Journal of clinical and diagnostic research

Lingual Artery Pseudoaneurysm after Total Laryngectomy: A Case Report

Gayathri Lekshmi, Santhi Thankappan Pillai, Susan James

Pseudoaneurysm of the lingual artery is an extremely rare condition, and the most common causes are trauma, inflammation, neoplasm, or iatrogenic factors. An aneurysm refers to a weakening of an artery wall that creates a bulge or distention of the artery. Aneurysms of the external carotid artery and its branches are rare, comprising only 2.2% of cervical carotid aneurysms, with an even rarer occurrence of mycotic pseudoaneurysm. The superficial temporal artery and facial artery are the most commonly involved branches. Pseudoaneurysms of the lingual artery are an extremely rare entity and are often a consequence of neck surgery, trauma, inflammation, chemoradiotherapy, or odontogenic infection. They may cause life-threatening bleeding. Hereby, the authors present the case of a 47-year-old male patient with biopsy-proven Squamous Cell Carcinoma (SCC) of the hypopharynx who underwent total laryngectomy with Pectoralis Major Myocutaneous Flap (PMMC) reconstruction. The patient presented with a chief complaint of massive bleeding from the oral cavity three weeks post-procedure. The patient was immediately managed conservatively and started on inotropes. Computed Tomography (CT) angiogram of the neck showed a well-defined rounded enhancing structure in relation to the right lingual artery, with enhancement comparable to a vascular structure suggestive of a pseudoaneurysm. The patient underwent lingual artery embolisation, resulting in complete occlusion of the pseudoaneurysm. It is difficult to diagnose and manage lingual artery pseudoaneurysms, and they can cause severe distress to patients when bleeding occurs. To prevent morbidity and mortality associated with lingual artery aneurysms, they must be diagnosed and treated as early as possible.

Pyogenic Granuloma or Haemangioma- A Diagnostic Dilemma in a 13-year-old Female

Shweta Singh, Sujeet Pal, Himanshu Chauhan, Kunal Sah, Suleman Abbas Khan

Pyogenic granulomas and haemangiomas are well-known benign lesions of the oral cavity. Although pyogenic granulomas are known to have a gingival preference, while capillary haemangiomas are more commonly found on the lips, cheeks, tongue, and palate. There are several lesions in the oral cavity that resemble haemangiomas microscopically. Pyogenic granuloma is one of these lesions, characterised by the proliferation of endothelial cells, and is often indistinguishable from true haemangiomas microscopically. The clinical diagnosis of such a rare phenomenon can be quite difficult, as they can sometimes resemble more serious lesions, such as malignancies. Hereby, the authors present a case report of capillary haemangioma in the maxillary left posterior region of the jaw in a 13-year-old female, which was clinically diagnosed as pyogenic granuloma. The patient presented with a painless swelling, and no significant findings were observed on radiographic examination. The present case report aimed to resolve the dilemma in the diagnosis of vascular tumours and malformations, and to assess their histological, biological behaviour, and clinical presentation.

Secondary Healing of Palatal Fistula by Simple Palatal Plate Obturator after Excision of Pleomorphic Adenoma- A Case Report

A Senthil Kumar, Yaseer Arafat, Y Naren Kumar, Unaiz Ejaz Kalsekar

Pleomorphic adenomas are the most common benign mixed tumours of the salivary glands. They typically occur at the junction between the hard and soft palate, but can also be found in the upper lip, buccal mucosa, floor of the mouth, tonsils, pharynx, and retromolartrigone. The present case of a 55-year-old woman focuses on the use of a palatal plate obturator to treat a soft palatal fistula that developed after the removal of a pleomorphic adenoma from the palate. By applying a self-cure resin to the posterior border of the palatal plate obturator, the postoperative issue of a palatal fistula was successfully managed. To aid in the healing of the palatal tissue and provide a scaffold for the regeneration of the surrounding palatal tissue, relief was applied to the intaglio surface of the palatal plate.

Successful Management of Metastatic Lymph Nodes in the Chest by Laser Ablation via Endoscopic Ultrasound: A Case Report

Rusy Bhalla, Keyur Sheth, Ravi Gupta

Isolated spread of metastatic breast carcinoma to mediastinal lymph nodes is not an uncommon phenomenon. The prognosis worsens with the advent of any metastases in the chest. Conventional treatment mandates chemotherapy or radiotherapy as a control measures. Laser treatment has helped many patients with inaccessible or inoperable tumours, as it works on devascularisation and can benefit both benign and malignant tumours. This is a case report of a patient who did not respond to Trastuzumab and T-DM1 (Trastuzumab with Emtansine). She developed mediastinal lymph nodes during treatment with TDM1. Additionally, she had a documented change in hormonal status from Human Epidermal growth factor Receptor-2 (HER2) positive to negative. She underwent laser ablation of mediastinal lymph nodes around the trachea. A Positron Emission Tomography (PET) scan after six months showed a total resolution of the lymph nodes with no significant uptake in the chest or any other part of the body. Laser ablation of mediastinal lymph nodes is a very skillful and demanding procedure that can be attempted in refractory and isolated cases where chemotherapy and radiation have failed. Further studies are needed to assess the long-term results of this new procedure.

Pseudoaneurysm of the Petrous Internal Carotid: A Co-incidence or a Complication of Chronic Otitis Media: A Case Report

Kamana Jyotsna Devi, Lokesh Kumar Penubarthi, Gayathri Rajangam, Arun Alexander

Although rare, a Petrous Internal Carotid Artery (ICA) pseudoaneurysm is a possible complication following chronic otitis media. A 57-year-old woman was brought to the Emergency Department with multiple painless episodes of right ear bleeding and epistaxis over the last two months. Upon evaluation, bony dehiscence was observed over the petrous carotid’s first (proximal) genu, along with a pseudoaneurysm detected in the Magnetic Resonance Angiography (MR angiogram). The Balloon Occlusion Test (BTO) showed no cross-flow from the opposite side. Consequently, the patient was considered for high-flow bypass surgery between the external carotid artery and the M2 segment of the Middle Cerebral Artery (MCA), utilising a radial artery graft in the neurosurgery specialty. The present rare case report emphasises the significance of maintaining a high index of suspicion and implementing prompt intervention through a multidisciplinary approach. It also raises an open-ended question about whether the petrous carotid pseudoaneurysm is a complication of chronic otitis media or merely a co-incidence.

Twisted Paraovarian Cyst with Secondary Torsion of the Fallopian Tube: A Rare Cause of Abdominal Pain with Diagnostic Dilemma

Acute abdominal pain is one of the common reasons for patients to seek medical attention. There are multiple medical and surgical causes of abdominal pain. One uncommon cause is a twisted paraovarian cyst, which requires prompt intervention to decrease the patient’s morbidity. A paraovarian cyst is a fluid-filled sac that develops in the broad ligament and is often asymptomatic. A 38-year-old woman presented with dull aching pain in her right lower abdomen for four days. Abdominal ultrasonography revealed thickening of the segmental bowel in the right lower abdomen with adjacent oedema. The uterus and both ovaries appeared normal. Contrast-enhanced Computed Tomography (CT) showed a cystic density lesion measuring 4.0×3.3 cm, adjacent to the uterus, and the right ovary could not be visualised separately. Inflammatory changes were observed in the small bowel, extending into the right iliac region, and the appendix could not be visualised separately. An emergency laparotomy was performed, which, however, revealed a twisted paraovarian cyst along with a right fallopian tube showing signs of complete necrosis. The paraovarian cyst and the right fallopian tube were removed, and the patient had an uneventful recovery. Torsion of the paraovarian cyst with secondary torsion of the fallopian tube is a rare phenomenon and should be considered as a cause of abdominal pain in females of reproductive age group.

Mucin-secreting Adenocarcinoma of the Appendix Presented as Abdominal Lump with Distension: A Case with Diagnostic Dilemma

Appendicular adenocarcinoma is a rare tumour, and the mucin variety is common. It is usually presented with symptoms such as abdominal pain, abdominal tenderness, nausea, vomiting, change in bowel habits, and unexplained weight loss. These symptoms can resemble those of other clinical conditions, making the diagnosis of appendicular adenocarcinoma challenging. Screening modalities such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) imaging, Contrast-Enhanced Computed Tomography (CECT), blood tests, and histopathological analysis can help confirm the diagnosis. This case is reported to highlight the unusual presentation and diagnostic difficulties associated with appendiceal adenocarcinoma. A 48 years old female patient presented with complaints of dull, continuous abdominal pain for the past six months, along with an abdominal lump and distension, without any other associated symptoms. Laboratory investigations for Cancer Antigen 125 (CA 125), β-Human Chorionic Gonadotropin (HCG), and α-fetoprotein were found to be within normal limits. Further, CECT imaging was suggestive of mucin-secreting adenocarcinoma of ovarian origin. The final diagnosis was confirmed by histopathological analysis as mucin-secreting adenocarcinoma of the appendix with pseudomyxoma peritonei and was managed through cytoreduction surgery.

Magnetic Resonance Imaging of Spinal Bone Marrow Signal Alterations with Emphasis on Pattern Recognition: A Case Series

Magnetic Resonance Imaging (MRI) is the most sensitive imaging modality available to detect bone marrow oedema. Different pathological conditions of the spine exhibit distinct and specific bone marrow oedema patterns or signal characteristics. Understanding these patterns for various types of bone marrow oedema in the spine, such as degenerative and pathological conditions, helps to prevent unnecessary investigations and further work-up. In this article, authors detail the specific imaging characteristics of benign versus malignant or pathological fractures, tuberculosis and non tubercular infections of the spine, as well as the imaging appearance of multiple myeloma, among others. Therefore, this article mainly emphasises the approach to bone marrow oedema detected in the spine, aiding in reaching the correct diagnosis and guiding proper management.

Case of Ray Fungus Presenting with Abdominal Distension

Trisha Sankaran, Gramani Arumugam Vasugi, Raja Senthil, Sandhya Sundaram

Actinomycosis is a rare infection caused by filamentous, non acid fast staining and gram positive bacteria. The diagnosis is rarely made preoperatively, and only histopathological examination can confirm it, as the condition presents with varied clinical manifestations, often resembling a malignant lesion on radiographic images. Hereby, the authors present a case of a 67-year-old female, who was admitted for evaluation of an abdominal mass. Radiologically, the mass resembled a desmoplastic fibroma, and clinically, it was suspected to be the same. The mass was excised and sent for histopathological examination. Grossly, two specimens were received. The first consisted of adherent bowel loops, including the ileum, appendix, caecum and descending colon, with the mass arising from mesentery involving the bowel, measuring 11.5x9.5x6 cm. The second specimen was a partial cystectomy specimen, with the abdominal wall mass infiltrating the bladder anteroposteriorly, measuring 11x10x8 cm. Microscopic examination revealed extensive areas of inflammation with actinomycotic organisms exhibiting the Splendore-Hoeppli phenomenon, along with numerous multinucleated giant cells and acute on chronic inflammatory infiltrate. Surrounding areas showed dense collagen bundles. The prognosis after complete surgical resection is good, along with the administration of broad spectrum intravenous antibiotics.

Tuberculosis of Penile Shaft- A Rare Clinical Presentation

Tuberculosis (TB) is an opportunistic infection caused by Mycobacterium TB, and it has plagued mankind since ages, posing a major health concern in developing countries. Pulmonary TB is the most common form, but extrapulmonary TB is also not uncommon, with an incidence of 8-14%. Cutaneous manifestations of TB, known as lupus vulgaris, are extremely rare, constituting less than 1% of cases worldwide. Diagnosing a cutaneous lesion of TB poses a challenge for clinicians, as it requires both absolute and relative criteria. In the present case report, the author presents the case of a 15-year-old male from a low socio-economic background who presented with painless oedema over the penis for one and a half months. The patient had a history of dry cough and tested positive for Coronavirus Disease-2019 (COVID-19). Systemic examination was normal, and vital signs were stable. Local examination revealed oedema, redness, and phimosis over the penile shaft, along with non tender ulcerative lesions and deep cracks in the groin crease. A skin biopsy revealed lymphocytic infiltration with Langhans-type giant cells and epithelioid cell granulomas, suggesting TB of the skin overlying the penis. Laboratory investigations revealed a positive Mantoux test and an elevated Erythrocyte Sedimentation Rate (ESR) of 42. The patient was initiated on antitubercular therapy, comprising isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). After one month of treatment, the oedema subsided, and the penile ulcers and groin skin cracks healed. Penile skin involvement in TB is rare, and the clinical appearance of such involvement may vary.

Partial Exchange Transfusion in the Management of a Preterm Neonate with Severe Anaemia from Acute Foetomaternal Haemorrhage: A Case Report

Basany Laxman, Batthula Vinay, Gandrakota Naga Priyanka, Giddaluru Rao Priyanka

Foetomaternal Haemorrhage (FMH) refers to the passage of foetal blood into the maternal circulation. FMH is rarely diagnosed antenatally as clinical findings are subtle and non specific. Massive FMH is suspected when foetal movements are decreased, and Cardiotocographic (CTG) findings are abnormal with decreased heart rate variability, saw-tooth or a sinusoidal pattern. Massive FMH can lead to foetal demise, stillbirth, hydrops, or the birth of a severely anaemic infant with hypovolaemic shock. A 35-week pregnant woman presented with decreased foetal movements, and an emergency caesarean section was performed due to late deceleration on the cardiotocograph. The baby was very pale at birth and in shock. The Kleihauer-Betke (KB) test performed on the mother’s blood shortly after delivery showed 2.7% foetal red cells, suggesting 135 cc of FMH. The clinical features and outcome of FMH depend on the gestational age, volume, and rapidity of FMH, as well as, whether it is acute or chronic. Packed cell transfusion is recommended, but in babies with severe anaemia and cardiac failure, partial exchange transfusion is performed. The baby was managed with a fluid bolus, inotropic support, respiratory support, and partial exchange transfusion, resulting in a successful outcome. A high index of suspicion enables the obstetrician to undertake diagnostic tests, cordocentesis, plan for intrauterine transfusion or delivery, and alert the neonatal team for a better outcome.

Severe Mitral Stenosis Presenting as Chronic Liver Disease: A Rare Case Report

Malay Acharyya, Debapratim Ganguly, Soutrik Ghosh

High Serum Ascites Albumin Gradient (SAAG) ascites in severe rheumatic mitral stenosis is very uncommon. Hereby, the authors present a similar case with this rare combination. The present case report describes a 42-year-old male with no history of hypertension or diabetes, but occasional alcohol consumption, who presented to department with complaints of recurrent anasarca over the past five years. The electrocardiogram showed an irregular R-R interval with no P waves, indicating atrial fibrillation. Ascitic fluid analysis revealed a high serum ascites albumin gradient with low ascitic protein levels. The patient responded well to treatment and was discharged with appropriate medications. He was referred to a higher centre with cardiothoracic surgical facilities for mitral valve replacement and tricuspid annuloplasty. The present case report highlights the uniqueness of the combination of severe rheumatic mitral stenosis and ascites.

A Case of Adenomatoid Odontogenic Tumour in a 14-year-old Female

Kaushik Chakraborty, Joyeeta Sardar

Adenomatoid Odontogenic Tumour (AOT) is a rare odontogenic neoplasm that primarily affects adolescents and young adults. The present case report discusses the presentation, diagnosis, and successful surgical management of AOT in a 14-year-old patient with a six-month history of upper left jaw swelling. Radiological investigations confirmed the lesion’s characteristics, leading to a provisional diagnosis of AOT. Subsequently, surgical enucleation and histopathological examination {Haematoxylin and Eosin (H&E)} confirmed the diagnosis. The patient showed no recurrence during follow-up at three weeks and six months postsurgery, with excellent functional and aesthetic outcomes. Postoperative follow-up is essential for optimal patient care and long-term outcomes. The present case report contributes to the existing literature on AOT, providing real-world clinical insights and data, which aids in a better understanding and management of this rare condition.

Improvement in Outcomes with a New Bedaquiline-based Regimen in Postoperative Cases of Drug-resistant Tuberculosis of the Spine: A Case Series

Soutrik Kundu, Sarvan Singh

The incidence of drug-resistant strains of Tuberculosis (TB) is rising at an alarming rate. With the emergence of newer drug-resistant strains, managing the disease with existing antitubercular agents is becoming increasingly difficult. Few studies exist regarding the treatment of drug-resistant TB of the spine using a Bedaquiline-based regimen. Therefore, the efficacy of shorter regimens with novel drugs such as Bedaquiline and Delamanid in drug-resistant TB of the spine must be analysed. The present case series highlights the outcomes of a newer Bedaquiline-based antitubercular regimen in postoperative cases of drug-resistant TB of the spine. All three cases discussed in this study-54-year-old female, 12-year-old female, and 19-year-old female patients-had a clinical and radiological diagnosis of TB of the spine with significant neurodeficits. They underwent decompression and instrumentation surgery. Postoperatively, all three were diagnosed with drug-resistant TB and were started on a Bedaquiline-based antitubercular regimen. Subsequently, all the patients showed significant improvement in neurodeficits with no radiological evidence of recurrence. Therefore, Bedaquiline might play an important role in the future management of drug-resistant spinal TB.

Atypical Morphological Presentation of Neoplastic Plasma Cells: A Series of Five Cases

The diagnosis of Multiple Myeloma (MM) is made by demonstration clonal plasma cells in Bone Marrow (BM) aspiration/biopsy, in addition to assessing serum biochemical parameters, conducting radiological examinations, and considering the clinical presentation. In most cases, predominantly mature plasma cells are observed, along with scattered immature forms in the BM. Several morphological variants of plasma cells have been reported, including Auer rod-like inclusions, small lymphocyte-like cells, hairy cell-like cells, anaplastic variants, promonocyte-like cells, crystal-storing histiocytes, Burkitt-like cells, and blastoid cells. In this series of five cases, most showed a typical clinical presentation and laboratory findings suggestive of plasma cell dyscrasia. However, the morphology of each case exhibited unusual morphological variants, posing diagnostic challenges. These variants included Auer rod-like inclusions, small lymphocytes/lymph-plasmacytoid cells, hairy-like cells, multilobulated nuclei, and anaplastic variants mimicking dysplastic megakaryocytes, leading to various differential diagnoses. The age range of these cases was 57-76 years. Most of the cases presented with generalised dull aching body pain. Imaging studies revealed lytic lesions involving various parts of the bone, including the skull, ribs, vertebrae, and femur. Biochemical assays suggested the possibility of plasma cell dyscrasia. Two of the cases had primary Plasma Cell Leukaemia (PCL), which is a rare and highly aggressive plasma cell neoplasm. The anaplastic variant is associated with a poor prognosis, aiding in predicting treatment responses. However, due to the unusual morphological presentation, the diagnosis of MM or PCL was made after conducting ancillary studies such as Serum Protein Electrophoresis (SPEP), serum free light chain assay, Immunofixation Electrophoresis (IFE), and immunophenotyping through Immunohistochemistry (IHC) or flow cytometry.

Ketodex for Electroconvulsive Therapy in Patients with Psychotic Disorders: A Case Series

Divya Devanathan, Avudaiappan Sankaran, Suriya Kumar

Before the introduction of antipsychotic medications, Electroconvulsive Therapy (ECT) was considered one of the first-line treatments for psychotic disorders. Although ECT is still recommended for certain patients with psychosis, the widespread use of antipsychotic drugs has made it less commonly utilised. However, the combination of ketamine and dexmedetomidine (Ketodex) may prove beneficial in controlling the haemodynamic response and preventing emergent confusion due to their opposing drug actions. Nonetheless, the use of Ketodex in patients with psychosis undergoing ECT has not been thoroughly explored. This series presents cases of five patients (22 years female, 25 years female, 28 years male, 19 years female and 25 years female patients) who underwent 25 sessions of ECT with the ketamine-dexmedetomidine combination. All patients demonstrated good cardiovascular stability without experiencing emergent confusion. Based on these findings, the study concludes that the combination of ketamine and dexmedetomidine is both effective and safe for patients with psychosis undergoing ECT.

An Unexpected Lingual Cortical Erosion in a Solitary Bone Cyst of the Mandible

W Maria Priscilla Wincy, R Sankar Narayanan, P Sri Neeraja

A 42-year-old woman reported to the outpatient department with the chief complaint of intermittent, sharp, radiating pain in the lower left back tooth region for the past five days which aggravated on mastication and reduced on medication. Medical history was non significant and dental history revealed that the patient underwent extractions five years before. On clinical examination, no extraoral abnormalities were detected (Table/Fig 1). Intraoral examination revealed decayed 27, 36, 47 teeth, missing 46,31,32, and tenderness on percussion in relation to 37,38. There was generalised gingival attachment loss and mobility in relation to 37,22,16,41,42 (Table/Fig 2). On further examination, a localised swelling was evident on the alveolar mucosa in relation to 37 and 38, measuring approximately 1×2 mm with a smooth surface and irregular margins. No discharge was present. On palpation, the swelling was tender with no pus discharge. No bony expansion was appreciated (Table/Fig 3). A provisional diagnosis of dental caries with a periapical abscess in relation to 37, 38 was given. An Intraoral Periapical Radiograph (IOPA) in relation to 37,38 was taken which revealed a well-defined corticated multilocular radiolucency with internal septations in the periapical region in relation to 37,38. The radiolucency extended from the mesial root of 37 to the mesial root of 38 (Table/Fig 4). The patient was then advised to take an Orthopantomogram (OPG). IOPA findings were confirmed in the OPG. OPG also revealed a well-defined, corticated, periapical radiolucency which appeared to extend from the distal root of 36 to the mesial root of 38. Horizontal bone loss was present and partially edentulous spaces in relation to 31,32,46 were present (Table/Fig 5). Cone Beam Computer Tomography (CBCT) was advised, which revealed distal proximal cervical radiolucency involving enamel dentin and approximating pulp in 36. And there was presence of unilateral, localised, well-defined radiolucency in the left mandibular body region in relation to the periapical region of 36,37 and 38. The margins were well-defined with thinly corticated. The shape appeared vaguely oval measuring approximately 23.1 mm anteroposteriorly, 11.5 mm buccolingually, and 11.7 mm superioinferiorly. The radiolucency extended anteriorly from the periapical region of 36 from the distal root to the mesial root of 38. Buccally and lingually it extended to the cortical plates with erosion of the lingual cortical plate, thinning, and cortical expansion. The lingual cortical erosion was unexpected as clinically there was no evidence of bony expansion. Superiorly, the lesion was a few millimetres short of the alveolar crest in relation to 37 and inferiorly above the mandibular canal. Internally the lesion was totally radiolucent (Table/Fig 6). Differential diagnosis was given as radicular cyst, simple bone cyst, odontogenic keratocyst, and ameloblastoma. Preoperative blood investigations were conducted, and the patient was found to have microcytic hypochromic anaemia with a haemoglobin level of 8 g/dL. Blood transfusion was performed twice, and the haemoglobin improved to 10 g/dL. Preanesthetic evaluation was conducted, followed by enucleation under general anaesthesia. The specimen was sent for histopathological examination. The Haematoxylin and Eosin (H&E)-stained histopathological section of the specimen revealed parakeratinised stratified squamous surface epithelium with underlying connective tissue stroma. The connective tissue stroma was moderately collagenised with a chronic inflammatory cell infiltrate. In a focal area, numerous cystic spaces surrounded by macrophages were observed. The cavity was filled with numerous extravasated red blood cells. Additionally, endothelial-lined blood vessels were also observed. Deeper within the connective tissue, normally appearing bony trabeculae with osteocytes were seen (Table/Fig 7). Based on these findings, a final diagnosis of a simple bone cyst was given. The patient was reviewed after one week, and a postoperative OPG was taken. The OPG revealed a bony defect with a complete loss of the corticated border of the cyst. Teeth 36, 37, and 38 were extracted, suggesting that complete enucleation of the cyst was performed (Table/Fig 8). The patient was instructed to return after three weeks for the replacement of the missing teeth. A simple bone cyst is a benign, empty, or fluid-containing cavity within the bone that lacks an epithelial lining. It is also known by various names such as traumatic cyst, solitary bone cyst, haemorrhagic cyst, extravasation cyst, unicameral bone cyst, and idiopathic bone cavity. Simple bone cysts are classified as intraosseous bone pseudocysts. They comprise approximately 1.25% of cysts in the jaw. The first description of a simple bone cyst was given by Carl Lucas and Theodor Blum in 1929 (1). According to the World Health Organisation (WHO), this cyst is defined as an uncommon, benign, asymptomatic, slow-growing, non expansile, intraosseous cavity that may be empty or filled with fluid. It has a delicate lining of connective tissue but lacks epithelium (2). Simple bone cysts are rare and account for about 1% of jaw cysts. They are often observed in the posterior mandibular region (3),(4). They can affect both males and females, but there is a male predominance. Simple bone cysts commonly occur in the second decade of life, but they can also affect individuals over 40 years of age. The posterior premolar-molar area of the mandible is the most frequently affected site (3). Simple Bone Cysts (SBC) are also known as traumatic cysts, as the trauma-haemorrhage theory has been widely discussed and accepted. This hypothesis was proposed by Howe. According to this theory, an insufficient level of trauma to the bone leads to the formation of an intraosseous haematoma, without causing a fracture. In the absence of organisation and repair, the haematoma has the potential to liquefy and subsequently give rise to a cystic defect (5). Radiographic features of SBC include unilocular or multilocular radiolucencies of variable size and shape, with well-defined borders. Resorption or displacement of teeth is not seen. Loss of lamina dura may be observed, and there may be widespread extension of the lesion without bone expansion, but cortical bone thinning due to endosteal erosion may be present (6). Therefore, the diagnosis of SBC is based on clinical examination, radiological investigation, and histological findings. Early treatment and regular follow-up are recommended to promptly diagnose and treat any recurrences.

Fibroadenoma of the Axillary Tail: A Common Lesion in an Uncommon Location

Dear Editor, A 49-year-old female patient presented with a complaint of a palpable lump in her right axillary region for two months. The lump was gradually increasing in size and associated with slight discomfort. On palpation, it was a smooth, mobile, non-tender lump of approximately 2×2 cm in size in the right axilla (Table/Fig 1) On sonomammography, the lump appeared well-defined and encapsulated, wider than taller, solid, with a nodular, hypoechoic, ovoid mass measuring 1.9×1.3 cm, showing minimal peripheral vascularity (Table/Fig 2). X-ray mammogram also revealed a well-defined, oval, dense lesion without any calcification in the axilla, suggestive of fibroadenoma. Various differentials such as lymphadenopathy, lipoma, and sebaceous cyst were considered (Table/Fig 3). Fine-Needle Aspiration Cytology (FNAC) of the lesion was performed, confirming the diagnosis of fibroadenoma. No similar lesions were noted in the bilateral breast parenchyma or contralateral axilla. The lesion was surgically removed.

Midgut Non Rotation in a Middle-aged Male with Suspected Pancreatitis

Dear Editor, Midgut development is a dynamic process that begins from the fifth week of development. During this process, the midgut undergoes physiological herniation in the umbilical cord. Subsequently, it returns to the abdominal cavity through a complex 270° counterclockwise rotation (1). This normal rotation results in the formation of a duodenojejunal loop on the left-side of the midline, a peripheral large bowel, a centrally located small bowel with the caecum in the right iliac fossa, and the duodenojejunal flexure on the left-side near the pylorus (2). Disruption of this sequential return can lead to anomalies in midgut rotation, such as non rotation, malrotation, or reverse rotation (1). A 33-year-old male patient presented to the Psychiatry Outpatient Department (OPD) with complaints of alcohol dependency. The patient reported consuming atleast 90 mL of whiskey daily for 17 years. He experienced low mood, irritability, and aggressive behaviour when attempting to quit alcohol abruptly. The patient was concerned about his aggressive behaviour and expressed a desire to quit alcohol. There is no significant past medical history. The patient was admitted for further evaluation, and a physician’s opinion was sought. Routine blood investigations and serum amylase and lipase level tests were recommended. Routine blood investigations were unremarkable, but the serum amylase and lipase levels were abnormal. Three samples were collected three days apart, all showing mild derangement as shown in (Table/Fig 1). On the third day of admission, the patient complained of abdominal pain and experienced two episodes of bilious vomiting. An ultrasound investigation was performed to assess the pain, but no abnormalities were found. Subsequently, a Contrast Enhanced Computed Tomography (CECT) scan was conducted to investigate possible pancreatic pathology. The scan revealed a normal appearance of the pancreas, as shown in (Table/Fig 2). The duodenojejunal loop and duodenojejunal flexure were observed on the right-side of the midline, along with the main bulk of the small bowel and mesentery, as shown in (Table/Fig 3). The caecum, iliocaecal junction, and appendix were positioned on the left-side of the midline in the left hypochondrium, as depicted in (Table/Fig 4). The spleen was located on the left, while the liver and gall bladder were on the right and appeared normal, as shown in (Table/Fig 5). The urinary system appeared unremarkable. The superior mesenteric artery and superior mesenteric vein showed no signs of volvulus and appeared normal, as shown in (Table/Fig 6). Based on the imaging findings, a diagnosis of incidental midgut non rotation was made, and the patient was advised to undergo gastroscopy. Despite slightly deranged serum amylase and lipase levels, the pancreas appeared normal in appearance. Anomalies of the midgut can be associated with gastrointestinal anomalies such as gastroschisis, omphalocele, duodenal atresia or stenosis, agenesis of the gall bladder, intra or extrahepatic biliary atresia, and hypoplasia or agenesis of the dorsal pancreas (3). Heterotaxy syndrome is frequently associated with midgut malrotation. Other possible associations may include choanal atresia, hypospadias, or congenital diaphragmatic herniation (4). The best way to appreciate midgut anomalies is through a Computed Tomography (CT) scan. On plain abdominal X-ray, midgut non rotation manifests as the absence of caecal gas visualisation in the right periphery of the abdomen. In cases of midgut non rotation, the distal duodenum and proximal jejunum do not cross the midline but instead descend inferiorly, resulting in a corkscrew appearance on a barium meal examination (5). In the present case, the patient presented with bilious vomiting and abdominal pain. The imaging findings revealed the duodenojejunal flexure on the right-side of the midline, the iliocaecal junction and appendix on the left-side in the left hypochondrium, small bowel anterior and right of the midline, and the large bowel not in the periphery. However, no other associations were identified. Not all patients with intestinal non rotation exhibit symptoms, and these findings are often incidentally detected. The necessity of intervention in such cases is still a subject of debate. Antenatal diagnosis of midgut rotation anomalies is crucial as the alignment of the bowel is typically completed by the third trimester. When asymptomatic, the need for surgical correction of malrotation is still under discussion.

Effect of Routine Vitamin D Supplementation on the Physical Growth of Exclusively Breastfed Infants at Six Months of Age: An Observational Study

Ved Pratap Tiwari, Aboli Dahake, Srushti Nakade, Purva Bendale

Introduction: Vitamin D is essential for bone mineral metabolism and for the growth and development of the skeleton. The American Academy of Paediatrics and the Indian Academy of Paediatrics recommend the administration of 400 IU per day of oral Vitamin D to all infants in the first year of life. The authors hypothesised that routine supplementation of 400 IU of Vitamin D to exclusively breastfed infants would result in better physical growth. Aim: To examine the effect of routine vitamin D supplementation (400 IU/day) on the weight, length, and head circumference of term, exclusively breastfed infants at six months of age. Materials and Methods: An observational study was conducted at Department of Paediatrics, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India, from November 2018 to March 2020, comparing the weight, length, and head circumference at birth and at six months of age for 111 exclusively breastfed term, appropriate for gestational age, healthy infants who were not supplemented with oral Vitamin D (Group-I) with 111 infants who were supplemented with 400 IU of oral Vitamin D daily (Group-II). Infants who presented at the Paediatric Out-Patient Department of SKNMC, Pune at around six months of age were enrolled in the study. Birth data and anthropometry at birth were recorded from available medical records. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Quantitative data were presented with the mean and standard deviation. Comparison among the study groups was done using an unpaired t-test as per the results of the normality test. Association among the study groups was assessed with the help of a Student’s t-test. A p-value of <0.001 was considered statistically significant. Results: The mean birth weight, length, and head circumference of infants who were not supplemented with vitamin D (Group-I) were 2907.57±250.18 gm, 53.34±1.47 cm, 35.99±1.067 cm, respectively, and those who were supplemented (Group-II) were 2901.08±231.63 gm, 53.75±1.51 cm, and 35.85±1.09 cm, which were comparable in both groups. At six months, the mean weight, length, and head circumference in Group-I and Group-II were 7211.08±626.39 gm, 70.25±1.58 cm, 43.82±1.19 cm, and 7973.87±532.31 gm, 70.90±1.75 cm, and 45.01±1.34 cm, respectively. There was an increase in anthropometric parameters in both groups. The increase was greater in Group-II than in Group-I and was statistically significant (p<0.001). Conclusion: Infants supplemented with vitamin D (400 IU/day) demonstrated better physical growth in terms of higher anthropometric values.

Patterns and Outcomes of Polypharmacy and Effect of Potentially Inappropriate Medications in Elderly Patients undergoing Orthopaedic Surgeries: A Retrospective Observational Study

Sara Yohannan, Serah Johny, Sara Korula Vergis, Celine Thalappillil Mathew

Introduction: Prescription of Potentially Inappropriate Medication (PIM) among elderly patients is becoming a global concern. There has been an increase in the number of elderly patients coming for operative procedures, especially in orthopaedic surgery, due to the association of advanced age with chronic musculoskeletal conditions, such as osteoarthritis, and an increased incidence of fragility fractures. Aim: To determine the prevalence of polypharmacy and PIMs among elderly patients undergoing orthopaedic surgery. Materials and Methods: A retrospective observational study was conducted from February 2022 to April 2022 in the Orthopaedic Department of Anaesthesiology, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India. Hospital records of 130 patients aged 65 years and above, who underwent orthopaedic surgeries from January 2016 to December 2021, were included. The prescriptions during the perioperative period were analysed for polypharmacy, defined as the use of five or more drugs. The American Geriatric Society (AGS) 2019 Beers criteria were used to identify PIMs, drug interactions, and drug-syndrome interactions. Chi-square tests were performed on clinically significant variables to assess their effect on hospital stay, with a p-value of <0.05 considered significant. Results: Polypharmacy was highest on postoperative day 1, with 119 patients (91.5%) experiencing it. The study observed a high prevalence of PIMs, with 106 patients (81.53%) affected. The most commonly used PIMs were Pantoprazole, followed by Piroxicam, Regular human Insulin, and Glimepride. A significant association was observed between hospital stay ≥10 days, postoperative Intensive Care Unit (ICU) stay, and preoperative polypharmacy (p-value=0.002). Conclusion: Polypharmacy and PIMs in patients above 65 years of age admitted for surgeries remain major concerns. Further exploration of current pharmacologic practices in the perioperative period and interventions, such as physician education programs regarding PIMs, are needed.

Evaluation of Developmental Delay in Term Babies on Ventilator Support: A Cross-sectional Study

R Hemanth Kumar, Jayesh Chandran

Introduction: Developmental limitation in two or more developmental domains that affects children under the age of five is termed as developmental delay. Due to various reasons such as drug-induced toxicity and maternal variables like a history of drinking, smoking, or infections during pregnancy (e.g., rubella), neonates may require admission to the Neonatal Intensive Care Unit (NICU). Although NICU admission improves survival rates, the extended stay and the use of different types of equipment in the NICU may lead to developmental delay. Aim: To identify the developmental delays in critically ill full-term babies on ventilator support, using the Ages and Stages Questionnaire-3 (ASQ-3) scale. Materials and Methods: A cross-sectional study was designed to evaluate developmental delays in term babies receiving ventilator support. A total of 35 babies who met the inclusion criteria were included in the study. Once the babies reached 17 to 18 months of age, parents were given ASQ-3 to complete. The data were analysed and expressed as mean, standard deviation, frequency, and percentage. Results: Out of the 35 full-term babies on ventilator support, 22 babies (62.9%) showed lower values in gross motor function, 12 (34.3%) in fine motor function, and 12 (34.3%) in problem-solving skills compared to communication and other components, according to ASQ-3. Conclusion: The findings of this research suggest that critically ill full-term infants on ventilator support exhibit significant developmental delays, particularly in gross motor, fine motor, and problem-solving skills.

Cardiorespiratory Fitness in Middle-aged Men and Women through the Queens College Step Test: A Cross-sectional Study

Dhanush Kotian, Yogita Hatmode

Introduction: Increased Body Mass Index (BMI) is associated with a decreased level of maximium oxygen uptake (VO₂ max), which indirectly affects Cardiorespiratory Fitness (CRF) in young adults. Therefore, it is important to assess CRF in the middle-aged population, despite a high burden of cardiovascular risk factors in this age group. CRF refers to the circulatory system’s ability to supply oxygen to functioning muscles during continuous physical exercise. Maximum oxygen uptake (VO₂ max) is the best measure of CRF and serves as the gold standard for quantifying an individual’s aerobic capacity. Aim: To evaluate CRF in middle-aged men and women. Materials and Methods: The present cross-sectional study conducted in the Department of Physiotheraphy, NITTE Institute of Physiotheraphy included a total of 134 subjects aged between 45 and 65 years, who were selected from Justice KS Hegde Charitable Hospital in Mangaluru, Karnataka, India. The male and female groups consisted of 67 subjects each. The study was conducted over a period of 12 months, from March 2022 to March 2023. All subjects were included based on specific inclusion criteria. VO₂ max was estimated by following the Queens College Step Test (QCST) method. The Pearson’s correlation coefficient was used to examine the relationship between age, height, weight, BMI, waist-to-hip ratio, heart rate, and VO₂ max. A p-value <0.05 was considered statistically significant. Results: The mean value of VO?SUB?2#SUB# max was assessed and compared between middle-aged males (65.8±3.5 mL/kg/min) and females (46.6±1.7 mL/kg/min). It was discovered that VO₂ max was significantly higher in middle-aged males than in middle-aged females (p<0.001), as indicated by heart rate changes from pretest to post-test. The mean value of BMI was compared between males (24.4±3.2) kg/m² and females (24.4±4.9) kg/m², and the difference was found to be statistically non significant (p-value=0.916). Similarly, the mean value of waist-to-hip ratio was compared between males (0.9±0.1) and females (0.9±0.1), and the difference was also statistically non significant (p-value=0.637). Conclusion: Middle-aged males exhibit substantially higher VO?SUB?2#SUB# max compared to middle-aged females (p<0.001). Consequently, middle-aged females demonstrate a considerable decrease in aerobic capacity, as indicated by VO₂ max, and decreased cardiovascular fitness, which serve as predictors of cardiovascular disease risk factors.

Comparative Analysis of Haemodynamic and Capnographic Changes in Laparoscopic Cholecystectomy and Open Cholecystectomy: A Randomised Clinical Study

Introduction: Laparoscopic cholecystectomy is now preferred over the open procedure due to advantages such as reduced blood loss and shorter hospital stays. However, concerns have been raised regarding the potential for increased Intra-abdominal Pressure (IAP) during laparoscopic procedures, which may impact haemodynamic stability and respiratory parameters. However, there is a lack of comprehensive analysis directly comparing both surgical approaches from both haemodynamic and capnographic perspectives. Aim: To compare the haemodynamic and capnographic changes between laparoscopic and open cholecystectomy. Materials and Methods: This randomised clinical study was conducted at Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India from May 2021 to June 2022. The study included 300 patients scheduled for cholecystectomy, divided into two groups: Laparoscopic Cholecystectomy (LC) Group I (n=150) and Open Cholecystectomy (OC) Group II (n=150). Haemodynamic parameters, including Pulse Rate (PR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Oxygen Saturation (SpO₂), were recorded. Capnographic parameters, such as End-Tidal Carbon Dioxide (EtCO₂) levels, were also measured at regular intervals. Data analysis was performed using the student’s t-test and Chi-square test with Statistical Package for Social Sciences (SPSS) version 21.0 software and Microsoft excel. Results: There were no significant differences in age, body weight, and sex distribution between Group I and Group II. However, significant differences were observed in PR and SBP at 15 minutes (PR: 101.46 and 95.86; SBP: 148.57 and 140.97), 30 minutes (PR: 104.52 and 99.82; SBP: 141.28 and 136.07), and 45 minutes (PR: 102.52 and 97.70; SBP: 140.59 and 133.95) (p-value <0.01). Highly significant differences were observed in MAP and EtCO₂ postinsufflation at 15 minutes (MAP: 118.38 and 108.61; EtCO₂: 36.48 and 33.89), 30 minutes (MAP: 111.11 and 106.01; EtCO₂: 41.02 and 36.15), 45 minutes (MAP: 110.73 and 103.48; EtCO₂: 42.65 and 38.36), and 60 minutes (MAP: 106.08 and 101.45; EtCO₂: 41.10 and 38.21) (p-value <0.01). DBP showed high significance at 15 minutes (103.21 and 93.23), 30 minutes (96.74 and 92.57), and 60 minutes (93.14 and 86.92) (p-value <0.01), and significant (p-value=0.01) at 45 minutes (95.53 and 87.59). Oxygen saturation showed significance (p-value <0.05) at 15 minutes (99.93 and 100). Conclusion: The present study demonstrated a significant increase in both haemodynamic and capnographic parameters, even in American Society of Anaesthesiologists (ASA) Grade-I and Grade-II patients undergoing laparoscopic cholecystectomy compared to the open surgical technique. These findings emphasise the need for careful monitoring during laparoscopic procedures.

Vitamin D Status and its Correlation with Carotid Intima-media Thickness amongst Type 2 Diabetes Mellitus Patients: A Hospital-based Cross-sectional Study

Introduction: There is rising concern about vitamin D deficiency around the globe due to its increasing association with multiple medical disorders. Diabetes Mellitus (DM) is an established risk factor for atherosclerotic disorders, and Carotid Artery Intima-Media Thickness (CIMT) is considered a radiological marker of subclinical atherosclerosis. Aim: To find a correlation between serum 25-hydroxy vitamin D (25-(OH)-D) levels and CIMT among patients with DM. Materials and Methods: A hospital-based cross-sectional study was conducted, including 100 adult patients with Type 2 DM who were admitted to the Department of Medicine at SCB Medical College and Hospital in Cuttack, Odisha, India from October 2020 to September 2021. Vitamin D deficiency was defined as serum 25-(OH)-D levels <20 ng/mL, and insufficiency as <30 ng/mL. The demographic profile of patients, family history of Type 2 DM, smoking history, blood pressure, haemogram, blood sugar, serum electrolytes, and lipid profile were studied. CIMT of the bilateral Common Carotid Artery (CCA) was measured by B-mode ultrasonography. CIMT values ≥ 0.8 mm were considered abnormal. Data were analysed using appropriate statistical tests in Statistical Packages for Social Sciences (SPSS) version 26.0. Results: The present study included 55% males (n=55) and 45% females (n=45). The average age of the patients was 60 ±10 years, ranging from 26-75 years. Vitamin D deficiency was highly prevalent among patients with Type 2 DM (73% deficient, 12.5 ng/mL; 21% insufficient, 24.7 ng/mL). Vitamin D deficiency/insufficiency was higher among male participants (57.5%, 62%) compared to females (42.4%, 38%). Vitamin D levels were significantly associated with dyslipidemia. Mean CIMT among the vitamin D deficiency versus insufficiency versus normal group were 0.87 versus 0.87 versus 0.7 mm on the right Common Carotid Artery (CCA), and 0.95 versus 0.86 versus 0.75 mm on the left CCA, respectively. Significant negative correlations were observed for HbA1c (r=-0.025), Triglycerides (r=-0.274), right CIMT (r=-0.284), and left CIMT (r=-0.264) with serum 25-(OH)-D levels. Conclusion: The majority of patients with Type 2 DM have concurrent vitamin D deficiency. A significant inverse linear association between serum vitamin D levels and CIMT was observed, indicating the association of vitamin D deficiency with subclinical atherosclerosis. Although unproven in the present study, the role of vitamin D supplementation in the improvement of atherosclerosis remains unclear.

p53 Expression in Gallbladder Lesions: A Cross-sectional Study from a Tertiary Care Centre in Northern India

Introduction: Gallbladder lesions comprise inflammatory, benign, pre-malignant, and malignant lesions. The progression of benign lesions into malignant ones involves a complex process. The p53 gene is commonly disrupted in carcinogenesis. Malignant lesions may exhibit p53 overexpression compared to benign and inflammatory lesions. Aim: To investigate the distribution of gallbladder lesions and the expression of the p53 nuclear protein in these lesions. Materials and Methods: A cross-sectional study was conducted at the Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, from June 2020 to December 2022. A total of 249 specimens of gallbladder lesions, including congenital, inflammatory, benign, pre-malignant, and malignant lesions, were included. All samples underwent Haematoxylin and Eosin (H&E) staining and Immunohistochemistry (IHC) with p53 antibody using the peroxidase-antiperoxidase method. The association of p53 expression with histopathological diagnosis was analysed using Fisher’s Exact test. The final analysis was performed using Statistical Package for Social Sciences (SPSS) software, version 25.0. A p-value <0.05 was considered statistically significant. Results: Out of 249 specimens, there were 217 (87.14%) inflammatory lesions, 9 (3.6%) benign lesions, 2 (0.8%) pre-malignant lesions, and 21 (9.26%) malignant lesions. The main inflammatory lesions were Chronic Cholecystitis (CC) with 132 cases (60.83%) and CC with cholesterosis with 36 cases (16.59%). The most common pre-malignant lesion was choledochal cyst with 3 cases (3.33%). Benign tumours (leiomyoma) were present in 2 (0.8%) patients. Among the 21 (8.46%) malignant tumours, 4 (19.05%) were moderately differentiated adenocarcinoma, 13 (61.9%) were poorly differentiated adenocarcinoma, and 4 (19.05%) were well-differentiated adenocarcinoma. p53 overexpression was significantly higher in patients with malignant tumours (9 cases, 42.86%) compared to inflammatory lesions (26 cases, 11.98%), benign lesions (0 cases, 0%), and pre-malignant lesions (0 cases, 0%) (p=0.003). Conclusion: Gallbladder lesions exhibit a wide range of histopathological presentations. Inflammatory lesions are the most common, followed by pre-malignant and malignant lesions. p53 can serve as a novel marker for differentiating inflammatory lesions from malignant lesions in the gallbladder.

Histopathological Spectrum of Appendicular Lesions: A Cross-sectional Study

Prachi Gholap, Swati B Ghanghurde, Priyanka Dhakare

Introduction: Multiple pathologies, ranging from non neoplastic to neoplastic tumours that may or may not obstruct the lumen, might result in appendicitis. Uncommon neoplastic appendix lesions show diverse morphologies, resembling adenomas to colorectal carcinoma. Identifying these traits is vital to differentiate them from non neoplastic mucinous lesions, as they require varied management approaches, including follow-up and chemotherapy. Aim: To assess the histopathological patterns in patients undergoing appendicectomy and to study the detailed morphological features of different non neoplastic and neoplastic lesions. Materials and Methods: This cross-sectional study was conducted in western part of Maharashtra for 3 years. It involved surgically removed specimens of appendix received for histopathological evaluation of the appendix from January 2019 to December 2022. A detailed gross examination of the appendicectomy specimens was carried out. Data were analysed using Statistical Package for the Social Sciences (SPSS) software, version 22.0. Categorical data such as sex, clinical presentation, gross presentation of the appendix, and histopathological findings were presented as n (%), whereas quantitative data such as age were presented as mean±SD. A p-value <0.05 was considered statistically significant. Results: A total of 716 patients were included in this study. The median age of the patients was 25.0 years. The majority of the population belonged to the 21-45 years age group, with 406 (56.7%) patients. The number of males were higher 236 (32.9%) than females 170 (23.4%). The number of patients with inflammatory or non neoplastic lesions was higher than those with neoplastic lesions, with 709 (99.02%) and 7 (0.98%) respectively. The highest number of patients had chronic appendicitis (284; 39.66%), followed by acute on chronic appendicitis (216; 30.16%) and acute appendicitis (188; 26.25%). Conclusion: In cases of appendicitis, histopathological examination of the appendix should be performed as it provides crucial clinical information in addition to operative findings. Hence, it is a benchmark in diagnosing acute appendicitis.

Hepatitis B Vaccination Coverage among Healthcare Workers and Evaluation of Immune Response by Estimating Anti-HBs Antibody Titers over Time at a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Healthcare Workers (HCWs) are at a high-risk of acquiring Hepatitis B Virus (HBV) infection. However, this risk can be prevented through Hepatitis B vaccination. In some institutes, HCWs have a lower percentage of HBV vaccination, leading to a higher risk of HBV transmission. Therefore, the coverage of vaccination is an important point, along with the evaluation of protective immune status. Aim: To assess the vaccination coverage and evaluate the immune response post-vaccination through Anti-Hepatitis B surface Antibodies (Anti-HBs) titre. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Pali, Rajasthan, India, over a period of one year from April 2021 to March 2022, following approval from the Institutional Ethics Committee (IEC). A total of 455 HCWs below 60 years of age were included in the study, and their demographic details such as age, gender, occupation, needle stick injury, blood exposure to mucous membranes and breached skin, hepatitis B vaccination status, and time duration since vaccination were noted. Additionally, their Anti-HBs titer was examined. The participants were initially classified into three groups: completely vaccinated, partially vaccinated, and non vaccinated. Among those who were vaccinated, they were further divided into two groups: vaccination ≤5 years (Group A) and >5 years (Group B). Furthermore, those who received a booster dose were divided into Group I (≤1 year) and Group II (>1 year). Blood samples were collected to assess the anti- HBs levels quantitatively in the sera using Enzyme Linked Immuno Sorbent Assay (ELISA). The data was entered into Microsoft Excel and later imported into Statistical Package for Social Sciences (SPSS) version 22.0 for statistical analysis. Results: Participants had a mean age of 29.65±9.603 years. Among them, 43 (30.1%) were doctors, and 37 (25.9%) were medical students who were found to be completely vaccinated. On the other hand, among other HCWs, 15 (10.5%) were nurses, 16 (11.2%) were nursing students, and 32 (22.4%) were lab technicians who were vaccinated. None of the support staff were vaccinated (p-value=0.0001). A total of 143 participants were completely vaccinated, and 97.9% (n=140) had protective immunity to Hepatitis B. The anti-Hbs titre was 567.32±434.494 in group A and 265.74± 211.80 in group B (p-value=0.0001). Similarly, it was 688.34±424.617 in group I and 221.14±141.221 in group II (p-value <0.0001).The anti-Hbs titre did not significantly increase among the partially vaccinated participants (n=162). It was found to be 25.47±27.595 in group A and 14.60±19.939 in group B (p-value=0.004). There was no significant difference in the results between males and females (p-value=0.961). Conclusion: The coverage of complete vaccination among HCWs was significantly low, which is crucial for obtaining a protective Anti-Hbs titre. Incomplete vaccination does not result in a sufficient level of anti-Hbs titre, and there may be a significant decline in the immune response over time (p-value <0.05). Therefore, it is essential to estimate the titre after 1-2 months of complete vaccination to ensure that individuals are fully protected against Hepatitis B.

Importance of Positive T-wave in Lead aVR and Major Adverse Cardiac Events in Patients with ST Elevation Myocardial Infarction: A Cohort Study

Sharan Badiger, Shruti Hiremath

Introduction: It is well known that ST-Segment Elevation Myocardial Infarction (STEMI) is a significant contributor to both illness and death on a global scale. An Electrocardiogram (ECG) is an easily accessible bedside tool for diagnosing acute myocardial infarction. The T wave is usually negative in lead aVR (augmented unipolar right arm lead). However, a positive T wave in lead aVR has been shown to be associated with adverse in-hospital outcomes in patients with Acute Coronary Syndrome (ACS). Aim: To examine whether a positive T wave in lead aVR can be used as an indicator to predict Major Adverse Cardiac Events (MACE) during the hospital stay in patients with STEMI. Materials and Methods: A cohort study was performed at Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, involving patients admitted with STEMI. A total of 98 newly diagnosed ST-segment elevation patients were classified into two groups: Group A (positive T wave) in lead aVR with an amplitude of ≥ 0 mV, and Group B (negative T wave) in lead aVR with an amplitude of ≤0 mV. The hospital stays of STEMI patients were evaluated for adverse cardiac events. Chi-square test was used to assess relationships between categorical variables. Results: A total of 98 patients were evaluated, among which two were excluded. Hence, among 96 patients considered, 25 were females and 71 were male, with average ages of 57 years in Group A and 55 years in Group B. Among the 96 patients, 34 had positive T waves (35.4%) and 62 had negative T waves (64.5%) in lead aVR. The study revealed significantly higher rates of in-hospital MACE (heart failure, pulmonary oedema, and arrhythmias) in patients with positive T waves (Group A) in lead aVR, with p-values <0.05, which were statistically significant. Conclusion: The present study showed that a positive T wave in lead aVR is a valuable and cost-effective tool for predicting in-hospital MACE in patients with STEMI. Utilising this simple and readily available ECG measurement could support clinicians in detecting high-risk patients who require closer monitoring and more aggressive interventions, potentially leading to improved patient outcomes and resource allocation.

COVID-19 Seropositivity among Adults of Tribal Origin Attending a Primary Care Centre in Wayanad Kerala- A Cross Sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) is a highly contagious viral illness caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Serological surveys help in understanding the burden of past infections. The World Health Organisation (WHO) suggests the need for population-based sero-epidemiological investigations to acquire data for implementing containment measures. The tribal population, being the most marginalised and vulnerable section, is at a higher risk for COVID-19. However, there is limited literature regarding the seroprevalence of COVID-19 among the tribal population in our country. Aim: To assess the COVID-19 seropositivity, associated factors, and knowledge among adults of tribal origin attending a primary care centre in Wayanad, Kerala. Materials and Methods: A cross-sectional study was conducted among 279 adults of tribal origin, aged between 18 and 95 years, attending a primary tribal healthcare centre at Amrita Institute of Medical Sciences, Kochi, Kerala, India, from August 2021 to October 2021. A semistructured questionnaire was used to collect socio-demographic details, history of COVID-19 infection, vaccination status, and participants’ knowledge and awareness about COVID-19. Antibody presence was tested using the WANTAI test kit. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0 A multivariable logistic regression was conducted following univariate analysis to identify independent factors associated with COVID-19 seropositivity. Results: The mean age of the study population was 45.34±15.86 years. Among the 279 participants, the proportion of seropositivity to COVID-19 antibodies was found to be 245 (87.8%) with a 95% confidence interval (CI) of 83.98 to 91.62. Regarding knowledge and awareness related to COVID-19, 186 (66.7%) participants were not aware of the common symptoms of COVID-19. Individuals aged above 60 years had a five times higher probability of having COVID-19 antibodies compared to those aged 30 years or younger (adjusted odds ratio (aOR) 4.71, 95% CI 0.111 to 20.025). Those who had received atleast one dose of the vaccine were nine times more likely to have seropositivity (aOR 8.58, 95% CI 1.390 to 53.028). Conclusion: The seropositivity of COVID-19 was high at 87.8%. Older people and vaccinated individuals were more likely to be seropositive. Therefore, it is necessary to strengthen vaccination efforts among all age groups. Continued sero-surveillance and vaccination surveys need to be conducted to gain more insights into the antibody kinetics of this novel pathogen.

Impact of BioFire FilmArray Multiplex PCR in the Detection of Microbial Agents causing Severe Acute Respiratory Infection in the COVID-19 Era: A Cross-sectional Study from a Tertiary Care Hospital in Central India

Introduction: Many viral and bacterial respiratory tract infections can present with respiratory signs and progress to complicated pneumonia. In the recent Coronavirus Disease-2019 (COVID- 19) pandemic, it is crucial to test all Severe Acute Respiratory Infection (SARI) patients for other microbial infections in addition to COVID-19, enabling timely diagnosis and treatment to reduce morbidity and mortality. The automated system, BioFire FilmArray, utilises multiplex Polymerase Chain Reaction (PCR) to rapidly detect and identify multiple respiratory pathogens, including selected Antimicrobial Resistance (AMR) genes, within an hour. Aim: To detect bacterial and/or viral pathogens associated with hospitalised COVID-19-negative SARI patients using the BioFire FilmArray Pneumonia Panel (BFPP). Materials and Methods: This laboratory-based cross-sectional study was conducted at All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India, from June 2020 to February 2021. Respiratory samples, such as sputum, tracheal aspirate, Endotracheal (ET) secretions, and Bronchoalveolar Lavage (BAL), were collected from COVID-19-negative hospitalised SARI cases. A total of 81 patients were included in the study. The samples were tested using the BFPP (multiplex PCR) system and processed using conventional culture techniques. Patient characteristics, clinical and laboratory investigation data, and findings of respiratory viral and bacterial agents, as well as antibiotic resistance genes detected by BioFire FilmArray, were recorded using paper case reports. The data were collected and analysed using Statistical Package for Social Sciences (SPSS) software. Results: Out of the 81 clinical samples processed, the BFPP detected 168 bacterial and 18 viral pathogens. Bacterial-viral co-detection was observed in 13 (16%) samples. Atypical bacteria were detected in 3% of cases. Among the bacterial pathogens, the AMR gene for New Delhi Metallo-beta-lactamases (NDM) was detected in 42 (25.9%) cases, followed by CTX-M beta-lactamases, VIM, and the oxacillinase group of β-lactamases. Conclusion: The BFPP test is a valuable tool for the rapid detection of a wide range of pathogens, including associated AMR genes, with high sensitivity and specificity. This can greatly aid in treatment decisions.

Targeting the Enterococcal Fibronectin Binding Protein- A of Enterococcus faecalis with Bioactive Compounds from Aegle Marmelos: An In-vitro and In-silico Pilot Study

Introduction: Enterococcus faecalis (E. faecalis) is a significant endodontic pathogen, and its virulence has been shown to be significantly influenced by Enterococcal fibronectin binding protein-A (EfbA). Targeting this virulent protein using alternative strategies would be a novel idea to combat the complications of E. faecalis in dental healthcare settings. Thus, the rationale of this investigation is to identify potent bioactive compounds from Aegle marmelos for their antimicrobial properties against EfbA of E. faecalis. Aim: To assess the frequency of EfbA among clinical isolates of E. faecalis and evaluate the antibacterial activity of essential bioactive compounds from Aegle marmelos. Materials and Methods: An in-vitro and in-silico pilot study was conducted from April 2022 to June 2022 in the Department of Microbiology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India to detect the frequency of EfbA in E. faecalis. Patients with typical root caries were included. Microbiological processing of 20 root caries samples was performed to characterise E. faecalis and detect the EfbA gene using Polymerase Chain Reaction (PCR) amplification. Crude methanol extract was obtained from A. marmelos and assessed for its antimicrobial effect against the isolated strains of E. faecalis. Furthermore, several biomolecules from A. marmelos were evaluated for their inhibitory properties through in-silico docking analysis. Results: E. faecalis was identified in 12 (60%) out of 20 root caries samples, and three isolates (25%) were identified as Multidrug-Resistant (MDR) strains based on the antibiogram susceptibility profile, showing resistance to more than three different tested antibiotic groups. EfbA was detected in two of the three MDR strains (66.7%). The crude extract of A. marmelos exhibited promising antibacterial activity. In-silico analysis of the essential oil compounds from A. marmelos revealed that Aegeline had a high interaction with low docking energy and a high number of hydrogen bonds. Conclusion: The current study highlights the potential of aegeline from A. marmelos as an antibacterial agent against resistant strains of E. faecalis. However, additional in-vivo research must be conducted to experimentally validate these findings.

Assessment of Functional Outcome and Quality of Life in Patients after Total Hip Replacement in Indian Population: A Prospective Cohort Study

Introduction: Hip osteoarthritis is a major public health issue associated with a considerable loss of Health-related Quality of Life (HR-QoL). However, not all patients achieve the same level of functional improvement after Total Hip Arthroplasty (THA) and it is unclear which factors are associated with it. Aim: To determine the functional outcome and QoL in patients who underwent Total Hip Replacement (THR) in an Indian set-up. Materials and Methods: The present prospective cohort study was conducted in the Department of Orthopaedics, Eras Lucknow Medical College and Hospital, Uttar Pradesh, India, from March 2020 to September 2021. A total of 100 patients who underwent THA were included through convenience sampling. Demographic and clinical information, like name, age, gender, Body Mass Index (BMI), duration of symptoms, co-morbidity, Visual Analogue Scale (VAS) score and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, were noted from the medical records. A single follow-up of all the patients who underwent THA was conducted to assess the complications, functional outcomes and QoL using VAS score (preoperative and postoperative), WOMAC score (preoperative and postoperative), Harris Hip Score (HHS) (postoperative), Short Form-36 (SF-36) health survey (postoperative) questionnaire. The data was analysed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Continuous variables were analysed using the Wilcoxon signed-rank test for paired data. Correlation assessment was done using Pearson’s correlation coefficient for continuous factors and Spearman’s correlation coefficient for categorical factors. Results: The average age of the patients who underwent THR was 58.90±15.93 years, with a range of 17-95 years. There were 72 males and 28 females. The mean VAS score preoperatively was 7.41±1.20, which decreased significantly to 2.93±0.81 in the postoperative follow-up (p-value <0.001). The mean total WOMAC score improvement was 38.51±10.26 (p-value <0.001). The average postoperative HHS was 73.53±16.16, suggesting a good outcome. The average postoperative SF-36 score was 68.89±12.88. A correlation coefficient of 0.21 (p-value=0.033) suggested that the WOMAC score improvement became higher with an increase in follow-up duration. Patients with postoperative complications had a significantly lower WOMAC improvement (r-value=-0.26, p-value=0.0084). It was observed that the follow-up duration (p-value=0.047) and postoperative complications (p-value=0.016) were significant factors of WOMAC score improvement. Conclusion: Follow-up duration and the presence of postoperative complications were important factors in the functional outcome of patients who underwent THA. Knowledge of these factors can help the clinician to plan the management accordingly while counseling the patients and their relatives regarding any possible adverse outcomes.

Evaluation of Endometrial Thickness by Transvaginal Sonography in Postmenopausal Women with Bleeding: A Cross-sectional Study

Ravidali Naga Swetha, Marri Pavani Rao, Rose Mary Penumaka

Introduction: Abnormal Uterine Bleeding (AUB), occurring atleast one year after menopause, is one of the most concerning complaints among gynaecological patients. Endometrial atrophy is the most common endometrial finding in women with Postmenopausal Bleeding (PMB), approximately 10-15% of whom have endometrial carcinoma. Earlier studies suggested that obesity, Type 2 diabetes mellitus, and hypertension are risk factors for endometrial hyperplasia. Diabetes mellitus, obesity, and hypertension form the triad of endometrial cancer. Aim: To assess endometrial thickness by Transvaginal Sonography (TVS) and compare it with histopathological findings in women with PMB, evaluating whether an endometrial thickness of <4 mm on TVS is more suggestive of malignancy. Materials and Methods: The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at King George Hospital, Vishakapatnam, Andhra Pradesh, India, from January 2022 to December 2022, comprising n=100 subjects. After routine necessary investigations for PMB, a transvaginal ultrasound examination was carried out to calculate endometrial thickness and compare it with the results of histopathological diagnosis of the endometrium. The parameters assessed were endometrial thickness and appearance, Type 2 Diabetes Mellitus (T2DM), hypertension, and Body Mass Index (BMI). The data was compiled and compared using the Chi-square test, with a p-value of ≤0.05 considered highly significant. Results: The results showed normal atrophic and thickened endometrium in 36% of subjects each, and abnormal endometrium such as hyperplasia, carcinoma, and polyps were recorded in 14%, 8%, and 6% (n=6) of cases, respectively. The histopathological results showed normal endometrium such as atrophic, secretory, and proliferative endometrium in 49%, 6%, and 19% of subjects, respectively. Abnormal endometrial findings such as endometrial hyperplasia, carcinoma, and polyps were observed in 14%, 7%, and 5% of cases, respectively. The majority of cases (58%) had endometrial thickness ≤4 mm, followed by 36% of cases with 5-10 mm and 6% of cases >11 mm, with mean and Standard Deviation (SD) values of 5.8±3 mm. Statistical analysis data on the association between TVS findings and Histopathological Examination (HPE) findings was observed to be statistically significant (p<0.001). A statistically significant association was observed between T2DM, and BMI >25 kg/m2 together, DM+hypertension+BMI (Triad) and endometrial thickness, respectively. Conclusion: The TVS is easy, simple, non invasive, and involves no complications. Therefore, it can be used as the first diagnostic step in the investigations of women with PMB, combined with histopathological assessment.

Comparison of Corneal Endothelial Cell Loss during Manual Small-incision Cataract Surgery using Visco-expression versus Irrigating Wire Vectis-assisted Nucleus Removal: A Prospective Randomised Study

Monika Dahiya, Manisha Rathi, Mohit Dua, Sumit Sachdeva, Ruchi Dabas

Introduction: Age-related cataract is the leading cause of curable blindness in India, and Manual Small-Incision Cataract Surgery (MSICS) is a machine-independent and cost-effective alternative to phacoemulsification for handling this significant burden. In every cataract surgery, some endothelial cell loss is inevitable. Therefore, the present study was conducted to compare endothelial cell loss in the two most commonly practiced methods of nucleus delivery in MSICS. Aim: To compare and analyse endothelial cell loss during MSICS using viscoelastic/viscoexpression-assisted nucleus removal versus irrigating wire vectis-assisted nucleus removal. Materials and Methods: A prospective randomised interventional study was conducted at the Regional Institute of Ophthalmology, Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India. The study duration was three years, from May 2018 to May 2021. A total of 250 patients with uncomplicated senile cataract over 40 years of age, with nuclear sclerosis of grade 2 or higher and “with the rule” astigmatism, were included in the study. The patients were randomly divided into Group A and Group B (125 each), who underwent MSICS using visco-expression (Group A) versus irrigating wire vectis-assisted (Group B) nucleus removal. Visual Acuity (VA), keratometry, astigmatism, pachymetry, and Endothelial Cell Density (ECD) were recorded in every patient preoperatively and postoperatively on day 1 and day 40. The Shapiro-wilk test was used to assess the normality of the data, and student’s t-test was performed to identify significant differences in continuous factors between the two groups. Chi-square test was used to find the association between factors and techniques, with a p-value <0.05 considered statistically significant. Results: The mean age of the patients was 68.5±9.4 years (range 52-89 years) with a significant male preponderance. The mean LogMAR visual acuity on Postoperative Day (POD)-1 was 0.3±0.1 for Group A, while for Group B, it was 0.5±0.2, showing a statistically significant difference (p=0.004). However, on day 40, visual acuity was comparable in both groups, with Group A (0.1±0.2) and Group B (0.1±0.1), and no significant difference (p=0.09). On POD-1, the percentage change in Endothelial Cell Density (ECD) was 4.2% in Group A and 10.6% in Group B, with a statistically significant difference (p=0.0017). On day 40, it was 2.1% and 4.8% in Group A and Group B, respectively, also showing a statistically significant difference (p=0.003). On postoperative day 40, the mean Surgically Induced Astigmatism (SIA) in Group A and Group B was 0.67±0.24 and 0.74±0.41, respectively, but this difference was statistically insignificant (p=0.074). Intra and postoperative complications such as hyphema, iridodialysis, and corneal oedema were more common in Group B than Group A. Conclusion: The study concludes that there was a statistically significant endothelial cell loss in the irrigating wire vectis-assisted nucleus delivery method compared to the visco-expression of the nucleus during MSICS. The present method also showed delayed visual rehabilitation and a higher risk of intra and postoperative complications. Therefore, visco-expression of the nucleus should be the preferred method of nucleus delivery in every MSICS where feasible.

Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations during Spinal Anaesthetic Drug Injection

Sandeep Krishnaji Patil, Supriya Praful Rawate, Zeenal Punamiya

Introduction: Spinal Anaesthesia (SA) has stood as the most favoured and dependable technique in regional anaesthesia for the past century. However, despite its widespread use, there are instances of occasional SA failure. Currently, there is no straightforward, cost-effective, and easily administered real-time test-aside from the positive aspiration of Cerebrospinal Fluid (CSF)-that can reliably confirm the deposition of local anaesthetic in the subarachnoid space. Aim: To evaluate the predictive value of subjective sensations (warmth/tingling/numbness) during the administration of SA for enhancing success rates. Materials and Methods: A prospective observational study preceeded the recruitment of 500 patients for this investigation. Following the confirmation of CSF aspiration upon injecting the SA drug, Bupivacaine, patients were queried about the sensations of warmth and/or tingling numbness in the lower limb, saddle part, and inner thighs. This assessment was conducted at 30 seconds and one minute after injection. Additionally, patients were asked to report any increase in the area and/or intensity of these sensations. The adequacy of SA was determined by achieving a sensory block upto the desired dermatome level and reaching a Bromage scale score of IV. Evaluations were performed at two minutes, five minutes, 10 minutes, and 15 minutes from the initiation of SA. Results: The population, predominantly ASA Class-I (60%) and II (40%), exhibited a median age of 45 years, with 54% being male. Intraoperative vital signs, including Heart Rate (HR), Systolic Blood Pressures (SBP), and Diastolic Blood Pressures (DBP), showed a consistent declining trend post-SA administration. Efficacy assessments revealed that Bromage Grade-IV was achieved in 99% of patients at 15 minutes. Notably, subjective sensations of warmth, tingling, and/or numbness proved to be robust predictors of successful SA, with a 218-fold increased likelihood. The diagnostic model demonstrated a high sensitivity of 98%, specificity of 85%, and a Positive Predictive Value (PPV) exceeding 99%. Conclusion: This study highlights the crucial role of warmth, tingling, and numbness as reliable indicators for successful SA, supported by a robust 97% success rate. Incorporating these patient-reported sensations in assessments provides a practical and accessible approach to improve the efficacy of SA procedures.

Comparison of Metformin and Myoinositol on Clinical, Hormonal and Metabolic Profile of Patients with Polycystic Ovarian Syndrome: An Open-label Randomised Clinical Trial

Introduction: The prevalence of Polycystic Ovarian Syndrome (PCOS), one of the common endocrine disorders among women of reproductive age, varies from 2.2% to 26% globally. The treatment for PCOS aims to reduce Body Mass Index (BMI), improve underlying hormonal disturbances, prevent future reproductive and metabolic complications, and enhance the quality of life. Aim: To evaluate the efficacy of metformin and Myoinositol (MI) on the metabolic, hormonal, and clinical profiles in PCOS. Materials and Methods: An open-label randomised clinical trial was conducted at the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengelpet, Tamil Nadu, India, from January 2019 to May 2020. The study included 80 women with PCOS who were randomly assigned to two groups. One group received metformin 1500 mg/day (in three divided doses), while the other group received MI 1 gram/day for three months. At the end of the 12-week therapy, the participants were evaluated for changes in clinical, metabolic, and hormonal profiles. The data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics such as frequency, proportion, mean, and standard deviation were used for quantitative data. Results: Both the metformin and MI-treated groups showed a significant reduction in BMI, fasting blood glucose, and fasting insulin. Both drugs were equally effective in changing the hormonal profile. There was a significant improvement in lipid parameters in both groups, with High-density Lipoprotein (HDL) levels being more significantly raised in the metformin group. The post-treatment HDL values in the metformin group were 75.69±19.16 mg/dL compared to 41.43±6.18 mg/dL in the MI group (p<0.0001). Both groups demonstrated similar efficacy in improving menstrual regularity, with 60% of the patients in the metformin group and 65% in the MI group having regular cycles at the end of treatment. Among infertility patients, the conception rate was 40% in the metformin group and 25% in the MI group (p=0.70). Conclusion: Both drugs were equally efficient in improving the clinical, metabolic, and hormonal profiles in PCOS. Metformin was found to be superior to MI in improving fertility and increasing HDL levels.

Efficacy of Dexmedetomidine and Labetalol for Induced Hypotension in Endoscopic Sinus Surgeries: A Randomised Clinical Study

Urmila Keshari, Sonali Gupta, Charulata Patidar, Richa Pandey

Introduction: Functional Endoscopic Sinus Surgery (FESS) is one of the most commonly performed surgical procedures that requires minimal bleeding during the procedure. Dexmedetomidine, an alpha-agonist and labetalol, a beta-blocker, have been used to decrease intraoperative bleeding and provide optimal surgical conditions. Aim: To evaluate the efficacy of labetalol and dexmedetomidine on intraoperative blood loss and surgical conditions during FESS. Materials and Methods: The present randomised single-blinded clinical study was conducted in the Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal, India, from January 2020 to May 2021. Study was performed on 60 patients aged 18-60 years undergoing FESS. The patients were divided into two groups: Labetalol (L) or Dexmedetomidine (D). Heart rate and arterial blood pressure were measured after induction, during and at the end of the surgery. An assessment of bleeding was done by a blinded surgeon. Surgical field quality, surgeon satisfaction, emergence time, Aldrete score and any side effects were observed. Data were analysed using the Statistical Package of Social Sciences (SPSS) software version 17.0 for Windows and the unpaired student t-test. Results: In the total study population, the mean age in group D was 42.96±11.52 years and in group L was 47.33±10.97 years. In both groups, female patients were more prevalent than males (Group L: 53.3%; Group D: 60%). There was a significant decrease in heart rate in group D compared to group L during and after the operation. Mean Arterial Pressure (MAP) after induction (106.63±6.094 mmHg vs 114.80±6.272 mmHg), at extubation and after extubation for six hours was significantly higher in group L than in group D. The emergence time of group D was higher than that of the labetalol group. The surgical field quality and surgeon satisfaction were significantly higher in group D. Time to reach Aldrete score ≥9 (15.67±1.788 vs 11.23±1.654), time for first analgesic requirement and Ramsay sedation score were found to be higher in group D and were statistically significant. Conclusion: Both dexmedetomidine and labetalol can be used for controlled hypotension during FESS. Dexmedetomidine provides more haemodynamic stability and is ideal for creating a better surgical field during endoscopic surgeries.

Use of Immunohistochemical Markers in Differentiation of Hepatocellular Carcinoma from Intrahepatic Cholangiocarcinoma and Metastatic Adenocarcinomatous Deposits in the Liver from Colon: A Cross-sectional Study

C Arun Prabhakaran, V Ramya, K Shanmugam, S Brihadisvarar, K Chandramouleeswari

Introduction: Hepatocellular Carcinoma (HCC) is a major worldwide health problem due to its high incidence and mortality rates. The liver often becomes a site for metastasis from various primary locations, benefiting from its abundant blood supply. Distinguishing liver metastatic tumours from HCC can pose a diagnostic challenge, significantly impacting prognosis and treatment decisions. Aim: To differentiate between HCC, Intrahepatic Cholangiocarcinoma (ICC), and metastatic colonic adenocarcinoma in the liver using Hep par-1, Cytokeratin (CK) 7, CK19, and CK20 as immunohistochemical markers. The manual Tissue Microarray (TMA) technique was employed for present study. Materials and Methods: The present cross-sectional study was conducted in Department of Pathology at Government Stanley Medical College, Chennai, Tamil Nadu, India, spanning a three-year duration from July 2012 to June 2015. A total of 60 cases diagnosed histologically with HCC, ICC, and metastatic colonic adenocarcinoma in the liver were included. The manual TMA technique was used to create recipient blocks, and immunohistochemistry was performed to assess the expression of Hep par-1, CK7, CK19 and CK20. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Values (NPV) of these markers in HCC, ICC, and metastatic colonic adenocarcinoma in the liver were analysed and tabulated using statistical software Statistical Package for Social Sciences (SPSS) version 16.0. Results: The study included a total of 60 cases, with 40 (66.7%) males and 20 (33.3%) females, ranging in age from 27 to 73 years with a mean age of 51.3 years. Among the cases, there were 30 (50%) cases of HCC, 14 (23%) cases of ICC, and 16 (27%) cases of metastatic colonic adenocarcinoma in the liver. The sensitivity, specificity, and PPV of Hep par-1 in distinguishing HCC from ICC and metastatic deposits were 80%, 100%, and 100%, respectively. The NPV of Hep par-1 in distinguishing HCC from ICC and metastatic deposits was 70% and 72%, respectively. The sensitivity, specificity, PPV, and NPV of CK7 in distinguishing ICC from HCC were 3.3%, 50%, 6.3%, and 34.1%, respectively. The sensitivity, specificity, PPV, and NPV of CK19 in distinguishing HCC from ICC and metastatic deposits were 0%, 50%, 0%, and 33.3%. The sensitivity, specificity, PPV, and NPV of CK20 in distinguishing HCC from ICC and metastatic deposits were 0%, 53.3%, 0%, and 34.8%, respectively. Conclusion: In conclusion, it was found that a panel of markers including Hep par-1, CK7, CK19 and CK20 can differentiate between HCC, ICC, and metastatic colonic adenocarcinoma in the liver. This differentiation is crucial for determining the appropriate treatment for patients by understanding the exact behaviour of the tumour.

Assessment of Parental Knowledge, Attitudes and Perceptions towards Conscious Sedation: A Quasi-experimental Study

Introduction: Dental anxiety is a common problem among children, leading to missed dental appointments and neglect of oral health. Conscious sedation is a technique used in dental clinics to alleviate anxiety and enhance the patient’s experience. However, parents often lack understanding about conscious sedation, which can hinder their consent for the procedure for their child. Aim: To assess parents’ knowledge, attitudes, and perceptions towards conscious sedation in dental care settings. Materials and Methods: This study employed a pre-test/post-test quasi-experimental design and involved 400 parents (aged 21-40 years) whose children, aged 3 to 16 years, were randomly selected to complete a questionnaire survey at the Department of Pedodontics and Preventive Dentistry at Rajarajeswari Dental College and Hospital in Bengaluru, Karnataka, India. The survey was conducted between December 2022 and March 2023, spanning a period of four months. Data collection methods included a pre-education questionnaire and a posteducation questionnaire after an educational intervention. The collected data underwent statistical analysis, utilising mean, Standard Deviation (SD), Analysis of Variance (ANOVA), Wilcoxon’s signed rank, and Tukey’s posthoc tests. Results: Prior to education, 393 (98.25%) of the study population were unaware that conscious sedation was safe and easy. It was observed that 368 (92%) of the participants opposed conscious sedation for their child, but following education, 400 (100%) agreed, resulting in a 95.2% shift in perception. Conclusion: The study revealed that, before the intervention, the majority of parents were unaware of and opposed to conscious sedation, indicating a significant knowledge gap. However, the implementation of educational interventions during dental visits, led by dentists, played a crucial role in improving their knowledge and significantly changing their attitude, with 400 (100%) agreeing to the use of conscious sedation.

Children Anxiety and Pain while Performing Interim Therapeutic Restorations with Hand Instruments compared to Rotary Instruments: A Randomised Clinical Trial

Osama M Felemban, Abraar M Bannan, Rahaf M Alqadi, Nada O Bamashmous

Introduction: Children with dental anxiety may avoid visiting the dentist until a more serious and painful condition develops. Dentists could use less stressful techniques, like Interim Therapeutic Restorations (ITR), to treat dental cavities in difficult or young patients. ITR performed with hand tools may be preferred due to the absence of handpiece vibration, sound, or smell. Aim: To assess the anxiety and pain levels experienced by children during ITR procedures performed with hand instruments compared to rotary instruments. Materials and Methods: The present randomised clinical trial was conducted in the Department of Pediatric Dentistry at King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The inclusion criteria consisted of children aged 3-12 years visiting the dental clinic for the first time and having a carious primary anterior (incisor or canine) tooth. Patients were recruited from the paediatric screening clinic and randomly assigned to either the “Hand instrument group” or the “Rotary instrument group.” Caries excavation was performed using a hand instrument in the former group, while a low-speed handpiece was used in the latter group. Anxiety levels were assessed using Venham’s anxiety rating scale before and after the procedure. Heart rate was measured using pulse oximetry every two minutes. Pain levels were evaluated using the Wong-Baker Faces Pain Rating Scale after completing the procedure. Results: The study included 60 patients, with a mean age of 5.87±2.09 years. The anxiety score after the procedure was significantly lower in the hand instrument group compared to the rotary instrument group (p=0.007). Although the heart rate was lower in the hand instrument group compared to the rotary instrument group, the difference was not statistically significant. The subjects in the hand instrument group reported lower pain levels compared to those in the rotary instrument group (p=0.029). Conclusion: Performing ITR using hand instruments resulted in reduced anxiety and pain levels among young children compared to ITR performed using rotary handpieces.

Efficacy of Erector Spinae Plane Block in Modified Radical Mastectomy for Postoperative Analgesia: A Randomised Controlled Study

Shrawan Soni, Archana Roy, Anindya Mukherjee, Keka Pandey, Dipankar Mukherjee

Introduction: The Erector Spinae Plane Block (ESPB) is a recently introduced Ultrasound (US)-guided interfascial plane block commonly used for treating thoracic neuropathic pain. Although ESPB has been used for pain control after Modified Radical Mastectomy (MRM), which is a frequently performed operation nowadays, its efficacy compared to other methods of pain control is yet to be established. Aim: To evaluate the effectiveness of ESPB in controlling acute postoperative pain after MRM surgery. Materials and Methods: A total of 64 adult females aged between 18-60 years, with American Society of Anaesthesiologists (ASA) physical status I and II, scheduled to undergo elective MRM, were enrolled in the present randomised, double-blinded, controlled study conducted at Department of Anaesthesiology and Critical Care, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India over a period of nine months (from March 2021 to November 2021). They were randomly assigned to two groups, with 32 patients in each group. Group A (n=32) received general anaesthesia only, while Group B (n=32) received US-guided ESPB in addition to general anaesthesia. Postoperative Visual Analogue Scale (VAS) scores, total intra and postoperative analgesic requirements for the first 24 hours, and duration of postoperative analgesia were recorded for each patient. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 24.0 software. Mean and Standard Deviation (SD) were used to express data for numerical variables, while count and percentages were used for categorical variables. Results: Demographic characteristics (age, weight), ASA status, and mean duration of surgery were similar between the groups. The duration of postoperative analgesia was significantly (p<0.05) prolonged in Group B patients (584.1±89.1 minutes) compared to Group A patients (78.0±53.1 minutes). Intra and postoperative analgesic requirements were significantly lower in Group B (fentanyl 87.0±16.8 mcg, tramadol 68.3±35.9 mg) compared to Group A patients (fentanyl 94.5±26.7 mcg, tramadol 158.3±32.3 mg). The postoperative VAS score was more favourable in Group B than in Group A (1.1±0.4 vs. 4.1±0.8 at rest). Conclusion: The US-guided ESPB is a simple and easy procedure that provides prolonged duration of postoperative analgesia with reduced overall analgesic requirement in the postoperative period after MRM surgery. Therefore, it can be concluded that ESPB is an effective method for controlling acute postoperative pain after MRM surgery.

Abdominal Ultrasonography and Splenoportal Doppler Study for Predicting Oesophageal Varices in Patients Admitted with Chronic Liver Disease at a Tertiary Medical Hospital in Kolkata, India: A Cross-sectional Study

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey’s Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease.

Risk Stratification of Foetuses based on Estimated Foetal Weight less than the 40^th Percentile and Evaluation of Perinatal Outcomes using Third-trimester Obstetric Ultrasound: A Prospective Cohort Study

Introduction: Perinatal mortality and morbidities constitute a burden on society and healthcare system. One of the major identifiable causes of these conditions in India is Low Birth Weight (LBW) and preterm births. Small for Gestational Age (SGA) infants account for almost 46.9% of LBW infants. They are prone to the morbidities of preterm birth and are the second major contributor to perinatal mortality. Recent studies have reported that higher screening performance for SGA can be achieved through ultrasonographic foetal biometry and Doppler studies during the third trimester. Aim: To stratify foetuses with Estimated Foetal Weight (EFW) below the 40th centile, as determined by obstetric ultrasound, into three categories (low, intermediate, and high-risk), and study the perinatal outcomes in each category. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India from November 2020 to April 2022. A total of 280 antenatal women, at a gestational period between 35 to 36+6 weeks with singleton pregnancies, were studied and based on the foetal biometry and Doppler parameters, women were classified into low (Group A), intermediate (Group B) and high risk (Group C) categories. Risk categorisation was based on EFW and Doppler indices. The low-risk group underwent an ultrasound Doppler scan after four weeks, the intermediate-risk group after two weeks, and the high-risk group was scanned weekly. The high-risk group was delivered at 39 weeks of gestation. Perinatal outcomes, neonatal weights, adverse neonatal outcomes {such as Neonatal Intensive Care Unit (NICU) admissions exceeding 48 hours}, stillbirths, and neonatal deaths were recorded. The Area under Curve (AUC) cut-off for EFW percentiles on ultrasonography was calculated as a predictor for SGA foetuses requiring NICU admissions. Concurrent admissions in the NICU of neonates delivered to unregistered pregnant mothers, who were not screened during the antenatal period, were also recorded. The Chi-square test was used to compare categorical data between groups. The receiver operating characteristic curve was used to determine the cut-off for foetal weight to predict NICU admission. A p-value of <0.05 was considered statistically significant. Results: Among the study population, 231 (82.6%) were between 21-30 years of age, and 250 (88.87%) had a normal Body Mass Index (BMI) with a mean age of 25.78±3.90 years. On risk categorisation, 71 (25.1%), 82 (29%), and 127 (45.9%) women were in the high, intermediate, and low-risk categories, respectively. All the neonates in the high-risk group were classified as SGA according to the INTERGROWTH 21st growth chart. Among the neonates, 18 (6.4%) weighed below 2100 g, 35 (12.4%) weighed between 2101 to 2200 g, 62 (22.3%) weighed between 2201 to 2400 g, and 165 (59%) weighed above 2401 g. NICU admissions occurred in 25 (35.2%), 10 (12%), and 5 (3.8%) neonates in the high, intermediate, and low-risk groups, respectively (p-value <0.001). At a cut-off of EFW (g) less than or equal to 2122 g (between the 10th and 20th centile) during the first ultrasound, it predicted SGA neonates requiring NICU admissions with a sensitivity of 80% and a specificity of 70%. No stillbirths or neonatal mortality occurred in the study group. Conclusion: A single third-trimester obstetric ultrasound, along with Doppler measurements, should be performed at 35 to 36 weeks as an important adjunct for identifying and stratifying the risk of singleton foetuses. Close monitoring and timely delivery can help reduce adverse perinatal outcomes in SGA foetuses.

Ultrasound-guided Supraclavicular Brachial Plexus Block with Ropivacaine in Basilic Vein Transposition Surgery for Chronic Renal Failure Patients: An Interventional Study

Keta Bhikhabhai Patel, Sanket Hirenbhai Mehta, Birva Nimit Khara

Introduction: Basilic Vein Transposition surgery (BVT) is preferred under ultrasound-guided supraclavicular brachial plexus block, which provides excellent and safe anaesthesia in Chronic Renal Failure (CRF) patients. Ropivacaine, with a shorter elimination half-life than bupivacaine and better pharmacokinetics, is a safer option as a local anaesthetic agent in CRF. Aim: To assess the onset and duration of sensory and motor blockade with 20 mL of 0.5% ropivacaine in ultrasound-guided supraclavicular block and the need for additional local infiltration at the surgical site for BVT. Materials and Methods: In present interventional study conducted in the Department of Anaesthesiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, 25 American Society of Anaesthesiologists (ASA) III/IV CRF patients, aged 18-80 years, who underwent BVT surgery, were included from December 2021 to November 2022. A 20 mL dose of 0.5% ropivacaine was administered to these patients via ultrasound-guided supraclavicular block. The surgeon performed local infiltration with 10 mL of lignocaine at the T2 dermatomal area in all patients. Descriptive statistics were calculated for age, weight, ASA status, onset and duration of sensory and motor blockade, and the need for additional local infiltration. Results: The mean age and mean weight of the patients were 52 years and 57.68 kg, respectively. Total 17 were male and eight were female, while 23 were ASA III and two were ASA IV. After administering the supraclavicular block, the mean onset of sensory and motor blockade was 9±2.3629 and 13.16±2.6721 minutes, respectively. The mean duration of sensory and motor blockade was 612.8±132.815 and 522.8±121.124 minutes, respectively. All patients required local site infiltration (10 mL of 1% lignocaine-Adrenaline) as the T2 dermatome is usually spared by the supraclavicular block. Three patients required additional local anaesthetic infiltration. Conclusion: Minimising the concentration and volume of local anaesthetic drugs without compromising efficacy is challenging, particularly in BVT, where the incision is extensive and performed under supraclavicular BPB in high-risk CRF patients. The anaesthesia practice of using a low volume of 0.5% ropivacaine in BPB under ultrasound guidance, along with local anaesthetic infiltration with 1% lignocaine with adrenaline at the T2 dermatome, can serve this purpose without any complications.

Analysis of Fall Incidence Rate and Risk Factors at a Tertiary Care Hospital Setting for Inpatient Neurological Care using the Morse Fall Scale: A Prospective Study

Riya Roy, Purusotham Chippala

Introduction: Falls are the most common adverse events related to a patient safety in healthcare institutions. Falls during hospitalisation, particularly in inpatient rehabilitation facilities, are a common phenomenon among hospitalised individuals. The rationale of the present study is to reduce the incidence of falls by early identification of fall risk using an outcome measure. Aim: The aim of this study is to identify the fall incidence rate and associated factors responsible for falls in inpatients with neurological diseases using the Morse Fall Scale (MFS). Materials and Methods: This prospective study included 128 patients hospitalised in the Medicine and Neurosurgery Units of Justice KS Hegde Charitable Hospital in Mangaluru, Karnataka, Southern India. The study was conducted from March 2022 to March 2023. Factors were analysed through direct patient interviews, and fall risk scores were identified using the MFS during admission and discharge. Categorical variables were presented as frequency and percentage, while descriptive variables were presented as Mean±Standard Deviation. The pre-post comparison of the outcome measure was conducted using the Z-test. Results: The fall incidence rate in neurological inpatients was found to be 15 (11.7%), and the majority of the population belonged to moderate to high-risk of falls. During the hospitalisation period, 99 (77.3%) individuals had a fear of falling, while 29 (22.7%) did not have any fear of falling. Among the study population, 113 (88.3%) had no falls during their hospitalisation, while 15 (11.7%) experienced falls. The majority of subjects had a moderate risk of falls: 63 (49.2%) upon admission and 68 (53.1%) at discharge. There was a significant difference in the MFS scores between admission and discharge (p-value=0.024). Conclusion: The present study concludes that the MFS enables the identification of individuals at risk of falling. The variables related to these findings were the use of continuous medications, balance issues, fear of falling, followed by other factors such as age, length of hospital stay, previous hospitalisation, and sensory disorders.

Chloride as a Prognostic Factor in Children with Diabetic Ketoacidosis: A Retrospective Cohort Study

Preethi Suresh, Suresh Rangaraj, Prasanna Raju, Subash Sundar

Introduction: In the management of Diabetic Ketoacidosis (DKA), importance is given to electrolytes such as sodium and potassium, but not chloride. There is evidence that high chloride levels can lead to Acute Kidney Injury (AKI). However, chloride as a prognostic factor has not been thoroughly investigated. Aim: To evaluate the role of chloride as a prognostic factor in the treatment of children with DKA. Materials and Methods: This retrospective cohort study collected data from 22 children with severe DKA, aged under 14 years, admitted to the Department of Paediatrics, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, between January 2016 and October 2020. Data included demographic details, blood glucose, arterial blood gas, renal function tests, serum electrolytes at admission and at 24 hours, and outcome parameters. All children received regular monitoring and standard treatment as per the International Society for Paediatric and Adolescent Diabetes (ISPAD) guidelines. The children were divided into two groups: Recovery within 48 hours (Group-A) and more than 48 hours (Group-B). Electrolyte and renal parameters after 24 hours of treatment were compared. Univariate analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0. Student’s t-test, Chi-square test, and odds ratio were used for statistical analysis. A p-value of <0.05 was considered significant. Results: Among the 22 children, 50% recovered within 48 hours, while the remaining half took more than 48 hours. A total of 13 had hyperchloraemia at 24 hours (59%). The mean serum chloride at 24 hours was 115.91 mmol/L in Group-B compared to 106.09 mmol/L in Group-A (p=0.0079*). Two developed AKI, requiring renal replacement therapy and ventilatory support, and eventually died. Conclusion: In the present study, children with severe DKA who developed hyperchloraemia after 24 hours of admission, following fluid resuscitation with 0.9% normal saline and subsequent standard treatment, took a longer time to recover.

Clinical Profile in Patients of Amoebic Liver Abscess with and without Hyperbilirubinemia: A Prospective Cohort Study

S Sujitha, Rajiv Ranjan Kumar, Jitendra Kumar, Rekha Dewan

Introduction: In tropical countries like India, two-thirds of liver abscess cases are amoebic. Along with abdominal pain, fever, and other non-specific clinical features, jaundice is commonly observed in Amoebic Liver Abscess (ALA) cases. However, the understanding of jaundice in a patients with ALA is limited, and it is associated with a poor prognosis. Aim: To compare the morbidity and mortality of ALA patients with and without hyperbilirubinemia, as well as their clinical outcomes. Materials and Methods: The present prospective cohort study was conducted at a tertiary teaching institute in northern India. It included 150 patients aged between 20 and 60 years with a confirmed diagnosis of ALA. The patients were divided into two groups based on the presence or absence of hyperbilirubinemia. Those with jaundice resulting from other causes or a history of hepatitis were excluded. Variables examined in the study included age, sex, alcohol intake, basic laboratory parameters, ultrasound-assessed abscess size and number, and duration of hospital stay. Results: Among the 150 cases, 22 (14.6%) had elevated serum bilirubin levels (>1 mg/dL). Additionally, 122 (81.33%) had a history of alcohol intake, and 117 (78%) had a single abscess cavity. In ALA patients with hyperbilirubinemia, 12 (54.55%) had abnormal creatinine values, and 6 (27.26%) experienced complications such as rupture and peritonitis. One mortality occurred in a patient with ALA and jaundice. Conclusion: ALA patients with jaundice exhibited larger abscess cavities, a higher complication rates, a longer hospital stays, and a poor prognoses.

Evaluation of Cytogenetic Damage Induced during Hysterosalpingography Procedure: A Cross-sectional Study

Introduction: Hysterosalpingography (HSG) is a radiographic procedure used to visualise the fallopian tubes and uterine cavity by injecting a contrast medium, commonly employed for diagnosing infertility cases. However, due to the associated radiographic and fluoroscopic exposure, there is an increased risk of chromosomal damage to the gonads. Aim: To investigate the impact of radiographic and fluoroscopic exposure on chromosomal integrity in peripheral blood lymphocytes using the Cytokinesis Blocked Micronucleus (CBMN) assay. Materials and Methods: This cross-sectional time-bound study included 10 patients (n=10) scheduled for HSG procedures at the Department of Radiology, Justice KS Hegde Hospital, Mangaluru, Karnataka, India from April 2021 to March 2022. Following radiation exposure, the CBMN assay was conducted to evaluate chromosomal damage in both test and control group blood samples. Blood samples from healthy donors were divided into three cryo vials, with one serving as the control and the remaining two exposed to radiation at the entrance and exit areas during the HSG procedure. The data were expressed as mean±Standard Deviation (SD). A p-value <0.05 was considered statistically significant. The analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: A statistically significant (p<0.05) increase in biological damage was observed when comparing the Micronucleus (MN) frequency of the test groups (entrance=0.022±0.005 and exit group=0.0172±0.005) with the control group (0.006±0.003). Additionally, a decrease in MN frequency was noticed within the test groups, particularly in the exit group, although the results were not statistically significant (p=0.066). Conclusion: The HSG is an effective clinical diagnostic technique. However, the present study indicates a potential risk of chromosomal damage associated with the procedure, emphasising the need for judicious use of radiation exposure during HSG.

A Randomised Split-Mouth Clinical Trial to Assess the Efficacy of OroQuiver: An Affordable Vibrotactile Device for Dental Injections

Ravindra Reddy, Varsha Haridas Upadya, Joyce Pascalia Sequeira, Jagadish Chandra

Introduction: Injection pain is a common concern among patients, including those receiving dental injections. Local Anaesthesia (LA) is a crucial procedure in dentistry to ensure painless treatment. Vibration stimuli have shown promise in raising the pain threshold, managing orofacial pain, musculoskeletal pain, and relieving dental pain. However, many vibrotactile devices available in the market are not affordable for common dentists. Aim: To compare pain perception in patients undergoing bilateral extractions using OroQuiver-assisted LA administration versus conventional LA administration. Materials and Methods: A randomised split-mouth clinical trial was conducted with 17 patients undergoing simultaneous bilateral extractions. LA was administered with and without OroQuiver on the right and left-sides, respectively. Pain assessment was performed using Wong Baker’s Facial Rating Scale and a questionnaire sheet comparing patient comfort following LA administration on both sides. Results: There was a significant difference in the Visual Analog Scale (VAS) score for pain experienced during LA injections using the vibrotactile device (4.29±1.1) compared to the conventional method (7.2±1.5). None of the patients reported discomfort with the device. The device reduced anxiety towards dental injections in 14 patients, and 16 patients indicated they would recommend the device to others. Conclusion: OroQuiver effectively reduced injection-related pain regardless of the type of nerve block administered. It is a cost-effective, easily maneuverable, feasible, sterilisable, and reusable device that effectively reduces LA injection-related pain.

Prevalence of Dental Anomalies in Maxillary Lateral Incisors: An Institutional Cross-sectional Study from Karnataka

Introduction: The majority of dental abnormalities are found in third molars, followed by permanent maxillary lateral incisors. The occurrence of these dental anomalies varies among different ethnic groups; hence, it is of prime importance for clinicians to know and understand the incidence of dental anomalies among the local population. Aim: To analyse the prevalence of dental anomalies in relation to permanent maxillary lateral incisors in the Karnataka region. Materials and Methods: A cross-sectional study was conducted in the Department of Conservative Dentistry and Endodontics of HKES’s S Nijalingappa Institute of Dental Science and Research, Kalaburgi, Karnataka, India from July 2022 to December 2022. A total of 1,116 subjects, aged between 15 and 50 years, were randomly screened. Each subject was clinically examined, and radiographs were taken for patients with dental anomalies. The five dental anomalies studied were congenitally missing permanent maxillary lateral incisors, peg laterals, dens in dente, talon’s cusp, and palato-gingival groove. Statistical analysis was performed using SPSS version 26. Descriptive statistics were estimated in terms of frequency and percentage. Results: A total of 43 subjects were found to have anomalies associated with the maxillary lateral incisor, including peg-shaped laterals (1.25%-14), dens in dente (0.81%-09), congenitally missing (0.45%-05), talon’s cusp (0.27%-03), and palato-gingival groove (1.07%-12). Conclusion: Anomalies in permanent maxillary lateral incisors were noted in 3.85% of the Karnataka population.

Detection of Early Smooth Surface Caries in Primary Molars using Conventional Methods in a Low-Resource Setting: A Cross-sectional Study

PN Nanmaran, Nilanjana Saha, Shiladitya Sil, Subhankar Ghosh

Introduction: Dental caries is a widespread chronic disease that affects nearly 100% of adults in developing countries. Detecting caries early is crucial for effective remineralisation and improved prognosis. However, identifying smooth surface caries in its early stages remains challenging for many healthcare professionals globally due to the subjective nature of visual inspection. Aim: To determine the most effective method for detecting early smooth surface caries in limited resource settings. Materials and Methods:The present cross-sectional study was conducted in the Department of Pedodontics, Dr. R. Ahmed Dental College and Hospital (tertiary care centre), Kolkata, West Bengal, India, from March 2021 to August 2022. Study was conducted involving 120 primary molars from Bengali children aged 5 years and above. The teeth were randomly selected while adhering to specific inclusion and exclusion criteria. The occlusal and proximal surfaces of the teeth were assessed using three methods: unaided Visual Examination (VE), Magnifying Loupe (ML)-assisted VE, and the fluorescence-based DIAGNOdent pen (considered the gold standard). Two assessments were performed for each method, one before air-drying and another after air-drying. Caries detection followed the International Caries Detection and Assessment System (ICDAS) II clinical scoring system, and data analysis was conducted using the Chi-square test for proportions. Results: In the present study, there were 76 male children and 44 female children and the mean age of the children was 7±2.5 years. Unaided VE exhibited a diagnostic accuracy of 87.5% and 77.5% for air-dried and non air-dried tooth surfaces, respectively. ML-aided VE yielded a diagnostic accuracy of 88.34% and 85% for air-dried and non air-dried tooth surfaces, respectively. Conclusion: The present study concluded that even without the assistance of an ML, drying the tooth surface can achieve a level of caries detection accuracy comparable to that of ML-aided VE.

Readiness for Self-directed Learning amongst First-year Medical Undergraduates in the Northern Part of Kerala, India: A Quasi-experimental Study

Sparsha Deep E Manjunath, Kavana G Venkatappa, GN Geetha

Introduction: The ability for independent learning is considered a critical component for university graduates to engage in continuous learning. Self-directed Learning (SDL) is necessary for learners to transition from passive to active learners. With the implementation of competency-based education, the concept of SDL is becoming increasingly important in undergraduate teaching. However, many students find the concept of self-learning unfamiliar, causing them undue anxiety. The improvement of lifelong learning thus depends critically on having an effective understanding of SDL skills. Aim: To assess the readiness for SDL and emphasise the need for assessing students’ readiness towards SDL. Materials and Methods: This quasi-experimental study involved 100 first-year medical students who provided informed consent. Readiness for SDL was determined using the Fisher SDL Readiness Scale (SDLRS). An SDLRS score of >150 is considered an acceptable level of SDL readiness. Six SDL sessions were conducted, and participants were assessed based on their performance in SDL. The study participants were grouped as high, mid, and low achievers, and their SDLRS scores were correlated. The data obtained were statistically analysed using descriptive and inferential statistics. Results: The median SDLRS score was 149, with 54 (54%) of students scoring below the acceptable level of 150. The median scores for the subscale of self-management were statistically high (p-value <0.001) among the high achievers. The SDLRS scores and SDL session test scores of the three groups of students showed a significant moderate positive correlation (r-value=0.356, p-value <0.001). Conclusion: The present study concluded that 54% of medical students scored below the acceptable level on the SDLRS, and there was a moderate positive correlation between SDLRS scores and SDL session test performance.

Evaluation of Variation in the Calot’s Triangle at a Tertiary Care Hospital in Northern Uttar Pradesh, India: A Cross-sectional Study

Pooja Pandey, Abhishek Ranjan, Irfan Khan, Shyamendra Pratap Sharma

Introduction: Cholelithiasis is the most common disease worldwide, and laparoscopic cholecystectomy is the standard treatment of choice. To perform laparoscopic cholecystectomy, it is essential to understand the critical view of safety, which primarily involves the dissection of Calot’s triangle. Anatomical variations in Calot’s triangle exist, and understanding them is crucial to avoid unintended situations during surgery. Mirizzi syndrome, a rare complication in Calot’s triangle, can significantly increase mortality and morbidity rates. Aim: To evaluate the anatomical variations in the Calot’s triangle. Materials and Methods: A cross-sectional study was conducted at Mayo Institute of Medical Sciences, Department of General Surgery, from October 2021 to September 2022. The total sample size included 100 patients with gallstone disease who underwent surgical intervention. Intraoperative findings, such as variations in the cystic artery and cystic duct, as well as Mirizzi syndrome grading, were recorded in an Excel sheet and tabulated. The results were expressed in terms of frequency and percentage. Results: The average age of the patients was 39.42±12.11 years, with females outnumbering males. Among them, 28% had a cystic artery lying outside of Calot’s triangle, and 96% had a cystic artery originating from the right hepatic artery. The remaining 2% originated from an aberrant right hepatic artery, 1% from the left hepatic artery, and 1% from the gastroduodenal artery. Cystic duct variations were found in 5% of cases. Of these, 2% had a short cystic duct (<2 cm), 1% had a long cystic duct (approximately 5 cm), one patient had an absent cystic duct, and one had a low insertion into the common hepatic duct. Mirizzi syndrome Grade-I and Grade-II patients accounted for 4% and 2% respectively, while Grade-III, Grade-IV, and Grade-V each contributed to 1%. Conclusion: Knowledge of Calot’s triangle variations is crucial, especially for aspiring surgeons, as it helps them make decisions promptly when encountering difficulties during surgery. Understanding the Calot’s region ensures the safety not only of patients but also of surgeons.

Effect of 5% Dextrose Infusion on Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Controlled Study

BR Lakshmi, Roopashree Nanjundappa, Vithal Kulkarni

Introduction: Postoperative Nausea and Vomiting (PONV) is defined as nausea, vomiting, or retching occurring in the postanaesthesia care unit within the first 24 hours of postoperative period. It is most common following laparoscopic cholecystectomy, causing postoperative discomfort and increasing patients’ stay in the postanaesthesia care unit. Aim: To evaluate the effect of a 500 mL infusion of 5% dextrose on PONV in patients undergoing laparoscopic cholecystectomy. Materials and Methods: A randomised controlled study was conducted at Department of Anaesthesiology, ESICMC PGIMSR, Bengaluru, Karnataka, India from January 2019 to June 2020, involving 90 consenting patients who were randomly assigned to two groups. One group (Group-C) received a 500 mL infusion of 5% dextrose, while the other group (Group-D) received Ringer’s lactate 30 minutes before the end of surgery. Anaesthesia and surgical techniques were standardised for all cases. Postoperatively, primary parameters such as the incidence of nausea, vomiting, and retching, and secondary parameters such as rescue antiemetic consumption and changes in blood glucose changes were recorded. The Bellville scale was used to assess PONV. Data were analysed using the Chi-square (χ2) test, with a significance level of 0.05. Continuous variables were reported as mean±Standard Deviation (SD), and categorical variables were reported as proportions. Results: Demographic parameters such as age (p=0.601), gender (p=0.259), weight (p=0.802), height (p=0.391), and Body Mass Index (BMI) (p=0.806) were comparable between the two study groups. A 5% dextrose infusion during laparoscopic cholecystectomy reduced nausea and vomiting during the postoperative period (p<0.05), decreased the overall incidence of PONV (p<0.001), and also reduced the requirement for rescue antiemetic dose (p<0.004). When comparing blood sugar levels, Group-D and Group-C showed no significant difference at T1, but there was a significant difference between the both groups at T2 (T1: p=0.211, T2: p<0.001). Conclusion: A 5% dextrose infusion during laparoscopic cholecystectomy reduces the incidence of PONV and decreases the need for rescue antiemetic medication. Additionally, comparing blood sugar levels, Group-D and Group-C showed a significant difference after the drug infusion. Therefore, a 5% dextrose infusion can be recommended as an effective and safe method for the prophylaxis of PONV in laparoscopic cholecystectomy.

Effectiveness of an Occupational Therapy Memory Strategy Education Group Intervention on Memory Difficulties and Activities of Daily Living Performance among the Geriatric Population: A Quasi-experimental Study

V Vishnupriya, Ganapathy U Sankar, Monisha Ravikumar

Introduction: Memory deficits are one of the common indications of cognitive aging, and they are an essential component for completing day-to-day activities in an effective, timely, and safe manner. Disturbances in memory can have a major impact on an individual’s performance in all areas of occupation. Memory alterations have a substantial influence on numerous elements of everyday living, including sentiments and conceptions of self, connections with others, participation in Activities of Daily Living (ADL), and engagement in leisure activities. Aim: To determine the effectiveness of an occupational therapy Memory Strategy Education Group (MSEG) intervention on memory difficulties and its impact on ADL performance among the geriatric population. Materials and Methods: The present quasi-experimental pre-post-test pilot study was conducted at Department of Occupational Therapy, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India. A total of 10 participants aged 60 years and above were recruited from a community setting through convenience sampling and were divided into an experimental group (n=5) and a control group (n=5). The experimental group participants received MSEG intervention, while the control group participants received conventional occupational therapy memory intervention for three weeks. The Canadian Occupational Performance Measure (COPM), Contextual Memory Test (CMT), and Functional Independence Measure (FIM) were used to measure occupational performance, memory, and ADL. The outcome measure scores within groups were analysed using the Wilcoxon signed-rank test, and the comparison of outcome measures between the groups was analysed using the Mann-Whitney U test. An alpha level of p=0.05 was considered to be statistically significant. Statistical Package for Social Sciences (SPSS) 24.0 version was used to analyse the data. Results: In the present study, a total of 10 participants from the age group of 60-75 years (mean age=67.4 years) were included, and each group (control and experimental) consisted of five participants (3 males and 2 females). The results showed that there was a significant difference (p<0.05) between the post-test scores of the experimental and control groups in COPM-Performance and CMT (p=0.032; p=0.018, respectively). However, there was no statistically significant difference (p>0.05) in the post-test scores of the experimental and control groups in FIM (p=0.347). Further analysis revealed a clinically significant difference between the control and experimental groups in post-test scores. Conclusion: The results of the study concluded that the MSEG intervention is effective in improving memory difficulties in the geriatric population but had a lesser effect on improving ADL performance.

Antimicrobial Efficacy of Different Concentrations of Sodium Hypochlorite in the Elimination of Enterococcus Faecalis: An In-vitro Study

Divya Mukundan, Ganesh Jeevanandan, S Rajesh Kumar

Introduction: Primary teeth are equally important as permanent teeth. Endodontic therapy aids in the preservation and maintenance of extremely carious primary teeth. For root canal therapy to be successful, root canals must be properly prepared and effectively irrigated. Sodium Hypochlorite (NaOCl) has been the gold standard for root canal treatment of primary teeth. However, there are a few drawbacks to using higher concentrations of sodium hypochlorite, such as toxic reactions from its apical penetration. In addition, an excess of irrigation fluid via the apical region could harm the permanent tooth underneath. Therefore, it is crucial to select the proper concentration to preserve the delicate balance between effectiveness and safety. Aim: The present in-vitro study was conducted in the city of Chennai, Tamil Nadu, between March and June 2022. The study aimed to evaluate the effectiveness of lower concentrations of sodium hypochlorite, such as 1%, 0.5%, and 0.25%, against Enterococcus faecalis. Materials and Methods: The antibacterial activity of different concentrations of sodium hypochlorite (1%, 0.5%, and 0.25%) against Enterococcus faecalis was performed using Muller Hinton agar. Three Mueller Hinton agar plates were prepared and sterilised for 15 minutes for each concentration. The volumes used were 25 μL, 50 μL, and 100 μL, respectively. E. faecalis was swabbed and poured into the sterilised plates. The plates were incubated for 24 hours at 37°C. After incubation, the plates were examined, and their zone of Inhibition was determined. ANOVA test was applied with Post-hoc Tukey’s analysis. Results: One-way ANOVA test showed that there was a significant difference with a p-value <0.001 in all three groups. Post-hoc Tukey’s analysis was done, and the test showed that the highest zone of inhibition was seen with 1% sodium hypochlorite at 100 μL, with zone diameter of 39 mm, and the least zone of inhibition was seen with 0.25% sodium hypochlorite solution at 25 μL, with zone diamter of 22 mm. Conclusion: The results of the present study show that a 1% sodium hypochlorite solution can be used to successfully disinfect root canals, indicating its potential as an effective antimicrobial agent in endodontic procedures.

Antimicrobial Efficacy of Tubulicid Red as a Cavity Disinfectant in Comparison with Chlor-X Gel against S. mutans in Primary Teeth: Randomised Split-mouth Clinical Study

Swapnika Vegi, Veena Arali, Harika Rapala, Sritha Kolluri, Sasidhar Vajrala

Introduction: Microorganisms act as precursors to dental caries. Following cavity preparation, traces of resident bacteria in the smear layer may contribute to the recurrence of caries. Thus, eliminating the underlying causes improves the likelihood of treatment success. Disinfectants are adjuvant tools that should focus on removing microorganisms when combined with procedures that yield positive outcomes. Aim: To compare and evaluate the antimicrobial efficacy of Tubulicid Red (TR) Label as a cavity disinfectant with Chlor X gel (2% chlorhexidine) in primary teeth. Materials and Methods: The present randomised double-blind clinical trial was conducted at the Department of Paediatric and Preventive Dentistry, GSL Dental College and Hospital, YSRUHS, Rajahmundry, Andhra Pradesh, India from September 2021 to April 2022. The study assessed the antimicrobial efficacy of TR label against S. mutans in 60 primary carious teeth involving 1/3rd of the dentin. The teeth were divided into two groups, each consisting of 30 teeth. Group-I received TR Label, while Group-II received Chlor X. After excavating the infected dentine, the affected dentine was left in the cavity, and a dentinal sample was collected from the base of the cavity. The cavity was then disinfected with either TR or Chlor X gel, followed by rinsing with saline. A second sample was collected from the base of the same cavity. The collected samples were transferred to Eppendorf tubes and subjected to microbiological analysis to calculate the number of Colony-forming Units (CFU) of S. mutans on Mutans Sanguis (MS) agar medium. The obtained data were subjected to statistical analysis using the Wilcoxon’s signed-rank test and Mann-Whitney test. Results: In the intragroup comparison (Wilcoxon’s signed-rank test), both groups showed significant reductions in S. mutans count (p<0.001). The intergroup comparison showed no statistically significant difference (p>0.05) between the Tubulicid and Chlor X groups at baseline and post-treatment. Conclusion: The TR could be used as an alternative to Chlor X gel as a cavity disinfectant in primary teeth before restoration, potentially reducing the occurrence of secondary caries.

Impact of COVID-19 Vaccines on Mortality Rates among Adult COVID-19 Patients

Mandar R Sane, Harshita Verma

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has been a public health concern since 2019. Multiple strategies have been implemented to flatten the curve of cases, including isolating active cases, contact tracing, quarantines, lockdowns, hand hygiene, face mask usage, and sanitisation. Vaccination has been used as a tool to reduce morbidity and mortality due to COVID-19. Aim: To analyse the impact of COVID-19 vaccines on mortality rates among COVID-19 patients, with a secondary objective of studying the association between age, time since vaccination, and mortality rates. Materials and Methods: The present cohort study was conducted in the Department of Forsenic Medicine at All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra,India, with a sample size of 60 cases, out of which 30 were included. Data was collected over a six month period from January 1, 2022, to June 30, 2022. The study included adult COVID-19 patients who were admitted to AIIMS Nagpur and subsequently died. Data on vaccine type, dose, and time since vaccination were also collected. Results: The mean age of patients was 53 years. Of the patients, 63.3% (n=57) were males and 36.6% (n=33) were females. Among the patients, 60% were vaccinated, while 40% were unvaccinated. Among the vaccinated patients, 14.8% received Covaxin, while 85.1% received Covishield. Regarding the vaccination dosage, 9.2% of the patients received a single dose, while 90.7% received two doses. All the patients who survived COVID-19 had been vaccinated for more than one month. Conclusion: Vaccination resulted in a 93.1% reduction in the odds of death among vaccinated patients. Among the unvaccinated patients, 80% died due to COVID-19. After adjusting for age and co-morbidities, vaccination was found to be independently associated with a lower risk of mortality (p<0.001). Furthermore, 73.3% of the deceased cases had co-morbidities (p<0.001). The study demonstrates the protective effect of vaccination with either Covishield or Covaxin, which should hopefully address any misconceptions among the general public.

Evaluation of Antimicrobial Efficacy of 3.8% Silver Diamine Fluoride as a Root Canal Irrigant against Enterococcus Faecalis in Primary Teeth: A Randomised Clinical Trial

Vajrala Sasidhar, Veena Arali, Rapala Harika, Vegi Swapnika, Kolluri Sritha

Introduction: During a pulpectomy, the infected or inflamed pulp tissues are removed, and the root canal is thoroughly cleaned with mechanical instrumentation and copious irrigation. Various endodontic irrigants are available, such as Sodium Hypochlorite (NaOCl), Chlorhexidine (CHX) gluconate, Ethylene Diamine Tetra Acetic Acid (EDTA), Mixture of doxycycline, citric acid, and a detergent (MTAD), etc. Among these, CHX gluconate is widely used as an endodontic irrigant and medicament due to its antibacterial effect and substantivity. Enterococcus faecalis is the most common bacterial species found in necrotic teeth, with high viability and antibiotic resistance. A 3.8% Silver Diamine Fluoride (SDF) has antimicrobial properties and has been shown to eliminate E. faecalis from the root canals of permanent teeth. However, there are no studies in the literature that have evaluated its efficacy as a root canal irrigant in primary teeth. Aim: To evaluate the antimicrobial efficacy of 3.8% SDF against E. faecalis in primary teeth. Materials and Methods: This was a in-vivo double-blinded randomised clinical trial conducted at Department of Paediatric and Preventive Dentistry, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India in children aged 3-8 years old. The study included 60 primary teeth that required pulpectomy. The teeth were divided into two groups and irrigated: 30 teeth with 3.8% SDF (Group I) and 30 teeth with 2% CHX (Group II). In all cases, two microbiological samples were taken using sterile absorbent paper points: the first after access opening and the second after the final irrigation. All samples were assessed using the agar plate method. The results were analysed statistically using a Student’s paired t-test. Results: After analysing the pre- and postirrigation samples, there was a statistically significant reduction in Colony Forming Units (CFU)/mL (p<0.05) in both groups. When comparing the two groups, no statistical difference was observed in the percentage reduction of bacterial colonies (p>0.05). Conclusion: The reduction in CFU/mL of E. faecalis was comparable in both groups. Thus, 3.8% SDF can be used as an alternative root canal irrigant to 2% CHX.

Osteological Analysis of Hard Palate in North Indian Skulls and its Forensic Significance: A Cross-sectional Study

Amarbir Kaur, Rajan Kumar Singla, Ravikant Sharma

Introduction: Various therapeutic procedures, such as cleft palate surgery, uvulopalatopharyngoplasty, nasopharyngoscopy, and nasogastric intubation, rely on the morphometric measurements of the hard palate. Additionally, it plays a crucial role in passive speech articulation. Therefore, understanding the morphological and osteological diversity of the hard palate holds clinical significance. Aim: To assess the normal and aberrant morphology and morphometry of the hard palate. Materials and Methods: The present cross-sectional study was initiated in December 2017 and completed in December 2021. It was conducted on 100 dry adult human skulls collected from the Department of Anatomy, Government Medical College, Amritsar, Punjab, India. The palate was analysed to determine the mean palatal length, breadth, and height. Additionally, the palatal index and palatal height index were calculated. Different osteological parameters of the lesser palatine foramen, including its number, distance from the greater palatine foramen, palatomaxillary suture, and interpalatine suture, were measured. Mean, standard deviation, range, and p-value were calculated for the metric parameters. Results: The mean palatal length, breadth, and height were 46.16±4.18 mm, 33.01±2.67 mm, and 11.06±1.88 mm, respectively. In the present study, 83% of skulls belonged to the leptostaphyline type, 10% to the mesostaphyline type, and 7% to the brachystaphyline type. The number of lesser palatine foramen varied from 0-2 on both sides, with predominance of a single foramen on both sides. The distances of the lesser palatine foramen from the greater palatine foramen, palatomaxillary suture, and intermaxillary suture were found to be 3.55±1.56 mm, 11.45±2.42 mm, and 17.57±3.06 mm on the right side, and 3.38±1.57 mm, 10.90±2.39 mm, and 17.47±2.99 mm on the left side, respectively. Conclusion: The data provided by this study will be helpful in various disciplines of medical, dental, and anthropometrical sciences.

S.T.O.N.E Score versus Guy’s Stone Score in the Prediction of Stone Clearance in Percutaneous Nephrolithotomy: A Cross-sectional Study

John Peter, Suresh Bhat, Fredrick Paul

Introduction: Percutaneous Nephrolithotomy (PCNL) has become the standard of care for large renal calculi. The aim of the surgery is to achieve maximum stone clearance with minimal postoperative complications. Various scoring systems have been described to predict both of these outcomes. S.T.O.N.E. Score and Guy’s Stone Score (GSS) are two of the most widely used scoring systems. S.T.O.N.E. Score comprises of Size of the stone, Tract length, degree of Obstruction of the urinary system, Number of stones, and Essence. Aim: To compare the predictive power for stone clearance and postoperative complications of the two scoring systems, namely S.T.O.N.E. Score and GSS. Materials and Methods: This cross-sectional study was conducted at the Department of Genitourinary Surgery at Government Medical College, Kottayam, Kerala, India from March 2019 to August 2020. All patients above 18 years undergoing PCNL were included. A total of 122 patients were studied by calculating the preoperative S.T.O.N.E. Score and GSS and comparing them with post-PCNL stone clearance and complications. The association of both S.T.O.N.E. Score and GSS with stone clearance was estimated by plotting the Receiver Operating Curve (ROC) curve using Statistical Package for Social Sciences (SPSS) version 20, International Business Machines (IBM) SPSS Statistics windows, version 20.0 (Armonk, NY: IBM Corp.). A p-value <0.05 was considered statistically significant. Results: The mean age of the subjects was 49.8±12.47 years. A total of 76 males and 46 females were included in the present study. The mean S.T.O.N.E. Score among the study subjects was 7.12±1.57, and the mean GSS was 2.09±0.48. Complete stone clearance was achieved in 96 (78.7%) patients. A total of 22 (18%) patients had postoperative complications. Both scores had a significant association with stone clearance (p<0.001 for both) and postoperative complications (p-value for S.T.O.N.E. Score was 0.019 and GSS was 0.007). Conclusion: Both the S.T.O.N.E. Score and GSS can predict post-PCNL stone clearance and complications with comparable efficacy.

The Relationship between Kinesiophobia, Pain Intensity and Functional Disability among Elderly Individuals with Low Back Pain: A Cross-sectional Study

Nireeksha N Shenoy, KU Dhanesh Kumar, Rakesh Krishna Kovela

Introduction: Low Back Pain (LBP) is the most common health problem among elderly individuals, leading to pain and disability. Alongside pain, psychosocial factors have a significant impact on patients with LBP. Kinesiophobia is defined as a fear of physical movement and activity, which can result in avoidance of activities and movement, leading to deconditioning. The relationship between kinesiophobia and pain severity is complex and interrelated, with each affecting the other and restricting the patient’s participation in daily activities. Aim: To investigate the relationship between kinesiophobia, pain severity, and functional disability in older people with LBP. Materials and Methods: A total of 49 participants over 60 years old with LBP were recruited for this cross-sectional study at the Department of Physiotherapy, Nitte Institute of Physiotherapy, Deralakatte, Mangaluru, Karnataka, India. Subjects were recruited from March 2022 to February 2023 based on inclusion criteria. Screened participants completed a self-reported questionnaire, The subjects themselves filled out the outcome tools. including the Tampa Scale of Kinesiophobia (TSK) Questionnaire, the Roland Morris Disability Questionnaire tool, and the Numerical Pain Rating Scale (NPRS) to assess various aspects of kinesiophobia, functional disability, and pain severity. Pearson’s correlation coefficient was used to determine the correlation between kinesiophobia, pain severity, and functional disability. A p-value <0.05 was considered statistically significant. Results: The age of the elderly participants ranged from 60 to 84 years, with a mean age of 70.9±6.5 years. Positive correlation was found between kinesiophobia and functional disability (r value=0.464, p-value=0.001), while no correlation was observed between kinesiophobia and pain intensity. Conclusion: It is concluded that kinesiophobia may contribute to disability, as a positive relationship between kinesiophobia and functional disability was observed in individuals with LBP. However, no correlation was found between kinesiophobia and pain intensity.

Cardiopulmonary Involvement in Patients with Systemic Sclerosis: A Cross-sectional Study

Akhila J Prasad, Jijith Krishnan, U Bijilesh

Introduction: One of the most challenging aspects of systemic sclerosis is the potential involvement of the cardiopulmonary system, which can lead to significant morbidity and mortality if not detected and managed promptly. Aim: To assess the clinical characteristics and prevalence of specific cardiopulmonary involvement and to investigate its association with disease duration in patients with systemic sclerosis from South India. Materials and Methods: This cross-sectional, observational study was conducted at the Department of General Medicine, Government Medical College, Thrissur, India, between January 1, 2020, and December 31, 2020. Forty patients with systemic sclerosis were included according to the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology classification criteria. Skin thickening was evaluated using the modified Rodnan Skin Score (mRSS). Investigations such as chest X-ray, echocardiogram, and antibody profiling were conducted to evaluate cardiopulmonary involvement. The data were analysed using Statistical Package for Social Sciences (SPSS) version 23.0, and the Chi-square test was used to compare qualitative variables between groups. Results: Sixteen patients (40%) had an mRSS score between 11 and 20, followed by 14 patients (35%) with mRSS scores between 21 and 30. The prevalence of Interstitial Lung Disease (ILD) was 50%. The echocardiogram findings showed mitral regurgitation and moderate Pulmonary Arterial Hypertension (PAH) in 30% (n=12) and 25% (n=10) of patients, respectively. High-Resolution Computed Tomography (HRCT) and pulmonary function tests were normal in 10 patients (25%). The duration of the disease was three to eight years in 14 patients and eight to 12 years in 12 patients. Both ILD and PAH were significantly associated with the duration of the disease (p<0.05). Anti-scleroderma-70 and anti-centromere were the most common antibodies present in patients with ILD and PAH, respectively. Conclusion: The study indicated a high prevalence of PAH and ILD in patients with systemic sclerosis. Moreover, both ILD and PAH were significantly associated with the duration of the underlying disease, with longer disease duration being associated with a higher likelihood of these conditions.

Clinico-Epidemiological Profile and Treatment Outcome of Severe Cutaneous Adverse Drug Reactions in the Paediatric Age Group of 0 to 18 Years: A Retrospective Cohort Study from Southern India

Smitha Ancy Varghese, Sandhya Somasekharan Nair, Deepthy Vasantha Gopinath

Introduction: The paediatric population is prone to developing cutaneous adverse drug reactions. However, the incidence of Severe Cutaneous Adverse Drug Reactions (SCAR) is rare in this age group, with few studies describing such reactions in detail. Aim: To describe the clinico-epidemiological factors, drug profile, laboratory parameters, and treatment outcomes of SCAR in children admitted to a tertiary care centre in South India. Materials and Methods: A retrospective cohort study was carried out over a 10-year period, including paediatric patients (0-18 years) admitted to Dermatology, Medicine, and Paediatric wards in the tertiary care centre. Demographic details, suspected drugs, comorbidities, personal and family history of drug reactions, physical examination, laboratory parameters, treatment received along with its duration, and the state of morbidity and mortality were recorded. SPSS version 18.0 was used for analysis. Descriptive statistics were used to summarise the demographics and clinical characteristics of the patients. Results: Among all the patients admitted with SCAR, 27 (15%) belonged to the paediatric age group. The median age was 15 years, and the female-to-male ratio was 1.25. Nineteen (70.3%) were diagnosed with Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN), and eight (29.6%) were diagnosed with Drug Reaction with Eosinophilia and Systemic Symptom (DRESS). There were no cases of Acute Generalised Exanthematous Pustulosis (AGEP). The most common class of drugs implicated was antiepileptics (62.8%). Two patients (7%) had a family history of drug reactions. All patients had mucosal involvement. The majority of the children responded to intravenous steroids, and two required additional intravenous immunoglobulin injections for clinical improvement. All cases were cured with no mortality or long-term sequelae. Conclusion: The incidence of SCAR in the paediatric age group is significant. Anticonvulsants, particularly phenytoin, carbamazepine, and lamotrigine, need to be used with caution in this age group. Prompt diagnosis and treatment with systemic steroids can reduce mortality, morbidity, and long-term sequelae.

Knowledge, Attitude and Barriers to Dental Treatment of Mothers Regarding Early Childhood Caries: A Cross-sectional Survey from Taif Province, Saudi Arabia

Fatam Salem Alzahrani

Introduction: Early Childhood Caries (ECC), also called ‘baby bottle tooth decay’ or ‘early childhood tooth decay,’ significantly affects infants and children aged six or younger, causing cavities and with lasting impacts on oral health and overall well-being. Its global prevalence concerns healthcare professionals and policymakers due to its multifactorial nature, influenced by diet, oral hygiene, socio-economic factors, and maternal awareness. Mothers, as primary caregivers during early childhood, play a crucial role in ECC prevention and early intervention. Aim: This study examines mothers’ knowledge and attitude regarding ECC and risk factors associated with children’s dental health, to determine difficulties in dental therapy in Taif, Saudi Arabia. Materials and Methods: Using a cross-sectional survey design in the province of Taif, Saudi Arabia, a random sample of 288 mothers of healthy children aged three to seven years were surveyed. A structured questionnaire containing 26 close ended questions was used to gather information regarding the socio-demographic characteristics, knowledge and attitude of the mothers regarding ECC, as well as barriers to dental care. The questionnaire was originally drafted in English and then translated into Arabic by a professional translator. Using Statistical Package for Social Sciences (SPSS) software, an analysis and a representation of data was performed. Results: More than half of the mothers 57.63% (n=166) understood the relation between poor dental health and hygiene and a child’s ability to learn, and 20.13% (n=58) didn’t know if poor dental health can impair a child’s ability to learn (p=0.02). The notion that a visit to the dentist should begin within six months of the appearance of milk teeth was agreed with by 55.55% (n=160) of the mothers, while 28.81% (n=83) of them didn’t know the proper time for a child’s first visit to the dentist (p=0.03). Only 22.22% of the mothers didn’t know what the nearest dental center to them was. Conclusion: The present study revealed that mothers did have awareness of different aspects of oral health and dental caries, several mothers exhibited unfavorable attitudes toward oral health practices, which could set a negative example for their children.

Correlation of HDL and LDL Cholesterol with Severity of Depression: A Cross-sectional Study

Introduction: Depression is one of the leading causes of morbidity worldwide. It can impact various biomarkers, including proteins, monoamines, and lipids. Lipids play a critical role in regulating cellular function by influencing transport, anchoring, and providing structural support. The present study aimed to explore any correlation between lipid profiles and depression. Aim: To investigate the correlation between different lipid profile parameters (serum triglycerides, total cholesterol, serum High-density Lipoproteins (HDL), and Low-density Lipoproteins (LDL) levels) and the severity of depression. Materials and Methods: A hospital-based, cross-sectional study was conducted at the Department of Psychiatry, Faculty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India, from June 2020 to June 2021. A total of 200 participants aged 18-65 years, diagnosed with depression according to the ICD-10 classification, were enrolled. Clinical assessments were conducted, and the Hamilton Depression Rating Scale (HAM-D) (17 items) and Beck's Depression Inventory II (BDI II) (21-item scale) were used. Lipid parameters were obtained from fasting blood samples. The Wilcoxon’s-Mann-Whitney U test was applied to assess the association between gender distribution and lipid profiles. Spearman's correlation test was used to analyse the correlation between HAM-D and BDI scores with lipid profiles. Statistical significance was set at a p-value ≤0.05. Results: The mean age of the participants was 36.05±11.24 years. Correlations between HAM-D levels and lipid profiles revealed that all lipid parameters, except for HDL (which showed a negative correlation), were positively associated with HAM-D scores. These correlations were statistically significant (p ≤0.05). Similarly, a positive correlation was observed between all lipid levels and BDI scores, except for HDL, which exhibited a negative correlation. These correlations were also statistically significant (p≤0.05). Conclusion: Higher levels of LDL cholesterol were found to be associated with elevated depression rating scale scores and increased susceptibility to depression. On the other hand, HDL cholesterol demonstrated protective effects against depression. Adopting a healthy lifestyle, implementing dietary measures, and addressing stressors promptly may help prevent depressive symptoms.

Assessment of Clinical and Biochemical Cardiac Risk Factors in Patients with Subclinical Hypothyroidism: A Cross-sectional Study

Rakesh Kumar, Priyank Rastogi, Rajesh Chetiwal

Introduction: Cardiovascular Diseases (CVD) are among the leading causes of morbidity and mortality in the current era, and the focus is gradually shifting towards identifying the risk factors and pathways leading to CVD. While hypothyroidism has been extensively studied and linked to CVD risk, the association between subclinical hypothyroidism and CVD risk factors is not well established. Aim: To investigate the association between subclinical hypothyroidism and cardiac risk factors such as obesity indicators {Body Mass Index (BMI) and Waist-hip Ratio (WHR)}, blood pressure, and lipid parameters. Materials and Methods: This cross-sectional study was conducted at the Department of Medicine, ESI PGIMSR, Basaidarapur, New Delhi, India, from December 2020 to April 2022. The study included 200 patients, with 100 patients recruited in the subclinical hypothyroidism group (Thyroid Stimulating Hormone (TSH) >4.8 μIU/mL with normal fT4) and 100 patients with euthyroid status (TSH 0.5-4.8 μIU/mL and normal fT4) included in the comparison group. Both groups were assessed for CVD risk factors including obesity indicators (BMI and WHR), blood pressure, and lipid parameters. The two groups were analysed for statistical significance using Student’s t-test. Results: Both groups had similar age distributions. However, there was a greater percentage of female patients in the subclinical hypothyroidism group (61%) compared to the euthyroid group (52%). As expected, TSH levels in the subclinical hypothyroidism group were significantly higher than in the euthyroid group. The subclinical hypothyroidism group recorded significantly higher mean values of BMI, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), total cholesterol, and triglycerides, which were higher by 18%, 17%, 17%, 41%, and 16% compared to the euthyroid group, respectively. Other parameters like WHR and Low-Density Lipoprotein-Cholesterol (LDL-C) were found to be raised in subclinical hypothyroidism compared to the euthyroid group, while High-Density Lipoprotein-Cholesterol (HDL-C) levels were significantly lower by 16% in subclinical hypothyroidism. Conclusion: Subclinical hypothyroidism is significantly associated with cardiac risk factors like obesity indicators (BMI and WHR), blood pressure, and lipid parameters.

Evaluation of Articular Manifestations in Hepatitis C Virus Infected Patients and its Association with Liver Fibrosis: A Cross-sectional Study from Rural Indian State of Manipur

Introduction: Hepatitis C Virus (HCV) is the main culprit for liver diseases worldwide. In Manipur its incidence is increasing, mainly due to blood borne transmission through intravenous drugs users. Among the extrahepatic manifestations of HCV infection-arthropathy (joint pain, swelling and stiffness) is most common. Exact mechanism of arthropathy are not well elucidated but are probably connected with the participation of the immune system and due to the replicating virus in the affected tissues, organ systems. Aim: To determine the articular manifestations in HCV infected patients and to study the association between articular manifestations and liver fibrosis. Materials and Methods: This cross-sectional study enrolled 100 hepatitis C infected patients above 18 years of age who attended Medicine OPD, gastroenterology and liver clinic or admitted in the General Medicine wards, Regional institute of Medical Sciences (RIMS), Imphal, Manipur, India. Blood samples were collected for Complete Blood Count, Erythrocyte Sedimentation Rate, C Reactive Protein, Liver function test, Renal function test, HCV, Rheumatoid Factor (RF), Antinuclear Antibody (ANA), anti-ds DNA. Ultrasound (USG) whole abdomen and X-rays of involved joints were done when indicated. Markers for liver stiffness/fibrosis, {Aspartate Aminotransferases (AST) to Platelet Ratio Index (APRI)} score, The fibrosis-4 (FIB-4) score and AST/Alanine Transaminase (ALT) ratio were calculated and compared. The Statistical Package for Social Sciences(SPSS) (IBM) version 21.0 was used for statistical analysis. Chi-square and Fischer’s-exact test were used. Results: A total of 100 hepatitis C infected patients were enrolled in the present study. Majority of the study subjects were males (63%) under 40 years of age (69%). Eighty-four (84%) patients were intravenous drug users. Joint pain, swelling and stiffness was present in 37 (37%), 31 (31%) and 24 (24%), respectively. Around 36 (36%), 45 (45%) and 29 (29%) of the participants had significant fibrosis with respect to FIB 4 score, APRI and USG finding, respectively. Conclusion: The prevalence of joint pain was 37% in this study. Females and younger age group were more associated with articular manifestation. The present study concluded that patient with articular manifestation were seen to have significant fibrosis with respect to FIB 4 score, APRI and USG finding, AST/ALT.

Estimation of Serum Adenosine Deaminase Levels as a Marker for Risk Assessment and Immunomodulation in Patients with Diabetic Foot

Introduction: Diabetic foot ulcers are critical complications of uncontrolled diabetes, with peripheral neuropathy, peripheral arterial disease, and immune suppression as primary contributing factors. Adenosine Deaminase (ADA), an enzyme, has been identified as a promising marker for cell-mediated immunity. Its estimation may serve as a predictive marker for immunomodulation, which, in turn, leads to complications among individuals with diabetes. Aim: To estimate serum ADA levels in diabetic patients without diabetic foot and diabetic patients with diabetic foot. Additionally, the study aimed to investigate the association of ADA serum levels with glucose, Glycated Haemoglobin (HbA1c), and the severity of wounds. Materials and Methods: This cross-sectional study was conducted in the central laboratory Department of Biochemistry at Krishna Rajendra Hospital (KR Hospital), Mysuru Medical College and Research Institute, Mysuru, India, from August to September 2021. The study included diabetic foot cases (n=45) and Type 2 diabetes patients on regular follow-up in the Department of Medicine without diabetic foot and any other complications (n=45). Venous blood samples were analysed for ADA, glucose, HbA1c, and complete blood count. The data were statistically analysed using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation test. Results: The present study observed a higher incidence of diabetic foot among males. It showed a statistically significant increase in serum ADA, HbA1C, and neutrophil count in patients with diabetic foot compared to patients with diabetes without diabetic foot ulcers, with mean Standard Deviation (SD) of 71.79±25.11, 11.53±3.11%, and 75.91±9.77%, respectively. Serum ADA exhibited a positive correlation with HbA1C and different grades of ulcers. Conclusion: The present study demonstrated a significantly increased serum ADA in diabetic ulcers and a positive correlation with different grades of ulcers. This finding contributes to a better understanding of the disease’s pathogenesis at different stages. Furthermore, the positive correlation between ADA and HbA1C levels may play an important role in predicting the glycaemic and immunological status of these patients.

Change in Health-seeking Behaviour among Elderly during the COVID-19 Pandemic in Rural Areas of Central Kerala: A Cross-sectional Study

Nimila Elsa Mathews, Ebin Thomas, Sumit Datta

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has had a significant impact on the elderly population, leading to both fatalities from the virus and delayed treatment of acute emergencies. Additionally, many elderly individuals have demonstrated poor health-seeking behaviour in managing chronic conditions. Reasons for this include fear, access barriers, and strain on healthcare resources and personnel. Aim: To evaluate the change in health-seeking behaviour among the elderly in rural areas of central Kerala during the pandemic and identify the associated factors. Materials and Methods: A community-based cross-sectional study was conducted in the rural field-practice areas of the Department of Community Medicine at a tertiary care Medical College in Kerala, India from May 2021 to August 2021. A total of 252 elderly individuals aged 60 years and above were interviewed using a structured pretested questionnaire. Socio-demographic details and responses on health-seeking behaviour during the pandemic were documented. Data were summarised using frequencies and percentages for categorical variables or mean and standard deviation for continuous variables. Associations were tested using the Chi-square test. Results: The study revealed that 83.73% (211 out of 252) of the elderly participants had Non Communicable Diseases (NCDs), with hypertension in 130 (51.59%) and diabetes in 90 (35.71%) being the most prevalent. A significant change in the preference for healthcare facilities was noted (p<0.001), with a decline in appropriate health-seeking behaviour by 16.16%. Moreover, 9.13% (23 participants) resorted to self-treatment at home, and 49.21% (124 participants) opted for traditional remedies to boost their immunity. The type of family was significantly associated with the decline in health-seeking behaviour (p<0.05). Of the 16 participants who indicated a lapse in their regular follow-up since the onset of the pandemic, the primary reasons for missing appointments were fear of contracting COVID-19 in 14 cases (87.50%), lockdown restrictions in six cases (37.50%), and transportation challenges in three cases (18.75%). Conclusion: The study revealed a high prevalence of chronic diseases like hypertension, diabetes, osteoarthritis, and Coronary Artery Disease (CAD) among the elderly. There was a decline in health-seeking behaviour by 16.16% among the elderly with chronic diseases due to various challenges posed by the pandemic. Implementing strategies such as utilising social media, promoting telemedicine, and adopting a comprehensive technological approach is crucial to enhance healthcare accessibility for elderly populations in rural areas.

Oral Clonidine versus Ivabradine for Attenuating Stress Response in Functional Endoscopic Sinus Surgery: A Randomised Placebo-controlled Study

Introduction: Peri-anaesthetic haemodynamic alterations, such as hypertension and tachycardia, can cause increased bleeding during Functional Endoscopic Sinus Surgery (FESS), impairing the visibility of the surgical field and resulting in scarring, adhesions, and prolonged surgery time. Various strategies involving pharmacological techniques have been used to mitigate these unfavourable reflexes. Alpha-2 agonists, such as Clonidine, are currently being employed to attenuate sympathoadrenal stimulation caused by tracheal intubation and surgery. Ivabradine is a new drug that selectively lowers Heart Rate (HR) by inhibiting cardiac funny current channels. Aim: To compare the effects of premedication with oral Clonidine versus oral Ivabradine on attenuating haemodynamic stress response and improving the quality of the surgical field in FESS. Materials and Methods: The present randomised, placebo-controlled, double-blind study was conducted in the Department of Anaesthesiology and Intensive care at Rajendra Hospital, Government Medical College, Patiala, Punjab, India from April 2021 to December 2022 on 90 American Soceity of Anaesthelogists (ASA) Physical status I and II adult patients (aged 18-60 years) undergoing FESS. Group A (n=30) received oral Ivabradine 5 mg, Group B (n=30) received oral Clonidine 0.2 mg, and Group C (n=30) received oral placebo tablets 2 hours before surgery. Haemodynamic parameters, including HR and Mean Arterial Pressure (MAP), quality of the intraoperative surgical field, postoperative sedation score, Visual Analogue Scale (VAS) score, time to analgesia request, blood loss, and adverse effects, were recorded. Descriptive statistics were used to calculate mean±Standard Deviation (SD) and percentage. Analysis of Variance (ANOVA), Tukey post-hoc test, Kruskal-wallis H test, and Pearson’s Chi-square were applied as appropriate. Results: The mean ages were 33.87±12.84, 35.03±12.93, and 40.9±14.46 years for Groups A, B, and C, respectively. The mean weights were 60.5±8.91, 57.83±5.66, and 57.9±5.42 kg, and the mean duration of surgery was 88.67±4.29, 88.8±4.29, and 88.03±3.93 minutes for Groups A, B, and C, respectively. There were no significant differences in terms of gender, ASA score, and type of surgery between the groups. Baseline HR and MAP were comparable among the groups. HR was significantly lower in both Groups A and B compared to Group C at all time intervals (p-value <0.001). Both drugs significantly attenuated tachycardia and hypertension in response to cardiovascular stress induced by laryngoscopy, endotracheal intubation, and extubation. However, Group B showed significantly better control of MAP throughout the intraoperative period and at extubation. The average category scale score, estimated blood loss, and postoperative VAS Score were all significantly lower in Group B than in Group A. Postoperative sedation scores were significantly higher in Group B, and the time to first rescue analgesic was longest in Group B (p<0.05). No significant side effects were observed. Conclusion: Both Clonidine and Ivabradine effectively attenuated the haemodynamic stress response. Clonidine provided better control of MAP, resulting in reduced bleeding, improved operative field visibility, and lower postoperative analgesic requirements compared to Ivabradine.

Endothelial Dysfunction in Type 2 Diabetes Patients and its Association with Microvascular Complications: A Cross-sectional Study

Ameya Sanjay Chogle, Arun Prasath, Chandni Chandramouli, Siva Ranganathan Green

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing worldwide. Microangiopathic and macroangiopathic complications are the main causes of morbidity and mortality in diabetes. Endothelial dysfunction is important in the early pathophysiology of vascular complications. Screening is very important in order to prevent these complications. Aim: To investigate endothelial dysfunction, as measured by Flow Mediated Vasodilation (FMD) of the brachial artery, in diabetic individuals. It also aims to explore the correlation between FMD and Glycated Haemoglobin (HbA1c), as well as the association between FMD and microvascular complications such as diabetic neuropathy, diabetic retinopathy, and albuminuria. Materials and Methods: This cross-sectional study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, between 2020 and 2021 on 160 patients. All patients diagnosed with T2DM, attending the Outpatient Department (OPD) or admitted to the ward, were enrolled in the study using consecutive sampling. FMD was measured for each patient, and Urine Albumin Creatinine Ratio (UACR) was also assessed. Diabetic retinopathy was evaluated through fundus examination, and diabetic neuropathy was screened using the monofilament test. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0 to determine the correlation between FMD and these variables. Results: A total of 160 patients were enrolled in this study, including 104 (65%) males and 56 (35%) females. The median age was 52 years, and the participants had a median Body Mass Index (BMI) of 29.5 kg/m². The median HbA1c was 8.7%. The median Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS) levels were 145 mg/dL and 242 mg/dL, respectively. The median FMD among all patients was 5.6%, with an Interquartile Range (IQR) of 4.9% to 6.6%. There was an inverse correlation between HbA1C and FMD values, with a correlation coefficient of -0.718 (p-value <0.01), indicating a strong and significant inverse correlation. Patients with significant macroalbuminuria had a lower median FMD compared to non albuminuric patients, and this difference was statistically significant. The median FMD was also lower in patients with diabetic neuropathy and retinopathy. Conclusion: The study findings suggest that endothelial dysfunction, as measured by FMD, is significantly impaired in patients with elevated HbA1c and microvascular complications of diabetes mellitus.

Morphology and Morphometry of the Pectoralis Minor Muscle: A Cadaveric Cross-sectional Study

Introduction: Shoulder pain is a common clinical presentation and can be attributed to an anatomically anomalous insertion of the Pectoralis Minor (PMn) muscle tendon into the glenohumeral joint capsule. Therefore, understanding these anomalous patterns is crucial for clinicians in diagnosing and treating patients to prevent misdiagnosis and iatrogenic injury. Aim: To analyse the morphological patterns in the origin and insertion of the PMn muscle and to assess the morphometric dimensions of the muscle. Materials and Methods: This observational cross-sectional study was conducted on 60 upper limbs from 30 embalmed cadavers of both sexes. The specimens were obtained from the Department of Anatomy, ESIC Medical College and Hospital, Hyderabad, Telangana, India, between November 2018 and January 2023. The PMn muscles were thoroughly examined, and the various patterns in the origin and insertion were recorded. The length of the muscle was measured from the sternocostal junction of the inferior aspect of the fourth rib to the medial border of the coracoid process. The width of the muscle was measured at the midclavicular line and at the insertion. The frequency and percentage of each pattern were recorded and statistically analysed. Results: The present study found that the origin of PMn Type-2 was predominantly observed, with an incidence of 86.6%. Type-1 was observed in 6.7% of the upper limbs, while Type-3 was observed in 6.7% as well. Regarding the insertion of the PMn, Type-1 was predominantly observed, with an incidence of 76.7%. Type-2 was observed in 20% of the upper limbs, and Type-3 in 3.3%. The average length of the muscle was 14.01 cm, while the average width at the midclavicular line and at the insertion were 6.16 cm and 1.69 cm, respectively. Conclusion: A high incidence of Type-2 patterns in the origin, and Type-1 was predominant in the insertion of the pectoralis minor muscle. Knowledge of the morphometric measurements of the PMn muscle would be valuable for surgeons performing surgeries in the shoulder and pectoral region.

Effects of Haemodialysis on Anterior Segment Parameters of the Eye in Patients with End-stage Renal Disease: A Cross-sectional Study

Introduction: Ocular manifestations of Haemodialysis (HD) are one of the important causes of morbidity in End-stage Renal Disease (ESRD) patients. According to studies, the incidence rate of glaucoma in the dialysis group was higher than that in the non dialysis group. Angle-closure glaucoma was found to be more common, which depends on anterior chamber morphology. Aim: To assess the effect of HD on Intraocular Pressure (IOP), Anterior Chamber Depth (ACD), and Lens Thickness (LT) in patients with ESRD. Materials and Methods: This was a single-centre cross-sectional observational study conducted in the Department of Ophthalmology on 170 eyes of 87 patients undergoing HD for at least three months. The study was conducted between October 2020 and October 2022 at the Dialysis Centre of Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India. These patients underwent ophthalmological evaluation pre- and postdialysis. IOP, ACD, and LT were measured 30 minutes prior to and 30 minutes after the HD session. The paired t-test was used to compare differences in means, and a p-value of <0.05 was considered significant. Results: The mean age of the study participants was 57.63±11.95 years. There was a decrease in mean ACD by 0.08±0.29 mm (p=0.0001) and an increase in mean LT by 0.06±0.42 mm (p-value=0.0001) postdialysis. The changes in IOP were variable and not statistically significant (p=0.45). Conclusion: Postdialysis, a significant increase in LT was observed corresponding to a decrease in ACD. Although the change in IOP was variable, this change might be more significant in pre-existing narrow-angle patients undergoing dialysis. As a result, the present study underscores the urgency of refining screening protocols for HD patients to effectively address these identified ocular changes and associated risks.

Prevalence, Risk Factors of Deep Venous Thrombosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

P Spurthy, P Theertha, S Mamatha, Alamelu Haran, BS Praveen Kumar

Introduction: It is important to increase awareness and identify the predictors of Deep Vein Thrombosis (DVT) in Chronic Obstructive Pulmonary Disease (COPD) patients presenting with worsening dyspnoea, as they are at a high-risk for Venous Thromboembolism (VTE) due to immobility, inflammation, and comorbidities. Aim: To determine the prevalence of DVT in hospitalised patients with acute exacerbation of COPD, as well as to identify associated risk factors for DVT in this group. Materials and Methods: A cross-sectional study was conducted from March 2021 to June 2022 in the Department of Respiratory Medicine at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. The sample population consisted of hospitalised patients with acute exacerbation of COPD who were aged over 40 years. All patients underwent routine blood investigations, Electrocardiograph (ECG), echocardiogram, arterial blood gas analysis, D-dimer test, chest radiograph, and lower-limb venous Doppler. Risk assessment was performed using the Modified Well’s criteria for DVT, and pretest probability was determined for all patients. The Chi-square test was used as a test of significance, with a p-value <0.05 considered statistically significant in all analyses. Results: The mean age of the study population was found to be 60.80±10.21 years. Among the 74 patients included in the study, it was found that 3 (4.05%) patients had DVT. There was no statistically significant difference between the DVT and non DVT groups regarding age, sex, obesity, modified Medical Research Council (mMRC) grade of breathlessness, smoking status, severity of airflow obstruction in spirometry, COPD class, type of respiratory failure, and presence of comorbidities. However, there was a statistically significant difference between the DVT and non DVT groups in terms of elevated D-dimer (>500 ng/mL), history of immobilisation for more than three days, and Modified Wells’ score (>2). Conclusion: Patients with acute exacerbation of COPD, associated with a significant history of immobilisation and high D-dimer values, along with a high-risk pretest probability using clinical predictors such as the Modified Wells’ score for DVT, should be considered for evaluation of VTE and early initiation of prophylactic anticoagulation therapy to prevent Pulmonary Thromboembolism.

Comparison of Conventional Small Group Teaching with Skill-based Teaching in the Proper Use of Drug Delivery Systems in Phase II MBBS Students of a Medical College in New Delhi, India: A Randomised, Crossover Experimental Study

Amit Arya, Sunita Singh

Introduction: The conventional small group teaching method primarily focuses on the knowledge aspect of Bachelor of Medicine and Bachelor of Surgery (MBBS) students. However, under the Curriculum Based Medical Education (CBME) framework, the National Medical Council (NMC) has introduced a new method of small group teaching called skill-based teaching for Phase II MBBS students. This method includes skill training and communication training in the proper use of Drug Delivery Systems (DDS), in addition to the knowledge aspect. Aim: To compare the conventional method of small group teaching with skill-based teaching in terms of learning the proper use of DDS in Phase II MBBS students. Materials and Methods: The present randomised, crossover experimental study was conducted in the Department of Pharmacology at North Delhi Muncipal Corporation Medical college, Hindu Roa Hospital, New Delhi, India, over a period of six months July 2022 to December 2022 to assess knowledge (cognitive domain), skill (psychomotor domain), and communication (affective domain). The students were initially given a questionnaire (pretest) followed by a didactic lecture on DDS. They were then randomly divided into two groups. Group A received skill-based teaching for insulin pen, while Group B received conventional teaching. The groups were then crossed over for Metered Dose Inhaler (MDI) training. After the teaching sessions, the students were given the same questionnaire (post-test). All students were assessed for their skill in using the device and their communication skills. The scores of the two groups were compared using an unpaired t-test. Results: A total of 51 students (31 males and 20 females; age range 18-20 years) participated in the study. There was a significant improvement in the questionnaire scores between the pretest and post-test (p<0.0001). In the skill-based teaching group, there was a significant improvement in the students’ performance in using MDI (p<0.05) and in communication of insulin pen (p=0.0001). Similar results were observed in the skill of using insulin pen and the communication aspect of MDI in both groups. Conclusion: Skill-based teaching resulted in similar or better performance in terms of skill and communication in the use of DDS compared to conventional teaching methods.

Utility of Multiparametric MRI of the Breast with Combined High b-value DWI and Dynamic Contrast MRI to Differentiate Benign and Malignant Lesions: A Cross-sectional Study

Pratiksha Yadav, Yashraj Patil, Saumya Harit

Introduction: Breast cancer is one of the most frequent malignancies in women worldwide, and it is the leading cause of cancer mortality. Early detection is key to a better prognosis. In India, many patients are diagnosed in later stages due to the absence of screening programs and less awareness in certain regions of the country. MRI is a highly sensitive investigation that can detect small and sometimes hidden or occult lesions not visible on mammography. The diffusion-weighted sequence has the potential to be used in conjunction with mammography, thereby improving diagnostic accuracy. Aim: To evaluate the utility of multiparametric MRI (mpMRI) of the breast, combining high b-value Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI), in differentiation benign and malignant lesions. Materials and Methods: This cross-sectional study was conducted at a Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India from Jan 2017 - Dec 2020. A total of 254 women with 272 breast lesions were included. All cases underwent mpMRI on a Tesla scanner, which included T2-weighted imaging, dynamic post-contrast study, and DWI with a b-value of 1500 sec/mm². Sensitivity, specificity, diagnostic accuracy, and area under the curve were calculated using the results of different parameters. Comparative Receiver Operating Characteristic (ROC) curves were plotted for DCE-MRI, DWI, and mpMRI. Histopathologic diagnosis was considered the standard of reference. Results: The mean age was 43.73±13.56 years, with an age range of 18-82 years. Both benign and malignant breast lesions were most common in the 40-49 years age group, accounting for a total of 80 (31.4%) lesions. Out of the 272 lesions, 141 (52.03%) were malignant and 131 (47.97%) were benign. DCE-MRI showed 97.87% sensitivity, 80.15% specificity, and 89.33% diagnostic accuracy. Diffusion-weighted MRI showed 97.16% sensitivity, 87.02% specificity, and 92.27% diagnostic accuracy. The ROC analysis for Apparent Diffusion Coefficient (ADC) values of the 272 lesions revealed an area under the curve of 0.985 (p<0.001) and a sensitivity of 92.91%, with an ADC cut-off of 0.987×10^-3 mm²/sec. The multiparametric study demonstrated 98.58% sensitivity, 93.13% specificity, and 95.95% diagnostic accuracy. The area under the curve was 0.959 for mpMRI, 0.921 for DWI, and 0.890 for DCE-MRI. Conclusion: mpMRI with DCE-MRI and DWI using a high b-value of 1500 sec/mm² can be utilised to improve diagnostic accuracy.

Comparison of Oropharyngeal Seal Pressure in Ambu AuraGain vs I-gel among Paediatric Surgery Patients: A Randomised Clinical Study

Rama Chatterjee, Deepika Kumari, CS Chatterji, Neelam Dogra, Pratibha Rathore

Introduction: The Oropharyngeal Seal Pressure (OSP) achieved by the supraglottic device holds significant importance as it indicates the feasibility of positive pressure ventilation, the degree of airway protection from supra cuff soiling, and also relates to postoperative morbidity. Supraglottic Airway Devices (SADs) have been increasingly used to mitigate the complications of endotracheal intubation. Aim: To compare the OSP in Ambu AuraGain versus I-gel SADs used in young children under general anaesthesia. Materials and Methods: The present randomised, single-blinded, interventional study included 88 patients aged between 1-5 years, weighing 10-30 kg, with American Society of Anaesthesiologists (ASA) Grade-I and II, undergoing elective inguinal and urology procedures under general anaesthesia. The children were randomly allocated to two groups of 44 each. In Group A, Ambu AuraGain was used, while in Group B, I-gel was inserted to secure the airway. The OSP was determined at the time of insertion and 30 minutes after insertion as the primary objective. The secondary objectives included the first attempt success rate, ease of SAD insertion, ease of gastric tube insertion, fiberoptic visibility of the glottic aperture, intraoperative vitals, and any adverse effects. Unpaired t-test was used to compare clinical indicators for quantitative data between the two independent groups. The Chi-square test was used for qualitative data when comparing two or more groups. The level of significance was set at a p-value <0.05. Results: The mean age in group A and group B was 3.45±1.41 years and 3.29±1.16 years, respectively. The mean weight in group A and group B was 15.13±3.67 kg and 14.25±3.18 kg, respectively. The OSP soon after insertion and 30 minutes after insertion was more in group B than group A. The p-values were 0.006 and 0.002, respectively, which were statistically significant. The first attempt success rate was higher in group A (97.7% versus 95.5%), and it was easier to insert with a shorter duration of time (17.70±2.707 versus 18±2.48 seconds). Gastric tube insertion was easier in group B (88.6% versus 84.1%), but the fiberoptic visibility was better in group A (77.3% versus 77.2%). Lesser intraoperative manipulation was required in group A (97.7% versus 93.2%), and the occurrence of postoperative complications was higher in group B. Conclusion: I-gel is better in terms of OSP, while Ambu AuraGain was superior in terms of ease of insertion, better fiberoptic visibility, and fewer postoperative complications.

Post-COVID-19 Menstrual Abnormalities among Medical Students at a Tertiary Care Medical College in Southern India: A Cross-sectional Study

Introduction: The emergence of Coronavirus Disease-2019 (COVID-19) caught the world by surprise, leading to a widespread global pandemic that has had profound and distressing effects on various levels. Its impact has been far-reaching, causing severe consequences that continue to unfold. COVID-19 is a multisystem inflammatory disease involving all organs, including the female reproductive system. Aim: To determine the prevalence of COVID-19 among students and compare post-COVID-19 menstrual abnormalities in the home and hospital groups. Materials and Methods: A cross-sectional study was conducted to assess post-COVID-19 menstrual abnormalities among medical students at Department of Obstetrics and Gynaecology, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, in southern India from April to December 2022. A total of 600 medical students were approached, and 549 responded, among whom 258 students were reported as COVID-19 positive and 291 reported as COVID-19 negative. After excluding risk factors, 204 COVID-19 positive students were selected as the study population. Data were collected using a prevalidated questionnaire. The COVID-19 study population of 204 (100%) was further stratified into two groups based on the treatment taken at home 162 (79.4%) or in the hospital 42 (20.5%). Chi-square test and Fisher’s-exact tests were used to compare post-COVID-19 menstrual abnormalities, including cycle length abnormalities, Heavy Menstrual Bleeding (HMB), dysmenorrhoea, Premenstrual Syndrome (PMS), and hypomenorrhoea. Results: The prevalence of COVID-19 in the study population was 204, accounting for 37.15% of the total population 204/549. Out of the 204 students, 162 (79.4%) received home treatment, and 42 (20.5%) received hospital treatment. Post-COVID-19 menstrual cycle abnormalities were more prevalent in the hospital group 26/42 (61.9%) than in the home treatment group 76/162 (46.9%). The most common abnormality in both groups was PMS, with a prevalence of 21 (50%) in the hospital group and 38 (23.4%) in the home group. In the home group, 37 (22.8%) experienced longer cycles, 33 (20.3%) had dysmenorrhoea, and 19 (11.7%) had shorter cycles. In the hospital group, 14 (33.3%) had longer cycles, 13 (30.9%) experienced dysmenorrhoea, and 9 (21.4%) had shorter cycles. HMB was reported by 6 (14.2%) in the hospital group and 13 (8%) in the home group, while hypomenorrhoea occurred in 11 (6.7%) in the home group and 5 (11.9%) in the hospital group. A significant association (p=0.001) was found between the COVID-19 treatment groups and PMS. However, for other post-COVID-19 menstrual abnormalities, such as cycle length, dysmenorrhoea, HMB, and hypomenorrhoea, there was no significant association between these abnormalities and COVID-19 treatment groups. Conclusion: Post-COVID-19 menstrual abnormalities were more frequently observed in the hospital group compared to the home group. All post-COVID-19 menstrual irregularities resolved within six months, except for PMS.

Medicine Crisis Indicators in the Pharmaceutical System of Iran: A Descriptive Strategic Analysis

Introduction: Iran is one of the countries that frequently encounters natural disasters. Providing and delivering medicine and initiating treatment for the injured in the early stages of disasters and crisis play a significant role in reducing pain, fatal injuries, and increasing the chances of recovery and survival for the injured individuals. Aim: To design a model for drug management during crises and hazards in Iran. Materials and Methods: This descriptive study was conducted from October 2019 to November 2020 at Department of Health Services Management, Islamic Azad University, Tehran, Iran. The opinions of 30 health and drug experts from the Food and Drug Administration and the Ministry of Health in Iran were considered in developing the initial conceptual model. Subsequently, a questionnaire was designed, and its validity and reliability were confirmed. The questionnaire evaluated seven parameters, including supply chain, policy-making, organisation, guidance and leadership, crisis instances, planning, and education. These parameters were scored on a Likert scale from 1 to 5. The total number of respondents was 403. Direct or reverse encoding was applied depending on the nature of the positive or negative questions. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0 and Analysis of Moment Structures (AMOS) version 22 software. Descriptive statistical analysis was performed to develop the final model for drug management during crises and hazards. Results: The results highlighted the importance of factors such as supply chain, policy-making, organisation, guidance and leadership, crisis instances, planning, and education in influencing drug management during crises and disasters. These findings were based on the perspectives of intermediate and senior managers in the medicine supply and distribution system in Iran. Conclusion: The model presented in the present study presents and emphasises the crucial factors that impact drug management during crises and disasters.

A Cross-sectional Study to Assess the Need for Standardisation of the Modified Mallampati and Friedman’s Scoring System

Introduction: The Modified Mallampati (MM) grading and Friedman’s Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current descriptions of performing these scores do not specify the route of breathing taken by the patient during the examination. The dynamic changes in the tongue and palate, in relation to the route of breathing, may contribute to the high interobserver variability in MM scoring. Aim: To explore the differences in MM scores and Friedman’s scores obtained during mouth breathing and nose breathing in order to standardise the scoring system. Materials and Methods: A community-based cross-sectional study was conducted at the Departments of Anaesthesiology and Community Medicine at Believers Church Medical College Hospital in Central Kerala, India between April 2022 and October 2022, on 702 adults. MM scores and FTP scores were recorded separately for each person during mouth breathing and nose breathing. Socio-demographic variables such as age, gender, and Body Mass Index (BMI) were also collected. The data was analysed using the Z-test for proportions. Results: The mean age of the study participants was 3.58±16.42 years. The majority of the participants were females (69.2%), and more than half (59%) were above 50 years of age. Out of the 135 participants with an MM Score-1 during mouth breathing, 99 (73.3%) had higher scores during nose breathing. For the 196 individuals with an MM Score-2 during mouth breathing, 87 (44.3%) had higher scores during nose breathing. Similarly, out of the 220 people with an MM score of -3 during mouth breathing, 106 (48.2%) had a Score-4 during nose breathing. A similar pattern was observed for the FTP scores. Conclusion: The present study demonstrates significant variability in MM and FTP scores obtained during oral and nasal breathing, highlighting the need to standardise the route of breathing during examination. The study suggests that advising patients to breathe through the mouth may relax the tongue and improve the predictive value of MM grading.

Assessment of Subclinical Cardiovascular Disease Risk by Measuring Carotid Intima Media Thickness in Rheumatoid Arthritis Patients: A Cross-sectional Study

Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects both synovial joints and extra-articular regions. Patients with RA have an increased risk of Cardiovascular Disease (CVD), leading to premature mortality. Aim: To assess subclinical atherosclerosis in RA patients using Carotid Intima Media Thickness (CIMT) and compare it with age-matched healthy individuals. Materials and Methods: This cross-sectional study included 50 RA patients and 50 healthy age- and sex-matched controls. Ultrasound was used to measure CIMT, which serves as an indicator of subclinical atherosclerosis. Framingham, Atherosclerotic CVD (ASCVD) risk scores, and QRISK3 scores were used to estimate the 10-year CVD risk. Student’s t-test and Chi-square test were used to identify statistically significant differences. Results: RA patients had significantly higher mean CIMT values compared to controls (p-value <0.001), indicating an increased burden of atherosclerosis. While ASCVD scores were comparable, Framingham scores were significantly lower (p-value=0.028), and QRISK3 scores were significantly higher (p-value=0.007) in RA patients. This suggests an underestimation of CVD risk by Framingham and potentially better prediction by QRISK3. Conclusion: The study highlights that RA patients have a higher burden of atherosclerotic disease compared to healthy adults of the same age when CIMT is used as a marker of atherosclerosis. These findings indicate the need for early CVD risk assessment and intervention in RA patients using appropriate risk-scoring systems and tools. Further research with larger sample sizes and longitudinal follow-up is warranted to confirm these findings.

Profile of Acute Poisoning and Its Outcome in Children Admitted to a Tertiary Care Hospital in Northeast India: A Cohort Study

Caroline D Shira, Manjit Boruah, Himadri Das

Introduction: Acute poisoning in children is an important public health problem. It is a significant paediatric emergency in both developing and developed countries, leading to preventable morbidity and mortality. While there is substantial research literature on acute childhood poisoning from developed countries, there is a lack of data from developing countries like India due to inadequate and poor surveillance of poisoning-related data. Aim: To investigate the clinical and epidemiological profile, as well as the outcome, of acute poisoning in children admitted to the paediatric emergency department of a tertiary care hospital in Northeast India. Materials and Methods: This prospective cohort study was conducted in the Paediatrics department of Assam Medical College and Hospital, Dibrugarh, Assam, India, from April 1, 2021, to March 31, 2022. All children under the age of 12 years who presented to the paediatric department with a history of exposure to toxic substances were included in the study. The admitted children were assessed in terms of demographic variables, type of poison, route of poisoning, time of presentation, circumstances of poisoning, storage place of poison, clinical presentation, and interventions provided. Data were presented as mean and frequency. Results: A total of 78 children under 12 years of age were enrolled in the study, with a mean age of three years and three months at presentation. The majority of cases (96.2%) involved accidental poisoning, while a small proportion (3.8%) was due to suicidal poisoning. Of the two reported cases of suicidal poisoning, one involved a male child and the other involved a female child. Both children were above six years of age. The most common causes of poisoning were kerosene (34.6%), organophosphorus compounds (10.3%), and liquid mosquito repellents (9.1%). Conclusion: This study revealed both unintentional and intentional poisoning cases, with a high prevalence of accidental poisoning observed in children below three years of age. Kerosene was identified as the most common cause of childhood poisoning.

Establishment of Reference Interval of Thyroid Hormones and Autoantibodies: A Cross-sectional Study

Introduction: The accurate diagnosis of thyroid disease relies on the sensitivity and specificity of laboratory tests, which require specific reference intervals. Thyroid hormone levels can be influenced by factors such as age, gender, iodine intake and geographical region. Therefore, it is recommended for clinical laboratories to establish their own reference intervals. Aim: To establish reference intervals for Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), Anti-thyroglobulin antibody (anti-TG), and Anti-Thyroid Peroxidase Antibody (anti-TPO) in males and and females. Materials and Methods: A cross-sectional study was conducted in the Department of Biochemistry, Amrita Institute of Medical Sciences (AIMS), Kochi, India, from December 2021 to July 2022. The study included 217 apparently healthy subjects aged between 18 years and 60 years. TSH, FT4, anti-TPO, and anti-TG levels were analysed to establish reference values for males and females in the two age groups: 18-40 years and 41-60 years. Reference intervals for thyroid parameters were expressed as mean±Standard Deviation (SD), median, 2.5^th and 97.5^th percentiles. The Mann-Whitney U test was used to assess the statistical significance of thyroid parameters between gender and age groups. Results: The mean age in the female population was 38.24±11.64 years, while in the male population, it was 39.24±10.98 years. The reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO in females were determined as 0.80-4.12 μIU/mL, 0.99-1.57 ngm/dL, <85.33 IU/mL and <45.13 IU/mL, respectively. In males, the reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO were determined as 0.51-5.09 μIU/mL, 1.03-1.79 ng/dL, <87.09 IU/mL and <33.88 IU/mL, respectively. There was a significant difference in anti-TPO (p-value=0.017) in males between the two age groups. A significant difference was also observed in FT4 (p-value=0.010) and anti-TPO (p-value=0.034) between males and females. Conclusion: The study successfully established reference intervals and cut-off values for TSH, FT4, anti-TG, and anti-TPO. It was found that anti-TPO levels decrease significantly with age progression. Additionally, the reference interval for TSH was wider in the 41-60 years age group compared to the younger age group.

Shear Bond Strength of Veneering Composite Versus Different Polyetheretherketone Materials after Various Surface Treatments: An In-vitro Study

Introduction: Polyetheretherketone, also known as PEEK, is a semicrystalline thermoplastic material with many advantages. Since its grey material, it has to veneering with composite resin to enhance its aesthetic appeal. Bonding PEEK and composite veneers poses challenges due to its inert surface. Aim: To assess and compare the Shear Bond Strength (SBS) between various polyetheretherketone materials and veneering composites following various surface treatments. Materials and Methods: The in-vitro study was conducted at KSR Dental College and Hospital in Tiruchengode, Tamil Nadu, India, over a period of three months from December 2022 to February 2023. A total of 108 PEEK discs were prepared for the study, divided into three groups: unfilled PEEK, 30% carbon reinforced PEEK, and 10% carbon+10% graphite+10% Polytetrafluoroethylene (PTFE) reinforced PEEK. The specimens underwent different surface treatments, including no treatment, sandblasting with 110 um alumina particles, and acid etching with 98% sulphuric acid. Additionally, 108 composite discs were prepared and bonded to the PEEK specimens using adhesive and resin cement. The bonded specimens were immersed in distilled water for 24 hours, and the Shear Bond Strength (SBS) was determined using a universal testing machine. Statistical analysis was performed using one-way ANOVA, and mean values were compared using posthoc tests. Results: The results indicated significant variation in SBS among the three groups without treatment (p=0.011) and after sandblasting with 110 um alumina (p=<0.001). The 30% carbon reinforced PEEK exhibited the highest SBS regardless of the surface treatments. Conclusion: Among the tested materials, 30% carbon reinforced PEEK demonstrated the highest SBS, regardless of the surface treatments. Acid etching yielded the highest SBS among the various surface treatments, irrespective of the type of PEEK material used.

Comparison of Haemodynamic Stability and Early Recovery Characteristics of Desflurane versus Sevoflurane in Robotic Prostatectomy: A Randomised Clinical Study

Kirti Gujarkar, Alka Mandke, Sharmila Ranade, Prajwal Mahatme

Introduction: An ideal anaesthetic for robotic surgery would allow for a quick induction with minimal discomfort, as well as a short operation duration, quick recovery, and minimal aftereffects. Additionally, it would enable speedy recovery. Aim: To compare the haemodynamic stability and recovery characteristics of sevoflurane with desflurane for robotic surgery. Materials and Methods: The present randomised clinical study was conducted for four years from January 2019 to January 2023 and included 60 patients undergoing elective robotic radical prostatectomy and randomised into the group receiving desflurane (Group D) and that receiving sevoflurane (Group S). All patients were monitored using the Bispectral index (BIS) monitor, in addition to standard monitoring. General anaesthesia was administered using midazolam, fentanyl, propofol, atracurium, and either desflurane or sevoflurane based on the assigned group. Throughout the surgery, patients’ haemodynamic stability was monitored, and vital signs were recorded at induction, intubation, after assuming the Trendelenburg position, and at 30-minute intervals, until extubation. The inhalational agent was turned off at skin closure, and the time to spontaneous eye opening (T1), time to extubation (T2), and time to verbal response (T3) were noted. After the verbal response, patients were assessed based on the Modified Aldrete Score (MAS) with a threshold of ≥9. Pulse rate, blood pressure, BIS, and MAS were recorded during this time period. Data was presented as mean, frequency, and percentage. MAS comparison among the study groups was assessed using the Chi-square test. Demographic, haemodynamic, and BIS variables were compared using paired t-tests. Results: The mean age of patients in group S was 67.67±6.07 years, while in group D, it was 65.17±6.69 years. The time required for extubation after turning off the agent was significantly shorter in group-D compared to group-S, with a mean of 16.07±13.00 minutes in group-D and 21.71±9.07 minutes in group-S (p-value=0.0001). The percentage of patients achieving MAS >9 at five minutes was significantly higher in group D. Additionally, the use of both agents was not associated with any major complications. Conclusion: Desflurane as the inhalational agent ensures faster recovery in the early postoperative period and minimal changes in haemodynamic parameters compared to sevoflurane. However, sevoflurane has fewer complications compared to desflurane.

Oral Daily Iron Supplementation among Rural Children Aged 36-59 Months with Mild-to-moderate Anaemia: A Quasi-experimental Study from Central Karnataka, India

Shubha Davalagi, Anurupa Maganalli, Muganagowda Patil, Vaman Nayak

Introduction: Anaemia is a serious concern for young children because it can result in impaired cognitive performance, behavioural and motor development, coordination, language development, and scholastic achievement, as well as increased morbidity from infectious diseases. While severe anaemia is typically addressed with urgency, mild-to-moderate anaemia is sometimes overlooked. However, even mild cases can have a significant impact on a child’s health and development. Thus, oral iron supplementation, by reducing anaemia, can contribute to the development of a healthier and more productive population. Aim: To assess the effect of daily Iron Folic Acid (IFA) supplementation among 36-59 month old children with mild-to-moderate anaemia. Materials and Methods: This quasi-experimental study was conducted in the rural field practice areas of a tertiary care teaching hospital in central Karnataka, India from March 2022 to February 2023. After baseline assessment, 53 children aged between 36-59 months old in Anganwadi centres of the study area with mild-to-moderate anaemia (Haemoglobin - Hb: 10.9 – 7 g/dL) were recruited for the study after obtaining informed written consent from the parents. The IFA supplementation was administered under supervision for six months. The primary outcome was rise in the Hb concentration. The paired t-test was used to statistically analyse the data. Results: Among the 53 study participants, the majority (27, 51%) were boys, and the mean age of the study participants was 46.6±8.4 months. The study showed that after six months of iron supplementation among 36-59 month old children with mild-to-moderate anaemia, there was a rise in the mean {Standard Deviation (±SD)} Hb by 0.71±0.32 gm/dL in the study participants, and it was found to be statistically significant (2.579, p=0.011). The increase in Hb was found in both girls (0.84±0.41 gm/dL) and boys (0.83±0.39 gm/dL). Conclusion: The study concluded that supervised intervention for mild-to-moderate anaemia in preschool children has the potential to reduce the prevalence of iron deficiency anaemia among this vulnerable population, but it requires a joint effort from all stakeholders involved.

Evaluation of Mental Health among School-going Children during COVID-19 Pandemic in Bankura Town, West Bengal, India: A Cross-sectional Study

Improving the Quality of Paediatric Discharge Summaries at the University Teaching Hospital: A Retrospective Chart Review

Introduction: The Discharge Summary (DS) is a vital document for ongoing patient care. Poor quality of DS may lead to adverse events, medication errors, readmission, or unnecessary repetition of diagnostic work-ups. DSs provided by academic institutions may not meet expectations and, therefore, need to be evaluated. Aim: To improve the quality of DSs issued from the paediatric ward of a tertiary-care teaching hospital. Materials and Methods: The present retrospective chart review was conducted in the Department of Paediatrics, Shree Krishna Hospital (a rural tertiary care teaching hospital), Karamsad, Gujarat, India, from May 2018 to May 2020. Thirty-three summaries were randomly selected from the last quarter (October to December) of each calendar year 2017, 2018, and 2019 (a total of 99 summaries), representing the pre-intervention, post-intervention, and retention phases, respectively. In the absence of a contextual paediatric DS assessment tool, a novel scoring system was developed to evaluate 33 components of the DS under seven broad domains. This scoring system was consensually validated. Residents responsible for preparing the DS were empowered in small groups. Peer audits of the summaries prepared by each resident were conducted on multiple occasions by consultants, followed by feedback highlighting areas for improvement. Review of the summaries by senior residents or consultants were promoted. Discussions on discharge processes were emphasised during ward rounds including important DS documentation points. The percentage mean±Standard Deviation (SD) domain scores and the total final score were compared using Analysis of Variance (ANOVA) with post-hoc comparisons by Scheffe’s test using Statistics and Data (STATA) software version 14.2. Results: Out of 33 summaries from 2017, one patient file was not traceable at the time of the study, and reviews of 30 and 32 DSs could be reviewed for the years 2018 and 2019, respectively. The scoring tool demonstrated good inter-rater reliability. The mean±SD total % score was 78.50±8.23 in 2017, 85.48±8.91 in 2018, and 88.48±9.05 in 2019. There was a significant improvement (p-value=0.012) from 2017 to 2018. Domains such as history, physical examination, and discharge plan showed significant improvement, while the hospital course domain remained resistant to improvement. Conclusion: The DS score improved consecutively for both years. The quality of DSs prepared by residents in a teaching institute can be enhanced through education, audit feedback, and changes in the work system. These methods can be incorporated into postgraduate training to improve documentation.

Efficacy of Two Paediatric Rotary Systems: Kedo-SG Blue^TM and Prime Pedo^TM Files in Primary Mandibular Molars: A Randomised Clinical Trial

Saranya Jeepalyam, SVSG Nirmala, Sivakumar Nuvvula

Introduction: The success of root canal procedures depends on cleaning and shaping of canals. There are several instrumentation techniques available for root canal preparation. Recently, exclusive rotary file systems called Kedo-SG Blue and Prime-Pedo have been introduced for root canal preparation in primary teeth. The inherent flexibility of these files allows them to preserve the anatomy of curved canals in primary molars. Aim: To compare the instrumentation time, obturation time, and quality of obturation using two paediatric rotary file systems, Kedo-SG Blue^TM and Prime-Pedo^TM, in mandibular primary molars. Materials and Methods: A randomised clinical trial was conducted in the outpatient Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore Andhra Pradesh, India, from February 1, 2019 to January 20, 2020. Fifty primary molars with necrotic pulp were included and randomly divided into two groups, with 25 teeth in each group. Group 1 and Group 2 were instrumented with Kedo-SG Blue^TM and Prime-Pedo^TM, respectively. The time taken for instrumentation and obturation was noted in minutes, and the quality of root canal filling was recorded as optimal, underfilled, or overfilled. The data were statistically analysed using an independent Student’s t-test for time measurements and a Chi-square test for the quality of obturation. Results: There was a statistically significant difference in instrumentation time and obturation time between the two groups (p-value=0.009; 0.011). The Kedo-SG Blue^TM rotary system showed a better quality of obturation compared to the Prime-Pedo^TM rotary system, although the difference was not statistically significant (p-value=0.22). Conclusion: The Kedo-SG Blue^TM rotary system demonstrated shorter instrumentation and obturation times, as well as a higher number of optimally filled canals compared to the Prime-Pedo^TM rotary system. Therefore, the Kedo-SG Blue^TM rotary system exhibited better clinical performance in primary molars than the Prime-Pedo^TM rotary system.

Association between Nocturnal Hypoxemia and COPD Severity: A Cross-sectional Study

Rohan Raman, Nilom Khound, Kripesh Ranjan Sarmah, Gayatri S Nair, Bhuwan Sharma

Introduction: Globally, Chronic Obstructive Pulmonary Disease (COPD) is the third most common cause of mortality. More than 80% of these fatalities happened in low- and middle-income nations. Transient desaturation during sleep occurs in healthy persons during Rapid Eye Movement (REM) sleep. This phenomenon is aggravated in COPD patients. As Nocturnal Desaturation (NOD) in COPD has been suggested to increase mortality, its early identification will aid in early initiation of treatment and prevention of associated complications. Aim: To estimate the prevalence of nocturnal hypoxemia in COPD and determine its association with COPD severity. Materials and Methods: A cross-sectional study was carried out at the Department of General Medicine, Apollo Hospitals, Guwahati, Assam, India during January to December 2021 involving 100 patients who had COPD symptoms. Continuous oxygen saturation monitoring with transcutaneous finger probe was done for the entire duration of sleep at night. Patients whose oxygen saturation falls below 90% for at least 30% of recording time in sleep were classified as desaturators. Statistical Package for Social Sciences (SPSS) Version 26.0 was used for data analysis. Using the Chi-square test, the relationship between the qualitative variables was evaluated. The Mann-Whitney test or the unpaired t-test was used to analyse the quantitative data between the two groups. A p-value of less than 0.05 was considered significant. Results: Prevalence of NOD among cases of COPD was observed as 26% in present study. A significant association was observed between presence of NOD in COPD cases with severity of COPD and with desaturation in 6-Minute Walk Test (6-MWT) (p<0.01). Severe cases had a prevalence of NOD as 65% as compared to 28.2% and 4.9% in moderate and mild cases respectively (p<0.01). A total of 61.9% cases with desaturation during 6-MWT showed NOD as compared to 38.1% without desaturation (p<0.01). Conclusion: One fourth of the normoxemic COPD patients had significant NOD. NOD episodes were observed to be positively associated with increasing severity of COPD. Assessing variations in oxygen saturation during a 6-MWT can be helpful in identifying COPD patients who may be at risk for severe night time desaturation.

Perception of Faculty Regarding Competency-based Medical Education: A Qualitative Study from Mizoram, India

Ganesh Shanmugasundaram Anusuya, Sabita Yograj, Manoj Balaji Patki, Ajay Kumar

Introduction: Competency-based Medical Education (CBME) has been implemented in India for undergraduate medical students since 2019. Understanding faculty perceptions regarding CBME will help identify barriers and suggestions for its better implementation. However, there have been limited studies conducted on this aspect in Northeast India. Aim: To examine the perception of teaching faculties at Zoram Medical College in Mizoram, India, regarding CBME. Additionally, it aims to identify barriers and suggestions for the improved implementation of CBME in the medical college through Focus Group Discussions (FGDs). Materials and Methods: A qualitative study was conducted at Department of Community Medicine, Zoram Medical College, Falkawn, Mizoram, India, involving FGDs with teaching faculties from May 2021 to April 2022. A total of 11 main FGDs were conducted with 36 faculty members. Each FGD involved a minimum of three participants and a maximum of six participants. The FGDs were recorded using mobile phones, and the audio recordings were transcribed verbatim. Themes were identified and entered into an Excel sheet for analysis. Statistical analysis was performed using the Chi-square test/Fisher’s-exact test. Results: The study included faculty members with a mean age of 41.06±7.24 years (range: 31 to 69). The majority of the study population (58.33%) were females, and 20 (55.56%) were Assistant Professors. Small group teaching was reported to be followed by 29 (80.56%) participants, while 32 (88.89%) followed both summative and formative assessment. All faculty members (100%) expressed the need for refresher courses for those who have already undergone training programs. Awareness regarding changes in marks allotment was only 69.44%. The major challenges reported included a shortage of faculty (50%), difficulties in implementing integration (36.1%), competency-related challenges (30.5%), and infrastructure-related challenges (19.4%). Suggestions for improvement included increasing the number of faculties (97.2%), providing more training and workshops (52.7%), and ensuring uniformity in implementation by the National Medical Council (NMC) (36.1%). Conclusion: The faculty members perceived that CBME can be effectively implemented by increasing the number of faculties, providing frequent training, and ensuring uniformity in implementation across all medical colleges in India.

Comparing the Clinical Spectrum of Paediatric In-patients in pre-COVID-19, during COVID-19 and post-COVID-19 Pandemic Periods in a Tertiary Level Teaching Centre

Veena Anand, AO Vinitha, Susy Joseph, VH Sankar, IP Yadev

Introduction: Public awareness of the COVID-19 pandemic has resulted in a reduction in healthcare utilisation for other diseases. Understanding how the COVID-19 pandemic affects hospital admissions and the disease patterns is crucial for proper triaging and planning of health resources in future pandemics. Aim: To compare the clinical spectrum of paediatric inpatients in the post-COVID-19, pre-COVID-19 and during COVID-19 pandemic periods in a tertiary level teaching centre. Materials and Methods: This ambispective study was conducted at the Paediatrics Department of SAT, Government Medical College, Thiruvananthapuram, Kerala, India. The analysis included all cases hospitalised from April 2019 to March 2022, with the data divided into three time periods. The discharge diagnoses of all cases admitted during the study period were coded according to the ICD-10 criteria and included in the analysis. Differences in admissions, disease patterns, and ICU admissions during the three time periods (pre-COVID-19, post-COVID-19, and during COVID-19) were compared using one-way ANOVA and Tukey’s post-hoc test. Results: In the present study, ward admissions (p-value <0.001), respiratory infections (p-value 0.031), asthma (p-value 0.009), and chronic systemic diseases (p-value 0.018) decreased in the post-COVID-19 period compared to the pre-COVID-19 period, whereas ICU admissions (p-value 0.010) and Diabetic Ketoacidosis (DKA) (p-value 0.002) increased. When comparing COVID-19 and post-COVID-19 periods, there was an increase in ward admissions (p-value 0.01), respiratory infections (p-value 0.018), and diarrhoea (p-value 0.029), but a decrease in the proportion of ICU admissions (p-value 0.01). There was no significant difference in mortality among the three time periods. Conclusion: There was a significant difference in the clinical spectrum of paediatric inpatients. The significant decrease in admissions of chronic systemic diseases, which require regular follow-up for management changes, raises concerns about the potential impact on patient care.

Efficacy of Salivary Urea and Creatinine Compared to Serum Levels in Chronic Kidney Disease Patients: A Cross-sectional Study

Introduction: Chronic Kidney Disease (CKD) has become an impending health concern due to the massive rise in the number of patients with diabetes mellitus and hypertension. Monitoring CKD patients typically requires regular invasive testing, and a simple diagnostic test that does not involve venipuncture would greatly benefit patients and healthcare professionals. Extensive research is being conducted to explore the use of saliva as a Non invasive tool for evaluation of systemic diseases like CKD. However, most of these studies have focused on End Stage Renal Disease (ESRD) patients. Aim: To investigate the correlation between salivary urea and creatinine levels and their serum counterparts in CKD patients and healthy controls. Additionally, the study aimed to assess the efficacy of salivary urea and creatinine compared to serum urea and creatinine in predicting CKD. Materials and Methods: The present cross-sectional study was conducted between January 2021 and July 2022 in the Department of Biochemistry, in collaboration with the Department of Medicine, at Heritage Institute of Medical Sciences in Varanasi, Uttar Pradesh, India. The study included a total of 60 participants: 30 CKD patients (stage 1-3) and 30 age-matched healthy controls. Serum and salivary urea were analysed using the Urease-Glutamate Dehydrogenase (GLDH) method, and creatinine was measured using the Modified Jaffe’s method on the Dirui-300B autoanalyser. Data were statistically analysed using Pearson’s correlation coefficient. The sensitivity, specificity, and Area Under the Curve (AUC) of salivary urea and creatinine were evaluated in comparison to their serum counterparts. Results: The participants consisted of 30 CKD patients with a mean age of 54.8±8.8 years and 30 age-matched healthy controls with a mean age of 52.42±8.4 years. A significant difference in salivary urea and creatinine levels was observed between the control and CKD groups. There was a strong and significant correlation (p-value <0.01) between salivary creatinine and serum creatinine in both the control group (r-value=0.76) and the CKD group (r-value=0.82). Additionally, a strong and significant correlation (p-value <0.01) was found between salivary urea and serum urea in the CKD group (r-value=0.63). However, the correlation between salivary and serum urea was not significant in the control group, with an r-value of 0.58 and a p-value of 0.24. Both salivary urea and creatinine demonstrated high sensitivity (90% and 89%, respectively), specificity (80% and 80%, respectively), and AUC (0.78 and 0.86, respectively) compared to their serum counterparts, validating their practical clinical utility. Conclusion: The concentration of urea and creatinine in saliva can reflect kidney damage and help monitor kidney function in CKD patients. Standardising the protocol for evaluation of salivary urea and creatinine and establishing a reference range will make it useful for screening for CKD.

Clinicopathological Outcomes in Focal Segmental Glomerulosclerosis: A Retrospective Cohort Study

Girish P Vakrani, R Priyashree, Tanuja Nambakam, KY Yashavantha Kumar

Introduction: Focal Segmental Glomerulosclerosis (FSGS) is a nephrotic syndrome with a variety of clinicopathological presentations and varied responses to treatment. Hence, this study attempts to classify FSGS based on clinical presentation and pathological findings on kidney biopsy, which is essential for appropriate treatment and avoidance of inappropriate use of immunosuppressants. Aim: To analyse clinicopathological findings and responses to immunosuppressants in FSGS. Materials and Methods: A retrospective cohort study was conducted at Department of Nephrology, Vydehi Institute of Medical Sciences and Research Centre Bengaluru, Karnataka, India, to analyse clinicopathological parameters such as urine analysis, 24-hour urine protein, serum creatinine, serum albumin, lipid profile, renal biopsy details, and response to treatment in 97 patients. The study was planned, analysed, and executed between January 2023 and February 2023. All variables were expressed as mean±standard deviation or percentage. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: Among a total of 97 patients, 64% were males. Sudden onset oedema was observed in 90% of the cases, while nephrotic proteinuria was seen in 71%. The Not Otherwise Specified (NOS) variant was noted in 60% of the cases. Complete remission was observed in 61%, suggesting a possible primary FSGS. Persistent nephrotic proteinuria with a poor response to therapy was noted in 32%, indicating a possible secondary/genetic FSGS, despite adequate immunosuppressive therapy. Therefore, differentiating between primary and secondary forms of FSGS has therapeutic and prognostic implications. Accurate diagnosis of each form of FSGS is vital to avoid unnecessary immunosuppressive-based therapy and establish appropriate treatment. Conclusion: Resistance to steroid therapy was observed in one-third of FSGS patients. It is likely that unrecognised genetic FSGS or secondary FSGS were included among the study group of primary FSGS, leading to misinterpretation of treatment responses in primary FSGS. Hence, a clinicopathological approach for correctly differentiating between primary FSGS, secondary (maladaptive, viral, or toxic) FSGS, and genetic FSGS helps in making correct treatment decisions.

Impact of Two Different High-power Pain Threshold Static Ultrasound Techniques on Myofascial Trigger Points: A Pilot Study

Anand Kumar Singh, Kamran Ali

Introduction: Myofascial Pain Syndrome (MPS) is a challenging musculoskeletal condition with a prevalence of upto 30% in certain populations seeking medical care. It is characterised by Trigger Points (TrPs) in muscle fibres, leading to spontaneous pain, referred pain, muscle tension, and restricted Range of Motion (ROM). The integrated TrP hypothesis proposes that an energy crisis triggers TrPs through calcium release, prolonged muscle activity, and localised ischaemia. Vasoactive substances sensitise nociceptors and perpetuate the cycle. High-power Pain Threshold Ultrasound (HPPTUS-9), a novel Ultrasound (US) therapy, shows promise in reducing pain from active TrPs. The present study investigates the effects of HPPTUS-9 on Pressure Pain Threshold (PPT), subjective pain intensity, lateral flexion ROM, and disability in MPS patients. Aim: To determine the impact of two different HPPTUS techniques on MTrPs. Materials and Methods: A randomised clinical trial was conducted using a two-way mixed analysis of variance at the Department of Physiotherapy, GD Goenka University in Gurugram, Haryana, India, over a four-month period from April 2023 to August 2023. A total of 16 individuals with TrPs in the upper trapezius muscle, comprising seven males and nine females, were included. They were equally divided into two groups: the HPPTUS-9 group 1 and the HPPTUS group 2. Both groups received treatments over a six-session period spanning two weeks. The primary outcome measure was the PPT, which evaluated the pain threshold of TrPs in the upper trapezius muscle. The secondary outcome measures included ROM, Neck Pain Disability Index (NPDI), and subjective pressure pain intensity. Statistical analysis was conducted using paired t-tests. Results: Between-group analysis revealed that participants who underwent nine applications of HPPTUS experienced a significantly greater increase in PPT (p=0.001) and ROM (p=0.001) compared to the other group at the end of the two-week intervention. Additionally, both groups demonstrated a significant decrease in pain (p=0.002) within their respective treatments. Notably, no adverse effects were reported in either group. Conclusion: The present study demonstrates that nine applications of HPPTUS led to significant improvements in PPT and ROM compared to the alternative treatment group. Both groups showed a notable reduction in pain during their respective interventions. Importantly, no adverse effects were reported in either group throughout the two-week study period. These findings suggest that HPPTUS has the potential to be an effective and safe treatment option for addressing pain and mobility issues.

Effect of Yoga Nidra on Perceived Stress in Individuals with High Blood Pressure: A Quasi-experimental Study

Krima Tanna, Subhash Khatri

Introduction: A persistently high level of stress can lead to a variety of diseases, such as anxiety, depression, sleeplessness, muscle discomfort, high Blood Pressure (BP) and a compromised immune system. Although 15% of adults in India suffer from hypertension, significant progress has been made in preventing and managing this condition. One alternative form of treatment that may help with stress management and BP regulation is Yoga Nidra. Aim: To assess the effect of Yoga Nidra on perceived stress in Individuals with High Blood Pressure. Materials and Methods: The present quasi-experimental study was conducted at various medical and physiotherapy Outpatient Departments (OPDs) in Veraval, Gujarat, India, from June 2021 to September 2022. A total of 49 individuals diagnosed with high BP, including both prehypertensive and hypertensive individuals (with BP >120/80 mmHg), were selected. Essential demographic information was gathered from the participants, who were also asked to complete the Perceived Stress Scale (PSS) questionnaire. Participants were introduced to the concept of Yoga Nidra and provided with instructions on how to perform the Yoga Nidra technique. They engaged in 12 sessions of this technique. After completing these 12 sessions, participants once again completed the PSS questionnaire. Since the collected data did not exhibit a normal distribution, a paired t-test was conducted at a significance level of 95%. Results: Out of 49 study participants, 22 (45%) were females and 27 (55%) were males, and mean±Standard Deviation (SD) age was 47.86±10.62 years. The analysis revealed a significant reduction in PSS scores following the Yoga Nidra sessions (p-value=0.0001). Additionally, both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) showed decrease with a p-value of 0.0001. Conclusion: Yoga Nidra has a significant effect on reducing perceived stress in individuals with high blood pressure, along with a reduction in blood pressure. This research provides valuable findings regarding the potential of Yoga Nidra as an additional relaxation therapy to help manage hypertension and enhance overall well-being.

Perception of Prophylactic Root Canal Therapy for Teeth used as Abutments in Fixed Partial Dentures among Dental Surgeons in Maharashtra and Kerala: A Questionnaire-based Cross-sectional Survey

Introduction: The pulps of healthy teeth used as abutments for Fixed Partial Dentures (FPD) undergo mechanical and thermal stresses during tooth preparation. The remaining dentin thickness, the heat produced during tooth preparation, and the permeability of dentinal tubules influence the severity of pulpal injury. Prophylactic Root Canal Therapy (RCT) could be an option to provide better outcomes for FPD treatment. Aim: To assess dentists’ perception regarding the need for prophylactic RCT of abutment teeth in FPD through a questionnaire. Materials and Methods: A questionnaire based cross-sectional surve was conducted among 200 dental professionals in the Indian states of Kerala and Maharashtra over a period of two months. The participants included dental professionals from private clinics, dental Institutions, and postgraduate students in these states. The Chi-square test of proportion was performed to assess significant differences between each response. Results: Total 67 out of 200 practitioners, accounting for 33.5%, recommended prophylactic RCT, while 60 (30%) practitioners disagreed with it. A total of 152 (76%) practitioners suggested clinical assessment of abutment teeth before starting the tooth preparation. Total 70 (35%) practitioners had never experienced pulpal damage in abutment teeth in their clinical practice. In contrast, 127 (63.5%) practitioners experienced pulpal damage in less than half of the total cases, and 3 (1.5%) practitioners experienced failures like pulp necrosis or irreversible pulpitis in more than half of the total cases. Conclusion: Total 33.5% of the surveyed dental practitioners recommended prophylactic endodontic treatment for abutment teeth in FPDs. Implementing precise elective RCT guidelines into dental curricula was suggested as a potential avenue to enhance decision-making and improve patient outcomes by reducing the incidence of pulpal damage beneath FPDs.

Knowledge of Computer Ergonomics among Third and Final year Dental Students: A Cross-sectional Survey from Nagpur, India

Smriti Jagdhari Golhar, Bhuvenshwari Bhalme, Mukta B Motwani

Introduction: During the Coronavirus Disease-2019 (COVID-19) pandemic, the world has experienced many changes, including increased computer and internet usage. Spending more time on computers can lead to the development of various postural problems, resulting in pain and inefficiency in the workplace. Aim: To assess the knowledge of computer ergonomics among third and final year Bachelor of Dental Surgery (BDS) students at VSPM’s dental college in Nagpur, Maharashtra, India. Materials and Methods: This cross-sectional, questionnaire-based study was conducted on third and final year students between November 2020 and February 2021 in the Department of Oral Medicine and Radiology at VSPMDCRC, Nagpur, Maharashtra, India. Ethical clearance was obtained from the Institutional Ethical Committee (IEC/VSPMDCRC/15/2020). A self-administered questionnaire, formulated and validated by independent subject experts, was used. A total of 216 students were included in the study over a two-month period. Informed consent was obtained from the students. The questionnaire consisted of 34 questions on computer usage and knowledge of ergonomics, and the responses were recorded. Descriptive statistics were performed using Statistical Packages for Social Sciences (SPSS) version 20.0 for Windows. Quantitative data were expressed as mean and standard deviation. The association between categorical variables was checked using the Chi-square test, with a significance level set at 5%. Results: The mean age of the students was 22.20 years total of 216 students, including 158 females and 58 males, were included in the study. The results showed that 20.37% of third year students (44/96) and 31.48% of final year students (68/96) were aware of the term “ergonomics”. The majority of students were unaware of the principles of ergonomics. However, 169 (78.2%) students knew the correct position of the head and neck while using a computer. Additionally, 164 (75%) students were aware of the need for lower back support, 167 (77.3%) were aware of the placement of input devices, and 174 (80.6%) were aware of the alignment of devices. Moreover, 168 (77.8%) subject knew that the monitor and working surface should be glare-free, and 120 (55.6%) were aware that a sloped desk surface is required for reading or writing. Furthermore, 157 (72.7%) subjects used a headset or speakerphone while writing, typing, or talking on the phone, and 164 (75.9%) subjects took regular eye breaks. Conclusion: The present study highlights a lack of practical knowledge and application of ergonomics among the participants. There is a need to prioritise creating awareness and developing healthy ergonomics practices among dental students through Continuing Dental Education programs (CDE). The authors also recommend that the curriculum for healthcare courses should incorporate healthy ergonomics practices as a part of the curriculum.

Sexual Dimorphism in Decompensated Non Ethanol-related Chronic Liver Disease: A Retrospective Cohort Study

Introduction: Women exhibit a distinct natural history of chronic liver disease compared to men, particularly regarding progression and outcomes. Although liver disease prevalence is generally higher in men, the incidence of non ethanol-related liver disease is increasing among females. Metabolic syndromes and their consequences are less recognised in the female population until they develop end-stage cirrhosis. Limited studies have explored the differences between male and female cirrhosis. The present study aimed to address the knowledge gap in female Decompensated Chronic Liver Disease (DCLD). Aim: To identify the differences in presentation and outcomes between females and males with non ethanol-related cirrhosis. Materials and Methods: The present retrospective cohort study was conducted in the Department of Medical Gastroenterology and Hepatology,Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, involving 27 males and 33 females with non ethanol-related decompensated cirrhosis. A comparison was made between the aetiologies, presenting symptoms, complications, laboratory values, Model for End-stage Liver Disease (MELD) score, and in-hospital mortality during the first decompensation. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 24.0 Quantitative variables were expressed as mean and Standard Deviation, while qualitative variables were expressed as frequency and percentage. The association between categorical variables was analysed using the Chi-square test, and the comparison of continuous variables between the two groups was analysed using independent sample t-test. A p-value of <0.05 was considered statistically significant. Results: The mean age of decompensation was 56.5 years for men and 50.9 years for women. The most common aetiology in men was Non Alcoholic Fatty Liver Disease (NAFLD) (63%), while in females, it was NAFLD (45%) and cryptogenic cirrhosis (45%) (p=0.020). Diabetes Mellitus (DM) was more prevalent in males (55.6% versus 33.3%). Variceal bleed was more common in females (66.7% versus 48.1%). Jaundice was more frequently observed in males (44.4% versus 21.2%) (p=0.05). Ascites was more prominent in males (70.4% versus 45.5%) (p=0.05). Hepatic Encephalopathy (HE) was more prevalent in males (22.2% versus 15.2%). Females had a lower MELD scores compared to males (12.4±6.1 versus 15.2±6.4). Mortality was higher in males (22.2% versus 12.1%). Conclusion: Women with Decompensated Chronic Liver Disease tend to decompensate at a younger age compared to males and have a higher risk of Upper Gastrointestinal (UGI) bleeding. NAFLD was the most common aetiology in both groups. Ascites and HE were more commonly observed in men. Females had lower MELD scores, resulting in a longer waiting period on the transplant list compared to males. Mortality was higher in males.

Early Diagnosis of Neonatal Sepsis Using the Leukocyte Alkaline Phosphatase Score: A Cohort Study

Y Muralidhar Bhat, V Arpitha, BJ Keerthi, S Shivakumar

Introduction: The clinical features of sepsis in neonates are subtle and non specific, requiring a high index of suspicion for early diagnosis. Blood culture is the gold standard for diagnosis, but it is time consuming. Therefore, there is a need for a cost-effective and reliable screening tool. The Leukocyte Alkaline Phosphatase (LAP) activity of neutrophils is known to increase during bacterial infections in adults. Aim: To determine the activity of LAP in Neonatal Sepsis (NS) and compare the results with blood culture. Materials and Methods: This is a prospective cohort study conducted from January 2018 to June 2019 at Mandya Institute of Medical Sciences, Karnataka, India. Total of 200 neonates by their haematological profile were clinically suspected of having sepsis. A peripheral smear was prepared from a drop of blood and stained to assess the LAP activity. In each smear, a total of 100 consecutive segmented neutrophils were examined and were rated from 0 to 4 according to the red granular precipitate intensity within their cytoplasm. The possible range of 0-400. The blood culture report was obtained from the case sheet. The neonates were divided into two groups: Group 1 consisted of culture-proven sepsis cases, and Group 2 consisted of neonates with clinical suspicion of sepsis but negative blood culture results. Descriptive analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. Chi-square test was conducted, and a p-value <0.05 was considered statistically significant. Results: Out of the 200 cases studied, 64 neonates showed a positive blood culture. The most common causative organism observed was Klebsiella pneumoniae, which was seen in 56 neonates. The age of the neonates ranged from newborn to 28 days old, with 115 being male. Furthermore, 116 neonates were term neonates, and 146 presented with early onset sepsis. The study revealed a wide range of LAP activity in both groups. In the culture-positive sepsis group, the LAP activity ranged from 36 to 350, while in the clinical sepsis group, it ranged from 10 to 354. Due to the broad range of LAP scores observed, it is concluded that LAP activity is not useful as a screening test. Conclusion: Findings of the present study indicate that LAP activity exhibited a wide range in both the culture-proven and clinical sepsis groups. However, due to this variability, LAP activity does not appear to be a reliable screening test for NS. While LAP activity assessment may still hold diagnostic value, further research is needed to refine its utility and explore its clinical relevance.

Evaluation of Periodontal Status in Female Patients with Endometriosis: A Protocol for a Cross-sectional Study

Dolly Gabada, Priyanka Jaiswal, Amit Reche

Introduction: Periodontal medicine indicates a strong relationship between Periodontal Health (PH) or disease and ‘systemic health.’ Although Periodontal Disease (PD) is quite distant from the area affected by endometriosis, both conditions share a similar pathogenesis. Both endometriosis and PD are chronic inflammatory diseases that occur more commonly in patients with systemic disorders. Moreover, significant alterations in immune modulators have been shown to occur in both diseases. Need for the study: The research is to evaluate the correlation between endometriosis and PH for early diagnosis, treatment planning, and prevention of long-term sequelae. Aim: To evaluate the PH status in female patients with endometriosis. Materials and Methods: A cross-sectional study will be carried out in the Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India from September 2023 to March 2024, involving 384 participants (192 patients diagnosed with endometriosis and 192 controls). Assessment of oral hygiene, plaque accumulation, gingival status, Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (GR), and other factors will be measured to evaluate the PH of the patients.

WHO-modified Partogram versus Paperless Partogram for Effective Management of Labour: A Research Protocol

Saloni, Jyotsana Potdar

Introduction: The partograph is a simple, inexpensive tool that provides a continuous pictorial overview of labour. It helps to identify obstructed or prolonged labour and determines when appropriate actions should be taken to prevent complications. The partograph is a valuable tool for making early decisions, including transferring patients to higher-level centres when labour is not progressing. Need for the study: This research aims to contribute to the development of a standardised approach for healthcare personnel to ensure accuracy and reliability in observations and data collection. Aim: This study will compare the efficacy of the World Health Organisation (WHO)-modified partograph versus the paperless partograph. Materials and Methods: This will be a prospective interventional study conducted at the Department of Obstetrics and Gynaecology, JNMC, Wardha, Maharashtra, India over a two-year duration from January 2024 to January 2026. The study will include 200 pregnant women who will be divided into two groups. One group will use the WHO-modified partograph, while the other group will use the paperless partograph. The comparison will be based on the effective management of labour using the action and alert line Estimated Time of Delivery (ETD) between the two partographs. The overall usefulness will be evaluated using the Chi-square test/Fisher’s-exact test, with a statistical value of <0.05 considered significant.

Remineralisation Potential of Self-assembling Peptide (P11-4) Compared to Other Remineralising Agents: A Narrative Review

Dana Alsenan, Amani Rozi, Njoud Alateeq, Shog Aleban, Jana Almusallam

Dental caries is a chronic infectious disease that affects the hard tissues of the teeth, primarily the enamel. Remineralisation involves depositing minerals back into demineralised enamel, repairing the damage, and preventing the formation of caries. Self-Assembling Peptide (SAP) P11-4 is a promising new remineralisation agent that mimics the natural process of remineralising dental enamel. It is a biomimetic peptide that binds to the surface of demineralised enamel, forming a three-dimensional network that supports mineral deposition and induces the production of reparative proteins. P11-4 is still in the early stages of development, but it has the potential to revolutionise the treatment of dental caries. SAP P11-4 has been shown to be safe and effective in remineralising early carious lesions. However, there is insufficient evidence to conclude that SAP P11-4 is more effective than other remineralising agents, such as fluoride, Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), and Silver Diamine Fluoride (SDF). The present review focuses on recent studies discussing the remineralisation potential of SAP P11-4 and compares it to other available remineralising agents. Overall, the review suggests that SAP P11-4 is a promising new remineralisation agent that is effective in treating early carious lesions. However, further research is needed to compare its effectiveness to other remineralisation agents and assess its long-term efficacy.

Role of Intestinal Microbiota in the Pathogenesis of Colorectal Cancer: A Narrative Review

Sharanya Menon, Kanishk K Adhit, Samarth Shukla, Sourya Acharya

The human gut microbiota forms a biome and acts as a neglected organ, playing vital roles in organ integrity, metabolism, immunity, and homeostasis. Variations in the microbiome can lead to disease initiation. Research using bacterial sequencing of faeces and digestive tissues has focused on understanding the role of gut microbiota in cancer development, particularly Colorectal Cancer (CRC), Dysbiosis and modifications in the intestinal microbiota have been observed in CRC cases. Hypotheses like the alpha bug hypothesis and the driver-passenger model aim to explain the correlation between gut microbiota and CRC pathogenesis. The present article summarise the functions of gut microbiota, mechanisms involved in colorectal carcinogenesis, and discusses the clinical significance of gut microbiota in CRC screening and therapy.

A Narrative Review of the Conventional and Contemporary Components of an Aesthetically Pleasing Smile

Sapna Rani, Pankaj Dhawan, Roshni Lekhi, Simran Chadha

The personality of a person is reflected by smile of that person. Smile designing encompasses hard tissue and soft-tissue components. The treatment plan includes facial, dental and gingival analysis to execute analysis and formulate treatment plan. The main objective of smile designing is to meet patient expectations and enhance patient’s smile with improved quality. Now, smile designing has shifted to digital platform. There has been evolution in smile designing from 2-dimensional (2D) to 3-dimensional (3D) and now further to 4-dimensional (4D). The techniques include veneers and laminates, bonded restorations, modification on tooth form and various prosthetic procedures including Digital Smile Designing (DSD). The artificial intelligence can be applied only when parameters, components and various principles are known to the clinician. Smile designing comprises of aesthetic and cosmetic principles for reconstruction of smile. Certain reference lines are to be considered for designing of aesthetic appealing smile. The present narrative review emphasises on all the factors which should be considered in smile designing and also the new concepts for smile designing.

Effects of Photofunctionalisation on Osseointegration and Stability of Dental Implants: A Systematic Review

Introduction: Dental implant osseointegration is crucial for the long term success of implant-supported restorations. Photofunctionalisation (PF), a novel surface modification technique, has been proposed as a means to enhance implant osseointegration. Aim: To evaluate the current evidence regarding the effects of PF on dental implant osseointegration. Materials and Methods: A comprehensive search was conducted in electronic databases, including PubMed, Directory of Open Access Journals, and Google Scholar, for studies published up until August 2022. The search strategy combined keywords related to dental implants, PF, and osseointegration. Two independent reviewers screened the titles, abstracts, and full texts of the identified studies, following predefined inclusion and exclusion criteria. Data extraction and quality assessment using the Cochrane Collaboration’s tool for randomised clinical trials, the ROBINS-I tool for non randomised studies, and the The Newcastle-Ottawa Scale (NOS) for observational studies were performed. Results: A total of five studies met the inclusion criteria and were included in the systematic review. The outcomes assessed included implant stability, osseointegration, and survival rates. The findings of the included studies suggested that PF of dental implants may promote osseointegration by enhancing early bone formation, increasing implant stability, and improving Bone-To-Implant (BIC) contact. Conclusion: The available evidence suggests that PF of dental implants may have a positive impact on osseointegration. However, due to the limited number of studies, further research is needed to provide more definitive conclusions regarding the clinical benefits of photofunctionalised dental implants in pathologically compromised bone sites.

DICOM: A Revolution in Facet of Maxillofacial Imaging

Samadrita Paul, Balaji Pachipulusu, TS MAHESH Kumar, Poornima Chandra

Digital Imaging and Communications in Medicine (DICOM) is a paradigm that enables interoperability between health-related digital applications, imaging devices, and Picture Archiving and Communications Systems (PACS). DICOM has its foundation in the USA, established by the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) in 1983 with the objective of establishing a “gold standard” for monitor and print-copy devices. In 1996, the American Dental Association (ADA) became a member of DICOM, followed by the American Academy of Oral and Maxillofacial Radiology and the American Association of Orthodontics. A working committee specifically for dentistry (WG-22) was initiated in 2003, and in 2005, it was finally adopted as an international standard. Currently, it is internationally recognised as the standard configuration for compatibility between dental radiological images and various scanners and digital X-ray devices. DICOM synchronises network communication and facilitates the exchange of patient data through a transmission protocol. The purpose of the present paper is to emphasise the reliance of digital dentistry on DICOM and its relationship with Three-Dimensional (3D) printing.

Effect of Exercise on Depression, Anxiety and Mood: A Narrative Review

In contemporary times, many individuals experiencing depression and anxiety have opted for non pharmaceutical and non traditional interventions, notably exercise, to manage their conditions. This trend is gaining popularity among those seeking alternative ways to address their mental health concerns. Regular exercise provides a lengthy list of advantages for both physical and mental well-being. It can be a pleasurable method to treat mild to moderate mental health disorders, and its effects can be both immediate and long-lasting. Despite individuals with mental health problems often being less physically active, increased Aerobic Exercise (AE) has been shown to significantly reduce symptoms. Evidence suggests a complementary relationship between regular exercise and psychological well-being, indicating that exercise can alleviate anxiety and depression while promoting a positive outlook. The underlying processes behind these effects are not fully understood. The present review summarises research on the impact of exercise on mental well-being, with a focus on its potential to alleviate depression, mood swings, and anxiety when incorporated into mental health therapy.

Augmented Reality in Dental Implants: A Systematic Review

Introduction: Augmented Reality (AR) in dentistry has evolved from computer-generated images overlaying the real world, stemming from advancements in software-based Virtual Reality (VR) for anatomic exploration. AR applications in dentistry range from simulations aiding in training to enhancing precision in dental procedures. By overlaying digital information onto the physical environment, AR facilitates better visualisation of dental anatomy and treatment planning. Its integration has shown promise in reducing errors, improving patient outcomes, and augmenting dental education through immersive experiences. Aim: To evaluate AR’s application in dentistry, with a particular emphasis on dental implants. Materials and Methods: A systematic review, using the Problem/patient Intervention Control or comparison Outcome (PICO) framework, selected six articles focusing on challenges in dentistry, specifically in training, practicing complex procedures accurately in implants, and maintaining patient confidentiality. The intervention compared AR with traditional methods. Results: The AR was mostly used in precision dentistry operations. Notably, it was discovered that three-dimensional (3D) AR outperformed two-dimensional (2D) image navigation techniques, resulting in fewer implant location errors. The highest absolute effect was 24.3%, with the angle of implant errors showing a reduction of 9.5% using AR. Conclusion: The findings support AR’s role in enhancing accuracy and efficiency while maintaining patient confidentiality.

Capacity Building in Research on Traditional Medicine: Experience of a Workshop Conducted under the Aegis of the Indian Council of Medical Research

Training healthcare professionals in research methodology is essential to promote research and innovation. This is particularly relevant in India, where there is a wealth of potential drug candidates from Indian Traditional Medicine (TM) systems that await exploration and scientific validation using modern medicine principles. Surprisingly, there is a lack of reported activities to train modern medicine practitioners in TM research in the literature. Recognising this need, a structured training program was planned and conducted under the auspices of the Indian Council of Medical Research (ICMR) to train modern medicine practitioners in TM research. A survey was conducted among modern medicine practitioners to assess training gaps and identify key areas to be covered in the workshop modules. The workshop received a positive response, as evidenced by the numerous registration applications and positive feedback from participants. The present article shares the experiences of conducting the pilot workshop, which may serve as a valuable resource for planning similar workshops.

Using Mobile Health (mHealth) Interventions to Optimise Breast Cancer Care: A Scoping Review

Introduction: Mobile phones have become ubiquitous in recent years. This portable device can be efficiently utilised to promote health and deliver high-quality healthcare services via Mobile Health (mHealth) technology interventions. In view of the increasing global burden of breast cancer cases, mHealth interventions can be constructive in breast cancer prevention and management. Nevertheless, there is a paucity of evidence to support the utility of mHealth interventions in breast cancer care. Aim: To analyse and synthesise evidence from published literature on the feasibility and effectiveness of mHealth interventions employed for breast cancer prevention, detection, management, and rehabilitation. Additionally, this study intends to draft a conceptual framework for mHealth intervention strategies in breast cancer management. Materials and Methods: A comprehensive literature search was conducted at Panimalar Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India, from June 2022 to December 2022. Google Scholar and PubMed databases were used to find published articles relevant to the study’s objectives. The reviewers selected articles based on the relevance of the article and eligibility criteria. Articles on mHealth interventions for the female population above 18 years of age with breast cancer were included. Results: A total of 13 articles were selected based on the eligibility criteria. Regardless of the type of mHealth technology employed, target population, and purpose of intervention, all the studies strongly support the use of mHealth technology-based interventions over usual care to enhance breast cancer management. Conclusion: The use of mHealth applications has increased exponentially in recent years. Since then, many studies have been conducted to validate their use. However, the usability of these applications is not well established. The involvement of not only patients but also healthcare professionals is crucial to develop well-equipped digital health applications. Personalised applications that provide security and safeguard user privacy are highly preferred by patients. A collaborative approach involving patients, healthcare professionals, and application developers will aid in the development of highly efficient mHealth applications.