Journal of clinical and diagnostic research

Ruptured Pulmonary Hydatid Cyst with Multiple Small Bronchopleural Fistula Formations: A Case Report

Asish Anand Subrata Sahu, Ajay Vare, Varsha Rote Kaginalkar

Hydatid disease is a zoonosis caused by Echinococcus granulosus. It manifests as cystic lesions, most commonly found in the liver and lungs, and rarely in other parts of the body. The disease occurs when a human host accidentally ingests contaminated food containing eggs from canine waste products. Since the clinical characteristics of this disease are nonspecific, radiological investigations play a crucial role in diagnosis. Diagnostic challenges arise due to atypical imaging features of complicated hydatid cysts. A 40-year-old female patient presented with fever, breathlessness, chest pain, and an unproductive cough persisting for eight days. Upon examination, she was in hypovolaemic shock, and an intercostal drainage tube had been inserted in the left sixth intercostal space. The chest radiograph revealed a dense, homogeneous opacity in the left hemithorax, partially compressing the left lung medially. An High-resolution Computed Tomography (HRCT) thorax showed a thick-walled cavity with an air-fluid level and layered membranes in the dependent part of the cavity, indicating a water lily sign in the left lower lobe of the lung, suggesting a ruptured hydatid cyst. The patient underwent cystectomy with suturing of a small bronchopleural fistula. Computed Tomography (CT) is the preferred imaging modality, especially for assessing associated complications and ruling out differentials in cases of ruptured pulmonary hydatid cysts.

Conservative Physiotherapy for Grade 4 Osteoarthritis Secondary to Genu Varum Deformity: A Case Report

Purva Gulrandhe, Pradhyum Kolhe, Pratik Phansopkar

Osteoarthritis (OA) is a prevalent form of degenerative joint disease that primarily affects the knees, leading to a gradual loss of function, severe pain, joint stiffness, and reduced quality of life. Despite its severity, exercise treatment offers promising results and proves beneficial for a wide range of patients. Preoperative rehabilitation for OA patients often involves therapeutic approaches such as exercise treatment, electrotherapy, and manual therapy. The present case revolves around a 58-year-old male diagnosed with OA in both knees, with the presence of genu varum deformity. A personalised preoperative rehabilitation protocol was designed based on his specific symptoms of pain, stiffness, and difficulties in daily activities. The case study highlights the effectiveness of the preoperative physical therapy approach for managing bilateral osteoarthritic knees with genu varum deformity.

Unusual Pregnancy-Cervical Prolapse and Preterm Birth: A Case Report

Cervical prolapse during pregnancy is quite rare. When it presents, it can be complicated by spontaneous abortions, preterm labour, cervical infections, and foetal and maternal mortality. To date, there is no set protocol for the management of this condition. In the present case of a 23-year-old unbooked third gravida, authors have discussed be discussing a 3rd gravida with the previous two live births presenting to the casualty with preterm labour pain and cervical prolapse in her trimester of pregnancy. She was initially managed by tocolysis, followed by insertion of a pessary, and her pregnancy was terminated at term by caesarean section. The management of cervical prolapse during pregnancy should take into consideration the gestational age and the degree of prolapse; it must be individualised to each patient.

Strongyloides stercoralis Infestation Manifesting as Protein Losing Enteropathy and Dyselectrolytaemia in an Immunocompetent Adult: A Case Report

Strongyloides stercoralis is an intestinal nematode which persists as chronic asymptomatic infection for several years. Clinical manifestations become apparent long after initial infection which includes non specific Gastrointestinal (GI) symptoms like pain abdomen, nausea, vomiting, altered bowel habits or weight loss. Larval reproduction can lead to disseminated infection in the immunocompromised. Very rarely, hyperinfection or disseminated strongyloides can lead to ulceration, bleeding, small bowel obstruction, colitis or ascites. In severe cases, electrolyte disturbances and protein losing enteropathy may occur. We present a unique case of intestinal infestation of Strongyloides stercoralis in a 42-year-old immunocompetent male with a rare manifestation of protein losing enteropathy and dyselectrolytaemia without any GI symptoms at the outset, whose presentation was anasarca and initial investigations including work-up for cardiovascular, hepatic and renal causes of anasarca were unremarkable except for hypoalbuminaemia and electrolyte abnormalities and notable absence of peripheral eosinophilia. The diagnosis was arrived at by simple and conventional investigations like stool microscopy which demonstrated the Strongyloides larvae and upper GI endoscopy aided the biopsy which was confirmatory. He responded to appropriate medical treatment. Helminthic infestation should be kept in mind as a rare cause of malabsorption syndrome manifesting as protein losing enteropathy in a tropical and endemic country like India. These are treatable causes and respond to specific cost-effective antihelminthic treatments.

Clinicopathological Features of a Lower Lip Verruciform Xanthoma: A Rare Case Report

Verruciform Xanthoma (VX) is an uncommon, benign, asymptomatic lesion of the oral cavity. The incidence rate of VX is 0.025%, with the most common location reported to be the gingival margin, followed by the tongue, hard palate, buccal and labial mucosa. It may also present on the skin and genitals. VX can manifest as a solitary or multiple lesion with well-defined margins. It appears as a papule or plaque with verrucous or papillary growth, exhibiting variable colours ranging from reddish-pink and yellow to grey. While the lesion typically appears verruciform, it may also have a polypoid, papillomatous, or sessile nature. In the present case report, the authors present a 45-year-old male patient with a history of tobacco use, who exhibited a reddish-pink papillomatous growth on his labial mucosa for a duration of three months. The growth was surgically excised, and histopathological evaluation confirmed the characteristic features of VX. The lesion healed without complications, and no recurrence was observed. Clinically, VX may be mistaken for various malignant or premalignant lesions such as papilloma, verrucous carcinoma, or proliferative verrucous leukoplakia. Therefore, it is crucial to differentiate VX from these conditions to avoid inappropriate intervention. Histopathological evaluation is necessary for the definitive diagnosis of the lesion, which reveals the pathognomonic presence of foamy histiocytes within the elongated dermal papillae. The present case report highlighted the diverse clinical features of VX and discusses its histological findings along with the differential diagnosis.

Epileptiform Discharges Presenting as Isolated Episodes of Semen Emission: A Case Report

Ankit Halder, Aditya S Nair

Epilepsy is a multifaceted disorder, whose presentation varies from person to person. Semen leakage is observed in instances such as nocturnal emission (nightfall), prostatitis, nerve injury, side-effects of medications, and sexual arousal. The emission of semen as a manifestation of epilepsy is rare. The authors present the case of a 28-year-old male, married for the past two years, with complaints of involuntary passage of semen in sleep which began one month back. The frequency was 3-4 times a week. Following this event, the patient observed that he had a splitting headache that was generalised in nature which would persist for the next few hours and would not even subside after taking a painkiller like paracetamol. An Electroencephalogram (EEG) was advised, showing generalised slowing with increased frequency of delta waves, which were suspected to be characterising post-epileptic changes. The patient was started on Tab Lamotrigine 25 once at night, which was eventually up-titrated to 105 mg per day on a divided dosage. The patient is well maintained now for three months on this medication and no repeat episode of involuntary seminal discharge has occurred. So, while encountering such a presentation a diagnosis of underlying seizure activity should be kept in mind.

Epidermoid Cyst of the Canal of Nuck: A Rare Differential for Inguinolabial Mass: A Case Report

Praveen K Sharma, Afwaan Faizal, Ajay Lucas Rubben Prabhu, Pavankumar Mathapati

Epidermoid cysts of the canal of Nuck are an uncommon surgical cause of female inguinal enlargement when the processus vaginalis fails to close during embryologic development. The canal of Nuck, formed by the processus vaginalis in the inguinal canal, is a homolog of the processus vaginalis in men. The canal of Nuck should be considered in the differential diagnosis when a non reducible groin mass is observed in women and girls. Ultrasonography (USG) is the primary imaging modality that accurately and reliably diagnoses these groin masses. The incidence of pathologies is mainly encountered in young girls and is lower in adults. Various pathologic disorders related to the failure of processus vaginalis obliteration can occur, including the herniation of intra-abdominal structures such as the uterus, fallopian tube, ovary and hydrocoele of the canal of Nuck. Hernias are often suspected in paediatric patients with lumps in the inguinal region. Here the authors, present a case of an epidermoid cyst of the canal of Nuck in a two-year-old female identified by USG and Magnetic Resonance Imaging (MRI). The two-year-old female underwent surgical treatment, and subsequent histopathologic evaluation of the cystic lesion revealed an epidermoid cyst. Due to its rarity, the epidermoid cyst of the canal of Nuck is commonly misdiagnosed as a typical groin mass.

An Uncommon Site of Cutaneous Leiomyoma on the Heel of the Foot

Abhilasha Bhargava, Suhas Jajoo, Bhushan Jajoo

Leiomyomas are common benign tumours of smooth muscles, often occurring in the uterine muscle wall. These growths usually appear during a woman’s reproductive years and are not malignant. Leiomyomas are quite common and impact a large percentage of women worldwide. Occasionally, leiomyomas can be located in the extremities and cause pain due to compression effects. Typically, foot leiomyomas appear as a lump or mass in the soft tissue of the foot that grows slowly. They are normally painless, but pain or discomfort occurs when the growth affects or compresses the surrounding tissues or nerves. Although the precise cause of leiomyomas is unknown, it is thought that hormone changes, genetics, and other unidentified factors play a role in their incidence. Cutaneous leiomyomas are most often benign, and surgical removal can benefit patients in terms of pain management or symptom relief. Leiomyomas of the foot are uncommon. The present case report illustrates the clinical, radiographic, and pathological findings of a rare subcutaneous leiomyoma in the foot. The authors present the case of a 50-year-old woman who visited the Outpatient Department (OPD) complaining of swelling over the back of her left heel. Magnetic Resonance Imaging (MRI) of the ankle depicted the characteristics of the swelling, which was confirmed as leiomyoma through Immunohistochemical (IHC) tumour markers {Haematoxylin and Eosin (H&E)}. The lesion was surgically excised, and histopathology of the excised sample revealed leiomyoma.

Collaural Fistula on the Left-side of the Face: A Case Report

Sagar Gaurkar, Chandraveer Singh, Jasleen Kaur, Prasad T Deshmukh

Collaural fistula, also known as cervico-aural fistula, is a rare anomaly that accounts for less than 8% of all branchial cleft anomalies. These fistulas result from incomplete closure of the first branchial cleft during embryonic development. A 21-year-old female exhibited depression on the left-side of her face since childhood, accompanied by a fistula. She had a history of intermittent discharge and a tuft of hair emerging from it. Additionally, the patient reported left ear discharge and an opening in the floor of the External Auditory Canal (EAC). Diagnostic imaging, including X-ray fistulogram, ultrasound, and Magnetic Resonance Imaging (MRI) neck fistulogram, played a crucial role in confirming the diagnosis of a collaural fistula. Surgical intervention involved excision of the fistulous tract and reconstruction of the EAC floor. The patient received antibiotic therapy, resulting in successful postoperative outcomes. The present case highlights the importance of recognising and appropriately managing collaural fistulas. When these fistulas are discovered early, along with a solid grasp of regional embryology and anatomy, there is a chance for better treatment outcomes.

Endovascular Management of an Unusual Mycotic Aneurysm of the Inferior Mesenteric Artery: A Case Report

Thandra Sahitya, Phani Chakravarty Mutnuru, Surya Ramachandra Varma Gunturi

Mycotic or infected Aneurysms (MA) are rare and typically affect major arteries. However, infective causes (mycotic) resulting in the formation of aneurysms in the Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA), despite their substantial rarity, are often symptomatic and may present acutely. Hereby, the authors present a case of a 29-year-old male patient who presented with abdominal pain, fever, and generalised weakness. Contrast-enhanced Computed Tomography (CECT) of the abdomen revealed peripherally enhancing hypodense collections with air foci along the subhepatic, peri-splenic, peri-gastric, bilateral paravertebral, and posterior pararenal spaces, extending to the lumbar region. Furthermore, multilobar saccular outpouching with irregular margins and soft-tissue thickening was observed, originating from the proximal IMA. Pigtail drainage was performed, and culture showed the growth of polymicrobial flora. Due to the irregularity of the aneurysm, with a high-risk of rupture, coil embolisation of the IMA aneurysm was carried out. The imaging characteristics of infected aneurysms should alert clinicians and radiologists to the diagnosis, enabling timely treatment, which may involve endovascular techniques.

Accidental Microcoil Migration into Right Atrium during Portal Vein Embolisation: A Case Report

Vishal Nandkishor Bakare, Ravi Arya, Ritesh Kumar Sahu

With the advancement of technology in the field of medicine, minimally invasive vascular procedures are widely utilised for therapeutic effects. Embolisation is a minimally invasive approach to occlude a vessel for therapeutic benefit. However, these procedures are associated with a small percentage of complications, one of which is the migration of the embolising agent. Migration refers to the movement of the embolisation agent (mostly a coil) from the original placement site to an unwanted location. A 59-year-old male presented with complaints of abdominal pain lasting 2-3 months. A Contrast-enhanced Computed Tomography (CECT) scan of the abdomen revealed an ill-defined infiltrative lesion arising from the neck and body of the gallbladder. Curative surgery was planned in the form of an extended right hepatectomy; however, the Future Liver Remnant (FLR) calculated was not optimal (19%). The patient was therefore referred for preoperative Portal Vein Embolisation (PVE). During the procedure, there was an accidental microcoil migration to the right heart post-PVE, which was managed by minimally invasive techniques. The importance of multimodality imaging techniques used to identify the location and multidisciplinary approaches to aid management has also been highlighted.

Reverse Intermetamorphosis Coexisting in a Case of Capgras Syndrome with Delusion of Subjective Doubles

Ishani Roy Chatterjee

‘Delusional misidentification syndrome’ is a fascinating phenomenon in which an individual misidentifies person, place, object or even themselves and falsely believes that they have been replaced or some sort of transformation has occurred. Capgras delusion, Fregoli delusion, Intermetamorphosis, Delusion of subjective doubles, all these phenomena broadly come under the psychiatric disorder of delusional misidentification syndromes. This case was established by its clinical characteristics along with associated clinical findings, the patient’s response to treatment in concurrence with psychological and neuro-cognitive theories. The present case report suggests that these symptomatology of misperception, miscomprehension and misinterpretation of others and of self are probably more prevalent than thought previously and should be actively sought and recognised in patients. This article sought to showcase a phenomenon which had a rare component of Reverse Intermetamorphosis along with Capgras Syndrome and Delusion of Subjective Doubles having no organic component in a 22 year old male patient who responded to pharmacotherapy with neuroleptics. The psychopathological symptoms demonstrating Capgras in itself is rare and inadequately researched. Presence of three distinctive patterns of symptomatology together in one subject is intriguingly unique.

Open Surgical Retrieval of a Foreign Body in the Neck: A Case Report

Virendra Sudhakar Athavale, Sudhir Ramchandra Jayakar, Smitha Moghekar

Foreign body retention in the neck may be either traumatic or iatrogenic. Penetrating neck injuries with retained bodies are critical, as the neck serves as a passage for structures essential to life. Therefore, prompt detection and retrieval of the foreign body are paramount in preventing mortality. Here, authors present a case in which a successful surgical retrieval was performed without any postprocedural complications, despite the patient presenting relatively late after the injury. In this case report, a 23-year-old male labourer presented with a right-sided neck swelling two months after a workplace injury involving a shattered metal plate. Imaging confirmed a 15×5 mm hyperdense metallic object penetrating the sternocleidomastoid muscle. Successful open exploration extracted a 1.5 cm metallic shard at the C6 vertebral level, with no major vessel or airway damage. Postoperatively, the patient exhibited no movement restrictions, highlighting the atypical presentation of a retained metallic foreign body and the importance of timely intervention and comprehensive imaging for successful management.

H-shaped Talon Cusp in the Anterior Maxilla: A Diagnostic Dilemma

Nawadir Hamoud Alanazi, Josnavinutha Yadiki

Dental anomalies are clinically evident abnormalities that cause a variety of dental problems. Depending on the tooth location, dens evaginatus indicates a posterior tooth abnormality, while talon cusp explains an anterior tooth anomaly. Identifying the problem and initiating treatment requires careful observation and proper investigations. Here, the authors present the case of a nine-year-old female child who had an H-shaped talon cusp or barrel-shaped bilateral maxillary lateral incisors in the form of premolars. The report includes clinical and radiographic interpretation. Associated problems and various treatment options are also explained. Although dental anomalies affecting the teeth are relatively common, the presentation of barrel-shaped or premolar-shaped bilateral maxillary lateral incisors is uncommon. Knowledge about the prevalence and distribution of such anomalies would aid various dental experts in early identification and recognition of dental malformations, as well as in complete treatment planning.

Case of Peritoneal Malignant Mesothelioma in a 60-year-old Lady Presenting Clinically with Huge Abdominopelvic Mass: A Diagnostic Challenge

Usha Sarma, Rituparna Das, Mayurpankhi Saikia

Peritoneal malignant mesothelioma is a rare tumour that poses diagnostic challenges due to vague clinical symptoms, a variable histologic picture and being a common site for metastasis from GI organ, ovary, kidney and several other organs. We presented a case of peritoneal malignant mesothelioma in a 60-year-old lady who presented clinical symptoms of abdominal obstruction due to an omental cyst on a Computed Tomography (CT) scan. The case has been diagnosed as peritoneal malignant mesothelioma on histology along with a panel of immunohistochemical stains like calretinin (diffuse nuclear and cytoplasmic positivity), WT1 (diffuse nuclear positivity), CK 7 (focal positivity), PAX8 (focal positivity), CK20 (negative). At least two positive immunohistochemical markers and one negative marker help to distinguish mesothelioma from other entities. There was no history of active or passive asbestos exposure. She has been referred to a nearby regional cancer centre and managed accordingly. During her first postoperative check-up, she was asked about the history of asbestos exposure either in active or in passive form, which she denied. The present case report discusses the diagnostic dilemma in routine Haematoxylin and Eosin (H&E) stained tissue sections with a list of differential diagnoses as: 1) Primary tumour (peritoneal malignant mesothelioma versus primary serous carcinoma); 2) Sex cord-stromal tumour of ovarian origin; 3) Metastatic adenocarcinoma from neighbouring organ.

Dexamethasone-induced Singultus Post-dental Extraction: A Case Report

Priya Lele, Manasi Yewale, Nishita Bhosale, Vasantha Vijayraghvan, Pooja Pharne

Hiccups are involuntary reflexes, usually habitual and self-limiting in nature, experienced by the majority of people at some point in their lives. Persistent hiccups induced by pharmacotherapeutic agents, such as steroids, are considered minor complications. They can cause extreme discomfort and significantly lower the patient’s quality of life. This is the first report of persistent severe hiccups after Dexamethasone intramuscular administration in Indian patients post-dental treatment. Hereby, the authors present a case of a 50-year-old male patient with a medical history of Rheumatoid arthritis who was administered 8 mg of dexamethasone Intramuscular (IM) post-extraction. The patient was extremely restless when he reported to the dental clinic, as he had developed persistent hiccups post-24 hours. Neither the home remedies by the patient nor the topical application gel prescribed by the clinician were successful. As intractable hiccups continued for upto 34 hours, immediate action was taken, and the patient was referred to the physician. Pharmacological agents were administered, and the patient’s hiccups resolved completely by 42 hours. At the 1-week postoperative appointment, counseling was given on the suspected drug-induced cause of the transient hiccups for his future benefit. There is limited literature in dentistry on the management of drug-induced hiccups, despite the fact that clinicians routinely prescribe steroids postoperatively. The present case report comprehensively discusses the treatment algorithm for managing patients with drug-induced hiccups. Further studies are necessary to investigate the role of potential biomarkers for indicating the susceptibility of patients likely to develop severe persistent hiccups post-administration of steroids.

Spontaneous Rupture of the Gravid Uterus in a Multigravida Women with a Previous History of Caesarean Section: A Case Report

Spontaneous uterine rupture is a rare obstetric complication that has catastrophic effects on both the mother and foetus, resulting in significant morbidity and 80 to 90% foetal mortality. Rupture of the uterus through a previous lower uterine segment scar is the most common cause in developing nations. However, factors such as lack of antenatal care, inappropriate obstetric interventions, obstructed labour, grand multiparity, unbooked status, limited access to emergency obstetric care, and low socioeconomic status play a crucial role in uterine rupture in developing countries like India. Hereby, the authors present a case report of a 31-year-old pregnant patient at 19 weeks of gestation with sudden severe lower abdominal pain. An ultrasound revealed the absence of foetal cardiac activity, placenta located outside the uterus, an empty endometrial cavity, and minimal free fluid in the pelvis. Further, an Magnetic Resonance Imaging (MRI) of the pelvis showed a rupture of the anterior and right lateral uterine wall, through which the foetus and most of the placental tissue had passed into the peritoneal cavity. After confirming the diagnosis, the patient underwent emergency laparotomy, during which the uterine wall defect was closed with appropriate haemostasis. The patient recovered without any untoward complications.

Anaesthetic Management for Charcot Joint Surgery in a Previously Operated Meningomyelocele Patient: A Case Report

Saiesh Narayan Raut Dessai, Sanjot Ninave, Amol Bele, P Shiras

Charcot joint, a degenerative condition characterised by bone and joint destruction, often requires surgical intervention to alleviate pain and prevent complications. However, when this condition coexists with a history of meningomyelocele repair, additional considerations are necessary to ensure patient safety. The anaesthesia management for Charcot joint surgery in a meningomyelocele patient who has previously undergone surgery presents a unique challenge. Preoperative assessment should involve a comprehensive evaluation of the patient’s medical history, including previous surgical procedures, neurological status, and associated co-morbidities. Given the possible problems such as scarring, adhesion, and altered anatomy that may affect the choice of anaesthetic approach and airway management, particular attention should be paid to the site of the meningomyelocele repair. Here, the authors report a case of failed spinal anaesthesia in a 20 years old male patient with a history of operating meningocele who underwent surgery for Charcot’s joint. Charcot’s joint is a rare complication of syringomyelia or meningomyelocele, which can cause severe neurological deficits and deformities. Surgery is often required to correct the deformity and relieve the symptoms. Spinal anaesthesia is a commonly used technique for surgeries involving the lower limbs. This abstract highlights anaesthetic management in patients with Charcot joint and a history of meningomyelocele repair.

A Case of Upper Limb Amputation Managed with USG-guided Continuous Infraclavicular Nerve Block for Improved Postoperative Analgesia

Yashwant Nankar, Anilin Joey, Atluri Harika

Phantom Limb Pain (PLP) is defined as any perceived painful sensation localised to the region of the amputated body part, while phantom limb sensations are non painful sensations emanating from the phantom limb, including proprioceptive awareness, kinetic, exteroceptive, and superadded sensations. The mode of anaesthesia administered during amputation is an important factor in determining the emergence of PLP or phantom sensations. The majority of patients requiring emergency care are victims of traumatic injuries to the upper limbs, which are most often treated conservatively. The authors present the case of a 67-year-old male patient who sustained a fall on his arm while carrying a metal container, resulting in a laceration to his left arm that led to disruption of brachial artery blood flow, necessitating amputation. Although upper limb injuries are relatively common, concurrent vascular injuries are rare. However, when a major vessel such as the brachial artery is injured, amputation may be required. This loss of a limb can result in PLP. To prevent this, the authors used a unique and rare protocol of Continuous Peripheral Nerve Block (CPNB) in the present case. It not only underscored the importance of intraoperative analgesia in preventing PLP but also proved to be a crucial anaesthetic tool in facilitating the surgery and providing the patient with a more comfortable postoperative recovery.

Variation in the Branching Pattern of the Radial Nerve Observed during Fixation of the Humerus Shaft: A Case Report

Dhananjay D Deshmukh

The posterior cord of the brachial plexus typically maintains a consistent branching pattern, and deviations from this norm are exceedingly rare. Even more infrequently encountered are variations in the branching pattern of the radial nerve. The current case report of a 45-year-old male patient presents a unique clinical scenario involving a middle third and distal third humerus shaft fracture, manifesting as the chief complaint of pain during movement, coupled with localised swelling. A posterior approach was employed for surgical intervention due to the expansile nature of the fracture within the middle and distal thirds. During the surgical exploration, an anomalous branching pattern of the radial nerve was observed when transitioning from the posterior to the anterior compartment. This atypical radial nerve branching consisted of a branch extending into the anterior compartment and an accompanying posteroinferior branch, which notably supplied the medial and long heads of the triceps muscle. The present case underscores the imperative role of the orthopaedic surgeon in considering the radial nerve’s intricate anatomy while exposing and stabilising segmental humerus fractures. It is of paramount importance to exercise vigilance, as the conventional practice of splitting the triceps muscle should be abstained from until an unusual branching or splitting of the radial nerve is definitively ruled out. The present case report elucidates the significance of meticulous anatomical awareness and surgical technique when addressing such complex humeral fractures, offering insights into the management of these uncommon clinical presentations.

Disseminated Peritoneal Leiomyomatosis: An Unusual Complication of Laparoscopic Myomectomy

R Vaishnavi, Sobha S Nair, S Sudha, PV Nitu

Disseminated Peritoneal Leiomyomatosis (DPL) is characterised by multiple smooth muscle tissues over the peritoneal surface of the pelvic and abdominal cavity. Possible causes of DPL include hormonal factors, subperitoneal mesenchymal stem cell metaplasia, genetic factors, or iatrogenic factors. Hereby, the authors represents a case of DPL in a 42-year-old female with a history of two Laparoscopic Myomectomies. She presented with complaints of abdominal distension and bilateral lower limb pain lasting eight months. She underwent a robotic hysterectomy with bilateral salpingectomy and the removal of intraperitoneal nodules. Intraoperative findings showed a mass resembling leiomyoma over the uterus, mesentery, spleen, and rectosigmoid. She was discharged on postoperative day 4 and has been asymptomatic for the past two years. Robotic surgery is an emerging surgical modality in the treatment of DPL due to its better precision and ease of accessibility to upper abdominal organs. More importantly, recovery time is enhanced, and it reduces the duration of hospital stay.

Giant Congenital Melanocytic Naevi in Newborns: A Case Series

Giant Congenital Melanocytic Naevi (GCMN) is a very rare condition that mostly occurs due to an oncogenic mutation involving the NRAS (neuroblastoma RAS viral oncogene homologue) gene. GCMNs can be clinically diagnosed due to their typical features, but histopathology confirms the diagnosis. GCMN has a high propensity for transforming into malignant melanoma and leptomeningeal melanocytosis, leading to neurological deficits such as epilepsy and neurofibromatosis. As it is associated with Central Nervous System (CNS) melanosis, Magnetic Resonance Imaging (MRI) of the brain and spine is crucial. Here, three cases are reported of the babies born with GCMN from August 2022 to July 2023 in a tertiary care hospital among a total of 11,915 live births, where the incidence is much higher than found in the literature. Present series describes three cases with GCMN, including clinical features, MRI findings, short-term outcomes, risk factors, and modalities of the management. All three cases showed extensive blackish pigmented patches involving most of the body surface and MRI evidence of Neurocutaneous Melanosis (NCM). The third baby succumbed to death due to fulminant sepsis on day 2 of life. Management of GCMN requires a multimodal approach, including medical, surgical, chemotherapeutic, palliative, and psychological support for patients as well as parents, and follow-up is necessary for the early detection of malignant transformation. Detailed knowledge of this very rare condition may enable us to develop newer treatment modalities to achieve better outcomes in the near future.

CT Imaging findings of Extra-adrenal Abdominal Paragangliomas: A Case Series

SSM Zainul Abidin Sarmast

Extra-adrenal paragangliomas are rare neuroendocrine tumours originating from paraganglia outside the adrenal glands. The present case series illustrates the Computed Tomography (CT) imaging features of three instances of extra-adrenal abdominal paragangliomas. The discussed cases include Retroperitoneal paraganglioma with Inferior Vena Cava (IVC) infiltration and associated hepatic, pancreatic, and skeletal metastasis; Inter-aortocaval paraganglioma; and Organ of Zuckerkandl Paraganglioma. The CT imaging features of the lesions and their relation with the adjacent vascular structures are described. The differential diagnosis and histopathological correlations are discussed. These cases underscore the importance of considering paragangliomas in the differential diagnosis of soft-tissue masses in the abdomen and highlight the role of Contrast-enhanced CT (CECT) imaging in their evaluation. Understanding the diverse imaging characteristics of extra-adrenal paragangliomas aids in accurate diagnosis and appropriate management. Further studies are needed to expand the authors knowledge of these rare tumours and optimise their imaging evaluation.

Spinal Tuberculosis in Pregnancy: A Case Series

Swaramya Chnadrasekaran, Karthick Anand Krishnamurthy, Balaji Kalimuthu

Spinal Tuberculosis (Pott’s Spine) infection during pregnancy poses significant challenges in early diagnosis, as it often resembles typical back pain experienced during pregnancy. Delayed diagnosis has resulted in maternal and foetal complications, including paraplegia, premature labor, preterm delivery, and foetal growth restriction. Treatment approaches are tailored to individual clinical presentations and may involve conservative or surgical intervention. Surgical decompression should be considered when there is a neurological deficit that could complicate the delivery process. The standard Antituberculous Therapy (ATT) regimen for 12 months is an accepted treatment protocol according to the World Health Organisation (WHO) guidelines during the antenatal period. The present case series comprises four middle-aged pregnant women (two aged 19 years, one aged 21 years, and one aged 35 years, all primigravida) diagnosed with Pott’s spine at various trimesters, exhibiting a range of clinical presentations from mild back pain to acute neurological deficits. One patient in the late trimester with a neurological deficit required surgical decompression, while the remaining patients were successfully managed with appropriate ATT.

Clinico-pathological Spectrum of Rare Skin Syndromes and Diseases: A Series of Five Cases

A significant threat to patients’ well-being, mental health, capacity to function, and social participation- a measure of disability- is posed by skin diseases, resulting in significant mortality and morbidity worldwide. Despite the fact that the majority of rare diseases are complex, disabling, and life-threatening, little knowledge has been gained in this area. The diagnosis and classification of these rare skin syndromes with pre-determined sets of symptoms present a challenge. To diagnose a rare skin syndrome, one frequently has to correlate histologic findings with clinical symptoms, as there is a vast range of skin disorders, many of whose histologic traits overlap with just slight variances. However, histologic knowledge alone makes it difficult to diagnose these; proper diagnosis demands appropriate clinical knowledge. In the present study institute, 675 skin biopsies were performed over the course of five years, from 2018 to 2022. Based on clinico-pathological analysis, various rare skin syndromes were diagnosed, as depicted in present case series of five cases (10 years old boy, 40 years old male, 27 years old male, 44 years old male, 52 years old male patients) for: a) Griscelli Syndrome; b) Gougerot-Carteaud Syndrome, considered rare as it is one of the underdiagnosed and misdiagnosed syndromes due to its similarity with Pityriasis versicolour; c) Kyrle’s disease, a rare perforating dermatosis occurring in 10% of chronic renal failure patients who are on dialysis; d) Nekam’s disease; e) Sweet syndrome, an uncommon syndrome occurring in about 10-20% of malignancies.

Respiratory Syncytial Virus-related Lower Respiratory Tract Infections in Neonatal and Post-neonatal Babies: A Series of Four Cases

Respiratory Syncytial Virus (RSV) is a highly contagious seasonal virus that is the leading cause of acute Lower Respiratory Tract Infections (LRTI) in the paediatric age group and is one of the leading causes of death in children under five in developing countries. There is evidence that severe RSV infection and hospitalisation in early life increase the risk of recurrent wheezing, childhood asthma, and allergic sensitisation. Even though RSV being a major global health concern, very few papers concentrate on the neonatal period in India. The present case series presents four cases (three females and one male baby) highlighting the impact of RSV in neonatal and post-neonatal infants in India. The cases highlight the diversity of presentation; one infant required prolonged High-flow Nasal Cannula (HFNC) support, while two needed just symptomatic care. The importance of Polymerase Chain Reaction (PCR) in resource-constrained situations is highlighted as diagnostic issues are examined. Treatment focuses on supportive care; oxygen and respiratory support are provided in more severe cases. The present study emphasises the need for early detection and preventative measures, such as using novel treatments like nirsevimab. The present case series advocates for focused therapies and additional research in the Indian paediatric environment, adding insightful perspectives to the expanding body of knowledge on RSV.

Contrast MRI findings of Guillain-Barré Syndrome

A 28-year-old female patient presented with complaints of progressive bilateral lower limb weakness for the past seven days, which had increased to involve bilateral upper limbs for the past two days. She also presented with difficulty in speaking for five days, associated with exhaustion after speaking more than 10 words. The patient also complained of diarrhoea for four days with bladder disturbances. Difficulty in initiation of micturition with incomplete evacuation of urine associated with dribbling was noted. The patient had a history of high-grade fever three weeks prior due to respiratory illness, which subsided with medications in three days. The patient also reported a history of tingling sensation and paresthesia in both lower limbs. There was no history of bronchial asthma, tuberculosis, cardiovascular abnormalities, chronic kidney disease, migraine, trauma, epilepsy, or transient ischaemic attacks. On clinical examination, the patient was conscious, oriented, and afebrile. Deep tendon reflexes were absent. No signs of cyanosis, icterus, oedema, pallor, rash, or eschar were found. The patient had reduced finger grip in both toes and difficulty in squatting, suggestive of both proximal and distal muscle weakness in bilateral lower limbs. There was no history of cranial nerve involvement. The patient was normotensive with normal blood sugar levels. Clinically, a diagnosis of Guillain-Barre Syndrome (GBS) was considered. Blood and urine investigations were normal. A 24-hour urinary protein test was within normal limits. Urine culture and blood culture were negative. Cerebrospinal Fluid (CSF) analysis was normal with no evidence of albumin-cytological dissociation. Electrophysiological and nerve conduction studies were not classical of GBS and were inconclusive. Although GBS was suspected clinically, the CSF and nerve conduction studies did not contribute to the diagnosis. Hence, the patient underwent contrast Magnetic Resonance Imaging (MRI) of the whole spine and brain for further evaluation and to rule out other causes. On plain study, the cord revealed normal signal intensity with normal cauda equina nerve roots without clumping (Table/Fig 1)a,b. Postcontrast administration showed smooth enhancement of the pial surface of the conus medullaris with smooth thickening and enhancement of all the cauda equina nerve roots (Table/Fig 2)a-c. Although the differential diagnosis for diffuse cauda equina nerve root enhancement were many, such as GBS, spinal meningitis or arachnoiditis, and chronic inflammatory demyelinating polyneuropathy, most of these were ruled out by correlating with clinical history, and GBS was considered an appropriate diagnosis. The patient then received Immunoglobulin therapy, with five daily infusions for a total dose of 1 g/kg/wt, resulting in the reversal of symptoms subsequently. The patient is presently on follow-up and is doing well.

Role of Ultrasound in the Diagnosis of Retained Placenta

A 30-year-old female, in her second pregnancy at approximately 37 weeks of gestational age, presented with excessive pervaginal bleeding for four hours following a home delivery. A previous single antenatal ultrasound was performed at 13 weeks of gestational age, which indicated that the placenta was developing along the posterior uterine wall. During the current ultrasound examination, the uterus was found to be enlarged and bulky. A large hyperechoic structure measuring approximately 11.2×7.6×6 cm was observed in the fundo-posterior wall of the uterus (Table/Fig 1), showing minimal vascularity on colour Doppler (Table/Fig 2). This was identified as the non expelled retained placenta. Due to the diagnosis of retained placenta and the possibility of atonic Postpartum Haemorrhage (PPH), a hysterectomy was performed by the obstetrician under anaesthesia to prevent further uncontrolled blood loss. The uterus, along with the retained placental tissue, was removed (Table/Fig 3)a,b. Following the surgery, the patient experienced a cessation of blood loss, and her vital signs remained stable. Retained placenta is a significant cause of maternal mortality and morbidity, particularly in developing nations. It affects nearly two percent of all deliveries, resulting in a maternal mortality rate of approximately 10% in rural areas (1). Non institutional and home deliveries are major risk factors for retained placenta (1). The PPH is the leading cause of maternal deaths worldwide, and about 20 percent of these cases are attributed to retained placenta, as it disrupts normal uterine haemostasis and involution (2). The ability to dynamically visualise the uterus during the third stage of labour using ultrasound has contributed to an increased understanding of the mechanism behind placental retention. The expulsion of the placenta occurs during the third stage of labour, and the contraction of the retroplacental myometrium leads to its spontaneous expulsion (3). However, if the retro-placental myometrium fails to contract, it results in placental retention. The placenta produces multiple inhibitors of myometrial contraction, with progesterone and Nitric Oxide (NO) playing significant roles. The continuous production of these inhibitors may be the reason behind the failure of contraction of the retro-placental myometrium (4). Active management of the third stage of labour, using interventions such as oxytocin administration, uterine massage, or controlled cord traction, is the most effective way to prevent placental retention. However, in cases of retained placenta, the most common treatment is Manual Removal of Placenta (MROP) under anaesthesia. In situations where the retained placental tissue is large and causes excessive bleeding, hysterectomy is the preferred choice (5). AlMousa R et al., found that despite adequate management with broad-spectrum antibiotics, the postpartum fever of the patient did not resolve. This prompted further investigation, which revealed retained placental tissue as a possible source of infection, using pelvic ultrasound (6). Qazi AS et al., reported that ultrasound imaging demonstrated a sensitivity of 75% for detecting retained placenta. However, it is important to consider other possible mimics, such as blood clots and necrotic material (7). Ultrasonography is a routine procedure for detecting cases with retained placentas. Monitoring the patient’s signs and symptoms, along with postoperative radiological investigations, aids in the diagnosis and management of the condition.

Panda Sign: The Defining Feature of Wilson’s Disease

Ojas Mahajan, Anamika Giri, Sunil Kumar, Sourya Acharya

Wilson’s disease is an autosomal recessive disorder caused by a mutation of the Wilson’s (global) disease (ATP7B) protein produced by chromosome 13 (1). It manifests as an inability to excrete copper in bile, leading to copper deposition in the liver, brain, and other organs. Clinical signs and symptoms include liver dysfunction and neuropsychiatric disorders (2). While copper accumulation primarily occurs in the basal ganglia, it can affect all parts of the brain. Magnetic Resonance Imaging (MRI) is an effective tool for assessing disease severity and treatment response (3). A 28-year-old male patient presented to the Emergency Department at Datta Meghe Institute of Higher Education and Research with complaints of tremors in the right lower and upper limbs for one year, diminished vision in both eyes for eight months, and speech slurring for five months. There were no significant past or family medical histories. Jaundice or cirrhosis, which would have indicated hepatic involvement, were absent. A slit-lamp examination revealed Kayser- Fleischer (KF) rings in both eyes. Laboratory investigations showed the following results: serum copper 70 mg/dL (normal range: 85- 150 mg/dL), serum ceruloplasmin 9.2 mg/dL (normal range: 15- 60 mg/dL), and 24-hour urinary copper 110 mg/day (normal range: 50-70 mg/day). Other routine investigations yielded normal results. Additionally, the patient displayed MRI findings. T2-weighted MRI images showed hyperintense regions in the bilateral thalami, brainstem, and middle cerebellar peduncles without diffusion restriction (Table/Fig 1),(Table/Fig 2). These MRI findings resembled the “face of the giant panda”, which is characteristic of Wilson’s disease. Similar MRI appearances can be observed in conditions such as Leigh’s disease, Japanese B encephalitis, methanol toxicity, extrapontine myelinolysis, malnourished patients, and in cases of rapid correction of hyponatraemia (4). The patient was started on daily tablet penicillamine 250 mg and tablet zinc 50 mg thrice a day. The “Panda sign,” although seen in various conditions, is classically observed the present patients with Wilson’s disease, as described in this clinical case.

Sentinel Vessel Sign: A Shadow of the Subway Storm Setting into Strike Sight

Rakesh Kumar Jha, Jaya Kaushik, Sunandan Bhatta

A 56-year-old woman presented with a complaint of painless diminished vision in the right eye for nine months. Best-corrected visual acuity was 20/400 Oclulus Dexter (OD) and 20/20 Oculus Sinister (OS). Ophthalmological examination revealed a prominent solitary, tortuous, dilated episcleral sentinel vessel in the superonasal aspect of the right eye (white arrow, (Table/Fig 1)a). An undilated examination revealed a normal pupillary area (Table/Fig 1)b, but a dilated examination revealed a retrolental dome-shaped dark-brown mass in the superonasal quadrant protruding into the vitreous cavity (Table/Fig 1)c. Ultrasonography revealed a 9 mm acoustically-solid mass in maximum dimension with medium internal reflectivity (Table/Fig 1)d. A diagnosis of ciliochoroidal melanoma was made. A Computed Tomography (CT) scan of the head excluded extraocular extension (yellow arrow, (Table/Fig 1)e). Metastatic work-up, along with radiological imaging, excluded distant metastasis. Given the involvement of the ciliary body (which carries a worse prognosis), the involved eye was enucleated after due counseling with the patient. Subsequent histopathological examination, along with immunohistochemistry analysis of the lesion, revealed it to be a grade III-pT1-stage malignant melanoma with no local invasion. After enucleation, subsequent follow-up examinations for one year excluded any recurrence.

Hypermobility of Tongue: A Clinical Curiosity

Dear Editor, A 43-year-old female patient presented to private dental clinic with a chief complaint of accumulated dirt and stains on teeth for the past two years. The patient expressed aesthetic discomfort and reported experiencing bad breath for approximately six months. No relevant medical, surgical, or habitual history was disclosed. During the general examination, the patient appeared well-oriented, co-operative, moderately built, and overall normal. Intraoral examination revealed generalised extrinsic stains, plaque, and calculus. No evidence of gingival pockets or recession was observed, leading to a diagnosis of generalised chronic gingivitis. The lingual surface of the tongue exhibited the absence of a lingual frenulum, resulting in an “abnormally moving tongue.” The dorsal surface of the tongue appeared depapillated and coated with food debris. Consequently, a scaling procedure was recommended. During scaling, the patient was instructed to retract her tongue to clean the lingual surface of the lower incisors. Unexpectedly, the patient folded her tongue back and placed it behind the uvula region. When asked to protrude the tongue forward, it extended beyond the chin (Table/Fig 1),(Table/Fig 2). Deformities in the lingual frenulum are typically of systemic, developmental, or genetic origin. Various conditions, such as Ehlers-Danlos Syndrome (EDS), Infantile Hypertrophic Pyloric Stenosis (IHPS), and non syndromic ankyloglossia, are commonly associated with the absence of the lingual frenulum (1),(2),(3). IHPS occurs in three out of 1000 live births, with a male predilection at a ratio of 3:1. It also shows a high familial predisposition. Infants between 3 and 6 weeks of age start exhibiting symptoms such as increased episodes of vomiting after each feed (2). However, since the patient in present case did not report any history of bowel obstruction or forceful vomiting, IHPS was ruled out. EDS is a connective tissue disorder that is usually of genetic origin. The prevalence of EDS is 1 in 400,000 people, with no prominent gender prevalence observed (3). The syndrome is divided into six types: classical, hypermobile, vascular, kyphoscoliotic, dermatosparaxis, and arthrochalasis. It involves mutations in multiple genes, including COL5A1, COL5A2, COL3A1, COL1A1, PLOD1, TNXB, and COL1A2. EDS affects multiple organs and can be life-threatening. One of its characteristics is the absence of the lingual frenulum. Other structures affected by this syndrome include joints, skin, and blood vessels. A hypermobile tongue is an important clinical feature, present in approximately 71% of the cases (4). Existing literature supports a hypermobile tongue as a unique diagnostic criterion for EDS. In present case, there were no signs or symptoms associated with EDS other than a hypermobile tongue. The ability to touch one’s nose tip or chin with the tongue is referred to as Gorlin’s sign. It is common in 5% of the general population (5) and in 50% of individuals with EDS (6). Interestingly, Gorlin’s sign was positive in the presented case as well. The first case series on hypermobile tongue was reported in 1742 (6). Petit brought excessive tongue mobility to the medical world’s attention in three children, two of whom died due to suffocation caused by it. In 1845, Fairbairn reported a similar case where the patient died due to airway obstruction. In 1877, Henning also reported a case of obstructing hypermobile tongue associated with mortality. Later, in 1958, Schiff reported a case without any symptoms during a routine Ear, Nose and Throat examination in the Navy (6). Cinar F et al., presented a case of a healthy 45-year-old Turkish man who could pass the tip of his tongue beyond the uvula and into his nasal cavity to clear nasal secretions (1). They referred to this condition as “idiopathic hypermobile tongue”. Cincik H et al., discovered a hypermobile tongue while examining a 16-yearold Turkish boy who came for evaluation of loud snoring (7). The boy’s tongue was capable of reaching the posterior nasal cavity. In 2012, Surendran S et al., reported a case series of 12-year-old and 16-year-old with hypermobile tongue that extended beyond the uvula during routine examinations (8). More recently, in 2019, Felemban R and Mawardi H reported a case of congenital absence of the lingual frenulum in a 21-year-old female patient without any associated syndrome (9). Idiopathic hypermobile tongue does not usually cause any functional disturbances. Hence, they are often ignored, but in some cases, they can result in choking and even death. These rare conditions have significant diagnostic value and can help prevent mortality caused by ignorance.

Teaching and Learning Strategies for First-year Medical Student

Sarita Anil Shinde, Umesh K More

Dear Editor, We read with great interest the article “Graph Constructors Versus Graph Interpreters Versus Non Graphers: A Search towards Better Cognitive Performers in Biochemistry among First-Year Medical Undergraduates,” published by Gunanithi K et al., in the July 2023 issue (BC01-BC04) of Journal of Clinical and Diagnostic Research (1). As a professor of biochemistry, I am aware that present teaching approach is a time-consuming process. The number of biochemistry lectures has been reduced for the academic year (2023-2024) in accordance with new The National Medical Commission (NMC) standards. Although this reduction has been promptly reversed, it will still take place (2). Creating intricate graphic representations of complicated metabolic pathways or chemical structures requires a significant amount of time. Sometimes, graphs and diagrams may not be suitable for explaining biological processes. Additionally, graph constructors might be more concerned with the aesthetic appeal of their diagrams than the accuracy of the content. In biochemistry, to improve cognitive performance, teachers must consider different teaching and learning styles. Based on individual variability in learning preferences, I believe we should adopt a more effective multimodal teaching approach rather than simply categorising students into specific learning styles, such as graph constructors. We can incorporate crucial strategies like “Active Learning Strategies,” including case studies, group discussions, and problem-solving exercises, to encourage student participation and critical thinking, as these abilities may aid in understanding biological concepts and applying knowledge in actual clinical settings. We can motivate students to discover their preferred learning methods by guiding them and encourage peer-to-peer interactions, which can enhance overall comprehension and build teamwork skills. Additionally, we can consider connecting theoretical concepts to real-life medical scenarios, using virtual simulations and online resources, among other methods. We experimented with a fresh approach last year. For first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students, we organised a Biochemistry Fun Day on July 29, 2022, in honour of the birth anniversary of “Carl Alexander Neuberg, a father of modern biochemistry.” As a part of this event, a variety of activities were conducted based on Competency-based Medical Education (CBME) competencies, such as a treasure hunt for clinical diagnosis, a culinary competition for nutrition, crossword activities for metabolic pathways, role plays, and many more (3). The program was well-received by the students, who were able to recall information and apply it in exams, as well as to enhance their understanding of higher education learning studies. In conclusion, as medical educators, it is our responsibility to recognise the significance of various learning approaches among first-year medical undergraduates. I genuinely hope that the present conversation sparks further curiosity and encourages additional study in the area of cognitive function in biochemistry instruction. By consistently exploring and improving our teaching methods, we can develop our students to become competent and well-rounded medical professionals. Author’s response Dear Reader, The study has not generalised that graphing is the only and best option for improving cognitive performance in all circumstances and scenarios of biochemistry teaching. It rather conveyed only for appropriate contents that can be graphed to facilitate teaching learning process and improving cognitive performance related to those contents. Further, regarding the time consuming nature of teaching sessions using graphs and distractions due to graph aesthetics. When contents are appropriate for graphing, facilitators should find their time in graph construction, if they are really concerned about improving cognitive performance. Regarding comment on aesthetics, graph appeal appears aesthetic only when the details of data are clear and well understood. It all depends on facilitators unless the sessions are conducted by primary school drawing teachers in medical schools. Finally, the study groups were categorised as per study design only for the study. It doesn’t mean to be generalised that pupils need to be categorised in any way during implementation of any teaching learning strategy in medical colleges. Regards, Dr. Gunanithi K, M.D. Corresponding Author

An Effective Self-directed Learning Method for Medical Students: Panel Discussion and Poster Preparation

Sandesh Thorat, Pradnya Phalak

Dear Editor, I have read with great interest the original article titled “Introducing Case Study-based Panel Discussion as an Effective Means of Self-directed Learning (SDL) in Phase 2 Bachelor in Medicine and Bachelor in Surgery (MBBS) Students: A Cross-sectional Study” by Raychaudhuri S et al., which was published in this journal in July 2023 (1). I would like to take the opportunity to comment on the same article. The faculty made exhaustive efforts and achieved positive outcomes. With the introduction of this teaching method, students showed improvement. After reading this article, my impression is that panel discussion is a very effective method for studying cases of particular diseases in detail. This study also shows that students’ response was very encouraging. The National Medical Council of India introduced Competency-based Medical Education (CBME), in which importance is given to methods such as Problem-based Learning (PBL) and SDL, where students’ involvement is more (2). Although it appears to be a very effective method, I would like to offer another suggestion that could make it even more effective. The suggestion is that the panel discussion method could be accompanied by another method, such as poster preparation of the cases discussed in the panel. Various studies have shown good results from poster preparation. The panel discussion in this study detailed the case topics, but if poster preparation of these cases is also included, it would be more useful for future studies. These cases will be in written form and available for access at any time in the future. Students might forget some points discussed in the panel, but by creating posters, these cases will be available for study during exams, providing an added advantage to the panel discussion of the topic. Our experience related to poster preparation by students is that they take interest in poster preparation and find it to be a good learning method. A similar view is provided by another study on poster preparation, suggesting that the concept of poster presentations was comfortable for students and they enjoyed poster preparation (3). Another study observed that during and after the poster presentation, there was a sense of confidence among students (4). Yet another study states that preparing a poster is a very effective research skill and enhances creative abilities (5). Previous literature also suggests that this activity fosters active learning and helps in deep learning (6). So, my suggestion is that the panel discussion SDL method should be combined with poster preparation so that the discussed topic will be available to the students for reference at any time in the future, as it will be in written form. A combination of the panel discussion method and poster preparation can prove to be more effective. Author’s response Dear Reader, Thank you for your valuable feedback. I completely agree with your suggestion that panel discussion method could be accompanied with other methods such as poster preparation of cases. In my opinion visual representation will enhance learning. I would incorporate your suggestion in my teaching and learning process. Regards, Dr. Namrata Kahlon

Exploring Matrix Metalloproteinases in Children’s Oral Health: Mechanisms, Implications and Therapeutic Insights

Swagata Saha, Manju Raman Nair

Dear Editor, The oral cavity is recognised as a dynamic environment where various physiological processes are set in motion during the course of a child’s development. These processes include significant events such as tooth eruption, gingival development, and tissue repair (1). Within this intricately orchestrated scenario, Matrix Metalloproteinases (MMPs) are identified as pivotal participants (2). MMPs comprise a family of enzymes that are widely acknowledged for their engagement in the degradation of the Extracellular Matrix (ECM) and the remodelling of tissues, both of which are fundamental processes in the maintenance of tissue homeostasis. Nevertheless, the equilibrium overseen by MMPs has the potential to be disrupted, thus giving rise to the possibility of oral diseases manifesting in paediatric patients. The MMPs, as zinc-dependent endopeptidases, hold central roles in the remodelling of the ECM, a critical aspect of maintaining oral tissue integrity. These enzymes are initially secreted as inactive proenzymes, becoming active upon cleavage of their propeptide domain. MMPs are further categorised based on their substrate specificity, encompassing collagenases, gelatinases, stromelysins, and membrane-type MMPs. They emanate from various cell types within the oral milieu, including fibroblasts, epithelial cells, and inflammatory cells, and their activity is tightly regulated to preserve tissue integrity (3). The primary function of MMPs in paediatric oral health revolves around tooth development and eruption. MMPs actively participate in the remodelling of the ECM within the dental follicle and alveolar bone, facilitating the emergence of primary and permanent teeth alike. Notably, gelatinases MMP-2 and MMP-9 assume a pivotal role in this context by degrading ECM components that might otherwise impede the natural eruption process, thereby ensuring teeth emerge in their correct positions within the oral cavity (4). In addition to their involvement in tooth development, MMPs are instrumental in maintaining gingival homeostasis, a critical aspect of paediatric oral health. Gingival tissues constantly undergo turnover and remodelling to preserve their structural integrity and functionality. Within the gingival milieu, MMP-1 and MMP-8, among others, regulate collagen metabolism. This regulation is crucial for conferring stability and resilience to the gingiva, enabling it to withstand mechanical stresses and microbial challenges (5). Furthermore, MMPs contribute significantly to the process of tissue repair within the oral cavity, a particularly relevant function in the context of paediatric dentistry. Children are susceptible to oral injuries and traumas, which may result from accidents, falls, or sports activities. In such scenarios, MMPs become activated to degrade the damaged ECM and facilitate efficient tissue healing. This function aids in the recovery of various oral tissues, including the gingiva and oral mucosa, ensuring that wounds heal effectively while minimising complications (6). Moreover, MMPs play a noteworthy role in maintaining the equilibrium of the oral microbiome - a diverse microbial community that resides in the oral cavity. Maintaining this balance is crucial for overall oral health. MMPs contribute to regulating the oral microbial environment through their involvement in the turnover of the oral mucosa and supporting tissues. This regulation serves to sustain a state of equilibrium within the oral microbiome, preventing the overgrowth of harmful bacteria that may lead to common dental diseases like dental caries and periodontal diseases (7),(8). Switching gears, MMPs also play a pivotal role in orthodontic treatment for children. They are involved in remodelling tissues during tooth movement, breaking down and rebuilding ECM components like collagen and proteoglycans. This enzymatic activity ensures precise tooth movement within the bone, a critical aspect of orthodontic treatment. Additionally, MMPs aid in adapting periodontal tissues to orthodontic forces, contributing to a stable occlusion after treatment. However, it’s crucial to carefully regulate MMP activity to prevent adverse effects like root resorption, ensuring the child’s oral health is optimised (9). A profound understanding of how MMPs influence tooth eruption, gingival health, tissue repair, and microbial balance equips paediatric dentists with invaluable insights for refining diagnostic and treatment strategies. This knowledge empowers dental professionals to enhance their management and preventive measures concerning paediatric dental issues, including dental caries, periodontal diseases, and malocclusion. Consequently, deciphering the multifaceted role of MMPs holds the potential to revolutionise treatment modalities, ushering in a new era of more effective and personalised care, ultimately securing the improved oral health and overall well-being of young patients (10). However, it is worth noting that while the importance of MMPs in paediatric oral health is evident, the scarcity of available literature addressing their impact highlights the need for meticulously designed, long-term research studies in this field. The future of MMP research in paediatric dentistry anticipates groundbreaking discoveries that encompass early disease detection using MMP biomarkers and the development of tailored therapies to modulate MMP activity. The integration of advanced imaging techniques and molecular approaches is poised to provide a more comprehensive and personalised approach to paediatric dental care. Furthermore, interdisciplinary collaboration and the accumulation of knowledge will shape the field of MMP research, ultimately resulting in enhanced oral health outcomes and an improved quality of life for young patients.

Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Intrathecal adjuvants can be added to extend the duration of analgesia. To achieve this, several adjuvants, such as the combination of dexmedetomidine with bupivacaine versus fentanyl with bupivacaine, have been used with local anaesthesia during lower limb surgeries. Aim: To compare the combination of dexmedetomidine versus fentanyl with bupivacaine administered intrathecally for the onset and duration of sensory and motor block, as well as their side-effects and the prolongation of postoperative analgesia in lower limb surgeries. Materials and Methods: A randomised clinical study was conducted on 120 American Society of Anaesthesiologists (ASA) grade I or II patients, aged between 18 and 65 years, who were admitted to the Department of Orthopaedics and General Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, India for lower limb surgeries under spinal anaesthesia. The patients were randomly assigned to two groups using a computer-generated technique. Group BD received 0.5% bupivacaine (2.5 mL)+10 mcg dexmedetomidine (0.5 mL), while Group BF received 0.5% bupivacaine (2.5 mL)+25 mcg fentanyl (0.5 mL). The onset and duration of sensory and motor blockade, haemodynamic parameters, sedation, and side-effects of the drugs were analysed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 2.0 after collecting all the data. Results: There were no statistically significant differences in the subjects’ demographics or duration of surgery. However, the duration of sensory block and motor block was significantly prolonged in Group BD compared to Group BF, with values of 720±32 and 640±32, respectively. The mean Heart Rates (HR) differed significantly between of the two groups (p-value=0.03). There was no significant difference in sedation scores between the two groups. Group BD showed a higher incidence of bradycardia (n=35) and hypertension (n=32). Conclusion: The combination of dexmedetomidine with bupivacaine, when used intrathecally for lower limb surgeries, demonstrated superior effectiveness in terms of prolonging sensory and motor block duration and providing extended postoperative analgesia, compared to the combination of bupivacaine and fentanyl. However, it is important to note that patients receiving the dexmedetomidine-bupivacaine combination had a higher incidence of bradycardia and hypertension. Therefore, careful monitoring and management of haemodynamic parameters are necessary when using this combination.

Onset and Progression of Urogenital Symptoms after Surgical Menopause: A Prospective Cohort Study

C Anjana, CR Resmy, Jisha Ismail

Introduction: Surgical menopause is the cessation of menstruation resulting from the surgical removal of the uterus and bilateral ovaries, which leads to a sudden decrease in oestrogen levels and its subsequent effects. Urogenital symptoms are chronic and progressive, but only a few women seek medical care for these symptoms, which are often overlooked during routine follow-ups. Aim: To investigate the onset and progression of various urogenital symptoms after surgical menopause. Materials and Methods: A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College, Thrissur, Kerala, India from January 2020 to December 2020. A total of 110 women who underwent Total Abdominal Hysterectomy (TAH) and Bilateral Salpingo-Oophorectomy (BSO) for benign conditions were included in the study. The women were asked about the onset of urogenital symptoms at six weeks and 12 weeks after surgery. They were required to indicate whether they experienced four urogenital symptoms (vaginal dryness, frequent urination, urinary incontinence, and reduced sexual desire) using a menopause rating scale. The severity of symptoms was categorised as none (0), mild (1), moderate (2), severe (3), or very severe (4). The progression of symptom severity from six weeks and 12 weeks of follow-up was analysed using Chi-square tests. Results: Urogenital symptoms that developed after surgery included vaginal dryness, dyspareunia, bladder symptoms, and reduced sexual desire. At least one of these symptoms developed in 95 (86.4%) women by 12 weeks. Vaginal dryness was reported by 40 subjects (36.4%) at six weeks, with 36 (32.7%) reporting mild symptoms, 4 (3.6%) reporting moderate symptoms, and none reporting severe or very severe symptoms. At 12 weeks, vaginal dryness was reported by 61 subjects (55.5%), with 21 (19.1%) reporting mild symptoms, 18 (16.4%) reporting moderate symptoms, 20 (18.2%) reporting severe symptoms, and 2 (1.8%) reporting very severe symptoms (p-value <0.05). Other symptoms showed a similar pattern of progression. Conclusion: Urogenital symptoms can start as early as six weeks after surgery and can worsen in severity if left untreated.

Evaluation of the Predictive Role of Neutrophil Lymphocyte Ratio and Mean Platelet Volume in Preterm Deliveries: A Cross-sectional Study

Disha Sai M Chandavar, Jessica Minal, KS Rashmi

Introduction: Preterm birth is associated with high perinatal morbidity and mortality. Identifying women at risk for preterm labour early in pregnancy may improve pregnancy outcomes. Neutrophil-Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) can be helpful in predicting preterm labour, as infection is an important factor in early preterm deliveries, with immunity playing a key role in preterm labour. Aim: To evaluate the predictive role of the NLR and MPV in preterm deliveries. Materials and Methods: This cross-sectional study was conducted in a tertiary care and research hospital from August 2022 to October 2023. Haematological and clinical data were retrieved for preterm deliveries (n=79, group I) and term deliveries (n=151, group II). The two groups were compared in terms of demographic characteristics, obstetric and laboratory findings, including maternal age, gravida, parity, birth weight, NLR, MPV, and haemoglobin levels. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 29.0. One-way Analysis of Variance (ANOVA) was used to compare the mean values among different groups. Categorical values were evaluated with Pearson’s Chi-square test. Receiver Operating Characteristic (ROC) curve was used to assess the diagnostic properties of the tests. Results: The two groups showed no statistical difference in terms of demographic parameters such as the mother’s age (p-value=0.611), parity (p-value=0.798), and gravida (p-value=0.583). The NLR was higher in group I (5.8±5.01) compared to group II (4.3±1.75), and this difference was statistically significant with a p-value of <0.001. MPV was observed to be lower in group II (8.7±0.96) compared to group I (8.9±1.07); however, this difference was not statistically significant (p-value=0.128). The mean baby weight and mean maternal haemoglobin in group I were significantly lower compared to group II. Conclusion: In this study, the NLR value was significantly higher in patients with preterm deliveries compared to term deliveries. This study highlights the role of NLR as an emerging predictor of preterm deliveries and emphasises that NLR, obtained from an inexpensive and routinely conducted haemogram, has the potential to be used as an early indicator of preterm deliveries.

School Teachers’ Knowledge and Attitude towards Mental Disorders among School-going Children: A Cross-sectional Study

Lubna Tyagdal, Akshay Shreekrishna Phatak

Introduction: Mental disorders in children can present with non specific behavioural issues, like irritability and procrastination. These issues are often neglected, which can negatively affect academic performance and overall development. Teachers hold a unique position to promote mental health and facilitate early identification of mental disorders, leading to timely referrals for early intervention. Aim: To examine the knowledge and attitude of school teachers towards mental disorders in school-going children. Materials and Methods: A cross-sectional study was conducted in Karwar city over a period of two months (July and August 2019) at the Karwar Institute of Medical Sciences, Karnataka, India. A total of 121 primary and high school teachers from 11 schools participated in the study. Purposive sampling was used, as all schools in Karwar city were approached for the study. A self-designed questionnaire consisting of 20 questions (10 questions on knowledge and 10 questions on attitude towards children with mental disorders) was used. Descriptive statistics, such as percentages, were used for data analysis. Results: The study revealed that teachers had moderate knowledge about child mental disorders. However, there was a lack of awareness about the treatment and care of such children. Sixty-three (52.07%) teachers believed that mental disorders result from incorrect thinking. Seventy-nine (65.29%) teachers were of the opinion that sleeping pills are not the only available treatment. Attitude towards children with mental disorders were both positive and negative. 82 (67.77%) teachers believed such children to be less intelligent, while 76 (62.81%) teachers did not believe mentally ill children indulge in violence. Many teachers were aware that these children can be vulnerable to bullying and discrimination by their peers. Conclusion: The study concluded that there is moderate knowledge and mixed attitude among school teachers regarding mental disorders in school-going children. This highlights the need for proper training programs that can aid in early identification, timely referrals for mental health evaluation, and the promotion of child mental health.

Serum Leptin-adiponectin Ratio in Patients With and Without Metabolic Syndrome: A Cross-sectional Study

Introduction: Metabolic Syndrome (MetS) is one of the most significant global public health concerns. Leptin, adiponectin, and the Leptin-adiponectin (LA) ratio have been shown to be informative biomarkers for obesity, Type 2 Diabetes Mellitus (T2DM), and Cardiovascular Diseases (CVD). Many contributing factors, such as Insulin Resistance (IR), adipose tissue dysfunction, chronic inflammation, and genetic factors, are proposed to be the aetiological factors of MetS. Leptin and adiponectin have opposite effects on IR, so the combined use of these adipokines may serve as a better biomarker in MetS. Aim: To determine serum leptin levels, adiponectin levels, and the LA ratio in patients with and without MetS. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry and Medicine at the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, from January 2021 to October 2022. The study included 50 diagnosed cases of MetS and 50 individuals without MetS. Leptin, adiponectin, and parameters of MetS {Body Mass Index (BMI), weight, Waist Circumference (WC), skinfold thickness, High-density Lipoprotein (HDL), Triglycerides (TG), and Blood Pressure (BP)} were assessed in the study. The data were statistically analysed using Independent Sample t-test and Pearson’s correlation test. Results: There were 23 males and 27 females in the study group. The mean age was found to be 61.10±12.52 years in cases and 57.08±10.67 years in controls. Leptin levels were significantly higher in cases (26.58±14.6 ng/mL) compared to controls (12.99±8.59 ng/mL). However, adiponectin levels were significantly decreased in cases (7.16±4.19 μg/mL) compared to controls (12.18±9.4 μg/mL). The LA ratio was found to be higher in cases (5.38±4.71 ng/μg) than in the controls (1.84±1.99 ng/μg). Multiple linear regression analysis demonstrated that the LA ratio was strongly associated with MetS among Leptin, Adiponectin, and the LA ratio (p<0.05). Conclusion: Metabolic syndrome was strongly associated with an increased LA ratio, leptin, and decreased adiponectin levels. The LA ratio can better discriminate the risk of MetS than leptin and adiponectin alone and may be used as a sensitive clinical surrogate biomarker of MetS.

Correlation of Cross-sectional Area of the Umbilical Cord on Antenatal Ultrasound with Neonatal Birth Weight in Pregnant Women with and without Gestational Diabetes Mellitus: A Prospective Cohort Study

Introduction: Many foetal and maternal complications, such as polyhydramnios, macrosomia, birth injuries, and operative interference, are linked with Gestational Diabetes Mellitus (GDM). Among these, macrosomia is particularly significant, as it increases the risk of shoulder dystocia, brachial plexus injury, birth asphyxia, and maternal complications, including emergency Lower Segment Caesarean Section (LSCS), Postpartum Haemorrhage (PPH), and perineal trauma. Therefore, one of the most essential perinatal goals in GDM is to predict macrosomia by estimating birth weight, thereby preventing adverse maternal and foetal outcomes. Aim: To evaluate whether there is a correlation between the cross-sectional area of the Umbilical Cord (UCA) and the Neonatal Birth Weight (NBW) in pregnant women with GDM. Materials and Methods: A prospective cohort study was conducted in the Departments of Radiology and Obstetrics Bangalore Medical College, Bengaluru, Karnataka, India. A total of 100 pregnant women (50 with GDM and 50 without GDM) were recruited from July 2021 to July 2022. Ultrasound examination (USG) was performed on pregnant women after 36 weeks of gestation. The UCA was measured in a free-floating loop, and the NBW was measured using a digital scale. The correlation coefficient was calculated to determine the degree of correlation between UCA and NBW. Results: The mean age of the subjects was 26.5±3.9 years. The frequency of macrosomia was higher in the GDM group (8%) compared to the control group (4%). A strong positive correlation was observed between UCA and NBW in both diabetics (r=0.819) and control groups (r=0.736). Conclusion: A strong positive correlation exists between UCA and NBW in women with GDM. Therefore, it should be estimated during routine antenatal USG for the prediction of birth weight in such women.

Effect of Sit-to-Stand Training on Balance, Muscle Strength, and Activities of Daily Living in Patients with Stroke: A Randomised Controlled Trial

S Amala, Purusotham Chippala

Introduction: Patients who have had a stroke often experience issues with static balance while sitting and standing. Additionally, they may encounter problems with dynamic balance, particularly when transitioning between sitting and standing positions, leading to reduced postural stability in both static and dynamic standing. This also contributes to weakness in the affected lower limb and decreased engagement in Activities of Daily Living (ADL). Nevertheless, few studies have investigated the impact of sit-to-stand training on balance, muscle strength, and ADL in stroke patients. Aim: To assess the impact of sit-to-stand training on balance, muscle strength, and ADL in patients who have had a stroke. Materials and Methods: This trial was an experimental, parallel, and assessor-blinded allocation with a computer-generated randomisation sequence. Sixty-six stroke patients (33 in each group) were enrolled from the inpatient Department of Medicine and the neurosurgery ward of Justice KS Hegde Charitable Hospital in Deralakatte, Mangaluru, Karnataka, India based on specific selection criteria. The trial was conducted from March 2022 to March 2023. Inclusion criteria included patients who had experienced a stroke involving the Anterior Cerebral Artery (ACA) and Middle Cerebral Artery (MCA), encompassing both ischaemic and haemorrhagic types of stroke, aged between 35-60 years, and including both male and female stroke patients who were able to effectively communicate and comprehend instructions. Other criteria included a Mini-Mental State Examination (MMSE) score greater than or equal to 23, the ability to independently have a transition from a supine position to a seated position, and a minimum score on the trunk impairment scale. In the experimental group, participants received sit-to-stand training for 45 minutes over five days, while the control group received conventional physical therapy, including tandem walking, single leg stance, double leg stance, early mobilisation, position and balance training exercises for 45 minutes over five days. The primary outcomes used for balance assessment were the Berg Balance Scale (BBS), and for ADL, the Barthel Index (BI) Scale was used, with muscle strength being measured using a push and pull dynamometer. The independent sample t-test was used to compare between groups, and within-group comparisons were conducted using the paired t-test. A p-value <0.05 was considered significant. Results: Significant differences (p-value=0.044) were observed in BBS score and muscle strength between the groups during both the pretest (Day-1) and post-test (Week-1). The BI exhibited a significant difference (p-value=0.016) during the post-test (Week-1) only. Additionally, a significant difference (p-value <0.001) was found in muscle strength, specifically in the Hip Extensors (HE) between the groups. Conclusion: The results of the current study showed a statistically significant difference in muscle strength of the HE. However, no significant difference was observed in BI and BBS between the groups. No side-effects or harms were reported, indicating that the approach is safe and feasible for stroke patients.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value <0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO₂ (p=0.404) were comparable between the two groups (p>0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

Postoperative Outcomes in Patients undergoing Transabdominal Preperitoneal Repair versus Lichtenstein’s Repair for Inguinal Hernia: A Prospective Cohort Study

Shankar Gururaj Kollampare, Abhay M Philip, Rakesh A Rai

Introduction: Transabdominal Preperitoneal (TAPP) and Lichtenstein tension-free repair are well-established methods for inguinal hernia treatment. There is a need to establish the short-term outcomes of both procedures. Aim: To determine the short-term outcomes of Lichtenstein and TAPP hernia surgery. Materials and Methods: A prospective cohort study was conducted in the Department of Surgery at Father Muller Hospital, Mangaluru, Karnataka, India from November 2020 to May 2022. A total of 30 male patients underwent TAPP and 30 male patients underwent Lichtenstein repair. Polypropylene mesh (Trulene macropore, Healthium Medtech, India) was used in both groups. Postoperative pain, early ambulation, number of days stayed in the hospital postoperatively, time taken to return to work, cost-analysis, and operating time were assessed between the groups using mean, percentage, Student’s t-test for continuous data, and Pearson Chi-square test for categorical variables. Results: The mean age of patients was 60.83±13.84 years in the TAPP group and 56.67±13.99 years in the Lichtenstein group, respectively. The Visual Analogue Scale (VAS) score at 24 hours was higher in the Lichtenstein group (p-value <0.001). Ambulation occurred on Postoperative Day 1 (POD1) in the TAPP group whereas it was on POD2/3 in the Lichtenstein group (p-value <0.001). The Length of Stay (LOS) in the hospital was higher in the Lichtenstein group (p-value 0.063). A total of 50% of the patients in the TAPP group returned to work by POD5, whereas 33.3% and 43.3% of patients in the Lichtenstein group returned to work by POD10 and POD11, respectively, with a p-value of 0.016. The cost was in the range of 30,000-45,000 rupees for the TAPP group (86.7% of patients) and 15,000-30,000 rupees for the Lichtenstein group (63.3% of patients) respectively, with a p-value <0.001. Conclusion: Laparoscopic surgery (TAPP) is superior to Lichtenstein repair despite higher fixation device costs because it is associated with shorter hospital stays, less pain, and earlier return to regular activities.

Correlation of Serum Plasminogen Activator Inhibitor-1 with Body Mass Index and Blood Pressure among Newly Diagnosed Primary Hypertensive Patients: A Cross-sectional Study

Introduction: Plasminogen Activator Inhibitor-1 (PAI-1), a serine protease inhibitor expressed in adipose tissue, causes inflammation in hypertension and vice versa. The excess adipose tissue increases the production of PAI-1. There have been no relevant studies conducted on PAI-1 in southern Odisha in relation to Body Mass Index (BMI) and hypertension. Aim: To compare the BMI, Waist Hip Ratio (WHR), Waist Circumference (WC), and serum levels of PAI-1 in hypertensive cases with controls, and also to correlate the serum level of PAI-1 with BMI and blood pressure. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine of MKCG Medical College and Hospital, Berhampur, Odisha, India from November 2020 to August 2021. A total of 45 newly diagnosed primary hypertensive patients and 43 healthy age and sex-matched individuals between the ages of 18 to 60 years were enrolled in the study. Serum PAI-1 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). BMI, WC, hip circumference, WHR, and blood pressures of the controls as well as cases were recorded. Data were statistically analysed using the Student’s t-test and Pearson’s correlation coefficient. Results: The proportion of males was higher (56%) than females (44%). The cases had a significantly higher level of serum PAI-1 (203.36 ng/mL) compared to the control group (60.11 ng/mL) (p-value <0.001). The cases had a higher BMI, WC (meters), and WHR compared to the control group. The serum PAI-1 level positively correlated with Systolic Blood Pressure (SBP) (r-value=0.852, p-value <0.001), Diastolic Blood Pressure (DBP) (r-value=0.726, p-value=0.000), BMI (r-value=0.620, p-value=0.001), WC (r-value=0.444, p-value=0.002), and WHR (r-value=0.593, p-value <0.001). Conclusion: A high serum PAI-1 level was found in the newly diagnosed hypertensive cases, and a significant positive correlation was observed between PAI-1 and systolic and diastolic blood pressure, along with BMI, WC, and WHR.

Self-care Behaviour of Pregnant Women with Gestational Diabetes Mellitus at a Tertiary Care Hospital in Lucknow, India: A Quasi-experimental Study

Introduction: India is now the diabetes capital of the world. The rising burden of Gestational Diabetes Mellitus (GDM) adds to the existing diabetes burden. Euglycemia is achieved once the baby is delivered. The first line of management of GDM is mainly through lifestyle modification with diet and physical activity. There is a dearth of information from Lucknow city about how well pregnant women with GDM adhere to dietary changes and exercise recommendations, or how counselling helps them deal with their GDM. Aim: To assess the self-care behaviour related to diet, physical activity, and Self-Monitoring of Blood Glucose (SMBG) of pregnant women diagnosed with GDM. Materials and Methods: A total of 188 pregnant women diagnosed with GDM were selected for present quasi-experimental study. The study participants were recruited from the antenatal Outpatient Department (OPD) at the Department of Obstetrics and Gynaecology of Queen’s Mary Hospital, King George Medical University (KGMU), Lucknow, India. The total study duration was from November 2019 to November 2022. Pregnant women diagnosed with GDM according to Diabetes in Pregnancy Study Group in India (DIPSI) criteria, up to 28 weeks of gestation, who gave their written consent to participate in the study and were living within a 15-kilometer radius of the study Institute, were included in the study. One group of the study participants received one-to-one counselling, an individualised diet plan, along with usual GDM care, and the other group received usual GDM care during their antenatal visits. The summary of diabetes self-care was adapted to assess adherence to the recommended dietary and physical activity modifications, as well as self-monitoring of blood glucose. Data were analysed using R software version 4.1.1 (R Core Team, 2021). All categorical data were presented using frequency and percentages. The comparison of baseline demographic and clinical parameters of pregnant women between the two groups was done using the Chi-square test or Fisher’s-exact test for categorical observations based on the expected frequency. The independent sample t-test or Mann-whitney U test for continuous measurements was used after checking the normality assumption using the Shapiro-wilk test. The change in scores of general diet, specific diet, physical activity, and SMBG throughout all follow-ups was assessed by repeated measures Analysis of Variance (ANOVA). The change from the first follow-up visit to subsequent follow-up visit was compared using a mixed linear model with follow-up visits. The p-value was considered significant at a 5% level of significance for all comparisons. Results: The mean age of the pregnant women with GDM was 27.6±3.7 years in the intervention group and 27.9±3.9 years in the control group (p=0.451). The pregnant women with GDM in the two groups did not show significant differences in terms of socio-demographic variables such as age, religion, education, socio-economic status, occupation, type of family, and family history of diabetes mellitus. A significant difference was observed in the dietary and physical activity scores between the two groups of pregnant women with GDM. However, no difference was observed in the case of self-monitoring of blood glucose scores of the two groups. Conclusion: The study concluded that counseling plays an important role in helping pregnant women with GDM adhere to the recommended dietary modifications and physical activity.

Role of Serum Lactate Clearance as a Predictor of Mortality and Morbidity in Neonatal Sepsis: A Prospective Cohort Study

Shreya Ray Chaudhuri, Sayan Chatterjee, Subhasish Bhattacharyya, Arijit Banerjee

Introduction: Neonatal sepsis is a global healthcare concern, which is more prevalent in developing countries. However, surprisingly, biomarkers with good sensitivity and specificity to predict mortality and morbidity are lacking. Higher levels of serum lactate are observed in patients exposed to an inflammatory response, but its practical use remains limited. Therefore, the author aimed to investigate the relationship between serum lactate measurements and the severity of neonatal sepsis. Aim: To assess the role of serum lactate clearance as a marker to predict mortality and morbidity in neonatal sepsis. Additionally, the secondary aim was to evaluate the demographic profile of neonatal sepsis and understand the relationship between C-reactive Protein (CRP), Procalcitonin, and lactate clearance in neonatal sepsis. Materials and Methods: A prospective cohort study was conducted in the Sick Newborn Care Unit (SNCU) and Neonatal Intensive Care Unit (NICU) of Chittaranjan Seva Sadan, College of Obstetrics, Gynaecology, and Child Health in Kolkata, India, from June 2020 to May 2021. A total of 93 confirmed cases of neonatal sepsis were included in the study. Serum lactate levels were measured at the time of sepsis diagnosis and 48 hours after the first sample. Lactate clearance was calculated, and the neonates were followed till discharge or death. Various parameters, including complete blood count, CRP, Procalcitonin, culture, and Cerebrospinal Fluid (CSF), were assessed. The data obtained were statistically analysed using paired t-test, one-way Analysis of Variance (ANOVA), and Pearson’s Chi-square test. Results: A total of 93 neonates were included after meeting the inclusion and exclusion criteria. Among them, 10 neonates died, while 83 were successfully discharged. It was found that death was significantly associated (p<0.0001) with lactate clearance. Total 9 (90%) of the deceased neonates had negative lactate clearance, while only 21 (25.3%) discharged neonates had negative lactate clearance. Lactate clearance was also significantly associated with the duration of hypoglycaemia (p=0.008), duration of Nil Per Mouth (NPM) (p=0.01), and need for reintubation (p=0.05). However, no association was found with the duration of hospital stay, duration of fluid therapy, duration of oxygen requirement, and need for ventilation. Conclusion: Lactate clearance showed a significant association with the risk of mortality in patients with neonatal sepsis. Therefore, lactate clearance can be used as a prognostic marker to identify sepsis. Early detection of sepsis can aid in proper management and subsequently reduce mortality.

Monitoring Blood Glucose as a Perioperative Stress Response Marker and the Effect of Dexmedetomidine Premedication in Laparoscopic Surgery Patients: A Randomised Controlled Study

Shree Nanda, Kanhu Charan Patro, Sunanda Gupta

Introduction: Perioperative stress increases cortisol levels, which in turn elevates glucose production. Thus, regular monitoring of glucose during the perioperative period can predict intraoperative stress and the depth of anaesthesia. Dexmedetomidine (Dex) is used as an adjunct during anaesthesia to attenuate the pressor response during tracheal intubation. Aim: To assess sequential blood sugar values in Dex-mediated attenuation of the perioperative neuroendocrine stress response. Materials and Methods: A randomised, controlled, double-blinded study was conducted at the Department of Anaesthesiology, M.K.C.G Medical College and Hospital, Berhampur, Odisha, India on 80 patients undergoing laparoscopic surgery, divided into two groups (n=40). Group-I was administered 50 mL of Normal saline i.v. over 10 minutes, whereas Group-II received Dex 1 mcg/kg in 0.9% normal saline diluted to 50 mL over 10 minutes i.v. Blood glucose levels and haemodynamic parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR) were evaluated in the preoperative room, 30 minutes after surgical incision, after extubation, one hour after surgery, and 2.5 hours following surgery. Unpaired Student’s t-test was used to compare the variables at different time points. Results: There was no significant difference in age (48.58±5.89 and 46.25±6.51 years; p>0.05), weight (57.07±7.84 and 56.8±7.4 kg; p>0.05), and American Society of Anaesthesiologists (ASA) status among the Group-I and Group-II patients. Female preponderance was observed, but it was not significant between Group-I and Group-II patients (27 vs 31; p>0.05). In Group-II, Dex-administered patients, the mean blood sugar levels at 30 minutes past surgical incision, after extubation, one hour, and 2.5 hours following surgery were 104.35±13.58, 97.15±5.86, 98.4±7.45, 94.08±7.37 mg/dL, respectively. This was lower when compared to Group-I saline-treated patients, 135.95±14.4, 137.38±7.93, 138.08±8.84, and 137.70±15.13 mg/dL, and was found to be significant (p<0.05). Conclusion: Serial blood glucose estimation can be a useful marker to evaluate the perioperative neuroendocrine response. Dex premedication has effectively modulated the neuroendocrine stress response during anaesthesia.

Quality of Reliability of Information on H3N2 Influenza in Youtube: A Cross-sectional Study

Introduction: Influenza is a highly communicable viral respiratory illness known to cause outbreaks, such as the current H3N2 outbreak in India. YouTube is one of the most popular sources to obtain information regarding symptoms, treatments, and prevention of diseases like influenza in the general public. Aim: To assess the quality and reliability of information related to H3N2 influenza using the Global Quality Score (GQS) and reliability score, respectively. Materials and Methods: A cross-sectional study was conducted to evaluate the type of information, quality, and reliability of videos about Influenza H3N2 on YouTube using the GQS and the Reliability Score (DISCERN) scale, respectively. The Kruskal-Wallis test was used to assess differences in quality and reliability depending on the type of uploader. Results: The study found that 85% of videos focused on prevention/vaccination, 83.3% discussed the cause/aetiology of influenza, while only 31.7% covered investigations/tests. News agencies uploaded the most videos (46.7%), followed by doctors (18.3%), with minimal contribution from hospitals (8.3%). News agencies had the highest Video Power Index (VPI) compared to other groups, and there were no significant differences in GQS score across different groups. Conclusion: Verified information from proper resources should be uploaded by responsible healthcare professionals like doctors and health organisations. The videos should have an exceptional reliability score and Global Quality Index. The quality of content should be easy to understand for the general public and should provide additional sources of information, educating the viewer to contact his/her physician concerning the diagnosis and further evaluation of the same.

Efficiency of Technical Assistance on Psychological Well-being and Work-life Balance: A Secondary Exploratory Qualitative Research

Aarushi Rajput, Neelam Pandey, Sonakshi Ruhela

Introduction: The effects of technical support on psychological health and work-life balance have long been a source of discussion. By examining and reviewing the research on technology and its effects on these factors in four major domains-education, organisation, health, and gerontology-this study seeks to investigate this problem. Aim: To understand the impact of technical assistance on psychological well-being and work-life balance. Materials and Methods: The data were collected online by reviewing relevant research papers from the past 22 years, from April 2000 to August 2022, at the Amity Institute of Psychology and Allied Sciences, Amity University, Noida, Uttar Pradesh, India. The process of data collection began in June 2023 and took two months (until August 2023) to review, refine, analyse, and form conclusions based on the obtained results. Qualitative exploratory research was carried out by reviewing publications about technology and its effects on the specified variables in four major domains-education, organisation, health, and gerontology. To explain the patterns of connections between the variables, the research utilised content analysis. Results: Themes were generated based on the content that was obtained from the extensive review of the articles in each sector. Four themes in each sector were obtained. In the Educational Sector, “Addictive Behaviour”, “Enhancing Support”, “Learning Outcome”, and “Supervisor Support” were obtained; In the Organisational Sector, “Social Capital”, “Social Media Fatigue”, “Schedule Flexibility”, “Remote Working” were obtained; In the Health Sector, “Interventions for Improvement”, “Digital Depression”, “Injury and Health Support”, and “Digital Divide” were obtained; and in the Gerontology Sector, “Technological Readiness and social exclusion”, “Technical Knowledge”, “Social Interaction and Communication”, and “Enhancing Independence” were obtained, accounting for both dimensions, namely psychological well-being and work-life balance. Conclusion: The study’s conclusions imply that rapid technological advancements have both beneficial and detrimental effects on several facets of human functioning. It can also be said that attempts to apply the newest technology to solve human problems efficiently and effectively can lead to the best possible use of technology. The optimal use of technology can help mitigate the negative impacts and maximise the positive impacts.

Diagnostic Performance and Comparative Analysis of Conventional Drug Susceptibility Testing, Line Probe Assay, and GeneXpert in Extrapulmonary Tuberculosis Cases: A Cross-sectional Observational Study

Ashima Jamwal, Anjali Swami, Ankita Mohanty, Sujata Baveja

Introduction: Tuberculosis (TB), a known threat to mankind for ages, causes a significant burden on healthcare worldwide. The alarming rise of Extrapulmonary Tuberculosis (EPTB) has led healthcare professionals to opt for molecular diagnostics. Despite the availability of rapid diagnostics, conventional culture Drug Susceptibility Testing (DST) is still considered the gold standard in diagnosing TB. Aim: To assess the diagnostic accuracy of culture DST which is considered the gold standard. Materials and Methods: This cross-sectional observational study included 150 suspected EPTB patients and was conducted over a period of one year (September 2018 to August 2019) at Lokmanya Tilak Municipal Medical College and Sion Hospital (LTMMC), a tertiary care hospital in central Mumbai, Maharashtra, India. The hospital is located adjacent to Dharavi, the largest slum area with a high population density, which contributes to the majority of patients attending clinics. Patients attending the pulmonary medicine Outpatient Department (OPD) with extrapulmonary manifestations and suspected cases of EPTB were enrolled in the study. Samples, excluding sputum, were sent to the Department of Microbiology, LTMMC, Sion Hospital for GeneXpert analysis. The samples were further evaluated by microscopy, GeneXpert, and culture DST to detect the presence of Mycobacterium tuberculosis (M. tuberculosis) and drug susceptibility, respectively. Patients positive for Pulmonary Tuberculosis (PTB) were excluded from the study. Categorical variables were described using percentages. A Chi-square test was applied, and a p-value of <0.05 was considered significant. All statistical analyses were performed using SPSS statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 150 extrapulmonary samples, 23 (15.33%) samples were culture positive for M. tuberculosis and were subjected to DST using the 1% proportion method and GeneXpert assay. The MDR isolates were tested using the first-line Line Probe Assay (LPA). Eleven (47.8%) showed resistance to first-line antitubercular drugs. Among the 12 new cases, only 2 (16.7%) showed resistance compared to 9 (81.8%) in previously treated cases. A discordance of 8.7% was observed between DST with GeneXpert and LPA. Additionally, a discordance of 8.7% was observed between DST and LPA for rifampicin resistance and 4.3% for isoniazid resistance. Conclusion: The paucibacillary nature of extrapulmonary samples contributes to the challenging diagnosis of EPTB cases, leading to increased drug resistance. Highlighting the importance of the conventional solid culture DST method, this study strongly recommends the use of conventional DST accompanied by LPA for extrapulmonary cases.

Evaluation of Hyponatremia in Patients on Fluoxetine Therapy at a Psychiatry Outpatient Department in a Tertiary Care Hospital: A Cross-sectional Study

SA Abirami Balambika, R Nalini, Y Nisha Maheshwari, J Ezhilramya

Introduction: Fluoxetine is a widely used Selective Serotonin Reuptake Inhibitor (SSRI) for various psychiatric illnesses. Identifying patients at increased risk of developing hyponatremia is essential for safe and successful treatment. Aim: To estimate the prevalence of hyponatremia in patients on fluoxetine therapy attending the Psychiatry Outpatient Department (OPD) at a tertiary care hospital and to compare the changes in serum sodium levels between patients younger than 55 years and those older than 55 years on fluoxetine therapy. Materials and Methods: The present cross-sectional study was conducted in the Outpatient Psychiatry Department of Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India over three months, from October 2022 to December 2022. It included patients on fluoxetine therapy for various psychiatric illnesses. The type and duration of psychiatric illness, detailed drug history, and any history suggestive of symptoms of hyponatremia were documented. Blood samples were collected for serum sodium level monitoring. Adverse drug reactions to fluoxetine were recorded and assessed for causality, severity, and preventability using the World Health Organisation (WHO)-Uppsala Monitoring Centre causality assessment scale, the modified Hartwig and Siegel scale, and the modified Schumock and Thornton scale, respectively. Descriptive statistics were used to analyse baseline and demographic characteristics. The comparison of sodium levels between patients younger than 55 years and those older than 55 was performed using the Mann-Whitney U test. Results: The mean age of the study participants being 41.03±13 years. The mean age of the males was 39±15.19 years, and that of the females was 42.05±12.29 years. A total of 30 participants were included in the study. Moderate depression was the most common condition for which fluoxetine was prescribed. Hyponatremia was present in 16.7% of the study participants. The median sodium level was 139±4.5 mEq/L in patients aged less than 55 years and 137±4 mEq/L in patients aged more than 55 years, with a p-value of 0.073. Among the reported adverse reactions, 64.5% were classified as possible, 67.74% as mild, and 58% as probably preventable. Conclusion: Serum electrolyte monitoring is not routinely performed in all patients on fluoxetine. Therefore, relying solely on symptoms to detect hyponatremia may lead to underdiagnosis. Consequently, routine and frequent testing of serum sodium levels is recommended to prevent complications associated with hyponatremia.

Seroprevalence of Transfusion Transmitted Infections among Blood Donors at the Tertiary Care Hospital in Nadiad, Gujarat, India

Introduction: Blood transfusion is an effective treatment for saving millions of lives, even though transfusion-transmissible infections are a major problem. An integrated approach for blood safety is required, which includes the collection of blood only from voluntary, non-remunerated blood donors. Aim: To assess the seroprevalence of Transfusion-Transmissible Infections (TTIs) among blood donors in a tertiary care center in Nadiad, India. Materials and Methods: A retrospective study was conducted from August 2019 to September 2022 at the blood bank of a tertiary care center in Nadiad, India. Data were collected in an Excel datasheet pertaining to all donors who were screened for Hepatitis B Surface Antigen (HBsAg), Hepatitis C virus (HCV), Human Immunodeficiency Virus (HIV), syphilis, and malaria and analysed. The associations between categorical variables were tested using the Chi-square test. Results: A total of 6103 voluntary and replacement donors were screened, out of which 5855 (95.93%) were males and 248 (4.06%) were females. The prevalence rate was highest for syphilis 81 (1.32%), then Hepatitis B Virus (HBV) 32 (0.52%), HCV 09 (0.14%), HIV 05 (0.08%), and malaria 00 (0%) in decreasing order. Out of 6103 donors, 127 donors showed seropositivity for TTI (2.08%). The present study shows seropositivity for TTI only in male replacement donors (100%). Conclusion: Blood is still one of the main sources of transmission of infections such as HIV, HBsAg, HCV, syphilis, and malaria. The present study showed a higher prevalence of syphilis than HBsAg, HCV, HIV, and malaria, in decreasing order. The study showed seroprevalence only in male replacement donors, so efforts to motivate and ensure the active participation of voluntary blood donors, including females, are needed. Meticulous donor screening, the use of highly sensitive techniques for the detection of TTIs, and improved post-donation counseling are highly recommended to ensure the safety of blood for recipients.

Unravelling the Enigma of Inflammatory Myofibroblastic Tumours: A Cross-sectional Study from a Regional Cancer Centre, Karnataka, India

Usha Amirtham, Rakshitha Hosur Mohan

Introduction: Inflammatory Myofibroblastic Tumour (IMT) is an unusual neoplasm with intermediate malignant potential, which rarely metastasises. IMT occurs in various anatomical sites, and the initial descriptions were primarily centered on its manifestation in the lungs. Although the age range is broad, IMT is most common in the first three decades of life, with a slight female predominance. Recent data and Anaplastic Lymphoma Kinase (ALK) gene aberrations confirm a neoplastic process for these lesions. Aim: To study the clinicopathological features of IMTs in a regional cancer centre in South India. Materials and Methods: A cross-sectional study included 17 cases of IMT over six years, from May 2014 to May 2020, at Memorial Kidwai Memorial Institute of Oncology (KMIO), Bengaluru, Karnataka, India. The clinicopathologic and immunophenotypic features were analysed on needle biopsies and resected specimens. Correlation between the expression of ALK-1 and histological patterns, mimickers, metastasis, and prognosis were described. Results were analysed using Microsoft Excel 2019 and Medcalc calculator. Results: Seventeen cases of IMTs were included in this study, out of which two were in the lung, and the rest were extrapulmonary. Sixteen cases were unifocal on presentation; however, one IMT of extremity showed evidence of secondaries on bone scan. The mean age at presentation was 33.47 years, and the male-to-female ratio was 1:1.12. Among the seventeen cases, sites are as follows: one each in the retroperitoneum, liver, soft-tissue (extremity), two each in the breast, lung, female genital tract, urinary bladder, and three each in the head and neck region (maxilla, trachea, and alveolus) and mesentery. Microscopically, IMTs showed various histological patterns. Immunostaining for ALK-1 was positive in seven out of seventeen cases, and the rest were diagnosed by excluding closer mimickers. Conclusion: The present study provides crucial insights into the clinicopathological features of IMTs. Immunohistochemistry (IHC) is an essential diagnostic tool that helps accurately differentiate IMT from its mimickers by identifying ALK protein expression. This distinction is essential for guiding targeted therapy in recurrent or metastatic cases.

Clinicoradiological Profile of Endobronchial Tuberculosis: A Cross-sectional Study

Introduction: Tuberculosis (TB) is a disease that causes severe mortality and morbidity worldwide, including India. Endobronchial Tuberculosis (EBTB) is an uncommon form of TB, which is often underdiagnosed due to the difficulty in diagnosis. This form of TB often has a poor prognosis and long-lasting sequelae. Aim: To study the proportion of EBTB in clinically diagnosed pulmonary TB and to study the clinicoradiological and bronchoscopic profile of EBTB. Materials and Methods: This study was a hospital-based record-based cross-sectional study that included patients with sputum smear negative for Acid-Fast Bacilli (AFB) and Mycobacterium tuberculosis (M. tuberculosis) not detected on Nucleic Acid Amplification Test (NAAT), who were clinically diagnosed with TB. Bronchoscopy was performed on such patients, and samples were sent for investigations, including histopathology and NAAT. Demographic characteristics, bronchoscopy and radiology findings, and microbiology results were documented. Quantitative variables were summarised as means, and categorical variables were presented as percentages. Results: A total of 198 underwent bronchoscopy, of which 20 (10%) were diagnosed with EBTB. The mean age was 22 years, and 65% were females. The most common clinical feature in these patients was fever, the most common radiological presentation was lobar collapse, and the most common bronchoscopy feature was a tumorous lesion. NAAT detected M. tuberculosis in the bronchial wash in 50% of patients diagnosed with EBTB. A total of 45% of patients had TB which was diagnosed on histopathology. Conclusion: EBTB was diagnosed in 10% of smear-negative, NAAT-negative cases. The use of NAAT on bronchoscopy wash samples resulted in a high yield in diagnosis.

Comparison of Outcomes Regarding Weight Loss in Laparoscopic Sleeve Gastrectomy vs Laparoscopic Mini Gastric Bypass in Morbidly Obese Patients- A Cohort Study

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m²) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI >37.5 without co-morbidities, and BMI >32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student’s t-test. For comparing categorical data, a Chi-square (χ2) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p<0.05) in % EWL at nine months in both procedures as MGB resulted in more % EWL than LSG. Perioperative results regarding the mean operative time for MGB was 3.24 hours and for LSG, 2.43 hours (p<0.05). A total of 50% (5/10) of patients who underwent MGB had remission, and 25% (1/4) of patients who underwent LSG had remission of T2DM after nine months (p>0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL).

Ergonomic Evaluation of Static, Revolving, and Wooden Chairs using Cornell’s Seating Evaluation v21 in Professionals with Prolonged Sitting: A Cross-sectional Study

Shrushti Naresh Arora, Subhash Khatri

Introduction: In contemporary workplaces, individuals using sedentary workstations often remain seated for approximately two-thirds of their workday, with extended periods of sitting lasting at least 30 minutes uninterrupted. The widespread use of various types of chairs in professional settings and their significant impact on individual well-being necessitate this ergonomic study. Given that professionals spend a considerable portion of their day seated, it is imperative to understand the ergonomic characteristics of different chair types to promote a comfortable and supportive work environment. This study focuses on evaluating static, revolving, and wooden chairs to identify their strengths and weaknesses. Aim: To compare the ergonomic features of static, revolving, and wooden chairs among in professionals with prolonged sitting using Cornell’s Ergonomic Scale. Materials and Methods: A cross-sectional study was conducted among professionals at a corporate company in Ahmedabad, Gujarat, India, from July 2021 to September 2022. Participants, regardless of gender, who had been using a laptop or desktop for at least four hours a day for a year were included. The study assessed three types of chairs: static, revolving, and wooden. The survey consisted of two sections: demographic and job-related information, and the Cornell Ergonomic Seating Evaluation v21 scale, which measured chair adjustment, seating comfort, ease of use, body support, and an overall ergonomic score. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0, employing one-way ANOVA. Result: A total of 217 participants were surveyed, including 182 males and 35 females. The overall Ergonomic Discomfort Score (EDS%) was 32.49±2.71% for static chairs, 66.3±3.56% for revolving chairs, and 25.26±3.27% for wooden chairs (p-value <0.001). Conclusion: The application of practical ergonomic principles with tools such as the Cornell scale can effectively minimise employee discomfort and enhance both work capacity and job satisfaction

Fear and Anxiety among Dental Students and Dentistry as a Career Choice Following the COVID-19 Pandemic in Saudi Arabia: A Cross-sectional Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has had a significant psychological impact on people’s lives, including healthcare providers. This impact has manifested in the form of anxiety and fear. Since COVID-19 is a respiratory disease spread through the mouth and nose, dental practitioners have experienced anxiety due to their close proximity to the oro-nasal tissues. Aim: To assess the mental health condition, specifically fear and anxiety, of a group of dental students in Saudi Arabia during the COVID-19 pandemic and to explore students’ perceptions about dentistry as a career choice following the pandemic. Materials and Methods: A cross-sectional questionnaire-based study was conducted, which included demographic data, the Coronavirus Anxiety Scale (CAS), the Fear of COVID-19 Scale (FCV-19S), as well as a few questions to assess why students chose dentistry as a career and their perceptions about dentistry as a career following the pandemic. A digital link to the questionnaires was distributed through social media outlets such as Twitter, WhatsApp, etc., with the aim of reaching dental students across all dental schools in Saudi Arabia. Dental students and those undergoing internships from both public and private Dental Colleges across Saudi Arabia were approached. The study included a total of 633 students from 21 dental schools across Saudi Arabia. Data were analysed using the Statistical Package for Social Sciences, including Analysis of Variance (ANOVA), independent t-tests, and Chi-square tests. Results: Fear and anxiety levels were found to be the highest among interns and fourth-year dental students, respectively. A total of 346 (54.66%) of the respondents reported that they chose dentistry as a career due to personal desire. Approximately, 239 (37.8%) of the respondents reported being either ‘Not Sure’ or would not choose dentistry as a career if they had the choice, considering the uncertainty created by the COVID-19 pandemic. Conclusion: Fear and anxiety were reported to be higher among dental students exposed to clinical practice. The majority of dental students reported that they would still choose dentistry as a career option despite the uncertainty caused by the COVID-19 pandemic.

Intraoperative Frozen Section Analysis and an Audit of its Diagnostic Accuracy: A Cross-sectional Study from Maharashtra, India

Introduction: Frozen Section (FS) is a diagnostic technique performed intraoperatively to obtain relevant information about the primary diagnosis, margin status, or sentinel lymph nodes, which helps guide the course of surgery. With the prevalent use of FS, it is imperative to recognise and scrutinise its diagnostic pitfalls and make efforts for rectification. Aim: To compare diagnostic results obtained on FS with final paraffin-embedded histopathology and calculate the Diagnostic Accuracy (DA) of FS. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at a tertiary care hospital, DVVPFs Medical College in Ahmednagar district, Maharashtra, India over a period of two years from January 1, 2020, to December 31, 2021. The diagnosis provided on specimens received for intraoperative FS was compared with the final histopathological diagnosis, considered as the gold standard for the same specimen. The results were categorised as concordant, discordant, and deferred cases. The diagnosis on FS and the final histopathological diagnosis, along with relevant clinical data, were entered into an excel sheet. Further, the DA of FS was calculated. All the discordant cases were analysed. Statistical analysis utilised simple percentage calculations from the excel sheet. Results: A total of 130 cases were analysed using FS, with the most common indication being sentinel lymph node analysis to detect metastatic deposits in 72 (55.4%) cases. Out of the total 130 cases, 119 (91.5%) were concordant, 10 (7.7%) were discordant, and 1 (0.8%) was deferred due to an insufficient specimen. Therefore, the overall DA rate was found to be 91.5% with an error rate of 8.5%. Upon analysis of the 10 discordant cases, the cause of inaccuracy was technical error in 7 (70%) cases and interpretation error in 3 (30%) cases. Conclusion: The DA obtained in the present study was somewhat lower than expected due to technical errors during FS sectioning, leading to artifacts, especially during lymph node processing. Analysis of the discordant cases unveiled this deficit. Therefore, such assessment studies should be performed periodically as they assist in highlighting the shortfalls and provide a plan to boost DA.

Assessment of Pulmonary Function in COVID-19 Recovered Health Science Students: A Descriptive Cross-sectional Study

Sudha Patil, Anita Teli, Rekha Nayaka, Parwati Patil

Introduction: Coronavirus Disease-2019 (COVID-19) impacts multiple organs like the kidneys, heart, and liver, but primarily affects the respiratory system, leading to symptoms such as cough with sputum production, fever, and in severe cases, respiratory failure. Research on Severe Acute Respiratory Syndrome (SARS)-Coronavirus-2 (CoV-2) has revealed impairments in lung function during the early recovery phase following COVID-19 infection. The aim is to understand the virus’s impact and identify any obstructive, restrictive, or mixed pulmonary alterations in medical professionals six weeks after recovery. Aim: To assess Pulmonary Function Tests (PFTs) six weeks after COVID-19 recovery in health science students at a medical college in North Karnataka. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College in North Karnataka, India, from January 2021 to December 2021. A total of 155 COVID-19-recovered health science students were included, and their anthropometry, physiological parameters, and pulmonary parameters were recorded. The “Spirometer Helios 401” was used to estimate an individual’s PFT. Data were analysed using independent sample t-tests, with a p-value <0.05 considered statistically significant. Results: The mean age of the participants was 21.73±3.04 years. The Mean±Standard Devaiation (SD) of Forced Vital Capacity (FVC) (L), Forced Expiratory Volume (FEV) at the end of one second (L), Peak Expiratory Flow Rate (L), forced mid expiratory flow 25-75 (L/s), forced mid expiratory flow 25% (L/s), forced mid expiratory flow 50% (L/s), forced mid expiratory flow 75% (L/s), Inspiratory Reserve Volume (IRV) (L), Expiratory Reserve Volume (ERV) (L), Inspiratory Capacity (IC) (L), and Maximum Voluntary Ventilation (MVV) (L)±SD of post-COVID-19 subjects were less compared to their corresponding predicted values. The Mean±SD of FEV1/FVC (%) and tidal volume (L) of COVID-19 recovered subjects were higher than their corresponding expected value. The FEV, Forced Expiratory Flow (FEF), and FEV1 values were significantly less in females compared to males. Conclusion: Coronavirus Disease-19-recovered subjects showed altered respiratory functions even after six weeks, with the majority having restrictive disease, followed by a mixed pattern and obstructive diseases, while the remaining showed no changes in lung function. Altered pulmonary functions in COVID-19 patients may be due to alveolar destruction or pulmonary interstitial fibrosis.

Ocular Diseases Presenting in Post-COVID-19 Patients: A Cross-sectional Study Conducted at a Tertiary Institute in Andhra Pradesh, Southern India

Muralidhar Parri

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, which started in December 2019, has rapidly spread across the globe. Although the prevalence of COVID-19 disease has significantly decreased, there are cases of post-COVID-19 complications affecting multiple organ systems, including the eyes. Aim: To evaluate ocular diseases presenting in post-COVID-19 patients and their association with demographic profiles, duration of post-COVID-19, and the type of treatment received. Materials and Methods: A descriptive cross-sectional study was conducted over a four-month period (August 2021 to November 2021) in the Department of Ophthalmology at AIIMS, Mangalagiri, Guntur, Andhra Pradesh, India. The study focused on post-COVID-19 patients who had been affected by COVID-19 no more than three months prior. Patients who were not post-COVID-19 and those who had contracted COVID-19 during the first wave were excluded from the study. The patients’ clinical history and symptoms were documented. Visual acuity, intraocular pressure, and detailed anterior and posterior segment findings were recorded for all patients. The study aimed to assess post-COVID-19 ocular complications and any potential associations with hospital stays, steroid intake, or oxygen inhalation on eye diseases. Mean and median calculations were performed for continuous variables, and a Chi-square test was used to study associations. Statistical Package for Social Sciences (SPSS) version 25.0 was employed, and a p-value <0.05 was deemed significant. Results: In the present study, males constituted 41 (62.1%) and females constituted 25 (37.9%), with a male-to-female ratio of 1.64:1. The majority of patients 23 (34.8%) were above 50 years old. Most patients 24 (36.4%) developed eye diseases one month after their COVID-19 infection. Out of 66 patients, 11 (16.7%) were diabetic, 8 (12.1%) were hypertensive, and 40 (60.6%) had no associated co-morbidities. During their COVID-19 illness, 53 (80.3%) patients underwent home isolation and received supportive treatment, while 13 (19.7%) patients were hospitalised. The most common ocular disease observed was conjunctivitis 39 (59.1% of patients) following post-COVID-19. Additionally, 4 (6%) patients developed central serous chorioretinopathy, 4 (6%) developed refractive errors, 5 (7.6%) experienced persistent headaches, and 2 (3%) developed orbital mucormycosis. Conclusion: The present study presents ophthalmic manifestations in post-COVID-19 patients. Conjunctivitis was found to be the most common ocular disease, more prevalent one month after the COVID-19 infection. COVID-19 retinopathy was the most common posterior segment complication, especially in patients above 50 years old and three months post-COVID-19.

Web-based Survey on the Knowledge, Attitude and Practice of COVID-19 Appropriate Behaviour among Vaccinated and Unvaccinated College Students in Puducherry, India: A Cross-sectional Study

Karthika U Priyadharshini, AK Jayamala, Subhashri Soundirarajan

Introduction: Coronaviruses (CoVs) encompass a large group of viruses known to infect the upper respiratory tract in humans. The devastating impact of the virus has led to widespread infections among millions of individuals. Widespread disregard for ‘Coronavirus Disease-2019 (COVID-19) Appropriate Behaviour’ (CAB) by the public has significantly strained the Indian healthcare system. Despite efforts to educate the public on CAB through social media since 2020, only a minority have incorporated these practices into their daily lives. Notably, some vaccinated individuals have been hesitant to adhere to CAB despite repeated awareness efforts. This study aims to understand adherence to CAB among vaccinated and unvaccinated students not associated with the healthcare system. Aim: To evaluate the Knowledge, Attitude and Practice (KAP) of CAB among vaccinated and unvaccinated college students. Materials and Methods: This descriptive cross-sectional study was conducted at Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India among various engineering and arts college students of Puducherry, India from December 2021 to February 2022. A web-based data collection tool was designed using Google Forms. Data was collected through invitation letters and questionnaires distributed via WhatsApp groups and Instagram. The study included a total of 360 responses, with the questionnaire comprising 40 questions related to KAP, consisting of 17, 7, and 16 questions, respectively. The results were expressed in percentages. Results: Among the vaccinated participants, 263 (89.7%) identified social media as the primary source of COVID-19 related information. Knowledge and attitude towards COVID-19 vaccination revealed that over 50% were aware of the safety and efficacy of vaccines and the necessity of receiving two doses as advised by the government. While knowledge and attitude were similar across vaccinated and unvaccinated college students, there was a slightly higher percentage among the vaccinated group. However, there was an increased percentage of practice among unvaccinated students, indicating greater awareness of infection prevention. Conclusion: The study found that the knowledge, attitude, and behaviour of college students, particularly those not in medical fields, were satisfactory, likely due to the widespread availability of information on social media. These findings can be valuable for public health departments to adopt a people-centered approach to raise awareness among the public and reduce vaccine hesitancy.

A Cross-sectional Study on Awareness and Utilisation of Government Health Insurance Schemes among Patients at a Tertiary Level Hospital in Kolkata, India

Poulomi Mukherjee, Adwitiya Das, Aditya Banerjee, Kaushik Mitra, Debasis Das

Introduction: Despite the presence of multiple Government Health Insurance (GHI) schemes in West Bengal, the National Family Health Survey report (NFHS-5) has indicated that only 29.3% of households are covered by a health scheme. Awareness of health insurance schemes increases their utilisation. The absence of health insurance coverage results in increased out-of-pocket health expenditures, pushing families into debt. Therefore, there is a need to determine whether this lack of awareness among patients contributes to the issue. Aim: To estimate the awareness level, enrollment in GHI schemes, experiences of their utilisation, and to determine the contributory factors of awareness and enrollment among patients attending the Outdoor Patient Departments (OPDs) at a tertiary care hospital in Kolkata. Materials and Methods: An observational cross-sectional study was conducted from April 2023 to June 2023 at Medical College, Kolkata, West Bengal, India. A total of 390 respondents were chosen using a systematic random sampling technique and were interviewed using a predesigned, pretested, and semistructured questionnaire. Data were analysed using R Studio version 4.3.0. A p-value <0.05 was considered statistically significant. Results: Awareness about Swasthya Sathi was found to be present in 318 (81.54%) patients, but only 109 (34.28%) of them were enrolled. Awareness of Sishu Saathi and Rashtriya Bal Swasthya Karyakram (RBSK) was 12 (3.08%) and 10 (2.57%), respectively, and none were enrolled. The major source of information (11.03%) regarding health insurance among respondents was informal sources such as friends, relatives, and neighbours. The age of the respondents, type of family, occupation, and economic status were found to have a significant association with the right awareness (p=0.008, 0.012, 0.0005, and 0.029, respectively). The patient satisfaction level after utilising Swasthya Sathi was found to have a significant positive correlation with the right awareness (Spearman’s ρ=0.322, p-value <0.01). The determinants of enrollment in Swasthya Sathi were female gender, rural residence, and right awareness (p<0.001). The commonest reason for not enrolling in any GHI among the non subscribers was a lack of awareness (82.56%). Conclusion: Correct awareness was found to be a determinant of enrollment in GHI. In order to bridge the gap between awareness and utilisation of GHI, there is a need to focus on Information, Education, and Communication (IEC) activities involving mass media and frontline health workers.

Impacts of the Surya Namaskar on Body Composition and Physiological Parameters among Yoga and Non Yoga Professionals: A Quasi-experimental Study

Introduction: Surya Namaskar (SN) (also known as Sun Salutation) in the Bihar School of Yoga tradition comprises eight different postures completed in twelve steps sequentially. There are different views and schools of SN according to various traditions. Several studies have been conducted to demonstrate the effects of SN on the physiological, physical, and mental aspects of practitioners; however, its comparative effect on Yoga professionals and Non Yoga professionals has not been extensively explored. Aim: To determine the impacts of SN on body composition and physical and physiological variables among Yoga and Non Yoga professionals. Materials and Methods: This was a quasi-experimental study conducted at Morarji Desai National Institute of Yoga, New Delhi, India from March 2021 to May 2021. The study involved three groups with 10 subjects each: the Non Yoga Professional Control group (NYPC), the Non Yoga Professional Surya Namaskar group (NYPS), and the Yoga Professional Surya Namaskar group (YPS). The NYPS and YPS groups practiced 12 rounds of SN, totaling 24 minutes daily for 5 days a week over 6 weeks. Height, weight, Body Mass Index (BMI), Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Breathe Holding Time (BHT), Right Hand Grip Strength (RHGS), Left Hand Grip Strength (LHGS), Flexibility, Muscle mass, Percentage Body Fat (PBF%), total Body Fat (BF), Bone Mass (BM), Waist to Hip Ratio (WHR), and Basal Metabolic Rate (BMR) were recorded on the first day and after six weeks. GraphPad Instat Windows-based software, version 3.0, was used to complete the statistical analysis. Intergroup comparison was performed using Repeated Measure Analysis of Variance (ANOVA). Pre- and post-comparisons were made using t-tests. The level of significance was set at p≤0.05. Results: A significant reduction was observed in HR (p≤0.05), SBP (p≤0.01), Pulse Pressure (PP) (p≤0.05), Double Product (DoP) (p≤0.05), and Rate Pressure Product (RPP) (p≤0.05) following SN in the NYPS group. A significant reduction was observed in SBP (p≤0.01), DBP (p≤0.05), and MBP (p≤0.01) following Surya Namaskar practice in the YPS group. BHT (p≤0.05), RHGS (p≤0.05), LHGS (p≤0.05), and flexibility (p≤0.01) significantly increased following SN in the NYPS group. Flexibility was significantly increased (p≤0.05) following SN in the YPS group. PBF and BF decreased significantly (p≤0.001) following SN in the NYPS group. Conclusion: The SN has demonstrated effects on the physical, physiological, and therapeutic aspects of practitioners. The present study established that the practice of SN improves body composition and cardiovascular function with increased efficiency, potentially aiding in the prevention of lifestyle-related cardiovascular diseases.

Comparison of Efficacy of a Novel Dual Channel Gastro Laryngeal Mask Airway versus Nasal Prongs for Airway Management in Day Care Gastrointestinal Endoscopy Procedures: A Randomised Clinical Study

Sejal Parmar, Divya Kheskani, Heena Chhanwal, Vipul Chaudhary

Introduction: The Gastro Laryngeal Mask Airway (LMA) is a newer supraglottic airway device specifically designed for Gastroinstestinal (GI) endoscopy procedures. Hypoxia is a common complication in endoscopy procedures performed under sedation without securing the airway. The Gastro LMA allows for oxygenation, ventilation, and the passage of a gastroscope through its integrated endoscope channel. Aim: To evaluate the utility of the Gastro LMA compared to nasal prongs in maintaining oxygenation and airway control during upper GI endoscopy procedures. Materials and Methods: The present double-blinded randomised, single-centre clinical study conducted in the Department of Anaesthesiology, GCS Medical College Hospital and Research Centre, Ahmedabad, Gujarat, India included 50 adult patients scheduled for elective GI endoscopy procedures in the supine or lateral position. The patients were divided into two equal groups: Group G (Gastro LMA) and Group N (Nasal prong). Preprocedural heart rate and SpO₂ levels were noted. All patients were observed for hypoxia (SpO₂ <92%), bradycardia, lowest heart rate and Saturation of Peripheral Oxygen (SpO₂) levels, conversion to endotracheal intubation, and any other intraoperative adverse events. Postoperatively, patients were observed for four hours for adverse effects and discharged after assessment using the modified Aldrete’s score. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0, and the results were expressed as percentages, mean±SD, and p-values. Results: Out of the 50 patients, 23 were male and 27 were female, with a median age of 59 years. The preprocedural mean lowest heart rate in Group G was 68/min, and in Group N it was 64/min. The mean lowest SpO₂ during the procedure was 94% in Group N and 96% in Group G. In Group N, two patients (8%) required conversion to endotracheal intubation. One patient had a longer duration of the procedure and experienced bronchospasm, while another patient with Chronic Obstructive Pulmonary Disease (COPD) developed bronchospasm. In Group G, one patient (4%) required endotracheal intubation, possibly due to increased intrabdominal pressure caused by air insufflation in an obese patient. Conclusion: In patients undergoing gastrointestinal endoscopy procedures, the Gastro LMA appears to be effective for clinical use. It provides good airway control and enables deeper sedation without respiratory compromise. Ventilation was well maintained with minimal intraoperative and postoperative adverse events.

Impact of COVID-19 Pandemic on Tuberculosis Treatment Outcomes at a Tuberculosis Unit in Southern India: A Retrospective Observational Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic significantly affected both existing and undiagnosed Tuberculosis (TB) patients worldwide. The impact of the pandemic on the treatment outcomes of these patients in India remains unclear. Aim: To assess the difference in TB treatment outcomes before and during the COVID-19 pandemic in an economically disadvantaged urban area in Southern India. Materials and Methods: A retrospective observational study was conducted at a TB Unit in South Bangalore, Southern India, serving a population of 2,50,000 from January 2022 to December 2022. Purposive sampling was employed to select 516 patients who had registered for TB treatment during the years 2019 and 2020. The socio-demographic details and TB profiles of the patients were collected and tabulated. Treatment outcomes were classified according to World Health Organisation (WHO) definitions after a case record analysis. Data were entered into Microsoft Excel 2018 and analysed using Open Epi software. Descriptive statistics, such as mean and standard deviation, were used to report socio-demographic profiles, and the Chi-square test was utilised to evaluate the differences in treatment outcomes. A p-value <0.05 was considered statistically significant. Results: The study included a total of 516 subjects. There were fewer cases registered in 2020 (n=202), especially after the first quarter, compared to the number registered in 2019 (n=314). The majority of the cases during both years were new instances of microbiologically confirmed pulmonary TB with no co-morbidities. Treatment success rates were 85.35% in 2019 and 88.61% in 2020, which was not statistically significant. Conclusion: There was a noticeable reduction in the number of cases registered during 2020, indicating that the COVID-19 pandemic had a definite effect on TB case notification. However, treatment success rates increased during the COVID-19 pandemic. This increase in the treatment success rate from 85.35% to 88.61% could be attributed to the decrease in the number of registered cases during the pandemic. The study thus found no significant impact on TB treatment success rate due to the COVID-19 pandemic.

Histopathological Spectrum of Central Nervous System Tumours in Adolescent and Young Adults: A Cross-sectional Study from Punjab, Northern India

Vikram Narang, Gagandeep Singh, Gursheen Puri Batta, Ankita Soni, Harpreet Kaur

Introduction: Central Nervous System (CNS) tumours are a common cause of cancer-related deaths in adolescents and young adults. The challenges in diagnosing and treating CNS tumours in this age group are unique and require special attention. Aim: To study the histopathological spectrum of CNS tumours in Adolescents and Young Adults (AYA). Materials and Methods: Present five-year cross-sectional study was conducted on CNS biopsies received in the Department of Pathology at Dayanand Medical College and Hospital, Ludhiana, Punjab, India, from July 1, 2016, to June 30, 2021, to analyse the histopathological spectrum of CNS tumours in the AYA group based on the site of the lesion, age, gender, and Isocitrate Dehydrogenase (IDH) status. Results: During the study period, a total of 215 cases of CNS tumours were identified, of which 52 (24.2%) belonged to the AYA group. Of these, 35 (67.3%) were males and 17 (32.7%) were females. The majority of the patients presented with complaints of headache (50/52, 96.1%), with the frontal lobe being the most common site of involvement (21/52, 40.4%). Diffuse astrocytic and oligodendroglial tumours were the most commonly observed (23/52, 44.2%). Conclusion: CNS tumours are one of the most common cancer diagnosis among the AYA group, and awareness should be enhanced among histopathologists and oncologists regarding these tumours based on the updated classification.

Histopathological Spectrum of Ovarian Tumours in a Tertiary Care Centre in South Kerala, India: A Cross-sectional Study

PH Anitha Das, I Praseeda, Anjali Sadanandan

Introduction: Ovarian tumours are among the most common tumours in females, exhibiting diverse histopathological patterns that remain crucial for early diagnosis. Proper classification of ovarian neoplasms, particularly malignant ones, is essential for accurate treatment. Accurately subclassifying ovarian tumours aids in treatments such as targeted therapy. Aim: To examine the histopathological spectrum of ovarian tumours and to assess the role of histopathology in accurate diagnosis and treatment. Materials and Methods: A cross-sectional study on the histopathological spectrum of ovarian tumours was conducted in Department of Pathology, Travancore Medical College, Kollam, Kerala, India, over a five-year period (January 2017 to December 2021). The study included 850 ovarian specimens, and the various histopathological patterns were studied according to the World Health Organisation (WHO) classification of ovarian tumours, 5th edition, 2020. These patterns and age distribution were expressed in frequency and percentage. Results: Out of the 850 ovarian specimens, 140 were neoplastic and 710 were non neoplastic. Abdominal pain was the most common clinical presentation (30%). Among the 140 neoplastic cases, 115 were benign, 20 were malignant, and five were borderline. The majority of cases, including benign, borderline, and malignant tumours, were seen in the age group of 31-40 years (25.71%). Benign tumours were more common than malignant ones in all age groups. Categorising based on histopathological patterns, epithelial tumours were the most common (88 cases, 62.86%). Serous cystadenoma was the most common benign tumour, constituting 36 out of 115 benign cases (25.71%). Borderline serous tumour was the most common borderline epithelial tumour (3 out of total 5 borderline ovarian neoplasms, 2.14%). Serous cystadenocarcinoma was the most common malignant tumour (5 cases, 03.57%). Conclusion: The wide spectrum of ovarian tumours presents diagnostic challenges. Effective therapeutic management of ovarian malignant tumours continues to be a challenge for clinicians. Histopathological examination remains crucial in diagnosis. Accurate histopathological diagnosis, combined with clinical staging, facilitates prompt and appropriate treatment and timely patient management.

Volumetric Analysis of Sphenoid Sinus in Patients with Symptomatic Nasal Septal Deviation: A Cross-sectional Study

Sheetal Rai, Rahul Kunnath, Adarsh Kibballi Madhukeshwar

Introduction: Nasal Septal Deviation (NSD) is known to influence the anatomy of the paraseptal structures, such as the lateral nasal wall and middle turbinate, thereby causing changes in ethmoid cell volume and maxillary sinus. However, there is not much literature on the influence of NSD on sphenoid sinus volume. Aim: To evaluate the effect of NSD on the volume of sphenoid sinus. Materials and Methods: A cross-sectional study was conducted over a period of one year at a tertiary care hospital in Karnataka, India on 45 patients with symptomatic NSD. Diagnostic Nasal Endoscopy (DNE) and Computed Tomography (CT) scans of the nose and Paranasal Sinuses (PNS) were performed on all patients. NSD was classified into three types based on the degree of septal deviation on CT scan. Sphenoid sinus volumes were measured, and the relationship between NSD and sphenoid sinus volume was analysed using OSIRIX software on the MAC system. Statistical analysis was done using the Wilcoxon signed-rank test and the Kruskal-Wallis test. Results: The mean age of the patients included in the study was 30.89±10.19 years. The male-to-female ratio was 2.75:1. The majority of the patients had NSD to the right (57%). NSD was found to be 1.3 times more frequent on the right-side compared to the left. The angle of NSD ranged between 2.10° and 18°. The majority of the patients were in group I (n=35), while group II and III had seven and three patients, respectively. The total ipsilateral volume was found to be 7.43±3.46 cm3 and the contralateral volume was 7.98±4.19 cm3. There was no statistically significant difference between ipsilateral and contralateral sphenoid sinus volumes in the population (p-value=0.781). When each group was compared, no significant difference between the total sphenoid cell volumes on the ipsilateral (p-value=0.557) and contralateral (p-value=0.405) sides of the NSD was seen. Conclusion: NSD does not affect the volume of the sphenoid sinus, irrespective of the degree of septal deviation.

Knowledge of Mothers on Multisensory Intervention for Preterm Babies: A Hospital-based Cross-sectional Study from Mangaluru, India

Sonya Sequeira, Kanagavalli Rajagopal, Prakash RM Saldanha

Introduction: Multisensory intervention for preterm babies is developmentally appropriate and has the capacity to integrate information from different senses-Auditory, Tactile, Visual, and Vestibular (ATVV). Involving mothers in the intervention may help mimic the preterm babies’ intrauterine environment. Mothers need to be systematically and effectively guided through the ATVV intervention. Before implementing the practice, it is important to ensure that mothers are sensitised with the necessary knowledge about multisensory intervention. Hence, assessing mothers’ knowledge of multisensory intervention is a significant step preceding any intervention. Aim: To assess the knowledge of multisensory intervention among mothers of preterm babies with the intention of preparing an educational package on multisensory intervention. Materials and Methods: A cross-sectional study was conducted among mothers of preterm babies admitted to the Neonatal Intensive Care Unit (NICU) of a selected hospital in Mangaluru, Karnataka, India. A total of 97 mothers were selected using a simple random sampling technique. Data on mothers’ knowledge were gathered using a proforma on baseline characteristics and a structured knowledge questionnaire on multisensory intervention for preterm babies. The data were analysed using descriptive and inferential statistics. Results: The overall knowledge scores of mothers on multisensory intervention showed a mean±SD of 7.42±2.06 with a mean percentage of 24.74%. Most mothers, 91 (93.8%), had inadequate knowledge, and 6 (6.2%) had moderate knowledge. The area-wise knowledge score of mothers revealed that in the concept of multisensory intervention, the mean±SD was 1.93±0.89 with a mean percentage of 38.56%. In the components of multisensory intervention, the mean±SD was 2.20±1.18 with a mean percentage of 24.40%. In understanding preterm babies’ behaviour, the mean±SD was 2.67±1.15 with a mean percentage of 29.67%. In aspects of practice in multisensory intervention, the mean±SD was 0.63±0.69 with a mean percentage of 8.98%. This indicates that most mothers had inadequate knowledge in the areas of multisensory intervention. A significant association between knowledge scores and the sex of the preterm babies was found (p-value=0.03). Conclusion: Most mothers had inadequate knowledge on multisensory intervention. Consequently, an educational package was developed, which included a video on multisensory intervention for preterm neonates and a handout to help mothers acquire knowledge and guide their practice.

Effectiveness of Tactile and Kinaesthetic Stimulation on Hyperbilirubinemia: A Feasibility Study

Saumya Kothiyal, Subhasish Chatterjee

Introduction: Neonatal hyperbilirubinemia is common among newborns, often necessitating hospitalisation and posing a risk of neural complications. Phototherapy, commonly used to treat hyperbilirubinemia, also has side effects, including eye and genital harm, dehydration, diarrhoea, and bronze baby syndrome. Therefore, there is a need to find alternatives or reduce treatment duration. Aim: To investigate the efficacy of tactile and kinaesthetic stimulation as adjunctive therapies with phototherapy for reducing bilirubin levels in preterm neonates with hyperbilirubinemia. Materials and Methods: A randomised controlled feasibility study, including 12 preterm neonates with hyperbilirubinemia, was conducted in the Neonatal Intensive Care Unit (NICU) of a Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, India. The experimental group (n=6) received three sessions of tactile and kinaesthetic stimulation for 15 minutes per session alongside phototherapy, compared to a control group (n=6) receiving phototherapy alone for three days. Results: While no significant differences (p>0.05) in demographics of neonates were observed, both groups experienced significant reductions (p<0.001) in Total Serum Bilirubin (TSB) and Transcutaneous Bilirubin (TCB) levels, with change scores of 7.88±2.29 (TSB experimental), 7.84±2.85 (TSB control), 6.63±2.77 (TCB experimental), and 6.27±1.92 (TCB control). However, the change in mean levels of TSB and TCB was not significantly different when compared between the two groups (p>0.05). Conclusion: There were significant reductions in TSB and TCB levels from Day 1 to Day 3 within each group. Both interventions were equally effective in reducing the bilirubin levels in the neonates.

Histopathological Changes and Clinical Outcomes in Placentas of COVID-19 Positive Mothers: A Cohort Study

Sukanta Tripathy, S Sreelakshmi, Asima Das

Introduction: Infection by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has been shown to affect multiple organs in the human body. Research shows that Coronavirus Disease (COVID-19)-positive pregnant women experience poorer perinatal outcomes related to placental infection, including higher risks of miscarriage, preeclampsia, preterm birth, and stillbirth. Aim: To evaluate the histopathological changes in the placentas of COVID-19-positive mothers and the associated foetal outcomes. Materials and Methods: This cohort study was conducted at Kalinga Institute of Medical Sciences (KIMS) Bhubaneswar, Odisha, India, over a period of one year and eight months, from November 2020 to July 2022. It included 23 COVID-19-positive pregnant females admitted for safe confinement during the first and second COVID-19 waves. Thirty COVID-19-negative pregnant women admitted for safe delivery during the same period served as controls. Placentas were collected, processed, and stained according to standard protocols. Descriptive data were interpreted as frequencies and percentages, and associations were tested using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: The study included 23 cases (mean gestational age: 37 weeks and 5 days) and 30 controls (mean gestational age: 38 weeks and 6 days). The prevalence of Maternal Vascular Malperfusion (MVM) and Foetal Vascular Malperfusion (FVM) was found to be higher among cases than controls. Conclusion: Compared to controls, COVID-19-positive placentas showed a higher prevalence of both MVM and FVM. This might be attributable to the hypercoagulable state associated with COVID-19. Further research is needed to explore the potential effects of intrauterine inflammation on neonates exposed to COVID-19.

Assessment of Stress and Resilience in the General Population during COVID-19: A Cross-sectional Study

Amritha Prasad, S Gopinath, E Sivabalan

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, which began in Wuhan, China, in December 2019, has quickly spread worldwide, causing numerous challenges for people, such as lockdowns, isolation, and subsequent mental stress. Developing mental resilience is crucial for handling stress effectively. Understanding the impact of the COVID-19 pandemic on stress and the resilience of the Indian population enables insight and facilitates thoughtful reformation in aiding the community. Aim: To assess the stress and resilience among the general population during the COVID-19 pandemic and to find the association between demographic variables and stress and resilience. Additionally, the study aimed to evaluate the correlation between stress and resilience among these subjects. Materials and Methods: A cross-sectional study was conducted Department of Psychiatry, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from February 2021 to April 2021. A total of 740 willing respondents affected by the COVID-19 pandemic participated in the study. A snowball sampling method was used in which participants were approached via a Google form circulated through their known contacts. The study encompassed those who had experienced either direct or indirect effects of the COVID-19 pandemic. The user-friendly Google form collected essential demographic information such as gender, marital status, and employment type. The stress and resilience levels were measured using the Perceived Stress Scale (PSS) and Resilience Scale. The statistical analysis of sample characteristics with frequency distributions and categorical variables was done with the application of Chi-square tests. Correlation analysis was done using the Spearman’s test. A p-value of <0.05 was considered statistically significant. Results: The research demonstrated remarkably low resilience levels and heightened stress levels among female participants (p<0.001, p<0.001) as well as single individuals (p=0.001, p<0.001). Conversely, a significant number of married men exhibited greater resilience (p=0.013) and reduced stress levels (p<0.001) compared to the rest of the population. Individuals in formal employment experienced less stress compared to those in informal employment (p=0.008). Notably, there was a moderate negative correlation between perceived stress and resilience which was significant (r=-0.562, p<0.001). Conclusion: The COVID-19 pandemic has greatly affected mental health and coping mechanisms; factors such as gender, social connections, and financial stability play significant roles. The study found that women, single individuals, and those working in informal sectors faced increased stress during these challenging times. Hence, psychological interventions targeting the pandemic crisis need to be planned considering the highlighted biological, socio-economic, and occupational factors.

Academic Achievement of First-year Medical Students using Self-directed Learning with Formative Assessment vs Conventional Teaching Method: A Longitudinal Study

Introduction: The Self-Directed Learning (SDL) approach is an important component of the Competency-Based Medical Education (CBME) curriculum. However, learning independently can be challenging, even for the brightest and most motivated students. Moreover, self-evaluation is quite difficult. If SDL is used in combination with formative assessment and constructive feedback for individual topics, it would facilitate self-modulation by learners and guide them towards higher academic achievement. Aim: To compare the academic performance of first-year medical students in Anatomy Practical class using SDL with formative assessment and feedback versus conventional teaching methods. Materials and Methods: A comparative evaluation was conducted using a longitudinal study design in the Department of Anatomy, Medical College Kolkata, West Bengal, India, from November 2022 to June 2023. During Anatomy Practical classes, 250 first-year medical students, (Batch 2022-2023), were divided into two equal groups using simple random sampling through a lottery method. One group (study group) was taught by implementing SDL followed by formative assessment with immediate feedback, and the other group was taught by the traditional method (control group). Following the completion of each of the first three consecutive regions (superior extremities, inferior extremities, and thorax) during Anatomy Practical classes, summative assessments were conducted. The collected data were calculated in an Excel sheet and computed using JAMOVI software (free version). Independent t-test statistics for the three summative assessments were evaluated, and the p-value of each assessment was determined. A p-value <0.05 was considered to be statistically significant. Additionally, students’ feedback was documented and analysed. Results: It was observed that there was an improvement in academic scores in both groups. However, higher academic performance was progressively attained in the group which was provided SDL sessions and formative assessment with immediate feedback. A total of 55 (80%) students passed the third summative assessment in comparison to 40 (59.7%) students of the control group who passed the same exam. Differences between the means of the control and study group were found to be statistically significant (p-value ≤0.001 and 0.023 in two summative assessments). Conclusion: The present study revealed that SDL with formative assessment followed by immediate feedback during Anatomy Practical classes had a remarkable positive impact on students’ academic performance compared to those students taught using conventional teaching methods and might be implemented in the future for better learning and improved academic achievement of students.

Microbial Profile and Antibiotic Sensitivity Pattern in Urinary Tract Infections among Children Attending a Tertiary Care Center, Idukki District, Kerala: A Cross-sectional Study

Mariya Biju, Angel Cham Philip, Gulsiv Nair

Introduction: Over the recent decades, the importance of Urinary Tract Infections (UTI) has been increasingly recognised in children. The occurrence of UTI during childhood may lead to acute and/or chronic consequences, such as impaired renal function, renal scarring, and hypertension. Due to the irrational use of antimicrobials, multidrug resistant bacterial strains are frequent. Hence, there is an urgent need for continuous surveillance of the microbiological profile of UTI. Aim: To investigate the microbial profile and antibiotic sensitivity pattern from the urine of paediatric patients suspected to have UTI in Idukki district, Kerala and to explore its association with seasonal variations. Materials and Methods: This clinical cross-sectional study was conducted in Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Idukki, Kerala, India, from January 2019 to December 2021. The study involved 882 paediatric patients in the age group 0-15 years with symptoms and signs suggestive of UTI. Data regarding age, gender, season, laboratory and culture results, and antibiotic sensitivity pattern were considered as variables of interest. Analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. The statistical analyses were conducted using Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: The study involved 882 patients, of which 399 were males (45.2%) and 483 were females (54.8%) with a male-to-female ratio of 0.8:1. The mean age of patients was four years, and a peak incidence was observed in children in the age group of 1-3 years, with 333 (37.8%) children. Microbial growth was observed in the urine of 325 (36.8%) patients. After excluding normal commensal perineal flora and insignificant bacteriuria, 233 samples had significant growth, with males accounting for 106 (45.5%) and females 127 (54.5%). The male-to-female ratio was 0.8 to 1. These samples mostly exhibited growth of aerobic bacteria (232, 99.6%) and Candida albicans (1, 0.4%). E. coli (106, 45.5%) was identified as the most predominant aetiological agent for paediatric UTI. Conclusion: The results of this study suggest that it would be advisable for paediatricians in Idukki district to refrain from using Ampicillin to treat cases suspected to have UTI. Preventive measures should be advised to all patients, with emphasis on urinary hygiene during the monsoon and winter seasons.

Clinical Manifestations and Treatment Outcomes of Brucella Endocarditis: A Retrospective Cohort Study at a Tertiary Cardiac Centre in Bengaluru, Karnataka, India

Introduction: Brucella is a rare cause of Infective Endocarditis (IE), requiring prompt early recognition and treatment to prevent life-threatening complications. Diagnosis is often missed or delayed, leading to an increase in cardiac morbidity and mortality. Aim: To analyse the clinical profile, laboratory parameters, cardiac manifestations, management patterns, and outcomes of Brucella endocarditis. Materials and Methods: A retrospective cohort study was conducted at the Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangaluru, Karnataka, India on patients with blood culture-confirmed Brucella endocarditis, diagnosed using modified Duke’s criteria between January 2010 and December 2021. The present study evaluated the clinical presentation, treatment modalities, and outcomes. Descriptive statistical analyses were performed. Results: A total of 34 cases were identified during the study period. The mean age of the patients was 35.6±14 years (age range: 15-66 years), with 82.4% males and 17.6% females. Underlying valvular heart disease was present in 82.4% of the patients, while 17.6% had no pre-existing valvular heart disease. Both aortic and mitral valves were involved with equal frequency. All patients presented with fever. Most patients had a normal leukocyte count (61.8%). Thrombocytopenia (32.3%) and pancytopenia (17.6%) were also observed. Large vegetations (>1 cm) were seen in 38.2% of patients, and complications related to IE were observed in 35.2%. The majority of patients (82.4%) were managed medically alone in the acute phase. The antibiotic regimen of doxycycline with rifampicin combined with intravenous gentamicin was used in the majority of the patients. The observed mortality rate was 17.6%. Conclusion: Brucella endocarditis can present with thrombocytopenia/pancytopenia along with normal or reduced leukocyte count. The addition of intravenous gentamicin to oral therapy may reduce relapse rates.

Impact of COVID-19 on the Risk of Development of Oligohydramnios in Pregnancy: A Retrospective Observational Study

Ipek Ulu, Aytaj Jafarzade, Muhittin Tamer Mungan, Aydan Biri

Introduction: The Coronavirus Disease-2019 pandemic is considered the most catastrophic disease of the last decades, with evolving knowledge and improved management over time. Pregnant women are known to be particularly vulnerable, and COVID-19 has been shown to damage the endothelium due to its proinflammatory nature. Aim: To determine the occurrence of oligohydramnios in pregnant women who tested positive for COVID-19. Materials and Methods: A retrospective observational study was conducted at the Department of Obstetrics and Gynaecology, Koru Health Groups, Ankara, Çankaya, Turkey from January 2023 to June 2023. The study included a total of 459 women who were followed during pregnancy and delivered in the same hospital between April 2020 and October 2022. The patients were divided into two groups: COVID-19 positive group (n=101) and negative group (n=358). Various parameters such as age, parity, gestational week at birth, Body Mass Index (BMI), 1s and 5th-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores, weight of the newborn, Amniotic Fluid Index (AFI), and the risk of developing oligohydramnios were assessed between the positive and negative groups. Parametric variables were analysed using independent t-tests and non parametric ones using Mann-Whitney U tests. Chi-square test was used to compare categorical variables. A p-value of <0.05 was considered statistically significant. Results: The mean age of the pregnant women was 29.2±4.4 years, ranging from 20 to 43 years. Oligohydramnios was detected in 95 women, with 64 of them testing positive for COVID-19. There were no statistically significant differences in terms of age, parity, gestational week of birth, weight at birth, and 1st and 5th-minute APGAR scores between the two groups. However, BMI was significantly higher in COVID-19 positive patients compared to negative ones (p=0.003). Oligohydramnios was found to be significantly higher in COVID-19-positive pregnant women (n=64) compared to negative ones (n=31) (p<0.0001). Conclusion: The COVID-19 pandemic has caused an unprecedented level of global health problems. The virus’s prothrombotic tendency leads to placental insufficiency, predisposing to oligohydramnios and intrauterine growth retardation.

Spectrum of Radiological Findings in Pulmonary Tuberculosis- A Tertiary Care Hospital-based Retrospective Descriptive Study

Introduction: Tuberculosis is a worldwide public health problem associated with high morbidity and mortality. Tuberculosis can manifest in active and latent forms. Improving the diagnosis, treatment, and screening of tuberculosis is crucial for effective tuberculosis control. Chest X-ray and Computed Tomography chest play a vital role in diagnosing and screening for tuberculosis. Aim: To analyse the spectrum of radiological findings in pulmonary tuberculosis. Materials and Methods: The present retrospective descriptive study was conducted at a teritary care hospital in the Department of Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India. The data of 160 patients diagnosed with pulmonary tuberculosis between January 2019 and December 2020 were accessed and analysed. The recorded variables included forms of pulmonary tuberculosis, age/gender distribution, co-morbidities, Acid-fast Bacillus (AFB) smear status, and radiological findings and distribution. Descriptive statistics are presented in frequency and percentage. Results: Among the 160 cases of pulmonary tuberculosis, 30 (18.75%) cases were active primary tuberculosis, 105 (65.63%) cases were active post-primary tuberculosis, and 25 (15.62%) cases were inactive tuberculosis. Among the 30 cases of active primary tuberculosis, 14 (46.67%) cases had consolidation with air bronchogram, and 6 (20%) cases had consolidation without air bronchogram. Among the 105 cases of active post-primary tuberculosis, 65 (61.9%) cases had consolidation, 50 (47.62%) cases had cavities, and 56 (81.9%) cases had centrilobular nodules with a tree-in-bud appearance. Among the 25 cases of inactive tuberculosis, 18 (72%) cases had fibrosis with bronchiectasis, while 4 (16%) cases had fibrosis without bronchiectasis, and 3 (12%) cases had calcified granulomas. Conclusion: The study conclusively demonstrates the diverse radiological manifestations of pulmonary tuberculosis in different patient demographics. It highlights a higher incidence of active post-primary tuberculosis, especially in patients above 45 years, with varying radiological findings such as consolidation, cavitation, and fibrosis.

Commonly Used Tests in the Assessment of Sacro-illiac Joint Dysfunction by Physiotherapists in India: A Cross-sectional Study

Aleena Philip, Saumya Srivastava

Introduction: Sacroiliac Joint Dysfunction (SIJD) refers to a condition that causes pain and discomfort, commonly due to dysfunction of the Sacroiliac Joint (SIJ). It is a plausible source of Low Back Pain (LBP). Static palpation tests, motion palpation, and pain provocation tests are mostly employed to check for SIJD. Aim: To determine the commonly used tests in the assessment of SIJD by physiotherapists. Materials and Methods: A cross-sectional Questionnaire-based study was conducted among physiotherapists in India from November 2022 to April 2023 at the Nitte Institute of Physiotherapy, NITTE (deemed to be University), Mangalore, Karnataka, India. The study included physiotherapists specialising in orthopaedics and obstetrics and gynaecology. The practitioners’ years of experience were considered. An online survey was conducted using a questionnaire developed to determine the frequently used bony landmark for checking SIJ asymmetry, commonly affected structures, and commonly used motion palpation and pain provocation tests for examining SIJD. Questionnaires were sent to at least 100 physiotherapists, and 72 responses were included in the study. Data was collected and analysed using descriptive statistics: frequency and percentage. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: Seventy-two practitioners responded to the online survey. The commonly assessed bony landmark was the Posterior Superior Iliac Spines (PSIS) with 52 responses (28%). The most frequently preferred motion palpation examination test was the compression test with 36 responses (17.2%). Tenderness or tissue texture change was mainly checked at the PSIS with 54 responses (37.8%), and the commonly used pain provocation tests were the thigh thrust test and supine SIJ springing test with 46 responses (26.6%). Conclusion: According to this study, many physiotherapists employed diagnostic techniques congruent with Mitchell’s model, but they also frequently added additional motion tests, measured tenderness, and used pain provocation techniques. Most preferred the ASIS compression and thigh thrust tests to assess SIJD.

Imaging Approaches in Dementia: A Retrospective Cohort Study of Cross-sectional Imaging in the Indian Population

Sanjana Sanzgiri, Mitusha Verma, Ritvik Thakrar, Prishaa Bhurrji, Deepak Patkar

Introduction: Dementia is a broad medical term that describes the progressive cognitive decline of brain function due to disease or impairment, resulting in interference with daily activities. Magnetic Resonance Imaging (MRI) is commonly used for the clinical diagnosis of dementia by identifying cerebral atrophy and structural alterations. Furthermore, Magnetic Resonance Spectroscopy (MRS) can detect biochemical abnormalities in dementia patients, which may be beneficial for early diagnosis and treatment. Aim: To provide a comprehensive protocol and a guidance tool for radiologists to effectively diagnose dementia and its subtypes {Alzheimer’s Disease (AD), frontotemporal lobe dementia, etc.} based on radiological findings coupled with volumetry, spectroscopy, and Arterial Spin Labelling (ASL) findings. Materials and Methods: A retrospective observational study was conducted in the Department of Radiology, Nanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India, between June 2022 and June 2023. A total of 125 patients were analysed to observe the correlation between whole brain volume, Intracranial Volume (ICV) of different cortical regions, hippocampal atrophy, and MRS findings. Descriptive statistics were used, and results were expressed as means and standard deviations for continuous variables, and as frequencies and percentages for categorical variables. Results: Out of 125 patients, 71 (56.8%) were males, and 54 (43.2%) were females, with ages ranging from 41 to 96 years. The majority presented with Mild Cognitive Impairment (MCI) 36 patients (28.8%) and Vascular Dementia (VaD) (18 patients - 14.4%). Some clinical features and imaging findings overlapped, resulting in some cases being a combination of different types of dementia. MRI, MRS, and Medial Temporal Atrophy (MTA) played a crucial role in allowing clinicians to perform a differential diagnosis. Conclusion: The use of MR volumetry and spectroscopy aids in classifying the type of dementia, which, in turn, gives treating clinicians a better perspective for further treatment and its outcomes.

Evaluation of Effectiveness of an Online Self-directed Learning Programme in Biochemistry for First-year Medical Undergraduate Students: A Quasi-experimental Study

Introduction: Self-directed Learning (SDL) has been suggested as a principle of adult learning to promote lifelong learning abilities among students. Though SDL is not a new concept, there is a lack of uniform implementation across the institutions in India. The Competency-based Medical Education (CBME) proposed by the National Medical Commission in 2019 has emphasised SDL for medical students. Aim: To evaluate the effectiveness of an online, case-based SDL activity in Biochemistry for the first-year MBBS students. Materials and Methods: This was a quasi-experimental study conducted at Father Muller Medical College, Mangaluru, Karnataka, India from May to July 2021. A purposive sampling technique was used, and 138 first-year MBBS students were enrolled for the research. The topic of lipid metabolism was chosen for SDL. Parallel to the online didactic lectures, a case-based, team-based, online SDL was implemented. Students were provided with case scenarios and were instructed to discuss the case scenarios and find answers to the accompanying questions in allotted groups for 15 days. A three-hour session was held for the presentation of the SDL, followed by a post-test and reflections of students. The data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The significance of the difference in pretest and post-test scores was assessed by paired t-test, and the level of significance was set at a p-value <0.05. Qualitative data were subjected to descriptive statistics, and thematic analysis of reflections was conducted. Results: The average post-test score of the participants was significantly higher by 99.3% compared to the pretest score (p-value <0.001). On average, 108 out of 138 (78.2%) agreed (agree/strongly agree) that SDL helped them to achieve the learning objectives,115 (83.3%) agreed that SDL helped them to develop as lifelong learners, 115 (83.3%) agreed that SDL helped them to develop as a health professional, and 83 (60.1%) agreed that enjoyed learning in online mode. The inclination of 110 (79.7%) students to have more SDL sessions in the future shows a behavioural change in favour of SDL. Time constraints and internet connectivity were the main challenges. Conclusion: SDL was effective and was received positively by the majority of the students. It is the need of the hour to develop lifelong learning and critical thinking among medical students and to make learning interesting with the use of case scenarios. Future research should assess the intermediate and long-term outcomes of case-based SDL on learning, behavioural changes, and its impact on patient care and the health of society.

Effect of Corneal Collagen Crosslinking with Riboflavin in Patients of Progressive Keratoconus: A Prospective Cohort Study

Sabna Sasidharan, Laly Thekkemeppilly Unnikrishnan, Faiza Ibrahim

Introduction: Keratoconus is a non inflammatory disease characterised by progressive corneal thinning that results in a cone-like ectasia, irregular astigmatism, and decreased vision. Advanced disease can result in corneal scarring and blindness, necessitating penetrating keratoplasty. The only treatment believed to have the ability to stop or decrease the progression of keratoconus is Collagen Cross-Linking (CXL). Aim: To evaluate the efficacy of corneal collagen cross-linking with riboflavin (C3R) in patients with keratoconus by studying the outcomes in terms of Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), manifest refraction, and corneal topography. Materials and Methods: A hospital-based prospective cohort study was conducted at the Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India from June 2017 to June 2018. Fifteen eyes of 12 patients who underwent corneal collagen cross-linking for progressive keratoconus were included. Routine ophthalmological examinations was done for all patients. Patients under the age of 35 years with progressive keratoconus, an average K value not exceeding 60 D, and who had not undergone any other surgical modalities of treatment were included in the study. Patients with scarred cornea or hydrops, active ocular infection, or pachymetry <400 μm were excluded. Detailed informed consent was obtained from all patients before surgery. Preoperative UCVA, BCVA cylinder, Spherical Equivalent (SE), and topography values were obtained. All patients were followed-up at three and six months postoperative period to look for changes in UCVA, BCVA, manifest refraction, and corneal topography. Data were expressed as the mean±Standard Deviation (SD) pre- and postoperatively and analysed statistically using the paired t-test, with p<0.05 considered statistically significant. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 16.0. Results: On follow-up at six months post-treatment, UCVA (log MAR) improved from 0.87±0.40 to 0.65±0.35 (p-value=0.001), and BCVA (log MAR) changed from 0.37±0.21 to 0.17±0.22 (p-value=0.001). K max decreased from 54.90±6.05 to 52.67±5.02 (p-value=0.001), and K min decreased from 48.14±4.24 to 45.93±4.07 (p-value=0.001). Astigmatism and SE also showed statistically significant improvement post-procedure (p-value 0.001 and 0.002, respectively). Astigmatism reduced from -3.50±1.58 to -2.90±1.37. SE reduced from -4.93±3.92 to -4.28±3.48. No significant complications were noted in any of the patients. Conclusion: The CXL is an effective procedure for stabilising the progression of keratoconus, thus reducing the burden of preventable blindness and the need for keratoplasty.

Assessment of Mechanical Properties and Antimicrobial Effects of Hyaluronic Acid Coating on Absorbable Suture Material: An In-vitro Study

P Swarna Meenakshi, Arvina Rajasekar

Introduction: The use of absorbable suture materials in surgical procedures is a critical aspect of wound closure and tissue repair. In recent years, there has been growing interest in exploring the potential benefits of incorporating Hyaluronic Acid (HA), a naturally occurring biopolymer, into these sutures. By shedding light on the interactions between HA and absorbable sutures, the present study seeks to provide valuable insights that could enhance the quality of surgical wound management. Aim: To assess the mechanical properties and antimicrobial effects of HA-coated and uncoated absorbable suture material. Materials and Methods: The in-vitro study was conducted at Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India in a year 2022. A total of 70 samples of HA-coated and uncoated Vicryl 4-0 suture material were tested for tensile strength using an Instron machine. An anti-bacterial effect against Pseudomonas aeruginosa and Streptococcus mutans was assessed using a Mueller Hinton agar (MHA) plate, and the zone of inhibition was measured. Additionally, both the uncoated and HA-coated Vicryl 4-0 suture materials were analysed under the Scanning Electron Microscope (SEM) to determine the surface characteristics. An independent t-test was used to compare the tensile strength of coated and uncoated suture materials. Results: The mean tensile strength of uncoated and HA-coated suture material was 6.47±0.23 MPa and 3.78±1.02 MPa, respectively. The difference between both groups was statistically significant (p<0.05). For Pseudomonas aeruginosa and Streptococcus mutans, the zone of inhibition was 8.0±0.5 mm in diameter and 9±0.5 mm in diameter, respectively, around coated Vicryl 4-0 suture material, whereas no zone of inhibition was observed for both Pseudomonas aeruginosa and Streptococcus mutans around uncoated suture material. SEM analysis showed superior surface characteristics of HA-coated suture thread when compared to uncoated suture thread. Conclusion: HA-coated suture material does not exhibit superior tensile strength when compared to the uncoated suture material. However, HA-coated suture material has potent antibacterial effects against Pseudomonas aeruginosa and Streptococcus mutans. Additionally, SEM analysis showed improved surface characteristics in favour of the coated suture material.

Unveiling the Unseen: Exploring the Lived Experiences of Family Caregivers of Young Adults with Chronic Mental Disorders: A Qualitative Phenomenological Study

Suja Chungathil Mathew, Thereza Mathias

Introduction: One of India’s most valuable resources is its young people, and this generation needs to be nurtured for the bright future of the nation. However, when the young generation is affected by chronic mental disorders, families find it difficult to take care of them and are burdened with the responsibility for several years. Aim: To explore the lived experiences of Family Caregivers (FCGs) of young adults with chronic mental disorders. Materials and Methods: This qualitative study was conducted at the selected mental inpatient and outpatient Department of a selected mental health facility in Urban Bangaluru, Karnataka, India from April 2021 to December 2021. The authors used a phenomenological qualitative study to explore the lived experiences of family caregivers of young adults with chronic mental disorders {mania, depression, Bipolar Affective Disorder (BPAD), schizophrenia} aged between 18-40 years. The Family Caregivers of young adults undergoing treatment were approached for written informed consent and recruited through purposive sampling. Data were collected using face-to-face, in-depth, semi-structured interviews. Each interview lasted around 45 minutes to one hour, and data saturation was achieved with 15 samples. Interviews were conducted over a period of nine months. The audio-recorded interviews were transcribed, interpreted, and investigated using Colaizzi’s data analysis framework. Baseline variables were analysed using descriptive statistics. Results: In the present, the family caregivers’ ages ranged from 28 to 60 years, with the majority (67%) being females and employed. One of the family members was affected by a mental disorder. A rehabilitation facility was unavailable to the majority (67%) of them near their residence. Regarding the young adults with chronic mental disorders, the majority (74%) were unemployed and diagnosed with affective disorders. The maximum duration of illness was 20 years, with onset typically at the age of 17-21 years. From the analysis, six main themes and 36 subthemes emerged. The main themes were as follows: family caregivers experience difficulty in identifying the responsible person and support system, providing physical care, tackling emergencies, problems with medication and early identification of relapse, problems with indecent behaviour, and knowledge deficit related to mental disorders and their management. Conclusion: The study concludes that family caregivers of young adults with chronic mental disorders experience various psychosocial and economic issues and problems while caring for a young adult with chronic mental disorders. The knowledge generated from the present study can be utilised by mental health professionals to plan home-based care strategies to improve the quality of life and reduce the burden of care for FCGs.

Association of Insulin Resistance with Hepatitis B and Hepatitis C Infection: A Cross-sectional Study

Shruti Bhanderi, Nivedita Priya

Introduction: Hepatitis B and C viruses (HBV and HCV) are the most common causes of chronic viral hepatitis in the United States and worldwide. As several studies have shown that some viral infections promote Insulin Resistance (IR), it becomes imperative to investigate the effect of HBV and HCV on the same. Aim: To investigate the association between IR and Hepatitis C and Hepatitis B infection. Materials and Methods: The present cross-sectional study was conducted in the Department of Paramedical and Health Sciences, Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat, India, from November 2022 to June 2023. The study comprised 100 consecutive patients, with 55% testing positive for Hepatitis B and 45% for Hepatitis C. Biochemical parameters such as fasting blood sugar, fasting insulin and IR via the Homeostasis Model Assessment (HOMA-IR) were determined. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 26.0. The z-test of proportion was calculated and a Z-score calculator was used for p-value. Results: In the present study, out of 100 consecutive patients, 76 were males and 24 were females. The mean insulin level for HBV patients was found to be high, with values of 28.94±2.22 mU/L in 23.63% of cases, whereas in HCV cases, 68.8% of patients were found to have higher levels, with mean values of 34.52±9.00 mU/L. The mean HOMA-IR values for HBV patients were found to be high, at 4.84±2.32 in 47.27% of cases, whereas in HCV cases, 77.7% of patients were found to have higher values of HOMA-IR, with a mean of 7.94±4.83. Conclusion: Insulin resistance can be a consequence of the inability of insulin to induce the appropriate effect on glucose metabolism and is the principal indication for the development of metabolic syndrome and diabetes mellitus. In the current study, HCV-positive patients showed more IR compared to HBV-positive cases.

Survival Outcomes and Prognostic Factors in Oral Squamous Cell Carcinoma with Locoregional Recurrence: A Retrospective Analysis

Anoop Attakkil, Sandeep Vijay, K Ratheesan, Aswin Mullath, Raveena R Nair

Introduction: Recurrence is known to occur in approximately 25% to 45% of patients treated for oral cancer. It is the most common cause of treatment failure in Oral Squamous Cell Carcinoma (OSCC), which adversely affects survival. Although recurrences in the oral cavity may be detected early, survival rates remain low. Aim: To identify the survival outcomes and prognostic factors in OSCC with locoregional recurrence. Materials and Methods: This retrospective study was conducted at the Malabar Cancer Centre between November 2020 to March 2021, analysing patients who were treated with curative intent between January 1997 and December 2017. It included 118 patients with OSCC who experienced recurrence-local, regional, or both-after curative treatment. Demographic variables, clinical variables, and follow-up details were analysed. Characteristics of the primary tumour, including nodal metastasis, stage, Extranodal Extension (ENE), Perineural Invasion (PNI), the extent of treatment, adjuvant therapy, and days to recurrence, were recorded. For the recurrent tumour, site, time to recurrence, and type of treatment received were noted additionally. Overall Survival (OS) was defined from the date of initial diagnosis, while the date of recurrence was determined by pathological confirmation. Statistical analysis was performed using SPSS software, version 20. All significant variables (p<0.05) were then tested in a multivariate analysis using Cox regression methods. Disease-specific Survival (DSS) and OS were analysed using the Kaplan-Meier method. Results: A total of 146 patients with OSCC (15.01%) experienced a recurrence-local, regional, or both-upon analysis of 973 OSCC patients who underwent primary curative intent surgery. One hundred eighteen patients were included in the final analysis. Salvage surgery was performed on 65 (55.08%) patients. Thirty-eight patients (32.3%) who presented with early-stage disease initially developed a recurrence, whereas recurrences were more common among patients with advanced-stage disease, accounting for 80 (67.7%) cases. The median age of patients with recurrence was 60 years, with a median follow-up period of 46 months. The median OS time for patients with recurrence was 34 months ranging from 26.343 to 42.457 months. Univariate analysis revealed that nodal stage, salvage surgery, and time to recurrence were significant factors affecting OS. On multivariate analysis, salvage surgery and time to recurrence remained significant factors impacting survival. Conclusion: Salvage surgery and time to recurrence were identified as significant prognostic factors affecting survival outcomes in patients with OSCC experiencing locoregional recurrence. Salvage surgery significantly improves survival in oral cancer, where recurrence is usually detected more easily unlike other subsites. Patients with late recurrences demonstrated better survival outcomes. Tumours that recur early indicated poor oncological outcomes, suggesting an aggressive nature. Tumor biology is essential in guiding treatment options in recurrent settings.

Attitude and Practice of Dental Practitioners Towards the Oral Biopsy Procedure: A Questionnaire-based Cross-sectional Study

Introduction: Dentists, the first medical professionals to be consulted for conditions involving the oral cavity, have the distinct advantage of being in a position to screen patients for oral cancer. To effectively manage patients, dentists must be familiar not only with where, when, how and why to perform biopsies, but also with when to refer them to specialised institutions. Aim: To assess the attitude and practice of dental practitioners towards the oral biopsy procedure. Materials and Methods: The present questionnaire-based cross-sectional study was conducted in the city of Jamnagar, Gujarat, India, from July 2023 to August 2023. Fifty dental practitioners with a minimum academic qualification of Bachelor of Dental Surgery (BDS) participated in the study, which was designed to collect information regarding the importance of oral biopsy, methods used to obtain biopsies, tissue preservation, diagnosis, referral to higher centers and the attitudes and practices of dental practitioners in examining oral mucosal lesions. The questionnaire was prepared using the Google Forms app. The received responses were compiled and statistical data (percentage) was calculated using Microsoft Excel 2020. Results: Out of total, 42 (84%) dentists encounter up to 10 oral mucosal lesions, such as potentially malignant disorders, in a month. Despite this, only 22% (n=11) of them performed biopsies themselves. Furthermore, 6 (12%) dentists did not know the proper medium for preserving biopsies. Of all, 24 (48%) dentists felt the need for proper training in biopsy techniques to be included in the undergraduate curriculum. Conclusion: Despite being aware of the importance of biopsy as a crucial diagnostic procedure, not many dentists perform it routinely due to reasons such as lack of training, patient non compliance and medicolegal implications. Hence, dentists should be educated in performing the oral biopsy procedure, including handling of specimens and referral to specialists.

Estimation of ABO Anti-A and Anti-B Agglutinin Titers among Blood Donors at a Tertiary Care Referral Teaching Hospital Blood Centre in Southern India: A Cross-sectional Study

C Ravikanth, R Arun, B Suresh Babu, KV Sreedhar Babu, G Sandhya, S Prashanth

Introduction: Transfusion of blood Group O and its components with high ABO antibody titers to non O recipients has been shown to cause acute transfusion reactions, especially in platelet transfusions, as platelets contain significant amounts of ABO antigen on their surface as well as Anti-ABO alloisogglutinins in plasma. Aim: To estimate the ABO Anti-A and Anti-B agglutinin titers among blood donors at a tertiary care referral teaching hospital blood centre. Materials and Methods: This cross-sectional observational study was conducted at the Immunohaematology laboratory of the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2021 to June 2022. All blood donors presenting to the blood centre were screened for eligibility for blood donation. Donors who fulfilled the eligibility criteria as per the Drugs and Cosmetics Act, 1940, and Rules, 1945 were included. Anti-A and Anti-B titers were determined by the conventional tube method with dilutions of 1 in 2, 1 in 4, 1 in 8, 1 in 16, 1 in 32, 1 in 64, 1 in 128, 1 in 256, 1 in 512, and 1 in 1024. A titer of <64 was considered as a low titer, while a titer of >64 was considered as a high titer. Results: A total of 399 donors were included in the study, with 393 (98.5%) being males and 6 (1.5%) being females. The mean age of the study population was 28.49 years. Among blood group A, the percentage of individuals with an IgM anti-B titer of <64 was 85.44% (88) and >64 was 14.56% (15), whereas in blood group B, IgM anti-A titers of <64 were 65.5% (93) and >64 were 34.5% (49). In blood group O, the percentage of individuals with <64 and >64 titers of IgM anti-A were 52.60% (81) and 47.40% (73), respectively, whereas for anti-B, <64 and >64 titers were 77.92% (120) and 22.08% (34), respectively. Conclusion: It is recommended that a database be maintained in all institutes by estimating antibody titers for every A, B, O blood group donors. Whole blood or platelets from group O donors with IgM Anti-A and Anti-B antibody titers <64 can only be transfused across the ABO barrier. As the majority of group A donors had titers <64, group A platelets may be transfused across the ABO barrier in emergency situations.

Assessment of Oncosurgical and Functional Outcomes in Patients undergoing Glossectomy for Advanced Carcinoma Tongue: A Cross-sectional Study at a Tertiary Cancer Care Centre in Northern India

Shivangi Sundram, Anshika Arora, Sourabh Nandi, Sunil Saini

Introduction: Tongue carcinoma presents a global oncological challenge due to its aggressive nature and late-stage diagnosis. Glossectomy, a key surgical procedure for advanced cases, significantly affects both cancer control and essential functions such as speech and swallowing. Aim: To analyse the impact of different glossectomy types on oncological and functional outcomes in patients with advanced carcinoma of the tongue. Materials and Methods: A cross-sectional study was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Uttarakhand, India over a one-year period from September 1, 2022, to August 31, 2023. The study included 47 patients with squamous cell carcinoma of the oral and posterior tongue who underwent glossectomy. Oncological outcomes (mortality and hospital stay) and functional outcomes (swallowing, speech, dysphagia, and Quality of Life (QoL)) were assessed. The questionnaires used were the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC questionnaire for the assessment of QoL in head and neck cancer patients (EORTC QLQ-H&N35), M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Follow-up was conducted at the 6th week to assess changes in the functional aspects compared to the baseline scores. Data were entered into Microsoft Excel, and the analysis was performed using Statistical Packages for Social Sciences (SPSS) software version 25.0. The data were analysed using the Wilcoxon Signed Rank test. A p-value of <0.05 was considered statistically significant. Results: The study comprised 37 (78.72%) males and 10 (21.28%) females, with a mean age of 47.77±12.6 years. Preoperative staging indicated that 22 (46.81%) patients had T2N0 stage, 16 (34.04%) patients had T3, and 9 (19.15%) patients had T4a disease. Among the patients, 14 (29.79%) underwent partial glossectomy, 27 (57.45%) underwent hemiglossectomy, and 3 (6.38%) underwent subtotal glossectomy, and 3 (6.38%) underwent total glossectomy. The mean duration of hospital stay was 10.09±2.87 days. There were no instances of mortality or tumour recurrence at the 6th week. Regarding the functional outcomes, compared to baseline, at the 6th week, there was a significant decrease in EORTC QLQ-H&N35 median scores from 6.94 to 1.73 (p=0.005), but no significant change in the mean EORTC QLQ-C30 (90±8.22 versus (vs) 89.72±8.52, p=0.368), mean MDADI (4.51±1.2 vs 4.43±1.19, p=0.585), and mean SHI (15.81±25.76 vs 13.43±26.19, p=0.052). Conclusion: It can be inferred that glossectomy for advanced carcinoma of the tongue leads to a significant improvement in symptoms; however, the overall Quality of Life (QoL) and functions of the tongue such as swallowing and speech remain comparable to pre-surgery levels.

Seropositivity and Trends of Transfusion Transmitted Infections among Blood Donors: Five Years Cross-sectional Study on 20,392 Blood Donors in a Tertiary Care Hospital of Ahmedabad, Gujarat, India

Introduction: Blood transfusion is a lifesaving intervention. However, it can also be a source of Transfusion-transmissible Infections (TTIs), posing a potential threat to the recipient. Testing for TTIs before blood transfusion is crucial for the safety of recipients. However, donations occurring during the window period, the prevalence of asymptomatic carriers, viral strains with high genetic variability, and technical errors are responsible for TTIs and remain one of the greatest obstacles in transfusion medicine to deal with. All blood donors are to be screened against five major infections-Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis, and Malaria. Aim: To study the seroprevalence and trends of TTI among healthy blood donors at the Blood Centre of Ahmedabad, Gujarat, India. Materials and Methods: A cross-sectional study was carried out by reviewing blood donors’ records over a period of five years from January 1, 2018, to December 31, 2022, at the Blood Centre, Department of Pathology, of Sheth L.G. General Hospital, Maninagar, Ahmedabad, Gujarat, India. The data collected for each seropositive donor included the results of TTI testing, the age group of donors, the type of donation, the frequency of donation, and co-infection. The results were expressed in numbers and percentages. Results: Among a total of 20,392 healthy blood donors during the five-year period, the total number of seropositive cases (n) was 243 (1.19%). TTI seropositive donors in years 2018, 2019, 2020, 2021, and 2022 were 60 (1.29%), 50 (1.16%), 39 (1.22%), 45 (1.14%), and 49 (1.16%), respectively. A maximum of 118 (48.56%) seropositive donors were recorded in age group of 18-29 years. Individual seropositive donors during the five-year period for HIV, HBV, HCV, syphilis, and malaria were 19 (0.09%), 155 (0.76%), 28 (0.14%), 41 (0.20%), and 00 (0.00%), respectively. Voluntary Blood Donors (VBD) 10,933 (53.61%) exceeded Replacement Donors (RD) 9,459 (46.39%), and repeat blood donors 14,462 (70.92%) surpassed first-time donors 5,930 (29.08%). The seroprevalence of TTI among replacement, voluntary, first-time, and repeat blood donors was 2.41%, 0.14%, 2.06% and 0.84% respectively. Out of 243 seroreactive donors, two donors (0.82%) showed dual reactivity for TTI during the five-year period. Conclusion: Implementation of strict donor selection criteria, utilisation of sensitive screening modalities, promoting public awareness, and dispelling myths regarding the merits of voluntary blood donation, judicious use of blood products, and mass immunisation for Hepatitis B infection are essential interventions needed to curb TTI to a significant extent.

Dosimetric Comparison of Hippocampal Sparing Whole Brain Radiotherapy by Volumetric Modulated Arc Therapy, Linac-based Intensity-modulated Radiation Therapy and 3-D Conformal Radiation Therapy: A Cross-sectional Study

Introduction: Brain metastases are treated with Whole-Brain Radiotherapy (WBRT) using the 3-D Conformal Radiation Therapy (3DCRT) technique. Attempts have been made to perform dosimetric analysis of WBRT with hippocampal sparing using 3DCRT, Volumetric Modulated Arc Therapy (VMAT), and Linac-based Intensity Modulated Radiation Therapy (linac-based IMRT), anticipating technical challenges during contouring and treatment planning. Aim: To perform a dosimetric analysis and comparison of hippocampal sparing cranial irradiation by 3DCRT, VMAT, and IMRT treatment plans in brain metastases patients. Materials and Methods: The analytical cross-sectional dosimetric study was conducted from November 2022 to September 2023 at Government Medical College, Kottayam, Kerala, India. Ten patients treated for brain metastases with WBRT using 3DCRT were considered for dosimetric analysis. The Planning Target Volume (PTV) dosimetry and hippocampal dosimetry were studied for all ten patients. The important dosimetric parameters included volume receiving 100% dose, Target Coverage (TC), Homogeneity Index (HI) in PTV dosimetry, the mean hippocampal dose, and maximal hippocampal dose in hippocampal dosimetry. The hippocampus and hippocampal avoidance volume were contoured. Treatment plans for 3DCRT, VMAT, and Linac-based IMRT were generated for each patient’s prescription dose of 30 Gy in 10 fractions. The non-parametric Kruskal-Wallis test was used for data analysis. Results: The mean whole brain Planned Target Volume (PTV) was 1190 cm³. The mean hippocampal avoidance volume was 30 cm³, which occupied 2.5% of the whole brain PTV. The average median dose received by the hippocampus was 30.05 Gy, 17.1 Gy, and 17.5 Gy for 3DCRT, Linac-based IMRT, and VMAT, respectively. The mean dose for the hippocampus was 31.03 Gy, 17.7 Gy, and 17.5 Gy for 3DCRT, Linac-based IMRT, and VMAT, respectively (p<0.001). VMAT offered better hippocampal sparing compared to IMRT and 3DCRT. On average, VMAT offered a 2% improvement, and 3DCRT offered a 5% improvement in TC compared to IMRT. The HI of 3DCRT was 0.09, IMRT 0.199, and VMAT 0.150. Conclusion: VMAT and LINAC-based IMRT permit hippocampal-sparing WBRT with adequate target volume coverage and acceptable homogeneity when compared to 3DCRT plans. Thus, the dosimetric study suggests that modern radiotherapy techniques should be advocated for hippocampal-sparing WBRT.

Comparison of Full Outline of UnResponsiveness Score and Glasgow Coma Scale in Predicting the Outcome of Children aged 3 to12 Years with Altered Level of Consciousness Admitted to the Paediatric Intensive Care Unit

Jayalakshmi Pabbati, Banoth Ravikumar, Syed AbuTalha Luqmaan

Introduction: The commonly used Glasgow Coma Scale (GCS) score for assessing consciousness has several shortcomings, especially in intubated patients. Recently, the Full Outline UnResponsive Score (FOUR) has been validated as an alternative to the GCS due to its additional benefits in evaluating brainstem reflexes and respiratory patterns. The use of the FOUR score can overcome the shortcomings of the GCS and aid in prognosticating patients with altered sensorium. Aim: To compare the FOUR score with GCS score to find a better scoring system for predicting outcomes among children aged 3-12 years with non-traumatic causes of Altered Level Of Consciousness (ALOC) in the hospital. Materials and Methods: A prospective cohort study was conducted on a total of 100 children with ALOC in the Paediatric Intensive Care Unit (PICU) of Gandhi Medical College and Hospital, Telangana, from December 2020 to November 2021. FOUR and GCS assessments were performed simultaneously within two hours of admission. For statistical analysis, continuous variables are expressed as mean±standard deviations. The predictive values of the GCS score and FOUR score were established using the Receiver Operating Characteristic (ROC) curve, by calculating the Area Under the Curve (AUC) with a 95% Confidence Interval (CI). Results: The mean age of the study population was 7.3±5.2 years, and the mean duration of hospital stay was 7.5±6.74 days. In-hospital mortality was 34%, and the survival rate was 66%. The mean FOUR score for in-hospital mortality and survival was 8.47±3.01 and 12.24±1.46, respectively (p-value <0.001). The mean GCS scores were 11.35±1.64 in survivors and 7.45 ±2.63 in non-survivors (p-value <0.001). A FOUR score of <10 was associated with higher mortality than a FOUR score of >10 (p<00.05). The Area Under Curve (AUC) for the FOUR score was 0.862 with a 95% CI (0.774 to 0.95) in the ROC curve (p-value <0.001), and for the GCS score, the AUC was 0.822 with a 95% CI (0.723 to 0.92) and p-value <0.001. The FOUR Score has a higher AUC than the GCS in the ROC curve, indicating that the FOUR Score has better discrimination than the GCS in outcome assessment. Conclusion: FOUR score and GCS score were comparable for predicting outcomes in children with ALOC. However, the FOUR score showed better discrimination than the GCS; hence, the FOUR score can be used as an alternative tool to the GCS for prognosis.

Efficacy of Magnesium Sulphate and Dexmedetomidine in Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Randomised Clinical Study

KP Nayantara, Vijay V Katti, Basavaraj N Patil

Introduction: The treatment of nasal sinus diseases with Functional Endoscopic Sinus Surgery (FESS) is a well-established and popular method. This procedure is performed under general anaesthesia or local anaesthesia. Intentional induction of hypotension has helped limit intraoperative blood loss. A bloodless surgical field improves visibility and lowers the possibility of damaging nearby structures, achieved by reducing the baseline Mean Arterial Pressure (MAP) by 30% or maintaining MAP at 60-70 mmHg. Aim: To compare the efficacy of dexmedetomidine and Magnesium Sulphate (MgSO₄) in producing hypotensive anaesthesia during FESS. Materials and Methods: This randomised clinical study was conducted at BLDE Shri BM Patil Medical College and Research Centre, Vijayapura, Karnataka, India, from January 2021 to July 2022. In this study, 70 patients, aged 18 to 60 years of either sex, admitted for FESS surgeries under general anaesthesia with American Society of Anaesthesiologists (ASA) Grade 1 and 2 were randomly divided into two groups: 35 patients in the dexmedetomidine group and 35 patients in the MgSO₄ group. Dexmedetomidine was given to group D as a loading dose of 1 μg/kg, followed by an infusion of 0.5 μg/kg/h, and MgSO₄ was given to group M as a loading dosage of 40 mg/kg, followed by an infusion of 15 mg/kg/h. MAP was kept above 65 mmHg during induced hypotension. Parameters studied included Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), MAP. Data was analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics Software Version 23.0. A p-value <0.05 was considered statistically significant. Results: The demographic profiles regarding age, gender, ASA grade, and duration of surgery in both groups were comparable and showed no significant differences. At 30 minutes of surgery, MAP in group D was found to be statistically lower than that in group M with a p-value of 0.0001. Dexmedetomidine induced a significant reduction in HR, which was statistically validated with a p-value of 0.004 at 15 minutes. A statistically significant reduction in MAP was found in group D compared to group M at the time of intubation and later at 10 minutes (p-value=0.005) and 15 minutes (p-value=0.006). Conclusion: The target MAP of 60-70 mmHg or a 30% reduction from the baseline MAP was achieved significantly earlier in group D as compared with group M. Group D had lower infusion dosages, better surgical field visibility, and caused less bleeding. The dexmedetomidine group experienced extended sedation and postoperative recovery.

Prevalence of Methicillin Resistant Staphylococcus aureus Colonisation in Patients undergoing Total Joint Arthroplasty: A Retrospective Observational Study

Pratibha Shamanna, Aparna Siddahalingappa Harbishettar

Introduction: Methicillin Resistant Staphylococcus aureus (MRSA) presents a significant, yet preventable, complication in Total Joint Arthroplasties (TJAs). Surgical Site Infections (SSIs) of prosthetic joints resulting from MRSA lead to substantial patient morbidity, mortality, and impose a significant burden on healthcare budgets. One method to mitigate these risks is to screen for MRSA colonisation prior to elective surgeries. The prevalence of MRSA colonisation in nasal mucosa ranges from 0.18-7.2% in different patient populations, with a nosocomial prevalence of 1.7%. Aim: To determine the prevalence of MRSA colonisation in all patients undergoing elective TJA, including Total Hip Replacement (THR) or Total Knee Replacement (TKR). Materials and Methods: A retrospective observational study was conducted on a total of 407 patients scheduled for elective TJAs. Data from 407 patients who underwent elective TJA between January 2020 and December 2022 (a period of three years) were selected for the study. Data compilation and analysis of the study subjects were performed retrospectively until March 2023 at the Sanjay Gandhi Institute of Trauma and Orthopaedics, a tertiary care Orthopaedic centre in Bengaluru, Karnataka, India. The study subjects were screened for MRSA colonisation through nasal swab culture and sensitivity. Patients with positive MRSA culture results were treated with decolonisation therapy, which involved the local application of 2% mupirocin and chlorhexidine body wash for five days. Descriptive data analytics were employed in the study, and tables were generated using Microsoft Word 2010 and Microsoft Excel 2010 (Microsoft Corp, Redmond, WA, USA). Results: The prevalence rates of MRSA nasal colonisation were n1=8 (8.42%), n2=2 (2%), and n3=16 (7.55%) for the years 2020 (n1), 2021 (n2), and 2022 (n3), respectively, at the centre. The period prevalence rate of MRSA colonisation in the nasal mucosa over three years was N=26 (6.4%). Conclusion: The present study revealed a high period prevalence of MRSA colonisation (6.4%) in patients undergoing TJAs. Therefore, all elective TJAs should undergo MRSA screening and decolonisation using 2% intranasal mupirocin and daily chlorhexidine body wash for five days as a successful treatment modality for all patients with MRSA-positive nasal colonisation. This approach helps prevent postoperative SSIs caused by MRSA.

Prevalence of Azygos Lobe of the Lung in Southern Indian Cadaveric Population: A Retrospective Observational Study

Gautham Kamble, S Roshan, CH Shivarama, MS Somesh

Introduction: The azygos lobe is a developmental anomaly found in the upper lobe of the right lung. It has a prevalence of 0.4% in clinical scenarios and 1% during routine anatomical dissections. Clinically, the azygos lobe mimics various conditions. It is a rare incidental finding during chest radiography or Computed Tomography (CT). Aim: To determine the prevalence of the azygos lobe during anatomical dissection. Materials and Methods: A retrospective observational study was conducted over a 13-year period from June 2010 to August 2023 in various medical colleges in Mangaluru, Karnataka, India. A total of 102 adult cadavers were studied. The dissected right and left lungs of each cadaver were examined for the presence or absence of an azygos lobe and recorded. The morphology of the azygos lobe was studied, including its size, the presence of the azygos fissure, the depth of the azygos fissure, and the course of the azygos vein. The presence of mesoazygos was also checked, and its attachments were noted. Descriptive statistics were used in terms of frequency and percentage. Results: Out of the 102 cadavers, only one right lung had an azygos lobe. None of the cadavers had bilateral azygos lobes. The maximum height of the lobe was 5.8 cm, and the width was 4.5 cm. An azygos fissure was found, through which the mesoazygos was present. The mesoazygos was located from the lung to the thoracic wall. Conclusion: Despite being an incidental finding, the azygos lobe is clinically important. Physicians should be aware of this anomaly, and thoracic surgeons should exercise caution during surgeries involving the thoracic region, such as Video-Assisted Thoracic Sympathectomy (VATS).

Effects of Differences in Epidural Needle Entry Point and Angle of Rotation of Needle Hub on the Onset and Duration of Sensory Blockade in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Epidural anaesthesia is a boon for providing prolonged analgesia for postoperative pain relief. The influence of epidural needle insertion on the onset of the block, which has not been studied previously, is significant. Aim: To analyse the effect of epidural needle entry and rotation of the needle on the onset and duration of the block. Materials and Methods: This double-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India from March 2020 to August 2021 on 70 patients undergoing leg and ankle surgeries. They were randomised into Group-ML (midline approach) and Group-PM (paramedian approach). In Group-ML, midline epidural needle entry was followed by catheter insertion. In Group-PM, the needle entry was paramedian, and the bevel was turned 45º towards the surgical site for catheter insertion. A 10 mL of 0.5% bupivacaine was administered. Postoperatively, epidural infusion was initiated using 0.125% bupivacaine with 2 μg/mL fentanyl. The time taken for catheter placement, onset of motor and sensory blockade, maximum sensory level attained, duration of sensory blockade, consumption of local anaesthetics, haemodynamic profile, and the need for rescue analgesia were monitored. Continuous data were analysed using the Student’s t-test, and categorical data were analysed using the Chi-squared test with International Business Machines (IBM) statistical product and service solutions software version 27.0. Results: Both groups were comparable with respect to demographics. The mean age in Group-ML was 40.9±25.93 years, while in Group-PM it was 41.028±20.576 years, with a p-value of 0.981. The mean BMI in Group-ML was 24.91±2.998 kg/m2, while in Group-PM it was 24.96±2.527 kg/m2, which was statistically insignificant with a p-value of 0.944. A total of 21 males in Group-ML and 28 males in Group-PM participated in the study; the distribution was found to be statistically insignificant with a p-value of 0.067. The time taken for the placement of the epidural catheter was around 288 seconds in Group-ML and 322 seconds in Group-PM, with a p-value of 0.0035. The onset of sensory block was around 17 minutes in Group-ML and 13 minutes in Group-PM, respectively, with a p-value of 0.0001. The duration of sensory block or the time taken for two-segment regression of level was around 102 minutes and 128 minutes in Group-ML and Group-PM, respectively (p-value 0.0001). The rescue analgesic was required in seven patients of Group-ML and none in Group-PM, with a p-value of 0.005. The haemodynamic profile intra and postoperatively and postoperative VAS score were statistically insignificant between the groups. Conclusion: The paramedian approach and epidural catheter insertion with the needle rotated at an angle of 45º towards the surgical side provide a rapid onset of the sensory and motor block with extended duration of the sensory blockade and reduced consumption of local anaesthetics.

Antioxidant Effect of Levetiracetam and Brivaracetam Acting on Presynaptic SV2A Receptors: An In-vitro Study

Riya Kataria, Kranthi Karunai Kadal, Kavitha Ramasamy, Kruthi N Parikh

Introduction: Epilepsy is a serious psychological condition associated with social stigma, psychiatric co-morbidity, and a high economic burden. It is pertinent to develop novel treatment methods given the ever-evolving nature of the disease. Recently, various newer Antiepileptic Drugs (AEDs) have been under study, among which a newer targeted modality consists of SV2A receptors. Aim: To compare the antioxidant properties or free radical scavenging activity of the newer heterogeneous AEDs acting on the SV2A receptors, namely Levetiracetam (LEV) and Brivaracetam (BRV). Materials and Methods: This in-vitro study was conducted at Department of Pharmacology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India from July 2021 to August 2021. The study evaluated the antioxidant properties of LEV and BRV using various assays such as the Ferric Reducing Antioxidant Power (FRAP) test, DPPH (1,1-diphenyl-2-picrylhydrazyl) assay, Nitric Oxide (NO) radical scavenging assay, Superoxide Dismutase activity (SOD), and catalase activity. The obtained results were expressed using specific formulas related to the absorbance of the respective chemicals, along with the percentage of inhibition, and have been tabulated in Microsoft excel Sheet Version 16.16.27. Half-maximal Inhibitory Concentration (IC50) values were calculated using scatter plot graphs. Results: The FRAP values for LEV were reported to be significantly higher compared to BRV at concentrations of 20, 40, 60, 80 μg/mL, while at 100 μg/mL, BRV showed better ferric reducing activity. Although both drugs exhibited antioxidant activity, the results clearly identified LEV as a better NO radical scavenger, with a percentage of inhibition reaching up to 80.52%. During the SOD assay, the percentage inhibition of superoxide generation by LEV was found to be 99.02%, while that of BRV was 97.07% at a concentration of 100 μg/mL. LEV (0.573) also showed a higher degradation of H₂O₂ per minute than BRV (0.065) at a concentration of 100 μg/mL. Conclusion: The results showed that both drugs, BRV and LEV, exhibited significant antioxidant capacity. However, LEV demonstrated increased antioxidant potency and efficacy compared to BRV.

T-cell Response after COVID-19 Vaccination: A Cross-sectional Study

Introduction: Even if antibody titers wane over time, T-cells demonstrate longevity and remain unaffected by viral variants. This study was done with the rationale of examining the virus-destroying cells post-vaccination, specifically focusing on their ability to produce the vital antiviral cytokine Interferon gamma (IFNγ) upon potential reinfection and investigates the impact of the Covishield vaccine on T-cell response, which is a largely unexplored domain due to the novelty of the disease. Aim: To study T-cell response by doing IFN γ release assay by employing Enzyme Linked Immunosorbent Spot (ELISpot) method. Materials and Methods: This was a cross-sectional study conducted from March 2021 to May 2023 at Sree Balaji Medical College and Hospital in Chennai, Tamil Nadu, India. The study included participants from all categories who were staff members of the College and Hospital. It is part of an extensive study done by the authors on immunological changes following Covishield vaccination. As part of this study, T-cell response was also separately studied by collecting an additional 2 mL of blood from 90 individuals one year after initiating the vaccination, specifically after administering the Covishield vaccine at 0 and 3 months. For T-cell response analysis, 2 mL of blood was collected and processed to separate Peripheral Blood Mononuclear Cells (PBMC). The Interferon Gamma Release assay (IGRA) was performed using ELISpot method, utilising a 96-well plate. The spots appearing in the sample wells {Spot Forming Cells (SFC)=T-cells} were quantified using an automated ELISpot reader. Sample wells demonstrating more than 12 spots were considered positive. The results were analysed using various statistical tests, including Chi-square test, One-way Analysis of Variance (ANOVA), Kruskal-Wallis Test, Karl Pearson correlation coefficient, t-test, and Mann-Whitney U-test. Results: The number of spots in the wells containing blood samples from volunteers ranged from a minimum of 2 to a maximum of 631. Importantly, all participants had detectable spots in their sample wells. Out of 90 participants, 84 (93.4%) had more than 12 SFC, while 6 (6.6%) had less than 12 SFCs. High Immunoglobulin G (IgG) levels were positively correlated with good T-cell responses (SFC). Participants under 60 years of age and females exhibited superior responses. Individuals with co-morbidities had lower levels of T-cell response compared to the healthy/normal participants. Conclusion: The volunteers in this study exhibited robust humoral and cellular immunity, with females showing a significantly better response. The T-cell response remained strong even nine months after the second dose of the vaccine.

Dermatoglyphic Patterns in Undergraduate Medical Students and their Association with Academic Performance: A Cross-sectional Study

Introduction: Dermatoglyphics is the study of fingerprint patterns, which are unique to each individual and remain unchanged after birth. It has been used in criminology for decades. In recent years, its role in screening various medical conditions has been established. Dermatoglyphics has also been associated with cognitive ability, making it a potential predictor of academic potential. Aim: To investigate the association between dermatoglyphic patterns and the academic performance of medical students. Materials and Methods: A cross-sectional study was conducted in the Department of Anatomy, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India on 200 undergraduate medical students (94 males and 106 females) from January 2019 to December 2020. Fingerprint patterns were obtained using the standard ink method. The parameters studied included arches, loops, whorls, composites, Total Finger Ridge Count (TFRC), and the ‘atd’ angle. The academic performance of participants was assessed based on the marks obtained in the National Eligibility Cum Entrance Test (NEET) and the overall marks scored in the first-year university examination. Statistical analysis involved the use of arithmetic mean, standard deviation, Chi-square test, and one-way Analysis of Variance (ANOVA). Results: In present study, the most common fingerprint pattern in the right hand was an arch (30.9%), followed by a whorl (24.5%). In the left hand, the most common fingerprint pattern was a whorl (40.6%), followed by an ulnar loop (20.1%), with no gender difference observed. Thumb, index finger, middle finger, ring finger, and little finger exhibited different fingerprint patterns between the right and left hand, indicating asymmetry. This asymmetry was associated with lower academic performance. Higher academic performers in the NEET had a higher frequency of whorls and composites. TFRC showed no association with academic performance. Students with an ‘atd’ angle between 41 and 50° demonstrated higher academic performance. Conclusion: The present study found that asymmetry of fingerprint patterns and a higher ‘atd’ angle (≥51°) were correlated with lower academic performance among medical students. These findings suggest potential directions for early academic intervention, provided multicentric studies are conducted in the future.

Comparison between Bispectral Index-guided Propofol Induction and Clinically-guided Induction in Adult Hypertensive Patients undergoing Elective Laparoscopic Surgery: A Randomised Controlled Study

Jayanti Chanda Das, Ashim Saikia, B Yogapriyan, Dul Deka, Karabi Patowary Deka

Introduction: Traditional clinical endpoints for propofol induction often led to unintentional overdose, leading to haemodynamic instability, delayed recovery, and other complications. Bispectral Index monitoring could potentially prevent undesired haemodynamic changes like hypotension. Aim: To compare BIS-guided propofol induction with clinically guided propofol induction. Materials and Methods: A randomised controlled study was conducted in the Department of Anaesthesiology at Apollo Hospitals, Guwahati, Assam, India, between December 7, 2020 and December 6, 2021, on adult hypertensive patients undergoing elective laparoscopic surgeries. The Clinical Group (n=30) received propofol induction based on clinical guidance, and the Bispectral index group (n=30) underwent Bispectral Index (BIS) guided induction. Demographic variables, the dose of drug required for BIS 50, and the total amount of drug consumed were recorded. After the administration of each dose, Systolic BP (SBP), Diastolic BP (DBP), Mean Arterial BP (MAP), Heart Rate (HR), and SpO₂ were recorded. Frequencies and percentages were used to describe qualitative data, whereas the mean and standard deviation were used to express quantitative data. Parametric tests included unpaired t-tests for comparison between groups. A p-value of <0.05 was considered statistically significant. Results: Total 60 patients with 30 in each group, were studied. There was a steady fall in SBP, DBP, and MAP with successive incremental doses of 0.5 mg in both groups. Mean SBP was comparable between the two groups at dosages of 1 mg/kg, 1.5 mg/kg, and 2 mg/kg. At 2.5 mg/kg, the clinical group had a significantly lower SBP (p=0.0001). Mean DBP was comparable in both groups at doses of 2 mg/kg and 2.5 mg/kg but significantly lower in the BIS group at 1 mg/kg and at 1.5 mg/kg (p=0.003, p=0.01). Mean MAP was comparable at doses of 2 and 2.5 mg/kg but significantly lower in the BIS group at doses of 1 mg/kg and 1.5 mg/kg (p=0.007, p=0.02). Mean HR was comparable between the two groups at doses of 1 and 1.5 mg/kg. HR showed an increase in group CL and a gradual drop in group BIS with incremental doses. Mean HR was significantly lower in the group BIS at doses of 2 mg/kg and 2.5 mg/kg (p=0.001, p=0.001). The BIS group required a substantially lower total dose of propofol compared to the CL group (158.63±30.57 mg vs. 118.23±28.53 mg, p=0.0001). Conclusion: BIS-guided propofol induction leads to more stable haemodynamics during induction. It helps to titrate propofol administration, which, in turn, reduces the frequency of propofol overdose and its subsequent adverse effects on haemodynamic stability. The total dose of propofol consumed is also reduced.

Level of Cognitive Domains and Weightage of Various Topics in the Undergraduate Summative Examination Question Paper of Community Medicine: A Cross-sectional Study

Preeti Tiwari, Angelin Priya, Arijit Datta

Introduction: Assessments direct students towards learning. There are three types of learning: cognitive, affective, and psychomotor. While all three are interlinked, the cognitive domain, which covers knowledge and intellectuality, is foundational and can be assessed through theory examinations. Theory exams are the best way to test the cognitive domain of a learner, while practical exams can assess the psychomotor and affective domains. Since the question paper is the most important tool in theory exams, it is essential that the question paper covers relevant topics and tests all levels of cognitive learning, which encompass knowledge, comprehension, application, analysis, synthesis, and evaluation. Aim: To assess the level of cognitive domains assessed and the weightage allocated to various topics in the undergraduate summative examination question paper of community medicine. Materials and Methods: A cross-sectional study was conducted at Department of Community Medicine, Pramukh Swami Medical College and Sri Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India in which the five-year question papers (2016-2020) from five Universities were analysed to assess the level of cognitive domains and the weightage assigned to various topics. Each question was categorised as recall, comprehension, or application based on the cognitive domain it assessed. Furthermore, each question was analysed to determine the topic it pertained to, and the marks allocated to that question were assigned to the corresponding topic. Results: The majority of marks in Universities 1, 2, 3, 4, and 5 were, respectively allocated as follows: 324 (80.62%), 459 (84.66%), 453 (75.5%), 895 (89.5%), and 379 (63.16%) for questions testing the recall ability of the learners. For questions assessing comprehension ability, the marks allotted were 20 (4.87%), 0, 81 (13.5%), 65 (6.5%), and 51 (8.15%). The fewest marks were assigned to questions testing application, synthesis, or evaluation abilities. Epidemiology had the highest weightage in all five Universities, with marks of 73 (18.25%), 75 (13.89%), 93 (15.5%), 141 (14.1%), and 83 (13.83%). Conclusion: The cognitive domains assessed in the subject across all five Universities were unsatisfactory. The weightage of marks allotted to topics varied, highlighting the need to develop a question paper plan that facilitates a systematic distribution based on different levels of cognitive domains and topics.

Assessment of Learning Styles Using Kolb’s Learning Style Inventory among Medical College Students: A Cross-sectional Study

Veena Rani Vemuri, Kiran Arun Rao

Introduction: Technology has become increasingly integral in medical education, especially with the implementation of newer Competency Based Medical Education (CBME) curricula. Blending conventional methods with e-learning and ensuring its effectiveness in supporting student learning requires effort and consideration. In this regard, Kolb’s learning styles, introduced in 1984, can be helpful in identifying different types of learners within the student population and tailoring teaching methods accordingly to enhance student outcomes. Aim: To assess the learning styles of medical students using Kolb’s Learning Style Inventory, version 3.1, and to compare the learning styles with the year of study. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in the Department of Pharmacology, Terna Medical College, Navi Mumbai, Maharashtra, India. on 194 first and second Bachelor of Medicine and Bachelor of Surgery (MBBS) students. The study included students who were present when the questionnaire was administered. The learning styles were assessed using Kolb’s Learning Style Inventory, version 3.1. Descriptive statistics were applied. Results: The total strength of both the first and second-year batches combined was 254. Out of these, 194 students were present when the questionnaire was administered, resulting in a response rate of 76.38%. Seven incorrectly answered questionnaires were excluded from the analysis. Among the 194 valid questionnaires received, 55 students (29.41%) had convergent as their learning style, making it the most common learning style. The next most common learning style was accommodative, with 52 students (27.81%) exhibiting this style. Specifically, among the first-year MBBS students, 35 out of 108 (32.41%) had a convergent learning style, while among the second-year MBBS students, 24 out of 79 (30.38%) had an accommodative learning style. There was a statistically significant difference observed in the learning styles between the first and second-year MBBS students (p-value <0.05). Conclusion: In present study, it was observed that the convergent learning style was dominant among the medical students in the first and second years combined, with the first year being predominantly convergent and the second year being predominantly accommodative.

Comparison of Haemodynamic Effects of Clonidine and Dexmedetomidine for Intubation using Intubating Laryngeal Mask Airway in Patients undergoing Elective Surgery under General Anaesthesia: A Randomised Clinical Study

Sofia Batool, Yogesh Narwat, Ram Bahadur Rai

Introduction: The Intubating Laryngeal Mask Airway (LMA) is a Supraglottic Airway (SGA) device through which endotracheal intubation can be performed. Laryngoscopy and intubation are known to initiate a haemodynamic response. LMAs in general produce a lesser pressor response, but intubating LMA provokes a higher response due to the invasiveness of tracheal intubation. Aim: To compare dexmedetomidine and clonidine in attenuating the haemodynamic response to intubating LMA, Ramsay sedation score, and the incidence of laryngopharyngeal injury. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India, over a period of one year spanning from June 2020 to May 2021 to compare the two drugs in patients with American Soceity of Anaesthesiology (ASA)-I. The doses of clonidine and dexmedetomidine were 2.5 mcg/kg and 0.5 mcg/kg, respectively. The study parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Blood Pressure (MBP), Peripheral Saturation of Oxygen (SpO₂) were recorded at baseline, pre- and post-induction, and at various time intervals (0, 1, 3, 5 minutes) after intubation. Sedation score was also recorded before intubation and after extubation. Statistical Packages of Social Sciences (SPSS) version 23.0 was used to analyse the data (χ2 test for categorical variables and analysis of variance for continuous data). Results: There was no statistically significant difference between the two groups for the duration of surgery (p=0.267), duration of anaesthesia (p=0.197), and the duration between closure and extubation (p=0.407). Dexmedetomidine better attenuated the response of HR and SBP just before induction, post-induction, and immediately post-intubation. All the haemodynamic parameters were better controlled by dexmedetomidine immediately after intubation. Sedation was better with dexmedetomidine in the pre-intubation as well as post-extubation period, except at five minutes post-drug infusion when clonidine was better. Conclusion: Compared to clonidine, dexmedetomidine was more effective in attenuating the patient’s haemodynamic response to intubating LMA in the immediate peri-intubation period. However, from 1 minute post-intubation onward, both drugs behaved similarly in controlling the pressor response.

Association of Platelet Indices with Diabetic Complications: A Cross-sectional Study

Introduction: Diabetes Mellitus is a prothrombotic state characterised by enhanced platelet activity, which may lead to microvascular and macrovascular complications. Platelet indices, such as Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW), are routinely available in laboratories and can serve as a prognostic markers for patients. Aim: To evaluate platelet indices in patients with Type 2 Diabetes Mellitus (T2DM) and associated complications. Materials and Methods: A cross-sectional study was conducted at the Department of Pathology in Krishna Vishva Vidyapeeth’s Krishna Hospital and Medical Research Centre, Karad, Maharashtra, India, from July 2020 to May 2022. A total of 120 patients with type 2 diabetes, both with and without complications, were investigated. Haematological parameters (platelet count and platelet indices such as MPV and PDW) and biochemical parameters {fasting blood sugar and Haemoglobin A1c (HbA1c)} were compared between the two groups. Platelet indices were measured using an automated haematology analyser. Statistical analysis was performed using the t-test, Analysis of Variance (ANOVA), and Statistical Package for Social Sciences (SPSS) version 16.0. Results: The study included 60 cases each of DM with complications and without. Among those with complications, 17 (28.33%) were aged 51-60 years, 14 (23.33%) were 61-70 years old, and 12 (20%) were over 70 years. The mean MPV was 12.74±3.076 fL for patients with complications and 8.65±1.58 fL for those without. The mean PDW was 15.54 15.54±3.31 fL for patients with complications and 13.94±2.66 for those without. The mean HbA1c levels were 8.33 mmol/mol for patients with complications and 6.75 mmol/mol for those without. The mean platelet count was 3.12 lakh/mm³ for patients with complications and 2.45 lakh/mm³ for those without. The mean fasting blood sugar levels were 219.65 mmol/L for patients with complications and 109.96 mmol/L for those without. Conclusion: Diabetes contributes to endothelial dysfunction and platelet hyperactivity. The present study reveals that diabetic patients with uncontrolled glycaemic indices and elevated fasting blood sugar levels have higher platelet indices compared to patients without complications, where the platelet count, platelet indices, and glycaemic indices were within normal limits. These indices may also serve as useful prognostic tools.

Efficacy of Tranexamic Acid Mesotherapy using a Novel Device versus Topical Tranexamic Acid in Patients with Melasma: Protocol for a Randomised Clinical Trial

Yash Kashikar, Bhushan Madke, Adarshlata Singh, Soham Meghe, Kaveri Rusia

Introduction: Melasma is a widely prevalent acquired condition characterised by gray-brown pigmentation with a predilection on the face, affecting the quality of life. Tranexamic Acid (TXA) has been used for managing melasma orally and topically, while mesotherapy is a well known modality in cosmetology. Need of the study: There is a paucity of literature comparing the efficacy of topical and intralesional microinjections of TXA. A novel device (Meso-Ice^®) has recently been commercialised for mesotherapy, working on the principle of electroporation technology for drug diffusion, which has not yet been evaluated for managing melasma using TXA. Aim: To compare the efficacy of TXA mesotherapy using the novel device versus topical TXA in patients with melasma. Materials and Methods: This is a randomised clinical trial assessing the comparative efficacy of Group 1: Mesotherapy using the novel device with TXA injection (4 mg/mL) and Group 2: Topical TXA gel (3%) for treating melasma. The severity of melasma will be assessed using the Melasma Area and Severity Index (MASI) at baseline, four weeks, and eight weeks. One-way Analysis of Variance (ANOVA) will be used to compare intra-group variables, and the paired t-test will be used for inter-group comparison. A p-value of <0.05 will be considered significant.

Comparative Evaluation of the Efficacy of Shallakyadi Plaster and Standard POP in the Management of Simple Fractures of Long Bones of the Upper Limb: A Research Protocol

GV Pavithra Jaivarshaa, Devyani Dasar

Introduction: Fracture management is one of the well-established concepts in Ayurveda with numerous fracture healing drugs mentioned for topical application. The present study is an attempt to form a compound of few of those drugs which can be used as a plaster cast. The effect of this Herbomineral ayurvedic plaster cast on fractures would be studied both in aspects of immobilisation and fracture healing. Shallakyadi plaster which is a novel compound composed of resin of Boswellia serrata Roxb, resin of Acacia nilotica (Linn.) Willd.ex Del, root of Glycirrhiza glabra Linn, whole plant of Cissus quadrangularis Linn, Stem of Rubia cordifolia Linn, bark of Terminalia arjuna Wight & Arn (W&A), resin of Commiphorawightii Arn, Kaolinite (phyllosilicate of aluminium) and hydrated magnesium silicate can be used as a herbomineral ayurvedic compound for the healing of fractures. Need of the study: Standard Plaster of Paris (POP) cast has no therapeutic role on healing of fracture other than the purpose of immobilisation, whereas the drugs in Shallakyadi Plaster have known effects on bone healing and also provide the adequate immobilisation provided by Standard POP cast. Hence, the present study will compare the efficacy of Shallakyadi Plaster and Standard POP in the management of simple fractures of long bones of upper limb. Aim: To study and compare the efficacy of Shallakyadi plaster and standard POP in the management of simple fractures of long bones of upper limb. Materials and Methods: The present study is designed as a randomised control trial which would be conducted in Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India for three months, in which 60 patients will be enrolled. Standard POP Plaster or Shallakyadi plaster will be applied for local application over the fractured area. Parameters like pain, swelling, loss of function, tenderness would be studied subjectively and callus formation would be taken as the objective parameter. Statistical analysis would be done using GraphPad Prism 7.0 V software and statistical tests- Chi-square test, Wilcoxon’s rank sum test and Wilcoxon’s signed rank test will be applied with level of significance as 0.05.

Evaluation of the Extent of Digital Divide among the Teachers in Healthcare Profession from Central India: A Research Protocol

Anjali Bhoyar, Sunita Vagha, Vedprakash Mishra, Seema Sathe

Introduction: Information and Communication Technology (ICT) has played a substantial role in the delivery of education. Despite the fact that technology-mediated interventions open up new avenues for health information dissemination and service delivery, there is concern that a knowledge gap, known as the digital divide, may exist. Need of the study: In order to properly use technology and assist learners, educators must have technical abilities. Evidence from the literature suggests that educators lack the knowledge and skills required for ICT, leading to a digital divide. However, there is a dearth of data pertaining to the domains of the digital divide among healthcare educators in Central India. Aim: The observational study is designed to evaluate the status of the digital divide among healthcare educators in Central India. Materials and Methods: The cross-sectional study will be conducted at Sharad Pawar Dental College and Hospital, along with the School of Health Professions Research in Wardha, Maharashtra, India. Permission will be obtained from Institutional Ethical Committee, Datte Meghe Institute of Higher Education and Research (DMIHER) Deemed to be University (DU), over a period of two years spanning from July 2023 to June 2025. A minimum of 97 participants, comprising teachers from the healthcare profession in Central India, will participate in the survey to evaluate the status of the digital divide amongst healthcare educators in Central India.

Efficacy of Short-course Weekly Isoniazid and Rifapentine Regimen as Tuberculosis Preventive Treatment among Population at Risk of Developing Disease: A Systematic Review and Meta-analysis

Ilangovan Ilavarasan, Vidhyanathan Ariharanathan, Chandrasekaran Sabitha Devi

Introduction: Tuberculosis (TB) remains a major public health problem in India. Individuals with latent infection do not have active disease and cannot spread Tuberculosis Infection (TBI). The prevalence of latent TB in India is very high, ranging from 40-50%. About 5 to 10% of them may convert into active TB disease. The national program primarily recommends treatment for active TB, while treatment of latent TB is recommended only in special situations. Aim: To assess the efficacy of short-course weekly Isoniazid and Rifapentine (HP) regimen as Tuberculosis Preventive Treatment (TPT) among various risk groups. Materials and Methods: A systematic review and meta-analysis were conducted, involving of about 10 Randomised Control Trials (RCTs). Studies published between 2006 and 2023 were included. Online databases such as PubMed, Google Scholar, Clinical Trial Registry India, and grey literature were searched using keywords like Isoniazid, Rifapentine, and trial. Results: In terms of TB incidence, the pooled risk ratio favoured the weekly HP regimen, estimated at 0.69 (0.49, 0.97, 95% CI). Regarding the incidence of hepatotoxicity, the weekly HP regimen showed neither superiority nor inferiority to comparators, with a pooled risk ratio of 0.50 (0.23, 1.05, 95% CI). The odds of completing treatment were 2.19 times greater for the weekly HP regimen than for controls, with a pooled odds ratio of 2.19 (1.64, 2.92; 95% CI). Conclusion: The weekly HP regimen is superior to other regimens in reducing the incidence of TB. Additionally, the duration of the HP regimen is shorter compared to the commonly advised nine-month Isoniazid regimen. Compared with the daily dosage of Isoniazid, the weekly HP regimen offers better compliance. It also exhibits a significantly higher treatment completion rate. In summary, the weekly HP regimen is superior to other regimens.

Raspberries: An Aggregation of its Bioactive Constituents- A Narrative Review

Gomathi Ramalingam, Uma Maheswari T Natarajasundaram, S Rajesh Kumar

According to the available literature evidence, regular consumption of fruits and vegetables is inversely proportional to the risk of developing certain types of cancer. Berries, such as raspberries, have a higher rate of antioxidants, anti-inflammatory properties, and chemopreventive properties. These attributes make them useful in the treatment of certain chronic diseases and cancer prevention. Raspberries are enriched with phytochemicals, with polyphenols being the major phytochemical present. These polyphenols include ellagitannins (tannins), phenolic acids, anthocyanins (flavonoids), catechins (flavonoids), and proanthocyanins (flavonoids). Available evidence indicates that natural extracts have no side effects, no drug interactions, and can be safely used in all populations, including pregnant women and children. Therefore, the utilisation of natural products for disease treatment is always encouraged. Berry fruits consistently rank among the top sources of total phenolics and Antioxidant Capacity (AOC), containing levels up to four times greater than other fruits. The polyphenolic compounds in raspberries play a significant role in mitigating the damaging effects of oxidative stress on cells and reducing the risk of chronic diseases such as cardiovascular diseases, type 2 diabetes, obesity, age-related neurodegenerative diseases, and infection-associated neurodegenerative diseases.

Current Perspectives on Proton Therapy: Techniques Shaping the Future of Cancer Treatment

Traditional Radiation Therapy (RT) predominantly comprises a targeted therapeutic strategy focused on improving localised tumour control and achieving a cure while minimising the occurrence of adverse side effects. It could be feasible to take advantage of the better dose distribution by enabling larger RT dosages to the malignancy while preventing a rise in the toxicity of RT-induced healthy tissue, or by reducing adverse reactions to manageable levels. Poor local disease control and important dose-limiting normal tissue, which prevent safe dosage increase with conventional photon RT, have been the key justifications for RT. Proton treatment, on the other hand, delivers therapeutic protons or positive particles using proton beams. The potential advantage of protons’ physical properties allows for more localised RT delivery. By increasing the dosage to equitoxic levels, it is also possible to take advantage of the potential improvement in normal tissue sparing to support local tumour management and, ideally, longevity. Proton treatment preserves more important structures than photon therapy because of its unique physics. Thus, there is a need for wide usage of Proton Therapy (PT) for successive cancer treatment. The present review focuses on PT based on tumour site, clinical studies, biological barriers, instrumentation of PT, significance, and limitations.

Programmed Cell Death Ligand 1 Immunoexpression in Head and Neck Squamous Cell Carcinoma: A Narrative Review of Considerations for the Histopathologist

Pooja Sharma Kala, Naveen Chandra Thapliyal

Head and Neck Squamous Cell Carcinoma (HNSCC) is one of the most common malignancies worldwide with most of the patients presenting in advanced stage. The associated high mortality and poor prognosis of the tumour has rendered the search for better therapeutic options than the traditional modalities of surgery, radiotherapy and chemotherapy. Immunotherapy targeting Programmed Cell Death Protein 1/Programmed Cell Death Ligand 1 (PD-1/PD-L1) has been approved in recurrent/ metastatic HNSCC cases. PD-L1 expressing HNSCCs are likely to respond to immunotherapy. PD-L1 expression has been studied in peripheral blood utilising Circulating Tumour Cells (CTC) and soluble exosomes. Despite these non invasive techniques, PD-L1 expression has been most frequently assessed by immunohistochemistry (IHC) application on the Formalin Fixed Paraffin Embedded (FFPE) tissue of the tumour. Currently, many antibody clones and various IHC platforms are available for PD-L1, but only 22c3 has been approved by the Food and Drug Administration (FDA). Although, the availability of multiple options has made PD-L1 assessment possible and affordable at many centres worldwide, but various procedural, pre-analytical, and analytic issues have to be considered prior to the interpretation of immunoexpression of PD-L1. In this review, the authors aim to highlight the problem areas, and to understand the implications of PD-L1 expression in HNSCC. The authors propose recommendations for the optimal assessment of PD-L1 expression in HNSCC on IHC.

Cell Sheet Engineering in Periodontology: A Review

Ruchita Tejrao Patil, Prasad V Dhadse, Shrishti Salian

Cell sheet engineering has developed its own place for the regeneration of tissues. It focuses on phenomena occurring at the cellular level, whereas regenerative medicine and tissue engineering aim to create or stimulate new tissue for the treatment of disease. In medicine and dentistry, tissue engineering, cell-based therapies, and regenerative medicine have been progressing rapidly for regeneration procedures. It has emerged as a promising strategy for scaffold-free cell-based regenerative medicine therapy by means of transplantable single or multi-layered cell-dense sheets to achieve tissue repair and regeneration. Cell sheet engineering could be one of the procedures for regeneration of periodontal tissues, which can yield better results. In this review, the authors will highlight the principal techniques of cell sheet engineering and its application in tissue regeneration in periodontal therapy.

Prospects and Future Scope of Self-healing Composites

Mariyam Sheikh, Priyanka Paul Madhu, Amit Reche

A biomaterial is a component that has been developed to interact with biological systems for therapeutic or diagnostic purposes in medicine. Tissue engineering, bioprinting, and regenerative medicine are just a few of the increasingly complex fields where biomaterials are being used. These applications frequently require difficult or even paradoxical combinations of biomaterial qualities that cannot be satisfied by traditional biomaterials. Many novel proposals have been introduced over the past 10 years to make biomaterials self-healing, opening up fresh possibilities for enhancing the functionality of conventional biomaterials. Thus, the self-healing composite that will be discussed in the present article is one such biomaterial that comes into play. Self-healing composites are composites that automatically heal in the area where damage has occurred. This material draws inspiration from the way our body heals itself through regenerative processes, and these self-healing composites utilise various additional healing methods as well. This paper outlines the various aspects of self-healing composites and their types, with a focus on capsule-based and vascular self-healing systems. As a complement to previous reviews, this paper provides insights into the diverse self-repairing concepts proposed so far, as well as compares the study of healing mechanisms and manufacturing approaches for the assembly of capsule and vascular networks. The current concept of self-healing polymers provides advanced avenues for secure, longer-lasting, and more durable products and parts across a wide range of industries, such as veneers, electronics, transport, and energy.

Pathogenicity and Antibiotic Resistance of Pseudomonas aeruginosa: A Comprehensive Review

Nadeem Ahmad, Areena Hoda Siddiqui, Meenakshi Sharma, Amita Arya

Pseudomonas aeruginosa (P. aeruginosa) presents a complex challenge in terms of pathogenicity and antibiotic resistance. This versatile pathogen adeptly colonises various host tissues and evades the immune system through its intricate virulence factors. The review delves into the antimicrobial resistance mechanisms at play, which encompass inherent resistance characteristics and those acquired through genetic mutations and horizontal gene transfer. Notably, efflux pump systems and limited membrane permeability underpin its inherent resistance, rendering many conventional antibiotics ineffective. Multidrug Resistant (MDR) strains are on the rise, posing a substantial threat to patient care and infection control. In response, innovative strategies are being explored, including combination therapies to enhance the effectiveness of existing antibiotics and drug repurposing, redirecting existing medications to target P. aeruginosa. Phage therapy, which leverages bacteriophages to combat P. aeruginosa infections, is gaining attention as a promising solution. Infection prevention and control are pivotal, particularly in healthcare settings, to curtail the spread of P. aeruginosa. Surveillance programs are crucial for monitoring the prevalence and dissemination of antibiotic-resistant strains and guiding response strategies during outbreaks. Comprehending P. aeruginosa’s complex virulence and resistance mechanisms is paramount for developing efficient treatments and effective infection control measures. Ongoing research and collaborative efforts are instrumental in mitigating the substantial impact of P. aeruginosa infections on public health, underscoring the need for sustained vigilance and innovation in infectious disease management.

Pulmonary Haemosiderosis Secondary to Mitral Valve Stenosis-Known Association of Uncommon Entity: A Case Report

Pulmonary haemosiderosis is a rare lung disease characterised by haemosiderin deposition in the lungs due to recurrent intra-alveolar bleeding. It can be idiopathic or secondary due to mitral stenosis. Affected patients will have symptoms of cough, haemoptysis, and shortness of breath. Radiologically, it is characterised by widespread tiny alveolar nodular opacities with or without septal thickening. Therefore, in the case of mitral valve stenosis, this imaging pattern on High-resolution Computed Tomography (HRCT) should prompt suspicion of secondary pulmonary haemosiderosis. Here, the authors present the case of a 27-year-old male patient with mitral stenosis who presented with progressive shortness of breath, mild atypical chest pain for two months, and a cough with occasional haemoptysis in the last 10 days before the hospital visit, along with typical radiological findings of widespread tiny ground glass alveolar nodules on HRCT. The radiological knowledge of this rare entity is very important for confidently making the diagnosis in the proper clinical context, to avoid unnecessary investigations and treatment.

A Bidirectional Immunological Relationship between Diabetes Mellitus and Tuberculosis: A Narrative Review

Tuberculosis (TB) is one of the most common contagious diseases worldwide. Over the past few decades, researchers have made significant efforts to prevent TB. Recent predictions indicate that the prevalence of Diabetes Mellitus (DM) will reach 552 million by 2023 due to ongoing epidemiological changes in several countries across the globe. India is expected to have 62-80 million people with diabetes by 2030, making it the “Diabetes Capital” of the world. Present review discusses the urgent need to understand the mechanisms and implications of DM on the immune systems of TB patients. The correlation between TB and DM has been shown to be bidirectional. Numerous studies have revealed a higher prevalence of diabetes in TB patients, as their immune systems are compromised. TB patients with DM experience progressive deficits in both innate and adaptive immune cell activity, reducing their ability to suppress Mycobacterium tuberculosis (M. tuberculosis) and increasing their risk of developing TB. Increased inflammation and elevated levels of inflammatory cytokines in circulation are characteristics of TB with DM co-morbidity, which indicate the active involvement of the angiogenesis-inflammation nexus. Therefore, to alleviate the burden of both disorders, it would be beneficial to make informed therapy choices by gaining a better understanding of TB immunology in the context of DM.