Journal of clinical and diagnostic research

Navigating Complex Airway Challenges in Advanced Laryngeal Cancer: A Case of Total Laryngectomy with Multidisciplinary Anaesthetic Care

Sivani Dasari, Jui Jadhav, Sanjot Ninave

Laryngeal Squamous Cell Carcinoma (SCC) is a head and neck cancer that usually causes airway compromise at advanced stages, with substantial anaesthetic implications for its surgical management. The author, here presents a case of a 57-year-old man with worsening hoarseness, dysphagia, and exertional dyspnoea, diagnosed with well-differentiated laryngeal SCC. The preoperative evaluation identified predictors of a difficult airway, such as limited mouth opening and limited neck extension. The anaesthetic management focused on preserving spontaneous ventilation, securing the airway, and ensuring safe positioning. Intravenous ketamine and dexmedetomidine were used to provide sedation, and continuous oxygenation was maintained with a high-flow nasal cannula using the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) technique. Fibreoptic intubation was performed. After confirming tracheal placement, neuromuscular blockade was administered, and anaesthesia was maintained with sevoflurane. The nasal endotracheal tube was replaced with a flexometallic tube through a tracheostomy stoma under surgical control, with uninterrupted ventilation. The patient underwent a total laryngectomy with tracheostomy and had an uneventful recovery. The case illustrates the importance of a personalised approach to airway management, advanced oxygenation techniques, and multidisciplinary coordination in the anaesthetic management of complex laryngeal cancer surgery.

Double Prepyloric Gastric Ulcer Perforations Managed with Emergency Gastrojejunostomy and Feeding Jejunostomy: A Rare Case Report

Abhiram Chadive, Rajesh Gattani, Sana Ahmed, Bhagyesh Sapkale

The perforation of prepyloric gastric ulcer is a surgical emergency that carries a high morbidity burden, but the rate of occurrence of double prepyloric perforation is extremely low, which thus presents both diagnostic and operative challenges. The presented case is of a 57-year-old male from India, who presented with a five-day history of abdominal pain, nausea, vomiting, and constipation. Cultural Extended Focused Assessment with Sonography for Trauma (E-FAST) and clinical examination indicated peritonitis with intra-abdominal fluid, thus warranting emergency exploratory laparotomy. During the intraoperative period, about 800 mL of purulent fluid was drained and 2 cm and 1.5 cm adjacent prepyloric perforations were detected along the lesser curvature. The patient had severe intraoperative malnutrition, which was manifested through cachexia, depleted omental fat, and hypoalbuminaemia and required a surgical approach based on his compromised physiological reserve. The perforations were primarily closed and then a gastrojejunostomy with feeding jejunostomy was done to provide sufficient gastric bypass and postoperative nutritional support. Histopathologic examination of the patient revealed gastric ulceration with mucosal denudation, fibrinous exudate, bacterial colonies, and inflammatory infiltration, which were consistent with perforation. The patient responded to antibiotics, analgesia, and enteral feeding, which was achieved through jejunostomy, with a gradual improvement in the clinical condition. Oral intake was then started and tolerated. After four weeks, the feeding jejunostomy was removed, and the patient also remained asymptomatic on follow-up. The case of double prepyloric ulcer perforations is quite rare, and it highlights the necessity of immediate surgical intervention and an individual approach to patients with poor nutritional status. Reporting of such cases is significant to provide insights into optimal operative decision-making in complex cases of upper gastrointestinal perforation.

Case Report of a Difficult Airway due to Calcinosis Cutis Universalis: An Anaesthesiologist Perspective

Priyadharshini Srinivasan, Venkatraman Rajagopalan

Difficult airway is defined as a situation where a trained anaesthesiologist encounters challenges in either face mask ventilation, tracheal intubation, or both, as stated by the American Society of Anaesthesiologists. A case of a difficult airway due to Calcinosis Universalis was encountered, which is a rare subtype of connective tissue disorder. In Calcinosis Cutis, calcium is diffusely deposited in the skin, subcutaneous tissue, muscles, and tendons. Calcinosis Universalis typically appears secondary to a connective tissue disorder such as juvenile dermatomyositis, systemic lupus erythematosus, Sjögren’s syndrome, and Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) syndrome, predominantly affecting females. There is no specific treatment available for this condition. Medically, it can be managed with calcium channel blockers like diltiazem, colchicine, immunosuppressants, and painkillers to alleviate discomfort. Antibiotics may be required for infected wounds. Surgically, lesions can be removed; however, there is a higher likelihood of recurrence. Patients with Calcinosis Universalis present a challenge for anaesthesiologists due to the involvement of joints and tendons. The present case report involves a 22-year-old female with a history of juvenile dermatomyositis for the past 15 years and Calcinosis Cutis universalis for the past 11 years presented to the Anaesthesiology department for nasal bone reduction. Upon examination, it was determined that she had a difficult airway, and awake fiberoptic intubation was performed. The present case report aims to provide unique insights into a rare case, highlighting the unusual presentation of a difficult airway and the associated perioperative challenges from an anaesthesiologist’s perspective.

Septic Pulmonary Embolism with Hepatic and Renal Abscesses in a Diabetic Patient Mimicking Tuberculosis or Metastasis: A Case Report

Amit Toshniwal, Babaji Ghewade, Alushika Jain, Poonam Patil, Souvik Sarkar

Septic Pulmonary Embolism (SPE) is a rare but life-threatening pulmonary condition characterised by the embolic spread of infected thrombi from extrapulmonary sources into the lungs. It most commonly occurs as a complication of systemic infections and presents with cavitating lung lesions, respiratory compromise, and multi-organ involvement. Immunocompromised individuals, particularly those with uncontrolled diabetes mellitus, are especially vulnerable to such infections. We present a case of a 41-year-old man with poorly controlled diabetes and a prior clinical diagnosis of pulmonary tuberculosis, who presented with a progressive cough, dyspnoea, and abdominal pain. Imaging revealed multiple cavitary lesions in the lungs, hepatic abscesses, and renal abscesses with partial renal vein thrombosis. Microbiological investigations confirmed infection with Klebsiella pneumoniae and Pseudomonas aeruginosa. A differential diagnosis of SPE, pulmonary tuberculosis, and cystic metastases was considered. The patient initially responded well to culture-sensitive antibiotics and improved glycaemic control. However, three months later, he was readmitted with worsening respiratory symptoms and hyperglycaemia, and despite appropriate interventions, he developed respiratory failure and succumbed to septic shock. This case highlights the diagnostic complexity of SPE, its overlap with other pulmonary pathologies, and the crucial role of metabolic control and vigilant follow-up in diabetic individuals with systemic infections.

Dilemmas to Proceed with High-risk NORA Endoscopy: A Case of Patient with Bradycardia

Sandeep Veer, Subhashree Jena, Ananth Kumar Sircilla

Colorectal cancer is a leading cause of cancer-related morbidity and mortality worldwide. Early diagnosis through colonoscopy remains a cornerstone in improving prognosis. However, performing such diagnostic procedures in elderly patients with significant co-morbidities poses unique challenges. The elderly population, often characterised by age-related physiological changes and multiple co-existing conditions, is especially vulnerable to perioperative complications, including cardiovascular instability, altered drug metabolism, and neurological disturbances. Authors present a rare and clinically significant case of a 62-year-old male patient with suspected colorectal malignancy and baseline sinus bradycardia, referred for diagnostic colonoscopy. Notably, this patient had previously been deferred from undergoing the procedure due to severe perioperative bradycardia at an outside hospital. Comprehensive preoperative evaluation, including Electrocardiography (ECG), echocardiography, and Holter monitoring, revealed no malignant arrhythmias but persistent physiological bradycardia. During the first colonoscopy attempt, profound bradycardia and hypotension occurred following standard sedation, requiring pharmacologic intervention and the eventual abortion of the procedure. A second attempt revealed intraprocedural hypocalcaemia as a contributing factor to both bradycardia and abnormal limb movements, which was successfully managed with intravenous calcium. A third, carefully adjusted sedation protocol-using preprocedure atropine and ketamine-based sedation-resulted in a stable and successful colonoscopy without complications. This case uniquely underscores the need for an individualised, multidisciplinary anaesthetic strategy in elderly patients with baseline conduction abnormalities undergoing Non Operating Room Anaesthesia (NORA). It highlights the interplay between bradycardia, hypocalcaemia, and sedation, emphasising the importance of proactive management, tailored drug selection, and readiness for cardiac intervention in diagnostic procedures with potential physiological risks.

Chronic Diarrhoea in Hyperthyroidism Leading to Rectal Prolapse:A Case Report

Samina Ruquaya, K Vivekananda Subramania Nathan, M Reegan Jose, Najeem Fazil

Rectal prolapse is typically associated with chronic constipation and pelvic floor dysfunction. However, its occurrence secondary to chronic diarrhoea from hyperthyroidism is exceptionally rare. This case emphasises a rarely discussed pathophysiological link between prolonged thyrotoxicosis and advanced rectal prolapse. In this report, a 67-year-old male presented with chronic diarrhoea and rectal prolapse for two years, along with classic hyperthyroid features like weight loss and a longstanding multinodular goitre. Clinical and hormonal evaluation confirmed uncontrolled hyperthyroidism, while local examination revealed Grade V rectal prolapse. Imaging and endoscopic workup ruled out malignancy or other structural causes. He was managed conservatively with antithyroid drugs, dietary changes, and pelvic floor rehabilitation. Uncontrolled hyperthyroidism can present atypically with advanced rectal prolapse due to persistent diarrheal episodes and weakened pelvic support. Early recognition, endocrine optimisation, and multidisciplinary care are pivotal in such rare yet clinically significant presentations.

Perioperative Anaesthetic Challenges in a Case of Lumbosacral Meningomyelocele: A Case Report

Poornima Dhakshinamurthy, Shyamolima Bhuyan

Meningomyelocele is a congenital neural tube defect caused due to incomplete closure of the neural tube during foetal development. In meningomyelocele, a sac is formed due to herniation of the neural tissues and cerebrospinal fluid through defective vertebral arches and is covered by a thin membrane. It produces paraplegia, hydrocephalus, urinary incontinence and higher mental function impairment. It is almost always associated with Arnold Chiari type 2 malformations, wherein there is cerebellar herniation. It is prevalent in developing countries due to non-compliant prenatal care. Proper folic acid supplementation throughout pregnancy helps prevent these neural tube defects. But owing to various socio-economic concerns, that is usually not the case. Paediatric anaesthesia can be a challenging task as they have various anatomical and physiological differences from adults. Proper counselling and explanation play a crucial role in meningomyelocele repair surgeries, especially in the paediatric age group. So many patients end up having post-neurological sequelae if not intervened at the right time. Sometimes, meningomyelocele repair surgeries can be done in the prenatal period as either an open or a foetoscopy approach. This case report is about a 15-day-old neonate with lumbosacral meningomyelocele associated with Arnold Chiari type 2 malformation, a soft palate cleft and a small atrial septal defect posted for meningomyelocele repair surgery. The presence of a cleft palate made it a case of an anticipated difficult airway and with Atrial Septal Defect (ASD), strict hemodynamic control had to be maintained throughout the surgery.

From Anaphylaxis to Arrhythmia: A Case Report of Fexofenadine-induced Bradyarrhythmia

S Subha Sree, Swathy Moorthy, Emmanuel Bhaskar

Anaphylaxis is a rapid, potentially fatal systemic hypersensitivity reaction, with adrenaline recommended as first-line treatment, followed by beta-2-agonists, glucocorticoids, and antihistamines. H1-antihistamines play a limited role but help relieve skin symptoms; undue side effects, such as sedation decrease with newer generations. Fexofenadine, a third-generation antihistamine, is preferred for its non-sedative profile and lack of anticholinergic or adrenergic effects. It reaches peak plasma levels in 2-4 hours, lasts 12-24 hours, and is 60-70% protein-bound with a half-life of 11-15 hours. As a terfenadine metabolite, it avoids QT prolongation and is considered safe. This is a rare case of sinus bradycardia following fexofenadine use in a 35-year-old female with no known comorbidities, who presented with angioedema and anaphylactic shock after taking cefixime and aceclofenac. She was stabilised with intravenous hydrocortisone and intramuscular adrenaline, then admitted to the Intensive Care Unit (ICU). Fexofenadine 180 mg twice daily and hydrocortisone 100 mg thrice daily were initiated. After three doses of fexofenadine, the patient developed worsening bradycardia, with a lowest recorded heart rate of 30 bpm. No other triggers were identified. Fexofenadine was discontinued, and symptomatic treatment included atropine and oral orciprenaline. Her heart rate stabilised without requiring pacing. Bradycardia resolved within three days of stopping fexofenadine, and orciprenaline was discontinued. The patient was discharged after a week. This case highlights a rare but significant adverse effect of fexofenadine, a commonly prescribed antihistamine. Clinicians should be aware of its potential to cause bradyarrhythmia and exercise caution when prescribing, especially in acute care settings.

Management of Female Dyspareunia with Ayurveda: A Case Report

Namrata Babasaheb Bhagaje, Kashavva Veerbasayya Hiremath

Sexual health is an important component of women’s health for maintaining physical, mental, emotional and social aspects. It involves experiencing healthy sexual relationships and timely recognising and consulting any dysfunctions like reduced desire, pleasure, painful intercourse and no conception. Dyspareunia, painful intercourse, is such common female sexual problem. It is defined as female sexual dysfunction presenting with pain during or after peno-vaginal intercourse or vaginismus affecting the marital relations. A 24-year-old married female visited the fertility outpatient department with complaints of pain during intercourse, reduced interest in sexual activity and dryness of the vagina. On vaginal examination, the patient expressed pain without any discharge or inflammatory signs. Based on these symptoms, she was administered Dhanvantara Taila Yonipichu (herbal oil vaginal tampon) once a day for seven consecutive days. The effect of the treatment was assessed through the Visual Analogue Scale (VAS) for pain, improvement in Frequency of Intercourse (FOI), Female Sexual Functioning Index (FSFI) on 0th, 8th, 15th and 30th day. The case had a prospective follow-up for six months and was found to be free from all symptoms. It is evident from this case that Ayurveda treatment is effective in managing dyspareunia and enhancing the quality of sexual functioning with no adverse effects at an economical approach. Further clinical trials with a large sample size can help to explore the true efficacy of the treatment.

Anaesthetic Management of a Patient with Acromegaly and Dilated Cardiomyopathy: A Case Report

Richa Tailor, Tejash Sharma, Anupama Kumari, Sara Mary Thomas

Acromegaly is a rare endocrine disorder primarily caused by excessive Growth Hormone (GH) secretion, often due to an anterior pituitary macroadenoma. Patients frequently experience cardiovascular complications, including hypertension and Dilated Cardiomyopathy (DCM). A 32-year-old male presented with features suggestive of acromegaly, including headache and blurred vision. Hormonal tests revealed a growth hormone level of 21 ng/mL and an Insulin-like Growth Factor-1 (IGF-1) level of 778.7 ng/mL. Magnetic Resonance Imaging (MRI) identified a 2.4×2.8×3.1 cm GH-secreting pituitary macroadenoma. Twodimensional echocardiography indicated severe DCM with a Left Ventricular Ejection Fraction (LVEF) of 15-20% and severe diastolic dysfunction. The patient had no prior history of diabetes or hypertension and underwent successful endonasal transsphenoidal excision of the tumour, despite challenges posed by impaired cardiac function. This case emphasises the importance of careful anaesthetic management in acromegaly patients with cardiomyopathy.

Lymphoplasmacytic Lymphoma Mimicking Plasma Cell Neoplasm: A Rare Case Report

Suman AG Patel, Rajeshwari S Handigund, Adarsh Sanikop, Sakshi S Anekar

Lymphoplasmacytic Lymphoma (LPL) is an uncommon B-cell neoplasm that may closely mimic plasma cell disorders, leading to diagnostic uncertainty. We report the case of a 56-year-old man who presented with fatigue and bone pain. Bone marrow evaluation revealed an admixture of plasma cells and plasmacytoid lymphocytes, showing significant morphological overlap between LPL and plasma cell neoplasm. An extended Immunohistochemical (IHC) panel demonstrated CD20 and CD79a positivity in B-lymphoid cells, CD138 positivity in plasma cells, and kappa light-chain restriction, consistent with a clonal B-cell proliferation with plasmacytic differentiation. Correlation of clinical, radiological, and laboratory findings established the final diagnosis of LPL. This case emphasises the limitations of relying solely on morphology and highlights the essential role of immunophenotyping in differentiating LPL from plasma cell neoplasms. The distinction carries therapeutic and prognostic significance; LPL typically responds to rituximab-based regimens targeting B cells, whereas plasma cell neoplasms require anti-myeloma therapy. Recognising such atypical marrow presentations is crucial to prevent misclassification, enable appropriate management, and improve patient outcomes.

Case of Folie à Famille: Family-wide Shared Psychosis

Anoop Jose Alappat, Srinivas Rajkumar

Folie à famille is an uncommon form of shared psychotic disorder in which a dominant family member induces fixed delusional beliefs in several relatives. Over the past 10 years, only about 60 cases of folie à famille, shared psychotic disorder, or similar family-wide delusional syndromes have been documented in PubMed/PMC-indexed literature that fully replicate the features observed in our patient. This is a case of a 71-year-old retired doctor who developed persecutory delusions directed at a deceased colleague and gradually induced identical delusional beliefs in both his wife and daughter over a 13-year period, leading to near total social isolation. The family was first identified clinically when a medical emergency—acute kidney injury and dyselectrolytaemia—made medical access unavoidable. During the inpatient stay, he was started on oral and parenteral anti psychotics. Mrs. S was treated with antipsychotics, and her daughter with antipsychotics and antidepressants. All three underwent structured psychoeducation and regular follow-up, achieving improved insight and gradual social reintegration. This case is novel for its unusually long duration before recognition, its inclusion of three family members in concord with the inducer, its discovery via medical rather than psychiatric crisis, and its successful non-separative therapeutic approach. Notably, despite all three being medical professionals, entrenched stigma and adverse psychosocial factors contributed to protracted delays in seeking psychiatric care. Further challenges arising from comorbid medical conditions and treatment-related adverse effects may also contribute to delayed or diminished treatment adherence. This case thus adds to the limited recent literature and offers evidence that insight-oriented, family-engaged treatment may succeed even in deeply entrenched folie à famille.

Pulmonary Hypertension and Arrhythmogenic Right Ventricular Cardiomyopathy in Atypical Sjögren’s Syndrome: A Rare Case Report

Sjögren’s syndrome is a chronic autoimmune condition in which the majority of patients present with sicca symptoms. About 20% of patients, however, do not have sicca symptoms and instead present predominantly with systemic or extraglandular involvement, posing a diagnostic challenge. Pulmonary Hypertension (PH) manifests as elevated pulmonary arterial pressure due to remodelling of the pulmonary vasculature as a result of various factors, including systemic involvement, infectious agents, connective tissue diseases, or toxin/drug exposure. PH in Sjögren’s syndrome is a dangerous complication that can significantly affect patient outcomes. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a genetic cardiomyopathy characterised by fibrofatty replacement of the right ventricular myocardium, predisposing patients to arrhythmias which may cause abrupt collapse or sudden death. Sjögren’s syndrome and ARVC are two distinct disorders that may lead to grave outcomes when they co-exist. Present case is a rare case of atypical Sjögren’s syndrome with PH and ARVC in a patient who suffered a cardiac arrest during her initial evaluation. Further work-up revealed ARVC, following which appropriate treatment was initiated. This case underlines the need for clinicians to consider Sjögren’s syndrome even in the absence of sicca symptoms, especially when unexplained systemic or cardiovascular findings are present. The co-existence of ARVC added further diagnostic complexity. Overlapping pathophysiology—right ventricular strain from PH combined with intrinsic ARVC-related myocardial damage—may accelerate clinical deterioration.

Adult-onset Still’s Disease without Elevation of Erythrocyte Sedimentation Rate, C-Reactive Protein or Serum Ferritin: A Case Report

Fever accompanied by arthralgia and rash has multiple differential diagnoses. It often resembles a viral exanthem and is treated accordingly. However, certain clinical and laboratory features may suggest a specific diagnosis. Here, authors present the case of a 19-year-old male who had fever, polyarthralgia, throat pain, and pinkish rashes. The rashes appeared with the onset of fever and resolved when the fever subsided. He was initially treated for a viral exanthem, with bacterial infection considered in the differential diagnosis. As he did not respond to standard fever management, proceeded to exclude specific infections, malignancy, and autoimmune conditions. After a thorough evaluation, he was diagnosed Adult-Onset Still’s Disease (AOSD), which responded well to oral corticosteroids. AOSD is an autoinflammatory disorder with systemic manifestations characterised by high spiking fevers, polyarthralgia, and a typical salmon-pink rash. The rash is usually non pruritic, macular or maculopapular, and often coincides with febrile episodes. It is one of the differential diagnoses in Pyrexia of Unknown Origin (PUO), warranting appropriate and comprehensive evaluation. Classically, AOSD demonstrates elevated inflammatory markers, particularly serum ferritin. Interestingly, index patient had normal values of all three inflammatory markers {Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and serum ferritin} despite having an inflammatory disease, which makes this presentation rare in an already uncommon condition. This report indicates that AOSD can present without a typical rise in inflammatory markers, creating a diagnostic dilemma. Only strong clinical suspicion may lead to an accurate diagnosis.

Uncovering Ulcerative Colitis with Bilateral Sacroilitis in a Patient of Chronic Back Pain: A Case Report

Ulcerative Colitis (UC) is the most common type of Inflammatory Bowel Disease (IBD), characterised by persistent and progressive inflammation. Unlike Crohn’s Disease (CD), which affects the entire thickness of the intestinal wall, UC is limited to the mucosal and submucosal layers of the colon and rectum. The condition typically begins in the rectum and may gradually extend proximally to involve other segments of the colon. Sacroiliitis refers to inflammation of the sacroiliac joints at the base of the spine and often presents with lower back and buttock pain. It is more common in individuals with ulcerative colitis due to shared immune-mediated inflammatory pathways. Hereby, the authors present a case of a 35-year-old male who arrived at hospital with complaints of back pain radiating to the left lower limb for the past 5-6 days, along with 5-6 episodes of loose stools over the preceding 10 days. Magnetic Resonance Imaging (MRI) of the lumbar spine revealed diffuse bowel wall thickening as an incidental finding. Subsequently, a contrast-enhanced MRI of the abdomen was performed, which demonstrated features suggestive of ulcerative colitis with bilateral sacroiliitis. Radiologists play a crucial role in identifying early or subtle manifestations of disease, particularly in asymptomatic or occult cases, thereby facilitating timely clinical suspicion.

Decidualised Caesarean Scar Endometriosis in a Gravid Woman: A Case Report

M Safin, S Revathy, J Thanka

Endometriosis is a pathological condition characterised by the presence of extrauterine endometrial tissue that responds to hormonal variations. Globally, endometriosis affects approximately 89 million females, accounting for a 5-10% prevalence of the disease. Cutaneous endometriosis over abdominal surgical sites accounts for less than 1% of all cases, of which 0.03-0.45% occur following a lower segment caesarean section. Only a few cases of hormonal decidualisation of scar endometriosis during pregnancy have been reported. A 27-year-old G2P1L1 pregnant woman presented with pain and tenderness over a previous Lower Segment Caesarean Section (LSCS) scar, occurring intermittently over three years. Clinicoradiological evaluation suggested scar endometriosis, which was subsequently confirmed histopathologically as decidualised scar endometriosis. The most widely accepted theory is that direct inoculation of endometrial tissue during surgical procedures is the major predisposing factor for scar endometriosis, particularly in cases involving hysterectomy at a young age or procedures performed for abortion. Scar endometriosis is an infrequent yet challenging condition following obstetric and gynaecological surgeries, including caesarean section. Therefore, this condition must be considered as a differential diagnosis in patients presenting with pain or a mass over a previous LSCS scar.

A Case of Infantile Achalasia in Alacrima–Achalasia–Mental Retardation Syndrome: A Rare and Complex Association

Apoorva Makan, Ritika Gupta, Pranav Jadhav, Aniruddha Bhagwat, Dhananjay Vaze

Alacrima-Achalasia-Mental Retardation (AAMR) syndrome, also known as GDP-Mannose Pyrophosphorylase A (GMPPA)-Congenital Disorder of Glycosylation (GMPPA-CDG), is a rare autosomal recessive condition characterised by alacrima, achalasia, and intellectual disability. Due to its rarity and the variable clinical presentation, diagnosis is often delayed. Hereby, the authors present a case of one-year-old female with progressive feeding difficulties, global developmental delay, and failure to thrive. Evaluation revealed absence of tear production, with radiologic and endoscopic confirmation of achalasia. Genetic testing identified a homozygous pathogenic variant in the GMPPA gene, confirming GMPPA-CDG. Despite an unremarkable perinatal and family history, the clinical triad was evident. Surgical management with Heller myotomy and Dor fundoplication led to significant symptomatic relief and catch-up growth. The present case highlights the importance of early syndromic recognition and genetic confirmation in children with feeding and developmental concerns. Timely surgical and multidisciplinary interventions can improve outcomes in rare neurogastroenterological disorders like GMPPA-CDG.

Paediatric Right Ureterocele Presenting with Urinary Obstruction: A Case Report

Harini Krishnan, Apurva Vaidya, Suresh Chandak, Abhijit Dhale

Ureterocele is a congenital urological defect involving the dilatation of the distal part of the ureter. This swelling can block the normal flow of urine, sometimes causing symptoms like abdominal pain, frequent urinary tract infections, or difficulty urinating. However, it can be asymptomatic in some patients. If left untreated, ureterocele can lead to serious problems with the urinary system, including kidney damage or even life-threatening complications. It is more commonly observed in females compared to males and can affect either a single ureter or both. The present case report involves a 4-month-old male infant with an antenatal diagnosis of right hydroureteronephrosis. He presented with fever and urinary retention. Clinical and radiological evaluation led to a diagnosis of right ureterocele, which was confirmed by Computed Tomography (CT) urography. He was successfully managed with endoscopic incision of the right ureterocele and Double-J (DJ) stenting. The 30-day follow-up showed resolved hydronephrosis, normal voiding, and no new urological complaints. The present case report highlights the importance of early diagnosis and suitable surgical management of ureteroceles in male children through endoscopic incision and DJ stenting. Timely diagnosis and intervention can yield favorable outcomes by resolving hydronephrosis and preventing long-term renal damage.

Ayurvedic Management of Dushta Vrana (Non Healing Wound) in a Diabetic Foot: A Case Report

Vrana is the break or destruction, or discontinuity, of body tissue or part of the body. Acharya Sushruta has provided a detailed description of managing Dushta Vrana in Shasti Upkramas in his Shushrut Samhita. Here, we present a case of a 66-year-old male who visited the OPD with a chief complaint of a wound between his big toe and the second toe of his right foot, associated with a foul smell and severe pain. This case was treated with prakshalan (cleansing) of the wound using Panchvalkal Kwath (decoction), followed by the application of Nirgundi Tail and oral intake of Kishoreguggulu, Agrogyavardhanivati, and Mhamanjisthaikwath. These medications have vranashodhana, vranaropana, and raktashodhak properties. They were applied topically on a non-healing ulcer/dushta vrana once daily for one month, along with pathya-apathya (prescribed diet and regimen). The patient experienced relief, and the wound healed completely with minimal scarring. Additionally, this classical herbal formulation was well accepted by the patient and caused no side effects during the entire study period.

Appendicular Base Perforation as a Rare Manifestation of Abdominal Tuberculosis in a Paediatric Patient: A Case Report

Ritika Gupta, Apoorva Makan

Pulmonary tuberculosis is the most commonly diagnosed site of tuberculosis infection in children and abdominal tuberculosis accounts for only 0.3-4% of all tuberculosis cases, especially in Indian children. Although India has made progress in reducing overall TB incidence in recent years, abdominal TB remains a rare and potentially life-threatening complication that presents diagnostic and therapeutic challenges. Here, in this case report, a 13-year-old female presented to the Department of Gastroenterology at a tertiary health-care centre. The patient presented with abdominal pain, fever and vomiting, with a history of abdominal distension. Imaging revealed inflammatory changes with perforation. During emergency laparoscopic appendectomy, perforation at the base of the appendix was identified along with multiple peritoneal granulomas. Histopathological examination and the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) were performed. After confirmation of the diagnosis, the patient was started on antitubercular therapy according to national guidelines and responded well to treatment. This case emphasises the importance of considering TB in atypical presentations of appendicitis, especially in children.

Preservation of Atlantoaxial Rotation in Type II Odontoid Fracture: Successful Single Screw Anterior Odontoid Fixation in a Young Adult

Type II odontoid fractures are the most prevalent type of cervical spine fracture in adults, and they are frequently linked with craniovertebral junction instability. Surgical fixation is recommended in young, active people to preserve cervical mobility and limit the likelihood of non-union. Anterior odontoid screw fixation is a well-established method that, unlike posterior fusion treatments, preserves atlantoaxial rotation. Here, a case is presented of a 30-year-old male patient who had a type II odontoid fracture as a result of a motor vehicle accident. A clinical evaluation indicated neck discomfort without neurological abnormalities. Radiological examination, including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), revealed a displaced fracture across the base of the odontoid process without transverse ligament rupture. The patient had a successful single-screw anterior odontoid fixation. Postoperative imaging verified the proper screw insertion and alignment. Serial radiographs after three months, nine months, and one year after surgery revealed gradual consolidation and radiological union of the odontoid fracture. Single-screw anterior odontoid fixation continues to be a useful surgical option for young adults with type II odontoid fractures, since it provides fracture stability while maintaining important cervical spine mobility. Successful outcomes need careful patient selection and precision surgical technique.

Drug-induced Neuropsychiatric Syndrome in a Liver Transplant Recipient: A Case Report

Ketaki Ladi, Akshay Naik, Archana Narendra Javadekar

In postliver transplant patients, numerous factors may lead to the presentation of neuropsychiatric symptoms. These may include pre-existing hepatic encephalopathy, metabolic disturbances, adverse drug reactions, and complex drug-drug interactions. Differentiating among these potential causes is often challenging for the treating team. However, it is crucial because distinguishing between them directly impacts treatment choices and patient outcomes. The present case report discusses a young 24-year-old female who developed acute psychiatric disturbances in the early postoperative period following a liver transplant. Her presentation was characterised by agitation, disorganised behaviour, and confusion. This raised questions about whether the patient was experiencing post-transplant delirium or primary drug-induced neurotoxicity. Laboratory evaluations revealed elevated serum tacrolimus levels at the time of symptom onset. The patient was concurrently receiving high-dose corticosteroids as part of her immunosuppression and antifungal therapy with fluconazole, a potent inhibitor of Cytochrome P450 3A4 (CYP3A4). This is known to reduce tacrolimus metabolism and increase circulating drug concentrations. The patient’s symptoms showed marked improvement following timely pharmacological adjustments, including modifications to her immunosuppressive and antifungal regimens. This underscores the reversibility of these manifestations when identified early. Therefore, the present case highlights how the use of tacrolimus, corticosteroids, and fluconazole may synergistically precipitate neuropsychiatric complications. It emphasises the need for close monitoring of immunosuppressant levels, regular reviews of concomitant medications, a high index of suspicion for drug-drug interactions, and a multi-disciplinary team effort in postliver transplant patients exhibiting acute neuropsychiatric syndromes.

From Size to Solution: A Case Report on Surgical Repair of a Colossal Incisional Hernia

Deepanshu Sharma, Imran Ali Kha Khan, Anup Zade, Sai Goutham, Shruthi Bikkumalla

A giant incisional hernia is a common health complication characterised by the loss of abdominal wall integrity. It is typically observed in patients who have undergone abdominal surgery. Incisional hernias present a significant burden in healthcare, particularly in cases involving laparoscopic surgeries. They occur when abdominal contents protrude through inadequately healed surgical incisions, with surgical history and obesity being major risk factors. Colossal incisional hernias are generally defined by their large size (>15 centimeters). Here, the authors present a case of a 45-year-old male who has had a large lump in his abdomen for the past two years. The lump worsened when the patient stood and improved when he lay down. The patient underwent umbilical hernia surgery eight years ago and has a history of heavy weight lifting. A positive cough impulse was observed, along with an old surgical scar. The patient underwent surgery that included adhesiolysis, omentectomy, omphalectomy, reduction of the hernia contents, closure of the defect with polypropylene loop sutures, and placement of a polypropylene mesh over the rectus sheath. The patient was discharged on the seventh Postoperative Day (POD). A six-month follow-up showed no signs of recurrence, indicating a favorable prognosis post-surgery. Anatomical knowledge is crucial for the effective management of any hernia. These hernias are managed through an interdisciplinary approach tailored to patient-specific factors.

Solitary Extramedullary Plasmacytoma of the Thyroid Cartilage: A Case Report

Lasima Rasheed, Shambhu Dev, T Santhi

Extramedullary Plasmacytoma (EMP) belongs to the category of haematolymphoid neoplasms of the larynx. This is a case report of a 51-year-old female patient who presented to the Ear, Nose and Throat (ENT) department with a change in voice and a swelling in the neck. On video laryngoscopy, a smooth bulge was observed arising from the right ventricle towards the midline. Magnetic Resonance Imaging (MRI) of the neck showed a large, relatively well-defined T1 hypointense, T2 and T2 FS hyperintense, mildly enhancing mass centred in the right lamina of the thyroid cartilage. Histopathology reported plasmacytoma with CD138 positivity and lambda restriction. Although EMP in the supraglottic region has been reported, plasma cell neoplasm involving the thyroid cartilage is extremely rare. Reaching such a rare diagnosis requires a collaborative effort, where each clinical and diagnostic finding plays a crucial role in achieving accuracy.

Exploring Ayurvedic Modalities in a Clinically Diagnosed Guillain-Barr’ Syndrome Patient: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Rohit A Waskar

Guillain-Barré Syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy characterised by rapidly progressive weakness, typically beginning in the lower limbs and ascending upwards. GBS can lead to significant motor and sensory deficits, impacting daily functioning and quality of life. Based on Ayurvedic principles, Kapha-Pitta Avarana (obstruction) blocking Sarvangagata Vata is associated with the clinical presentation of GBS. A 48-year-old male patient came to the Ayurvedic Hospital in a bedridden condition with both lower limbs immobile, an inability to close his eyes, slurred speech, and tingling sensations throughout the body for 15 days. This case report advocates for the application of classical Ayurvedic treatments, including Shodhan (biopurification treatment) and Shaman (curative treatment) therapies, as an alternative to relying on harmful corticosteroids, potentially lowering the risk of associated complications. This study shows significant improvement in the Barthel Index, Power grading, Hughes Functional Grading Scale, and reflex responses.

Choroid Plexus Papilloma: A Case Report with Special Emphasis on Diagnosis and Pathology

Apoorva Pande, Samarth Shukla, Milind Pande, Suhit Naseri, Saurabh Gawand

Choroid plexus papilloma is a rare, benign neuroepithelial tumour arising from the choroid plexus of the brain. It is reported to be more common in the lateral ventricles among paediatric populations and in the fourth ventricle in adults. These tumours are known to cause hydrocephalus, resulting in increased intracranial pressure, which in turn leads to symptoms such as headaches, nausea, and vomiting. Pathologically, choroid plexus papilloma is noted as well-circumscribed, cauliflower-like masses macroscopically. The tissues of the choroid plexus papilloma exhibit a papillary, finger-like architecture comprised of singular cuboidal-columnar epithelial cells with very low mitotic activity and mild nuclear pleomorphism. This is case of a 50-year-old male, presented with headache and was diagnosed with choroid plexus papilloma. The patient was successfully managed by surgical excision. The novelty of imaging in choroid plexus papilloma lies in the multimodal approach, where Magnetic Resonance Imaging (MRI) offers superior soft-tissue detail, Computed Tomography (CT) detects calcifications, and ultrasound enables early diagnosis in neonates.

Tophaceous Gout Presenting with Normouricaemia: A Diagnostic Challenge

Mayanka Lodha Seth, Bhavinee Pathak, Siddharth Manish Lodha, Manish Seth

Tophaceous gout is a chronic manifestation of gouty arthritis characterised by the deposition of Monosodium Urate (MSU) crystals in soft tissues. Although hyperuricaemia is the usual finding, uncommon cases may present with normal Serum Uric Acid (SUA) levels (3.4-7 mg/dL), which can make diagnosis challenging. We report a case of a 60-year-old non-diabetic, non-alcoholic hypertensive male with a long-standing nodular lesion over the left lateral malleolus. The patient’s Complete Blood Count (CBC), Liver Function Test (LFT), and Renal Function Test (RFT) were within normal limits. The SUA level was 5.4 mg/dL. The Anti-Nuclear Antibody (ANA) profile and Rheumatoid Arthritis (RA) factor were negative. Radiology indicated a soft tissue lesion with calcific bodies near the lateral malleolus. Fine Needle Aspiration (FNA) showed inflammatory pathology and crystalline deposits that was indistinguishable from calcification. Histopathology revealed abundant MSU crystal deposition with a foreign body giant cell reaction, even after formalin fixation, suggestive of tophaceous gout. Raised SUA level is the basis for gout. A clinical diagnosis of gout is considered when a patient presents with SUA levels more than 7 mg/dL with the characteristic arthritis. However, some patients with gouty tophus have normal SUA levels, especially noted in cases of diabetes and alcoholism. Rarely, tophi may occur in patients with normal uric acid levels due to fluctuations in serum concentration, previous treatment, or renal excretion abnormalities. Histological recognition of MSU deposits is critical in these atypical cases. This case underscores the importance of histopathological examination in chronic joint lesions and highlights that normouricaemia does not exclude the diagnosis of tophaceous gout.

The Diagnostic Odyssey of Congenital Bile Acid Synthesis Defect Type 1: A Case Report

R Afraneha, Jyothi Nallaparaju, Jayakavaiya, T Hariharasudhan, AP Krithika

Congenital Bile Acid Synthesis Defects (BASDs) are rare, autosomal recessive metabolic conditions defined by defects in primary bile acid synthesis, leading to the accumulation of toxic intermediate sterols, a deficiency of normal primary bile acids (cholic and chenodeoxycholic acid), and subsequent cholestasis and fat-soluble vitamin malabsorption. Early diagnosis and targeted replacement therapy are vital to prevent progressive liver damage and fatal outcomes. This report describes a 6-year and 5-month-old male from a consanguineous marriage in Chennai, presenting late with right arm swelling, gum bleeding, and progressive pallor for one week. He had a significant history of neurodevelopmental delay and a sibling’s death from jaundice. Physical examination revealed severe malnutrition, icterus, widespread ecchymoses, ichthyosis, and spastic quadriparesis. Blood investigations confirmed severe microcytic hypochromic anaemia (Hb 1.6 g/dL) and severe coagulopathy {Prothrombin Time (PT) >100, International Normalised Ratio (INR) >8}. A diagnosis of congenital BASD type 1 was established through abnormal urinary bile acid profiling Fast Atom Bombardment–Mass Spectrometry (FAB-MS) and was confirmed by genetic testing showing biallelic pathogenic variants in the HSD3B7 gene. The child was managed with aggressive supportive care, including blood and Fresh Frozen Plasma (FFP) transfusions and high-dose Vitamin K, alongside targeted therapy with oral cholic acid and fat-soluble vitamins. The child showed dramatic clinical improvement within six days, reinforcing the therapeutic benefit of even delayed intervention, although liver transplantation was advised for the advanced liver disease. This case underscores the challenges of late diagnosis and the life-threatening coagulopathy associated with severe BASD type 1.

Rupture of Rudimentary Horn Pregnancy at 16 Weeks Gestational Age in Women with Previous Caesarean Section: A Case Report

Vidhi Singh, Anu Priya, Mansi Tripathi, Shubhangi Mishra

Rudimentary horn pregnancy is a rare and potentially fatal form of ectopic gestation, often presents significant diagnostic challenges and carrying a high risk of uterine rupture during the second trimester. We report a case involving a 22-year-old woman, Gravida 2 Para 1, at 16 weeks of gestation, who presented with acute abdominal pain and haemodynamic instability. Despite a previously documented intrauterine pregnancy on routine antenatal ultrasound, further evaluation revealed a ruptured non-communicating left rudimentary horn pregnancy. The patient underwent an emergency laparotomy due to haemoperitoneum and signs of shock. Intraoperative findings confirmed a ruptured rudimentary horn containing a foetus and placenta, along with significant intra-abdominal bleeding. Surgical excision of the horn and ipsilateral salpingectomy were performed successfully. Histopathology confirmed chorionic villi within the excised rudimentary horn, consistent with a non-communicating rudimentary horn pregnancy. The patient had an uneventful postoperative recovery and was discharged in stable condition. Ruptured rudimentary horn pregnancy is a rare but life-threatening obstetric emergency that often mimics other conditions and requires high clinical suspicion for timely diagnosis. Prompt surgical excision with ipsilateral salpingectomy remains the definitive management, ensuring maternal survival despite poor foetal outcomes.

Balancing Cardiac Rhythm and Surgical Risk: Anaesthetic Management of Hepatic Hydatid Cyst in a Pacemaker Patient

Dhwani Jatin Sheth, Neeta Verma, Amreesh Paul, Saiesh Raut Dessai, Saurav Shah

Hydatid disease, caused by Echinococcus granulosus, is a parasitic infection that commonly affects the liver and may require surgical intervention as definitive treatment. Anaesthetic management of such cases can be complex, particularly when compounded by significant comorbidities. Patients with cardiac implantable electronic devices such as pacemakers present additional perioperative challenges due to risks of Electromagnetic Interference (EMI) and haemodynamic instability. A 65-year-old male with a history of Complete Heart Block (CHB) and a permanent pacemaker presented with right hypochondrial pain and was incidentally diagnosed with a hepatic hydatid cyst. He was scheduled for marsupialisation of the cyst under General Anaesthesia (GA). The patient had underlying hypertension and was otherwise medically stable. Preoperative preparation included reprogramming the pacemaker to VOO mode to mitigate EMI risks during electrocautery. Intraoperatively, standard ASA monitoring and invasive arterial pressure monitoring were used. GA was induced by Etomidate for cardiovascular stability and was maintained using oxygen, air, sevoflurane, and muscle relaxants. Analgesia was achieved with fentanyl. A transient malfunction of the pacemaker occurred during monopolar cautery, which was recognised early on by the anaesthesia team and recovered spontaneously. Surgical management involved excision and irrigation of the cyst with cetrimide, followed by placement of an omental flap. After full recovery, the patient was extubated postoperatively and shifted to the intensive care unit for monitoring. He remained stable, recovered without complications, and was discharged with instructions for follow-up. This case highlights the importance of coordinated perioperative care and vigilant intraoperative monitoring in patients with cardiac devices undergoing hydatid cyst surgery.

Effective use of Low-dose Isotretinoin for Trametinib-induced Acneiform Eruptions in Metastatic Melanoma: A Case Report

Raja Narasimha Rao, Sakshi Malpani, Ramesh Nanisetty

Trametinib, a Mitogen-activated Protein Kinase (MEK) inhibitor used in the treatment of B-Raf proto-oncogene (BRAF) mutated metastatic melanoma, frequently causes acneiform eruptions that may impair patient compliance. We report a case of a 25-year-old male with metastatic melanoma harbouring BRAF fusion mutations who developed severe papulopustular eruptions four weeks after initiating trametinib therapy. Conventional therapy with oral doxycycline and topical antimicrobials resulted in only transient improvement, with rapid recurrence. Low-dose oral isotretinoin (0.4 mg/kg/day) was started in view of refractory disease, leading to marked improvement within four weeks and near-complete clearance by eight weeks, without requiring trametinib interruption. The patient tolerated isotretinoin well, with no adverse effects or laboratory abnormalities, and remained free of recurrence after discontinuation. This case highlights the effectiveness and safety of low-dose isotretinoin in managing MEK inhibitor-induced cutaneous toxicity, allowing uninterrupted cancer therapy and improved patient comfort.

A Multistage Surgical Approach to a Compound Grade 2 Supracondylar Femur and Patella Fracture: A Case Report

Dhairya Vijay Veragiwala, Sandeep Shrivastava

Supracondylar femur and patella fractures compromise knee stability and function. Compound injuries with bone loss are best managed in stages. The authors present a case of a 22-year-old female with a Gustilo-Anderson Grade 2 open supracondylar femur fracture and an associated patella fracture following a road traffic accident. Initial management included thorough wound debridement, temporary external fixation of the distal femur, and Kirschner wiring (K-wiring) of the patella. On the eighth day after confirming satisfactory wound status and the absence of clinical signs of infection, definitive Open Reduction and Internal Fixation (ORIF) with a distal femur locking plate was performed, along with the placement of antibiotic-impregnated cement beads. At six weeks postoperatively, autologous iliac crest (5×2 cm corticocancellous block) and fibular grafts were inserted to address the residual metaphyseal defect. The patient was then managed with structured rehabilitation and achieved union with a final knee range of motion of 0-90° at the most recent follow-up (38 months from injury), after elective implant removal. This case underscores the rationale for staged fixation and delayed grafting in open distal femur fractures with bone loss.

Management of Allosensitisation in Allogeneic Haematopoietic Stem Cell Transplantation: A Case Report

S Lakshman Prakash, R Krishnamoorthy, A Ashwin, J Betsy Jonahs, R Niranj Rathan

In partially matched Stem Cell Transplantation (SCT), the presence of Donor-Specific Anti-HLA antibodies (DSAs) is a critical factor contributing to graft rejection. This is particularly challenging for patients with restricted donor availability who need rapid access to transplantation. Managing DSAs before transplantation is essential to improve engraftment success and overall transplant outcomes in these high-risk individuals. The use of partially HLA-mismatched donors is increasingly favoured in transplantation, particularly in cases where fully matched donors are scarce or when time-sensitive procedures are required. However, the presence of DSAs has emerged as a major barrier to effective engraftment, posing a threat to transplant viability. This case describes the application of a desensitisation protocol in a highly sensitised patient with DSAs exceeding 5000 Mean Fluorescence Intensity (MFI). The approach included alternate-day Plasma Exchange (PLEX), rituximab and Intravenous Immunoglobulin (IVIg), all administered before proceeding with a partially matched stem cell transplant. Post-transplant, neutrophil engraftment was achieved on day 17 and platelet engraftment on day 23, both slightly delayed relative to expected norms. Other than mild to moderate gastrointestinal and febrile symptoms, which were managed medically, no acute complications such as primary graft failure or Graft-versus-Host Disease (GvHD) were observed. At six-month follow-up, the patient demonstrated stable trilineage haematopoiesis with no evidence of relapse, graft failure, or chronic GvHD, highlighting the potential utility of desensitisation in overcoming DSA-mediated barriers to successful transplantation.

Liposarcoma of Thigh: A Case Report

Aniketh Purushothaman, Varun S Shetty, Iqbal M Ali

Soft-tissue tumours of the extremities often present with a deceptively benign clinical course, leading to delayed diagnoses in cases of malignancy. Among them, Well-Differentiated Liposarcoma (WDLS) is one of the most prevalent lipogenic sarcomas, yet its resemblance to indolent lesions such as lipomas, fibromas, or chronic haematomas can obscure its true nature. The present case report details a 52-year-old man presenting with a slow-growing, painless thigh mass initially presumed to be benign. Advanced imaging revealed features suggestive of a lipomatous tumour with atypical septations. Subsequent core biopsy and immunohistochemistry confirmed the diagnosis of WDLS. The patient underwent successful Wide Local Excision (WLE) with negative margins and remains recurrence-free at 18 months. The case underscores the diagnostic dilemma faced in primary care and surgical settings, where limited access to Magnetic Resonance Imaging (MRI) or biopsy may delay definitive treatment. Differentiation between benign and malignant adipocytic tumours hinges on subtle radiologic cues such as thickened septa and non-lipomatous nodules, as well as confirmatory molecular markers like Murine Double Minute 2 (MDM2) and Cyclin-Dependent Kinase 4 (CDK4). As highlighted by this case and supported by recent World Health Organisation (WHO) updates, a structured diagnostic algorithm combining clinical suspicion, imaging, and histopathology is vital. Mislabeling malignant lesions as benign risks inadequate resection, recurrence, and suboptimal outcomes. Early recognition and referral remain critical to optimising management and preserving limb function. The present report serves as a practical reminder to maintain a high index of suspicion when evaluating persistent extremity swellings, even in the absence of alarming features.

A Case of Combined Spinal-epidural Anaesthesia and Fascia Iliaca Compartment Block in an Elderly Patient with Multiple Co-morbidities: A Tailored Approach to High-risk Hip Fracture Surgery

Prachi Siddharth Kamble, Neeta Verma, Amreesh Paul

Co-morbidities and frailty augment the physiological changes associated with ageing, making the elderly more susceptible to perioperative complications related to surgical interventions. With this in mind, the planning of anaesthesia management needs to be carried out with caution, aiming at risk reductions that would include cardiopulmonary instability, postoperative cognitive dysfunction, and neuromuscular complications. Authors hereby, report a case of an 83-year-old male patient who underwent orthopaedic surgery and bring to the fore the challenges encountered in perioperative management. The patient with multiple comorbidities was subjected to a detailed preoperative assessment using a comprehensive geriatric assessment. The anaesthetic approach was tailored to this patient with a reduction in drug doses, preference for Regional Anaesthesia (RA), and the use of neuroprotective agents. Intraoperatively, careful cardiopulmonary monitoring was facilitated. He received an epidural and spinal anaesthesia to decrease opioid use. Postoperative precautions were taken regarding delirium and pulmonary disorders. He stayed well postoperatively and was discharged to the rehabilitation centre for follow-up. Elderly patients have characteristic features and problems during anaesthesia. Proper management in the perioperative period involves thorough preoperative assessment, judicious selection of the chosen anaesthetic techniques, and appropriate postoperative vigilance. Any approach to managing the elderly patient undergoing anaesthesia and surgery should take into account a holistic approach to anaesthesia and surgical care, while keeping safety at the forefront and emphasising the improvement of prognosis for recovery in this fragile group.

A Case Report of Cerebellitis with Cranial Nerve Involvement in a Patient with Scrub Typhus Encephalitis

Meningoencephalitis refers to inflammation involving both the meninges and brain parenchyma and represents a critical neurological emergency. The clinical picture can be diverse, often including altered sensorium, fever, seizures, and focal neurological deficits. The presence of both cerebellar and cranial nerve involvement leads to a complex presentation, causing the diagnosis to be more difficult due to the overlap with other neurological disorders. This case study aims to describe an uncommon presentation of scrub typhus-related meningoencephalitis with bilateral sixth nerve palsy and pan-cerebellar clinical presentation in a young adult. A 20-year-old female presented with high-grade fever, severe headache, vomiting, diplopia, and unsteady gait. Systemic examination revealed signs of cerebellar dysfunction, including ataxia and dysdiadochokinesia, along with involvement of the 6th cranial nerve with bilateral lateral rectus palsy and papilloedema. Laboratory workup included haematological and biochemical investigations, Cerebrospinal Fluid (CSF) analysis. Specific serological testing for tropical infections was also performed, which showed scrub typhus IgM positivity. Magnetic Resonance Imaging (MRI) showed meningeal enhancement involving the bilateral tentorium cerebelli. The patient received intravenous antibiotics, cephalosporins and tetracyclines, corticosteroids and anti-oedema measures with appropriate therapy, and neurological deficits gradually resolved over the next 10 days. In endemic areas, scrub typhus should be considered in the differential diagnosis of meningoencephalitis, particularly when accompanied by atypical features like cerebellar signs and cranial nerve palsies. Early detection and appropriate management often lead to the resolution of neurological symptoms and prevent long-term complications.

Anaesthetic Management for Patient of Mucopolysaccharidosis undergoing Bilateral Functional Endoscopic Sinus Surgery: A Case Report

Mucopolysaccharidosis (MPS) represent rare, group of inherited lysosomal storage disease characterised by deficiencies in specific lysosomal enzymes involved in the metabolism of glycosaminoglycans. These conditions present significant anesthetic challenges due to progressive airway obstruction, cardiovascular complications, and skeletal abnormalities. Hereby, the authors present the case of a 12-year-old female patient with MPS who underwent bilateral Functional Endoscopic Sinus Surgery (FESS) and was successfully managed under general anaesthesia. The patient presented with characteristic features including short stature, short hands, receding mandible, short neck, corneal clouding, and mouth breathing. Her surgical history included two previous FESS procedures, the first 10 years ago and the second five years ago, both performed under general anaesthesia. She also had a history of recurrent convulsions, managed with antiepileptic therapy. Preoperative assessment revealed stable vital signs with a blood pressure of 95/60 mmHg. Anaesthetic management included premedication followed by induction, complicated by a difficult airway. Despite challenging mask ventilation, endotracheal intubation was successfully achieved. Maintenance of anaesthesia with sevoflurane provided stable intraoperative conditions. Surgery proceeded without complications, and the patient had a favourable postoperative recovery. The present case highlights the importance of thorough preoperative assessment, careful anaesthetic planning, and preparedness for airway management challenges in MPS patients undergoing Ear, Nose and Throat (ENT) procedures.

Diagnostic Dilemmas in Obstetric Medical Emergencies: A Case Series

Sangeetha Karunanithi, Sindhu Gunasekaran, Sankareswari Raja

The differentiation among hepatic, hypertensive, and gastrointestinal disorders during pregnancy poses significant diagnostic challenges due to overlapping clinical manifestations and biochemical abnormalities. Conditions such as Intrahepatic Cholestasis of Pregnancy (IHCP), preeclampsia, HELLP syndrome, Acute Fatty Liver of Pregnancy (AFLP), and gallbladder disease share common symptoms—including pruritus, hypertension, right upper quadrant pain, and elevated liver enzymes—complicating timely and accurate diagnosis. This case series highlights the diagnostic dilemmas encountered across four distinct clinical presentations: (1) IHCP presenting with pruritus and elevated liver enzymes, initially raising suspicion for AFLP and viral hepatitis; (2) Preeclampsia with markedly elevated alkaline phosphatase, requiring differentiation from HELLP syndrome; (3) Gallbladder calculi mimicking IHCP and hypertensive disorders due to biochemical abnormalities and localised pain; and (4) An isolated 14-fold increase in alkaline phosphatase, which proved heuristically complex. A systematic, multidisciplinary approach—integrating detailed clinical assessment, laboratory investigations, and imaging—was essential for precise diagnosis and optimal management. Emphasising careful clinical judgment, the exclusion of severe conditions, and tailored interventions, this case series underscores the need for clear diagnostic algorithms and management guidelines to improve maternal and foetal outcomes in overlapping obstetric hepatobiliary and hypertensive disorders.

Correction of Pre-existing Against-the-rule Corneal Astigmatism by Temporal Approach Manual Small Incision Cataract Surgery: A Case Series

Narendra Kumar Keisham, R Ranjiv, K Shyamsundar, Bhupesh Bhatkoti, Sankalp Seth

Against-the-rule corneal astigmatism is more prevalent in senile cataracts and results in poorer uncorrected visual acuity if not corrected at the time of cataract surgery. Although phacoemulsification with toric IOL implantation is preferred for the management of pre-existing corneal astigmatism, ophthalmologists often encounter cases of cataracts with significant corneal astigmatism in which phacoemulsification surgery is not feasible. This case series describes six eyes of six different patients with cataracts and against-the-rule corneal astigmatism who underwent cataract surgery by temporal-approach Manual Small Incision Cataract Surgery (MSICS), and their postoperative astigmatism outcomes were evaluated. The first patient was initially planned for phacoemulsification with toric IOL implantation; however, an intraoperative posterior capsule rupture occurred, and the surgeon opted to convert to MSICS. The second patient had a hard brown brunescent cataract with a visual acuity of finger counting close to the face. The third patient could not afford a foldable IOL required for phacoemulsification and therefore opted for MSICS with a rigid Polymethyl Methacrylate (PMMA) IOL. The fourth patient had a white intumescent mature cataract with visual acuity of only light perception. This patient was planned for phacoemulsification but experienced an intraoperative capsulorhexis extension to the lens equator, leading to abandonment of phacoemulsification and conversion to MSICS. The fifth patient had a black hard cataracta nigra with visual acuity of only light perception. The sixth case was a post-traumatic white mature cataract with visual acuity of only light perception and zonular dialysis, and MSICS with anterior vitrectomy and retropupillary-fixated iris-claw IOL implantation was performed. All patients, on review at one month after surgery, showed reduced or neutralised corneal astigmatism.

CT-guided Coeliac Plexus Neurolysis for Refractory Pain in Pancreatic Disorders: A Ten-patient Case Series

Aparna Bagle, KS Navya

Coeliac Plexus Neurolysis (CPN) is a useful interventional technique for managing intractable upper abdominal pain, particularly in patients with chronic pancreatitis and pancreatic cancer. Hereby, the authors present a case series that emphasises the clinical effectiveness of CT-guided CPN in ten patients suffering from severe abdominal pain secondary to either pancreatic cancer or pancreatitis who were unresponsive to conventional analgesics. All patients received a bilateral paravertebral approach to CPN with CT guidance, involving 3-5 mL of 0.25% bupivacaine followed by 13 mL of 60% alcohol for neurolysis. Pain relief was quantified using the Numerical Rating Scale (NRS) at 24 and 48 hours, one week, one month, and even two years, while Quality of Life (QOL) was measured using the Short Form (SF)-12 health survey. All patients experienced significant pain relief within 48 hours following the procedure. Among the four patients available for long-term follow-up, three (75%) experienced sustained pain relief, with NRS scores remaining below 3.0 over a three-month period. These patients also demonstrated improved functional status, including the ability to perform daily activities independently, and a reduction in opioid use by an average of 60% compared to baseline. The SF-12 survey conducted among the four patients revealed mean scores above 50, indicating better physical and mental health status. The procedure was well-tolerated, with no major complications such as hypotension, neurological deficits, or infections reported. Although a small number of patients were lost to follow-up, this case series provides evidence that CT-guided CPN is a safe and effective intervention for both immediate and prolonged relief of chronic upper abdominal pain.

Diagnostic and Management Complexities in Epilepsia Partialis Continua: A Case Series

Ritika Singh, Deepika Yadav, Dinkar Yadav, Suchi Bhalla, Kapil Bhalla

Epilepsia Partialis Continua (EPC) is a variant of focal motor status epilepticus wherein frequent repetitive, usually rhythmic muscle jerks continue over prolonged periods of time. EPC can occur because of any space-occupying lesion, vascular aetiology, mitochondrial disease, and Rasmussen encephalitis. There is a paucity of evidence regarding the prevalence; however, regional studies have suggested a prevalence of one per million population. This case series presents three cases wherein the aetiology has been known to have a highly rare correlation with the clinical presentation of EPC. Index case one, already a known case of generalised epilepsy, presented with clinical features suggestive of acute viral hepatitis, later found to be hepatitis A positive, had EPC that lasted around four days. In index case two, the child presented with features suggesting focal status epilepticus, which also persisted despite use of multiple anti-epileptic agents, and was later found to be positive for parvovirus antibodies in serum as well as Cerebrospinal Fluid (CSF). In index case three, the child presented with focal seizures, which on imaging had structural changes and an abnormal Electroencephalography (EEG). These children were given multiple antiepileptic agents; however, the repetitive movement subsided on its own and all of them were discharged on haemodynamically stable conditions. The present case series highlights the clinical heterogeneity of the disease process, as well as the challenges and complexities involved in diagnosis and management.

Forehead Bindi Tattoo Removal using the R20 Technique with Low-fluence Q-switched Nd: YAG Laser: A Case Series

Manjeet Naresh Ramteke, Pralhad Ramdhan Rathod

A bindi tattoo on the forehead is a cultural practice among Indian women, particularly in rural areas. Some individuals may choose to remove a bindi tattoo for personal reasons, such as a change in style, appearance, or a shift in their identity. The Q-switched Nd: YAG (QSNY) laser is considered a good standard device of choice for laser tattoo removal. However, despite undergoing multiple treatment sessions, the effectiveness is often found to be limited. In the present case series, six patients with a bindi tattoo on the forehead were treated using the R20 method with a low-fluence Q-switched Nd: YAG Laser, resulting in complete clearance of the tattoo in five patients with no adverse effects. This method facilitates quicker, less painful, and complication-free tattoo removal.

Association between Leg Dominance and Symptom Onset in Knee Osteoarthritis: A Cross-sectional Study

Sanjana Pammannavar, Basavaraj Motimath, Samruddhi Bhobe

Introduction: Knee Osteoarthritis (KOA) plays a substantial role in the global burden of musculoskeletal disorders. Biomechanical factors such as leg dominance are hypothesised to contribute to the onset and progression of KOA; however, the relationship between dominant limb use and symptom development remains unclear. Aim: To investigate the association between leg dominance and the onset and side of symptoms in KOA, utilising both a validated questionnaire and standardised functional task assessments. Materials and Methods: A cross-sectional study was conducted at the Department of Sports Physiotherapy, KLE Institute of Physiotherapy, Belagavi, Karnataka, India, over 11 months, from May 2024 to March 2025. It involved 131 individuals aged between 45 and 70 years with radiologically confirmed Grade I or II KOA. Leg dominance was assessed through a standardised questionnaire and six motor tasks. The data collected were compiled in Microsoft Excel and analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 29.0. Chi-square tests and t-tests were used to analyse associations. Results: A total of 131 participants (55 males and 76 females) were included in the final analysis. Right leg dominance was identified in 124 (94.7%) of the participants across all motor tasks, with a high concordance noted in the ball-kicking task between self-report and observation. Right knee pain was more common, reported by 111 (84.7%) participants, and the majority noted a gradual onset of symptoms, with 110 (84%) indicating this pattern. All left-leg dominant individuals were female and exhibited left-sided KOA (p-value <0.001). Sudden onset of symptoms was significantly associated with left-leg dominance, observed in 5 (71.4%) participants (p-value=0.001). Conclusion: The study identified a significant association between leg dominance and both the side and onset of KOA symptoms. Dominant limb mechanics may play a role in asymmetric joint loading and early symptom manifestation. Assessing leg dominance through both self-report and task observation may aid in the early identification of at-risk individuals and support targeted rehabilitation planning.

Prevalence and Virulence Potential of Candida Species for Proteinase and Phospholipase Activity in Head and Neck Cancer Patients: A Cross-sectional Pilot Study

Introduction: Head and neck cancer patients undergoing Chemotherapy (CT) and Radiation Therapy (RT) are at a high-risk of oral Candida infections, mainly due to immune suppression and mucosal damage. Candida spp. most commonly implicated in such conditions are Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei. Candida spp. also has some virulence factors, which include secreted aspartyl proteinase and phospholipases. They can enhance the ability of Candida spp. to colonise and penetrate host tissue along with evasion of the host immune system. Aim: To determine the prevalence of Candida species and evaluate their virulence markers, specifically proteinase and phospholipase activity, in head and neck cancer patients. Materials and Methods: This hospital-based cross-sectional pilot study was conducted in the Department of Microbiology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India, from January 2022 to December 2022. Forty-three patients with histologically confirmed head and neck cancer, planned for 3-4 cycles of CT, RT, or both, and willing to provide informed consent were included. Saliva samples were collected using the spitting technique and inoculated with chloramphenicol on Sabouraud Dextrose Agar (SDA) slants. Germ tube tests identified Candida albicans morphologically, while Chrom agar incubation for 48 hours in the dark aided speciation. Proteinase activity was assessed using the modified SDA with 1% bovine serum albumin method, and phospholipase activity was evaluated using the modified SDA with egg yolk emulsion method. Demographic parameters, including age, gender, and tumour stage, were recorded. Statistical analysis employed Pearson’s Chi-square tests, with significance set at p-value <0.05. Results: Among 43 patients, Candida spp. were isolated in 35 (81.3%), with Candida albicans being the most prevalent, 32 (74.4%). Non NCAC (Non–Candida albicans Candida)3 (6.9%) included two Candida krusei and one Candida tropicalis. Proteinase and phospholipase activities were detected in 34/35 (97%) and 33/35 (94%) of isolates, respectively, with all C. albicans isolates expressing both enzymes. Concurrent chemoradiation was often accompanied by Candida positivity 17/35 (48.6%), but this association did not reach statistical significance. Conclusion: The high prevalence of Candida species, particularly I#ICI?I. albicans, with significant expression of virulence factors underscores their pathogenic potential in immunocompromised patients with head and neck cancer. These findings emphasise the need for early detection and antifungal prophylaxis to manage infections in this population.

Comparison between Intrathecal Hyperbaric Bupivacaine with Nalbuphine and Hyperbaric Bupivacaine with Fentanyl in Infraumbilical Surgeries: A Randomised Clinical Trial

Richa Tailor, Kartik H Sangam, Nilesh Shah, Sara Mary Thomas

Introduction: Intrathecal adjuvants to local anaesthetics have been introduced to enhance clinical efficacy and prolong the duration of analgesia following infraumbilical surgical procedures, as spinal anaesthesia alone often provides inadequate postoperative pain relief. The addition of intrathecal opioids has been shown to effectively extend postoperative analgesia. Aim: To compare the efficacy of intrathecal nalbuphine (0.4 mg) vs fentanyl (25 μg) as adjuvants to hyperbaric bupivacaine in infraumbilical surgeries. Materials and Methods: The present triple-blinded randomised, clinical study was conducted at Dhiraj General Hospital, Vadodara, Gujarat, India, from February 2025 to June 2025. Sixty American Society of Anaesthesiologists (ASA) I-II patients undergoing elective infraumbilical surgeries were randomly allocated into two groups (n=30 each). Group A received bupivacaine (15 mg) with fentanyl (25 μg) and group B received bupivacaine (15 mg) with nalbuphine (0.4 mg) intrathecally. Primary outcomes included onset and duration of sensory/motor blockade and duration of analgesia. Secondary outcomes included haemodynamic parameters, sedation scores, and side-effects. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Independent Student’s t-test was used for continuous variables and Chi-square test for categorical variables. The p<0.05 was considered significant. Results: Both groups had comparable demographic characteristics with no significant differences in age, weight, gender distribution, ASA grading, or surgery duration (p>0.05). Onset of sensory (4.07±1.12 vs 6.67±1.01 min, p<0.001) and motor blockade (6.73±1.00 vs 7.87±1.20 min, p=0.009) was faster in group A. Duration of analgesia was significantly longer in group B (404.76±25.23 vs 291.91±31.87 min, p<0.001). Group B required fewer rescue analgesics (2.03±0.95 vs 3.57±0.88, p<0.001). Pruritus occurred only in group A (13.3%), while bradycardia (23.3%) and hypotension (26.7%) were higher in group B. Conclusion: Nalbuphine (0.4 mg) provides superior postoperative analgesia compared to fentanyl (25 μg) as an intrathecal adjuvant, making it an effective alternative for infraumbilical surgeries requiring prolonged pain relief.

A Comparative Evaluation of Cytotoxic Effects of Two Different Self-adhesive Luting Resin Cements: An In-vitro Study

Introduction: Resin cements are commonly used for luting porcelain inlays, porcelain laminate veneers, resin-bonded metallic prostheses, and ceramic restorations. However, the monomers found in these cements- such as Bisphenol-A-Glycidyl Methacrylate (Bis-GMA), Urethane Dimethacrylate (UDMA), Diethylene Glycol Dimethacrylate (DEGDMA), Triethylene Glycol Dimethacrylate (TEGDMA), and 2-Hydroxyethyl Methacrylate (HEMA) has demonstrated cytotoxic effects. When these monomers come into direct contact with fibroblasts, they can lead to pulp tissue damage and induce cell death. Aim: To evaluate and compare the cytotoxic effects of two self-adhesive luting resin cements SoloCem (Coltene) and SmartCem 2 (Dentsply). Materials and Methods: The present in-vitro cytotoxic study was conducted in SDM Institute of Dental Sciences, Dharwad, Karnataka, India. for two years from October 2016 to October 2018. Two luting resin cements SoloCem and SmartCem were tested in this study. Ten samples for each group (SoloCem, SmartCem and control) were taken. The specimens were immersed in a culture medium. Mouse fibroblasts were cultured. The culture medium, containing material extracts was evaluated. The cell viability was assisted using MTT assay. Colony formation assay was done to evaluate morphological changes. The statistical analysis was done by using Graph pad prism version 3.02. A p value of <0.05) was considered significant. Statistical analysis done by the One-way ANOVA analysis and post-hoc test of variance among the groups. Results: There was a significant difference in Optical Density (OD) values between the three groups when the three groups were compared p<0.001**. According to post-hoc analysis it was seen that Smart CEM significantly promotes higher cell survival compared to Solo CEM 2 p<0.001**. Both SoloCem and SmartCem 2 significantly reduced cell viability when compared to the control group p<0.001** and p=0.027, respectively. These results indicate that Smart cem resin cement promoted better cell viability while Solo Cem 2 led to increased fibroblast cell death. Conclusion: Based on the study findings, SmartCem was found to be the more biocompatible luting resin cement to the pulp and fibroblasts than Solo which Cem which has shown less cell survival rate. So, in general smart cem 2 cement can be considered as a safe resin cement to be used for cementation of all fixed prosthesis.

Comparison of the Effect of Two Different Doses of Oral Pregabalin in Reducing Postoperative Analgesia in Patients Receiving Neuraxial Anaesthesia for Surgical Procedures: A Randomised Controlled Trial

Nanditha Padikkasu, Karthik Krishnamoorthy, Vishak Manoj Bhaskar

Introduction: Effective postoperative pain management is vital for patient recovery and comfort. Due to the side effects associated with opioids, alternative strategies such as Pregabalin are being explored. As a Gamma-aminobutyric Acid (GABA) analogue, Pregabalin may reduce pain and analgesic requirements by modulating central sensitisation. The present study evaluates the impact of preoperative oral Pregabalin on enhancing subarachnoid block, prolonging postoperative analgesia and improving recovery in patients undergoing neuraxial surgeries. Aim: To evaluate the efficacy of oral Pregabalin (150 mg and 300 mg) compared with a placebo in reducing postoperative pain in patients undergoing surgical procedures under spinal anaesthesia. Materials and Methods: The present double-blinded randomised controlled trial was conducted in the Department of Anaesthesiology at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from September 2024 to February 2025 over a duration of six months. After obtaining written consent, 90 patients undergoing surgery under neuraxial blockade were recruited and randomised into three groups. The study drugs were administered one hour before surgery as follows: Group C (Placebo drug), Group P1 (T. Pregabalin 150 mg), Group P2 (T. Pregabalin 300 mg). The Ramsay Sedation Scale was used to assess sedation levels before and after the procedure. Pain intensity was assessed using the Visual Analogue Scale (VAS). Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) software (version 26.0), with a significance level set at 0.05. Results: There was no statistically significant difference in the demographic characteristics of the study participants, such as age, height and weight (Mean=40.01 years, 166.42 cm, 67.3 kg; p=0.537, 0.454, 0.349, respectively). The time to first analgesic requirement after spinal anaesthesia was significantly longer in patients who received pregabalin compared with those who received the placebo (Mean=105.83, 120.33, 126.67 minutes, respectively; p<0.001). Corresponding VAS scores at the time analgesia was administered were also statistically significant (Mean=4.04, 3.08, 2.99, respectively; p<0.001). Conclusion: Compared with placebo, preoperative oral pregabalin was effective in enhancing sedation, delaying the onset of postoperative pain and reducing the need for early rescue analgesics.

Pharmaceutical and Analytical Study of the Modified Form of Pathyadi Lepa as an Ointment

Sonam Premanand Kanzode, Pawan Ramesh Naukarkar, Neha Libde

Introduction: Pathyadi Lepa is an Ayurvedic topical treatment described in Bharat Bhaishajya Ratnakar. It contains Haritaki, Karanjbeeja, Sarshap, Haridra, Bakuchi, Saindhava Lavan, and Vidang. Traditionally prepared Lepa formulations are not convenient to use due to their time-consuming preparation and application. Staining of clothing is another hurdle associated with Lepa application. Aim: To develop a modified ointment formulation that minimises oiliness and improves packaging to address patient concerns. Materials and Methods: A pharmaceutical analytical study was conducted at the Dattatraya Ayurveda Rasashala Laboratory of Mahatma Gandhi Ayurved College, Wardha, Maharashtra, from July 2023 to August 2023. The Pathyadi ointment was prepared at Rasashala, and its organoleptic, physicochemical, and microbiological parameters were assessed. Results: The analytical study results showed pH 5.5; rancidity was absent; iodine value 19.77; peroxide value 11.32. No microbiological growth was detected. Conclusion: The analytical parameters were within the normal range for use in skin disorders. Therefore, the modified Pathyadi Lepa ointment can be used in Vicharchika.

Comparison of Epidural Infusion of 0.1% Ropivacaine and 0.2% Ropivacaine for Postoperative Analgesia using Elastomeric Pump in Abdominal Hysterectomies: A Randomised Controlled Trial

Introduction: Epidural analgesia is a common and one of the standard modes of postoperative analgesia for surgeries involving the lower abdomen and lower extremities. The duration of action of Ropivacaine is longer and is favoured for its sensory block with minimal motor impairment, yet the optimal concentration for analgesia and adverse effects remains unclear. Aim: To compare the efficacy and safety of 0.1% Ropivacaine with Fentanyl 2 mcg/mL versus 0.2% Ropivacaine with Fentanyl 2 mcg/mL for postoperative pain relief using an elastomeric pump in abdominal hysterectomy patients. Materials and Methods: This was a double-blinded, randomised controlled trial conducted at the Department of Anaesthesia, SRM Medical College Hospital and Research Institute, Kattankulathur, Tamil Nadu, India, from August 2023 to December 2024. Patients who were undergoing abdominal hysterectomy as elective surgeries with American Society of Anaesthesiologists (ASA) physical status grading as I, II, or III from 35 years to 65 years were included. The study was conducted on 100 patients, who were divided into two groups: Group R1 (0.1% Ropivacaine with 2 mcg/mL Fentanyl) and Group R2 (0.2% Ropivacaine with 2 mcg/mL Fentanyl) as a continuous epidural infusion at 5 mL/hour via elastomeric pump for 48 hours postoperatively. Visual Analogue Scale (VAS) was used to assess the intensity of pain at rest, on movement and while coughing at regular intervals. Motor blockade was evaluated with the modified Bromage scale. Haemodynamic parameters were monitored, and rescue analgesia was provided with Intravenous (i.v.) Paracetamol or Tramadol as required. An Unpaired t-test was used to compare continuous variables. Results: Between groups R1 and R2, demographic characteristics such as age, weight, height, Body Mass Index (BMI), baseline pulse rate, baseline Systolic Blood Pressure (SBP), and baseline Diastolic Blood Pressure (DBP) were comparable. At 30 min, 45 min and 1 hour, the heart rate was lower in group R2 (p-value <0.0001). At 15 min and 12 hours, group R2 had a lower Mean Arterial Pressure (MAP) (p-value=0.0005, p-value=0.0089) in contrast to group R1. VAS scores were comparable between the two groups, except at 24 hours, which was lower in group R2 (p-value=0.0232). Group R2 had significantly lower VAS scores during movement and cough. Significant motor blockade was observed in group R2 (p-value <0.05). Group R2 required fewer rescue analgesics (p-value <0.05). Conclusion: Ropivacaine (0.1%) provided adequate pain relief at rest. While on movement and coughing, 0.2% Ropivacaine had lower VAS scores with comparable haemodynamic stability between both groups. Motor blockade was more with 0.2% Ropivacaine.

Unveiling Global Research Dynamics in Medical Education Aligned with Sustainable Development Goal 4: A Scientometric Study

Duragappa, M Chandrashekara

Introduction: The pursuit of Sustainable Development Goal 4 (SDG 4), which promotes complete and equitable quality education, is paramount in medical training. Understanding global research trends is crucial to aligning efforts with this goal. The current study maps the intellectual landscape of medical education research to assess its alignment with the principles of SDG 4. Aim: To analyse global research trends of medical education research, evaluating their focus on quality, inclusivity, and innovation as aligned with SDG 4. Materials and Methods: A scientometric study was conducted on 11,265 global publications retrieved from the Web of Science database for the time period 2016-2024, using visualisation tools like VOSviewer and Bibliometrix to examine trends in productivity, citation impact, international collaboration, and thematic evolution. Results: Research output peaked in 2021 before stabilising. Open-access articles made up 50% of all publications. Both open and closed-access papers received a similar number of citations. The USA led in publication volume with 5,166 papers, while European countries like the Netherlands showed higher citation efficiency (ACPP 13.21). The journal Cureus published the most papers, whereas BMJ Open and the Journal of General Internal Medicine achieved higher citation efficiency. Research in this field is highly collaborative, with an average of 5.45 authors per paper. However, international collaboration remains limited at 15.36%. Thematic analysis highlights a strong focus on evidence-based practices such as simulation and a major shift toward digital learning during the Coronavirus Disease 2019 (COVID-19) pandemic. Conclusion: Medical education research demonstrates strong alignment with SDG 4 through its emphasis on quality and innovative pedagogies. However, to achieve truly equitable education, it must address the geographical disparities in research influence. The field also needs to promote stronger global collaboration to ensure inclusive sharing of knowledge.

Work Stress among Traffic Police of Ahmedabad City, Gujarat, India: A Cross-sectional Study

Dhara Chavda, Nehal Shah

Introduction: The traffic police maintain a smooth flow of traffic and maintain safe and secure movements on the roads. Police face various kinds of hazards such as accident hazards, physical, chemical, and biological hazards, ergonomic hazards, psychosocial hazards, and hazards related to organisational factors of the police department. Work stress is a result of psychosocial hazards, and it has the potential to affect an individual’s health and efficiency to perform police work. Aim: The study aimed to investigate work stress, an occupational health disease, in the traffic police of Ahmedabad city, Gujarat, India. Materials and Methods: In the present descriptive, cross-sectional study, 420 traffic police from all fourteen traffic police stations of Ahmedabad city, Gujarat, India were randomly selected. The study included male and female traffic police from all cadres, and data was collected from November 2019 to March 2021. The study used an informed consent form and self-administered questionnaire to collect data on demographics, work profile, and Occupational Stress Index (OSI). The Mann-Whitney U test was used to evaluate the hypotheses, and a Significant p-value was set at 0.05. Results: When measured using OSI, 257 (61.19%) participants had moderate work stress, and 111 (26.43%) participants had high work stress. The traffic police reported work stress owing to all twelve OSI dimensions of work stress. Apart from OSI, factors such as public friction and public distrust could be potential stressors and cause work stress. Conclusion: The study discovered that traffic police of Ahmedabad city were not bulletproof against work stress, and it was widely prevalent. Multiple work-related factors were taxing the traffic police, which ultimately led to work stress. The research findings provide an insight into the current health status of the traffic police. Moreover, not only the identification of the work stress important but also the management is equally important.

Management of Miller’s Class I and II Gingival Recession with FGF-2 Impregnated versus Plain Bioresorbable Collagen Membrane: A Randomised Controlled Trial

Introduction: Gingival Recession (GR) is a prevalent clinical condition that compromises both aesthetics and function. The concept of Guided Tissue Regeneration (GTR) aims to regenerate periodontal tissue using an occlusive barrier membrane. Recent advances in the utilisation of different barrier membranes suggest that growth factors such as Fibroblast Growth Factor-2 (FGF-2) may further enhance regenerative outcomes. Aim: To compare the efficacy of Coronally Advanced Flap (CAF) with FGF-2 impregnated bioresorbable collagen membrane versus CAF with plain bioresorbable collagen membrane in treating Miller’s class I and II GR. Materials and Methods: This randomised controlled trial was conducted in the Department of Periodontics and Oral Implantology at Santosh Dental College, Ghaziabad, Uttar Pradesh, India, from October 2022 to November 2024. Individuals aged 18-40 years old, predominantly females, participated in the study. Out of 30 patients screened, a total of 24 sites in 24 patients were included and were randomly assigned to Group A (CAF with collagen membrane) and Group B (CAF with FGF-2 impregnated membrane). Clinical parameters- Recession Depth (RD), Width of Keratinised Gingiva (WKG), Clinical Attachment Level (CAL), Probing Pocket Depth (PPD), gingival biotype, Plaque Index (PI), Gingival Index (GI) - were measured at baseline, three months, and six months. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0 with a significance level set at p-value ≤0.05. The Shapiro-Wilk test and the Wilcoxon signed-rank test were used for analysis. Results: A total of 24 patients, predominantly females, were included with a mean age of 29±6.35 years. Both groups showed clinical improvements; which were significantly greater in group B by six months. A reduction in RD was observed in both groups at three months, but group B showed a significantly greater reduction by six months (p-value=0.026*). For WKG, group B demonstrated a significantly greater gain than group A at six months (p-value=0.002*). Group B demonstrated a significantly lower mean CAL than group A at six months (p-value=0.043). The PPD values remained comparable across all intervals. By six months, gingival biotype values yielded a significant intergroup difference (p-value=0.042). The PI decreased significantly in both groups, with the test group showing consistently lower PI scores (p-value=0.002). Differences in GI were not statistically significant between groups at baseline, three months and six months. Conclusion: The study results support that both CAF with collagen membrane and CAF with FGF-2 impregnated collagen membrane effectively addressed the recession defects. However, the use of collagen membrane along with FGF-2 can be a promising adjunct in periodontal regenerative procedures.

Association of Serum Hepcidin Levels and Cardiovascular Disease among Patients with End Stage Kidney Failure: A Prospective Observational Study

Introduction: Chronic Kidney Disease (CKD) is emerging as a global pandemic. CKD increases the risk of cardiovascular morbidity and mortality. Hepcidin, a major regulator of iron homeostasis, is increased in CKD due to reduced clearance, inflammation, and iron overload. Hepcidin has been suggested as an indicator of cardiovascular risk in CKD patients. Aim: The present study aimed to estimate serum hepcidin levels in patients with End-Stage Kidney Failure (ESKF) and to evaluate the association of hepcidin levels with cardiovascular disease, iron status and anaemia. Materials and Methods: The present prospective observational study was conducted at SRM Medical College Hospital and Research Centre, Tamil Nadu, India between October 2023 and October 2024. Forty-five patients with ESKF undergoing maintenance haemodialysis for at least three months were included, and their clinical and biochemical parameters, including serum hepcidin, were recorded. Cardiac evaluation was performed by clinical assessment, electrocardiography, and echocardiography. Follow-up cardiac evaluation was performed at six and twelve months. All statistical analyses were conducted utilising Statistical Package for the Social Sciences (SPSS) version 15.0. The Kruskal-Wallis test and the Chi-square test were used to compare continuous and categorical variables, respectively. Results: Forty-five patients, with a mean age of 51.33±11.6 years, were studied. Of them, 33 (73.3%) were male. Serum hepcidin was elevated in all patients. Mild (50-100 ng/mL), moderate (101-150 ng/mL), and severe (>150 ng/mL) hyperhepcidinemia were observed in 8 (17.8%), 11 (24.4%), and 26 (57.8%) subjects, respectively. In the present study, 39 (86.6) patients had prevalent Cardiovascular Disease (CVD). A significant association was observed between severe hyperhepcidinemia and cardiovascular disease. A total of 29 patients (64.4%) had high serum ferritin and a high transferrin saturation ratio, indicating iron-replete status. A total of 42 (93.3%) patients were anaemic {mean Haemoglobin (Hb) 9.68±2 g/dL}. There was no significant association between serum hepcidin and serum ferritin or haemoglobin levels. Conclusion: There was a statistically significant association between hyperhepcidinemia and prevalent cardiovascular disease. Cohort studies with a larger number of participants would be worthwhile to explore the utility of serum hepcidin as an indicator of cardiovascular disease risk in ESKF patients.

Comparison of Haemodynamic Responses between Oxiport and Conventional Laryngoscopes during Paediatric Intubation under General Anaesthesia: A Randomised Controlled Trial

Jatin Patel, Karnati Eshwar, Priya Kishnani, Kalpesh Patil

Introduction: Paediatric airway management presents unique challenges due to higher oxygen consumption and lower functional residual capacity, predisposing children to rapid desaturation during intubation. The Oxiport laryngoscope provides continuous oxygen insufflation during laryngoscopy, potentially improving oxygenation and haemodynamic stability. Aim: To compare haemodynamic responses and oxygenation parameters during intubation between Oxiport laryngoscope and the conventional laryngoscope in paediatric patients up to 3 years undergoing general anaesthesia. Materials and Methods: This single-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, Dhiraj General Hospital, Vadodara, Gujarat, India, from December 2022 to January 2025. Sixty American Society of Anaesthesiologists (ASA) physical status grade I-II paediatric patients aged 6 months to 3 years were randomly allocated into two groups (n=30 each): Group O (Oxiport laryngoscope) and Group C (Conventional laryngoscope). Primary outcomes included the lowest Oxygen Saturation (SpO₂) attained, time for 1% desaturation, rate of desaturation, and haemodynamic parameters. Secondary outcomes included the number of intubation attempts, duration of laryngoscopy and intubation, and the incidence of severe desaturation (SpO₂ <90%). Statistical analysis was performed using an Unpaired t-test and Chi-square test, with a p-value <0.05 considered significant. Results: Both groups were comparable in demographic characteristics (age: 19.63±8.27 vs 19.53±8.92 months, p-value=0.963; weight: 11.33±1.97 vs 11.30±2.04 kg, p-value=0.957). The Oxiport group demonstrated significantly higher lowest SpO₂ (97.37±0.72% vs 91.87±1.14%, p-value <0.0001), longer time to 1% desaturation (17.90±1.11 vs 10.19±0.85 seconds, p-value <0.0001), and slower desaturation rate (0.0822±0.0105 vs 0.3445±0.0358%/sec, p-value <0.0001). Heart rate was significantly lower in the Oxiport group at 3 minutes (121.53±8.40 vs 126.33±8.98 bpm, p-value=0.033). Systolic and diastolic blood pressures were significantly lower in the Oxiport group from 1 minute onwards (p-value <0.0001). No severe desaturation (SpO₂ <90%) occurred in the Oxiport group versus 20% in the conventional group (p-value=0.0097). Conclusion: The Oxiport laryngoscope provides superior oxygenation and a more stable haemodynamic profile compared to conventional laryngoscopes during paediatric intubation, potentially improving safety in this vulnerable population.

Aesthetic Evaluation of AI-generated Digital Smile Designs among Dental Students: A Cross-sectional Study

Introduction: Smile design integrates art, science and technology to enhance facial aesthetics. Digital tools, including Artificial Intelligence (AI), have advanced personalised smile design. Aim: To evaluate the aesthetic perception of digitally altered smile designs among dental students and assess their preferences for specific smile parameters such as smile arc, smile line, incisor shape, anterior tooth proportion and incisal edge form. Materials and Methods: A cross-sectional study was conducted at the Department of Prosthodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India, from January 2025 to March 2025, among 257 dental students using a structured Google Form survey containing AI-generated and Photoshop-modified images illustrating five aesthetic smile parameters. Participants rated the aesthetic appeal of each variant. The collected data were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistics version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics summarised responses and the Chi-square test assessed associations between categorical variables. Results: The parallel smile arc was the most preferred across all smile line categories (64.6-72.0%), while the reverse arc was the least favoured. Square incisors were the most preferred shape, with significant variation in ovoid preferences based on smile line (p=0.001). The golden proportion was favoured overall, especially by those with average and low smile lines, while the Recurring Aesthetic Dental (RED) proportion was more preferred among participants with high smile lines (p<0.001). Rounded incisal edges were generally preferred, but without a significant association with smile line (p=0.331). Conclusion: Dental students showed significant preferences for specific smile design elements, with notable associations between smile line and both anterior tooth proportions and incisor shape. These insights reflect an individualised aesthetic approach that combines clinical principles with personal perception.

Analysis of Surgical Outcomes and Clinical Improvements following Surgery in Tetralogy of Fallot: A Retrospective Cohort Study

R Arunsingh, R Sivakumar Pandian, Rajan Sethuratnam

Introduction: Tetralogy of Fallot (ToF), is the most common type of cyanotic Congenital Heart Disease (CHD). Even after anatomic correction and physiological correction complications such as pulmonary regurgitation leading to Right Ventricular (RV) dysfunction, recurrent obstruction of the RV outfl ow tract, arrhythmias and sudden death are found in late survivors. Aim: To analyse the clinical presentation, surgical outcomes, and clinical improvements after surgical repair of ToF. Materials and Methods: The present single-centre, retrospective cohort study was carried out, from 1st January 2005 to 31st December 2015. Case records of consecutive patients aged 18 years and above who underwent Intra cardiac repair for ToF in the Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, Tamil Nadu, India, institute were analysed. Patient baseline characteristics, symptoms, New York Heart Association Class, and associated complications were studied. Preoperative Electrocardiogram (ECG) and Echocardiogrphy (ECHO) findings were recorded. Data was analysed by using coGuide software. Results: A total of 41 subjects (mean age 27.3±10.2 years; 56.1% male) were analysed. Cyanosis (85.4%), dyspnoea (75.6%), and clubbing (63.4%) were the most common preoperative symptoms. Preoperative New York Heart Association (NYHA) class II/III was common, with significant improvement noted at follow-up, where 43.9% of patients were asymptomatic (p<0.05). Oxygen saturation increased from 83.8% to 98.5% (p<0.001), and RVOT gradient decreased significantly (p<0.001). ECG differences were observed between preoperative, postoperative, and follow-up stages (p<0.05). Significant differences were also found between procedures like infundibular resection (alone), pulmonary valve commissurotomy (alone), trans annular patch and PR status (p<0.05). Conclusion: The results of the present study showed that long-term survival after successful surgical correction of ToF was good.

Effectiveness of Seprafilm in Reducing Postoperative Adhesions after Abdominopelvic Surgery: A Prospective Interventional Study

M Malarmannan, A Pravindhas, Debarath Das, R Lakshmana, N Soorya, N Snigdha

Introduction: Postoperative adhesions are indeed a significant concern following abdominopelvic surgeries. These fibrous bands of tissue can form between abdominal or pelvic organs and tissues, leading to various complications. Postoperative Peritoneal Adhesions (PPAs) barriers are safer and better because they lower the risk of illness and the need for repeated interventions. Various agents and techniques have been studied to prevent PPAs, including activating fibrinolysis, interrupting blood coagulation, inhibiting collagen synthesis, reducing cellular inflammatory responses, and creating a physical barrier between the wound and surrounding tissue or organ. Seprafilm acts as a physical barrier on wounded tissue surfaces, minimising tissue adhesions during wound healing. Aim: To compare the outcomes of patients undergoing abdominopelvic surgery with and without Seprafilm application, in terms of adhesion formation and complication rates. Materials and Methods: The present prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from July 2023 to December 2024. In this study, group A, 50 patients underwent surgery with the use of Seprafilm, while group B (50 patients) underwent surgery without the use of Seprafilm. The outcomes measured were: postoperative complications, 20th day adhesions as seen in CT abdomen, postoperative pain, and intraoperative blood loss. Blood loss was estimated using a Gauze Visual Analogue (GVA), and pain was estimated using a visual pain analogue. Results: Among the 100 patients, the mean age was 44 years in group A and 45 years in group B, and among the gender distribution, group A had 21 males and 29 female patients, group B had 23 males and 27 female patients. A total of 42 patients (42%) belonged to the age group of <40 years, of which 22 patients (44%) belonged to group A and 20 patients (40%) belonged to group B. In the present study, 10 patients developed postoperative complications in group A and 22 patients developed postoperative complications in group B (p-value=0.010). A total of 34 patients had developed adhesions, among which 8 (23.5%) patients belonged to group A and 26 (76.5%) belonged to group B (p-value=0.001). Conclusion: In this study, the group that used seprafilm as an adhesion barrier following abdominopelvic surgeries had a significant reduction in the incidence of postoperative adhesions compared to the group in which an adhesion barrier was not used.

Evaluation of Prunus dulcis as an Adjunct in Major Depressive Disorder: A Randomised Open Label Controlled Study

Ganga Muruga Bharathi, Gayathri Elango, K Ponnuswamy

Introduction: Depression is a common mental disorder affecting over 264 million people worldwide, impacting daily life and overall mental and physical well-being. Commonly used antidepressants often cause significant side effects, creating a need for safer alternatives or adjunctive treatments to existing medications. Aim: To evaluate the effect of inositol-rich Prunus dulcis as an adjunct to standard therapy in individuals diagnosed with Major Depressive Disorder (MDD). Materials and Methods: An open-label, randomised, parallel-group controlled trial included 61 patients with MDD, divided into two groups: the control group (n=32), which received escitalopram (10-20 mg/day) for eight weeks, and the study group (n=33), which received escitalopram (10-20 mg/day) plus 6g/day of Prunus dulcis (eight almonds) for eight weeks. Primary outcomes assessed changes in Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) scores from baseline to weeks 4, 6, 8, and 12. Secondary outcomes included clinical health improvements (weight, blood pressure) and adverse drug reactions. Intergroup comparisons used an unpaired t-test, with p<0.05 considered statistically significant. Results: Most patients were aged 41-50 years, with 59% female and 41% male participants. Mean BDI scores in mild depression patients at the 4th, 6th, 8th, and 12th weeks were 10±12, 8.8±2.1, 7.6±1.2, and 6.9±1.2 in the study group versus 9±13.89, 12.9±1.7, 10.6±1.2, and 8.9±0.9 in the control group (p<0.05). Other grades showed no significant differences. Mean HDRS scores in mild depression at the 6th week were 8.0±1.7 (study group) versus 10.3±1.1 (control group, p=0.003). HDRS scores for moderate depression at the 8th and 12th weeks also showed significant differences (p<0.05). Overall weight comparisons between groups showed significant differences (p<0.05) at each assessment point, with the study group consistently having a higher mean weight. Conclusion: Prunus dulcis (almond), when used as an add-on to standard antidepressant therapy, accelerated recovery among patients with mild depression from the 6th week onwards. Furthermore, it also contributed to significant weight gain in patients suffering from MDD.

Efficacy of 3 mg versus 6 mg Oral Melatonin in Improving Sleep Quality among Intensive Care Unit Patients: A Randomised Controlled Trial

Garima Anant, Anju Ghai, Vivek Singh Kataria, Aarushi Sahni

Introduction: Melatonin, a molecule found in nearly all living organisms, plays a vital role in regulating circadian rhythm and sleep, while also influencing immune function, cell growth, and endocrine processes. Its role in improving sleep in Intensive Care Unit (ICU) patients remains under investigation. Aim: To compare the efficacy and safety of oral melatonin at two different doses (3 mg vs 6 mg) on sleep characteristics in ICU patients. Materials and Methods: This single-centred, double-blinded, randomised controlled trial was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India, on 46 adult ICU patients {≥18 years, Glasgow Coma Scale (GCS) ≥10}. Patients were randomly allocated to receive either 3 mg or 6 mg melatonin orally or via feeding tube at 9:00 pm for three consecutive nights, along with earplugs and eye masks. Sleep parameters were recorded from day 1 to day 3. Agitation was assessed using the Riker Sedation-Agitation (RSA) scale at 10:00 am and 6:00 pm. The length of ICU stay was noted. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0, with p-value ≤0.05 considered statistically significant. Results: Baseline demographics and American Society of Anaesthesiologists (ASA) status were comparable between groups. Total sleep time in the 3 mg group: 7.57±2.57 h (day 1) to 8.48±2.92 h (day 3); 6 mg group: 9.48±2.74 h to 9.93±2.55 h with no significant overall difference (p-value=0.780). Night sleep was higher on day 2 in the 6 mg group (p-value=0.009), but no significant overall trend (p-value=0.084). Day sleep, arousals, and RSA scores were non significant between the two groups (p-value >0.05), and the mean ICU stay was 4.35±1.46 days in the 3 mg group and 4.48±1.55 days in the 6 mg group, with no statistically significant difference between the groups (p-value=0.781). Both doses were well-tolerated without major adverse effects. Conclusion: Higher-dose melatonin (6 mg) significantly improved nocturnal sleep on one study day compared to 3 mg but showed no overall benefit in total sleep time, diurnal sleep, arousals, delirium, or sedation needs. Both doses were safe and welltolerated.

Prevalence of Herpes Simplex Virus in Genital Ulcer Patients: A Cross-sectional Study from South Assam, India

Priyanka Mukherjee, Joydeep Roy, Debadatta Dhar Chanda, Bhaskar Gupta

Introduction: Herpes Simplex Virus (HSV) causes an ulcerating Sexually Transmitted Infection (STI). It produces painful and recurrent genital ulcers. In recent years, there have been increasing reports of genital herpes due to HSV-1 from various parts of the world. There is a lack of documented HSV Polymerase Chain Reaction (PCR) studies in this part of the country. So, this study was planned to estimate the prevalence of HSV type 1 (HSV-1) and type 2 (HSV-2) in patients with genital ulcers. Aim: To estimate the prevalence of HSV-1 and HSV-2 in patients with genital ulcers. Materials and Methods: The present cross-sectional study was conducted at Virus Research Diagnostic Laboratory (VRDL), Department of Microbiology, Silchar Medical College and Hospital, Silchar, Assam, India, among all the samples consecutively collected from patients presenting with genital infection in the Sexually Transmitted Infections Clinic of the Department of Dermatology for the period from April 2022 to August 2023. A total of 86 genital swab samples were collected from the base of the ulcer of patients, placed in viral transport media and transported at 4°C to VRDL for further testing. Out of 86 samples tested for HSV, 44 were males and 42 were females. Viral genomic Deoxyribonucleic Acid (DNA) was extracted from all the samples. Furthermore, from the extracted DNA, Real-time PCR (qPCR) was performed to detect the presence of HSV-1 and HSV-2 genes in the samples. Statistical analysis was performed using Microsoft Excel. Results: Out of 86 samples collected, DNA PCR was positive in 46 (53.5%) patients with genital ulcers. Herpes Simplex Virus type 2 (HSV-2) was detected in 27 (31.4%) samples, making it more prevalent than HSV-1, which was found in 16 (18.6%) samples. Co-infection with both HSV-1 and HSV-2 was observed in three patients (3.5%). Conclusion: Although there is a change in the aetiology of genital herpetic ulcers from HSV-2 to HSV-1, however, the present study showed that there is still an increased prevalence of HSV-2 in genital ulcers found in patients in South Assam.

Electrophysiological Profile of Neuropathy in Rheumatoid Arthritis Patients: A Cross-sectional Study

Hrudya Venugopal, N Shobana, A Mahesh, M Raveendran

Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory condition that mainly affects the small joints of hands and legs. Peripheral neuropathy is one of the most common manifestations of Rheumatic disease. Aim: To describe the electrophysiological profile of neuropathy in RA patients attending the Rheumatology Clinic of a Medical College in Southern India. Materials and Methods: The present cross-sectional study was conducted in Department of Rheumatology, Coimbatore medical college, Coimbatore, Tamil Nadu, India, between September 2019 and September 2020. A total of 50 consecutive patients diagnosed with RA based on American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria 2010, with disease duration more than two years were included in the study. Clinical examination, Erythrocyte Sedimentation Rate (ESR), Rheumatoid Factor (RF), Renal Function Tests (RFT), Liver Function Tests (LFT), Complete Blood Count (CBC), Human Immunodeficiency Virus (HIV) antibody testing, blood sugar and Nerve Conduction Studies (NCS) were performed in patients satisfying inclusion and exclusion criteria. Chi-square test was used to compare proportions of categorical variables and t-test was used to compare means across groups with various types of axonal neuropathy. Results: Of 50 patients with RA, 37 (74%) patients had peripheral neuropathy electrophysiologically, whereas 27% (10 patients of 37) had sensory symptoms. Subclinical neuropathy was present in 73% (27 patients out of 37) of patients. Mixed non-compressive neuropathy of the lower limb was most common 25 (50%) Statistically significant association was found between the presence of neuropathy and RF positivity and also with duration of illness. No association was found with age, sex, ESR levels. Conclusion: Prevalence of subclinical peripheral neuropathy is very common among patients with RA. Electrophysiological studies can detect peripheral neuropathy earlier. Hence, all RA patients should undergo NCS periodically to detect neuropathy early and to prevent development of complication related to it.

Comparison of Intranasal Saccharin Test and Intranasal Schirmer’s Test in Identifying Altered Nasal Mucociliary Clearance Time in Type 2 Diabetic Patients: A Cross-sectional Study

Karthika Rajendran, CRK Balaji, PM Raghuraman

Introduction: Mucociliary Clearance (MCC) is an essential respiratory defence mechanism that is often impaired in patients with Type 2 Diabetes Mellitus (T2DM) due to hyperglycaemia-induced neuropathy and reduced nasal secretions. Identifying reliable methods to evaluate nasal function in patients with Diabetes Mellitus (DM) is crucial for the early detection of dysfunction. Aim: To compare the intranasal saccharin and Schirmer’s tests for assessing nasal MCC in patients with T2DM. Materials and Methods: This cross-sectional study was conducted in the Department of Ear, Nose, and Throat (ENT) at a tertiary care centre SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, over a period of three months, from March 2025 to May 2025, involving 120 patients with T2DM aged 18-75 years. Patients underwent intranasal saccharin and Schirmer tests under standardised conditions. Data were analysed using descriptive statistics, Chi-square test, and Receiver Operating Characteristic (ROC) curve analysis by IBM Statistical Package for Social Sciences (SPSS) software version 25.0. A p-value <0.05 was considered significant. Results: The mean age of the participants was 57.70±12.08 years, and 66 (55%) were female. Prolonged Saccharin Transit Time (STT) (≥30 min) was noted in 91(75.8%) of patients, while reduced Schirmer’s test values (≤6 mm) were observed in 81 (67.5%) and normal values (>6 mm) in 39 (32.5%) patients. All patients with Schirmer’s values ≤6 mm [81 (100%)] had prolonged STT, whereas 29 (74.4%) of those with values >6 mm [39 (32.5%)] showed normal MCC. Schirmer’s test showed a sensitivity of 89.01%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 74.36%, and an overall accuracy of 91.67%. The ROC curve yielded an AUC of 0.997. Conclusion: Schirmer’s test demonstrated high sensitivity and specificity as a simple, non invasive screening tool for detecting nasal dysfunction in patients with DM. It may serve as a practical adjunct to the saccharin test in clinical practice, enabling the early recognition of MCC impairment in patients with T2DM.

Efficacy of Two Doses of Dexmedetomidine as an Adjuvant to Intrathecal Hyperbaric Ropivacaine in Lower Limb Surgeries: A Randomised Controlled Trial

Introduction: Regional anaesthesia techniques are widely used for lower limb surgeries, offering superior postoperative pain relief and faster recovery. Dexmedetomidine, a highly selective α2-adrenergic agonist, has emerged as a promising adjuvant to local anaesthetics in intrathecal anaesthesia, providing prolonged analgesia without significant adverse effects. Aim: To compare the efficacy of two different doses of dexmedetomidine (5 mcg versus 10 mcg) as an adjuvant to intrathecal hyperbaric ropivacaine in patients undergoing lower limb surgeries. Materials and Methods: This double-blinded, randomised controlled trial was conducted at the Department of Anaesthesia and Critical Care, Pradyumna Bal Memorial Hospital (PBMH), Kalinga Institute of Medical Science, Bhubaneswar, Odisha, India, from May 2023 to September 2025. The study included 76 American Society of Anaesthesiologists (ASA) physical status I-II patients aged 18-60 years undergoing elective lower limb surgeries. Patients were randomly allocated into two groups. Group A (n=38) received 3 mL of 0.75% hyperbaric ropivacaine with 5 mcg dexmedetomidine, and Group B (n=38) received 3 mL of 0.75% hyperbaric ropivacaine with 10 mcg dexmedetomidine intrathecally. Primary outcomes included postoperative Visual Analogue Scale (VAS) scores and duration of analgesia. Secondary outcomes encompassed haemodynamic parameters, onset of sensory and motor blocks, sedation scores, and adverse effects. Data analysis was performed using IBM Statistical Package for Social Sciences (SPSS) software version 25.0 with the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. A p-value <0.05 was considered statistically significant. Results: Both groups were comparable regarding demographic variables, including age (group A: 41.0±10.5 years vs group B: 38.5±11.2 years, p-value=0.28), gender distribution, Body Mass Index (BMI), and ASA physical status. Group B demonstrated significantly lower VAS scores at 2, 4, 6, and 8 hours postoperatively compared to Group A (p-value <0.05). At 2 hours, mean VAS was 1.5±1.2 in group B versus 3.2±1.5 in group A (p-value=0.01). The requirement for rescue analgesia was significantly delayed in group B, with 71.05% of group A patients requiring tramadol at 6 hours versus only 2.63% in group B (p-value <0.001). Group B achieved faster sensory block onset to T8 level (mean time: 4.5±0.8 minutes) compared to group A (mean time: 5.8±1.2 minutes, p-value=0.01). Haemodynamic parameters remained stable in both groups with no significant differences. No cases of postoperative nausea and vomiting were observed in either group. Conclusion: Intrathecal dexmedetomidine 10 mcg provides superior postoperative analgesia, faster sensory block onset, and reduced rescue analgesic requirements compared to the 5 mcg dose, while maintaining a comparable haemodynamic safety profile. This higher dose represents an optimal balance between enhanced analgesic efficacy and safety in lower limb surgeries.

Assessing Changes in Platelet and White Blood Cell Counts and the Risk of Bacterial Contamination during Storage of Single Donor Platelets: A Cross-sectional Study

Harshita, Kandukuri Mahesh Kumar, Sudhir Kumar Vujhini

Introduction: Single Donor Platelets (SDP) is crucial in managing thrombocytopenia and other platelet-related disorders. Compared with random donor platelets, SDPs minimise donor exposure and reduce the risk of alloimmunisation. Although SDPs are preferred over random donor platelets, their quality deteriorates during storage due to metabolic, biochemical, and morphological changes. These changes can influence post-transfusion platelet recovery and clinical efficacy. Moreover, the risk of bacterial contamination increases with longer storage duration despite leucoreduction and improved storage conditions. Therefore, continuous evaluation of in-vitro quality parameters and post-transfusion outcomes is essential to ensure that stored SDP units remain effective and safe for patient use. Aim: To assess changes in platelet and White Blood Cell (WBC) counts and the risk of bacterial contamination during storage of SDP, and to evaluate post-transfusion platelet count increment in recipients. Materials and Methods: The present prospective observational cross-sectional study was conducted in the Department of Immunohematology and Blood Transfusion (IHBT), Nizam’s Institute of Medical Sciences, Hyderabad, Telangana State, India, from April 2023 to March 2024. One hundred SDP donors and 100 transfusion recipients were included (patients). The collected platelets were stored in sterile, oxygen permeable polyvinyl chloride bags. A 5 mL sample was drawn on day 0 (day of collection) for WBC and platelet count estimation and for bacterial culture using BACT/ALERT PF+ culture bottles. Comparisons of WBC and platelet counts between day 0 and subsequent storage days (days 1-5) were performed using the paired t-test. Bacterial contamination was assessed by sterility testing (culture reports) from samples collected on each storage day. For evaluating platelet count increments in patients, mean pretransfusion and post-transfusion platelet counts were calculated and compared using the paired t-test. Microsoft Excel was used for data entry, and statistical analysis was performed with IBM Statistical Package for Social Sciences (SPSS) software, version 2022. Results: The mean donor age was 29.7 years, with an average height of 168.9 cm and weight of 75.5 kg. The most common patient diagnoses were AML (18 cases), followed by CML (14 cases) and lymphoma (15 cases); refractory ITP and cholangitis with severe anaemia were least common (1 case each). Platelet counts showed no significant change on days 0 and 3, but significant reductions were observed on days 1, 2, 4, and 5. Bacterial contamination was detected in some units by day 3 and day 5. There was a significant increase in the patient platelet count (p<0.05). Conclusion: Platelet counts in SDP units decline with longer storage, and patients transfused earlier experience better count recovery. Bacterial contamination risk increases after day 3.

Radiographic Evaluation of Greater Sciatic Notch for Sex Determination: A Cross-sectional Study from Sri Ganganagar, Rajasthan, India

Introduction: Sex estimation forms a fundamental step in forensic anthropology, bioarchaeology and medicolegal identification. The pelvis is considered the most reliable skeletal element for this purpose, with the Greater Sciatic Notch (GSN) being one of the most sexually dimorphic landmarks. Radiographic evaluation of the GSN offers a non invasive and practical alternative to traditional osteological analysis, particularly when skeletal remains are unavailable. Aim: To evaluate the morphometric and radiological characteristics of the GSN on plain pelvic radiographs in the population of Sri Ganganagar, Rajasthan and to assess sexual dimorphism in its parameters. Materials and Methods: A cross-sectional study was conducted at the Department of Radiodiagnosis, Jansewa Hospital, Sri Ganganagar, Rajasthan, India, on 200 Anteroposterior (AP) pelvic radiographs (92 males, 108 females) obtained between August 2024 and July 2025. Radiographs with fractures, deformities, or prior pelvic or hip surgeries were excluded. Bilateral measurements of GSN width, depth, posterior segment, Index I (depth/width×100) and Index II (posterior segment/width×100) were obtained using digital callipers. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Sex differences were assessed using the independent samples t-test, with p<0.05 considered statistically significant. Results: All measured parameters exhibited statistically significant sexual dimorphism. Females demonstrated greater mean width (Right: 54.56±2.18 mm; Left: 54.67±2.10 mm), depth (Right: 26.52±1.21 mm; Left: 26.64±1.18 mm) and posterior segment (Right: 28.5±0.98 mm; Left: 28.7±1.06 mm) compared to males. Index I was higher in males (Right: 61.08±3.18; Left: 60.8±2.95), whereas Index II was significantly (p<0.001) higher in females (Right: 52.3±2.84; Left: 52.5±2.51). Conclusion: The GSN showed marked sexual dimorphism in the studied population, with width, depth, posterior segment and Index II being greater in females, while Index I was higher in males. Plain radiography provides a reliable, cost-effective and non invasive method for sex determination and can serve as a valuable adjunct in forensic and anthropological practice.

Comparison of Intravenous Lignocaine versus Intravenous Magnesium Sulphate as Premedication for Haemodynamic Stability in Laparoscopic Surgery: A Randomised Controlled Trial

Jatin Patel, Neelam Labana, Richa Tailor, Jigisha Mehta

Introduction: Laparoscopic surgeries currently represent the mainstay of surgical modalities. Pneumoperitoneum imposes significant intraoperative haemodynamic alterations, which are more pronounced in elderly patients and those with co-morbid conditions. Inadequate pain relief in the perioperative period may result in various physiological and psychological traumas. Therefore, effective premedication is required to attenuate haemodynamic responses during laryngoscopy and intubation while ensuring optimal postoperative recovery. Aim: To compare the efficacy of intravenous lignocaine versus magnesium sulphate as premedication for perioperative analgesia, haemodynamic stability, and postoperative recovery in laparoscopic surgery under general anaesthesia. Materials and Methods: This double-blinded, randomised controlled trial was conducted at Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS), Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat, India, from January 2023 to June 2024. Sixty patients aged 18-65 years, American Society of Anaesthesiologists (ASA) physical status grade I-II, scheduled for elective laparoscopic surgery, were randomly divided into two groups. Group L (n=30) received lignocaine 2 mg/kg intravenously (i.v.), and Group M (n=30) received magn esium sulphate 30 mg/kg i.v. ten minutes before induction. Haemodynamic parameters {Heart Rate (HR), Blood Pressure (BP)} were monitored intraoperatively for 90 minutes, postoperative sedation scores, and complications were recorded. Data analysed using an Unpaired t-test and a Chisquare test. The p-value <0.05 is considered significant. Results: Both groups were demographically comparable (mean age: 42.13±16.41 vs 42.33±15.82 years; gender: 50% male in both groups; weight: 68.40±11.19 vs 66.03±10.84 kg for groups L and M, respectively, all p-values >0.05). Throughout 90 minutes of intraoperative monitoring, group M showed superior haemodynamic stability. At one minute post intubation, percentage increase from baseline was significantly lower in group M compared to group L for HR (mean HR: 102.53±7.16 vs 80.07±5.17 bpm; 10.44% vs 40.78%, p-value <0.001), Systolic Blood Pressure (SBP) (mean SBP: 144.90±3.83 vs 127.43±7.09 mmHg; 4.48% vs 17.17%, p-value <0.001), Diastolic Blood Pressure (DBP) (mean DBP: 97.57±6.96 vs 85.60±5.65 mmHg; 11.13% vs 24.0%, p-value <0.001), and Mean Arterial Pressure (MAP: 113.35±5.30 vs 99.54±5.68 mmHg; 8.18% vs 21.0%, p-value <0.001). Group M showed better postoperative recovery with Ramsay Sedation Score (RSS) scores of 3 compared to 2 in group L at one hour postoperatively, and fewer complications (6.67% vs 23.33%). Conclusion: Magnesium sulphate provides superior haemodynamic stability during laryngoscopy and intubation compared to lignocaine, with a better postoperative recovery profile in laparoscopic surgery. This study demonstrates that magnesium sulphate at 30 mg/kg is more effective than lignocaine 2 mg/kg in attenuating the haemodynamic stress response, offering a valuable premedication option for patients undergoing laparoscopic procedures, particularly those at risk for cardiovascular instability.

Correlation Between Anthropometric Measurements and Intramedullary Nail Length in Patients with Femoral Fracture: A Cross-sectional Study

Introduction: Intramedullary (IM) nailing is the gold standard treatment for femoral shaft fractures. Selecting the optimal IM nail length is crucial for ensuring proper alignment and minimising complications. Aim: To explore the relationship between anthropometric measurements and appropriate IM nail length in patients with femoral fractures. Materials and Methods: This cross-sectional study was conducted in 30 patients in the Department of Casualty and Orthopaedics, SRM Medical College Hospital, Chennai, from October 2023 to February 2025. It included 30 patients with femoral fractures. Anthropometric measurements, including the distance from the greater trochanter to the proximal pole of the patella, lateral knee joint line, tip of the olecranon to the tip of the little finger, fibular length combined with femoral head diameter, and patient height, were recorded. The correlations between these measurements and the IM nail size were analysed using Pearson's correlation test. Results: The mean age of the patients was 40.67±7.89 years, and 63.33% were men. The distance from the olecranon to the tip of the little finger showed the strongest positive correlation with the IM nail size (R=0.81, p-value <0.001), followed by the distance from the greater trochanter to the proximal pole of the patella (R=0.74, p-value <0.001). Fibular length and femoral head diameter together demonstrated a weaker but statistically significant correlation (R=0.41, p-value=0.024). Height showed the weakest correlation with nail length (R=0.37, p-value=0.043). Conclusion: Anthropometric measurements were significantly correlated with the IM nail length in femur fractures. The olecranon-to-little finger length was the most reliable predictor, followed by the distance from the greater trochanter to the proximal patella and the lateral knee joint line. These findings support the use of anthropometric parameters for preoperative IM nail selection, which may improve surgical outcomes.

Histopathological Patterns of Lung and Pleural Diseases: A Cross-sectional Study

Introduction: Lung diseases, including lung cancers, are prevalent and deadly worldwide, especially in India. Lung biopsies are crucial for diagnosing pulmonary conditions when non invasive methods are inconclusive. Histopathological examination of biopsy samples provides vital insights for accurate diagnosis and effective treatment planning. Aim: To evaluate the frequency of various histopathological lung lesions detected through biopsy and to assess the demographic and clinical characteristics of patients with lung pathologies. Materials and Methods: This cross-sectional, retrospective study was conducted over a period of 12 months (August 2023 to July 2024) at a tertiary care hospital in Ahmedabad, Gujarat, India. It included 50 patients who underwent lung or pleural biopsies. Patient demographics (age and gender) and clinical features were recorded. The anatomical location (topography) and types of biopsies performed were also evaluated. Histopathological evaluation was done to determine the frequency of neoplastic and non neoplastic lesions. Data were analysed using Microsoft Excel (version 2021). Descriptive statistics and Chi-square tests were applied as appropriate. Results: The cohort consisted of 50 cases who underwent lung biopsy consisted of 32 males and 18 females, with a mean age of 55.18 years. The most common symptoms were cough in 40 (80%), expectoration in 36 (72%) and breathlessness in 30 (60%). A smoking history was noted in 26 (80%) males. Most biopsies were lung-based, predominantly transbronchial in 30 (60%). Histopathologically, 25 (50%) had non neoplastic lesions, including non specific inflammation 16 (64%), granulomatous inflammation indicative of tuberculosis 4 (16%), fungal infection in 2 (8%), reactive mesothelial hyperplasia in 2 (8%), and interstitial fibrosis in 1 (4%). Neoplastic lesions were found in 24 (48%) cases, with Squamous Cell Carcinoma (SCC) being the most frequent in 8 (33%), followed by non small cell lung carcinoma in 5 (21%), adenocarcinoma in 3 (12.5%), small cell carcinoma 3 (12.5%) and solitary fibrous tumour in 1 (4%). Other findings included atypical cells suspicious of malignancy, high-grade bronchial dysplasia, and metastatic carcinoma. Gender differences were statistically significant in both non neoplastic (p-value=0.037) and neoplastic lesions (p-value=0.016). Conclusion: Histopathological examination of lung biopsy specimens plays a crucial role in the accurate diagnosis of various lung diseases, including infections, inflammation, and cancers. Minimally invasive techniques like transbronchial and imaging-guided needle biopsies provide essential tissue samples, enabling early and precise diagnosis. This facilitates tailored treatment plans, ultimately improving patient outcomes and prognosis.

Effectiveness of the STUMBL Scoring System in Predicting Outcomes of Blunt Chest Trauma Patients Admitted to the Trauma ICU: A Retrospective Cohort Study

Vijayavani Palani, George Prashanth Kurian, Shona Rachel Mathuram

Introduction: Blunt chest trauma is one of the leading causes of trauma related admission to the Emergency Department (ED). Risk prediction tools are widely used to estimate patient outcomes and guide clinical decision making. The Study of Management of Blunt Chest Wall Trauma (STUMBL) (Study of Management of Blunt chest wall trauma) score is a prognostic score developed to aid in the management of patients presenting with blunt chest injuries in the ED. Aim: The present study aimed to evaluate the STUMBL scoring system to predict the outcomes in blunt chest trauma patients admitted to the trauma ICU. Materials and Methods: The present retrospective analysis was conducted on adult blunt chest trauma patients admitted to the trauma ICU between January 2023 and January 2024. Patients less than 18 years of age, severe head injury and life threatening polytrauma were excluded from the study. Patient demographics, STUMBL scores, clinical interventions and outcomes were analysed. Results: A total of 99 patients were enrolled in the study. The mean (SD) age was 44.83 (14.87) years, with a male/female ratio of 10:1 and a median Charlson comorbidity index of 0.50 (0.00, 2.00). Blunt chest trauma from road traffic accidents accounted for 76 (82.61%) of cases. Isolated blunt chest trauma was observed in 32 (32.32%) of patients and 95 (95.9%) patients had at least one rib fracture. The mean (SD) STUMBL score was 23.26 (11.65). There was a statistically significant association between higher STUMBL scores and the need for ventilatory support. Patients requiring NIV had significantly higher STUMBL scores (p=0.0002). STUMBL score>=26 had sensitivity of 68.00%, specificity of 67.65%, positive likelihood ratio of 2.10 and negative likelihood ratio of 0.47. Similarly, for HFNC use, Score >=26, had sensitivity of 60.98%, specificity of 72.55%, positive likelihood ratio of 2.22 and negative likelihood ratio of 0.53 (p=0.0018). Higher STUMBL score were also significantly associated with longer ICU stay (p=0.0104) with a positive correlation (Spearman’s rho=0.2709). Conclusion: The STUMBL score demonstrated good discrimination in predicting the need for ventilatory support (NIV/HFNC) and longer ICU stay in patients with blunt chest trauma admitted to trauma ICU. A score of >/=26 was associated with increased need for respiratory support and prolonged ICU length of stay. These findings support the utility of the STUMBL score as a valuable prognostic tool in guiding early management decisions for blunt chest trauma patients in the ICU setting.

Preoperative International Prostate Symptom Score as a Predictor of Postoperative Urinary Retention in Patients of Inguinal Hernia Surgery: A Prospective Observational Study

Naren Kumar Reddy Telluri, KR Bhagavan, Suraj P Hegde

Introduction: The International Prostate Symptom Score (IPSS) is a self-reported questionnaire intended to evaluate the severity of Lower Urinary Tract Symptoms (LUTS) in individuals with prostate conditions such as benign prostatic hyperplasia. It can assign a severity level (mild, moderate, severe) for individuals experiencing urine symptoms. Postoperative urinary retention is one of the significant complications following any surgical procedure, among all age groups, regardless of prior history of urinary problems. Aim: To evaluate the role of preoperative IPSS in predicting Acute Urinary Retention (AUR) in patients undergoing hernioplasty. Materials and Methods: The present prospective observational study was conducted at KS Hegde Medical Academy, Mangaluru, Karnataka, India, from January 2019 to June 2020 on a study population of 100 male patients. These patients were assessed with the IPSS IX questionnaire preoperatively for urinary tract symptoms. This was graded into mild (0-7), moderate (8-19) and severe (20-35) categories. They were observed for the incidence of urinary retention in the postoperative period. Subsequently, a comparison is made between IPSS and postoperative urinary retention. Results: The mean age of the study population was 59.57±9.07 years. Out of 100 males studied, six patients developed AUR. One patient out of 71 patients who had mild IPSS and five patients out of 29 patients with moderate IPSS developed AUR. Patients with higher IPSS were found to have a higher chance of AUR (p-value=0.005). Conclusion: According to the present study findings it was observed that patients with inguinal hernias who have higher IPSS scores have a higher incidence of urinary retention postoperatively.

Correlation between Anthropometric Measurements and Intramedullary Nail Length in Patients with Femoral Fracture: A Cross-sectional Study

Introduction: Intramedullary (IM) nailing is the gold standard treatment for femoral shaft fractures. Selecting the optimal IM nail length is crucial for ensuring proper alignment and minimising complications. Aim: To explore the relationship between anthropometric measurements and appropriate IM nail length in patients with femoral fractures. Materials and Methods: This cross-sectional study was conducted in 30 patients in the Department of Casualty and Orthopaedics, SRM Medical College Hospital, Chennai, from October 2023 to February 2025. It included 30 patients with femoral fractures. Anthropometric measurements, including the distance from the greater trochanter to the proximal pole of the patella, lateral knee joint line, tip of the olecranon to the tip of the little finger, fibular length combined with femoral head diameter, and patient height, were recorded. The correlations between these measurements and the IM nail size were analysed using Pearson’s correlation test. Results: The mean age of the patients was 40.67±7.89 years, and 63.33% were men. The distance from the olecranon to the tip of the little finger showed the strongest positive correlation with the IM nail size (R=0.81, p-value <0.001), followed by the distance from the greater trochanter to the proximal pole of the patella (R=0.74, p-value <0.001). Fibular length and femoral head diameter together demonstrated a weaker but statistically significant correlation (R=0.41, p-value=0.024). Height showed the weakest correlation with nail length (R=0.37, p-value=0.043). Conclusion: Anthropometric measurements were significantly correlated with the IM nail length in femur fractures. The olecranon-to-little finger length was the most reliable predictor, followed by the distance from the greater trochanter to the proximal patella and the lateral knee joint line. These findings support the use of anthropometric parameters for preoperative IM nail selection, which may improve surgical outcomes.

Comparative Analysis of Mobile versus Personal Computer Gaming on Neck Posture and Pain: A Cross-sectional Study

Introduction: Increased screen time, especially for gaming, causes postural alterations such as rounded shoulders and Forward Head Posture (FHP) which can lead to neck pain. Altogether, this poor posture and screen time raise concerns about musculoskeletal issues. Mobiles and Personal Computers (PCs) are the main gaming devices; hence research into their different effects on posture and musculoskeletal health is necessary. Aim: To observe the difference between neck pain and Craniovertebral (CV) angle among PC and mobile gamers. Materials and Methods: The present cross-sectional study conducted at Galgotias University, Greater Noida, Uttar Pradesh, India, included 45 right-handed participants residing in hostels from September 2023 to December 2024. Based on primary gaming modality and screen usage frequency, participants were divided into three groups: group A (n=15) comprised PC gamers and group C (n=15) comprised mobile gamers and group B (n=15) comprised non-gamers. Participants in group A and group C underwent 30-minute gaming sessions daily for one week with a 6-day habituation period to minimise adaptation effects. Final data collection was performed on the 7th day to obtain stable postural responses. During the 30-minute gaming session on 7th day, lateral photographs were captured every five minutes to assess CV and thoracic angles using MB RULER software. Markers for anatomical reference were placed at the tragus, C7, and thoracic vertebrae. The Numeric Pain Rating Scale (NPRS) was used to assess neck pain. Statistical Package for Social Sciences (SPSS) version 27.0 was utilised for data analysis. groups were compared using One-way Analysis of Variance (ANOVA), and correlations were assessed with Pearson correlation, considering a p-value <0.05 as statistically significant. Results: The average age of the participants were 20.78±0.72 years and a Body Mass Index (BMI) of 24.87±4.61. Non-gamers had the most favourable CV angle (47.46°±1.63), compared to PC gamers (44.70°±1.13) and mobile gamers (42.76°±0.75), with the differences being statistically significant (p<0.001**). Similarly, non-gamers reported the lowest neck pain score (1.5±0.45), compared to 6.87±0.77 in PC gamers and 7.01±0.63 in mobile gamers (p<0.001**). No statistically significant difference in pain was observed between the two gaming groups (p=0.74) There was a positive correlation between the gaming duration and the deviation in the CV angle (r=0.72, p<0.001**) and with the level of pain experienced (r=0.65, p<0.001**) which were statistically significant. Conclusion: According to the present study results,Mobile devices are not suitable for gaming because they put more strain on the cervical spine and enhance the risk of neck pain and FHP.

Evaluation of Artificial Intelligence Driven Digital Morphology for Estimation of Platelet Count: A Cross-sectional Study

Introduction: Nowadays different technologies are employed in the field of automated haematology analyser that provides rapid and reliable estimations and is regularly used for determining the platelet counts. In some cases, it gives erroneous results, especially with Red Blood Cells (RBC)-platelet interference and giant platelets, which need to be verified by manual methods. The traditionally used manual method microscopic estimation of platelet on smear is labour-intensive, produces variable results and is subject to observer bias. Aim: The present study aimed to compare platelet count estimation by SigTuple-AI100 ShonitTM (AI100)- a digital morphology analyser with manual platelet counts and automated haematology analyser (HORIBA Yumizen H2500). Materials and Methods: The present cross-sectional comparative study done in Department of Haematology, Suburban Diagnostics Referral Laboratory, Mumbai, India for a period of eight months from June 2023 to February 2024. One hundred Ethylenediaminetetraacetic Acid (EDTA) whole blood samples were analysed for platelet count by an automated haematology analyser (HORIBA Yumizen H2500), manual microscopic method, and digital morphology platform (SigTuple-AI100). Results were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistical Software version 26. Estimated platelet counts of AI100 were compared with manual platelet count and Yumizen H2500, using Pearson’s correlation coefficient and Bland-Altman plot analysis. Manual platelet count was used as a reference method. Results: Platelet counts from the AI100 system showed an R2 of 0.91 when compared to manual platelet estimates and an R2 of 0.92 when compared to the automated haematology analyser results. Conversion factor was derived and validated on 100 consecutive thrombocytopenic samples. Coefficient of Variance (CV%) of AI100 was 4.95. Conclusion: The study suggested that the platelet count obtained via the AI100 compared well with both automated haematology analyser and manual method. Though similar platforms are available worldwide, the cost of AI100 is cheaper than other platforms. There is also ease of operations and it being cloud based allows skilled Pathologists and lab technologists to report remotely.

Diagnostic Utility of the Systemic Immune-inflammation Index for Acute Coronary Syndrome in Young Adults: A Prospective Case-control Study

Introduction: Acute Coronary Syndrome (ACS) in individuals under 40 years of age presents with distinct epidemiological characteristics, risk profiles and outcomes compared to older patients. Identifying cost-effective and reliable prognostic markers in this population is essential, particularly in resource-limited settings. Composite inflammatory indices, such as the Systemic Immune-inflammation Index (SII), derived from platelet, neutrophil, and lymphocyte counts, has emerged as a promising biomarker in cardiovascular disease risk stratification. Aim: To evaluate the diagnostic utility of SII in differentiating young ACS patients from healthy controls, and to explore its prognostic value in predicting short-term Major Adverse Cardiac Events (MACE) within 30 days. Materials and Methods: The present prospective case-control study was conducted including 30 ACS patients aged <40 years and 30 age and sex-matched healthy controls, demographic data, clinical history, and laboratory parameters were collected. SII was calculated ((Platelet count*neutrophil count)/lymphocyte count). Statistical analyses included ROC curve analysis for diagnostic performance and other respective statistics based on the variable and normality. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) (v24.0). Results: The mean age of participants was 35.47±3.25 years, with 42 (70%) being male. The median SII was significantly higher in ACS patients compared to controls (p<0.001). ROC analysis demonstrated that SII (AUC 0.863, cutoff 613.875, sensitivity 96%, specificity 46%) for ACS diagnosis. Only two patients experienced MACE within 30 days, although the SII values were numerically higher, the difference was also statically significant (p=0.014). Conclusion: The SII, derived from routine complete blood count parameters, demonstrated strong diagnostic performance in identifying acute coronary syndrome among young adults. Given its simplicity and low cost, SII may serve as an adjunct diagnostic biomarker in early ACS detection, particularly in resource-limited settings. However, its prognostic value for short-term adverse outcomes remains exploratory and requires validation through larger, multicentric, and homogenous cohort studies.

Prevalence of Fusion between Adjacent Cervical Spinous Processes in Adult Cadavers: A Cross-sectional Study

Introduction: Cervical spine surgery is associated with a considerable risk of performing procedures at the wrong level. Errors in accurately identifying the appropriate level for spinal interventions can result from various factors, including an inadequate understanding of anatomical variations, such as fusion of the Cervical Spinous Process (CPS), abnormalities at the craniocervical junction, cervical ribs, hemivertebrae, and blocked or fused vertebrae. Furthermore, patient-specific factors, including tumours, infections, previous cervical spine surgeries, obesity, and osteoporosis, significantly contribute to the incidence of surgeries performed at incorrect levels. Aim: To determine the prevalence of fusion between adjacent CPS. Materials and Methods: The present cross-sectional study examined the spinous processes of the cervical vertebrae in 30 formalin-preserved adult cadavers (15 males and 15 females), aged between 60 and 95 years, in Smt. BK Shah Medical College and Research Institute, Vadodara, Gujarat, India. Fusion between the CPS of adjacent vertebrae was recorded after the removal of soft-tissue from C1 to T1. Results: The present study found fusion between adjacent CPS in only 2 male (6.66%) cadavers. whereas none were observed in females. This fusion was exclusively observed between C2-C3 vertebrae. The fused spinous processes demonstrated complete osseous continuity without visible fusion lines. Conclusion: CPS fusion is relatively uncommon in the adult Indian population; however, when it occurs, it is predominantly observed at the C2-C3 level in male cadavers. These findings provide a crucial reference for spinal surgeons to prevent surgical errors. Both preoperative and intraoperative imaging is essential for minimising surgical errors.

Comparison of the Pheochromocytoma of the Adrenal Gland Scaled Score (PASS), Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) and Modified GAPP: A Cross-sectional Study

Introduction: Pheochromocytoma (PCC) is a rare adrenal tumour with variable biological behaviour. Several histopathological scoring systems have been proposed to predict metastatic potential, including the Pheochromocytoma of the Adrenal Gland Scaled Score (PASS), the Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP), and the Modified GAPP (M-GAPP) incorporating Succinate Dehydrogenase Subunit B (SDHB) Immunohistochemistry (IHC). The present study focused to compare the performance of these scoring systems in an Indian single-centre series of adrenal PCC. Aim: To evaluate and compare the prognostic performance of PASS, GAPP, and M-GAPP scoring systems in predicting the malignant potential of adrenal PCC. Materials and Methods: This retrospective cross-sectional study was conducted at tertiary care centre, India, and included 111 histopathologically confirmed adrenal PCC cases diagnosed between 2000 and 2020 at a tertiary care centre in India. Clinical, biochemical, histopathological, and follow-up data were analysed. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Receiver Operating Characteristic (ROC) curve analysis, with the Area Under the Curve (AUC), was used to calculate at predefined cut-offs (PASS ≥4; GAPP ≥3; M-GAPP high-risk). Chi-square test, Fisher’s exact test, Student’s t-test, or Mann-Whitney U test was used where appropriate, with significance set at p-value <0.05. Results: The mean age at diagnosis was 36.8±14.8 years. Tumours were right-sided in 45.05%, left-sided in 39.64%, and bilateral in 15.31%. Metastasis occurred in 8.11% of cases, while recurrence was seen in 3.60%. Among syndromic cases, Von Hippel–Lindau (VHL) mutation was associated with metastasis in 11.76% of patients. Comedo-type necrosis showed a significant correlation with metastasis (p-value=0.008). PASS (≥4) showed a sensitivity of 55.56% and specificity of 67.60%. GAPP (≥3) showed a sensitivity of 66.67% and specificity of 59.80%. M-GAPP incorporating SDHB loss showed higher specificity (71.40%) and NPV (98.00%), though sensitivity was 21.30%. ROC curve analysis demonstrated M-GAPP had the highest AUC compared to PASS and GAPP. Conclusion: In this Indian Institutional series, M-GAPP outperformed PASS and GAPP by demonstrating better specificity and NPV, making it more reliable in excluding aggressive tumours. Incorporating SDHB IHC into histopathological assessment may improve risk stratification. Limitations include the retrospective, single-centre design and small number of metastatic events.

Prevalence and Determinants of Childhood Obesity: A Cross-sectional Study from Vadodara, Gujarat, India

Arpan Pandya, Anil Kumar Sharma

Introduction: The world is heading towards an obese future and as a result, childhood obesity is rising at an alarming pace. According to the World Obesity Atlas (2024), it is projected that by 2035, 88% of children classified as overweight or obese will reside in low- and middle-income countries. Aim: To identify the prevalence of childhood obesity among individuals aged 12 to 16 years, using the criteria established by the Centres for Disease Control and Prevention (CDC). Materials and Methods: A descriptive cross-sectional study was conducted among 606 school children selected through purposive sampling from three distinct schools in the Vadodara District, Gujarat, India, including one government, one semigovernment, and one private school, over a period of one month (July 2024). The researcher employed a quantitative research approach. The study gathered written informed parental consent and participant assent from students to assess their Body Mass Index (BMI). Data were collected on Demographic Variables (DV) and BMI based on the CDC BMI tool metric version and analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. To determine prevalence rates, associations of DVs with BMI, correlations of BMI with height, weight and Mid-Arm Circumference (MAC), Odds Ratio (OR), Analysis of Variance (ANOVA) and logistic regression were performed. Results: Among the 606 study participants, the overall prevalence of obesity was 224 (36.96%). Out of these, 67 (11.06%) were underweight, 315 (51.98%) were normal weight, 134 (22.11%) were overweight, 58 (9.57%) were classified as obesity class I, 21 (3.47%) were classified as obesity class II and 11 (1.82%) were in the obesity class III category. Overall, males (22.77%) exhibited a higher prevalence of obesity compared to females (14.19%), with the majority representing urban residents. When analysed using logistic regression, the researcher found that age (13-15 years), private school enrollment, urban residence, vehicle transportation, higher socioeconomic status and daily consumption of sugarsweetened beverages were significant predictors of obesity. Conclusion: The study concluded that obesity was more prevalent among urban residents and a strong correlation was found between MAC, gender and school type, with an inverse relationship between physical activity and obesity.

Effect of Home-based Exercise Program on Postural Kyphosis in Adolescent Population: An Interventional Study

R Harihara Prakash, Jigar N Mehta, Swati Jagdish

Introduction: With the increasing prevalence of musculoskeletal issues like thoracic kyphosis, caused by inappropriate modern lifestyle habits, the aim of this study is to assess whether exercise can improve postural alignment and maintain these improvements over time. Aim: This study investigates the effects of a Home Exercise Program (HEP) on the Thoracic Kyphosis Angle (TKA) in adolescents aged 10 to 18 years. Materials and Methods: This is an interventional study observing the effect of a four-week home exercise program on postural kyphosis in adolescents, conducted at KM Patel Institute of Physiotherapy in Karamsad, Gujarat, India. The study duration was from January 2024 to March 2025, during which a total of 84 participants were screened. Out of these, 44 were recruited into a single group according to the inclusion criteria, with a TKA (θ) >40°, from various local schools in the Anand district. Participants were preassessed (TKA (θ)-A) and then given a four-week HEP. Postintervention, participants were reassessed (TKA (θ)-B), and after four weeks of cessation of the intervention, a final assessment (TKA (θ)-C) was conducted. Statistical analysis was performed using paired t-tests (p-value <0.05) in Statistics and Data (STATA) version 14.2. Results: The study found that thoracic kyphosis is slightly more prevalent in males (52%) than in females (48%). There were statistically significant improvements (p<0.05) in TKA, indicating the effectiveness of the exercise program. After the cessation of exercise for another four weeks, no significant difference was found in TKA (p>0.05), which shows the retention effect of exercise after four weeks of inactivity. Conclusion: The study concluded that the given home-based exercise program is effective in improving thoracic kyphosis and maintaining postural alignment over time, even four weeks after discontinuation. However, intermittent exercise can still be beneficial to prevent further postural deviations.

Perception of Phase I MBBS Students on the Early Clinical Exposure Module in Anatomy: A Cross-sectional Study

Anil Kumar Dwivedi, Niyati Airan

Introduction: Early Clinical Exposure (ECE) is an innovative approach in medical education that introduces MBBS students to patient care from the very beginning of their studies. By linking theoretical learning with clinical experience, ECE helps students better understand and apply basic science concepts. This early clinical exposure not only strengthens core medical knowledge, but also develops empathy and social awareness, key qualities in effective healthcare. Early and consistent exposure to clinical settings improves communication skills, sharpens clinical abilities, and enhance confidence, shaping students into compassionate and capable future doctors. Aim: To introduce structured ECE module in anatomy and to assess perception of phase I MBBS students about ECE. Materials and Methods: The present cross-sectional study was carried out among MBBS phase I students between March to June 2025. Purposive sampling was used and 150 students were selected for the study. Structured and validated ECE module was used to conduct session of ECE with the support of Department of surgery. Patients’ images and video of clinical findings and examination of branchial cyst, branchial fistula, thyroglossal cyst and fistula was used as case scenarios during session on pharyngeal apparatus. After the session, student’s perception of ECE were recorded with ten closed ended questions based on a five-point Likert scale having 0 to 4 marks for strongly disagree to strongly agree. The response was represented as frequencies, percentages. and bar charts. Results: Out of 150 students 141 (94.00%) students perceived ECE is more interesting teaching learning method in comparison to tradition didactic lectures. 137 (91.33%) students observed that Early Clinical Exposure (ECE) enhanced their attentiveness during class sessions. Majority of students noticed that ECE developed interest in the topic, helped in understanding, motivated to read more and better retention. The majority of students believed that early clinical exposure facilitated a stronger correlation between anatomy and clinical cases, and suggested its inclusion across other topics in anatomy as well as in other preclinical subjects. Conclusion: First-year MBBS students showed a positive response to early clinical exposure. Engaging with clinical scenarios deepened their understanding of anatomy, continued their enthusiasm and strengthened their commitment to learn. ECE proved to be an effective strategy for integrating basic sciences with clinical context, promoting better comprehension and retention.

Predictive Value of Platelet Parameters MPV and PDW in Diagnosing Acute Appendicitis and its Complications: A Prospective Observational Study at a Tertiary Care Centre in Belagavi, Karnataka, India

Basavaraj M Kajagar, B Sushanth Kumar, Seema V Kamaraddi, Harpreet Kour

Introduction: Acute appendicitis is one of the most common surgical emergencies encountered in clinical practice. Early diagnosis and prompt intervention significantly improve outcomes. Various quick, low-cost and accessible laboratory markers such as C-reactive Protein (CRP), serum bilirubin and total leukocyte count are being explored to assist in diagnosis and assess complications. Among these, platelet parameters like Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) have recently garnered interest. Aim: To evaluate the predictive value of MPV and PDW in diagnosing acute appendicitis and its complications. Materials and Methods: The present prospective observational study was conducted in the Department of General Surgery at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India. Seventy patients diagnosed with acute appendicitis and undergoing appendectomy between January 2021 and December 2021 were included. Preoperative MPV and PDW values were analysed and compared with standard laboratory reference values and correlated with histopathological findings. Results: Out of 59 patients with confirmed acute appendicitis, 34 had MPV values >8.1 fL and 36 had PDW values <12.2%. However, these differences were not statistically significant. Notably, both MPV and PDW values were significantly elevated in patients with complicated appendicitis compared to those with uncomplicated cases (p<0.001). Conclusion: MPV and PDW may not be reliable standalone markers for diagnosing acute appendicitis. However, they hold potential as cost-effective, supplementary tools for assessing the severity and complications of the disease, particularly in resource-limited settings.

Outcomes of the Reverse Homodigital Island Artery Flap in Fingertip Reconstruction: A Retrospective Study

Yadavalli RD Rajan, Ganji Raveendra Reddy, Gagannatham Swathi

Introduction: Fingertip injuries are common hand traumas that often necessitate surgical reconstruction to restore both form and function while preserving sensation. The Reverse Homodigital Island Artery (RHDIA) flap has emerged as a reliable option for such defects. Aim: To evaluate the outcomes of the RHDIA flap in fingertip reconstruction. Materials and Methods: The present retrospective study was conducted between January 2024 and December 2024 in the Department of Plastic Surgery, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India, including 15 patients with post-traumatic fingertip defects. Patients with prior surgery, burns, or contractures of the affected finger and immunocompromised status were excluded. The RHDIA flap was raised from the proximal phalanx of the same finger and transposed to resurface the fingertip defect, with donor sites closed primarily or covered with split-thickness skin grafts. Demographic, operative, and postoperative parameters were analysed using EPI info 7.2. Continuous data were presented as mean±Standard Deviation (SD) or median (IQR), and categorical variables were presented as frequencies and percentages. Results: All 15 patients underwent fingertip reconstruction using the RHDIA flap with 100% flap survival. One patient (6.6%) developed partial distal necrosis that healed secondarily. The mean flap size was 3.7±0.22 cm², and mean healing time was 17.1±2.1 days. Functional outcomes were rated good to excellent in 93.3% (n=14) of cases, with high patient satisfaction in 86.6% (n=13). Aesthetic outcome was assessed using a 5-point Likert scale and the median score was 4 (IQR=2), indicating overall good aesthetic satisfaction. No donor-site complications, stiffness, or contracture were observed. Conclusion: The RHDIA flap is a reliable, single-stage option for fingertip reconstruction, offering good tissue match and satisfactory functional and aesthetic outcomes. Although limited by small sample size and retrospective design, this study reinforces the role of RHDIA as an effective reconstructive modality for fingertip defects.

Evaluation of Nebulised Dexmedetomidine in Blunting Haemodynamic Response to Laryngoscopy and Intubation in Adults undergoing General Anaesthesia for Laparoscopic Surgeries: A Randomised Control Trial

ET Muhammed Jaseel, Shweta Sedani, Dipakkumar Hiralal Ruparel, Ramesh Sugandh

Introduction: Laryngoscopy and endotracheal intubation can trigger sympathetic stimulation, potentially leading to cardiovascular or cerebrovascular complications in high-risk patients. Dexmedetomidine, when administered via nebulisation, allows effective absorption without the adverse effects of intravenous administration (bradycardia and hypotension). Aim: To assess the efficacy of nebulised dexmedetomidine in blunting haemodynamic response to intubation in adult patients undergoing general anaesthesia for laparoscopic surgery. Materials and Methods: The present randomised control trial conducted during August 2023 to December 2024. A total of 60 American Society of Anaesthesiologists (ASA) I and II adult patients undergoing elective laparoscopic surgeries with tracheal intubation were randomised to receive either nebulised dexmedetomidine (1 μg/kg in 5 mL saline) or saline alone, 30 minutes prior to induction. Heart rate and Mean Arterial Pressure (MAP) were monitored for 10 minutes post-laryngoscopy every 15 minutes following pneumoperitoneum. Statistical analysis was done using Chi-square test and one way analysis of variance. Results: There were no statistically significant differences between Group S and Group D in any of the demographic or surgical variables (p>0.05). A statistically significant difference was observed from 1-minute postintubation onward, with Group S showing consistently higher mean HR and MAP values than Group D. For HR, Group S had higher means at 1-min (105.36±19.58 vs 89.66±11.80 bpm, p=0.0004), 3-min (98.36±15.64 vs 85.40±12.59 bpm, p=0.0008), 5-min (p=0.0054), 10-min (p=0.0049), and all time points after CO2 insufflation (p<0.0001). For MAP, Group S recorded higher values at 1-min (96.0±9.0 vs 90.0±10.09 mmHg, p=0.018), 3-min (93.0±8.23 vs 86.0±11.32 mmHg, p=0.008), 5-min (p=0.038), 10-min (p=0.014), and throughout CO2 insufflation (p<0.0001). No significant differences were noted at baseline, after nebulisation, or after induction (p>0.05). It also attenuated response to pneumoperitoneum without any risk of adverse effects like bradycardia and hypotension. Conclusion: Nebulised dexmedetomidine at a dose of 1 μg/kg effectively blunted the rise in heart rate and mean arterial pressure after laryngoscopy and minimised intraoperative haemodynamic fluctuations during pneumoperitoneum, without risk of adverse effects like bradycardia and hypotension.

Effect of Yoga on the Mental Wellbeing of Caregivers of Children with Special Needs: A Randomised Controlled Study

Introduction: Children with special needs require additional assistance in their everyday activities. The involvement of parental caregivers in their child’s life is influenced by the severity of the child’s disability. Although caregiving can be deeply fulfilling, it is often physically and emotionally taxing. The ongoing stress of caregiving may intensify the burden, negatively affecting caregivers’ physical and mental wellbeing and increasing the risk of anxiety, depression, and the worsening of existing health issues. Aim: To study the effect of yoga on the mental wellbeing of caregivers of children with special needs. Materials and Methods: This randomised controlled study was conducted at Satya Special School in Pondicherry, India, from July 2022 to September 2023. After obtaining ethical clearance from the institute, 68 parental caregivers were selected as eligible caregivers, who satisfied the inclusion criteria and did not meet any exclusion conditions were then randomly assigned into two groups. The intervention group engaged in yoga sessions lasting one hour, conducted twice per week for a duration of 24 weeks. Psychological outcomes were assessed using two standardised scales. The Zarit Burden Interview (ZBI) and the Depression, Anxiety, Stress Scale (DASS-21)—administered at pretest, midtest, and post-test, along with a general demographic form at baseline. Descriptive statistics such as mean, median and interquartile range was assessed using the Mann-Whitney test, with analyses performed in Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 16.0. Results: The findings indicated that parents in the intervention group reported a decrease in caregiver burden, depression, anxiety, and stress after the yoga sessions (p-value <0.05). However, in the control group there was a significant increase in both caregivers’ burden and DASS-21 scores from pretest to post-test (p-value <0.05). In intergroup comparison, caregiver burden, anxiety, depression, and stress were significantly lower in the experimental group than in the control group at post-test (p-value <0.001). Conclusion: Yoga was effective in alleviating stress, caregiver burden, depression and anxiety, while improving the quality of life among parental caregivers.

Diffusing Capacity of the Lung for Carbon Monoxide-based Phenotypic Stratification in Asthma-COPD Overlap Patients: A Cross-sectional Study from India

Gyanshankar Mishra, Ashish Madhav Kendre, Neha Dnyanoba Munde, Radha Munje

Introduction: Asthma-Asthma-Chronic Obstructive Pulmonary Disease (COPD) Overlap (ACO) is a distinct entity characterised by overlapping features of both asthma and COPD. The Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) is usually reduced in COPD but preserved or elevated in asthma, making it a potential phenotypic marker. Aim: To assess the diffusing capacity of the lungs for carbon monoxide in asthma-COPD overlap patients. Materials and Methods: This was a cross-sectional study conducted at the Department of Respiratory Medicine of Indira Gandhi Government Medical College Hospital, Nagpur, Maharashtra, India, between January 2020 and October 2021. A total of 43 stable ACO patients were enrolled. Data included demographics, smoking history, dyspnoea ({Modified Medical Research Council (MMRC), Borg}, Borg), quality of life (St. George’s Respiratory Questionnaire), spirometry, and DLCO (single-breath). Patients were classified as asthma-predominant ACO (DLCO ≥76% predicted) or COPD-predominant ACO (DLCO <76%). Associations of DLCO with clinical parameters were examined by group comparisons and correlations. Data were analysed using descriptive statistics, t-test, Mann-Whitney U, Chi-square, and correlation analysis. A p-value <0.05 was considered statistically significant. Results: Among 43 ACO patients (mean age 49.2±16.3 years; 74.4% male), breathlessness was universal, with cough (86.1%) and rhinorrhoea (69.8%) being common. Moderate dyspnoea (MMRC II) occurred in 51.2% (mean Borg 4.8±1.6). Smokers comprised 39.5% (mean duration 26.1±10.3 years). Mean DLCO was 68.77±36.17%, reduced in 69.77% overall and 94.1% of smokers. Smokers had significantly lower DLCO (49.0±19.0% vs. 76.9±35.7%; p-value=0.0023) and >6 fold higher odds of impairment {ODD’s Ratio(OR)=6.43, 95% Confidence Interval (CI): 1.16-35.46}. Severe/very severe spirometric impairment ({Forced Expiratory Volume in one second (FEV1) <50%}) occurred in 62.8%. Median BODE (Body mass index, airflow Obstruction, Dyspnoea, and Exercise capacity) index was 3.0 (IQR 2.0-5.0). DLCO correlated negatively with symptom duration (Spearman’s ρ=-0.464, p-value=0.002), the BODE index (Spearman’s ρ=-0.654, p-value <0.001), and total St. George’s Respiratory Questionnaire (SGRQ) scores (Spearman’s ρ=-0.465, p-value=0.002). Two phenotypes emerged: asthma predominant (30.2%) with preserved/elevated DLCO and COPD predominant (69.8%) with reduced DLCO. Compared with asthma predominant, COPD predominant patients were older (52.8 vs. 40.8 years; p=0.019), more often smokers (53.3% vs. 7.7%; p-value=0.013), had worse airflow limitation (FEV1 36.2% vs. 57.5%; p-value=0.006), lower DLCO (59.4 vs. 85.6; p-value <0.0001), and poorer functional status (BODE 4.0 vs. 2.0, p-value=0.0009; Borg 5.0 vs. 4.0, p-value=0.010; 6-Minute Walk Distance (6MWD) 390 vs. 483 m, p-value=0.010; SGRQ 66.2 vs. 41.4, p-value=0.019). Conclusion: DLCO-based stratification distinguishes asthma- and COPD-predominant ACO phenotypes, links diffusion impairment to smoking, airflow limitation, functional decline, and poorer quality of life, and establishes a reproducible framework for diagnosis, prognosis, and individualised management.

Influence of Chronotype Profile, Personality Trait and Emotional Competence on Perceived Stress in Undergraduate Medical Students: A Cross-sectional Study

Vasanthi Chandrasekaran, Preetha Paul, Porchelvan Swaminathan

Introduction: Physical, emotional, and behavioural changes are hallmarks of stress, which is a normal human reaction to demanding or difficult circumstances. High stress levels can significantly impact the academic performance and mental health of young students. Chronotype represents genetically determined behavioural characteristics of a person’s twenty-four-hour activity cycle and is pivotal in mental health. Individual differences in stress experiences may be partially explained by personality traits. Individuals with greater emotional intelligence tend to exhibit lower stress reactivity. Aim: To assess the influence of chronotype, personality, and Emotional Competence (EC) on perceived stress among undergraduate medical students. Materials and Methods: This cross-sectional study was conducted in the Department of Physiology at Panimalar Medical College Hospital and Research Institute in Chennai, Tamil Nadu, India, from November 2024 to January 2025. It involved 114 first-year medical students, with the primary inclusion criterion being that participants were first-year medical undergraduates aged 18-25 years. Both genders were included. Participants, after giving informed consent, completed the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ), the Big Five Inventory, the Profile of EC, and the Perceived Stress Scale via Google Forms. Statistical Package for the Social Sciences (SPSS) version 29 was used for data analysis. Spearman’s correlation test was employed to examine the association between perceived stress and additional variables. Multiple regression analysis was performed to predict the level of perceived stress based on variables such as chronotype, EC, and personality traits (Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism). Statistical significance was set at p<0.05. Results: The mean age of the study population was 18.75±0.64 years, out of which 80 were females and 34 males. The data indicated that most participants had an intermediate chronotype 69 (60.5%), followed by the morning type 31 (27.2%) and evening type 14 (12.3%). A significant, strong positive correlation was observed between neuroticism and perceived stress (r=0.74, p<0.01). A significant negative correlation was found between perceived stress and the measured variables, namely chronotype (r=-0.25, p=0.01), conscientiousness (r=-0.35, p<0.001), extraversion (r=-0.49, p<0.001), agreeableness (r=-0.27, p<0.001), intrapersonal EC (r=-0.53, p<0.001), interpersonal competence (r=-0.29, p<0.001), and global EC (r=-0.52, p<0.001). Regression analysis revealed extraversion as a negative predictor and neuroticism as a positive predictor of perceived stress among medical students. Conclusion: The present study reveals complex relationships between chronotype, personality traits, EC, and perceived stress among students. Intermediate chronotypes were the most common, with morningness negatively correlated to stress. Personality traits, especially extraversion and neuroticism, significantly predicted stress levels. Higher EC was associated with lower perceived stress, potentially indicating better stress management skills. These findings contribute to the understanding of factors influencing stress perception in students and may inform targeted interventions for stress management in academic settings.

Comparison of Videolaryngoscopy-guided and Blinded Paramedian Techniques for Ambu AuraGain Insertion in Elective Surgeries: A Randomised Controlled Trial

Abhishek Yadav, Nidhi Agrawal, Swati Jain, Prashant Kumar

Introduction: Blind insertion of Supraglottic Airway Devices (SAD) often results in suboptimal positioning in the oropharynx or hypopharynx. On the other hand, laryngoscopy-guided insertion will give a better One-Lung Ventilation (OLV) and prevention of aspiration. A limited number of studies have been done to compare this blind and videolaryngoscopic positioning of a new device, Ambu® AuraGain™, which is a single-use, anatomically curved device with intubation capabilities. Aim: To compare videolaryngoscopy-guided insertion with the blind paramedian insertion technique of Ambu® AuraGain™ for the efficacy of ventilation. Materials and Methods: This Randomised Controlled Trial (RCT) was conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, over a period of 18 months (July 2022 – December 2023) in 100 patients in a tertiary care centre of a tier one city. At the end of 5 minutes and 30 minutes after device insertion, oropharyngeal leak pressure was measured as the primary outcome of the study. Randomisation was done into two groups (B and V). Group B was taken as the control group and group V was the test group, where the videolaryngoscopic-guided insertion of the device was done. Other parameters studied were successful attempts, ease of insertion and passage of the gastric catheter. Independent t-test, Chi-Square test, Fisher’s-exact test and Statistical Package for Social Sciences (SPSS) 25.0 were used to analyse data. For statistical significance, a p-value of less than 0.05 was considered statistically significant. Results: The demographic profile of all 100 patients was comparable in both groups, based on age, gender, American Society of Anaesthesiologists Physical Status (ASA) classification, and Body Mass Index (BMI). C-MAC® videolaryngoscopy-guided technique of insertion of Ambu Aura Gain provides better efficacy of ventilation in terms of higher Oropharyngeal Leak Pressure (OLP) as compared to the blind paramedian insertion technique in adult patients undergoing elective surgery under General Anaesthesia (GA). The mean oropharyngeal leak pressure (cm of H2O) at 5 minutes and 30 minutes post device insertion in group V and group B was 37.14±1.77 vs. 34.20±1.68 and 37.9±1.61 vs. 35.2±1.54, respectively. Time taken for effective ventilation was more in the C-MAC® group (34.64±0.98 sec vs. 27.18±1.35 sec, respectively). Conclusion: C-MAC® videolaryngoscopy-guided technique of insertion of Ambu® AuraGain™ provides better efficacy of ventilation in terms of higher oropharyngeal leak pressure as compared to the blind paramedian insertion technique in adult patients undergoing elective surgery under GA.

Exploring the Antibacterial Potential of Murraya koenigii Phytochemicals: An In-silico Docking Approach against Porphyromonas gingivalis

Introduction: Porphyromonas gingivalis, a primary bacterium in dental plaque, is a key pathogen in periodontal disease. Murraya koenigii has got a range of therapeutic properties, including antioxidant, antibacterial, antifungal, antidiarrhoeal, antidiabetic, and anti-inflammatory effects. The specific phytocompound in M. koenigii responsible for inhibiting P. gingivalis has not yet been identified. Aim: The present study was aimed to identify the Murraya koenigii phytocompounds against Porphyromonas gingivalis proteins using molecular docking and with Molecular dynamics (MD) simulations for the phytocompound Koenigine. The secondary objective was to Evaluate the drug-likeness of Murraya koenigii phytocompounds by assessing its gastrointestinal absorption and compliance with Lipinski’s Rule of Five. Materials and Methods: The present in-silico computational study was conducted in the Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India from October 2024 to November 2024. Predominant phytochemicals, including o-methyl murrayamine, koenigine, koenigicine, and murrayone, were identified from Murraya koenigii. The three-dimensional structures of Porphyromonas gingivalis virulence proteins, gingipain and FimA type 4 protein were retrieved from the Research Collaboratory for Structural Bioinformatics (RCSB) Protein Data Bank (PDB), and molecular docking was performed to predict the binding efficacy of these compounds. Results: Koenigine demonstrated the highest binding affinity of -4.123 kcal/mol, forming a stable hydrogen bond with Ser156 of gingipain. Additionally, koenigine showed strong binding to the FimA type 4 protein, with a docking score of -5.675 kcal/mol, interacting with Asp53 through two hydrogen bonds. Koenigine also exhibited high gastrointestinal absorption, and adhered to Lipinski’s Rule of Five. Conclusion: The present study emphasises the promising therapeutic potential of the phytocompound koenigine from Murraya koenigii in inhibiting P. gingivalis activity associated with periodontitis. Incorporating the active compounds of Murraya koenigii into oral healthcare products, such as mouthwashes and gels, may help reduce the progression of periodontal disease.

Effectiveness of a Multi-intervention Program on Haemoglobin Levels among Adolescent Girls with Anaemia: A Prospective Interventional Study

Kavita Chandrakar, P Thenmozhi, Shreemayee Panda

Introduction: Anaemia continues to be a major health concern among adolescent girls, affecting their growth, cognitive abilities, academic performance, and future maternal and child health. Although iron and folic acid supplementation programmes have been implemented, long-term improvement in haemoglobin levels remains a challenge. Holistic approaches that combine dietary interventions to enhance iron intake, yoga, lifestyle modifications, and health education have proven to be more beneficial in improving overall health and haemoglobin status. Schools provide an ideal platform to effectively deliver such integrated interventions to adolescents. Aim: To evaluate the effectiveness of a structured multi-intervention program-including iron-rich nutritional supplementation, structured health education, and supervised yoga-on haemoglobin levels among adolescent girls with anaemia. Materials and Methods: The present prospective interventional study was conducted among 64 adolescent girls (aged 14- 18 years) with mild to moderate anaemia (Hb 7-12 g/dL) at a government high school in Raigarh, Chhattisgarh, India, from August 2022-January 2023. The 12-week intervention included daily consumption of iron-rich nutritious balls, interactive educational sessions on nutrition, dietary diversification, and menstrual hygiene, and supervised yoga sessions lasting 60-70 minutes, conducted six days per week. Haemoglobin levels were measured at baseline and at 6, 11, and 15 weeks. Paired t-tests and Pearson correlation analyses were used to assess changes over time and the consistency of haemoglobin improvement, with p<0.05 considered statistically significant. Results: At baseline, 51 participants (79.7%) had mild anaemia and 13 (20.3%) had moderate anaemia; no cases of severe anaemia were observed. Mean haemoglobin levels increased steadily from 10.54±0.94 g/dL at baseline to 11.52±0.95 g/dL at 15 weeks. Normal haemoglobin status improved from 0% at baseline to 3.1% at 6 weeks, 12.5% at 11 weeks, and 37.5% at 15 weeks, while moderate anaemia declined to 6.3% by the final assessment. Paired t-tests showed a non-significant change at 6 weeks (t=1.725, p=0.089) but significant improvements at 11 weeks (t=-4.316, p<0.001) and 15 weeks (t=-11.623, p<0.001). Strong positive correlations between baseline and follow-up haemoglobin values (r=0.718-0.781, p<0.001) indicated consistent and stable improvement throughout the intervention period. Conclusion: The current study demonstrated that a combined approach of nutritional supplementation, supervised yoga, and health education produced sustained improvements in haemoglobin levels among adolescent girls with anaemia, shifting many from moderate to mild or normal status within 15 weeks. This holistic, school-based model is practical, effective, and scalable for anaemia management.

Thera-Connect 2K25 International Conference

Pooja Anand

SGT University is a UGC-recognized Institution, established in 2013, that has broad ambitions to promote research, innovation, and multidisciplinary education. Thera-Connect 2K25 International Conference Abstract Proceedings

Role of Physiotherapy in Long COVID Rehabilitation: A Review

Ansh Goyal, Divya, Jyoti Yadav, NK Vidhya

The COVID-19 pandemic has affected everyone on a large scale, even after recovering from the acute phase of infection number of individuals have experienced symptoms such as fatigue, breathlessness, muscle weakness and reduced exercise tolerance. Commonly referred to as long COVID or post covid syndrome. These symptoms affect physical health as well as Psychological, Social well-being and also it affects day to day living of the individual which highlights the need for a comprehensive rehabilitation strategy. This review aimed to highlight the role of physiotherapy in managing long COVID symptoms and improving quality of life. The review was conducted by using the search engines PubMed, Google Scholar, CINHAL and Cochrane. Research articles published from 2020 to date in the English language were considered. Presentations, non-peer-reviewed literature and dissertations were been excluded. Based on the evidence, physiotherapy rehabilitation was assumed to reduce symptoms like dyspnoea, improve lung function, improve mobility, increase exercise capacity and promote functional independence in long COVID patients. Also, individualised programmes enhance endurance and muscle strength. Education on pacing and energy conservation minimise post exertional fatigue. Functional outcome measured through 6- min Walk test, Borg dyspnoea scale and fatigue severity scale shows positive results followed by physiotherapy interventions. Physiotherapy plays a critical role in multidisciplinary Management of Long Covid Rehabilitation programmes. It improves lung function, strength, endurance and overall quality of life. Different rehabilitation programmes, which are designed according to patients' needs, improve the condition of the patient, help in recovery and improve the quality of life. Thera-Connect 2K25 International Conference Proceedings Abstract

Balancing the Unbalanced: Decoding Postural Instability and Role of Early Intervention in Adolescents with Intellectual Disabilities: A Narrative Review

Abhilipsa, Bhavika Yadav, Shweta Sharma

Adolescents with Intellectual Disabilities (ID) frequently struggle with postural instability, or the inability to maintain balance during either static or dynamic activities. Limitations in adaptive behavior and intellectual functioning that start in the developmental years are what that constitute ID. According to a research article published in year 2020, 1-3% of adolescents worldwide suffer from ID, and research indicates that 40 to 57% of them struggle with balance as a result of issues with motor coordination, sensory integration, and cognitive processing. These problems reduce independence and general quality of life by raising the risk of falls and associated accidents. This narrative review looked at 17 peer-reviewed publications that were mostly retrieved from PubMed, Google Scholar, Frontiers, Science Direct, and the Wiley Online Library and were published between the year 2013 and 2024. 12 papers were thoroughly examined and included in the following narrative review. Adolescents with mild to moderate ID who were diagnosed and had documented balance impairments between the ages of 10 and 19 are included in this review study. In conclusion, overall the results show that postural instability is a common and complex problem among adolescents with ID. With the help of Physiotherapy interventions that combine multiple approaches particularly balance training have shown promising results in improving postural control. This review highlights importance of structured, evidence based rehabilitation strategies to reduce fall risk, support mobility, enhance independence and quality of life in this specific population. Thera-Connect 2K25 International Conference Proceedings Abstract

Wearable Technology in Female Athletes: Monitoring Physiology for Individualised Training and Injury Prevention: A Review

Ritika Kinra, Mansi Dewan

Women first competed in the Olympics in Paris in 1900, comprising just 2.2% of athletes. This has grown to 49% in Paris 2024, making the understanding of female-specific performance factors crucial. Sleep, energy expenditure, and menstrual cycle changes significantly influence outcomes, yet individualised monitoring remains a challenge. Wearable devices now enable real-time tracking of these parameters, supporting physiotherapists in optimising recovery, performance, and injury prevention. To investigate how sleep, energy expenditure, and menstrual cycle variations affect female athletic performance and to explore the role of wearable devices in individualised monitoring for adaptive physiotherapy, injury prevention, and performance optimisation. A retrospective review, following PRISMA guidelines, analysed studies on the effects of sleep, energy expenditure, and menstrual cycle changes on sports performance and injury risk. Research on wearables, including the Apple Watch, Fitbit, Oura Ring, Whoop, EmbracePlus, and Empatica E4 were assessed for their role in personalised monitoring and adaptive therapy programmes. Performance and injury risk are strongly influenced by sleep, energy expenditure, and menstrual cycle changes. Each hour of sleep loss raises injury risk by 39%, while low energy availability increases it by 36%. Wearables such as Fitbit and Apple Watch, Oura Ring, which is most reliable for sleep, Whoop for energy expenditure and Empatica E4and Embrace Plus, which monitors menstrual cycle parameters, enable real-time tracking of body temperature, heart rate, heart rate variability, and electrodermal activity. This data guides training: strength and skill work in the follicular phase, peak power during ovulation, endurance and recovery in the luteal phase, and low-intensity focus during menstruation. Evidence supports wearable technology for real-time physiological monitoring, enabling individualised and preventive physical therapy. By adapting training and rehabilitation to sleep, energy, and menstrual cycle variations, physiotherapists can enhance performance, reduce injury risk, and support athletes’ long-term health. Thera-Connect 2K25 International Conference Proceedings Abstract

Comprehensive Paediatric Assessment and Rehabilitation of Spastic Cerebral Palsy with Global Developmental Delay Using the ICF Framework: A Case Study

Disha Gupta, Harshita, Himanshu Gakhar, Pooja Anand

This case report addresses the physiotherapeutic management of a 3-year old boy with spastic cerebral palsy along with global developmental delay, a neurological deficit. The patient presented with a two-year history of developmental delay and progressive musculoskeletal and neurological decline, including muscle spasticity, speech disorders and coordination issues. Cerebral palsy primarily impacts development and growth, which significantly affects the patient’s functional independence. A comprehensive rehabilitation programme was designed to improve the patient’s coordination, mobility and overall functional abilities. The primary goal was to improve the condition by addressing key issues such as strength, gait and coordination. A tailored rehabilitation program was developed, incorporating the ICF framework, which involved weight-bearing and mat activities, stretching, strengthening, gripping exercises, and hippotherapy. He was also referred for speech and occupational therapy. These interventions were designed to target the patient’s specific deficits related to cerebral palsy. Regular assessment ensured adjustments to the therapy, optimising the treatment procedure. Following the rehabilitation programme, the patient demonstrated significant improvement in coordination and mobility. There was a noticeable reduction in cerebral palsy symptoms, including improved coordination and reduced spasticity. The application of the ICF framework combined with exercises may offer a promising approach for managing cerebral palsy symptoms. Further research is required to validate these findings and optimise treatment protocols. Thera-Connect 2K25 International Conference Proceedings Abstract

Sex-specific Association of Sleep Quality with Cardiovascular Markers in Young Adults: A Pilot Study

Khushi Sharma, Paras Khatter, Sahil Yadav, Aditi

Introduction: Sleep quality affects cardiovascular, mental, and reproductive health. However, we know little about the specific factors influencing young adults based on sex. Aim: This pilot study aimed to look at the connections between sleep quality and cardiovascular markers in young adults, focusing on differences between males and females. Materials and Methods: The cross-sectional comparative study included a total of 30 participants and divided the sample into two groups (15 male and 15 female) based on inclusion and exclusion criteria. The study was conducted at the faculty of physiotherapy, S.G.T.U., after receiving informed consent. Standardised blood pressure using the JNC-7 protocol and short-term heart rate variability with a 5-minute recording according to the international Heart Rate Variability (HRV) guidelines were measured. Sleep quality, physical activity, and perceived stress with Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), and Perceived Stress Questionnaire (PSQ), respectively, were assessed. Results: Data were collected in a controlled environment with consistent participant preparation. The obtained physiological and questionnaire data were scored, analysed, and compared across groups to explore differences in cardiovascular and psychosocial parameters. The study explored associations between sleep indices and cardiovascular parameters using Pearson or Spearman correlation as appropriate. We conducted statistical analyses in SPSS (version 26), setting significance at p<0.05. Conclusion: In this pilot sample, sleep disturbances were more significant in females, likely due to hormonal, psychosocial, and circadian factors. These findings support the need for larger studies that consider sex differences and targeted efforts to improve sleep and cardiovascular health in young adults. Thera-Connect 2K25 International Conference Proceedings Abstract

Athlete-Centred Digital Innovation in Sports Injury Management

Kusumita Sood, Himanshi Saini, Shazia Mattu, Sampada S Jahagirdar

The sports sector has witnessed a rapid technological transformation, influencing training, performance, and injury management. Digital tools are increasingly integrated to assess physical demands, support rehabilitation, and enhance overall athletic well-being. This study explores the contribution of digital innovations from 2010 to 2023, highlighting their role as key drivers in reshaping athlete care. This review aimed to apply athlete-centred digital innovations for performance enhancement, injury prevention and detection, personalised rehabilitation, psychological support, inclusivity, data-driven decision making, and athlete empowerment. A focused literature review was conducted through Google Scholar and PubMed using keywords such as “wearable sensors” and “biometric tracking.” Ten peer-reviewed studies published between 2010 and 2023 were analysed to examine recent advancements in digital tools relevant to sports injury management. Wearable devices, biometric monitoring, and motion-tracking technologies are central to athlete-centred digital health. These tools enable continuous monitoring, optimise training regimens, and contribute to early injury detection. Evidence indicates that integrating digital health with sports science improves performance outcomes, supports recovery, and enhances rehabilitation strategies. Innovations such as virtual reality, social media platforms, and online performance tracking provide additional dimensions of support by addressing psychological health, engagement, and accessibility. Digital innovations are redefining approaches to sports injury management and athlete performance. Research highlights their capacity to provide objective measurements, refine training techniques, and promote inclusivity. Athlete-centred applications of these technologies empower individuals, improve recovery processes, and enable data-informed decisions, underscoring their growing significance in modern sports science and healthcare. Thera-Connect 2K25 International Conference Proceedings Abstract

Optimising 100-Meter Sprint Performance through Blood Flow Restriction Training: A Review

Anamika Thakur, Devansh Goswami, Pious Divya, Barnali Bhattacharjee

The 100 m sprint demands exceptional explosive strength, power generation, and rapid recovery. Conventional high-load resistance training (≥80% 1RM) has long been the cornerstone of sprint preparation, but often leads to increased fatigue and musculoskeletal strain. Emerging evidence suggests that Blood Flow Restriction (BFR) training, which combines low-intensity resistance exercise (20-30% 1RM) with controlled vascular occlusion, can elicit comparable hypertrophic and strength adaptations to high-load training while minimising joint stress. This literature review explores the efficacy of low-intensity BFR training as a supplementary modality for improving power output, muscle hypertrophy, and recovery in elite 100 m sprinters. A comprehensive review of peer-reviewed literature from databases including PubMed, Scopus, and Web of Science was conducted. Studies investigating low-load BFR training and its effects on muscular adaptations, performance metrics, and recovery parameters in athletic populations were analysed. Key findings were synthesised to assess the potential transferability of BFR protocols to sprint-specific training contexts. Evidence consistently demonstrates that BFR training induces significant increases in muscle cross-sectional area and strength comparable to high-intensity protocols (Slysz et al., 2016; Patterson et al., 2019). Furthermore, neuromuscular adaptations and enhanced fast-twitch fi bre recruitment under hypoxic stress has been reported, suggesting potential benefits for sprint performance. BFR has also been associated with reduced perceived muscle soreness and faster recovery, likely due to lower mechanical strain and metabolic stressmediated hormonal responses. Limited but promising data indicate improvements in sprint-specific power outputs, such as vertical jump height and short-distance acceleration. Low-intensity BFR training offers a novel, evidence-based adjunct to traditional resistance programs for 100 m sprinters. By promoting hypertrophy and strength adaptations while minimising fatigue, BFR can optimise both in-season performance maintenance and rehabilitation strategies. Future longitudinal studies should investigate the direct impact on sprint times, optimal cuff pressures, and individualised application protocols for elite and youth athletes. Thera-Connect 2K25 International Conference Proceedings Abstract

Tele-physiotherapy: A Sustainable and Innovative Model Redefining Patient-Centred Rehabilitation

Palak Saluja, Pragati, Anushka Kahar

Tele-physiotherapy, defined as the delivery of physiotherapy services through digital communication technologies, has emerged as a transformative solution in modern healthcare. Traditional physiotherapy has relied on in-person assessments and interventions, restricting availability for individuals in distant regions facing movement challenges or during global crises such as the COVID-19 pandemic. With the global rise in chronic diseases and the rapid digital transformation of health services, tele-physiotherapy emerges as a scalable and timely response to the growing demand for accessible, affordable, and patient-centered rehabilitation across diverse healthcare settings. This review aims to explore how tele-physiotherapy addresses these barriers by enabling remote assessments, supervised exercise programs, patient education, and tracking improvement. It also examines its clinical efficacy and factors for integration into routine healthcare. This narrative review synthesises recent evidence on telephysiotherapy and examines advancements in telecommunication and portable digital devices. These innovations support features, including immediate responses from users, individualised exercise programmes, and interactive patient engagement tools. Findings from published studies suggest that telephysiotherapy provides clinical outcomes comparable to conventional in-person therapy for physical activity for those with muscle, nerve, or long-term health issues. Patients report greater adherence, satisfaction, and self-management, while healthcare systems benefit from reduced costs and resource utilisation. Telephysiotherapy further improves accessibility in rural or underserved regions, ensures continuity of care after surgery or in chronic conditions, and supports service delivery during public health emergencies. Challenges include patient selection, digital literacy, and ethical concerns such as data privacy. Tele-physiotherapy represents a sustainable, scalable, and innovative model of rehabilitation that extends beyond crisis-driven solutions. By enhancing accessibility, engagement, and quality of care, it is well-positioned to redefine patient-centred physiotherapy. Its successful integration into mainstream practice requires thoughtful strategies to address technological and moral aspects; upcoming studies need to focus on extended results, cultural adaptability, plus creating uniform guidelines to maximise its global acceptance and effectiveness. Thera-Connect 2K25 International Conference Proceedings Abstract

Musculoskeletal Disorder in Esports Players: A Scoping Review of Prevalence, Risk Factors and Interventions

Shimon Michael Massey, Tripti, Sakshi, Anushree Rai

Esports is a rapidly growing sport that has made gaming a physically demanding task that requires prolonged sitting, repetitive hand movements and static posture. These aspects put players at risk of Musculoskeletal Disorders (MSDs) like overuse injuries in occupational and athletic groups. Despite this growth, musculoskeletal health awareness is still low. The purpose of this scoping review is to examine the prevalence, risk factors, and intervention of musculoskeletal disorders in Esports players. Following the Population, Concept, Context (PCC) framework, this review targets Esports players in the age group of 16-30 years that indulge in competitive, semi-competitive and recreational gaming conditions with prolonged sessions with sustained postures and repetitive hand use on platforms like PC, console and mobile gaming duration between 4 and 12 hours per day. It deals with MSDs such as neck and shoulder pain, low back strain, carpal tunnel syndrome and De Quervain’s tenosynovitis. Most of the studies were cross-sectional surveys taken from PubMed, Scopus, Science Direct, PEDro and Cochrane (CENTRAL) using the keywords: Esports, Musculoskeletal disorders, Repetitive Strain injuries and Physiotherapy interventions, starting from December 2020 to December 2025. The prevalence rates of MSDs were between 55% and 75%, with the neck, shoulders, wrist and lower back being the most affected. Risk factors that were reported were repetitive movements, poor ergonomics and low physical fitness. The MSDs are very common in Esports. Preventative steps like posture correction, periodic breaks and strengthening programmes appear promising but are not empirically proven. Thera-Connect 2K25 International Conference Proceedings Abstract

Future Horizons of Digital Transformation in Sports: A Narrative Review

Shruti Kumari, Shruti Goswami, Tulsi Jaiswal, Shazia Mattu, Sampada S Jahagirdar

Sports digital transformation has evolved through artificial intelligence, wearable technology, virtual reality, and big data analysis. These technologies enhance the performance of athletes as well as the fans, governance, and sustainability. Future perspectives indicate the intersection of innovation with sustainability, inclusion, and economic development, suggesting that digital transformation is an area worth further investigation. A narrative review was conducted, synthesising literature related to sports innovation, sustainability frameworks, governance models, and policy formulation. International case studies, systematic reviews, and insights from major publications like Global Perspectives of Sustainability in Sports Organisations were utilised. A comparative analysis was employed to examine current innovations and developing strategies. Wearable tech, AI analytics, and immersive platforms became the focus of training and performance enhancement. Digital transformation also supports sustainability through lowered resource consumption, inclusive remote engagement, and new economic prospects. Data privacy and fair access concerns persist, while more organisations anchor digital strategies in the UN Sustainable Development Goals. Sports ecosystems in the future will be joined by smart infrastructure, blockchain transparency, and AI-driven decision making. In addition to performance, digital transformation will promote sustainability, governance, and social development. Strong policies and equitable access will be essential to unlocking its full world potential. Thera-Connect 2K25 International Conference Proceedings Abstract

Linking Attention Span and Role of Early Intervention in Children with Intellectual Disabilities: A Narrative Review

Sidharth Mallick, Kalpna, Shweta Sharma

Intellectual Disability (ID) is a condition in which children face difficulties in learning new concepts as well as managing their daily routines. According to a research study in 2022, the prevalence rate of 2% children with intellectual disabilities was reported in India. One of the major issues of children with ID is difficulty staying attentive. Attention span, the ability to focus on a task, is usually lower in these children and this affects learning, social interaction and independence in daily life. This review study was done to explore the role of attention span on the overall functioning of children with ID and highlights the need for early detection and focused interventions. This review utilised PubMed, Google Scholar and Cochrane were used to collect the relevant literature. A total of 17 studies published in 2015-2025 were looked at and 10 were selected after screening and removing duplicates. These were cross-sectional, observational, meta-analytic and narrative review studies. The study indicates that the attention span of children with ID is always shorter than that of typically developing children and severely restricts the performance in school and everyday activities. Meanwhile, research study also indicate that structured training programmes, music therapy, phonological therapy and pictorial supports can be used to reinforce attention and achieve more independence. In general, this review highlights the critical role of attention span as a primary outcome of intervention in children with ID because the improvement of this domain can have a significant impact on learning and quality of life. Thera-Connect 2K25 International Conference Proceedings Abstract

Application of Pune Shoulder Rehabilitation Programme in Treating Scapular Dyskinesis: A Case Study

Aleeza Khan, Pooja Sethi, Shweta Sharma

Scapular dyskinesis refers to abnormal static positioning and dynamic motion of the scapula, often resulting from altered bony stabilisers and impaired muscle activation patterns. These changes disrupt the scapulo-humeral rhythm, leading to functional limitations and shoulder dysfunction. The muscular system, including the pectoralis minor, rhomboids, trapezius and serratus anterior, plays a vital role in maintaining optimal scapular motion and positioning. This case study aims to evaluate the effectiveness of Pune Shoulder Rehabilitation Program (PSRP) in improving scapular alignment, shoulder mechanics and function in an individual with scapular dyskinesis. A 27-year-old male presented with asymmetric shoulder mechanics—anterior translation of the right and posterior translation of the left shoulder during gait. Symptoms began in 2018, after intense shoulder exercises and gradually worsened. Physiotherapy assessment confirmed type II scapular dyskinesis based on Kibler's classification, with an altered scapulo-humeral rhythm and weakness in scapular stabilisers. Assessments included static scapular positioning (acromion-to-wall distance, scapular medial border to T4 spinous process), pectoralis minor length, and MMT-based muscle strength, muscle tightness and shoulder angle analysis via Kinovea software. An 8-week PSRP protocol, administered 5 days/week, emphasised scapular stabilisation, strengthening, postural correction and symmetrical alignment restoration. By the 6th week, notable improvements were observed in acromion and scapular border measurements and pectoralis minor length. By 8th week, shoulder angles and muscle strength showed marked improvement. PSRP effectively improved scapular alignment, muscle strength and shoulder function in a case of scapular dyskinesis. Thera-Connect 2K25 International Conference Proceedings Abstract

Beyond the Game: Micro-Traumas and Their Effect on Hand Health in Esports Athletes

Srishti Nahar, Ravi Shankar, Jyoti, Anushree Rai

Introduction: Esports refers to video games in which teams or individuals compete against each other. It is considered a sporting activity in which players can develop and train their mental skills and handcoordination while playing. India is currently ranked fifth among the list of top countries by game downloads globally. This makes a subset of the population of India extremely vulnerable to the harms associated with excessive digital gaming. Need for this study: The increasing popularity of esports has raised concerns about its impact on musculoskeletal health. Apart from neck, back muscles, and poor posture, arguably, the most essential parts of a gamer’s body are their hands. Aim: The objective of the study is to analyse the muscle activity pattern of wrist flexors, extensors, and thenar muscles using Electromyography (EMG) and to evaluate alterations in hand functioning before and after a prolonged gaming session. Materials and Methods: In the study, 3 separate groups with 10 male participants each, aged 16 to 30 years, will be taken, who will perform different categories of gameplay (MOBA, FPS, SANDBOX). For assessing the grip strength, a hand-held dynamometer and for pinch strength, a pinch gauge will be used. For endurance and speed, the finger tapping test will be used before and after 30 minutes of the match, EMG will be recorded during the gameplay continuously, with electrode placement on the Flexor Carpi Radialis and Extensor carpi Radialis. In Esports, it is generally made to be related to backache, postural changes, neck pain, but the minor changes happening in the wrist are often ignored. These microtraumas do not give any early symptoms, but collectively give difficulty to the individual later in life. Conclusion: Thus, after assessing these parameters, this study will give evidence on the differences in hand functioning, which can be further prevented or corrected to improve the quality of life. Thera-Connect 2K25 International Conference Proceedings Abstract

Effects of ACSM-Recommended Exercise Interventions on Aerobic Capacity in Patients with Stage-2 Hypertension: A Systematic Review

Aditi Jain, Bhumika Chhibber

Introduction: Hypertension remains a major global public health concern, contributing significantly to cardiovascular diseases. While pharmacological therapy is fundamental for blood pressure control, exercise-based interventions have emerged as a crucial non-pharmacological strategy to enhance the cardiovascular function and overall health outcomes. The American College of Sports Medicine (ACSM) provides comprehensive, evidence based guidelines that advocate for regular moderate to vigorous intensity aerobic activities, such as brisk walking, cycling, or swimming, performed on most days of the week to achieve optimal blood pressure regulation and cardiovascular benefits. This systematic review aims to critically study the efficacy of the ACSM-recommended aerobic training protocols in patients with Stage-2 hypertension, with particular emphasis on their impact on aerobic capacity as measured by maximal oxygen uptake (VO2 max) and the Six-Minute Walk Test (6MWT). By synthesising findings from recent clinical trials and exercise interventions, this review seeks to provide an evidence-based understanding of how structured aerobic exercise, aligned with ACSM-based guidelines contribute to improved cardiovascular fitness and functional capacity in hypertensive populations. Aim: This systematic review aims to analyse the effects of ACSM-recommended exercise interventions on aerobic capacity in patients with stage-2 hypertension. The study specifically focuses on the change in aerobic capacity, as quantified by measures such as VO2 max and the 6MWT. Materials and Methods: A systematic review was conducted across PubMed, Scopus, ScienceDirect, Google Scholar for research articles published from 2013 to 2024. This systematic review includes 18 clinical trials and longitudinal cohort studies that assessed the effects of ACSM-based aerobic therapies on aerobic capacity in stage-2 hypertensive patients, analysing the intervention parameters and outcomes. Results: Most trials in this systematic review reported significant improvements in aerobic capacity among stage 2 hypertension patients following ACSM-based exercise protocols. On average, VO2 max increased by 10-18%, with aerobic training performed 3-5 times per week for 30-60 minutes, yielding the most consistent gains. These interventions also improved 6MWT performance and reduced resting blood pressure, reflecting enhanced cardiovascular efficiency. Additionally, supervised High-Intensity Interval Training (HIIT) programmes produced comparable or even greater improvements in aerobic capacity, emphasising the adaptability and effectiveness of ACSM-guided exercise prescriptions for hypertensive individuals. Conclusion: Aerobic training based on ACSM guidelines significantly enhances aerobic capacity in individuals with stage-2 hypertension, contributing to improved cardiovascular health and a more favorable prognosis, as reflected by increased VO2 max and endurance levels. Achieving optimal outcomes depends on an individualised programme design, consistent participation, and sustained adherence. Future research should emphasise the standardised implementation of ACSM principles and investigate long-term adherence and outcomes within this population. Thera-Connect 2K25 International Conference Proceedings Abstract

Association between Anthropometric Measurements and Fatigue, Stress, Anxiety, and Depression among Female Collegiate Students with Polycystic Ovarian Disease: A Cross-Sectional Study

Khushi Raj, Prince Kumar, Garima Lakra, Lalli Singh

Introduction: Polycystic ovarian disease is among the most prevalent hormonal illnesses in young collegiate females. Aside from menstrual and reproductive problems, it is associated with weight gain, insulin resistance, and mental illness. Fatigue, stress, anxiety, and depression are common among women with polycystic ovarian disease, affecting their daily activity and academic performance. Anthropometric indicators, including body mass index, waist-hip ratio, and waist-to-height ratio, are easy but informative measures with which to examine the relationship between body composition and physical and psychological well-being. Aim: This study examines the relationship between anthropometric measurements and fatigue, stress, anxiety, and depression in young collegiate females diagnosed with polycystic ovarian disease. Materials and Methods: A cross-sectional correlational study will be carried out among 40 female students aged 18-25 years, who were clinically diagnosed with polycystic ovarian disease for more than one year. The participants will be chosen by convenience sampling. Anthropometric data will be obtained in conjunction with validated questionnaires-the Fatigue Severity Scale (FSS) and Depression, Anxiety, and Stress Scale (DASS-21). Students with illnesses like thyroid conditions/diabetes or on drugs that influence their weight or cognition will be excluded. Results: We expect that a higher BMI and central adiposity will correlate positively with increased fatigue, stress, anxiety, and depression scores. Conclusion: By linking body composition with psychological wellbeing, this study aims to understand how polycystic ovarian disease affects young collegiate females, to promote early lifestyle changes and mental health support designed for this vulnerable group. Thera-Connect 2K25 International Conference Proceedings Abstract

Association between Forward Head Posture and Impaired Sleep Quality in OTT Users: A Cross-Sectional Study

Tamanna, Anant Tyagi, Himanshu Gakhar

Introduction: The growing popularity of Over-The-Top (OTT) media platforms has led to increased screen time, often accompanied by poor sitting postures, particularly Forward Head Posture (FHP). This postural issue may contribute to physical discomfort and disturbances in sleep. Aim: The present study aims to explore the relationship between FHP and sleep quality in regular OTT users. Materials and Methods: A cross-sectional study was conducted among 200 individuals aged 18-35 years who reported daily OTT usage. FHP was evaluated by measuring the Craniovertebral Angle (CVA) through lateral photographs. Sleep quality was assessed using the standardised Pittsburgh Sleep Quality Index (PSQI). Data were analysed using correlation and regression methods to determine the association between FHP and sleep quality. Result: Our data revealed that the majority of the OTT users belongs to the 24-29 years age group (36%, followed by 30-34 years (28%), 18-23 years (21%), and 35-40 years (15%). This concentration of the younger age group as major OTT consumers proved that students and young adults are predominantly engaged with OTT platforms like Amazon Prime, Hotstar, and YouTube. The correlation analysis of this study revealed a weak and positive correlation between PSQI score and OTT usage (r=0.18). The relationship between OTT usage and CVA was very weak and Negative (r=-0.06). Conclusion: This study found a significant prevalence of FHP and neck pain among people who spend prolonged time watching OTT content, especially those using poor postures on small devices. The research suggests this leads to musculoskeletal issues, and the resulting pain and discomfort is associated with poor sleep quality and disrupted circadian rhythms. It highlights the need for awareness about postural correction and healthy screen-time habits in young adults, and for healthcare professionals to include postural/sleep screening in their practice. Thera-Connect 2K25 International Conference Proceedings Abstract

Investigating Clinical Outcomes of Physiotherapeutic Intervention in Shoulder Impingement Syndrome: A Case Series

Deepika Patel, Bhumija Singh Sisodia, Prachi Sathe, Divya Khare

Shoulder Impingement Syndrome (SIS) is a common cause of pain and dysfunction in the shoulder in the active young adult population who participate in overhead activities, primarily resulting from compression of subacromial structures and rotator cuff pathology. It includes two main pathologies: subacromial impingement and internal impingement. This case series aimed to investigate the effectiveness of physiotherapy interventions, including functional rehabilitation and agility exercises to improve pain, range of motion and functional outcomes in patients with SIS. Five patients (aged 30-45 years old) with SIS were included. For confirmation of the SIS, Neer’s impingement test and Hawkins- Kennedy test were applied. Other tests, such as the painful arc syndrome test, drop arm test, and internal rotation strength test was applied for differential diagnosis. The shoulder range of motion by the Goniometer, functional outcome measures by Disability of Arm, Shoulder and Hand (DASH) questionnaire, Shoulder Pain and Disability Index (SPADI), and pain intensity using the Visual Analogue Scale (VAS) before and 6 weeks after the treatment were assessed. Results revealed a significant improvement observed in all outcome measures (p<0.05). The pre- and postintervention values (mean±SD) were VAS (6.60±1.140 to 2.00±0.707), SPADI (65.80±7.190 to 17.80±2.280), DASH (61.80±6.017 to 21.40±2.608), fl exion range (87.80±10.25° to 167.00±9.434°), extension range (29.60±3.209° to 52.20±6.058°), external rotation range (24.80±6.380° to 57.60±8.325°), and abduction range (65.00±15.811° to 136.00±19.812°). These results suggest that a structured physiotherapy programme incorporating special test-guided assessment, agility training, and functional exercises are effective in reducing pain, improving shoulder function, and enhancing the Range of Motion (ROM) in individuals with SIS, thereby facilitating a safe return to daily and overhead activities. Thera-Connect 2K25 International Conference Proceedings Abstract

Respiratory Muscle Training and Shoulder Conditioning for Optimising Ventilatory and Functional Performance in Young Cadets: A Narrative Review

Riya Kumari, Neha Reyalch, Himanshu

Optimal ventilatory function and functional performance are crucial for National Cadet Corps (NCC) cadets to meet physical training demands. Respiratory Muscle Training (RMT) using devices like the Aerofit trainer and shoulder flexibility and strengthening exercises have individually shown benefits in enhancing pulmonary function and musculoskeletal performance. However, limited research exists on their combined effects in cadet populations. This narrative review synthesised existing literature on RMT and shoulder conditioning interventions in young adults, athletes, and military personnel. Databases including PubMed, PMC, and Google Scholar were searched using keywords: “Aerofit respiratory trainer,” “respiratory muscle training,” “shoulder flexibility,” “strengthening exercises,” “ventilatory function,” and “functional performance.” Studies assessing pulmonary outcomes (FEV, FVC, inspiratory muscle strength) and functional performance measures (6-minute walk test, endurance tests) were included. Evidence gaps and potential synergistic mechanisms were identified. RMT significantly improves inspiratory muscle strength and exercise capacity. Shoulder flexibility and strengthening exercises enhance thoracic mobility, posture, and accessory respiratory muscle recruitment. Limited studies explored combined interventions, but evidence suggests a potential synergistic effect on ventilatory efficiency and functional endurance. Cadet-specific research is sparse, highlighting the need for randomised controlled trials in this population. Integrating aerofit respiratory training with shoulder flexibility and strengthening exercises may offer a promising approach to improve both ventilatory function and functional performance in NCC cadets. This review identifies a clear research gap and provides a rationale for conducting RCTs to determine efficacy and implementation strategies in cadet training programs. Thera-Connect 2K25 International Conference Proceedings Abstract

Effect of Diaphragmatic Breathing vs Mindful Breathing Practice on Attention Span, Reaction Time and Short-Term Memory in University Students: A Study Protocol

Priyanshi, Sheetal Kiroula, Antriksh, Ankita

Introduction: It is well acknowledged that breathing exercises are simple ways to improve cognitive abilities. The mindful breathing enhances executive functioning and attention control and diaphragmatic breathing promotes parasympathetic activation and stress reduction. Need for this Study: There is, however, no data that explicitly compares how well they perform on important cognitive domains among college students. Aim: The purpose of this study is to evaluate the effects of mindful breathing versus diaphragmatic breathing in university students short-term memory, attention span, and reaction time. Material and Methods: At SGT University, a comparative experimental design will be carried out among healthy students between the ages of 15 and 25 years. Participants will be randomly allocated into two groups: Diaphragmatic breathing and mindful breathing. Each group will undergo a 10-minute guided session of their assigned breathing technique. Cognitive performance will be assessed pre- and post-intervention using standardised tools: Digit Span Test (for attention and short-term memory), Ruler Drop Test (for reaction time), and the Mindful Attention Awareness Scale. Data will be analysed to compare within-group and between group changes. Results: The result will be declared on the day of the paper presentation, and the work is still in progress. Thera-Connect 2K25 International Conference Proceedings Abstract

Virtual Reality Therapy for Motor, Balance, and Cognitive Outcomes in Neurological Disorders: A Systematic Review

Pooja Rani, Aparna Bararia, Jashandeep Kaur

Introduction: Virtual reality therapy (VRT) has emerged as an innovative approach in neurorehabilitation, offering immersive and engaging environments that enhance engagement, motivation and functional recovery. Neurological disorders such as stroke, Parkinson’s disease, Multiple Sclerosis (MS), Cerebral Palsy (CP), and Traumatic Brain Injury (TBI) result in severe motor, cognitive, and functional impairments. Conventional physiotherapy is effective but often limited by patient adherence and lack of task-specific training, VRT easily overcomes these challenges through the gamification of the rehabilitation protocols. Aim: This systematic review of randomised controlled trials evaluating the effects of VRT across major neurological conditions, focussing on functional, motor, balance, cognitive, and quality-of life outcomes. Materials and Methods: A systematic review of randomised controlled trials published between 2021 and 2024 was performed. Twenty eligible trials with PEDro scores ranging from 5 to 7 were included. The studies enrolled diverse populations, from children with cerebral palsy to adults with stroke, Parkinson’s disease, MS and TBI. VRT platforms included Adapt Rehab VR, PRISMA, Oculus, Unity, and EPIC, with interventions ranging from 4 to 12 weeks. Outcomes assessed included upper and lower limb motor recovery, balance, gait speed, cognitive function, swallowing, and activities of daily living. Results: In stroke populations, VRT improved upper limb motor scores, gait speed, balance, independence, and recovery from neglect and dysphagia. Parkinson’s trials demonstrated enhanced gait, reduced freezing of gait, and improved Unified Parkinson’s Disease Rating Scale (UPDRS) and balance confidence. MS patients benefited from VR exergaming with reduced fatigue, better balance, and cognitive gains. Paediatric CP trials showed significant improvements in gross motor function and upper limb active range of motion. In TBI, VR cognitive rehabilitation improved attention and memory performance. Across conditions, VRT was consistently safe and well-tolerated, with outcomes superior or comparable to conventional therapy. Conclusion: Evidence from randomised controlled trials supports VRT as an effective, engaging, and feasible adjunct to conventional rehabilitation in neurological disorders. Benefits span motor, balance, cognitive, and functional domains, although long-term efficacy and standardised protocols require further study. Thera-Connect 2K25 International Conference Proceedings Abstract

Laser and Regenerative Therapies for Striae Distensae and Striae Alba: A Systematic Review of Comparative Efficacy

Shagandeep Singh, Aparna Bararia

Introduction: Striae distensae and striae alba are common dermatological conditions with significant cosmetic and psychosocial impact. Despite multiple treatment approaches including lasers, light therapies, microneedling, and regenerative techniques, a consensus on the most effective modality remains unclear. Advances in laser technology and adjunctive regenerative treatments such as platelet-rich plasma and stem cell-derived products have prompted numerous clinical trials to evaluate comparative efficacy. Aim: This review aimed to synthesise evidence from randomised controlled studies evaluating various therapeutic modalities for striae management and to identify the most promising interventions. Materials and Methods: A systematic review of randomised controlled trials and comparative clinical studies published between 2012 and 2025 were performed. Databases including PubMed, Google Scholar and NCBI were searched using keywords related to striae treatment and lasers, light therapy, or regenerative approaches. Eight eligible studies with PEDro scores ranging from 5 to 8 were included, assessing modalities such as Poly-L-Lactic Acid (PLLA), Er: YAG, diode and Nd: YAG lasers, fractional CO2, Intense Pulsed Light (IPL), microneedling, and regenerative adjuncts, including Stromal Vascular Fraction (SVF), Platelet Rich Plasma (PRP) and Mesenchymal Stem Cell (MSC)-conditioned medium. Results: PLLA and its combination with NAFL demonstrated superior outcomes compared to laser monotherapy. Er: YAG combined with SVF yielded the best improvement compared to PRP or saline. Diode LLLT showed comparable results to fractional CO2 with mixed outcomes when combined. Long-pulsed Nd: YAG was slightly superior to fractional CO2. Nd: YAP and fractional CO2 lasers consistently produced significant improvement and safety. Fractional CO2 was superior to topical tretinoin. Microneedling with MSC-conditioned medium significantly outperformed the control. Conclusion: Evidence suggests that laser-based therapies, particularly fractional CO2, Nd:YAG, and Nd:YAP, provide significant clinical improvement in striae, with enhanced outcomes when combined with regenerative adjuncts such as PLLA, SVF, or MSC-conditioned medium. While these interventions are generally safe and effective, further standardised, large-scale trials are warranted to establish optimal protocols and long-term outcomes. Thera-Connect 2K25 International Conference Proceedings Abstract

Novel Therapeutic Approaches for Spinal Cord Injury: A Systematic Review

Ritu Raj, Aparna Bararia

Introduction: Spinal Cord Injury (SCI) results in profound motor, sensory, and autonomic impairments that limit independence and quality of life. Conventional rehabilitation approaches provide partial recovery but often fail to optimise cardiovascular health, ambulation, and psychosocial outcomes. Recent advances in exercise, neuromodulation, exoskeleton robotics, and hybrid Functional Electrical Stimulation (FES) has expanded opportunities for functional recovery. Aim: This systematic review aimed to synthesise evidence from randomised controlled trials and related protocols investigating rehabilitation interventions in adults with acute, subacute, and chronic SCI, highlighting their efficacy across motor, cardiovascular, and quality-of-life domains. Materials and Methods: A systematic review of Randomised Controlled Trials (RCTs) and pilot studies published between 2021 and 2024 were conducted. Databases, including PubMed and Google Scholar, were searched using terms related to SCI rehabilitation, locomotor training, FES, exoskeletons, neuromodulation, and virtual exercise. Twenty relevant studies were included, with sample sizes ranging from pilot cohorts to multi-site trials, and interventions including hybrid FES rowing, Trans-spinal Stimulation (TSS), exoskeleton-assisted walking, progressive resistance training, blood flow restriction exercise, and virtual or tele-exercise programmes. Results: Hybrid FES interventions improved cardiovascular parameters and body composition, although neurological recovery remained limited in some trials. TSS combined with locomotor training enhanced walking independence and plasticity compared to sham. Exoskeleton training consistently improved ambulatory outcomes, especially in incomplete and subacute SCI, with metaanalysis confirming greater benefit in patients less than six months post-injury. Progressive resistance training with FES increased strength and muscle volume, while blood flow restriction promoted hypertrophy without major strength gains. Virtual and tele-exercise programmes demonstrated feasibility and improved activity levels. Behavioural care models reduced pain, depression, and improved quality of life. Conclusion: Rehabilitation strategies combining advanced technologies such as FES, TSS, and exoskeleton robotics with conventional therapy signifi cantly enhance functional outcomes and cardiometabolic health in SCI. While feasibility is established, large-scale standardised trials are required to optimise protocols and tailor interventions to injury stage and severity. Thera-Connect 2K25 International Conference Proceedings Abstract

A Literature Review on Transcutaneous Electrical Nerve Stimulation: A Non-Pharmacological Option for Labour Pain Management

Brahmleen Bajaj, Shweta Kumar, Kangna Juneja Kansal

Labour pain represents one of the most intense forms of acute discomfort encountered during childbirth, prompting widespread dependence on pharmacological interventions like epidural analgesia. However, such methods may introduce notable side effects throughout the birthing process. In seeking alternative strategies focused on safety and maternal welfare, Transcutaneous Electrical Nerve Stimulation (TENS) has gained attention as a viable, non-drug-based method for alleviating pain during labour. Through specific nerve stimulation pathways, TENS enables the natural release of analgesics, offering meaningful symptom relief while permitting greater mobility. This review aims to assess and compare the effectiveness of TENS with standard epidural analgesia in reducing pain intensity among women in active labour, focusing on maternal satisfaction and birthing outcomes. A comprehensive literature review was performed using recent peer-reviewed studies (2020-2025) examining TENS during labour. Reviewed articles included randomised controlled trials and observational research, with emphasis on method parameters, outcome measures, and comparison groups. The studies evaluated both subjective (pain scores, satisfaction) and objective (delivery type, complications) outcomes. Studies involving more than 2,500 participants found TENS can effectively reduce pain during childbirth when administered at high frequency and low intensity. Maternal satisfaction rates were comparable to, or higher than, those using pharmacological approaches, and TENS did not lead to an increase in complications or adverse neonatal outcomes. Although epidural analgesia was associated with greater absolute pain relief, TENS was preferred by participants valuing mobility and reduced side effects. TENS provides a safe and efficient alternative for pain management in labour, particularly beneficial for individuals seeking drug-free methods or when epidural use is not advised. Clinical best practices should include patient education, careful protocol adherence, and individualised application. Thera-Connect 2K25 International Conference Proceedings Abstract

Influence of Scapular Stabilisation and Cervical Spine Alignment on Rotator Cuff Function: A Systematic Review

Aditi Dimri, Bhumika Chhibber

Introduction: The shoulder complex relies on precise interaction between the rotator cuff, scapula, and cervical spine to maintain dynamic stability and mobility. Dysfunction in either scapular control or cervical alignment—such as forward head posture or scapular dyskinesis—can alter neuromuscular activation, reduce subacromial space, and overload the rotator cuff. Conventional rehabilitation often emphasises isolated rotator cuff strengthening; however, growing evidence highlights the value of integrating scapular stabilisation and cervical postural correction. Aim: This review aimed to evaluate the influence of scapular stabilisation and cervical spine alignment on rotator cuff function, and to determine the clinical impact of combined interventions in shoulder rehabilitation. Materials and Methods: A systematic literature search was conducted in PubMed, Scopus, PEDro, and Web of Science using keywords including scapular stabilisation, cervical spine alignment, rotator cuff function, and shoulder rehabilitation. Studies involving adults (≥18 years) with clinically or radiologically confirmed rotator cuff tears and functional limitations were included. Both conservative and surgical management studies were considered. Exclusion criteria were previous shoulder surgery (unless postoperative trials), other shoulder pathologies, neurological disorders, systemic inflammatory diseases, fractures, infections, tumors, or non-compliance with protocols. Results: Across studies, poor scapular stabiliser strength and altered kinematics were consistently associated with impaired rotator cuff efficiency and increased impingement. Cervical malalignment, particularly forward head posture, was shown to disrupt scapulohumeral rhythm and increase upper trapezius dominance. Interventions incorporating scapular stabilisation (serratus anterior and lower trapezius activation) alongside cervical postural correction demonstrated greater improvements in pain, range of motion, and functional performance than isolated cuff strengthening. Electromyography (EMG) trials further confirmed enhanced muscle recruitment when scapular activation preceded rotator cuff engagement. Conclusion: This review emphasises that optimal rotator cuff rehabilitation should not be limited to isolated strengthening but must integrate scapular stabilisation and cervical alignment strategies. Such a holistic physiotherapy approach improves neuromuscular control, accelerates recovery, and reduces recurrence. Incorporating cervical and scapular assessment into routine shoulder rehabilitation protocols is strongly recommended to enhance clinical outcomes and long-term function. Thera-Connect 2K25 International Conference Proceedings Abstract

Exploring the Approaches of Performance Enhancement by Plyometric Exercise in Badminton Players: A Systematic Review

Khushi Vats, Isha Gupta, Priyanka Siwach

Introduction: Plyometric exercises are widely used nowadays for athletes. Badminton is a sport that requires many performance parameters like agility, endurance and power with good reaction time, etc. Plyometrics includes high-intensity and velocity activities to improve power, speed, agility and endurance of an individual. Aim: To perform a systematic review to evaluate how effective plyometrics would be for increasing these performance parameters in badminton players. Materials and Methods: A comprehensive search was conducted across PubMed and Google Scholar for randomised controlled trials published between 2015 and 2025. Studies were screened through titles, abstracts and full texts based on predefined eligibility criteria. Result: Included articles and research have shown us the significant increase in performance in the badminton players by affecting their power, agility, speed and endurance by giving some weeks of plyometric training. The data was collected pre and post the training given. Some studies have also given positive effects on balance and control. Conclusion: Plyometric exercises are an effective method for improving the performance parameters, including power, agility, speed and endurance of badminton players. Large well-designed trials are present to prove the above-mentioned data. Thera-Connect 2K25 International Conference Proceedings Abstract

Impact of Smartphone Usage Patterns on Cognitive Outcomes in University Students: A Narrative Review

Shimon Michael Massey, Preeti, Priya Dagar, Himanshu Gakhar

Smartphones have become a vital aspect of university life, which facilitates academics, social communication, and entertainment. However, the cognitive consequences of such extensive use remain unclear, especially when we take into account the purpose of smartphone use, whether academic, social, or recreational. This narrative review examines the impacts of such smartphone use patterns on cognitive performance, indicating reaction time, decision making, and dual-task performance among university students. The sources of the relevant studies include platforms like PubMed, ScienceDirect, Scopus, Cochrane, and PEDro databases. Eleven articles were shortlisted from the twenty that met the inclusion criteria of being published between 2015 and 2025 and they were screened to ensure relevance and avoid duplication. Articles included were mostly cross-sectional, correlational, observational, and meta-analytic in design. The results show that long-term recreational and multitasking smartphone use is linked to sluggish reaction times, an increase in dual-task costs, and loss of executive control. Research on decision-making has shown a greater prevalence of impulsivity and preference for immediate rewards, and late-night use being linked to poor quality of sleep and diminished attention. Whereas study-related and well-organised smartphone usage shows neutral or adaptive impacts, potentially enhancing sustained attention when intentional. Taken together, it is likely that cognitive inefficiency is more about context and intent of use than duration. Neurocognitive hypotheses refer to prefrontal fatigue, dopaminergic system desensitisation, and impaired circadian regulation. More longitudinal studies, which combine purpose-specific smartphone measurements and standard cognitive measures, are required to clarify the causal relationship and digital behaviour interventions in university students. Thera-Connect 2K25 International Conference Proceedings Abstract

Understanding Posture-Pain Dynamics in Ankylosing Spondylitis: A Narrative Review

Reetuja, Akanksha Pal, Muskan Kumari, Lalli Singh

This review article responds to the question of whether postural changes in Ankylosing Spondylitis (AS) represent a cause, consequence, or aggravating factor of pain. AS is a chronic inflammatory disease of the axial skeleton that results in progressive stiffness, structural deformity, and functional impairment. Postural changes such as thoracic hyperkyphosis, forward head posture, loss of lumbar lordosis, and sagittal imbalance are frequently observed and are thought to contribute to mechanical strain, impaired mobility, and increased pain. However, the precise nature of the relationship between posture and pain in AS remains uncertain. This review summarises current evidence from randomised controlled trials, biomechanical studies, and systematic reviews published over the past two decades. Evidence indicates that abnormal postural alignment is uniformly linked to increased pain intensity and lower quality of life. Evidence states that intervention in maintaining movement, spinal mobility, and functional exercise is a more significant contributor to pain reduction and quality of life compared to static posture correction alone. However, heterogeneity of methods, limited follow-up, and absence of standardised postural assessment tools confound the quality of existing evidence. In summary, although posture seems to be strongly associated with pain in AS, it is still uncertain whether postural deviation is a diseaserelated consequence or an underlying cause of pain. Longitudinal and methodologically sound studies are needed to better establish causality and to refine posture-based rehabilitation in this patient group. Thera-Connect 2K25 International Conference Proceedings Abstract

Effects of Exercise Interventions on Fatigue-Related Myalgia Associated with Postpartum Depression: A Narrative Review

Ritika Saini, Himanshu Gakhar, Saurabh Kumar

Postpartum Depression (PPD) often occurs within the first year after childbirth and is commonly accompanied by fatigue and muscle pain (fatigue-related myalgia). These symptoms can negatively impact a mother’s emotional well-being and ability to care for her baby. While medication is available, many women prefer non-drug treatments such as exercise. This review explores how structured physical activity may help reduce postpartum fatigue and depressive symptoms. The impact of exercise on postpartum women’s depression and fatigue is examined in this narrative review. Randomised Controlled Trials (RCTs), systematic reviews, and meta-analyses were the main topics of the studies that were gathered from PubMed, ScienceDirect, the Cochrane Library, and Web of Science. Included studies tested structured exercise programmes such as aerobic training, yoga, aquatic therapy, relaxation techniques, or a combination of these, and specifically looked at postpartum women. They also used validated tools to measure fatigue, myalgia, or depressive symptoms. The studies with unclear results or unstructured activities were excluded. The review compares the types, frequency, and duration of exercise to determine what works and where there is still a lack of evidence. The findings show that moderate-intensity exercises—such as Pilates, walking, aerobic workouts, and aquatic routines—consistently improved fatigue, depressive symptoms, sleep quality, and functional ability in postpartum women. The most effective programmes were those that lasted 6-12 weeks and were supervised or performed in group settings. Home-based or low-intensity routines were generally less effective. Supervised and group-based exercise interventions provided both physical and psychological benefits, helping to reduce symptoms of fatigue and depression. Key factors influencing success included exercise type, intensity, duration, and consistency. Long-term participation and support were also crucial in maintaining results, and group settings offered added emotional and social benefits. Structured, moderate-intensity exercise is a safe and effective strategy to manage postpartum fatigue and depression. It should be included as part of routine postnatal care. Future research should focus on identifying the most effective exercise formats and ways to encourage ongoing participation, particularly among women at high risk for postpartum mental health issues. Thera-Connect 2K25 International Conference Proceedings Abstract

Blending Yoga with Modern Sports Science - Ancient Wisdom, Modern Performance: A Review

Ankita, Gaurav Kadyan, Sadhan Berry

Yoga is an ancient Indian discipline that focusses on body, mind, and spirit harmony. In contrast, modern sports science optimises athletic performance by utilising psychology, physiology, and biomechanics. A comprehensive model for improving physical fitness, recuperation, and mental health is offered by combining these two strategies. The relationship between yoga and sports science in modern athletic training is examined in this abstract. This review aimed to evaluate the role of yoga when blended with modern sports science in improving physical performance, psychological resilience, and rehabilitation outcomes in athletes. Databases like PubMed, Scopus, and Google Scholar were used to review pertinent research published between 2015 and 2024. Yoga interventions in athletic or physically active populations were the subject of reviews, experimental studies, and randomised controlled trials. Flexibility, strength, endurance, mental focus, cardiorespiratory efficiency, and recovery speed were among the outcomes that were examined. Several advantages of integration were identified by the analysis- • Flexibility & Injury Prevention: Yoga poses improved joint mobility and decreased strain on the musculoskeletal system. • Breathing Efficiency & Endurance: Pranayama increased stamina and lung function. • Mental Focus & Stress Reduction: Meditation techniques helped people perform at their best under pressure, reduced anxiety, and improved concentration. • Recovery & Rehabilitation: Yoga reduced delayed muscle soreness, enhanced balance, and sped up post-exercise recovery. • Performance Improvement: Yoga resulted in quantifiable gains in agility, posture, and coordination when paired with sports science concepts like strength training and biomechanics. Yoga’s integration with modern sports science provides an evidence-based, culturally grounded, and long-lasting approach to athlete development. It supports both elite and grassroots sports by boosting mental and physical capabilities. In the context of contemporary athletics, this hybrid approach offers a progressive model for comprehensive training and recovery. Thera-Connect 2K25 International Conference Proceedings Abstract

The Athelete’s Nightmare: A Comprehensive Review of Quadriceps Contusion Grading and Rehabilitation Strategies: A Scoping Review

Vankita Tandon, Sadhan Berry, Gaurav Kadhyan

Among the most prevalent catastrophic injuries in contact sports are quadriceps contusions, which can result in functional impairment, extended playtime absences, and possible long-term complications like myositis ossificans. To maximise recovery, reduce recurrence, and guarantee a safe return to sports, accurate grading and prompt rehabilitation are essential. However, evidence-based clinical decision-making is impeded by variations in grading schemes and rehabilitation procedures. This review aimed to synthesise existing literature, providing a practical assessment of the strengths and weaknesses of current systems for grading and managing quadriceps muscle injuries. A scoping review of 24 peer-reviewed studies were conducted using databases including PubMed, Scopus, and Google Scholar from 2015 to 2025. Relevance, methodological accuracy, and clinical outcomes were the criteria used to screen the studies. To compare grading standards, diagnostic methods, and rehabilitation frameworks, data were thematically synthesised. Three main grading schemes were identified by analysis: hybrid classifications, imaging-assisted (MRI, ultrasound), and clinical severity-based. Considering that it is accessible, clinical grading is still the most popular method, but in more serious cases, imaging improves diagnostic accuracy. Early pain management, progressive strengthening, gradual range-of-motion exercises, and sport-specific drills were all consistently emphasised in rehabilitation strategies. Adjunct modalities like cryotherapy, neuromuscular stimulation, and blood flow restriction training has been shown to improve recovery in recent studies. Athletic performance is still significantly hampered by quadriceps contusions, and clinical results are impacted by inconsistent grading and rehabilitation techniques. Even though multimodal, progressive rehabilitation produces positive outcomes, there is an urgent need for agreement on evidence-based grading and protocol standardisation. To maximise athlete recovery and return-to-sport timelines, future research should concentrate on high-quality trials combining objective biomarkers, cutting-edge therapeutic modalities, and advanced imaging. Thera-Connect 2K25 International Conference Proceedings Abstract

Comparative Effect of Plyometric Training versus Sportsmetrics Jump Training on Explosive Strength, Speed and Agility in Under-18 Basketball Players: A Systematic Review

Disha Bansal, Gaurav Kadyan

Introduction: Explosive strength, speed, and agility are critical components of athletic performance. Although plyometric training and the Sportsmetrics jump training programme are widely used plyometric exercises, to enhance these attributes, yet no studies have directly compared their effectiveness in adolescent basketball players. Aim: This study aims to systematically review the comparative effects of plyometric training versus the Sportsmetrics jump training programme on explosive strength, speed, and agility in under-18 basketball players. Material and Methods: Following the PRISMA 2020 guidelines, a systematic electronic search was conducted across PubMed, ResearchGate and Google Scholar databases from July to August 2025. Eligible studies were those that evaluated the effects of either the plyometric training or the Sportsmetrics jump training programme in male or female basketball players under-18 years of age, reported at least one outcome measure of interest, and were published in the English language. Risk of bias was assessed using the PEDro scale (RCTs) and Newcastle-Ottawa scale (non-RCTs). The protocol has been registered in PROSPERO 2025 (ID:CRD420251146587). Results: A total of six studies were included, which enabled the outcomes of plyometric training (n=5) and the Sportsmetrics jump training (n=1) programmes to be narratively synthesised. The results indicated that plyometric training showed significant improvement in explosive strength, but low to moderate effects in speed and agility, while the single Sportsmetrics study reported enhancement in explosive strength. Conclusion: Plyometric training demonstrated consistent effects on explosive strength, speed and agility, while the Sportsmetrics jump training programme showed potential benefits, but evidence was limited to a single study. Hence, further trials directly comparing the two interventions are needed to establish their relative effectiveness in under-18 basketball players. Thera-Connect 2K25 International Conference Proceedings Abstract

Intelligent Wearable Device the Future of Sports Medicine: A Narrative Review

Radhika, Stuti Khanna, Garima Wadhwa

Injuries resulting from sports can pose a substantial problem for players’ economic well-being and quality of life. A new age of proactive injury prevention has begun with the recent integration of Artificial Intelligence (Al) and Inertial Measurement Unit (IMU) devices. IMU provides real-time objective data on the athletes’ movement, fatigue and workload allowing early detection of overuse or improper technique. These sensors combine accelerometers, gyroscope and magnetometers to track acceleration, orientation and direction. Al provides valuable direction for the analysis of this data to make adjustments to the training. This review aimed to explore the impact of Al and IMU wearables in sports physiotherapy to provide sports performance monitoring, prevention of injury and optimisation in training. The databases PubMed, Google Scholar and Science Direct were researched thoroughly, duplicates were removed and final data were extracted. The database search yielded a total of 250 articles, of which only five met the inclusion criteria. AI-powered wearables have enabled athletes to have better athletic performance, physiological efficiency and reduced injury risk. Al assisted training increased sprint speed, endurance, and shortened muscle recovery time and prevented injury, which ultimately raised athletes’ performance. Al and wearable technology have completely transformed sports training from injury prevention and diagnosis to recovery and performance enhancement. Thera-Connect 2K25 International Conference Proceedings Abstract

Enhancing Balance and Mobility Rehabilitation in Diabetic Neuropathy through Virtual Reality: A Review

Alwia Saeed, Stuti Khanna, Garima Wadhwa

Diabetic Peripheral Neuropathy (DPN) is a prevalent complication of diabetes characterised by sensory deficits, proprioceptive loss, neuropathic pain, and gait disturbances, which significantly impair functional independence and increase fall risk. Conventional physiotherapy addresses these impairments but may be limited by low patient engagement and insufficient sensory feedback. Virtual Reality (VR) provides immersive, interactive environments that enhance motor learning, sensory integration, and neuroplasticity, thereby offering potential therapeutic advantages in DPN rehabilitation. A scoping review was conducted following the framework of Arksey and O’Malley. Electronic databases including PubMed, PEDro, Scopus were systematically searched using relevant key terms. Studies were screened by title and abstract, and those evaluating VR interventions in individuals with DPN were included. Data on participant characteristics, intervention protocols, and outcomes were descriptively analysed. A total of 243 records were identified, with nine studies meeting inclusion criteria. VR interventions demonstrated significant improvements in postural stability, gait parameters, sensory feedback, pain modulation, and functional mobility compared to conventional therapy alone. VR shows considerable potential as an adjunct to physiotherapy for DPN rehabilitation. Further randomised controlled trials are required to establish standardised protocols and long-term efficacy. Thera-Connect 2K25 International Conference Proceedings Abstract

Exercise-Driven Brain Adaptation: Unlocking Athlete Cognition and Neuroplasticity: A Narrative Review

Pragati Parwal, Stuti Khanna, Garima Wadhwa

Neuroplasticity is the brain’s lifelong capacity to reorganise, driving habit formation, skill learning, and recovery. In sports, it supports motor learning, coordination, reaction time, and skill refinement. Repetitive, task-specific practice strengthens the motor cortex and enhances brain muscle communication. This review aims to explore the role of neuroplasticity in sports training with a focus on motor learning, skill acquisition, performance, and rehabilitation. A narrative review was conducted. Databases including PubMed, Google Scholar, Research Gate, and ScienceDirect were searched for studies published between 2017 and 2025 using key terms. Identified publications were searched by title and abstract. The database search yielded a total of 345 articles of which only 10 met the inclusion criteria. Training induces neuroplastic changes, improving cortico-spinal connectivity, coordination, and reaction time. Open-skill sports enhanced decision-making and attention, while closed-skill sports improved precision and memory. Case evidence and experimental studies confirmed cortical reorganisation through task-specific practice. Neuroplasticity also supported rehabilitation, emotional adaptation, and return-to-play. This review concludes that exercise induces neuroplastic changes which significantly improves the performance of athletes. Thera-Connect 2K25 International Conference Proceedings Abstract

Exercise Interventions Targeting Physical Fitness, Cardiovascular Outcomes and Body Composition in Early Adulthood Obesity: A Systematic Review

Simran Sethi, Priyanka Rishi, Lalli M. Singh

Introduction: Obesity during early adulthood is a growing public health concern, strongly associated with an increased risk of developing chronic conditions such as cardiovascular disease, reduced physical functioning, and unfavorable body composition. A clearer understanding of these outcomes is essential to optimise prevention and treatment strategies for obesity-related complications in this age, which is determined by different modes of exercise in this systematic study. Aim: This systematic review aimed to evaluate and synthesise evidence from Randomised Controlled Trials (RCTs) assessing the effects of structured exercise interventions on physical fitness parameters, cardiovascular outcomes and anthropometric measures in obese individuals. Materials and Methods: The PubMed, Scopus and Google Scholar databases were utilised to search for the literature. Titles, abstracts and subsequently the full texts were screened to identify papers that met the inclusion criteria. The methodological quality of the studies was assessed on the 11-point PEDro scale. Risk of Bias assessment was carried out using the Risk of Bias 2 (RoB 2) tool in Cochrane review tools. Studies were included. Results: Ten studies met the inclusion criteria. This indicated that exercise interventions, especially combined aerobic and resistance training, significantly improved VO2 max and muscular strength in physical fitness, cardiovascular benefits included reductions in systolic and diastolic blood pressure and resting heart rate. Anthropometric benefits comprised reductions in body weight, Body Mass Index (BMI) and waist circumference. Combined training was always made superior to aerobic or resistance training alone for all outcomes assessed. Conclusion: Exercise interventions present, especially those that include both aerobic and resistance training are effective in enhancing physical fitness, cardiovascular indices, and body composition among obese young adults. The evidence provides support for the inclusion of structured exercise as a key component of obesity treatment during early adulthood, but furthermore, studies are needed to confirm long-term effects and outcomes. Thera-Connect 2K25 International Conference Proceedings Abstract

Efficacy of Square Stepping Exercises versus Conventional Balance Training on Balance, Gait Speed and Fear of Fall among Frail Individuals: A Pilot Study

Aman Kanda, Mansi Mittal, Adarsh Sharma, Sampada Jahagirdar

Introduction: Frailty is a state of increased vulnerability due to agerelated decline across multiple systems, often leading to walking difficulties and higher fall risk. Square Stepping Exercise (SSE) is a cognitively engaging, low-cost intervention performed on a grid-patterned mat, challenging visuomotor coordination, dynamic balance, and anticipatory adjustments, potentially enhancing neuroplasticity and sensorimotor integration. Aim: As the growing burden of frailty and its associated healthcare costs, the findings of this study could have significant implications for improving functional independence and quality of life among frail individuals and provide evidence-based recommendations for clinicians to optimise fall prevention strategies. Materials and Methods: Thirty-six participants (both male and female, aged 60-85 years) were randomly assigned into two groups using the chit method: Group A {SSE + Conventional Balance Training (CBT)} and Group B (CBT). Inclusion criteria were Fried Frailty Scale ≥3, Hindi Mini-Mental State Examination ≥21, and Tinetti POMA >19. Exclusion criteria included regular exercise participation in the past 3 months or presence of any severe musculoskeletal, neurological, or cardiovascular disorders interfering with safe participation. Both groups underwent supervised training for 4 consecutive weeks (3 sessions/week, 40-45 min/session). The following outcome measures were assessed at baseline and postintervention: Mini-BESTest (balance), 6-Metre Gait Speed Test (gait speed), and Hindi-Version Fall Efficacy Scale (fear of fall). Results: Both groups demonstrated significant improvements for within-group analysis on Mini-BESTest (p=0.012), 6m-GS (p=0.002) and H-FES (p=0.024) from baseline and post-intervention. However, between-group comparisons showed that participants in the SSE+ CBT group showed significant improvements on MiniBESTest (p=0.046) and 6m-GS (p=0.0014), whereas nonsignificant results were observed in H-FES (p=0.57), compared to the CBT group. Conclusion: Square Stepping Exercises combined with CBT were more effective than CBT alone in improving balance, enhancing gait speed, and reducing fear of fall among frail individuals. This pilot study suggests that SSE may be a valuable, low-cost, and clinically feasible adjunct to traditional balance training programs for fall prevention and functional independence among frail individuals. Thera-Connect 2K25 International Conference Proceedings Abstract

Therapeutic Role of taVNS in Neuro Rehabilitation: A Narrative Review of Current Evidence

Simran, Aman Kanda

Introduction: Non-invasive neuromodulation techniques are increasingly being recognised for their potential to improve outcomes in neurorehabilitation. Transcutaneous auricular Vagus Nerve Stimulation (taVNS) is an emerging, low-risk technique that stimulates auricular branch of the vagus nerve, which influences the central nervous system activity, promotes neuroplasticity, and supports functional recovery. Given that taVNS has been applied in various neurological conditions, it is important to conduct a thorough review of its current therapeutic effectiveness in neurorehabilitation to guide clinical practice and direct future research. Aim: The purpose of this narrative review is to compile and analyse the existing evidence regarding the therapeutic use of taVNS in neurorehabilitation among individuals with chronic neurological conditions. Materials and Methods: A comprehensive search was carried out across PubMed, Google Scholar, and Cochrane Library from 2015 to 2025. After screening, Randomised Controlled Trials (RCTs) and pilot studies were included, which examined the effects of taVNS in participants with neurological disorders. Results: The studies showed varying levels of effectiveness across the different patient groups. The taVNS improved sleep quality and measurable sleep parameters, motor function and nonmotor symptoms like gait, balance, sensorimotor integration, and cardiovascular regulation. It also increased cortical arousal and alertness, and improved brain connectivity. Overall, taVNS was found to be safe and well-tolerated in all the studied populations. Conclusion: The current findings suggest that taVNS has a promising role in neurorehabilitation. Thera-Connect 2K25 International Conference Proceedings Abstract

Effects of Training Transversus vs Rectus Abdominis in Diastasis Recti: A Scoping Review

Pratibha Kashyap, Ankita Yadav, Renuka

Diastasis Recti Abdominis (DRA) is a common postpartum condition marked by the separation of the rectus abdominis muscles, leading to reduced core stability and altered biomechanics. The prevalence of DRA decreases to approximately 52% by 4-6 weeks after delivery and about 39% by six months. Clinically, DRA is identified when the Inter-Recti Distance (IRD) exceeds 1.5 cm at the xiphoid, 2.2 cm above, or 1.6 cm below the umbilicus. Rehabilitation programmes focussing on transversus abdominis activation, Pelvic Floor Muscle (PFM) training, and hypopressive exercises have shown positive outcomes. To review available evidence on the effectiveness of Rectus Abdominis (ReA) and Transversus Abdominis (TrA) training in reducing Inter-Recti Distance (IRD). A literature search was conducted using PubMed, Scopus, Google Scholar, Research Direct, and Elsevier with keywords including diastasis recti, exercise, IRD and postpartum. Case reports and studies without exercise interventions were excluded, while full-text English reviews, eligible RCTs, and CCTs were included. A significant reduction in IRD (0.8-1.5 cm) was reported after 6-12 weeks of training. All rehabilitation programmes improved IRD, core stability, and functional performance. TrA-focussed exercises consistently showed better outcomes than traditional abdominal training, while TrA combined with PFM activation produced the most comprehensive results. TrA-focused exercise protocols were more effective in reducing IRD and improving core function than ReA-based training. Deep core stabilisation exercises are effective for postpartum DRA. Standardised protocols and more high-quality studies are needed to establish best practices and enhance maternal health outcomes. Thera-Connect 2K25 International Conference Proceedings Abstract

Integrating Virtual Reality with Constraint-Induced Movement Therapy for Motor Recovery in Spastic Hemiplegic Cerebral Palsy Patient: A Review

Sakshi Kour, Neha Mehra, Himanshu Gakhar

Cerebral Palsy (CP) refers to a group of disorders that affect movement, posture, and coordination due to early brain damage affecting 2-3 children per 1,000 years. This condition, which is not progressive, typically results from injury before, during, or shortly after birth, while the brain is still developing. Spastic hemiplegic CP is a common form that impacts one side of the body, reducing a child’s ability to perform everyday tasks independently. Although the initial brain injury does not worsen, changes in movement can occur over time due to growth, nervous system development, muscle imbalances, and treatment responses. Over the past two decades, rehabilitation strategies such as Constraint-Induced Movement Therapy (CIMT) and Virtual Reality (VR)-based interventions have gained attention for improving motor performance and functional independence in children with hemiplegic CP. This review aimed to summarise and compare the evidence on the effectiveness of CIMT and VR in enhancing upper limb function, motor control, and participation in children with CP. An extensive search of databases, including PubMed, Scopus, Web of Science, and Google Scholar were searched for articles published between 2005 and 2025 only in english language. Studies focusing on children aged 3-16 years with CP undergoing CIMT and VRbased rehabilitation were included. Randomised controlled trials and pilot studies were analysed. CIMT has been shown to improve hand function, strength, and the performance of specific upper-limb tasks through structured, repetitive practice. VR-based therapy offers similar benefits, particularly in enhancing movement speed, coordination, and user motivation, due to its interactive and engaging design. While CIMT is effective for refining targeted motor skills, VR tends to boost participation and consistency. Integrating both methods may provide more comprehensive and effective rehabilitation outcomes. Both CIMT and VR-based therapies are evidence-supported for improving upper-limb function in children with CP. VR offers a motivating and accessible option, whereas CIMT remains a gold standard for structured motor retraining. Future studies should explore combined protocols, long-term outcomes, and accessibility of VR in clinical and home-based settings. Thera-Connect 2K25 International Conference Proceedings Abstract

The Role of ChatGPT in Sports Rehabilitation: A Narrative Review

Vanshika Kulshrestha, Deepak Malhotra

Artificial Intelligence (AI) is increasingly applied in healthcare, with large language models such as ChatGPT showing potential in physiotherapy and sports rehabilitation. These tools may support clinicians, improve patient education, and enhance rehabilitation planning. However, their clinical utility and limitations need to be critically evaluated. This article aims to review recent evidence on the role of ChatGPT in sports rehabilitation and physiotherapy practice. A narrative review of recently published articles was conducted. The studies assessed ChatGPT in areas including musculoskeletal rehabilitation, decision support, patient education, and individualised rehabilitation programme design. Findings were synthesised thematically. Five key insights were identified. ChatGPT demonstrated potential for interdisciplinary support by simulating expert panel discussions, though limitations in emotional nuance and privacy remain. GPT-4 responses aligned strongly with musculoskeletal rehabilitation guidelines but lacked consistency and detail in specific interventions. ChatGPT generated largely accurate clinical content but often produced unreliable or fabricated references. Decision-support accuracy reached approximately 80%, with strong performance in the upper limb (100%) and lower limb (87%) rehabilitation, but weaker outcomes for spinal cases (60%). In knee osteoarthritis, ChatGPT achieved 74% agreement with an expert-designed rehabilitation protocols, though detailed progression and frequencies were insufficiently addressed. ChatGPT shows promising applications in sports rehabilitation by supporting clinical decision-making, enhancing patient education, and assisting with personalised programme planning. However, challenges such as incomplete clinical detail, unreliable referencing, and ethical considerations highlight the need for human oversight. It should be considered a complementary tool rather than a replacement for physiotherapists. Future research must focus on clinical validation and regulatory frameworks for safe integration. Thera-Connect 2K25 International Conference Proceedings Abstract

Comparison of Box Breathing and Deep Breathing Exercises on Functional Capacity in CABG Patients: A Pilot Study

Anchal Gupta, Navya Jain, Neha Reyalch

Introduction: Coronary Artery Bypass Grafting (CABG) patients frequently present with reduced functional capacity after surgery, largely due to impaired pulmonary function and deconditioning. Breathing exercises are a cornerstone of cardiac rehabilitation. However, limited evidence exists comparing the effectiveness of box breathing with incentive spirometer-based deep breathing exercises in this population. Aim: To compare the effects of box breathing and incentive spirometer-assisted deep breathing on functional capacity in post-CABG patients. Material and Method: This pilot study will recruit post-CABG patients who will be randomly divided into two groups. Group A will perform box breathing (6 cycles per session) daily for 5 consecutive days. Group B will perform deep breathing exercises using an incentive spirometer for the same duration. Functional capacity will be assessed using the Six-Minute Walk Test (6MWT) before and after the intervention. Data will be analysed to evaluate within-group and between-group differences. Expected Result: It is anticipated that both groups will demonstrate improvements in 6MWT distance, indicating enhanced functional capacity. Box breathing is expected to show outcomes comparable to, or possibly greater than, incentive spirometer-based deep breathing. Conclusion: This pilot study will provide preliminary insights into the role of different breathing strategies in improving functional capacity in CABG patients. Findings may support the inclusion of simple, equipment-free methods like box breathing in cardiac rehabilitation programmes. Thera-Connect 2K25 International Conference Proceedings Abstract

Acute Facet Joint Dysfunction in a Young Female Following Tug of War: A Case Report

Kartika Agarwal, Soumya Srivastava, Meenakshi Choudhary, Priyanka Rishi

Facet joint dysfunction is a common but often underdiagnosed cause of mechanical low back pain, frequently mimicking discogenic pain. It may develop following sudden or repetitive lumbar loading, and recognition of characteristic symptom patterns with positional relief is crucial for accurate diagnosis. We report the case of a 28-year-old female who presented with gradual-onset low back pain after participating in a tug of war one week earlier. The pain progressively worsened and was aggravated by prolonged sitting, standing, walking, and lying in prone or supine positions, while relief was achieved in side-lying and slouched sitting postures. Neurological examination was normal, with no motor or sensory deficits. Clinical assessment suggested L4-L5 facet joint dysfunction. Conservative management included patient education, activity modification, flexion-biased exercises, cryotherapy with ice packs, therapeutic ultrasound, and Transcutaneous Electrical Nerve Stimulation (TENS). After three weeks of treatment, the patient reported marked improvement, with pain intensity decreasing from 7/10 to 4/10 on the Visual Analogue Scale (VAS), accompanied by improved tolerance of daily activities. This case emphasises the importance of considering facet joint dysfunction in young patients presenting with acute low back pain following sudden spinal loading. The presence of pain aggravated by extension and relieved by flexion-related positions provides a valuable clinical clue. Early recognition and targeted conservative management can lead to significant pain reduction, functional recovery, and prevention of chronicity. Thera-Connect 2K25 International Conference Proceedings Abstract

The Effect of Incentive Spirometry and Deep Breathing Exercise in Cardiopulmonary Patient: An Interventional Study

Ishani, Puneet Jaiswal, Tasreefa Tahseen, Priyanka Rishi

Introduction: Pulmonary complications are one of the most frequent issues following cardiopulmonary and thoracic surgery, even in the face of improved surgical care. Atelectasis, secretion retention, postoperative pain and anxiety, compromised ventilatory function are commonly encountered making it difficult for patients to breathe deeply or cough efficiently and contribute to extended stays in the hospital and increased costs of recovery. To treat these problems, respiratory physiotherapy is commonly employed. Of the options available Incentive Spirometry (IS) and Deep Breathing Exercises (DBE) are the most prevalent. IS stimulates the patient to breathe slowly and deeply with visual feedback, whereas DBE is based on controlled inhalation via the nose with relaxed exhalation. Both are simple to use, risk-free, and cost-effective. Objective: The aim of this study was to evaluate the role of IS and DBE in patients recovering from cardiopulmonary surgery and to compare their effect on oxygen saturation and chest expansion. Methods: Thirty patients aged between 40 and 69 years were included, all treated at Apex Hospital and Apex College of Physiotherapy, Varanasi. They were equally distributed into two groups: 15 patients in Group A underwent IS, and 15 in Group B had DBE. The intervention was for a period of three weeks, with three supervised sessions weekly. Outcomes were assessed through oxygen saturation (SpO2), as measured using a pulse oximeter, and chest expansion, as measured with a tape. Pre- and post-programme assessments were done. Results: Both groups improved greatly. In Group A, p-values were 0.000000015 for SpO2 and 0.000073 for chest expansion. In Group B, p-values were 0.0000000074 and 0.0000000043, respectively. The findings indicate that both interventions increased lung capacity, oxygenation, and alleviated breathlessness. Conclusion: Incentive spirometry and the performance of DBE were similarly effective in improving postoperative pulmonary function. Since both are useful techniques, the selection can be based on patient comfort and preference. Incorporation of either of these easy manoeuvres into standard care can reduce complication rates, accelerate recovery, and enhance results. Thera-Connect 2K25 International Conference Proceedings Abstract

Effect of Aerobic Endurance Exercises and Relaxation Training on Young Adult having Migraine: A Comparative Study

Jahnavi Jaiswal, Reena Kumari, Bhawana Yadav, Priyanka Rishi

Introduction: Migraine is one of the most disabling neurological conditions worldwide. It causes repeated, severe headaches, often on one side of the head, along with nausea, vomiting, and sensitivity to light and sound. These symptoms are linked to neurovascular changes and possible brainstem dysfunction. Since medicines may not always be effective or suitable for long-term use, non-drug approaches like exercise and relaxation are gaining importance. Aim: This study compared the effect of aerobic endurance exercise and relaxation training on reducing migraine severity and frequency in young adults. Materials and Methods: A total of 20 subjects meeting the inclusion criteria were recruited and randomly divided into two groups (N=10 each). • Group A: Performed aerobic endurance exercises for 15 days. • Group B: Followed relaxation training for the same duration. Outcome measures included the Numeric Pain Rating Scale (NPRS) for pain intensity and the Migraine Severity Scale (MIGSEV) for symptom impact. Pre- and post-intervention scores were statistically analysed using paired t-tests. Results: Both groups showed a clear reduction in migraine symptoms after the intervention (p<0.001). • Aerobic exercise group: NPRS scores improved from 6.2±2.10 to 4±2.11. • Relaxation group: NPRS scores reduced from 5.8±1.62 to 4.1±1.52. MIGSEV scores also decreased in both groups, showing improvement in severity and daily impact. Conclusion: Both aerobic endurance exercise and relaxation training significantly reduced migraine symptoms over the 15-day programme. There was no significant difference between the two, suggesting that either method can be used as a safe, effective, and practical non-pharmacological option for managing migraine in young adults. Thera-Connect 2K25 International Conference Proceedings Abstract

Post-operative Rehabilitation after Posterior Decompression and Pedical Screw Fixation in Patient with PIVD and Lumbar Canal Stenosis: A Clinical Case Study

Bhawna Yadav, Jahnavi Jaiswal, Lalli Singh

Introduction: Low back pain is a major global health concern and one of the leading causes of disability worldwide. Structural pathologies such as Prolapsed Intervertebral Disc (PIVD), lumbar spinal stenosis, and degenerative scoliosis are common contributors. Their coexistence poses a complex clinical challenge requiring surgical and multidisciplinary rehabilitative management. Case Description: A 65-year-old female presented with chronic low back pain radiating to the left lower limb, accompanied by tingling and numbness. Radiological and clinical evaluation confirmed PIVD at L3-S1, lumbar canal stenosis, and degenerative scoliosis with an 18° Cobb angle. Special tests, including straight leg raise and slump, were positive. Surgical management involved posterior decompression with laminectomy, medial facetectomy, discectomy, and pedicle screw fixation at L3-S1. Intervention: A structured, phased physiotherapy rehabilitation programme was initiated. During the inpatient phase (0-7 days), goals included pain control, breathing exercises, log rolling, gentle limb mobilisation, and early ambulation with a spinal brace. The early outpatient phase (1-3 weeks) emphasised progressive mobility, core activation, and independent ambulation. The later outpatient phase (4-8 weeks) incorporated advanced gait training, trunk and lower-limb strengthening, endurance building, stair climbing, squats, and balance exercises. Outcomes: The patient demonstrated significant reductions in Numeric Pain Rating Scale (NPRS) scores and improvements in Oswestry Disability Index (ODI), highlighting pain reduction, enhanced spinal stability, functional independence, and better quality of life. Conclusion: Individualised, phase-wise rehabilitation following posterior decompression and pedicle screw fixation optimises recovery, restores function, and promotes safe reintegration into daily life. Thera-Connect 2K25 International Conference Proceedings Abstract

Assessment of Fatigue Among Pregnant Women Using the Fatigue Assessment Scale: A Cross-Sectional Study

Poorvi Mathur, Meghana Reddy, Renuka Jakhar

Introduction: Fatigue is a common symptom in pregnancy, especially in the first and third trimesters, caused by hormonal changes like increased progesterone, increased blood volume and heart rate, and the physiological demands of supporting foetal development, disrupted sleep. It may affect physical as well as psychological wellbeing and maternal quality of life. Aim: This study aimed to assess the prevalence and the severity of fatigue among pregnant women using the FAS questionnaire and to explore its association with demographic and obstetric variables. Materials and Methods: A cross-sectional survey will be conducted among pregnant women attending the Gynecology OPD. Participants will be administered the Fatigue Assessment Scale (FAS) questionnaire, a 10-item self-reported measure of fatigue. Its scoring will be done out of a total score of 50, with a cut-off values,10-21, no fatigue; 22-34, substantial fatigue and more than 35, severe fatigue. Demographic characteristics and obstetric variables will be collected. The questionnaire will be distributed to pregnant females coming for antenatal checkups; 155 filled questionnaires will be collected; the data will be coded and stored in MS Excel. Result: Responses will be analysed to assess the severity of fatigue experienced in various trimesters and their effect on Quality of Life (QOL) and physical and mental well-being of the pregnant women. Statistical association between fatigue levels and age of mother as well as gravid and period of gestation will be calculated. Conclusion: Fatigue is highly prevalent among pregnant women and warrants greater attention in routine antenatal care. The FAS questionnaire is a valid tool for assessing fatigue, highlighting the need for early identification and supportive interventions to improve maternal well-being. Thera-Connect 2K25 International Conference Proceedings Abstract

Variations in Perceived Exertion during Climbing Stairs and Elevated Walking

Diksha Sharma, Ankita Sharma, Kshitija Bansal, Sunita Kumari

Background: Stair climbing and walking on a ramp are considered low-impact activities. However, the quantification and effect of physiological and cardiovascular responses are lacking. Understanding these differences is crucial for developing targeted exercise protocols that will give overall health benefits and help regulate vital physiological covariates. Aim: To compare the changes in rate of perceived exertion by comparing heart rate and blood pressure before and after exertion in adults while climbing stairs and walking on an elevated ramp. Methodology: A total of 30 subjects participated in the activity, which was divided into two groups: 15 subjects walked on the elevated ramp, and 15 subjects climbed the stairs. Once the subject is ready, they are asked to complete the IPAQ short version questionnaire, and a modified Borg rating scale is administered to assess their breathing rate. A pulse oximeter, a sphygmomanometer, and an RPE scale were used to determine the exertion rate in the adults. Result: A total of 30 subjects were recruited, with 15 subjects using stairs and 15 subjects using a ramp to assess the rate of perceived exertion. There was a significant difference in exertion rate, as measured by respiratory rate and blood pressure, between the two activities. Conclusion: The study concludes that while ramp walking and stair climbing have similar health advantages, stair climbing is a more strenuous kind of exercise. To optimise benefits and adherence, exercise prescription should take into account cardiovascular health, individual fitness levels, and personal preferences, as well as long-term adaptations to these activities. Thera-Connect 2K25 International Conference Proceedings Abstract

Development of AI-Driven Fatigue Detection System Using Wearable EMG Sensors for Safe Resistance Training

Prerna Yadav, Sadhan Berry, Gaurav Kadyan

Introduction: Muscle fatigue is a key factor contributing to musculoskeletal injuries during resistance training. Traditional physiotherapy assessments, such as manual muscle testing and observational analysis, are often subjective and fail to capture real-time fatigue. Wearable surface Electromyography (sEMG) sensors provide objective monitoring of muscle activity, and when integrated with Artificial Intelligence (AI) methods such as Support Vector Machines (SVMs) and Convolutional Neural Networks (CNNs), they offer promising potential for real-time fatigue detection. Aim: To review the current literature on AI-driven fatigue detection systems using wearable EMG technology in resistance training and evaluate their clinical implications for physiotherapy-based injury prevention and rehabilitation. Materials and Methods: A literature search was conducted in PubMed, IEEE Xplore, Scopus, and Google Scholar for studies published between 2010 and 2025. Studies involving EMG-based AI models for fatigue detection in healthy adults during resistance or strength training were included. Extracted data focused on EMG features such as Median Frequency (MF), Mean Power Frequency (MPF), and root mean square (RMS), along with model performance and sensor accuracy. Results: Twenty-four studies met the inclusion criteria. AI models, including SVM, Random Forest, and CNN, demonstrated fatigue classification accuracies between 82% and 94%. Reductions in MF and MPF by 10-25% consistently indicated fatigue, while correlations with biomechanical markers (r>0.70) supported their validity. Realtime EMG feedback reduced compensatory movements by up to 50% during resistance training. Integration with wearable platforms enabled mobile-based alerts, improving exercise safety and personalisation. Conclusion: AI-integrated wearable EMG systems provide reliable, real-time fatigue detection in resistance training. They enhance physiotherapy assessment by delivering objective, dynamic insights into neuromuscular performance, thereby supporting safer training and individualised rehabilitation strategies. Thera-Connect 2K25 International Conference Proceedings Abstract

Effect of Aerobic Exercises versus Resistance Training on Abdominal Strength, Sexual Dysfunction, Pain and Menstrual Parameter in Women Suffering from PrimaryDysmenorrhoea: A Case-Control Study

Meenakshi, Jaganjyoti Das

Introduction: Menstruation is the monthly, cyclical, repeated passage of blood from the uterus through the vagina that occurs during the reproductive years. In the absence of pregnancy, menstruation happens when progesterone and estrogen level drop, shedding the accumulation of uterine lining. The typical age of the menarche is still between 12 and 13 old years. Dysmenorrhoea, or problematic menstrual flow, refers to uncomfortable 9 periods. It is among the most prevalent gynaecological conditions, affecting 20-90% of female throughout their reproductive years. A broad range of physical (mental) symptoms are recognised to be a part of dysmenorrhoea syndrome. Research studies indicate a link between physical exercise and dysmenorrhoea. The females who are involved in physical activity are at 3.5 times lower risk of developing dysmenorrhoea. Studies indicate that a 15-minute resistance training session causes the body to produce lactic acid and growth hormones, activating fat metabolism. Aim: To compare the effect of aerobic exercise and resistance training on abdominal strength, sexual dysfunction, pain, and menstrual parameters in women suffering from primary dysmenorrhoea. Materials and Methods: Forty-five subjects with diagnosed dysmenorrhoea after the menarche were allocated to the experimental and control groups (N=45, n=15). Participants of all groups were asked to perform a set of exercises. The intervention of the experimental group consisted of aerobic exercise and resistance training along with stretching and hot packs, whereas the control group was given only stretching exercise and a hot pack. The intervention was prescribed 4 days a week for 6 weeks. All the outcome variables (abdominal strength, sexual dysfunction, pain, and menstrual symptoms) were recorded at baseline and the end of 6 weeks. Results: A statistically significant difference (p≤0.05) was found in the mean value of pre- and post- values of the experimental groups as well as between the groups. The difference was found to be more than that of the control group in the abdominal strength, sexual dysfunction, pain and menstrual parameters. Conclusion: In this study, it was found that aerobic exercises are more effective in improving sexual dysfunctions, and menstrual parameters, whereas resistance training could improve abdominal strength, as found in the study. Thera-Connect 2K25 International Conference Proceedings Abstract

Prevention of Low Back Pain in Sewing Workers - An Integrated Review of Physical Activity, Psychosocial, and Ergonomic Strategies: A Review

Rashmi Kaushal, Nitesh Malhotra

Sewing employees are particularly susceptible to occupational Low Back Pain (LBP) because of their limited biomechanics, repetitive motions, and extended periods of static position. The bio-psycho-social approach emphasises the importance of the significance of psychosocial stressors, while traditional prevention has concentrated on physical aspects. This review of the literature summarises the most recent research on the causes of LBP in sewing workers and assesses the efficacy of preventative measures that include ergonomics, physical activity, and psychosocial therapies. A thorough search was carried out using a structured combination of keywords in the main academic databases (PubMed/MEDLINE, Scopus, Web of Science, and CINAHL). Studies that examined LBP risk factors or therapies having particular study categories such as observational studies or clinical trials, and those which concentrated on sewing workers, were all included. The review finds that psychosocial stresses like high job demands, poor control, and a lack of social support aggravate the physical risk factors of prolonged sitting and repetitive jobs. Research suggests that the best preventative approach is a comprehensive programme that incorporates: Ergonomic modifications (e.g., adjustable chairs, workstations), structured exercise programmes focusing on core strengthening and stretching, combined with frequent active breaks and psychosocial and organisational interventions such as job redesign, training on stress management, and creating a positive work atmosphere. For LBP in sewing workers to be effectively prevented, a thorough, bio-psycho-social strategy is required. The most promising way to lower the prevalence and severity of LBP and improve worker well-being and productivity is to combine ergonomic, physical, and psychosocial methods within a collaborative framework. Future initiatives have to concentrate on putting such integrated programmes into practice and assessing their effectiveness in actual industrial contexts. Thera-Connect 2K25 International Conference Proceedings Abstract

Prevalence of Chronic Respiratory Diseases Among Adults in Delhi NCR: A Pilot Study

Ankita Samuel, Pooja Bhati, Sonia

Introduction: Chronic Respiratory Diseases (CRDs) remain a significant contributor to morbidity and reduced quality of life among adults in urban India, especially in heavily polluted metropolitan regions like the Delhi National Capital Region (NCR). Despite increasing awareness, community-level epidemiological data on CRD prevalence in this area is limited. Aim: To determine the prevalence and symptom profile of chronic respiratory diseases among adults in Delhi NCR through validated patient-reported measures in a pilot setting. Materials and Methods: A cross-sectional pilot study was conducted involving 60 adult residents from various localities of Delhi NCR. Participants were screened for diagnosed CRDs and respiratory symptoms. The Chronic Respiratory Questionnaire (CRQ) was administered to evaluate domains of dyspnoea, fatigue, emotional function, and disease mastery, and the Medical Research Council (MRC) dyspnoea scale was used to grade the severity of breathlessness. Demographic details, digital connectivity, and device ownership were also documented. Descriptive statistics were performed to summarise CRQ and MRC scores and to estimate the prevalence and impact of respiratory morbidity. Results: Among the 60 participants, a notable proportion reported doctor-diagnosed CRDs and moderate to severe respiratory symptoms. CRQ scores reflected variable but often moderate impairments across dyspnoea, fatigue, and emotional function domains, with several individuals reporting significant limitations on mastery. MRC grading among affected subjects indicated a spectrum of exertional breathlessness, with the majority experiencing at least minimal activity limitation. High rates of digital literacy and device ownership were also observed, indicating suitability for potential digital health interventions in this population. Conclusion: This pilot analysis highlights an appreciable prevalence and burden of chronic respiratory diseases among adults in Delhi NCR, with marked effects on quality of life and daily functioning. The use of CRQ and MRC enables nuanced detection and quantification of symptom burden in epidemiological research. These findings support the feasibility of larger-scale studies and targeted public health interventions in urban Indian settings. Thera-Connect 2K25 International Conference Proceedings Abstract

The Impact of Inspiratory Muscle Training on Musicians: A Comprehensive Review

Barnali Bhattacharjee, Tabish Fahim, Kangana Juneja Kansal

Inspiratory Muscle Training (IMT) has demonstrated benefits in diverse populations, particularly in improving respiratory muscle strength, endurance, and overall pulmonary function. For musicians, especially wind and brass instrumentalists and singers, optimal respiratory control is central to performance, yet research on IMT in this group remains limited. This review synthesises the existing literature on the role of IMT in enhancing respiratory function and performance outcomes in musicians. We conducted searches across multiple electronic databases like PubMed, Scopus, Web of Science, and the Cochrane Library using Mesh Terms IMT and musicians. The review considered outcomes including inspiratory muscle strength, respiratory endurance, breath control, tone stability, postural support, and perceived performance ease. Evidence indicates that IMT significantly increases inspiratory muscle strength and endurance. In musicians, these gains have been linked to improved breath control, sustained note production, tone quality, and reductions in performance-related fatigue. Findings from broader non-musician populations support IMT’s efficacy in enhancing lung function and postural stability; however, studies directly involving musicians are few, often limited by small sample sizes and methodological heterogeneity. IMT shows promise as a performance-enhancing and health-promoting strategy for musicians, yet the evidence base is preliminary. Larger, rigorously designed, musician-specific studies are needed to establish the effectiveness and practical applications of IMT in musical training and performance. Thera-Connect 2K25 International Conference Proceedings Abstract

Outside the Operating Room - The Efficiency of Physiotherapy for Endometriosis: A Narrative Review

Kangana Juneja Kansal, Dheeraj Kumar, Barnali Bhattacharjee

Endometriosis is a widespread gynaecological condition burdening millions of women globally, with chronic pelvic pain as a primary symptom, followed by dysmenorrhoea, dyspareunia, fatigue, and emotional distress. Confirmation of diagnosis is usually delayed for years, leaving the patient in a stressful stage, both physically as well as emotionally. The pain is often complex and can be an excessive burden on women of reproductive age. It demands a broad-based management in addition to traditional medical and surgical options. This narrative review aims to consolidate the current literature available one challenges associated with the diagnosis of Endometriosis-Related Pelvic Pain (ERPP) and to assess the efficiency of women’s health physiotherapy as a domain of care. A review was performed on available literature, focusing on the diagnosis of endometriosis and the effect of physical therapy management, including pelvic floor rehabilitation, manual therapy, and condition-specific exercises to reduce pelvic distress and related musculoskeletal impairment. The review exhibits that physical therapy is an essential adjunct to the traditional medical and surgical approach. It specifically focusses on pain caused by musculoskeletal dysfunctions, and various modalities are shown to result on significant reduction of pain intensity, which helps to ameliorate sexual dysfunction, and improves the overall well-being for women suffering from endometriosis. ERPF affects quality of life, sexual functioning and activities of daily living. Combining physical therapy with traditional medical management can complement existing interventions to reduce treatment disparities, enabling a multidimensional and impactful approach for addressing chronic pelvic pain in females with this condition. Thera-Connect 2K25 International Conference Proceedings Abstract

Surface Electromyography as an Assessment Tool to Guide Physiotherapy Protocols in Stroke Rehabilitation: A Narrative Review

Manu Pathania, Nitesh Malhotra

Stroke is a major cause of disability globally, upper extremity motor impairment being more prominent, affecting quality of life and functional independence. Physiotherapy plays a vital role in recovery, but the conventional assessments mostly rely on subjective observations. Surface Electromyography (sEMG), as a non-invasive technique, detects muscle activity and offers real-time insights that can guide and optimise physiotherapy protocols. This review aimed to elaborate on the clinical applications of sEMG as an assessment tool in physiotherapy for improving motor recovery after stroke and to highlight the need for using sEMG at regular intervals during upper extremity motor recovery physiotherapy protocols, to modify the protocols based on sEMG findings. The narrative review was carried out by searching major databases (Scopus, PubMed/MEDLINE, Google Scholar and Web of Science) by using keywords. Studies focusing primarily on sEMG as an assessment tool, biofeedback, and personalised rehabilitation was included. Evidence suggests that sEMG helps in early detection of muscle activity, abnormal synergies and inappropriate co-contractions in stroke survivors. Integrating sEMG into physiotherapy protocols facilitates tailored interventions, enhances patient engagement through biofeedback and provides quantifiable outcomes. It supports individualised physiotherapy planning and promotes precision rehabilitation. Despite its advantages, it is not being used as it should be in clinical practice. Various challenges such as high equipment cost, errors in electrode placement, limited accessibility and lack of standardised protocols, hinder widespread adoption of sEMG in clinical settings. sEMG is a valuable adjunct for guiding physiotherapy protocols, enabling personalised rehabilitation and improving motor function after stroke. Its integration into routine clinical practice enables accurate evaluation, guides targeted therapy to enhance motor recovery, reduce disability and improve quality of life. Addressing barriers to its clinical adoption may be advantageous for motor recovery in stroke survivors. Thera-Connect 2K25 International Conference Proceedings Abstract

Evolution of Healthcare - Role of Telerehabilitation and IoT in Robot assisted Knee Replacements: A Narrative Review

Dheeraj Kumar, Jasmine Kaur Chawla

Health care has evolved over the last decade, diversifying its horizons from in-person rehabilitation care to technology-based tele-rehabilitation facilities. Latest trends like Internet of Things (IoT), sensors and virtual reality have changed the definition of telehealth. This narrative review aims to identify the impact of in-person physiotherapy care and telerehabilitation. To review recent literature on technological interventions and tools utilised in physiotherapy teleconsultations on effectiveness, patient satisfaction, access, and clinical outcomes. A narrative review was performed using the Scopus, Elsevier, PubMed, Google Scholar, and Web of Science databases, with a temporal scope extending from 2015 to 2025. Eligibility was restricted to articles that examine technological advancements pertinent to physiotherapy, encompassing not only Artificial Intelligence (AI), but also other modalities employed within teleconsultative settings. In total, 17 studies qualified for our analysis. The primary technologies employed consisted of video conferencing, wearable sensors, mobile applications, AI, and virtual and augmented reality. The majority of studies found an increase in patient and clinician involvement, compliance with exercise regimens, and clinical results. Virtual reality, machine learning, and distributed sensor technologies have profoundly enhanced teleconsultation in the field of physiotherapy. When combined, AI-augmented diagnostic instruments, tethered and untethered biofeedback systems, and bidirectional immersive environments have elevated both the efficacy and the responsiveness of remote physiotherapy interventions clinically applied to musculoskeletal, cardiac, and neurological disorder domains. Thera-Connect 2K25 International Conference Proceedings Abstract

Instrumented Gait Assessment for Spinal Cord Injury: A Review of Technology Driven Objective Measures

Garima Wadhwa, Pooja Anand, Priyanka Rishi

Individuals with Spinal Cord Injuries (SCI) tend to develop slow, inefficient, unbalanced, or uncoordinated gait patterns. Traditional clinical tools, although found to be reliable measure for assessing gait deviations, are subjective and often have inter-rater variability. The technology-driven instrumented gait assessment tools may offer an objective and quantifiable method of assessing gait deviations among individuals with SCI. This review aims to synthesise the current application of objective gait analysis tools to detect gait abnormalities in individuals with SCI. A literature search was conducted on PubMed and Scopus databases to identify studies that have assessed the gait of individuals with spinal cord injury using technology-driven tools. Studies were included if they utilised any technology-driven tool, including Inertial Measurement Units (IMU) sensors, wearable sensors, 3D motion kinetic systems, pressure-sensitive platforms, etc., for gait assessment in SCI, either to evaluate reliability/validity or as an outcome measure in randomised controlled trials. Data extracted included characteristics of participants, features of the tools, gait parameters evaluated, and main study findings. Our search yielded 1728 articles. The title and abstract screening reduced the number of articles to 22 and finally 10 studies were included for this review based on the eligibility criteria. Most of the studies utilised IMU sensors for the gait evaluation of individuals with SCI, followed by a 3D kinetic motion sensor system. The IMU sensors are a reliable technology-driven objective measures for determining spatiotemporal parameters such as stride length, step length, cadence, and double support time. However, 3D kinetic motion systems allow detailed information on kinematic parameters, including joint range of motion at the hip and knee. Instrumented gait assessment offers objective and quantifiable insights into locomotor function in individuals with spinal cord injury. Among the available technologies, IMU-based wearable sensors have emerged as the most practical and widely adopted tool due to their portability, ease of use, and ability to capture spatiotemporal parameters in real-world conditions. Meanwhile, 3D motion analysis provides more in-depth biomechanical insights. Thera-Connect 2K25 International Conference Proceedings Abstract

A Case Study on the Role of Deep Transverse Friction and Splint Therapy in Managing Temporomandibular Joint Dysfunction

Shashank Kumar, R Arunmozhi, Sumit Khattri

Temporomandibular Joint Dysfunction (TMD) is a common musculoskeletal disorder involving pain, limited jaw movement, and functional impairment affecting the head and neck region. It often presents with symptoms such as headache, muscle twitching, ear fullness, or tinnitus. Physiotherapeutic management plays a vital role in addressing these symptoms, with Deep Transverse Friction (DTF) massage and splint therapy are effective modalities for pain reduction and functional restoration. In this case study, a 28-year-old individual presented with pain during mouth opening and chewing, accompanied by reduced mandibular range of motion persisting for over three months. Following a diagnosis of TMD by a dentist, the patient underwent a combined intervention of DTF applied to the masticatory muscles along with the use of a customised splint. The outcome measures included the Numerical Pain Rating Scale (NPRS) for pain intensity, mandibular range of motion assessment using a vernier caliper, the Oral Impact Profile Questionnaire, and the Jaw Functional Limitation Scale (JFLS). After the intervention, the patient demonstrated a marked reduction in pain, increased mandibular mobility, and improved quality of life and functional performance. The combined use of DTF and splint therapy exhibited a synergistic effect in enhancing joint function and relieving discomfort. This case emphasises the significance of integrating manual therapy with splint therapy in the conservative management of the TMD. The positive outcomes observed encourage further research through larger clinical trials to substantiate these results and establish evidence-based physiotherapeutic protocols for TMD management. Thera-Connect 2K25 International Conference Proceedings Abstract

Effect of Yoga on Memory and Problem Solving Ability of Haryana State University Players

Charan Singh

This study investigates the impact of yoga on memory and problem-solving abilities among athletes from Haryana State Universities. Recognising the increasing emphasis on mental fitness in sports, the research aims to explore how yoga practices influence cognitive functions critical for athletic performance. A sample of university players engaged in regular yoga sessions was compared to a control group with no yoga intervention. Standardised tests for memory retention and problem-solving skills were administered before and after the yoga training period. Results indicated significant improvements in both memory and problem-solving abilities among the yoga group, suggesting that the mindfulness and stress-reduction techniques inherent in yoga may enhance cognitive performance. This study highlights the potential of integrating yoga into training regimens for athletes to optimise their mental acuity and competitive edge. Further research is recommended to explore long-term effects and the underlying mechanisms of these cognitive enhancements. Thera-Connect 2K25 International Conference Proceedings Abstract

Quality of Life, Sleep Quality and Academic Performance in Smartphone Addicts and Non-Addicts: A Cross-Sectional Study

Riya Sharma, Ankita Samuel, Deepak Kumar, Shweta Kumar

Introduction: Smartphone addiction, increasingly prevalent among young adults have been implicated in compromised sleep, diminished academic performance, and altered quality of life. Understanding these interrelationships is critical for developing effective health promotion interventions in university populations. Aim: This study aimed to systematically compare the quality of life, sleep quality, and academic performance between smartphone-addicted and non-addicted university students. Materials and Methods: A cross-sectional survey was conducted among 140 randomly selected university students aged 18-25 years in the Delhi NCR region. The Smartphone Addiction Scale-Short Version (SAS-SV) was administered to classify participants as addicts or non-addicts. Sleep quality, health-related quality of life, and academic performance were assessed using the Pittsburgh Sleep Quality Index (PSQI), SF-36 questionnaire, and Academic Performance Rating Scale (APRS), respectively. Data collection was undertaken via online forms. Pearson’s correlation analysis was performed using SPSS version 21.0 to determine associations among variables. Results: A significant negative correlation was observed between smartphone addiction and both sleep quality and academic performance, indicating that higher degrees of addiction were associated with poorer sleep and reduced academic outcomes (p<0.05). However, no significant relationship was identified between smartphone addiction and overall quality of life as measured by the SF-36. Conclusion: Excessive smartphone use adversely impacts sleep and academic achievement, but does not significantly affect quality of life in the studied population. These findings highlight the urgent need for targeted interventions to foster responsible smartphone use among university students. Thera-Connect 2K25 International Conference Proceedings Abstract

A Preliminary Investigation of MDT Efficacy in Controlled and Uncontrolled Diabetic Frozen Shoulder

Sheena Arora, Kshitija Bansal, Khyatee

Introduction: Adhesive Capsulitis (AC) is frequently associated with diabetes mellitus, attributed to increased glycosylation of collagen fibres in the shoulder joint capsule. Exercise-based interventions remain the primary treatment; however, the role of Mechanical Diagnosis and Therapy (MDT) in diabetic AC has not been widely investigated. Aim: To determine the effectiveness of MDT in the assessment and management of AC among patients with controlled and uncontrolled diabetes. Materials and Methods: Patients clinically diagnosed with diabetic AC by a physician or orthopaedician were recruited and allocated into two parallel groups: controlled diabetes (HbA1c <7) and uncontrolled diabetes (HbA1c >7). Participants were assessed using MDT principles and classified into derangement or articular dysfunction syndromes, followed by individualised interventions based on movement responses. Outcome measures included pain (Visual Analogue Scale, VAS), shoulder Range of Motion (ROM), and functional status (Upper Extremity Functional Index, UEFI), assessed at baseline, and at 2, 6, and 10 weeks. Results: Baseline demographics and outcome measures did not significantly differ between groups, except for Glycosylated Haemoglobin (HbA1c), which was significantly higher in the uncontrolled group (p<0.001). Significant time effects were observed for VAS, ROM, and UEFI (p≤0.002). Group effects were significant for abduction ROM (p=0.013) and UEFI (p=0.025), while no significant time × group interaction was found. Post hoc analysis revealed significant improvements between baseline and week 2, and baseline and week 10, for VAS, ROM, and UEFI (p≤0.05). Additional improvements were noted between weeks 2 and 6 for flexion, external and internal rotation, and UEFI (p≤0.029), and between weeks 6 and 10 for VAS, flexion, internal rotation, abduction, and UEFI (p≤0.024). Conclusion: MDT is effective in reducing pain and improving ROM in both controlled and uncontrolled diabetic AC. Functional outcomes, however, improved more significantly in patients with controlled diabetes, highlighting the role of glycaemic status in rehabilitation outcomes. Thera-Connect 2K25 International Conference Proceedings Abstract

Impact of Blood Flow Restriction Aerobic Training at 40% and 60% Occlusion Pressure on Body Composition in Sedentary Young Adults: A 4-Week Randomised Pilot Study

Tanya Gujral, Kamran Ali

Introduction: Training with Blood Flow Restriction (BFR) has become a popular way to improve exercise results at lower intensities. The relative effects of various occlusion pressures on body composition in sedentary populations; however, it is not well supported by data. Aim: The purpose of this pilot study was to examine how aerobic exercise with arterial occlusion pressures of 40% and 60% affected the Body Mass Index (BMI) and Waist-Hip Ratio (WHR) of sedentary young adults. Materials and Methods: Using computer-generated randomisation, 30 sedentary young individuals were gathered and divided into two intervention groups. For four weeks, both groups engaged in three sessions of supervised treadmill training using the modified Bruce protocol, along with BFR at 40% or 60% Arterial Occlusion Pressure (AOP). BMI and the WHR were measured both before and after the intervention. Results: Repeated measures Analysis of Variance (ANOVA) was used in the statistical analysis to evaluate both between-group differences and within-group differences changes over time. Both groups showed changes in the body composition, with WHR and BMI possibly declining more at 40% AOP was higher than at 60% AOP. Conclusion: This pilot investigation will help guide future large-scale clinical trials by offering initial data on the ideal occlusion pressure for BFR aerobic exercise to change body composition in inactive young adults. Thera-Connect 2K25 International Conference Proceedings Abstract

Exercise Induced Changes in Testosterone: A Systematic Review of Different Exercise Methods

Himanshu, Amit Saraf, Pooja Anand, Himanshu Gakhar

Introduction: Testosterone marked as a performance pointer so it has become crucial to look towards the physiological measures with physical outcomes. Diverse influence of testosterone and other hormones from the existing literatures marks it perfect that variability arises from the exercise either to lower or higher adjacent. The adaptations observed in notable studies are variable and dictating the part to detect further because of its lower side by some trainings. Tapering shows its own impact among athletes and ordinary population and makes clear that the variability arises from different levels of trainings and their specificity. Aim: This systematic review aimed to discover a cumulative impact of various trainings or exercise methods on the biochemical levels of testosterone. Material and Methods: Various studies were collected from different databases and their engagement was done according to titles and their respective data with registering on review portal (PROPSPERO). Various quality assessment tools were used i.e. Cochrane risk of bias II and PeDRo scale for minimising the inaccuracies and appropriate estimates of data. PICO framework was used to incorporating the studies in analysis and PRISMA approach was used for inclusion. Results: According to studies searched and included in review, the observation of studies was that there was a significant rise in testosterone, cortisol and other physical measures. Variability was observed in tapering type of training because they were also showing deterioration. Maximum studies favors the risen level of testosterone and significance was observed below the value of (p<0.005). Cortisol value were variable among the older and female population incorporated by researchers. Conclusion: The suggested data concluded that the changes in values of various biochemical markers i.e. testosterone, cortisol, and other hormones shows a significant variability in different exercise conventions. Thera-Connect 2K25 International Conference Proceedings Abstract

Impact of an Artificial Intelligence Based Application Intervention on Emotional Intelligence and Hedonic Tone Among University Level Female Basketball Players: A Pilot Study

Komal, Sumit Kumar Singh

Introduction: Female varsity basketball players experience increased academic and athletic expectations that might erode resilience, emotional regulation, and overall well-being. Hedonic Tone (HT) and Emotional Intelligence (EI) are critical to the psychological health and performance of athletes. Enhancing EI and HT in supporting performance and mental health. Applications of Artificial Intelligence (AI) are a promising route for boosting these psychological assets through systematic, technology-based interventions in sports environments. Aim: The pilot study tested the impact of an AI-supported application intervention on EI and HT in university-level female basketball players. Materials and Methods: Twenty women basketball players (18-23 years) from a sports university participated voluntarily. A 6-week mobile application programme using AI was implemented with daily modules on recognising emotions, regulating emotions, perceiving others’ emotions, and empathy. The Emotional Intelligence Scale and the Snaith Hamilton Pleasure Scale were applied to measure HT. Pre- and post-intervention outcomes were compared using paired-samples t-tests. Results: The intervention yielded notable gains in EI p=0.040 (<0.05) from pre to post, and also statistical significance: p=0.006 (<0.05) shows a statistically significant gain in Hedonic tone from pre to post. In the post-intervention, the participants showed notable gains on emotional intelligence scores and self-rated increased positive hedonic tone. The AI application was acceptable, showing good adherence and usability. Conclusion: The results indicate that AI-powered psychological training programmes can significantly boost EI, and HT in female university basketball players. These initial findings add strength to the notion of incorporating AI tools into sport psychology interventions among athletic population, making it a subject of further inquiry with larger sample and follow-up. Thera-Connect 2K25 International Conference Proceedings Abstract

Examining the Relationship between Adherence to Pelvic Floor Rehabilitation and Improvements in Mental Health Outcomes: A Systematic Review

Yukti Gogia, Priyanka Rishi, Kalpana

Introduction: Vulvovaginal Atrophy (VVA), a key component of genitourinary syndrome of menopause, significantly impairs sexual function, urinary health, and quality of life in postmenopausal women. While pharmacological therapies such as topical oestrogen are widely used, non-hormonal interventions are increasingly important. Pelvic Floor Rehabilitation (PFR) and Cognitive-Behavioural Therapy (CBT) have individually shown benefits in improving urogenital symptoms and psychological outcomes. However, the combined effect of these interventions remains unclear. Aim: To systematically review and synthesise the evidence on the effectiveness of combined PFR and CBT compared to usual care, PFR alone, CBT alone, or other interventions in postmenopausal women with VVA. Materials and Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and Web of Science, as well as ClinicalTrials.gov and WHO ICTRP. Randomised controlled trials and controlled studies will be eligible. Two independent reviewers screened studies, extracted data, and assessed risk of bias using RoB 2 (RCTs) or ROBINS-I (nonrandomised studies). The primary outcomes include VVA symptom severity and sexual function. Secondary outcomes include pelvic floor muscle strength, quality of life, depression, and anxiety. Data was synthesised narratively; meta-analysis was performed where ≥2 comparable trials exist. PRISMA 2020 guidelines were followed. Results: Forty articles met the inclusion criteria. The majority of the studies included physiotherapy interventions such as PFR, CBT in treating postmenopausal women with vulvovaginal atrophy. Exercises, counselling as well as physical therapy are effective to improve vulvovaginal atrophy symptoms and vaginal muscle strength. Conclusion: This systematic review provides consolidated evidence on whether integrating PFR with CBT improves physical and psychological outcomes in postmenopausal women with VVA, informing future rehabilitation strategies and clinical practice. Thera-Connect 2K25 International Conference Proceedings Abstract

Effectiveness of Different types of Kinesio Taping Application on Calf Muscle Fatigue in Healthy Collegiate Athletes: An Experimental Study

Deepak Tyagi, Vinay Kumar Singh, Ajeet Kumar Saharan, CS Ram

Introduction: Fatigue is a highly common phenomenon among athletes in life and sports. It results in decreased muscle strength, pain, decreased range of motion, balance, and agility and increased risk of injury, which ultimately results in decreased sports performance of the athlete. Many studies have examined the effects of Kinesio Taping (KT) on muscle fatigue. However, the effect of different types of application of KT has been rarely reported. Aim: This study aimed to fill this research gap by examining the effects of different types of applications of KT on muscle fatigue. Materials and Methods: A three-arm parallel pretest-post-test experimental design was used. Forty-five collegiate athletes were randomly assigned to three groups. Group A received Y shaped application of KT, Group B received I shaped application of KT and Group C was the control group without KT. The number of heel rises was measured before and after taping in all the groups, using a habermeter and metronome. The taping was done following the principles of kenso kaze. Results: Group A (Y-shaped) number of heel rises significantly increased 18.76% (p-.001) after applying KT. Group B (I-shaped) results shows non-significant effect on heel rises(p-.136). Conclusion: Y-shaped application of KT over the calf muscle is effective in reducing fatigue. Thera-Connect 2K25 International Conference Proceedings Abstract

Seroanalysis of TORCH Group of Microorganisms among Pregnant Women attending the Antenatal Clinic of a Tertiary Care Centre: A Cross-sectional Study

Ravikant, Vibhuti Kotiya, Parul Shah, Soeb A Jankhwala, Madhuri Alwani

Introduction: Maternal Toxoplasma, Rubella viruses, Cytomegalovirus, and Herpes viruses (TORCH) infections continue to be a challenge in obstetric practice since they can cause severe congenital abnormalities. Evaluating seroprevalence among pregnant women at a tertiary care facility helps identify immunity gaps and inform the development of appropriate screening procedures. Aim: To determine the pre-intervention serological status of expectant mothers undergoing maternal clinical visits for prenatal care. Materials and Methods: This cross-sectional study was conducted at the Department of Microbiology, Nootan Medical College and Research Centre, Sankalchand Patel University, Visnagar, Gujarat, India, from July 2023 to January 2025. A total of 249 pregnant women aged 18-41 years were enrolled through random sampling, and blood samples were taken after obtaining informed consent. Every participant had their antibody levels checked against TORCH using the Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was done by parametric tests, such as Analysis of Variance (ANOVA) and non parametric tests, such as Chi-square, to compute p-value, correlation coefficient (r), and Phi/Cramer’s V. A p-value of <0.05 was considered statistically significant. Results: A total of 249 pregnant women were included in the study, with a mean age of 27 years and a range of 18 to 41 years. IgM was found in 31 (12.4%) and IgG in 244 (97.99%) out of the 249 (100%) samples. Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV), and Herpes 2 had IgM seropositivity of 4 (1.6%), 7 (2.8%), 11 (4.4%), and 11 (4.4%), respectively. In contrast, IgG antibodies to Herpes 1+2, Rubella, Toxoplasma gondii, and CMV were detected in 71 (28.5%), 133 (53.41%), 18 (7.3%), and 241 (96.78%) of the samples, respectively. Conclusion: Women who have more pregnancies are more likely to become infected with several agents, and Women tend to be seropositive to many agents than just one. So, prenatal screening for immunity and immunisation status is recommended for women of reproductive age.

Antinuclear Antibodies Profiling in Patients with Autoimmune Diseases: A Cross-sectional Study from Tertiary Care Centre in Southern India

Introduction: Over past few decades, autoimmune disorders have been increasing in India but adequate research on it hasn’t been done yet. Antinuclear Antibodies (ANA) serve as one of the most important hallmarks of autoimmunity. Recent studies and research are focusing on demonstrating the correlation between the wide range of ANA and various autoimmune disorders. Aim: To profile ANA and correlate their patterns with clinical manifestations in patients with autoimmune diseases at a Tertiary Care Centre in South India. Materials and Methods: The present cross-sectional study was carried out for 12 months (from February 2023 to January 2024) at SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India. Patients presenting with rheumatic symptoms and referred for ANA testing using the Indirect Immunofluorescence (IIF) method were included in the study. The study population comprised both male and female participants, with age groups ranging from paediatrics to geriatrics. A total of 526 blood samples (3-5 mL) were collected from patients with rheumatic complaints and processed to obtain serum. IIF was performed using the Mosaic HEp-20-10/Liver (Monkey) BIOCHIP kit to detect ANA patterns. Positive samples (n=67) were further evaluated using EUROLINE ANA Profile 3 Plus DFS70 IgG immunoblot for specific autoantibodies, and the results were correlated with the clinical diagnosis of autoimmune disorders. The collected data were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistics software. Descriptive statistics and inferential tests such as the Chi-square test was applied. A p-value of <0.05 was considered statistically significant. Results: A total of 526 patients were investigated for ANA testing. A total of 67 samples positive for IIF-ANA were further tested using the immunoblot method. Out of the 67 samples processed/tested for presence of the human antibodies specific to 16 nuclear, mitochondrial and cytoplasmic antigens, 55 (82%) samples showed positivity. Out of the 67 samples, 49 (73.13%) were female and a significant number of the patients were in the age groups 31-40 (16, 23.8%) and 41-50 years (16, 23.8%). Speckled pattern was most frequently observed 21 (31.3%). The majorly identified autoantibodies were against U1RNP 18 (26.8%) and nucleosomes 18 (26.8%). Conclusion: A higher- ANA pattern positivity could be correlated with a high prevalence of autoimmunity in this geographical location, promoting its use as a means for detecting suspected autoimmune illnesses.

Impact of Social Integration on Mental Health in Individuals with Spinal Cord Injury: A Cross-sectional Study

Introduction: Individuals experiencing Spinal Cord Injury (SCI) often face physical, emotional, and social challenges. Social integration significantly influences their mental health, affecting recovery, quality of life, and overall psychological well-being. Aim: To determine the impact of social integration on mental health in individuals with SCI. Materials and Methods: This cross-sectional study was conducted at the Outpatient Department (OPD), Karnataka Lingayat Education (KLE), Hubli Co-operative Hospital, Hubballi, Karnataka, India, from 13th June 2025 to 13th July 2025. Data were gathered from 30 individuals with traumatic SCI using the Craig Handicap Assessment and Reporting Technique (CHART-SF) questionnaire and Positive Mental Health (PMH) Scale. An Independent sample t-test revealed a statistically significant difference in social integration scores between PMH groups among individuals with SCI (p-value=0.045). Data were analysed using Statistical Package for Social Sciences (SPSS) version 29.0.1, with p-value <0.05 considered statistically significant. Results: The study included 30 participants. A total of 30 participants were enrolled in the study, among whom 22 (73.3%) were male and 8 (26.7%) were female. Based on the American Spinal Injury Association (ASIA) impairment scale, 17 were grade C, 10 grade B, and 3 grade A. Social integration scores ranged from 16 to 80, with a mean of 37.13±18.19. PMH total scored 0 and 9, with a mean of 4.20±4.57. Among the participants, 16 (53.3%) had a PMH score of 0, while 14 (46.7%) had a score of 9. A comparison of social integration according to PMH score showed a “t” value of 2.10 with a p-value of 0.045. Conclusion: The present research highlights the significant role of social integration in influencing the mental health of individuals with SCI. The findings emphasise a comprehensive biopsychosocial rehabilitation approach that combines mental healthcare, social reintegration, and environmental support to enhance overall quality of life.

Aetiologies of Subcortical T2 Hypointensity on MRI in Patients Presenting with Seizures or Visual Symptoms: A Cross-sectional Study

Surbhi Gupta, Vineet Mishra, Palak Dhakar, Priyanka Yadav

Introduction: Magnetic Resonance Imaging (MRI) findings in seizures associated with hyperglycaemia, particularly non ketotic hyperglycaemia, are distinctive and can aid diagnosis. Characteristic features include focal subcortical T2-weighted hypointensity, with or without cortical hyperintensity, reflecting underlying metabolic disturbances. Aim: To analyse patients presenting with seizures or visual symptoms who demonstrate subcortical T2 hypointensity on MRI and by correlating these radiological patterns with clinical and laboratory findings. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, between 2020 and February June 2022. Patients presenting with seizures and/or visual disturbances who demonstrated focal subcortical T2 hypointensity on MRI were included. Imaging was performed on 1.5T and 3T scanners. Sequences analysed included T2, Fluid Attenuated Inversion Recovery (FLAIR), Diffusion Weighted Imaging (DWI), Apparent Diffusion Coefficient (ADC), and Susceptibility Weighted Imaging/Gradient Echo (SWI/GRE). Results: Twenty-two patients were evaluated. Hyperglycaemia was confirmed in nine patients (serum glucose 384-520 mg/dL; HbA1c 7.1-14%). MRI consistently showed subcortical hypointensity on T2-weighted, FLAIR, and SWI/GRE sequences, with corresponding reduced signal on DWI. No haemorrhage was detected. The parieto-occipital lobes were predominantly affected (77.8%), while frontal and temporal lobes were less frequently involved (22.2%). One patient demonstrated complete resolution of abnormalities on follow-up after glycaemic control. The remaining 13 patients had alternative diagnoses, including infarcts, meningitis, metastases, cerebritis, and Sturge-Weber syndrome. Conclusion: Subcortical T2 hypointensity, especially in the parieto-occipital regions, is a subtle but reliable MRI marker of hyperglycaemia-related seizures. Recognition of this finding facilitates accurate diagnosis, prevents misinterpretation as stroke or infection, and enables timely initiation of metabolic correction. Isolated subcortical T2 hypointensity in the parietooccipital regions should alert radiologists to hyperglycaemia as an underlying cause of seizures or visual symptoms, allowing timely metabolic correction and complete reversibility of MRI findings.

Efficacy of Dexmedetomidine Infusion on Propofol Requirement in Maintaining Depth of Anaesthesia in Elective Neurosurgical Procedures: A Randomised Controlled Study

Introduction: Dexmedetomidine, a selective alpha-2 adrenergic receptor agonist, is gaining momentum in neurosurgical anaesthesia for its sedative, analgesic, and sympatholytic effects. Propofol, although widely used, has its risks, like hypotension and respiratory depression at high doses. When these two drugs are given together during neurosurgical procedures, evaluating those changes may provide their potential as an anaesthetic adjunct while reducing risks associated with excessive propofol use when used alone. Aim: To evaluate the efficacy of Dexmedetomidine infusion in reducing intraoperative Propofol requirement and maintaining depth of anaesthesia during elective neurosurgical procedures. Materials and Methods: This was a randomised controlled study conducted at the Department of Anaesthesiology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, India, from February 2023 to October 2024. It comprised 50 the American Society of Anesthesiologists Physical Status (ASA-PS) I–II patients aged 18-60 years undergoing elective neurosurgery. Patients were randomised into two groups: Group P (standard anaesthesia with Propofol infusion) and Group PD (same regimen plus Dexmedetomidine infusion: 1 μg/kg bolus over 10 minutes followed by 0.5 μg/kg/hr). Propofol was titrated to maintain the Bispectral Index (BIS) between 40-60. Haemodynamic parameters, total Propofol consumption (mg/kg/hr), and intraoperative complications were recorded and analysed using Repeated-measures One way-Analysis of Variance (ANOVA) or Student’s t-test. Results: The two study groups were comparable in age (group P: 42.3±10.5 years; group PD: 41.8±9.8 years; p-value=0.82), Body Mass Index (BMI) (group P: 24.9±2.5 kg/m2; group PD: 25.1±2.4kg/m2; p-value=0.85). Group PD showed significantly reduced intraoperative Propofol consumption compared to group P (3.00±0.8 mg/kg/hr vs. 4.50±1.0 mg/kg/hr, p-value <0.001). Haemodynamic parameters {Heart rate (HR), Mean Arterial Pressure (MAP)} remained more stable in the Dexmedetomidine group across all intraoperative time points. In the group PD, the incidence of hypotension was slightly lower than in group P {3(12%) vs. 6 (24%)}. Target BIS range (40-60) was maintained in both the study groups. However, group PD consistently demonstrated lower BIS values (e.g., 52.0±3.8 vs. 55.2±4.5 at 5 min, p-value=0.02), with reduced variability (5.8±0.9% vs. 7.2±1.1%, p-value <0.001). Conclusion: Dexmedetomidine infusion significantly reduces the intraoperative Propofol requirement while maintaining adequate depth of anaesthesia and providing superior haemodynamic stability in elective neurosurgical procedures. Its use as an adjuvant can enhance anaesthetic efficiency and patient safety when carefully monitored.

Intraoperative and Postoperative Outcomes after Percutaneous Nephrolithotomy under General and Spinal Anaesthesia: A Prospective Observational Study

Introduction: Percutaneous Nephrolithotomy (PCNL) is still the best way to deal with large or complicated kidney stones. It clears stones more effectively and has fewer side effects than open surgery. It can be done with either General Anaesthesia (GA) or Spinal Anaesthesia (SA), and each has its own pros and cons. Aim: To compare the outcomes of PCNL performed under GA and SA during and after surgery. Materials and Methods: This prospective observational study was conducted in the Department of Anaesthesia, LN Medical College and JK Hospital, Bhopal, Madhya Pradesh, India, in collaboration with the Department of Urology from December 2019 to May 2021, involving 60 adult patients American Society of Anaesthesiology-Physical Status (ASA-PS) I-II receiving PCNL under GA or SA. Patients were allocated to either group (GA, n=30; SA, n=30) based on the anaesthesiologist’s clinical assessment and the patient’s appropriateness. Postoperative pain {Visual Analogue Scale (VAS) scores}, total analgesic use, time to initial rescue analgesia, recovery duration to an Aldrete score of nine, and patient satisfaction ratings were assessed. Stata 16.1 was used to analyse the data, and a p-value <0.05 was considered statistically significant. Results: The mean age was 42.6±12.6 years (GA) and 34.3±11.5 years (SA). The average time to the first rescue analgesia was 97.87±8.8 minutes in the GA group and 444.13±90.3 minutes in the SA group (p-value <0.0001). Postoperative pain scores (VAS) were significantly lower in the SA group at all recorded time points (0, 2, 6, 8, 12, and 24 hours) compared to the GA group (p-value <0.0001). The average total analgesic dose in the first 24 hours was much higher in GA (225±19.7 mg) than in SA (102.5±41.7 mg, p-value <0.0001). It took longer for SA (162.3±51.5 minutes) to reach an Aldrete score of nine than it did for GA (76.6±6.0 minutes, p-value <0.0001). The average satisfaction score for the SA group was higher (8.43±0.56) than for the GA group (7.86±0.90, p-value=0.005). Conclusion: Compared to GA, PCNL with SA provides superior postoperative analgesia, evidenced by lower pain scores, diminished analgesic requirements, and an extended duration until the first rescue.

Anterior Segment Optical Coherence Tomography in Evaluation of Impact of Laser Peripheral Iridotomy on Anterior Segment Morphology and IOP in Primary Angle Closure Spectrum Patients: A Quasi-experimental Study

Gandavarapu Asritha, Athira Ajay Ghosh, Lavanya Ganesan, Abhishek Bharatkumar

Introduction: A leading cause of bilateral blindness worldwide, Primary Angle Closure Glaucoma (PACG) is estimated to affect 16 to 20 million people, with an estimated four million bilaterally blind. Laser Peripheral Iridotomy (LPI) is the primary treatment for angle closure based on its ability to relieve pupillary block. After LPI in eyes with narrow angles, progression to angle-closure glaucoma is uncommon, even in high-risk eyes such as the fellow eyes of patients with a unilateral acute angle-closure attack. Gonioscopy is limited in its ability to accurately characterise Anterior Chamber (AC) morphology. Anterior Segment Optical Coherence Tomography (AS-OCT), however, has emerged as a method for obtaining objective, reproducible high-resolution images that allow for quantification of AC parameters. Aim: The present study was aimed to evaluate, by AS-OCT, the changes in the AC angle width parameters following N:d YAG LPI in patients with Primary Angle Closure (PAC) spectrum patients and to study the Intraocular Pressure (IOP) changes following N:d YAG LPI in patients with PAC Spectrum (PACS) patients. Materials and Methods: The present quasi-experimental study was done in the Ophthalmology Department at SRM Medical College Hospital and Research Centre, Katthankulathur, Chennai, Tamil Nadu, India. Forty eyes were included in the study, this includes Best-Corrected Snellen Visual Acuity (BCVA), Slit-lamp evaluation including Van Herick’s Grading of angle and Lens status, Goldmann Applanation Tonometry, Corneal Pachymetry (CCT), undilated fundoscopy, gonioscopy and anterior segment OCT were performed at baseline. Tonometry and gonioscopy were performed on first week follow-up visit. While repeat AS-OCT was performed at one month follow-up visit. Changes in mean values between baseline (Pre LPI) and post LPI visits were assessed using statistical methods such as paired student’s t-test and Chi-square test. The p-value less than 0.05 were considered statistically significant. Results: The mean IOP prior to LPI was 22.33 mmHg, which reduced to 16.95 mmHg following LPI (p<0.001). Mean CCT was 536.675 um, with minimum being 500 μm and maximum being 560 um. AC angle parameters on AS-OCT, i.e.,- Trabecular-Iris Angle (TIA), AOD 500, AOD 750, TISA 500, TISA 750, Scleral Spur Angle (SSA), Anterior Chamber Width (ACW) and Anterior Chamber Area (ACA), all increased significantly following LPI (p<0.001 for all parameters). Thus, demonstrating widening of AC angle and flattening of the convex Iris configuration following LPI. Central AC depth had insignificant but minimal change following LPI (p>0.05). Conclusion: LPI is efficacious in widening of the AC angle in eyes with PACS disease in the short term. AS-OCT as an imaging modality has several advantages that make it an excellent tool for large-scale screening of PACG.

Correlation of C-Reactive Protein with Cardiac Enzymes and Left Ventricular Function in Patients with Acute Myocardial Infarction: A Cross-sectional Study

Introduction: Coronary Artery Disease (CAD) is a leading cause of morbidity and mortality worldwide, arising from atherosclerotic narrowing or acute occlusion of the coronary arteries. Acute Myocardial Infarction (AMI), a severe manifestation of CAD, is influenced by risk factors such as hypertension, diabetes, smoking, and hyperlipidemia. C-Reactive Protein (CRP), an inflammatory marker produced by the liver in response to Interleukin-6, is elevated in AMI and may reflect the degree of myocardial damage and ventricular dysfunction. CRP not only reflects the underlying inflammatory processes that contribute to plaque instability and rupture, but may also play a direct role in promoting endothelial dysfunction and thrombosis. Aim: To assess the levels of serum CRP in patients with AMI and to determine the correlation of CRP with cardiac enzymes and left ventricular function. Materials and Methods: This cross-sectional study was conducted at the Department of Medicine, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from May 2022 to July 2024. A total of 81 patients aged≥18 years with AMI were included. Clinical data, Electrocardiogram (ECG) findings, serum CRP, cardiac enzymes {Creatine Kinase-Myocardial Band (CK-MB), High-sensitivity Troponin I (hs-TnI)}, and 2D echocardiographic parameters were recorded. Pearson’s correlation was used for statistical analysis, with significance set at p<0.05. Results: The mean age of patients was 63.6±12.4 years, with a male-to-female ratio of 1.5:1. Chest pain (93.8%) and shortness of breath (43.1%) were common symptoms. Risk factors included smoking (63%), hypertension (46.9%), and diabetes (33.3%). Mean CRP was 20.8±20 mg/L, CK-MB 74.1±53.5 U/L, and hs-TnI 7.42±9.39 ng/mL. CRP negatively correlated with Left Ventricular Ejection Fraction (LVEF) (r=-0.605, p<0.001) and positively with Regional Wall Motion Abnormalities (RWMA) segments (r=0.664, p<0.001) and Left Ventricular Diastolic Dysfunction (LVDD) grade (r=0.462, p<0.001). hs-TnI showed similar correlations: negative with LVEF (r=-0.591, p<0.001) and positive with RWMA (r=0.651, p<0.001) and LVDD (r=0.462, p<0.001). CK-MB was positively correlated with RWMA (r=0.384, p<0.001), but not significantly with LVEF or LVDD. Conclusion: Elevated serum CRP levels correlated significantly with impaired Left Ventricular (LV) function in AMI patients. CRP may serve as a useful biomarker for assessing the severity and prognosis of myocardial infarction.

Barriers to Obtaining Informed Consent among Surgeons: A Cross-sectional Study at a Tertiary Care Hospital in Dakshina Kannada, India

Mohammad Zahed Khan Gooty, Supriya Pinto, Caren Dsouza

Introduction: Informed consent involves the patient in shared decision-making by providing adequate information about the disease, recommended plan of care and authorisation to proceed. During the consent process, factors such as the educational status, regional background, health literacy and anxiety of the patient are often overlooked. Recognising these barriers would be a stepping stone to finding ways to improve the informed consent process, thereby enhancing the trust and understanding between the surgeon and the patient. Aim: To identify the sociodemographic barriers and the ethical challenges faced by surgeons while obtaining informed consent. Materials and Methods: A cross-sectional, validated questionnaire-based study was conducted over three months from January 2023 to March 2023 at the Department of Surgery, Justice KS Hegde Hospital in Mangaluru, Dakshina Kannada district, South India. The study included 218 consenting consultants and postgraduate students from the surgical departments. Participants were selected using purposive sampling. Data collection was facilitated through Google Forms, which included three sections: sociodemographic barriers, components of informed consent and the doctors’ perspectives on barriers and challenges in obtaining informed consent. The reliability of the questionnaire was assessed using Cronbach’s alpha coefficient. The results were analysed using frequencies and percentages with Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Among the 218 surgeons surveyed, 138 were male and 80 were female. The patient’s age was perceived as a barrier by 141 surgeons, while 181 cited the patient’s level of education. Language was reported as a barrier by 204 surgeons and 202 identified the patient’s personality traits as contributing factors. Additionally, 170 surgeons noted a lack of trust in the healthcare system and 143 considered cultural and religious beliefs as barriers. The use of complex medical terminology was reported by 169 participants, while 188 highlighted issues related to the content and readability of consent forms. Furthermore, 125 surgeons felt that excessive online health information complicated the consent process. A majority, 163 respondents, agreed that the informed consent process upholds the principles of bioethics. Conclusion: Informed consent is a major aspect of surgical practice and the present findings indicate that the majority of surgeons in the Indian context are proficient in obtaining it. Surgeons have a challenging task when communicating specialised clinical information to patients from various sociocultural backgrounds, particularly those with low health literacy, impaired autonomy and debilitating conditions. Therefore, it is crucial to identify and overcome the barriers and challenges faced in obtaining legally valid informed consent.

Assessing Cancer-related Fatigue in Survivors undergoing Diverse Treatments: A Prospective Cohort Study

Abhishek Basu, Saikat Sheet, Ipsita Palui

Introduction: Cancer-related Fatigue (CRF) is a common and debilitating concern among cancer survivors, significantly affecting their physical, emotional, and social well-being. In India, the growing number of survivors has made CRF a major post-treatment issue. However, it remains under-recognised and inadequately addressed. This study explores the prevalence, determinants, and severity of CRF among Indian cancer survivors, underlining the need for targeted interventions. Aim: To assess the prevalence and contributing factors of CRF in cancer survivors undergoing diverse treatments. Materials and Methods: This prospective cohort study was conducted at the Outpatient Department (OPD) of Radiotherapy (RT), Midnapore Medical College and Hospital, West Bengal, India, between 1st May 2024 and 31st October 2024. Demographic and clinical data were collected through case files and structured interviews. The Brief Fatigue Inventory (BFI) was administered pre- and post-treatment. Statistical analysis was performed using Chi-square and Fisher’s-exact test to compare the means of clinical data and other demographic data, with a significance threshold of p-value ≤0.05. IBM, Statistical Package for Social Sciences (SPSS) software, version 23.0, was used. Results: A total of 154 patients were evaluated, with a median age of 50 years and a female predominance of 122 (79.20%). Breast cancer was the most prevalent cancer, 72 (46.80%), followed by head and neck, 20 (13%) and gynaecological cancers (ovary+cervix) 28 (18.20%). Multimodality treatment was administered to 94 patients (61%). Disease status was stable in 117 (75.97%) and relapsed/progressive in 37 (24.03%) patients. Median BFI scores increased from 2.80 (pre-treatment) to 4.55 (post-treatment), indicating a shift from mild to moderate fatigue. Significant associations were observed between fatigue severity and advanced stage, combined treatment modality, multiple chemotherapy lines, poor Performance Status (PS), and relapsed disease (p-value <0.05). Conclusion: CRF was highly prevalent among Indian cancer survivors, particularly in those with advanced-stage or relapsed disease and those undergoing multimodal treatment. These findings highlight the pressing need for structured interventions and fatigue-specific support in survivorship care.

Role of ARNT2 in Cancer with Specific Emphasis on Oral Squamous Cell Carcinoma: A Bibliometric Review

Introduction: Oral Squamous Cell Carcinoma (OSCC) remains a significant public health issue worldwide, given its rising incidence and unfavourable survival rates, even with treatment advances. Owing to its bivalent function in cancer biology as an oncogene or tumour suppressor, depending on the cellular environment, Aryl Hydrocarbon Receptor Nuclear Translocator 2 (ARNT2), a bHLH-PAS transcription factor, has emerged as a potential biomarker and therapeutic target. Aim: This article reports an exhaustive bibliometric examination of worldwide research trends on ARNT2 with specific emphasis on its significance to OSCC. Materials and Methods: The present bibliometric study employed targeted keyword approaches, articles between 1996 and 2025 were retrieved from PubMed and Scopus. Network mapping, co-authorship, citation analysis, and keyword clustering were all performed in R software (v4.5.1). Original, peer-reviewed articles and reviews only were included. The evaluated parameters comprised publication year, journal source, country of origin and citation counts. Results: Analysis of 220 documents identified significant growth in ARNT2 over the last 20 years. The role of ARNT2 in hypoxic transcriptional control, its tumour-suppressive activity by regulation of cell growth and apoptosis, and its effect on reprogramming of the metabolism by the VHL-HIF1α-GLUT1 pathway were the three predominant thematic groups identified. The suppression of ARNT2 in OSCC and its potential as a marker for prognosis are emphasised in the highest cited publications. It has its greatest input from China, Japan, and the US, and global collaboration is expanding. Conclusion: ARNT2 plays a critical role in the pathogenesis of OSCC, as per the bibliometric picture, and its diagnostic and therapeutic possibility is increasing. For maximising the potential of ARNT2 in targeted interventions in oral cancer, there is a need for increased translational research.

Interventions for Tocophobia: A Systematic Review of Randomised Controlled Trials

Ishita Parshottam Shah, Anjali Pushkar Tiwari

Introduction: Many women experience fear regarding childbirth, scientifically known as tocophobia. Mild levels of tocophobia may be normal during pregnancy, but higher or severe levels can be pathological and detrimental to the health of both the pregnant woman and her unborn child. The present systematic review focuses on understanding the various interventions used to manage tocophobia among pregnant women. Aim: To systematically evaluate and synthesise Randomised Controlled Trials (RCTs) published between 2019 and 2024 that examine the effectiveness of interventions in reducing tocophobia. Materials and Methods: A systematic search was conducted using databases such as PubMed, EBSCOhost, and Google Scholar. Only articles that met the predefined inclusion and exclusion criteria were selected for this review. Studies were included if they were RCTs published in English and focused on interventions such as counselling, Cognitive Behavioural Therapy (CBT), psychoeducation, and mindfulness. Pharmacological studies and non-RCT designs were excluded. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP) RCT Checklist (2018), which evaluates 11 parameters: clarity of research focus, randomisation, follow-up, blinding, baseline group similarity, equal treatment, clarity of results, estimate precision, consideration of benefits versus harms, applicability, and value of findings. Results: Eighteen RCTs met the inclusion criteria. Interventions included CBT, mindfulness-based interventions, midwife-led counselling, psychoeducation, and hypnobirthing. CBT and midwife-led interventions consistently reduced tocophobia scores. Quality appraisal showed that most studies had moderate to high methodological quality. These interventions ranged from 2 to 8 sessions and were delivered individually or in groups, through face-to-face, online, or telephonic formats. Conclusion: Findings from this systematic review indicate that CBT and midwife-led counselling are highly effective in reducing childbirth-related fear. These non-pharmacological approaches enhance mental well-being and improve the overall birth experience. Implementing these evidence-based strategies can lead to more positive childbirth outcomes, greater maternal confidence, and reduced reliance on unnecessary medical interventions such as elective caesarean sections. Future research should focus on identifying the optimal timing, delivery format, and long-term impact of these interventions in diverse settings.

Synergy of Yogic Pilates and Pranayama to Combat Stress and Cognition in Premenstrual Syndrome for Sustainable Health: An Experimental Study

Abha Khisty, Zafar Azeem, Rucha Choudhari, Tushar Palekar

Introduction: Premenstrual Syndrome (PMS) affects many women of reproductive age. It has a detrimental effect on health-related quality of life and work productivity. Additionally, it contributes to increased levels of lifestyle-related stress. There are established approaches for the treatment of the physical symptoms of PMS. However, the combined management of physical symptoms with mental health is quite limited. Aim: To observe the effect of Yogic Pilates and pranayama on stress, cognitive status, and core strength in females suffering from PMS. Materials and Methods: The present study was an experimental study conducted at Dr. D. Y. Patil College of Physiotherapy, Pune, Maharashtra, India. A total of 30 females, with a mean age of 23 years, diagnosed with moderate to severe PMS—specifically, experiencing one affective symptom (depression) and one somatic symptom (backache)—and a history of significant interference in social activities, were selected. They were screened for core strength, PMS-related stress, levels of Anti-Müllerian Hormone (AMH), and cognition at two points: on the 1st day and the 24th day of treatment. A paired t-test for all five outcome measures was used to analyse the results. The confidence interval was 95%, and the level of significance was set at p-value <0.05. Results: There was a significant improvement in core strength (p-value=0.01) postintervention, along with a reduction in stress levels (p-value=0.01). However, no difference was observed in cognitive status (p-value=0.08) postintervention, and no significant difference was found in the levels of AMH (p-value=0.09). Conclusion: The present study highlights the effectiveness of a combined Yogic Pilates and pranayama intervention in reducing stress and enhancing cognitive function in individuals with PMS. Participants demonstrated significant improvements in emotional balance, mental clarity, and overall wellbeing. The synergistic approach provided both physiological relaxation and improved body awareness, addressing both physical and psychological aspects of PMS. These findings support the integration of mind-body practices as a sustainable, non pharmacological strategy for managing PMS symptoms.

Knowledge, Attitude and Practices of Mercury Toxicity among Dental Undergraduate Students in Belagavi, Karnataka, India: A Descriptive Study

Introduction: Mercury, a key component of dental amalgam, is a known neurotoxin that can accumulate in the body and impact health. Mercury waste, under the Biomedical Waste Management Rules, 2018, must be safely stored and sent to authorised recyclers, as improper disposal causes neurotoxicity and environmental harm. The rationale of the current study highlights the need to assess the awareness and safety practices among future dentists who use mercury in their day-to-day practice, to minimise exposure and protect community health. Aim: To assess the knowledge, attitudes and practices regarding health hazards of mercury toxicity and evaluate the safety practices of mercury disposal among undergraduate dental students. Materials and Methods: A hospital-based descriptive study was conducted among 101 3rd and 4th year undergraduate dental students, who worked with mercury amalgam in their daily practice at Karnataka Lingayat Education Society’s, Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India, from August 1st 2024 to October 30th 2024. Data was collected using a pre-designed and structured questionnaire, entered into Microsoft Excel, and analysed using frequency, percentage, Mean±Standard Deviation (Mean±SD) and multiple linear regression analysis test (p-value <0.05) using IBM Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 19.58±2 years; of 101 students, 76 (75.25%) students were females, 57 (56.44%) students were in 4th year, and 44 (43.56%) students were in 3rd year. The Mean±SD scores were 15.60±3.93 (knowledge), 2.93±1.62 (attitude), and 6.45±2.99 (practice); among the 12 students with “good knowledge,” the subgroup was 22.17±1.20. Lower knowledge was associated with fewer amalgam restorations (<4), while attitudes were more positive among males (p-value=0.012) and 4th year students (p-value=0.045). Practice scores were strongly linked to formal training on mercury waste disposal during Bachelor of Dental Surgery (BDS) (p-value <0.001), though only 58 (57.43%) had attended such training. Notable gaps remained in curriculum adequacy, disposal awareness, and adherence to mercury protocols. Conclusion: Dental undergraduates exhibited good knowledge regarding the health hazards of mercury toxicity, but their mercury safety and disposal practices were poor. Incorporating structured practical training and integration of Minamata Convention guidelines into the dental curriculum is recommended to ensure effective translation of knowledge into safe clinical practice.

Impact of OM Chanting versus Diaphragmatic Breathing on Cardiorespiratory Endurance Level in Young Adults: A Prospective Interventional Study

Tejas R Chokshi, Neha R Mukkamala, G Palani Kumar

Introduction: Adulthood is a critical period during which modifiable behaviours influence long-term health outcomes. Physical inactivity contributes to poor cardiorespiratory endurance and increased risk of mental health disorders. OM chanting and diaphragmatic breathing have demonstrated several physiological benefits; however, their comparative effects on cardiorespiratory endurance remain underexplored. Aim: To evaluate and compare the effects of OM chanting and diaphragmatic breathing on cardiorespiratory endurance in young adults. Materials and Methods: This prospective interventional study was conducted at College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat, India. The study included 24 healthy young adults aged 20-35 years, who were randomly assigned to either the OM Chanting Group or the Diaphragmatic Breathing Group. Both groups practiced their respective interventions twice daily (5 minutes per session, 60 breathing cycles per day) for 30 consecutive days. Cardiorespiratory endurance was assessed using the 6-Minute Walk Test (6MWT) before and after the intervention. Participants were further stratified according to their Body Mass Index (BMI) based on the World Health Organisation (WHO) classification for subgroup analysis. Paired t-tests were applied for intragroup (pre-post) comparisons, while independent t-tests were used for intergroup analysis. A p-value <0.05 was considered statistically significant. Results: In the Diaphragmatic Breathing Group, participants with normal BMI demonstrated a significant increase in 6-Minute Walk Test Distance (6MWTD) from 540.50±42.46 m to 576.00±37.81 m (p-value=0.001). Those in the Obese I subgroup improved from 527.00±52.33 m to 559.50±53.03 m (p-value=0.009). In the OM Chanting Group, participants with normal BMI showed an increase in 6MWTD from 444.29±152.63 m to 476.29±133.73 m (p-value=0.005), while Obese I participants improved from 350.00±45.83 m to 390.00±50.00 m (p-value=0.020). Between-group comparison revealed that the Diaphragmatic Breathing Group had a significantly lower postintervention pulse rate compared to the OM Chanting Group among normal BMI participants (p-value=0.002). In the Obese I subgroup, the Diaphragmatic Breathing Group demonstrated a higher postintervention 6MWTD (p-value=0.030) and lower pulse rate (p-value=0.010) than the OM Chanting Group. Conclusion: Both diaphragmatic breathing and OM chanting improved cardiorespiratory endurance in young adults. However, diaphragmatic breathing showed superior benefits in enhancing exercise capacity and respiratory endurance. These accessible techniques can be integrated into preventive and rehabilitative health programs for young adults.

Effect of Therapeutic Phlebotomy on the Haematological Parameters in Polycythaemia Cases: A Cross-sectional Study from a Tertiary Blood Centre in Southern India

Padmini Chitradurga Vijayasarathy, Haroon Adoni, Brilsee Simeon

Introduction: Therapeutic phlebotomy involves the controlled removal of blood from a patient to reduce complications in polycythemia, in which 300 to 400 mL of blood is removed. Polycythaemia is a condition characterised by an increase in red cell mass and is commonly seen secondary to smoking, Chronic Obstructive Pulmonary Disease (COPD), congenital heart disease and polycythaemia vera. Patients with polycythaemia have an increased risk of thrombotic events such as stroke, coronary artery disease and deep vein thrombosis compared with normal individuals. Aim: To evaluate the effect of therapeutic phlebotomy on haematologic parameters in cases of polycythemia. Materials and Methods: This was a retrospective, cross-sectional study conducted in the Department of Transfusion Medicine, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India, for a period of one year from January 2024 to December 2024. A total of 186 therapeutic phlebotomy procedures were recorded for polycythemia, involving 104 patients during the study period who were included in the study. Polycythaemia was defined as Haemoglobin (Hb) >16.5 g/dL and Haematocrit (Hct) >48%. All data were collected in Microsoft Excel. Prephlebotomy haematologic values such as Hb and Hct were recorded for all patients. Status of Janus Kinase 2 (JAK2) mutation analysis was recorded from departmental archives when available. Categorical variables were expressed as counts and percentages; continuous variables were expressed as means, medians and ranges. The Pearson’s correlation coefficient was used to correlate pre- and post-phlebotomy Hb and Hct values. A paired t-test was used to determine whether the drop in Hb and Hct was statistically significant. A p-value <0.05 was considered statistically significant. Results: The study included 104 cases and showed male predominance with a male-to-female ratio of 51:1. The patients ranged in age from 23 to 73 years, with a mean age of 47 years. The average fall in Hb was 1.2 g/dL and the average fall in Hct was 3.6 percentage points after a single session of therapeutic phlebotomy (approximately 350 mL). The post-phlebotomy drop in Hb of ≥1 g/dL was observed in 81 (77.8%) patients, while 23 (22.1%) patients showed a drop <1 g/dL. It was noted that 36 (34.6%) patients underwent multiple repeated sessions of therapeutic phlebotomy within eight weeks to bring Hb and Hct to the normal range. Conclusion: Therapeutic phlebotomy, involving removal of 300-400 mL of blood, can reduce Hb by about 1 g/dL and is recommended in polycythaemia to reduce the risk of arterial and venous thrombotic events. Polycythemia, irrespective of the cause, should be treated with aspirin in addition to therapeutic phlebotomy to maintain Hct below 45%.

Relationship between Serum Testosterone Levels, Severity of Dependence, Impulsivity and Craving in Alcohol Dependent Males: A Prospective Observational Study

Vignesh Raja, Aravindh Manogaran, Kailash Sureshkumar, Shabeeba Z Kailash

Introduction: Alcohol dependence is a chronic relapsing disorder characterised by compulsive alcohol use, craving, and withdrawal symptoms. Emerging evidence suggests testosterone may influence craving intensity and impulsivity during early abstinence. Aim: To determine relationship between serum testosterone, severity of dependence, impulsivity, and craving in males with alcohol dependence. Materials and Methods: The present single-centre, prospective observational study was conducted in the Psychiatry Outpatient Department (OPD) of Chettinad Hospital and Research Institute, Chennai,Tamil Nadu, India (May 2024-June 2025); 55 male patients (18-59 years) with International Classification of Diseases (ICD)-11 alcohol dependence (6C40.2) were enrolled after written informed consent and Institutional Human Ethics Committee (IHEC) approval (IHEC-I/2824/24; 02/05/2024). Serum total testosterone (CLIA) was measured on days 1 and 7, alcohol craving (PACS) on days 1 and 7, dependence severity (SAD-Q), impulsivity (BIS-11) and sociodemographics; analyses used Statistical Package for Social Sciences (SPSS) v26 with Shapiro-Wilk tests for normality, independent-t/Analysis of Variance (ANOVA) for group comparisons, paired-t for within-person change, and adjusted (partial) Pearson correlations (two-tailed α=0.05). Results: Craving scores were significantly higher among patients aged 40-60 years (mean=24.1, p=0.001). Impulsivity scores were significantly elevated in lower socioeconomic backgrounds (mean=67.1, p=0.021). On day 1 of abstinence, craving increased with severity of dependence, ranging from 19.2 (mild) to 23.3 (severe), with statistically significant differences (p=0.002), while all groups showed significant craving reduction by day 7 (p<0.001). Serum testosterone levels declined from day 1 to day 7, particularly in moderate and severe groups (p=0.014 and p=0.001, respectively), though between-group differences remained non-significant. A significant positive correlation was found between testosterone and craving on day 7 (r=0.382, p=0.004), and reduction in testosterone strongly correlated with reduction in craving over 7-day period (r=0.529, p<0.001). Conclusion: The study found a significant positive correlation between changes in serum testosterone levels and craving during early abstinence in alcohol-dependent males. These findings suggest that testosterone may serve as a potential biomarker for craving intensity.

Determination of Gender and Age by Analysis of Mental Foramen using CBCT in a Subset of Population in Kolkata, India: A Retrospective Study

Introduction: Out of all the morphological landmarks in the human body, the Mental Foramen (MF) is thought to be one of the most reliable for determining age and gender. It has therefore been utilised in the current investigation to assess age and gender because of its durability. Aim: To determine sexual dimorphism and to ascertain the age in a subset of Kolkata population, in West Bengal, India, by analysing the MF using images obtained from Cone Beam Computed Tomography (CBCT). Materials and Methods: The present retrospective study was conducted in Kolkata, West Bengal, India over a period of six months (January to June, 2024). Dentulous patients of age ranging from 18-60 years were included in the study. Among CBCT images of 70 subjects, 50 were included in the study as per the inclusion and exclusion criteria. The subject’s Outpatient Department (OPD) registration number, gender and age were kept confidential, and a unique study number was allotted. The required measurements in the CBCT images, were done on these following parameters in both right and left side: 1) Superior Border or crest of Mandible to Superior Border of MF (SBM-SBMF); 2) Superior Border or crest of Mandible to Inferior Border of MF (SBM-IBMF); 3) Superior Border of MF to Inferior Border of Mandible (SBMF-IBM); 4) Inferior Border of MF to Inferior Border of Mandible (IBMF-IBM); 5) Superior Border of MF to Inferior Border of MF (SBMF-IBMF); 6) Superior Border of Mandible to Inferior Border of Mandible (SBM-IBM). A subset of Bengali Population was considered for the study. The information gathered was entered into a Microsoft Office Excel sheet, from which it was extracted to produce the desired outcomes using Stata version 13.1 (Stata Corp, USA). An independent t test was used to compare the distance between the reference points and between the genders. Wilcoxen’s correlation coefficient test was used to assess the strength of the correlation between the right and left-sides. Comparison between age groups was analysed by Mann-Whitney U test and p-value of 0.05 was considered significant. Further logistic regression analysis was made, and the predictive percentage was calculated. Results: In this subset of Kolkata population the mean measurement of SBM-SBMF on the right and left-side for the males were 13.40±3.33 and 12.12±3.25, respectively. Similarly for the females the measurements for the right and left-side were 12.58±2.47 and 12.49±2.66, respectively. The study’s findings indicate that there is bilateral dimorphism in the (SBM-SBMF) and (SBM-IBMF) and (SBMF-IBMF) distances for both genders, making it a useful tool for distinguishing gender. Regarding age estimation, the research demonstrated substantial values for each of the four criteria. There were also bilateral differences noted. There is a substantial correlation between the estimated and original ages, according to the age regression model. Conclusion: The MF being a sturdy landmark is a useful tool for determining gender and age. As a result, using particular MF measurements, one can determine the age of an individual. Additionally, preprosthetic surgery, implant placement, and orthognathic treatments use its location and distance from the alveolar crest as a guidance.

A Clinical Measurement of Supraeruption in Unopposed Posterior Teeth in Kheda Population: A Cross-sectional Observational Study

Saumya Patel, Somil Mathur, Trishala Patel, Archana Shah, Vishal Rathod

Introduction: Supraeruption causes an interruption in occlusal harmony, hampers speech, disrupts masticatory patterns and complicates subsequent restorative dentistry. Despite its clinical significance, there is limited literature quantifying the extent of supraeruption in unopposed posterior teeth. This gap hinders early diagnosis and timely intervention. Therefore, it is important to raise awareness regarding the prevalence, consequences, preventive measures and management of supraeruption to support evidence-based treatment planning and improve long-term oral health outcomes. Aim: To clinically measure the extent of supraeruption in unopposed posterior teeth in Kheda population using a standardised photographic method and to evaluate its association with variables such as the duration of edentulism, age groups and arch location. Materials and Methods: This cross-sectional observational study was conducted in the Department of Prosthodontics, Crown and Bridgework and Oral Implantology at the Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, India, from July 2023 to September 2023. Patients who reported to the outpatient department were screened based on selection criteria by the principal investigator. Demographic information such as the patients’ age group, years since tooth extraction and cause of tooth loss were recorded. Patients with unopposed posterior teeth, with at least a canine and second molar present, who gave written informed consent were included in the study. A total of 81 patients were selected and diagnostic impressions of the arch with unopposed posterior teeth were made, followed by pouring casts. Images of the casts were captured using a standardised photographic setup. The extent of supraeruption was measured using Adobe Photoshop software. Statistical analyses included the Shapiro-Wilk test, unpaired t-test, Analysis of Variance (ANOVA) with post-hoc test and chi-square (χ²) test, with p≤0.05 considered significant. Results: The variable assessed was the extent of supraeruption over the period of edentulism. The mean±Standard Deviation (SD) of tooth loss for durations of 1-5 years, 6-10 years and 11-15 years were 1.27±0.46, 2.48±0.41 and 3.22±0.19, respectively. The data revealed a statistically significant correlation between mean supraeruption ratios and the duration of edentulism. Conclusion: The study concluded that unopposed posterior teeth contributed significantly to supraeruption, with a higher prevalence in the maxillary arch. Moreover, there was a notable difference in the mean ratios of supraeruption based on the duration of edentulism.

Retinal Degenerative Changes and Complications in Pathological Myopia: Cross-sectional Study from a Tertiary Care Centre

Athira Ajayghosh, Gandavarapu Asritha, Sharon Mary George, Ruthra

Introduction: Higher degrees of pathologic myopia are more frequently associated with degenerative changes which occur in the posterior segment of an eye with high myopia. Early identification of the complications due to pathological myopia will help in the identification of patients with high-risk and the need for frequent follow-up and screening of the fundus. Aim: To study the presence of degenerative changes in the fundus among patients with pathological myopia, and to compare these fundus changes among the various categories of pathological myopia. Materials and Methods: This is a cross-sectional study conducted in the Outpatient Department (OPD) of Ophthalmology, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from July 2023 to June 2024. Based on predetermined inclusion and exclusion criteria, 144 patients with high myopia (≥–6.00 dioptres (D); axial length >26 mm) who were seen in the Ophthalmology OPD were enrolled. Following informed consent, demographic information and a thorough examination of the eyes, including a history, evaluation of the anterior and posterior segments (fundus examination), and a visual acuity test were conducted. Refractive error was used to stratify patients into three groups: >-14D, -14D to -10D, and -6D to -10D. Retinal degenerations, tessellated backgrounds, tilted discs, myopic crescents, peripapillary atrophy, lacquer cracks, posterior staphylomas, foster fuchs spots, chorioretinal atrophy, retinal tears/breaks, and retinal detachment are among the degenerative changes linked to high myopia that were recorded and compared across categories. Data was recorded in MS Excel sheet and analysis was done using Statistical Package for Social Sciences (SPSS) software version 16.0. A p-value less than 0.05 was considered a cut-off for statistical significance. Results: The study involved 288 eyes (144 patients). The mean age among the subjects was 43.93 (±16.99) years, ranging from 13 to 89 years. Among the subjects, 75 (52.08%) were females, and 69 (47.92%) were males. Among the subjects, 107 eyes (37.15%) had 6-10D followed by 93 eyes (32.29%) had >10-14D and least 88 eyes (30.56%) had >14D. Most common abnormalities observed in the study was tessellated background among 254 eyes (88.19%), 143 eyes (49.7%) had peripapillary atrophy, 41 eyes (14.2%) had chorioretinal atrophic patch, 40 eyes (13.9%) had retinal tear, 22 eyes (7.6%) had tilted disc, 18 eyes (6.3%) had lattice degeneration, 16 eyes (5.6%) had staphyloma. Subjects with greater myopia (>14D) had a significantly higher proportion of peri-papillary atrophy, tessellated background, retinal tear, tilted disc, lattice degeneration, chorioretinal atrophic patch, staphyloma, lacquer cracks, atrophic retinal hole, and retinal detachment. Conclusion: Tessellated background, peripapillary atrophy, myopic crescent, chorioretinal atrophic patch, retinal tear, tilted disc, lattice degeneration, and staphyloma are common abnormalities observed in high-grade myopia. Hence, early screening of these abnormalities and effective control of myopia can prevent these abnormalities.

Evaluation of Antimicrobial Efficacy of Modified Novel Double Antimicrobial Preparations against E. Faecalis and C. Albicans: An In-vitro Study

N Meena, G Vinay Kumar, Vinoo Subramaniam, Sibi Swamy, VK Vijay

Introduction: The aim of endodontic treatment is the reduction of microbial load inside the root canal, for which Calcium hydroxide {Ca(OH)2} is the most commonly used medicament, which is ineffective against resistant microbes such as E. faecalis and C. albicans. Hence, this study was designed to develop an effective medicament which includes a combination of drugs such as diclofenac, ciprofloxacin, fluconazole, with Ethyl Cellulose (EC). Aim: To evaluate the antimicrobial efficacy of different combinations of Diclofenac, Ciprofloxacin and Fluconazole (DCF) with EC against E. faecalis and C. albicans. Materials and Methods: This in-vitro study, conducted at the Department of Conservative Dentistry and Endodontics in RVS Dental College and Hospital, Coimbatore, Tamil Nadu, India, from September 2024 to January 2025. This included quality control strains of C. albicans and E. faecalis, which were cultured in Tryptic soy broth supplemented with 5% defibrinated sheep blood under anaerobic conditions at 37°C for 45 hours. The two groups (E. faecalis group and C. albicans group) with test materials, which were further divided into three groups: Group I-Calcium hydroxide, Group II-Saline, and Group III-Test drugs. Test drugs were prepared by making different combinations of drugs {Active Pharmaceutical Ingredient (API) powders} of the test drugs, weighed and mixed in 1:10, 2:10, 3:10 ratios with Ethylcellulose polymer (Test drugs-Diclofenac, Ciprofloxacin and Fluconazole). A sample of three different concentrations was examined across all combinations of drug preparations. The antimicrobial activity was assessed using the disk diffusion method. Microbial lawns were prepared on Mueller-Hinton plates with inoculum standardised to 1.5×108 CFU/mL. A disk (6 mm diameter) was punched aseptically and filled with 20 μL of test materials. Wassermann filter paper discs were incubated at 37°C for 24 hours, and zones of inhibition were measured using a HiMedia antibiotic scale. Data were statistically analysed using One-way Analysis of Variance (ANOVA) in the Statistical Package for Social Sciences (SPSS) software 24.0. Results: ANOVA statistics revealed that DCF (3:10) consistently demonstrated the highest antimicrobial efficacy against both E. faecalis and C. albicans, with a p-value of <0.001. These findings suggest that novel antibiotic combinations, especially those incorporating Diclofenac, may serve as effective therapeutic agents in combating resistant pathogens. Conclusion: Within the limitations of the study, it can be concluded that DCF (3:10) consistently demonstrated the highest antimicrobial efficacy against both E. faecalis and C. albicans; therefore, it can be considered a potential intracanal medicament against these pathogens.

Perceived Stigma and Social Distance towards People Suffering from Leprosy: A Cross-sectional Study in Dibrugarh District of Assam, India

Manas Jyoti Kotoky, Gourangie Gogoi, Tanzil Sohail Ahmed

Introduction: Leprosy presents as painless, hypopigmented, anaesthetic lesions on the body, which, when left untreated, progress to cause destructive and irreversible damage to the skin, nerves, eyes, and other body parts. The disease is often diagnosed late in its natural progression as it remains undetected as innocuous lesions. Additionally, the stigma and social distancing associated with leprosy further challenge its early diagnosis and control efforts. Aim: To assess the perceived stigma and social distance towards people suffering from leprosy. Materials and Methods: A community-based cross-sectional study was conducted among leprosy patients who were already undergoing Multi-Drug Therapy as well as new cases detected in the Leprosy Case Detection Camps (LCDC) in various locations of Dibrugarh district, Assam, India. A total of 42 leprosy patients were interviewed for the study over a six-month period from September 2024 to February 2025 to assess their fear of discrimination or perceived stigma. Additionally, 14 close contacts of the leprosy patients who accompanied them were also interviewed to assess their attitudes regarding maintaining social distance towards the leprosy patients. Analysis was performed and presented as frequencies, percentages, and proportions. Appropriate statistical tests, such as Chi-Square and Fisher’s exact test, were conducted. Results: Out of the 42 patients interviewed, the majority were male (32, 76.2%), with most patients belonging to the age group of 21-30 years (12, 28.6%). The majority of the patients were Multibacillary (MB) (23, 54.8%) and 19 (45.2%) were Paucibacillary (PB). Out of 42, 10 (23.8%) respondents reported experiencing stigma related to leprosy. Eight out of 14 respondents had a mean score for the Social Distance Scale (SDS) indicating an unwillingness to maintain closeness or social interactions with leprosy patients. Conclusion: Intense active case finding needs to be conducted through grassroots-level frontline workers, and more cases should be detected at an early stage before the onset of deformity. Awareness campaigns, education, and improved healthcare access can reduce the stigma and social taboos associated with leprosy.

Matrix Metalloproteinase-9 Expression in Surface Epithelial Ovarian Carcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study

Introduction: Ovarian cancer is one of the most lethal gynaecological malignancies worldwide, largely due to its late-stage diagnosis and high metastatic potential. The tumour microenvironment plays a crucial role in disease progression, with Extracellular Matrix (ECM) remodelling being a key process in tumour invasion and metastasis. Among the mediators of ECM degradation, Matrix Metalloproteinase-9 (MMP-9) has garnered significant attention due to its ability to degrade type IV collagen, a major component of the basement membrane. MMP-9, a member of the gelatinase subfamily of MMP, is involved in multiple oncogenic processes, including tumour growth, angiogenesis, and immune evasion. Overexpression of MMP-9 has been observed in various malignancies, including ovarian cancer, where it is associated with poor prognosis, increased tumour aggressiveness, and resistance to therapy. Aim: To analyse the expression of MMP-9 and its association with different clinicopathological parameters in surface epithelial ovarian carcinoma. Materials and Methods: This observational, cross-sectional descriptive study included 80 cases of epithelial ovarian carcinoma diagnosed at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. Tumour samples were collected and processed for histopathological examination, followed by immunohistochemical analysis to assess MMP-9 expression. Clinicopathological parameters, including histological type, grade, and stage, were recorded. The intensity of MMP-9 expression was categorised into two groups—high and low expression—based on a predetermined scoring system. The association between MMP-9 expression and various clinicopathological features (such as tumour laterality, histological type, tumour grade, tumour stage, and presence of malignant cells in ascitic fluid) was analysed using IBM Statistical Package for the Social Sciences (SPSS) for Windows, Version 10.0, Armonk, NY: IBM Corp.). Descriptive statistics were calculated in terms of frequency and percentages for the qualitative variables. Clinical features were evaluated by descriptive analysis; mean and median values were calculated. Differences between variables were assessed using the chi-square (χ²) test. A p-value <0.05 was considered statistically significant. Results: Among the 80 samples analysed, high epithelial MMP-9 expression (moderate or strong) was observed in 63 (78.75%) cases, while 17 (21.25%) showed negative or weak expression. Stromal MMP-9 expression was detected in 76 (95.00%) out of 80 specimens, with 48 (60.00%) tumours demonstrating high stromal MMP-9 levels. High stromal MMP-9 expression was significantly associated with advanced stage (p-value=0.001), high grade (p-value=0.01), and serous histology (p-value=0.026). However, epithelial MMP-9 expression showed no statistically significant association with any clinicopathological parameters. Conclusion: High stromal MMP-9 expression is associated with poor prognosis in ovarian cancer patients. Down-regulation of MMP-9 may be an important therapeutic strategy to reduce cancer-related mortality.

Effects of Blood Flow Restriction Training on Muscular Adaptations among Fitness Enthusiasts: A Scoping Review

Sarfraznawaz F Shah, Neha Mukkamala, G Palani Kumar, Amruta Chauk

Introduction: Blood Flow Restriction (BFR) training has proved to be a viable option to cause muscular adaptations under low loads, thus ideal for persons who cannot tolerate high-resistance training. By creating external pressure that limits venous return with continued arterial inflow, BFR causes local hypoxia, metabolic stress, and enhanced recruitment of muscle fibres. These physiological processes create adaptations equivalent to high-intensity training, which has endeared BFR as a valuable option for athletes and fitness enthusiasts seeking to enhance performance with less mechanical tension on joints and tissues. Aim: To examine the effect of BFR on muscular strength, hypertrophy, endurance, and aerobic capacity in healthy, active subjects. Materials and Methods: A scoping review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Review Extension (PRISMA-ScR ) guidelines, for a period of six months i.e., from February 2025 to July 2025. Electronic databases such as PubMed, Scopus, Web of Science, and Sports Documentation and Information Service were searched for peer-reviewed English-language articles from inception until 2025. Eligible studies were experimental and observational designs that studied BFR in recreationally active healthy adults. A total of 25 Randomised Controlled Trials (RCTs) were included after screening. Results: BFR training improved muscle strength and hypertrophy in all age groups and training backgrounds with consistency. Such improvements were present even at low intensities {(20-30%, one Reptition Maximum (1RM)}, where the results were often as good as high-load training. A number of studies also showed that muscular endurance and systemic adaptations, including cross-education effects, were improved. Aerobic capacity and vascular function outcomes were inconsistent with probable protocol differences. BFR exercise was safe and tolerated well, with minor and transient side-effects. Personalised occlusion pressures and training loads optimised safety and efficacy. Conclusion: BFR is a potent, low-load training modality that increases strength, hypertrophy, and muscular endurance in healthy individuals. It provides a joint-sparing intervention for those with load constraints and has future potential in sport and rehabilitation. Standardisation of training parameters and additional research on long-term adaptations, gender differences, and ideal pressure values are required to further develop its clinical and sporting application.

Acute Kidney Injury among the Hospitalised Children Treated with Aminoglycosides: A Prospective Observational Study

Introduction: Acute Kidney Injury (AKI) is frequently encountered among critically ill hospitalised children treated with Aminoglycosides (AGs). However, data regarding non-critically ill hospitalised children treated with AGs is lacking in the literature. Aim: To evaluate the occurrence of AKI among non-critically ill hospitalised children treated with AGs. Materials and Methods: The present prospective observational study was conducted in the Departments of Paediatrics and Paediatric Nephrology at the Government Medical College Srinagar, Jammu and Kashmir, India, from October 2018 to September 2020, on 142 children aged between one month and 18 years. These patients had normal renal function at admission and received at least one AG as in-hospital treatment for five days or longer. The rate of occurrence of AKI in the present study was evaluated using the paediatric Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (pRIFLE) and Acute Kidney Injury Network (AKIN) criteria. Frequency and percentage were calculated for qualitative variables, while the relationship between variables was analysed using the Student’s t-test and Chi-square test. Results: Out of 142 children studied, 78 (54.92%) were males. Glomerular Filtration Rate (GFR) was estimated using the Schwartz formula, wherein 29 (20.4%) patients had AKI by AKIN criteria and 36 (25.3%) patients had AKI by pRIFLE criteria. The children with AKI were younger (mean age 23.8 months). Compared to a 12-hour AG dosing interval, patients who received a 24-hour dosing interval had a significantly lower rate of AKI (p<0.05). Conclusion: A substantial proportion of non-critically ill young children receiving daily multiple doses of AGs for five days or longer developed AKI.

Determining Stature from Auricular Parameters in Adult Population of Garhwal Region of Uttarakhand, India: A Cross-sectional Study

Niyati Airan, Anil Kumar Dwivedi, Viyom Agarwal

Introduction: Estimation of stature from different body parts is an essential component of forensic anthropology for the identification of unknown individuals. This becomes particularly important during mass disasters, when stature assessment becomes challenging due to the non availability of intact body parts. In such instances, the auricle can be used as an alternative for stature estimation, as reported in the literature. Aim: To explore the relationship between stature and different auricular parameters in the adult population of the Garhwal Himalayas. Materials and Methods: A cross-sectional study was conducted involving 208 healthy adult subjects aged 18-40 years of both genders from Garhwal, Uttarakhand, India. The study was carried out over a period of one year after obtaining approval from the Institutional Ethics Committee. Stature was measured using a metallic measuring tape, and auricular parameters (auricle, conchal, and lobular length and width) were measured using Vernier callipers. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 19.0 software. Pearson’s correlation coefficient was applied to determine the association between stature and ear parameters. Simple and multiple linear regression models were established to assess the predictive value of auricular dimensions in stature estimation. Results: Statistical analysis revealed a significant correlation between stature and the length of the auricle (males: r-value=0.204, p-value=0.026; females: r-value=0.328, p-value=0.002) and concha (males: r-value=0.267, p-value=0.003; females: r-value=0.331, p-value=0.002). Gender-specific regression equations were formulated for calculating stature from these parameters, with greater predictive accuracy. The regression equations were: Males: Stature=146.6+0.35×auricle length; Females: Stature=124.9+0.53×auricle length. Conclusion: This study developed region- and gender-specific regression models that can reliably be used for assessing stature and thus aid in the identification of unknown individuals with mutilated or burnt body parts during mass disasters or medico-legal cases. Therefore, this approach to stature estimation has practical utility and relevance in forensic science and anthropology.

Impact of Maternal Corticosteroids on Foetal and Uteroplacental Blood Flow Dynamics in Preterm Pregnancies with Growth Restricted Foetus: A Prospective Observational Study

Aswini Shanmugam, Sunil Samal, Seetesh Ghose

Introduction: Foetal Growth Restriction (FGR) is a critical condition where a foetus fails to achieve its genetically determined growth potential for gestational age. Studies using doppler ultrasonography have shown beneficial modifications in blood flow indices following corticosteroid administration, though there are some concerns regarding potential adverse effects. Aim: To evaluate the effects of maternal corticosteroids on foetal and uteroplacental blood flow dynamics in preterm pregnancies complicated by FGR. Materials and Methods: A prospective observational hospital-based study was conducted at a Tertiary Care Centre in Puducherry, India over a period of 18 months from October 2022 to March 2024, involving pregnant women between 28 to 36 weeks of gestation diagnosed with FGR with normal doppler as per delphi consensus criteria. A total of 84 patients were enrolled in the study. Pretreatment doppler indices were recorded for Umbilical Artery (UA), Middle Cerebral Artery (MCA), and maternal Uterine Artery (UtA) at ‘0’ hour and 24-48 and 72-96 hours following corticosteroid administration, and neonatal outcome in terms of Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score and Neonatal Intensive Care Unit (NICU) admission were observed. Statistical analysis was done to determine the significance of the observations. Results: Maternal corticosteroid administration significantly increased the UA Pulsatality Index (PI) at 24-48 hours (mean difference=0.107, p<0.0001) with return towards baseline at 72-96 hours (mean difference=0.020, p=0.722). MCA PI showed significant reductions at 24-48 hours (mean difference=-0.139, p<0.0001) and 72-96 hours (mean difference=-0.181, p<0.0001) compared to baseline. The UtA PI remained stable throughout the observation period. 51% neonates had APGAR score <7 at five minutes and needed NICU admission. Conclusion: Maternal corticosteroids appear to positively influence foetal and uteroplacental blood flow in pregnancies affected by FGR. These findings may have clinical implications, enhancing strategies for the management of preterm FGR and improving outcomes for affected neonates.

Influence of Core Strength on Hamstring Flexibility and Pelvic Tilt among Sedentary Individuals: A Cross-sectional Study

Nagaveni Hegde, Saumya Srivastava

Introduction: The kinetic chain theory highlights the interconnectedness of the core and extremities in generating and transmitting motion and force. The core serves as the center of this chain, stabilising the body during dynamic movements. However, modern sedentary lifestyles, particularly among college students aged 18-25, often lead to hamstring stiffness, which is linked to poor core muscle coordination. Although hamstring tightness is believed to compensate for weak core muscles, little is known about the relationship between hamstring flexibility and core strength. Aim: To ascertain whether there is a connection between core muscle strength and hamstring tightness in sedentary individuals. Materials and Methods: A cross-sectional study was conducted at the Department of Physiotherapy, Justice KS Hegde Charitable Hospital, Mangalore, Karnataka, India, over one year (April 2021-April 2022). Ethical approval was obtained from the Institutional Ethics Committee. Seventy-eight sedentary individuals (aged 18-25 years) were recruited using purposive sampling methods. Core strength, hamstring flexibility, and pelvic tilt were assessed using a handheld dynamometer, the Active Knee Extension (AKE) test, and the Palpation Meter (PALM), respectively. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) software (version 20). Descriptive statistics were used for demographic and outcome data, while Pearson’s or Spearman’s correlation coefficients were employed to determine relationships between variables. Statistical significance was set at p<0.05. Results: The mean age of the participants was 21.41±1.77 years, with a mean Body Mass Index (BMI) of 20.94±3.37 kg/m². Anterior pelvic tilt was observed in 91% of the participants, while posterior pelvic tilt was noted in 9%. The mean hamstring flexibility was 48.41°±9.14° (right) and 47.60°±8.67° (left), while core muscle strength ranged from 10.01±2.83 kg to 13.23±2.57 kg. Pearson’s correlation analysis showed no significant relationships between core strength, hamstring flexibility, and pelvic tilt (p>0.05). Conclusion: According to the present study findings, no correlation between core strength and hamstring flexibility in sedentary individuals.

Accuracy of Electrocardiographic Criteria in the Diagnosis of Left Ventricular Hypertrophy in Complete Left Bundle Branch Block: A Systematic Review with Meta-analysis

Pallaseena Seetharaman Seshadrinathan, Aruna Bholenath Patil

Introduction: Left Ventricular Hypertrophy (LVH) is commonly present in patients with complete Left Bundle Branch Block (LBBB) and has significant prognostic implications. The LBBB fundamentally alters ventricular depolarisation and repolarisation patterns, complicating the Electrocardiography (ECG) diagnosis of LVH. Despite decades of research, accurate diagnostic criteria remain unclear. Aim: A systematic review and meta-analysis was conducted to evaluate the accuracy and clinical utility of various electrocardiographic criteria in diagnosing LVH in patients with complete LBBB. Materials and Methods: A search was performed using PubMed and institutional databases from 1969 to August 2024 for studies evaluating ECG criteria for LVH diagnosis in LBBB patients, using echocardiography, Cardiac Magnetic Resonance Imaging (CMRI), or autopsy as reference standards. Sixty-four ECG criteria were analysed across 15 studies comprising 1,595 patients. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random-effects meta-analysis was conducted to calculate pooled sensitivity, specificity, likelihood ratios, and Diagnostic Odds Ratios (DOR). Studies were stratified by cumulative sample size, and heterogeneity was assessed using the I² statistic. Results: Among the parameters evaluated in studies with sample sizes exceeding 400 patients, Left Atrial Enlargement (LAE) criteria demonstrated the highest DOR and predictive accuracy. However, decision-curve analysis could not demonstrate the clinical utility of any ECG criteria for adequately diagnosing LVH in the study population. Conclusion: No ECG criteria demonstrated significant diagnostic accuracy for LVH in patients with LBBB. Therefore, multimodal diagnostic approaches incorporating clinical assessment, risk stratification, and confirmatory imaging are essential for accurate LVH diagnosis in patients with complete LBBB in clinical practice, in addition to ECG.

Pattern of Antimicrobial Drug usage among Inpatients of a Government Medical College Hospital in Kerala, India: A Cross-sectional Study

Vinu Wilson, Kala Kesavan Parvathy

Introduction: Antimicrobial Resistance (AMR) has become a global emergency threatening to once again make infectious diseases the number one killer of mankind. Antimicrobial Stewardship (AMS) programs require baseline antimicrobial use and microbial drug resistance patterns to formulate rational antimicrobial use policies. However, information about the pattern of antimicrobial drug use among inpatients of government medical colleges in Kerala is scarce. Aim: To describe the antimicrobial use pattern among inpatients of a government medical College Hospital in Kerala. Materials and Methods: A medical-record-based cross-sectional study of antimicrobial use among inpatients admitted to Government Medical College Hospital, Alappuzha, Kerala, India was conducted on a single calendar day (16th January 2019). Data was collected in a structured case record form and expressed as counts (%) or median (25th percentile, 75th percentile). Summary statistics were prepared using Microsoft Excel® spreadsheets. Results: Among 210 (107 female) inpatients admitted on 16th January 2019, 137 (65.2%) received at least one empiric antimicrobial despite being indicated in 118 (56.2%) only. Among inpatients prescribed antimicrobials, each received a median of 1 drug for treatment over a median of 3 (0,8) days of therapy. A total of 55 (40%) of antimicrobial use was for surgical prophylaxis in different specialties, but for much longer than recommended by guidelines. Details of culture and sensitivity tests were available in only 10 (4.3%) inpatient records, precluding any change in empiric to definitive antimicrobial therapy in virtually all cases. Third-generation cephalosporins, belonging to the watch group of World Health Organisation (WHO) Access, Watch and Reserve (AWaRe) classification, were the most widely used class of antimicrobials. Topical moxifloxacin was the most common antimicrobial prescribed for ocular disorders. Antimicrobial use from the access category was achieved in roughly 50% of cases, which was much below the target of 60% set by WHO for the period of 2019-23. Conclusion: The present study found unindicated use as well as prophylactic overuse of antimicrobials, especially from the WHO watch category of drugs, among inpatients at a Medical College Hospital. Defensive clinical practice and lack of faith in infection control systems may be contributing factors to this phenomenon. Regular, prospective and collaborative monitoring of antimicrobial use patterns in all tertiary care hospitals may help in strengthening AMS and combating AMR.

Alterations in Electrolyte and Renal Profile in Chronic Kidney Disease Patients with Coexisting Cardiovascular Complications: A Cross-sectional Study

Apoorva Gupta, Chaitali Maitra, Parveen Kumar Sharma, Dhiraj Mangal

Introduction: Chronic Kidney Disease (CKD) is often complicated by coexisting Cardiovascular Disease (CVD), which increases morbidity and influences biochemical markers. Electrolyte imbalances contribute to various systemic complications and elevate the risk of cardiovascular disease. Aim: To compare the electrolyte and renal function profiles of chronic kidney disease patients based on the presence or absence of coexisting cardiovascular disease. Materials and Methods: A hospital-based cross-sectional study conducted was conducted in the Department of Biochemistry, Dr. S.S. Tantia Medical College, in collaboration with Jan Sewa Hospital, Sri Ganganagar, Rajasthan, India, from November 2023 to July 2025. conducted on 150 CKD patients—50 with CVD (Group-A) and 100 without (Group-B) Biochemical markers, including electrolytes (Na+, K+, Cl+), renal function tests (urea, creatinine, uric acid), inflammatory markers {C-reactive Protein (CRP), procalcitonin, high-senstivity troponin I (hs-Trop I)} and proteinuria indicators were measured. Results: The CKD patients with CVD were significantly older (58.2±15.65 vs. 49.23±12.71 years; p<0.001). They had lower serum sodium levels (p<0.001) and higher potassium levels (p=0.03). The hs-Trop I and CRP levels were markedly elevated in the CVD group (p<0.001). Urea levels were also significantly higher (83.35±15.65 vs. 68.1±13.51; p<0.001). Serum Sodium S.Na. levels were notably lower in CKD patients with CVD (139.09±2.76 mEq/L) compared to those without CVD (141.2±3.04 mEq/L) (p=0.001). Similarly, Serum Potassium S.K. levels were slightly higher in the CVD group (4.52±0.64 mEq/L) compared to the non CVD group (4.3±0.50 mEq/L) and this difference was statistically significant (p=0.03). However, the difference in Serum Chloride S.Cl. levels was not statistically significant (p=0.21). Conclusion: Coexisting cardiovascular disease in CKD patients is associated with distinct alterations in electrolyte balance, increased inflammation and worsened renal function. Monitoring these biomarkers is crucial for the effective management of CKD patients with cardiovascular co-morbidities.

Comparison of Two Different Doses of Intrathecal Clonidine as Adjuvant to Hyperbaric Levobupivacaine for Spinal Anaesthesia in Femur Fracture Surgeries: A Randomised Triple-blind Clinical Study

Jatin Patel, Radhika Jain, Priya Kishnani, Charmi Shah

Introduction: Femur fractures in elderly patients present unique challenges for anaesthetic management. Spinal anaesthesia with adjuvants has emerged as a preferred technique to enhance the quality of blockade while minimising local anaesthetic doses. Intrathecal clonidine, as an adjuvant to local anaesthetics, enhances the quality and duration of spinal anaesthesia. However, the optimal dose remains controversial due to dosedependent side-effects. Aim: To compare the efficacy and safety of two different doses of intrathecal clonidine (30 μg vs 50 μg) as an adjuvant to hyperbaric levobupivacaine for spinal anaesthesia in femur fracture surgeries. Materials and Methods: This randomised triple-blind clinical study was conducted at the Department of Anaesthesiology at Shrimati Bhikhiben Kanjibhai Shah (SBKS) Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India, from January 2022 to December 2024 after institutional ethics committee approval. A total of 62 American Society of Anaesthesiologists (ASA) I-II patients aged 18-65 years undergoing femur fracture surgeries were randomly allocated into two groups. Group LC30 (n=31) received 3 mL of 0.5% hyperbaric levobupivacaine with 30 μg clonidine and Group LC50 (n=31) received 3 mL of 0.5% hyperbaric levobupivacaine with 50 μg clonidine, both diluted to a total volume of 3.5 mL with normal saline. The onset and duration of sensory and motor blockade, along with the duration of absolute and effective analgesia, were assessed. Data analysis was performed using Jamovi software with independent t-tests for continuous variables and Chi-square tests for categorical variables. A p-value <0.05 was considered statistically significant. Results: Demographic parameters, including age, gender, ASA grade and baseline haemodynamics, were comparable between the groups. No significant difference was observed in the onset of sensory or motor blockade between the two groups. The duration of sensory and motor blockade was longer in Group LC50 (263.30±9.2 and 359.20±18.1 min, respectively) compared to Group LC30 (215.78±7.7 and 300.27±10.6 min, respectively). The durations of absolute and effective analgesia were also longer in Group LC50 (300.50±18.2 and 451.70±18.2 min, respectively) compared to Group LC30 (289.90±11.9 and 315.10±37.6 min, respectively), with rescue analgesia required more frequently in the LC30 group. However, the LC50 group demonstrated a higher incidence of bradycardia (32.3% vs 12.9%), hypotension (45.2% vs 19.4%) and greater sedation compared to the LC30 group. Sedation scores were significantly higher in the LC50 group throughout the perioperative period. Conclusion: Intrathecal clonidine 50 μg combined with hyperbaric levobupivacaine provides significantly prolonged sensory and motor blockade with extended postoperative analgesia compared to a 30 μg dose. However, the higher dose is associated with an increased incidence of haemodynamic sideeffects, necessitating closer monitoring and prompt intervention.

Physiotherapy Interventions to Improve Mobility in Children with Spastic Diplegic Cerebral Palsy: A Systematic Review

Introduction: Spastic diplegic Cerebral Palsy (SDCP) is a common paediatric motor disorder primarily affecting lower limb mobility. While various physiotherapy interventions have been developed to improve mobility, their comparative effectiveness remains inconclusive. Aim: To systematically review Randomised Controlled Trials (RCTs) evaluating physiotherapy interventions aimed at enhancing mobility in children with SDCP. Materials and Methods: This review included RCTs published between January 2014 and December 2024 that involved children aged 2-18 years diagnosed with SDCP. Comprehensive searches were conducted in PubMed, Medline, Embase, and Web of Science. Twelve eligible RCTs were evaluated for intervention type, outcomes, duration, and methodological quality using the PEDro scale. Results: Interventions such as task-specific training, treadmill-based therapy, neurodevelopmental treatment, virtual reality, and functional electrical stimulation demonstrated varying levels of improvement in gross motor function, gait, and balance. While most studies showed moderate methodological quality, comparisons were limited due to diverse outcome measures. Conclusion: Task-oriented, repetitive physiotherapy interventions appear effective in improving mobility among children with SDCP. However, further high-quality trials using standardised measures and long-term follow-up are needed to strengthen clinical guidance.

Antioxidant Therapy using Astaxanthin and Quercetin against Chloramphenicol-induced Hepatotoxicity in Wistar Rats: A Randomised Controlled In-vivo Interventional Study

Brijesh Kumar Verma, Jaimin Chaudhari, Debashis Banerjee

Introduction: Drug-induced Liver Injury (DILI) remains a major clinical concern, particularly with antibiotics like chloramphenicol, which are known to cause oxidative stress and hepatotoxicity. Mitochondrial dysfunction is increasingly recognised as a key mechanism in such liver damage. Aim: To evaluate the protective effects of the antioxidants astaxanthin and quercetin against chloramphenicol-induced hepatotoxicity in Wistar rats by assessing biochemical markers of oxidative stress. Materials and Methods: The present randomised controlled, in-vivo interventional study was conducted at Zydus Research Centre, Gujarat, India, from May to July 2023. Twenty-four healthy male Wistar rats (180-200 g) were randomly assigned into four groups (n=6 each): control, chloramphenicol-only, chloramphenicol+astaxanthin, and chloramphenicol+quercetin. Chloramphenicol was administered intraperitoneally (25 mg/kg/day for 14 days), followed by oral antioxidant therapy for 14 days (Astaxanthin: 20 mg/kg; Quercetin: 30 mg/kg). Blood samples were collected on days 0, 15, and 30 to assess Glutathione (GSH) and Nitric Oxide (NO) levels. Statistical analysis was performed using Analysis of Variance (ANOVA) and Sidak’s multiple comparisons test (GraphPad Prism v8.0.2), with p<0.05 considered significant. Results: Chloramphenicol significantly reduced GSH and elevated NO levels (p<0.01), indicating oxidative stress. Both antioxidants mitigated these effects, with Quercetin showing slightly superior efficacy in restoring GSH levels. Conclusion: Astaxanthin and Quercetin exhibit significant hepatoprotective effects against chloramphenicol-induced oxidative damage. Further research is warranted to explore dose optimisation, long-term effects, and translation to clinical settings.

Association of Maternal Inflammatory Markers and Risk Factors with Adverse Pregnancy Outcomes: A Cross-sectional Study

Introduction: Adverse pregnancy outcomes are a common health problem, particularly in resource-poor settings. However; their multifaceted causes are not fully understood. Investigating the association between inflammatory markers throughout pregnancy and adverse birth outcomes may provide insights into potential intervention pathways. Aim: To determine the association between maternal inflammatory markers and risk factors with adverse pregnancy outcomes. Materials and Methods: The present cross-sectional study was conducted at Dr. Prabhakar Kore Hospital, Belagavi, Karnataka, India between August 2021 and August 2022. The present study included 714 pregnant women aged between 18-40 years, who presented for delivery at the institution. Maternal blood samples were collected before delivery to measure high-sensitivity-C Reactive Protein (hs-CRP), ferritin, albumin, and Erythrocyte Sedimentation Rate (ESR). Chi-square tests were performed to assess the association between these inflammatory markers and adverse pregnancy outcomes (Preterm Birth (PTB), Low Birth Weight (LBW), and stillbirth). Results: The median age of participants was 24 years (Q₁, Q₃: 21, 26). Education level, gestational age, higher Body Mass Index (BMI), and history of hypertension were associated with adverse pregnancy outcomes. Serum ferritin levels were significantly higher in the adverse pregnancy outcomes group (48.0 ng/mL; Q1, Q3: 26.0, 86.0) compared to the group without adverse outcomes (35.0 ng/mL; Q₁, Q₃: 18.0, 62.0). Other inflammatory markers showed no statistically significant associations (p<0.05). Conclusion: The present study found a significant association between serum ferritin levels and adverse pregnancy outcomes. Other inflammatory markers (hs-CRP, albumin, and ESR) showed no significant association at the time of labour presentation.

Assessing the Dosimetric Advantage of Deep Inspiration Breath Hold Technique in Left-sided Breast Cancer Radiotherapy: A Prospective Observational Study

Introduction: Addition of RT to breast cancer patients after surgery {Breast Conserving Surgery (BCS) or Modified Radical Mastectomy (MRM)} has clearly demonstrated clinical benefits in many randomised trials and meta-analyses. However, the long-term survival achieved with multi-modality treatment in breast cancer patients may be overshadowed by late toxicities like cardiac morbidity and mortality. Hence, various techniques are used to reduce the cardiac dose, with one crucial measure being the breath hold technique. Aim: To assess the reduction of cardiac and left anterior descending artery radiation dose using the Deep inspiration breath hold technique during tangential irradiation in left-sided breast carcinoma patients. Materials and Methods: The present prospective observational study was conducted in the Department of Radiation Oncology in Acharya Harihar Postgraduate Institute of Cancer, Cuttack, Odisha, India, from January 2015 to December 2016. Twelve patients with histopathologically proven left-sided breast cancer who have undergone modified radical mastectomy and have received radiotherapy to the chest wall with or without regional nodal irradiation were included. After adequate training, a planning Computed Tomography (CT) scan was performed at Free Breathing (FB) and another at deep inspiration and Voluntary Breath Hold in Deep Inspiration (VBH-DI). For each patient, target volumes and organs at risk were delineated according to Radiation Therapy Oncology Group (RTOG) guidelines. Further, the following dosimetric parameters were collected for both FB and VBH-DI plan- Heart D_mean, Heart D_max, the percentage of the organ volume receiving at least 5 Gy (V5),10 Gy (V10), 20 Gy (V20), 30 Gy (V30), 40 Gy (V40), Left Anterior Descending Coronary Artery (LADCA) D_mean and LADCA D_max. Differences between the two respiratory techniques were analysed using the Shapiro-Wilk test for normality, followed by the independent t-test for normally distributed data and the Mann-Whitney U test for non-normal dosimetric, MHD, and proximal/middle/distal LADCA data, with p<0.05 considered statistically significant. Results: A total of 12 breast cancer patients (each simulated in both FB and vDIBH) were analysed; the mean age was 46.8±9.0 years (31-61), and ECOG performance status was 0 in 41.7% and 1 in 58.3%. The mean heart dose was reduced from 6.49 Gy in FB to 4.96 Gy in VBH-DI, i.e., a 24% reduction, and this difference was statistically significant (p=0.017). Except for V40 of the heart, the mean values of Heart V5, V10, V20, and V30 were reduced in the VBH-DI technique as compared to the FB technique (18.68% vs 13.34%, 15.98% vs 11.03%, 13.74% vs 8.94%, and 11.44% vs 6.85%, respectively), p<0.001. Similarly, the mean dose to the LADCA was reduced from 29.70 Gy in FB to 25.14 Gy in VBH-DI technique (p<0.001). Conclusion: The present study showed a clear superiority of the VBH-DI technique in cardiac sparing, which will result in a significant reduction in late major coronary events.

Effect of Low versus High Level Task Difficulty Balance Training on Dynamic Postural Control, Speed and Skating Performance in Young Roller Skaters: A Comparative Study

Introduction: Roller skating is a complex sport requiring high levels of dynamic balance, coordination, agility, speed and postural control. Training methods that enhance these attributes are crucial for improving skating performance and preventing injuries. Task Difficulty Balance Training (TDBT) has shown promise in enhancing neuromuscular control, but its specific impact on roller skaters remains underexplored. Aim: The present study aimed to compare the effects of low and high task difficulty balance training on dynamic postural control, speed, and roller skating performance in young athletes. Materials and Methods: The present comparative study was conducted at Sprint skating academy, Pimpri, Pune, Maharashtra, India during the 2023-2025 academic period. Sixty roller skaters (aged 10 to 15 years) were randomly assigned to two groups: Group A (Low Task Difficulty Balance Training (LTDBT) and Group B High Task Difficulty Balance Training (LTDBT). Both groups completed a 5-week training program (three sessions per week) with progressive balance exercises. Pre and post-training assessments included the Roller Skating Performance Test, Arrowhead Change of Direction Speed Test, and Modified Star Excursion Balance Test (mSEBT). Statistical analyses were performed using Wilcoxon Signed Rank and Mann-Whitney U tests. Results: Both groups showed significant improvements in roller skating performance, speed, and dynamic balance (p<0.05). However, the high task difficulty group exhibited superior improvements in performance time (6.14±1.27 vs. 3.60±0.88sec), speed (Arrowhead test: 2.32±0.52s vs. 1.34±0.54s), and dynamic balance (mSEBT reach distance, p<0.05). Intergroup analysis showed significant differences favouring high task difficulty training, except for mSEBT right-leg performance (p>0.05). Conclusion: TDBT enhances dynamic postural control, speed, and skating performance. High task difficulty balance training yields greater benefits, emphasising the need for progressive balance exercises in roller skating programs to optimise performance and injury prevention.

In-vitro Antimicrobial Screening, Enzymatic Assays and Metabolome Profiling and In-silico Analysis for Anticancer Potency of Talaromyces pinophilus (AVK3), Isolated from the Rhizome of Zingiber officinale

Vunnam Krishnaveni, Shaik Mahekal Kousar, Amrutha Valli Audipudi

Introduction: Endophytic fungi are prolific sources of bioactive constituents with considerable therapeutic efficiency against various diseases, including cancer, by acting as anticancer and antimicrobial agents. The bioprospecting of novel endophytic secondary metabolites has gained momentum in the treatment of cancer with minimal side-effects. Talaromyces pinophilus (AVK3) is known to produce pinophilin and talaromycesins (A and B), which inhibit cancer cell growth. Aim: To evaluate the isolation, antimicrobial screening, enzymatic assays, and metabolomic profiling (GC-MS analysis) of an endophytic fungus of ginger, Talaromyces pinophilus (AVK3), along with in-silico studies of its anticancer properties. Materials and Methods: An in-vitro experimental study was conducted from June 2023 to May 2024 at Acharya Nagarjuna University, Guntur, Andhra Pradesh, India. Thirty fresh ginger rhizomes were collected from Mamillapalli village, Andhra Pradesh, following strict inclusion criteria (healthy, undamaged rhizomes harvested within 24 hours) and used for the isolation of endophytes. The endophyte AVK3 was isolated using surface sterilisation methods and identified as Talaromyces pinophilus through 18S ribosomal Ribonucleic Acid (rRNA) sequencing (GenBank accession: PP957929). Antimicrobial screening was performed against human pathogens using agar well diffusion and Minimum Inhibitory Concentration (MIC) methods. Enzymatic assays and metabolomic analysis were conducted to identify potential bioactive compounds. The anticancer potential of bioactive compounds was further evaluated through molecular docking studies against cancer target proteins. Results: Talaromyces pinophilus exhibited a high zone of inhibition (30 mm in diameter) against Salmonella typhimurium, with a MIC value of 6.25 μg/mL and an Half maximal Inhibitory Concentration (IC50) of 13.397 μg/mL, demonstrating efficient antibacterial activity. Metabolomic profiling through Gas Chromatography–Mass Spectrometry (GC-MS) analysis revealed bioactive compounds like 3,5-dihydroxy-6-methyl-2,3-dihydro-4H-pyran-4-one; 1,2,3-propanetriol; HMF; 3-acetoxy-3-hydroxy-propionic acid methyl ester; 2-piperidinone; furandimethanol; hexahydropyrrolo(1,2-a)pyrazine-1,4-dione; terrain; and 3,6-diisobutyl-2,5-piperazinedione. Enzymatic assays showed the presence of hydrolytic enzymes such as amylase, lipase catalse, gelatinase, and lipases. Conclusion: In-vitro antimicrobial studies and in-silico analysis of anticancer potential demonstrated binding affinities of –19.5 kcal/mol against the lung cancer target protein (PDB ID: 7W8O) and –22.9 kcal/mol against the breast cancer target protein (PDB ID: 3HBS), confirming Talaromyces pinophilus as a promising source for anticancer treatment. The extensive array of bioactive compounds exemplifies the chemical diversity of Talaromyces pinophilus, particularly highlighting its potential in biomedical innovation.

Effectiveness of Otago Exercise Programme on Balance and Prevention of Fall in Post-stroke Patients: A Quasi-experimental Study from Assam, India

Dikshita Rabha, Pallabi Goswami

Introduction: A stroke is the sudden loss of nerve cells caused by a shortage of oxygen due to an arterial rupture or a blockage in blood flow to the brain. Stroke occurs when the blood supply to the brain is interrupted, resulting in an abrupt loss of neurological function. The Otago Exercise Program (OEP), an evidence-based fall-prevention program composed of muscle strengthening, balance training, and walking, was implemented in this study. Aim: To determine the efficacy of OEP on balance and fall prevention in post-stroke patients. Materials and Methods: A quasi-experimental study was conducted at the Pews Group of Institution, Bonda, Guwahati, Assam, India, over the period of six months from March 2019 to August 2019. The study involved 30 post-stroke patients irrespective of the underlying vascular territory, who could walk independently without an assistive device and were classified as grade 4 on the functional ambulation category (able to ambulate independently on level surfaces but requiring supervision to negotiate). Participants had no cardiovascular disease, were at Brunnstrom recovery stage 4 (indicating voluntary movements outside synergy patterns and decreasing spasticity), and had no visual or auditory impairment, limb loss, bone impairment in the past years, or cognitive dysfunction. Patients with visual defects, vestibular dysfunction, hypertension, or an inability to follow commands and concentrate on the experiment were excluded. A two-stage sampling method was used: first stratified sampling, followed by simple random sampling. The intervention was administered for eight weeks, three times per week. The first part of the exercise program consisted of strengthening the muscles in the front and back of the knees, hip abductors, calf muscles, and toe extensors. Outcome measures—including the Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), and Falls Efficacy Scale (FES)—were recorded before and after the exercise program to evaluate balance and fall prevention. Using Statistical Package for the Social Sciences (SPSS) software, statistical analyses were carried out, and results were presented in terms of mean, Standard Deviation (SD), and p-value. Results: A total of 30 post-stroke patients participated (23 males and 7 females). A paired t-test revealed a statistically significant improvement in all variables with a p-value <0.001. Significant differences were observed in the BBS mean and SD values (-2.400±-1.773), TUGT (1.5833±1.3646), and FES (4.233±2.315). These findings indicate that OEP improved balance ability, enhanced confidence levels, and reduced fear of falling during activities. Conclusion: The OEP helped participants maintain confidence in performing routine activities without fear of falling while also improving muscle strength and balance. The program demonstrated improvements in all three parameters—BBS, TUGT, and FES—indicating a beneficial effect of OEP on post-stroke patients.

Efficacy of Abhadi Ghanvati versus Diclofenac Sodium in the Management of Avabahuka (Frozen Shoulder): A Research Protocol

Sudha Rani Verma, Vinod N Ade, Mukesh Kumar Bisen, Divya Patel

Introduction: Avabahuka is a disease of the shoulder joint characterised by shoola (pain), stambha (stiffness), and loss of bahu praspandana (decreased range of motion). This condition affects an individual’s overall health, daily life, and ability to perform routine activities. The pathophysiology and clinical manifestations of Avabahuka and frozen shoulder are very similar. Need of the study: Conventional treatments such as analgesics and corticosteroid injections often provide only temporary relief, and long-term use may be associated with side-effects or complications. Abhadi Ghanvati has shown promising results in managing asthi-sandhigata vata and snayu-majja-gata vata. Aim: To evaluate and compare the efficacy of Abhadi Ghanvati versus a standard control (Diclofenac sodium) along with Abhadi oil in the management of Avabahuka (frozen shoulder). Materials and Methods: A randomised, single-blind clinical trial will be conducted from October 2023 to August 2025 at Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India. A total of 86 patients will be randomised into two groups: Group A (Intervention group): Abhadi Ghanvati 500 mg twice daily along with local abhyanga with Abhadi taila. Group B (Control group): Diclofenac sodium 50 mg twice daily along with local abhyanga with Abhadi taila. The duration of treatment will be 15 days. Assessment will be carried out on day 0, day 7, day 21, and day 30. Patients will be evaluated using objective parameters such as Range Of Motion (ROM) and subjective parameters such as shoulder joint stiffness and pain using the Visual Analogue Scale (VAS). Statistical analysis will be performed using paired and unpaired t-tests, along with the Chi-square test, with a statistically significant p-value <0.05.

Pattern of Chest Injuries and Role of Intercostal Chest Drain in Patients Presenting with Blunt Trauma: A Research Protocol

Pankaj Babubhai Katariya, Swati Deshpande

Introduction: Chest trauma remains a significant contributor to morbidity and mortality worldwide, particularly in rural areas where access to advanced healthcare services is limited. Understanding the patterns of chest injuries and optimising their management is crucial for improving patient outcomes in resource-constrained settings. Need of the study: Blunt chest trauma is a major clinical concern, often leading to life-threatening complications such as pneumothorax, haemothorax, and respiratory failure. Intercostal Chest Drains (ICDs) are integral to the management of these conditions; however, clinical practice lacks clear, evidence-based guidelines on their optimal use. By evaluating common injury types and the effectiveness of ICDs, this research aims to provide actionable insights that can optimise care and improve outcomes for chest trauma patients in rural areas. Aim: This study seeks to assess the patterns of chest injuries and evaluate the role of ICDs in their treatment. Materials and Methods: A prospective observational study will be conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi (Meghe), Wardha, Maharashtra, from March 2024 to March 2026. The study will follow ethical guidelines outlined in the Declaration of Helsinki. Data will be collected using a structured case record form, including: Patient demographics (age, sex, occupation). Clinical findings (vital signs, presenting symptoms). Injury details (mechanism of trauma, such as motor vehicle accidents, falls from height, and sports-related injuries; type and pattern of chest injury). Radiological findings {chest X-ray, Computed Tomography (CT) thorax}. Details of ICD (indication, output volume, duration). Treatment outcomes (complications, length of hospital stay, mortality). The Chi-square test will be used to assess associations between categorical variables. A p-value of <0.05 will be considered statistically significant.

Effect of Curing Light on Crown Discolouration of Restored Primary Teeth following Silver Diamine Fluoride and Potassium Iodide Application: An In-vivo Study Protocol

Rutuja Pralhad Patil, Monika Khubchandani, Nilima Thosar, Harikishan Kanani

Introduction: Dental caries treatment has evolved from surgical methods to Minimal Intervention Dentistry (MID), which focuses on preserving tooth structure and utilising biological methods. Silver Diamine Fluoride (SDF) is a notable approach with strong antibacterial properties that prevent the growth of caries. Researchers have explored a method involving SDF, potassium iodide solution and Glass Ionomer Cement (GIC), which has shown minimal impact on caries-arresting effectiveness while enhancing the darkening of demineralised tooth surfaces. Need of the study: By assessing the discolouration levels in primary teeth, the present study seeks to elucidate the potential role of curing light in exacerbating or mitigating discolouration. The findings will provide valuable insights into optimising restorative protocols to minimise discolouration and enhance aesthetic outcomes in paediatric dental practice, ultimately improving patient satisfaction and treatment efficacy. Aim: To investigate the impact of curing light exposure on crown discolouration in primary teeth treated with SDF and potassium iodide. Materials and Methods: An experimental study will be conducted in the Department of Paediatric and Preventive Dentistry at Sharad Pawar Dental College and Hospital, Maharashtra, India, from March 2025 to August 2025. The study will involve four groups: Group I, Group II, Group III and Group IV. Participants will be divided as follows: Group I will receive one drop of SDF applied to the carious tooth surface. Group II will receive one drop of SDF combined with potassium iodide. Group III will receive a drop of SDF solution. Group IV will receive a drop of SDF combined with potassium iodide. All groups will undergo curing treatment for 20 seconds. Follow-up appointments will be scheduled at one, three and six months to assess the progress of the treated tooth and evaluate the need for additional applications. Three time points will be used for color assessments: T0 (immediately after treatment) T1 (three months) T2 (six months). A dental spectrophotometer will be used to measure the color of the dentin surface adjacent to the restoration. Descriptive statistics and frequency distribution will be performed. An Analysis of Variance (ANOVA) test will be conducted for intergroup comparisons at p<0.05.

Effect of Specific Strength and Pilates Training on Deceleration and Agility among Young Elite Male Cricket Batters: A Randomised Controlled Trial

Shivani Patil, Isha Joshi, Pooja Motar Sublok, Mrunali Kerkar

Introduction: Cricket is a high-intensity sport that requires agility, strength, and core stability, particularly during running between the wickets, which involves rapid acceleration, sprinting, and controlled deceleration. Core and lower-limb strength support stability, efficient load transfer, and injury prevention. Pilates, which focuses on core control, flexibility, and neuromuscular coordination, may complement strength training to enhance deceleration, agility, and Change of Direction (COD) performance. Need of the study: Despite the significance of agility and deceleration in cricket, limited evidence exists on integrated training methods. This trial investigates the combined effect of specific strength and Pilates training on agility and deceleration in young elite cricket batters. Materials and Methods: A randomised controlled trial will be conducted at KLE College of Physiotherapy, Hubballi, Karnataka, India, over six months from April 2025 to September 2025. Ethical approval has been obtained, and the study is prospectively registered. A total of 32 elite male cricketers aged 18-22 years will be recruited and randomly assigned into two groups. The intervention group will receive Pilates and specific strength training in addition to conventional training, while the control group will follow routine exercises. Training will be conducted thrice weekly for six weeks. Outcomes (agility t-test, shuttle run test, and 505 COD test) will be measured at baseline, six weeks, and eight weeks. Data will be analysed using Statistical Packages for the Social Sciences (SPSS) version 27.0.

Essential Steps for Establishing a Molecular Pathology Lab: A Narrative Review

Anand Mohanraj

Molecular pathology has emerged at the forefront in the era of personalised and targeted therapy. Molecular testing is essential to identify actionable therapeutic targets, especially in oncology. There is an increasing need to integrate routine histopathology and hematology laboratories with molecular techniques. A slow but definite shift is occurring toward incorporating molecular diagnostics into routine traditional pathology services. However, there remains a significant gap in knowledge and technical know-how regarding the integration of molecular diagnostic practices within routine histopathology services. With very few regulatory bodies and limited guidelines for day-to-day practice, there is considerable confusion about establishing and operating molecular laboratories. Molecular pathology also includes several subdivisions, such as cytogenetics {Fluorescence In Situ Hybridisation (FISH) and karyotyping}, molecular diagnostics {Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Next Generation Sequencing (NGS)}, and protein studies (mass spectrometry). The latter is primarily research-based and lies outside the purview of this review article. Immunohistochemistry (IHC) is also considered an integral part of molecular work-up. Each of these individual subdivisions has its own technical, infrastructural, and personnel requirements. NGS, in particular, requires bioinformatics support and stringent quality control measures. In this review article, the necessary infrastructure, instruments, laboratory personnel, and support staff required for establishing and running a molecular laboratory are discussed. Currently, there are very few guidelines and review papers available for setting up molecular pathology laboratories. Through the present review, the authors aim to outline the essential steps involved in establishing and operating a molecular laboratory.

Digital Medicine Crushers in Paediatric Care: A Narrative Review

Sonali Prakash Kolhekar, Ashish Varma, Bibin Kurian Joseph

Ensuring safe and reliable oral medication administration in paediatrics has been a clinical challenge for years, due to the absence of age-specific formulations and difficulties in preparing accurate doses. A comprehensive evaluation of the efficacy, handiness, and safety of a new wave of digital medicine crushers reveals a promising frontier in paediatric oral medication administration. However, a critical analysis of the methodologies used to assess these devices highlights the need for more rigorous and standardised approaches to validate their superiority over conventional crushing methods. Yet, existing studies comparing these devices are not methodologically uniform, and thus, conclusions are weakened. Few measures recover the dose quantitatively using validated methods, such as high-performance liquid chromatography, and paediatric dosing evaluations are still limited. Usability testing has mainly assessed qualitative impressions as opposed to validated rating tools or time-motion analysis. Safety findings are encouraging but await controlled comparisons across devices and settings. The current research has identified differences in drug recovery, particle size uniformity, and patient experience based on device and environment. Closed-unit automated systems with disposable parts have shown the ability to reduce medication residues, decrease aerosol formation, and enhance dose consistency, especially in paediatric dosing where weight-based precision is critical. Early investigation also reveals workflowrelated advantages, such as lowered preparation time and physical workload for healthcare providers. This review examines the complex challenges of paediatric dosing, the inherent risks associated with traditional practices, and the technological promise of digital solutions, while providing a framework for their robust comparative evaluation.

A Narrative Review of Different Nasotracheal Intubation Techniques with Recent Advancements in Clinical Practice

Yan-Qiu Zhang, Ji Zhao, Cheng-Cheng Liang, Yong Wang

Nasotracheal intubation is commonly used in clinical practice for procedures requiring general anaesthesia, mechanical ventilation, and emergency treatment of critically ill patients. It presents a new good surgical field and operating space for maxillofacial surgeries, offers an artificial airway for long-term mechanically ventilated patients in the Intensive Care Unit (ICU), and provides a method for emergency and difficult airway intubations. Compared to orotracheal intubations, nasotracheal intubation has advantages such as minimal stimulation to the throat, good patient tolerance, easy fixation, facilitation of oral care, and longer duration of placement. However, it requires higher level of technical skill from the operator and carries a higher incidence of complications like epistaxis and sinusitis, which have restricted its widespread application. From the early blind intubation method to the current direct laryngoscopy, video laryngoscopy, and fibreoptic bronchoscopy, the success rate of nasotracheal intubation has increased, while the incidence of complications has decreased. This review summarises the common methods, advantages and disadvantages of nasotracheal intubation, as well as the research progress on related complications and coping strategies, aiming to enhance the application of this technology in clinical practice.

Integrating Prosthodontics, Orofacial Pain Management and Public Health Strategies to Improve Patient Outcomes: A Narrative Review

Orofacial Pain (OFP) is a complex, multifactorial condition that significantly impairs daily functioning and Quality of Life (QoL) across global populations. OFP often manifests through conditions such as Temporomandibular Disorders (TMD), bruxism, and occlusal disharmony. Prosthodontic interventions, particularly occlusal splints and full-mouth rehabilitation, are essential in mitigating symptoms and restoring functional harmony. However, access to such care remains uneven due to socioeconomic disparities, geographic limitations, and inadequate public awareness. The current review supports the concept of an integrative methodology that connects prosthodontic care to a nation’s social policy, digital innovation, and psychosocial support. To overcome these barriers, it is essential to include prosthodontic therapies in schemes such as Ayushman Bharat and Medicaid, introduce school and community-based screening services, and train healthcare providers in stress management approaches as well as early disease detection. This model enhances the use of preventive care and long-term care, addressing the overall social determinants of oral health by coordinating clinical care with community-based outreach and a behavioural approach to health.

Enhancing Anaesthesia Crisis Resource Management through Simulation: A Narrative Review on Current Evidence and Future Directions

Karuna Taksande (Patil)

Crisis Resource Management (CRM) is a structured approach designed in maximising teamwork, communication, leadership, and situational awareness under high-risk perioperative conditions. Adapted from aviation, CRM principles have been implemented in anaesthesia to ensure non technical skills can influence patient outcomes to the same extent as technical expertise. High-Fidelity Simulation (HFS) is a core facilitator of Anaesthesia Crisis Resource Management (ACRM), allowing clinicians to practice rare but potentially fatal events—such as malignant hyperthermia, perioperative cardiac arrest, and airway disasters in safe, controlled conditions. Simulation-based training enhances crisis preparedness, improves interprofessional communication, and develops team performance, with structured debriefing reinforcing learning and promoting effective behavioural responses. Skill acquisition, retention, and clinical performance can be objectively evaluated using behavioural rating scales, global evaluation forms, and digital analysis. Innovative educational approaches—including mental rehearsal, flipped classroom, video-assisted debriefing, telesimulation, Virtual Reality (VR), and Artificial Intelligence (AI)—are expand access, realism, and overall effectiveness of ACRM programs. Simulation-based CRM education provides a scalable model for enhancing patient safety in anaesthesia by addressing challenges related to standardisation, cost, and scalability. This review examines the clinical application and future directions of ACRM, emphasising technological advancements, current research, and strategies to translate non technical skills into safer perioperative practice. The novelty of this review lies in its comprehensive integration of emerging technologies such as VR, AI, and telesimulation with traditional ACRM methods, offering fresh perspectives on enhancing accessibility, realism, and scalability in anaesthesia crisis management training.

Exploring the Role of Patient Education by Nurses in Improving Hypertension Medication Adherence: A Narrative Review

Divya Jain, Sapna Bhavin Patel

Hypertension is one of the major global health issues contributing to cardiovascular morbidity and mortality. Despite the availability of effective pharmacological treatments, many patients struggle with adhering to their medication regimens, especially for chronic conditions like hypertension. Nurses can play a crucial role in improving patients’ compliance with antihypertensive medications through focused instruction and support. The present narrative review evaluated Randomised Controlled Trials (RCTs) and quasiexperimental studies to assess the impact of nurse-led educational interventions on medication adherence among patients with hypertension. The findings indicate that these interventions significantly enhance the medication adherence and lead to better management of hypertension. Incorporating nurse-led educational interventions into standard care can greatly improve the management of chronic diseases. Future research should focus on integrating digital tools for ongoing support, standardising interventions, and involving diverse populations.

Cost Considerations in Healthcare: Review Analysis of Break-even Point of Spirometry

For financial sustainability and service-based efficiency in healthcare services, there is a need for better understanding and application of cost analysis, Break-even Point (BEP) analysis, and Cost-benefit Analysis (CBA). The present article focuses specifically on Paediatric spirometry and highlights literature and case-based evidence to show how BEP helps determine the minimum service volume required for cost recovery. Evaluating healthcare expenditures against medical benefits, pricing decisions, and investment planning is crucial from a healthcare administration perspective, and these objectives can be achieved through CBA. The present review emphasises the importance of structured financial planning to ensure high-quality, cost-effective healthcare services by integrating break-even and cost-benefit analyses.

Neurophysiological Consequences of Caffeine Consumption in Youth: A Narrative Review

Shubham Pramod Deshpande, Alka Rawekar, Avinash Taksande

The last two decades have seen a notable rise in the consumption of Energy Drinks (EDs). Particularly, alcoholic ED for young individuals and adolescents. Caffeine is the most extensively used psychoactive stimulant that people of all ages consume. It is found in nature and may be obtained from cocoa beans, coffee seeds, leaves of tea, and kola nuts. There are no known safe amounts for kids to consume ED or caffeine. Furthermore, there are no appreciable advantages to these substances/products regarding how the brain, psychomotor abilities, or social development grow over the short- or long term. Adverse consequences, notably when correlated with acquiring excessive amounts of caffeine, have been reported in the literature. High levels of caffeine consumption have been found in more recent research to contribute to anxiety, insomnia, and cardiovascular irregularities among adolescents. In addition, mixing alcohol with caffeine has also been found to be related to higher levels of risk-taking and substance dependence. The World Health Organisation (WHO) has also warned against the use of ED among children based on these possible health hazards. Here, it is indicated that there is an immediate need for public health campaigns and regulatory action seeking to control energy drink use among youth populations. This study highlights key facts about the adverse effects of these drugs, their intensity, and the reasons behind their use.

Hereditary Multiple Exostoses: A Narrative Review of Clinical Spectrum, Molecular Pathogenesis, Diagnostic Advances, and Emerging Therapeutic Approaches

Shashank Yadav, Ratnakar Ambade, Neelaksh, Krishna Sambare, Bhagyesh Sapkale

Hereditary Multiple Exostoses (HME), also known as multiple osteochondromas, is a rare autosomal dominant skeletal disorder characterised by multiple benign cartilage-capped bony outgrowths that develop along the metaphyses of long and flat bones. Clinically, HME presents as palpable lesions, which are usually painless, but complications such as mechanical pain, skeletal deformities, joint restriction, neurovascular compression, and, rarely, malignant transformation to chondrosarcoma can occur. Classical radiography remains the first-line diagnostic tool, while advanced imaging modalities, including Magnetic Resonance Imaging (MRI), Computed Tomography (CT), whole-body MRI, and PET/CT, are used to detect complex lesions and early signs of malignancy. Uncertain cases can be confirmed by molecular analysis of EXT1/EXT2 genes and Next-Generation Sequencing (NGS). Treatment is largely symptomatic and includes surveillance, surgical resection, and corrective orthopaedic procedures for deformities. Emerging disease-modifying agents, such as palovarotene and heparanase inhibitors, may alter osteochondroma formation, as suggested by preclinical trials. This narrative review summarises current knowledge on the clinical spectrum of HME, its pathogenesis, diagnostic methods, treatment options, and emerging therapeutic approaches.

Cognitive Behavioural Therapy for Hemiplegic Shoulder Pain in Chronic Stroke Rehabilitation: A Case Management with Biopsychosocial Perspective

Rajeev Kumar Singh, Nitika Roy, Shazia Mattu, Prince Rohilla

Stroke impairments can lead to various complications, including hemiplegia, sensory loss, dyspraxia, and hemianopsia. It is estimated that 16% to 84% of stroke patients experience Hemiplegic Shoulder Pain (HSP). In the present case, a 38-year-old man who had a left middle cerebral artery infarct two years prior showed good recovery of voluntary movement but continued to struggle with low self-esteem, psychological distress, mild weakness, and spasticity. He also experienced a dull ache in his right shoulder. To address these issues, a multimodal program integrating physiotherapeutic rehabilitation along with a structured Cognitive Behavioural Therapy (CBT) programme was implemented. The CBT programme consisted of 30-minute sessions held five days a week for four weeks and included three phases: educating the patient about stroke and CBT principles, focussing on cognitive restructuring and behavioural strategies, and consolidating skills learned. Depression, anxiety, and stress levels were measured using the Depression Anxiety Stress Scale (DASS) at baseline, after the intervention, and at a six-month follow-up. Significant reductions in psychological distress were noted after the CBT sessions, with sustained improvements observed at follow-up. The multimodal rehabilitation program was effective in addressing biopsychosocial factors and successfully reduced HSP in this patient with a chronic left Middle Cerebral Artery (MCA) infarct.