Journal of clinical and diagnostic research

Autoimmune Haemolytic Anaemia, Acute Pericarditis with Cardiac Tamponade as Presenting Manifestations in Systemic Lupus Erythematosus- A Rare Case Report

Apurva Dubey, Sourya Acharya, Samarth Shukla, Sunil Kumar, Himanshu Dodeja

Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that affects mostly young women in which tissue-binding autoantibodies and immune complexes cause damage to organs and tissues. SLE is characterised by aberrant immunological responses that result in the release of higher levels and immunogenic nucleic acids, proteins, and other self-antigens. Autoimmune Haemolytic Anaemia (AIHA) is a condition in which antibodies against red blood cells are present. It is classified as a warm and cold antibody AIHA. The causes of warm antibody AIHA are autoimmune illnesses, infections, or even malignancy. The presence of Immunoglobulin G (IgG) antibodies can indicate warm autoimmune haemolytic anaemia (warm agglutinin anaemia), which is characterised by fatigue and other constitutional symptoms. Although, autoimmune haemolytic anaemia can be a component of the SLE spectrum, warm autoimmune haemolytic anaemia as the first manifestation of SLE is exceedingly rare. This case report describes a case of a 23-year-old female who presented to the hospital with complaints of breathlessness and chest pain. After evaluation she was found to have pericardial tamponade and AIHA. Pericardiocentesis was done and further investigations confirmed the diagnosis of SLE. She was treated with injectable methylprednisolone, injectable antibiotics, Tab. hydroxychloroquine, Tab. febuxostat ,Tab. colchicine, oral antidiuretic, oral levothyroxine and other supportive management. The lack of unambiguous pathognomonic characteristics or tests, coupled with the variable presentation of SLE, makes diagnosis tricky. Overall, AIHA can be an initial presentation as well as a part of other disease processes, emphasising the significance of a comprehensive work in patients with AIHA.

A Rare Presentation of Subhepatic Caecum and Appendix with Atrophic Gall Bladder in a Cadaver

Anasuya Ghosh, Arpita Sarkar

A case of subhepatic, mobile caecum and appendix was found in a 65-year-old male cadaver. The appendix was attached to the right wall of caecum, in addition, a small and atrophic gall bladder, only 1.5 cm in length, was noted in the fossa for gall bladder of liver, connected to the right colic flexure by a cystocolic peritoneal band. The case was found during the routine dissection for the undergraduate medical students. This kind of finding has not been reported in any previous literature associated with subhepatic caecum. This unusual position of appendix might cause atypical sign and symptoms during episode of acute appendicitis. This might affect the gall bladder, located in close vicinity, leading to inflammation, atrophy and adhesion to the adjacent right colic flexure. This type of case might cause diagnostic and management challenges for the clinicians and complicated disease conditions in the patients.

CAD-CAM Designed Ceramic Veneer for the Restoration of Peg-shaped Lateral Incisor: Case Report

Mohammad H Al Refeai

Peg shaped lateral incisors are considered to be the most common discrepancy concerning tooth size. This results in reduced size of the tooth, anterior diastema, and most often an unpresentable smile. Nowadays, the concepts of Adhesive Dentistry and wider use of ceramic veneers have allowed all ceramic restorations to be more acceptable in terms of function and aesthetics as well as establishing a good smile harmony. The aim of the clinical report presented, is to demonstrate a conservative approach of treatment so as to improve an aesthetically disharmonious smile resulting from a unilateral peg-shaped lateral incisor. Here the authors present a case of 33-year-old Saudi male, who sought treatment for solving his aesthetically disharmonious smile. Digital Impression guides were utilised for planning and fabricating Lithium Disilicate veneers. This was done to restore the size, morphology, function, as well as the aesthetics of upper lateral incisors including the overall smile of the patient. The veneers using Lithium disilicate provided the harmonisation of smile of the patient. It further resulted in recovering of the tooth size including its shape as well as anatomical characteristics.

Asymptomatic Pharyngeal Pouch in Laimer Hackermann Triangle in Oral Cavity

Karthikeya Patil, KP Mahesh, S Viveka

Laimer’s or Laimer triangle Hackerman’s area is a potentially weak location behind the cricopharyngeal muscle, where the posterior oesophageal wall is thin because of a single layer of circular fibres. Dysphagia, odynophagia, and hoarseness of voice are the predominant symptoms, although they can also be asymptomatic and get worsen to aspiration and pharyngeal pouch rupture. The authors here present a case report of a rare, normal anatomical variation in a 76-year-old male patient, which was diagnosed accidentally as Laimer Hackermann diverticulum when he arrived to seek a treatment for missing teeth. Clinically, it presented as an asymptomatic palatal pouch in the left faucial pillar region. The asymptomatic presentation of Laimer Hackermann diverticulum has rarely been reported previously in the literature and this report is the first of its kind to add a unique asymptomatic presentation of the Laimer Hackermann pharyngeal pouch.

Total Spinal Anaesthesia after Interscalene Brachial Plexus Blockade- A Case Report

Kapil Kamlesh Khandelwal, Nikhil Bhalerao, Jayashree Sen

Brachial plexus blockade has been used for a variety of procedures on the hand, upper extremities, and shoulder. After giving an effective brachial plexus block, total spinal anaesthesia may develop, perhaps due to epidural or prevertebral diffusion of anaesthetic drugs. When administering regional nerve blocks, the findings should underline the significance of cautious technique, but more significantly, the requirement for good patient monitoring and fast availability of resuscitation equipment. This case report was about a 45-year-old woman who underwent an external fixator application to a forearm injury under an interscalene nerve block. Subsequently, she developed haemodynamic deterioration and respiratory arrest. She was manually ventilated with positive pressure and was administered crystalloids intravenously with complete recovery of neurological function. This is being reported as total spinal anaesthesia, an extremely rare complication of the interscalene brachial plexus block.

Protein S Deficiency with Favourable Foetomaternal Outcome: A Case Report

Swati Sugandha, Shivanshi Sharma, Monika Jindal, Santosh Minhas

Protein S is a multifunctional plasma protein, whose deficiency, results in a rare congenital thrombophilia, inherited in an autosomal dominant pattern. It can aggravate the hypercoagulable state of pregnancy, when it presents in parallel with the condition, leading to adverse maternal outcomes and foetal loss. A 35-year-old female third gravida having previous 2 deliveries by Lower Segment Caesarean Section (LSCS) presented to emergency at 10 weeks pregnancy with chief complaints of pain and swelling in left thigh since 4-5 days. After thorough investigations and work-up, the patient was diagnosed with Protein S deficiency. She was managed conservatively and was delivered by elective LSCS with bilateral tubal ligation at 38 weeks of gestation with good foetal and maternal outcomes.The rarity of Protein S deficiency along with the successful outcome of the pregnancy makes this a unique case.

Isolated Pneumopericardium in a Neonate: A Case Report

Rakesh Kumar, Sanober Wasim, Girish Gupta, Suraj Singh, Radhika Jatana

Pneumopericardium (PPC) is a rare but life-threatening condition that mostly accompanies air leak syndromes in neonates receiving positive pressure ventilation. PPC results from the rupture of the alveoli and subsequent dissection of air through the tissue planes into the mediastinum, pleura, or pericardial sac. This report describes the case of a term low birth weight neonate born in a peripheral hospital who developed respiratory distress soon after birth. He was transported with manual bag and tube ventilation, and was found to have air leak syndrome in the form of isolated PPC. The neonate was managed conservatively with spontaneous resolution of the PPC.

Twin In-vitro Fertilisation Pregnancy Complicated with Appendicular Perforation: A Case Report

Akruti Shinde, Kamlesh Chaudhari, Nova Shinde

Appendicitis is an infection and inflammation of the appendix, a finger-shaped pouch that projects from the colon. It is a frequent and severe disorder that can appear anytime during pregnancy. It needs to be diagnosed and treated immediately. Otherwise, there would be a high risk of morbidity and mortality. Diagnosis is challenging due to the absence of the disorder’s typical clinical image, the ambiguity of its symptoms, and the frequency with which they occur during pregnancy. Due to the gravida uterus’s ability to displace the appendix within the abdomen, pregnancy may conceal the diagnosis and make it challenging to examine the patient physically. Obstacles in diagnosis caused by pregnancy lead to significantly increased risk to both the mother and foetus and raise the possibility of foetal loss following a negative appendicectomy. Usually, the biochemical and analytical tests used to diagnose this disease are unreliable during pregnancy. This is a case of a 38-year-old female primigravida who was 31 weeks pregnant with twins conceived via In-Vitro Fertilisation (IVF) and was diagnosed with acute appendicitis. She had surgery without complication and had a necrosed appendix, which was confirmed by histopathology. This report covers, in general terms, how to diagnose, treat, and manage a ruptured appendix with surgery and antibiotics with multidisciplinary management of such patients to improve their outcomes.

Granular Cell Ameloblastoma: A Rare Case Report and Literature Review

Ameloblastomas are rare, benign, aggressive neoplasms of odontogenic epithelial origin. Among the various types of ameloblastomas, granular cell ameloblastoma is rare and accounts for less than 5% of the total. Granular cells are epithelial in origin. The distinct histopathological characteristics of granular cells are associated with high lysosomal content in tumour cells cytoplasm. A 43-year-old female patient presented with a painful swelling on the left-side of the jaw. The diagnosis was based on clinical, radiological and histopathological examination. A complete surgical resection was done. Histopathology showed features of granular cell ameloblastoma. The operative procedure was uneventful. Granular cell ameloblastoma has a high tendency for recurrence. Around 33.3% recurrence is reported, according to various studies. This rate is much higher than other subtypes of ameloblastoma, which are more common. Hence, it is essential to provide appropriate surgical treatment on time to prevent tumour recurrence and metastasis.This case report aims to highlight the unique features of granular cell ameloblastoma, distinguishing it from other subtypes and discussing the pathogenesis and treatment modalities.

Orthodontic Camouflage of Borderline Skeletal Class III Malocclusion- A Report of Two Cases

Pooja Harish, Shweta Nagesh, Anup Belludi

Camouflage treatment in borderline Class III patients, especially those who refuse a surgical line of treatment, remains a challenge to the orthodontists. Such patients were usually treated using Class III elastics and lower premolar extractions. Mandibular arch distalisation is an alternative option for non extraction Class III camouflage. Temporary Anchorage Devices (TADs) help in achieving effective mandibular molar distalisation and are more accepted by adult patients. This case report discusses the diagnosis and management of two different presentations of borderline skeletal Class III malocclusion treated with miniscrew assisted mandibular arch distalisation. Two adult female patients between 18-20 years of age presented with a skeletal Class III malocclusion, average growth pattern, super Class I molar relationship and straight facial profile. The patients did not agree for a surgical line of treatment. Camouflage treatment by distalisation of mandibular arch using buccal miniscrew implants was done. Inter-radicular miniscrews were placed between mandibular second premolar and first molar to apply distalisation force of 250 gm/side. Lower arch distalisation of 2-3 mm was achieved in an average of 4.6 months. The outcomes were well retained three years post-treatment.

Quad Fever after Acute Traumatic Spinal Cord Injury

Quad fever is a rare and sometimes fatal condition characterised by sustained high temperatures of 40.8°C (105.4°F) and above, in spinal cord injury patients. Patients are often unresponsive to routine antipyretics and diagnosis is usually one of exclusion after other causes of fever are ruled out. This condition is understood to be secondary to autonomic dysfunction leading to thermoregulatory impairment. In the present case report, a 53-year-old male patient developed a fever of 104°F two days after a traumatic spinal cord injury involving C6-C7 segments. The fever did not respond to paracetamol, empirical broad-spectrum antibiotics or thromboprophylaxis. After ruling out both infectious and non infectious causes of fever, the hyperthermia was attributed to quad fever, a type of neurogenic fever. The patient continued to have non relapsing high fever and died five days after presentation. The case highlights the need to be aware of this differential in cases of high fever following traumatic spinal cord injury, in order to better prognosticate and also avoid unnecessary antimicrobial usage.

Extraosseous Ectopic Meningioma on Temporoparietal Region Mimicking a Soft Tissue Tumour: A Case Report

Swati Tyagi, Arun Yadav, Anshul Singh, Vatsala Misra

Ectopic meningiomas are very rare tumour entities that account for approximately 1-2% of all meningiomas and appear extracranially mostly in the head and neck region. Usually they create diagnostic confusion in an ectopic site with other soft tissue neoplasms, mostly peripheral nerve sheath tumours, myogenic tumours and vascular tumours, more so, with morphological variants like fibroblastic, angiomatous, etc. that may not show the meningothelial cells conspicuously. Here authors report one such case of a 55-year-old female, presenting with a slowly growing non tender left temporal mass since childhood that was thought to be a myogenic tumour on Computed Tomography (CT) scan but on microscopy was a transitional meningioma with mixed fibroblastic and meningothelial pattern. Hence, ectopic meningioma is one of the imperative diagnosis that a pathologist should keep in mind while dealing with soft tissue neoplasms of the head and neck region.

Rehabilitation with Table-Top Restoration Post Bicuspidisation: An Interdisicplinary Case Report

The first teeth to erupt in the oral cavity are the mandibular molars which are more prone to endodontic and periodontal involvement. This may lead to significant issues like an increase in pocket depth, furcation involvement, loss of clinical attachment and mobility of teeth ultimately resulting in tooth loss. Thus, it necessitates cautious oral hygiene measures. Advances in dentistry have led to treatment modalities for preserving teeth which were earlier indicated for extraction. Hence, periodontally compromised tooth with severe furcation involvement, which may not be amenable for regeneration, may be retained by bicuspidisation. Bicuspidisation is a surgical technique which involves separation of mesial and distal roots of mandibular molars along with its crown portion, where both segments are then retained individually, followed by rehabilitation with fixed prosthesis of the individual segments. This not only eliminates furcation involvement but also facilitates effective oral hygiene maintenance. In the present case report, a 50-year-old male patient reported with the chief complaint of pain, sensitivity and food lodgement in left mandibular first molar. Clinical and radiographic examination revealed grade III furcation involvement, significant pocket depths, delayed electric pulp test response and bone loss in furcation area. Bicuspidisation was opted as the suitable treatment modality. Root canal treatment was done, followed by bicuspidisation and subsequent rehabilitation with novel prosthetic technique. The bicuspids were restored using combination of deep margin elevation, and non splinted Lithium Disilicate table-top restorations. Six month follow-up showed good healing of hard and soft tissues around the bicuspidized sections, which was indicative of a successful treatment outcome, and can be attributed to a careful case selection, choice of restorative materials and techniques as well as good oral hygiene compliance.

A Combined Case of Neonatal Teeth, Bohn’s Nodules and Eruption Haematoma in an Infant Presenting as a Diagnostic Dilemma

Parika Vaid, Harmesh Lal Chouhan, Nitish Yadav, Shikha Dogra

Abnormalities in the oral cavity of infants are not uncommon, but most are innocuous and resolve with age in the absence of treatment. Some of the most prevalent oral findings are oral inclusion cysts, vascular lesions, natal and neonatal teeth. The American Academy of Paediatric Dentistry (AAPD) recognises that perinatal and infant oral health are the basics upon which preventive education and dental care must be built to enhance the opportunity for a child to have a lifetime free from preventable oral disease This report describes the clinical presentation, diagnosis and suggestive management for a 32-day-old male child patient reported with neonatal teeth, Bohn’s nodules and further at the age of 18 months, with eruption haematoma in the maxillary alveolar region. “Bohn’s nodules” are keratin-filled cysts with prevalence of 47.4% with no gender predilection. Natal and neonatal teeth considered as critically important conditions as their presence can lead to numerous complications such as ulceration on the ventral surface of the tongue caused by the sharp incisal edge of the tooth and condition known as Riga-Fede disease or syndrome. “Eruption haematoma” is circumcoronal cystic cavity which contains blood usually associated with an erupting primary or permanent tooth which is in its soft tissue eruption phase. Therefore, a thorough clinical examination and knowledge of the various lesions is essential for precise diagnosis, management, as well as parental counselling.

Aggressive Non-Hodgkin’s Lymphoma: A Case Series and Literature Review

S Manjani, S Preethi, S Balamurugan, K Khowsalyasubraja

Aggressive lymphoma of non-Hodgkin’s type is uncommon. The most common clinical presentation is lymphadenopathy and fever. One-fifth of Non-Hodgkin’s Lymphoma (NHL) present with serous effusions involves the body cavities like pleural, abdominal and pericardial cavities. Ten percent of aggressive lymphomas occur without an underlying immunosuppressive status. The NHL is more common in the elderly with a male preponderance. Paraneoplastic syndromes are rarely associated with non-Hodgkin’s lymphoma. Peritoneal lymphomatosis is extremely rare and associated with a poor prognosis. Since clinical suspicion for underlying malignancy is higher with peritoneal carcinomatosis (than for serous effusion of body cavities), they get recognised early. However, peritoneal lymphomatosis can be neglected and misdiagnosed. This series is about five cases of aggressive non-Hodgkin’s lymphoma. These cases are presented here for their rarity and diverse clinical manifestations. The case of angioimmunoblastic lymphoma was seen in an elderly male who presented with hypoglycaemia serous effusion and lymphadenopathy. Two patients were diagnosed with Natural Killer (NK) cell lymphoma and they presented with serous effusion with a jejunal thickening, as visible in the CT scan. One case of Diffuse Large B Cell Lymphoma (DLBCL) was seen in an elderly female presenting with inguinal lymphadenopathy. Lymphoma shows a varied clinical and radiological presentation and it should always be a differential diagnosis in the massive serous effusion and unexplained bowel thickening in Computed Tomography (CT) imaging with or without lymphadenopathy. The cases reported here emphasise the importance of early pathological diagnosis and immunohistochemical confirmation to ensure that the right treatment can be started at an appropriate time.

Multifaceted COVID-19 Associated Coagulopathy: A Case Series

Manisha Bhardwaj, Pratibha Himral, Deepak Aggarwal

The pathophysiology behind Coronavirus Disease-2019 (COVID-19) has remained blur even after more than two years of onset of the pandemic. Apart from pulmonary parenchymal involvement, widespread vascular thrombosis affecting both pulmonary and extra-pulmonary systems has also been seen to contribute to COVID-19 associated morbidity. This vascular manifestation often remains undiagnosed due to non specific and varied symptoms that range from asymptomatic detection to life threatening presentations. A series of six COVID-19 positive (three male and three female) cases who presented with thrombosis of pulmonary, coronary and cerebral vessels despite being on thromboprophylaxis are reported herein. The age of patients ranged from 32 to 80 years. Out of six patients, three had co-morbidities. The most common complication was Pulmonary Thromboembolism (PTE, n=3) followed by Brain infarct (n=2) and Myocardial Infarction (MI, n=1). Out of three patients with PTE, one patient had concurrent Deep Vein Thrombosis (DVT). All patients were managed as per guidelines issued by the Ministry of Health and Family Welfare for severe COVID-19 disease. Out of six patients, three patients died and three were discharged. The series highlights the need for high index of suspicion on the part of the treating physician that could aid in early detection and successful management of this potentially fatal condition.

Unusual Presentation of Peripartum Cardiomyopathy-A Case Series

A rare condition called Peripartum Cardiomyopathy (PPCM) causes a pregnant woman’s heart to weaken and expand. It occurs in the last month of pregnancy or within five months of delivery. The presented paper was a series of three cases (29-year-old women, 26-year-old women, 26-year-old women) with unusual presentations of PPCM. Cases 1 and 2 demonstrated unique PPCM presentations that included abrupt cardiogenic shock and failure symptoms and signs. The postpartum period’s typical PPCM appearance is illustrated by case 3. The index patients (cases 1 and 2) had low systemic blood pressures, acute respiratory distress, and reduced cardiac output that was indicative of cardiogenic shock. An early echocardiogram was ordered as a result, and the results were suggestive of heart failure. Their varying clinical manifestations posed a significant diagnostic problem due to the heterogeneity. Even though they are uncommon, such catastrophic presentations including acute respiratory distress and low-output cardiac failure can happen. In these unusual cases, rapid pharmacological and mechanical support is required. In order to provide patients with the finest and most efficient care possible, it is crucial to understand the aetiology, clinical signs and symptoms, management, and prognosis of PPCM. Thus, physicians need to be familiar with different presentations of PPCM and always consider it with a high index of suspicion to expedite treatment for a potentially lethal condition to get a better outcome.

Elective Splenectomy for Haemolytic Anaemia: A Case Series

R Lakshmana, A Ajay Raja, K Navaneetha, A Pravindhas, Neethish K Paul

The spleen plays an important role in immune surveillance and haematopoiesis. Elective splenectomy is sometimes indicated for excessive cellular destruction (hypersplenism) or sequestration, lymphomatous or myeloid disease, or tumours. Hereditary haemolytic anaemias are disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anaemias, thalassaemia syndromes, and haemoglobinopathies. Splenectomy is one of the therapeutic approaches in the management of haematological conditions. This is case series of 12 cases who underwent elective splenectomies for haemolytic anaemias in a tertiary care centre, over a period of one year. Out of the 12 patients, 10 patients were diagnosed to have Hereditary Spherocytosis (HS) and two patients were diagnosed with sickle cell anaemia. For all patients, preoperative blood transfusion was done to bring the Haemoglobin (Hb) above 9 g/dL for elective splenectomy. Among the 10 patients with HS, six patients had concomitant cholelithiasis for which cholecystectomy was done in the same sitting and three patients developed postoperative complication which was managed appropriately with no mortality and minimum morbidity. However, more detailed studies on this subset of patients are needed for the establishment of guidelines and optimal outcomes.

NUT Carcinoma: A Diagnostically Challenging Rare Entity with an Aggressive Course: A Case Series

KR Anila, Anitha Mathews, Nair P Sindhu, Kumar Rejnish, T Priyakumari

Nuclear Protein in Testis (NUT) carcinomas are rare, extremely aggressive, poorly differentiated squamous carcinoma, characterised by the presence of NUT gene (NUTM1) rearrangement. NUT carcinoma most commonly arises in head and neck region and thorax however, they can occur in other parts of the body also. Here, we are presenting a case series of three cases of NUT carcinoma. All patients were females with disease involving head and neck region. The first case was an eight-year-old girl. The second case was a 36-year-old woman. The third case was a 61-year-old woman. Histopathology of all cases showed poorly differentiated neoplasm, comprising of sheets of monotonous cells with minimal indistinct, clear cytoplasm, round to oval nuclei with prominent nucleoli. High mitotic rate with areas of tumour necrosis were also present. Areas of abrupt keratinisation classically described in this entity were seen in two of the cases. Speckled nuclear positivity for NUT1 monoclonal antibody by immunohistochemistry, which is sensitive and specific for diagnosis was observed in all three cases. There is no definite treatment for this disease, and most patients respond poorly to conventional chemotherapy and radiation. Targeted therapy targeting the BRD4 portion of BRD4-NUT, termed BET bromodomain inhibitors, are in clinical trials. Two of our patients succumbed to disease within one year of diagnosis. Third patient is on follow-up for eleven months after diagnosis.

Role of Ultrasonography in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis

A 28-day-old male baby was brought by his mother with complaints of projectile non bilious vomitings after feeds, excessive crying, and decreased frequency of stools for three days. The baby was born at full-term by normal vaginal delivery to a primigravida. There was no history of fever/Neonatal Intensive Care Unit (NICU) admission/any significant complication at birth. The family history was unremarkable. The laboratory investigations were within normal limits with no alkalosis or hyperbilirubinaemia. The baby was referred to the department of radiology for Ultrasonography (USG). USG showed lengthening of the pyloric canal (measuring 21 mm in length) and thickened hypoechoic pyloric muscle (measuring approximately 5.4 mm in thickness), giving the classic cervix sign on the longitudinal section (Table/Fig 1)a and target of doughnut sign on transverse section (Table/Fig 1)b. A distended stomach was seen proximal to the pylorus (Table/Fig 1)c. These USG features fulfil the criteria for the diagnosis of Infantile Hypertrophic Pyloric Stenosis (IHPS). The diagnosis was confirmed during surgery.

Management of Pitted Keratolysis- A Rare Dermatological Condition

Aman Chhabra, Vaishali Kuchewar, Twinkle Joshi

Pitted keratolysis, a skin condition that damages the stratum corneum of the arch of the foot, is caused by gram positive bacteria. Responsible agents include Dermatophiluscongolensis, Corynebacterium sp., and Micrococcus sedentarius. These microbes all cause the epithelial tissue to develop tiny burrows (1). Erythrasma, trichomycosisaxillaris, and pitted keratolysis each have been documented as concomitant corynebacterial illnesses, indicating that corynebacterium is a significant causative factor in all three conditions (2). As per Ayurvedic texts, kustha illness refers to all skin conditions. Pitted keratolysis is a form of kustha disorder and can be categorised as Vipadika. It is successfully managed through adequate foot hygiene, antibiotic ointments, and bactericidals. This manuscript presents a 50-year-old male military employee, who visited the Outpatient Department (OPD) of the Department of Kayachiktsa with chief complaints of small punched-out lesions and itching on the plantar surface of bilateral feet for 2-3 months. The patient suffered from severe itching on sole of bilateral feet and having mild pain at the sole region while walking, which was associated with gradual peeling of the surface of skin. No such lesions were there elsewhere in the body. There was no relevant family history of the patient. There was no any significant medical history of hypertension or diabetes mellitus or any other allergic illness. On physical examination, small punch out lesions on the plantar surface of bilateral feet were observed. As in (Table/Fig 1), pitted keratolysis was diagnosed from the clinical appearance. Palmoplantar keratoderma, keratoderma, punctate palmoplantar, palmoplantar hypokeratoses, and verucae, are among the primary differential diagnoses (3). In this case, for one month, the medicinal cleansing therapy and the ayurvedic palliative care were administered. Dhavan (proper wash) with Triphala patra kwath and Nimba patra kwath twice a day was advised as the medicinal cleansing therapy and Sarivadyasav in a dosage of 20 mL twice a day after meals with equal quantity of water, Mahatikta Ghrita in the dosage of 10 mL in the morning on empty stomach with lukewarm water was administered to the patient. For the preventive measure, proper maintenance of hygiene, always keeping the feet dry and altering socks and shoes frequently, along with rotating or letting out shoes was strictly advised to the patient. Triphala and Nimba possess antimicrobial action and so proper wash of bilateral feet with their decoction yields good results. Sarivadyasav is considered to be having Rakta shodhak action, which means, it helps in purifying the impure blood. Mahatikta Ghrita is described as Kushtaghna and helps in treating many kinds of skin diseases (4). After the completion of the treatment, it was found that the punched out lesions associated with itching in bilateral feet healed significantly. Following a one month follow-up, significant recovery was seen. A good prognosis was seen and the lesions healed within three to four weeks (Table/Fig 2).

Poller Screw Supplemented Fixation of Tibial Metaphyseal Fractures with IMN- Criticism and Update for Clinicians as per Existing Literature

Sharat Agarwal

Sir, I read with great interest the article entitled “Intramedullary Nail Supplemented with Poller Screws for Proximal and Distal one-third Shaft Tibial Fracture: A Prospective Interventional Study from North India (1). I congratulate the authors for the study undertaken. However, certain key concerns have remained unaddressed and require some criticism and information on literature updates. It should be highlighted that where the name “POLLER” or “BLOCKING” screw came from. It originated from the name “BOLLARD”. And it does exactly the same. It stands in the way of a nail and doesn’t let the nail go its way, and it only goes in the direction determined by the screw. Besides, can also reduce the fragments and compress them. Here correction is required as the term blocking screw was first introduced by Donald G and Seligson D in 1983 as they ‘block’ the nail from malreducing the fracture (2). The author has not used nailing for the fixation of Grade 3 Gustilo and Anderson open tibial fractures. Unreamed intramedullary cannulated nailing has been used now, for a long time in type 3 open fractures. A meta-analysis summarised the existing evidence for the use of unreamed intramedullary nailing or external fixators to treat severe open tibial fractures in case of Gustilo Grade III and above cases (3). Certain key points are required to be emphasised while considering the use of poller screws in tibial fractures for clinicians’ knowledge. - Use the thinnest possible nail while using poller screws, to allow the nail to deform and not break the bone. - Poller screws, placed adjacent to the nail and perpendicular to the interlocking screw holes, usually in an anteroposterior direction, have been suggested as one possible method for improving the stability of metaphyseal fractures (4),(5) and have been described as a reduction tool, used to overcome the displacing forces at the time of introduction of the intramedullary nail (5). The screws functionally decrease the width of the metaphyseal medulla and are particularly useful with nails of smaller diameter, which has not been emphasised by the authors. - The screws used for blocking were 4-4.5 mm locking screws - Intramedullary nails of 8 or 9 mm diameter are used which are unreamed and cannulated - The acceptable mis-alignment as per Trafton’s recommendations is less than 5 degrees of varus-valgus angulation, 10 degrees of anteroposterior angulation, 10 degrees of rotation, and 15 mm of shortening (6),(7). Moreover, it is pertinent to decide where to place a poller screw? Author failed to give details about it. As per literature, there are three known ways: • Concave side of the fracture. • The acute angle of the fracture lines. Alignment lines are drawn on both fragments and a screw is placed at the acute angle between both lines. The Poller screw goes in the bone slightly away from the centre. • Mobile and static fragment. Poller screw is usually placed in a dynamic fragment of the fractured tibia. It is very rare that poller screws are required in both static and dynamic fragments. The author has not emphasised the evolution and generations developed of “Poller screws” over time. Readers will find it informative too, as mentioned below: First generation of poller screws were screws inserted to create a corridor inside the bone. Second generation of poller screws is inserted in a way that the fracture is reduced and compressed using the elastic properties of a nail. The nail would deflect and create long-term compression on the fracture. It was not a rare occurrence that reduction has improved over time. But the poller screws are placed on one side of the fracture only (one fragment). Third generation of poller screws are screws inserted on both sides of the fracture. Use of poller screws from the use of a single screw to create a corridor inside the bone, ‘first-generation’ of poller screw, through to the ‘third-generation’ of poller screw with poller screw placement on both sides of the fracture line to create long-term compression and reduce the working length of the nail (8),(9),(10). Author should have mentioned that depending on fracture pattern, at least one poller screw in the sagittal and one in the coronal plane may be needed to fully control alignment to avoid the failure seen in one patient in Ricci WM et al., cohort (11). Poller screw are placed at right angle to the interlocking screw holes, usually in an anteroposterior direction, beside the nail close to apex of deformity, Centre of Rotation of Angulation (CORA) (12), improve the stability of metadiaphyseal fractures (4),(5) and enables control of angular deformities (9). Moreover, as an alternative to poller screws, K wires have been described as reduction aids and used in a similar fashion to poller screws to aid centralisation of IM nails, which are removed post locking screw insertion. Poyanli OS et al., place K wires before the guidewire, as we do with poller screws (13). Other techniques to prevent malreduction include, the use of percutaneous clamps and provisional plating with unicortical screws. The use of a femoral distractor or an external fixator can be helpful to hold the fracture in a reduced position while nailing (14). Results shown to be evaluated with Karlstro¨m-Olerud’s scoring criteria by the author. This does not include the functional outcomes of knee in these patients and as per the literature to circumvent this limitation for functional result evaluation, studies have used AOFAS (100 points) ANKLEHINDFOOT SCALE for ankle and RASMUSSEN’S FUNCTIONAL SCORE SYSTEM for knee (15). Finally, author gave the details about the complications found in the study but he has not described as to how he managed those complications, which is a very important implications for the readers of this article. The current study has several limitations. It is a non randomised, non controlled clinical trial. There were several different surgeons carrying out the technique (16). 1. The term poller screw was first used by Kretek. The term blocking was used by Donald, however, the basic principle of both are the same. 2. In Grade 3 GUSTILO ANDERSON, clinician can do unreamed intramedullary cannulated nailing or external fixators but we had preferred exfix to prevent infection. In our clinical experience, the authors have found a high rate of infection by doing intramedullary nailing in grade 3. 3. The authors used 4.5 mm poller screws, with an Intramedullary nail of 8 mm diameter which was unreamed and cannulated. 4. Poller screws were placed on the concave side of the fracture as mentioned in the article. 5. Depending on fracture pattern, poller screws were used to decrease varus/valgus and procurvatum/recurvatum deformity. The authors used 2 poller screws in 2 different planes to correct the deformity. 6. The poller screws were retained to maintain the reduction and to increase the bone-implant construct stability. 7. In response to the query from the reader, whether K-wire can be used as an alternate to the poller screw, the authors emphasise that Kirschner wire cannot be used to maintain the reduction. 8. Regarding management of complications, nothing was done for shortening of 0.5 cm, physical therapy was advised for decreased range of motion and pus discharge was treated conservatively with debridement, and appropriate antibiotics after getting the antimicrobial sensitivity test. 9. Karlstro¨m-Olerud’s scoring was frequently used by many authors previously. This score includes 11 components to evaluate the functional outcome of the patient, that’s why Karlstro¨m-Olerud’s scoring have been used in the present study.

Thyroid Dysfunction and its Correlation with Metabolic Syndrome among Perimenopausal and Postmenopausal Women Attending a Tertiary Care Hospital in Karnataka: A Cross-sectional Study

MK Vishwas, BN Phaneshwara, Uday Raghavendra, KV Vasudha, B Shruthi

Introduction: Thyroid dysfunctions are more common among women than men and increase near menopause. These are also associated with metabolic syndrome, increasing cardiovascular risk. These cardiovascular events and cerebrovascular events increase women’s morbidity and mortality, especially after menopause. Though many researchers in the past few decades have tried to highlight this problem, majority of them have focused on the elderly population. Studies on women of the perimenopausal age group are still not frequently found. Aim: To assess the correlation between thyroid dysfunction and metaoblic syndrome among perimenopausal and postmenopausal women. Materials and Methods: A cross-sectional study was conducted among women attending the Medicine Outpatient Department (OPD) of Adichunchanagiri Institute of Medical Sciences, Nagara BG, Karnataka, India, from December 2017 to May 2019. Total 100 participants were included in the study, of which 50 were perimenopausal and 50 were postmenopausal women. Clinical history, examination and relevant investigations {Free T3 or Total T3, Free T4 or Total T4, Thyroid Stimulating Hormone (TSH)} were recorded. Association was studied using Chi-square test, groups were compared using Analysis of Variance (ANOVA) test, and correlation was estimated using Pearson’s correlation test. Results: Mean age of the study participants was 55.14±8.05 years. Thyroid dysfunction was observed in 17% of the participants, of whom 14% had subclinical hypothyroidism, 2% had overt hypothyroidism and 1% had hyperthyroidism. Prevalence of metabolic syndrome was 45%. There was a significant association of hypothyroidism with Fasting Blood Sugar (FBS) (p-value=0.005) and a positive correlation between FBS and TSH level and High Density Lipoprotein (HDL) with T3 and T4 levels. Conclusion: Prevalence of hypothyroidism and metabolic syndrome were high among perimenopausal women and as FBS increases or HDL decreases, the chances of hypothyroid increases. Therefore, early identification and reduction of these components of metabolic syndrome decreases hypothyroidism and cardiovascular events.

Phenylephrine and Ephedrine for Prevention of Hypotension in Women during Lower Segment Caesarean Section under Spinal Anaesthesia: A Randomised Clinical Study

Introduction: Hypotension is the most common serious adverse event associated with Spinal Anaesthesia (SA) and is associated with nausea and vomiting leading to pulmonary aspiration, respiratory depression and cardiac arrest. Phenylephrine (PE) and Ephedrine (EP) are vasopressors commonly used for prevention of hypotension associated with SA. Aim: To compare the efficacy and safety of PE and EP in prevention of hypotension induced by SA in women during Lower Segment Caesarean Section (LSCS) surgery. Materials and Methods: The present randomised clinical study was conducted on 60 women, between 18-36 years of age and a Heart Rate (HR) of 60-100 per minute randomised to receive either 100 mcg Intravenous (i.v.) bolus of PE, or 12 mg i.v. of EP during intrathecal block. Women having intraoperative hypotension were injected additional doses of vasopressor. Cardiovascular parameters were recorded at baseline (before block) and then at 1, 5, 10, 15, 30, 40 and 60 minutes. Further, safety was also assessed based on hypotension events and adverse events reported during immediate postoperative period. Data analysis was done using IBM SPSS 17 and a p-value <0.05 was considered statistically significant. Results: The mean age of the study participants in PE and EP group was 26.67±5.40 and 26.23±4.59 years, respectively. Significant differences were observed between PE and EP groups for change in Systolic Blood Pressure (SBP) after 1, 10, 30, 40 and 60 minutes. Overall, there was a slight fall in SBP with PE, whereas, with EP there was a slight rise in SBP. Also, the Diastolic Blood Pressure (DBP) was maintained with EP throughout the 60 minute period, whereas with PE there was an initial rise in DBP followed by a slight fall in DBP. The Mean Arterial Pressure (MAP) was well-maintained with PE throughout, whereas with EP there was a fall in MAP after 15 minutes. However, these changes were not clinically significant. The Pulse Rate (PR) was lower with PE compared to EP group at time points of 1, 5, 15 and 20 minutes. The mean respiratory rates and blood oxygen saturation were similar with PE and EP administration (p>0.05). A total of 13 (43.3%) patients in the PE group and 14 (46%) in the EP group had adverse events excluding hypotensive patients. Conclusion: According to the findings of the present study, the i.v. bolus of 100 mcg PE and 12 mg EP administered immediately after SA are equally effective in prevention of maternal hypotension and do not cause any significant cardiovascular and respiratory effects.

Dexmedetomidine versus Lignocaine in the Prevention of Etomidate-induced Myoclonus- A Randomised Double-blinded Study

Introduction: Etomidate is a preferred induction agent owing to its stable haemodynamic profile, minimal respiratory side-effects, minimal histamine release, cerebral protection and its property of rapid onset and short duration. However, myoclonus has been reported as one of its side-effects which poses great concern. Amongst the various drugs used to attenuate it, the role of intravenous (i.v.) Dexmeditomidine and Lignocaine have been reported in literature to be of great success. Aim: To compare the efficacy of Dexmedetomidine and Lignocaine in preventing Etomidate-induced Myoclonus. Materials and Methods: The randomised, double-blinded study included 104 adult consented patients, of either sex, American Society of Anaesthesiology (ASA) I and II, aged 18-65 years, undergoing routine surgery under general anaesthesia. They were randomly allocated into two groups of 52 patients each viz., Group I receiving 0.5 μg/kg of injection (inj.) Dexmedetomidine i.v. and Group II 1 mg/kg of inj. Lignocaine diluted in 10 mL normal saline i.v. The incidence and severity of myoclonus were assessed and recorded within 90 seconds after etomidate injection using a four point severity scale. The collected data were entered in Statistical Package for Social Sciences (SPSS) version 21.0. Results: Total 104 subjects with the demographic parameters such as age, sex, ASA and weight comparable between the two groups were analysed. Group I recorded lesser number of patients (17, 32.7%) to myoclonus as compared with Group II (21, 40.4%), (p-value=0.41). Maximum patients in Group I developed grade I myoclonus while in Group II, it was grade 2. No patients in Group I developed grade 3 myoclonus as against 5 patients in Group II (p-value=0.03). Conclusion: Dexmedetomidine and Lignocaine were equally effective in the prevention of Etomidate-induced myoclonus but dexmeditomedine was better because of lesser incidence of severe grade myoclonus.

Repercussions of Consanguinity on Metrical Traits at Different Phases of Growth

Gulrukh Begum

Introduction: Consanguinity is associated with increase in the likelihood of receiving two copies of deleterious gene from parents, which brings the hidden recessive disorders. This further increases the risk of neonatal and post neonatal mortality. Some of which may also have negative effect on metrical traits of the children, thereby affecting their development and reducing their cognitive abilities. Aim: To examine the effect of parental consanguinity on various metrical traits like linear, circumferential and weight measurements among the Muslim males. Materials and Methods: A cross-sectional study was conducted amongst the Muslim males living in the different river islands of Barpeta district in Assam. The study consisted 1438 males (587 inbred and 851 non inbred). A total of 936 boys (3-18 years) were measured at an interval of one year. The rest (502 adult men) from 19-60 years were in age cohorts of five-years age interval. They were measured for stature, sitting height, lower extremity length, body weight, waist circumference, abdominal circumference and hip circumference. Inbreeding depression on trait was calculated using average coefficient of inbreeding and % of depression in a trait. Wright’s path coefficient method was used for the calculation of inbreeding coefficient. Results: The average coefficient of inbreeding was found to be 0.01637931154. A significant increase in the difference of mean values in all the linear, circumferential and weight measurements has been observed at many ages with the increase in the inbreeding coefficient during childhood and adolescence phase of life. But the difference in mean variance in the adult body parameters between the inbred and non inbred was statistically insignificant at almost all ages (p>0.05). Conclusion: Consanguinity has not affected any of the adult body measurements. A significant positive association between consanguinity and diminution of body measurements found during the growing period needs to be correlated with the other socio-demographic variables because the growing period is always more dependent on environmental variables.

Assessment of DNA Ploidy in Oral Potentially Malignant Disorders using a VELscope

Pushpanjali Das, Revati Shailesh Deshukh

Introduction: The device VELscope (Visually enhanced lesion scope) is intended as an aid to the clinician to complement a conventional white light exam (whether it be a general oral cavity examination or examination of a particular lesion) to detect abnormal tissue that might have otherwise been overlooked. In this study, it was used concomitantly with ploidy status to evaluate the malignancy potential of Oral Potentially Malignant Disorders (OPMD). Aim: To evaluate potential of Deoxyribonucleic Acid (DNA) ploidy as a preliminary adjunct to oral biopsy to identify patients with aneuploidy for the necessity of biopsy, and to assess the sensitivity of VELscope in the determination of accurate clinical parameters of the lesions in the oral mucosa. Materials and Methods: This in-vivo cross-sectional study was carried out in Department of Oral and Maxillofacial Pathology and Oral Microbiology, Bharati Vidyapeeth Deemed to be University, Pune from February 2020 to February 2021. Clinically diagnosed OPMD were included in the study, after verification of clinical extension boundaries by VELscope. DNA ploidy status was evaluated with DNA image cytometry and exclusive individuals with aneuploidy were biopsied followed by histopathological evaluation and surgical removal of the lesion. One way Analysis of Variance (ANOVA) test was used to compare the mean in 4 study groups [Oral leukoplakia, Oral submucous fibrosis, Oral lichen planus and Tobacco pouch keratosis] vs control. Sensitivity, specificity, positive predictive value and negative positive value was calculated by using the ROC (Receiver Operating Characteristic Curve) analysis. A p-value <0.05 was considered as significant for evaluating sensitivity of VELscope and evaluation of ploidy status. Results: The study included patients whose mean age was 45.8 years. The groups had tobacco habits in one of the various forms [smoke or smokeless] both in experimental and control group. VELscope could identify the clinical borders of the OPMDs considered via the loss of autofluorescence. Lesion borders were identified precisely with the loss of autofluorescence. It was quite helpful especially in aneuploid cases where the whole margin could be removed leaving no genetically aberrant cells behind. Oral submucous fibrosis was concluded to have maximal sensitivity of 86.7%, 100% in specificity and positive predictive and 88.2% negative predictive value. Conclusion: The DNA ploidy could decipher the malignancy potential and could identify the individuals who needed biopsy. VELscope was able to mark the clinical diameters which were not visible to naked eyes clinically. Oral submucous fibrosis was found to be grouped with the maximum potential of malignancy followed by Oral Lichen Planus, Oral Leukoplakia and Tobacco Pouch Keratosis.

Efficacy of In-utero Infusion of Autologous Platelet Rich Plasma Therapy in Women with Recurrent Implantation Failure: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Introduction: In-utero infusion of autologous Platelet Rich Plasma (PRP) is found to be a novel approach to address the thin, non receptive endometrium leading to recurrent implantation failure. Aim: To estimate the efficacy of intrauterine PRP infusion in subfertile females affected with recurrent implantation failure via the conduction of a systematic review and meta-analysis of the available Randomised Controlled Trials (RCTs). Materials and Methods: A systematic literature search was done in electronic databases like Medline (through PubMed), Embase, Scopus, Web of Science, and Cochrane database from January 2000 to November 2020 using keywords like “In-vitro Fertilisation” OR “IVF” OR “Intracytoplasmic sperm injection” OR “ICSI” OR “Embryo transfer” AND “Platelet rich plasma” OR “PRP” OR “Autologous platelet rich plasma” OR “Platelet rich plasma” and “recurrent implantation failure”. The randomised controlled trials, comparing intrauterine infusion of PRP versus no intervention or placebo in a study population of subfertile women with recurrent implantation failure and having medically confirmed pregnancy outcomes like live birth, clinical pregnancy, chemical pregnancy, and miscarriage were included in this systematic review. Studies with inadequate details in the methodology or result section were excluded from this analysis.This meta-analysis involved a pooled data analysis of 335 participants (174 cases and 161 controls) from four RCTs. Results: Compared with the control group, patients in the PRP group were found to have more beneficial effects in terms of implantation rate (Relative risks: 1.51, 95% Confidence interval: 0.94, 2.44; Heterogeneity: Tau²=0.08; I²=44%; Test for overall effect: Z=1.69, p-value=0.09) and clinical pregnancy (Relative risk: 1.88, 95% CI: 1.17, 3.03; Heterogeneity: Tau²=0.12; I²=51%; Test for overall effect: Z=2.62; p-value=0.009). Conclusion: Intrauterine PRP infusion increases the implantation rate and clinical pregnancy rate in women undergoing the frozen embryo transfer cycle.

Development and Validation of Stroke-specific Shoulder Disability Index: A Cross-sectional Study

Subhasish Chatterjee, Kamran Ali

Introduction: Shoulder difficulties are the most prevalent secondary musculoskeletal dysfunction after stroke, accounting for 34-85% of patients. To resolve these issues, a comprehensive evaluation is necessary. Currently, there is no evaluation instrument, that includes all shoulder problems. Aim: To develop and evaluate the content validity of stroke-specific shoulder disability index, unique to stroke patients. Materials and Methods: The present study was a cross-sectional content validation study, conducted at a tertiary care hospital from August 2020 to March 2021. Domains included in the scale were muscle tone, pain, subluxation, synergy pattern, active (within synergy, mixed synergy, away from synergy), and passive range of motion, sensation, and Activity of Daily Livings (ADLs) by an exhaustive literature search and direct patient interview. Prior to the construction of the scale, two physiotherapists with relevant field experience were interviewed, to identify domains and items. Then, 10 stroke patients were interviewed to generate new items depending on the challenges they experienced. The scale was subsequently sent to a panel of eight experts for content evaluation. Results: Initial production yielded 49 items over 10 domains. On the advice of the reviewers, one item was added to the pain domain after the original Delphi survey round. The first-round I-Content Validity Index (CVI)/Average (Ave) score was 0.97, which was a good content validity score; nevertheless, the second round of the Delphi survey was conducted since reviewers suggested modifying the scoring criteria for some domains. Following any required revisions, the scale was resubmitted to a panel of eight experts for final approval. In the second round, the proposed stroke-specific shoulder disability index achieved an I-CVI/Ave score of 0.98, therefore, no extra survey was required. Conclusion: Stroke-specific shoulder disability index was developed and earned a strong validation score. Therefore, the items collected under various domains, may be utilised to develop a shoulder impairment index, unique to stroke patients.

Effect of Growth Hormone Therapy in Indian Children with Short Stature- A Retrospective Study

Ruchi Mishra, Smriti Rohatgi, Jyoti Bagla, Rajeev Kumar Malhotra

Introduction: The causes for short stature are multifactorial. The recombinant Growth Hormone (rGH) is used worldwide for its treatment, however, there is paucity of data on use of growth hormone in Indian Children. Aim: To study the effect of rGH in Indian children with short stature, who were enrolled under ESIC scheme. Materials and Methods: This was a retrospective observational study. Subjects, who had short stature and diagnosed to have Growth Hormone Deficiency (GHD) by stimulation test and other causes for which growth hormone was indicated were enrolled. All subjects received treatment at ESI PGIMSR Basaidarapur, New Delhi, India, from July 2016 to July 2020, without discontinuation for more than one week. The data regarding gain in height was collected at the end of first year and then, at the end of second year. Height velocity and change in Height SD were calculated (Mean±Standard Deviation). The associations and correlations were calculated by Spearman’s correlation test. Results: The present study included data of 27 children (19 males and eight females) with short stature. The mean age at treatment initiation was 9.85 years±3.04. The most common aetiology for which growth hormone was started was Idiopathic GHD (IGHD) seen in (15/27) 55.5% followed by Multiple Pituitary Hormone Deficiency (MPHD) 18.5% (5/27). The mean height and height SD at baseline was 111.76 cm±17.40 and -3.85±1.19 (-6.0 to -1.5), respectively. The mean bone age delay (chronological age bone age difference) was 40.96±25.58 months. The height velocity response was maximum during the first year of treatment (8.74±2.59 cm), declining to 8.13±2.30 cm in the second year. Correlation of the treatment response with age at treatment initiation, bone age delay and MPH was not significant. Conclusion: It was found that the growth velocity was significantly increased after one year of treatment. The study provides long term follow-up and response to rGH Treatment (rGHT) in Indian children enrolled under ESIC scheme, however, prospective studies with large sample size and longer follow up duration, which can report final height outcomes are needed.

Comparison of NGSP Certified Methods and their Cost Analysis for Estimation of HbA1c- A Cross-sectional Study

Bhasker Mukherjee, Chirag Hooda, Virender Singh, Rajesh Sahu, Mukesh U Singh

Introduction: Diabetes Mellitus (DM) is a major non communicable disease that adversely impacts the health of the global community, contributing significantly to mortality. Estimation of glycated haemoglobin (HbA1c) is an integral component of diagnosis, treatment and follow-up of cases of DM as the various protocols have included it for therapy. In order to regularise the estimation of HbA1c, it is mandated by American Diabetes Association (ADA) to perform the test on NGSP certified methods only. Aim: To compare the results of HbA1c analysis by SIEMENS DIMENSION EXL 200 and BIORAD D-10 (NGSP certified methods). Materials and Methods: This was a cross-sectional observational study done in Department of Biochemistry, Armed Forces Medical College, Pune, Maharashtra, a tertiary care centre. One hundred and twenty blood samples in Ethylene Diaminetetraacetic Acid (EDTA) tubes for haemoglobin variant analysis, received from patients with unexplained anaemia or screening for antenatal care were included in the study. The tests for HbA1c were performed by HPLC based BIORAD D10 and enzymatic based method, SIEMENS DIMENSION EXL 200 analyser. Cost analysis of both the methods was also performed. Students paired t-test was done to look for any significant statistical difference. Kappa coefficient was also calculated to analyse for agreement between values. Results: HbA1c estimation by SIEMENS DIMENSION EXL200 and BIORAD D-10 (both NGSP certified) showed marginally different results, but it was not significant enough to make a clinical difference (5.308% on BIORAD D10 and 5.211% on SIEMENS DIMENSION EXL 200). On performing the cost analysis, there was a significant difference observed with a figure of Rs 476.05/- per test on the SIEMENS DIMENSION EXL200, while it was significantly cheaper at Rs 266/- per test on the BIORAD D10. Conclusion: Estimation of HbA1c on SIEMENS DIMENSION EXL200 and BIORAD D10 was not clinically significant. As per cost analysis, BIORAD D10 is a cheaper alternative and suitable for tertiary care or large volume centres.

Audiological Assessment in Post COVID-19 Patients- A Cross-sectional Study

Angela Grace Abraham, RB Namasivaya Navin, S Prabakaran, S Rajasekaran

Introduction: Hearing loss following a viral infection is a common entity. In recent studies, hearing loss has been seen among Coronavirus Disease 2019 (COVID-19) infected patients, but its association is yet to be established. Aim: To determine the presence of hearing loss and its type in patients after COVID-19 infection. Materials and Methods: A cross-sectional study was conducted at a tertiary health centre, Department of Otorhinolaryngology at Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, from October 2021 to April 2022. Total of 125 patients, who had a positive history of COVID-19 infection, were reviewed in the Otorhinolaryngology Department, one month after they were tested Real Time-Polymerase Chain Reaction (RT-PCR) positive. After obtaining proper clinical history and examination, Pure Tone Audiometry (PTA) were done. Audiological report was assessed and analysed. Qualitative variables will be expressed in proportions and quantitative variables in Mean±SD/Median (IQR), Chi-square test was applied. Results: This study included 65 (52%) males and 60 (48%) females, and the mean age was 38.44±10.9 years. Among the 125 patients, 12 (9.6%) were diabetic, 14 (11.2%) were hypertensive, 5 (4%) had dyslipidaemia, 3 (2.4%) were hypothyroid, while remaining 91 patients (72.8%) had no co-morbidities. Sensorineural Hearing Loss (SNHL) was found among 45 patients (34 with unilateral and 11 with bilateral involvement). Out of them, 2 (4.5%) were in the age group of 18-30 years, 19 (42.2%) in 31-45 years and 24 (53.3%) between 46-60 years age group. Based on the World Health Organisation (WHO) classification of hearing loss, 27 patients had mild sensorineural hearing loss, 12 patients with moderate, and six patients with moderately severe sensorineural hearing loss. Conclusion: SNHL were found among patients who had COVID-19 infection, but due to the absence of a pre COVID-19 documented audiogram, it was difficult to conclude whether the hearing loss had occurred due to COVID-19, pre-existing hearing loss, or age-related. Further studies are required for proper understanding and correlation.

Efficacy of Antibody Cocktail Drug in COVID-19 Positive Patients: A Retrospective Single-centered Study

Introduction: Neutralising monoclonal antibodies (mABs) have been proposed and developed for the treatment of Coronavirus Disease-2019 (COVID-19) patients with mild to moderate diseases and to prevent further progression. The combination of Casirivimab and Imdevimab blocks the entry of virus into cells by attaching to receptor binding domain of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) spike glycoprotein. The mABs are utilised as a pre-emptive strategy in certain high-risk groups such as those suffering from chronic liver, kidney and respiratory disease, malignancies and other immunocompromised states where efficacy of vaccines may be suboptimal. Aim: To evaluate the clinical outcomes in COVID-19 patients who were treated with Antibody Cocktail drug (casirivimab and imdevimab). Materials and Methods: A retrospective observational study was conducted in patients confirmed positive for SARS-CoV-2 from June 2021 to January 2022 and subsequently, the collected data was analysed from May 2022 to June 2022. The study was conducted in a tertiary care referral hospital in eastern India. All eligible patient subsequently received casirivimab and imdevimab at COVID-19 facility. Monitoring of patients was done upto 12 hour postinfusion. Demographic parameters, routine investigations and clinical outcomes were assessed. Data entry was done using Microsoft excel. Data was entered, coded and analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0. All analysis was done at a preset alpha error of 5% and results expressed at confidence levels of 95%. Results: Total 104 eligible cases were taken in present study. Nearly, 93% of those patients who had not been vaccinated were at higher risk for having severely elevated levels of C-Reactive Protein (CRP) as compared to 48% of those with COVID-19 vaccination. Nearly, 9 out of 10 patients with moderate-severe CRP levels were at nine times more risk for longer duration of hospitalisation as compared to normal levels of CRP. All patients having moderate-severe CRP levels required mechanical ventilation in comparison to mild CRP levels. Patients with co-morbidities were more likely to get severe COVID-19 infections (p-value ≤0.05). Unvaccinated subjects were more likely to have severe infections than vaccinated subjects. (p-value ≤0.05). Prolonged hospitalisation (>7 days) was statistically significant in severe COVID-19. Unvaccinated subjects had a statistically significant rise in CRP over vaccinated subjects. The majority of the patients receiving antibody cocktail did not require prolonged hospitalisation while a minor fraction required invasive ventilation. Antibody cocktail was safe, well tolerated and had good efficacy and low mortality rate as compared to other modalities of treatment in this study. Conclusion: The duration of hospitalisation and outcomes were superior in patients having mild to moderate COVID-19 who received antibody cocktail without any serious side-effects.

Comparison of Monoclonal Antibody Cocktail (Casirivimab-Imdevimab) Treatment with Remdesivir and Favipiravir in Mild to Moderate COVID-19 Infection: A Retrospective Study

Introduction: Favipiravir and remdesivir are antiviral drugs being used in the COVID pandemic and were also used previously for other viral infections in the past. Monoclonal antibody (Mab) Casirivimab-Imdevimab is a Coronavirus Disease 2019 neutralising antibody approved in the last one year. Therefore, a clinical comparison with the existing treatment modalities is imperative. Aim: To compare Mab with remdesivir and favipiravir for mild to moderate COVID-19 disease. Materials and Methods: A retrospective, observational and single-centre study was conducted at a COVID-19 infection facility and private tertiary care hospital, Mumbai, Maharashtra, India. Data of patients admitted during the period of 1st June 2021 to 31st August 2021 was collected and analysed in the months of September 2021 and October 2021. Adults participants diagnosed to have COVID-19 infection, not requiring critical care or oxygen therapy were included in the study. Time to recovery from treatment onset and the need for treatment escalation were the primary outcome measures. Data was entered into Microsoft excel spreadsheet version 16 and analysed. Statistical analysis was carried out using Chi-square test for the significance of association between tabulated values of data for qualitative and categorical data. Two-tailed unpaired t-test and Analysis of Variance (ANOVA) was used for quantitative tabulated data. Results: This study included 158 participants, grouped into remdesivir (n=63), favipiravir (n=30) and Mab (n=65) treatment groups. Gender distribution was comparable in all groups (p-value=0.08). The three groups were compared for need of treatment escalation and time of recovery. The Mab treatment group (on comparing with other treatment arms) had earlier symptom recovery when given to patients with mild COVID-19 disease (p-value=0.006 for major symptoms) or when treatment was started within five days of symptom onset (p-value <0.001). Patients in Mab treatment group with mild illness required no treatment escalation compared to other groups (p-value=0.011). However, time to recovery patients in all treatment groups was comparable in case of patients with moderate COVID-19 illness (p-value=0.7381). In patients with moderate COVID-19 illness Mab treatment group required more frequent treatment escalation compared to remdesivir treatment group (p-value=0.044), when treatment was started within 5 days of symptom onset remdesivir and mab were comparable for treatment escalation (p-value=0.144). Vaccination status of the three groups differed significantly (p-value=0.033) hence a further subanalysis was done. On further analysis, non vaccinated patients receiving Mab recovered from minor symptoms (p-value=0.0006) earlier than those receiving Remdesivir. Amongst the participants of the Mab treatment-group, vaccinated and non-vaccinated patients had comparable recovery time and need for treatment escalation (p-value=0.57 and p-value=0.76, respectively). Participants who received Mab-treatment within five days of symptom onset; recovered earlier compared to those who received Mab treatment after five days (p-value=0.019). Conclusion: Monoclonal antibody treatment group compared to the other treatment groups had earlier recovery in non vaccinated patients, mild COVID-19 disease, and when treatment was started before or on the 5th day of symptom onset.

Clinical Syndromes of Cerebral Venous Thrombosis: An Institutional Study

Ajit Prasad Mishra, Shubhankar Mishra, Ashok Kumar Mallick

Introduction: Cerebral Venous Sinus Thrombosis (CVST) is a neurovascular syndrome in contrast to more common arterial disease. Despite advances in the recognition of CVST in recent years, diagnosis and management can be difficult because of the diversity of underlying risk factors and the absence of a uniform treatment approach. Aim: To evaluate the syndromes associated with the CVST spectrum and its association with veins with detailed prognostication. Materials and Methods: The present hospital-based, observational study was conducted in the Department of Neurology, Sri Ramachandra Bhanja Medical College and Hospital, Cuttack, Odisha, India. A total of 52 patients of age >14 years, who presented with radiological confirmation of venous sinus thrombosis were included in the study. All their clinical and epidemiological parameters were tabulated. They were classified into four clinical syndromes namely syndrome of raised intracranial hypertension without focal deficit, syndrome of the focal neurological deficit with or without raised intracranial hypertension, syndrome of cavernous thrombosis and syndrome of early altered consciousness with involuntary movements/diffuse encephalopathy. Clinical parameters were analysed according to syndromic presentation. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: A total of 52 patients with radiological confirmation of CVST were evaluated over a period of two years. The mean age of presentation was 31.8±12.3 years. The mean duration of symptoms prior to hospitalisation was 13.6±11.9 days. Sensorium was normal in most of the admitted patients. In the present study, syndrome-2 (syndrome of focal neurological deficit) was the most common syndrome reported (n=32, 61.6%). Conclusion: Cerebral venous sinus thrombosis should be classified according to the syndromic association of clinical features. It will help in easy diagnosis based only on assessment of the clinical features.

Prevalence of White Spot Lesions in Patients Treated with Passive Self-ligation Orthodontic Appliances: A Retrospective Study

Kavitha Ramsundar, Ravindra Kumar Jain, Nivethigaa Balakrishnan

Introduction: White Spot Lesions (WSLs), also known as “white opacity,” are the result of the demineralisation occurring on tooth surfaces in patients undergoing fixed orthodontic treatment. In addition to the various other factors, development of WSLs can also be influenced by the type of brackets and ligation employed. Aim: Evaluating the prevalence of WSL among patients who underwent fixed orthodontic treatment with passive self-ligation mechanotherapy. Materials and Methods: This retrospective study was conducted using photographic records of patients who received orthodontic treatment using a passive self-ligation system at Saveetha Dental College in Chennai, Tamil Nadu, India. The records of 97 patients in the age range of 10-30 years who received orthodontic treatment using the Damon self-ligating system regardless of gender were obtained from April 2016 to April 2021. The presence of WSL was investigated retrospectively before and after treatment. Modified Gorelick’s scale was used for scoring the lesions. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software version 17.0 and paired t-tests were done. Results: Data of total of 97 subjects (45 females (46.39%) and 52 males (54.63%), mean age: 17.70±5.72 years) undergoing orthodontic treatment with self-ligation brackets was included in the study. The overall prevalence percent of WSLs in the study was 71.13%. The prevalence of WSLs among females was 70.5% and in males, it was 73%. There was no statistical significance for association between gender and severity of WSLs and there was a statistical significance for association of age group and severity of WSLs in upper lateral incisors and canines (p<0.05). Conclusion: The most commonly involved teeth were upper central incisors and second premolars, and the overall WSLs incidence in subjects undergoing passive self-ligation therapy was 71.9%. No influence of the gender was noted and severe lesions were commonly noted in maxillary lateral incisors of young individuals.

Heart Rate Variability Biofeedback Psychophysiological Rehabilitation in Coronary Artery Disease Patients: State of Heart as the State of Brain

Moli Jai Jain, Vishnu Vardhan, Vaishnavi Yadav, Pallavi Harjpal

Introduction: Psychological therapies in cardiac rehabilitation programs were found to be effective for patients with Coronary Artery Disease (CAD). Heart Rate Variability Biofeedback (HRV-BF) is a behavioural neuro-cardiac intervention designed as a natural oscillation between the breathing cycle and Heart Rate (HR), also known as refractory sinus rhythm biofeedback. Aim: To find the potential effects of heart rate variability biofeedback for psychophysiological rehabilitation in CAD patients. Materials and Methods: In this systematic review included five databases (PubMed, Scopus, web of science, and Google Scholar) were searched for publications between January to December 2021. Randomised control trials published in the English language, done on the effect of HRV-BF on psychophysiological rehabilitation in CAD, were included. High-quality experimental trials were chosen for the study, using Arksey and O’Malley framework. The records were screened against eligibility criteria and methodological quality analysis was done using Downs and Black N checklist. Results: Overall, 11,048 articles were extracted, from which 56 records were screened, and three randomised control trials were included in the study. All the three studies scored within a range of 20-25, with good methodological quality. They demonstrate practical feasibility of HRV-BF device with both short-term and long-term effect on psychophysiological rehabilitation in CAD patients. Conclusion: This systematic review showed the potential effects of HRV-BF for psychophysiological rehabilitation in CAD patients. Patients have reported the benefits of HRV-BF therapies by patient reported as well as therapies reported outcome measures.

Role of Aspergillus Specific IgG Titres as a Therapeutic Target for Chronic Pulmonary Aspergillosis: A Longitudinal Study

Kshitij Agarwal, Gaurav Bhati, Prateek Gupta, Amit Kumar Verma

Introduction: Chronic Pulmonary Aspergillosis (CPA) continues to be an enigma to clinicians in regions with a high prevalence of pulmonary tuberculosis and is often misdiagnosed as the latter, attributable to the significant overlap in symptoms and radiology. Moreover, although the diagnostic criteria for CPA have been standardised, the role of serological markers in monitoring disease activity and response to therapy is still not well characterised. Aim: To understand the characteristics, risk factors and treatment outcomes in patients developing CPA and to determine the role of serological markers as indicators of disease activity. Materials and Methods: The present longitudinal study was conducted in the Department of Respiratory Medicine, University College of Medical Sciences and its associated Guru Teg Bahadur Hospital, Delhi, India from February 2021 to June 2022. Study included 46 patients suspected of harbouring CPA attributable to their clinico-radiological presentation. The diagnosis of CPA was made using the established criteria. Patients with a confirmed diagnosis of CPA received oral azole antifungals for six months and were monitored at three monthly intervals for reduction in baseline parameters to determine treatment success/failure. Paired and unpaired parametric variables were compared using the t-test and non parametric methods were compared using the Chi-square test. Results: The diagnosis of CPA was established in 31 (67.4%) patients of whom 74.2% were males and the mean age was 47.3±2.2 years. These patients had been symptomatic for 5.8±1.2 years. Underlying risk factors (such as the history of tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, history of long-term glucocorticoid use etc.) had been present for 6.9±1.3 years. Patients harboured an average of two risk factors with tuberculosis and diabetes mellitus being the most common local and systemic affliction, respectively. Patients with tuberculosis (p-value=0.001) and chronic steroid use (p-value=0.029) were significantly at higher risk of developing CPA. Six months of azole therapy led to significant reduction in specific IgG titres (p-value=0.001), and serum precipitins (p-value=0.004). Two patients on itraconazole relapsed within 12 months but were successfully treated with voriconazole. Conclusion: Tuberculosis was the most significant local risk factor leading to the development of CPA, which developed soon after diagnosis of another systemic risk factor. Six months of azole therapy was adequate to induce remission of the disease, activity of which can be monitored though the measurement of serum IgG antibody titres.

Corneal Endothelial Morphology and Central Corneal Thickness Changes in Type 2 Diabetes Mellitus using Specular Microscopy and Ultrasonic Pachymetry: A Cross-sectional Comparative Study

Vijay Singh, Prakriti Chourasia, Sandeep Kumar

Introduction: Diabetes Mellitus (DM) is a metabolic condition characterised by chronic hyperglycaemia, causing raised blood glucose levels which result in microvascular and macrovascular disorders and may introduce ocular manifestations including changes in corneal Endothelial Cell Density (ECD), corneal thickness, and intraocular pressure. It is clinically important to analyse the corneal endothelial status in patients with type II DM as preoperative corneal endothelial cell dysfunction may cause more corneal endothelial cell damage postoperatively leading to corneal decompensation. With the advent of precise and better measurement tool Central Corneal Thickness (CCT) and corneal endothelial morphology measurement has become more accurate. Aim: To compare corneal endothelium cell density, polymorphism, polymegathism and CCT in type 2 DM with age-matched, non diabetic control subjects using CEM-530 Specular microscope and ultrasonic pachymeter Tomey SP-100. Materials and Methods: This cross-sectional, comparative study was conducted at Eye Department at ESI Post Graduate Institute of Medical Sciences and Research, Basaidarapur, Delhi, India, from October 2018 to November 2019 on a total of 150 patients. Seventy five known type 2 DM patients were enrolled in diabetic group (case group) and 75 non diabetic, age-matched subjects were enrolled as control group. Cases were classified under three major groups, namely on the basis of duration of DM and severity of Diabetic Retinopathy (DR) and glycaemic control {glycosylated haemoglobin (HbA1c) level}. All the findings were endorsed on a predesigned performa. Statistical Package for Social Sciences (SPSS) version 17.0 was used for analysis of data. Results: Among the 150 patients evaluated, type 2 DM patient’s corneas (540.51±32.578 μ) were thicker as compared to control group 517.51±22.155 μ(p-value <0.001). The mean ECD of control and diabetic group patients was 2723.75±287.253 cells/mm2 and 2716.11±296.081 cells/mm2, respectively, found insignificant (p-value=0.821). The mean Coefficient of Variation (CV) of cell area of control and diabetic patients was 28.87±3.950 and 29.85±4.027, respectively, and was significant (p-value=0.034). The mean percentage of endothelial Hexagonal cells (HEX%) of control and diabetic patients were 67.39±6.419 and 67.41±5.493, respectively and was non significant (p-value=0.985). Thus, statistically significant difference was found with CCT (p-value <0.001) and CV (p-value=0.034) but not with ECD and hexagonality, between control and diabetic eyes. There was a correlation between CCT, CV, HEX% and ECD with duration of DM2 but it was statistically insignificant. There were higher CCT, CV and HEX% and lower ECD in >10 years of duration of diabetes mellitus than in patients with duration of diabetes mellitus ≤10 years. There was a correlation of CCT, CV, ECD and HEX with HbA1c level. There were significant higher CCT and CV values in >7% HbA1c level group than in group with ≤7% HbA1c level. There was also increased ECD in >7% group, but it was found to be insignificant. Percentage of hexagonality in >7% HbA1c level group was lower than in group with ≤7% HbA1c level, but found insignificant. There were higher values of CCT and CV in Non Proliferative Diabetic Retinopathy (NPDR) subgroup compared to Proliferative Diabetic Retinopathy (PDR) and no Diabetic Retinopathy group. Conclusion: The present study documented that DM has considerable effects on all the layers of the cornea especially endothelial layer, causes reduction of ECD and increased CV. Diabetic cornea has increased CCT and lower percentage of hexagonal cells than normal subjects. In addition, there is a correlation between the changes in corneal parameters like ECD, CV, HEX%, CCT with the duration of DM and severity of DR and glycaemic control {glycosylated haemoglobin (HbA1c) level}.

Correlation of Sleep Quality with Body Mass Index and Blood Pressure among the Healthcare Students in Karnataka: A Cross-sectional Study

Nisha, Mahadev Prasad, US Pavithra, Dona Babu, Benazeera, S Padma Priya

Introduction: A quality night sleep is essential for physical, cognitive, and emotional well-being. The amount of sleep may have an effect on both weight and metabolism. In India, for the last few years, decline in sleep duration has been noted with an average sleep duration of seven hours per night and one-third sleeping less than seven hours per night. Televisions and smartphones which came into households as remarkable source of information and entertainment has caused the voluntary sleep restriction. Aim: To evaluate the sleep quality, Body Mass Index (BMI) and Blood Pressure (BP) of the healthcare students and also to find the correlation of sleep quality with BMI and BP. Materials and Methods: The present cross-sectional study was conducted on 138 healthy males and females healthcare students residing in hostel premises of Yenepoya (Deemed to be University), Karnataka, India from November to December 2021. Pittsburgh Sleep Quality Index (PSQI) questionnaires administered to assess the sleep quality by adding the seven components of PSQI score ranging from 0-21. A weighing scale, sphygmomanometer, and stadiometer instruments were used to record the weight, BP and height. Data were computed in International Business Management (IBM) Statistical Package for Social Sciences (SPSS) software version 23.0 to analyse descriptive and inferential statistics. Results: The mean age in present study was 23±0.72 years and 71 (51.4%) belonged to 22-23 years, majority 112 (81.2%) were female students. In present study, moderately obese students (33.15±0.72) and severely obese (35.39±0.10) had mean sleep score of 6.00±3.46 and 11, respectively indicating poor sleep quality. The underweight (16.91±1.17), normal weight (21.49±2.04) and overweight (26.49±1.48) had mean sleep score of 3.08±1.62, 3.08±1.12 and 4.66±3.05 respectively, which indicated good sleep quality. Students with hypotension, normal BP and hypertension stage-1 showed mean sleep score of 3.52, 2.71 and 4.77 respectively, showing good sleep quality. A statistically significant positive correlation of BMI was found with SBP (r-value 0.273, p-value 0.001) and DBP (r-value 0.181, p-value 0.033). Conclusion: The BMI and BP were positively correlated with sleep quality. Therefore, creating awareness among healthcare students on healthy lifestyles such as exercise, healthy sleep and regular health supervision is essential to prevent prehypertension and maintain normal BMI status.

Exposing the Iceberg: A Study on Risk Assessment and Chronic Morbidity due to Non Communicable Diseases among Rural Population of Kerala using STEPS Survey

Introduction: Non Communicable Diseases (NCDs) (heart diseases, chronic respiratory disease, stroke, diabetes, cancer) pose a significant public health burden especially in low and middle income countries. The increasing prevalence of NCDs will have significant implications in socio-economic and health sector and hence, needs immediate attention. Aim: To see the prevalence of NCDs and its risk factors among residents in a rural population of Pathanamthitta district. Materials and Methods: This cross-sectional survey was conducted among 2236 adults of both gender residing in Konni Block, Pathanamthitta over a period of six months using the World Health Organisation STEPwise approach to surveillance (WHO STEPS) survey, the Achutha Menon Centre Diabetes Risk Score (AMCDRS) and risk score to predict hypertension in primary care settings. Variables were expressed using proportions with 95% Confidence Intervals (CI). Chi-square test was used for comparison of proportions across groups. Logistic regression analysis were used to determine the predictors of morbid conditions. Results: Total of 2236 study participants consisted of 53.8% females and 46.2% males with the mean age 47±17.5 years was included. Among them, 683 (30.7%) suffered from one or more morbidity. Around 18.1% and 19.9% of study participants suffered from diabetes and hypertension, respectively. More than 25% of the study population was at risk of developing hypertension and diabetes. Substance abuse, obesity and family history of diabetes were found to be risk factors for the development of morbidity. Conclusion: The present study provides evidence of the growing burden of morbidity from NCDs. Increasing prevalence of multimorbidity and clustering of risk factors demand urgent and co-ordinated attention.

Association of β-Globin Gene Haplotypes with Haematological Parameters and Foetal Haemoglobin among Patients with Sickle Cell Disorder in Raipur, Chhattisgarh, India

Sanjana Bhagat, Amar Singh Thakur

Introduction: Sickle cell disease is caused by a single nucleotide substitution in the β-globin gene. The variations in Foetal Haemoglobin (HbF) levels, β-globin gene cluster haplotype have been used as predictors of disease severity in sickle cell disease patients. Aim: To determine the frequency of β-globin gene haplotypes in sickle cell disease patients and also to establish their association with haematological parameters and HbF. Materials and Methods: The present cross-sectional study was conducted in Department of Biochemistry, Government Medical College, Jagdalpur, Chhattisgarh, India, in collaboration with Department of Biotechnology, Government Nagarjuna PG College of Science, Raipur, Chhattisgarh, India, from April 2021 to May 2022. A total of 100 patients with Sickle Cell Disease (SCD) and 50 with sickle cell traits were included in the study. Haplotypes were identified by Restriction Fragment Length Analysis (RFLP) method for seven polymorphic sites in β-globin gene cluster. Haematological parameters such as Hb, Haematocrit (HCT), Mean Cell Volume (MCV), Mean Cell Haemoglobin (MCH) and HbF levels were estimated. Data was analysed using various statistical tests such as Shapiro-Wilk test, Levene’s test, student t-test, Mann-Whitney test and Kruskal-Wallis tests as per analysis requirement. Results: In the present study, 51 (51%) males and 49 (49%) females were in sickle cell disease group (SS), while 25 (50%) males and 25 (50%) females were in sickle cell trait group (AS). The mean age of the sickle cell disease patients was 23.84±8.38 years and for sickle cell trait group was 26.3±7.37 years. There was a significant difference (p-value <0.0001) in HbF levels among haplotypes. Additionally, higher HbF concentration was found in Arab-Indian haplotypes in SCD patients. No significant association was observed between the haplotypes and haematological parameters. Conclusion: The findings suggested that haematological parameters were not significantly associated with β-globin gene haplotypes. The β-globin gene haplotypes influence the HbF levels in sickle cell patients.

Doxycycline-resistant Scrub Typhus in a Syndromic Child

Priya Margaret, S Ramitha Enakshi Kumar, V Revathi

Scrub Typhus, a human febrile illness caused by Orientia tsutsugamushi, is common in Asia and infects persons those visiting the endemic areas. Scrub typhus is a zoonotic infection. It is transmitted by a trombiculid mite which introduces the bacteria by its bite. Scrub typhus is associated with maculopapular rashes and local and/or generalised lymphadenopathy.It is characterised by eschar at the site of the bite. A child with doxycycline-resistant scrub typhus is being presented here. A 10-year-old female child was brought to the hospital with complaints of fever for six days, cough for three days, loose stools for two days, and vomiting for one day duration. S1 and S2 sounds were heard while bilateral vesicular breath sounds were normal. There was no hepatosplenomegaly and Central Nervous System (CNS) examination showed no focal neurologic deficits. Investigations showed a normal leukocyte count and Differential Leucocyte Count (DLC), microcytic hypochromic anaemia, thrombocytopenia, hyponatraemia, and elevated liver enzymes. Scrub Immunoglobulin M (IgM) was positive. Chest radiograph showed a bell-shaped chest with vertical straightening of ribs. The child was started on intravenous (i.v.) fluids, Doxycycline 4 mg/kg, and paracetamol. The child continued to spike fever at day six of Doxycycline and hence was started on Azithromycin 10 mg/kg, following which the fever subsided and the child was discharged.

Cognitive Impairment in Children with Beta-Thalassaemia Major at a Tertiary Care Centre, Rajasthan, India: A Cross-sectional Study

Introduction: Thalassaemia is one of the most common genetic disorders. Iron overload due to repeated blood transfusions and chelating therapy leads to oxidative stress and possible irreversible brain tissue damage, causing cognitive impairment in these children. Aim: To study cognitive impairment in children with beta-thalassaemia major in a tertiary care centre in Bikaner, Rajasthan, India. Materials and Methods: This was a hospital-based cross-sectional observational study conducted in the Department of Paediatrics, Sardar Patel Medical College, Bikaner, Rajasthan, India from September 2019 to August 2020. Sixty-five children with thalassaemia and 65 children without thalassaemia (as controls) were recruited and assessed using modified Mini-Mental State Examination (MMSE) for cognitive impairment. Results: Majority of children belonged to age group 6-11 years (67.7% in cases and 68.8% in controls). The mean MMSE scores were significantly lower among children with thalassaemia (26.82±6.45) compared to the controls (29.08±5.71). There was a significantly higher prevalence of cognitive dysfunction in thalassaemia children (72.3%) as compared to controls (33.8%). Children who were compliant with chelation medications (n=30) were found to have a lesser prevalence of cognitive dysfunction (60%) than those who were not compliant (n=35) with medications (82.86%) (p-value=0.013). Among cases, the mean ferritin levels were higher in children with cognitive dysfunction (3399.00±1489.18) compared to those with normal cognitive function (2412.38±1117.26) (p-value=0.046). There was moderate positive correlation between thalassaemia child’s Body Mass Index (BMI) and modified MMSE score. Conclusion: This study highlights the higher prevalence of cognitive impairment in children with thalassaemia (72.3%). The key contributing factors were lack of compliance to chelation therapy, higher serum ferritin levels and low BMI.

Evaluation of the Effectiveness of Topical Anaesthetic Gel and Needle Free Jet Anaesthesia in Root Planing: A Cross-sectional Study

Bhavya Shetty, Khadijathul Irfana, Ibrahim Fazal, Irfana Shabeeba

Introduction: Although traditional local anaesthetic technique by injection is considered as gold standard for dental procedure, the resultant pain and anxiety caused by the needle prick makes the patient less compliant for further treatment. Many alternatives have been developed by the researchers in the last two decades. Jet anaesthesia and the topical gel are the commonly used alternatives to anaesthetise the local area. Aim: To evaluate and compare the effectiveness of topical anaesthetic gel (MucopainR gel) and jet anaesthesia (Sure ShotR needle free jet injection) during root planing. Materials and Methods: The present cross-sectional split mouth study was conducted on 20 patients who required root planing in the maxillary quadrant bilaterally, where one quadrant was anaesthetised with benzocaine 20% (MucopainR) gel, and sure shotR jet anaesthesia was used on the adjacent quadrant. The side and order of placement of topical gel and jet anaesthesia were randomised. The same operator delivered anaesthesia on both the sides. The root planing was carried out by another operator at two sittings and pain was assessed immediately using Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and Verbal Response Scale Statistical . Results: The mean NRS score of the jet injection group was 1.50±1.54 and that for the gel group was 3.15±2.16. Also, the mean VAS score of the jet injection group was 1.50±1.54 and that for the gel was 3.15±2.16. The difference between two groups were statistically significantly (p-value=0.008). Conclusion: Jet anaesthesia was significantly superior to gel in providing anaesthesia during root planing.

Molecular Characterisation of X-ray Cross-complementing Group 1 (XRCC1) Gene and Risk Factors in Senile Cataract Patients attending a Tertiary Care Hospital, Uttar Pradesh, India

Introduction: Cataract arises because of aging of the crystalline lens of the eye which prevents clear vision. X-ray Cross-complementing Group 1 (XRCC1) is a Deoxyribonucleic Acid (DNA) repair protein which is involved in Single-Strand Breaks (SSBs) and Base Excision Repair (BER) pathway which is responsible for the efficient repair of DNA damage is mainly responsible for cataract in patients. Aim: To study the prevalence, risk factors and the molecular characterisation with its special association to XRCC1 gene in senile cataract patients. Materials and Methods: This was a cross-sectional study carried out in the Department of Anatomy and Ophthalmology, Rama Medical College Hospital and Research Centre, Kanpur, Uttar Pradesh, India, from April 2021 to April 2022. A total of 500 clinical patients were included in which 250 patients were confirmed as cataract positive patients. Venous blood of 5 mL was collected in Ethylene diamine tetra-acetic acid tubes. The DNA extraction for the detection of XRCC1gene was done using Qiagen DNA extraction kit as per manufactures guidelines, which was further confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Results: A total of 500 clinically suspected patients were included in which 250 cases were confirmed as cataract positive patients. The ratio of females was more (n=130, 52%) compared to males (n=120, 48%) with the mean age for females with 57.6% and for males with 61.13%. Hypertension (n=173, 69.2%) was the most common disease associated with the cataract patients. The ratio of males were more (n=91, 75.8%) compared to females (n=82, 63.07%). The mean age of males was 64.40 years and that of females were 62.45 years. The other co-morbidity included diabetes (48.8%), in which males constituted 67 (55.83%) participants compared to the females with 55 (42.3%) participants. The presence of XRCC1 gene was detected in all cataract positive patients, which was also confirmed by RT-PCR. Conclusion: The polymorphisms of DNA repair genes decreased their ability to repair DNA damage, leaving human body a greatly increased susceptibility to cancer or age-related diseases. The association of XRCC1 gene with age-related cataract susceptibility observed in the present study supports the view that XRCC1 gene plays an important role in susceptibility to age-related cataract, so early screening and its molecular profiling will help the clinician in the early diagnosis as well as early treatment.

Efficiency of a Bite Wafer on Pain Relief after Self-ligating Orthodontic Fixed Appliance Placement in Adolescents: A Single-centre Randomised Controlled Trial

Pascaline Dieudonné;, Laurence Seidel, Adelin Albert, Annick Bruwier

Introduction: The most common treatment proposed to relieve pain and discomfort stemming from the orthodontic treatment is Non Steroidal Anti-inflammatory Drugs (NSAID). Non pharmacological approaches, such as chewing a Bite Wafer (BW), have emerged to manage orthodontic pain to avoid side-effects of ibuprofen or paracetamol in adolescents. Aim: To compare efficiency between a BW chewing group and a control group to relieve orthodontic pain after the placement of a self-ligating fixed appliance in adolescents. Materials and Methods: The present single-centre randomised controlled trial in the Department of Orthodontics and Dentofacial Orthopaedics, University Hospital, Lie`ge, Belgium, between August 2019 and December 2020 included 33 teenagers who needed a self-ligating bimaxillary fixed orthodontic appliance. The patients were randomly allocated either to a test group encouraged to first chew on a BW to relieve the pain and then use paracetamol according to need, or to a control group authorised to consume paracetamol only. The BW group was hypothesised to be non inferior to the control group with a margin of 250 mg (one tablet). Data were collected for eight times over a seven-day period. For both groups, pain during four oral functions (biting with front and back teeth, chewing a piece of apple and tapping teeth together three times) were assessed at each time point through the use of a numerical analog scale. The impact of orthodontic appliance on eating habits and functional limitations was evaluated at the end of the study period. Data was calculated as means and standard deviation for quantitative variables, median and Interquartile Range (IQR) were added for skewed data. Results: The mean age of study participants was 12.3±1.1 years and 12.9±1.8 years for control group and BW group, respectively. At each time point, no statistically significant difference was observed between the two groups for the paracetamol consumption and the pain reported while the four oral functions. Functional limitations were also comparable. Total average consumption of paracetamol over seven days was lower in the test group (1000±954 mg vs 1150±844 mg) but non inferiority of BW compared to paracetamol only could not be statistically demonstrated. The test group used BW on average 5.6±8.9 times and 12.8±12.4 minutes during the seven days. Conclusion: No significant difference in consumption of paracetamol was seen between the BW and paracetamol group.

Disease Spectrum and Triage Assessment among Children Presenting to the Paediatric Emergency Department at a Tertiary Care Centre in Telangana, India

Introduction: Triage is a sorting process to quickly assess patients upon their arrival in the emergency department which helps to stream them to an appropriate location and adequate treatment. Triage assessment helps in recognising the commonly presenting childhood emergencies to optimise quality of care delivered in the Paediatric Emergency Department. Priority attention can be given to the critically ill or injured patients as how long the patient can safely wait, is predicted by triage. Aim: To provide data on disease spectrum and triage assessment of children presenting to an exclusive Paediatric Emergency Department. Materials and Methods: This was a cross-sectional study which was conducted from October 2020 to September 2021 over a period of one year in the Paediatric Emergency Department at Niloufer Hospital, a tertiary care children hospital in Hyderabad, Telangana, India. All children in the age group of one month to twelve years triaged by five-level Canadian triage and acute scale were included in the study. Data was collected from the register maintained at the Emergency Department. Descriptive statistics was used to analyse the data. Micosoft excel sheets were used for recording data. Results: During the study period, 7986 children were admitted with 5718 (71.6%) males and 2268 (28.4%) females. A total of 4352 (54.5%) patients were less than one year age. Neurological emergencies, acute febrile illnesses, respiratory illnesses were most common reasons for emergency visits. The number of chidren presenting with triage level 1,2,3 were n=4369 (54.71%). Conclusion: Majority of the patients attending the Emergency Department were less than one year old and acute febrile illnesses and seizures were the most common causes for admissions. Triaging and prioritisation of paediatric emergencies is strongly recommended for early recognition of life threatening illnesses and to improve outcomes. Specially trained nurses, healthcare professionals trained in Basic Life Support (BLS) and Paediatric Advanced Life Support (PALS) will go a long way in reducing morbidity and mortality.

Sitting against Lateral Position for Spinal Anaesthesia in Elderly Patients Undergoing Lower Limb Surgeries: An Observational Study

Shilpa Bansal, Minnu Mridul Pandit Rao, Mridul M Pandit Rao

Introduction: Age-related degenerative anatomical changes may make the spinal anaesthesia difficult. Sitting position is preferable due to easy identification of landmarks whereas lateral position is easy to maintain in case of elderly premedicated patients. Aim: To compare the effects of spinal anaesthesia position (sitting versus lateral) in the elderly patients on block characteristics (sensory and motor), haemodynamic parameters, patient’s comfort and satisfaction. Materials and Methods: The present prospective observational study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India, from November 2021 to May 2022. A total of 116 American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes, age more than 70 years undergoing lower limb surgeries under spinal anaesthesia either sitting or lateral position were included in the study. These patients were divided in to two groups (sitting position-Group SP, lateral position-Group LP). Hyperbaric bupivacaine (0.5%) was injected into the subarachnoid space. After the spinal injection, assessments were made for block characteristics (sensory and motor), haemodynamic parameters and patient’s comfort and satisfaction. The discrete and categorical variables were analysed using Chi-square test. Results: The mean age of participants in group SP and group LP was 77.31±4.015 years and 76.69±4.901 years, respectively. Onset of sensory block after was significantly slower in group SP (75.31±10.384 seconds) as compared to group LP (64.23±7.758 seconds). Time required to achieve maximum level of sensory block was significantly higher in group SP (8.11±1.416 minutes) than group LP (6.67±1.324 minutes). There was no significant difference in Heart Rate (HR) in both groups, but there was significantly lower Systolic Blood Pressure (SBP) in group SP than group LP upto 12 minutes after spinal injection. However, the lateral position appears to be more comfortable for elderly patients as per the comfort score. Conclusion: Position for spinal anaesthesia, either sitting or lateral, has insignificant effects on block characteristics or on haemodynamic parameters except there was faster onset of sensory and motor block and more comfort in lateral position.

Effect of Fastened Ankle Multidirectional Jumping Exercise Program on Jumping Performance among Athletes with Chronic Ankle Instability: A Randomised Controlled Trial

Fiza Raza Rizvi, Jasobanta Sethi, Anu Bansal, Vimal Sharma

Introduction: Chronic ankle instability leads to alterations of ankle joint function, especially during jumping and running leading to diminished athletic performance. Multidirectional jumping exercise program with fastened ankle are required to be explored to overcome the challenges faced by the clinicians for management of ankle injuries, as well as, early return of athletes to sports. Aim: To find out the effect of fastened ankle multidirectional jumping exercise program on jumping performance among athletes with chronic ankle instability. Materials and Methods: This single-blinded randomised controlled trial was conducted at Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India in June 2022, and included 30 athletes with ≥6 months of Grade I and II ankle sprain, with instability and history of two or more episodes of injury. All subjects were distributed into three groups of 10 each. Pain and ankle disability were assessed using Numerical Pain Rating Scale (NPRS), vertical jump test and Foot and Ankle Disability Index tool (FADI-sports module). Therefore, recorded at baseline, 3rd week, and 5th week of intervention. Group 1 received ankle active range of motion exercises, while Group 2 received multidirectional jumping exercises, and Group 3 received multidirectional jumping exercise program with fastened ankle. Before exercise the involved ankle was taped with rigid tape. One-way Analysis of Variance (ANOVA) was used for between group analysis and ANOVA using repeated measure were used for within group analysis. Results: There was improvement in experimental group (group 2 and 3) from baseline to 5th week. Group 3 showed significant improvement in pain (NPRS) with mean difference of 5.4 from baseline to 5th week, Vertical jump height (vertical jump test) with mean difference of 24.7 from baseline to 5th week, ankle disability (FADI-sports module) with mean difference of 42.80 from baseline to 5th week with p<0.001. whereas group 2 showed improvement in pain with mean difference of 5.2 from baseline to 5th week, vertical jump height with mean difference of 18.5 and ankle disability with mean difference of 44.9 from baseline to 5th week with p<0.001. Conclusion: The study concluded that, five weeks of fastened ankle multidirectional exercise program improved the jumping performance, among athletes with chronic ankle instability.

Diagnosis of Acute Appendicitis using Alvarado Score, Ultrasound Abdomen, and C-Reactive Protein in Different Combinations: A Prospective Observational Study

Laxmi Narayan Meena, Vivek Rajan, Naresh Kumar Mangalhara, Deeksha Mehta

Introduction: Appendicitis is the most commonly encountered surgical emergency worldwide. Numerous diagnostic methods, including clinical scoring systems, radiological modalities, and laboratory markers have been suggested over time to diagnose appendicitis correctly, but a Negative Appendectomy Rate (NAR) of 20-30% is still maintained. Aim: To determine the effect of using all three modalities together i.e., a clinical modality {The Alvarado Score}, a radiological modality {Ultrasound (US)}, and a laboratory parameter {C-Reactive Protein (CRP)} in diagnosing acute appendicitis. Materials and Methods: This was a hospital-based, prospective observational study, carried out in the Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India, from March 2019 to June 2020. The three diagnostic modalities were arbitrarily categorised into different combinations: Combination 1: Alvarado score ≥5 with C-Reactive Protein (CRP) ≥0.8; Combination 2: Alvarado score ≥5 with US grade 4 with CRP ≥0.8; Combination 3: Alvarado score ≥5 with US grade 4 with CRP ≥4); and the individual modalities i.e., the alvarado score and the US abdomen were also categorised into four categories each. Each of the individual modalities along with their different combinations were tested for their sensitivities, specificities, Positive and Negative Predictive Values (PPV, NPV) etc. Chi-square and t-test, sensitivity test and Receiver Operating Characteristic curve (ROC) and, Analysis of Variance (ANOVA) was used. Results: Total 200 cases were analysed in this study with mean age 32.33±15.78 years. Alvarado score had a sensitivity and specificity of 95.83% and 75%, respectively. US had a sensitivity and specificity of 71.35% and 75%, respectively while CRP had the highest sensitivity with 98.96%, but very low specificity (37.5%). The sensitivity, specificity, PPV and NPV of the combination 1 were found to be 98.96, 37.50, 97.44, 60.00, and of combination 2 was found to be 70.83, 87.50, 99.27, 11.11 and for combination 3 was 56.77, 100, 100, 8.79, respectively. Combination 2 also had the highest Area Under Curve (AUC) in Receiver Operating Characteristic (ROC) curve. Conclusion: The Combination 2 of three modalities proved to be the best diagnostic tool in the present study. It can pave the way, for a better diagnostic scoring system and future studies in this field.

Postoperative Analgesia in Ultrasound-Guided 3-in-1 Block versus Fascia Illiaca Compartment Block in Adult Patients Undergoing Lower Limb Orthopaedic Surgeries under General Anaesthesia: A Randomised Clinical Study

S Keerthana, Vijay Kumar Nagpal, Uma Hariharan, Mohandeep Kaur

Introduction: Three-in-one block and Fascia Illiaca Compartment Block (FICB) are two peripheral nerve block techniques that target the femoral nerve, obturator nerve and lateral femoral cutaneous nerve in a single injection. Both nerve blocks are used to provide anaesthesia and analgesia to the lower limb for various surgical procedures. The use of ultrasonography in peripheral nerve blocks helps to visualise the nerve, needle, and the distribution of the drug in real-time. It, thus, shortens the time of onset of sensory block, decreases performance time, and lowers the required drug doses, and finally increases chances of a favourable outcome from the nerve block. Aim: To compare the postoperative analgesic efficiency of ultrasound-guided 3-in-1 block with FICB in patients undergoing lower limb orthopaedic surgeries under General Anaesthesia (GA). Materials and Methods: A randomised clinical study was conducted at a tertiary care hospital. One hundred and fifty patients were randomly allocated to two groups, 3-in-1 block group or FICB. Both groups received the respective blocks after surgery before extubation. Postoperatively, Visual Analog Scale (VAS) scores were evaluated hourly for first six hours and two hourly thereafter until rescue analgesia was instituted. Time period from giving the block to giving rescue analgesia was noted as duration of analgesia. Injection diclofenac 1.5 mg/kg Intravenous (i.v.) was given when VAS value reached ≥4. Results: On analysis of 150 patients, divided into 3-in-1 block group (N=75) and FICB group (N=75); mean age: 53.29±8.69 years; the VAS scores at 2 to 18 hours, 20 hours, and 22 hours after performing the blocks were significantly less in the 3-in-1 block group compared to FICB group. Also, the mean time (hours) for first rescue analgesia in FICB group (3.49±0.53) was earlier compared with 3-in-1 block group (7.35±0.51). Conclusion: A 3-in-1 block provides effective and prolonged postoperative analgesia in comparison to FICB.

Prevalence of Adverse Events in Healthcare Professionals Using Personal Protective Equipment to Treat COVID-19: A Web-based Survey

K Priya Gayathri, R Kavitha Ramasamy, S Ramya, K Punnagai

Introduction: Healthcare Professionals (HCPs) involved in managing Coronavirus Disease-2019 (COVID-19) pandemic were instructed to wear Personal Protective Equipment (PPE) to protect themselves from contracting virus. However, PPE use can sometimes lead to adverse events which create greater impact on health status of HCPs. Thus, the prevalence of adverse events and associated risk factors should be estimated for taking necessary preventive measures. Aim: To evaluate the prevalence of adverse events in HCPs due to PPE use during second wave of COVID-19 in Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted in different levels of healthcare centres in Tamil Nadu, India, from April to May 2021. Data were collected using a prevalidated questionnaire from HCPs of any discipline who were directly involved in managing COVID-19 patients. A total of 282 responses were collected through Google forms and proportion of HCPs who experienced adverse events due to PPE and percentage of different adverse events associated with PPE wearing were assessed. Data were analysed using Chi-square test. Results: Out of 282 respondents of the survey included 224 doctors, 34 nurses and 24 lab technicians with a mean age of 30 years. There were 164 females and 118 males. A total of 177 (62.76%) participants experienced adverse events which included dehydration, thirst and heat, headaches, inability to go to restroom and other urinary/respiratory problems. With respect to duration of exposure to PPE, 163 (57.8%) HCPs had >6 hours/day and 102 (36.2%) had 4-6 hours/day. It was observed that factors such as age, gender, profession, various wards posted for COVID-19 duty and duration of PPE worn daily were significantly associated with adverse events to PPE (p-value <0.05). Conclusion: The results of the study concluded that higher prevalence of adverse events with PPE was seen among doctors and nurses. Most common encountered adverse events were dehydration, headache and skin problems, which have been associated with prolonged use of PPE.

Saliva as a Viable and Simple Alternative to Nasopharyngeal and Oropharyngeal Swabs for COVID-19 Real-Time Reverse Transcriptase Polymerase Chain Reaction

Leimapokpam Sumitra Devi, Mukesh Sharma, Moumita Sardar

Introduction: Attributable to the difficulties in specimen collection, discomfort and symptoms caused on by Nasopharyngeal Swab (NPS) and Oropharyngeal Swab (OPS) collection, and significant risk to Healthcare Workers (HCW), evaluation of an alternative specimen for the diagnosis of Coronavirus Disease-2019 (COVID-19) is required. Saliva specimen could be an alternative specimen with many advantages over NPS and OPS, however little is known about how well it performs this purpose. Aim: To assess the efficacy of saliva as a viable and simple alternative specimen to NPS and OPS for COVID-19 Real-Time reverse transcriptase Polymerase Chain Reaction (rRT-PCR). Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, SGT Medical College Hospital and Research Institute, Haryana, India, from July to December 2020. A total of 60 symptomatic and 20 asymptomatic COVID-19 patients were recruited for the study and specimen viz., saliva, NPS and OPS were collected at four different sampling points i.e., on day one, five, seven and 14 after confirmation of COVID-19 rRT-PCR test positivity. Data obtained from the study was analysed and expressed as median, frequency, interquartile range and Chi-square test was done for comparison of categorical variables. Results: Majority of the patients in symptomatic hospitalised COVID-19 patients were males 49 (81.7%) and remaining were females 11 (18.3%) and in asymptomatic group 8 (40%) were males and 12 (60%) were females. Saliva was the most sensitive specimen (74.2%), followed by NPS, Naso Oropharyngeal Swab (NOPS) with 70.8% each and OPS (65.8%) for detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in symptomatic patients at four different sampling points. Comparable findings were also observed in specimens obtained from asymptomatic individuals as well. In addition, the viral load was also highest in saliva sample, as measured by Cycle Threshold (Ct) value. Across all specimen types, high viral load (lower Ct values) was observed during the early period of infection. Majority of the study participants reported discomfort during NPS and OPS collection (90% and 85%, respectively), lacrimation, sneezing and gag reflex being the most commonly reported induced symptoms. Conclusion: In the present study, saliva could be a viable and alternate specimen for COVID-19 diagnosis due to its ease in sample collection, specimen stability and reduced risk of transmission of infection due to droplets.

Knowledge, Attitude and Practice of Pharmacovigilance among Ayurveda Doctors Practicing in Wardha, Maharashtra, India: A Cross-sectional Study

Ishita Sirsikar,Bharat Rathi, Renu Rathi, Amol Deshpande

Introduction: Adverse Drug Reactions (ADRs) significantly, cause morbidity and mortality worldwide. As a result, proper ADR monitoring is required. Considering the consequence of this area, the Ministry of AYUSH has introduced a Pharmacovigilance programme for Ayurveda, Siddha, Unani and Homeopathy (ASU&H) drugs. Every Ayurveda Practitioner’s (AP) immense responsibility is to detect and report ADR. Aim: To evaluate the knowledge, attitude, and practice of pharmacovigilance among AP in Wardha, Maharashtra, India. Materials and Methods: A cross-sectional survey was conducted in a Government Hospital, Wardha, Maharashtra, India, during March to May 2022. Total 38 Ayurveda Doctors of Wardha city having Bachelor of Ayurvadic Medicine and Surgery (BAMS), Doctor of Medicine (MD) degree, either working in private clinics and hospitals or as medical officers were enrolled in the study. A validated questionnaire was prepared on Google form, circulated through WhatsApp to the doctors, and asked them to fill and submit it within seven days. The collected data were analysed using Microsoft excel 2007 and expressed in percentages (%). Results: A 28 (73.67%) male, and 10 (26.31%) female doctors possessing BAMS degrees (68.42%) and postgraduate degrees (37.57%), with practice experience between 5-30 years participated in the study. Present study revealed that 32 (84.21%) of the BAMS doctors from Wardha city believed that Ayurveda drugs cause ADRs, and only 7 (18.4%) have encountered ADRs in their practice, of which only 02 (5.26%) reported an ADR. Conclusion: The present study revealed that AP are well aware about ADR but lacking in the knowledge of its reporting. There is a strong need to organise sensitisation and awareness programmes to implement the pharmocovigilance effectively.

Is Helicobacter Pylori Infection Associated with Insulin Resistance? A Tertiary Care Centre Experience at Kattankulathur, Tamil Nadu, India

Introduction: H.pylori is the most common infection leading to gastrointestinal and extra-gastrointestinal lesions. Few studies had studied about H.pylori’s effect on glucose metabolism and insulin resistance and found thatH.pylori is associated with increase in mean Glycated Haemoglobin (HbA1c) levels and insulin resistance. But few studies have found no association between H.pylori and glucose metabolism. Aim: To determine the relationship between H.pylori infection and glucose metabolism profiles in dyspeptic patients, based on the histopathological examination. Materials and Methods: This prospective case-control study was carried out in the Department of Pathology at SRM Medical College Hospital and Research Centre from April 2021 to September 2021 on 70 dyspeptic patients. They were split into two groups: H.pylori positive (Group I, n=35) and H.pylori negative (Group II, n=35) groups. The age and gender of Group I were matched with Group II. Endoscopic gastric biopsy was taken and tissue sections were stained with Haematoxylin and Eosin (H&E), and Immunohistochemical (IHC) stain using H.pylori (Clone: EP279) rabbit monoclonal antibody. Blood samples were collected to test Fasting Blood Glucose (FBG) and insulin. Insulin resistance was calculated using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Histomorphological changes and H.pylori colonisation were graded according to Updated Sydney System and correlated with HOMA-IR levels. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: There was no significant variation between H.pylori positive and negative groups in demographic variables such as age (p-value=0.45) and gender (p-value=0.23). Body Mass Index (BMI) and H.pylori infection showed statistically significant association (p-value=0.04). Increase in mean values of FBG, insulin and HOMA-IR were statistically associated with H.pylori positive (p-value <0.05). Degree of H.pylori bacterial density (r_s=0.2992), chronic inflammation (r_s=0.3193), activity (r_s=0.4576) and atrophy (r_s=0.2542) were positively correlated with HOMA-IR. Conclusion: This study showed that chronic active gastritis with atrophic related changes and H.pylori colonisation were significantly correlated with HOMA-IR. Patients with H.pylori induced gastritis should be followed with regular monitoring of HOMA-IR; as early diagnosis and eradication of H.pylori might reduce the risk of insulin resistance and glucose metabolism dysregulation.

Association of Thrombocytosis and its Prognostic Significance in Cervical Cancer

Sahithya Sivaprasad, SR Sheela

Introduction: Thrombocytosis is associated with progression of many diseases. There is increasing evidence that tumour cells, platelets, endothelial cells interact with each other leading to spread of tumour cells into the microvasculature which results in poor prognosis due to metastasis. Thrombocytosis is an indirect marker of occult advanced disease. Aim: To determine thrombocytosis in diagnosed carcinoma cervix patients and its association with stage of cancer cervix and prognosis. Materials and Methods: This was the retrospective study conducted at Sri Devaraj Urs Medical College, Kolar, Karnataka, India, from April 2021 to May 2022, on medical records of 52 patients who were diagnosed with cancer cervix. The data abstracted from each subject’s medical record include the following: age, parity, clinical staging as per International Federation of Gynaecology and Obstetrics (FIGO), size of the lesion, complete blood count and length of the survival. Patients underwent surgery followed by appropriate chemo-radiotherapy or brachytherapy. They were followed-up after treatment every three months for the first two years and every six months for the next three years and annually thereafter. The five-year survival rate of these patients who were on complete follow-up was analysed. The normal platelet count was considered as 4.5×109/L. Data was entered into Microsoft excel data sheet and was analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean age of the study population was 50.28 years. Among the 52 patients, 47 (90.03%) were with advanced stages of cancer cervix (stages IIB-IVB) and 5 (9.6%) belonged to early stages of cancer cervix (stages 1B-IIA). Forty patients (76.92%) had a platelet count less than 4.5×109/L, out of which 2 patients were in early stage of cervical cancer and 16 patients were with tumour size less than 4 cm. A total of 12 patients had the platelet count more than 4.5 lac. All these 12 patients belonged to advanced stages of cancer cervix (stage IIB-IVB), p-value of 0.001. Among the 12, 11 patients had a tumour size of more than 4 cm, p-value 0.040. The mean five-year survival rate among patients with advanced stages of cancer cervix associated with thrombocytosis was 18%. Conclusion: The platelet count was found to have strong association with the tumour size, stage of the cervical cancer and five year survival rate thus making thrombocytosis to be a strong prognostic factor in cancer cervix.

Prevalence of Ophthalmic Manifestations in COVID-19 Positive Indoor Patients during Second Wave at Rural Tertiary Care Hospital of Gujarat: A Prospective Observational Study

Dhwani Satishbhai Mehta, Harsha Chetan Jani, Jane Manishkumar Mehta

Introduction: Coronavirus Disease-2019 (COVID-19) can affect multiple system of body including eye. In eye, it can cause mild conjunctivitis, posterior segment involvement, neuro-sensory involvement and lethal opportunistic infection like mucormycosis. Associated co-morbidities, severity of COVID-19 infection and corticosteroids used in its management can affect ophthalmic involvement. Aim: To determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. Materials and Methods: This prospective observational study was conducted on indoor patients of Shree Krishna Hospital, a rural, tertiary care hospital affiliated with Pramukh Swami Medical College, Karamsad, Gujarat, India, from 1st May 2021 to 1st January 2022. Second wave of COVID-19 was from 13th March 2021 to 19th June 2021. Patients’ demographic data, details of COVID-19 infection severity score, oxygen requirement, use of corticosteroids, history of various co-morbidities and stages of Rhino-Orbital-Cerebral Mucormycosis (ROCM) (if present) were noted. Bedside ophthalmic examination was done with torch light, fluorescent strip, cobalt blue light of direct ophthalmoscope and fundus examination with indirect ophthalmoscopy under institutional COVID-19 guidelines. Descriptive Statistics {Mean, (SD), Frequency, (%)} were used for analysis of the collected data. Results: Out of 649 COVID-19 patients, 368 were male and 281 were female with mean age of 52.58 (±15.38) years. All over prevalence of ophthalmic manifestations was 9.86% (n=64 out of 649 patients). A total of 63 patients (9.71%) did not require any oxygen supplement, 352 patients (54.24%) required nasal prongs, 201 patients (30.97%) required non invasive ventilator support and 33 patients (5.08%) required mechanical ventilation. The 378 patients (58.24%) received corticosteroids in oral or intravenous form. A total of 325 patients (50.1%) had diabetes, 267 patients (41.1%) had hypertension, 29 patients (4.5%) had chronic kidney disease and 15 patients (2.3%) had thyroid disease. A total of 52 patients (8.01%) had conjunctivitis. Mean age of patients with conjunctivitis was 50.04 (±15.28) with male preponderance (n=30, 57.7%). Most common systemic presentation was fever (n=29, 55.8%). Patients with conjunctivitis had high D-dimer (>500 ng/mL) (n=42; 80.8%) and C-Reactive Protein (CRP) values (>3 mg/L) (n=39; 75%). A total of 144 patients (22.2%) were vaccinated with COVID-19 vaccine first dose while 10 patients (19.23%) out of 52 patients having conjunctivitis were vaccinated. Out of 649 patients, prevalence of ROCM was 1.85% (n=12) with mean age 58.58 years (±9.71 years) and male preponderance (n=8, 66.66%). Nine out of 12 patients had high blood sugar levels (mean level 340 mg/dL) at the time of admission. Out of 12, eight patients had received corticosteroids for management of COVID-19 infection. Six patients of ROCM (50%) did not require any oxygen support while two patient (16.7%) required nasal prongs for mean 7.50 days and four patient (33.3%) required non invasive ventilator support for mean 7.33 days (±2.5 days). One patient had stage 2C disease, one had stage 3B, five patients had stage 3C while five patients had stage 4C disease. Conclusion: Ocular manifestations of COVID-19 range from conjunctivitis to ROCM. Conjunctivitis has mild and self-limited course while ROCM is sight threatening and life-threatening condition, if not treated appropriately.

Perioperative Factors Influencing Outcome in Palliative Cancer Surgery at a Tertiary Cancer Care Institute in Northeast India- A Retrospective Study

Marie Ninu, Barnali Kakati, Dokne Chintey, Sonai Datta Kakati

Introduction: Surgical palliation of malignancy is defined best as a procedure used with the primary intention of improving Quality of Life (QoL) or relieving symptoms caused by an advanced malignancy. Surgical procedures for palliation include resections, reconstruction, functional repairs, drainage, and biopsy. Primary benefits include QoL improvement through symptom prevention or control, with survival advantage as a secondary benefit. Aim: To evaluate mortality (30 days and six months), length of hospital stay and Intensive Care Unit (ICU) stay and QoL among patients undergoing palliative surgery for advanced cancer. Materials and Methods: A retrospective study was conducted at Dr. B. Borooah Cancer Institute, India, from September 2020 to March 2021. The clinicodemographic profile, tumour type and staging, treatment, investigations, surgery, anaesthesia and complications were studied. The outcome was defined by mortality, length of hospital stay and quality of life. Descriptive statistics was used for analysis. A p-value of less than 0.05 was considered significant at 5% level of significance. Results: A total of 86 patients underwent palliative surgeries, out of which 52 (60.5%) were females and 34 (39.5%) were males with the mean age of 49.6±15.9 years. Among them, 8 (9.3%) died within 30 days of surgery and 11 (12.8%) at six months after surgery. There was a significant association of mortality with pallor, deranged Thyroid Stimulating Hormone (TSH), co-morbidities, chemotherapy, type of surgery and anaesthesia but not with age, sex, type and stage of cancer, American Society of Anaesthesiology (ASA) status and General Condition (GC) of the patient. The mean duration of postoperative hospital stay was 15.8 days and mean ICU stay was 0.8 day for all patients. Patients with pallor had longer duration of hospital and ICU stay. Type of surgery was significantly associated with hospital stay but not with ICU stay. On evaluating the quality of life using Eastern Cooperative Oncology Group (ECOG) score, it was seen that the number of patients with poor ECOG scores (3 to 5) increased significantly from 10 (11.63%) to 13 (15.12%) in the immediate postoperative period. Conclusion: Patient factors affected the outcome after palliative surgery more than surgical and anaesthetic factors. The high mortality rate of 12.8% warrants detailed prospective studies in the future.

Knowledge, Attitude and Practices towards COVID-19 Vaccine in Pregnant and Postpartum Women: A Cross-sectional Study

Nupur Mandar Deshpande, Rohan Udayan Patwardhan, Shilpa Nitin Chaudhari

Introduction: Pregnant and lactating women have been included in the ongoing vaccination drive against Coronavirus Disease 2019 (COVID-19) by the Government of India. Despite the fact, the vaccination rates among this particular group were fairly dismal. Aim: To study the Knowledge, Attitude and Practices (KAP) related to the COVID-19 vaccine in pregnant and postpartum women in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted in Obstetrics and Gynaecology wards and Outpatient Department, Smt. Kashibai Navale Medical College and General Hospital (tertiary care hospital), Pune, Maharashtra, India, from August 2021 to October 2021 among 251 pregnant and postpartum patients. The data was collected using a face-to-face questionnaire. The questionnaire included demographic characteristics of study participants and a set of questions to test the KAP towards COVID-19 vaccination in pregnancy. Results: A total of 251 pregnant and postpartum women, with a mean age of 24.54 years, were surveyed. Among all the participants, 223 (89.92%) knew about the existence of the COVID-19 vaccine, however, only 23 (9.16%) were vaccinated. The most common reasons for refusing the vaccine were concerns for their own safety (n=39, 17.5%) or that of the foetus (n=107, 48.1%), lack of awareness (58.5%), and lack of recommendation by healthcare workers (63.5%). Only 67.8% of subjects believed in the efficacy of the vaccine. Overall, 16 (9.41%) women with no history of miscarriages or abortions had taken the vaccine, whereas, seven (9.33%) participants with a history of miscarriage or abortions had taken the vaccine. Conclusion: The present study reported low acceptance of the COVID-19 vaccine in pregnant and postpartum women. Lack of awareness and concern for vaccine safety were the major reasons for this. Recognising the major reasons for vaccine hesitancy among this population will be useful for creating effective strategies to increase vaccine acceptance during this pandemic.

Preference for Postendodontic Restoration for Fractured Anterior Teeth: A Questionnaire-based Cross-sectional Study among Dentists in Maharashtra, India

Meenakshi Muthiah, Manjusha Warhadpande, Darshan Dakshindas

Introduction: One of the common dilemmas faced by today’s clinicians is the management of structurally and aesthetically compromised endodontically treated teeth due to various treatment options available. There is no one factor which is the sole determinant for treatment planning. And there are various parameters contributing to the long-term success of a postendodontic restoration, especially in a fractured anterior tooth. Aim: This study is aimed to investigate the preference for postendodontic restoration for fractured anterior teeth with respect to the tooth structure and aesthetics. Materials and Methods: This cross-sectional study was conducted in the Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India, from August 2021 to December 2021 among 150 clinicians in Maharashtra. A validated questionnaire containing 17 close-ended questions was given to the participants which ascertained their treatment choices, the importance of preserving the tooth structure, aesthetics and the consideration given to the physical properties while choosing the material and planning the treatment. Data obtained from the survey were statistically analysed by the Chi-square test. Results: The mean age of the participants was 30.25±9.08 years. Among the 150 participants, postgraduates were 60 (40%) followed by general dentists 38 (25.3%), endodontists 36 (24%) and other specialists 16 (10.7%). Out of total, 82 (54.7%) preferred composites when more than 50% of the tooth structure remained. Crowns increased the longevity of the tooth according to 50 (83.3%) postgraduates. Among them, 28 (77.8%) endodontists opted for IPS Emax crowns over zirconia veneer for better aesthetics, 71 (47.3%) preferred glass fibre posts and 113 (75.3%) preferred ideal ferrule for better fracture resistance. Reattachment of the fragment was also a preferred option in all groups. Conclusion: A 77.8% of the endodontists preferred IPS Emax crowns while 71.1% of the general dentists preferred zirconia veneers. Good awareness was seen among endodontists regarding method, patient preferences and aesthetics, very good awareness in materials and excellent awareness in treatment choices. More awareness is needed among general dentists, postgraduates, and other specialists in terms of treatment methods.

Antibacterial Activity of Ulva lactuca against Multidrug Resistant and Betalactamase Producing Isolates from Food Samples- An In-vitro Study

M Manivannan, G Subramanian

Introduction: Antibiotic resistance is a problem of deep scientific concern, both in hospital and community settings. Due the presence of highly resistant microorganisms in food, it may lead to serious health issues to the human beings and other animals also. This can be controlled by novel control methods using natural products. Algae are one such wonderful source that helps in treating such dreadful microorganisms. Ulva lactuca incorporate discrete active compounds, hence, exhibit antibacterial property to control the Multidrug Resistant (MDR) bacteria. The present research aims in exploring the potential antibacterial property of such dreadful bacteria. Aim: To evaluate the potential bioactive compound of Ulva lactuca and its antibacterial activity against MDR and betalactamase producing food isolates. Materials and Methods: The present pilot in-vitro study was carried out at Arignar Anna Government Arts College, Namakkal, Tamil Nadu, India, in the period of December 2017 to December 2020. Total 18 bacterial isolates were isolated from five retail chicken meat samples. These were then, tested for its antibiotic resistance property using standard antibiotic discs. The algae Ulva lactuca was isolated and extract was prepared using ethanol and chloroform solvents, followed by which the phytochemical studies were performed. These extracts were then tested, against the selected organisms for its potential activity. Results: Among the 12 antibiotics tested, all isolates were resistance to variety of antibiotic classes, mainly aminoglycosides, cephalosporins and fluoroquinolones and also 55% of the bacteria were able to produce betalactamase enzyme. The ethanol extract of Ulva lactuca was highly active against all isolates and exhibited a range of 10±1.24 mm to 22±1.24 mm inhibition zone. The chloroform extract, exhibited less potency, which exhibited 10±0.816 mm to 13.16±1.027 mm inhibition zone. Each organic solvent showed positive result for following metabolites- alkaloids, carbohydrates, flavonoids, sterols, tannins and terpenoids. Conclusion: The ethanolic extract of Ulva lactuca was very effective against the selected MDR and betalactamase producing food isolates. Therefore, it could be suggested as an antibacterial agent in the future. Further studies are needed to reveal the behavioural mechanisms of this plant and its pharmacological effects.

Comparison of Intrathecal Bupivacaine with Levobupivacaine using Fentanyl as an Adjuvant for Transurethral Resection of Prostate-A Randomised Controlled Trial

Introduction: Transurethral Resection of Prostate (TURP) is a common surgical procedure performed for Benign Prostatic Hypertrophy (BPH), most commonly under Spinal Anaesthesia (SA). It is generally tolerated well by the elderly but since they suffer from several co-morbidities, therefore, it is desirable to avoid hypotension following SA, in these patients. Levobupivacaine, a pure S enantiomer of racemic bupivacaine has emerged as a safe alternative to bupivacaine with similar efficacy and better pharmacokinetic profile. Aim: To compare the efficacy of intrathecal levobupivacaine with bupivacaine using fentanyl as adjuvant in TURP. Materials and Methods: This randomised controlled trial was conducted at Pandit BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between March 2022 to September 2022. Fifty patients, 50-80 years of age, American Society of Anaesthesiologists (ASA) I-III, posted for TURP under SA, were included in the study and divided into two groups: group B (n=25): Inj. bupivacaine (0.5%) hyperbaric 12.5 mg+25 μg fentanyl citrate, group L (n=25): Inj. levobupivacaine (0.5%) isobaric 12.5 mg+25 μg fentanyl citrate. Onset of sensory and motor block, time to onset of maximum sensory and motor block, Heart Rate (HR), Systolic Bood Pressure (SBP), Diastolic Bood Pressure (DBP) and Mean Arterial Pressures (MAP) were recorded. Data analysis was done with the help computer software using Statistical Package for the Social Sciences (SPSS), version 24.0. Means, standard deviations, Chi-square, t-values and p-values were calculated, p-value <0.05 was considered significant at 95% confidence level. Results: Demographic data of the patients was comparable. The mean time to onset of sensory block in group B was significantly faster (3.72±0.96 min) than group L (4.47±0.73 min). The mean time to onset of motor block was faster in group B (4.74±0.91 min) than group L (7.57±1.51 min). HR was lower in group B, after SA at 5, 10, 15, 20, 30, and 45 min after SA. Group B recorded a lower SBP, DBP and MAP following SA, compared to group L (p<0.001). The duration of analgesia was significantly longer in group B (232.80±14.07 min vs 221.80±15.47 min in group L) (p<0.05). No adverse effects were reported from either of the groups. Conclusion: Levobupivacaine provided very stable haemodynamics, good quality analgesia and muscle relaxation intraoperatively. Postoperative analgesia was clinically similar to bupivacaine, no adverse effects were reported. Thus, levobupivacaine is a safe and reliable alternative to bupivacaine for elderly patients undergoing TURP.

Effect of a Nurse Led Multi-intervention Program on Quality of Life, Subjective Well-being and Level of Thyroid Hormones among Patients with Hypothyroidism- A Quasi-experimental Double arm Study

S Salina, KC Leena

Introduction: Hypothyroidism is a leading public health concern, affecting one in ten Indians. Along with conventional treatment with supplemental Thyroid Hormones (TH), problems associated with hypothyroidism can be managed with complimentary nursing interventions. Aim: To assess the effect of a nurse-led multi-interventional program on Quality of Life (QoL), Subjective Well-Being (SWB) and level of TH among patients with hypothyroidism. Materials and Methods: A quasi-experimental double arm study was conducted from August to October 2021, at selected endocrinology clinics on patients with hypothyroidism were divided into interventional (n=39) and control group (n=38) non randomly. Information related to socio-demography, QoL, SWB and TH levels were collected and followed by the implementation of a nurse-led multi-intervention program for the intervention group. The intervention was done individually, which consisted of a demonstration of yoga asana, yoga mudra and neck exercises. Two-way repeated measures Analysis of Variance (ANOVA) was performed, to check if there is any significant difference in the average QoL/SWB/level of TH across different time points as well as between the experimental and control group. Results: A total of 77 participants, 64 (83.1%) males and 13 (16.9%) females were included in the study with maximum participants belonged to the age group of 18-28 years. It was observed that after the implementation of multi-intervention program QoL was significantly improved among the experimental group (F=31.53, <0.001), and SWB also significantly improved (F=36.615, <0.001). Thyroid Stimulating Hormones (TSH) were significantly reduced among the experimental group (F=3.39, p=0.022) and Thyroxine (T4) levels were statistically significant among the experimental group (F=3.151, p=0.030). Conclusion: Patients with hypothyroidism require holistic care.Patients with hypothyroidism could be intervened with programs like yoga, neck exercise, pranayama and yoga mudras.

Classification of Acute Leukaemia based on Blast Morphology, Cytochemistry and Flow Cytometry

P Jubit Paulose, J Latha Fathima

Introduction: Acute leukaemias are a heterogeneous group of malignancies due to the abnormal proliferation of immature cells. The classification of acute leukaemia has been transformed over a period. French American British’s (FAB) classification of acute leukaemia is based on morphology and cytochemistry. Later, the World Health Organisation (WHO) classification stressed immunophenotyping to be done in the classification of acute leukaemia. Immunophenotyping is a powerful tool for classification and also for treatment and prognosis. Aim: To study the morphology of blasts in the peripheral smear and bone marrow cytochemistry and to compare with immunophenotyping in the classification of acute leukaemia. Materials and Methods: A prospective and cross-sectional study was undertaken in the Department of Transfusion Medicine and Immunohematology, at St. Johns National Academy of Health Sciences a Tertiary Care Hospital in Bengaluru, India, over a period of one year from November 2018 to October 2019. The morphology of the blast was studied in peripheral blood and bone marrow aspirate stained by Leishman stain. Cytochemistry in peripheral smear and bone marrow with Sudan Black B and Periodic Acid-Schiff (PAS) stain was done in all acute leukaemia. The flow cytometry samples were processed within 24 hours of collection of the samples with a panel of markers including myeloid and lymphoid lineage and precursor markers. The results of morphology were confirmed with flow cytometry and final reports were released. Microsoft excel was used to enter data. Results: A total of 112 cases of acute leukaemia were studied and classified based on morphology, cytochemistry and immunophenotyping of blasts. A total of 46 cases of Acute Myeloid Leukaemia (AML) and 63 cases of Acute Lymphoblastic Leukaemia (ALL). Two cases were found with Chronic Myeloid Leukaemia (CML) in blast crisis, one with myeloid and another with lymphoid blast crisis. One biphenotypic leukaemia was noted. Sudan Black was positive in 35 (76%) of AML and PAS was positive in 28 (44%) of ALL. The most common AML subtype was AML-M2 and the most common ALL subtype was B cell ALL. The most common symptom was fever and the sign was pallor. Conclusion: The present study showed that morphological diagnosis is important, based on which the cytochemistry and flow cytometry is performed for diagnosis. In cases of the diagnostic dilemma of acute leukaemia with morphology and cytochemistry, immunophenotyping supports diagnosing and classifying acute leukaemia.

Diagnosing Descemet Membrane Detachment in Patients Undergoing Cataract Surgery using an AS-OCT-based HELP Algorithm: A Prospective Cross-sectional Study

Ajit Kamalakar Joshi, Manasa Reddy Kakulavaram, Rajesh Balkrishna Gotekar

Introduction: Descemet Membrane Detachment (DMD) is a rare complication of cataract surgery which is more likely to occur during the learning curve especially during surgical training in residency. There are various methods of diagnosing DMD using slit lamp biomicroscopy, Ultrabiomicroscopy (UBM) and Anterior Segment Optical Coherence Tomography (AS-OCT). AS-OCT can be utilised to confirm, classify DMD and decide the plan of management by using Height, Length, Extent and Pupil (HELP) algorithm. Descemetopexy is the gold standard treatment in the management of DMD. The management of DMDs usually depends upon the site and extent of the detachment. Prompt diagnosis and timely management, leads to a good functional and anatomical outcome. Aim: To study the occurrence and management of DMDs during cataract surgeries using an AS-OCT-based HELP algorithm in a training hospital. Materials and Methods: This prospective cross-sectional study, included 25 eyes of 25 patients, who underwent cataract surgery which resulted in DMD in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India, from June 2021 to December 2021. AS-OCT-based HELP algorithm was used for diagnosis and determining, whether medical management needs to be done or surgical management. Either medical or surgical management (Descemetopexy) was done in all the 25 eyes. All the study subjects were followed-up Postoperative Day (POD)- 1,7,30 for Descemet’s Membrane (DM) reattachment. The outcome measures were successful DM reattachment and/or improvement in visual acuity by atleast two Snellen lines. Paired t-test was used to test the mean difference between LogMAR visual acuity values pre and postoperatively. The p-value <0.05 was considered as statistically significant. Results: Out of 1008 cataract surgeries, 25 patients had DMD intraoperatively. The mean age of the patients was 61.12±7.29 years with a male:female ratio of 2:3. The most common surgery preceding DMD was Manual Small Incision Cataract Surgery (MSICS) (84%; n=21). The mean pre and postmanagement visual acuities were 0.96±0.445 and 0.215±0.196, respectively (p<0.0001). A successful DM reattachment was seen in 92% (n=23) with the first attempt. There was a statistically significant improvement in visual acuity after management (p<0.0001). Conclusion: Management of DMD is crucial, as early diagnosis and treatment of patients with DMD leads to good visual outcome. AS-OCT-based HELP algorithm is very beneficial in the diagnosis of DMD. Descemetopexy is the gold standard in the management of DMD.

Awareness about Importance of Clinical and Radiological Details for Histopathological Reporting among Practicing Oral Pathologists in Kerala, India

Subhashree Mohapatra, Rahul Mohandas, Pratibha Ramani

Introduction: Clinical history and examination, radiography and histopathology are the three pillars of accurate diagnosis. The decisive nature of histopathology reporting has made it the cornerstone of modern medical science, thus making it extremely important to render timely and well-elaborated reports with utmost diagnostic accuracy. Inadequate communication between the clinician/surgeon, radiologist and the histopathologist hampers the delivery of correct and complete diagnosis on time. Aim: To assess the awareness among practicing Oral pathologists from Kerala, India about importance of clinical and radiographic details for histopathological reporting. Materials and Methods: A population-based, cross-sectional questionnaire study was conducted from January 2022 to April 2022. Kerala was divided into four zones-North, South, East and West. An online questionnaire containing eight questions was devised and circulated among 75 practicing Oral Pathologist from each zone through digital messenger platforms or e-mail. Descriptive statistics (frequency and percentage) was calculated using Microsoft excel 2020. Results: A total of 220 responses were received. Among the participants, 100 (45.5.%) stated that their clinician or surgeon did not provide them with adequate clinical and radiographic details. It was found that 140 (63.6%) participants opined that their clinicians or surgeons used to specify the clinical details and in 188 (85.5%) cases the surgeon or clinician mentioned the demographic data. Conclusion: It was concluded that there was a good awareness among practicing Oral Pathologists from Kerala, India, regarding the importance of clinical and radiographic details for histopathological reporting.

Seroprevalence and Molecular Detection of Symptomatic and Asymptomatic Genital Herpes Simplex Virus 2 among HIV Positive Patients: A Cross-sectional Study

Betha VVV Tejaswini, Mano Chandrika Yarra, Shaik Naseema, I Jahnavi

Introduction: Genital Herpes Simplex Virus (HSV) infection is the most common infection in Acquired Immunodeficiency Syndrome (AIDS) patients, occurring in 60-90% according to World Health Organisation (WHO) reports. Early detection of HSV-2 infection, the introduction of chemotherapy and prophylaxis improve the lifespan of AIDS patients. Aim: To detect the HSV-2 seroprevalence that is Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies in Human Immunodeficiency Virus (HIV) positive serum and molecular detection of HSV-2 Deoxyribonucleic Acid (DNA) in symptomatic HSV-2 patients. Materials and Methods: The descriptive cross-sectional study was conducted in the Guntur Government Hospital with the help of the Antiretroviral Therapy (ART) Centre and Department of Dermatology, Venereology and Leprosy (DVL) in GGH, Guntur, Andhra Pradesh, India. A total of 100 blood samples from HIV positive individuals were collected and for those with symptoms on the external genitalia, a biopsy specimen from the ulcer and fluid from vesicles were taken. All the cases in the study group are on ART and without any antiviral treatment. A blood sample was collected for IgG (Calbiotech kit), IgM detection (Merilisa kit), and biopsy from genital ulcer for gene detection by real-time Polymerase Chain Reaction (PCR) (HELINI Biomolecules, Chennai). Statistical analysis was done by mean and percentages with p-value by calculating Chi-square test, Fisher’s-Exact test to know significance of association between HSV-2 and HIV. Results: Among the total 100 HIV positive patients, it was observed that IgG seroprevalence of HSV-2 in HIV positive individuals is 78%, while it is 19% for IgM. In the present study, 19 symptomatic cases showed DNA of HSV-2 in PCR, out of which, 17 were from genital ulcers and two from vesicle fluid. Conclusion: As HSV-2 is a lifelong infection, serological testing provides the best method, to estimate its prevalence even in asymptomatic individuals.

Spectrum of Renal Involvement in Cancer Patients: A Cross-sectional Descriptive Study

Pideno Ngullie, Smita Nath, Alpana Raizada, Sunil Agarwal

Introduction: Cancer is associated with multiple renal manifestations like Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), proteinuria, and electrolyte imbalance. The reason behind renal dysfunction in cancer patients is multifactorial and can be attributed to underlying cancer and treatment modalities, in addition to co-morbidities surgical procedures and infections. Aim: To assess the spectrum of renal involvement in cancer patients presenting at a tertiary care hospital. Materials and Methods: The cross-sectional descriptive study, was conducted in the Department of Medicine of University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. One hundred consecutive patients referred for nephrology consultation with diagnosed cancer, irrespective of cancer aetiology between the age group of 15-70 years with deranged kidney function test were recruited. Detailed medical and treatment history, including the type of cancer-solid or haematological, cancer status-cured or continuing, treatment given-chemotherapy, radiotherapy or surgery or a combination and associated co-morbidities like diabetes mellitus and hypertension were recorded. Routine investigations and special investigations, including assessment of estimated Glomerular Filtration Rate (eGFR) and estimation of Albumin-Creatinine Ration (ACR) was done. Patients were then segregated, based on their kidney function test into groups with AKI or CKD and underlying cause was valuated. Summary statistics was presented as mean, median or frequency and data analysed using Statistical Package of Social Sciences (SPSS) version 24.0. Results: The mean age of the study population was 53.73±12.20 years with 63% male and 37% female participants; 87% patients had solid cancers, while 13% had haematological cancers. The median duration, since the diagnosis was seven months and the patients were undergoing chemotherapy, radiotherapy or a combination of both; seven patients had surgery for underlying malignancy and an additional six had received chemotherapy or radiation therapy along with surgery. At the time of recruitment, 78% patients had AKI and 22% patients were diagnosed with CKD. Chemotherapy-induced nephropathy was the most common cause of AKI (n=46). In the CKD group diabetes (n=7) was the most common aetiology. Conclusion: The kidneys in cancer patients can be involved in a number of ways, as a consequence of the cancer itself, its treatment, superimposed infections or associated co-morbidities. Chemotherapy-induced nephropathy is the most common cause of AKI, whereas, diabetes is the most common cause of CKD in cancer patients.

Association of C677T Polymorphism of Methylenetetrahydrofolate Reductase with Metabolic Syndrome among Eastern Indian Women: A Case-control Study

Kaziashique Firdoush, Rituparna Maji, Ritam Banerjee, Anindya Dasgupta

Introduction: Polymorphisms of Methylene Tetrahydrofolate Reductase (MTHFR) gene have been associated with hyperhomocysteinaemia, which in turn may lead to hypertension, insulin resistance and abnormality of lipid metabolism. All these abnormalities are also components of Metabolic Syndrome (MetS). Thus, there is possibility of an association between MetS and MTHFR polymorphism. Literature search revealed paucity of data on this association, particularly from India. Aim: To evaluate the association of C677T polymorphism of MTHFR gene with MetS, among women of eastern Indian population. Materials and Methods: A hospital-based case-control study was conducted in the Department of Biochemistry, Calcutta National Medical College, Kolkata, West Bengal, India, between December 2016 to June 2018. Anthropometric and biochemical profiling of all 417 study subjects were done. Genetic work-up was done by Polymerase Chain Reaction (PCR), using suitable primer, followed by restriction fragment length polymorphism analysis using Hinf 1 enzyme to identify MTHFR C677T polymorphism. Subjects were divided into two groups according to presence or absence of MetS as per International Diabetic Federation worldwide definition and compared with Mann-Whitney U Test. Logistic regression analysis was also performed. Results: Out of enrolled 417 female subjects, 243 were categorised as MetS group. Mean age (in years), of MetS group (48.70±9.03) was found to be significantly higher (p<0.001) than that of control group (42.83±10.90). A total of 45 (25%) females with MetS exhibited the presence of heterozygous CT genotype; that was significantly higher (p=0.026) than the non MetS group 21 (14.9%). The mutant T allele frequency was also significantly higher among the subjects suffering from MetS; 45 (12.5%) compared to 21 (7.4%) in the control group (p=0.036). Multiple logistic regression analysis revealed the odds of developing MetS among subjects with heterozygous CT genotype was 7.721 times (CI: 2.38-25.05) compared to those with wild genotype. Conclusion:a C677T polymorphism of MTHFR gene was associated with the occurrence of MetS among woman.

Association of Junk Food Consumption, Daily Screen Time and Daily Physical Activity with Overweight and Obesity among School Children Aged 8-10 Years- A Cross-sectional Case-control Study

Roshan Joseph John, Lalitha Kailas, Swapna K Pillai

Introduction: The prevalence of obesity among school children in Kerala is on a steady rise. Consumption of food with high glycaemic index, change in sleep patterns, reduced physical activity and the use of screen has been linked to obesity in children. Published literature on this association is scarce from urban Thiruvananthapuram, hence, the present study. Aim: To identify the association of various risk factors such as frequency of junk food consumption, dietary preferences, physical activity and daily screen time and weight related disorders among school going children (8-10 years) in Thiruvananthapuram. Materials and Methods: The present cross-sectional case-control study was conducted in one Rural Government School (Venjaramoodu Government Upper Primary School) and one Urban Private School (S.N. Public School, Chenkottukonam) of Thiruvananthapuram, Kerala, India, and enrolled school going children aged 8-10 years with higher than recommended Body Mass Index (BMI) for age as cases, age and gender-matched children with normal BMI as controls. Participants with BMI above 23rd and below 27th adult equivalent for age and gender were considered overweight and those above 27th adult equivalent for age and gender were considered as obese. A structured questionnaire was sent home with the children, and the parents were requested to answer the questions along with written informed consent. Socio-demographic parameters, anthropometric measurements were obtained by trained staff, dietary habits, and details regarding physical activity and screen usage were collected. Variables were categorised according to the standard recommendations by World Health Organisation (WHO) and Indian Association of Paediatrics (IAP). Variables were expressed as frequencies and the tests of significance used were Chi-square test and Odds ratio, to express the strength of association between parameters. A p-value <0.05 was considered statistically significant. Results: The mean age of cases and controls was nine years. A total of 708 school children were screened and 352 participants (175 cases and 177 controls) were enrolled in the present study. The BMI of cases was 29.3 kg/m2 and of controls was 20.2 kg/m2. Higher than recommended screen time (p<0.001), more frequent junk food consumption (p<0.001) and lack of physical activity (p<0.001) were found to be significantly associated with obesity and overweight. Dietary preference was not associated with obesity or overweight and obesity and overweight was more common in children studying in private schools (p<0.001). Conclusion: Reducing screen time, reducing junk food consumption and increasing physical activity will help in reducing the prevalence of life style diseases among school children. Further evaluation is necessary to determine the factors contributing to the increased prevalence of these disorders in private schools.

Effect of Graphene Oxide Nanoparticles on the Flexural Strength of all Ceramics-An In-vitro Study

K Yogitha, Kasim Mohamed, Preetha Krishnamurthy

Introduction: Desirable properties of monolithic ceramics like strength, stability at high temperatures, high stiffness has made it useful for biomedical, electronic, automotive, industrial, defence and space applications. The brittle nature and mechanical unreliability of monolithic ceramics limit their use. Aim: To evaluate, if there is an increase in flexural strength of all ceramics incorporated with graphene nanoparticles. Materials and Methods: This in-vitro study was conducted in the Department of Prosthodontics and Crown and Bridge, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from February 2021 to April 2021, where 20 specimens of all ceramic dimensions of 20×5×3 (20 mm in length, 5 mm in width, 3 mm in thickness) according to American Dental Association (ADA) specification number 69, 1991 for flexural strength were grouped into group A (Control) with no Graphene Oxide (GO), group B with GO added. A universal testing machine with a cross head speed of 0.5 mm/min and a span length of 15 mm was used to load the specimen in the centre. To compare the flexural strength of the two groups, the Mann Whitney U-test was used. Normality was the data assessed using Shapiro-Wilk and Kolmogorov-Smirnov test. Results: The results show that there was a significant difference (p=0.001) in the mean flexural strength between the groups. Group B had the highest mean flexural strength of 562.61 MPa, while Group A had the lowest of 458.61 MPa. Conclusion: The results concluded that, all ceramics incorporated with graphene nanoparticles showed superior flexural strength.

A Fractal Dimension Analysis to Evaluate the Change in the Alveolar Osseous Structure of Mandibular Incisors after Orthodontic Treatment: A Retrospective Study

Introduction: As bone traces tooth movement during orthodontic treatment, leading to biological response of the surrounding tissues of the teeth resulting in remodelling of the socket, favourable bone response is expected after incisor retraction. Orthodontic treatment causing changes in alveolar bone can be evaluated using Fractal dimension (FD) analysis, a mathematical method of information processing, where the input data is in the form of an image and generated information is displayed as numbers. Aim: To evaluate changes in the trabecular structure of alveolar bone after incisor retraction in the mandibular symphysis region in adult patients using fractal analysis. Materials and Methods: This retrospective study was conducted with digital Orthopantomogram (OPG) of 30 patients with class I and class II malocclusion with mandibular incisor protrusion treated with extraction and retraction of anterior teeth were taken with standard protocols at the three different periods, before orthodontic treatment (T0), before retraction (T1) and after retraction of anterior teeth (T2) included in the study. Regions of interest were located between the apices of mandibular incisors. FD was calculated using Image J software. Statistical Analysis was carried out by repeated Analysis of Variance (ANOVA) test and post-hoc test. Results: Total of 30 cases were selected, out of which 15 were males and 15 females with the mean age of 21±2 years. FD values of the alveolar bone of mandibular incisors at T0 were 1.470±0.09 which reduced to 1.390±0.09 at T1 and to 1.350±0.08 at T2. This overall changes in FD values were significant (p-value=0.001). Conclusion: Fractal dimension analysis demonstrate significant changes in bone trabeculation of the mandibular symphysis region before and after orthodontic treatment. It has valuable impact in the cases of fenestration, dehiscence’s, and osteoporosis.

Evaluation of Serum Lipoprotein (a) Levels and Novel Lipid Indices in Patients with Chronic Kidney Disease- A Case-control Study

R Kalaivani, K Anuja, T Uma, J Siva Somana

Introduction: Majority of Chronic Kidney Disease (CKD) patients are more likely to die of cardiovascular complications, before reaching End Stage Renal Disease (ESRD). Although there are many risk factors contributing to pathogenesis of cardiovascular disease in CKD subjects, dyslipidemia represents one of the modifiable risk factors. American Heart Association has recommended that CKD patients should be classified in the highest risk group for developing cardiovascular events. Kidney Disease: Improving Global Outcome (KDIGO) recommends, these patients should be evaluated for dyslipidemia and for treatment to reduce the risk of cardiovascular events. Aim: To evaluate serum Lipoprotein (a) {Lp(a)} levels and assess the significance of novel lipid indices in non dialysis patients of CKD. Materials and Methods: This analytical case-control study was conducted from January 2016 to June 2016 at Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India. It included 70 non dialysis CKD subjects and 70 healthy control subjects, adhering to inclusion and exclusion criteria. Fasting Blood Samples (FBS) were collected and analysed for: Fasting blood glucose, Fasting Lipid Profile, Serum Lp(a). Serum Lp(a) was estimated by immunoturbidimetry method and lipid profile by enzymatic method. Estimated Glomerular Filtration Rate (eGFR) was calculated using Modification of Diet in Renal Disease (MDRD) formula and staging of CKD subjects was done, based on KDIGO guidelines. Novel lipid indices were calculated using appropriate formula. Statistical analysis of the tabulated data was done using Social Sciences of the Statistical Package (SPSS) software. Results: There were significant differences in the levels of FBS, Triglycerides (TG), Lp(a) between controls and non dialysis CKD subjects (p<0.001). Among Lipid Indices, Atherogenic Index of Plasma (AIP) and Lipid Tetrad Index (LTI) values were significantly higher in CKD subjects compared to controls (p<0.001), but no significant difference was seen in Atherogenic Coefficient (AC), Castelli’s Risk Index-I (CRI-I) and CRI-II values. AIP and LTI showed significant positive correlation with Lp(a). LTI had the highest Positive Predictive Value (PPV) (77.8%) and Negative Predictive Value (NPV) (72.7%); AIP had PPV of 65.3% and NPV of 66.2%. Conclusion: The present study concludes that, among lipid indices, AIP and LTI are the most suitable for assessment of atherogenicity in non dialysis CKD. In developing countries like India, owing to high cost of tests like Serum Lp(a), novel lipid index AIP can serve as a cost-effective screening tool for monitoring cardiovascular disease risk in CKD patients.

Prevalence of Social Phobia and its Determinants among Undergraduate Medical Students of Tamil Nadu, India: A Cross-sectional Study

Introduction: Social Phobia (SP) is described as a persistent fear of one or more social performances. The sustained SP among medical students without prior identification raises susceptibility to substance abuse and poor quality of future life. Aim: To estimate the prevalence of SP and determine the risk factors contributing to the development of SP among medical students in a tertiary teaching institute in Perambalur, Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted among 538 undergraduate medical students, in a tertiary teaching institute in Perambalur, Tamil Nadu, India, from September 2021 to November 2021. Medical students, who were willing to participate, were included in the study. A semi-structured questionnaire was used to collect socio-demographic and personal characteristics and family variables. SP was measured by using Social Phobia Inventory (SPIN) scale. Binary logistic regression was used to expose the definitive predictor factors. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 26.0 software. Results: A total of 538 students were included. The majority of students 339 (63%) were female and 199 (37%) were male. The mean (±SD) age of the participants was 21.27 (±1.73) years. The prevalence of SP among medical students was 41.1%. The predictor for SP was found to be rural residence Adjusted Odds Ratio (AOR): 1.748 (95% CI: 1.184-2.582), female sex AOR: 2.002 (95% CI: 1.358-2.952), mothers’ illiteracy AOR: 3.640 (95% CI: 1.430-9.266), students experiencing humiliation (OR 2.3; 95% CI: 1.5-3.6), students with family conflicts (OR 2.4; 95% CI: 1.3-4.4), lack of relationship with parents (OR 2.3; 95% CI: 1.2-4.2). The mean score of the SPIN questionnaire was 19.05±13.05. Conclusion: The prevalence of SP was high among medical students in Tamil Nadu. So, early detection and appropriate intervention need to be done by their institution among the students to enhance social interaction and improve academic performance.

Transoral versus Extraoral Approach in the Management of Mandibular Angle Fracture: A Retrospective Study

Ashish Shivendra Singhal, Sagar Nambiar, Aravind Lakshman Rao

Introduction: Mandibular fractures are the most common of all maxillofacial fractures and almost one third of these have mandibular angle fractures. Restoration of anatomic form and the union of bone fragments is of utmost important during the management of mandibular angle fractures and several methods have been discussed in the literature. Aim: To compare the transoral and extraoral approaches for the management of mandibular angle fractures in terms of postoperative outcomes including the incidence of postoperative pain, infection, scarring mouth opening and facial nerve injury. Materials and Methods: This retrospective study was performed in the Department of Plastic Surgery, Father Muller Medical College and Hopsital, Mangalore, Karnataka, India, from January 2019 to December 2021. A total of 21 patients were divided into two groups; transoral (n=12) and extraoral (n=9), based on the type of approach used for surgery. The outcomes were assessed in both groups in terms of postoperative outcomes including the incidence of postoperative pain, infection, scarring, mouth opening and facial nerve injury. Data were statistically analysed using appropriate statistical tests. Results: Out of the 21 patients studied, one patient in the extraoral group developed postoperative surgical site infection. There was a statistically significant difference in duration of surgery and postoperative mouth opening (p-value=0.006) and a highly significant difference in postoperative pain (p-value <0.001) and scar (p-value <0.001) between the two methods, proving transoral approach as effective method. Conclusion: The transoral approach is a better approach for fixation and management of mandibular angle fractures, as compared to the extraoral approach.

Psychological Morbidity in Young Adults with Acne Vulgaris: A Hospital-based Study

Deepika Agarwal, Deepak K Mathur, Vijay Paliwal

Introduction: Acne vulgaris is a disorder of pilo-sebaceous glands characterised by polymorphic lesions. Acne is highly prevalent among teenagers during which period body undergoes various developmental, hormonal and social changes. Acne may therefore affect the psyche of the patient leading to psychological morbidity. Aim: To study the prevalence and gender-based variations of psychological morbidity in young adults with acne vulgaris. Materials and Methods: This was a hospital-based observational cross-sectional study done in the Dermatology Outpatient Department, SMS Medical College and Attached Hospitals, Jaipur, India, from October 2012 to October 2013 on 660 acne patients. Patients aged 13-24 years clinically diagnosed with acne vulgaris were enrolled for the study and psychological morbidity was assessed by Goldberg’s Health Questionnaire-12 scores (GHQ) and depression and anxiety were assessed using Beck Depression Inventory (BDI) scores and Hamilton Rating Scale for Anxiety (HAMA) scores, respectively. Results: Among 660 acne patients, 71.51% were males and 28.48% were females. Female patients had mean±Standard Deviation (SD) age of 18.06±2.93 years and male patients had mean±SD age of 18.16±2.41 years. Among 188 females, mild, moderate and severe acne were observed in 40.96%, 48.40% and 10.64% cases, whereas, among 472 males, 37.92%, 38.35% and 23.73% had mild, moderate and severe acne, respectively. Psychological morbidity was observed in 92 (48.94%) females and 227 (46.09%) male patients. In the study population, 5.32%, 28.19%, 13.83%, 1.60% patients had minimal, mild, moderate and severe depression, respectively in female group whereas in the male group 21.19%, 16.10%, 7.84% and 2.97% patients had minimal, mild, moderate and severe depression, respectively. Further, 27.66%, 10.64%, 3.72%, 6.91% of female patients whereas 30.51%, 8.26%, 3.81%, 5.51% of male patients had mild, moderate, severe and very severe anxiety level, respectively. Conclusion: The study assessed that acne affected self-esteem and confidence of the youth and can lead to mental health conditions such as anxiety and depression. The severity of depression and anxiety was linked with gender in the present study.

Comparison of Cepheid Xpert Xpress SARS-CoV-2 Assay with Standard RT-PCR Test for Detection of COVID-19 Infection: A Retrospective Cohort Study

Nitika Dhuria, Nitin Nagpal, Vishal Sharma, Arun Kumar

Introduction: Real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test, the gold standard test for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) detection, is a tedious process and requires proficient workforce. Accurate and fast test results may permit more efficient use of protective and isolation resources and allow rapid therapeutic interventions. Aim: To evaluate the analytical performance characteristics of the Cepheid Xpert Xpress SARS-CoV-2 test, a rapid, automated molecular test for SARS-CoV-2 with gold standard RT-PCR test. Materials and Methods: This retrospective cohort study was conducted in Virus Research and Diagnostic Laboratory (VRDL) in Department of Microbiology at GGS Medical College, Faridkot, Punjab, India, from January to June 2021. A total of 100 nasopharyngeal samples, collected from clinically suspected Coronavirus Diseae-2019 (COVID-19) cases admitted at GGSMC during 1st January-30th June 2021 were tested both by Xpert assay and RT-PCR test simultaneously, taking RT-PCR as the gold standard test. The data was analysed by MedCalc® statistical software version 19.6.4., and sensitivity, specificity, predictive values, likelihood ratios and the agreement between the two tests were calculated. Results: The mean age of the study participants was 46 years. Of these, 55 were males and 45 were females. The overall sample sensitivity and specificity of the Xpert assay were both 100% and there was perfect agreement across specimens, if authors, set a cut-off Cycle threshold value (Ct value) at 40 cycles for Xpert. Of 100 samples, 32 were positive for SARS-CoV-2 by either of the tests and 68 were negative. Xpert assay could detect 100% positive cases and RT-PCR test could detect 84.37% positive cases. Out of the 32 samples which were positive by Xpert assay, 5 (15.62%) samples had a Ct value greater than 40. Conclusion: The Xpert assay found to be useful as a point-of-care test in acute scenario, where rapid and authentic diagnosis is essential, but do not have expertise and infrastructure to perform RT-PCR.

E-cadherin Immunoexpression Patterns in Gastric Carcinoma Histological Subtypes: A Hospital-based Descriptive Study

Introduction: Gastric carcinoma is the second common Gastrointestinal (GIT) malignancy. Based on Global Cancer Observatory (GLOBOCAN) 2020 data, it is the 5th most common neoplasm and the 4th most common cause of death. Epithelial-cadherin (E-cadherin) is a transmembrane glycoprotein which plays a crucial role in maintaining cell-cell adhesion. Loss of E-cadherin contributes to enhanced invasion and metastasis in human cancers. Aim: To study E-cadherin immunohistochemical expression in tumour cells and its association with gastric carcinoma histotypes. Materials and Methods: It is a hospital-based descriptive study conducted at Department of Pathology, Osmania General Hospital, Hyderabad, Telangana, India from January 2010 to December 2012 as it was my dissertation. Routine histopathology and immunohistochemistry for E-cadherin were done on the sections. E-cadherin immunohistochemical staining and expression in tumour cells were evaluated according to the study by Jawhari A et al., Scores (0-3) were applied: 0-No staining; 1-Only cytoplasmic staining; 2-Cytoplasmic and membranous staining in the same case, 3-Normal membranous immunoexpression. Staining was evaluated based on absence of membranous expression scores (0 and 1) versus the presence of membranous expression (scores 2 and 3). Statistical analysis of the data was done by Chi-square test using Epi Info software. Results: Total 70 cases were studied, of which 48 were gastric biopsies and 22 were gastrectomies. Gastric adenocarcinomas were classified as intestinal 40 cases (57.14%) and diffuse 30 cases (42.85%) according to Lauren’s classification. Membranous staining of E-cadherin was seen in 34/40 cases (85%) of intestinal gastric cancer and 9/30 cases (30%) of diffuse intestinal cancer whereas non membranous or absent E-cadherin was seen in 6/40 cases (15%) of intestinal gastric cancer and 21/30 cases (70%) of diffuse gastric cancer. In this study, significant association was found between membranous E-cadherin expression (score 2 or 3) and intestinal histotype and absence of membranous expression (scores 0 or 1) and the diffuse histotype of gastric cancer. Conclusion: Normal gastric mucosa shows strong membranous E-cadherin positivity. There is a change in the pattern of E-cadherin expression from membranous in intestinal type gastric adenocarcinoma to non membranous expression of E-cadherin in diffuse type of gastric carcinoma.

Comparison of Gabapentin and Esmolol in Reducing Haemodynamic Response to Laryngoscopy and Intubation: A Randomised Clinical Trial

Introduction: Haemodynamic stress response to direct laryngoscopy and endotracheal intubation have been well established. Both gabapentin and esmolol facilitates in attenuating this stress response through different mechanisms. Aim: To compare the efficacy of gabapentin and esmolol in reducing the haemodynamic stress response to laryngoscopy and intubation. Materials and Methods: The present single centre, randomised clinical trial was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from May 2022 to August 2022 among 90 American Society of Anaesthesiologist (ASA) I and II patients. The patients were divided into two groups, group G and group E. In group G, tablet gabapentin 800 mg was given three hours before surgery while injection normal saline 10 mL intravenously was given two minutes prior to induction. Group E received tablet placebo three hours before surgery and injection esmolol 1.5 mg/kg diluted upto 10 mL was given intravenously two minutes prior to induction. The baseline Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) and the change at 1, 2, 5 and 10 minutes after laryngoscopy and intubation was observed. Comparison of continuous variables between two groups was done using independent t-test and comparison of percentages between two or more groups was done using Chi-square test. Results: The mean age of group G and group E was 41.52±9.87 years and 38.54±10.06 years, respectively. Male to female ratio in group G and group E was 20:25 and 21:24, respectively. There was no significant difference in haemodynamic response to intubation between both gabapentin group and esmolol group. However, the esmolol group had more falls in all haemodynamic parameters such as HR, SBP, DBP and MAP (<20%) intraoperatively. Conclusion: Both esmolol and gabapentin were effective in attenuating the stress response to laryngoscopy and endotracheal intubation when used as premedication. But there was more decrease in HR and blood pressure intraoperatively, when injection esmolol was used.

Species Distribution of the Aerobic Bacterial Profile in Pyoderma with Special Reference to Antibiotic Susceptibility Pattern of the Isolates at a Tertiary Care Hospital of West Bengal, India

Introduction: Pyoderma is a common health problem characterised by pyogenic infections of the skin and its appendages. Though, easily treatable, the condition is known for its chronicity, recurrence and other complications. Therefore, timely recognition and prompt bacterial diagnosis with antimicrobial sensitivity is imperative for the effective management and treatment of pyoderma. It is a common bacterial skin infection accounting for nearly 25% of patients attending Dermatology Outpatient Department (OPD) in India and other tropical countries. Aim: To determine the incidence of pyoderma in relation to age, sex and socio-economic status, to isolate and identify the common aerobic microbial pathogens associated with pyoderma prevalent in the community and antibiotic susceptibility pattern. Materials and Methods: An institutional based cross-sectional observational study was conducted on 148 cases in Department of Microbiology, Rampurhat Government Medical College and Hospital, Burdwan, West Bengal, India, clinical features of suspected pyoderma for a period of 12 months from March 2021 to February 2022. Lesion swabs were collected and isolates were identified; antibiotic susceptibility testing was also performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines using antibiotic discs. Descriptive data was presented as count and percentages. Results: Out of 148 samples collected, 144 (97.3%) were culture positive while, rest 04 (2.7%) were culture negative. Overcrowding and low socio-economic group were closely related with pyoderma patients. Primary pyoderma (72.2%) cases were detected more than the secondary (27.8%) cases. Impetigo contagiosa (54%) were detected more among the primary pyoderma patients. High numbers (66.7%) of pyoderma were detected among children (0-10 years). The culture positive samples were more in male patients (68.7%) than in female patients (31.3%) and mostly detected from OPD. Out of 144 isolates, 89 (61.8%) were Staphylococcus aureus, 23 (15.9%) isolates were Coagulase-negative Staphylococci (CoNS) and 04 (2.8%) were Streptococcus pyogens. Further 06 (4.2%) isolates of Pseudomonas aeruginosa, 10 (6.9%) isolates of Escherichia coli and 08 (5.5%) isolates of Klebsiella pneumonia were found. Conclusion: The present study results suggest that the era of antibiotics has ushered in an unprecedented predominance of Staphylococcal rather than Streptococcal infections and other gram negative infections for pyoderma cases. Increasing incidence of methicillin, quinolones and amikacin resistance in Staphylococci and other gram negative isolates have limited treatment options. For this, a single infection like pyoderma is challenging in all the healthcare facility.

Assessment of Socio-economic Status and Personality Traits on Academic Performance of Second Year MBBS Students: A Cross-sectional Study from a Teaching Hospital of Eastern India

Sushobhan Pramanik, Akash Saha, Baisakhi Mallick

Introduction: The skill and quality of doctors largely depend on their academic performances. Examination scores of medical students can be impacted by their personality and Socio-economic Status (SES). Identification of the effects of different personality traits and socio-economic profile on the academic results of medical undergraduates can help to identify the vulnerable groups and consider possible support by counselling, financial aids and policy formulation. Aim: To assess the correlation of personality traits and SES with the academic performances of undergraduate medical student based on the marks scored in the second professional Bachelor of Medicine and Bachelor of Surgery (MBBS) examination. Materials and Methods: An observational cross-sectional study of 10 months duration from May 2017 to February 2018 was done on 143 students of sixth semester (Part I) of MBBS course, in a Government Medical College of Kolkata, West Bengal, India. Participants filled up the Big Five Inventory (BFI) questionnaire that evaluates dimensions like extraversion, agreeableness, conscientiousness, neuroticism and openness, and the Kuppuswamy’s SES scale form which considers education of the head of family, occupation of head and monthly family income. The examination marks were collected from the student’s section of the institution. Demographic parameters of the population like age, gender and religion were considered. Data was tabulated in MS excel spreadsheet and a descriptive statistical analysis was performed. Any correlation of the study parameters with student’s academic performance was determined through statistical analysis using Spearman correlation coefficient and p≤0.05 was considered significant. Results: Among the participants of the study (n=143), a mean age of 21.53 years was observed with male:female ratio of 2.04; about 87.41% of the students were Hindu while rest were Muslim. The results showed conscientiousness (r=0.1842) and neuroticism (r=0.1799) were correlated with total academic score as well as openness to pathology (r=0.1783) and forensic medicine (r=0.2362). Higher SES positively affected the results in microbiology (r=0.1698). Occupation of the head of the family was correlated positively with total marks (r=0.1677) and performances in microbiology (r=0.2256) and pathology (r=0.1919). Conclusion: Conscientious behaviour, an attitude of openness and even neuroticism, can contribute to better grades. Higher occupation of the head of the family may also contribute positively. Appropriate counselling to nurture beneficial personality traits and adequate guidance by mentors may help students achieve better academically.

Helicobacter pylori Infection in Patients with Non Alcoholic Fatty Liver Disease: A Cross-sectional Study

Introduction: Helicobacter pylori (H. pylori) infection is postulated to predispose Non Alcoholic Fatty Liver Disease (NAFLD) through alteration of lipid profile, reduction of adiponectin, insulin resistance, etc. In the setting of increased incidence of NAFLD, the possible therapeutic and preventive implications of an association of H. pylori infection with NAFLD holds interest. Aim: To determine the prevalence of H. pylori infection among NAFLD patients and its association with severity of NAFLD. Materials and Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital in Imphal, Manipur, India, during July 2019 to December 2021 among 197 patients diagnosed with NAFLD. H. pylori infection was diagnosed by H. pylori specific anti-Immunoglobulin M (IgM) and anti-IgG antibody tests. Descriptive statistics like proportions, mean and Standard Deviation (SD) were used. Chi-square test was used to check for associations of disease severity with H. pylori infection. Results: The study population included 90 females and 107 males. A total of 121 (61.4%) subjects had grade 1 fatty liver, while 46 (23.4%) had grade 2 fatty liver and 30 (15.2%) had grade 3 fatty liver. A total of 125 (63.45%) were H. pylori IgG positive. H. pylori infection positively associated with disease grade, Chronic Liver Disease (CLD) and decompensation (p-value <0.001). Conclusion: The prevalence of H. pylori infection in patients with NAFLD was 63.45% and H. pylori seropositivity was significantly associated with disease severity.

Colour Doppler and Adverse Perinatal Outcomes in Pregnancies with Foetal Growth Restriction: A Prospective Longitudinal Study

Shelly Khillan, Sarbhjit Kaur

Introduction: Foetal Growth Restriction (FGR) accounts for a significant proportion of perinatal morbidity and mortality. The study was done to diagnose the foetuses “at risk”, so that timely intervention could prevent perinatal morbidity and mortality, as FGR foetuses with deranged velocimetry of Uterine Artery (UA), Umbilical Artery (UMA), Middle Cerebral Arteries (MCA) are associated with high perinatal morbidity and mortality. Aim: To evaluate the usefulness of blood flow velocimetry of UA, UMA, and MCA as well as a Cerebroplacental Ratio (CPR) on colour doppler and their prediction of adverse perinatal outcome. Materials and Methods: This was a prospective longitudinal study done in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India from October 2021 to March 2022. The study was conducted among 200 antenatal patients, who had a singleton pregnancy, irrespective of age and parity and had FGR foetuses. Blood flow velocities in the UA, UMA, MCA, and CPR were measured. Patients were divided into four groups with 50 patients in each group. Group I included FGR foetuses with normal blood velocities, group II included FGR foetuses with abnormal UA velocimetry, group III included FGR foetuses with abnormal UMA and MCA velocimetry and group IV included FGR foetuses with abnormal CPR. Adverse perinatal outcomes in the form of Respiratory Distress Syndrome (RDS), prematurity, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) <7 at 5 minutes, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality were assessed in relation to these doppler blood flow patterns. Categorical variables were analysed with the help of Chi-square test and Fisher-exact test. Continuous variables were analysed with ANOVA when data were normally distributed otherwise Kruskal Wallis H test was used. Results: The mean birth weight was 2432±423, 2209±329, 2100±223 and 1329±403 grams in groups I, II, III, and IV (p-value of <0.001.) The mean gestational age was 38.1±2.3, 37.3±3.2, 36±3.6 and 33.1±3.1 weeks in groups I, II, III, and IV (p-value of <0.001). Perinatal morbidity in the form of RDS and prematurity were compared among four groups with 0, 3 (6%), 17 (34%), and 39 (78%) in groups I, II, III, and IV (p-value of <0.001). APGAR score <7 at 5 minutes was 0, 2 (4%), 9 (18%), and 13 (26%) in groups 1, II, III, and IV (p-value of <0.001). A total of 6 (12%), 16 (32%), 37 (74%) and 46 (92%) C-sections were performed in group I, II, III and IV, respectively, p-value of <0.001. Maternal mortality of 1 (2%) in group III and 2 (4%) was observed in group IV. But no maternal death was there in group I and II. Conclusion: The adverse perinatal outcomes were seen with changes in Pulsatility Index (PI) value of UA, UMA, MCA. But the patients with a deranged CPR ratio had got worse perinatal outcomes than either deranged MCA, PI or UMA PI alone. Hence, doppler ultrasound especially CPR ratio should be an integral component of routine evaluation of FGR pregnancies, as it helps in obstetrical surveillance and management, and thereby improving adverse perinatal outcomes.

Relationship of PLR, NLR and LMR with Metabolic Syndrome in Schizophrenic Patients on Antipsychotics: A Longitudinal Case-control Study

Introduction: Cytokines are the small cell signalling proteins like granulocytes, lymphocytes, monocytes, etc. which may indirectly play a role in the pathophysiology of schizophrenia via inflammation. Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR) and Platelet-to-Lymphocyte Ratio (PLR) are consistently used as a biomarkers for the innate immunity. Metabolic syndrome has been established as a serious public health concern over the last decade with increased morbidity associated with it. However, data regarding changes in LMR and PLR in metabolic syndrome is sparse. Therefore, the relationship between metabolic syndrome and raised inflammatory markers is not established. Aim: To find out the relationship between inflammatory markers and metabolic syndrome in patients of schizophrenia and normal population. Materials and Methods: A longitudinal case-control study was conducted in the Department of Psychiatry, Sanjay Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India, between February 2019 and January 2020. The study consisted of 84 schizophrenic patients from Inpatient and Outpatient Departments and 100 healthy controls from the general population, and data were collected using semi-structured proforma. Participants were evaluated for Complete Blood Count (CBC), parameters of metabolic syndrome (systolic and diastolic blood pressure; high density lipoprotein; triglycerides; fasting blood glucose; waist circumference) and severity of symptoms using Brief Psychiatric Rating Scale (BPRS). Data was analysed using IBM Statistical Package for the Social Sciences (SPSS) version 22.0 by Student’s t-test, one way Analysis of Variance (ANOVA), repeated measure ANOVA, Spearman’s rho correlation and linear regression analysis. Results: The mean age of cases and controls was 31.4±11.9 years and 35.4±14.1 years, respectively. There were 54 (64.3%) males and 30 (35.7%) females in cases and 62 (62%) males and 38 (38%) females in controls. There was a significant difference between cases and controls for LMR, and NLR at baseline and four months (p-value <0.01). There a was significant difference between two antipsychotics group for NLR and PLR at baseline, two months, and four months (p-value <0.01) with moderate to large effect size. There was a significant correlation between metabolic syndrome and LMR, NLR and PLR for cases as well as controls (p-value <0.05). Conclusion: The study established the alteration of NLR, LMR and PLR in patients of schizophrenia, and also established a relationship between MetS and inflammatory markers which suggested some common pathway between inflammation, metabolic syndrome and schizophrenia.

Questionnaire-based Survey on Radiation Treatment Planning using Multimodality Facilities in Radiotherapy Centres across India: A Cross-sectional Study

Introduction: India is a low-middle-income country, and there is an increase in the burden of cancer under Non Communicable Diseases (NCD) in past decades. Around 60% of cancer patients require Radiotherapy (RT), either definitive or palliative in conjunction with other modalities. Considering the present requirements in the field of RT, data has been presented about centres providing both basic and advanced RT facilities. Aim: To give an overview of current facilities available and to identify the multimodality-based planning in RT centres across India. Materials and Methods: A cross-sectional questionnaire-based survey was conducted in centres having RT facilities in India, from March 2021 to April 2022. A systemic list of the current existing RT centres was taken from the Atomic Energy Regulatory Board (AERB) website. From the database list, 100 participants were selected randomly, with their contact information such as E-mail and WhatsApp. A Google survey form with a questionnaire was created for the study. The survey link forms were circulated across the RT centres in India. Results: A total of 65 centres participated in the study. The percentage of responses found to be from North India 17 (26%), South India 24 (36.9%), West India 7 (10.8%), East India 9 (13.8%) and central India 7 (10.8%) with one centre (1.5%) not disclosed. The number of government, semi-private, private and not disclosed types of hospitals participated in the survey were 19 (29.2%), 5 (7.7%), 38 (58.5%) and 3 (4.6%), respectively. The average number of functional teletherapy machines, telecobalt and linear accelerators per centre was found to be 1.24±1.33, 0.34±0.54, and 1.11±1.06, respectively. The multimodality imaging facility for RT planning was found to be 36 (55.4%) MRI and 23 (35.4%) Positron Emission Tomography-Computed Tomography (PET-CT). The median cost of Intensity Modulated Radiotherapy (IMRT), Intensity Guided Radiotherapy (IGRT), 4-Dimensional IMRT (4-D IMRT), and 4-Dimensional IGRT (4-D IGRT) in Lakhs (L) was found to be 1.20 L (0.00-3.00), 1.50 L (0.00-3.30), 1.50 L (0.00-4.00), 1.50 L (0.00-4.00), respectively. For advance PET-CT based RT planning the median cost was found to be, for IMRT treatment 1.20 L (0.00-3.50) and for IGRT treatment 1.60 L (0.00-4.00). Conclusion: There is a significant increase in radiation facilities in the recent millennium, especially in the private sector. The latest RT centres are equipped with multiple imaging modalities to accommodate the advanced RT planning features.

Clinicopathological Profile of Patients with Multiple Myeloma: An Ambispective Study

Introduction: Multiple Myeloma (MM) is a clonal expansion of B lineage plasma cells in bone marrow. MM accounts for 10-15% of haematological malignancies and 1% of all malignant diseases. Though, the aetiology of the disease is largely unknown, various factors have been found to increase the incidence of MM. The present comprehensive research work on MM in the Malwa region of central India is an attempt to establish on clinicodemographic, haematological, biochemical and radiological parameters and finally to stage them according to Durie Salmon Staging (DSS) system. Aim: To study clinicopathological profile of patients with MM. Materials and Methods: The present ambispective study was conducted on total 70 cases of MM reported in the Department of Pathology at Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India, from July 2012 to June 2020. The study design included retrospective studies from July 2012 to December 2018 (six years and five months) and prospective studies from November 2017 to April 2019 (one year and five months). The demographic data of patients’ including history and clinical findings were recorded. Complete Blood Count (CBC) was done in all cases. Biochemical investigations were also done. Urine samples of all patients were screened for the presence of Bence Jones protein. Biochemical parameters and staging of MM patients was done. Statistical analysis prepared in excels spreadsheet and quantitative data were presented as proportions. Results: The study included a total of 70 cases of MM diagnosed on peripheral smear and/or bone marrow examination. The male:female ratio was 2.1:1, with a male preponderance. The results of the present study, reported 48 (68.57%) patients were male and 22 (31.43%) patients were females. In the present investigation, the authors diagnosed serum Lactate Dehydrogenase (LDH) levels were estimated in 65, out of 70 patients. Out of which, 25 (35.71%) patients had levels <240 U/L, while 23 (32.85%) and 17 (24.28%) patients had levels between 241-480 U/L and >480 U/L, respectively. Conclusion: The present study, underlines the association between clinical presentation, laboratory parameters and radiological findings in establishing the diagnosis of MM. The present study emphasises not only the role of a bone marrow aspiration and biopsy in establishing a diagnosis of MM, but also, assessing the plasma cell burden in the marrow.

Molecular Detection of H1N1 and Impact of Cytokines among Infected Patients with Respiratory Distress: A Cross-sectional Study

Introduction: Viruses are spread from one individual to another. In respect to the mode of transmission, the majority of them enter the human body by the inward breath of infective respiratory beads. Upper Respiratory Tract Infections (URTI) are infections of the body’s respiratory tract, which include the sinuses, nose, throat, airways, and lungs. The influenza virus has four key structural antigens: the internal Ribonucleoprotein (RNP), the viral envelope Matrix (M), and two surface Glycoproteins (GP), Neuraminidase (NA) and Haemagglutinin (HA). A respiratory virus called swine flu/H1N1 evolved and spread widely around the world. H1N1 outbreaks with various virus strains were noted before the most recent severe pandemic, which occurred in 2009. Seasonal outbreaks that are extremely infrequent since the 2009 pandemic the influenza strain have occurred. Aim: To assess the prevalence and level of cytokines in H1N1-infected patients with signs and symptoms of respiratory distress. Materials and Methods: This is a cross-sectional study of viral molecular, immunological and epidemiological parameters. The study was done at the Indian Council of Medical Research (ICMR) at the Department of Health Research (DHR), Virus Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Burdwan Medical College and Hospital (BMCH), Burdwan, India. The duration of the study was seven months, from January 2022- July 2022. Samples in Viral Transport Medium (VTM) were collected from suspected influenza patients with mild or severe Acute Respiratory Distress Symptoms (ARDS) and Influenza Like Symptom (ILS). The RNA samples were isolated and the nucleic acid purified from samples was screened by Real-time Polymerase Chain Reaction (RT-PCR). The extracted clinical Ribonucleic Acid (RNA) samples are then converted into Complementary Deoxyribonucleic acid (cDNA). The HA gene sequences of endemic swine influenza A virus (H1N1) and sequences from a panel of human and avian type A influenza virus strains, including the type A human seasonal strains, were retrieved from the GenBank database in the National Centre for Biotechnology Information (NCBI) portal. The Enzyme-linked Immunoassay (ELISA) method was used to measure the proinflammatory cytokines Interleukin (IL)-8, IL2 and anti-inflammatory cytokine IL10, as well as the IL3 concentration level in severe Acute Respiratory Distress Syndrome (ARDS) +Immediate Life Support (ILS) positive H1N1 infected patients. Analysis of all the data was performed by Statistical Package for Social Sciences (SPSS) software version 22. Results: In this study, all samples (n=120) were examined using RT-PCR, which revealed that 53 samples were infected with the Influenza A Virus (IAV). Among the total positive 24 were males and 29 were females. the average concentration of IL3 was 1749.49 pg/mL. The increase in IL8 was not as big as the increase in IL2 and IL3. IL8 was identified as a significant proinflammatory factor during angiogenesis, or uncontrolled cell growth. Conclusion: The prevalence of H1N1 infection was found to be high in children under the age of ten. The concentration of IL-3 in H1N1-infected patients’ samples was higher than the concentrations of the other three cytokines.

Utility of p63 and Alpha Methyl Acyl CoA Racemase in the Lesions of Prostatic Mimickers: An Observational Study

Introduction: Prostate adenocarcinoma is the most commonly occurring cancer in men. Differentiation of prostatic adenocarcinoma from prostatic mimickers is sometimes difficult on the sole basis of histologic findings. Diagnosis of carcinoma is based on Immunohistochemistry (IHC) by negative immune reaction with p63 and positive staining with Alpha Methyl Acyl CoA Racemase (AMACR). Aim: To evaluate the utility of p63 and AMACR in the prostatic mimickers. Materials and Methods: In this analytical observational study, all prospective prostatic mimickers with Transrectal Ultrasound (TRUS) guided biopsies received in the Pathology Department of Bharati Vidyapeeth Medical College, Pune, India in a tertiary care hospital from July 2020 to July 2022 were studied. 70 cases were collected, studied and analysed which included 38 Transurethral Resection of the Prostate (TURP) specimens and 32 TRUS guided tissue biopsies. The Haematoxylin and Eosin (H&E) stained slides of all the cases were examined and divided into three categories-malignant (08 cases), prostatic mimickers (53 cases) and suspicious for malignancy (09 cases). Further, these cases were subjected to IHC for p63 and AMACR. Statistical Package for Social Sciences (SPSS) version 25.0 software was used for data analysis using Chi-square test along with p-value. Results: Out of the 53 cases of prostatic mimickers and nine cases suspicious for malignancy, 56 were positive for p63 and six were negative for p63. There was a statistically significant association between p63 IHC staining and the differentiation of benign cases from malignant prostatic lesions (p<0.001). The sensitivity and specificity of p63 were 93.3% and 100%, respectively. There were eight cases of prostate adenocarcinoma stained with AMACR, all were positive. The sensitivity and specificity being 100%. Results revealed that there was a significant statistical association between the positive IHC staining of AMACR and prostatic adenocarcinoma (p<0.001). Conclusion: The diagnostic performance of p63 and AMACR proves to be significant in differentiating between the mimickers of prostatic lesions and adenocarcinoma. IHC is recommended to reduce diagnostic error in suspected cases.

Profile of HER2/neu Expression in Surface Epithelial Ovarian Tumours: A Clinicomorphological Study

Abbirami Rajarajan, Kalaivani Amitkumar, Muthu Sudalaimuthu

Introduction: Surface Epithelial Ovarian Tumours (SEOT) are most prevalent tumours and account for about two third of all ovarian cancers. Survival of ovarian carcinoma is poor despite optimal surgical and chemotherapeutic management. Evaluation of new diagnostic and prognostic Immunohistochemical (IHC) markers will be essential in this aspect. Aim: To evaluate quantitatively the profile of Human Epidermal growth factor Receptor 2 (HER2)/neu IHC expression with standard scoring system in SEOTs and their association with various clinicpathologic variables (age, laterality, CA 125 levels, histological subtype and FIGO staging). Materials and Methods: The present ambispective study was done in the Department of Pathology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India, from August 2020 to August 2022 with a sample size of 166 cases. All the histopathological samples of SEOT during the study period from August 2020 to August 2022 (prospective) and all borderline, malignant and few benign cases from June 2016 to August 2020 (retrospective) were also included in the study. Cases for which slides and blocks were not available and patient treated with neoadjuvant chemotherapy or radiotherapy were excluded in the study. For prospective cases after getting clinical history and Cancer Antigen 125 (CA 125) level, specimens were fixed, processed and Haematoxylin and Eosin (H&E), IHC staining was done as per standard lab protocol, for retrospective cases clinical history, CA 125 levels, pathological diagnosis and tissue blocks were retrieved, IHC performed and finally both prospective and retrospective cases HER2/neu IHC expression association was studied related to clinicopathological parameters. Results: Out of total sample, SEOT was the most common (n=184, 76.98%) tumour cases, followed by germ cell tumours (n=42, 17.57%) cases and least common was sex cord stromal tumour (n=13, 5.43%). HER2/neu had higher IHC expression in malignant tumours and showed statistically significant positive association with age (p-value=0.001), CA 125 level (p-value-0.001), and histological diagnosis (p-value <0.001), but there is no significant association with size of tumour (p-value=0.786), parity (p-value=0.717), laterality (p-value=0.514) and the International Federation of Gynaecology and Obstetrics (FIGO) grading (p-value=0.274). Conclusion: Malignant tumours had high HER2/neu IHC expression, thus emphasising its carcinogenic role and helps in the diagnostic differentiation of benign and borderline tumours with malignant potential from actual malignant tumours and can be a therapeutic target in future.

Diphtheria Remains a Threat to the Health System Even in the Era of Vaccination: A Cross-sectional Observational Study from Karnataka, India

Laxmi Kamath1, L Ramitha, Vinod Ratageri

Introduction: Diphtheria is an infectious disease caused by a gram-positive facultatively anaerobic bacilli, Corynebacterium (C.) diphtheriae. The present health statistics and data from the few studies that have been carried out suggest that our war with this disease is still going on and is far from being over inspite of the vaccine that’s freely available. Aim: To study clinical profile, complications, and outcome of diphtheria in Karnataka population and to correlate with immunisation status. Materials and Methods: This was a hospital-based prospective cross-sectional observational study done in the Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, from January 2018 to November 2018. Patients admitted with history suggestive of diphtheria were enrolled and categorised into probable and confirmed cases. The age, sex, area of residence, religion, immunisation status, mean time of presentation to hospital from onset of illness, use of inotropes and mechanical ventilation were recorded in a predesigned proforma. Throat swab smear for C.diphtheria and culture, complete blood count, Renal Function Tests (RFT) with serum electrolytes, chest radiograph, Electrocardiogram (ECG) and 2-Dimensional (2D) Echocardiogram (ECHO) were also recorded. Results: Out of total 28 cases, 18 fulfilled the inclusion criteria. Male to female ratio was 2:1 and the mean age of presentation was 9.7 years. Highest incidence (n=14, 77.8%) was seen in the age group of 09-11 years. Most common clinical presentation was fever and sore-throat present in all 18 (100%), neck swelling in 13 (72.2%), dysphagia in 05 (27.7%). Examination revealed tonsillar hypertrophy and pseudomembrane in 17 (94.4%) patients, whereas one patient had laryngeal diphtheria, which was diagnosed when swab was sent while intubating in view of membranous laryngitis. Mean time of presentation to hospital after the onset of symptoms was 5.65 days. All children received appropriate antibiotics and Antidiphtheritic Serum (ADS). Total of seven patients were ventilated, of which 5 (27.7%) succumbed, and two were extubated. Four (22.2%) patients developed myocarditis in the second week, and all succumbed to resistant arrhythmias. One patient developed sepsis with ventilator dependency, and succumbed to inotrope resistant septic shock. On follow-up, 5 (27.7%) developed palatal palsy among which three had associated polyneuropathy; all these children recovered with only supportive care. Conclusion: Diphtheria is down but not out, the present study unmasks the fact that the disease is equally prevalent in immunised and older children with the changing epidemiology of diphtheria in the era of vaccines.

Localised Morphea Treated Empirically with Ceftriaxone

Localised morphea is an autoimmune sclerosing disorder of unknown aetiology. Various triggering factors are known to be associated with the disease including infections, vaccination, autoimmune disorders, and trauma. Amongst the infections, the common causative organisms associated with morphea are Borrelia burgdorferi, varicella, and Epstein-Barr virus (EBV). Localised morphea presents as an initial inflammatory stage and a late inactive stage. It is characterised by sclerosis of skin with hyper or depigmentation. The antibiotics effective against borrelia infection are benzyl penicillin, doxycycline, and ceftriaxone. These antibiotics are tried in the treatment of localised morphea. Ceftriaxone is one of the best antibiotics preferred to treat borrelia infection at all stages. Apart from its antibiotic properties, it also has an anti-inflammatory and collagen remodelling properties. All five cases of localised morphea reported here were biopsy proven, Antinuclear Antibody (ANA) and Rheumatoid Arthritis (RA) factor negative. All the cases were treated with weekly single intramuscular dose of ceftriaxone 250 mg. After eight weeks there was remarkable improvement in the induration and pigmentation of the lesions.

Clinical and Dermoscopic Evaluation of Melasma in Men- An Observational Study at a Tertiary Health Care Centre in Western Odisha, India

Swati Sarangi, Kuldip Das, Tanmay Padhi

Introduction: Melasma is one of the most common cause of facial hypermelanosis presenting as symmetrical hyperpigmented macules over sun exposed areas especially in women and sizeable proportion in men causing a detrimental effect on the quality of life. Aim: To evaluate the clinical profile and dermoscopic features of melasma in men. Materials and Methods: A single centre hospital-based observational cross-sectional study was conducted at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Odisha, India, from November 2018 to October 2020. 245 men, clinically diagnosed with melasma were included in the study with due consent and evaluated for age, family history, skin type, drug intake history, duration, duration of sun exposure, disease pattern, Melasma Area Severity Index (MASI) Score and dermoscopic feature. Data was collected using questionnaire, managed by Microsoft excel 2016 and analysed using Statistical Package for Social Sciences (SPSS) 20.0. Results: Melasma occurred most commonly in the age group of 31-35 years (37.9%) with mean age of occurrence being 34.5±7.9 years affecting most commonly Fitzpatrick skin type IV (47.3%). There was positive family history in 63 patients (29.7%) and history of Diabetes Mellitus (DM) type 2 in 24 cases (9.7%). There was increased occupational sun exposure in 93% of cases with average duration of exposure being 7-8 hours/day in 98 cases (42.9%). The most common clinical pattern observed was malar pattern in 156 cases (63.6%) and epidermal dermoscopic pattern in 128 cases (52.2%). Majority of cases had a MASI Score between 5-10 with mean being 8.7±7.7. On comparing MASI Score and sun exposure, the average sun exposure was highest for a MASI Score 20-25 i.e., 7.4 hours/day. Conclusion: The most common age group affected by melasma in males is 20-40 years, with prevalence being greater in higher Fitzpatrick skin type (III, IV), with positive history of occupational sun exposure and positive family history. The severity of melasma in form of MASI score was formulated. The knowledge acquired through the study can help bridge the knowledge gap to improve its management and quality of life.

Mucinous Carcinoma of Breast: A Histopathological and Immunohistochemical Study

Introduction: Mucinous Carcinoma (MC) is a special type of breast cancer. It comprises 4% (1-7%) of all invasive breast cancer. MC is also called colloid breast cancer characterised by nests of cells floating in lakes of mucin. It is divided into two subtypes Pure Mucinous Carcinoma (PMC) and Mixed Mucinous Carcinoma (MMC). PMC classified into two main types according to its structural and cytological features type A (paucicellular) the classical variant with a large amount of extracellular mucin, and type B (hypercellular) a hypercellular variant with less mucin and often with neuroendocrine differentiation. Hormone receptors, Human Epidermal growth factor Receptor-2 (HER2) and MUC2 status play an important role in prognosis and management. Aim: To study histopathological features of MC breast and Immunohistochemical (IHC) status. Materials and Methods: A retrospective study of patients who presented with breast cancer were studied at Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. The study was analysed in June 2002 and authors included data from January 2021 to June 2022. The data included the age at diagnosis, Tumour (T), Lymph Nodes (N), and Metastases (M) (TNM) stage, presence and number of Lymph Node (LN) metastases, Oestrogen Receptor (ER), Progesterone Receptor (PR), HER2 and MUC2 status. The patients in whom the diagnosis of MC of breast was given on histopathology were only included in the study. Patients of breast cancer of other pathological types were excluded from the detailed study. Descriptive statistics like mean, tables, and charts were used with the help of Microsoft office 2007 to interpret the results. Results: A total of 245 patients reported as invasive breast cancer during 18 months of study period, out of which 12 cases diagnosed as MC were taken in study. Amongst 12 cases, eight cases were PMC and four cases were MMC. The mean age at presentation was 63.37±16.38 years (eight PMC) and 60.0±19.30 years (four MMC). A total of 11 out of 12 cases were females and only one was male case (PMC). Majority of PMC 04 (50.0%) and MMC 03 (75.0%) were observed to be in TNM Stage 2, and four of 12 cases of MC had LN metastasis with no distant metastasis. MC showed higher expression of hormone receptors and lower expression of HER2/neu and MUC2 positivity, which corroborates with other studies and concluded that, MC with such an immunohistochemistry profile was prognostically better. Conclusion: Mucinous Breast Carcinoma (MBC) is a rare type of breast cancer accounting for about 4% of all diagnosed breast cancers. These are associated with a better long-term prognosis than other breast cancers. Hormone receptors and HER2 status play an important role in prognosis and management. MUC2 also plays a major role in mediating the proliferation, apoptosis, metastases of breast cancer cells and determining the use of chemotherapy drugs.

Sleep Quality, Daytime Sleepiness and Mental Health in Undergraduate Medical Students: A Cross-sectional Descriptive Study

Saurav Kumar, Abhishek Samal, Suyash Dwivedi

Introduction: Sleep deprivation is a growing problem, especially among medical students who must meet high academic standards, as well as, their parent’s expectations. Since poor sleep quality and daytime sleepiness have important consequences in the mental health of medical undergraduate students, the management of these problems would begin with and be guided by assessment of these sleep-related and mental health parameters. Aim: To evaluate the sleep quality and effects of sleep deprivation on the psychological well-being and mental health of undergraduate medical students. Materials and Methods: This was a cross-sectional descriptive study conducted by Department of Psychiatry, G.S. Medical College and Hospital, Pilkhuwa, Hapur, Uttar Pradesh, India, on undergraduate students, for a period of a month in May 2022. Four hundred medical undergraduate students from 1st, 2nd, 3rd part 1 and 3rd part 2 Bachelor in Medicine and Bachelor in Surgery (MBBS) years, who fulfilled the inclusion and exclusion criteria, were enrolled in the present study after their informed consent was taken. Epworth Sleepiness Scale (EPSS), Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale 21 (DASS-21), and Psychological General Well-Being Index (PGWBI) were used to assess the participants. Sleep quality and sleepiness were correlated with anxiety depression, stress, and subjective general well-being using Spearman’s coefficient with significance at 0.05 and 0.001 levels. Results: The study participants were in the age group of 17-24 years and majority of the students (n=130, 32.5%) were 20-year-old. Females accounted for near half of the study participants (n=190, 47.5%). Most of the students in the participant group had poor sleep quality with a mean of 6.75±1.811 and issues of daytime sleepiness (10.68±3.481). The DASS-21 revealed severe anxiety (15.5±2.473) and moderate stress (22.89±3.396) levels. Significant positive correlation was seen between the anxiety (r=0.110; p-value <0.05) and stress (r=0.452; p-value <0.01) index with EPSS. A significant positive correlation was found between anxiety (r=0.118, p-value <0.05), stress (r=0.410; p-value <0.01) and psychological well-being (r=0.119; p-value <0.01) and PSQI score. Conclusion: The study revealed that, many undergraduate medical students in different semesters slept insufficiently and struggled with daytime tiredness. Among the students, higher stress and anxiety levels, along with a low level of subjective psychological well-being were discovered. Additionally, the study revealed higher levels of anxiety and stress in medical undergraduates, who had poorer sleep quality and excessive daytime sleepiness. Also, students with poor quality of sleep had lower psychological general well-being.

Comparison of Non Surgical Periodontal Treatment Outcome and Clinician’s Comfort Levels using LM ErgoMax over Hu-Friedy Hand Instruments- A Randomised Clinical Trial

Introduction: Non surgical periodontal therapy by scaling is done by using different sets of hand and motor driven instruments. The best instrument for non surgical periodontal therapy has to be identified, so that, it will benefit the clinicians in point of ergonomics and for patients in terms of less discomfort caused during scaling. Aim: To compare the effectiveness of Linear Monolithic (LM) instruments to Hu-Friedy instruments in non surgical periodontal treatment. Materials and Methods: The split-mouth randomised clinical trial study comprised 50 patients, who were selected from those attending the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, and who were classified with gingivitis or moderate to severe periodontitis according to American Academy of Periodontology (AAP) standards from 1999 and had not undergone any periodontal therapy in the previous six months to one year. The study was conducted from September 2021 to February 2022. Periodontal treatment outcomes were evaluated by plaque index, bleeding index, probing pocket depths, gingival index and clinical attachment level. Clinicians comfort levels and handling characteristics of two sets of hand instruments (Test: LM instruments to control: Hu-Friedy instruments) were assessed by questionnaire consisting of 10 closed ended questions immediately after the non surgical therapy. The unpaired t-test was used for intergroup analysis and one-way ANOVA was used for intragroup analysis. Results: The mean gingival index scores for test and control sites at baseline were (1.65 and 1.72), at one week were (0.89 and 0.64) and at one month were (0.46 and 0.31). The mean periodontal pocket depth for test and control sites at baseline were (3.93 and 3.79), at one week were (3.40 and 3.25) and at one month were (3.18 and 2.42). A statistically significant difference seen in gingival index (p=0.001), sulcus bleeding index (p<0.001), periodontal probing depths (p<0.001) and clinical attachment level (p<0.001) at one-month interval. Conclusion: The findings demonstrate that LM instruments have higher handling features and cutting efficiency than Hu-Friedy instruments, although there is no significant difference in plaque index, gingival index, probing depth reduction, sulcus bleeding index, or clinical attachment level.

Clinicopathological Study of Testicular Lesions in a Tertiary Care Centre of Dakshina Kannada, India

KP Athira, T Umashankar, Mohit Kumar

Introduction: Testicular biopsies are performed for both diagnostic and therapeutic purposes. Diagnostic testicular biopsies are usually performed as a part of a male infertility work-up. Therapeutic testicular excision biopsies are performed for a wide range of disorders, including neoplastic lesions, inflammatory lesions, cryptorchidism, testicular trauma, and as a part of prophylactic treatment of carcinoma prostate. Aim: To evaluate the indications for orchidectomy and diagnostic testicular biopsies and to understand the histopathological spectrum of testicular lesions and concordance with clinical diagnosis. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India. The study period is from July 2017 to June 2020. Data was collected and analysed in August 2020. All testis’ biopsies, including excision and diagnostic biopsies, are included in the study. Histopathological findings and the clinical diagnosis were evaluated for concordance. Data were tabulated and statistically evaluated for age distribution, laterality, and frequency using Microsoft excel 2021. Percentages for the variables and concordance rate were calculated. Results: A total of 139 cases (mean age 54.5 years) were included in the study. Prophylactic orchidectomy for carcinoma prostate (64/139=46.04%) was the most common clinical indication. Non neoplastic lesions account for 48.20% (67/139). Frequent non neoplastic lesions are testicular torsion (23/139=16.55%) and abscess (12/139=8.63%), followed by cryptorchidism (9/139=6.47%). Left-sided lesions are more frequent than right-sided lesions. Histopathology confirmed two cases of suspected male infertility and Androgen Insensitivity Syndrome (AIS). Neoplastic lesion accounts to 6.47% (9/139). Frequent neoplasm in the study was seminoma (3/139=2.16%), followed by lymphoma (2/139=1.44%). Other neoplasms included in the study were mixed germ cell tumours, postpubertal teratoma, and spermatocytic tumour. Testicular tuberculosis accounts to 1.44% (2/139) in the present population. Conclusion: Non neoplastic lesions were common compared to testicular neoplasms. Testicular torsion, followed by abscess, was the most common indication for orchidectomy. Testicular Tuberculosis can mimic a neoplasm on clinical and radiological work-up. Hence, careful evaluation has to be performed in young suspected cases of tuberculosis.

Effectiveness of Corticosteroids Alone versus Corticosteroids and Cyclosporine in the Management of Patients with Severe Cutaneous Drug Reaction

Lav Patel, Samidh Shah, Neha Jangid, Chetna Desai, Bela Shah

Introduction: Severe Cutaneous Adverse Reactions (SCADRs) are emergency dermatologic manifestations associated with high morbidity and mortality. Their management includes immediate withdrawal of suspected causal agent followed by prompt management with drugs such as corticosteroids, cyclosporine and cyclophosphamide. Aim: To compare the effectiveness of corticosteroids alone versus cyclosporine and corticosteroids in management of SCADRs. Materials and Methods: This was a prospective observational study carried out in Indoor patients of Dermatology Department, Civil Hospital Ahmedabad, Gujarat, India, from October 2019 to September 2022. Twenty six patients were diagnosed with SCADRs and grouped according to the treatment received in two groups: corticosteroids alone (group B), and corticosteroids along with cyclosporine (group A). The efficacy was assessed based on: the days of disease arrest, days of complete re-epithelialisation, duration of hospitalisation and final outcome. To know the prognosis of the patients, Score of Toxic Epidermal Necrosis (SCORTEN) score was used. Data was entered and analysed with the help of Microsoft excel ® 2019. Results: There were 14 patients in group A and 12 in group B. In a total 26 cases majority were of Stevens-Johnson Syndrome (SJS) (50%) followed by SJS-Toxic Epidermal Necrolysis (TEN) (27%) TEN (15%), Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) (8%). The mean duration of disease arrest was significantly shorter in group A (n=14) when compared to group B (n=12) (p-value <0.001**). Also, the time for complete re-epithelisation was significantly shorter in group A than group B (p-value=0.025*). While no significant difference between the two groups was observed in SCORTEN score. Mortality was 3/12 in group B, nil in group A. Conclusion: Combination therapy with corticosteroids and cyclosporine leads to an early arrest of the disease progression, better prognosis and outcome in patients of SCADRs.

Effectiveness of Dynamic Neuromuscular Stabilisation and Neurodevelopmental Therapy on Gross Motor Function and Trunk Control in Children with Spastic Diplegic Cerebral Palsy: A Protocol for a RCT

Swati Gupta, Rakesh Krishna Kovela

Introduction: The Dynamic Neuromuscular Stabilisation (DNS) technique uses feed forward feedback to involuntarily activate the diaphragm and deep abdominal muscles prior to purposeful movement in humans. It is an efficient approach for facilitating deep core muscle activation of the underactive muscle chain consisting of the Internal Oblique (IO), transverse abdominals and diaphragm, thereby enhancing age appropriate jumping, walking and standing, in participants with Spastic Diplegic Cerebral Palsy (SDCP), whereas the primary goal of Neurodevelopmental Therapy (NDT) is to facilitate more normal movement patterns for performing performance skills and rectifying abnormal postural tone. Need of the study: Even though studies have been done in the past, utilising DNS and NDT in children with diplegic CP, for improving core stability, balance, posture and diaphragmatic movement; however, Gross Motor Function (GMF) and trunk control are the aspects that have not been aimed with DNS. There is scarcity in the literature related to impact of DNS on GMF and trunk control in children with diplegic CP. As DNS has specific role on core strength it can be a valuable in the management of trunk control. Because no study comparing the impact of DNS and NDT on trunk control and functions of gross motor in diplegic children has been found; there is a strong need to perform a study to evaluate the same. Aim: To compare the impact of DNS to NDT on gross motor performance and trunk control in children with SDCP. Materials and Methods: It will be a Randomised Clinical Trial (RCT) with the assessor blinded, conducted in the Outpatient Department of Physiotherapy, AVBRH Sawangi, Meghe, Wardha, Maharashtra, India, from July 2022 to April 2023. Following the baseline assessments, children with SDCP (n=36) will be enlisted and randomly assigned into two groups, groups A and group B. Group A will be treated using conventional therapy along with NDT; group B will be given conventional therapy as well as DNS. Treatment will be given for four weeks, five days a week. On the first and the last day of the intervention, primary outcome measures Gross Motor Function Measure-88 (GMFM-88), Trunk Impairment Scale (TIS) and secondary outcome measure Modified Ashworth Scale (MAS) will be employed (on the first day and after the completion of four weeks). Mini-mental Scale Examination (MMSE) will be used as inclusion criteria for the children. Statistical analysis will be carried out using Statistical Package for the Social Sciences (SPSS) software version 27.0. Conclusion: The present study is expected to prove DNS approach to be successful in enhancing the control of the trunk and gross motor abilities in children with SDCP.

Effect of Central Fatigue on Dynamic Balance and Knee Joint Proprioception in Recreational Athletes: An Experimental Study

Pooja Sharma, Moattar Raza Rizvi, Irshad Ahmad

Introduction: The salient constituent of physical activity is fatigue that can influence execution of sports as well as it can also affect the activities of daily living. Abundant conventions are being used to magnify the fatigue, resisting dimension of the individual but none has proven to be effective. Therefore, this research will give perception about the central fatigue, that can affect dynamic balance and knee joint proprioception in healthy individuals. This can further be related in athletes also; in designing their training protocol to minimise the fatigue level and thus enhancing the performance of an individual. Aim: To study the effect of central fatigue on dynamic balance and knee joint proprioception in recreational athletes. Materials and Methods: This experimental study was conducted at the Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India from 25th March 2022 to 25th June 2022. Twenty-five subjects were recruited in the study on the basis of inclusion and exclusion criteria. Star Excursion Balance Test (SEBT) and proprioception were measured before and after inducing central fatigue. The paired t-test was used to compare pre and post values of SEBT and proprioception. Results: There was significant effect of central fatigue in different excursion reach of dynamic balance from pre to post, anteromedial (p-value <0.001), medial (p-value <0.001), posterolateral (p-value <0.001), lateral (p-value <0.001) and anterolateral (p-value <0.001) directions. In addition, the knee joint proprioception was significantly reduced following central fatigue was initiated. Conclusion: Dynamic balance and knee joint proprioception reduced when the individual was undergoing central fatigue.

Morphological Variations of the Lumbricals in Adult Cadaveric Hand: A Cross-sectional Study

Sudagar Muthusamy, Bavithra Bascarane, Prithiviraj Nagarajan

Introduction: The development of the human hand is unprecedented. Despite being tiny in size, the lumbricals play a far more significant role in the dynamic actions of the fingers. At the Metacarpophalangeal (MCP) and interphalangeal joints, they do flexion and extension. Lumbricals also exhibit some variations of developmental anomalies in attachments and morphology. Aim: To classify morphological patterns of the lumbrical muscles and their anatomical variations in the hands and to discuss their clinical implications. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy of Aarupadai Veedu Medical College and Hospital, Puducherry, India, from July 2020 to July 2021 on 50 disarticulated upper limbs during routine dissection of cadavers. In the present study, the limbs were labelled R or L for right or left, M or F for male or female. The variation in origin (including architecture), insertion (including split insertions, misplaced insertions, or absence of muscles, and the lengths of the muscle belly and tendon of all lumbricals were studied and noted. The dissection was carried out based on the steps as per Cunningham’s manual. Analysis of the data was done using Microsoft excel software 2016. Results: In this study, 86% of the lumbricals were found normal in origin, innervation and insertion. Split insertion in the 3rd lumbrical was seen in 6% of the lumbricals, and a unipennate in the fourth lumbrical was seen in 2% of the total specimens. In 2% of the specimens, the 4th lumbrical was absent, the 1st lumbrical was hypertrophied in 2%, and the accessory belly in the 2nd lumbrical was also observed in 2%. Conclusion: The findings of this research may provide light on the role of the lumbrical muscles in diagnostic and surgical procedures involving the hands.

Dehydroepiandrosterone and Acute Stress Attenuation: An Interventional Rodent Study

Introduction: Stress activates hypothalamo-pituitary-adrenal axis leading to the release of glucocorticoid that mediates the stress response. This adaptive response is self-limited but if persistent for prolonged periods can lead to disease states. Nature has endowed the body with efficient buffer systems to attenuate the stress effects and Dehydroepiandrosterone (DHEA), a steroid hormone with neuromodulatory functions is implicated as an efficient candidate to buffer stress. Aim: To assess the effect of prophylactic administration of DHEA in the attenuation of acute stress in male Wistar rats. Materials and Methods: This interventional study was carried out at centre for Toxicology and Developmental Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, between June 2021 and August 2021, in compliance with the animal welfare guidelines of CPCSEA, and in accordance to the protocol approved by Institutional Animal Ethics Committee. The 18 male Wistar rats approved for the study were segregated into 3 groups with 6 animals in control (no stress) group, 6 in stress group and 6 in intervention group that received DHEA prophylactically 30 min before stress procedure. Animals in stress and intervention groups were subjected to one hour immobilisation stress. Blood samples were collected from all animals after the stress period and serum corticosterone, the stress marker, was estimated. The data were expressed as mean±standard error of mean (mean±SEM) and Mann-Whitney U test was used to test the significant difference between the: (i) control and stress groups; (ii) stress and study groups; and (iii) control and study groups. The p-value <0.05 was considered significant. The analysis was done using SPSS version 23.0. Results: The values of corticosterone in control, stress and intervention groups were 26.6±4.4 ng/mL, 51.6±3.9 ng/mL and 23.4±3.6 ng/mL, respectively. Significant difference in the mean serum corticosterone levels with p-value 0.013 between control and stress groups and with p-value 0.008 between stress and DHEA groups were observed. Conclusion: It could be observed from the findings that prophylactic DHEA administration attenuated acute stress efficiently in male Wistar rats as reflected by the significant decrease in serum corticosterone levels in the group that received DHEA intervention, thus inferring the efficiency of DHEA in stress buffering.

Correlation of Serum Testosterone Levels in Men with Severity of Liver Dysfunction in Chronic Liver Disease- An Observational Study at a Tertiary Care Centre in Uttarakhand, India

Naveen Kumar Rajput, Reshma Kaushik, Shekhar Khushwah

Introduction: Chronic Liver Disease (CLD) and/or cirrhosis of liver represent different liver disorders of varying severity in which liver injury, inflammation, and fibrosis continue for more than six months. Various aetiologies including drugs toxins, alcohol abuse, infections, autoimmune disorders, genetic and metabolic diseases are implicated for CLD. Regardless, the aetiology of the CLD, the serum testosterone falls as the disease advances. Aim: To study the serum testosterone level in male patients with CLD and its correlation with the severity of the disease. Materials and Methods: A prospective observational study was conducted on patients reporting to Himalayan Hospital in OPD and IPD between June 2021 to May 2022. A total of 58 male patients of CLD were recruited. All patients were examined with clinical history, physical examination, laboratory blood and biochemical and radiological investigations, including total serum testosterone estimation. Testosterone value of <3 ng/mL was considered as low level. Child-Turcotte-Pugh (CTP) scores and Model for End-Stage Liver Disease-sodium (MELD-Na) scores were calculated to assess the severity of CLD. Results: The mean age of the patients was 47.87±10.3 years. The majority of patients, 52/58 (89.65%), had low serum testosterone levels. As the severity of CLD increases, the testosterone falls progressively, and the finding was statistically significant (p-value=0.001). The mean testosterone levels (0.9±0.38) in patients with MELD-Na score of ≥20 was significantly (p-value=0.02) lower than the patients with MELD-Na score of <20. There was a strong negative correlation between low testosterone and CLD severity. Conclusion: Overall, 89.65% of the patients had a low testosterone level. Serum testosterone level can be an independent marker for the severity of CLD in male patients.

Evaluation of Serum Soluble Endoglin Levels in Pre-eclampsia: A Case-Control Study

Introduction: Soluble Endoglin (sEng) has an antiangiogenic effect, by inhibiting of Transforming Growth Factor (TGF)-β1 bond at endoglin receptors and inhibiting vasodilatation. sEng levels increase in Pre-eclampsia (PE) due to hypoxic placenta and there have been possible role of it in the pathogenesis of PE and its therapeutic implications. Aim: To compare serum sEng levels in pre-eclamptic patients (cases) versus control. Materials and Methods: This case-control study was carried out November 2019 to October 2021, in the Department of Obstetrics and Gynaecology, University College of Medical Sciences, Delhi. On 40 cases with a singleton pregnancy with diagnosis of PE enrolled as cases and 40 normal healthy pregnant women matched for age and gestational age as controls. sEng was estimated using commercially available Enzyme- Linked Immunosorbent Assay (ELISA) kit. Last uterine (Ut) and Umbilical Artery (UA) doppler findings were noted and sEng levels were compared with doppler studies. The analysis was done using student t-test and Chi-square test. Results: A total of 80 participants were included in the study, 40 in case group (mean age 26.53±4.93 years) and 40 in control group (mean age: 25.35±3.10 years). A total of 21 PE cases were Non Severe PE (NSPE) (52.5%) and 19 were Severe PE (SPE) (47.5%). Early-onset PE was observed in n=11 (28%) and the remaining n=29 (72%) had late-onset PE. sEng was significantly higher in pre-eclamptic women 55.08±21.42 ng/mL as compared to controls 44.15±12.02 ng/mL (p=0.006). Higher levels of sEng were seen in SPE 59.20±28.44 ng/mL vs NSPE 51.36±11.66 ng/mL (p=0.066). sEng levels between early onset PE (50.93±5.89 ng/mL) and late onset PE (56.66±24.84 ng/mL) (p=0.832). sEng levels were higher in cases with abnormal Resistance Index (RI) of Ut artery 54.23±6.68 ng/mL than in normal RI of Ut artery 54.23±6.68 ng/mL, though not significant. Abnormal Ut artery RI doppler was seen more in early-onset (n=2, 33%) than in late onset PE (n=1, 7%). Conclusion: The PE cases had significantly higher levels of sEng compared to controls. Thus, it can be concluded that, there is a definitive role of sEng in pathogenesis of PE due to its antiangiogenic action.

Antimicrobial Effectiveness of Different Root Canal Irrigants on Viablility of Root Canal Flora

Rohit Sharma, John Johnson Panadan, Madhurima Sharma, Syeda Afeefa Tanweer

Introduction: Cleaning and shaping of sophisticated root canal system plays an important role in the success of endodontic treatment. In addition to root canal instrumentation, irrigation also becomes a crucial aspect in the effective disinfection of root canal system. The chemical substances like acids, chelating agents, alkaline solutions, Sodium Hypochlorite (NaOCl), oxidative agents, and normal saline are used as root canal irrigants. But each irrigant has its own limitations. With the advent of novel materials and techniques, the search for the optimal root canal irrigant still continues. Aim: To evaluate and compare the antimicrobial effectiveness of various root canal irrigant solutions such as combination of 5.25% NaOCl and 2% Chlorhexidine gluconate, 2% Chlorhexidine gluconate, Miswak extract and normal saline for root canal irrigation. Materials and Methods: In this prospective observational study was conducted from February 2021 to April 2021, on 10 patients with persistent endodontic infection on single rooted teeth. After obtaining access to the root canals, paper points were inserted and the soaked paper points were placed immediately in a microtube with two mL of Reduced Transport Fluid (RTF) to obtain the bacterial suspension. The sensitivity of Gram negative anerobic bacteria and E.faecalis to different irrigants was assessed with disc diffusion test and bacterial load was evaluated with Colony Forming Unit (CFU) assay. The study was analysed statistically using Kruskal-Wallis test and Dunn test (post-hoc test). Results: The results of disk diffusion method showed that the zone of inhibition for 2% chlorhexidine gluconate was 29 mm for Gram negative anerobic bacteria and 22 mm for E.faecalis, and the zone of inhibition for Miswak extract was 8 mm for Gram negative anerobic bacteria and 10 mm for E.faecalis. Gram negative anerobic bacteria on the culture plates treated with Miswak extract had 6.41 CFU/mL, and E.faecalis had 5.21 CFU/mL. Gram negative anerobic bacteria on the culture plates treated with normal saline had a CFU/mL of 6.77, and E.faecalis had a CFU/mL of 5.77. The antibacterial activity of miswak extract was lower than that of other irrigants. The normal saline lacked any antimicrobial qualities. Conclusion: The antibacterial effectiveness of the combination of 5.25% NaOCl and 2% Chlorhexidine gluconate was found to be higher than, 2% Chlorhexidine gluconate, Miswak extract and normal saline for root canal irrigation. A combination of 5.25% NaOCl and 2% Chlorhexidine gluconate can be used as a better choice over the other three irrigants.

Effects of Intravenous Ketamine, Butorphanol and Fentanyl for the Management of Intraoperative Shivering under Spinal Anaesthesia- A Randomised Clinical Trial

Pradeep Kumar Dash, Ayesha Pattnaik, Sidharth Sraban Routray, Mousumi Das

Introduction: Neuraxial block can cause intraoperative shivering. Though, so many drugs have been studied for treatment of shivering, none has been found ideal. N-methyl-D-aspartate (NMDA) antagonist like ketamine, k-opioid receptor agonist butorphanol and μ receptors agonist fentanyl have shown antishivering effect but each one has its own demerits. Aim: To examine the efficacy of ketamine, butorphanol, and fentanyl in suppressing shivering under spinal anaesthesia in elective lower abdomen and lower limb surgery. Materials and Methods: The double-blind, randomised trial was conducted between June 2011 to September 2013. A total of 90 patients, posted for surgery under spinal anaesthesia, were randomly allocated into three groups of 30 each. After giving spinal anaesthesia, patients who developed shivering (grade 3 or more), lasting for more than 3 minutes, the study drugs were administered. Patients in Group I received ketamine (0.5 mg/kg), Group II received butorphanol (0.02 mg/kg) and Group III received fentanyl (1 μg/kg), intravenously. Time taken to control shivering, sedation and any side-effects nausea and vomiting were assessed. The dose was given over 60 seconds and the time duration for the complete disappearance of shivering was noted (after the drug administration) at 2 min, 5 min, 10 min, 20 min, and 30 min. The sedation score was determined after 10 minutes of administering drug. Comparison of the observations among different groups was done and statistically analysed using Fisher-exact test, ANOVA, Chi-square test. Results: Shivering control time was much shorter in Group II (3.6±1.20 min) than in Group I (3.867±1.676 min), but significantly longer in Group III (5.467±2.047 min). Mean age of Group I, II and III was 37.6, 34, 36.7 respectively. Reappearance of shivering was substantially more common in Group III (20%) than in Groups-I (0%) and II (0%). Conclusion: Ketamine, buterophanol and fentanyl are equally effective for controlling shivering at 10 minutes after the administrating of study drugs but butorphanol is faster acting, followed by ketamine and then fentanyl to control of shivering.

Efficacy of One Stage Full Mouth Disinfection on the Oral Health-Related Quality of Life in Patients with Generalised Chronic Periodontitis

Introduction: Intraoral translocation of periodontal pathogens from untreated intraoral niches can lead to recolonisation and reinfection of recently treated periodontal pockets. Poor oral health hampers the patient’s Quality of Life (QoL) as it causes social isolation, inferiority and the development of psychiatric conditions. Full Mouth Disinfection (FMD) performed within 24 hours using chlorhexidine has reported significant improvements in clinical, microbiological and psychological parameters when compared to conventional periodontal treatment. Aim: To investigate the long-term effect of FMD on Oral Health-Related Quality of Life (OHRQoL) in patients with generalised chronic periodontitis. Materials and Methods: This study was a prospective clinical study conducted in the Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Pune, Maharashtra, India, from October 2019 to December 2021. Study consisted of 60 participants who were allotted into two groups; 30 periodontally healthy volunteers (control group) and 30 patients (test group) diagnosed with generalised chronic periodontitis. The test group was asked to fill out the Oral Health Impact Profile-14 (OHIP-14) questionnaire to assess the OHRQoL at baseline followed by FMD protocol. All the patients were kept at periodic recall, and the OHRQoL was assessed again taken after one month, three months, and six months. The control group was asked to fill out the questionnaire at the baseline. Repeated measure analysis of variance with post-hoc bonferroni test was used to compare differences in variation present from baseline to one month, three months and six months. For intergroup comparison at different time intervals, an unpaired t-test was applied. Results: The age group of participants ranged from 25-55 years with a mean age of 41.3 years. Test group had 18 males and 12 females and, 20 males and 10 females were in the control group. The mean OHIP-14 score at baseline was 3.58±3.29 in the control group and 42.35±4.32 in the test group at baseline, showing a mean difference of -38.76±0.93, which was statistically significant. After one month there was a significant improvement in the OHIP-14 scores of the test group (26.35±2.60), which was further reduced to 17.17±3.41 and 12.5±3.93 by the end of three and six months. Therefore, a notable improvement in the QoL and periodontal conditions of the patients following FMD was appreciated. Conclusion: Periodontitis negatively impacts the OHRQoL. FMD provides an improvement in the perceived QoL among periodontitis patients.

Comparative Evaluation of Levobupivacaine with Fentanyl Versus Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Patients Undergoing Gynae-Oncological Surgeries: A Randomised Clinical Study

MM Shobha, BH Arathi, Namrata Ranganath, SS Srihari, VB Gowda

Introduction: Epidural analgesia is one of the preferred mode of perioperative management. Neuraxial opioids like fentanyl when used in epidural offer advantage of augmenting local anaesthetic effect and reducing the anaesthetic and analgesic requirement. Aim: To compare the adequacy of analgesia, requirement of rescue analgesics between 0.125% bupivacaine with 2 mcg/cc fentanyl and 0.125% levobupivacaine with 2 mcg/cc fentanyl. Materials and Methods: The randomised clinical study was carried out from September 2016 to May 2017 in 70 patients (35 in each group) of American Society of Anaesthesiologists (ASA) I and II scheduled for elective gynae-oncological surgeries. The epidural analgesia in group Bupivacaine with Fentanyl (BF) was 0.125% Bupivacaine with 2 mcg/cc Fentanyl and group Levobupivacaine with Fentanyl (LF) was 0.125% Levobupivacaine with 2 mcg/cc fentanyl. All data was statistically analysed and compared using Student t-test, Chi-square/Fischer’s-exact test. Results: Total of 70 patients were analysed, 35 each in Group BF (mean age: 50.06±7.19 years) and Group LF (mean age: 46.43±8.41 years). Both the groups were compatible with regard to demographic data and haemodynamic variables. The mean Visual Analogue Scale (VAS) score was higher in group BF compared to group LF at 0,1,4,6,1,2 and 18 hours but the observed difference in both the groups was not statistically significant except at 2nd (p-value: 0.016) and 24th hour (p-value 0.017). Number of rescue analgesics as epidural boluses (p-value=0.001) and paracetamol (p-value=0.044) requirement were more in group BF compared to group LF, respectively. Conclusion: On account of adequate postoperative analgesia, haemodynamic stability, levobupivacaine with fentanyl is a better option than bupivacaine with fentanyl for epidural infusion.

Evaluation of Cella Media Index by Computed Tomography in Hydrocephalic Children in Tertiary Hospital of Telangana- A Retrospective Study

Radhakrishna Palla

Introduction: Hydrocephalus is a common clinical condition in children with a mortality rate of 0-3%. Any obstruction in the flow of Cerebrospinal Fluid (CSF) in the ventricular system leads to its collection and accumulation in the brain causing its compression. Such ventricular enlargement can be studied by many linear and volumetric measurements out of which the Cella Media Index (CMI) is one. Computed Tomography (CT) scan is the safest non invasive investigation commonly used by radiologists to study the ventricular system. Aim: To evaluate CMI in hydrocephalic children by CT and also to compare with the control group, attending tertiary hospital in Telangana state. Materials and Methods: A retrospective study was conducted by obtaining CT Scans of 50 normal children and 50 hydrocephalic children within the age group of 0-12 years, from the Department of Radiology, Niloufer Hospital, Hyderabad, Telangana from November 2013 to August 2014. The CT scans were studied and analysed between August 2014 to November 2014. Maximum transverse inner diameter of the skull and maximum width of the cella media were measured and cella media index was calculated. The data was statistically analysed by using T test. One way Analysis of Variance (ANOVA) was used to check for differences in ventricular dimensions across age groups. Results: The mean age of the subjects was 2.9±3.0 years with 51 female and 49 male children. Mean of cella media index in cases (3.02±1.24, 95% CI 2.66-3.37) was less than in controls (11.9±2.87, 95% CI 11.1-12.7) with p-value <0.001. The mean cella media index of males (2.74±0.93, 95% CI 2.66-3.14) was less than in females (3.28±1.40, 95% CI 2.88-3.37) with p-value=0.1. Among the hydrocephalic children there was no significant difference of mean of cella media index between males and females. The mean cella media index in children below three years (2.81±1.36, 95% CI 2.66-3.12) was less than in children above three years (3.43±0.87, 95% CI 3.09-3.37) with p-value=0.049. Among the hydrocephalic children there was significant difference of mean of cella media index between two age groups. Conclusion: The present study concluded that cella media index in hydrocephalic children was decreased in comparison with the control group.

Histopathological Spectrum of Cardiac Lesions in Sudden Cardiac Death- An Autopsy Study

Introduction: Sudden Cardiac Death (SCD) is a serious health concern, and the incidence of SCD is rising globally. A number of causes can result in SCD in apparently healthy individuals and in people with undiagnosed cardiac disease. The study was done to evaluate the probable cause of death by observing various histomorphological changes in cardiac autopsies. Aim: To establish the cause of SCD and study the histopathology, age and sex distribution, frequency, and location of different types of cardiac lesions. Materials and Methods: The study was a descriptive, cross-sectional, observational study carried out in the Department of Pathology and Forensic Medicine and Toxicology (FMT) at PRM Medical College and Hospital, Baripada, Odisha, over a period of three years. Gross and microscopic findings on Haematoxylin & Eosin (H&E)-stained cardiac sections were studied. The final diagnosis was made on the basis of clinical, autopsy, and histopathological findings. The study was compared with other relevant studies. The data was analysed using Microsoft excel 2019 software. Results: A total of 164 cases of SCD were included in this study. The maximum number of deaths occurred in the age group of 51-60 years (42 cases). The male to female ratio was 2.6:1, indicating an overall male preponderance. Out of 164 autopsied hearts, 85 cases of Ischaemic Heart Disease (IHD), including new, old, and mixed lesions were found, followed by Hypertrophic Cardiomyopathy (HCM) in 25 cases, multiple lesions in 12 cases, dilated cardiomyopathy in four cases, tubercular pericarditis with myocarditis in one case, infective endocarditis in three cases, atherosclerosis in one case, coronary insufficiency in one case, cardiac myxoma in one case. Conclusion: Many factors can lead to SCD in apparently healthy individuals or in people with cardiac disease. In the present study, the most common cause contributing to SCD was IHD. The cause of SCD can be identified by a thorough postmortem examination and histological analysis.

Impact of Electronic Gadgets Overuse on Myopia Progression among Young People: A Prospective Study

Pooja Singh, Pankaj Choudhary

Introduction: Myopia has a multifactorial aetiology, involving interplay between environmental, genetic and behavioural factors. In today’s times of digitalisation, young people are now more exposed to digital devices, which is another possible risk factor for myopia. Aim: To determine the effect of mobile and laptop overuse on progression of myopia in young people at three time points of six months interval. Materials and Methods: This prospective observational study was conducted in the Department of Ophthalmology, Shyam Shah Medical College and associated Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India, from of January 2019 to September 2020. A total of 400 eyes of 200 myopic patients were included. All the eyes were categorised into three groups based upon degree of myopia at the time of presentation. Cycloplegic autorefraction followed by subjective refinement of refraction was done and Spherical Equivalent (SE) was calculated in time 1, time 2 and time 3. Progression of myopia was calculated as increase in myopic refraction of subject’s eye between time 1 and time 3. Questionnaire survey about amount of time spent on mobile and laptop and their working distance was done. Then task-specific-dioptre-hours per day were calculated. Multivariate analysis was done to estimate the adjusted odds ratio for mobile and laptop use associated with myopia progression. Results: The present study was conducted on 200 patients having varying degree of myopia. Mean age of patients with low, moderate and high myopia was 18.62±3.18, 17.65±3.59 and 17.49±3.91 years, respectively. The male to female ratio was 1.04:1. This study documents task specific mobile and laptop dioptre hours per day was significantly higher in eyes with progression as compared to no progression in low, moderate as well as in high myopes (p-value <0.05). Conclusion: In the present study, risk of progression of myopia was significantly higher in patients engaged for longer duration on mobile and laptop and at near distance. Thus, this study concludes that overuse of electronic gadgets has a significant adverse impact on myopia progression in young people.

Role of Two Antibodies Panel High Molecular Weight Cytokeratin and Alpha-Methylacyl-CoA Racemase in Diagnosing Prostatic Lesions: A Cross-sectional Study

Sheenam Azad, Neelima Bahal, Kavita Rawat, Seema Acharya, Vivek Vijjan

Introduction: Prostatic diseases cause significant morbidity and mortality. Although histopathological examination is the gold standard for diagnosing prostatic lesions but diagnosis may be challenging in the presence of benign mimickers or a very small focus of malignancy. Immunohistochemical aid to morphology helps in making a timely and accurate diagnosis. Aim: This study was done to evaluate the role of two antibodies panel High Molecular Weight Cytokeratin (HMWCK) and Alpha-Methylacyl-CoA Racemase (AMACR) in improving the diagnostic accuracy of prostatic lesions. Materials and Methods: This was an observational cross-sectional study conducted in the Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS), Dehradun, Uttarakhand, India, from May 2019 to October 2020. Haemotoxylin and Eosin (H&E) stained sections of prostatic biopsies were classified into benign and malignant. Amongst malignant lesions, prostatic adenocarcinomas were graded according to Gleason’s grading system and Gleason’s scores were noted. One section from each was subjected to AMACR and HMWCK antibody tests. HMWCK was interpreted as negative/positive and continuous/discontinuous. For AMACR, both location and intensity of stain was observed. The parameters studied were Gleason’s score, group grade, expression of HMWCK and AMACR. Categorical data was presented in form of frequency and percentage. Independent t-test, Yates Chi-square test were used. Data was entered in Microsoft (MS) excel sheet and analysis was done using CRAN R 2.1. Results: Total of 80 prostatic biopsies were taken, 24 were malignant and 55 were benign and one was Benign Prostatic Hyperplasia (BPH) with a focus suspicious for malignancy showing atypical small acinar proliferation on histopathological examination. The mean age of non neoplastic cases was 67.68±8.56 years, while that of neoplastic lesions was 75.41±9.34 years. Amongst benign, 56.3% (31/55) cases were BPH, 43.6% (24/55) cases were BPH with associated lesions which included 62.5% (15/24) cases of BPH with non specific prostatitis; 29.2% (7/24) cases of BPH with adenosis and 8.3% (02/24) cases of BPH with basal cell hyperplasia. Of malignant cases, 24 cases were of adenocarcinoma with maximum cases having Gleason’s score 9 (11/24;45.8%) and group grade V (18/24;75%). The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) of HMWCK and AMACR were calculated using histopathology as the gold standard. Conclusion: Although histopathology is the gold standard in prostatic biopsies but immunohistochemistry is additional diagnostic aid in confirmation of diagnosis. Immunohistochemistry not only confirms the histological diagnosis but is of great help in challenging cases. It has markedly increased the diagnostic accuracy.

Effect of Therapeutic Touch on Maternal and Neonatal Outcomes in Primiparous Women: A Systematic Review and Meta-Analysis

Shampa Saha, Atima Bharti, Arpita Rai, Amit Kumar, Kumari Sandhya

Introduction: Childbirth is one of the most wonderful yet painful experiences in a woman’s life. Non pharmacological interventions like Therapeutic Touch (TT) can improve labour experiences in women. Aim: To assess the effect of TT on labour pain intensity, neonatal Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score and admission to neonatal intensive care unit in primiparous women. Materials and Methods: In this review, PubMed-MEDLINE, Google Scholar, Cochrane CENTRAL databases were searched till February 2022, for prospective studies fulfilling inclusion and exclusion criteria. Randomised controlled trials comparing TT and massage therapy with usual intranatal care in primiparous women with singleton foetus and without any risk factors for pregnancy were included in this review. Two independent reviewers extracted data and assessed the quality of the trials. The results were presented in form of forest plots. Results: A total of 13 studies, including 1302 primiparous women, were included in the review for qualitative analysis. Amongst them ten studies involving 621 women included meta-analysis of labour pain intensity. Nine studies were included in the meta-analysis of the active phase of labour and four studies included in the transitional phase and one study in the fourth stage of labour. Eight studies used the Visual Analogue Scale (VAS) to assess pain intensity. Overall, there was a small reduction in pain intensity of primiparous women receiving massage/TT compared to routine care {SMD: -0.96 (95% CI: -1.33, -0.60)}. Significant reduction of pain intensity was found in active {SMD: -0.79 (95% CI: -1.26, -0.32)} and transitional phase of labour {SMD: -1.18 (95% CI: -1.67, -0.69)}. No significant reduction of neonatal admission to the intensive care unit and APGAR score <7 at 5 minutes {RR: 0.71 (95% CI: 0.31, 1.62)} was found. Conclusion: TT has beneficial effect on reduction of labour pain intensity in primiparous women. But no detectable effect was found for neonatal outcomes.

Morphometric Analysis of Great Cardiac Vein and its Clinical Implication-A Cadaveric Study

Jolly Agarwal, Anurag Agrawal, Virendra Kumar, DN Sinha

Introduction: Great Cardiac Vein (GCV) is the longest venous vessel of heart. It is the main tributary of the coronary sinus and anterior wall of the left ventricle and interventricular septum are drained by GCV. Aim: To study the morphometry of GCV and its variations in north-western region of India. Materials and Methods: The present cross-sectional study was conducted in the Department of Anatomy, SRMS IMS, Bareilly, Uttar Pradesh, India, from January 2012 to December 2013. Thirty hearts of different ages and of both sexes (22 males and 8 females) procured from cadavers in the department were studied. The length and diameter of GCV were measured with help of thread and digital vernier callipers. The mean, standard deviation and correlation were calculated using Microsoft office excel 2007. Results: In present study, 30 hearts (mean age: 41.83±12.37 years) of both sexes (22 males and 8 females) were studied. The mean length of GCV was 79.26±22.78 mm and the range of length was from 55.50±27.57 to 112.33±36.07 mm. The mean diameter of GCV was 2.85±1.32 mm. The mean length of GCV in males was 83.26±22.05 mm, while in females, the mean length of GCV was 74.72±22.08 mm. The diameter of GCV was having significant relation with weight (r=-0.663, p-value=0.0007) and age group (r=0.481; p-value=0.023) in cadaveric males. Conclusion: The present morphometric study of GCV provides data for measurement of interventional devices required during interventional procedure in Indian setting.

Comparative Assessment of Commercially Available and Silver Dioxide Surface Modified Fixed Orthodontic Lingual Retainer for its Anti-adherent and Anti-bacterial Properties: A Research Protocol for an In-vitro study

Anjali Sudhakar Kathade, Rizwan Gilani, Rozina Gilani

Introduction: Enamel gets demineralised when they get exposed to acidic environment. Very common issue seen after orthodontic treatment is white spot lesion and also there is a chance of inflammation in periodontal fibres if the fixed lingual retainer is given to the patient. Furthermore, it enhances the plaque and calculus accumulation. So, to minimise these deleterious effects, lingual retainer is modified by surface coating with silver dioxide which shows anti-bacterial and anti-adhesive properties. Aim: To assess the anti-adherent and anti-bacterial properties of silver dioxide (AgO₂) surface modified Orthodontic lingual retainer against S.mutans. Materials and Methods: This in-vitro cross-sectional study will use 60 orthodontic lingual retainer specimens. The samples will be divided into four groups for testing with 15 specimens in each group. The samples will be divided into four groups: two control groups with commercially available lingual retainer will be used for assessing anti-bacterial and anti-adhesion properties and other two will be of surface treated lingual retainer for testing. Bacterial strains will be taken with sample size 15 in each group then the preparation of photocatalytic silver dioxide coated orthodontic lingual retainer. Even coating will be ensured by sputtering technique and thickness of coating will be 50-60 nm. Chi-square test will be used to analyse differences in categorical variables. Expected outcome: The photocatalytic (AgO₂) coated retainer will reduce the bacterial accumulation and adhesion. Conclusion: Surface modification of lingual retainers with photocatalytic AgO₂ will reduce the bacterial adhesion which can be used to prevent the formation of dental plaque and demineralisation orthodontic treatment, thereby preventing demineralisation of enamel and periodontal breakdown.

Comparison of Intubating Conditions of Two Doses of Rocuronium Bromide with Succinylcholine in Children-Protocol for a Randomised Control Trial

Maitri Patel, Vijay Chandak

Introduction: As a depolarising Neuromuscular Blocking Drug (NMBD), succinylcholine is a muscle relaxation of choice during intubation due to its fast onset effect and ultrashort duration of action. But, it is associated with complications like bradycardia, asystole, hyperkalaemia, myalgia, an increase in intraocular pressure and masseter spasm in children. Rocuronium bromide is an intermediate-acting non depolarising muscle relaxant with faster onset of action. So, it can be used as an alternative for intubation to avoid unwanted side-effects of succinylcholine. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations and complications associated with muscle relaxant. Materials and Methods: A randomised double blinded clinical trial will be planned after taking prior permission from ethical committee. A total 90 children of age between 1-10 years with American Society of Anaesthesiologists (ASA I) and ASA II would be equally divided into three groups. Group S would receive succinylcholine 1.5 mg/kg while Group R9 and R12 would receive rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively. Comparative evaluation of intubating conditions would be done around 60 seconds in all three groups. Also, the duration of action, haemodynamic parameters and complications would be observed. Conclusion: At the end of study, one can compare the two doses of rocuronium bromide against succinylcholine which provides the same intubating conditions without haemodynamic variations and complications.

Evaluation of Effectiveness of Contrast Bath vs Knee Pad Device on Pain, Range of Motion and Functional Disability in Knee Osteoarthritis Patients: A Research Protocol

Pranali Sunil Fokmare, Pratik Phansopkar

Introduction: Osteoarthritis of knee is one of the most enfeebling conditions that causes pain and functional impairment that adversely affects life quality. Contrast bath therapy causes alternate vasodilatation and vasoconstriction when limb is dipped in warm and cold water, respectively. Knee pad device gives vibrations and heating therapy by infrared light and ice pack is used to give cryotherapy. Here otago exercise program is used to strengthen lower limbs and balance training along with walking protocol. Need of Study: One of the most frequent joint ailments in the adult population is osteoarthritis because of which there is a notable limitation of mobility. In grade 1 and 2 osteoarthritis people experience pain and stiffness in knee joint. Many studies have been done using traditional immersion contrast bath technique for reducing pain. But it is difficult to find research on contrast therapy using a device. Aim: To compare the effect of contrast bath therapy and knee pad device on pain, range of motion and functional disability in grade 1 and 2 knee osteoarthritis. Materials and Methods: This study will be a randomised clinical trial and will be conducted in the Outpatient Department, AVBRH and Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha, Maharashtra, India. This study has been approved from Institutional Ethical Committee of Datta Meghe Institute of Medical Sciences, (DU). Duration of this study will be for a period of one year fromJanuary 2022 to January 2023. Sixty participants with grade 1 or 2 osteoarthritis of knee will be included in the study and randomly divided in two groups with 30 in each. Group A will be given contrast bath therapy and group B will be given treatment with knee pad device and otago exercise program given in both groups. Treatment will be given for two weeks with three sessions per week. Pre and post-treatment pain, range of motion and functional disability will be noted and statistical analysis will be done. Conclusion: The present study results are expected to establish knee pad device as more effective and easy method than contrast bath therapy in knee osteoarthritis.

Ameloglyphics-An Advancement in Forensic Science

The human teeth are considered as hard tissues similar to finger impressions (trustworthy means in a body found before decay or marring). Forensic dentistry is a comparatively young science that employs the awareness of dentists to assist the legal system. It has recognised itself as a vital science in medical and legal problems, particularly in the areas of individual recognition, sex determination, and age approximation. Teeth are highly repellent to surrounding influences like erosion, dehydration, putrefaction, and they can be utilised as criminal proofs. Skeletal remains, particularly teeth, can be used to identify people in crimes and catastrophic disasters. Enamel rod end motifs have recently become prominent as a subject of study. Ameloglyphics is a phrase that has been used to describe the investigation of these prints. The tooth imprints are one of a kind with differences between teeth from different people as well as within the same person. In terms of criminal dental recognition, mostly when it comes to recognising preys of man-made disasters, such as multiple casualties in army conflicts and wars, new and applicable methods of recognition and validation are urgently needed. This review article focuses on the rationale for employing enamel rod end patterns, as well as the methods for collecting them and identifying their sub-patterns and further suggests these tooth prints as analogues for fingerprints in deceased identification in disasters, crimes and other tragedies.

Quality Control in Clinical Biochemistry Laboratory-A Glance

Manoj Naphade, Panchbudhe Sanjyoti Ankur, Shivkar Rajni Rajendra

Quality Control (QC) is a process, designed to ensure reliable test results. It is a part of overall quality management of the laboratory in terms of accuracy, reliability and timeliness of reported test results. Two types of quality control are exercised in clinical biochemistry: Internal quality control and external quality assurance. Internal Quality Control (IQC), are the methods, which are performed every day by the laboratory personnel with the laboratory’s materials and equipment. It checks primarily the precision (repeatability or reproducibility) of the method. External Quality Assurance Service (EQAS) which are performed periodically (i.e. every month, every two months, twice a year) by the laboratory personnel, It checks primarily the accuracy of the laboratory’s analytical methods. Consequences of inaccurate results could be unnecessary treatment, treatment complications, failure to provide the proper treatment, delay in correct diagnosis, additional and unnecessary diagnostic testing leading to result in increased cost, in time and personnel effort and often in poor patient outcomes. By running quality control, a laboratory self-monitors its testing process and substantiate that the results produced are accurate and precise. Quality management system, looking at every aspect of the laboratory from sample collection to result dispatch is very important for achieving good laboratory performance. A QC programme allows the laboratory to differentiate between normal variation and error. This review article outlines indispensable role of quality control in clinical biochemistry laboratory which ensures patient satisfaction, the credibility of laboratory, generate confidence in laboratory results and reduce unnecessary financial burden.

Potential Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate on Salivary Properties in Patients with Xerostomia: A Narrative Review

Azizah Almutairi, Maha Aldawsari, Hafsah Al Ali, Abrar Tounsi

Changes in the makeup of saliva and/or a reduction in saliva flow are the two main causes of dry mouth. Dental caries, oral fungal infections, difficulty speaking and chewing or swallowing, mucositis, and burning mouth syndrome are associated with xerostomia, all of which have a detrimental effect on the quality of life associated with oral health. Although xerostomia is common in the general population, there are no standardised treatment standards. Recent research has indicated that topical treatments available without a prescription cannot be routinely recommended. Casein Phosphopeptide-Amorphous Calcium Phosphate complexes (CPP-ACP) and Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride have been shown to play a significant role in reducing dental caries, plaque, and pathological microorganisms, maintaining pH, and treating hypersensitivity. There is insufficient evidence that CPP-ACPs can induce salivation in patients with hyposalivation. This article reviews recent studies on the effect of CPP-ACPs on salivary traits and their use in treating patients with xerostomia.

Hyaluronic Acid in Periodontal Regeneration and Implant Dentistry-A Review

Deepika Ajit Masurkar, Priyanka Jaiswal, Bhairavi Kale, Aishwarya Rathod

The glycosaminoglycan Hyaluronic Acid (HA) is present in the connective tissue of vertebrates. In the extracellular matrix of soft periodontal tissues, it is the most prevalent glycosaminoglycan with a higher molecular weight. In medical fields such as orthopaedics, dermatology, and ophthalmology, the use of HA in the treatment of inflammatory processes is well established. The extracellular matrix of various tissues, including connective tissue, synovial fluid, and other tissues, contains HA, a naturally occurring linear polysaccharide. Its efficacy in the treatment of inflammatory conditions has been proven. It has anti-inflammatory and antibacterial effects in the treatment of gingivitis and periodontitis in dentistry. It could be used as an adjunct to mechanical therapy in the treatment of periodontitis because of its tissue healing properties. Use of HA for implant surface modification has also been extensively studied. HA has proven to be effective in peri-implantitis. The purpose of this review paper is to explain HA’s involvement in periodontal therapy.

Nipah Virus: A Threatening Outbreak

Nipah Virus (NiV) first identified in Malaysia in 1998, was found to be a highly pathogenic re-emerging paramyxovirus able to produce febrile encephalitis and respiratory sickness for which there are no vaccinations or approved therapies present. Pteropus species bats act as the main natural reservoir. NiV comes under level-4 in biosafety and most commonly spreads through Pteropus fruit bat saliva or excrement, or through close contact with intermediate hosts such as pigs. This virus is predominantly common in Southeast Asia and is considered one of the deadliest viruses in the world with the highest mortality rates. Different strains of the virus were found to display different epidemiological and clinical features. In order to contain outbreaks, quick diagnosis and infection control measures are needed. For diagnosis and surveillance, varieties of serological and molecular diagnostic approaches have been developed. Here, the authors review the current concepts in NiV genome, structure, replication, epidemiology, different viral strains, pathogenesis, clinical signs and symptoms, diagnosis, treatment, vaccines and prevention in human beings.

An Unconventional Presentation of Mucormycosis in a 10-Year-Old Child: A Case Report

Anannya Tripathy, Lakshmi Krishnan, James Thomas, Harsh Singh

Since the Coronavirus Disease (COVID-19) pandemic, there have been several unusual presentations of mucormycosis in India, especially amongst immune-competent adults. COVID-19 infection has been found to have profound effects on the patient’s immunity and some patients, though asymptomatic for COVID-19, can be infected by mucormycosis and develops dangerous complications. Skin involvement of the orbital, zygomatic and maxillary areas is a common occurrence in extensive cases of rhino-orbital mucormycosis, however, isolated involvement of the alar skin is an extremely rare occurrence in such patients. Paediatric cutaneous mucormycosis is by itself a rare entity, seen majorly in children with history of allogeneic hematopoietic stem cell transplantations, chemotherapeutic treatment, or patients with human immunodeficiency virus infections, herpes and other life-threatening viral infections. Patients receiving long-term steroid therapy are also predisposed to invasive fungal infections. This case was about a 10-year-old boy presented with a black crusted lesion over the nose to the otolaryngology outpatient department. The patient had history of contact with a COVID-19 positive individual. Examination revealed a necrotic patch over the palate and Non Contrast CT Scan of (NCCT) the paranasal sinuses showed pansinusitis. A KOH mount showed fungal elements and the patient underwent emergency debridement of nasal skin with endoscopic sinus and palatal debridement. Injectable liposomal Amphotericin-B was started. Over a period of one month, the patient showed significant clinical improvement. Though rare, sinonasal mucormycosis can present in the form of a cutaneous lesion which is an unconventional symptom. A general awareness amongst healthcare professionals, with a multidisciplinary approach, timely diagnosis and specialist intervention can improve outcomes in this sinister disease.

Post COVID Mucormycosis- A Narrative Review

Sakshi Dinesh Firke, Prasad Deshmukh

Mucormycosis is an Acute Invasive Fungal Rhinosinusitis (AIFR). Omnipresent fungi and their interaction with humans are both boon and a bane. Fungal rhinosinusitis is now becoming an alarming situation in today’s world, especially in India. It can be classified further into invasive or non invasive and acute or chronic. Categorisation helps us with its diagnosis and management. The invasion of the hyphae portrays mucormycosis into sinus tissue within less than four weeks. It comes with various predisposing factors such as underlying systemic disease, drug therapy, transplantation, and local lesion. Clinical manifestations such as headache, sinonasal congestion, black lesions on the nasal bridge, and facial inflammation associated with pain are prevalent in immunocompromised patients. Crucial steps such as early identification, definite treatment with a multidisciplinary integrated approach of various departments such as ENT, medicine, and radiology should be made. Intraorbital and intracranial complications can be prevented by treating disease process in the early stage.

Phytotherapy-A Drive towards Green and Clean Dentistry!

Aakansha Periwal, Ashwini Gaikwad, Varsha Pandit, Aishwarya Handa, Mrunal Shinde

The term “Phytotherapy” refers to the direct or indirect treatment of disease through the use of plants and plant-derived products. Since the dawn of time, people have employed herbs as a type of traditional medicine. Natural remedies obtained from therapeutic plants have shown an abundant supply of biologically active ingredients, several of which have served as the inspiration for creation of novel molecules for different medications. A single herb exhibits multiple benefits, such as anti-inflammatory, antibacterial, and antifungal activity, and its use in dental treatment proves to be an effective adjuvant. The applications of medicinal plants in endodontics are varied ranging from intracanal medicaments to irrigants and retreatment agents. Various synthetic chemicals play a significant role in disinfection in endodontics but also have undesirable properties such as allergic potential, increased microbial resistance, toxicity, safety concerns and bitter taste. Due to their widespread availability, low toxicity, and cost-effectiveness, herbal remedies are now being used more frequently as part of dental treatment and have experienced an exceptional surge in popularity in recent years. Therefore, this article aims to provide a comprehensive review of various phytochemicals and its endodontic applications, standardisation, possible side-effects and its benefits as an adjunctive therapy.