care of treatment as received by the control group. The primary outcome was assessment of clinical recovery, proportion of patients with swabs negative for COVID-19 in RT-PCR and reduction of viral cycle threshold ratio. The results of the both group were analysed and compared using Chi-square test and Student’s t-test. Results: Total 100 patients were enrolled for the study, mean age of test group was 36.64 and control group was 31.08. Significant improvement (p-value=0.0338) was seen in patients on day 5, who got treated with clevira as add on drug. An 43 (86%) of patients turned out to be COVID-19 RT-PCR test negative on day 5 while in the control group 33 (66%) of patients turned out to be negative. There was a statistically significant difference (p-value=0.0196) between the test and control groups on comparing the mean difference in CT value results between day 1 and day 5. Clevira when given in addition to the standard of care, showed a significant improvement in signs and symptoms of COVID-19 infection. Conclusion: Clevira, with its polyherbal ingredients showed a significant antiviral action against coronavirus when given in addition to the standard of care medications suggested by Indian Council of Medical Research (ICMR), over a period of 14 days in treatment of mild to moderate COVID-19 patients.

Association of Mid-sagittal Anteroposterior Diameter of Lumbar Canal in Patients with Low Back Pain using MRI: A Cross-sectional Study from West Bengal, India

Chinmay Nandi, Dipankar Bhaumik, Krishnendu Bhowmik, Kaushik Mitra
Introduction: Lumbar spinal canal stenosis is the progressive narrowing of spinal canal that causes compression of nerve roots before their exit. The presenting symptoms of spinal canal stenosis includes bilateral lower extremity pain, altered sensation in both legs and poorly localised weakness and generally associated with low back pain. Determination of normal diameter and its variation with development of low back pain could prove useful in determining the aetiology and outcome of congenital or acquired causes of stenosis like spondylolisthesis, Paget’s disease, fluorosis, etc. Aim: To measure and compare the mid-sagittal anteroposterior diameter of lumbar canal in symptomatic cases with low back pain and asymptomatic subjects using Magnetic Resonance Imaging (MRI). Materials and Methods: The present study was a hospital- based cross-sectional, observational study involving Outpatient Department (OPD) patients of Bangur Institute of Neurosciences, Kolkata, West Bengal, India, was undertaken from May 2012 to July 2012. The study participants were selected by systematic random sampling. Total number of 102 cases were investigated in the present study. Out of these, 52 cases were symptomatic patients of low back pain and rest 50 cases were asymptomatic. Magnetic Resonance Imaging (MRI) was done to estimate the mid-sagittal anteroposterior diameter at different levels of lumbar canal. Unpaired t-test was used as test of significance using Statistical Package for the Social Sciences (SPSS) version 19.0. A p-value <0.05 was considered as statistically significant. Results: In the present study, in the asymptomatic group, the anteroposterior diameter at the intervertebral disc level- between L1-L2=18.364±1.4351 mm, L2-L3=17.470±1.3298 mm, L3-L4=16.670±1.6042 mm, L4-L5=15.200±1.8906 mm, L5-S1=14.196±2.1092 mm. Mean diameter of central lumbar vertebral canal was found to be lower in symptomatic cases with low back pain at different vertebral levels and the difference was found to be statistically significant between symptomatic and asymptomatic subjects. It was found that age of presentation did not show any statistical significance with the presence of low back pain. Conclusion: The lumbar vertebral canal diameter was found to be significantly lower in subjects with low back pain than subjects having no complaints.

Cyclin D1: A Prognostic Marker in Multiple Myeloma and its Association with CRP and β2-Microglobulin Level
Introduction: Cyclin D1 is a protein encoded by the I#ICCND1 (BCL-1)I?I gene on chromosome 11q13 and it is an important regulator of G1 to S phase progression. Over expression of cyclin D1 protein releases cells from their normal controls when they need to exit from the cell cycle. This obstructs their maturation, and promotes transformation into a malignant phenotype. Aim: To study the role of cyclin D1 expression in trephine biopsies of multiple myeloma patients and its association with C-Reactive Protein (CRP), β2-microglobulin level and treatment response rate. Materials and Methods: This prospective observational study was conducted at Department of Pathology in collaboration with Department of Clinical Haematology, King George’s Medical University, Lucknow, India, from September 2018 to August 2019. Total 40 cases of multiple myeloma fulfilling inclusion and exclusion criteria were enrolled. Bone marrow aspiration and biopsy was done in all the cases. Immunohistochemical (IHC) expression of cyclin D1 on trephine biopsy was associated with CRP levels and β2-microglobulin expression. All investigations were repeated at six months follow-up and response was compared with expression of cyclin D1. The statistical tests applied were Chi-square test, Student t-test and paired t-test. Results: The age of cases ranged between 44 to 78 years and the mean age of the study subjects was 64.40±7.13 years. Total 67.5% of patients were males. On IHC, cyclin D1 expression was not observed in majority of cases (n=23), weak cyclin D1 expression was observed in 8 cases, while strong cyclin D1 expression was observed in 9 cases. Out of eight cases with weak cyclin D1 expression, five cases achieved partial response and two cases achieved complete response. One case was lost to follow-up. Among nine patients with strong cyclin D1 expression, six patients expired on six months follow-up and three patients achieved partial response. On comparison of two groups cyclin D1 positive and cyclin D1 negative cases it was found that cyclin D1 positive cases had an early age of onset, more than 50% plasma cells on marrow aspirate and were associated with plasmablastic morphology. Cyclin D1 positive cases also had increased CRP level as compared to cyclin D1 negative cases. Similarly, serum calcium, serum creatinine and β2-microglobulin levels were more in cyclin D1 positive group. Conclusion: Cases who have strong cyclin D1 expression at time of diagnosis showed poor response to treatment. This was also associated with increased serum CRP and β2-microglobulin levels. Hence, cyclin D1 can be used as a prognostic marker in multiple myeloma.

Immediate Effect of Ujjayi Pranayama on Attention and Anxiety among University Students: A Randomised Self-control Study

Parajuli Niranjan, Pradhan Balaram
Introduction: Elevated level of anxiety and low attention in university students has detrimental effects on their academic performance and well-being. The practice of pranayama is considered to enhance the attention and reduce anxiety of individuals. Though, ujjayi pranayama has a relaxing and tranquilising effect, its effects on attention and anxiety in students has not been explored yet. Aim: To assess the immediate effect of ujjayi pranayama on sustained attention, selective attention and state-trait anxiety in university students. Materials and Methods: This was a randomised self-control study in which 34 students were randomly divided into group A and group B using the lottery method. Inclusion criteria were students in the age range of 18-35 years, conversant in English, willing to participate and having at least two years of proficiency in pranayama practice. The assessment and intervention were conducted at the yoga hall of Swami Vivekananda Yoga Anausandhana Samsthana, Bangalore, Karnataka, India, in the month of April 2015. The duration of intervention was for 10 minutes. On day one, group A practiced ujjayi pranayama for eight minutes and two minutes of breath observation. Students in group B were asked to sit in a meditative posture with eyes open. The order was reversed on the day two. Students from both groups were assessed just before and immediately after the intervention using the Digit Letter Substitution Test (DLST), Six Letter Cancellation Test (SLCT), and State-Trait Anxiety Inventory (STAI). Results: A total of 34 participants with mean age 23.35±3.82 years were randomised into group A and group B. Statistical analysis showed, a significant difference in STAI scores (9.00±3.05 vs 10.29±3.23, p=0.005). No significant difference was observed in other variables in between group comparison. Likewise, the within group analysis showed a significant difference in pre and post scores of DLST (53.68±9.35 vs 59.65±9.66, p<0.001), SLCT (30.21±10.29 vs 33.71±11.67, p=0.007), and STAI (11.5±3.40 vs 9.00±3.05, p<0.001) in the group A as well as a significant difference in pre and post scores of DLST (55.82±10.44 vs 60.00±9.51, p=0.002) and STAI (10.94±3.19 vs 10.29±3.23, p=0.024) in the group B. Conclusion: The present study suggested that ujjayi pranayama improves sustained and selective attention and reduces the state-trait anxiety of university students. However, further studies to assess the chronic effect of ujjayi pranayama with greater sample size and advanced tools are required to support the present finding.

Association of Severity of Coronary Artery Disease with Left Ventricular Diastolic Dysfunction among Diabetics with Stable Ischaemic Heart Disease: A Cross-sectional Study from Odisha, India

Sura Kishore Mishra, Avradip Santra, Trinath Kumar Mishra
Introduction: Ischaemic Heart Disease (IHD) is one of the most common co-morbidity among Indian population, so is Diabetes Mellitus (DM). IHD is associated not only with systolic, but also with Diastolic Dysfunction (DDFx) of Left Ventricle (LV). However, there is scarcity of data correlating the severity of Coronary Artery Disease (CAD) with LV DDFx. Aim: To assess the severity of CAD in diabetic stable IHD patients with normal LV systolic function (LV Ejection fraction ≥50%) and it’s association with degree of DDFx. Materials and Methods: A prospective cross-sectional study was conducted over a period of one year, in a tertiary care hospital of Odisha, India among diabetic stable IHD patients. Grades of DDFx were assessed among the study population, using Transthoracic Echocardiography (TTE). Subsequently, severity of CAD was assessed, using invasive Coronary Angiography (CAG) using The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score. Next, grades of DDFx were correlated with severity of IHD. Results: Among a total of 93 diabetic stable IHD patients with normal LV ejection fraction, 76.3% were males and the mean age was 60.7±8.9 years. Majority presented with chronic stable angina (59, 63.4%). Hypertension (50, 53.7%), followed by dyslipidaemia (36, 38.7%) and renal dysfunction (19, 20.4%) were the most common co-morbidities. Majority of patients had grade I (39.8%), followed by grade II (17.2%), and grade III (9.7%) DDFx. On invasive CAG, 39.8% had a SYNTAX score of ≤22, 36.6% had a score of 23-32, and 23.6% had a score of ≥33. Grades of DDFx were found to be significantly higher among the patients with greater SYNTAX score. Conclusion: Among diabetic stable IHD patients, greater the severity of CAD on CAG, higher were the grades of DDFx.

Comparative Analysis of Tear Film Parameters in Patients Undergoing Pterygium Excision by Conjunctival Autograft or Bare Sclera Technique Augmented by Intraoperative Mitomycin C Application

Neeraj Sharma, Sonakshi Sehrawat, Saumya Sharma
Introduction: Excision of the pterygium has been shown to enhance tear film stability. The study was designed to assess the effects of pterygium removal utilising two different surgical procedures on tear film parameters: bare sclera with Mitomycin C (MMC) and conjunctival autograft. The bare sclera with MMC application and conjunctival autograft techniques are the two most common treatments for pterygium. Conjunctival autograft is a procedure in which the superior conjunctiva of the patient’s eye is removed in one piece and the excised tissue is used to cover the area where the pterygium was removed. The bare sclera with MMC application procedure involves removing the pterygium and intraoperatively applying 0.02% MMC to the scleral bed, leaving it to re-epithelialise. Aim: To analyse the improvement in tear film parameters of patients undergoing pterygium excision by conjunctival autograft or bare sclera technique augmented by intraoperative MMC application. Materials and Methods: The prospective interventional study was conducted in Department of Ophthalmology, SGT University affiliated hospital, Gurugram, Haryana, India, from January 2019 to January 2020. A total of 54 patients were divided into two groups: Group 1 has 26 patients undergoing pterygium excision with bare sclera technique (with MMC 0.02%), and Group 2 has 28 patients undergoing pterygium excision with conjunctival autograft technique (with MMC). Tear Break-up Time (TBUT) and Schirmer’s I were measured in 54 eyes with pterygium before and after surgery. Data analysis was done using two tail (inequality) test on Statistical Package for the Social Sciences (SPSS) software version 28.0. Patients were randomly divided into two groups by using RAND between software. Results: The mean preoperative Schirmer’s I was 9.333 mm which improved to 12.203 mm after pterygium excision, which was a statistically significant change irrespective of the technique used. The mean preoperative Tear Break-up Time (TBUT) was 7.212 seconds which improved to 13.059 seconds after pterygium excision, which was a statistically significant change irrespective of the technique used. In the autograft group, TBUT improved from preoperative mean value of 7.253 seconds to 14.0 seconds and Schirmer’s I mean values improved from 9.178 mm to 12.678 mm, respectively. In the bare sclera group, TBUT improved from preoperative mean value of 7.169 second to 12.046 second and Schirmer’s I mean values improved from 9.500 mm to 11.692 mm, respectively. The mean postoperative Schirmer’s I in autograft technique was 12.678 mm and postoperative Schirmer’s I in bare sclera technique was 11.692 mm. The postoperative improvement in both groups was statistically similar. The mean postoperative TBUT in autograft technique was 14 seconds and postoperative TBUT in bare sclera technique was 12.046 seconds. Postoperative results in the autograft group were statistically better than the bare sclera group. Conclusion: The tear film stability parameters in pterygium patients improved after surgery in both the groups. Statistical analysis of postoperative Schirmer’s I data was similar in both the techniques. Although postoperative TBUT values were statistically better in the autograft group, the mean value in both the techniques were more than ten seconds. The analysis of data indicates that bare sclera technique with MMC can be used as an alternative surgical procedure in patients with scarred conjunctiva or in situations where superior conjunctiva has to be preserved for future use.

Congenital Central Nervous System and Associated Systemic Anomalies in Foetal and Perinatal Autopsy- A Retrospective Study
Introduction: Congenital malformations in India accounts for 10-15% of perinatal deaths. Congenital Heart Defects (CHD) is most common congenital anomaly followed by Central Nervous System (CNS) anomalies, among which Neural Tube Defects (NTD) are most common. Folic acid deficiency can lead to NTDs and can be corrected by its supplementation in subsequent pregnancies. The authors analysed neurological anomalies in foetal and perinatal autopsies to ascertain distribution of various congenital neurological malformations and to classify those according to World Health Organisation (WHO) classification system and their association with other systemic malformation. Aim: To study CNS and its assosciated systemic anomalies in foetal autopsies. Materials and Methods: This retrospective study was conducted in Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India from July 2015 to June 2020 and analysed 500 foetal autopsies retrospectively. Data regarding maternal age, parity, history of previous abortion, foetal birth weight, gestational age, gender and CNS and other systemic anomalies detected at autopsy were included from departmental autopsy database. Data was presented as frequencies and percentages using Microsoft Excel 2017. Results: In the study, 500 foetal autopsies were analysed, out of which 70 (14%) foetuses had CNS anomalies. Among 70 foetuses with CNS anomalies, anencephaly was most common 25 (35%) followed by meningomyelocele 19 (27%), Arnold chiari type 2 malformation 8 (11.4%), congenital hydrocephalus and encephalocele 5 (7%). Multiple neurological anomalies were observed in various combinations. Neurological with musculoskeletal anomalies were also observed in the present study. Conclusion: Foetal autopsy plays an important role in arriving at final diagnosis and detecting cause of death. Findings of autopsy are of practical significance to clinicians in the form of estimating risk of recurrence and genetic counselling.

Efficacy of Diclofenac Transdermal Patch versus Diclofenac Rectal Suppository for Management of Postoperative Pain Following Open Cholecystectomy: A Randomised Clinical Trial

Puneet Agrawal, Shivangna Singh, Vivek Gautam, Bushra Hasan Khan
Introduction: Postoperative pain can have detrimental effects if proper analgesia is not provided. The most widely used medicines for the management of postoperative pain is Non Steroidal Anti-Inflammatory Drugs (NSAIDs), among the NSAIDs the most commonly used drug for postoperative pain is diclofenac sodium. Repeated intramuscular/intravenous (i.m/i.v.) injections of diclofenac are associated with pain and discomfort while oral use of diclofenac before and after surgery is limited and is also associated with increased risk of gastrointestinal complications like dyspepsia, peptic ulcer etc. Diclofenac Transdermal Patch (TD) and Rectal Suppository (RS) are good methods of drug delivery as they avoid first pass metabolism, gastrointestinal complications and pain associated with i.m/i.v. route. Aim: To evaluate the efficacy of the transdermal diclofenac patch versus the diclofenac RS for management of postoperative pain following open cholecystectomy. Materials and Methods: This hospital-based, randomised, prospective, interventional, open label comparative clinical trial was conducted in Department of General Surgery and Department of Pharmacology at FH Medical College and Hospital, Agra, Uttar Pradesh, India, from April 2021 to September 2021. A total of 64 patients were included in the trial and they were randomly divided into two groups using simple randomisation technique. Group A received 100 mg diclofenac TD (n=32) and group B received 100 mg diclofenac RS (n=32) just before induction of anaesthesia and repeated 12 hourly for 48 hours. Pain was assessed postoperatively at 6, 12, 24 hours, respectively using the Visual Analogue Scale (VAS) and adverse effects like gastrointestinal complications were also noted in the both groups. The Student’s t-test was applied to compare the mean values of quantitative variables while qualitative variables were analysed using Chi-square test. A p-value <0.05 was considered statistically significant. Results: Both the groups were comparable with respect to age (p-value=0.1048) and gender distribution (p-value=0.3760). VAS score at 12 hours and 24 hours postsurgery in patients of both groups showed significant decrease (p-value=0.0001), when compared with VAS score values at 6 hours postsurgery of the same group. On comparison of VAS score between the two groups at 6 hour, 12 hour and 24 hour significant decrease (p-value <0.05) in VAS score was observed with a higher decrement in group B patients i.e., those who received diclofenac rectal suppositories. In group A, seven patients needed rescue analgesia while in group B only three patients required rescue analgesia. Conclusion: Rectal diclofenac suppository had higher efficacy in comparison to transdermal diclofenac patch in management of postoperative pain.

Antibacterial Activity of Ricinus communis Extracts against Common Human Pathogens Obtained from Surgical Wound Infections in a Tertiary Care Hospital of Semi-urban Set-up at Andhra Pradesh, India
Introduction: A number of medicinal compounds are manufactured with great exactness and simply from easily available raw materials at normal temperature and pressure from highly sophisticated chemical factories called plants and its parts. There are many methods of research associated with the medicinal plants and traditional medicine has shown very little attention in modern research and less effort has been done to upgrade the practice of using medicinal plants. Aim: To assess the antibacterial activity of Ricinus communis leaf extracts against common human pathogens obtained from surgical wound infections in a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology of a Tertiary Care teaching Hospital for a period of one month in January 2021. The pathogenic bacteria isolated from the surgical wounds were used for this study and the antibacterial activity of medicinal herb leaf extract Ricinus communis L. was investigated against gram positive bacteria and gram negative bacteria. Antimicrobial susceptibility testing was done as per Clinical and Laboratory Standards Institute (CLSI) guidelines by Kirby-Bauer disc diffusion technique using the extract, ampicillin as positive control and Dimethyl Sulphoxide (DMSO) as negative control. The zones of inhibition were measured using a special measuring scale. The Minimum Inhibitory Concentration (MIC) and the Minimum Bactericidal Concentration (MBC) of the medicinal plant were also tested against the same pathogenic bacterial strains that were isolated. The statistical analysis of frequency and mean were calculated and the results were tabulated. Results: The methanol crude extract of plant leaves (300 mg/mL) showed significant zone of inhibition against gram positive and gram negative bacteria. Comparatively, very less zone of inhibition was obtained from the aqueous unrefined extract of medicinal plant when compared to the methanol solvent extracts. DMSO was taken as negative control and no zone of inhibition was seen. Ampicillin (10 μg) was taken as positive control and has shown significant zone of inhibition against the isolated bacterial pathogens from wound infections. The best MBC value was observed in the methanol extract and in aqueous extract, the growth was extensive and full. Conclusion: Ricinus communis concentrated methanol leaf extract had shown effective antibacterial activity in comparison with the standard ampicillin. Based on further chemical, pharmacological and molecular studies in the future on this leaf extract and identify phytochemical constituents in the leaf, seed, stem, roots and to screen other potential bioactivities of the leaf extract may be recommended for the treatment of wounds.

Comparison of PRISM III and PIM II Score in Predicting Mortality in Paediatric Intensive Care Unit: An Observational Study

V Muthupandi, R Dianagrace, E Narayanan, J Sathya
Introduction: Prognostic scores play a vital role in predicting the outcome of children admitted in Paediatric Intensive Care Unit (PICU) thereby reducing the mortality. For paediatric population, Paediatric Risk of Mortality (PRISM III) and Paediatric Index of Mortality (PIM II) are the principal scores. As limited PICU beds are available in many tertiary care centres, PRISM III score helps in predicting mortality risk and admission to PICU. Aim: To compare PRISM III and PIM II in predicting the mortality in sick children in a PICU and their relation between observed and predicted mortality. Materials and Methods: This was a prospective observational study, conducted in Chengalpattu Medical College Hospital, Chennai, Tamil Nadu, India, from July 2018 to June 2019 that enrolled 102 children who were admitted to PICU. At first hour of admission, PIM II score was assessed and at 24 hours of admission, PRISM III score was assessed and the mortality was predicted. Children were followed-up until discharge or death, and the predicted mortality was compared with actual mortality and validation of scores was done using Statistical Package for the Social Sciences (SPSS) version 16.0. Results: Mean age of the population was 37.6 months, and majority of the children were aged less than 12 months. Male children were predominant (52%). Major system involvement was respiratory system 38 (37.3%) and mortality was 18 (17.6%). The mean score for death in PRISM III and PIM II were 11.8 and 19.9, respectively. The mean score for survival in PRISM III and PIM II were 4.4 and 9, respectively. Total PRISM III and PIM II score was lower in children who survived and mortality has been observed with higher scores. On comparison, PRISM III score was better to predict the mortality than PIM II. The Area Under Curve (AUC) and sensitivity for PRISM III score were 0.881 with 95% CI (0.769 to 0.992) and 94.44% respectively versus the AUC and sensitivity for PIM II score were 0.768 with CI (0.628 to 0.908) and 61.11%, respectively. Using logistic regression, risk of mortality was analysed and found that increase in one score has 0.62 times the increased risk of death in PRISM III score and thus, it predicts the mortality better. Conclusion: The PRISM III score was better than PIM II score for risk stratification and to optimise available limited resources. Both scores underestimate the predicted mortality in comparison to observed mortality.

Disorders of Sexual Differentiation: A Clinicopathological and Histological Study

Neethu Tony Mampilly, Anuradha Ananthamurthy, Suravi Mohanty, Kanishka Das
Introduction: The term ‘Disorders of Sexual Differentiation’ (DSD) is defined as a congenital discrepancy between external genitalia, gonadal and chromosomal sex. The Chicago consensus based on the primary genetic defect is used for current nomenclature and classification. A child with DSD, if identified and treated early, may grow to become a well-adjusted, functional member of the society. Patients with DSD carry a low but definite risk of developing germ cell tumours which necessitates a histological analysis in all cases. Aim: To describe the clinicopathological features of individuals with DSD and to classify the available cases according to the Chicago consensus which is based on karyotype and histopathology. Materials and Methods: This retrospective descriptive study was done at a tertiary referral centre in South India, for a period of four months from May 2016 to August 2016. Case charts and histopathology slides of cases received in the Department of Pathology from January 2011 to May 2016 were included and reviewed. Cases where the histopathology slides/blocks were not retrievable/difficult to assess due to technical issues were excluded. Case charts and slides were reviewed retrospectively with a view to classify as per karyotypic or histological classification. The slides were reviewed by two Pathologists to help in the classification wherever possible. Statistical measures like mean and percentages were used to describe the results. Results: A total of 22 cases of DSD were studied for which karyotype was available in 13 cases. Common clinical presentations were primary amenorrhoea, cryptorchidism and ambiguous genitalia. Age at presentation varied from nine months to 30 years. The initial diagnosis based on karyotype, clinical findings, hormonal assays and imaging were concordant with the final diagnosis in 11 cases. In two cases, histopathology was essential in arriving at a definitive diagnosis. Of the 13 cases with karyotype reports available, five were sex chromosome DSD, five were 46XY DSD and three were 46XX DSD. Gonadoblastoma was seen in three cases. Conclusion: Histopathological examination together with karyotype plays a crucial role in proper categorisation of disorders of sexual differentiation. A multidisciplinary team approach for early diagnosis and management of DSD is essential for the psychosexual development of these individuals.

Effect of Incisional Negative Pressure Wound Therapy Following Incisional Hernia Repair- A Randomised Controlled Trial

Arindam Mondal, Manwar S Ali, Indira Galidevara, Murugan Arumugam
Introduction: Incisional hernia is one of the common complications following abdominal surgery in patients undergoing laparotomy. Various surgical procedures are performed by creating a potential space and placing a foreign body (mesh), which may render the wound susceptible for many postoperative complications. It is clinically important to evaluate the efficacy of Incisional Negative Pressure Wound Therapy (INPWT) in reducing wound complications. Aim: To compare the efficacy of INPWT dressing with traditional gauze dressing in reducing postoperative complications following meshplasty in incisional hernia repair. Materials and Methods: This was a hospital-based randomised controlled trial, conducted in the Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, from October 2013 to July 2015. Total 64 consenting patients with incisional hernias undergoing meshplasty were included in this study. After being randomised into the two study groups, they had their postoperative wounds dressed with either INPWT (group A) for five days, or traditional gauze (group B) based dressings. Operative parameters like duration of surgery, type of dissection and type of skin sutures used were studied and analysed. Also, postoperative outcomes like Surgical Site Infection (SSI), seroma, duration of drain, hospital stay were analysed using Chi-square or Fisher’s-exact test. Results: Group A and B had the mean age of 47±11.61 years and 43±10.53 years respectively. Out of total 64 patients, there was a statistically significant reduction in the volume of drain (p=0.004) and duration of wound drainage (p=0.029) with the use of INPWT. There was also a reduction in the incidence of SSI (6.7% vs 17.6%) and seroma (6.7% vs 11.8%) and the duration of postoperative hospital stay (6.03±1.99 days vs 7.09±2.31 days) in the INPWT group, which were however not statistically significant. Age, co-morbidities, Body Mass Index (BMI), duration of surgery, type of dissection and type of skin sutures were not found to have any effect on the parameters assessed. Conclusion: Incisional negative pressure wound therapy in postoperative wounds, following meshplasty for incisional hernia significantly reduces the volume and duration of wound drainage. It also reduces the incidence of SSI, seroma and the duration of hospital stay.

Effect of Low Dose Intravenous Dexmedetomidine with 4% Sevoflurane on Haemodynamic Response during Laryngoscopy and Tracheal Intubation: A Randomised Controlled Study

Maninder Kaur, Sargam Goel
Introduction: Over the last decade, the use of dexmedetomidine has found favour in obtunding the haemodynamic response during laryngoscopy and tracheal intubation but the use of higher doses has lead to a number of adverse effects. Aim: To compare the effect of low dose dexmedetomidine (0.5 μg/kg) and 4% sevoflurane (dial setting) with, Normal Saline (NS) and 4% sevoflurane (dial setting) on haemodynamic response to laryngoscopy and intubation. Materials and Methods: This randomised double blind controlled study was carried out in 60 patients of American Society of Anaesthesiologists (ASA) class I, undergoing elective surgery under general anaesthesia. The patients were allocated to group DX (n=30) and group NS (n=30), who received dexmedetomidine 0.5 μg/kg infusion and NS infusion intravenous (i.v.) respectively, in equal volume over 10 minutes before anaesthesia induction. They were evaluated for the requirement of thiopentone sodium, vecuronium bromide and sevoflurane, total i.v. fluids transfused haemodynamic parameters intraoperatively (pre and post induction) and postoperatively at regular intervals, and side effects. Results: On statistical comparison, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were found to be significantly less in group DX than in group NS with a p-value of <0.05. The total i.v. fluids infused in group NS and DX expressed as mean±Standard Deviation (SD) were 1145.00±228.21 and 1325.00±359.64, respectively. This was statistically significant. Thiopentone requirement was statistically more in group NS with a mean±standard deviation of 249.17±37.99 than in group DX (225.00±38.84). Similarly, sevoflurane requirement was statistically less in the DX group at various time intervals. Ten patients (33%) in group DX required antiemesis, compared to 13 patients (43%) in group NS. Two patients in group NS and three patients in group DX required injection (inj.) atropine to treat bradycardia. Conclusion: On comparison, a combination of 4% sevoflurane with 0.5 μg/kg dexmedetomidine was more effective in attenuating pressor response than 4% sevoflurane (dial setting) alone, but is associated with minor and manageable risk of bradycardia and hypotension.

Knowledge, Awareness and Practices of the use of Digital Technology in Dentistry among Postgraduate Students and Dental Practitioners in India: A Cross-sectional Study
Introduction: Currently, digital dentistry is an umbrella topic that predominantly includes the areas of intraoral scanning, Three-dimensional (3D) printing and Computer-aided Designing/ Computer-aided Manufacturing (CAD/CAM). It allows the transfer of information between physical and digital data, with the significant advantage of easing the transition process and increasing efficiency. Digital technology is a crucial component of modern dentistry which has a significant influence on our present and future dental practice. Aim: To assess the knowledge, awareness and practices of the use of digital technology and its implications in dentistry among dental postgraduate students and dental practitioners. Materials and Methods: A cross-sectional questionnaire based online survey was undertaken at KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India between April 2021 and July 2021 amongst dental practitioners and dental postgraduate students of different regions across India. The questionnaire consisted of 21 questions which evaluated their awareness towards digital dentistry, its advantages and shortcomings, their knowledge and practices towards digital dentistry. Statistical analysis was done using Chi-square test in each group, using Statistical Package for the Social Sciences (SPSS) version 20.0. The p-value <0.05 was considered significant. Results: Of total 270, 261 respondents (96.67%) were aware of CAD/CAM technology in dentistry. A total of 237 respondents (87.78%) felt that the lack of knowledge was one of the shortcomings of CAD/CAM with a p-value=0.039 rather than its high cost (184 respondents 68.15%, p-value=0.009) and there was a need to increase the knowledge and understanding regarding the same. A total of 252 respondents (93.33%) were of the opinion that digital technology is the future of dentistry and it will have a positive impact on our profession and 83.59% respondents felt that digital technology would have a role to play in the current COVID-19 scenario. The teaching faculty (92.86%), showed better understanding about the digital technology compared to private practitioners (66.22%) and postgraduate students (62.59%). Conclusion: In the given set of participants, most of the participants were aware about digital technology which shows a satisfactory outcome. The teaching faculty showed better understanding about the digital technology compared to private practitioners and postgraduate students. However, to make them acquainted with CAD/CAM, dental education programmes and workshops should be conducted which will create a future generation of dentists who will be well-versed with digital dentistry. With so much room to grow, it will help dentists to work as one and deliver the absolute best care to their patients and create a better tomorrow.

Clinico-immunological Study of HIV Infected Children Attending ART CentreA Prospective Longitudinal Study
Introduction: Human Immunodeficiency Virus (HIV) infection is a growing concern in paediatric population and large number of children are registered and treated at Antiretroviral Treatment (ART) centres across the country. Children with HIV progress more rapidly, develop more bacterial infections, suffer from neurologic developmental problems and have higher mortality than adults. So the screening and counselling of HIV positive parents and their children must be done timely. This helps the physician for starting the treatment timely. Aim: To determine the clinico-immunological profile of paediatric patients registered in ART, and to compare the immunological profile and clinical staging of paediatric patients receiving ART. Materials and Methods: This prospective longitudinal study was conducted in the ART centre of Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from October 2017 to October 2018. Total 51 children, upto the age group of 18 years, suffering from HIV/Acquired immunodeficiency syndrome (AIDS) were enrolled in the study. Diagnosis of HIV was confirmed using Enzyme-Linked Immunosorbent Assay (ELISA) method (using two different antigens Comb HIV test, TRI-DOT) in children more than 18 months of age. In children less than 18 months age, diagnosis was confirmed using Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) (repeated twice with cessation of breast feeding for minimum of six weeks). Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) trial version 23.0 and simple frequency and Chi-square test was used for analysis. Results: Majority of the children (20, 39.26%) were in the age group of 5-10 years, and male:female ratio was 2.4:1. Most common presenting complaint was cough (52.94%), followed by fever (47.05%), chronic diarrhoea (37.25%). Most common clinical signs seen were hepatosplenomegaly (41.17%), pneumonia (33.33%) and lymphadenopathy (31.37%). Initially the mean CD4 count was 370.31±231.5 cell/mm³, and after starting ART mean CD4 count was 524.6±260.4 cell/mm³. Significant improvement in CD4 count was observed in age group of 5-10 years (p-value=0.009), and 10-15 years (p-value=0.001) after six months of starting the ART. In the beginning, maximum (56.7%) children belonged to World Health Organisation (WHO) clinical staging III and after starting ART maximum 40% belonged to stage II. Conclusion: The ART improves symptomatology and immunological status HIV infected children, so there is need to screen the children of HIV affected parents and identify the children suffering with HIV in order to initiate ART at the earliest indication in order to improve their general health, freedom from illness and better immunological status.

Concurrent Presence of Hashimoto’s Thyroiditis with Papillary Carcinoma of Thyroid- A Retrospective Study

Anita Desayappa Aramani, Savita Lasrado, Aishwarya Hegde, Saurabh Kumar
Introduction: Hashimoto’s thyroiditis is the most common inflammatory disease of thyroid. Papillary carcinoma of thyroid is an epithelial malignancy and is the most frequent thyroid neoplasm. The association between Hashimoto’s thyroiditis and papillary carcinoma of thyroid has been debatable due to conflicting evidence. Aim: To know the socio-demographic determinants of Hashimoto’s thyroiditis and to find out the association between Hashimoto’s thyroiditis and papillary carcinoma of thyroid. Materials and Methods: In this retrospective study, clinical and histopathological data of 720 patients who underwent thyroidectomy between October 2013 to September 2018 were studied at Father Muller Medical College, Mangalore, Karnataka, India. Clinical case records, from October 2013 till September 2018, and histopathological reports were collected. The results were expressed in percentages, proportions and means with standard deviation. Chi-square test was used to find out the association of age group, sex and histopathologic findings with Hashimoto’s thyroiditis. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 23.0 and p-value <0.05 was considered as statistically significant. Results: Mean age of the study participants with and without Hashimoto’s thyroiditis was 45.94 (±10.60) years and 45.88 (±12.88) years respectively. Out of 720 study participants, 623 (86.5%) were females and 97 (13.5%) males. The most common indication for thyroidectomy was benign thyroid disorders followed by papillary carcinoma of thyroid. Hashimoto’s thyroiditis was seen significantly higher in females compared to males (χ²=12.214, p<0.001) and odds of females having Hashimoto’s thyroiditis was 3.76 times that of males. Papillary carcinoma was seen in 157 cases out of 720 cases, and amongst them, 51 (32.5%) had Hashimoto’s thyroiditis. Papillary carcinoma was found to be associated with the presence of Hashimoto’s thyroiditis (χ²=17.5, p<0.001). Conclusion: Female sex was the significant socio-demographic determinant of Hashimoto’s thyroiditis. Papillary carcinoma of thyroid was found to be associated with Hashimoto’s thyroiditis.

Pathological Features of Lung in COVID-19 Disease Subjects: A Postmortem Study

Bhanu Rekha Bokam, Chetana Gondi, Revanth Kumar Nakka
Introduction: The current Coronavirus Disease-19 (COVID-19) pandemic is considered as one of the most serious public health crises which caused more than 1.62 million deaths from October 2020 to November 2020. Acute respiratory failure is leading cause of death followed by sepsis, cardiac failure and haemorrhage. Since the pathological findings are diverse in COVID-19 and majority of studies in literature were by open autopsy; the present study was done using percutaneous core needle biopsy. Postmortem lung biopsies are rather easy and quick to perform and decrease the infective risk caused by full autopsies. This could be an essential tool for diagnosis, surveillance and research. Aim: To study the pathological features of lung in COVID-19 deceased patients by postmortem. Materials and Methods: This cross-sectional study was conducted in the Department of Pulmonary Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India from October 2020 to November 2020. In present study, postmortem percutaneous core needle biopsies from lung were performed within two hours of death from eight deceased patients who died of COVID-19. Clinical history, inflammatory markers and treatment details were collected from case sheets, biopsy was done, specimen was collected and sent for pathological examination. Data was presented in the descriptive form for each variable. Results: Out of eight cases, five were men and three were women with a mean age of 54.12 years. Majority of patients presented with complaints of shortness of breath and fever. Hypertension, type 2 diabetes mellitus, obesity, hypothyroidism, history of pulmonary tuberculosis were the co-morbidities noticed. Four biopsies presented acute lung injury with hyaline membrane changes, Diffuse Alveolar Damage (DAD) with hyaline membrane was seen in two cases, squamous metaplasia was seen in two cases and acute lung injury with organising pneumonia was seen in two cases. Conclusion: Postmortem lung biopsies are safe, easy to perform and provide insights of possible undergoing pathology of the disease with regard to clinical presentation.

Vaginal Cuff Closure by Endosuturing in Total Laparoscopic Hysterectomy as Compared to Transvaginal Route of Suturing
Introduction: In present times, Total Laparoscopic Hysterectomy (TLH) is one of the commonly performed gynaecological procedure. Vaginal vault or cuff closure is crucial and critical in performance of TLH. During TLH, vaginal vault or cuff closure is done using a variety of available sutures. The techniques of suturing and approaches, either endoscopic or transvaginal, can vary. The skill, experience and preference of the surgeon counts in the final outcome of the surgery. Aim: To compare and study the frequency of minor and major complication rates of intracorporeal (endosuturing) cuff closure technique and routinely used transvaginal route of suturing vaginal vault in TLH. Materials and Methods: This prospective cohort research was conducted in the GCS Medical College and Hospital, Ahmedabad, India, from May 2018 to December 2019. A total of 102 TLH were studied. In 51 cases (50%), vault was sutured endoscopically and in other 51 cases (50%), vault was sutured transvaginal, using single continuous interlocking suturing of vaginal vault with Vicryl 1-0 in all cases. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: In the follow-up of three months period, there were no cases of Vaginal Cuff Dehiscence (VCD). In present study, 21 cases (20.6%) out of 102 presented with vaginal cuff complications. A 15.7% cases with minor vaginal cuff complications were noted in laparoscopic endosuturing group and 25.5% cases of vaginal suturing group presented with minor vaginal cuff complications. Conclusion: Both the techniques of suturing the vaginal vault following laparoscopic hysterectomy delivered the desired results. The laparoscopic route of suturing vaginal cuff following TLH had lesser complication rate though not statistically significant over vaginal route and none of the two groups had any major complication (VCD).

A Community-based Cross-sectional Study on Knowledge and Belief of Menstruation and Practices of Menstrual Hygiene among Adolescence Girls of Vadodara, Gujarat, India
Introduction: Women undergo menstruation as part of their normal physiological cycle. In Indian society, it is associated with taboos, myths, misbelieves and malpractice. Majority of adolescent girls are unprepared in terms of knowledge, attitude and hygienic practices for managing the menstrual cycle when they enter menarche. A better understanding of the scientific process of menstruation and good menstrual hygiene is very crucial for the health and well-being of adolescent girls. Unsafe practices are associated with unwanted outcomes. Aim: To assess the knowledge, beliefs and sources of information adolescents have about menstruation, along with their management of menstrual hygiene. Materials and Methods: The present community-based cross-sectional study was conducted among the adolescent school going girls of rural and urban areas in 2019 in Vadodara, Gujarat, India, among 240 adolescent girls of 14-17 years of age using multistage sampling methods. Data were collected by using pre tested, structured self-administered questionnaire after having informed consent. Descriptive statistics was applied for analysis and results were presented into table and graph. Results: A total of 98 (40.8%) girls were aware of menstruation before attaining menarche. Out of total 240, 26(10.83%) did not knew the cause of menstruation and 11 (4.58%) were not aware about the organ from where menstrual bleeding occurs. Total 55.42% girls used only sanitary pads whereas 43.33% used both old clothes and sanitary pads as the absorbents. A 46.25% changed absorbent frequently (≥4 times in a day). A 54.17% washed their genitals frequently. The most common method of absorbent disposal was disposal in a dustbin. Mother was the main source of information regarding menstruation. Conclusion: Majority of adolescent girls were not having enough knowledge regarding menstruation and their menstrual practices are inexact. This is requisite for menstrual hygiene programme.

Animal-assisted Therapy as a Potential Tool for Management of Dental Anxiety in Children: A Questionnaire-based Cross-sectional Study

Bashyam Nalini, Chandrabhatla Srinivaskumar
Introduction: Animal-Assisted Therapy (AAT) is being developed as an alternative approach to reduce the anxiety and comfort the apprehensive patients. Hence, to evaluate the child’s and parental acceptance of pets in dental operatory, their favourite pet, child’s choice of live pet over soft toy, their preference of own pet vs therapy, more hairy pets vs less hairy pets, play area vs child’s lap, the present study is undertaken. Aim: To evaluate the influence of pets in reducing anxiety of children in the dental operatory and acceptance of this technique by the children and the parents. Materials and Methods: This questionnaire-based cross-sectional study was conducted on 65 children of age group 3-12 years and their parents who attended the Department of Pedodontics and Preventive Dentistry, GITAM Dental college and Hospital, Visakhapatnam, Andhra Pradesh, India for a period of two weeks in the month of July 2018. They were assessed for anxiety and the influence of pets on anxiety levels using questionnaire and picture cards. The data was statistically analysed using Chi-square test. Results: An 83.3% of parents and 75.4% of children felt that pets in the dental operatory are useful in reducing the anxiety. A 58.5% of children preferred live pets whereas only 33.3% parents preferred them. Dog was found to be the most favourite pet for very young children (31.6%) whereas older children preferred rabbit (43.5%). Conclusion: Animal-assisted therapy was found to be useful in reducing the anxiety of children during dental visit.

Origin and Prevalence of the Retroportal Course of Hepatic Artery- A Retrospective Study

Priya Appanraj, M Venugopal
Introduction: Anatomical variations of celiac and hepatic arteries are relatively common and impact operative time and technique. Intraoperative identification of the entire course of these vessels can be a challenge due to limited surgical field and increases the chance of iatrogenic injury. Aim: To evaluate and describe the origin and prevalence of retroportal course of hepatic arteries seen in Computed Tomography (CT) angiography in a large series of patients. Materials and Methods: The present retrospective study was conducted in the Department of Radiology, affiliated to a tertiary cancer centre in Southern India. CT angiogram done between January 2020 to June 2021 were included. Total of 326 abdominal CT angiograms were studied for celiac axis variations, variations in the origin and branching pattern of hepatic arteries, trajectory of the hepatic artery and its relation to portal vein. The branching pattern of celiac axis was analysed with adherence to the modified definition of Common Hepatic Artery (CHA) and it was classified as normal/variant/ambiguous. Based on the origin and branching pattern, hepatic arteries were divided into standard/replaced/accessory and classic/variant divisions, respectively. Variant divisions include trifurcation, duplicate or double hepatic artery and late origin of Gastro Duodenal Artery (GDA). Retroportal hepatic arteries under each variation was identified separately and their prevalence calculated. Confidence interval was calculated using simple proportion-frequency analysis open Epi version 3 software. Results: The age of the patients varies from 3-83 years (mean age 53.7 years). A 207 (63.49%) cases were male and 119 (36.5%) cases were female. A 262 (80.37%) cases had a normal celiac axis anatomy. Eight specific types of celiac axis variations were observed in 48 (14.72%) cases. In the remaining 16 (4.91%) cases, the celiac axis anatomy was ambiguous. CHA originated from the celiac axis, Superior Mesentric Artery (SMA) and aorta in 294 (90.18%), 10 (3.07%) and 6 (1.84%) cases respectively. Out of the 52 replaced Right Hepatic Artery (rRHA), 48 (14.72%), 3 (0.92%) and 1 (0.30%) cases had Right Hepatic Artery (RHA) replaced to the SMA, aorta and GDA, respectively. Except for the one rRHA from GDA, all of them had a retroportal course. Classic branching pattern of hepatic artery was seen in 154 (47.24%). Trifurcation, early branching of RHA and early branching of LHA were found in 49 (15.03%), 4 (1.22%) and 8 (2.45%) respectively. 63 (70%) cases of variations in hepatic artery origin, 15 (16.67%) cases of variations in hepatic artery branching and 12 (13.33%) cases of variations in celiac axis contributed to a total of 90 cases with retroportal hepatic artery. Prevalence of retroportal hepatic artery in the present study is 27.61% (confidence interval 22.82-32.8) and the most common cause was aberrant RHA origin. Conclusion: Knowledge about the origin and prevalence of retroportal course of hepatic artery will help the surgeon to approach it systematically. Preoperative knowledge of the variations in origin and branching patterns and its influence on the trajectory will help in a better intraoperative identification of these variant vessels.

Whole Brain CT Perfusion Evaluation in Transient Ischaemic Attack: A Cross-sectional Study from a Tertiary Care Centre, New Delhi, India

Prateek Kumar Madaan, Rohini Gupta Ghasi
Introduction: Few studies exist in current literature regarding imaging features in Transient Ischaemic Attack (TIA) and most of the previous studies on Computed Tomography Perfusion (CTP) have used old generation scanners with limited brain coverage. Aim: To study the spectrum of whole brain CTP parameters in patients presenting with TIA using a 256 slice CT scanner. Materials and Methods: This cross-sectional observational study was conducted on 15 patients, tertiary care centre in New Delhi, India over a period of 18 months from October 2017 till March 2019. All patients presenting with the first episode of TIA were evaluated with Non Contrast Computed Tomography (NCCT), Whole brain CTP, and Colour doppler of carotid vessels. Quantitative assessment and statistical analysis of the alteration of CT perfusion parameters was done in areas of visualised Focal Perfusion Abnormalities (FPA) and seven predefined locations in bilateral hemispheres on perfusion maps. Results: Five out of 15 patients had FPAs in the colour maps and there was a significant elevation of Cerebral Blood Flow (CBF) and Cerebral Blood Volume (CBV) in the FPA region (p-value=0.018) suggestive of postischaemic hyperperfusion. The mean hemispheric CBF was increased in the abnormal hemisphere compared to the normal hemisphere (p-value=0.04). Conclusion: CTP parameters are significantly altered in the patients with TIA with predominant increase in CBF and CBV in the patients who have FPA on CTP. CTP shows postischaemic hyperperfusion changes in the form of increased CBF in the hemisphere corresponding to the symptoms.

Papillary Thyroid Carcinoma- Variants and Associated Disorders

Savithri Ravindra, HB Kavyashri
Introduction: Papillary Thyroid Carcinoma (PTC) is a malignant epithelial tumour. It is the most common form of thyroid cancer. Several variants have been described like classic, follicular, tall cell, diffuse sclerosing, papillary microcarcinoma and others. Aim: To study the variants of PTC and to evaluate the presence of associated disorders. Materials and Methods: In this retrospective study, total of 41 cases of PTC were studied from January 2016 to December 2018 in the Department of Pathology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. Demographic data and clinical findings were retrieved from case files. The histopathological slides were studied and the results were analysed using Fischer’s-exact test using R (Robert Gentleman and Ross Ihaka) Statistical Software version 4.0.0. Results: Total data of 41 cases of PTC was collected and analysed. The patient age range between 20-70 years with mean age of 47 years. Female preponderance was noted. Among 41 cases, most were classic variant (31, 75.6%) followed by follicular variant (6, 14.6%), papillary microcarcinoma (3, 7.31%) and diffuse sclerosing variant (1, 2.4%). Multinodular goitre was associated with 8 cases of PTC and Hashimoto’s thyroiditis was associated with 5 cases of PTC. Among 13 cases of associated disorders, only six had preoperative diagnosis of PTC and remaining seven cases were diagnosed on histopathological examination. Conclusion: Classic variant is the most common type of PTC. All thyroidectomies done for multinodular goitre and Hashimoto’s thyroiditis should be screened thoroughly for PTC especially microcarcinoma.

Body Weight as a Major Determinant of Thyroxine Sodium Dosage in the Treatment of Primary Hypothyroidism

Surendra Kumar
Introduction: Several formulae have been proposed for optimising the dosage prerequisites of levothyroxine (LT4), and body weight and Body Mass Index (BMI) have been suggested to be broadly dependent on the formulae range. Aim: To evaluate the role of body weight as a determinant of LT4 dosage in the treatment of primary hypothyroidism. Materials and Methods: The present study was a prospective observational study conducted at Outpatient Department (OPD) Endocrinology, Patna Medical College Hospital, Patna, Bihar, India, on 100 patients diagnosed with untreated primary hypothyroidism between February 2020 and January 2021. Demographic details, anthropometric measurements, vital signs, and details of types and dosage of treatment received were collected. LT4 dose requirement for each individual patient was then generated as mcg per kg/body weight per day. Estimation of serum Thyroid Stimulating Hormone (TSH), Free T4 (FT4), creatinine and thyroid peroxidase levels were carried out as per standard diagnostic protocols and the dosage adjustment was conducted based on target TSH levels. Population characteristics were expressed as mean±standard deviation. The Python version 3.4.5 with the package seaborn was used for statistical analyses and preparation of figures, distribution and correlation plots. Results: The study enrolled 100 individuals (88 women and 12 men) with mean age of 40.69 years (age range 17 to 72 years). A significant positive correlation was noted between the LT4 dose and total body weight (p-value <0.001). The association was also significant when the LT4 dose was correlated with BMI (p-value <0.001) and FT4 (p-value <0.001). However, the correlation of Thyroid Peroxidase Antibodies (TPO Ab), TSH, height and age with the LT4 daily dose (p-value >0.05) was found to be statistically non significant. Conclusion: There exist a significant positive correlation between LT4 dosage and body weight. Hence, body weight should be considered as a key determinant while prescribing LT4 therapy for the treatment primary hypothyroidism.

Maternal and Perinatal Outcomes in Placenta Previa: A Retrospective Study at a Tertiary Care Centre of Western India

Shital Umesh Lad, Mangala Ashok Shinde
Introduction: Placenta previa is a condition characterised by abnormal placental implantation and usually presented as painless vaginal bleeding in second or third trimester of pregnancy. Various studies have reported adverse outcomes in the cases of placenta previa. Aim: To find incidence, maternal and perinatal outcomes in placenta previa. Materials and Methods: This retrospective study was carried out during April 2021 to June 2021 at a Government tertiary care centre in Maharashtra. Total 260 cases of placenta previa managed at the institute between 1^st January 2017 to 31^st December 2019 were included in study. Primary data from labour room and operation theatre was collected and detailed case papers were accessed from medical records section. Data was analysed using Microsoft Excel Windows 2013. Results: Incidence of placenta previa was 1.09%. Majority of cases were from age group of 26-30 years, booked, gravida 2-3, belonging to low socio-economic status and without any history of risk factors. In 81.15%, cases Lower Segment Cesarean Section (LSCS) was required. Post Partem Haemorrhage (PPH) (32.30%) and need for blood transfusion (86.15%) were major complications. Maternal mortality in cases of placenta previa was 4.23%. In perinatal outcome, prematurity was reported in 44.30% cases while 57.46% needed Neonatal Intensive Care Unit (NICU) admission. Perinatal mortality was 17.53%. Conclusion: There is need for regular Antenatal Care (ANC) check-up and timely referral to tertiary care obstetrical care centre with availability of Blood bank and NICU for better outcome.

Intracranial Complications due to Chronic Suppurative Otitis Media-Atticoantral Disease with a Reference to its Microbiological Profile: A Retrospective Study
Introduction: Intracranial Complications (ICC) in patients with Chronic Suppurative Otitis Media-Atticoantral Disease (CSOMAAD) is a life threatening disease. Knowing the microbiological profile of the causative organisms will help in selecting empiric antibiotic. Aim: To determine the demographic pattern and clinical presentation of patients with CSOM-AAD presenting with ICC, and to assess the microbiological profile of causative organisms. Materials and Methods: This was a retrospective study, where medical records of all patients diagnosed with CSOM-AAD and ICC, in a tertiary teaching hospital, Manipal, Karnataka, India, between July 2012 and June 2018 were reviewed. The data regarding demographics, clinical and audiological evaluation, microbiological reports were analysed. Data was entered into Microsoft Excel sheet 2010 and was calculated as mean, median and percentages. Results: Out of total 244 patients with CSOM-AAD, 15 presented with ICC. The age range was between 17-41 years (median age21years). The most common complaint was headache, n=11 (73%) and the most common complication was intracranial abscess, n=10 (67%). In three cases, sampling from different sites isolated different organisms and hence a total of 20 samples (11 from ear swab, six from abscess drained pus, two from cerebrospinal fluid and one from blood culture) were analysed. Gram Negative Bacilli (GNB) were isolated most of the times, n=10 (50%) followed by Gram Positive Cocci (GPC), n=6 (30%) and anaerobes, n=2 (10%). Most of the isolated GNB and GPC were susceptible to carbapenem and vancomycin, respectively. Conclusion: Intracranial complications are usually seen in young adults, and they present with headache, fever and ear discharge. Majority of the complications are caused by GNB. Vancomycin and carbapenem provide empiric cover for GPC and GNB, respectively.

Iron Deficiency Anaemia among Exclusively Breastfed Term Infants of 4-6 Months Age and its Contributing Factors: A Cross-sectional Study

Eesha , KC Aggarwal , Sumita Saluja
Introduction: The risk of Iron Deficiency (ID) is a major concern associated with exclusively breastfed infants of age 4-6 months. According to World Health Organisation (WHO) iron should be universally supplemented from six months onwards instead of four months as recommended by American Academy of Paediatrics (AAP). Aim: To determine ID and Iron Deficiency Anaemia (IDA) among infants of age 4-6 months and relation of same to various socioeconomic and maternal parameters. Materials and Methods: This was a hospital-based, prospective, cross-sectional study conducted in the Department of Paediatrics of a tertiary care hospital in India. It included a sample population of 200 exclusively breastfed term infants, of age 4-6 months. Iron status was determined by studying the haemoglobin and serum ferritin levels and their associations to demographic, socio-economic and maternal parameters. Qualitative variables were analysed using the Chi-square test/Fisher’s-exact test. Univariate and multivariate logistic regression was used to find out significant risk factors of ID and IDA. Results: Age wise distribution of infants was 91 (45.5%), 62 (31%), and 47 (23.5%) at 4, 5, and 6 months. Male-to-female ratio was 1.7:1. Mean±SD value of haemoglobin and serum ferritin was 10.82±0.60 g/dL and 44.60±25.02 µg/L, respectively. Prevalence of ID was 11 (12.09%), 16 (25.81%), and 16 (34.04%) at ages 4, 5, and 6 months, respectively. On multivariate regression analysis, age of mother <20 years (p-value 0.043), and increasing parity (p-value 0.001) were associated with low iron status. Conclusion: Almost one-third healthy term exclusively breastfed infants become iron deficient by the age of six months. The study supports the need for iron supplementation from the age of four months universally instead of six months in exclusively breastfed term infants.

First Trimester Combined Aneuploidy Screening for Trisomy 21: A Three Years Retrospective Study
Introduction: Prenatal testing also known as maternal screening is primarily performed to screen out most common chromosomal anomalies in the foetus using maternal blood. It provides an accurate and sensitive assessment of a patient’s risk of carrying a foetus with chromosomal anomalies. Aim: To study the first trimester prenatal screening using a Foetal Medicine Foundation (FMF) certified platform to estimate the risk of foetal trisomy 21. Materials and Methods: This retrospective study was conducted at Global Reference Laboratory, Mumbai, Maharashtra, India, from January 2018 to March 2021 on samples of 86118 pregnant Asian women with respect to age, the risk cut-off was set at 1:250 for trisomy 21. The study included determination of free β-human Chorionic Gonadotropin (β-hCG) and Pregnancy Associated Plasma Protein-A (PAPP-A) in maternal serum, ultrasound studies of Crown Rump Length (CRL), Nuchal Translucency (NT) and nasal bone and maternal characteristics. Concentration of biochemical parameters was expressed in Multiple of Medians (MoM) respective to gestation age. Risk assessment of trisomy 21 was analysed using lifecycle software cut-off being 1:250 at sampling. Results: The overall positive risk (high risk) for trisomy 21 obtained was 2.58%, association with advanced maternal age, history of Insulin dependent diabetes mellitus and absent nasal bone status. Biochemically, the MOM of β-hCG was high with mean MoM of 2.40 (>1.5) and MoM of PAPP-A was low with mean MoM of 0.64 (≤0.6). Conclusion: This study enabled us to understand the importance of prenatal testing, a non invasive screening of chromosomal disorders like trisomy 21 which gives the advantages of early counseling and diagnosis quite as early as in the first trimester of pregnancy. It helps in drastically reducing the use of invasive procedures associated with risk of miscarriages. It is suggested that screening for chromosomal abnormalities be offered in all antenatal women irrespective of age and parity.

Role of Immunohistochemical Expression of p53 in Intestinal Epithelial Cells to Detect Dysplasia in Patients with Inflammatory Bowel Disease

Neethu Elizabeth George, Sarojini, George Thomas
Introduction: Inflammatory Bowel Disease (IBD) has a genetic predisposition, in which patients are more prone to develop colorectal carcinoma. Dysplasia, a precursor of malignancy, can be very difficult to detect based on histopathological features alone. Tumour suppressor gene, p53, is overexpressed in IBD even when there is no histological evidence of dysplasia. Therefore, p53 can be used as a tissue biomarker for routine surveillance to initiate treatment for prevention of carcinoma. Aim: To identify the diagnostic utility of p53 immunohistochemistry in the detection of dysplasia in patients with IBD. Materials and Methods: This cross-sectional diagnostic study was conducted in the Department of Pathology at Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India, from June 2016 to June 2018. Total 31 cases of intestinal biopsies in patients with chronic bloody diarrhoea were selected for the study. Immunohistochemical (IHC) staining using anti p53 antibody was done in all the cases to detect the expressed protein. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Significance of p53 immunostains was done using Fischer’s-exact test. Results: The age group of patients with IBD ranged from 15-73 years with a bimodal age peak between 20-29 years and 60-69 years. Male predominance was seen among 20 cases while 11 cases were among females. Negative staining for p53 was seen in 28 cases which were negative for dysplasia histopathologically. Only one case which was histopathologically positive for dysplasia and one of the negative cases of dysplasia showed p53 positivity. Another case which was histopathologically positive for dysplasia showed negative staining for p53. Sensitivity of p53 in this study was 50% while the specificity was 96.55%. Conclusion: The finding of positive p53 expression in dysplasia positive case follows the fact that p53 mutations found in dysplastic mucosa precedes progression to neoplasia. In contrast, positive p53 expression in a case that was negative for dysplasia histopathologically, should be handled cautiously and warrants regular follow-up in order to prevent neoplastic progression. However, diagnosis of dysplasia should not be made in areas of active inflammation as inflammatory changes can lead to regenerative atypia which could result in over interpretation of histological features attributing it to dysplasia.

Assessment of Knowledge of Glaucoma in General Practitioners, Resident Doctors and Interns in Anand District, Gujarat, India

Sonal Dhruvpal Sisodia, Harsha Chetan Jani, Anuja Parikh, Priya Ishwar Hingorani
Introduction: Glaucoma has been established as the second most leading cause of blindness after cataract, which is usually irreversible and accounts for 10.1% of total blindness worldwide. Glaucoma has affected 79.6 million people worldwide by 2020. The estimated prevalence of glaucoma in India is 12 million. The Government of India aims to reduce the prevalence of blindness to 0.25/1000 by 2025 and disease burden by one third from current levels. In a developing country, like India, ‘physician of first contact’ may be a general practitioner, resident doctor or intern. Aim: To assess knowledge of glaucoma in general practitioners, resident doctors and interns in Anand district, Gujarat and to identify the level of difference of knowledge in each group and to suggest remedial measures for the same. Materials and Methods: A descriptive semi-structured questionnaire based cross-sectional study was conducted in Pramukhswami Medical College, Karamsad, Gujarat, India, after obtaining ethical clearance from the Institutional Ethics Committee between July 2017 to September 2017. Informed written consent was taken from 240 medical doctors comprising of interns (undergoing compulsory rotatory internship), 1^st to 3^rd year resident doctors (postgraduate students) working in different wards of all the clinical department and general practitioners practising in radius of 15 kilometers from the main hospital located in Anand district of Gujarat state (80 in each category) and a questionnaire was administered. Participants were inquired about the knowledge of glaucoma, the sneak thief of sight. Residents of Ophthalmology were excluded to avoid bias. Cramer’s V association, Chi-square test and Fisher's-Exact tests were applied for data analysis. Results: Respondents included general practitioners, residents and interns (80:80:80). Glaucoma knowledge was to be higher in residents as compared to interns and general practitioners. About 78.75% residents scored 7 and above out of 10 whereas 61.25% interns and 50% general practitioners obtained the same score. Conclusion: The authors found that knowledge about glaucoma in multi-scale medical practitioners was not uniform and reasonably less than it should be. Resident doctors (fresh graduates and completed compulsory rotatory internship) have better knowledge about various aspects of glaucoma as compared to general practitioners and interns which demands the need for frequent reorientation programme and internship in Ophthalmology guiding about various aspects of disease entities responsible for blindness.

Rhino-orbital Fungal Invasion in Post COVID-19 Cases at a Tertiary Eye Care Centre in Hyderabad- A Cross-sectional Study

BM Shanker Venkatesh, P Ganga Bhavani, K Manjusha, Sania Sultana
Introduction: In India, especially in Southern part of the country during the second wave of the pandemic there has been a sudden surge of rhino-orbital invasion by various fungi like Fusarium, Mucor, Aspergillus etc., in post Coronavirus Disease-2019 (COVID-19) patients. Several risk factors have been attributed like lowering of cell-mediated immunity by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), lymphopenia and associated reduction in CD4+ (Cluster of Differentiation) and CD8+ cell population, Steroid-induced hyperglycaemia, immunosuppression, and uncontrolled diabetes. Aim: To detect rhino-orbital fungal conquering post COVID-19 cases. Materials and Methods: This was a cross-sectional study done at a tertiary eye care centre in Hyderabad, between May to June 2021 and the study subjects were post COVID-19 patients with fungal invasion reporting to Government SD Eye Hospital and Government ENT Hospital Hyderabad, India. The patients were evaluated for associated co-morbidities, location of fungal infection, use of steroids, oxygen therapy usage and microbiologically identified the causative fungi. Descriptive analysis was done and data was presented as numbers and percentages were calculated. Results: Overall, 470 cases of post COVID-19 suspected fungal invasion cases were referred from the Ophthalmology and Ear, Nose, and Throat (ENT) Departments, of which 287 (61.06%) cases were culture positive for various fungal elements. Fusarium spp. was predominantly seen in 165 (57.49%) cases followed by Aspergillus spp. in 71 (24.74%) cases, Mucor was isolated in 42 (14.64%) cases and other fungi like Candida spp. were isolated in 5 (1.74%) cases and Bipolaris spp. was seen in 4 (1.39%) cases. Pre-existing Diabetes Mellitus (DM) was present in 233 (81.18%) cases, cases, corticosteroid intake for the treatment of COVID-19 was recorded in 203 (70.73%) cases and oxygen therapy was administered in 160 (55.74%) cases. Conclusion: As per the evaluation especially in post COVID-19 patients there seems to be a nexus between diabetes, imprudent use of steroids, decreased immune status, inappropriate use of oxygen therapy and invasion of fungi, therefore cautious and prudent use of the steroids and oxygen among the COVID-19 treatment protocol is advised.

Early Identification and Antimicrobial Susceptibility Testing of Short versus Standard Incubated Blood Cultures from a Tertiary Care Centre in Southern India

Kanne Padmaja, Sukanya Sudhaharan, Lakshmi Vemu, Vijay Dharma Teja
Introduction: Blood cultures play an important role in the early diagnosis of sepsis and its management. Early detection of pathogens in Blood Stream Infections (BSI) and their Antimicrobial Susceptibility Testing (AST) pattern, plays a vital role in the diagnosis of sepsis and is important for guidance of appropriate therapy. Aim: To evaluate the accuracy of shortly incubated blood cultures in comparison with standard method for an early Identification (ID) and AST. Materials and Methods: This was a prospective observational study undertaken from July 2015 to June 2016 at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. The blood cultures were loaded in the BacT/Alert system. A total of 92 patients with two sets of blood cultures that flagged positive within 24 hours of collection were included in the study. Grams stain and subcultures of the broths were done. The culture plates were examined after four hours and then at hourly intervals for the presence of growth. Once the growth was sufficient it was processed immediately for ID and AST by Vitek 2C. Incubation of the plates was continued for the rest of the 24 hours at 37^oC and was processed again. The mean time for detection were compared between short and standard cultures. Results: Gram negative pathogens were the predominant organisms isolated in 82/92 (89.1%) followed by gram positive in 10/92 (10.9%). The short and standard cultures had comparable results with respect to ID of the isolates. But, the AST results were comparable only in 88/92 (95.6%) patients. Of the remaining four patients, the AST showed Very Major Error (VME) in 3 (3.3%) patients and Major Error (ME) in 1 (1.08%) patient. Conclusion: Short incubation of cultures enabled earliest ID and AST of the isolates from blood cultures than standard incubation.

Impact of School-based Online Oral Health Education Programme during COVID-19 Pandemic: A Cross-sectional Study in Riyadh, Saudi Arabia

Rabaa Mahmoud Aboubakr, Abrar Tounsi
Introduction: Oral Health (OH) is essential to general health and quality of life. It is affected by the individual’s experiences and perceptions. Aim: To evaluate the effect of online Oral Health Education (OHE) programme on OH knowledge level on school students in Riyadh, Saudi Arabia. Materials and Methods: This cross-sectional study was conducted virtually on school students in Riyadh city, Saudi Arabia, between February 2021 and May 2021. The sample was based on non probability convenience sampling technique in which 489 students participated in the study. The electronic survey consisted of questions about demographics, school characteristics, and OH knowledge. Online OHE was conducted by dental students of Vision colleges via Zoom and Microsoft teams. Collected data were analysed using using IBM, Statistical Package for the Social Sciences (SPSS) version 20.0, IL, USA. Comparison of differences in the mean knowledge scores across different variables was done using Independent t-test for two means and one-way Analysis of Variance (ANOVA) for more than two means. Linear regression analysis was used to analyse the association between knowledge and other variables in a multivariate environment, and presented by β coefficients and 95% Confidence Interval (95% CI). Significance level was set at p-value <0.05. Results: Online education had significantly increased the level of knowledge about OH compared to no education (β: 0.46, 95% CI: 0.01, 0.89, p-value=0.04). Students in public schools had significantly higher level of knowledge about OH compared to private schools (β: 0.60, 95% CI: 0.10, 1.11, p-value=0.02). Compared to ‘1st to 3rd grade’, students in ‘middle to high grades’ had significantly lower knowledge about OH (β:-1.17, 95% CI:-1.87,-0.47, p-value=0.001). Conclusion: It was concluded that the online health education programme increased the OH knowledge of school students. Students in public schools had higher level about OH compared to private schools’ students. Additionally, primary schools’ children had higher knowledge than middle and higher schools’ children.

Blood Lactate Levels and PRISM III Scores for Prognosis of Shock during Paediatric Emergencies: A Prospective Observational Cross-sectional Study

S Sri Raksha, J Krishnappa, KN Shashidhar
Introduction: The appropriate management of shock in paediatrics includes early recognition of tissue hypoxia and its timely intervention thus preventing shift to anaerobic metabolism, metabolic acidosis and cell death. Aim: To determine the effectiveness of blood lactate levels as a prognostic indicator of mortality in children with shock admitted to Paediatric Intensive Care Unit (PICU) and to correlate between blood lactate levels and Paediatric Risk of Mortality III (PRISM III) scores. Materials and Methods: This was a prospective observational cross-sectional study conducted between January 2018 to May 2019 in the PICU of a tertiary care centre in rural India. A total of 144 children presenting with shock to PICU were included in the study. The serum lactate values were assessed at 0, 12 and 24 hours of admission. The various parameters of PRISM III scores was documented for each child at 0, 12 and 24 hours of admission and score was calculated. Lactate levels and PRISM III score were analysed using the Receiver Operating Characteristic (ROC) curve and optimal cut-off points were chosen for the calculation of sensitivity, specificity, positive and negative predictive values. An area under the ROC curve above 0.8 indicated fairly good prediction. Results: The most common aetiologies for shock in the present study included severe sepsis (42.3%), acute gastroenteritis (21.5%) and dengue fever (21.5%). Persistent hyperlactatemia was observed in non survivors and serum lactate values persistently greater than 4 mmol/L within the first 24 hours of admission were associated with greater risk of mortality. The area under the ROC curve for the serum lactate levels (0.958) suggested that, it was a strong predictor of mortality in study subjects when compared to PRISM III score which had area under the ROC curve 0.866. Conclusion: Serum lactate values are an early useful predictor of mortality in children with shock and it is more feasible indicator when compared to PRISM III scores.

Anticarcinogenic Efficacy of Fucoxanthin on HepG2 Cell Lines

P Sangavi, K Langeswaran, S Gowtham Kumar
Introduction: Hepatocellular Carcinoma (HCC) is considered one of the deadliest cancers which grow rapidly worldwide. Fucoxanthin can be acquired from edible brown seaweeds, reported that fucoxanthin has numerous physiological functions and biological abilities, and various medicinal properties. Aim: To evaluate the anticarcinogenic efficiency of fucoxanthin against the Human Hepatoma Cell Line (HepG2). Materials and Methods: This in-vitro examination and research was carried from June 2018 to August 2018, at Alagappa University, Karaikudi, Tamil Nadu, India. Fucoxanthin at different concentrations was taken to demonstrate its antiproliferative potential and its cytotoxic effect. In this present examination, based on the outcome of the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay, 80 μM and 100 μM were chosen for further in-vitro studies. It was noted that remarkable leakage of Lactate Dehydrogenase (LDH) and a noteworthy decrease in the Glutathione (GSH) content of 80μ M and 100μM of fucoxanthin treated HepG2 cells. Under light and fluorescence microscopic examination, there was a significant reduction in cell growth and cell proliferation in the fucoxanthin-treated HepG2 cells. Data were presented as the mean±standard deviation. The one-way analysis of variance (ANOVA) and Tukey’s multiple comparison method were used to find the level of significance. Results: The human HepG2 to be studied and analysed were divided into group I: control group; group II: comprising those cells treated with fucoxanthin in concentration of 80 μM; group III: comprising those cells treated with fucoxanthine in concentration of 100 μM. The results of the MTT assay put forward that fucoxanthin has the cytotoxic and antiproliferative potential against HepG2 further fucoxanthin significantly alter the marker enzymes level (p-value <0.05). The therapeutic efficiency of fucoxanthin might be due to the antioxidant effect of the bioactive compound. In this present investigation, the results of in-vitro studies, fucoxanthin strongly put forward that it has potential anticarcinogenic efficacy against the hepatic tumour (p-value <0.05). Conclusion: The results of this analysis undoubtedly symbolise that fucoxanthin has antioxidant activity and anticarcinogenic efficacy against primary liver cancer HCC. Due to their therapeutic efficacy, may be considered as an excellent candidate against HCC.

Muscle Strength in Type-2 Diabetes Mellitus and its Relationship with Biochemical Parameters and Microvascular Complications
Introduction: Sensory symptoms and deficits are frequently observed in diabetic polyneuropathy, but motor deficits are more difficult to recognise or often neglected. As a part of a rehabilitation team, we observed altered muscle strength in Type-2 Diabetes Mellitus (T2DM) in relation to neuropathy. Weakness in muscles in DM has significant effects on patient's daily living activities. Aim: To find the relationship of muscle strength in diabetes subjects characterised by microvascular complications (retinopathy, nephropathy and peripheral neuropathy associated) and biochemical measurements. Materials and Methods: The present observational study was conducted at the Department of Orthopaedics, Srinivas Institute of Medical Sciences, Mangaluru, Karnataka, India for a period of nine months from February 2020 to November 2020. Study included 72 patients divided into T2DM subjects (n=36) and non diabetic controls (n=36) with age <75 years, with a diabetic history ≥5 years. By using standard laboratory methods, biochemical measurements were taken, which included Fasting Blood Sugar (FBS) level, Glycated Haemoglobin (HbA1c), serum creatine, serum insulin, C-peptide and albumin excretion rate. The retinal status of the diabetic subjects were classified as normal, non proliferative and proliferative retinopathy, renal status classified as incipient and overt nephropathy and neuropathy as asymptomatic and symptomatic by ophthalmologist, nephrologist and neurologist respectively. Muscle strength of the upper extremities and lower extremities were measured by using hand-held dynamometer (Baseline® LiTE®). Results: Out of total 72 subjects, the mean age of diabetic and non diabetic group was 55.69±5.50 years and 55.91±5.21 years, respectively. In diabetic subjects, the median value of serum creatine was 1.04 mg/dL , FBS was 171 mg/dL, HbA1c was 9.1%,serum insulin was 24.62 mU/L, C-peptide was 1.13 ng/mL and albumin excretion rate was 57.6 mg/24 hours. Approximately, 10.5% reduction was observed at ankle dorsiflexion and plantar flexion of both sides, 7% reduction of knee extension (both side), and right knee flexion, whereas, the left knee shows a marked 10.81% reduction in muscle strength. Conclusion: Type-2 diabetes subjects have weakness of extensors and flexors of the upper and lower extremity (shoulder and hip strength not assessed in this study) with predominant reduction of muscle strength in the lower limbs.

Implementing a Fever Clinic for Managing COVID-19 Patients using Hydroxychloroquine Protocol- An Experience from a Primary Healthcare Centre in Riyadh, Saudi Arabia
Introduction: During the initial weeks of the COVID-19 pandemic, there was limited information and evidence about therapeutic interventions for management of COVID-19 infections. Consequently, fever clinics were established in Saudi Arabia to provide supportive treatment for all COVID-19 patients as specialised clinics. During the early months of 2020, Hydroxychloroquine (HCQ) was being used as part of the Saudi Ministry of Health (MoH) protocol for management of COVID-19 infections. Aim: To report the experience with implementing fever clinic utilising the HCQ-based protocol for adults with mild and moderate symptoms of COVID-19, and provide further evidence regarding the efficacy and safety of HCQ. Materials and Methods: A prospective observational study was conducted in one of the primary healthcare centres in Saudi Arabia. All patients with suspected or confirmed COVID-19 who visited the fever clinic and met the eligibility criteria of starting HCQ based protocol were included in the study. Beside supportive treatment, the intervention dose of HCQ was 400 mg twice a day for one day followed by 200 mg twice a day for another four days. Statistical Package for Social Sciences (SPSS) version 22 was used for data analyses. Results: A total of 108 patients with mean age of 36 years with Standard Deviation (SD) of 9.3 were included in the study. The mean Body Mass Index (BMI) was 27.1 (SD 4.9). In addition, 73.1% of the patients were males and 25% were smokers. The study findings showed that the fever clinic was effective in managing the symptoms of COVID-19 and treating the patients regardless of the use or completion of HCQ. In particular, on day 6, cough improved in >85% of the patients and fever was resolved in >83% of patients. However, there were no statistically significant differences among the patients who received/completed HCQ and those who did not start or complete the protocol in terms of negative conversion based on the Nasopharyngeal (NP) swab real time Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) by day 14, and resolution/improvement of symptoms on day 6 (p>0.05). Conclusion: This study documented the experience of implementing a fever clinic to manage the suspected and confirmed COVID-19 patients with mild to moderate symptoms during the initial phase of the pandemic in Saudi Arabia. The study findings revealed that the concept of fever clinics was useful for managing suspected and confirmed cases. At the same time, there were no additional benefits of HCQ compared to the supportive treatment in this study.

Efficacy of Kinesio Taping among Females with Postpartum Low Back Pain- A Quasi-experimental Study

Priyanka Rishi, Joginder Yadav, Pooja Anand, Bindoo Yadav
Introduction: Low Back Pain (LBP) is considered to be the most salient feature during the postpartum period. The incidence of postpartum symptoms peculiarly back pain varies from women to women with vanishing of symptoms in over 60% in two days postpartum to as high as 82% at 18 months. Aim: To explore the efficacy of kinesio tape on pain and Inter-Recti Distance (IRD) in women with Postpartum LBP. Materials and Methods: A quasi-experimental study was conducted at SGT Medical Hospital and Research Institute, Gurugram, Haryana, India in Physiotherapy Outpatient Department (OPD) and Obstetrics and Gynaecology OPD of SGT Hospital. The data was collected from July 2019 to August 2020. Participants were randomly assigned to either the experimental group (group A) or control group (group B). Group A that performed combined kinesio taping along with exercises and hot pack five times/week for six week and group B that followed conventional treatment that included exercises and hot pack. Pain and IRD was measured and analysed using Independent t-test at the baseline, end of 3^rd week and at the end of 6^th week. Independent t-test was used to compare the demographic characteristics as well as baseline criterion measures between both the groups. Results: Significant improvement in pain scores (mean value of 13.75 at baseline to 3.75 at end of 6^th week ) and IRD scores (mean value of 28.37 at baseline to 27.38 at last day of 6^th week) were observed in group A that received kinesio taping along with conventional treatment in comparison to group B. Conclusion: Group A showed significant improvement in IRD and pain parameters indicating improvement in LBP in postpartum women. Therefore, kinesio taping in combination with exercises may be incorporated in the management programs of the women suffering from postpartum LBP.

Role of Platelet Rich Plasma in the Management of Plantar Fasciitis: A Prospective Interventional Study

Sridevi Bezwada, Tarun Khare, Bhuvanamha Devi Ramamurthy, S Devisriprasad
Introduction: Plantar Fasciitis (PF) is one of the most common chronic degenerative foot condition associated with pain in the bottom of the foot (enthesopathy), encountered by an orthopaedic practitioner. Various treatment options have been implicated and it has been frustrating problem for both patients and treating doctors. Very limited studies are available showing the variable effects of Platelet Rich Plasma (PRP), the autologous conditioned plasma, in human tissues. Aim: To determine the role of PRP in the management of patients with PF. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics in collaboration with blood bank in SRM Medical College and Hospital, Potheri, Chengalpet district, Tamil Nadu, India, between November 2017 to April 2019. In this study, 70 patients with PF were treated with single dose of local injection of 3 mL autologous PRP. These patients were assessed for pain relief using the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM). In addition ultrasonographic evaluation of thickness of plantar fascia was done six months after treatment. The statistical analysis of each clinical outcomes was analysed individually, using Statistical Package for the Social Sciences (SPSS) version 22.0. Statistical significance was done with student’s t-test and p-value <0.05 was considered statistically significant. Results: The mean age of the patients in this study was 38.8±4 years. There were 39 (55.7%) female and 31 (44.3%) male patients in the study. The mean symptom duration from the approximate onset of symptom to the study enrollment was 7±2.3 months. The statistically significant reduction in VAS score from the baseline and reduction in thickness of plantar fascia was observed in the study. FAAM score also gradually improved from mean 32.05±8.20 at baseline to 60.97±8.94 after 24 weeks with mean difference of 28.92. Conclusion: The present study observed that PRP is potentially effective and safe treatment option for long term relief of PF.

MRI Study of Lumbar Canal Stenosis by Morphological Grading and Thecal Sac Measurement: A Cross-sectional Study
Introduction: Lumbar Spinal Stenosis (LSS) is a condition in which the spinal canal narrows to the point at which it can exert pressure on the nerves that travel through the spine. Aetiology is categorised into congenital, developmental and acquired (degenerative) causes. Magnetic Resonance Imaging (MRI) is an investigation of choice in the evaluation of patients with symptoms related to lumbar central canal stenosis. Aim: To assess the morphologically grade of thecal sac in lumbar central canal stenosis on MRI. Materials and Methods: This cross-sectional observational study was conducted from November 2017 to October 2019 at Department of Radiology of Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India. Study included 100 patients who were referred with symptoms of lumbar stenosis and outcome was to determine the correlation between the morphological grade and thecal sac axial anteroposterior diameter grade. Correlation was assessed by Fisher’s-exact test and Spearman’s rank correlation coefficient test. A p-value <0.0001 was considered highly significant. Results: Morphological Grade II corresponded to maximum number of cases, amounting to 46% with mean anteroposterior thecal sac diameter of 6.21 mm, followed by 36% of Grade III with mean thecal sac diameter of 4.57 mm. Grade I corresponded to 14% of cases mean thecal sac diameter of 8.35 mm and Grade IV corresponded to 4% of cases with mean thecal sac diameter of 1.1 mm. A significant correlation was obtained (r=0.78) in this study between the morphological grade and thecal sac measurement. Conclusion: Morphological grade of the thecal sac has significant correlation with the canal measurements and it helps in quick assessment of the severity of the lumbar canal stenosis.

Expression of PDL-1 Receptors in Prostate Cancer Patients and its Association with Tumour Aggressiveness: A Cross-sectional Study
Introduction: Prostate cancers are infiltrated with Programmed Death-1 (PD-1) expressing Cluster of Differentiation (CD)8+ T-cells which interact with Programmed cell Death Ligand-1 (PDL-1) receptors on Tumour Cells (TC). However, in many studies, male with prostate cancer did not respond to monotherapy (PDL blockade). This unresponsiveness could be due to the fact that prostate cancer usually does not express PDL-1. The PDL-1 expression has demonstrated a significant correlation with increased risk of disease progression in various tumours but data regarding its role in prostate cancer is conflicting. Aim: To study the occurrence rate of PDL-1 expression and its association with tumour aggressiveness in prostate cancer. Materials and Methods: This cross-sectional observational study was conducted at ABVIMS and Dr. Ram Manohar Hospital, New Delhi, India, from October 1st, 2018 to April 30th, 2020. A total of 120 males with prostate cancer who had their diagnosis established by a prostate biopsy were included. Histopathology reports were analysed and PDL-1 immunohistochemical staining was carried out with PDL-1 monoclonal antibodies. PDL-1 expression on TCs was defined by the percentage of PDL-1 positive TCs (<1%=0 or negative, 1 to 5%=+1, ≥5%=+2). The relationship between PDL-1 expression in prostate cancer cells and clinicopathological factors like Gleason grade, lymph node positivity, perineural invasion, lymphovascular invasion, distant metastasis and Prostate Specific Antigen (PSA) level was investigated using univariate tests and multivariate logistic regression analyses. Results: Overall, high PDL-1 expression was observed in 21.7% of patients. PDL-1 positivity 1+ and 2+ was found among 11.67% and 10% cases, respectively. Significantly higher expression (p-value <0.05) of PDL-1 was noted in cases with higher preoperative PSA levels (>40), high Gleason score (≥7), distant metastasis and cases with lymphovascular invasion. Conclusion: Present study suggests that PDL-1 is associated with the tumour aggressiveness in prostate cancer patients and can be used for the identification of more aggressive diseases.

Sperm DNA Fragmentation Index in Infertility Patients vs Normal Individuals: A Cross-sectional Study

Manisha B Sinha, Nighat Hussain, Sarita Agrawal
Introduction: Infertility is a major problem among married couples. The male factor contributes to around 30-40% of all cases of infertility. With advancing age, reducing sperm count may magnify the problem. The awareness of qualitative change along with quantity is important for people seeking advice in infertility. Aim: To find the prevalence of sperm Deoxyribonucleic Acid (DNA) fragmentation with Sperm Chromatin Dispersion (SCD) test. Materials and Methods: The present study was prospective cross-sectional study which was carried out on semen sample given for routine check-up in department during the period from August 2017 to August 2018. A total of 180 couples, including 88 infertile couples and 92 couples with known fertility were enrolled in the study. Sperm Count and sperm DNA Fragmentation Index (DFI) were calculated and determined by SCD test by kit method. Comparison between groups was done according to distribution of data using Mann-Whitney rank-sum (two tailed) statistical test. Results: Among 180 subjects, (88 cases and 92 control) no significant difference in the age was found. The sperm count was not significantly different in cases (group of men of infertile couple) and controls (group of men of proven fertility). The highest value for DFI was 27% in controls and 97% in cases. Statistically significant difference was found in DFI (p=0.008) in both groups. DFI and sperm count showed negative correlation both in cases and controls with a correlation coefficient 0.213 (p-value <0.001) and 0.754 (p-value <0.005) respectively. A significant difference was observed in the median value of sperm DFI of men of infertile couple as compared to men of fertile couple. Conclusion: On comparing, significant difference was observed in the median value of sperm DFI in infertile couple. Sperm DFI at cut-off value 27% has higher diagnostic significance. SCD method is simple, easiest and standard tool to assess DFI.

Effect of Perioperative Music Therapy/Medicine on Postoperative Pain in Women Undergoing Elective Lower Segment Caesarean Section Delivery under Spinal Anaesthesia: A Case-control Study

Abhishek Halder, Ashok Kumar, Uma Hariharan, Bangali Manjhi

Anxiety and Coping Strategies among Medical Students during COVID-19 Pandemic: A Cross-sectional Study

C Ruth EstherTaruni Reddy, Kranti Tekulapally
Introduction: Coronavirus Diseaese 2019 (COVID-19) pandemic has impacted the mental health of medical students due to multiple factors like the fear of getting infected, the stress of maintaining the preventive measures, the demands of the online classes, and the uncertainty of the future. Aim: To assess the anxiety levels of the medical students and strategies, they used to cope up with the anxiety during the pandemic. Materials and Methods: A cross-sectional study was carried out among all the first and final year MBBS students of a Women’s Medical College and Teaching Hospital in Hyderabad, Telangana, India. The questionnaire contained a total of 25 questions- three questions to collect the demographic data, a 7-item Generalised Anxiety Disorder Scale (GAD), and 15 questions assessing their coping strategies; was distributed to all the study participants as a Google form. Data from completed questionnaires were entered into an excel sheet and analysed using Jamovi software version 1.6.23.0. Results: A total of 164 students completed the questionnaire of which, 59.1% were first year MBBS students and 40.8% final year MBBS students. Mean age of the participants were 19.4 years among the first year MBBS students, and 21.7 years among the final year MBBS students. Majority of the participants had mild anxiety (43.2%). There was no statistically significant difference in the anxiety levels of the first year MBBS and final year MBBS students. The most commonly used coping strategy factor was putting trust in the God (59.7% of first year MBBS, and 62.6% of final year MBBS) while the least commonly used coping strategy was substance abuse-use of alcohol or drugs to feel better (0 among first year MBBS and 2.9% among the final year MBBS). There was statistically significant association between one of the coping strategy and anxiety-I can adjust to the situation and deal with the changes and anxiety levels (p-value=0.010). Conclusion: COVID-19 pandemic has impacted the mental health of medical students by causing anxiety. There is a need to mitigate these negative effects by introducing supportive programs in the form of educational programs, yoga and meditation to relieve anxiety and maintain mental health of medical students.

Learning Motivation and Self-efficacy towards Improved Clinical Performance in Undergraduate Nursing Students: A Cross-sectional Study

Ghareeb Bahari , Kholoud N Alharbi , Latifah Alenazi
Introduction: Learning motivation promotes academic achievement, satisfaction and education of students. Self-efficacy helps students overcome challenges associated with clinical nursing education. A gap remains in the literature related to learning motivation and selfefficacy in undergraduate nursing programs. Aim: The purpose of this study was to examine the relationship between learning motivation and self-efficacy among undergraduate nursing students. Materials and Methods: A cross-sectional, descriptive study was conducted on undergraduate nursing students from a public university in Saudi Arabia from February 2021 to April 2021. The Science Motivation Questionnaire II (SMQ-II) to assess motivation and General Self-Efficacy (GSE) scale to assess selfefficacy were used for data collection. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 26.0, bivariate analyses were used where needed and multiple linear regression analysis was conducted to examine the relationship between motivation levels and self-efficacy while controlling for demographic variables. Results: A total of 110 undergraduate nursing students participated in the study. Most of the sample reported a slightly high level of both learning motivation with a mean of 75.5, range: 8-100 and selfefficacy with a mean of 29.3, range: 1-40. None of the demographic variables were significantly associated with either learning motivation or self-efficacy (p-value >0.05). Learning motivation was found to have a strong, positive and significant correlation (r-value=0.663, p-value <0.001) with self-efficacy. In regression, learning motivation was the only variable significantly associated with self-efficacy (β=0.655, p-value <0.05). Conclusion: The findings demonstrated that motivation is critical in explaining attitudes, predicting consequences of actions, and directing behaviour to fulfill the goals of clinical courses. Selfefficacy is another important factor in student nurses’ progress.

Biochemical and Haemodynamic Changes during Transurethral Resection of Prostate and Percutaneous Lithotripsy- An Observational Pilot Study

Nandita Adlakha, Sujata Chaudhary, Prashant Kumar, Sharmila Ahuja, RL Tripathi
Introduction: Fluid absorption and associated electrolyte derangement is an inevitable complication of Transuretheral Resection of Prostate (TURP) and Percutaneous Lithotripsy (PCNL) irrigation during transurethral resection of prostrate and PCNL. Aim: to analyse changes in serum electrolytes, Lactate Dehydrogenase (LDH) and acid base status, and to evaluate their role as early predictors of clinical and haemodynamic changes following continuous irrigation during transurethral resection of prostrate and PCNL. Materials and Methods: The present observational study was conducted on 20 patients, who underwent TURP and 20 patients who underwent PCNL. A 1.5% glycine and 0.9% normal saline were used for irrigation during TURP and PCNL, respectively. The levels of serum sodium, potassium, free calcium ion, LDH and acid base status were monitored in all patients preoperatively, intraoperatively, at the end of surgery, 6 hours and 24 hours postoperatively. Intraoperative and postoperative haemodynamic parameters were also studied. Results were expressed in the form of mean and standard deviation. A p-value <0.05 considered significant. Results: In TURP group, statistically significant changes were seen in serum sodium, potassium, LDH and free calcium ions. There was no change in acid base status of patients. In PCNL group, statistically significant changes were seen in serum sodium, LDH, free calcium ion and acid base status. It was observed that some of these changes persisted even 24 hours, postoperatively. However, despite the above changes, the haemodynamic parameters remained within normal limits. Conclusion: Changes in serum sodium, serum potassium and free calcium ion during TURP and PCNL were consistent findings which implies fluid absorption. These changes persist upto 24 hours postoperatively. The monitoring of these parameters in postoperative period should be continued especially in patients suspected to develop or having TURP syndrome.

Bacteriological Profile of Sepsis among Low Birth Weight Neonates: A Hospital-based Cross-sectional Study from Northern India

Neeraj Singh, Rupa R Singh, Baljeet Maini, Bablu Kumar Gaur
Introduction: Septicaemia in neonates is characterised by the generalised bacteriological infection which is characterised with a blood culture positivity after 28 days of birth along with clinical presentation of systemic infection. It is one of the common causes of death among Low Birth Weight (LBW) neonates. Incidence of sepsis varies based on different variables, such as hospitals, obstetric and nursing procedures, gender, period of gestation, weight of the baby at birth, place of delivery status, mother’s health and nutrition and perinatal care. Aim: To know the bacteriological profile and antibiotic susceptibility patterns of organisms causing sepsis in LBW neonates. Materials and Methods: This cross-sectional hospital-based observational study was conducted in tertiary care hospital, Moradabad, Western Uttar Pradesh, India. LBW newborns (Birth weight <2.5 kg) hospitalised in the Neonatal Intensive Care Unit (NICU) over a period of one year from June 2019 to May 2020 with a diagnosis of clinical sepsis were enrolled. Relevant investigations and treatment were started as per our NICU protocol. Data was entered sequentially in Microsoft Excel spreadsheet and analysed in Statistical Package for the Social Sciences (SPSS) (version 20.0) using Chi-square test. Results: During the study period, total 145 LBW neonates were admitted in NICU. Out of whom, 83 neonates were admitted with clinical sepsis. A 87.9% of LBW neonates were preterm. Blood culture reports were positive in 30 (36.2%) LBW neonates. In culture proven sepsis, 20 (67%) neonates had early onset neonatal sepsis and 10 (33%) had late onset neonatal sepsis. In culture proven early onset neonatal sepsis, 13 (65%) LBW neonates had gram negative sepsis and 7 (35%) had gram positive sepsis. The most frequently isolated organisms were Acinetobacter baumannii (23.3%) and Klebsiella pneumoniae-(16.7%). These organism were resistance to cefotaxime, ampicillin, amikacin and ciprofloxacin. Conclusion: Acinetobacter sepsis in LBW neonates is surging rapidly and is associated with high degree of Antimicrobial Resistance (AMR). Therefore, knowledge and awareness of multidrug resistant organism causing sepsis in LBW neonates and their latest antimicrobial sensitivity pattern is essential to choose most appropriate antibiotics.

Elucidation of Histological Features of Pericardium in Cases Clinically Presented as Constrictive Pericarditis: A Retrospective Observational Study

Chayanika Kala, Ashutosh Bajpai, Lubna Khan, Vinay Krishna, Rakesh Kumar Verma
Introduction: Constrictive Pericarditis (CP) is an uncommon but important disease characterised by impaired diastolic ventricular filling and impaired ventricular ejection as a result of thickened, fibrosed and often calcified pericardium. Aim: To analyse histomorphological features of pericardial biopsy removed in patients with clinical and radiological features of constriction. Materials and Methods: The present study was a retrospective observational study conducted at LPS Institute of Cardiology and Cardiothoracic Vascular Surgery and Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India. A total of 108 patients with CP were studied between a time period of January 2008 to June 2019. Clinical, demographic, laboratory and operative data of patients were retrieved from record section of mentioned departments and analysed. On histology the following parameter, if present, were recorded: inflammation and its type, granulation tissue, fibrosis, extracellular collagen deposition, granuloma, haemosiderin deposition, mesothelial hyperplasia, capillary proliferation, and calcification. Data was analysed using Microsoft Office Excel spread sheet. Results: Out of 108 cases, 98 cases (90.7%) had increased pericardial thickness and 10 cases (9.2%) had normal pericardial thickness, despite clinical and echocardiographic features of restriction. In majority of cases (96 cases, 88.9%), inflammation was of chronic type and only in 8 cases (7.4%), it was of acute nature. Tubercular pericarditis was the major cause in 46 cases (42.6%) followed by chronic non specific idiopathic in 39 cases (36.1%). Conclusion: The current study evaluated the histological features of CP in a semiquantitative grade manner thus helping clinician and pathologists to guide for other ancillary testing and thus guide toward accurate diagnosis. The current study evaluated the histological features of CP in a semiquantitative grade manner thus helping pathologists to guide for other ancillary testing and thus guide toward accurate diagnosis.

In-vitro Evaluation of Antimicrobial Activity of Nargenicin-A1 against Gram Positive Clinical Isolates and its Comparison with Various Antibiotics

Sheetal Gouda, Basavaraj V Peerapur, Abdul K Bahadur, Venkatesh R Naik
Introduction: The development of Multidrug Resistance (MDR) is a serious health problem, which demands the quest and development of many antibacterial agents. The class Actinomycetes represents best source for many antimicrobial agents. The present focus on Actinomycetes has yielded many antimicrobial agents including Nargenicin-A1. The Nargenicin-A1 belonging to class macrolides was found to have strong antibacterial activity against Staphylococcus and Streptococcus. Aim: To determine the Minimum Inhibitory Concentration (MIC) of Nargenicin-A1 against clinically isolated aerobic gram positive bacteria and comparing its antimicrobial activities with various antibiotics. Materials and Methods: A prospective, hospital-based, observational study was conducted at the Department of Microbiology, Raichur Institute of Medical Sciences, Raichur, Karnataka, India, from August 2015 to July 2016. All the clinical samples like pus, sputum, urine, ear swabs, wound swabs and body fluids received for culture and sensitivity testing at the Department of Microbiology during the study period was included. The antimicrobial activity was determined by measuring the MIC of Nargenicin-A1 by broth dilution method following standard procedure and the mean MIC was calculated. Pearson’s coefficient of correlation was calculated to find out correlation between MIC of Nargenicin-A1 and MIC of various antibiotics effective against gram positive bacteria. Results: The most common isolate was Staphylococcus followed by Enterococcus and Streptococcus. The least mean MIC of Nargenicin-A1 was observed for Streptococcus (0.017 μg/mL) followed by S. aureus (3.97 μg/mL), and the highest mean MIC value was recorded for Enterococcus (27.34 μg/mL). Among Staphylococcus aureus, the mean MIC value of Nargenicin-A1 for Methicillin Sensitive Staphylococcus aureus (MSSA), Methicillin Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Staphylococcus aureus (VRSA) was 0.06 μg/mL, 0.12 μg/mL and 25 μg/mL, respectively. When compared Nargenicin-A1 with various antibiotics in terms of their MICs, the activity of Nargenicin-A1 was in close proximity to that of vancomycin and linezolid against MSSA, MRSA, and Enterococci and marginally with linezolid against VRSA. Conclusion: Nargenicin-A1 exhibits strong antibacterial property against a broad spectrum of aerobic gram positive bacteria, including VRSA. The study revealed that Nargenicin-A1 can be considered as a potential alternative against MDR gram positive bacteria.

Seroprevalence of IgG Antibodies against Rubella in Young Females in a Medical College in Chennai, India

KJ Nandhini, Anandhi Lakshmanan, Manisha S Mane, MP Saraswathy
Introduction: Rubella being a mild infection, rarely causes any complications in childhood, will cause adverse effects during pregnancy ranging from miscarriage to a child born with congenital rubella syndrome. Females of reproductive age group must be immune to rubella to prevent infection during pregnancy. Medical students and healthcare workers should have sufficient immunity to rubella as there are increased chances of them getting exposed to the infection. To estimate the immune status against rubella, measurement of Immunoglobulin G (IgG) antibody titre will be helpful. Aim: To detect the level of IgG antibodies specific to rubella in the sera of young female students in a Medical College in Chennai, Tamil Nadu, India and to determine the proportion of anti-rubella IgG seropositivity. Materials and Methods: A cross-sectional study was conducted at ESIC Medical College and PGIMSR, KK Nagar, Chennai, Tamil Nadu, India, from July 2019 to August 2019. A total of 90 female students of the age group 19-26 years were selected by random sampling method. After obtaining informed consent, their blood samples were collected. The IgG antibody titre in the serum was estimated by indirect Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: Based on the test results, 62 (68.9%) were immune, 25 (27.8%) were not immune, and 3 (3.3%) had indeterminate results. No association was found between the age of the participants and their immune status. Conclusion: Through the present study, it can be concluded that there was a low level of seropositivity of protective rubella antibodies among females, particularly the medical students who were the study population.

Protective Role of Vitamin C against Biochemical Enzymes Alterations Induced by Exposure of Allethrin-based Mosquito Coil Smoke on Cerebellum of Male Albino Rats-An Experimental Study

Ranjana Sachan, Arvind Kumar Pankaj, Anita Rani, Swati Yadav
Introduction: Among synthetic pyrethroids, allethrin is widely used as active ingredient in mosquito coils. Many experimental studies have proved that pyrethroids cause neurotoxicity and results into derangements of biochemical enzymes including oxidative stress markers and antioxidant levels in brain. Aim: To study alterations in biochemical markers (oxidative and antioxidant enzymes) in cerebellum of male albino Wistar rats induced by the exposure of allethrin-based mosquito coil smoke along with protective role of withdrawal and exogenously administered vitamin C on these markers. Materials and Methods: This experimental study was conducted in the Department of Anatomy, King George’s Medical University, Lucknow, Uttar Pradesh, India, during October 2014-September 2015. Total 42 male albino Wistar rats were divided into four groups. The first group contained 12 rats was used as control, group II with 12 rats was given 8 hours daily exposure of allethrin-based mosquito coil smoke via whole body inhalation for 6 days in a week for a total of 12 weeks. Group III contained eight rats and was given exposure same as group II and were further kept for 8 weeks to see the withdrawal effect. Group IV with 10 rats was given same exposure as group II, along with oral administration of 20 mg/kg body weight vitamin C. After 12 weeks of exposure, cerebellum was dissected and then sent for biochemical enzyme estimation. Rats in group III were dissected after 8 weeks post 12 weeks of exposure. Comparisons were made between groups by using one way Analysis of Variance (ANOVA). Results: The exposure Group II showed significant rise (p<0.001) in level of oxidative stress marker enzyme Malondialdehyde (MDA) and significant (p<0.001) reduction in activities of antioxidants Glutathione Peroxidase (GPO), reduced Glutathione (GSH), Superoxide Dismutase (SOD) and Catalase (CAT) in comparison to Group I, III and IV. In vitamin C administered group IV the above parameters were found to be less affected. Intergroup comparison of oxidative stress markers level showed significant intergroup difference between group I, II, group II, III and group II, IV. Conclusion: Allethrin-based mosquito coil smoke causes oxidative stress in cerebellum of albino Wistar rats and vitamin C has ameliorative effect on biochemical alterations induced by sub-chronic whole body exposure of mosquito coil smoke.

Comparative Evaluation of Passive Tactile Sensibility Associated with Osseointegrated Implants in Various Regions of Partially Edentulous Arch- A Prospective Cohort Study
Introduction: The extremely sensitive tactile sensors periodontal mechanoreceptors play a key role in sensory innervation of teeth. The oral kinaesthetic perceptual abilities in the absence of periodontal mechanoreceptive input can be achieved by osseointegrated prosthesis. Aim: To evaluate the passive tactile sensibility associated with osseointegrated dental implant in various regions of the maxillary and mandibular arch. Materials and Methods: A prospective cohort study was performed in SRM Dental College, Chennai, India between August 2013 to February 2015. Fifty patients who had single tooth replacement with functioning implants loaded six months before were included. A compressive force was applied along the long axis of the implant supported prosthesis using a push type force measuring gauge until the subject felt the first sensation of pressure and subsequently, it displayed the magnitude of force that provided the tactile sensation. The force measuring gauge used was Model: FG 5000 A form Lutron electronic enterprises co., ltd. The procedure was repeated thrice. The patient was guided to record the force perception on visual analogue scale with continuous force. The visual analogue scale has values 0-4 starting from no sensation, mild, moderate, intense and pain and the average force measured. The values of the force recorded were statistically analysed using the t-test, Statistical Package for the Social Sciences (SPSS) version 17.0 was used. The p-value of 0.05 was considered statistically significant. Results: The overall mean value of maxilla was 23.12 N and the standard deviation was ±2.88 N. The overall mean value of mandibular was 22.44 N and the standard deviation of ±2.06 N and there was no significant difference in the threshold for passive tactile perception between maxilla and mandible. Conclusion: The results showed that mandibular anterior teeth had least threshold for force applied than any other region of the mouth and the maxillary posterior had the highest threshold. The anterior region exhibited better passive tactile threshold measure when compared to posterior region.

Assessment of Awareness among Physicians Regarding Gingival Overgrowth Induced by Anticonvulsant, Calcium Channel Blocker, and Immunosuppressant Therapy
Introduction: Drug-Induced Gingival Overgrowth (DIGO) is caused due to prolonged use of anti convulsants, immunosuppressant, and calcium channel blockers given for non dental purpose. It affects the maintenance of oral hygiene and may cause speech, mastication, tooth eruption and aesthetic problems. General physicians can play a key role as they can inform the patient about gingival overgrowth as an adverse effect of these drugs. Aim: To evaluate the awareness regarding drug-induced gingival overgrowth and to know the impact of educational qualification on their awareness among physicians. Materials and Methods: This cross-sectional questionnaire survey was conducted from January 2019 to June 2019 in Latur district of Maharashtra, India. A total of 196 practicing physicians were approached with self-structured questionnaire and answers were collected in the presence of the investigator. Survey responses were divided into two groups based on educational qualification as group A: physicians educationally qualified to practice Allopathy, group B: physicians educationally qualified to practice alternative medicine (Ayurveda, Homeopathy etc.,). Comparison of responses for qualitative variables was carried among groups using Chi-square test with p-value set as p<0.05 significant. Results: Total 167 (85.20%) general physicians responded willingly and completed the questionnaire. A total of 129 participants were male and 38 were female with age ranging from 27 to 61 years. Among total 88.62%, 34.73%, 43.11% of the physicians knew about adverse effect of antiepileptic, antihypertensive, immunosuppressant drug as gingival overgrowth respectively. Around 50.89% physicians’ check the gingival status of their patients and 21.56% refer their patients to dental practitioners for signs and treatment of gingival overgrowth. Overall, 77.25% of participants said that surgical excision with drug substitution should be the line of treatment for these cases. Statistically significant difference was seen on comparative analysis of responses between group A and group B (p<0.05). Conclusion: The findings of the present study showed that even though physicians know about DIGO they were unable to mention the accountable drug. Only few of them check gingival status of patients taking these drugs during follow-up visits and refer such patients to dental practitioners. Although physicians qualified in Allopathy have more knowledge about these drugs, their approach towards this condition was somewhat similar to the physicians qualified in alternative medicine.

Knowledge and Perception of Pregnant Women regarding Excess Maternal Weight, Gestational Weight Gain and their Impact on Foetomaternal Outcomes: A Cross-sectional Study

Dalia Rafat, Modassar Sulaiman, Tabassum Nawab
Introduction: Well recognised associations exist between maternal obesity, Gestational Weight Gain (GWG) and adverse health outcomes for mothers and their babies. Studies regarding women’s knowledge of the risks of excess maternal weight and GWG are limited in both the populations assessed and also in their description of knowledge. Aim: To examine women’s perception of their own weight in pregnancy and to assess pregnant women’s knowledge of complications of obesity and excess GWG and ways to manage the appropriate GWG. Materials and Methods: A total of 216 pregnant women were recruited in this cross-sectional study from the antenatal clinic of Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India between May and June 2018. Data was collected using an interviewer administered prestructured and pretested questionnaire. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Mean age of study population was 25.02±4.6 years. Mean Body Mass Index (BMI) was 24.55±4.07 kg/m². Frequent misclassification of their own BMI and inappropriate estimation of GWG by pregnant women was found in the present study. Overweight and obese women were more prone to inaccurate self-classification as 68.7% of overweight women and 62.5% of obese women underestimated their weight. Women had optimum knowledge for complications of obesity (69.4%) to mothers but knowledge is poor regarding complications to babies (45.5%). Also, awareness is significantly lower in obese women as compared to normal weight women p<0.05. Conclusion: Notable deficiencies in the knowledge and perception of pregnant women regarding their weight, obesity, GWG and their impact on foetomaternal outcomes were found in the present study. Bridging this knowledge gap would be an important step towards improving short and long-term adverse maternal and perinatal outcomes.

Dihydrotestosterone- A Potential Biomarker of Hyperandrogenaemia in Polycystic Ovary Syndrome: A Case-control Study from North India

Hemant Kumar, Ashutosh Halder, Mona Sharma, Manish Jain, Amanpreet Kaur Kalsi
Introduction: Polycystic Ovary Syndrome (PCOS) is a complex reproductive disorder characterised by hyperandrogenism, ovulatory dysfunction and polycystic/enlarged ovary. Although clinical and/or biochemical hyperandrogenism is one of the major features of PCOS, biochemical hyperandrogenism in the form of high testosterone and/or Free Androgen Index (FAI) is rarely observed in the Asian Indians. Aim: To assess various androgens to determine best available biomarker of androgens in PCOS from North India. Materials and Methods: This case-control study was conducted in the Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India, between January 2016 to December 2019. During this period 137 female with PCOS and 49 female as control were included. Serum total testosterone (T), FAI, Dehydroepiandrosterone Sulphate (DHEAS), androstenedione and Dihydrotestosterone (DHT) were measured besides assessment of hirsutism using the Ferriman-Gallwey (FG) scale. Statistical differences were derived using Mann-Whitney U test, Receiver Operating Characteristic (ROC) curve analysis and Spearman’s correlation test. Results: There were 87 PCOS cases with phenotype A, 25 PCOS cases with phenotype B, 10 PCOS cases with phenotype C and 15 PCOS cases with phenotype D. The mean age was 23.7 years in the PCOS group and 26.2 years in the control group. The mean Body Mass Index (BMI) in the PCOS group was 25.23 kg/m2 and in the control was 22.6 kg/m2 . FG score of ≥9 was observed in 75.9% PCOS cases. High (mean+2SD) levels of T (≥0.51 ng/mL), FAI (≥2.55), DHEAS (≥309 ug/dL), androstenedione (≥2.2 ng/mL) and DHT (≥462 pg/mL) were observed in 35.29%, 56.25%, 14.18%, 18.62% and 61.38% cases, respectively. Mean DHT value was 584.27 pg/mL in study group whereas in control was 257.15 pg/mL (p-value <0.00001) and area under ROC curve was 0.895. Similarly, area under ROC curve was 0.86, 0.817, 0.721 and 0.63 for FAI, testosterone, DHEAS and androstenedione, respectively. Spearman’s correlation test of androgens with BMI, age and FG Score did not find any associations with DHT. Conclusion: Dihydrotestosterone (DHT) is best available biomarker and can be considered as diagnostic biomarker of hyperandrogenemia in PCOS women from North India.

Accuracy of Demirjian's, Willems, Nolla's and Modified Cameriere's Dental Age Estimation Methods in Young Western Indian Children- A Cross-sectional Study

Anshula Deshpande , Neha Pradhan ,Kinjal Patel
Introduction: In forensic odontology, Dental Age (DA) assessment has gained popularity, since it is less variable than other indices and is less impacted by environmental variables. One of the methods used in estimating dental development is radiological method which is most practical and reliable. Aim: To compare accuracy of Demirjian’s, Willems, Nolla’s and modified Cameriere’s DA estimation methods in young western Indian children. Materials and Methods: This cross-sectional observational study was conducted in the Department of Paediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep University, Vadodara, Gujarat, India, from May 2014 to May 2017. A total of 224 orthopantograms (OPGs) of children aged between 3-11 years having the anthropological roots in the western part of India, were analysed for the accuracy of the following age estimation methods: 1) Demirjian’s; 2) Willems; 3) Nolla’s; and 4) Modified Cameriere’s method in various age group ranges and in both the genders of the study population. To avoid observer bias, each digital OPG of an individual was coded with a numerical identity number. Results were analysed using unpaired t-test and Spearman’s correlation test (p-value <0.05). Results: An overestimation was observed in the Demirjian’s and Willems DA estimation methods in all the age groups and both the genders, while modified Cameriere’s method gave overestimation in the older age groups and approximation to the Chronological Age (CA) in younger age groups. Nolla’s method proved to be the best method in study population. Conclusion: Nolla’s method of age estimation was more accurate than other methods for determining the age in 3-11 years old western Indian children.

Acute Renal Failure in Pregnancy: A Prospective Cohort Study
Introduction: Pregnancy related acute renal failure is a common occurrence and is associated with substantial maternal morbidity and mortality in developing countries. It may comprise up to 25% of the referrals to dialysis centres in developing countries. Acute kidney injury in pregnancy bears a high risk of bilateral renal cortical necrosis and resultant chronic renal failure. Acute renal failure in pregnancy follows bimodal relation to period of gestation. First peak is seen in early pregnancy between 7-16 weeks of gestation and second peak occurs in later part of pregnancy and puerperium. The incidence and aetiology are changing over time. Socio-economic and environmental factors are accountable for a regional difference in incidence, aetiology and outcome also. Aim: To analyse the current aetiological factors, clinical spectrum of presentation of Acute Renal Failure (ARF) in pregnancy and to assess its maternal and foetal outcome. Materials and Methods: It was a prospective cohort study of 100 patients presenting with acute renal failure during pregnancy and puerperium which was done at SCB Medical College, Odisha, India. Inclusion criteria were previously healthy pregnant females with sudden oliguria anuria, sudden increase in serum creatinine to more than 1.5 mg/dL or increase in serum creatinine of more than 0.5 mg/dL per day from base line if haemodialysis was indicated. Maternal outcomes were recovery with conservative treatment, dialysis, Intensive Care Unit (ICU) admission and maternal death. Foetal outcomes were gestational age at delivery, birth weight, stillbirth or perinatal death. All these were recorded. Results: During the first trimester of gestation acute renal failure developed most often due to septic abortion (3%). Preeclampsia was the most common cause of acute renal failure (50%) in late third trimester and postpartum periods followed by puerperal sepsis (9%), abruptio placentae (3%), and Postpartum Haemorrhage (PPH) (5%). Oedema and oliguria were the most common presentation in 81% and 30% of cases. A 87% with i.v. fluids and diuretics (conservative management), 13% required dialysis, 23% required blood and Fresh Frozen Plasma (FFP), 30% needed ICU admission and 11% died during treatment. Foetal outcome were measured in terms of foetal growth restriction (24%), preterm delivery (14%), foetal distress (13%), Special Newborn Care Units (SNCU) admission (23%) and stillbirth (5%). Conclusion: This study concludes that pregnancy related acute renal failure is associated with serious prognosis both for the mother and child. Even though, good obstetric care can reduce morbidity and mortality associated with it, these patients require special and intensive care management facility which can bring them better survival rates.

Association between Intrapartum Cardiotocography and Umbilical Cord Blood pH in Term Pregnancies: A Cross-sectional Study in a Tertiary Care Centre, Kolkata, India

Roshni Sethia, Animesh Naskar, Saikat Tripathy, Rupkamal Das
Introduction: Labour, a physiological process for majority of foetuses, often acts as a challenge to foetal reserves causing foetal hypoxia. Foetal monitoring with intrapartum cardiotocography is an important tool to enable timely intervention to reduce adverse neonatal outcomes like postnatal cerebral palsy. Aim: To determine an association between cardiotocography tracing and umbilical artery cord blood pH in term pregnancies in labour where the influence of drugs and the presence of other co-morbid medical/obstetric adverse outcomes have been ruled out. Materials and Methods: This cross-sectional, hospital-based, observational study involved singleton uncomplicated term pregnancies with a normal baseline cardiotocography and spontaneous labour onset and progression admitted to the Labour Ward of the Department of Obstetrics and Gynaecology, of R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. Intrapartum continuous cardiotocography traces were recorded and those showing abnormal traces were documented and delivery expedited within two hours. Total of 90 such consecutive women were included in the study and umbilical arterial cord blood sample was taken for all these pregnancies immediate postpartum. Cardiotocography traces were then statistically compared with cord blood parameters and the findings were computed using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: Out of 90 participants, the mean age was 24.21±3.43 years, most (43, 47.8%) of them were in between 21 to 25 years. Of the abnormal traces, 51 (56.7%) were NICE Category II (suspicious) and 39 (43.3%) were NICE category III (pathological). Cord blood analysis revealed that 40% had a pH value <7.0, 44.4% had blood lactate levels above 6 mmol/L and another 47.7% had a base deficit ≥12 mmol/L. On cross-tabulation and Chi-square analysis, these were all found to be statistically significant (p-value <0.05). Abnormalities of Foetal Heart Rate (FHR) and baseline variability had higher Odds ratio of predicting umbilical artery acidemia with Odd’s ratio for baseline variability abnormality as high as 2.768. Conclusion: Although there has been a rising trend towards operative deliveries, the overall incidence of neonatal morbidity due to cerebral palsy is still on the rise. Cardiotocography can be a very important tool to identify neonatal acidosis in “at risk” foetuses and helps in timely intervention giving long term best outcomes.

Dynamics of SARS-CoV-2 Antibody Response in a Longitudinal Cohort of Healthcare Workers from India
Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide. Healthcare Workers (HCWs) form one of the most at-risk population groups for acquiring infection. Trend analysis of anti Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody titres in vaccination naïve HCWs will give an insight into the role of natural protective immunity against reinfection. Aim: To understand the dynamics of anti SARS-CoV-2 antibody response and its protective role against reinfection in a cohort of HCWs. Materials and Methods: This observational longitudinal cohort study was conducted in a tertiary care hospital in Gurugram, Haryana, North India from June to December 2020. The study was approved by the Institutional Ethics Committee. Serum specimens from 230 HCWs were tested for anti-spike protein Immunogloublin G (IgG) antibodies by chemiluminescence immunoassay. The HCWs with positive antibody status and previous Polymerase Chain Reaction (PCR) confirmed infection (n=47) were followed-up over 180 days for serial antibody titres at four visits, each at a gap of 30-45 days. Participants were classified into asymptomatic (n=18), mild (n=17) and moderate (n=12) disease categories based on severity of previous COVID-19 illness. SPSS version 22.0 was used for statistical analysis. Intergroup comparison of means was done using Kruskal-Wallis test and Chi-square test. The p<0.05 was considered statistically significant. Results: Positivity rate for anti SARS-CoV-2 IgG antibodies was 25.7%. Seroconversion rate was 90.74% in HCWs with history of previous Real Time-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 infection. Incidence of infection in seronegative group (n=171) was 12.96 per 10,000 person days while in seropositive group, it was 1.29 per 10,000 person days. Risk ratio for infection (baseline seronegative vs baseline seropositive) was determined to be 8.12 [95% Confidence Interval (CI) 1.068-61.755]. Incidence of PCR confirmed SARS-CoV-2 reinfection was inversely associated with antibody titres (p=0.018). Antibody response trend showed a peak in mean titres in the 46-90 days period followed by steep decline till 135 days and a gradual waning till 180 days. Conclusion: Significant postinfection immunity is offered by even low to moderate amounts of antibodies and this occurs regardless of whether a seropositive HCW had previous asymptomatic or symptomatic infection. These findings have significant implications in establishing the protective role of anti-spike protein antibodies against subsequent infection.

Menstrual Hygiene Practices, Social Taboo and Attitude towards it- A Community-based Cross-sectional Study among Young Women in a Rural Area of West Bengal, India

Ferdousi Fahmida Amin, Amrita Samanta, Santanu Ghosh
Introduction: In developing countries like India, awareness about menstrual hygiene is limited among women leading to stigma, restriction of social activities and various menstrual and urogenital ill-health among women. Aim: To find out the menstrual hygiene practices, social taboos and attitude towards it among 15-24 years aged women of a rural area of West Bengal, India. Materials and Methods: This observational descriptive study with cross-sectional design was conducted during September-December 2019, among 110 young women in the age group of 15-24 year residing in Amdanga community development block. Multistage sampling technique was adopted and data was collected by interviewing study subjects with a predesigned, pretested and semi-structured questionnaire. Data were analysed with the Statistical Package for the Social Sciences (SPSS) software (version 20.0). Proportion and Chi-square test were applied where applicable. The p-value <0.05 was taken as significant. Results: Nearly 80% of the study subjects used only sanitary napkins. Disposal of used pads under the soil was most common practice. Restrictions to social activities like taking part in religious activity, going outdoor, kitchen and household work were reported by 100%, 85.45%, 58.18% and 74.54% participants, respectively. A 64% of study subjects were unaware of menstruation before menarche. Statistically significant association was observed between socio-economic condition and number of sanitary pad use, (p<0.0001) and school absenteeism, (p=0.011634). Education above primary level was positively associated (p<0.00001) with awareness about menstruation before menarche. Conclusion: The study conveyed that wide spread social stigma, restrictions and poor attitude still exists in this rural community about menstruation which is affecting safe disposal of used absorbents and overall health of women.

Evaluation of Changes in Serum Insulin like Growth Factor-1 Levels with Growth Modulation via Twin Block Therapy- A Prospective Clinical Study

Sakshi Asija, Manisha Kamal Kukreja, Paramjeet Gill
Introduction: Serum insulin like growth factor is a pertinent growth regulator in bone and cartilage, therefore assessment of changes in serum Insulin like Growth Factor (IGF) levels in patients undergoing functional appliance therapy can act as valuable tool to understand the mode of action of functional appliances. Aim: To evaluate the changes in serum Insulin like Growth Factor-1 (IGF-1) levels in the patients undergoing twin block therapy and to establish IGF-1 as a biochemical marker produced in response to mechanical disturbance in the condylar region by twin block appliance. Materials and Methods: This prospective clinical study was conducted in the Department of Orthodontics and Dentofacial Orthopedics, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India from May 2014 to November 2015. Total 27 patients included in study, divided into two groups, the test group which comprised of 15 patients treated with standard twin block appliance therapy and the control group which comprised of 12 patients not treated with the same. Serum samples were collected from test group and control group patients at four time intervals {pretreatment (T0), 1 month (T1), 3 months (T3) and 6 months (T6)} and subjected to Enzyme-Linked Immunosorbent Assay (ELISA) to measure IGF-1 levels. The data thus obtained was subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) for windows version 20.0. Intragroup differences were evaluated using paired t-test, while intergroup differences were evaluated using Independent sample t-test. The p-value <0.05 was considered as statistically significant. Results: The data was obtained from 11 patients (6 males and 5 females) in the test group and 10 patients (6 males and 4 females) in the control group after elimination of dropouts. Mean age of the test group subjects was 12.8±0.9 years and that of control group subjects was 13.1±0.9 years. The mean IGF-1 levels in the test group were 124.5 ng/mL (T0), 126.27 ng/mL (T1), 130.90 ng/mL (T3) and 135.54 ng/mL (T6). In the control group, 151.5 ng/mL (T0), 140.8 ng/mL (T1), 157.8 ng/mL (T3) and 120.2 ng/mL (T6). In the test group, mean levels of serum IGF-1 did not change significantly when baseline levels were compared with the serum IGF-1 levels at T1 (0.467), T3 (0.729) and T6 (0.62) of functional appliance therapy, although an increase in IGF-1 levels was noted at each interval. Comparison of serum IGF-1 levels of test and control group showed no statistically significant difference between the groups at T0, T1, T3 and T6. Conclusion: Functional appliance therapy was not found to be associated with concomitant increase in serum IGF-1 levels.

Intraperitoneal Bupivacaine versus Nalbuphine in Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomised Clinical Study

Samiksha Khanuja, Pratibha Panjiar, Sana Hussain, Khairat Mohammad Butt
Introduction: The rationale for using an intraperitoneal route for instilling a drug, local anaesthetic or opioid is that the exposure of peritoneum to visceral nociceptive conduction provides additional mechanism of analgesia. Aim: To compare the effectiveness of intraperitoneal bupivacaine and nalbuphine for postoperative pain relief after laparoscopic cholecystectomy. Materials and Methods: The present study was a randomised clinical study in which 80 patients underwent laparoscopic cholecystectomy, received either bupivacaine (n=40) or nalbuphine (n=40) intraperitoneally. Each patient was monitored postoperatively, as per the institution protocol. Severity of pain was assessed using the Visual Analog Scale (VAS) at rest and at movement Immediately After Recovery (IAR), after one hour and every four hours thereafter. The time to first rescue analgesic was compared. The data analysis was carried out with unpaired Student’s t-test and Chi-square test using software Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: The study included 35 males and 45 females, with a mean age of 42.8±7.1 years. Both groups were well-matched demographically. There was no significant difference in the Heart Rate (HR) or Mean Arterial Pressure (MAP) between the groups postoperatively. However, VAS score was significantly lower in nalbuphine group at one hour (2.52±0.640) as compared to bupivacaine group (2.88±0.791, p=0.028), but on movement at 16 hours it was lower in bupivacaine group (1.43±0.501), as compared to nalbuphine group (1.67±0.474, p=0.030). The mean time of first rescue analgesic in nalbuphine group was 20.25±7.983 minutes, while in bupivacaine group it was 26.9±6.95 minutes (p-value-0.0002). Postoperative Nausea and Vomiting (PONV) was significantly higher with nalbuphine (35% vs 12.5%). No other significant complication was noted in either group. Conclusion: Intraperitoneal instillation of nalbuphine is an effective and safe way to reduce postoperative pain in patients undergoing laparoscopic cholecystectomy.

Assessment of Impact of Vitiligo and its Distribution on Psychosocial Life: A Cross-sectional Study

Aarzoo Pahwa, Suganita, Praveen Kumar Rathore
Introduction: Vitiligo is a common depigmenting disorder of skin/mucosa. Its aetiology is multifactorial. Clinically, it presents as milky white macules as a result of loss of melanocytes from skin, hair or both. It does not cause any physical hindrance but can cause cosmetic deformity, which has a serious effect on patient’s quality of life. Aim: To evaluate and compare the psychosocial impact on vitiligo patients having lesions on exposed and unexposed site using Vitiligo Impact Scale (VIS)-22. Materials and Methods: A cross-sectional study was conducted on 70 vitiligo patients attending the Outpatient Department (OPD) of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, over a period of six months between October 2020 to March 2021. Patients were categorised into two groups i.e., exposed and non exposed group. VIS-22 scores were calculated and effect on quality of life in vitiligo patients was calculated. Demographic data and clinical characteristics were also documented. Appropriate statistical software, including Statistical Package for the Social Sciences (SPSS) version 23.0 was used for statistical analysis and Chi-square test was applied. Results: A total of 70 patients (24 males and 46 females) were enrolled in this study who were similar in demographic profile. A mean VIS score in exposed group was 31.51 and in non exposed group was 21.45 which indicated large effect and moderate effect on their psychosocial life respectively. Mean score of each question was calculated, with highest mean score of 2.68, showing that patients were worried regarding the progression of disease. Most patients felt that others do not think that the disease spreads by touch and this was indicated by the mean score of 0.75. Conclusion: In this study, it was seen that patients having lesions on exposed sites had a greater impact on quality of life, interpersonal relationships and patients felt more depressed as compared to those on non exposed sites.

Incidence of Non Amplification of N Gene of SARS-CoV-2 using Commercially Available Real Time Polymerase Chain Reaction Kit and its Comparison with Two Other Different Kits
Introduction: Novel Coronavirus Disease-2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in an unprecedented global pandemic. Real Time Polymerase Chain Reaction (RT-PCR) tests are being used in the diagnosis of COVID-19 worldwide however mutations in the SARS-CoV-2 genome have generated many SARS-CoV-2 genome variants and which may affect the correct Reverse transcriptase-Real time Polymerase Chain Reaction (RT-PCR) diagnosis. Aim: To confirm and study the incidence of the non amplification of the SARS-CoV-2 Nucleocapsid gene (N gene) target among known SARS-CoV-2 positive samples. Materials and Methods: This retrospective observational study was carried out at the State Virology Laboratory, Gandhi Medical College, Bhopal, Madhya Pradesh, India, during January to May 2021. During the study period, a total of 159 SARS-CoV-2 positive samples were failed to amplify the N gene target. To investigate the non amplification of N gene target of SARS-CoV-2, a total of 20 samples were selected and retested using the initially used RT-PCR kit (VIRALDTECT RT-PCR kit) and also with the two different RT-PCR kits (TaqPath RT-PCR kit and Hi-PCR RT-PCR kit) which also contain primers/probes for the SARS-CoV-2 N gene target. Results: Amplification and detection of the SARS-CoV-2 N target gene was not observed in VIRALDTECT RT-PCR test results. In contrast, amplification was detected in the N gene target of SARS-CoV-2 while using the TaqPath and Hi-PCR kits. Obtained results confirm the failure of the annealing of VIRALDTECT kit N gene primer/probe and suggest the possible mutation event in the SARS-CoV-2 N gene among the N gene non amplified samples. Conclusion: Present study reports, the incidence of non amplification of SARS-CoV-2 N gene, where the RT-PCR kit failed to detect N gene target and seriously affect RT-PCR diagnosis. Hence, the study emphasises the revalidation of commercially available SARS-CoV-2, RT-PCR kits to identify these kinds of failure incidence.

Assessment of Dental Care Seeking Behaviour and Attitude among Adults in a Metropolitan City in Southern India- An Observational Study

Devapriya Appukuttan, Anupama Tadepalli, Sangeetha Subramanian
Introduction: Understanding the factors that promote or impede dental visits is a prerequisite for devising healthcare changes because underuse of dental services is linked to an increased burden of oral disorders. Aim: The study aimed to comprehensively explore the factors that could have a positive or negative influence on oral health care seeking behaviour among adults in Chennai. Materials and Methods: The present descriptive, cross-sectional study was conducted among patients visiting the Outpatient Department (OPD), SRM Dental College, Ramapuram, Chennai, India from April 2019 to January 2020. A structured questionnaire was admistered via both printed and online Google forms to adult patients aged above 18 years. Google forms were shared via WhatsApp social media platform. A total of 503 completed responses were statistically analysed. The Chi-square test and logistic regression analysis was applied to assess the association and the strength of association between the various factors and dental visits. Results: A total of 503 subjects were surveyed of which 75.94% had visited a dentist previously, of which males were 216 and females were 287. The most frequently cited reasons for not visiting a dentist were lack of time (60.23%), high cost (56.06%) and not having dental problems (52.88%). It was observed that higher number of respondents who perceived dental problems as serious or life threatening (65.80%), felt they had poor oral health (2.18%) and need dental treatment (53.87%) had been to the dentist more often in the past. A significant association was observed between dental visits and educational qualification, family structure, time constraints, absence of dental problems, religious beliefs and perceived need for treatment (p-value <0.05). Conclusion: Among Indian studies, the current study found the highest frequency of dental visits. Dental visits were hampered by the time constraints, high cost of dental treatment and a lack of dental problems. Awareness that regular dental visits enhance good oral health was comprehended and linked to a higher frequency of dental visits. The study highlights the importance of providing affordable, high quality dental care as well as promoting public awareness in order to overcome barriers to dental service utilisation.

Severity of COVID-19 in Vaccinated and Non Vaccinated COVID-19 Positive Cases: A Cross-sectional Study
Introduction: Coronavirus Disease-2019 (COVID-19) vaccine was reported to be used in China, after the outbreak of Coronavirus. COVID-19 vaccine requires validation of efficacy and adverse reactions as target vaccine population include high risk over the age of 60, medical frontline workers and people working in essential industries. After Spanish flu, COVID-19 pandemic is most devasting situation in the world. Aim: To evaluate the effectiveness of COVID-19 vaccine in COVID-19 positive vaccinated cases compared to non vaccinated cases. Materials and Methods: This cross-sectional study was conducted in Government Super Specialty Hospital Andhra Pradesh, India, from July to September 2021. COVID-19 positivity was confirmed by Reverse Transcription Polymerase Chain Reaction (RT-PCR) test in vaccinated and non vaccinated patients, admitted in a Government Super Specialty Hospital. Severity of the disease was studied in 1423 non vaccinated and 601 vaccinated cases of all age group above 18 years. Patients were categorised based on symptoms and oxygen saturation (SpO₂) in to Mild-SpO₂ >94%, Moderate- SpO₂ <94%, Severe- SpO₂ <90%. Patients were subdivided into three groups based on age 18-44 years, 45-64 years and ≥65 years age. Data was collected and tabulated using Microsoft excel and Statistical Package for the Social Sciences (SPSS) version 15.0. The statistics of percentage was used. Results: A total of 2024 COVID-19 positive cases were studied, out of which, 1423 were non vaccinated and 601 were vaccinated. Among non vaccinated group of 1423 cases, 712 cases had mild symptoms, 510 patients were of moderate symptoms, 201 patients were of severe symptoms. In 601 vaccinated cases, mild cases were 352, moderate cases were 185 with SpO₂ <94%-90%, 64 cases are severe with SpO₂ <90%. In this study the vaccinated patients had less severe disease with mild symptoms, in the cases of present study from COVID-19 compared to non vaccinated cases. Conclusion: Vaccine effectiveness was noted after two doses. Vaccinated people had less severe symptoms and disease compared to non vaccinated people. Finding would support the effort to maximise vaccine with two doses among vulnerable population.

Comparison of Different Phenotypic Methods Including E-test, Cefoxitin and Oxacillin Disk Diffusion for Detection of Methicillin Resistant Staphylococcus aureus

Geeta Gupta, Pradeep Kumar
Introduction: Methicillin-Resistant Staphylococcus aureus (MRSA) has spread throughout the world as a hospital and community-acquired illness. Although, a variety of strategies have been employed, laboratory identification of MRSA remains a difficulty. Aim: To examine several phenotypic approaches for accuracy results, with an (Epsilometer) E-test based method serving as the gold standard for MRSA identification. Materials and Methods: A prospective observational study was conducted in the Microbiology Department of Santosh Medical College, Ghaziabad, Uttar Pradesh, India, from August 2020 to July 2021. Total of 384 isolates S. aureus were identified by using the required samples including pus, swab, blood, wound and urine, etc., which were collected from the Microbiology department and the comparison was done between E-test serving as the gold standard for MRSA identification with Cefoxitin Disk Diffusion (CDD)/Oxacillin Disk Diffusion method (ODD). The diagnostic kit for using E-test in collected samples was purchased from Himedia Laboratries Pvt., Ltd., Mumbai, India (EM0065). The data was calculated by using MS-Excel. Results: A total of 113 strains were revealed to be MRSA in clinical specimens out of 384 isolated S. aureus according to Cefoxitin (disc diffusion method). The gold standard method was chosen to be the E-test, which had found a high sensitivity of 79.8% and a specificity of 94.2% compared to the cefoxitin/ODD method. Isolates including MRSA were highly susceptible to teicoplanin and linezolid. Conclusion: The present study concludes that E-test (strip) method is a high sensitivity and highly specific for detecting MRSA in comparison to other disk methods used in this study. Due to less number of sample size and lesser time period more studies are needed to establish this fact.

Predictors of Mortality due to COVID-19 Infection among Adults: A Cross-sectional Study

Devi Kittu, Saranya Periyasamy, Zubaida Begum Kadar
Introduction: Coronavirus diseases-2019 (COVID-19) has emerged as a pandemic with significant mortality risk. The early predictors of mortality in COVID-19 patients are older age, male gender, co-morbidities like uncontrolled diabetes, hypertension, severe asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease (CKD), Coronary Artery Disease (CAD), Chronic Liver Disease and malignancy and raised pro-inflammatory markers in most of the studies from China, Western Europe and US. Aim: To determine the various risk factors associated with outcomes of COVID-19 infection among laboratory confirmed COVID-19 patients. Materials and Methods: This descriptive cross-sectional study was conducted among 420 laboratory confirmed COVID-19 patients, aged 18 years and above, who were admitted in a designated COVID-19 hospital in Puducherry, India. Pretested structured questionnaire was used to collect the data through telephonic interview. Descriptive statistics, frequency, mean and standard deviation was estimated for demographic characteristics as appropriate. Chi-square test was used to investigate demographic and health related predictors of COVID-19 outcomes. Results: The mean age of the study participants was 41.38 (±17.552) years. Thirty five (8.3%) patients died during their treatment. The common presenting symptom was fever (142, 33.80%), followed by cold and cough (96, 22.85% each). Factors such as more than 60 years of age, female gender, resident of rural area, patients owning yellow ration card, unemployment, overcrowding, current smoking and alcoholics, attending social gathering, social distancing, hand washing, level of wearing mask were found to be significantly associated with fatal prognosis. Conclusion: Risk factors such as older age, females, rural residence, unemployment, overcrowding, smoking and alcoholism, co-morbidities, social gathering, social distancing, hand washing and mask usage were found to be associated with COVID-19 deaths.

QT Changes of Unforeseen Implications and Bedaquiline: An Observational Study

Samya Dutta, Chitrita Ghosh, Sandip Mukhopadhyay, TA Rupam Kumar
Introduction: Bedaquiline (BDQ), a diarylquinoline class of antimicrobial, is one of the latest anti-mycobacterial agents to be developed in several decades. Despite the drug being a great hope for the Drug Resistant Tuberculosis (DR-TB) patients, previous studies have raised alarm about BDQ-induced QT prolongations of serious clinical implication. Unfortunately, knowledge about adverse drug reaction of BDQ on Indian patients remains limited. Therefore, dedicated research focused on safety of BDQ in Indian population can provide valuable insight. Aim: To assess the short-term safety of BDQ on Indian DR-TB patients. Materials and Methods: This prospective observational study was conducted over a period of one year on 49 DR-TB patients under BDQ therapy. Data of all the DR-TB patients from the first 14 days of BDQ therapy were enrolled in the study. All adverse events during this period were closely observed and recorded. Electrocardiography (ECG) were recorded daily during this period. From the observed QT value, a ‘corrected QT’ (QTc) value was calculated using Fridericia’s formula (QTcF). Values above 440 ms were noted as prolonged QTcF and values >500 ms were given a special consideration. Results: Total 49 patients were recruited in the present study, with mean age of 38.63±1.63 years. A total of 124 reports of adverse events or symptoms were recorded during the 14 days in-hospital period. Nausea was the most commonly reported complaint (n=33) followed by headache (n=30) and arthralgia (n=28). A total of 278 observations of prolonged QTcF values (>440 ms) was noted out of 686 ECG recordings. The mean QTcF values among day 1, day 7 and day 14 showed statistically significant difference {p=0.01, 95% CI (Confidence Interval)}. Moreover, a mean increase of 14.2% was observed in the QTcF values between day 1 and day 14. There were a total of 69 observations of QTcF value more than 500 ms. The incidence of such value was maximum on day 14 (n=9). The QTcF values were found to follow three distinct trends: a) Initial rise then fall (n=9), b) Initial fall and then rise (n=10) and c) Rise followed by further rise (n=30). Conclusion: The present observational study was targeted to detect the short-term safety of BDQ in the DR-TB patients during the initial 14 days of therapy. The patients complained of several non serious adverse effects. Three distinct patterns of QT changes and reduction of QTcF values were relatively new findings with the merit for further investigation. However, a longer perspective of adverse events was beyond the scope of this study.

Comparision of Low Birth Weight Babies in Mothers Seeking Antenatal Care Services at a Tertiary Care Hospital and at Other Healthcare Facilities: A Cross-sectional Study

Neelima Alka Singh , Akash Mishra , RN Mishra , Durgesh Shukla
Introduction: The high prevalence of Low Birth Weight (LBW) due to Preterm Birth (PTB) and Intrauterine Growth Restriction (IGUR) still persists a challenge in India. This happens due to poor and infrequent utilisation of Antenatal Care (ANC) service. Aim: To assess the difference of PTB and LBW newborns in mothers, who availed ANC at a tertiary care hospital against those who availed ANC at other healthcare facility. Materials and Methods: This cross-sectional study was conducted at Gynaecology Department in Sir Sundarlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India and 1858 mothers and their newborn were analysed. The data was obtained from the delivery register maintained at the Labour Room of the Department. The age of the mother, place where ANC services availed, birth weight of the newborn and the gestational age were recorded on a master chart. The newborn were considered LBW, if birth weight was <2500 gm, PTB if birth occurred <37 completed weeks of gestation and Intrauterine Growth Restriction (IUGR), if birth weight was below the expected weight at birth for the gestational age. The prevalence of PTB, LBW and mean with SD of LBW were obtained. The association of PTB and LBW with place of ANC services availed was judged using Chi-square test. The 95% confidence interval of the prevalence was obtained by using logit transformation. Results: Out of total 2420 deliveries, 1858 mothers and their newborn were analysed. The mean age of mothers was 26.4±4.3 years. Half (50.1%) of the mothers had taken ANC at SS Hospital and the rest at other healthcare facilities. The prevalence of LBW and PTB babies were 29.2% (95% CI: 27.1-31.3) and 28.8% (95% CI: 26.7-30.9), respectively. Overall, both PTB and LBW were found to be significantly associated with the place of ANC services. Prevalence of LBW born in mothers who received ANC at tertiary care hospital was 19.4%; while it was 39.0% in those receiving at other healthcare facilities. The prevalence of PTB and LBW was more than 1.6 times and twice in those taken ANC at other healthcare facilities than those at TCH irrespective of gestational age. Among the PTB, the LBW were 42.2% in mothers receiving ANC at the Tertiary Care Centre (TCH) against 65.6% in those receiving at other healthcare facilities. Among the full-term deliveries also, the LBW born were 13.1% in mothers receiving ANC at tertiary care as against 24.3% in those receiving at other healthcare facilities. Conclusion: The mothers seeking ANC services at other healthcare facilities need education about the advantage of ANC by the service providers, for timely and better adherence to ANC.

Analysis of Best Management of Proliferative Sickle Cell Retinopathy in African Population- A Retrospective Analytical Study

Francis Kwasi Obeng, Vipan Kumar Vig, Preetam Singh, Rajbir Singh, Yao Ahonon
Introduction: Visual impairment in Proliferative Sickle Cell Retinopathy (PSCR) starts with neovascularisation. Treatment armamentaria including diathermy, retinopexy, Autoinfarction (AI), surgical procedures and intravitreal Anti-Vascular Endothelial Growth Factors Injections Monotherapy (AEGFM) have been applied. Some outcomes led to blindness but data on how effective AEGFM is in treating PSCR is lacking in several publications. Aim: To assess outcome and complication profile of large series of patients who underwent AEGFM after being diagnosed with PSCR. Materials and Methods: This was a retrospective analytical study conducted in October 2020 on records of 40 patients who underwent AEGFM and other treatment on account of PSCR at Department of Ophthalmology, 37 Military Hospital, Accra, Ghana. The records were reviewed retrospectively for visual outcomes and complications. Patients’ demographic data, indications of treatment, best corrected preoperative and postoperative visual acuities, complications of surgery and length of follow-up were collected and analysed using chi-square and paired t-tests. Results: A total of 80 eyes of 40 patients (36 males and four females) were identified. Mean age during AEGFM (72 eyes) and vitreoretinal surgery (eight eyes) was 31.7±9.3 years (range 26- 56 years) with mean follow-up period of 6±1 years (range 5-7 years). A total of 70 (87.5%), 2 (2.5%) and 8 eyes (10%) had improvement, maintenance and worsening of final visual acuities, respectively. A total of 8 (16%) eyes developed postoperative complications from retinal surgeries with Proliferative Vitreoretinopathy (PVR) being the most common. Forty (50%) eyes with old retinal Laser Photocoagulation (LP) scars reported with fresh elevated Sea Fans (SF) and Vitreous Haemorrhage (VH). LP is therefore a major source of SF formation and VH in PSCR. Conclusion: AEGFM is better treatment than other available modalities in management of undetached PSCR.

Common Modalities of Reconstruction for Scrotal Defects at a Tertiary Care Hospital in Eastern India: An Observational Study

Gouranga Dutta, Abhishek Kumar Rai, Manoj Kumar Singh, Rupnarayan Bhattacharya
Introduction: Scrotal reconstruction remains a challenging problem to the surgeons. The various techniques used for scrotal reconstruction includes residual tissue re-arrangement, skin grafts, pedicled and free tissue transfer. There is lack of unified approach to deal with the issue. Aim: To discuss the surgical techniques performed for scrotal reconstruction in a tertiary care centre along with its epidemiological factors. Materials and Methods: This observational descriptive study was conducted on 33 cases in a tertiary care centre located in Eastern India over a period of three years. Scrotal reconstruction was planned according to aetiology, defect size, associated co-morbidity and age of the patient. Evaluation to assess the efficacy of each procedure was done with patient’s satisfaction scoring. At the time of discharge, with simple four level Likert scale, patient’s satisfaction was assessed. Descriptive statistics was used and results were expressed in terms of frequency and percentage. Results: The mean age of the patients with scrotal defects was 48±15.98 years. Fournier’s gangrene (n=21) was the leading cause of scrotal defects followed by trauma (n=8). The most common scrotal defect size was 50-75% (n=12). The most common scrotal reconstruction performed was Pudendal artery flap (Singapore flap) (n=12). Donor site scar was limited and acceptable. Wound related complications detected clinically as partial tissue necrosis, was observed in two cases. Most patients were satisfied with the final outcome, assessed by Likert scale. Conclusion: Scrotal reconstruction should be performed taking in account its aetiology, associated co-morbidity, age and the scrotal defect size. Aesthetically and psychologically, well planned flap is reliable and better in comparison to Split-Thickness Skin Graft (STSG) and most of the complications can be managed conservatively.

Mental Health Status of Dental Faculty, Students and their Parents during COVID-19 Pandemic in Southern India: A Cross-sectional Study
Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is an infectious and devastating disease that has created heightened levels of anxiety and fear among the general population. Coronavirus Disease-19 (COVID-19) has also brought many changes in everyone’s lives including closing of schools, colleges/universities and social isolation in an unexplained manner. In these unprecedented times, lot of sway has been developed among teaching faculty, students and student’s parents in the medical profession including dental schools. However, the impact on students is likely to be noteworthy. Aim: To assess the awareness, attitude, anxiety and perceived mental healthcare during the COVID-19 pandemic among dental faculty, students and their parents in South India. Materials and Methods: A cross-sectional, observational questionnaire based study was carried out among 1000 dental faculty, students and student’s parents in South India between August 2020 to December 2020. A questionnaire with 20 items regarding awareness, attitude, anxiety and perceived mental healthcare was designed on Google forms and sent through e-mails and WhatsApp. Snowball sampling technique was used and 1000 self-selected dental faculty, students and student’s parents in South India were included in the study. Data was subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) software v. 20.0 International Business Machines Corporation-United States of America (IBM-USA). Chi-square test was used to analyse the data. The p-value <0.05 was considered statistically significant. Results: The findings showed all the respondents were aware with positive attitude and awareness on this pandemic in regard to its spread and precautions to be taken. However, parents (59.2%) were more preoccupied with eliminate thoughts and more were anxious when compared to faculty (32.1%) and students (32.4%), whereas faculty were more concerned about family’s health and safety (49%) and financial status (54.5%) (p<0.001). All the respondents felt that getting engaged and sharing their worries would help them and mental health help requirement is greater in students (86.5%), student’s parents (81.4%) followed by faculty (71.5%) (p<0.001). Conclusion: During this pandemic even though respondents were aware of the possible squeal of infection and preventive measures. The findings suggest a need to address the mental health worries of the people during these pandemics.

Childhood Hypertension: An Observational Study from a Tertiary Care Centre, Gujarat, India

Dhara Gosai, Bela Shah, Kiran Chaudhary, Amit Das
Introduction: Childhood hypertension is an underestimated problem in India and other developing countries and it often reported in adults. Hypertensive children, although usually asymptomatic, already manifest evidence of target organ damage. Many of hypertensive children have left ventricular hypertrophy and increased carotid intima-media thickness, a marker of early atherosclerosis. Hypertensive children are very prone to develop target organ damage like retinopathy, renal damage, cardiac complications if remains undiagnosed and untreated for long. Other risk factors like cardiovascular disease, diabetes mellitus and hyperlipidaemia must also be looked for in hypertensive children. Aim: To study the prevalence, clinical profile, aetiology of hypertension and to analyse various management protocol, complications, and early outcomes of hypertension in hospitalised children aged between 5-10 years. Materials and Methods: This was a prospective, observational analytical study conducted in the Department of Paediatrics of a tertiary care centre at Ahmedabad, Gujarat, India, from 1^st October 2017 to 30^thSeptember 2019. Blood pressure was measured by mercury sphygmomanometer using auscultatory method in all admitted patients in Paediatrics Department between the age of 5-10 years as a part of vital monitoring. A total of 103 patients having average systolic blood pressure and/or diastolic blood pressure greater than or equal to 95^th percentile for that age, sex and height on three or more occasions were included in the study and their comprehensive details were recorded in prestructured proforma. The outcome was recorded as data in excel sheet and arranged in tables. Results: The prevalence of hypertension was 0.96%. The mean age of the study population was 8 years, and the male:female ratio was 1.09:1. Vomiting was the most common presenting complaint followed by fever and puffiness of eyes. A higher incidence of fever on presentation was due to the associated infective pathology of Central Nervous System (CNS). Pallor was the most common finding on general examination. Neurological deficit was observed in patients with hypertensive encephalopathy and stroke. Overall, 21 (20.38%) patients were in stage 2 hypertension, accounting to hypertensive emergencies, 48 (46.6%) patients with hypertension had an underlying renal disorder, followed by CNS disorder in 47 (45.6%). Amlodipine (26.21%) was the most common drug used in hypertensive patients. Most common complication of the present study was hypertensive retinopathy seen in 14 patients (13.59%). Conclusion: In hospitalised patients, the prevalence of hypertension was 0.96% with a male preponderance. On admission, the most prevalent complaints were vomiting and fever. Pallor and puffiness of eyes were the most common general examination findings, and ascites was the most common systemic examination result. The most common secondary cause of hypertension was renal disease, with acute glomerulonephritis as most prevalent.

Aetiological Profiles of Pancytopenia in Children between 2 months to 12 years of Age- A Retrospective Study from a Tertiary Care Centre, Chennai, India
Introduction: Pancytopenia is a medical condition that generally exists among children in which the peripheral blood cell lineages are found to reduce in blood. The condition is diagnosed as a common haematological problem with an extensive differential diagnosis and vary according to the geographical distribution and genetic mutation. The condition is reversible and easily treatable if identified at the earliest. Aim: To determine the frequency of aetiological spectrum of pancytopenia in children between the age of 2 months to 12 years from Chennai, Tamil Nadu, India. Materials and Methods: A retrospective descriptive study was carried out at the Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India, from January 2016 to December 2016. Out of 12,869 patients admitted, 91 children were identified with pancytopenia based on peripheral blood smear analysis. Complete blood count, peripheral smear, red blood cell indices, bone marrow examination, and serum vitamin B12 levels were analysed. The complete data was tabulated in Microsoft excel sheet and frequency(n) and percentage (%) analysis was performed. Results: Total of 91 children with pancytopenia (45 males and 46 females, aged from 6 months to 12 years) were included in the study and analysed. Majority of the pancytopenia children belonged to the age group of 1 to 6 years (40, 43.9%). The identified common clinical presentations for admission included the unexplained fever (82.92%), pallor (10.8%), and bleeding (9.79%). The common major aetiologies were megaloblastic anaemia (23, 25.2%), acute lymphoblastic leukaemia (17, 18.6%), and aplastic anaemia (12, 13.1%). Infections due to microorganisms in children also cause pancytopenia and there was one child each with the infectious symptoms due to Human Immunodeficiency Virus (HIV), tuberculosis, and Epstein-Barr Virus (HBV). Conclusion: Acute leukaemia and bone marrow failure were identified as the most common causes of pancytopenia in children. It is highly advisable to record the symptoms related with iron deficiency anaemia along with the symptomatic issues of certain viral and bacterial infections among children from the developing nations while diagnosing pancytopenia.

Liver Disorders in Pregnancy- A Retrospective Study

Archana Kumari, Tanu Sharma, Suchita Singh
Introduction: Liver disorders associated with pregnancy are important medical disorders that carries grave prognosis and challenging for both obstetricians and hepatologists. It affects about 3% of pregnancies worldwide and about 3-5% pregnancies in India. It can present with various symptoms like yellowish discolouration of sclera, dark coloured urine, anorexia, nausea, vomiting, abdominal pain etc. The liver disorders unique to pregnancy includes-hyperemesis gravidarum, preeclampsia, eclampsia with liver dysfunction, Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome, Intrahepatic Cholestasis of Pregnancy (IHCP) and acute fatty liver of pregnancy. Aim: To evaluate demographic variables, causes of liver dysfunction during pregnancy and foeto-maternal outcome of pregnancies complicated by jaundice and liver dysfunction. Materials and Methods: This was a retrospective hospital based observational study on the pregnant women admitted with jaundice or any liver disorders in Department of Obstetrics and Gynaecology in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, over a period of one year from March 2018 to February 2019. The incidence of liver disorders in pregnancy, its causes, the foetal outcome in terms of preterm birth, stillbirth, Foetal Growth Restriction (FGR) and Intrauterine Foetal Death (IUFD), the maternal outcome in terms of mode of delivery, complications, need for Intensive Care Unit admissions and maternal mortality were evaluated. Descriptive statistics like percentage and mean calculation were used to interpret the data. Results: Out of 8264 obstetrics admissions, 126 had liver disorder in pregnancy, incidence being 1.52%. Total 87 (69%) cases were primigravida, 115 (91.3%) cases presented during 3^rd trimester of pregnancy, 101 (80.1%) were unbooked for our institution. A total of 92 (73%) were referred to us. Preeclampsia, eclampsia, HELLP syndrome was the most common cause of liver dysfunction accounting for 46.8% followed by IHCP in 31 (24.6%) cases. Out of 126, 115 women admitted in labour, of which 75 (65.3%) delivered vaginally, 38 (33%) taken for caesarean section and two died undelivered. Nine cases were admitted in 1^st trimester and two cases in second trimester who did not turn up after discharge. Neonatal mortality was seen in 18 (15.6%). Conclusion: Liver dysfunction in pregnancy carries grave prognosis with high incidence of perinatal and maternal morbidity and mortality. This study emphasises the need for regular Antenatal Care (ANC), need to remain vigilant for preventable causes like haemolytic jaundice, early diagnosis, proper treatment and timely referral of liver disorders with pregnancy to prevent the complications and improve foetal and maternal outcome.

Association of Chest CT Severity Scores and Vaccination Status in COVID-19 Infection: A Cross-sectional Study

TT Vishwanath, BR Rajalakshmi, KS Sadananda, CN Manjunath
Introduction: Coronavirus Disease-2019 (COVID-19) has emerged as a pandemic with substantial morbidity and mortality. While global efforts towards mitigating the infection are focused on the vaccination of population, studies are warranted to prove the efficacy of vaccine in prevention of infection or reducing the severity of infection in affected patients. The 25-point High Resolution Computed Tomography (HRCT) severity score has proved to be an effective tool in estimating the severity of lung infection and correlates with laboratory parameters and disease outcome. The HRCT scores hence provide an objective evidence to prove the efficacy of vaccines in vaccinated individuals by assessing the extent of lung involvement. Aim: To compare the chest CT severity score in vaccinated and unvaccinated COVID-19 infected patients. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology, at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. The data of HRCT scores and vaccination status was collected during the month of April 2021 from patients who were suspected to have COVID-19 infection and underwent a chest HRCT scan. The severity of lung infection in vaccinated and unvaccinated individuals were compared based on the HRCT scores and the association between these variables were analysed. The association between the respective variables were studied using Fisher’s-exact and Kruskal-Wallis tests. Results: The study involved a total of 178 subjects (males were 98), where 127 (71.3%) were unvaccinated and 51 (28.6%) were vaccinated with one or both doses {Covaxin (Bharat Biotech) vaccine or Covishield (Oxford-AstraZeneca) vaccine approved by Emergency Use Authorisation (EUA)}. The frequency of disease was least in 14 (7.9%) among fully vaccinated subjects. Severe COVID-19 associated pneumonia with severity score of 18 or more was seen in 7% of unvaccinated individuals, while none of the partial/fully vaccinated individuals had severe disease. The median CT severity score was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients (p-value=0.001). Fully vaccinated patients had almost low CT severity score indicating mild form of disease. Conclusion: To the best of authors knowledge, this study was the first to describe the chest CT severity scores of vaccinated individuals in comparison with the unvaccinated COVID-19 infected patients. The disease severity was significantly higher among unvaccinated patients compared to partially or fully vaccinated patients. The present study has provided substantial evidence of vaccine efficacy in reducing the disease severity in COVID-19 infected patients.

Role of Infrared Imaging for Detection of Subclinical Inflammation of Joints: A Prospective Cohort Study

Satyabrata Nath, Kakali Das, Mrinal Kanti Bhowmik
Introduction: The detection of inflammation is important for diagnosis of inflammatory joint diseases and its severity. There are clinically doubtful cases of inflammation of joints. Advanced thermal cameras are able to detect the presence of inflammation. Hence, thermal imaging technology has been used for detection of this type of subclinical inflammation of joints. Aim: To study the efficacy of infrared imaging to detect the subclinical inflammation of joints in doubtful cases of arthritis. Materials and Methods: A prospective cohort study was conducted for a period of one year from January 2016 to June 2017. The study comprised of 60 patients of all age groups. Patients with joint pain attending Outpatient Department (OPD) of Physical Medicine and Rehabilitation Department (PMR), Agartala Government Medical College (AGMC) and Govind Ballav Pant Hospital (GBPH), Agartala, India, irrespective of the duration of illness and diseases were selected considering inclusion and exclusion criteria. They were evaluated clinically (swelling, tenderness, redness, increased temperature and the presence of restriction of movement) for presence of inflammation in the joint. Blood tests were done for Acute Phase Reactant (APR) namely Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) and infrared imaging of the respective joints were taken. On the basis of clinical examination, all these patients were divided in three groups: (i) patients with inflamed joint; (ii) non inflamed joint; and (iii) doubtful inflammation of joints. Infrared imaging of all the respective joints of all the patients were compared with the respective results of APR for presence of inflammation. Values more than the normal range of APR were considered as positive marker for inflammation. The data was analysed statistically by calculating sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) using Matrix Laboratory (MATLAB) 2013b software. Results: Out of 60 cases, 37 (61.66%) patients showed clinically inflamed joints, 10 (16.66%) showed no inflammation and 13 (21.66%) showed clinically doubtful cases of inflammation. The results were statistically analysed and the sensitivity, specificity, PPV and NPV of infrared imaging for detection of joint inflammation were 91%, 80%, 94% and 72%, respectively. Conclusion: Infrared imaging is a very sensitive tool for the detection of inflammation of joints and is very useful for detection of subclinical inflammation of joint.

Effectiveness of Multimodular Interventions of Lifestyle Modification on Symptoms of Polycystic Ovarian Syndrome and Quality of Life among Women- A Pilot Study
Introduction: Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder encountered in female. Multimodular interventions of lifestyle modifications emphasise bearable weight loss through dietary, exercise, and behavioural modification. The timely recognition, understanding, and handling of clinical characteristics of this syndrome shall prevent long-term health issues. Aim: To evaluate the efficacy of multimodular interventions on symptoms of PCOS and the quality of life of women with PCOS. Materials and Methods: A pilot study was conducted at Father Muller College of Nursing, Mangaluru, Karnataka, India, between May 2019 to February 2020. The female diagnosed with PCOS were selected through a purposive sampling technique, from two tertiary settings (15 subjects for the intervention group and 15 for the control group). The multimodular interventions (diet, exercises, and behavioural modifications) were provided to the study group. Follow-up was done in the 2^nd, 4^th and 6^th month. The control group subjects continued the regular medical treatment and followed-up at 6^th month. The intervention and control group results were compared in the 6^th month. The tools used for data collection were baseline variables, PCOS symptom assessment tool, and World Health Organisation Quality of Life questionnaire (WHOQOL-BREF) tool. Results: The mean age of study participants was 24.26±3.84 years in the intervention, and 24.20±3.54 years in the control group. A significant improvement in the waist-hip ratio, hirsutism acne (p-value <0.001) and quality of life in women with PCOS was observed in the post-test 2 (2^nd month), post-test 3 (4^th month), and post-test 4 (6^th month) in the intervention group (p-value <0.001). A minimal change was noticed in the Body Mass Index (BMI) and Fasting Blood Sugar (FBS) scores. The Mann-Whitney test (z values) revealed a significant difference in the symptoms of PCOS of waist-hip ratio (z value=3.328, p-value <0.001) and hirsutism (z-value 2.296, p-value <0.022) between intervention and control group after the 6 months. The pretest mean and standard deviation of physical health domain was 21.00±2.59, psychological health domain 18.13±3.04, social relationship 9.27±1.67, and environmental domain 23.00±3.66. The post-test mean and standard deviation was 24.00±3.05, 22.67±4.03, 12.20±1.74, 28.07±6.71 (p-value <0.001) in physical, psychological, social, and environmental domain, respectively. A statistically significant increase in quality of life observed in the intervention group (p-value <0.001) whereas in the control group there was no change. Conclusion: The multimodular interventions were found to be effective in reducing the clinical symptoms of PCOS like hirsutism acne and the quality of life steeply improved after 6 months of these interventions in PCOS women.

Evaluation of Osteopontin and Malondialdehyde Level and its Correlation with Iron Status in Hypothyroidism Patients: A Case-control Study

Sumesh Prasad Sah, Jyoti Batra, Manisha Arora, Sudeep Kumar, Sonu Sah
Introduction: Hypothyroidism is a clinical condition characterised by abnormally low thyroid hormone production. Hypothyroidism is associated with increased Malondialdehyde (MDA), Total Iron Binding Capacity (TIBC) and decreased Osteopontin (OPN), iron and ferritin level. Aim: To evaluate OPN and MDA level and its correlation with iron status in hypothyroidism subjects also to compare the OPN, MDA, iron, ferritin and TIBC levels in cases with the controls. Materials and Methods: This case-control study was done at Santosh Medical College, Ghaziabad, in collaboration with Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India from September 2018 to September 2020. The current study involved a total of 240 female participants. There were 120 female hypothyroidism (cases) and 120 female normal healthy (control) participants of the same age group in the current study (30-60 years). Blood samples were collected from all participants and analysed for OPN, MDA, iron, ferritin and TIBC. OPN was estimated using sandwich- Enzyme Linked Immunosorbent Assay (ELISA) method. MDA was estimated by Kei satoh method. Serum ferritin was estimated by Immuno-turbidimetric on Access 2 Immunoassay Beckman Coulter and serum iron and TIBC were estimated by Beckman Coulter AU480 Clinical Chemistry Analyser. Pearson’s correlation was used to evaluate the association between these parameters, which were represented as mean with Standard Deviation (SD). Results: Female hypothyroidism subjects had significantly (p-value <0.001 for all) increased body mass index, waist circumference, hip circumference, and waist hip ratio than controls. Study showed increased levels of MDA and TIBC and decreased levels of serum OPN, ferritin and iron in hypothyroid subjects as compared to controls. A significant positive correlation was found between OPN vs ferritin (r=0.465, p-value <0.001), OPN vs iron (r=0.521, p-value <0.001) , MDA vs TIBC (r-value=0.591, p-value <0.001), whereas significant negative correlation was found between OPN vs TIBC (r=-0.454, p-value <0.001), OPN vs MDA (r=-0.501, p-value <0.001), MDA vs ferritin (r=-0.543, p-value <0.001) and MDA vs iron (r=-0.573, p-value <0.001). Conclusion: The decreased levels of OPN and increased level of MDA in hypothyroidism subject, which increases risk of iron deficiency anaemia in hypothyroidism patients. Furthermore, OPN and MDA were well correlated with ferritin, iron and TIBC in hypothyroidism subjects. As a result, these aspects should be considered while assessing risks of iron deficiency anaemia in hypothyroidism.

Clinical Characteristics of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma Patients: A Retrospective Cross-sectional Study
Introduction: Pseudoexfoliation (PEX) is a systemic disease characterised by the accumulation of dandruff-like fluffy deposits of fibrillar granular material. It is the most common cause of secondary open angle glaucoma. Pseudoexfoliation Glaucoma (PXG) is typically associated with rapid visual field loss, greater severity of optic neuropathy and pressure spikes. Aim: To evaluate the clinical characteristics of Pseudoexfoliation Syndrome (PXS) and PXG in the eastern part of Uttar Pradesh. Materials and Methods: This retrospective cross-sectional study was done on a total of 40 patients with 78 eyes, at Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India. The authors reviewed the medical records database to identify all patients aged 35 years or older with PXG or PXS who attended the outpatient clinic between January 1, 2020 and January 31, 2021. Ethical approval was obtained from the Institutional Review Board at Sitapur Eye Hospital, Sitapur. Continuous variables were calculated by Mann-Whitney U test student’s t-test and qualitative variables using the chi square test. The p-value <0.05 was considered significant. Results: A total of 40 patients with 78 eyes were diagnosed as having PXG or PXS. The mean age of study patients was 66.12±11.63 years. The male to female ratio was 2.64:1. The average Intra Ocular Pressure (IOP), Cup:Disc ratio was more in the patients having PXG (p<0.001) as compared to PXS. The PEX at the pupillary margin and pupillary ruff atrophy was more in PXG. The bilateral involvement of disease was observed in most of the patients. Conclusion: The spectrum of PEX includes a detailed ocular and systemic examination. Dilated anterior segment examination should be emphasised in routine practice to prevent missed diagnosis of early PEX patients, thus, resulting in decreased glaucomatous damage.

Effectiveness of Dexamethasone as an Adjunct Drug in Treatment of Critical COVID-19 Patients: An Observational Single Cohort Study

Arvinder Pal Singh, Sahiba Kukreja, Rohit Arora, Manmeet Kaur Gill
Introduction: Corticosteroids have shown controversial results in severe infections. Limited data is available to prove the efficacy of this drug against Coronavirus Disease 2019 (COVID-19) infection. Such studies have highlighted that steroids such as dexamethasone can be effective against the patients who are exhibiting severe symptoms of COVID-19. Aim: To determine the effectiveness of dexamethasone as adjunct drug in treatment of critical COVID-19 patients. Materials and Methods: This observational single cohort study was conducted on 50 COVID-19 positive patients admitted to the tertiary care hospital, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India during August 2020 to October 2020. Critically ill-patients suffering from COVID-19 receiving 6 mg dexamethasone along with standard treatment protocol as prescribed by the Indian Council of Medical Research (ICMR) were included in the present study. Serum interleukin-6, D-dimer, ferritin levels along with Cycle threshold (Ct) values from RT-PCR of nasopharyngeal and oropharyngeal swab were recorded on the day of admission and after 7 days of dexamethasone therapy along with standard treatment protocol of ICMR. The data was analysed using descriptive statistics and paired-t test. Results: There were 22 males and 28 females enrolled in the study with mean age of males as 55 years and mean age of females as 56 years. The mean weight of males was 68.4 kg, while the mean weight of females was 59.8 kg. Statistically significant decrease in serum levels of interleukin-6, D-dimer, and ferritin after 7 days of dexamethasone treatment along with standard treatment protocol of ICMR was observed. The results were found to be different with p-values=0.001, 0.003 and 0.002, respectively. Conclusion: Dexamethasone, as an adjunct drug, is an important corticosteroid that is efficient in countering the inflammatory response generated in COVID-19 patients along with standard treatment protocol of ICMR. It reduces the inflammatory markers in patients suffering from COVID-19.

Assessing Time Gap between Alveolar Cleft Repair and Dental Implant Placement: A Systematic Review

Rizwana Mallick, Sweta Kale Pisulkar, Srinivas Gosla Reddy, Vanshika Jain
Introduction: Orthodontic treatment is commonly undertaken in cleft patients for space closure in cleft region. However, it is only able to achieve 50-75% closure, resorting to use of dental prosthesis in form of removable or fixed partial dentures. Dental implant-based rehabilitation provides a suitable solution however, their success depends on the quality and quantity of the residual bone. Resorption of bone graft is a known scientific fact and thus, it is important to know the minimum time after which the implant can be placed so that the grafted bone is minimally lost. However, this time gap between final bone grafting and implant placement in cleft patients has not been well established. Aim: To determine whether the clinical and/or radiological success of dental implant-based rehabilitation depends on the time elapsed between the last grafting procedure and dental implant placement in cleft region with missing permanent teeth in a unilateral or bilateral alveolar cleft patient. Materials and Methods: The systematic review was registered in PROSPERO (International Prospective Register of Systematic Reviews) via registration number CRD42020187709. Systematic review was done at GSR Institute of Craniomaxillofacial and Facial Plastic Surgery, Hyderabad, Telangana, India, between March 2020 to July 2020 wherein articles in electronic databases (PubMed, ScienceDirect, Web of Science, (Literatura Latino-Americana de Ciencias da Saude), Cochrane Library and Google scholar, published between January 2011 to February 2020 were searched. Combination of Medical Subject Headings (MeSH) terms used included “cleft palate”, “cleft lip”, “alveolar bone grafting”, and “survival” as some of the key terms. Additional information was sought by contacting the corresponding authors. Search items included were cleft, alveolar bone grafting and dental implants. Only studies with details of time gap between last grating procedure and implant placement were included. Data extraction was done independently by two authors using pre-defined fields. Results: Total of 12 studies were included wherein 255 dental implants were placed in 180 patients. In patients undergoing tertiary grafting, a time of 0 to 26 months was given prior to implant placement while in patients where tertiary grafting was not done, a time of 24 to 144 months was seen between two procedures. A high implant success of 95-100% was seen irrespective of the grafted bone. The JBI (Joanna Briggs Institute) tool of risk of bias assessment was used. Low level of evidence was presented by case reports and case series. Conclusion: In case of tertiary grafting, a healing period of 3-6 months was seen to be sufficient for successful implant treatment however, a need for more comprehensive studies was recognised due to lack of mutual assessment parameters and shared information in the currently reviewed literature.

Role of Epigenetics in Developing Therapeutic Strategies against COVID-19

Rahul Saxena, Kunal Tiwari
Epigenetics showcases an interconnection between genes and the environment. The expression or repression of genes can result from epigenetic regulatory mechanisms like Deoxyribonucleic Acid (DNA) methylation, histone modifications and chromatin remodelling. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) regulates host epigenetic machineries to mutate itself, improve its replication and increase its persistence by alienating the host’s antigen-presenting molecules and modulating interferons expressing genes. The previous outbreak of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) reveals that DNA methylation by the virus plays a crucial role in the loss of antigen-presenting molecules in the host. Since these coronaviruses share an ancestorial link, it is believed that the new coronavirus acts similarly. Recent reports of increasing morbidity, mortality and persistence of Coronavirus Disease 2019 (COVID-19) points to the rapid mutation and evading of immunity of the host. Vaccines, although they have helped to prevent the pandemic but their action remains questionable with new developing variants. We explore the possibility of developing epigenetic-based drugs and vaccines and other immune modulators that are being investigated to end the present COVID-19 pandemic and open new avenues for any such pandemics in the future. Comprehensive review regarding COVID-19 was obtained from PubMed and other search engines. Insights about the COVID-19 vaccines were reported from scientific sources. Epigenetics is a crucial subject to explore for the development of therapeutic strategies against the COVID-19 virus. Epigenetic modulators that can be re-programmed to counter the replication and infection efficiency of this virus and medications, including transcription suppressors, nucleoside inhibitors, can be one of the new strategies which may have a better outcome.

A Review of Calendula officinalis-Magic in Science

Karthikeya Patil, CJ Sanjay, Nagabhushana Doggalli, KR Renuka Devi, N Harshitha
Calendula officinalis (Calendula), a member of the Asteraceae family, is often known as English Marigold or Pot Marigold. Marigold is a fragrant herb that has been used in traditional medicine for centuries. Calendula species have been highlighted in order to better understand their diverse biological activities and modes of action. Carotenoids, flavonoids, glycosides, steroids and sterols, quinines, volatile oil, and amino acids are all found in abundance in this plant. Calendula oil is still used as an antitumour agent in medicine, which is also a wound healing agent. Among herbal medicines, Calendula suspension or tincture is used to treat acne locally, reduce inflammation, control bleeding and soothe irritated tissues. This Calendula plant’s extract, a pure chemical extracted from it, have been shown to have a variety of pharmacological properties including anti-inflammatory, antioedematous, antioxidant activity, antibacterial and antifungal activity, anti-Human Immunodeficiency Virus (HIV) and antiviral activity, wound healing and immunostimulant activity. Anticytotoxic, hepatoprotective, spasmolytic properties and also impacts on exhibiting increased levels of proinflammatory cytokines Interleukin (IL)-1 beta, IL-6, Tumor Necrosis Factor (TNF)-alpha and Interferons (IFN)-gamma and acute phase protein, C-reactive protein. C.officinalis may have an important future impact on the development of new cancer treatment strategies, and until now it has been specifically used to reduce the side-effects of radiotherapy. This review looked at the organoleptic, in-vitro, and in-vivo pharmacological activities, as well as the description, cultivation, and active chemical constituents of Calendula officinalis in order to fill in the gaps in current knowledge about this plant and to highlight its potential applications as a medicinal agent.

A Systematic Review on Nano Coated Orthodontic Brackets and its Antibacterial Effects

Suvetha Siva, Shreya Kishore, Priyanka, Aadhirai Gopinath
Introduction: Oral cavity is a natural habitat of bacteria which proliferates when an orthodontic appliance is placed which leads to enamel demineralisation or white spot lesions. In order to reduce the bacterial proliferation, the surface coating of brackets using nano particles came into existence. Aim: To assess the different surface modifications using nano coating materials and to evaluate the antibacterial properties of these nano coated orthodontic brackets. Materials and Methods: A systematic review was conducte in September 2021, analysing the microbial adhesion and antibacterial properties of orthodontic brackets after application of nano coating against uncoated brackets was conducted from the available electronic database during January 2000 to June 2021, which included PubMed, Embase, Google Scholar and Medical Literature Analysis and Retrieval System Online (MEDLINE). Due to less number of in-vivo studies, in-vitro studies were also included. An analysis on the microbial adhesion and antibacterial effects of various orthodontic brackets was done. The results were tabulated after performing risk of bias assessment for each study. Results: Based on the inclusion and exclusion criteria, 13 studies were included in the study. Risk of bias was medium for majority of the selected studies. As per the previous literature, bacterial adherence of Streptococcus mutans, Streptococcus sobrinus, Aggregatibacter actinomycetemcomitans, Lactobacillus acidophilus, Actinomyces viscous and Candida albicans was reported lower in groups of brackets coated with silver nano particles than that in the groups of brackets without the addition of silver nano particles. The corrosion level on the silver or silver platinum (Ag-Pt) coated specimens was lower than that on the non coated specimens. Conclusion: The stainless-steel orthodontic brackets coated with various nano coating materials like silver, silver-platinum, titanium, Zinc Oxide (ZnO) and Copper Oxide (CuO) exhibited adequate antibacterial effect. This shows that in orthodontic patients, especially the one susceptible to caries, the amount of plaque accumulation is significantly reduced when nano-coated orthodontic brackets are used. They reduce the microbial colony count, prevent enamel demineralisation and white spot lesions. Further clinical trials must be carried out on a large scale to confirm the results.

Implant Impression Techniques using Different Materials and Methods: A Review

Muhammed Necati Yasar, Cem Cetinsahin, Omer Bayar, Hasan Yildirim Ozer
Dental implants have emerged as the treatment of choice for restoring missing teeth in situations that require functional and aesthetic replacements. Reproduction of the position and orientation of intraoral implants by means of an accurate impression in the definitive cast is the first step in achieving a passively fitting multi-implant supported prosthesis, to decrease the mechanical and biological complication of the prosthesis. The accuracy of the impression making procedure in the usage of osseointegrated implants used for the rehabilitation of fully and partially edentulous patients is a very important factor for the long-term success of dental implants. It has been reported that the precision of implant impressions is affected by various factors such as impression materials, impression technique, splinting of impression posts, impression level and depth, as well as the angle of the implants. Also, the incompatibility between implant and prosthesis, which may occur as a result of an incorrect impression, may cause problems such as screw loosening, screw fracture, loss of osseointegration and even implant fracture. In recent research, there are many articles and reviews about implant impressions. Although the authors found consistent results in many studies, there are differences of opinion on some issues. In general, polyether and additional type silicones were found to be successful in the conventional impression technique. Digital impression technique, on the other hand, has been found as successful as conventional measurement techniques in some studies. Controversial results have been obtained about the number of implants and their angulation. In general, the direct open tray splinted impression method is recommended for four or more implants, while there was no difference between the direct or indirect method for three or less implants.

Sports and Exercise Medicine in India: The Past and the Challenges

Hanjabam Barun Sharma
Sports and Exercise Medicine (SEM) started in India with Postgraduate (PG) Diploma in Sports Medicine (DSM) in 1986-87 and Doctor of Medicine (MD) more than two decades later. However, the concept of exercise is medicine can be traced back to the ancient Indus Valley civilisation. To fully develop and utilise this specialty, there is a need of continuously updating the current DSM and MD syllabus to world-class level, introduction of SEM into undergraduate curriculum, opening of SEM training-research institutes, recruitment of SEM-physicians as faculty and experts in various government and non government programmes and organisations dealing with various aspects of Sports Medicine (SM), Exercise Medicine (EM) and Sports and Exercise Sciences (SES). With only adequate development and growth of SEM and SES, will the dream of making India a fit, healthy and a world sports-giant be materialised. This review article has been compiled to provide information regarding SEM as a new medical specialty in India, its history and the current challenges.

Obesity: Overview of a Universal Health Conundrum
Obesity is a worldwide health issue which is displaying increasing prevalence trend. World Health Organisation (WHO) has already given it as epidemic status. Many physiological parameters such as Body Mass Index (BMI), Waist Circumference (WC), Waist to Hip Ratio (WHR) are used for measurement of obesity. This review was written with the aim to give an inclusive picture of current prevalence of obesity along with discussing the physiology and function of different adipocytes and the numerous chemical messengers released by them. The manifold impact of obesity on various body systems can be elucidated by exploring the adipocytes, adipokines, its functions and signalling mechanism. The adipokines enlist as key players in numerous systemic diseases. Obesity has a significant pathophysiological role in morbidity and mortality causing conditions globally. Obesity can potentially be the leading reason of economic burden on global healthcare, adversely impacting the comprehensive quality of life. This review is an effort to provide a better understanding of the current obesity status and emphasise further researches on its diverse aspects.

Impact of Physical Activity on Physical and Mental Health of Postmenopausal Women: A Systematic Review

Sheetal Kalra, Joginder Yadav, Puneeta Ajmera, Bijender Sindhu, Sajjan Pal
Introduction: Menopause is associated with a variety of physical and mental issues. It’s critical to pay attention to postmenopausal women’s health issues and develop prevention strategies. Aim: To evaluate association between physical activity and physical and mental health problems in postmenopausal women. Materials and Methods: In the present systematic review, relevant studies were searched in international electronic databases such as, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and Google Scholar from 2004 to 2021. Terms like physical activity, physical health, mental health, bone mineral density, exercise training, and postmenopausal women were searched. All papers were screened for eligibility. Inclusion criteria of the study was, studies with atleast one exercise group versus one control group, should include women who were postmenopausal at the time of the study, studies that examined effect of physical activity on physical and mental health of postmenopausal women, full text articles written in English language. Results: Total 27 studies were included in the present review. The results revealed that resistance, aerobics, walking, pilates and aquatic exercises have shown benefits in improving physical and mental health parameters of postmenopausal women. Conclusion: Physical activity plays a great role in maintaining overall health and Quality of Life (QOL) of Women. To avoid fractures, these women should engage in workouts with prudence. Physical and mental fitness can be achieved by incorporating exercise into daily routine of postmenopausal women.

Orthodontic Limitations in Adults: A Review

Subi Singh , Mona Prabhakar , Jasmine Nindra , MS Sidhu , Shikha Ahlawat
The scope of orthodontics has broadened in the current era. It is no longer limited to the treatment of children and adolescents but includes the treatment of adults that are non growing thereby extending the age limit. The number of adults seeking orthodontic treatment has considerably increased over the past few years as people have become aesthetically conscious and aware of treatment modalities available through channels like internet and social media. While treating adult patients, a multidisciplinary approach should be adopted, taking into consideration several factors like systemic diseases and psychological factors so as to formulate a holistic treatment plan. Orthodontists face challenges in treating older adult patients whose growth is already completed. There are various elements that differentiate adult orthodontic treatment from that of children or adolescents. Therefore, this article highlights the constraints or challenges faced by an orthodontist in treating adult patients.

Association of COVID-19 and Endocrine Disorders

Deep Hathi, Sourya Acharya, Samarth Shukla, Vidyashree S Hulkoti
Coronavirus Disease 2019 (COVID-19), caused by the coronavirus, since its start in Wuhan a city in China has spread like a wild fire and created havoc all over the globe. Initially, the disease was thought to be causing only respiratory complications, but gradually it was found to be causing multiorgan complications. Due to the hypercoagulable property of coronavirus, it has shown neurological, cardiological and endocrine complications. Recently, the effect of the virus on endocrine system has also been noted. Evidence has shown that COVID-19 can hamper the hypothalamo-pituitary axis resulting in altered adrenal response to stress. The immune-mediated damage to the endocrine glands results in subacute thyroiditis. The presence of Angiotensin Converting Enzyme 2 (ACE 2) receptors on various tissues could be the cause of this immune mediated damage. The COVID-19 has also precipitated hyperglycaemia and in few cases, uncovered the insulin resistance in previously undiagnosed cases. It is crucial to have knowledge about the impact of endocrine system, as it is the powerhouse of the body.

Influence of Season on the Incidence of Postdural Puncture Headache- A Clinical Audit

S Parthasarathy, TS Shanthi
Introduction: Postdural Puncture Headache (PDPH), even though becoming uncommon, is still one of the distressing postoperative complications after spinal anaesthesia. The reports on the incidence of PDPH are inconsistent, being 2-40% with different sizes of needles. A previous study conducted by the authors in the winter months in non obstetric cases, found a low incidence of PDPH and authors had suggested that there is a need to examine the association between PDPH and different seasons. Aim: To find out the incidence of PDPH in obstetric population and any finding for differential incidence with different seasons. Materials and Methods: The present study was a single centre retrospective clinical audit of lower segment caesarean cases (N=782) under spinal anaesthesia with 25-gauge Quincke needle. The records of summer and winter months were separated as two groups for each year of 2019 and 2020. The cases done in the months of March, April and May formed the summer group, while the October, November and December patients formed the winter group. Results: There was no significant difference between the groups with regard to age (p-value=0.5). The incidence of PDPH was significantly higher in summer months than winter months in two consecutive years (p-value=0.0068). Fourteen out of 390 patients in the summer group and one out of 392 patients of the winter group suffered from PDPH overall. Conclusion: There should be an urgent need to control ambient temperature in patients at risk of PDPH. The optimisation of coincident dehydration is essential.

Journal of clinical and diagnostic research

Scrofula Presenting as Tubercular Meningitis: A Neglected Sequelae

Supervised Structured Exercise Program on Adolescents with Polycystic Ovary Syndrome: Two Case Reports

A Serviceable Treatment Option for Partially Edentulous Cases- From Traditional to Technological

Scleral Necrosis in Porphyria Cutanea Tarda: A Case Report

Novel Pathognomonic Variant of Atypical Type IV Usher Syndrome with Retinitis Pigmentosa- A Case Report

Thrombocytopenia in an Apparently Healthy Neonate: An Unusual Report of Postnatally Acquired Dengue Infection

An Unusual Case of Rectal Bleed in an Adolescent: Solitary Rectal Ulcer Syndrome Mimicking Rectosigmoid Malignancy

Embryonal Rhabdomyosarcoma: A Tale of Two Cases with Unusual Presentation

Botulinum Neurotoxin Injection as a Therapeutic Option in Thoracic Outlet Syndrome Caused by a Supernumerary Scalenus Muscle: A Case Report

An Extremely Rare Case of Granular Cell Tumour of Right Nasal Vestibule

Dorsal Cord Herniation with Diastematomyelia- A Rare Case

Chronic Indolent Community-acquired Pneumonia due to Pseudomonas Infection in an Immunocompetent Patient- A Case Report

Intravesical Migration of the Longest Forgotten Intrauterine Contraceptive Device with Secondary Vesicolithiasis in a 70-Year-Old Female: A Rare Case Report

A Rare Case of Purple Urine Bag Syndrome Presenting with Delirium and Associated with Acidic Urine and UTI due to Serratia marcescens: But do we Still know Enough?

Stenotrophomonas maltophilia: Threat of a Multidrug Resistant Infection in Hosts with Co-morbidities- A Case Series

Clinicopathological Parameters of Haemolytic Anaemia in COVID-19 Infection: A Series of Three Cases

Management of Closed Tendoachilles Rupture- A Case Series

Adrenal Myelolipoma: A Series of Three Cases

Laparoscopic Pyeloplasty in Paediatric Age Group with Standard Adult Sized Laparoscopic Instruments

Morphological Study of Left Ventricular False Tendons in Human Cadaveric Heart Specimens

Lost Opportunities for Cornea Retrieval: A Cross-sectional Study from District Hospital, Tumakuru, Karnataka

Knowledge, Attitude and Perception about Neurodevelopmental Disorders among Pregnant Women: A Cross-sectional Study

Effect of Non Incentivised and Incentivised Free COVID-19 Vaccination Camps in Augmentation of State’s Efforts in Achieving Vaccination Targets Necessary for Herd Immunity

Comparison of Oral Labetolol and Oral Pregabalin in Attenuating Pressor Response to Endotracheal Intubation in Patients undergoing Mastoidectomy under General Anaesthesia- A Randomised Control Study

Lipid Abnormalities in Tuberculosis Patients with Diabetes Mellitus: A Hospital-based Cross-sectional Study

Three Dimensional Morphological Grading of Ankylosed TMJ for Surgical Planning: A Retrospective Observational Study

Factors Determining the Functional and Radiological Outcome after Secondary Nailing in Open Fractures of Lower Extremity- A Prospective Cohort Study

Association of Serum Lactate Dehydrogenase and Qualitative C-Reactive Protein with the Severity of COVID-19 Disease

Evaluation of Efficacy and Safety of Clevira as an Add on Drug in Mild to Moderate COVID-19 Positive Patients: A Randomised Control Trial

Association of Mid-sagittal Anteroposterior Diameter of Lumbar Canal in Patients with Low Back Pain using MRI: A Cross-sectional Study from West Bengal, India

Cyclin D1: A Prognostic Marker in Multiple Myeloma and its Association with CRP and β2-Microglobulin Level

Immediate Effect of Ujjayi Pranayama on Attention and Anxiety among University Students: A Randomised Self-control Study

Association of Severity of Coronary Artery Disease with Left Ventricular Diastolic Dysfunction among Diabetics with Stable Ischaemic Heart Disease: A Cross-sectional Study from Odisha, India

Comparative Analysis of Tear Film Parameters in Patients Undergoing Pterygium Excision by Conjunctival Autograft or Bare Sclera Technique Augmented by Intraoperative Mitomycin C Application

Congenital Central Nervous System and Associated Systemic Anomalies in Foetal and Perinatal Autopsy- A Retrospective Study

Efficacy of Diclofenac Transdermal Patch versus Diclofenac Rectal Suppository for Management of Postoperative Pain Following Open Cholecystectomy: A Randomised Clinical Trial

Antibacterial Activity of Ricinus communis Extracts against Common Human Pathogens Obtained from Surgical Wound Infections in a Tertiary Care Hospital of Semi-urban Set-up at Andhra Pradesh, India

Comparison of PRISM III and PIM II Score in Predicting Mortality in Paediatric Intensive Care Unit: An Observational Study

Disorders of Sexual Differentiation: A Clinicopathological and Histological Study

Effect of Incisional Negative Pressure Wound Therapy Following Incisional Hernia Repair- A Randomised Controlled Trial

Effect of Low Dose Intravenous Dexmedetomidine with 4% Sevoflurane on Haemodynamic Response during Laryngoscopy and Tracheal Intubation: A Randomised Controlled Study

Knowledge, Awareness and Practices of the use of Digital Technology in Dentistry among Postgraduate Students and Dental Practitioners in India: A Cross-sectional Study

Clinico-immunological Study of HIV Infected Children Attending ART CentreA Prospective Longitudinal Study

Concurrent Presence of Hashimoto’s Thyroiditis with Papillary Carcinoma of Thyroid- A Retrospective Study

Pathological Features of Lung in COVID-19 Disease Subjects: A Postmortem Study

Vaginal Cuff Closure by Endosuturing in Total Laparoscopic Hysterectomy as Compared to Transvaginal Route of Suturing

A Community-based Cross-sectional Study on Knowledge and Belief of Menstruation and Practices of Menstrual Hygiene among Adolescence Girls of Vadodara, Gujarat, India

Animal-assisted Therapy as a Potential Tool for Management of Dental Anxiety in Children: A Questionnaire-based Cross-sectional Study

Origin and Prevalence of the Retroportal Course of Hepatic Artery- A Retrospective Study

Whole Brain CT Perfusion Evaluation in Transient Ischaemic Attack: A Cross-sectional Study from a Tertiary Care Centre, New Delhi, India

Papillary Thyroid Carcinoma- Variants and Associated Disorders

Body Weight as a Major Determinant of Thyroxine Sodium Dosage in the Treatment of Primary Hypothyroidism

Maternal and Perinatal Outcomes in Placenta Previa: A Retrospective Study at a Tertiary Care Centre of Western India

Intracranial Complications due to Chronic Suppurative Otitis Media-Atticoantral Disease with a Reference to its Microbiological Profile: A Retrospective Study

Iron Deficiency Anaemia among Exclusively Breastfed Term Infants of 4-6 Months Age and its Contributing Factors: A Cross-sectional Study

First Trimester Combined Aneuploidy Screening for Trisomy 21: A Three Years Retrospective Study

Role of Immunohistochemical Expression of p53 in Intestinal Epithelial Cells to Detect Dysplasia in Patients with Inflammatory Bowel Disease

Assessment of Knowledge of Glaucoma in General Practitioners, Resident Doctors and Interns in Anand District, Gujarat, India

Rhino-orbital Fungal Invasion in Post COVID-19 Cases at a Tertiary Eye Care Centre in Hyderabad- A Cross-sectional Study

Early Identification and Antimicrobial Susceptibility Testing of Short versus Standard Incubated Blood Cultures from a Tertiary Care Centre in Southern India

Impact of School-based Online Oral Health Education Programme during COVID-19 Pandemic: A Cross-sectional Study in Riyadh, Saudi Arabia

Blood Lactate Levels and PRISM III Scores for Prognosis of Shock during Paediatric Emergencies: A Prospective Observational Cross-sectional Study

Anticarcinogenic Efficacy of Fucoxanthin on HepG2 Cell Lines

Muscle Strength in Type-2 Diabetes Mellitus and its Relationship with Biochemical Parameters and Microvascular Complications

Implementing a Fever Clinic for Managing COVID-19 Patients using Hydroxychloroquine Protocol- An Experience from a Primary Healthcare Centre in Riyadh, Saudi Arabia

Efficacy of Kinesio Taping among Females with Postpartum Low Back Pain- A Quasi-experimental Study

Role of Platelet Rich Plasma in the Management of Plantar Fasciitis: A Prospective Interventional Study

MRI Study of Lumbar Canal Stenosis by Morphological Grading and Thecal Sac Measurement: A Cross-sectional Study

Expression of PDL-1 Receptors in Prostate Cancer Patients and its Association with Tumour Aggressiveness: A Cross-sectional Study

Sperm DNA Fragmentation Index in Infertility Patients vs Normal Individuals: A Cross-sectional Study

Effect of Perioperative Music Therapy/Medicine on Postoperative Pain in Women Undergoing Elective Lower Segment Caesarean Section Delivery under Spinal Anaesthesia: A Case-control Study

Anxiety and Coping Strategies among Medical Students during COVID-19 Pandemic: A Cross-sectional Study

Learning Motivation and Self-efficacy towards Improved Clinical Performance in Undergraduate Nursing Students: A Cross-sectional Study

Biochemical and Haemodynamic Changes during Transurethral Resection of Prostate and Percutaneous Lithotripsy- An Observational Pilot Study

Bacteriological Profile of Sepsis among Low Birth Weight Neonates: A Hospital-based Cross-sectional Study from Northern India

Elucidation of Histological Features of Pericardium in Cases Clinically Presented as Constrictive Pericarditis: A Retrospective Observational Study

In-vitro Evaluation of Antimicrobial Activity of Nargenicin-A1 against Gram Positive Clinical Isolates and its Comparison with Various Antibiotics

Seroprevalence of IgG Antibodies against Rubella in Young Females in a Medical College in Chennai, India

Protective Role of Vitamin C against Biochemical Enzymes Alterations Induced by Exposure of Allethrin-based Mosquito Coil Smoke on Cerebellum of Male Albino Rats-An Experimental Study