Journal of clinical and diagnostic research

Conservative Management of Traumatic Intercostal Lung Hernia: A Case Report

Sandhya Gupta, Kushal Choksi, Gagandeep Chauhan, Naresh Modi, Digpal Thakore

Pulmonary herniation is an uncommon phenomenon. It has been described sporadically in obscure case reports and rare case series. Owing to its sparse occurrence, a calibrated algorithm for its management does not exist. Even then, the popular consensus advises surgical management comprising prosthetic mesh repair. Hereby, authors report a case of a 24-year-old male, who developed left lung herniation after blunt trauma to the chest wall. Non Contrast Computed Tomography (NCCT) of chest revealed herniation of left lung through 3^rd intercostal space, a hernia defect of 1.8 cm and a small left pneumothorax. Patient was managed conservatively with intercostal drainage and was discharged on day 5 of admission. This case report aims to delineate the conditions where conservative management of lung hernias can be undertaken successfully.

Very Early Onset Severe Preeclampsia and Eclampsia Syndrome with Posterior Reversible Encephalopathy Syndrome- A Catastrophe

Ruby Bhatia, Sukhbir Pal Kaur, Arshdeep Kaur, Renuka Raina

Early onset severe preeclampsia and eclampsia is a direct cause in the deadly triad of maternal mortality along with haemorrhage and sepsis with high perinatal mortality. Antiphospholipid Syndrome (APS) with Recurrent Pregnancy Loss (RPL) may also result in early onset severe preeclampsia, eclampsia and its catastrophic complications. Present report is a rarest case of a 33-year-old, unbooked G6A5 at 21+4 weeks gestation with eclampsia, HELLP (Haemolysis, Elevated liver Enzymes, Low Platelet count) syndrome, Posterior Reversible Encephalopathy Syndrome (PRES), Intrauterine foetal demise (IUFD) with RPL due to APS with Hepatitis B positive status. Patient was managed by a multidisciplinary team of Obstetricians, Intensivists, Cardiologists and Neurologists. Eclampsia was managed with magnesium sulphate (Pritchard’s regime), intravenous labetalol and delivery of stillborn male foetus weighing 645 gm achieved within 24 hours of eclamptic seizure. Lupus anticoagulant and beta-2 glycoprotein IgM (Immnoglobulin M) antibodies were positive in high titres confirming APS. Postdelivery patient had persistent headache with blurring of vision. A diagnosis of PRES was confirmed on Magnetic Resonance Imaging (MRI) brain. Patient was put on Levetiracetam and low molecular weight heparin and was discharged in satisfactory condition on seventh postpartum day with an advice to follow-up at two weeks, six weeks and 12 weeks. Early onset preeclampsia is encountered in Obstetrics but very early onset severe preeclampsia (<24 weeks of gestation) and eclampsia with HELLP syndrome, PRES in a patient of RPL due to APS is rarest. Early diagnosis of APS and early onset preeclampsia with timely referral to tertiary care and multidisciplinary management can save women from severe dreaded complications with a good obstetric outcome in future.

Intramedullary Spinal Ependymoma with Signet Ring Cell/Adipocytic Morphology- A Rare Case Report

Ependymoma is neuroepithelial tumour with ependymal differentiation that most commonly has ventricular involvement and arises in the cerebrum and spinal cord. It has bimodal age distribution. Incidence rate highest in infant less than one year and second peak is in the 4th decade. Ependymoma with signet ring type of morphology is rare variant. A 57-year-old male patient came with complaints of tingling sensation over bilateral upper limbs. Magnetic Resonance Imaging (MRI) showed cervical intramedullary well defined short segment solid-cystic lesion. Microscopy showed perivascular pseudorosettes and some ependymal rosette focally, in a fibrillary background. Cell forming pseudorosettes have clear vacuolated cytoplasm with eccentrically placed nucleus giving signet ring/mature adipocytic morphology. Thick walled hyalinised blood vessels, occasional mitosis were seen. On histomorphology differential diagnosis were ependymoma with signet ring/adipocytic morphology grade II and metastatic adenocarcinoma with signet ring cell morphology. The cells were positive for Glial Fibrillary Acidic Protein (GFAP), perinuclear dot like positivity for Epithelial Membrane Antigen (EMA). Cell show focal nuclear positivity for Cyclin-D1. MIB-1 (cell proliferation marker) index was 1-2% in highest proliferating. Final impression was ependymoma WHO grade II with signet ring/Adipocytic morphology. Clinically the prognosis of this histological type remains same as conventional ependymoma. These patterns are not decisive for clinical prognosis and treatment. It is necessary to differentiate it from metastasis of signet ring cell adenocarcinoma as the management of such cases is completely different from ependymoma.

A Rare Case of Bilateral Paratesticular Malignant Mesothelioma of Tunica Vaginalis with Bilateral Hydrocele

Prakhar Verma, Mohammad Nafees Ahamad, Guljabin Sultana

Paratesticular region is an indeterminate anatomical region including the spermatic cord with its contents- tunica vaginalis of the testes, epididymis and its appendices and testis. Paratesticular tumours may mimic testicular tumours and is clinically indistinguishable. Paratesticular malignant mesothelioma is an extremely rare tumour, representing only 0.3-5% of all mesotheliomas. There is not a specific clinical presentation however, it may present as a mass which is painless or as a hydrocele, having a wide age distribution. Lack of specific tumour markers presents a challenge in its diagnosis and management. Extreme diagnostic difficulty arises preoperatively in distinguishing malignant and benign tumour. Most of the cases are diagnosed intraoperatively or postoperatively when found on biopsy. Pleural and peritoneal mesotheliomas are known to occur in individuals exposed to asbestos. The case reported here is of a 32-year-old male who reported in the Out Patient Department (OPD) with the complaint of painless bilateral enlarged scrotum without history of exposure to asbestos. Bilateral orchidectomy followed by biopsy reported paratesticular malignant mesothelioma. Bilateral malignant mesothelioma of tunica vaginalis with bilateral hydrocele occurrence is rare, and it has an aggressive clinical progression, so clinical presentation and histopathology features are being presented to emphasise on the fact that it is critical for the urologists to be aware of such potentially rare entity. A mandatory high index of clinical suspicion is required, as lack of knowledge would result in an unnecessary radical orchidectomy as happened in present case.

Pelvic Lipomatosis in a Young Male: A Case Report

Sunirmal Choudhury, Shantanu Gaur, Dilip Kumar Pal

Pelvic Lipomatosis (PL) is a rare benign disease of unknown aetiology characterised by intrapelvic overgrowth of mature fatty tissue. Although non malignant, the adipose tissue is infiltrative and causes compression of the pelvic structures-the genito urinary tract, lower gastrointestinal tract or the vascular system leading to a broad range of symptoms. With limited cases of PL reported in the literature there are no clear-cut guidelines for its management and both conservative and surgical modalities have been described with varying results. This report describes a case of PL in a young 34-year-old male which was associated with bilateral hydroureteronephrosis and was well managed conservatively. PL is also known to be associated with complications like hypertension, severe upper tract obstruction, renal failure and rarely pulmonary thromboembolism, portal vein thrombosis and adenocarcinoma bladder, thus commanding early diagnosis of the disease and long-term follow-up in all the patients.

Effect of Topical Application of Tea Tree Oil (Melaleuca alternifolia) on Hand Warts

B Deenadayalan, V Venugopal, K Maheshkumar, A Akila, C Yoga Priya

Tea Tree Oil (TTO) is one of the most widely used aroma oil and is documented to be beneficial in the management of viral infections such as Herpes Simplex Virus (HSV) and Human Papilloma Virus (HPV). Hereby, authors report a case of 22-year-old female diagnosed with HPV infection with cutaneous wart (Verruca Vulgaris) on distal phalange of the right index and middle fingers. She had complained of pain and discomfort while writing. Tea tree oil was mixed with carrier oil (coconut oil) in a ratio of 1:5, and she was advised to apply it over the wart directly for 21 days. At the completion of 21 days, the warts resolved completely and there was no recurrence during the one month follow-up after intervention. In addition, the patient also reported a reduction in pain with the treatment. Tea tree oil could thus be effectively used for treating cutaneous warts. However, further studies with adequate sample size would help further validate the findings.

Infective Endocarditis of Native Valves due to Aspergillus in an Immunocompetent Host: A Rare Presentation

Aspergillus endocarditis is a rare entity in an immunocompetent host with native valves. Late or misdiagnosis leads to increased morbidity and mortality. In this report authors present a case of native valve Aspergillus endocarditis, in 30-year-old male immunocompetent patient with no co-morbidities. The patient also had a parietal glioma. He underwent four surgeries including valve replacement during the course of illness. Patient improved with appropriate antifungal therapy and surgeries. He was on suppressive antifungals and continued to do well. Aspergillus endocarditis is to be considered in culture negative endocarditis. The optimal management includes adequate surgical debridement in conjunction with prolonged antifungal therapy.

Arachnoid Cyst: A Solitary Intracranial Cyst in the Occipital Lobe of the Cerebrum in a Cadaver

MV Ravishankar, CS Vidya, Sapna Patel, MN Suma

Cyst is a closed sac, having distinct envelop; they may be filled with air, fluid, semi-solid material etc. Often cyst is a self-limiting and uneventful condition; they may get resolve with some time duration. If they fail to self-limit by themselves, depending on its size and location it needs timely surgical intervention. A cerebral cyst is a lesion with fluid filled sac in the brain. It may be benign, or malignant. This may be filled with blood, pus, Cerebrospinal Fluid (CSF), etc. Intracranial arachnoid cysts are congenital lesions of an arachnoid membrane which accounts for 1% of cases of intracranial space occupying lesions. Clinically, a brain cyst may remain silent, often it is an accidental finding on radiological investigations which are correlated in the patients with a history of vague neurological complaints. Often, headaches are a chronic complaint presented with underlying causative factors ranging from psychological stress to severe neurological deficits. The primary brain cyst that exists congenitally by birth will have no definite causality; a secondary brain cyst may exist with diversified aetiological factors including trauma. Elucidation of chronic symptoms dominated with migraine-like headache is very much essential; despite showing a good relief with a palliative treatment it will warrant clinicians to rule out cerebral cystic lesions. Such accidental findings during the dissections set as a natural cadaveric illustration, which build curiosity, and motivation among preclinical student learning from the point of integration of basic subjects. One such case of the cerebral cyst was found during the dissection in the Department of Anatomy, JSS Medical College, Mysuru, Karnataka, India. The present case is of a 70-year-old male cadaver diagnosed with the arachnoid cerebral cyst along with other varieties of cystic brain swellings.

Acute Presentation of Upper Limb Ischaemia Requiring Amputation: A Case Report

Shriya Himmat Thacker , Mukesh Chande , Manish Raval , Navin Gagal

Peripheral Artery Disease (PAD) of the upper extremities is common. It is most often asymptomatic but may cause exertional pains, ischaemic pains, gangrene or ulceration. The risk factors for PAD are smoking, obesity, hypertension, diabetes, hypercholesterolaemia and end stage renal disease. Here the authors reported a case of 45-year-old male patient, presenting with severe aching type of pain associated with paraesthesia and numbness and blue, cold and gangrenous right forearm which was amputated below the elbow. After amputation, the condition advanced and led to weakness of the right upper arm with bone necrosis and surrounding skin was hyperaemic and oedematous with differential warmth, therefore the patient undergone amputation of the right upper arm and was managed postoperatively with antibiotics and the wound was closed with non absorbable sutures and was on oral anticoagulant therapy and after complete recovery, patient was discharged. On follow-up, removal of sutures was done and patient was referred for physiotherapy for muscle strengthening and prosthesis fitment.

Nicolau Syndrome in a Child Caused by Penicillin Injection

Rafat Abdulroof Alkadi, Ahmed Saleh Hudna, Mohammed Ali Al-Shehab, Omar Alzomor

A wide range of side effects can occur during drug administration. Nicolau Syndrome (NS) is a rare iatrogenic side effect of medications injected Intramuscularly (i.m.). The clinical manifestations range from localised pain and erythema to total necrosis requiring amputation. The present report is about a five-year-old boy, who developed NS after receiving an i.m. injection of benzathine penicillin for treatment of pharyngitis. He developed symptoms minutes after the injection including intense pain at the site of injection followed by progressive discolouration and impairment of movement of the affected limb. The patient was treated with pentoxifylline, methylprednisolone, heparin and antibiotics in a hospital and after one month, complete improvement was noticed.

Eagle’s Syndrome- Enigma behind Atypical Orofacial Pain

Pulkit Khandelwal, Harish Saluja, Seemit Shah, Anuj Dadhich

Eagle’s Syndrome (ES) is characteristically distinguished by cranio-cervico-pharyngeal signs and symptoms associated with elongation of styloid process which compresses vital neurovascular and muscular elements and other anatomical structures. Elongation of styloid process may cause intense facial pain, dysphagia, headache, otalgia, trismus, buzzing sensations and numerous other symptoms. Ossification of stylohyoid or stylomandibular ligament and/or growth of stylohyoid apophysis cause this elongation. It is not a rare condition; however, it is rarely considered as diagnosis by physicians. Definite diagnosis of this syndrome is difficult as it is frequently confounded by radiological examination, differential diagnosis and other manifestations of cervicopharyngeal pain. Non surgical management include reassurance, anti-inflammatory medications and analgesics; and surgical treatment options include a transoral or transcervical approach to resect elongated styloid process. Hereby, the author report a rare case of ES in a 45-year-old female patient who reported with pain on lateral aspect of her neck and throat bilaterally which had been present for nearly 10 years. On clinical examination, bilateral retromandibular region and tonsillar region were tender on palpation with blunt bony elevation palpable bilaterally. Computed Tomography (CT) scan revealed ossification and elongation of styloid processes bilaterally. Surgery was performed for resection of elongated styloid process bilaterally using retromandibular approach. Patient was discharged on 3rd postoperative day and her complaints resolved within seven days. Patient was symptom free and comfortable at one year postoperative follow-up.

Refractory Hypoglycaemia in Hepatocellular Carcinoma Treated with TACE Leading to Tumour Lysis Syndrome- A Double Trouble

Saurabh Kumar, Ishita B Sen, Vivek Vij, Ashish Singhal, Ajitabh Srivastava

Hepatocellular Carcinoma (HCC) is the most common type of primary liver cancer. Hypoglycaemia is a well-established paraneoplastic manifestation of HCC. Cytoreduction by surgery or Transarterial Chemoembolisation (TACE) has been effective treatment options in such cases when conservative treatment fails. Tumour Lysis Syndrome (TLS) is an oncological emergency following treatment of malignancies with high cell turnover and can be seen in liver-directed therapy in the form of both ablative therapies and transarterial therapies for HCC. Authors present a rare case of 65-year-old male, with HCC presented with symptoms of refractory hypoglycaemia which was managed by TACE procedure with further patient developing TLS which was medically managed.

Sacral Dural Arteriovenous Fistulas, a Rare and Underdiagnosed Subtype of Spinal Dural Arteriovenous Fistulas: A Case Series with Review of Literature

Spinal Dural Arteriovenous Fistulas (SDAVFs) are the most common type of spinal vascular malformations with arterial feeders usually from the intercostals, vertebral, subclavian and lumbar arteries and rarely from the internal iliac arteries. Authors report three cases of SDAVFs at our institution where arterial feeders were from internal iliac artery. The endovascular embolisation of arterial feeders was done using n-BCA (n-butyl cyanoacrylate) embolic agent in one case and with Ethylene Vinyl Alcohol (Onyx) in two cases with complete obliteration of the fistula. This resulted in marked clinical improvement in all the patients. The lateral sacral arteries are not a common site of origin of arterial feeders to the SDAVFs and can be easily overlooked if thorough spinal Digital Subtraction Angiography (DSA) is not performed. Through these three cases, authors want to highlight the importance of performing complete spinal DSA.

Breakthrough Cases of COVID-19 among Healthcare Workers: A Case Series

Anuradha Mohapatra, Gajanan D Velhal, Uma R Nair, Nived G Sudarson

Breakthrough infections after Coronavirus Disease-2019 (COVID-19) vaccinations are an expected phenomenon as no vaccine is 100% effective. Healthcare Workers (HCW) are at a higher risk of contracting the infection owing to the exposure at the workplace. This case series describes clinical profile of 27 breakthrough infections after two weeks of second dose of vaccination. Of the total HCWs with the COVID-19 infection during the study period, 21.77% were breakthrough infections. The mean age of these HCWs was 36±12.02 years. The mean interval between the second dose of vaccine and being detected COVID-19 positive was 24.41±7.69 days. Majority of them were doctors (66.67%) and nurses (14.81%). All of them suffered from mild disease and recovered fully. Availability of vaccines coupled with pandemic fatigue has led to false reassurance among population. Hence, COVID-19 Appropriate Behaviour (CAB) before and after vaccination should be followed rigorously to prevent such infections.

Ocular Rhinosporidiosis and Recurrence Postsurgery: A Case Series

Rhinosporidiosis, a chronic granulomatous disease, is caused by Rhinosporidium seeberi. It is an endosporulating microorganism causing polypoidal ocular mass. A clinician needs to have high degree of suspicion for oculosporidiosis, as it is more common in nasal cavity and other respiratory passage as compared to ocular lesion. The authors intend to increase awareness among ophthalmologists through this case series. It was intended to evaluate profile, clinical presentation and recurrence rate of ocular rhinosporidiosis in a tertiary care setting in Eastern India. The present case series is about 15 patients diagnosed with rhinosporidiosis, that was reported within one year. Age range was 6-50 years, with male:female was 9:6. All patients underwent total excision with around 2 mm lesion free margin and electrocautery of base. Postoperatively, antibiotic and lubricant eye drops were given, a follow-up schedule was day 1, 7, 30, six months and one year. Majority of the patients showed involvement of lower tarsal conjunctiva (eight), followed by upper (four), then bulbar conjunctiva (one), lower lid (one), and lacrimal sac (one). All patients recovered completely postoperatively. At one year follow-up no patient had any recurrence. Ocular rhinosporidiosis may have diverse presentation from chalazion, papilloma, keratoconjunctivitis etc. This disease is often missed because of poor pathological back up at many centres. In an endemic area, a high degree of suspicion should be there to detect this relatively rare entity.

A Rare Case of Familial Progressive Ataxia with Palatal Tremors

Abhilash Mishra, Sourya Acharya, Gaurav Jagtap, Praraj Jaiswal, Sunil Kumar

Carcinocythemia-associated Microangiopathic Haemolysis

Hamza Tariq

Carcinocythemia defined as the presence of circulating carcinoma cells in the peripheral blood identifiable on routine light microscopy is an extremely rare complication of widely disseminated and usually end-stage solid organ malignancies. Given the rarity of this entity, it can cause diagnostic challenges for pathologists interpreting the peripheral blood smear. Microangiopathic Haemolytic Anaemia (MAHA) has been reported in the literature in patients with carcinocythemia. The author reports a case of 57-year-old female with widely metastatic lobular breast carcinoma who presented with bleeding gums and worsening fatigue. Peripheral blood smear showed findings consistent with MAHA as well as numerous circulating adenocarcinoma cells. A bone marrow biopsy showed near-complete replacement of the marrow by metastatic carcinoma. This case brings to light the association of carcinocythemia with haemolysis. Given the high incidence of MAHA in carcinocythemia and the differential treatment, a careful screening of peripheral smears maybe warranted in patients with a known history of metastatic carcinoma and laboratory suspicion of haemolysis.

Pictorial Essay of Named CT Signs in COVID-19 Pneumonia on High Resolution Computed Tomography

Chandrashekar Patil, Raja Kollu, KS Prashanth Kumar, Smitha Yesumalini Ravula

The Need to Emphasise on Confirmatory Test in the Diagnosis of Syphilis in Low and Middle Income Countries

Mariam M Mirambo, Stephen E Mshana

In-vitro Study of Macelignan as a Potential Anticancer Drug against Colorectal Cancer using HCT116 Cell Line

M Salma Kausar, BK Manjunath

Introduction: Many recent studies have shown that lignans from many plant sources have an effective impact on cancer treatment and it is evident that many medicinal plants are rich in lignans. Genus Leucas is known for its medicinal use and is rich in lignans. Macelignan a polyphenolic derivative might play significant roles as clinically useful anticancer agents in treating Colorectal Cancer (CRC). Aim: Isolation, characterisation and pharmacological profiling of bioactive compound lignan from Leucas aspera and Leucas cephalotes and to assess the anticancer potential using in-vitro methods using Human Colorectal Cancer (HCT116) cell lines. Materials and Methods: This in-vitro study was conducted from August 2018 to January 2020 at The Oxford College of Engineering in Bengaluru, Karnataka, India. Anticancer potential of Macelignan was evaluated through 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Reactive Oxygen Species (ROS) measurement, cell cycle study, apoptosis analysis, and gene expression studies. One-way Analysis of Variance (ANOVA) was performed for the total phenolic content estimation and the results were expressed as mean±SD with n=3 trials. Results: The MTT assay result indicated that macelignan has an IC50 value of 22.8 μM with 73% of cells showing inhibition, ROS production was enhanced 2.5-fold at a maximum concentration at 100 μM. Macelignan (12.5 μM and 25 μM) significantly prevented cell growth in G0/G1 and G2 phases of the cell cycle, while the apoptotic study showed that 12.5 μM and 25 μM macelignan induced early and late apoptosis in HCT116 cells with 21.28% and 19.17%, 21.54 % and 29.02% apoptosis at cellular level, respectively. This set of tests sought to examine the effect of macelignan on the Caspase 3 gene expression in HCT116 cells by semi-quantitative Polymerase Chain Reaction (PCR). The study showed that Caspase 3 expression was upregulated up to 1.98 and 2.87 folds when treated with macelignan. Conclusion: The macelignan could serve as a potent drug derivative for the treatment of colon cancer with further study on the mechanism of action, structure-activity relation, toxicity profiling, bioavailability.

Clinicoepidemiological Study on Patients with Dermatosis Papulosa Nigras and Acrochordons- A Longitudinal Study

Rajkumar Kannan, Samuel Jeyaraj Daniel, A Ramesh, P Deepavarshini

Introduction: Dermatosis Papulosa Nigras (DPNs) and Acrochordons are benign epidermal outgrowths that frequently occur together over face, neck, axilla and other flexures. These are common dermatoses with high cosmetic concerns. Knowledge about the clinicoepidemiological patterns of these dermatoses will help in better management and prevention of recurrence. Aim: To study the clinicoepidemiological patterns of DPNs and acrochordons, and to evaluate the outcome of treatment with Radiofrequency (RF). Materials and Methods: The present study was a longitudinal study done on 121 patients in the Out-Patient Department (OPD) of Dermatology from January 2017 to June 2021 with DPNs. and acrochordons who were followed-up for three years. The lesions were treated with RF removal (the number of sessions varied depending on the number of lesions). Data regarding relevant history, complete dermatological examination, and recurrences (if any) were recorded. Results: Male versus female ratio was 1:1.8. The mean age of the study group was 34.28 years. The most common lesions were papular type DPNs, seen more commonly over face and neck (40%), 35 patients (28.9%) were obese (≥30 kg/m2), 19 patients (15.7%) had diabetes, and 13 patients (10.7%) had Polycystic Ovarian Syndrome (PCOS). There was a positive association between co-morbidities such as obesity, diabetes and PCOS and occurrence of the lesions. Overall, 70 patients had recurrence, out of which 26 (37.1%) were obese. Fifty-three patients used sunscreen regularly and usage of sunscreen showed significant association with prevention of recurrence, p-value-0.001. Conclusion: In this study, it was found that females presented with complaints of DPNs and acrochordons more than males. The most common lesions were papular DPNs over face and neck. The most common co-morbidity in patients was obesity followed by Diabetes Mellitus (DM). Majority of patients (71%) who did not use sunscreen after treatment experienced recurrence of lesions.

A Bolt from the Blue for an Obstetrician: A Case Series of Life Threatening Surgical Emergencies following Evacuation of Unwanted Pregnancy

Anandhita Neelakandan, Rachna Agarwal, Shilpa Singh, Kusum Dogra, Kavita Sharma

Unwanted pregnancies are those that are mistimed, unplanned or unwanted at the time of conception and mostly end up in induced abortion. Dilation and Curettage (D&C) is a procedure which involves dilatation of the cervix and introduction of a thin instrument to remove tissue from the inside of the uterus. D&C is associated with quite a few complications, one being perforation of the uterus which isn’t an uncommon accident during D&C. Uterine perforation consequent intestinal perforations and bowel prolapse not only occur with inexperienced and untrained persons but also amongst experienced doctors in certain cases. The most frequent surgical management of uterine perforation with bowel injury is repair of the uterine wall along with resection and anastomoses of the injured bowel. In the present series, three cases, a 24-year-old, 26-year-old and 29-year-old of abortions performed by cervical D&C in a tertiary care hospital of which two resulted in uterine perforation and bowel prolapse through the vagina, and one was a suspected perforation. Both patients with bowel prolapse were rigorously resuscitated and taken up for an emergency laparotomy. Though complications such as perforation and bowel injury are inevitable, further morbidity to the patients can be alleviated if handled with expedient identification and intervention.

Effect of Saline Irrigation for Transurethral Resection of Prostate on Acid Base and Electrolyte Status- A Prospective Cohort Study

Nilam Dharma Virkar, Aparna Ashay Nerurkar, Geeta Anant Patkar

Introduction: Transurethral Resection of Prostate (TURP), using bipolar resectoscope, is performed using 0.9% Normal Saline (NS) as irrigating fluid. The NS is absorbed at about 10-30 mL per minute of resection time. The TURP averages 45 to 90 minutes of resection time. Thus, 450-2700 mL of NS is expected to be absorbed in this short time. Rapid administration of higher quantities of NS can cause hyperchloraemic acidosis, hyperkalaemia and negative protein balance. Aim: To detect changes in pH, serum electrolytes (serum bicarbonate, serum chloride, serum sodium, and serum potassium) and to record complications, if any, in patients undergoing bipolar TURP with 0.9% NS irrigation. Materials and Methods: This prospective cohort study was conducted at Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India, from May 2017 to May 2018. Thirty patients undergoing saline bipolar TURP under subarachnoid block were studied. Preoperative and postoperative venous blood pH and serum electrolyte samples were collected. The quantity of NS used, duration of resection, and occurrence of complications were recorded and statistically analysed. Results: The mean age, mean gland size, resection time and volume of irrigation fluid used were 65.17±7.2 years, 64.9±30.85 cc, 60.67±14.17 minutes and 23.73±4.78 Litres, respectively. The mean preoperative pH of 7.33±0.047 fell by 0.03 postresection (p-value=0.02) and mean serum sodium increased from 139±3.65 meq/L to 142.2±3.60 meq/L, which was statistically significant (p-value=0.01). Serum bicarbonate, serum potassium, and serum chloride did not show any significant change. On relating the various intraoperative parameters with biochemical changes, a statistically significant but clinically insignificant association was found between the amount of irrigation fluid used and changes in serum sodium levels. Conclusion: The use of approximately 23.73 L NS in 60.67 mins of resection time and gland sizes up to 64.91 cc appear to produce no clinically significant changes in pH, serum electrolytes or complications with Bipolar TURP. However, further studies are needed to determine the acid base changes and safety with higher gland sizes requiring prolonged resection times and subsequently higher NS absorption.

MU-Opioid Receptor (OPRM1) Gene Polymorphism and its Association with Alcohol Dependence: A Single Centre Study from Southern India

Navina Suresh, Suvarna Jyothi Kantipudi, K Sandhya, Sathianathan Ramanathan

Introduction: Asn40Asp Opioid Receptor (OPRM1) polymorphism of the MU-OPRM1 gene has been widely studied with regard to its association with alcohol dependence however results have been conflicting with evidence of ethnicity mediated effects. Aim: To examine the association between OPRM1 polymorphism and alcohol dependence in patients of South Indian ethnicity. Materials and Methods: This cross-sectional study was conducted at Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India, from November 2018 to May 2019. Cross-sectional assessments and peripheral venous blood genotyping were done in 50 male South Indian participants attending a tertiary care psychiatric setting. Clinical parameters such as severity of dependence and craving were assessed in addition to the subject’s OPRM1 genotype. The data collected was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The mean age of the subjects was 39.62±8.50 years. This study showed a statistically significant association between alcohol dependence and the OPRM1 polymorphism Asn40Asp among the study subjects (p-value <0.05). Furthermore, there was a higher than expected prevalence of the polymorphism of 86% among patients. However, there was no significant association between the polymorphism and clinical phenotypes such as severity of dependence or craving. Conclusion: This study indicates a possible role of OPRM1 polymorphism in alcohol dependence in South Indian patients and warrants further research with larger sample sizes. The association if replicated will shed light on aspects of aetiopathogenesis as well as have implications on treatment.

A Randomised Clinical Study on Haemodynamic Effects of Thiopentone and Etomidate as Induction Agents in General Anaesthesia

Priyanka Kumari, Arunava Biswas, Sankar Roy

Introduction: Thiopentone and Etomidate like anaesthetic agents are often used for induction during anaesthesia. Induction is the preliminary step in general anaesthesia and the search for a perfect agent is a persistent quest for the anaesthetist. Aim: To compare the haemodynamics status and safety profile of thiopentone and etomidate as induction agent. Materials and Methods: The present randomised clinical trial was conducted on 120 patients, of either sex between 18-45 years of age belonging to American Society of Anesthesiology (ASA) grade I and II. They were divided into two groups with 60 patients in each. Group T patients were induced with injection (inj.) thiopentone 5 mg/kg and group E patients were induced with inj. etomidate 0.3 mg/kg as an induction agent. Vital parameters like heart rate, non invasive blood pressure of all patients were recorded at baseline (before induction), after induction and post intubation at an interval of 1, 3 and 5 minutes. Adverse effects during intraoperative period were noted and later analysed. Quantitative data were analysed using Unpaired t-test to assess the changes within group. Results: Out of 120 study participants, 70 were males and 50 females with the mean age of 35.63±12.20 and 34.50±7.46 in group T and group E respectively. The induction time in the Group E (27.5±3.31 seconds) was significantly less (p<0.05) as compared to group T (31.71±4.8 seconds). Change in heart rate was lesser (p<0.05). There were no significant changes in the respiratory rate in either at any stage of anaesthesia. Adverse effects like apnoea were evident more in the group T patients whereas pain at injection site and myoclonus was more evident in the group E patients. But, the overall safety profile of etomidate was better than thiopentone. Conclusion: Etomidate found to be more effective, rapid acting induction anaesthetic agent with good cardiovascular stability and respiratory stability with least incidences of apnoea as compared to thiopentone.

Surface Electromyography of Perianal Muscles in Children with and without Enuresis: A Cross-sectional Study

Vidhi Shah, Tushar Palekar, Padmaja Guruprasad

Introduction: Enuresis or bedwetting is the most common urological problem seen in children from the age of 5-15 years. Various diagnostic procedures like urodynamics study, urinary system ultrasonography and Electromyography (EMG) are widely used. In most cases, endoanal probe is used for the procedure of EMG which is an invasive technique but surface EMG is pain free and easier. Aim: To assess the activity of perianal muscle in children with enuresis using surface EMG. Materials and Methods: Present study was a cross-sectional study in which 20 healthy children and 20 enuretic children in the age group of 5-15 years participated. Both boys and girls without central nervous system disorder were included. Surface EMG of the perianal muscles were performed. The homogenecity of demographic data like age, weight and height were checked using Student’s t-test. Normality of the data was established using Shapiro-Wilk’s test. Results: On analysis, the mean age (years) of normal children was 8.75±2.09 and for enuretic children was 9.3±2.63. The mean value of amplitudes of surface EMG (Quotient of Motor Unit action Potential-QMUP) in normal children was 428.6±118.6 µV and for enuretic children was 248.01±45.85 µV (p<0.05). Mean score for enuretic girls was 260±42.95 and normal girls was 414.7±118.1 (p<0.05). Similarily, mean score for enuretic boys was 236±47.71 and normal boys were 442.8±123.7 (p<0.05). Conclusion: The perianal muscle activity is lowered in children with enuresis than in their age matched normal children. In the enuretic children, there is a need to manage pelvic floor muscle strength along with neuronal control.

Effect of Preoperative Ketamine Nebulisation on Attenuation of Incidence and Severity of Postoperative Sore Throat, Hoarseness of Voice and Cough: A Randomised Double-blind Study

Introduction: Postoperative Sore Throat (POST) occurs in a majority i.e., upto 62% of patients who undergo endotracheal intubation under general anaesthesia. Ketamine nebulisation has been reported to reduce the incidence and severity of POST. Aim: To evaluate the effect of ketamine nebulisation on incidence and severity of POST, hoarseness of voice and cough. Materials and Methods: This prospective, randomised, double-blind study was conducted between September 2020 to February 2021 at J.L.N. Medical College, Ajmer, Rajasthan, India. Total of 100 American Society of Anesthesiologists (ASA) physical status I and II patients were enrolled, and randomly allocated into two groups of 50 each. The patients in Group K (n=50) were nebulised with ketamine (50 mg) with 4 mL normal saline (NS) and in Group S (n=50) were nebulised with 5 mL NS 15 minutes prior to endotracheal intubation. The incidence and severity of POST, hoarseness of voice and cough were assessed just after extubation (0 hour) and thereafter at 2, 4, 6, 12 and 24 hours postoperatively. Haemodynamic parameters {Heart Rate, (HR) Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Oxygen Saturation (SpO₂)} were noted before and after nebulisation, and just after intubation. Side-effect profile was also noted. The data from patients was analysed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 21.0 for windows). Results: Mean age of Group S was 36.22±9.386 years and Group K was 37.40±9.604 years (p-value=0.534). The incidence and severity of POST was significantly lower in patients in Group K at 0 hours (p-value=0.003), at 2 hours (p-value=0.001), at 4 hours (p-value=0.003), at 6 hours (p-value=0.004) and at 12 hours (p-value=0.003), when compared to patients in Group S. The incidence and severity of cough was also significantly lower in patients in Group K at 0 hours, 2 hours, 4 hours and 6 hours (p-value <0.001). Incidence and severity of postoperative hoarseness of voice in Group K was significantly less as compared to Group S at 0 hours, 2 hours, 4 hours and 6 hours (p-value <0.001) and at 12 hours (p-value=0.001). No significant haemodynamic changes (p-value >0.05) and side-effects (p-value=0.727) were noted in both the groups. Conclusion: Preoperative ketamine nebulisation was found to be effective in reducing the incidence and severity of postoperative sore throat, hoarseness of voice and postoperative cough after general anaesthesia with endotracheal intubation along with no or minimal haemodynamic changes and side-effects.

Diagnostic Accuracy of STANDARD Q COVID-19 Antigen Detection Kit in Comparison with RT-PCR Assay using Nasopharyngeal Samples in India

Seema Aleem, Naziya Zahoor, Asif Jeelani, SM Salim Khan

Introduction: Real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) can be considered to be the gold standard for diagnosis of Coronavirus Disease-2019 (COVID-19). Though it is highly accurate but has some limitations in terms of its use, which means that Rapid Antigen Tests (RAT) can support COVID-19 mitigation efforts. Aim: To estimate sensitivity, specificity and degree of agreement of STANDARD Q COVID-19 Antigen Detection Kit in comparison to real-time quantitative RT-PCR (qRT-PCR). Materials and Methods: This cross-sectional study was conducted at Government Medical College, Srinagar, Jammu and Kashmir, India, in April 2021. Socio-demographic and clinical information was collected on a pretested schedule after which two consecutive nasopharyngeal swabs were collected from each subject. One sample was tested using the STANDARD Q COVID-19 antigen test and the other was tested using qRT-PCR. Sensitivity and specificity were calculated using standard formulas. Cohen’s Kappa was calculated and Mann-Whitney U test was used for comparison. Results: The study included 473 subjects with a mean age of 38.4±12.2 years. Around 1/4^th (124 subjects) of subjects were symptomatic at testing with the most common symptoms being fever (57.2%), cough (50%), sore throat (43%), myalgia (25%) and diarrhoea (13%). The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were estimated to be 54.4%, 99.2%, 71.49 and 0.46, respectively. The Cohen’s Kappa between the two tests was 0.644. Cycle threshold value was significantly lower in subjects with symptoms and those with a positive rapid test among those positive on qRT-PCR. Conclusion: The STANDARD Q COVID-19 antigen test has a reasonable sensitivity, high specificity with a substantial inter-test agreement in comparison to qRT-PCR.

Comparison of Stress and Periodontal Health Status among Individuals Practicing Yoga with Age and Gender Matched Controls in Hyderabad City

Introduction: Stress, the most basic psycho-social factor causes disruption of a person’s physiological as well as psychological well-being. Yoga originated in India thousands of years ago, is a primordial philosophical system aimed at bringing harmony to the individual’s physical, mental, and emotional aspects. Aim: To examine and compare the stress and periodontal health status of yoga practitioners in Hyderabad city with age and gender matched controls. Materials and Methods: This case-control study was conducted on 278 subjects by the Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketpally Nalgonda, Hyderabad, Telangana, India from August 2019 to January 2020. Out of the selected subjects, 139 were the cases, aged between 25-40 years, who were practicing yoga in hyderabad city regularly while 139 were age and gender matched controls, selected from general population, not practicing yoga. The survey tool comprised of the Perceived Stress Scale (PSS developed by Cohen S et al.,). Oral health status was recorded using the World Health Organisation (WHO) Basic Oral Health Survey Assessment Form of 2013. The data was analysed using version 21.0 of the Statistical Package for Social Sciences (SPSS). Statistical significance was set at p≤0.05. Results: The total of 278 subjects (139 cases; mean age 28.30±7.73 years and 139 controls; mean age 29.25±7.73 years) were included. Both the genders in the control group had noticeably elevated mean scores for caries status (1.50±0.59), periodontal status (3.69±0.57) and Loss of Attachment (LOA) (code 1: 1.63±1.33) and overall PSS score (1.81±0.60) compared to cases. The difference in periodontitis (p-value=0.05), OHI-S (Simplified Oral Hygiene Index) scores (p-value <0.001), PSS scores (p-value <0.001) and gingival scores (p-value <0.001) was found significant. A similar trend was noted when compared with both males and female regarding OHI-S and gingival scores but the difference was statistically non significant. The PSS score difference was found significant with age (p-value=0.02), gender (p-value=0.02) and subjects who were practicing yoga regularly (1.67±0.69) (p<0.001) as compared to controls. However, all age groups who were not practicing yoga reported with poor periodontal health with high LOA scores compared to practitioners and no significant association was found between perceived stress and method (p-value=0.22) or frequency (p-value=0.17) of cleaning their teeth. Conclusion: This study finding is extremely important for Indian population, where more than 50% of the population is suffering with gum diseases due to stress. Hence, suitable preventive and treatment approaches are endorsing to combat from the stress and periodontal disease. Therefore, yoga is effective in prevention of oral diseases and maintenance of personal as well as oral hygiene and healthy gingiva by improving the lifestyle, reducing the tension and periodontal inflammation.

Efficacy of Different Doses of 1% of 2-Chloroprocaine in Spinal Anaesthesia for below Umbilicus Surgery: A Randomised Clinical Trial

Introduction: A 2-chloroprocaine is a short acting amino-ester group of local anaesthetic drug used in spinal anaesthesia. The dose of 30 mg of 1% 2-chloroprocaine can also be used for below umbilicus surgery. Aim: To compare the efficacy of two doses of 1% of 2-chloroprocaine in spinal anaesthesia for below umbilicus surgery. Materials and Methods: This prospective randomised clinical trial was conducted from December 2019 to April 2020, on 32 patients who were allocated into two groups. Group A received 30 mg of 1% of 2-chloroprocaine and group B received 40 mg of 1% of 2-chloroprocaine for spinal anaesthesia. Onset of motor and sensory block, peak block height and haemodynamic parameters were noted in the intraoperative period. Recovery from spinal anaesthesia was noted and transient neurologic symptoms were also noted after 24 hours and seven days after surgery. Mean and standard deviations were calculated from the collected data and Statistical Package for Social Sciences (SPSS) version 20.0 was used for the analysis. Results: A total of 32 subjects (aged 20-60 years) were divided into group A (n=16; mean age: 31.56±10.05 years) and group B (n=16; mean age: 34.19±11.72 years). Time taken for the onset of sensory and motor block was similar in both the groups. The peak height reached was T8-T10 in group A and T6-T10 in group B. During recovery period, time taken for regression of sensory block were similar between the groups. Complete recovery from motor block took 75.69±10.78 minutes in group A and 93.53±8.96 minutes in group B which was statistically significant (p<0.001). Time taken for mobilisation without support was 113.85±25.50 minutes in group A and 119.87±13.42 minutes in group B (p=0.4115). There were no Transient Neurological Symptoms (TNS) in both the groups. All the patients were haemodynamically stable. Conclusion: Both doses of 2-chloroprocaine can be used in day care surgery due to its short duration of action.

Comparative Evaluation of Flexural Strength and Surface Roughness of Three Different Commercially Available Provisional Restorative Materials: An In-vitro Study

Rashmi Rajput, Anurag Hasti, Ashish Choudhary, Surabhi Duggal, Sheeba Ali

Introduction: Provisional restorative materials require good mechanical properties for long term restorations. Provisional restorative materials are continuously being updated and improved upon for these mechanical, biological and esthetic properties. Aim: To determine and compare the surface roughness and the strength of three different commercially available provisional restorative materials at different periods. Materials and Methods: This in-vitro study involved 120 samples of a stainless steel mould fabricated and equally divided. The study was carried out for one year in the Department of Prosthodontics and Crown & Bridge, School of Dental Sciences, Sharda University between June 2020 to June 2021. Materials compared were Dental Products of India (DPI) heat cure acrylic, Protemp 4 and Revotek LC. Each group was further categorised into four groups to measure the flexural strength (after 24 hours, storage in artificial saliva for seven days and 30 days) and surface roughness. A Universal Testing Machine determined the flexural strength and Perthometer for surface roughness. Statistical analysis was done using a one-way Analysis of Variance (ANOVA) test followed by a post-hoc test. Results: In the three types of materials studied, flexural strength after 24 hours, 7 days, and 30 days was statistically significantly higher (p-value=0.001) in DPI than Protemp 4 and Revotek LC whereas, DPI exhibited a decrease in surface roughness when compared to Protemp 4 and Revotek LC (p-value=0.002). Conclusion: Within the limitations of the study it was found that DPI demonstrated a higher flexural strength at 24 hours than Protemp 4 and Revotek LC. After storage in saliva for 7 days and 30 days, there was a decrease in the flexural strength of three commercially available provisional materials. The mean surface roughness of Revotek LC was more than DPI and Protemp 4.

Efficacy and Safety of Oral Terbinafine with Itraconazole or Griseofulvin Combination Therapy in the Management of Dermatophytosis- A Randomised Clinical Trial

A Ramesh, S Devasena, Dhanyamol Mathew

Introduction: Dermatophytosis is a common fungal infection caused by Trichophyton, Epidermophyton, Microsporum species. Combination of systemic and topical antifungal therapy is in vogue for all patients with dermatophytosis, except in cases of localised naïve Tinea. Recently, a rising prevalence of poor response to standard regimen of treatment has been noted. In this study, we tried to find out the benefits and adverse effects of systemic antifungal combination therapy in the treatment of tinea. Aim: To compare the efficacy of oral terbinafine with itraconazole or griseofulvin combination therapy in the management of dermatophytosis and to assess the adverse effects associated with these combination therapies. Materials and Methods: The present randomised clinical trial comprised of 60 patients with dermatophytosis who were divided into two groups. The study was conducted in the Department of Dermatology, Outpatient Department (OPD), Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, from December 2020 to May 2021. Group I was treated with terbinafine 250 mg OD and itraconazole 200 mg OD and group II with terbinafine 250 mg OD with griseofulvin 250 mg BD for a period of four weeks and the patients were followed-up every two weeks with appropriate investigations. Outcome of the treatment was assessed at four weeks and eight weeks. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0. Descriptive analyses were performed to compare the baseline characteristics of the participants between the two study groups. Student t-test was applied to compare the mean values of quantitative variables. Chi-square test was used for analysing the categorical variables. A p-value of <0.05 was considered as significant. Results: Itraconazole containing group reported a better clinical cure rate than the griseofulvin containing group (p<0.05). Neither of the combination showed effectiveness against tinea infections pretreated with topical steroid containing formulations. Conclusion: Combination of terbinafine with itraconazole produce higher clinical cure rate as compared to the combination of terbinafine with griseofulvin; but the percentage of clinical cure rate is less as compared to published studies in the past. Neither of the combination of systemic antifungals has shown efficacy against tinea infections pretreated with topical steroid containing formulations.

Effects of Sintering Temperature and Finishing Procedure on Surface Roughness of Different Yttria Content Zirconia

Canan Dogdu, Gulsum Ceylan

Introduction: Zirconia-based ceramics have been successfully used to fabricate dental prostheses using the dental Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) system. Fabrication and finishing of new generation zirconia ceramics is an important issue for the success of restorations. It is necessary to investigate whether these processes affect the surface properties of zirconia materials. Aim: To investigate the effects of different sintering temperatures and finishing procedures on the surface roughness of zirconia. Materials and Methods: This in-vitro study was carried out in the Erciyes University Research Laboratory from 7^th January to 4^th April 2021. Katana Ultra Translucent Multi Layered (KT10; Kuraray Noritake Dental Inc., Tokyo, Japan) and Zolid High Translucent+Preshade (AmannGirrbach AG, Herrschaftswiesen, Austria) were the two types of zirconia materials used in this in-vitro study. Total 40 samples (20 in each group) were produced using the dry program in the I?nLAB MC X5 milling machine (Dentsply Sirona, Bensheim, Germany). Total 20 specimens (10 from each group) were sintered in a furnace for 2 hour at 1450°C and the remaining 20 specimens (10 from each group) were sintered at 1650°C. The two surfaces of the specimens were divided into two groups; one surface of the specimens underwent polishing and the other underwent glazing. A profilometer was used to analyse the surface roughness of the specimens. Three-way analysis of variance was used to assess significant differences in the average roughness values based on the material, sintering temperature, finishing procedure. Results: The surface roughness values differed between specimens that underwent the glazing and the polishing process at high sintering temperatures. The glazed samples (1.154 µm) had higher surface roughness values than the polished samples (0.808 µm) at 1650°C. Conclusion: The polishing process is recommended instead of glazing as a finishing procedure for zirconia materials.

Macroscopic Study of Temporoparietal Suture Closure at Autopsy for Estimation of Age

Gagandeep Kalsi, Amandeep Singh, Dasari Harish

Introduction: Age estimation is an integral part of identification of an individual which is needed for social and medicolegal purposes, whether in living, dead or in skeletal remains. Aim: To evaluate the utility of fusion of temporoparietal cranial suture for estimation of age at autopsy. Materials and Methods: This cross-sectional study was conducted on the medicolegal postmortem cases that came to the Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, India during the period between October 2018 and July 2019. A total of 280 cases were studied. The fusion of temporoparietal suture was studied macroscopically during the routine postmortem examination. The temporoparietal suture was studied ectocranially and endocranially by dividing it into two equal parts (T1 and T2), and applying Acsadi-Nemeskeri scale (0-4). Mean and standard deviation were calculated for ectocranial and endocranial suture closure (left and right sides). Also, it was calculated for total mean of the segments (T1+T2) taken together on both sides. Actual age and the scored values were plotted in a linear regression curve and estimated age was calculated. Statistical analysis was carried out by using Statistical Package for the Social Sciences (SPSS) software version 22.0. Spearman’s correlation analysis was applied to determine the variable correlations. The p-values of less than 0.05 were considered statistically significant. Estimated age for males and females was tested by Student’s t-test of significance. Results: Out of total 280 cases studied, maximum (219) were males. Maximum number of males and females were found to be in age group of 26 to 35 years. It was observed that closure commenced at the age of 18 to 25 years (Acsadi-Nemeskeri scale mean of 0.87, 0.84 for T1, T2, respectively on left side) and (Acsadi-Nemeskeri scale mean 0.84 for T1 and T2 on right side). Closure was not complete even at the age of 76 years and above (Acsadi-Nemeskeri scale mean 2.67, 2.50 for T1, T2, respectively on left side) and (mean 2.33, 2.67 for T1, T2, respectively on right side). Conclusion: From the present study, it can be concluded that endocranially temporoparietal suture was closed at 18 years and above of age and it was found unfused even at age of more than 76 years for the identification of an individual especially in advanced age, and was consistent with the studies conducted by various authors.

Prevalence of Tuberculosis in the North Indian Subcontinent Kashmir Valley: A Cross-sectional Hospital-based Study

Introduction: Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. TB is one of the biggest public health challenges in the world especially in under-developing and developing countries. Aim: To determine the prevalence of TB in the Kashmir valley. Materials and Methods: The present cross-sectional study was conducted in the Department of Chest Medicine, Chest Diseases Hospital (CDH), Government Medical College, Srinagar and Intermediate Reference Laboratory (IRL), State TB Training and Demonstration Centre (STDC), CDH, Srinagar and in association with State TB Office (STO) Kashmir, India, from March 2019 to December 2020 in 10 districts. A total of 66,829 presumptive TB samples in 2019 inclusive of 450 samples of CDH and 63532 presumptive TB samples in 2020 inclusive of 400 samples of CDH were collected from Department of Chest Medicine, CDH, Government Medical College, Srinagar and Revised National TB Control Programme (RNTCP) Centres of Kashmir valley under State TB office Director Health Kashmir as per World Health Organisation (WHO) criteria. It included both the positive and negative cases of TB registered during the year 2019 and 2020. Results: The total prevalence of TB disease during the year 2019 was found to be 49.03 per 100,000 population and 37.31 per 100,000 population in the year 2020 respectively. There was no correlation among the surveyed demographics in the positive TB cases in the Kashmir valley (p>0.05). Srinagar city reported highest cases whereas Budgam and Pulwama reported least cases in the year 2019 and 2020. Conclusion: The respiratory precautionary measures like social distancing and use of face masks during the ongoing COVID-19 pandemic has reduced transmission and incidence of TB. Proper identification and treatment of infectious cases will prevent TB in the ethnic population. More studies are needed on large sample size.

Reduced sRAGE Production and ADAM10 Gene Expression in Peripheral Blood Samples of Diabetic Nephropathy Patients

Claire Gabriella Dias, Lakshmaiah Venkataswamy, Sharath Balakrishna

Introduction: Excessive signalling via the Receptor for Advanced Glycation End products (RAGE) is implicated in inflammatory renal damage in Diabetic Nephropathy (DN). RAGE signaling is modulated by its soluble form (sRAGE) that arises due to ectodomain cleavage catalysed by A Disintegrin and Metalloproteinase 10 (ADAM10). The sRAGE functions as a decoy and competes with RAGE for binding to the cognate ligand. Aim: The aim of this study was to evaluate sRAGE and ADAM10 gene levels in peripheral blood samples of Diabetic Nephropathy patients. Materials and Methods: The present observational study was conducted in the Department of General Medicine, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, between January 2019 to April 2020. Study comprised of three groups: group 1 of 30 DN patients; group 2 of 28 Type II Diabetis Mellitus (T2DM) patients without microvascular complications and group 3 comprised of 30 healthy volunteers. Blood samples obtained from the study participants were cultured for 24 hours along with insulin treatment or a suitable control. sRAGE levels were measured in the conditioned media by Enzyme Linked Immunosorbent Assay (ELISA) technique. Expression of the ADAM10 gene was measured in the cell pellet by using the quantitative real-time Polymerase Chain Reaction (PCR) technique. Results: A total of 88 subjects were included in the study, with 30 patients in group 1 (DN, mean age 55.34±7.76 years), 28 patients in group 2 (T2DM, mean age: 55.07±7.7 years) and 30 subjects in group 3 (healthy individuals, mean age: 55±8.05 years). sRAGE levels were significantly lower in nephropathy patients when compared to healthy volunteers (p=2.5×10^-9). Likewise, ADAM10 expression levels were also significantly lower in nephropathy patients when compared to healthy volunteers (p=1.3×10^-4). Insulin treatment led to significantly higher sRAGE production in healthy volunteers as compared to T2DM patients (p-value 3.3×10^-11). Insulin treatment leads to significant upregulation of the ADAM10 gene expression in healthy volunteers as compared to DN and T2DM. Conclusion: Abnormal RAGE signaling in DN may arise due to diminished sRAGE production as a consequence of reduced ADAM10 expression.

Intraperitoneal Instillation of Magnesium Sulphate and Dexmedetomidine for Postoperative Analgesia after Laparoscopic Cholecystectomy- A Randomised Clinical Study

Manju Lata Shakya , Dinesh Kumar Patidar , Hansraj Baghel

Introduction: Magnesium sulphate and dexmedetomidine can decrease the duration and intensity of postoperative pain due to their antinociceptive effects. Magnesium sulphate blocks N-methyl-D-aspartate receptor (NMDA) channel in a voltage dependant way, while dexmedetomidine acts on dorsal root neurons. Aim: To compare the analgesic efficacy and duration of postoperative analgesia after intraperitoneal instillation of magnesium sulphate and dexmedetomidine in laparoscopic cholecystectomy. Materials and Methods: The present study was a randomised clinical study, in which 90 patients of age 18-60 years, belonging to American Society of Anaesthesiologists (ASA) grade I or II were randomly selected and divided in three groups. Group M received magnesium sulphate 50 mg/kg with 0.25% bupivacaine 30 mL, group D received dexmedetomidine 1 µg/kg with 0.25% bupivacaine 30 mL, and group B received 0.25% of plain bupivacaine 30 mL. Pain was assessed using Visual Analog Scale (VAS) score as primary outcome, recorded at 0, 2, 4, 6, 8, 10, 12 and 24 hours after surgery. Time to rescue analgesia (VAS ≥4 or on demand) and patients satisfaction score were the secondary outcomes. All recorded data were analysed by statistical test (Analysis of Variance (ANOVA), post-hoc Tukey’s HSD (Honest Significant Difference) test and Chi-square test). Results: The mean VAS score was 2.40±0.84, 2.57±0.78 and 2.88±0.92 in group M, group D and group B, respectively (p<0.05). The total analgesic requirement (Paracetamol) in first 24 hours postoperatively was lower in group M (1.73±0.58 gm), and group D (2.17±0.53 gm), than group B (2.70±0.47 gm). Highly satisfied patients in group M were 10, group D were 03, and none in group C. There were 14 highly dissatisfied patients in group B. The difference in the patient satisfaction score between groups was statistically significant (p=0.0002). Time to first rescue analgesia was highest in group M then group D. Conclusion: Intraperitoneal instillation of magnesium sulphate was found to be superior for postoperative analgesia in first 24 hours after laparoscopic cholecystectomy as reflected by a lower VAS score and longer duration of analgesia.

Assessment of Foetal Nuchal Translucency and its Relationship with Crown Rump Length in Normal Foetuses using Ultrasonography in a Subset of South Indian Population

Introduction: Assessing Nuchal Translucency (NT) accurately is necessary in detection of various anomalies as described in the literature. Studies deriving reference range for NT in Indian population is not widely available. Aim: To derive a normal reference range value of NT with respect to Crown Rump Length (CRL) by using ultrasound in South Indian population. Materials and Methods: A cross-sectional study was conducted on 470 pregnant women from December 2018 to March 2020. Measurement of NT thickness and CRL was performed by ultrasound at 11-14 weeks of gestation. Association between quantitative explanatory and outcome variables was assessed by calculating Pearson correlation coefficient and the data was represented in a scatter diagram. The relationship between NT thickness, CRL and gestational age was studied by using linear regression analysis. The Statistical Package for Social Sciences (SPSS) software version 22.0 was used for statistical analysis. The p-value less than 0.05 was considered statistically significant. Results: Total sample of 470 pregnant females (mean age 25.626±3.82 years, 357 multipara, mean gestational age 12.60±1.36 weeks) was analysed. The mean CRL was 59.84±10.17 mm and mean NT thickness was 1.3±0.26 mm, respectively. The median gestational age was 12.4 weeks. The regression equation which showed relation between median NT thickness and CRL was described as follows: Expected NT thickness=-1.652+(0.050)×CRL mm (R² linear=0.995, p<0.0001). Conclusion: The study provides normative data of NT thickness in normal foetus. This data can be used as reference to screen various chromosomal abnormalities between 11-14 weeks of gestation.

Illness Perception and Quality of Life in Patients with Environmental Dermatoses: A Cross-sectional Study

Introduction: The skin conditions or disorders that develop due to various environmental or climatic factors are included under environmental dermatoses. A few studies have shown that different environmental factors can cause skin disorders but have not commented on the Quality of Life (QoL) and perception of the illness due to environmental dermatoses. Aim: To assess Illness Perception (IP) and QoL in patients with environmental dermatoses and to evaluate the extent to which IP is associated with the QoL in patients with environmental dermatoses. Materials and Methods: A cross-sectional study was conducted on 117 patients with environmental dermatoses who had visited the Outpatient Clinic of Dermatology, Venereology and Leprosy, Kolar, Karnataka, India, between February 2021-May 2021. All patients were assessed with the help of Dermatological QoL and Brief Illness Perception questionnaires. Data was analysed using Statistical Package for the Social Sciences (SPSS) 21.0 version. Analysis of Variance (ANOVA) was used to see the variances between more than two quantitative variables. Correlations were performed with Spearman correlation coefficient. The p-value <0.05 was considered as statistically significant. Results: Out of 117 patients, 54.7% patients were males and 45.3% were females with the mean age of 35.13 years. Infections and infestations (47%) were most commonly encountered which was followed by photodermatoses (25.6%), contact dermatitis (20.5%) and dry skin (6.8%). Dermatological Quality of Life (DQOL) mean score for infections and infestations was 12.63±7.15, contact dermatitis was 10.71±6.81, photodermatoses 9.13±3.94, and dry skin 8.26±4.06. The QoL of overall patients were moderately affected (mean DQOL score of 11). Patients with infections and infestations had more treatment expectations (8.58±1.13), concern (8.40±1.43), strong identity (5.53±3.32), more emotional (7.29±1.80) as compared with other dermatoses which were statistically significant (p<0.05). There were statistically significant positive correlation of QoL with consequences (r_s=0.679), timeline (r_s=0.196), concern (r_s=0.602), and emotional impact (r_s=0.583). Conclusion: Present study shows that the patients’ QoL with environmental dermatoses is largely affected. Patients’ perspective towards the illness directly influences their QoL, so clinicians should be aware of this. Also, if necessary, it is suggested to integrate psychological intervention in the patient management by the clinicians, which will potentially affect the treatment outcome.

Comparison of Percutaneous Instillation of Aqueous Jelly with Intravenous Contrast for Magnetic Resonance Fistulography- A Prospective Cohort Study

Shyam N Kumar, B Padmini, Lokesh T Kumar, Saravana S Kumar

Introduction: The perianal fistulae are complex clinical scenarios, often complicated by direct or blind surgical exploration. A precise preoperative evaluation of the perianal fistulous tract is not only an essential diagnostic requirement but a presurgical prognostic determinant. The usefulness of Magnetic Resonance Imaging (MRI) in such instances is established, but if aqueous jelly can be used instead of regular contrast during fistulography is not clear. Aim: To evaluate the diagnostic accuracy of Magnetic Resonance (MR) percutaneous aqueous jelly compared to intravenous (i.v.) contrast enhanced MR fistulography in perianal fistulous tracts. Materials and Methods: A prospective cohort study was carried out on 40 participants who were referred for MR fistulography (with suspected anal fistulae) to the Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, form March 2017 to October 2019. Total 40 subjects presented with signs and symptoms of perianal fistula were injected with i.v. contrast and MR Fistulography sequences were obtained. Same subjects were injected with aqueous jelly two days prior to surgery and MR fistulography sequences were obtained. Both the sequences obtained were compared with respect to primary tract, internal opening and lateral ramification. These MR fistulography results were compared with intraoperative findings. Presence and absence of internal opening was analysed using Chi-square test for comparison of intraoperative internal opening and aqueous jelly internal opening. The specificity, sensitivity, Positive Predictive Values (PPV), Negative Predictive Values (NPV) and accuracy were estimated. Results: Patients included in the study ranged from 25-65 years with a mean age of 41.5±7.3 years. Among the 40 subjects included, 37 were male and three were females. Aqueous jelly showed a good sensitivity of 96.67% overall in diagnosing internal opening as compared to intravenous (i.v.) contrast. Sensitivity and specificity of aqueous jelly in identifying internal opening was found to be 89.47% and zero respectively with an accuracy of 85% as compared to intravenous (i.v.) contrast in Grade I and II intersphincteric fistula. The PPV was 94.44% and NPV was found to be zero with respect to comparison of aqueous jelly with i.v. contrast grade I and II fistula. Conclusion: Overall results of this study demonstrated that the instillation of the aqueous jelly is safe and provided diagnostic accuracy in identifying internal openings as compared to surgical findings.

Effectiveness of Self-paced and Instructor-led Online Learning: A Study among Phase I Medical Students

Introduction: Online teaching is a crucial challenge in the current pandemic situation. Choosing the right modality for teaching and delivering the information in a very effective manner is critical. Self-paced learning is an important modality that moulds the students into adult learners. Aim: To compare the effectiveness of teaching modalities like self-paced learning and instructor-led live online lecture class based on performance in assessments. Materials and Methods: A cross-sectional study was conducted on phase I medical students over a period of three months where they were given self-paced learning and online instructor-led lecture sessions. Topics and reading materials for self-paced learning were provided to the participants through Telegram. After one week they were evaluated using objective-based assessments. Instructor-led live online lecture classes also were taken for them through Impartus followed by assessments. Independent t-test was done to assess the difference between the both performances based on the scores attained. Results: Total of 86 subjects were included in which 54 were females with mean age 18.75 years and 32 males with mean age 18.84 years. After online lecture sessions, 93.02% (n=80) of students came in the high performers group, while only 65.12% (n=56) of students belonged in self-paced learning sessions. There was no significant difference in performance in both modalities between gender (p>0.05). Conclusion: Instructor-led live online methods are more effective than self-paced learning. Self-paced learning is also important in education as it enhances the quality of adult learning. Implementing e-learning into the current syllabus can be more productive as it augments student teacher interaction.

Maternal Mortality: A Five Years Retrospective Analysis from a Tertiary Care Hospital, Rajasthan, India

Introduction: Women die due to complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and many are preventable or treatable. Maternal mortality in developing countries acts as one of the health indicators and reflects the efficiency of the nation health system. Aim: To analyse the cause of maternal death in tertiary care setting over a period of five years. Materials and Methods: The present study was a retrospective, observational study, conducted over a period of five years, from April 2015 to March 2020 in the Department of Obstetrics and Gynaecology, Jhalawar Medical College, Jhalawar, Rajasthan, India. The case records and death review forms of all maternal mortality were collected from hospital records and studies. Data regarding age, parity, locality, booking status, mode of delivery, cause of death, neonatal outcome, etc were collected in pretested proforma and then statistically analysed. Results: There were 115 maternal deaths from April 2015 to March 2020. The average Maternal Mortality Ratio (MMR) over a period of five years was 243 per one lac live births in institute setting. Majority of maternal mortality were from toxaemia (25.2%), anaemia (20.8%), haemorrhage (20.0%) and sepsis (15.7%). Conclusion: High maternal mortality is an important issue regarding maternal care. Toxaemia (hypertensive disorder of pregnancy), haemorrhage, sepsis and anaemia are still the common cause of maternal death. It can be prevented/reduced by improving healthcare facility in rural area by ensuring round the clock availability of gynaecologist, anaesthetist, blood product, intensive care facility and timely referral of high risk pregnancies. Family welfare services should be improved to reduce unwanted pregnancy.

Evaluation of Protein Carbonyl and Vitamin C in Seminal Plasma of Infertile Male: A Hospital-based Study in Bengali Population

Introduction: Male infertility has been coupled with the imbalance between production of Reactive Oxygen Species (ROS) and antioxidant (e.g., vitamin C) level. Elevated concentrations of ROS in the semen can lead to oxidative protein damage as they counter with the amino acids’ side chains in the protein, leading to the production of carbonyl groups. Aim: To assess if there is any difference of seminal plasma Protein Carbonyl (PC) and vitamin C level in male infertile and fertile subjects in the midst of their correlation with other relevant seminal parameters. Materials and Methods: This was a hospital-based case-control study of a Bengali population. Semen samples of 124 males (group A; 68 infertile males, group B; 56 fertile males) were tested. Seminal fluid analysis was done with Makler counting chamber. PC and vitamin C were measured by Levin’s and Roe’s photometric methods respectively. To evaluate the differences in the mean ranks of these parameters Mann-Whitney U test was used. Results: Out of 124 male subjects, 68 infertile (55%) termed as cases and 56 fertile (45%) were termed as controls with mean age of cases (32.81±5.02) and controls (33.29±5.53). Both in group A and group B sperm count was positively correlated with motility and vitamin C but negatively correlated with PC at significant level p<0.05. Statistically significant differences of mean ranks of these parameters (sperm count: 52.82 and 74.26, motility: 52.10 Vs 75.13, PC: 76.57 and 45.41, vitamin C:55.99 and 70.40, Mann-Whitney U:1245, 1197, 947 and 1461, respectively) between the two groups were found. Hence, indicate that in infertile subjects the balance between PC and vitamin C is disturbed. Conclusion: Assessment of oxidative status may serve the clinician in additional management of idiopathic male infertility.

Effect of Convolvulus pluricaulis and Omega-3 Fatty Acid alone and in Combination on Learning and Memory

Introduction: Mental disorders contribute to a significant load of morbidity and disability. In neurological disorders, alternative medicine use is common due to their fewer side-effects. There are scant evidences regarding the role of Convolvulus pluricaulis (C. pluricaulis) and Omega (?)-3 fatty acids in learning and memory, and none for their combined effect. Aim: To evaluate the effect of C. pluricaulis alone and in combination with Omega-3 fatty acids. Materials and Methods: The present study was an animal study done on Wistar rats. C. pluricaulis whole plant powder in doses of 100 mg/kg body weight (b.w.) and 400 mg/kg b.w. was used. Omega-3 fatty acid (500 mg/kg b.w.) was administered orally alone and along with a higher dose of C. pluricaulis. Scopolamine induced model for amnesia in rats was used in the study and donepezil was taken as standard. Apart from the behavioural analysis, Acetylcholinesterase (AchE) estimation in rat’s whole brain tissue was done using spectrophotometry. Results: C. pluricaulis showed significant memory enhancement in a dose dependent manner (100 mg/kg b.w. and 400 mg/kg b.w.) alone and in combination (C. pluricaulis 400 mg/kg b.w.) with ?-3 fatty acid in dose of 500 mg/kg b.w. Conclusion: The combination of C. pluricaulis and ?-3 fatty acid showed greater significant effect as compared to alone which was comparable to standard drug.The encouraging results reveal the importance of herbal drugs and nutrients in cognition improvement.

National Conference on Innovations in Health Professions' Education Nov 17-18, 2021

B Vishnu Bhat

National Conference on Innovations in Health Professions' Education Nov 17-18, 2021

Culture Positivity of Cerebrospinal Fluid by Automated Blood Culture System in Neonates: A Cross-sectional Study from Loni, Maharashtra, India

Introduction: Bacterial meningitis especially in neonates remains a major cause of mortality and long term health sequelae. There is a need for periodic review, since pathogens responsible for the meningitis vary with time and geography. Aim: To find the culture positivity of Cerebrospinal Fluid (CSF) specimens before and after installation of automated blood culture and identification system in suspected neonatal meningitis cases. Materials and Methods: The present descriptive cross-sectional study was carried out during July 2020 to December 2020, for six months duration in Department of Microbiology, Rural medical college, (Pravara Institute of Medical Sciences-Deemed University), Loni, Maharashtra, India. All CSF specimens from neonates <28 days received in Department of Microbiology were included in the study. All CSF specimens collected in BacT/Alert bottle were incubated and further subjected to identification by Vitek 2 system. All CSF specimen smears, received were subjected to Gram staining and Ziehl Neelsen Staining. Descriptive statistics was used for result analysis. Results: A total of 265 CSF specimens were received during the study period. Males (59%) outnumbered females (41%) in the present study. Bacterial growth by automated blood culture system (BacT/Alert 3D) was detected in 85 CSF specimen giving the culture positivity as 32.08%. The most common bacterial isolate was found to be Staphylococcus haemolyticus followed by Enterococcus species and Acinetobacter species. Also, an attempt was made to compare culture positivity results with results by conventional culture method before installation of automation which showed heightened results for culture positivity and diversity of clinical isolates. Conclusion: Bacterial neonatal meningitis is a common entity and aetiological diagnosis is crucial in every healthcare setting. The present study describes the various aetiological agents isolated by automated blood culture system in neonatal CSF specimens. Retrospective comparison with conventional culture has shown promising results for automated system. Early isolation and definitive identification with drug sensitivity, has got massive impact in management of neonate, further in timely progression of child’s developmental milestones.

Factors Associated with Mortality among COVID-19 Patients Admitted in an Intensive Care Unit at a Tertiary Care Setting: A Retrospective Study from Mizoram, India

Introduction: Characteristics of Coronavirus Disease-2019 (COVID-19) patients from different tertiary centres in India are beginning to be enumerated with limited data on critically ill patients admitted in Intensive Care Units (ICU), with low SpO₂ levels. Aim: To describe clinical profile and identify the factors associated with mortality among COVID-19 positive patients admitted in ICU at a tertiary care setting in Mizoram, India. Materials and Methods: A retrospective study was conducted in Zoram Medical College, Mizoram, India, among 55 confirmed COVID-19 patients admitted in ICU between March 2020 and March 2021. All the patients admitted in ICU during the period was included in the study. Demographic data, symptoms, co-morbidity, investigations, ventilation required, treatment given, duration of ICU stay, and outcomes were recorded from case sheets. The primary outcome was inpatient mortality. Secondary outcomes included length of ICU stays, SpO₂ levels, need for oxygen support. The p-value was set at <0.05 analysed using coGuide software. Results: The mean age was 56.47±15.24 years, and 38 (69.1%) participants were males. Most of 45 (81.8%) participants survived, and 10 (18.2%) patients died in ICU. The mean length of ICU stay was 7 (4 to 13) days in the survival group and 13 (7.5 to 17) for non survivors. The mean SpO₂ levels at the time of admission were 95% (90 to 97) in survivors and 80% (72.25 to 95.50) among non survivors. Following admission to ICU, 16 (29.1%) patients required intubation, High Flow Nasal Cannula (HFNC) was given to 2 (3.6%), and oxygen support (non rebreather mask) was required in all 55 (100%) patients. Pharmacological treatment included empiric antibiotics in 51 (92.73%), antiviral in 30 (54.55%), steroids in 45 (81.8%), Ivermectin in 21 (38.2%), and low molecular weight heparin in 36 (65.5%) patients. Binary logistic regression analysis found low SpO₂ levels at the time of admission (CI:0.85-0.97, p-value=0.008), hypotension (p-value <0.001), tachycardia (p-value=0.001), use of remdesivir (odds ratio 14.82, 95% CI:1.72 to 127.52), use of tocilizumab (odds ratio 14.33, 95% CI: 2.14 to 95.85) and use of meropenem (odds ratio 8.00, 95% CI: 1.51 to 42.45) were significantly associated with in-hospital mortality. Conclusion: Oxygen saturation below 90%, hypotension, and tachycardia, at the time of admission in ICU were considered as predictors of in-hospital ICU mortality in COVID-19 patients. The reason for low mortality among patients admitted in ICU can be attributed to early admission to ICU and care when SpO₂ reading has reached 94%.

Robot Assisted Laparoscopic Repair of Vesicovaginal Fistula: A Retrospective Study at a Tertiary Care Centre, Chennai, India

Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley’s catheter removal done at 2-3 weeks based on operating surgeon’s preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases.

Dexamethasone Induced Perineal Pruritus in Patients Undergoing Minor Oral Surgical Procedures- A Prospective Cohort Study

Sukhvinder Bindra, Vinitha Annavarjula, David Tyro

Introduction: Dexamethasone is frequently used by oral and maxillofacial surgeons to control postoperative oedema and pain in minor oral surgery procedures. Intravenous administration of dexamethasone may result in perineal pruritus i.e., perineal itching, pain and burning sensation. Different studies previously have reported these symptoms in patients. The incidence of these symptoms can vary between 25-100% depending on the dose of dexamethasone administered. Aim: To evaluate the relationship between intravenous administration of dexamethasone and perineal pruritus in patients requiring minor oral surgical procedures; and its association with the phase of the menstrual cycle in female patients. Materials and Methods: A prospective cohort study was conducted in the Department of Dentistry, Apollo Hospitals, Secunderabad, Telangana, India, which included 81 patients (43 females and 38 males) between October 2020 to March 2021. All patients included in the study were given preoperative 2 mL (8 mg) of intravenous dexamethasone, 30 minutes before commencing the minor oral surgical procedures and patients were enquired about symptoms of perineal pruritus. Female patients were asked about the phase of the menstrual cycle. All observations recorded were analysed using the Chi-square test and Spearman’s analysis. Statistical Package for the Social Sciences (SPSS) version 26.0 software was used for statistical analysis and p-value <0.05 was considered statistically significant. Results: A total of 81 patients (aged 19-52 years) were assessed, with the mean age of male patients being 29.3 years, and the mean age of female patients being 28.7 years. Most patients (female 82% and male 35%) experienced symptoms of itching and burning sensation for 60-90 seconds, which subsided without any further treatment. Female patients out numbered the male patients in experiencing the symptoms of perineal pruritus significantly (p-value <0.001). Correlation coefficient was 0.234 (p-value=0.037) which showed a weakly but positive correlation which was statistically significant between the phase of the menstrual cycle and symptoms experienced. Conclusion: The study established a relation between the administration of i.v. dexamethasone and perineal pruritus. The symptoms were found to be more evident in females and the intensity of the symptoms varied with phases of the menstrual cycle. Females in the postovulatory phase and postmenopausal phase had experienced it more than others. Hence, the knowledge of such incidence and prior education of the patient would reduce the unpleasant experience.

Evaluation of the Awareness and Knowledge of Orthodontic Treatment in Purvanchal Region (Uttar Pradesh): A Questionnaire-based Cross-sectional Study

Neelam Mittal, Ashish Agrawal, Tej Bali Singh, Ankita Singh, Manami Das

Introduction: Individuals who did not have the opportunity to undergo orthodontic treatment due to lack of information or financial resources, find themselves physiologically deprived of aesthetics. So, awareness must be a part of planning oral health problems in every stratum of the society. Aim: To evaluate the awareness and knowledge of Orthodontic treatment among patients from Purvanchal region, Uttar Pradesh. Materials and Methods: This self-designed questionnaire based descriptive and cross-sectional study, was conducted from May 2018 to June 2019 at Faculty of Dental Sciences, Unit of Orthodontics, Banaras Hindu University, Uttar Pradesh, India. Four subject expert and one public health dentist formulated 22 bilingual questions. A pilot study was conducted on 200 randomly selected study participants and the internal consistency of the questions were measured statistically (Coefficient of variation ratios, Cronbach’s alpha=0.659, Lawshe’s index= 0.626). The study sample size was then computed using nMaster 1.0 software to be 1748 which was later increased to 2112. Patients were randomly selected and categorised depending on age groups (10-15, 16-20, 21-25, 26-30 years), sex (male/female) and residential area (rural/urban). The questionnaire was distributed among the study group and response were collected on the same day. The data acquired was later subjected to statistical analysis. Chi-square, t-test and Analysis of Variance (ANOVA) were carried out using Statistical Package for the Social Sciences (SPSS) version 20.0 (p-value <0.001). Results: Of the total samples (N=2112), 1316 were males, 82.2% were from urban locations. Overall awareness in the study was found to be maximum for 16-20 years (25%) and minimum for 26-30 years 2.6%. Males were more cautious about their treatment needs (Awareness was 21.3% in male, 12.4% in female). Response to importance of teeth alignment for better facial appearance based on gender and residence was found to be highly significant (p<0.001). Conclusion: There was a sudden decline in dental knowledge about orthodontics after 26 years of age with the maximum awareness in age group 16-20 years. Urban males were more conscious of orthodontic treatment.

Multiparametric Cranial Ultrasound Evaluation of Normal Neonatal Cerebral Ventricular Dimensions to Establish Nomograms in the Eastern Indian Population: A Cross-sectional Study

Alayna Reddy Kandadhi , Satyaswarup Jena , Niranjan Sahu

Introduction: Cerebrospinal Fluid (CSF) filled ventricles and their connecting foramina make up the brain’s ventricular system. Ventricles hold around a fifth of an adult’s CSF volume, approximately 20-25 mL. Two lateral ventricles and midline third and fourth ventricles make up the ventricular system. Aim: To study normal neonatal cerebral ventricular dimensions to develop reference ranges in the Eastern Indian population. Materials and Methods: This was a hospital-based observational cross-sectional study carried out on 189 neonate in the Department of Radiodiagnosis in collaboration with the Department of Neonatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India. Measurement of ventricular size is of prime importance in diagnosing posthaemorrhagic ventricular dilatation and evaluating the need for intervention. Authors have studied Frontal Horn Width (FHW), Thalamo-Occipital Distance (TOD), Third Ventricle Width (TVW), Ventriculo-Hemispheric Ratio (VHR) and Levene index to establish nomograms showing normal reference range. Linear regression model was used for correlation. Results: The FHW in present study showed a linear increase in the size with a corresponding increase in the gestational age, from 1.38 mm at 33 weeks to 1.59 mm at 40 weeks of gestation with a weak positive correlation. The TOD showed negligible change with increasing gestational age, from 17.24 mm at 33 weeks to 17.17 mm at 40 weeks. The TVW study showed a slight increase in width with increasing age, from 1.20 mm at 33 weeks to 1.45 mm at 40 weeks gestation. The VHR showed a negligible change with increasing gestational age, from 0.120 at 33 weeks to 0.100 at 40 weeks. The Levene index showed a slight increase, from 10.30 at 33 weeks to 11.64 at 40 weeks of gestation. Conclusion: Neurosonogram has valid implications for measurement of ventricular size in diagnosing pathologic ventricular dilatation and for evaluating the need for intervention. Nomograms for different parameters (FHW, TOD, TVW, VHR and Levene index) as well as corresponding reference ranges are established for normal preterm and term neonates.

An Interventional Study on the Impact of Pictorial Primed Lecture Session towards the Performance at Lower and Higher Cognitive Domain Levels among 1^st Year Medical Undergraduates

K Gunanithi, S Sakthidasan

Introduction: Lectures play a major role in teaching large group of learners in a medical institution. Priming involves familiarising students with background information on the cognitive content just before its actual delivery during lecture sessions. Considering the monotonous textual lectures of present day medical education, there is always a need for making the lecture sessions interactive at the same time improving the performance of the learners at the cognitive level. Aim: To assess the performance of 1^st year medical undergraduates at lower and higher cognitive domain levels after pictorial concept priming before lecture session. Materials and Methods: The present study was an educational interventional study and a prospective cohort design, the study was conducted during March to April 2019 in Department of Biochemistry, Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS) Tamil Nadu, India, as a part of Advance Course in Medical Education (ACME) 2018B Project work. With sample size suggestion made using universal sampling techniques, 120 Phase I medical undergraduates of both sexes aged 17-21 years were enrolled into the study who were divided into two groups, randomised, cohort-60 and control-60 students. The lecture delivery was on glycolysis pathway for both groups with cohort alone being primed using standardised polygonal pictorial concepts during priming session before lectures. Cognitive performance assessment after lecture being made using validated Multiple Choice Question (MCQ) questionnaire which included five lower cognitive level questions at recalling aspects and five higher cognitive level questions at creating aspects and total attainable cognitive performance score at 10. Scores obtained were tabulated and statistical analysis was done using Independent sample t-test for mean score comparisons and relative risk estimation at lower and higher cognitive domain levels using Statistical Package for the Social Sciences (SPSS) version 18.0. Results: The results of the present study showed that cohort group who were primed with pictorial concepts had significantly higher mean score at total cognitive performance score (7.03±1.37) than the control group (6.15±1.83) at (t=-2.98, p=0.003) and significantly higher mean score at higher cognitive performance score (3.75±1.14) than the control group (3.20±1.33) at (t=-2.42, p=0.01) who were not primed with pictorial concepts. However, the results obtained at the lower cognitive performance scores which although shows a higher score among cohort group with mean value (3.28±1.09) when compared to control group with mean value (2.95±1.01), the mean difference obtained remains insignificant (t=-1.73, p=0.08). Exposure outcome relative risk estimation on priming exposure to outcome (50% total cognitive score) showed primed group which is RR=1.567 (0.895-2.744). Conclusion: The study concludes that priming sessions using pictures have a significant impact on improving the cognitive performance of the learners when delivered during lecture sessions in a medical college. Adding to the conclusion, the impact of the pictorial priming sessions is even more on the higher level cognitive performance, which includes evaluating and creating aspects of the knowledge domain. This reiterates the role of the importance of dual added benefits of pictures and priming during teaching cognitive domain aspects of lecture sessions in medical institutions.

Variations in the Origin of Middle Hepatic Artery in Living Liver Donors using CT Angiography in South Indian Population: A Retrospective Study

P Ashok, Gunapriya Raghunath, V Anantha Kumari, BH Shiny Vinila

Introduction:The middle hepatic artery is an artery which supplies blood to the fourth segment of the liver. Most commonly, it originates from the right hepatic artery. Injury to the middle hepatic artery during liver transplant surgeries may lead to ischaemia and also may lead to life threatening conditions like hepatic artery thrombosis in donor as well as recipient. The variations in the origin of the middle hepatic artery in the living donors were focused in the present study as it has surgical importance in the liver transplantations. Aim: To find out the incidence of the variations in the origin of the middle hepatic artery in living liver donors using Computed Tomography (CT) angiography. Materials and Methods: This was a retrospective observational study conducted from August 2018 to October 2021 in the Department of Anatomy, Deccan College of Medical Sciences, Hyderabad, Telangana, India. The images of CT angiographies of 100 living liver donors were collected from the Department of Radiology, Global Hospital, Hyderabad, Telangana, India. All the CT angiographs of the living liver donors were observed for any variations in the origin of the middle hepatic artery and recorded and the percentage of each variation was calculated. Results: Out of 100 CT angiographs studied, the incidence of the origin of middle hepatic artery was reported as 55% from right hepatic artery, 34% from the left hepatic artery, 5% from replaced left hepatic artery, 2% from the hepatic artery proper, 1% from the common hepatic artery, 1% from left gastric artery. Double middle hepatic arteries were observed in 1% of cases. Accessory middle hepatic artery was observed in 1% cases. Conclusion: To increase the success rate of liver transplantations, the clear knowledge on the possible variations of the middle hepatic artery is needed. The variations of the middle hepatic artery reported in this study are rare and will be useful for the liver transplant surgeons.

Relationship between Stature and Hand Parameters in Adults- An Autopsy Study

Bincy Babu, Krishnan Balendran, CS Sreedevi

Introduction: Estimation of stature is important in the process of identifying unknown and co-mingled human remains in mass casualties and natural disasters. Forensic experts are asked by the investigating officer to help to identify the person from dismembered parts of the body and skeletal remains. Estimation of stature is based on a principle that every body part bears more or less a constant relationship with height of an individual. Literature have documented that the hand parameters can be successfully used for stature estimation. Aim: To determine the relevance of hand parameters in the estimation of stature and also to derive a regression formula for stature from the hand parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Forensic Medicine, Government TD Medical College, Alappuzha, Kerala, India, from June 2017 to June 2018. A total of 210 postmortem cases aged above 20 years were included in present study for the comparison of stature, hand length and hand breadth based on age were measured using standard methodology. Average of measurements of right and left hands were taken. Descriptive statistics were used to summarise height, hand breadth and hand length. Categorical and continuous variables were expressed as mean±SD. Correlation was done using Analysis of Variance (ANOVA) and t-test and predictive equations obtained using Karl Pearson’s correlation coefficient. Results: A total of 210 included 157 males and 53 females, and maximum subjects (78,37.1%) belonged to the age group 41-60 years. Hand length and hand breadth showed significant correlation with stature in both males and females with a significant p-value <0.01. Statistically significant age-related difference between the age groups 21-40 years, age 41-60 years was noted in stature, average hand length and hand breadth. The study variables like stature, hand length and hand breadth showed statistically significant higher values for males than females. It was observed that though both hand parameters showed positive correlation with stature, hand length was more predictive in both sexes. Regression equations for estimation of stature from hand length and breadth were derived for males, females and also for the total population irrespective of the gender in cases when only hand length or hand breadth is available and also when both hand length and breadth are available. Conclusion: From the data obtained it can be concluded that estimation of stature can be done with reasonable accuracy using hand parameters with hand length showing greater correlation with stature than hand breadth in both sexes. Though statistically significant, the correlation coefficient for females was considerably less using both hand parameters.

Effect of Periglossal Electrical Stimulation on Haemodynamic Parameters in Stroke Patients- An Experimental Study

Jayaprakash Jayavelu, Jasobanta Sethi, Sahil Kohli, Sachin Gupta, Tariq Matin

Introduction: Tongue stimulation has been used in rehabilitation of wide variety of patients like sleep apnea, multiple sclerosis and stroke patients. It helps in improving swallowing functions, balance and reducing sleep apnea symptoms. Tongue stimulation is also being used in stroke rehabilitation for improving balance. Aim: To find out the effect of periglossal electrical stimulation on haemodynamic parameters in stroke patients. Materials and Methods: The present study was an experimental study in which, 30 stroke patients in the age group of 30-60 years, admitted during the period between October 2020-March 2021, were included. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Respiratory Rate (RR) and oxygen saturation were measured before stimulation. All patients were given 15 minutes of tongue stimulation once. All the haemodynamic parameters were measured during the stimulation, immediately after tongue stimulation and 15 minutes after the completion of stimulation. Results: There were 15 males and 15 females in the study. There were no significant changes in HR, RR and oxygen saturation during tongue stimulation (p>0.05). Although, there were statistically significant changes in SBP, DBP during tongue stimulation, they were clinically insignificant and returned to baseline within 15 minutes after stimulation. Conclusion: Tongue stimulation has been found to be safe and effective for rehabilitation of stroke patients with respect to haemodynamic variables.

Behavioural Disturbances Related with Febrile Illnesses: A Hospital-based Longitudinal Study

Amrendra Kumar Singh, Umesh Pathak, Rajesh Singh, Sunil Kumar Ahuja

Introduction: Various psychiatric symptoms are seen in patients with fever and during the course of treatment of fever. Due to meager understanding and limited knowledge along with poor infrastructure and lack of facility in peripheral healthcare centres, many patients of febrile psychosis are referred to tertiary centres. Aim: To study the demographic, clinical profile and diagnostic categorisation of various behavioural manifestations in febrile patients. Materials and Methods: The present hospital-based longitudinal study was conducted at Department of Psychiatry, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from January 2021 to August 2021, on 54 patients, who developed psychiatric symptoms during course or after remission of fever. Detailed socio-demographic characteristics, clinical profile, along with psychiatric assessment, were recorded in proforma designed for the study. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 26.0 (IBM Corp. Armonk, NY, USA). Results: Out of total 54 patients, in the age group of 21 to 30 years, there were 18 (33.3%) patients and in 31 to 40 years, there were 12 (22.2%) patients who developed psychiatric symptoms after remission or during the course of fever. Most of the patients 40 (74.1%) were hailed from rural areas, 26 (48.1%) patients belonged to lower-middle socio-economic status, majority of the subjects (19, 35.2%) were shop owners, clerks and farmers. Overall, 19 (35.1%) patients developed psychosis due to malarial fever followed by enteric fever (13, 24.1%), viral fever (9, 16.7%), tuberculosis (3, 5.6%) and rheumatic fever (1, 1.8%). Drug-induced behavioural disturbance was found in 9 (16.7%) patients. Conclusion: General conception among peripheral healthcare workers is that behavioural abnormalities associated with fever occur solely due to serious illnesses like meningitis, encephalitis and cerebral malaria, but present study suggests that a fair number of these psychiatric manifestations are either induced or precipitated functional psychosis and resolve on appropriate management.

A Study to Evaluate the Causes of Delayed Presentation for Cataract Surgery at a Tertiary Eye Centre, Odisha, India

Matuli Das, Saswati Sen, Khushi Agrawal

Introduction: Inspite of being advised surgery by doctor and several health schemes made available by the Government of India for the economically backward section, people still present late for surgery, inviting many complications in the long run. Aim: To study the causes of delayed cataract surgery in Below Poverty Line (BPL) patients in a tertiary health care centre in Eastern India. Materials and Methods: The present hospital-based and cross-sectional study included 58 patients who presented to the Outpatient and Emergency Department of a tertiary care hospital in Eastern India between December 2020 to April 2021. At presentation, detailed history was taken and patients were asked questions related to the cause of delay, which was categorised into- barriers to patient’s attitude and barriers related to cost, affordability and service delivery. Comprehensive ophthalmological examination for each and every patient was done. Routine blood investigations needed for cataract surgery were done. Surgery was done for all cases by a single surgeon and intraocular complications if any were noted. Results: A total of 58 patients included in this study, females (57%) were more than males (43%). Majority of them were from semi urban areas (13.79%). A 60% were dependent on family members for their expenses. About 94.8% had government insurance schemes but still had financial constraints which caused delayed presentation. A 70.7% of people did not attend hospital due to negative peer group effects and almost 84.5% people had no direct means of transportation to the hospital. Fear of surgery (96.6%) and fear of contracting Coronavirus Disease-2019 (COVID-19) (94.8%) were certain other factors which caused delay in presentation for surgery. Conclusion: Through this study, certain possible reasons were found, catering to social, economic as well as factors like fear of surgery, negative peer pressure, financial constraints responsible for the delay in acceptance of cataract surgery in such a set up.

Diagnostic Utility of Bone Marrow Examination in Bicytopenia

V Shulbha Sejekan, K Sree Lakshmi, S Dayananda Biligi, BS Ramya

Introduction: Bicytopenias refer to condition in which either of the two cell lineages is reduced because of various diseases affecting the bone marrow. Bone marrow examination plays an important role aiding the peripheral smear and complete blood count findings in various haematological disorders. The present study has emphasised on the utility of bone marrow aspiration and bone marrow biopsies in cases of bicytopenias to assess the causative disease thus aiding for further clinical management. Aim: To study the cytomorphology of bicytopenia in peripheral smear and bone marrow examination and to estimate the utility of bone marrow examination in bicytopenia in arriving at the diagnosis of the disease. Materials and Methods: The present descriptive study was carried out in the Department of Pathology, Bangalore Medical College and Research Institute (BMCRI), Banglore, India, for a period of one year from April 2016 to April 2017. Total 80 confirmed cases of bicytopenias were included. Bone marrow aspiration, imprint smears and biopsy was performed for all cases. The parameters assessed after bone marrow aspiration and biopsy were on cellularity, myeloid to erythroid ratio, cytomorphological details of the cells. The data obtained was tabulated, descriptive statistics and Chi-square test was used for statistical analysis. Results: Out of total 80 subjects, age group ranged from two to 79 years. The bicytopenias observed in peripheral smear examination has been anaemia and thrombocytopenia in 88.75% of cases, followed by anaemia and leukopenia in 8.75% of cases, lastly followed by leukopenia and thrombocytopenia in 2.5% of cases. Bone marrow aspiration performed showed predominantly normoblastic maturation followed by megaloblastic maturation and micronormoblastic maturation. The bone marrow aspiration yielded cellular marrow in 75 cases and diluted marrow in five cases. Imprint smears and bone marrow biopsy was performed in all the cases. Out of five diluted aspiration both imprint smears and bone marrow biopsy revealed normoblastic marrow in three cases, single case showed myelofibrosis and a single case of non Hodgkin’s lymphoma. Conclusion: Bone marrow aspiration helps to understand the cytomorphological details. In cases with diluted marrow or dry tap, imprint smears along with bone marrow biopsies help to arrive at the diagnosis. So, they complement each other along with haematological parameters and clinical details to aid for a better clinical management of the patients.

Attitude of Undergraduate Medical Students towards Classroom Lecture Absenteeism and its Association with Academic Performance

Parama Sengupta, Sarmishtha Saha, Tania Sur

Introduction: Classroom lecture absenteeism is a challenging issue among medical educators. The benefit of attending lecture classes on academic performance has already been documented. Very few studies have explored the attitude of undergraduate medical students towards classroom lecture absenteeism and its association with the students’ academic performance. Aim: To explore undergraduate medical students’ attitude towards classroom lecture absenteeism, its association (if any) with academic performance (measured by total marks obtained in semester marks) and also to evaluate the attitude of the students towards attending classroom lectures on pre and paraclinical subjects. Materials and Methods: This anonymous structured questionnaire based observational study was conducted in the Departments of Biochemistry and Pharmacology in the month of September 2021, of a tertiary care government medical college. Phase 1 (n=98) (batch 2021-22) and phase 2 (n=97) (batch 2020-2021) MBBS students of the government medical college were included. Descriptive statistics, Chi-square test and one-way Analysis of Variance (ANOVA) tests were used to analyse the data. The p?0.05 was considered as statistically significant. Results: Out of 195 students, (male: female ratio being 2:1) 94.87% stayed at hostel. Most of them (51.28%) agreed to attend the classroom lectures for pre and paraclinical subjects for getting attendance. It significantly affected the academic performance of the students (p=0.005). A 61.02% students wanted the lecture classes for pre and paraclinical subjects to be optional. Again 76.92% of them thought attending lecture classes have positive impact on their academic performance. The choice of opinion significantly (p<0.001) affected their academic performances. A 56.41% of the students agreed to skip lecture classes 2-3 times per week and cited the most common reason being “not liking the teaching of a particular teacher.” The choice of the students significantly affected the academic performance (p<0.001). A 67.69% of them opined that by reducing the duration of the class, classroom lecture classes on pre and paraclinical subjects can be improved, and there was significant association between the choice and the academic performance of the students (p<0.001). Conclusion: Although majority of the students understood the positive impact of lecture classes on academic performances and they do not want the lecture classes to become optional, they wanted certain modifications like making the traditional didactic lecture classes more interactive, exam oriented, and concept based. Also some of their attitudes (if not all) affected their academic performances significantly.

Antifungal Activity of Calliandra haematocephala against Selected Pathogenic Fungi: An In-vitro Study

I Glory Josephine, K Punnagai

Introduction: Pathogenic fungi cause a wide range of infections which include life-threatening diseases particularly in immunocompromised individuals. Plant derived secondary metabolites have significant therapeutic role in pathogenic fungal infection because of their fungicidal, immunity enhancing and least toxic properties. Calliandra haematocephala also called ‘Red Powder puff’ possess greater antimicrobial and immunoadjuvant activities. Aim: To evaluate the antifungal activity of Calliandra haemato-cephala against selective pathogenic fungal species. Materials and Methods: The present in-vitro study was conducted in central laboratory in association with Department of Pharmacology at Sree Balaji Medical College, Chennai, Tamil Nadu, India, during six months from June 2018 to December 2018. Antifungal activity of the Calliandra haematocephala (leaves extract) were examined against six pathogenic fungal species Candida albicans, Aspergillus niger, Trichoderma viride, Rhizopus microsporus, Penicillium chrysogenum and Trichophyton rubrum using agar disc diffusion method by measuring the zone of inhibition. Results: The ethanolic leaf extract of Calliandra haematocephala showed strong inhibitory activity against all six fungal species. However, it showed significant inhibitory activity against Aspergillus niger (12 mm) and Penicillium chrysogenum (11 mm) when compared with standard drug Amphotericin B. Conclusion: The antifungal activity of Calliandra haematocephala suggested its potential role in opportunistic fungal infections with immunocompromised conditions.

Correlation between Pain, Disability and Levels of Disc Herniation in Michigan State University Grade-3 Disc Prolapsed Patients using Magnetic Resonance Imaging: A Cross-sectional Study

Introduction: Sciatica is considered as a pain with radiation from the back to the dermatome of the nerve root which gets compressed. Clinical decision making for the diagnosis and treatment of the patients with sciatica need the support from the imaging of the spine. Magnetic Resonance Imaging (MRI) is the best modality for screening the spine. Aim: To identify the relationship between pain, disability and levels of disc herniation in grade-3 disc prolapsed patients. Materials and Methods: The present study was a cross-sectional study, which was conducted in the King Khalid Hospital, Hail, Saudi Arabia from November 2019 to May 2020. In this study, 57 patients were included and their consent was obtained. Patients reported their intensity of back and leg pain in Visual Analogue Scale (VAS) and recorded their disability in the Roland Morris Disability Questionnaire (RMDQ-Arabic version). Clinical examination of the spine and the lower extremity was done, followed by MRI for all the patients. The degree of the disc displacement and nerve root compression was graded according to the Michigan State University (MSU) classification of disc herniation. Documented data was statistically analysed using Statistical Package for the Social Sciences (SPSS) 20.0 version with the Pearson’s correlation. Results: Correlation between the pain intensity (VAS), Functional Disability (RMDQ) and grade-3 disc herniation in MRI were measured with Pearson correlation coefficient. Grade-3 disc herniation had weak correlation with pain intensity (r=-0.147) and also with functional disability (r=0.155). In these patients, pain intensity and functional disability also showed weak correlation disability (r=0.293). Conclusion: Level of the disc herniation shows weak correlation with both intensity of pain and functional disability; thus, it is advisable to correlate the clinical symptom of the patients with MRI to decide the therapeutic intervention.

Effectiveness of Preoperative Multimedia Video-based Education on Anxiety and Haemodynamic Stability of Oncosurgery Patients Undergoing Spinal AnaesthesiaA Randomised Controlled Trial

Introduction: Most of the patients posted for surgery experience anxiety and this is more pronounced in cancer patients posted for oncological surgery. The majority of it arises from apprehension stemming from a lack of understanding of anaesthetic procedures and surgery. Aim: To assess the effectiveness of multimedia-based educational video shown preoperatively to cancer patients posted for surgery in alleviating anxiety associated with spinal anaesthesia/sub arachnoid block. Materials and Methods: This was a randomised controlled trial conducted on a total of 200 patients posted for oncological procedure in Department of Anaesthesiology and Pain relief, Kidwai Memorial Institute of Oncology, Bengaluru, India. the total subjects included were randomised into two groups: Video group, where a short educational video depicting procedure of spinal anaesthesia was shown preoperatively to the patients and non video group (control group) where no video was shown. Anxiety using Visual Analogue Scale (VAS) and haemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Systolic blood Pressure (SBP), Diastolic blood pressure (DBP) were assessed pre and post intervention in both groups. Categorical data were compared using Chi-square test. Student’s unpaired t-test was used for inter-group comparison. The p-value <0.05 was considered statistically significant. Results: Out of total 200 patients (93 males and 107 females; 18-60 years of age) enrolled in the study, 100 patients were categorised in video group (41.53±11.60 years) and remaining 100 were included in non video group (42.92±11.63 years). There was no statistically significant difference in the mean anxiety score and haemodynamic parameters at the baseline for both the groups. Post intervention, the video group showed a greater reduction in anxiety than the control group (intra-group reduction: 1.84±1.20 vs 1.42±1.18), and the difference was statistically significant (p-value=0.013). Mean HR was significantly higher in the control group (84.66±13.22, 80.46±13.11 and 79.44±14.05 at 5, 10 and 15 min, respectively) when compared with the video group (81.75±11.49, 77.35±12.59 and 74.82±13.05 at 5, 10 and 15 min, respectively). Similarly, SBP, DBP and MAP were noted significantly higher in the control group compared to the video group (p-value <0.001). Conclusion: Multimedia-based educational video depicting technique of spinal anaesthesia/sub arachnoid block significantly reduces anxiety and associated haemodynamic variations. Showing short video clip about spinal anaesthesia technique is an easy way for transfer of information about anaesthesia for patients and allows time for patients to reflect on this preoperatively and thereby reduces their anxiety.

Evaluation and Management of Suspicious Adnexal Masses in Pregnancy- A Retrospective Study

Kavitha Sukumar, Delphin Supriya, P Usha

Introduction: The incidence of suspicious ovarian masses in pregnancy is on the rise due to the increased use of ultrasonography in recent times. However little is known about their management during pregnancy due to the lack of large randomised trials. Aim: To evaluate the incidence, nature and management of suspicious adnexal masses diagnosed during pregnancy at our institution. Materials and Methods: This was a retrospective study of 33 pregnant women who presented with suspicious ovarian masses at the Department of Gynaec Oncology at the Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai, Tamil Nadu, India, from August 2018 to September 2020. Patients were evaluated with imaging studies as per the International Ovarian Tumour Analysis (IOTA) ultrasound rules along with Magnetic Resonance Imaging (MRI) and tumour markers and surgical intervention were performed for cases with definite indications. The Statistical Package for Social Science (SPSS) version 28.0 was used for statistical analysis. Results: Mean age of the patients was 26.1±2.1 years (20-33 years). Most common gestational age of presentation was the 2^nd trimester of pregnancy (mean-18.9 weeks). Out of 33 patients, 27 were benign (81.82%) and 6 (18.18%) malignant. Surgical intervention was done for 18 cases (54.55%) and 15 (45.45%) patients were kept under observation. Five were primary ovarian and one was metastatic from carcinoma stomach. Conclusion: Thorough clinical evaluation with personalised imaging and appropriate timely intervention aid in the diagnosis and management of suspicious adnexal masses in pregnancy.

High Resolution Computed Tomography Findings of Pulmonary Fibrosis in COVID-19 Survivors and its Association with Inflammatory Markers- A Retrospective Study

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection enters human body through respiratory tract and then rapidly spread to involve lungs and multiply swiftly leading to severe hypoxic pneumonia. Clinically, Coronavirus Disease-2019 (COVID-19) infection is identified by three stages based on viral infection, lung involvement with inflammation and pulmonary fibrosis. High resolution Computed Tomography (HRCT) lung play an important role in diagnosis and management of lung fibrosis in coronavirus disease patients. Aim: To study association between inflammatory markers and development of lung fibrosis in post COVID-19 patients. Study also aimed at assessment of chest Computed Tomography (CT) Involvement Score (CT-IS) and COVID-19 Reporting and Data System (CO-RADS) for chest CT in post COVID patients presented with lung fibrosis. Materials and Methods: This retrospective study included elaborate evaluation of HRCT findings and inflammatory markers of 54 patients presented with pulmonary fibrosis at tertiary care centre for duration of six months from 1^st June to 30^th November 2020. Only those patients were included in which both HRCT findings and clinical laboratory parameters were available. Interleukin-6 (IL-6), C-Reactive Protein (CRP), serum ferritin, Lactate Dehydrogenase (LDH), Erythrocyte Sedimentation Rate (ESR) and Procalcitonin (PCT) markers were studied. Statistical analysis was conducted using Chi-square test to compare the inflammatory markers with CT-IS score with p-value <0.05 was considered significant. Results: Total 536 COVID positive patients were admitted in hospital and underwent HRCT lung from June 2020 to November 2020. Out of 536, 54 (10.07%) patients showed findings of lung fibrosis on follow-up CT scan. Among 54 patients with lung fibrosis, CRP, serum ferritin and IL-6 levels were high in 46 (85.19%), 42 (77.77%) and 48 (88.89%) patients respectively. Lactate dehydrogenase, ESR and PCT were increased in 12 (22.22%), 15 (27.78%) and 06 (11.11%) patients respectively. These levels were higher in fibrotic phase compared to prefibrotic phase. Erythrocyte sedimentation rate was significantly associated with the severity of lung fibrosis, having significant p-value=0.004. Conclusion: Among all inflammatory markers, ESR value may be useful as a surrogate marker to predict the pulmonary fibrosis in COVID-19 patients. C-reactive protein, IL-6, LDH, serum ferritin and PCT levels do not show significant association with lung fibrosis on HRCT scan.

Peritumoural and Tumour Infiltrating Lymphocytes in Breast Carcinoma and their Relation with Tumour Grade, Lymphovascular Emboli and Nodal Metastasis: A Cross-sectional Study

Sreeja Jayalakshmi, Anupama Achyuthan Manjula

Introduction: Inflammatory cell infiltrate in tumours may be involved in immunosurveillance or tumourigenesis. Tumour Infiltrating Lymphocytes (TILs; within the tumour) and peritumoural lymphocytes (at the invasive margin) are associated with improved prognosis and response to therapy. Aim: To estimate the presence of peritumoural lymphocytes and TILs in breast carcinoma, identify their subsets by Immunohistochemistry (IHC) and assess the relationship between them and tumour grade, lymphovascular emboli and axillary lymph node metastasis. Materials and Methods: This was a cross-sectional study with a sample size of 75 done in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India from November 2017 to April 2019 with the approval of Institutional Ethics Committee. The demographic data of the patients were collected and histopathological assessment of tumour type, grade, lymphovascular emboli, nodal metastasis and lymphocytic infiltrate was done on Haematoxylin and Eosin (H&E) stained sections. Immunohistochemical evaluation was performed using antibodies against Cluster of Differentiation 4 (CD4) and CD8 and cells were scored separately in the stromal and peritumoural areas. The results were analysed by Analysis of Variance (ANOVA) and Chi-square test. Association between the immune infiltrate and histopathological variables were assessed separately in stromal and peritumoural compartments. Association between the score obtained on H&E and subpopulation score obtained on IHC was also analysed in both the compartments. Results: Total of 75 subjects were included and the mean age was 52.31 years with a standard deviation of 9.774 years. The degree of stromal TIL infiltrate ranged from 10% to 95%, with a mean of 48.47%. High grade peritumoural infiltrate was seen in 66.67% (50 out of 75 cases). The stromal TILs were significantly higher in higher grade tumours and tumours without nodal metastasis. The peritumoural lymphocytes were also significantly higher in high grade tumours. The scoring of the immune infiltrate on H&E sections and subpopulation score on IHC showed significant association for both stromal and peritumoural compartments. Conclusion: Stromal TILs and peritumoural lymphocytes were significantly higher in high grade tumours. Stromal TILs were also significantly higher in tumours without axillary lymph node metastasis. No significant association was found between the lymphocytic infiltrate and lymphovascular emboli. The immune infiltrate within breast carcinoma has association with tumour grade and lymph node metastasis.

Effect of Water-based Inspiratory Muscle Training on Lung Functions and Respiratory Muscle Strength in Parkinson’s Disease: A Longitudinal Study

Priya Chauhan, SD Shahanawaz, Gaurav Kapoor, Hardik Dogra

Introduction: Water-based exercises are widely accepted exercises due to its acceptance and additional benefits from them. Exclusively, aquatic exercises are more advantageous than Land Exercises (LE), particularly in the early phase after rehabilitation for respiratory benefits. Aim: To evaluate the efficacy of water-based inspiratory muscle training in respiratory muscle strength, lung functions and functional capacity in patients with Parkinson’s Disease (PD). Materials and Methods: A longitudinal study was conducted on 30 participants with idiopathic PD, at Chandigarh University, Mohali, Punjab, India, between 50-65 years and in stages I-III (Modified Hoehn and Yahr Scale). Respiratory muscle strength was evaluated through inspiratory muscle training and functional capacity was evaluated with a 6-minute walk test. After the assessment, the participants were randomly assigned into two groups. Group A: Along with conventional exercise, water-based inspiratory muscle training was given to the population of this group. Group B: Along with conventional exercise, land-based respiratory muscle training was given to the population of this group. Results: Mean age of group A was 69±6 years and group B was 69±4 years (p-value=0.90). As per statistical analysis using paired t-test, both the groups showed improvement from baseline in all the parameters {Forced Vital Capacity (FVC)%, Forced Expiratory Volume in one second (FEV1)%, Maximal Expiratory Pressure (MEP) (cmH₂O)} after the intervention. When compared within the groups using independent sample t-test, there was statistically significant change seen in mean value of the parameters and group A was found to be better as compared to Group B. Conclusion: The study revealed that water-based respiratory muscle training is safe and more effective intervention as compared to land-based exercise. Further, water-based intervention safely helps in improvement of inspiratory and expiratory muscle strength, pulmonary functions as well as for general body activity in patients with mild-to-moderate PD.

Factors Affecting Ambulatory Status in Children with Cerebral Palsy: A Cross-sectional Study

Annie Mathew, Nonica Laisram

Introduction: Cerebral Palsy (CP) is one of the most common causes of physical disabilities in childhood. Most children with CP are facing limitations of walking and other physical activities. Limitation in ambulation presents potential barriers to activities of daily life, participation in physical, recreational, and social activities, which further hampers the quality of life. Thus, attainment of walking is an important goal for the children with CP, as well as doctors for optimum rehabilitation plan. Aim: To study the ambulatory status in different types of CP and factors affecting ambulatory status in children with CP. Materials and Methods: This observational, cross-sectional study was conducted in the Outpatient Department of Physical Medicine and Rehabilitation (PMR) of VMMC and Safdarjung Hospital, New Delhi, India, from November 2018 to April 2020. Total 100 children with CP of age group 2-18 years were enrolled in the study. The type of CP was determined based on tone pattern and limb involvement. Walking ability was assessed using Gross Motor Function Classification System (GMFCS), Functional Mobility Scales (FMS) and Gillette Functional Assessment Questionnaire (FAQ). Factors such as age of independent sitting, presence of accompanying impairments which may influence the walking ability were also studied. Quantitative variables were compared using Kruskal-Wallis test and qualitative variables were compared using Chi-square test. Results: In the study population of 100 children with CP, 68 were males and 32 were females. Total 55% were independent ambulators, 14% were ambulatory with aids and 31% were non ambulators. 86% had spastic CP, 6% had dyskinetic CP, 6% had mixed CP and 2% had hypotonic CP. Among spastic CP (86), 56% had diplegia, 16.2% had quadriplegia, 24.4% had hemiplegia and 3.4% had triplegia. Children with spastic hemiplegia showed highest potential for independent walking. Among 100 children with CP, 56% achieved independent sitting by 2 years of age, 31% achieved independent sitting after 2 years of age and 13% did not achieve sitting. Total 82.14% of children who achieved independent sitting by 2 years of age were ambulatory without aids. Total 36% of total children had no impairments, 44% had one or two impairments and 20% had three or more impairments. Total 88.8% of children who had no impairments were ambulatory without aids, thus showed good walking potential. Where as 70% of children who had three or more impairments were non ambulators. Conclusion: The spastic hemiplegia type of CP, achievement of independent sitting by 2 years of age and absence of accompanying impairments are good prognostic predictors of ambulation in children CP.

Autoantibody Profile of Childhood Onset Systemic Lupus Erythematosus: An Audit of Immunopathology Laboratory of a Tertiary Care Centre, Varanasi, India

Introduction: Systemic Lupus Erythematous (SLE) is an autoimmune disease, which commonly affects females and is associated with formation of various Antinuclear Antibodies (ANA). Childhood onset SLE has some similarities and differences in immunological profile and clinical manifestations from adult onset SLE patients. Aim: To study the spectrum of clinical manifestation and autoantibody profile of childhood onset SLE patients and to compare with adult SLE patients. Materials and Methods: This was a retrospective observational study conducted from October 2017 to March 2021 in Department of Immunopathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. This includes 74 patients of childhood onset SLE and 91 patients of adult SLE. Detailed clinical and laboratory data were collected from medical records. Serum ANA and anti-dsDNA (Deoxyribonucleic Acid) detection was done by solid phase enzyme immunoassay methods. Antibodies to extractable nuclear antigen were detected by dot blot immunoassay. Chi-square test {International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0} was used to compare categorical data of childhood onset SLE and adult SLE patient groups. Results: The mean age of childhood onset SLE patients was 13.05±4.26 years with female:male ratio of 3.93:1. Malar rash (p=0.001) and renal involvement (p=0.021) was significantly more frequent in childhood onset SLE but oral ulcer was significantly more frequent (p=0.038) in adult patients. Anti-ds DNA positivity and reduction in complements C3 and C4 were more commonly seen in childhood onset SLE patients. Conclusion: Age is an important influence on clinical manifestations and autoantibody profile of SLE. Childhood onset SLE showed more frequent renal and skin involvement and more significant activity measured by reduction of complements. Awareness of the same will help our clinicians to detect renal involvement at an early stage and develop organ specific management protocol.

Correlation between Age and Modified Star Excursion Balance Test in Healthcare Workers: A Cross-sectional Study

Ahmad Dhahawi Alanazi

Introduction: With advancing age, the ability to maintain postural stability may decline. Healthcare workers might be prone to musculoskeletal symptoms which may lead to greater decline in postural stability with advancing age. However, the relationship between age and balance in healthy hospital staff has not been elucidated. Aim: To identify the correlations between age and balance measured by the modified Star Excursion Balance Test (mSEBT) performance and determine if age predicts mSEBT performance in healthy male hospital staff. Materials and Methods: A cross-sectional observational study was conducted at Rabigh General Hospital, Rabigh, Saudi Arabia, from December 2020 to June 2021. Fifteen male hospital staff were included in this study. Participants were instructed to perform three trials of mSEBT. Normalised composite scores and reach distances in each direction for both legs were calculated. Pearson correlation was conducted to identify the correlations between age and mSEBT performance. Also, simple linear regression was performed to determine if age predicts mSEBT performance. Results: Significant moderate negative correlations were observed between age and non dominant Posteromedial (PM) direction (r=-0.44, p=0.04) and non dominant composite score (r=-0.48, p=0.03). Also, there was a significant strong negative correlation between age and dominant PM direction (r=-0.52, p=0.02) and a significant moderate negative correlation between age and dominant composite score (r=-0.44, p=0.04). The regression analysis showed that age significantly (p=0.046) predicted 27.3% of the variation in the dominant PM reach direction distance (B=-1.35). Conclusion: The results showed, that age was negatively correlated with PM direction and composite scores for both limbs. Also, age was a predictor of the mSEBT performance only in the dominant PM reach direction.

Comparison of Paediatric Index of Mortality 3, Paediatric Risk of Mortality III, Paediatric Logistic Organ Dysfunction-2 for Assessing Patient Mortality: A Prospective Observational Study

SV Kishore, Anil Kumar Mohanty

Introduction: Numerous scoring systems have been proposed in an effort to increase the prognostic accuracy and predicting outcome. In order to measure the risk of mortality, scores are employed that establish a numerical scale and in this way, they compare estimated mortality in % with the observed mortality. Known as prognostic scores, these can be used to evaluate the quality of medical care and to optimise the employment of resources, aiming at improving the cost-benefit relationship. Since, they compare mortality adjusted by disease severity these scores can also be used for comparisons between clinical trials and for planning technological resources. Aim: To compare the performance of the Paediatric Risk of Mortality III (PRISM III), the Paediatric Index of Mortality 3 (PIM 3) and Paediatric Logistic Organ Dysfunction-2 (PELOD-2) scores in a Paediatric Intensive Care Unit (PICU) in a tertiary care hospital. Materials and Methods: The present study was prospective observational study which included children from one month to 14 years of age admitted to PICU, and who remained in PICU after 24 hours. Within the first hour of admission PIM 3 was assessed. Further at 24 hours of admission, PRISM III and PELOD-2 score were assessed. Performance of different scores were evaluated. Calibration by HosmerLemeshow goodness-of-fit test {χ²(p)} Discrimination was assessed by the ROC curve. Standardised Mortality Rate (SMR) was calculated to predict the mortality. Results: Total 281 children were enrolled in the study, out of which 62 patients died. Neurological illness was the most common cause of death (12, 19.35%) followed by respiratory and haemato-onco cases (10, 16.13%) each. The Area Under the ROC Curve-Receiver Operating Characteristics (AUC-ROC) of PELOD-2, PIM 3 and PRISM III were 0.862, 0.847 and 0.838, respectively. Among the three scores PELOD-2 had poor calibration for the study population (χ²=18.837, p=0.016, d=8). PIM 3 was a better predictor of mortality (with SMR of 1.33) when compared with PRISM III and PELOD-2 (which had SMR of 1.57 and 1.83, respectively). Conclusion: All the three scores had good discrimination, however PELOD-2 had poor calibration for the given study population, with respect to better predictor of mortality all the scores underestimate the mortality. Among these, the better predictor mortality was PIM 3. Since, PIM 3 also had good calibration for the study population and is associated with less variables to monitor there is ease of estimation and hence it is more suitable to score and to assess mortality.

Prevalence of Anxiety and its Severity among Different Specialities of Healthcare Professionals during COVID-19 Pandemic

Meghna Gupta, Vitull Kumar Gupta, Parneet Kaur Hari, Kashish Goyal, Harry Goyal

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has adversely affected people’s physical and mental health necessitating a comprehensive public and mental health strategy focusing on venerable populations including Healthcare Professionals (HCPs). Anxiety is a common mental health problem and untreated anxiety may cause immediate and long-term adverse health effects. Currently, the data on the psychological impact of COVID-19 among specialities of HCPs is sparse. Aim: To study the prevalence of anxiety and its severity among different specialities of HCPs during COVID-19 pandemic. Materials and Methods: This cross-sectional survey was conducted among HCPs from 1^st October, 2020 to 20^th February, 2021 at Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India, during COVID-19 pandemic in India using e-copies and hard copies of anonymously complete voluntary survey proforma. The proforma included socio-demography variables and a validated pretested structured Generalised Anxiety Disorder Scale (GAD-7) questionnaire distributed physically and by social media platforms to Indian doctors and medical students of >18 years of age from all over India. From all responses received, 2246 were found to be valid responses from HCPs comprising of 1624 from medical specialities, 225 surgical specialities, 101 emergency/critical care specialities and 296 from students/dental speciality. No HCPs other than doctors with valid MBBS/BDS degrees or MBBS/BDS students were included. Valid responses were analysed according to the speciality in relation to prevalence of anxiety, its severity, age and gender. Mann-Whitney U test was used to compare GAD-7 score among different specialty group. Results: About 972 (43.3%) were in 20 to 40 years age group including 655 (67.4%) medical, 42 (4.3%) surgical, 37 (3.8%) emergency/critical care and 238 (24.5%) from students/dental speciality. Male HCPs were 1513 and female HCPs were 733. Prevalence of anxiety was 79.3% among all HCPs. According to gender groups, prevalence of anxiety was 78.1% in males and 81.6% in females. According to age groups the prevalence of anxiety was 81.3% in 20-40 years age group, 81.6% in 41-60 years and 61.5% in >60 years age group. Among specialities, prevalence of anxiety was 78% in medical speciality group, 86.7% in surgical speciality group, 92.1% in emergency/critical care group and 76.4% in students/dental speciality group. Results showed maximum mean score in emergency/critical care speciality group and minimum mean score in medical speciality group. Conclusion: High prevalence of anxiety and its severity among HCPs across specialities highlights the adverse mental health impact of the COVID-19 pandemic underscoring the need for appropriate mental health support with multidisciplinary comprehensive mental healthcare measures.

Systemic Immune-inflammation Index in Acute Coronary Syndrome and its Role in Predicting Disease Severity: A Cohort Study

Anvith Sherwin Pinto, Akshatha Rao Aroor, Pradeep Pereira

Introduction: Systemic Immune-inflammation Index (SII) is a novel marker of inflammation, used extensively in prognosticating various cancers. Recent studies have shown SII to be a predictor of adverse events and death in Acute Coronary Syndrome (ACS) patients who undergo intervention. The role of SII in medically managed SII patients has not been studied. There are no Indian studies available which study the prognosticative role of SII in ACS. Aim: To study systemic immune-inflammation index in acute coronary syndrome and its role in predicting disease severity and mortality. Materials and Methods: This prospective cohort study was conducted in Department of General Medicine at Father Muller Medical College Hospital, Mangaluru, India between February 2021 and July 2021. The study included 45 ST Elevation Myocardial Infarction (STEMI) and 45 Non ST Elevation Myocardial Infarction (NSTEMI)/Unstable Angina (UA) patients, aged 30 years or more. The SII, Neutrophil-to-Lymphocyte Ratio (NLR) and Total Leucocyte Count (TLC) were compared using independent sample t-test. Killip class, Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) 2.0 scores were used to determine disease severity. Pearson’s and Spearman’s correlation coefficient were used to determine correlation between parametric and non parametric parameters, respectively. Receiver Operator Curve (ROC) was used to see for predictability of outcomes. The role of SII to predict Major Adverse Cardiac Events (MACE) and death at one month follow-up period was assessed by Kaplan-Meier analysis and Cox regression analysis. Results: The mean SII was significantly higher in the STEMI group (20.9 vs 9.79; t-value= 3.65, p-value <0.001). SII correlated significantly with Killip class (r=0.502), TIMI (r=0.417) and GRACE 2.0 scores (r=0.529), better than NLR or TLC. High SII were associated with a higher risk of MACE (Odds ratio=13.82, p-value <0.001) and death (OR=4.413, p-value=0.015). The SII had an Area Under the Curve of 0.67 for predicting MACE and had a negative predictive value of 96%. Kaplan-Meier analysis showed that patients with higher SII had a lower survival at one month (median: 24.5 days vs 29.32 days, Log-rank=6.44, p-value=0.011). The SII predicted MACE and death better than left ventricular Ejection Fraction (EF) and troponin I. Conclusion: The SII is a cost-effective, novel marker of inflammation that can predict short term outcomes in ACS. This was the first cohort study which studied the role of SII in ACS in patients undergoing any type of intervention.

Awareness about Ban on Single-use Plastic Items among Nursing Professionals: A Cross-sectional Survey

Sukhbir Singh, Madan Gopal Vashihst, Mahesh Mahla, Ramesh Verma, Ishwanti Malik

Introduction: The government hospitals work round the clock and huge single-use non biodegradable plastic materials are used by patients, their attendants, staff and the public at large for their day-to-day activities. Therefore, awareness among the healthcare workers is essential for the full implementation of the policy of ban on single-use plastic items. Aim: To study the awareness regarding ban on single-use plastic items among nursing professionals. Materials and Methods: The present study was a cross-sectional study done on nursing professionals across all seniority and from various specialty departments. Overall, 550 nursing professionals were included in the study. A pretested questionnaire, comprising 16 questions, was used as a study tool. Chi-square test was applied for studying the significant association among different variables. Results: The response rate was 91% i.e., out of total 550 nursing professionals 498 participated in the study. It was observed that 37.4% of participants were in the 31-40 years age group, 95% were females, 90.6% were married and 90.4% were from the urban area. It was found that the mean knowledge score of three knowledge questions (mean=1.120, SE=0.032, SD=0.715, 95% CI=1.057-1.183) was higher among females, unmarried staff and respondents with a rural background. Primarily, majority of the nursing staff (i.e., 82%) had learned about the ban on single-use plastic from television and newspaper rather than formal teaching/training. Conclusion: The hospitals should start regular formal teaching/training programme for increasing awareness of healthcare workers regarding ban of single-use plastic items. Thus, it is relevant to address this issue through well-planned formal training sessions.

Angiographic Localisation of Culprit Vessel in Non ST Elevated Acute Coronary Syndrome

Introduction: Coronary Artery Disease (CAD) is a major cause of mortality and morbidity. Among Acute Coronary Syndrome (ACS), Non ST Elevated Acute Coronary Syndrome (NSTE-ACS) continues to increase. Unlike ST Elevated Myocardial Infarction (STEMI), association of ischaemic changes in Electrocardiogram (ECG) with culprit lesion localisation in NSTE-ACS has not been well reported. Aim: To investigate the association between ECG abnormalities and angiographic localisation of culprit vessel in patients of NSTE-ACS. Materials and Methods: This observational, prospective study was conducted in SCB Medical college and Hospital, Cuttack, Odisha, India, from December 2019 to November 2020. A total of 200 eligible patients of newly diagnosed NSTE-ACS were included. Demographic and risk factor assessment, clinical examination and routine blood investigations were done. All patients had an admission Electrocardiogram (ECG), Echocardiography (Echo) and Coronary Angiography (CAG) done within 72 hours of admission. Admission ECG was associated with CAG to assess predictive value in localisation of culprit vessel. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR), pre and post-test odds of individual ECG findings were assessed. Statistical Package for the Social Sciences (SPSS) version 24.0 was used for statistical analysis. Results: Sensitivity, specificity, PPV, NPV, LR+, pretest odds and post-test odds of anterior wall, inferior wall, lateral wall and augmented Vector Right (aVR) group ECG changes in predicting Left Anterior Descending (LAD), Right Coronary Artery (RCA), Left Circumflex Artery (LCX) and Left main or Triple Vessel Disease (LM/TVD) as culprit artery were 75.9%, 90.5%, 91.7%, 73.1%, 7.96, 1.38 and 10.98; 69.1%, 91.5%, 87.8%, 76.9%, 8.14, 0.89 and 7.21; 64%, 93%, 87.3%, 77.4%, 9.10, 0.75 and 6.86 and 69.2%, 96.3%, 90%, 86.7%, 18.66, 0.48 and 8.98, respectively. Sensitivity, specificity, PPV and NPV of anterior and lateral, inferior and lateral and anterior and inferior wall ECG changes in predicting LAD and LCX, RCA and LCX and LAD and RCA as culprit vessels were 75.0%, 82.6%, 27.27% and 97.43%; 47.0%, 88.5%, 27.5% and 94.73% and 53.3%, 83.2%, 20.51% and 95.65%, respectively. The ECG was normal in 31% of which Myocardial Infarction with Non Obstructive Coronary Artery (MINOCA) (34%) and Single Vessel Disease (SVD) (30.6%) were prevalent. The MINOCA were mostly seen in normal ECG pattern. Conclusion: An ECG is a moderately sensitive but highly specific parameter in predicting LAD, LCX, RCA and LM/TVD as culprit vessels in Non ST Segment Elevation Myocardial Infarction- Acute Coronary Syndromes (NSTE-ACS). Double territory ECG changes have a poor association in predicting culprit vessel. However, a good association was noted for (anterior and lateral) wall ECG changes in predicting LAD and LCX as culprit arteries.

Evaluation of Role of Magnetic Resonance Imaging in Newborns with Suspected Hypoxic Ischaemic Injury and its Association with Clinical Staging: A Cross-sectional Study

Parinita Sadhanidar, Nabanita Deka, Sushant Agarwal

Introduction: Hypoxic Ischaemic Injury (HII) also known as Hypoxic Ischaemic Encephalopathy (HIE) is one of the most common causes of neonatal morbidity and mortality in most countries of the world. Perinatal asphyxia being the most frequent cause of HII, some of its long-term sequelae includes impaired neurological development, cerebral palsy, recurrent seizures, etc. Magnetic Resonance Imaging (MRI) has been found to be most sensitive in detecting lesions in the brain of neonates with HII. Aim: To evaluate the role of MRI in assessing neurologic damage in newborns with suspected HII and its association with clinical staging. Materials and Methods: An institution-based descriptive cross-sectional study was conducted in a tertiary care Government Hospital in Guwahati, Assam, India for a duration of 15 months from May 2017 to July 2018 on 50 neonates with history of perinatal asphyxia. Assessment of conventional T1 and T2 weighted images, Diffusion Weighted Imaging (DWI) and Susceptibility Weighted Imaging (SWI) was done and association of MRI findings with gestational maturity, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores and clinical staging (Sarnat and Sarnat Staging system) was studied. Results: In majority of cases with clinically mild HII, MRI findings were either normal or of mild degree whereas in cases of clinically advanced stages of HII, MRI findings were moderate-to-severe, suggesting a positive association between clinical grading and severity of brain injury. Term neonates sustained injuries mostly in cortical-subcortical/watershed zones of brain whereas preterm neonates were seen to sustain mainly periventricular lesions. Basal ganglia, thalamic and midbrain lesions were seen to be associated with severe degree of HII in term neonates whereas germinal matrix haemorrhage was observed in preterm neonates with severe HII. A positive association was seen between severity of brain lesions with both low APGAR scores and gestational prematurity. Conclusion: MRI is helpful to study the pattern of brain involvement in term and preterm neonates with suspected HII and to assess the severity of injury. MRI findings are seen to correlate well with clinical staging.

Role of Tzanck Smear Cytology in Dermatology: A Clinicopathological Study

Hn Shruthi, Bn Kumarguru, As Ramaswamy, V Shivakumar

Introduction: Variety of lesions affecting the skin range from non specific dermatoses and inflammatory lesions to neoplastic changes in different components of the skin tissue. Tzanck smear is a simple, easy, rapid and inexpensive diagnostic technique which now being used for the diagnosis of erosive vesiculobullous lesions, tumours, granulomatous lesions and cutaneous infections. Aim: To compare between the clinical diagnosis and Tzanck smear cytology diagnosis. Materials and Methods: It was a cross-sectional study on Tzanck smears, conducted at a tertiary care referral Institute, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam, Andhra Pradesh, India, from March 2016 to April 2017. In each case, Tzanck smear cytology diagnosis and clinical diagnosis was documented and compared with each other and with that of the available histopathological diagnosis. The clinicopathological concordance was calculated. All statistical calculations were done through Microsoft (MS) Excel 2007. Results: Total of 50 cases of Tzanck smears were analysed. On Tzanck smear cytology, the common diagnostic entities included cutaneous infections and non specific inflammatory lesions each constituting 22 cases (44%). When compared with the Tzanck smear diagnosis, the diagnostic accuracy of clinical diagnosis was 60% on applying partial concordance criteria. When compared with the histopathological diagnosis, the diagnostic accuracy of clinical diagnosis and Tzanck smear cytology diagnosis were 66.67% and 83.33%, respectively on applying partial concordance criteria. Conclusion: Tzanck smear is a prudent diagnostic tool for cytological evaluation of cutaneous lesion. It serves as a complimentary investigative modality to histopathology.

Feedback Integrated with Objective Structured Clinical Examination Module- A Teaching Tool in Physiology Department

Introduction: Objective Structured Clinical Examination (OSCE) is designed to evaluate various learners’ skills. Formative feedback reinforces appropriate learning and contributes to correction of learner’s deficiencies. It was observed that the students in Clinical Physiology labs did not have direct observation and feedback on performance of clinical examination to address the gaps in knowledge and clinical skills. Aim: To evaluate the perception of students and faculty on the effectiveness of structured feedback integrated with OSCE module for teaching clinical skills in Physiology Department. Materials and Methods: A non randomised, intervention study was conducted on 100 phase I Bachelor of Medicine and Bachelor of Surgery (MBBS) students. Students were sensitised to OSCE topics. After taking written informed consent, initial OSCE sessions integrated with 1:1 feedback was conducted followed by OSCE sessions after 20 days in the same topics of clinical examination. OSCE scores were recorded. Feedback survey questionnaire to assess the perceptions of phase I MBBS students and retrospective pre-post assessment questionnaire was designed and administered. Student’s t-test, Likert scale analysis and Thematic analysis of the responses were done. Results: Of the total 100 phase I MBBS students, males were 46 and females were 54 with a mean age of 20 and 19 years, respectively. Significant percentage of students got the opportunity to have constructive discussions of their strengths and weaknesses of learning clinical skills with the faculty (p-value=0.0246) and also felt satisfied with the structured points of the feedback given by the faculty (p-value=0.03181). There was significant increase in the OSCE scores of the students after the OSCE session integrated with feedback. Majority of the faculty felt satisfied with self assessment of student’s learning gaps and with the performance of clinical system examination by the students. Faculty confidence to give structured feedback to the students had improved. Conclusion: It can be concluded that 1:1 structured feedback integrated with OSCE has significant educational impact and is an effective method for teaching clinical skills in physiology labs. It is one of the efficient ways to use OSCE checklists as an effective teaching resource.

Pharmacovigilance in Geriatric Patient-A Prospective Observational Study done in a Tertiary Care Hospital of Odisha, India

Introduction: Geriatrics is a speciality that focuses on healthcare of elderly people. Geriatric population is defined as people above 60 years of age. Geriatric population constitute 8.14% of total population in India. They have diverse physiological and pathological profiles which have an impact on the pharmacokinetic and pharmacodynamic properties of the administered drug. Very often they are under polypharmacy due to multisystem involvement and thereby subjected to numerous drug interactions and Adverse Drug Reactions (ADRs). There are few studies conducted in India regarding ADRs in Geriatric Patients and none in Odisha, India. Aim: Pharmacovigilance study in Geriatric patients was taken up in a tertiary care hospital to assess the spectrum, cause, severity and preventability of ADRs. Materials and Methods: This prospective, observational study was conducted in Department of Pharmacology in collaboration with Departments of Geriatric Medicine, Medicine and Skin and Venereal Disease (VD) of SCB Medical College and Hospital, Cuttack, Odisha, India. All geriatric patients (aged ≥60 years) diagnosed with ADR, from September 2016 to September 2018, were included. The detailed information of type of ADR and its characteristics were filled up in Suspected ADR Reporting Form. The prevalence and profile of ADRs in geriatric patients were studied. Their causality, severity and preventability were assessed by World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) System, Modified Hartwig’s Severity Scale and Schumock and Thornton Preventability Scale, respectively. Results: A total of 236 geriatric ADRs were reported in two years, out of which, the most common ADRs were cutaneous 100 (42.4%), followed by metabolic 68 (28.8%) and Gastrointestional (GI) involvement 26 (11%). Out of the geriatric ADRs, 128 (54.2%) ADRs were possible, 65% were moderate in intensity and 70.3% ADRs were probably preventable. Conclusion: Cutaneous and metabolic ADRs were most common in geriatric patients in present study. Majority of ADRs were possibly caused due to the drug used, were of moderate intensity and probably preventable.

Left Ventricular and Right Ventricular Functional Changes in Cases of COPD and its Correlation with Severity-A Cross-sectional Study

Keertivardhan D Kulkarni, PA Mahesh

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a global health problem, mainly in developing countries. It affects pulmonary blood vessels, right ventricle, and also left ventricle leading to pulmonary hypertension, cor pulmonale and right and left ventricular dysfunction. Aim: To assess the cardiac, right and left ventricular changes in subjects with increasing COPD severity staged according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and to compare Arterial Blood Gases (ABG), St. George’s Respiratory Questionnaire (SGRQ) percentages and BODE (Body-mass index, airflow Obstruction, Dyspnoea, and Exercise) scores to cardiac changes in COPD. Materials and Methods: The present study was a cross-sectional study conducted at tertiary care hospital in Southern Karnataka, India. The sample size was 60. A structured questionnaire was administered which included demographic, clinical variables followed by a detailed clinical examination, spirometry, Electrocardiograph (ECG), ABG, chest radiograph, echocardiography and a 6-Minute Walk Test (6MWT). Data collected was analysed using Statistical Package for the Social Sciences (SPSS) and Epi Info software for mean, Standard Deviation (SD) and multivariate analysis. Results: All the patients diagnosed with COPD (using GOLD criteria) were included in study and assessed for right and left ventricular changes. Out of 60 patients, 58 were males and two were females, with mean age being 64.71±28.28 years. Among the study population, 45 (75%) patients had one or the other cardiac condition. Cardiac changes included left ventricular diastolic dysfunction (58.3%), right ventricular dilatation (33.3%), right ventricular hypertrophy, right atrial dilation, tricuspid regurgitation and pulmonary hypertension and left heart changes included left ventricular hypertrophy. Conclusion: The study highlights the need for early and active cardiac screening of all COPD patients. This will help in early treatment and good prognosis, and will further contribute in reducing the morbidity and mortality.

Estimation of Ferritin and D-Dimer Levels in COVID-19 Patients with Mucormycosis: A Cross-sectional Study

Introduction: There are increasing reports of the occurrence of fungal co-infections in Coronavirus disease-2019 (COVID-19) patients resulting in severe morbidity among predisposed individuals. Mucormycosis is an Invasive Fungal Infection (IFI). Early anticipation and identification of fungal co-infections can significantly reduce morbidity rate among COVID-19 infected patients. Aim: To determine quantitatively the levels of ferritin and D-dimer in COVID-19 infected patients with mucormycosis. Materials and Methods: This cross-sectional study was conducted on 84 Real Time Polymerase Chain Reaction (RT-PCR) positive for COVID-19 in oropharyngeal swab patients from June 2021 to August 2021 at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. D-dimer and ferritin levels were measured in the patient’s blood sample using Latex Enhanced Immunoturbidimetric method in Vitros 5.1 FS and Vitros Eci Immunodiagnostics, respectively. Continuous data represented as mean and standard error of mean, Kruskal-Wallis test and Mann-Whitney U test was used to test significance, p-value <0.05 was considered as statistically significant. Results: Of the 84 COVID-19 Infected patients, 40 were included in group 1, 25 patients in group 2 and 19 patients in group 3. A total of 21 patients were aged between 20-40 years, 48 patients between 41-60 years age group and 15 patients were in 61-80 years of age group. The number of male patients was 63 and female patients were 21. The D-dimer levels were 1259.37±258.9, 2632.60±472.6 and 229.53±18.4 (p-value <0.001) in group 1, 2 and 3, respectively and ferritin levels were 528.58±45.03, 511.48±74.4, and 256.89±51.8 (p-value <0.007) in group 1, 2 and 3, respectively. Conclusion: Serum ferritin and plasma D-dimer were significantly elevated in COVID-19 patients with mucormycosis. Mucormycosis in COVID-19 patients without pre-existing co-morbidities may be attributed to the use of steroid therapy in these patients for COVID-19 infection. Thus, serum ferritin and plasma dimer levels may have a significant predictive role in the risk assessment for the development of mucormycosis among COVID-19 infected patients.

Bronchial Hyper-responsiveness in Post-tubercular Patients: A Case-control Study

Shamshad Ahmed, Zuber Ahmed, Ummul Baneen, Imrana Masood, Rakesh Bhargava

Introduction: Bronchial hyper-responsiveness is the manifestation of excessive bronchoconstriction in response to diverse types of stimuli both physical and chemical. It is the most characteristic feature of bronchial asthma; it also occurs in a spectrum of other diseases like Chronic Obstructive Pulmonary Disorders (COPD) and reactive airway syndrome and may be provoked by a variety of stimuli like histamine and methacholine. Patients of healed pulmonary Tuberculosis (TB) show varying extent of lung impairment such as fibrosis, collapse, emphysema and broncho alveolar destruction. Aim: To assess the incidence and severity of obstructive airway diseases in previously treated TB patients. Materials and Methods: This was a prospective case control study, carried out in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from September 2017 to September 2019, this study included 120 patients of previously treated TB, who were divided into two groups. The case group (71) included patients who completed treatment for TB and had dyspnoea. The control group (49) consisted of patients who completed the treatment but did not have dyspnoea. The patients were subjected to spirometry, histamine bronchial challenge test and computed chest tomogram along with routine investigations including sputum for Acid Fast Bacilli (AFB). Results: The present study showed significant histamine hypersensitivity among post TB patients. In the case group, 34 (56%) patients showed positive response to bronchial challenge test with histamine; while in control group only 7 (14%) showed a positive response (p-value=0.004). Pulmonary function test (spirometry) showed an obstructive pattern in 35 (49%) case group patients, while normal pattern was the most common finding seen in 23 (47%) in the control group followed by obstruction in 10 (21%) patients. Among the cases, the mean Forced Expiratory Volume in the first second (FEV1) was 65.77±15.98, while among the controls, it was 80.02±8.81. The case group had a mean Forced Expiratory Volume in the first second/Forced Vital Capacity (FEV1/FVC) of 78.09±15.75, as against 81.33±16.79 in the control group. Conclusion: Airway bronchial hyper-reactivity is a prominent feature in previously treated tubercular patients. This underlines the need for proper attention towards post-tubercular lung function impairment and proper treatment of such patients so as to lessen the impact of bronchial hyper-reactivity on patient symptoms and their quality of life.

Foetomaternal Outcomes in COVID-19 Positive Obstetric Patients: An Observational Study

Sahana Gowda, KB Suma

Introduction: In Coronavirus Disease-2019 (COVID-19) pandemic, a serious concern has been raised regarding the health of the newborn and the pregnant mother. Limited data is available on the foetomaternal outcomes in this pandemic. Aim: To assess the foetomaternal outcomes in COVID-19 positive pregnant patients. Materials and Methods: A prospective cohort study was conducted from October 2020 to December 2020, at JSS Medical College, Mysuru, Karnataka, India, on 27 COVID-19 positive obstetric patients admitted to the ward who had confirmed COVID-19 on the basis of Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) or lung opacities. The study period belonged to first wave of COVID-19. The foetomaternal outcomes such as mode of delivery, abortions, foetal admission in Intensive Care Unit (ICU) and mortality among the mother and the baby were recorded. The data was collected and tabulated in Microsoft Excel sheet and frequency (n) and percentages (%) were calculated. Results: Total of 27 COVID-19 positive obstetric patients (age 19-37 years; mean gestational age 34.84±7.75 weeks) formed the sample of the study. The mean age of the study patients were 27.11±4.5 years. The primary symptoms included cough (18.52%) and breathlessness (11.11%). After diagnosis, seven cases (25.92%) continued pregnancy and were lost to follow-up while among those who delivered (n=20), the mode of delivery was Lower Segment Caesarean Section (LSCS) in 12 (44.44%), normal vaginal 6 (22.22%), emergency laparotomy in 1 (3.7%) and incomplete abortion in 1 (3.7%) women. Among the 20 who delivered, 1 was Intrauterine Death (IUD) and the rest of the 19 foetuses were negative for COVID-19. Of the total 20 foetuses delivered, 10 required Neonatal Intensive Care Unit (NICU) admission where one died. Repeat testing was done in 13 female subjects, all of them were negative, while rest of the seven patients did not turn in for repeat testing and were lost. Among the pregnant women, one patient died secondary to COVID-19 bronchopneumonia in the postpartum period. Conclusion: If managed properly without any complications, the outcomes are good for the mother and the baby without a significant risk of transmission. However, the long-term follow-up is needed to assess the mortality of the patients.

A Laboratory-based Exploratory Study of Tumour-associated Macrophages and their Subpopulation M1 and M2 by Immunohistochemistry in Primary Breast Carcinoma

Gaurav Khichariya, K Manjula

Introduction: Breast carcinoma is one of the common causes of mortality in women. The macrophage is the primary immune cell present in the tumour microenvironment. They are, therefore, also called Tumour-Associated Macrophages (TAMs). CD68 has a proinflammatory and anti-tumour response. CD (cluster of differentiation)163 has an anti-inflammatory response. The collection of TAMs correlates with adverse clinical outcomes. Tumour microenvironment targeting helps in reducing tumour burden and improving prognosis. Aim: To study the density of expression of TAMs in primary breast carcinoma and study the association of TAMs with stage and grade of primary breast carcinoma. Materials and Methods: This was a laboratory-based exploratory study conducted in the Kolar district of Karnataka, from December 2018 to May 2020 and data of 55 primary breast carcinoma cases were included. Cases with metastatic tumours from other sites, recurrent lesions, and patients subjected to chemotherapy and radiotherapy were excluded. Haematoxylin and Eosin (H&E) slides were reviewed. Immunostaining for CD68 and CD163 was performed. The cases were distributed into low and high groups based on cut-off points according to the median. Statistical Package for Social Sciences (SPSS) version 22.0 was used for statistical analysis and a p-value of <0.05 was considered statistically significant. Results: Out of the total 55 cases, the maximum number of cases were between 50-59 years and maximum patients lump sized between 2-5 cm. The study demonstrated that the density of CD68 macrophages in the peritumoural area increased as the pathological stage increased (p-value 0.037) and the density of CD68 macrophages in the intratumoural area decreased as the tumour grade increased (p-value 0.023). Cancer tissue showed higher CD163 TAMs density than those in normal tissues, but the association with pathological stage, grade, and lymph node metastasis was not significant (p-value >0.05). Conclusion: The CD68 targeted therapy can be used to treat breast carcinoma as it inhibits the tumourigenic factors at the interface between tumour and stroma.

Phenotypic Characterisation of Proteus Species Isolated from Different Clinical Samples with Special Reference to Antibiotic Resistance Pattern in a Tertiary Care Centre

P Snega Priya, Manonmoney, KV Leela

Introduction: The Proteus species are vulnerable to cause community-acquired and Healthcare Acquired Infections (HCAI). This organism is grouped under opportunistic pathogen and implicates a wide range of infection in humans. The emergence of antimicrobial resistance in this species is alarming and life threatening. Aim: To evaluate the prevalence and the resistance pattern of Proteus species isolated from various clinical samples by conventional culture methods. Materials and Methods: This was a cross-sectional study conducted from May 2020 to April 2021. The study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, after approval from the Institutional Ethical Committee. Proteus isolates from various clinical samples like wound swab, pus, urine, Cerebrospinal Fluid (CSF), tracheal swabs, endotracheal aspirate, vaginal swabs, blood, body fluids, ear swab, tissue were collected as per standard protocols. The phenotypic characterisation and resistance pattern of Proteus isolates were done by conventional culture methods. The analysis was done using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: Out of 100 isolates, the higher number of Proteus species was isolated from pus sample (35%), wound swab (22%) and urine sample (25%). Males were found to have a higher prevalence (65%) of infections by Proteus species than females. Proteus mirabilis was the most common isolated species (89%) in this study. The Extended Spectrum Beta Lactamase (ESBL) producers among Proteus species were found to be 39%, AmpC producers to be 20% and carbapenemase producer 1%. Proteus species had the highest sensitivity to piperacillin tazobactam (100%), tigecycline (100%), meropenem and imipenem (98%) in this study. Conclusion: It was concluded that there was an increasing occurrence of drug resistance Proteus species. Their resistance is contributed by production of ESBL, AmpC and carbapenemase enzymes. The screening test alone is sufficient for detection of antibiotic resistance. Hence, there is a need for reliable phenotypic confirmatory test to identify the resistance among Proteus species.

Real-world Retrospective Assessment of Initiation and Effectiveness of Dual Combination Therapy with Metformin and Teneligliptin in Drug Naïve Indian Type 2 Diabetes Mellitus Patients (INITIATE)

Introduction: Diabetes Mellitus (DM) has become the leading health concern worldwide over the last few decades. But despite advances in both understanding of the pathophysiology of Type 2 Diabetes Mellitus (T2DM), and the development of new treatment strategies, current management of patients with T2DM remains suboptimal. Initial monotherapy is frequently inadequate in patients with high baseline Glycated Haemoglobin (HbA1c). Thus, initial combination therapy has emerged as an alternative approach. Aim: To assess INItiation and effecTiveness of dual combInation therapy with metformin And Teneligliptin in drug naïvE T2DM patients (INITIATE). Materials and Methods: In this retrospective, multicentre study, newly diagnosed drug naïve T2DM patients failed with diet and exercise prior to screening and initiated with dual therapy of metformin and teneligliptin were enrolled. Data of all the patients prescribed with any therapeutic dose of metformin (250 mg, 500 mg, 750 mg, 1000 mg, 1500 mg, 2000 mg) and teneligliptin (20 mg, 40 mg) was considered. The data was analysed to assess change in glycaemic parameters from baseline to 12 weeks. Paired t-test was applied for statistical results. Results: Data of 7857 patients were analysed. The mean change of Fasting Plasma Glucose (FPG) from baseline {202.29±52.2 mg/dL (11.23±2.89 mmol/L)} to 12 weeks {142.57±34.5 mg/dL (7.91±1.91 mmol/L)} was -59.72±17.7 mg/dL (-3.31±0.98 mmol/L) (p-value <0.0001). The absolute change in mean Postprandial Plasma Glucose (PPG) from baseline {(286.26±80.43 mg/dL (15.89±4.46 mmol/L)} to 12 weeks {(198.30±42.24 mg/dL (11±2.34 mmol/L)} was -87.96±38.19 mg/dL (-4.88±2.12 mmol/L) (p-value <0.0001). Mean HbA1c level was 8.11%±1% (65±10.9 mmol/mol) at baseline and decreased significantly to 7.15%±0.94% (55±10.3 mmol/mol) (p-value <0.0001) with a mean change of -0.96±0.06 (-10.5±0.7 mmol/mol) at 12 weeks. Total 42.83% (n=3365) patients achieved target HbA1c (<7%) at 12 weeks. Conclusion: Initiation of dual therapy with metformin and teneligliptin in drug naïve Indian T2DM patients significantly improved glycaemic control.

Assessing the Validity of Nine Different Formulae for LDL-C Estimation in a Tertiary Care Centre, Hyderabad, India

Introduction: Conventionally, Friedewald’s formula has been used to calculate Low Density Lipoprotein- Cholesterol (LDL-C) due to its simplicity and convenience although it has limitations. Many researchers have proposed different formulae to increase the accuracy of calculated LDL-C, but none of those have concluded about a single best formula owing to differences in selected study populations. As LDL-C measurement is of utmost importance for assessing the cardiovascular risk according to National Cholesterol Education Programme’s (NCEP) Adult Treatment Panel III (ATP III), a search for a better formula to improve accuracy of cardiovascular disease (CVD) risk prediction is essential. Aim: To assess the validity of calculated LDL-C by nine formulae and compare them to values obtained by the direct method. Materials and Methods: A total of 324 participants were assessed retrospectively for serum lipid profile by standard methods from December 2020 to February 2021 at Employee State Insurance Corporation Medical College and Hospital, Sanathnagar, Hyderabad, Telangana, India. LDL-C was calculated using nine different formulae (Ahmadi, Anand, Chen, de Cordova, Friedewald, Hattori, Martin-Hopkins, Puavillai and Vujovic) and correlated with direct LDL-C. For further analysis, subjects were divided into five groups based on the Triglyceride levels (TG) viz; group 1 (TG <100 mg/dL), group 2 (TG: 100-150 mg/dL), group 3 (TG: 151-200 mg/dL), group 4 (TG: 201-400 mg/dL), group 5 (TG >400 mg/dL). Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 23.0. Results: Total of 324 lipid profile reports were analysed and calculated LDL-C by nine formulas were compared. At TG levels <100 mg/dL, Puavillai was the most accurate. Between TG levels 100-200 mg/dL, Martin-Hopkins showed better accuracy and correlation with direct LDL-C. At TG levels 201-400 and >400 mg/dL, Puavillai had better accuracy. But, none of the formulae showed strong correlation with Direct LDL-C at TG >400 mg/dL. ROC curves also showed that Puavillai performed better among all formulae, at all TG levels. Conclusion: Among the nine equations, Puavillai and Martin-Hopkins showed highest accuracy and better performance than others in the present study population. Martin-Hopkins can be used at TG levels of 100-200 mg/dL while Puavillai can be used at lower and higher TG levels in this demographic population for estimating LDL-C.

Referral Patterns for Furcation Management among Dental Clinicians in an Academic Setting- A Preliminary Study

Introduction: A critical prognostic factor in multirooted teeth is the involvement of furcation. This can often pose challenges to the clinicians which makes them lean towards extraction and replacement rather than a comprehensive periodontal treatment. Aim: To evaluate the choice of treatment and referral pattern for advanced Furcation Involvement (FI) among dental clinicians. Materials and Methods: This was a cross-sectional study conducted in the Department of Periodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India from August 2018 to September 2019. In this study, two complete case details of furcation involved teeth (C1 and C2) were distributed among the dental faculty of different specialities other than periodontics from various dental colleges in Chennai, India. Both cases were complex and manageable by experienced Periodontists. A total of 414 clinicians completed a closed-ended questionnaire consisting of 15 questions. The questions were grouped under 4 domains, evaluating their diagnosing capability, treatment planning expertise, referral pattern to Periodontist and their insight on periodontal treatment outcomes. The collected data were analysed using Statistical Package for the Social Sciences (SPSS) software 23.0 version. Pearson’s Chi-square test was carried out to find association between specialties, years of experience and age with all questions regarding case scenario and periodontal disease management. The p-value of ≤0.05 was considered to be statistically significant. Results: A total of 414 dental clinicians completed the questionnaire, the response rate being 95.2%. Of the total, 178 (43%) were males and 236 (57%) were females. The participants who opted for periodontal treatment accounted for 57.7% for C1 and 86% for C2. Total 31.2% for C1 and 5.8% for C2 opted for extraction and Fixed Partial Denture (FPD), whereas, only 8.7% for C1 and 3.9% for C2 opted for extraction and implant placement. The endodontists opted more for periodontal management. The prosthodontists, for C1 (48.1%) and oral surgeons for C2 (11.4%) showed more interest towards extraction and FPD. The clinicians with 10-20 years experience identified the defect more appropriately (82.5% for C1 and 47.5% for C2), (p-value <0.001) and suggested appropriate management {57.5% for C1 (p-value <0.001) and 65% for C2}. Of the cohort, 20.8% of the entire population and 50% with >20 years of experience constantly referred their patients for periodontal opinion and management (p-value <0.001). Conclusion: Periodontal therapy for furcation involved molars seemed to be widely accepted by the survey respondents than extraction of the tooth followed by implants or FPD. The important factors affecting referral were the specialty of the dental clinicians and the number of years of clinical experience.

Impact of Knee Osteoarthritis on Physical Performance and Quality of Life in Obese Adults: A Cross-sectional Study

B Keerthana, N Malasree, R Angeline, N Venkatesh, K Soundararajan

Introduction: Obese subjects with Knee Osteoarthritis (KOA) demonstrate poor Physical Performance (PP) and impaired Quality Of Life (QOL). The burden of OA in obese subjects is not well understood. Aim: To evaluate PP and QOL in obese subjects with KOA and in obese subjects without KOA. Materials and Methods: A cross-sectional observational study was conducted at the Outpatient Physiotherapy Department, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from July 2017 to June 2018. Twenty-four obese subjects with and without KOA were included in the current study based on their BMI and American College of Rheumatological criteria for OA knee. The subjects were randomly allocated into two groups with; Obese KOA and Obese non KOA. All subjects were evaluated for anthropometric (BMI, Waist-Hip Ratio and Fat Percentage) and PP {30 Second Chair Stand Test (SCST), Stair Climb Test (SCT), 40 m Fast-Paced Walk Test (40 m FPWT), Timed up and Go test (TUGT), 6 Minute Walk Test (6 MWT)}. Additionally, all subjects responded to self-reported disability measures (KOA Outcome Score - KOOS) and Medical Outcome Study Short Form measure (SF-36). Results: Intergroup statistical difference was found in both PP and QOL. The PP and QOL was significantly lower in obese KOA subjects when compared with their counterparts, {mean±SD; 30 SCST (8.58±1.62 vs 17.08±3.26), SCT (36.25±13.16 vs 9.58±1.62), 40 m FPWT (64.75±14.35 vs 29.92±3.99), TUGT (17.7±2.42 vs 7.58±1.51), 6 MWT (244.25±63.03 vs 508.83±76.42), KOOS (42.52±5.73 vs 91.42±4.58), SF-36- Physical, Mental Cumulative Health Score (36.23±5.7, 45.52±9.13 ; 53.80±2.15, 53.89±2.47); (p<0.05)}. Conclusion: The KOA is a predictor for reduction of PP and QOL among obese subjects. Early physiotherapy intervention of obese subjects may prevent KOA and helps to progress or maintain PP and QOL in obese subjects.

Impact of Training on Knowledge, Attitude and Perceived Barriers for Compliance Regarding use of Personal Protective Equipment Kit among Frontline Healthcare Workers during COVID-19 Pandemic

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the novel Coronavirus, the causative agent of Coronavirus Disease-2019 (COVID-19) pandemic has grasped the whole world. Healthcare Workers (HCWs) are at an increased risk. The usage and awareness of entire Personal Protective Equipment (PPE) kit in hospitals on such wide scale has not been seen for some time in healthcare setting. Improper use of these equipment may result in the spread of infection. Aim: To assess the knowledge and attitude of HCWs regarding the correct use of PPE at the beginning of COVID-19 pandemic in order to find the gap in knowledge and to address the perceived barriers in compliance and further to assess the same after training and reinforcement to ensure the HCWs safety. Materials and Methods: A cross-sectional hospital based study was carried out in a designated COVID-19 hospital of Shaheed Hasan Khan Mewati Government Medical College from April 2020 to October 2020 on frontline HCWs posted in various areas of hospital. Sample size was calculated as a minimum of 500 HCWs using appropriate statistical formula. A predesigned, pretested structured questionnaire both online and offline mode was used. The data that was obtained was analysed using Statistical Package for the Social Science (SPSS) version 20.0. Results: Seven hundred frontline HCWs were included in the study. Mean age of study population was 30.5 years. Among 700 HCWs, 200 (28.57%) were doctors, 360 (51.42%) were nursing staff and 140 (20%) were housekeeping staff. Knowledge level of PPE kit and its use varied across doctors, nursing staff and housekeeping staff. Knowledge about donning and doffing was largely lacking with only 9% doctors and none of other staff were aware which improved to more than 80% post-training. Attitude regarding PPE kit usage was largely positive. Conclusion: The study concludes that there is a constant need of training and re-training of HCWs in order to keep them safe from not only COVID-19 but also from future infections. An active infection prevention training program is crucial to ensure HCWs safety.

A Novel Custom Fabricated Teeth Guard for Boyle Davis Mouth Gag- A Feasibility Study

Introduction: Despite increase in the knowledge about reduction of dental injuries after tonsillectomy, the incidence is still considerable to attract attention. Presently gauze pieces, rubber or soft plastic materials are used. Hence, it was attempted to use a soft elastomeric putty dental material for this purpose which moulds perfectly to the shape of the upper dentition when applied and also gives full coverage of teeth with no reduction of the space when mouth is opened for surgery. It also gives better protection to the upper dentition as the gag fits perfectly on to it when applied. This, unlike gauze piece threads does not get interwined between the gaps of malaligned, prominent or crooked teeth, thereby offering superior protection. Aim: To describe the feasibility of custom fabricated teeth guard for Boyle Davis mouth gag in oral and oropharyngeal surgeries. Materials and Methods: An cross-sectional study was conducted in the Department of Ear, Nose and Throat, Mahatma Gandhi Medical College, Puducherry, India, in association with Indira Gandhi Institute of Dental Sciences, kerala, India, from February to April 2019. The equipment was simple, comprising of a paste of elastomeric silicone putty which had a base and catalyst which was custom made for the patient, just minutes before application over the patient’s upper dentition and over which the Boyle Davis mouth gag was applied and then the mouth opened for surgery. Total 50 consecutive patients, in the age group of 6-18 posted for tonsillectomy, were inserted with the equipment before application of Boyle Davis (BD) gag. The ease of insertion with a score of 1-4 was recorded from the surgeon. Postoperatively, once the gag was removed along with the custom made putty, the patient’s upper dentition was examined to look for any dental injuries that might have occurred due to gag insertion. The comfort level was assessed by a targeted questionnaire over a scale of difficulty from 1-4, 1 being comfortable and 4 being difficult. Results: The mean age of the patients was 10.56 years with the mean weight of 38.55 kilograms. There were 27 males and 23 females. In all the patients, pre and perioperative period was uneventful. The ease of insertion score was 1 in all the 50 patients; there were no oral injuries and no residual side-effects due to the material used. The mean score for comfort level was 1.8. Conclusion: An indigenously made elastomeric teeth guard is extremely effective in preventing dental injuries after application of Boyle Davis mouth gags in cases of adenotonsillectomy under controlled general anaesthesia.

Correlational Analysis of Socio-demographic and Clinical Profile in Determining the Treatment Response in Patients with Catatonia in the Psychiatric Inpatient Department of a Rural Tertiary Care Centre in Eastern India

Avik Kumar Layek, Uttam Majumder, Parthasarathy Biswas

Introduction: Catatonia, a poorly understood syndrome challen-ging the clinician’s diagnostic and management skills, has scarce literatures regarding the clinical correlates and determining factors towards treatment response. Aim: To find the correlates of socio-demographic, clinical profile, catatonic features and identifying determining factors of treatment response to lorazepam and Modified Electroconvulsive Therapy (MECT) in catatonia. Materials and Methods: This cross-sectional study was conducted at the Department of Psychiatry, North Bengal Medical College, Siliguri, West Bengal, India from January 2020 to February 2021. The catatonia cases satisfying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were studied. A total of 66 patients were evaluated using the 23-item Bush Francis Catatonia Rating Scale (BFCRS) for severity and later grouped into lorazepam responder (Group I) and non responders (Group II) who received MECT. Background diagnoses using DSM-5 was made after symptom resolution. Statistical analyses like Chi-square and student’s t-test to compare frequencies and means respectively, Pearson’s and Spearman’s correlation test for bivariate correlation and linear and logistic regression to predict factors for treatment outcome were employed using Statistical Package for the Social Sciences (SPSS) 16.0 with a p-value <0.05 considered significant. Results: Among 66 patients, group I had total 54 patients (mean age=25.25±7.03 years) and group II had 12 patients (mean age=23.25±4.30 years). Schizophrenia spectrum disorders were the major underlying psychiatric diagnosis. The MECT was needed in 58.33% of patients with positive family history of psychiatric disorders as compared to 14.81% who responded to lorazepam (p-value=0.001). Severity of catatonia measured by the total BFCRS Scores was higher in the Group II (p-value <0.001). Positive family history (Spearman’s rho=-0.512, p-value <0.001) and longer hospital stay (Spearman’s correlation coefficient=0.344; p-value=0.005) had significant correlation to catatonic severity. The BFCRS subscale bivariate correlational analysis showed high scores on immobility, mutism, staring, grimacing, rigidity, negativism, withdrawal and autonomic abnormality correlated significantly with MECT response. High scores on stereotypy, waxy flexibility and excitement correlated significantly with lorazepam response. Conclusion: Lorazepam was effective in most cases. Higher scores on BFCRS, positive family history of psychiatric illness, presence of mutism, rigidity, immobility, withdrawal and negativism correlated with lorazepam resistance and MECT response. Waxy flexibility, stereotypy and excitement correlated to lorazepam response. Severity of catatonic symptoms and positive family history were the determining factor for non response to Lorazepam. This could provide insight into the management strategies and treatment protocol in catatonia.

Sequential Shock Index as a Prognostic Marker in Children with Septic Shock- A Cohort Study

Gulnaz Nadri, Deepti Jain, Vineeta Wadhwa

Introduction: Shock Index (SI), is a simple ratio of Heart Rate (HR) and Systolic Blood Pressure (SBP) and a good marker of haemodynamic stability than HR or SBP individually. Aim: To assess the prognostic value of sequential SI and to compare whether higher SI at admission or worsening SI since admission predicts higher mortality in children. Materials and Methods: The present cohort study included 50 children between 1-5 years who presented in the Paediatric emergency with shock. The HR, SBP and SI were calculated at 0 and 6 hours of admission. According to the changes in SI over time, the children were divided into four groups, Group 1 (normal SI at 0 and 6 hours), Group 2 (normal SI at 0 hours and abnormal SI at 6 hours), Group 3 (abnormal SI at 0 hours and normal SI at 6 hours), Group 4 (abnormal SI at 0 and 6 hours). They were followed to their condition at discharge and were further subdivided into two groups (survived/died). The relative risk of death was compared among the groups. Results: Taking the first group as the reference, the relative risk of mortality was 1.442 (Group 2), 1.026 (Group 3), 2.712 (Group 4) i.e., the risk of mortality was highest in the children with worsening SI since admission. Difference in SI at 0 and 6 hours was statistically significant between survivors and non survivors (p=0.001, p<0.001, respectively). In the ROC, SI at 0 hours (0.877) had more sensitivity than SI at 6 hours (0.863). Conclusion: The SI is a simple, non invasive, cost-effective and a quick tool to detect patients with high risk of mortality and can be used as a quick non invasive method for prompt identification and categorisation of critical illness in Emergency Department. It should be added to HR and SBP, thereby assisting in early identification of septic shock and also the need for aggressive management. Sequential SI values can have a better prognostic value than single admission SI.

Furcation Anatomy Revisited: A Twodimensional Radiographic Evaluation of Healthy Mandibular Molars

Introduction: Furcation regions present some of the most significant challenges to the successful outcome of periodontal therapy. Due to their anatomical complexities, the areas become inaccessible, and instrumentation is generally tricky and often incomplete. Hence, it is essential to have a thorough knowledge of molar anatomy to assess the case difficulty, appropriate diagnosis, and treatment planning. Aim: To radiographically evaluate and classify the furcation anatomy of mandibular first and second molars based on root trunk length and root divergence angle. Materials and Methods: This retrospective observational study was carried out in AB Shetty Memorial Institute of Dental sciences, Mangalore between February and March 2020. Orthopantomograms (OPG) with permanent healthy first (25 right and 25 left) and second mandibular molars (25 right and 25 left) with no alveolar bone loss obtained from systemically healthy individuals were selected for the study. They were screened for root divergence angle and root length to root trunk length ratio. According to the root divergence angle, the total sample was classified as Group I (with angle <30°), Group II (with angle 30°to 60°), Group III (with angle >60°). They were classified into Type A, B, and C based on Hou and Tsai classification. Type A root trunks involving the cervical third or less, Type B involves upto cervical half of the length of the root and Type C involves cervical two-thirds of the root, respectively. The data were collected and entered in the Microsoft Excel sheet. Mean and standard deviation was calculated for root divergence. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Student t-test was used to compare intragroup variations in root divergence in the left and right molars. The p<0.05 was considered to be significant. Results: Total 100 teeth (50 mandibular first molar (25 left and 25 right) and 50 mandibular second molars (25 left and 25 right)) were included in the study and analysed. In terms of Furcation Angle (FA), mandibular left first molar showed an increased frequency of Group II (48%) and Group III (48%), while mandibular left second molar showed an increased frequency of Group II (68%). Among mandibular right first molar Group III (56%) showed an increased frequency, while Group II (92%) was commonly seen in right second molar. Intergroup comparison revealed a statistically significant difference in divergence between mandibular left first and second molars (36 and 37) p<0.01, mandibular right first and second molars (46 and 47) (p<0.01). Divergence of furcation was more significant in 36 and 46 than 37 and 47, respectively. The current study results showed a higher frequency of Type A in all the four involved teeth, i.e., left first (96%) and second (68%) molars, right first (92%) and second (88%) molars. Conclusion: The study results showed an increased frequency of Group II FA and Type A root trunks. The divergence of furcation was greater in first molars compared to the second molars.

Role of Magnetic Resonance Imaging in Diabetic Foot: A Cross-sectional Study

Introduction: Diabetes related foot problems like osteomyelitis and Charcot (neuro-osteoarthropathy) are associated with high morbidity and high healthcare costs. Soft tissue and bone infection involving the foot is particularly common in patients with diabetes mellitus. Osteomyelitis and neuropathic osteoarthropathy often co-exists in diabetes. Differentiating between these two entities is often difficult but crucial as the management may differ significantly. Aim: To assess the role of Magnetic Resonance Imaging (MRI) in diabetic foot and its ability to identify features which help to reliably differentiate infection from neuropathy and to describe the MRI imaging findings of infection and neuropathic changes in diabetic foot. Materials and Methods: The present cross-sectional study was conducted in Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India, from June 2013 to October 2015. All diabetic patients with suspected osteomyelitis or charcot who were referred for MRI were included. MRI was interpreted based on the following parameters location, distribution of oedema pattern, deformity, soft tissue changes and bone marrow signal change. Forty eight patients with diabetic foot, who underwent foot surgery with debridement or drainage and MR findings of the patient were compared with histopathology or culture respectively. Comparison of MR findings were also done with Computed Tomography (CT)/Positron Emission Tomography (PET) wherever available. Results: In this study, MRI findings with focal single bone involvement along with diffuse marrow oedema pattern, absence of deformity, forefoot/hindfoot location, presence of soft tissue changes like ulcer/sinus tract/fistulas and abscess formation were in favour of osteomyelitis. Several bones and joints involvement along with subchondral/periarticular location, presence of deformity, absence of soft tissue changes and midfoot location were in favour of Charcot’s. Conclusion: The MRI was found to be the most reliable and sensible tool for imaging techniques to differentiate osteomyelitis with diabetic neuropathic arthropathy, with the sensitivity and specificity of MRI as 83.3% and 77.8%, respectively.

Evaluation of Clinical and Pathological Response in Breast Cancer Following Neoadjuvant Chemotherapy- A Single Institution Experience

Introduction: In locally advanced breast cancer, Neoadjuvant Chemotherapy (NACT) is the mainstay of treatment. NACT is also considered as a potentially helpful treatment option in early-stage HER2 positive and triple-negative breast cancer. Aim: To assess pathological Complete Response (pCR) in patients with breast cancer who received NACT and to evaluate the association with clinical and pathological factors. Materials and Methods: The present retrospective analysis was conducted at Breast Oncology Division of Regional Cancer Centre, Thiruvananthapuram, Kerala, India, from January 2013 to December 2015. The data of patients with invasive breast cancer who received NACT were retrieved from medical records and analysed in August 2021. In the surgical pathology specimens, pCR was defined as ypT0 ypN0: no residual invasive cancer and/or in-situ cancer in the breast or axillary lymph nodes. All factors identified with univariate analyses were entered into multivariate analysis, and statistical analysis was done using logistic regression. The p-value <0.05 was considered significant. Results: This study included 586 breast cancer patients who received NACT, with mean age of 50.7 years. The proportion of postmenopausal patients was higher than premenopausal patients (56.3% vs 43.7%). Overall, 21.3% patients (125/586) attained pCR (ypT0 ypN0). In univariate analysis, factors associated with pCR were higher histologic grade (grade III) of tumour {Odds Ratio (OR): 2.879, 95% Confidence Interval (CI): 1.615-5.129, p-value=0.001)}, lower composite clinical stage (OR: 2.236, 95% CI: 1.468-3.408, p-value=0.001), lack of Oestrogen Receptor (ER) expression (OR: 3.23,95% CI: 2.10-4.968, p-value=0.001) and lack of Progesterone Receptor (PR) expression (OR: 4.396, 95% CI: 2.714-7.121, p-value=0.001). Higher grade of tumour (OR: 2.211, 95% CI: 1.179-4.146, p-value=0.013), lower composite clinical stage (OR: 2.033, 95% CI: 1.262-3.276, p-value=0.004) and lack of PR expression (OR: 3.823, 95% CI: 2.301-6.350, p-value=0.001) remained predictive variables in multivariate analysis after correction for the other variables. Conclusion: The lower composite clinical stage, lack of Progesterone Receptor (PR) expression and higher histologic grade of tumour are associated with good response to NACT in breast cancer patients.

Hepatitis B and C Viral Infections among Dialysis Patients and Related Factors of Dialysis Centres in Saudi Arabia

Badr M Aljarallah

Introduction: Viral Hepatitis is a global disease, affecting millions of patients around the world. Dialysis dependent patients use an artificial kidney (haemodialyser) to remove waste product from the blood in severe renal impairment patients. Hence, they are more vulnerable to viral hepatitis. Aim: To investigate the prevalence of hepatitis B and C infections among dialysis patients and related factors of dialysis centres in the Qassim province, Saudi Arabia. Materials and Methods: This cross-sectional study, reviewed the medical records of 707 patients from the data registry of 18 affiliated dialysis centres across Al Qassim region of Saudi Arabia, during August 2017 to August 2018. A detailed questionnaire regarding the general information about the dialysis centre, isolation and screen status, vaccination status, and vascular access was completed by the Dialysis Centre Manager of all the 18 affiliated centres. The details of Hepatitis B Surface Antigen (HBsAg) and Hepatitis C Virus (HCV) serology reports were extracted to establish the prevalence and epidemiological profile of these patients. Descriptive analysis was conducted, where numbers and percentages were used to summarise all categorical variables. Results: The majority 14 (77.8%) of the centres were government entities and the rest were for profit centres. Out of the 18 centres, 10 (55.6%) were hospital based, 5 (27.8%) were free-standing and 3 (16.7%) were free-standing but owned by a hospital. The prevalence of HBsAg positive cases among incentre haemodialysis patients was 3.2% and the prevalence of Hepatitis C (HBC) antibody positive cases was 6.4% with 0.3% cases of the HBsAg and HBC converted to positive during the previous 12 months. Conclusion: The incidence of hepatitis B and C positivity was common in patients receiving haemodialysis. The study found low prevalence of both Hepatitis B and C positive cases in comparison to several published articles. The decrease in HBV and HBC prevalence seen in the present study may be attributable to the development and implementation of preventive strategies, increased adherence by medical staff to aseptic measures, better infection management, immunisation, and isolation of affected patients. However, further studies are needed to generalise the outcome of the present study.

Cardiovascular and Metabolic Adverse Reactions Associated with the Use of Antipsychotic Drugs: A Narrative Review

The adverse drug reaction profile of antipsychotic drugs includes neurological, endocrinal anticholinergic and cardiovascular effects. The profile of each cardiovascular adverse effects, specific for each antipsychotic medication includes QT prolongation, orthostatic hypotension, myocarditis and metabolic effects, it also reduce the life expectancy of schizophrenic patients. There is a major clinical concern for the patients on long term therapy. This narrative review is focused on the cardiovascular profile of antipsychotic medications. The detailed aetiology, mechanism, monitoring and management of cardiovascular adverse effects are discussed in this review.

Low Intensity Pulsating Electromagnetic Field as an Adjunctive Therapy for Bone Regeneration around Fractures, Dental Implants and Orthodontic Therapy- A Clinical Update

Pulsed Electromagnetic Field (PEMF) is a non invasive, therapeutic form of low field magnetic stimulation that has been used for several years to supplement bone healing. It is known to generate pulsating magnetic frequencies within the body that accelerate the process of healing and reduce postoperative pain. The survival rate of dental implants over a 10-year observation has been reported to be higher than 90%. Success of dental implant therapy depends on the quality and quantity of available bone in which they are inserted. Implants with poor early or primary stability frequently may require additional time for osseointegration or may sometimes fail. Development of procedures which accelerate osseointegration of dental implants, reduce the period of healing, and lead to an early rehabilitation of the patient are required for successful oral rehabilitation. The potential for bone repair can be stimulated through non invasive adjunctive treatments such as application of pulsating electromagnetic field therapy, Low-Intensity Pulsed Ultrasound (LIPUS), and Low-Level Laser Therapy (LLLT). These methods of biophysical stimulation of bone union were developed initially to enhance the healing of fractures, healing of bony non unions and have been hypothesised to improve implant osseointegration. This study sought to report latest trends in PEMF Therapy stimulations in oral tissues and its use to enhance the bone repair and regeneration. Pulsed electromagnetic field stimulation to induce bone regeneration mandates a broad range of settings that include magnetic field intensity, frequency, type of signals and duration of application etc. The present study analyses these clinical settings in published human trials and is expected to serve as a treatment guide for the clinicians to bring into their clinical use these strategies to improve bone regeneration and implant osseointegration in deficient and osteoporotic bone.

An Insight into the Conventional and Ayurvedic Therapies for the Treatment of Parkinson’s Disease

Parkinson’s Disease (PD) is the second most common neurodegenerative disorder that has been the center of the vast majority of researches. The development of various environmental and transgenic animal models of PD has provided evidence for discovering new drug therapies. The management of PD has always been challenging due to the progressive neurodegeneration, numerous genetic and environmental risk factors, and a broad spectrum of Motor Symptoms (MS) and Non Motor Symptoms (NMS). Therapies such as levodopa etc., result in long term side-effects. In the last twenty years, more researches have been done on Ayurvedic herbal preparations showing their neuroprotective properties with minimal side-effects. Some of the most common herbal preparations are Bacopa monnieri, Mucuna Pruriens (MP), Withania Somnifera (WS) etc., which delay and slow down the neurodegeneration. The article focuses on the importance of ayurvedic therapies in management and treatment of PD.

Postoperative Outcomes Following Preoperative Respiratory Muscle Exercises in Patients Undergoing Abdominal Surgery: A Narrative Review

Prakashkumar Jayantibhai Patel, VP Hathila

Abdominal surgeries are the most common operative procedures including a wide range of both emergency and elective surgical interventions. Postoperative Pulmonary Complications (PPCs) following upper abdominal surgery are the most common surgical complications. The combined effect of surgical trauma and anaesthesia results in reduced lung volumes and respiratory muscle dysfunction. Chest physical therapy is widely recommended to prevent and treat PPCs, using a wide variety of techniques and devices, including incentive spirometry, continuous positive airway pressure, positive expiratory pressure, intrapulmonary percussive ventilation and Inspiratory Muscle Training (IMT) using a pressure threshold device that targets the muscles of inspiration. The present narrative review aimed to determine the available literature to evaluate whether preoperative respiratory muscle training is effective on pulmonary function test, Respiratory Muscle Strength (RMS) and preventing PPCs after abdominal surgery. A computer-based literature search was done using the PubMed, PubMed Central, Science Direct and Google Scholar. Relevant articles with full text published in English from 1995 to 2021 were screened and included. Studies were included which had preoperative physiotherapy techniques on patients undergoing abdominal surgery. Editorials, commentaries, discussion papers, conference abstracts, reviews and duplicates were excluded. After screening, only studies with full text articles were included that comprised of nine relevant articles. It is imperative to discover the probable outcome of preoperative respiratory exercises training. Hence, a review could be helpful in delivering a perception about which exercises program could cause improved and enhanced postoperative outcome.

A Review of Hyperuricaemia Management with Febuxostat: Dosage Titration, Monitoring and Maintenance

Deepak Shankar Ray, Tiny Nair, Ramesh Dargad, Verinder Dhar

The burden of hyperuricaemia has been steadily increasing both globally and in India. The increasing number of hyperuricaemia-associated co-morbidities, such as Chronic Kidney Disease (CKD), Type 2 Diabetes Mellitus (T2DM), Cardiovascular Diseases (CVD), and hypertension, implies that hyperuricaemia is associated with an increased risk of other chronic conditions or diseases. Despite the availability of several guidelines on hyperuricaemia, recommendations for appropriate titration of Urate Lowering Therapy (ULT) to achieve and maintain appropriate serum Uric Acid (sUA) levels in the Indian context are unclear. Another important challenge is the diagnosis and management of asymptomatic hyperuricaemia with ULT. This review summarises evidence-based discussion and review of literature by expert panellists on hyperuricaemia management with ULT, particularly with Xanthine Oxidase (XO) inhibitors. Based on the discussion, the experts developed a dose-titration algorithm for initiation and long-term management of hyperuricaemia with ULT, comprising febuxostat. The review also highlights some of the current challenges in hyperuricaemia management, which when addressed would benefit primary care physicians across the country for early screening and timely management of hyperuricaemia.

Biosensors in the Field of Dentistry

Biosensors are small, integrated, self-contained and self-analysing scientific devices that are used to identify and measure topics of interest. Biological detection components (e.g., enzymes, antibodies and nucleic acids) are closely related to transducers (e.g., optical, electrochemical, piezoelectric) that makes the concept of biodegradation more complex and quantitative. As a general rule, the strength of the output signal corresponds to a group of analysers. Finally, the results are created using applied gadgets and the programming framework that are involved. These provide an easier and advanced visualisation that can be handled even by a non expert. In simpler words biosensor can be termed as an ‘easy-to-use’ tool for diagnostic purposes, that are developed to help in the early diagnosis and treatment of disease. Early diagnosis is the key to successful treatment of many diseases. Biosensors utilise the unique properties of biological and physical materials to recognise a target molecule and effect transduction of an electronic signal. The key advantages of biosensors are fast responsiveness and high sensitivity. Also, the basic advantage for ‘Point of Care’ (POC) devices such as biosensors would include integration of nano materials, microfluidics, automatic samplers and transduction devices on a single chip. Biosensors are also being used as new analytical tools to study medicine related diagnostic aspects. This paper reviews the significance of biosensors for clinical diagnosis and therapeutic applications in the field of dentistry and its application during the Coronavirus Disease 2019 (COVID-19) pandemic era. It provides a comprehensive account of progress in biosensors for dental applications.

Sarcopenia- A Growing Geriatric Giant of Society

Kairavi Kishorbhai Trivedi, Subhash Khatri

The process of aging is associated with various structural and functional changes in the body. During aging, loss of muscle tissue and muscle mass make the individual bed bound and physically disabled. The term “sarcopenia” refers to loss of muscle mass, strength and function in older subjects. There are many theories like mitochondrial dysfunction, hormonal changes, decline in neural function, reduced satellite cell function, chronic inflammation support the process of sarcopenia in later life. Though, still the proper pathophysiology remains unclear in sarcopenia. There are various groups of criteria for defining sarcopenia like European Working Group on Sarcopenia Older People (EWGSOP), International Working Group on Sarcopenia (IWGS) and European Society for Clinical Nutrition and Metabolism-Special Interest Group (ESPEN-SIG), Asian Working Group for Sarcopenia (AWGS). Among these, AWGS criteria are mainly used for screening of Asian patients. Various non imaging and imaging techniques are also available for diagnosing sarcopenia. Mainly diet, nutrition and physical healthy lifestyle are needed to prevent sarcopenia. In physical therapy aerobic training, resistance training, group therapy, whole body vibration therapy are available for sarcopenia patients. Among these therapies, a combination of diet (protein, amino acids supplements) and endurance training are useful approach. The pathophysiology and diagnostic criteria could be useful to do early detection of the disease in geriatric populations. To reduce severity and avoid further progression of the disease proper treatment options are needed. Further researches are required to develop effective exercise regime for the treatment of sarcopenia.

Influence of Protein Diet on Weight Change in Obesity: A Systematic Review

Keng Sue Yin, Nur Aishah Che Roos, Justin Gnanou, Brinnell Caszo

Introduction: High protein in the diet has been shown to have a beneficial effect in promoting weight loss through its effect on satiety. This effect is mediated in part by the release of anorexigenic hormones which decrease subsequent food intake, leading to weight loss. A high protein content enhances muscle mass, has a higher thermogenic effect. The effect of a high protein meal on weight loss and satiety has been the subject of concern as only few studies are available. Therefore, the rationale of this review was to investigate the evidence supporting a relationship between protein content on weight loss and satiety in obese subjects. Aim: The aim of this systematic review was to compare the effect of high dietary protein versus normal protein content or non protein diet on both weight loss and satiety in obesity. Materials and Methods: In this systematic review, the studies were identified by searching Ovid Medline, Scopus, PubMed, and Evidence Based Medicine (EBM)-review Cochrane database and was restricted to English language only, from the inception until 10^th June 2019. Studies which were included fulfilled the following criteria: Randomised Controlled Trial (RCT) duration of atleast 3 weeks; subject age ≥18-year-old; obese or overweight subject whose Body Mass Index (BMI) ≥25; composition of protein diet of 20-30%; satiety assessment by the Visual Analogue Scale (VAS) and Satiety Quotient (SQ); report on the mean difference of weight loss. Results: Total 727 studies were screened, eleven studies were selected as they fulfilled the inclusion criteria. In the overall analysis, five studies revealed a significant difference in satiety measurement while only three studies had observed significant difference in weight loss. The remaining studies showed a similar mean weight loss and satiety outcome achieved in both the control and intervention groups. Conclusion: The present systematic review demonstrated that the high protein content in the diet shows no significant effect on weight loss and satiety. However, it is important to note that though weight loss is mainly due to energy restriction, high protein in diet could influence satiety and thus both can complement each other.

Contributing Factors of Hypothyroidism- A Systematic Review

Salina Sunil, KC Leena

Introduction: Hypothyroidism is an emerging public health concern, which need to be of due significance. Inspite of iodine supplementation started three decades ago, hypothyroidism is still a problem to be tackled. Apart from iodine deficiency, the contributing factors of hypothyroidism have to explored. Aim: To identify the contributing factors of hypothyroidism in adults. Materials and Methods: A systematic literature search was done using PubMed, MEDLINE, Embase, Google Scholar and the internet search from 2000 to 2018. The key words used were hypothyroidism, thyroid disorders, underactive thyroid, contributing factors, causes and associative factors. All the articles were analysed and the data were extracted using eligibility (inclusion and exclusion criteria) criteria. A total of 14 articles, which are either review articles or systematic reviews, in English language, and are fully retrievable were analysed and a systematic review was performed. Among the reviews, nine were review analysis and five were systematic reviews. The risk of bias assessment was done at the study level and data synthesis was done based on the criteria satisfied by the checklist. Results: The present analysis has included studies related to contributing factors of hypothyroidism. The analysis revealed the following contributing factors of hypothyroidism. Too little or too much iodine (43%), excess fluoride (7%), female gender (14%), presence Thyroid Per Oxidise (TPO) antibodies (36%), smoking status (14%), age above 70 years (21%), unregulated use of pesticides (14%), contaminated drinking water (14%), certain medicines (29%), use of plastic bottles contain Bisphenol A (BPA) and paper cups insulated with plastics (7%) and exposure to goitrogens (7%). Conclusion: Hypothyroidism is a leading emerging health problem in India. The prevalence is 11-15%. Despite the fact iodine fortification since 1983, hypothyroidism is a major public health to be tackled. In the current review five studies from India were included. Most of the studies showed the iodine as the contributing factor either in too much level or too little level.

Will AETCOM Resurrect Empathy in Medical Profession? A Lost Touch of Compassionate Communication

Niraj Rathod, Seema Rawat, Uttam Kumar Solanki, Komal Makwana

To make the existing Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum more effective as per the healthcare needs of the nation, the Medical Council of India (MCI) has taken a bold step by proposing new teaching-learning approaches including, a structured longitudinal program on attitude, ethics, and communication, which is named as the Attitude, Ethics and Communication Module (AETCOM). Intervention like AETCOM is required because the fragmental, ignored and traditional approach of learning empathy and communication was not standardised nor effective. This lead to devastated doctor patient relationship resulting in rising number of medicolegal cases in the scenario. It’s been two years since the introduction of the module and many studies have been conducted to analyse the effectiveness of the same. However, some questions still remain unanswered, such as- Will this introduction of humanities in medicine infuse values and art of medicine with ever-growing science? Will it be successful in inculcating probity in Indian medical graduate? If no, then what needs to be done to get a better outcome for the same. Authors want to spread awareness by sparking curiosity in both medical and general population through this article and in the process, make efforts wants to find out improvements to be done right now to ensure we get good doctors in the future.

Congenital Absence of Stapedius Muscle and Tendon: Case Report with Review of Literature

Samyadipta Dey, Mainak Dutta, Saibal Misra

Absence of stapedius muscle and its tendon is an extremely rare congenital anomaly, with only nine indexed reports in live patients. It presents with non progressive, occasionally bilateral conductive deafness, although this cannot be confirmed from Pure Tone Audiometry (PTA) and High Resolution Computed Tomography (HRCT). This makes it one of the least probable differential diagnosis of conductive deafness with unremarkable tympanic membrane. The definitive diagnosis is made only at time of surgery. The condition often co-exists with other genetic/acquired disorders of the middle/inner ear (otosclerosis, tympanosclerosis, etc.,). In absence of standardised, evidence based management protocol, diagnosis and appropriate treatment become challenging, and are predominantly situational. Its occurrence follows complex embryologic sequences where the internal portion of the interhyale- the mesenchymal condensation separating the cranial mesenchyme of the second pharyngeal arch (stapedial anlage) from Reichert’s cartilage- remains either absent or undergoes regression. Here, authors presents a case of 19-year-old female with congenital absence of stapedius muscle and tendon. She presented with congenital, bilateral, non progressive, moderate conductive hearing loss, and was diagnosed with this condition at surgery. There was co-existent tympanosclerosis in the middle ear that resulted in ossicular chain fixation and absence of round window reflex. The tympanosclerotic plaques were meticulously removed, ossicular chain mobility was restored, and a type II ossiculoplasty was done, along with reconstruction of the posterosuperior bony canal wall with cartilage perichondrium complex. Apart from the clinical presentation and its management, the present report also emphasises the plausible theories on relevant embryology explaining such an unusual event.

Fracture in a Person with Spinal Cord Injury with Heterotopic Ossification due to Improper Exercise in Pandemic: A Case Report

Raktim Swarnakar, Shreya Santra, SL Yadav

Fractures following inappropriate exercises are rarely reported in Spinal Cord Injury (SCI) population. During pandemic, physical inactivity and barriers to access to rehabilitation facility are conspicuous. Authors report a case of 23-year-old male with femur fracture following improper exercise and its interrelationship with Heterotopic Ossification (HO) and impact of pandemic. Patient reported with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade C tetraplegia, presented with operated left femur shaft fracture following care-partner administered sudden improper exercise. X-ray of left hip and femur revealed HO around left hip joint and intramedullary nailing of shaft of femur. Routine rehabilitation protocol for SCI was followed especially focusing on safety home-exercise precaution program during pandemic time. To the best of our knowledge, this is the first case report of long bone fracture in a person with SCI following improper exercise which is influence by pandemic situation. Here, authors described the causation of fracture in perspective of the vicious cycle of HO, improper exercise and pandemic impact. Further studies are required to find out appropriate precautionary guidelines regarding exercise during pandemic times for people with SCI.

A Case of Dengue Co-infection with Microfilaria

K Sarika, K Anbukkarasi, M Sai Sudha, Mary Lilly

Filariasis is one of the leading causes of long term and permanent disability worldwide. One of the main problem of the disease is that it remains dormant for years but the person is still capable of transmitting the infection to others. Over the past few years dengue has emerged as a rapidly growing and widespread public health problem, with more than half of the world’s population and countries at risk. Majority of cases are subclinical i.e., they are asymptomatic or present with mild flu-like symptoms which are often misdiagnosed as acute febrile illness leading to delay of treatment. Here, authors report a case of 20-year-old male, presented with continuous high grade fever for three days associated with severe headache and generalised body pain. On examination, patient was febrile and all vitals were normal. Laboratory results showed thrombocytopenia, increased haematocrit and peripheral smear findings showed leukopenia, thrombocytopenia and eosinophilia with microfilaria. Hence, this is a case of incidental finding of concurrent infection of dengue with microfilaria.

Correction: 2016 Apr:10(4): NC15-NC17

Abhinav Dhami, Renu Dhasmana, R.C. Nagpal, Correlation of Retinal Nerve Fiber Layer Thickness and Axial Length on Fourier Domain Optical Coherence Tomography (Published in Journal of Clinical and Diagnostic Research. 2016 Apr, 10(4): NC15 - NC17 ) There was a correction in The Second Author's Designation. This has been now corrected to Associate Professor. Issue 4, volume 10 (jcdr 2016)

Journal of clinical and diagnostic research

Conservative Management of Traumatic Intercostal Lung Hernia: A Case Report

Very Early Onset Severe Preeclampsia and Eclampsia Syndrome with Posterior Reversible Encephalopathy Syndrome- A Catastrophe

Intramedullary Spinal Ependymoma with Signet Ring Cell/Adipocytic Morphology- A Rare Case Report

A Rare Case of Bilateral Paratesticular Malignant Mesothelioma of Tunica Vaginalis with Bilateral Hydrocele

Pelvic Lipomatosis in a Young Male: A Case Report

Effect of Topical Application of Tea Tree Oil (Melaleuca alternifolia) on Hand Warts

Infective Endocarditis of Native Valves due to Aspergillus in an Immunocompetent Host: A Rare Presentation

Arachnoid Cyst: A Solitary Intracranial Cyst in the Occipital Lobe of the Cerebrum in a Cadaver

Acute Presentation of Upper Limb Ischaemia Requiring Amputation: A Case Report

Nicolau Syndrome in a Child Caused by Penicillin Injection

Eagle’s Syndrome- Enigma behind Atypical Orofacial Pain

Refractory Hypoglycaemia in Hepatocellular Carcinoma Treated with TACE Leading to Tumour Lysis Syndrome- A Double Trouble

Sacral Dural Arteriovenous Fistulas, a Rare and Underdiagnosed Subtype of Spinal Dural Arteriovenous Fistulas: A Case Series with Review of Literature

Breakthrough Cases of COVID-19 among Healthcare Workers: A Case Series

Ocular Rhinosporidiosis and Recurrence Postsurgery: A Case Series

A Rare Case of Familial Progressive Ataxia with Palatal Tremors

Carcinocythemia-associated Microangiopathic Haemolysis

Pictorial Essay of Named CT Signs in COVID-19 Pneumonia on High Resolution Computed Tomography

The Need to Emphasise on Confirmatory Test in the Diagnosis of Syphilis in Low and Middle Income Countries

In-vitro Study of Macelignan as a Potential Anticancer Drug against Colorectal Cancer using HCT116 Cell Line

Clinicoepidemiological Study on Patients with Dermatosis Papulosa Nigras and Acrochordons- A Longitudinal Study

A Bolt from the Blue for an Obstetrician: A Case Series of Life Threatening Surgical Emergencies following Evacuation of Unwanted Pregnancy

Effect of Saline Irrigation for Transurethral Resection of Prostate on Acid Base and Electrolyte Status- A Prospective Cohort Study

MU-Opioid Receptor (OPRM1) Gene Polymorphism and its Association with Alcohol Dependence: A Single Centre Study from Southern India

A Randomised Clinical Study on Haemodynamic Effects of Thiopentone and Etomidate as Induction Agents in General Anaesthesia

Surface Electromyography of Perianal Muscles in Children with and without Enuresis: A Cross-sectional Study

Effect of Preoperative Ketamine Nebulisation on Attenuation of Incidence and Severity of Postoperative Sore Throat, Hoarseness of Voice and Cough: A Randomised Double-blind Study

Diagnostic Accuracy of STANDARD Q COVID-19 Antigen Detection Kit in Comparison with RT-PCR Assay using Nasopharyngeal Samples in India

Comparison of Stress and Periodontal Health Status among Individuals Practicing Yoga with Age and Gender Matched Controls in Hyderabad City

Efficacy of Different Doses of 1% of 2-Chloroprocaine in Spinal Anaesthesia for below Umbilicus Surgery: A Randomised Clinical Trial

Comparative Evaluation of Flexural Strength and Surface Roughness of Three Different Commercially Available Provisional Restorative Materials: An In-vitro Study

Efficacy and Safety of Oral Terbinafine with Itraconazole or Griseofulvin Combination Therapy in the Management of Dermatophytosis- A Randomised Clinical Trial

Effects of Sintering Temperature and Finishing Procedure on Surface Roughness of Different Yttria Content Zirconia

Macroscopic Study of Temporoparietal Suture Closure at Autopsy for Estimation of Age

Prevalence of Tuberculosis in the North Indian Subcontinent Kashmir Valley: A Cross-sectional Hospital-based Study

Reduced sRAGE Production and ADAM10 Gene Expression in Peripheral Blood Samples of Diabetic Nephropathy Patients

Intraperitoneal Instillation of Magnesium Sulphate and Dexmedetomidine for Postoperative Analgesia after Laparoscopic Cholecystectomy- A Randomised Clinical Study

Assessment of Foetal Nuchal Translucency and its Relationship with Crown Rump Length in Normal Foetuses using Ultrasonography in a Subset of South Indian Population

Illness Perception and Quality of Life in Patients with Environmental Dermatoses: A Cross-sectional Study

Comparison of Percutaneous Instillation of Aqueous Jelly with Intravenous Contrast for Magnetic Resonance Fistulography- A Prospective Cohort Study

Effectiveness of Self-paced and Instructor-led Online Learning: A Study among Phase I Medical Students

Maternal Mortality: A Five Years Retrospective Analysis from a Tertiary Care Hospital, Rajasthan, India

Evaluation of Protein Carbonyl and Vitamin C in Seminal Plasma of Infertile Male: A Hospital-based Study in Bengali Population

Effect of Convolvulus pluricaulis and Omega-3 Fatty Acid alone and in Combination on Learning and Memory

National Conference on Innovations in Health Professions' Education Nov 17-18, 2021

Culture Positivity of Cerebrospinal Fluid by Automated Blood Culture System in Neonates: A Cross-sectional Study from Loni, Maharashtra, India

Factors Associated with Mortality among COVID-19 Patients Admitted in an Intensive Care Unit at a Tertiary Care Setting: A Retrospective Study from Mizoram, India

Robot Assisted Laparoscopic Repair of Vesicovaginal Fistula: A Retrospective Study at a Tertiary Care Centre, Chennai, India

Dexamethasone Induced Perineal Pruritus in Patients Undergoing Minor Oral Surgical Procedures- A Prospective Cohort Study

Evaluation of the Awareness and Knowledge of Orthodontic Treatment in Purvanchal Region (Uttar Pradesh): A Questionnaire-based Cross-sectional Study

Multiparametric Cranial Ultrasound Evaluation of Normal Neonatal Cerebral Ventricular Dimensions to Establish Nomograms in the Eastern Indian Population: A Cross-sectional Study

An Interventional Study on the Impact of Pictorial Primed Lecture Session towards the Performance at Lower and Higher Cognitive Domain Levels among 1st Year Medical Undergraduates

Variations in the Origin of Middle Hepatic Artery in Living Liver Donors using CT Angiography in South Indian Population: A Retrospective Study

Relationship between Stature and Hand Parameters in Adults- An Autopsy Study

Effect of Periglossal Electrical Stimulation on Haemodynamic Parameters in Stroke Patients- An Experimental Study

Behavioural Disturbances Related with Febrile Illnesses: A Hospital-based Longitudinal Study

A Study to Evaluate the Causes of Delayed Presentation for Cataract Surgery at a Tertiary Eye Centre, Odisha, India

Diagnostic Utility of Bone Marrow Examination in Bicytopenia

Attitude of Undergraduate Medical Students towards Classroom Lecture Absenteeism and its Association with Academic Performance

Antifungal Activity of Calliandra haematocephala against Selected Pathogenic Fungi: An In-vitro Study

Correlation between Pain, Disability and Levels of Disc Herniation in Michigan State University Grade-3 Disc Prolapsed Patients using Magnetic Resonance Imaging: A Cross-sectional Study

Effectiveness of Preoperative Multimedia Video-based Education on Anxiety and Haemodynamic Stability of Oncosurgery Patients Undergoing Spinal AnaesthesiaA Randomised Controlled Trial

Evaluation and Management of Suspicious Adnexal Masses in Pregnancy- A Retrospective Study

High Resolution Computed Tomography Findings of Pulmonary Fibrosis in COVID-19 Survivors and its Association with Inflammatory Markers- A Retrospective Study

Peritumoural and Tumour Infiltrating Lymphocytes in Breast Carcinoma and their Relation with Tumour Grade, Lymphovascular Emboli and Nodal Metastasis: A Cross-sectional Study

Effect of Water-based Inspiratory Muscle Training on Lung Functions and Respiratory Muscle Strength in Parkinson’s Disease: A Longitudinal Study

Factors Affecting Ambulatory Status in Children with Cerebral Palsy: A Cross-sectional Study

Autoantibody Profile of Childhood Onset Systemic Lupus Erythematosus: An Audit of Immunopathology Laboratory of a Tertiary Care Centre, Varanasi, India

Correlation between Age and Modified Star Excursion Balance Test in Healthcare Workers: A Cross-sectional Study

Comparison of Paediatric Index of Mortality 3, Paediatric Risk of Mortality III, Paediatric Logistic Organ Dysfunction-2 for Assessing Patient Mortality: A Prospective Observational Study

Prevalence of Anxiety and its Severity among Different Specialities of Healthcare Professionals during COVID-19 Pandemic

Systemic Immune-inflammation Index in Acute Coronary Syndrome and its Role in Predicting Disease Severity: A Cohort Study

Awareness about Ban on Single-use Plastic Items among Nursing Professionals: A Cross-sectional Survey

Angiographic Localisation of Culprit Vessel in Non ST Elevated Acute Coronary Syndrome

Evaluation of Role of Magnetic Resonance Imaging in Newborns with Suspected Hypoxic Ischaemic Injury and its Association with Clinical Staging: A Cross-sectional Study

Role of Tzanck Smear Cytology in Dermatology: A Clinicopathological Study

Feedback Integrated with Objective Structured Clinical Examination Module- A Teaching Tool in Physiology Department

Pharmacovigilance in Geriatric Patient-A Prospective Observational Study done in a Tertiary Care Hospital of Odisha, India

Left Ventricular and Right Ventricular Functional Changes in Cases of COPD and its Correlation with Severity-A Cross-sectional Study

An Interventional Study on the Impact of Pictorial Primed Lecture Session towards the Performance at Lower and Higher Cognitive Domain Levels among 1^st Year Medical Undergraduates