Journal of clinical and diagnostic research

Yellow Nail Syndrome: An Unusual Cause of Pleural Effusion

Preetam Goswami, Anirban Das, Pronoy Sen, Rana Barik

Yellow Nail Syndrome (YNS) is a rare clinical syndrome charecterised by the classical triad of thickened and dystrophic yellow nails, pleural effusion and primary lymphoedema. It usually occurs in older adults of over 50 years but there is no sex predilection. This was a case report of a 21-year-old male, who presented with dyspnea on exertion, dry cough and abdominal distension for past 15 days and bilateral lower limb swelling for past two years. On general examination, patient had pallor with bilateral non pitting oedema of lower limbs and had yellow thick and dystrophic nails. There was clinical evidence of pleural effusion and ascites. Pleural fluid analysis showed lymphocytic and exudative picture with low Lactate Dehydrogenase (LDH) and Adenosine Deaminase (ADA) levels and was negative for malignancy. Duodenum Second part (D2) biopsy showed Primary Intestinal Lymphangiectasia (PIL). Hence, a final diagnosis of yellow nail syndrome was confirmed. Symptomatic management was done following which patient had relief of symptoms and in subsequent follow-ups patient was doing better. A detailed clinical history with investigations helps in attaining the diagnosis. Although there is no definitive treatment but diagnosis helps in avoiding unnecessary treatment and symptom based management helps in improving the quality of life of the patient.

Pulp Polyp Exhibiting a Unique Worm-shaped Presentation in an Ectopic Deciduous Tooth: A Novel Case Report

Pulp polyp is a reactive lesion that occurs as a result of chronic long standing caries. Dental caries is common in children for a variety of reasons, including increased bacterial colonisation, frequent exposure to dietary sugars, improper bottle feeding technique, low community water fluoride levels, inadequate tooth brushing, and a lack of parental knowledge about oral health. Failure to treat such carious lesions during childhood will result in chronic long-term caries leading to pulpal necrosis or reactionary proliferations of pulpal tissue, known as pulp polyp. Apart from caries, trauma can also lead to hyperplastic behaviour of the pulp. Pulp polyps are most commonly found in the molars due to their abundant blood supply, whereas their presence in the anterior teeth is considered uncommon. Pulp polyp can cause anxiety among parents when they spot it in their child’s oral cavity. This is due to the unique clinical appearance, discomfort while having food and occasional bleeding, when irritated. This case report presents an unusual presentation of pulp polyp in an 11-year-old female patient with chief complaints of pain, discomfort, and bleeding on irritation. Its peculiar worm-shaped clinical appearance in the anterior attached gingival region imposed a diagnostic dilemma which on histological examination was confirmed to be pulp polyp and was subsequently excised. Therefore, this emphasises the fact that pulp polyps are not only limited to the occlusal surface of posterior teeth with a typical mushroom-shaped appearance, but also have a wide range of presentations regardless of their location and appearance.

Fatal Recurrent Angioedema with Systemic Lupus Erythematosus in a Young Female: A Disturbing Decline

Dhruv Talwar, Sunil Kumar, Sourya Acharya, Akhilesh Annadatha, Twinkle Pawar

Recurrent angioedema is a particularly puzzling problem for clinicians worldwide. The cause is often idiopathic with chronic angioedema recurring over weeks to months. Intake of certain drugs and contact with other offending agents can also induce chronic angioedema. In systemic lupus erythematosus patients, recurrent angioedema may be due to an acquired deficiency of C1 inhibitor (C1-INH) caused most probably due to formation of antibody against C1-INH molecule. A 26-year-old female, who had systemic lupus erythematosus, presented to the Emergency Department with the chief complaint of puffiness of face, swelling of lips and bilateral lower limbs since one day, which occurred following application of aloe vera cream thrice within a duration of 24 hours. Upon investigations, absolute eosinophil count was raised while C4 and C1q levels were reduced. A diagnosis of acquired angioedema was made. Patient was managed with corticosteroids, cyclophosphamide, antibiotics, antihistaminics, oxygen support and other supportive measures. However, the patient’s condition declined further and she succumbed on day 5 of admission. Therefore, this report highlights the importance of chronic angioedema in a patient with systemic lupus erythematosus and the potential lethal outcome that it can result into.

An Unusual Site of Aneurysmal Bone Cyst in the Ethmoid Sinus- A Case Report

Dhaarna Sharma, Aditi Vohra, Harneet Narula, Anshul Arora

Aneurysmal bone cyst is a rare non neoplastic tumour of bones. It is a cystic vascular lesion causing local destruction and invasion of adjacent structures with rapid invasion. Therefore, it requires early intervention. It typically involves long bones of limbs, ribs of thoracic cage, pelvic bones, and vertebrae in axial skeleton. Rarely it occurs in the head and neck region where mandible is found to be the most common site. It has been reported to arise from paranasal sinuses. However, ethmoid sinus is a very rare site. The rarity of aneurysmal bone cyst in such a location, involvement of adjacent structures, and recurrences makes it more interesting for radiologists. Here, the authors present an unusual site of aneurysmal bone cyst in a 22-year-old female involving the right ethmoid sinus with its typical Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) features.

Giant Cervical Polyp in Primigravida: A Rare Case Report

Caroline Laishram, GS Triveni, Kiran Aggarwal, Aprajita Gupta

Cervical polyp is the most common benign lesion arising from the cervix. It is usually found incidentally unless it is symptomatic or gargantuan in size protruding from the introitus. The giant cervical polyp with size greater than 4 cm are rare in gravid women. Most of the obstetricians would prefer a conservative management for polyps in pregnancy. The present unusual case is of a 30-year-old primigravida, 19 weeks gestation with giant, symptomatic, significantly growing endocervical bifid appearing polyp. The case was managed with transvaginal polypectomy without any need of cervical cerclage. The giant polyp specimen measuring 7×3 cm though appeared clinically malignant, histopathology confirmed its benign aetiology. It is prudent to excise cervical polyp, when symptomatic and suspicious of malignancy. The gravid women undergoing cervical polypectomy may carry risk of premature delivery and hence pregnancy has to be carefully supervised.

Malignant Melanoma Presenting as Multiple Lytic Bone Lesions Masquerading as Carcinoma of Unknown Primary on Clinical and Histopathological Examination

Renu Sukumaran, Lakshmi Haridas, Venugopal Muraleedharan

Malignant melanoma presenting as multiple lytic bone lesions masquerading as carcinoma of unknown primary on clinical and histopathological examination. Malignant melanomas are aggressive tumours with frequent metastasis to lymph nodes and viscera. However, patients presenting with osseous metastasis of melanoma with no known primary source is relatively rare. The terminology “metastases of unknown origin” is used when the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and imaging studies. Metastatic melanoma can have varied presentations. Herein, this is a case report of a 63-year-old female who presented with swelling in the occipital region of eight-month duration. Examination showed bony hard fixed swellings in the occipital and mastoid regions. Computerised Tomography scan (CT scan) showed lytic bone destruction in the occipital and mastoid part of right temporal bone, associated with soft tissue mass. With the differential diagnosis of metastatic carcinoma and myeloma, biopsy was taken which showed infiltrating neoplasm with plasmacytoid cells in cords and in vague nests surrounded by fibrosis. The neoplastic cells were Cytokeratin negative, Cluster of Differentiation (CD) 138 negative and showed patchy nuclear positivity for S100. On subsequent examination, the neoplastic cells showed diffuse strong positivity for HMB 45 (Human Melanoma Black) and patchy moderate positivity for Melan A confirming the diagnosis of malignant melanoma. Primary lesion could not be detected even after a detailed past medical and surgical history, physical examination and radiological investigations. The main causes of skull lytic lesions in adults are metastatic carcinoma and plasma cell myeloma. Possibility of metastatic melanoma should also be considered in cases of skull bone lesions as melanomas could exhibit varying cellular morphology mimicking carcinoma, sarcoma or haematolymphoid neoplasms.

Acute Myleoid Leukaemia t(8;21)- A Close Differential Diagnosis to Myelodysplastic Syndrome with Excess Blasts-2: A Case Report

Bhusari Harveen, Masamati Smita

Acute Myeloid Leukaemia (AML) with t(8;21) (q22;22) is a distinct, rare type of AML, generally occurs in young patients which has a favorable prognosis. It is found in approximately 5% cases of all AML. This translocation (8;21) usually correlates with specific morphological features which include large blasts with auer rods and large Pseudo-Chediak-Higashi granules in neutrophils. These features are also seen in myelodysplasia related changes, hence should be differentiated as the latter have worse prognosis. Detection of chromosomal abnormalities by cytogenetics is very important for risk stratification and prognosis. Hence, authors reports a very unusual case of AML t(8;21) in a 32-year-old female patient presented with features of Myelodysplastic Syndrome (MDS) with Excess Blasts-2.

Post Dengue Reactive Thrombocytosis- A Case Report

Richa, Shikha Sadadiwala, Antan George, Pankaj Abrol, Shashi Sharma

Dengue fever is common in tropical countries like India. Typically, dengue fever and dengue haemorrhagic fever is characterized by high grade fever with arthralgia, myalgia and headache. Leukopaenia, thrombocytopaenia, and fluid leak is the hallmark of dengue which normalises with recovery. However, it is very uncommon in these patients to progress to severe thrombocytosis. Authors hereby report an unusual case of dengue followed by severe reactive thrombocytosis. A 13-year-old male child was admitted with complaints of fever and headache for the past two days and vomiting for one day. There was right hypochondrium tenderness. Investigations revealed leucopaenia (total leucocyte count was 3500/μL), platelets count was 150×10³/μL, haematocrit was 34.5%, and dengue virus antigen detection (NS1) was positive. Coronavirus Disease 2019 (COVID-19) Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was negative. The patient was managed conservatively with intravenous fluid ringer lactate, acetaminophen, antiemetics and antacids. After 72 hours of discharge, patient came back with thrombocytosis. He was medicated on aspirin and the platelet count was monitored on a daily basis. The platelet count kept on increasing, and on 4^th day it reached 1350×10³/μL, but declined to normal (450×10³/μL) over the next 10 days. Hence, aspirin was stopped. The patient was later discharged, and on follow-up the blood counts were normal.

Rehabilitation of Mandibular Partial Edentulous Arch using Ceka Revax Semi-precision Attachment: A Case Report

Chithra Melavanki, Zarir Ruttonji, Preethi Kusugal, Kurugodu Kishor Kumar

There are many prosthetic treatments modalities in rehabilitating partially edentulous condition. It is a technically difficult task for any prosthodontist to treat partially edentulous condition because retention and stability are the two main problems. Attachments are available with small interlocking devices which connects prosthesis and abutments which improves retention and stability and esthetics. Ceka attachment can be used to obtain retention and stability for the prosthesis. A 48-year-old-female patient reported to the Department of Prosthodontics, Crown and Bridge with chief complaint of missing teeth with respect to teeth number- 12,13,14, 22,25,26,35,36,37,45,46,47. This case describes rehabilitating maxillary missing teeth and posterior edentulous mandibular arch using semi precision attachment (Ceka Revax Extracoronal Green). Precision attachments have two metal components which form an articulate joint with first component or matrix or keyway which is attached to clinical contours of a cast restoration and the second component of patrix is attached to the removable partial denture. This case required multidisciplinary approach, technical skills and treatment offered showed excellent patient acceptance and also met aesthetic demands too.

Familial Fibrous Dysplasia in Two Subsequent Generations in a Family

Indra Gopi, Arvind Muthukrishnan, Jayapriya Ramadurai

Cherubism also known as familial fibrous dysplasia is a rare, non neoplastic, self-limiting fibro-osseous disorder commonly affecting the jaws in children and young adults. It is also described as familial multilocular cystic disease and familial benign giant cell tumor of the jaw. It is characterised by bilateral, painless swelling involving the mandible giving a cherubic (angel like) appearance. As it is a rare disorder, it is challenging to determine the disease frequency. A familial disorder like cherubism is more likely to be of autosomal dominant trait and shows 100% male sex predilection compared to female which is 50-70%. Although cherubism becomes noticeable in childhood (2-7 years of age), the treatment is however contentious as the disorder is believed to regress gradually after the onset of puberty and surgical intervention is to be decided based on aesthetics or functional difficulties. Numerous researches have been conducted to prove that cherubism is a genetically mediated disorder and the chromosome mapped is 4q16.3. This paper describes a case of an 11-year-old girl with cherubism and also encountered in two subsequent generations of a family, the father and his three children. The genetic and pedigree analysis carried out in this family proves hereditary basis in better understanding the genetic association related with the disorder. All the patients were educated about the disorder and were advised for surgical management after the onset of puberty.

Silent Otitis Media Presenting as Subperiosteal Abscess- A Case Report

S Rajasekaran, K Gowthame, R Guna Keerthana, Angela Grace Abraham, SR Karthika

Otitis media is an inflammation of mucoperiosteal layer of the middle ear cleft which occurs mostly due to eustachian tube dysfunction superadded with an infective aetiology. It is said that younger children are more commonly affected due to the anatomical difference of eustachian tube in children from an adult, but adults are affected as well. Usually acute otitis media may settle following a course of antibiotics, however, it can lead to persistence of infection or becoming chronic and may lead to severe intra and extracranial complications. This report is of a 16-year-old male who presented with a painful swelling in right postauricular region for two weeks duration. The right ear had a diffuse swelling of size 6×1×5 cm in the postauricular region, tender on palpation, firm in consistency, and was fluctuant. Otoscopic examination of the right ear showed bulge out and intact tympanic membrane without active discharge and congestion. High Resolution Computed Tomography (HRCT) of temporal bone showed right otomastoiditis with erosion of the lateral cortex of the right mastoid. He underwent right cortical mastoidectomy under general anaesthesia. The patient was on follow-up for six months and no recurrence was noted.

Ulcerative Colitis and Guillain-Barré Syndrome: Co-existence or Complication

Rashmi Mishra, Sandeep Garg, Monika Gajendrakumar, Rajesh Jakhar, Praveen Bharti

Ulcerative Colitis (UC) is a chronic recurring inflammatory illness of the gut, whereas Guillain-Barré Syndrome (GBS) is a sudden onset of muscular weakness produced by the immune system attacking the peripheral nerve system. Both UC and GBS can be caused by immune system dysfunction and can co-exist. There are just a few case reports in the literature of GBS occurring in UC patients. However, present case report is an unusual instance of UC that developed during GBS on Intravenous Immunoglobulin (IVIG) treatment.

Case Report of a Rare Intracranial Tumour

PP Sathi, Janaky Ramakrishnan, Bimal Govind

A meningeal Solitary Fibrous Tumour (SFT), also called hemangiopericytoma is a fibroblastic type of mesenchymal tumour. These tumours often show a rich, well-branched vascular pattern that encompasses a histological spectrum of tumours which was previously classified separately as meningeal SFT and haemangiopericytoma. Discovery of I#INAB2-STAT6 I?Ifusion in a vast majority of haemangiopericytomas and solitary fibrous tumours indicates a possibility of morphological continuum. Herein, authors report a case 65-year-old female known case of hypertension and type II diabetes mellitus, presented with complaint of headache since 2 months and left side weakness since 3 weeks. On clinical examination, she was found to have motor weakness of left upper limb and lower limb with no sensory deficit. Magnetic resonance imaging showed an extra axial, right frontoparietal convexity, solidly enhancing tumour with transosseous invasion and the imaging features were suggestive of atypical meningioma. After craniotomy, immunohistochemical evaluation showed tumour cells were strongly positive for CD34 and STAT-6 exhibited the characteristic nuclear localization.The case was reported as Solitary fibrous tumour/Haemangiopericytoma-Grade II. The patient was advised adjuvant radiotherapy but deferred treatment. Regular follow-up after 2 years post surgery has shown that the patient is disease free.

Multiple Tortuous Arteries in Thoracic and Abdominal Walls: A Cadaveric Case Report

The thoracic aorta extends from lower border of 4^th thoracic vertebra upto the aortic hiatus of thoracic-abdominal diaphragm at the lower border of 12^th thoracic vertebra. Then after it continues as abdominal aorta upto lower border of 4^th lumbar vertebra where it terminates as common iliac arteries. Commonly the facial, superficial temporal, splenic artery have tortuous course which are routinely taught to the undergraduate students. During routine dissection we noticed variations in the thoracic and abdominal aorta in a female cadaver. The thoracic and the abdominal aorta were found to have a tortuous course instead of a straight course. The bilateral renal arteries were also tortuous. Further the bilateral common iliac and internal and external iliac arteries were also tortuous in their course. Such a case of multiple arteries being tortuous indicates a possibility of arterial tortuosity syndrome which is autosomal recessively inherited. Familial screening is also needed in such cases. Marked tortuosity of the arteries may be an incidental finding and if so, should raise a suspicion for the underlying clinical condition and search for its cause. These many curves in the course of aorta is hazardous for any patient during vascular procedures. Probabilities of blockage or rupture of the arteries increase with the number of twists in the arteries.

Anaesthetic Management of a Patient with Advanced Abdominal Pregnancy, Intrauterine Foetal Death and Celiac Disease

Rashmi, Anish Kumar Singh, Amit Dahiya, Mamta Jain, Nidhi Bangarwa

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. If diagnosed late maternal and foetal mortality is very high. The major cause of death in abdominal pregnancy is haemorrhage. The case report is about a 31-year-old gravida two with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring due to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, with celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed with crystalloids, colloids, blood products and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit.

Pulmonary Cavity: An Additional Entity to the Spectrum of COVID-19 Complications

Keertivardhan D Kulkarni, V Pranavi, Apoorva Ravi, HT Lathadevi, SM Biradar

The latest pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is known to manifest in various forms, ranging from a mild illness to a life-threatening condition. Though lung cavitation has not been commonly reported as a post Coronavirus Disease 2019 (COVID-19) infection complication, there has been a rise in the number of patients presenting with lung cavitation post the viral infection. In this case series, authors have reported four cases of lung cavitation developed post COVID-19 infection. Three out of four patients were newly diagnosed cases of diabetes, all received steroids as a part of treatment for COVID-19 infection. Three patients showed a temporary improvement in their condition after COVID-19 treatment, in the form of decreasing trends of inflammatory markers and decreased total count, but subsequently developed signs of super added infection during the course of their illness. Two patients had associated sino-orbital mucormycosis. Two patients required the support of non invasive ventilation and did not show clinical improvement, while one amongst the two succumbed to the infection. The cause for the development of lung cavities post COVID-19 infection is difficult to speculate it appears to be multifactorial with factors including isolated bacterial, fungal infections or bacterial and fungal co-infection, SARS-CoV-2 specific inflammatory pathways, and the immunosuppressive effects of glucocorticoids.

Atypical Breast Carcinoma- A Series of Six Cases

Smritiparna Das, Chhanda Das, Rama Saha

Breast cancer comprises 10.4% of all cancer among women world and it the second most common type of cancer. Increased public awareness and screening have led to earlier diagnosis at different stages. Surgical resection can be done earlier and complete cure of the disease can be achieved. As a result survival rates for breast cancer in young women have improved significantly. Six unusual type of breast carcinoma, presented to the Surgery Outpatient Department were referred to Pathology Department for further investigations. Patient age and sex, clinical characteristics of the tumour, the duration of the lesion, the size, radiological investigation, Fine Needle Aspiration Cytology (FNAC), trucut biopsy and histopathological examination were noted. Immunohistochemical examination also done in all the cases. Out of the six cases of breast carcinoma, one was the mucinous carcinoma of breast, two invasive papillary breast carcinoma, one apocrine carcinoma, one invasive Pleomorphic Lobular Carcinoma (PLC) of breast and one was fibromatosis like metaplastic carcinoma of breast. All the patients were female except, a 71-year-old male who presented with invasive papillary carcinoma. All the female patients were presented at postmenopausal age group. After careful examination of the cytology and histopathological slides the final diagnosis was made which helped the clinician for further treatment. Rare breast cancers do not differ from other types of breast cancer in their presentation. But they vary by treatment regimens and outcomes. So, proper diagnosis with imaging, FNAC, trucut biopsy and histopathological examination is a combined tool for proper diagnosis and treatment.

Difficult Airway Management- A Challenge to Anaesthesiologists

LK Shivanand, SD Pratibha, Sai Prasad, Divya Shankar, Vidya Patil

Anticipated and unanticipated difficult airway remains an everlasting challenge for anesthesiologist. Most airway problems can be solved with enough resources available but clinical judgment borne of experience, and expertise is crucial in implementing the skills in any difficult airway scenario. Detailed patient history, best utilisation patient protocols, with good clinical assessment may reduce the difficult airway complications. The present series reports six patients with anticipated difficult airway-burn contracture, fractured mandible with restricted mouth, meningo myelocoele (in a neonate, and there was difficulty in positioning for intubation), anterior mediastinal mass (with difficulty in maintenance of anesthesia), cervical spine injury and one patient with left mandible fracture with history of road traffic accident. Different methods were successfully adopted for managing all of these difficult airway cases. Hence planning, preparation, and execution is very important in successful management of difficult airway.

An Insight into Maternal Deaths: A Retrospective Analysis and Pathologists Perspective in Series of 16 Autopsy Cases

Introduction: Maternal mortality continues to be of great concern with most maternal deaths occurring in developing countries which accounts for about one in 180 deaths during childbirth as compared to 1 in 4,900 in developed nations. Aim: To determine the common causes of maternal deaths and to study their clinicopathological profile. Materials and Methods: The present study included series of 16 cases of maternal deaths from January 2018 to June 2020. The study was conducted at Indira Gandhi Medical College, Nagpur, Maharashtra, India. The post mortem examination in all these deaths was conducted as per institutional policy. The external, in-situ examination along with histological findings are studied in each case. Results: The study group comprised of 16 cases, in the range of 21 to 37 years with a mean age of 27 years. Seven deaths antepartum, 2 intrapartum while seven postpartum period and all the deliveries took place in hospital. Amongst these 16 deaths, 11 were brought dead while in rest five, deaths were hospital based. Conclusion: The autopsy provides an invaluable information and insights about pathophysiological changes and sequence of events leading to death. Usefulness of relevant clinical data in complementing the diagnosis cannot be overemphasized. Their in-depth analysis can certainly help to prevent future maternal deaths and also in early picking up of complications; which further can avoid this preventable and inevitable loss and reduces the national burden on maternal mortality

A Rare Case of Ectrodactyly Ectodermal Dysplasia and Cleft Lip Syndrome

Havoc caused by the SARS-CoV-2 Omicron (B.1.1.529)

Prithiviraj Nagarajan, Kumar Rangarajalu

Barriers of Newborn Vaccination Coverage among Institutional Deliveries: A Mixed-method Study from Sonepat, Haryana

Ramesh Kumar Verma, Annu Kadyan

Introduction: World Health Organisation (WHO) recommends the administration of three vaccines soon after birth, namely Hepatitis B Virus (HBV) vaccine, Bacillus Calmette-Guerin (BCG), and Oral Polio Vaccine (OPV). Various studies reported that early administration of these vaccines have a marked beneficial impact on infant survival. As birth is the most reliable point of healthcare contact worldwide and effective vaccination at birth would provide early protection for newborns. Hence, expanding and improving the available means of neonatal vaccination is an unmet medical need and a public health priority. Aim: To determine left-out vaccination rate for birth doses and the barriers of newborn vaccination coverage among institutional deliveries, in Sonepat District, Haryana. Materials and Methods: A mixed-method study (qualitative and quantitative) was conducted in rural tertiary healthcare institute and two secondary (district hospital Sonepat and sub-divisional hospital Gohana) public healthcare facilities of district Sonepat during 1^st June 2019 to 31^st July 2019. Records of live births that occurred during the study duration at selected facilities were taken to find out the left-out vaccination rate for birth doses. Focus Group Discussions (FGDs) of staff nurses posted at immunisation clinic, labour room, obstetrics and gynecology and paediatrics department were carried out to find the barriers of newborn vaccination. Results: Total 1943 live births occurred at selected public healthcare facilities during the study duration. Vaccination coverage of birth doses recorded among 1381 (71.1%) neonates and 562 (28.9%) were left-out. Barriers for newborn vaccination were non availability, vaccine at birth places, training and skill to administer vaccine by staff, human resource constraints, and socio-demographic factors. Conclusion: This study provided a roadmap to develop a vision for strengthening newborn vaccination coverage among institutional deliveries.

Utility of Serum Markers in Obstructive Sleep Apnoea Syndrome: A Case-control Study

Introduction: Obstructive Sleep Apnoea Syndrome (OSAS) consists of cessation of breathing for at least 10 seconds during sleep in spite of inspiratory efforts. The OSAS is an independent risk factor for a number of cardiovascular diseases and cerebrovascular events. The OSAS is diagnosed and assessed by polysomnography which is time consuming and expensive. C-Reactive Protein (CRP) and Creatine Phosphokinase (CPK) are markers of systemic inflammation. Inflammatory component is present in OSA. Biomarkers like CRP and CPK may serve as diagnostic tools which are simpler, cheaper and quicker alternatives. Aim: To study the role of serum markers CRP and CPK in the diagnosis of sleep disordered breathing. Materials and Methods: This was a case-control study, conducted from May 2021 to October 2021, in the Department of Pulmonary Medicine, NRI Medical College, Guntur, Andhra Pradesh, India. Total 50 patients were studied for their various symptoms suggestive of OSAS and confirmed by polysomnography were selected for the study. Total 40 age and weight matched controls were included in the study. The association of serum CRP and CPK with OSA was assessed. The Z-test of difference between two proportions was used to compare gender and smoking status of study participants of the two groups. The p-value <0.05 was reported as statistically significant. Results: The mean CRP in those suffering from obstructive sleep apnoea was 12.075±7 mg/dL with 13.89 in moderate to severe OSAS group and 10.26 in mild cases. The CRP showed statistically significant association (p-value=0.00344) with OSA whereas CPK levels in OSA subjects showed no statistically significant association with OSAS. Sensitivity of CRP and CPK compared to the Apnoea Hypopnea Index (AHI) in the diagnosis of OSAS was 66% and 34%, respectively. Specificity of CRP and CPK was 87.5% for both. Positive predictive value for CRP and CPK was 86.8% and 77.2%, respectively. Conclusion: C-reactive protein, a systemic inflammatory marker has a potential role in the diagnosis of OSAS.

Serum Kynurenine Levels in Patients of Depression with and without Suicidality: A Case-control Study

Virendra Singh Pal, Koustubh R Bagul, Varchasvi Mudgal, Priyash Jain

Introduction: Depression is a common mental health disorder and suicide is one of the most dreaded outcomes of depression. In India, the suicide rate is reported to be 12.91 of 100,000 population and as per the estimates, it is further going to increase in time to come. Several potential biomarkers for suicidality have been identified over the last years in an effort to devise an investigational test to detect suicidality. Kynurenine, a tryptophan metabolite, is one of the potential biomarkers as it has been found to be elevated in patients with suicidality. Aim: To assess the levels of kynurenine in patients of severe depression with and without suicidal attempt. Materials and Methods: This was a case-control study conducted in MGM Medical college, Indore from April 2020 to March 2021. Socio-demographic parameters like age, gender, residence, marital status were collected along with hamilton depression rating score, suicidal behaviour questionnaire score. Blood samples of sixty patients with depression having suicide attempt (case group) were compared to the similar parameters of the 60 patients with depression not having any history of the suicide attempt (control group). Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 and relevant statistical tests were applied with the p-value <0.05 was considered as statistically significant. Results: Mean age of the case group was 39.03±11.58 years and in control group was 41.92±11.62 years. The mean serum kynurenine for depression with suicidal attempt was 464.05±89.11 ng/mL which is considered a high value as per the criteria for cut-off for normal level.While for depression without suicidal attempt was 420.78±69.66 ng/mL which is low. The present study had a positive correlation of serum kynurenine levels with the suicidal behaviour questionnaire (r-value=0.48, p-value=0.001) but not with the hamilton depression rating scale (r-value=-0.243, p-value=0.061). Conclusion: Case group has shown higher mean serum kynurenine than control group, which was statistically significant. This study concluded that, serum kynurenine was not correlated with the severity of depression which makes it a good prospective for further research as a biomarker for early prediction of suicidality.

Sleep Quality and Daytime Sleepiness among Medical Undergraduate Students in Tamil Nadu: A Cross-sectional Study

R Anuradha, S Hemachandran, Aruna B Patil

Introduction: Sleep quality is strongly related to psychological and physical well-being. Medical students experience long duration of study period, academic over load, frequent exams, fear of failure and highly demanding lifestyle. They are vulnerable to poor sleep quality. Aim: To find the prevalence of sleep quality and daytime sleepiness and their associated factors among medical undergraduate students in Tamil Nadu, India. Materials and Methods: This was a cross-sectional study conducted among 367 undergraduate medical students from first year to final year of a Government Medical College, Chennai, Tamil Nadu, India. A self-administered questionnaire was used to collect data on socio-demographic characteristics, lifestyle behavioural factors, mobile phone usage and academic performance. Pittsburgh Sleep Quality Index (PSQI) and Epworth Daytime Sleepiness Scale (EDSS) were used to assess sleep quality and excessive daytime sleepiness, respectively. Descriptive statistics was used to express baseline characteristics. Chi-square test was applied to test associated factor. Pearson correlation coefficient was used to find correlation between continuous variables. Results: Poor quality of sleep and excessive daytime sleepiness was found among 54.2% and 28.6% of students, respectively. Poor sleep quality and excessive daytime sleepiness was significantly associated with increased duration of mobile phone usage (p=0.030 and p=0.009 respectively). Significant association was found between sleep quality and academic performance (p=0.004). Statistically significant correlation was found between sleep quality and duration of mobile phone usage (r=0.18, p=0.0001) as well as sleep quality and excessive daytime sleepiness (r=0.14, p=0.005). Conclusion: Prevalence of poor quality sleep and excessive daytime sleepiness was found to be high among medical students. Mobile phone overuse was significantly associated with poor sleep quality and excessive daytime sleepiness. Students with good quality of sleep had better academic performance when compared to poor sleepers. Excessive daytime sleepiness was found in increasing pattern among those with poor quality sleep.

Extra Nodal Non Hodgkin’s Lymphomas using Immunohistochemistry from a Tertiary Care Centre, Andhra Pradesh, India- A Retrospective Study

N Rukmangadha, Sivakumar Vulava, C Suresh Praveen

Introduction: Primary Extra nodal Lymphomas (pENL) are a group of lymphomas arising from tissues other than lymph nodes and even sites which normally contain no lymphoid tissue. Over the past 25 years pENLs have shown a rapid increase in incidence. The pENLs can originate from almost any anatomical site such as the gastrointestinal tract (most common), head and neck (waldeyer’s ring, nose/paranasal sinuses/nasopharynx, salivary glands, etc.,), skin, Central Nervous System (CNS) etc. The definition of Extra nodal Lymphoma (ENL), particularly in the presence of both nodal and extra nodal disease remains a controversial issue. To categorise these entities, different criteria were proposed by different authors. Aim: To study the occurrence of extra nodal non hodgkin’s lymphomas in different sites/organs using Immunohistochemistry (IHC). Materials and Methods: This was a retrospective study carried out in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India, over a period of seven years six months starting from January 2010 to July 2017. Data was retrieved from the medical records and paraffin blocks were retrieved from the stores. All cases of extra nodal primary lymphomas were included in the study. All cases were classified based upon morphologic and immunophenotypic criteria according to World Health Organisation (WHO) 2008 classification. The distribution of primary extra nodal lymphomas among different age groups with mean age of occurrence was noted. Distribution of pENLs among male and female population with male to female ratio was calculated. The percentage of different sub-types of ENL and the Immunohistochemistry (IHC) markers in each subtype of ENL were calculated. Results: In this retrospective study, a total of 317 newly diagnosed lymphoma cases were included. Among them, 79 cases were pENL. A total of 77 (24.29%) cases of primary extra nodal non hodgkin’s lymphomas were included in the study. The age of the patients ranged from 4-81 years with mean age of 48.42 years, with male predominance (M:F-1.85:1). Gastrointestinal Tract (GIT) (35/77-45.45%) was the most common site, followed by head and neck (16/77-20.77%), mediastinum (4/77-5.19%), kidney (4/77-5.19%) were the common sites of occurrence of primary extra nodal NHLs. In the GIT, stomach was the most commonly involved site (24/35) followed by the small intestine (5/35), colon and anal canal (3/35) and caecum region (3/35). The Diffuse Large B-cell Lymphoma (DLBCL) was the most common histological type observed in 51/77 (66.23%), followed by Peripheral T-cell Lymphoma- Not Otherwise Specified (PTL-NOS) were observed in 14/77 (18.18%) cases, and extra nodal marginal zone lymphoma of Mucosa-associated Lymphoid Tissue (MALT) type seen in 9/77 (11.68%) cases. Conclusion: pENLs are a diverse group of haemato-lymphoid malignancies, the incidence of which is low in India compared to rest of the world, the prognosis of which depends on the extra nodal site. The diagnosis is challenging due to the morphological mimics and varied clinical presentation and that is the reason, all should keep in mind the possibility of pENLs.

Prevalence and Phenotypic Profile of Antimicrobial Resistance Pattern of Multidrug Resistant Uropathogens in a Rural Tertiary Care Hospital, Gujarat, India

Introduction: Multidrug Resistant (MDR) organisms have become a major problem for the treatment of various infections and are imposing the greatest challenge to public health worldwide. Uncomplicated Urinary Tract Infections (UTIs) are treated empirically sometimes with broad spectrum antibiotics without performing drug susceptibility tests that adds to drug resistance in bacteria. Aim: To identify the current prevalence and evaluate phenotypic profile of antimicrobial resistance pattern of MDR uropathogens. Materials and Methods: This was a cross-sectional descriptive study conducted from January 2019 to July 2021 at Parul Sevashram Hospital Vadodara, Gujarat, India. Total 960 uropathogens were analysed for prevalence, their phenotypic antimicrobial resistance mechanism and antibiotic sensitivity pattern. Isolated organisms, their phenotypic resistance pattern and antibiotic sensitivity data was entered in Microsoft excel and data were analysed using Statistical Package for the Social Sciences (SPSS) 25.0 version. Results: During the study period, total 960 urinary isolates were analysed of which 891 (92.8%) were gram negative bacilli, 69 (7.2%) were gram positive cocci. Probable antimicrobial resistance pattern in gram negative isolates causing UTI were 317 (35.6%) of Extended Spectrum Beta Lactamase (ESBL) producer, While carbapenemase (+ or - ESBL) were 328 (36.8%) and impermeability carba (+ESBL or +High-Level Ampicillinase C (HL AmpC)) were 311 (34.9%). Amikacin was highly sensitive antibiotic in 378 (75.3%) of Escherichia coli (E. coli) and 111 (52.9%) of Klebsiella pneumoniae (K. pneumoniae) isolates causing UTI. Conclusion: The study concluded that carbapenem resistance was more in K. pneumoniae isolates causing UTI than E. coli. Aminoglycosides like amikacin was highly effective for the treatment of UTI caused by E.coli and K. pneumoniae.

Influence of Age on Arterial Stiffness among Healthy Pregnant Women: A Cross-sectional Study

Nitesh Kumar Gupta, Laxmi Sangolli, Sumangala M Patil, Jyoti P Khodnapur

Introduction: Normal pregnancy is associated with physiological cardiovascular system adaptations. Previous studies stated that physiological changes like arterial vasodilatation occurs for successful results for both mother and baby during pregnancy. Also, increased arterial stiffness during pregnancy causes several disorders, such as Pregnancy-Induced Hypertension (PIH) and foetal growth restriction. Aim: To evaluate the influence of age on arterial stiffness among third-trimester healthy pregnant women using Pulse Wave Velocity (PWV). Materials and Methods: This cross-sectional observational study was conducted at BLDE (University), Vijayapur, Karnataka, India, between April 2019 to July 2019. A total of 60 pregnant women were screened and 48 healthy pregnant women between 20-40 years with resting blood pressure <140/90 mmHg, non smokers and subjects not taking medications were included in the present study. The sample size was divided into four groups (Group 1: 20-24 years; Group 2: 25-29 years Group 3: 30-34 years; and Group 4: 35-40 years). Each group contained 12 participants and vascular stiffness parameters like brachial-ankle PWV (b-a PWV) and carotid-femoral PWV (c-f PWV) were evaluated. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software 16.0 version. Comparison between the mean values was done using Analysis of Variance (ANOVA) and Post-Hoc test (LSD) and correlation was assessed using Pearson’s correlation test. The p-value ≤0.05 was considered significant. Results: Mean and standard deviation of b-a PWV (Group 1: 934.82±97.66; Group 2: 970.27±101.92; Group 3: 1077±112.20; Group 4: 1563.2±143.47) c-f PWV (Group 1: 574.78±62.81; Group 2: 662.26±61.88; Group 3: 769.88±65.51; Group 4: 967.96±70.52) showed statistically significant (p<0.001) increase in both b-a PWV and c-f PWV with age among third trimester healthy pregnant women. Pearson’s Correlation test showed significant positive correlation between b-a PWV (r=0.516, p<0.001) and c-f PWV (r=0.532, p<0.001) with age among third trimester pregnant women. The values of present study observed increase in both b-a PWV and c-f PWV with age. Conclusion: Increased arterial stiffness with age among pregnant women, as assessed by PWV, predates the development of cardiovascular risk in women. This study may help obstetricians to reduce cardiovascular complications due to pregnancy in different age groups by suggesting regular physical activity, relaxation techniques and a healthy lifestyle to pregnant women in the early stage.

Early Prediction of Small for Gestational Age: The Predictive Role of Pregnancy Associated Plasma Protein-A

Introduction: Small for Gestational Age (SGA) is a compelling obstetric adversity with multiple consequences. Early diagnosis, although a challenge, can help blunt the adverse effects. One of the markers is Pregnancy Associated Plasma Protein-A (PAPP-A) which can be an early predictor of SGA. Aim: To find the association of low levels of pregnancy associated plasma protein-A with small for gestational age. Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at All India Institute of Medical Sciences, Raipur, Chhattisgarh, India, between June 2018 and September 2019. The demographic profile, PAPP-A Multiples of Median (MoM) levels, complications in pregnancy and birth outcome data of a total of 203 women were noted. For analysis of descriptive and categorical data, IBM Statistical Package for the Social Sciences (SPSS) statistical software version 23.0 was used. Shapiro-Wilk and Kolmogorov-Smirnov tests were performed to assess normality of distribution Qualitative data were analysed by Chi-square test and categorical data, by Mann-Whitney’s U test. Results: The mean maternal age of the study sample was 27.4±2.23 years. The prevalence of SGA was 18.2%, out of which PAPP-A MoM levels were ≤0.49 in 59.4%. The association between PAPP-A levels and SGA was statistically significant (p-value=0.03) with unadjusted odds ratio of 8.27 (95% CI, 3.78-18.08). Simple logistic regression showed an inverse relationship of PAPP-A with SGA. At the cut-off of ≤0.49 considered in the study, sensitivity was 86.7%, specificity was 54.1%, positive predictive value was 29.5% and negative predictive value was 94.8%. Positive likelihood ratio was 1.88 and negative likelihood ratio was 0.24 and the diagnostic accuracy was found to be 59.9%. Conclusion: An inverse relationship between levels of PAPP-A MoM (≤0.49) and SGA was found in the study. Low levels of PAPP-A MoM can be a useful early predictor of SGA.

Effect of Pelvic Floor and Abdominal Muscle Exercise on Women with Stress Urinary Incontinence: A Quasi-experimental Study

R Balambika, B Sathyaprabha

Introduction: International continence society and the international urogynaecology association defined the Urinary Incontinence (UI) as “the complaint of any involuntary urine loss”. Pelvic Floor Muscles (PFM) weakness leads to Stress Urinary Incontinence (SUI). There exists an association between physical exertions along with urinary loss in UI. For decreasing urine leak episodes in women, PFM exercises are recommended. The PFM serves as the inner unit and the transverse abdominal muscle, multifidus along with diaphragm act as core muscles. Therefore, for treating SUI, abdominal muscle strengthening might be efficient. Aim: To analyse the effect of combined PFM exercises and abdominal muscle exercises on SUI symptoms. Materials and Methods: A quasi-experimental study was executed with 15 subjects in the Experimental Group (EG) and 11 subjects in the Control Group (CG) via purposive sampling technique at Outpatient Department (OPD), Sri Ramachandra Hospital, Chennai, Tamil Nadu, India. The study was conducted from December 2018 to April 2019. The EG was treated with abdominal muscle exercises along with Pelvic Floor Exercises (PFE) for eight weeks while the CG was treated with PFE. Via phone calls, the training follow-up was conducted. PFM strength and the Questionnaire for Urinary Incontinence Diagnosis (QUID) were the outcome measures. The between group perineometer scores analysed with paired t-test. For examining the pre and post-test score of PFM strength scores the independent t-test was employed. For analysing the QUID score Wilcoxon signed-rank test, Mann-Whitney U test was applied. Results: The mean of PFM strength (mmHg) for the interventional group was 5.4 while in the CG the mean was 1.64 as exhibited by the within group analysis (p=0.001). An enhancement in every component of QUID in the interventional group was shown in the post-test QUID score between groups which depicted a statistically significant difference in all the components (cough p=0.001, bending p=0.002, walk p=0.001). Conclusion: Abdominals and PFM exercise lessens the SUI symptoms even though PF exercise is the regular treatment aimed at SUI. Better improvement in SUI symptoms and PFM strength is possible by the abdominal exercises along with eight week PF exercise program.

Short-term Effect of Mulligan SNAGs on Pain Intensity, Cervical Range of Motion and Craniovertebral Angle in Patients with Non Specific Neck Pain: A Quasi-experimental Study

Karthik Vijayan, Arulpragassame Sivaraman, Parkavi Kumaresan, Jayalakshmi Palani

Introduction: The extended use of smartphone, laptops and computers alters the posture of the neck which results in non specific neck pain. Though the physical therapy modalities give symptomatic relief, the forward head posture is left uncorrected. Mulligan Sustained Natural Apophyseal Glides (SNAGs) stimulate the mechanoreceptors and proprioceptors around the joints that might correct the faulty posture of neck. Aim: To evaluate the short-term effect of mulligan SNAGs on pain intensity, cervical range of motion and craniovertebral angle in patients with non specific neck pain. Materials and Methods: This quasi-experimental study was conducted in Department of Physical Medicine and Rehabilitation at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India, from August 2021 to October 2021. Total 20 patients diagnosed having non specific neck pain and Craniovertebral angle (CV) angle less than 45 degrees were included in the study. The participants were randomly allotted into two groups. Group A received interferential therapy and static neck exercises. Whereas, group B received Mulligan SNAGs in addition to interferential therapy and static neck exercises and serves as the experimental group. Mulligan SNAGs was given to each cervical movement as six repetitions×two sets/session×three sessions/week. The intervention was given for two weeks. Preintervention and postintervention evaluation of pain intensity, cervical range of motion and CV angle was made and statistically analysed using Paired t-test for within group analysis and independent t-test for between group analysis at 5% level of significance (p-value <0.05). Results: The mean age the participants in group A was (32.2±6.3 years) and group B was (32.7±6.03). Within group analysis was made and it was observed that group A and B showed significant reduction in Numerical Pain Rating Scale (NPRS) score (p-value=0.004, p-value=0.005), improvement in CV angle (p-value=0.001, p-value=0.001) and increased cervical range of flexion (p-value=0.001, p-value=0.001), cervical extension (p-value=0.004, p-value=0.001) and rotation movements (p-value <0.05), respectively. The between group analysis of pre-post mean differences in the NPRS score (3.30±0.67, 4.60±0.96), CV angle (0.46±0.24, 5.62±1.21), cervical movement of flexion (10±2.36, 19±4.59), extension (6.50±2.53, 21±8.23), right lateral rotation (8±2.58, 15±4.08) and left lateral rotation (8.5±2.49, 16±4.24) was made using Independent samples t-test. It was observed that, all the outcomes showed significant difference. The mean difference in the outcome measures were significantly greater in group B who received mulligan SNAGs than group A. Conclusion: Thus, the short-term application of Mulligan SNAGs along with conventional physiotherapy proves good in reducing pain, improving cervical range of motion and normalising the reduced CV angle in patients with non specific neck pain.

COVID-19 Related Mental Health Issues among Patients with Cancer: A Pilot Study

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic is associated with more psychological distress than its rampant spread, mortality, and morbidity. Cancer patients are at increased risk of mortality and morbidity than the general population. Due to this, there is a possibility that cancer patients may be suffering from a higher level of COVID-19 related anxiety, fear, and obsession. Aim: To explore COVID-19 related mental health issues (anxiety, fear, and obsession) and its correlates in patients with cancer. Materials and Methods: The present study was a cross-sectional pilot study which was conducted in a tertiary care teaching hospital located in Ratnagiri, Maharashtra, India. Patients receiving treatment for cancer (n=55) consequently at tertiary care teaching hospital of India were recruited. The Corona Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), Fear of COVID-19 Scale (FCV-19S), Patient Health Questionnaire-9 (PHQ-9), and Generalised Anxiety Disorder-7 Scale (GAD-7) were used to assess all eligible patients. Fisher’s-exact test, spearman’s rank correlation, and logistic regression were used to analyse the data. Results: Among the 55 patients (mean age was 49.64±13.08 years) with cancer, 11 (20%) had Coronavirus related anxiety and 2 (3.6%) had obsession related COVID-19, 22 (40%) had depression and 18 (32.7%) has GAD. CAS score positively correlated with FCV-19S score [ρ=0.50 (p<0.001)], PHQ-9 score [ρ=0.90 (p<0.001)] and GAD-7 score [ρ=0.74 (p<0.001)]. Conclusion: COVID-19 related mental health issues (fear, anxiety), depression, and GAD were prevalent among patients with cancer. Further, COVID-19 specific issues may not be addressed in routine screening and evaluation in current practice. Therefore, there is an urgent need to develop systematic strategies to screen and develop specific mental health interventions for patients with cancer.

Effectiveness of Abdominal Breathing Exercise on Biological Parameters among Hypertensive Patients at Selected Tertiary Care Hospital, Mangaluru, India

Akshatha Salian, GR Gireesh

Introduction: High blood pressure, also known as Hypertension (HTN) is a long-term medical condition in which the blood pressure in the arteries remains consistently high. HTN rates in India are expected to rise. Abdominal breathing exercise activates the parasympathetic nervous system which decreases the heart rate and dilates blood vessels, reducing overall blood pressure. Aim: To find out the effectiveness of abdominal breathing exercise on biological parameter among hypertensive patients. Materials and Methods: This quasi-experimental time series design study was conducted at Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, from February 2021 to March 2021. A total of 60 samples were selected, with 30 samples in each of the control and experimental groups. Abdominal breathing exercise was given for 5-10 minutes about 3-4 times a day for seven days after the pretest of biological parameter assessment. Data was collected for three alternative days. The tools used were demographic proforma and clinical assessment proforma. Unpaired t-test and chi-square test were used for statistical analysis. Results: About 53.3% of the participants in the control group were males as compared to 66.7% in experimental group. The mean value of pretest Systolic Blood Pressure (SBP) and the Diastolic Blood Pressure (DBP) had no significant difference (p>0.05). However, after the abdominal exercises, there was significant difference in the mean SBP (p=0.01), DBP (p=0.01), Pulse Rate (p=0.05), Respiratory Rate (RR) (p=0.01) in experimental group when compared to control group. Conclusion: The study concluded that abdominal breathing exercise reduced BP, HR and RR among hypertensive patients and it is an effective technique to reduce BP, PR and respiration.

Novel Synthetic Peptide-based Enzyme Linked Immunosorbent Assay for Antibody Detection in Viral Infections of the Central Nervous System

Introduction: Viral infections of Central Nervous System (CNS) are associated with severe neurological sequelae and can lead to significant morbidity if not adequately diagnosed and treated. An immunological assay detecting antibodies in the Cerebrospinal Fluid (CSF) of the patients is widely used for diagnosis of viral infections of the CNS. In the present study, diagnostic efficacy of in-house designed synthetic peptide based Enzyme Linked Immunosorbent Assay (ELISA) was evaluated for detection of antibodies against neurotropic viruses panel such as Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Varicella Zoster Virus (VZV), Japanese Encephalitis Virus (JEV), Dengue (DENV), West Nile Virus (WNV) and Chandipura Virus (CHPV) in CSF of suspected cases. Aim: To determine the diagnostic efficacy of in-house developed synthetic peptide-based ELISA in viral infections of the CNS. Materials and Methods: A retrospective study was conducted in Central India Institute of Medical Science, Nagpur, Maharashtra, India. The suspected case of CNS viral infections of the patients were enrolled in this study from January 2013 to December 2015. Total 150 suspected cases of viral CNS infections and 135 control cases were recruited. Total 32 synthetic peptides of highly immunogenic proteins of respective seven neurotropic viruses were designed and synthesised. The designed peptides were evaluated in CSF samples of both the viral CNS infections and control cases for detection of Imunoglobulin G (IgG) and IgM antibodies using in-house developed antibody detection method. The developed tests were further compared with commercially available antibody detection ELISA kit. The sensitivity and specificity of peptide-ELISA were determined by Receiver Operating Curve (ROC) analysis and p-value was calculated by comparison of means by t-test. Results: Out of total 150 cases of CNS viral infections, a total of 31 CSF samples including 15 for CMV and 16 of JEV were positive by in-house peptide ELISA. The synthetic peptides STGDVVDISP, KQKSLVEL, RTLEVFKE, RSSNVED of CMV and ITYECPK, RRSVSVQT, GESSLVN of JEV showed a significant difference in mean absorbance value for IgM and IgG antibodies in CSF of suspected cases of viral CNS infection. Conclusion: The results demonstrated that the synthetic peptide-based ELISA is rapid, cost-effective, simple and efficient immunodiagnostic assay for initial screening of viral CNS infection.

Morphometry of Adult Human Trachea and its Clinical Implications: A Cadaveric Study in Northern India

Stuti Mahajan, Anupama Mahajan, Monika Lalit, Poonam Verma

Introduction: There is a wide variation in different dimensions of trachea in same age group as well as in different age groups in both sexes. Besides anthropometry, the study of these morphometric variations is of profound clinical importance as it may help the pulmonologists to understand the aetiology of several pulmonary diseases like bronchitis, emphysema, pulmonary fibrosis and tuberculosis. Aim: To determine the variations in the dimensions of human trachea in the cadavers of age group 20-70 years in Northern India. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, during March 2019 to December 2021. A total of 40 tracheas were obtained from adult human cadavers which were included in present study by convenience sampling. The trachea was dissected with the larynx and principal bronchi and measurements were taken. Data collected was saved on Microsoft excel and was analysed by calculating percentages, mean and Standard Deviation (SD). Results: Mean length of trachea was 109.25 mm, mean subcarinal angle was 75.45°. Mean anteroposterior diameter, transverse diameter, mean height and distance between posterior ends of rings was 16.70 mm and 18.10 mm, 4.53 mm and 12.15 mm respectively and mean of inter-ring distance between 1^st-2^nd, 5^th-6^th, 10^th-11^th, 15^th-16^th Tracheal rings was 1.12 mm. Conclusion: The present study revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters, mean height, inter-tracheal ring distance and the subcarinal angle. Accurate anatomical knowledge of the variations is essential for understanding the pathophysiology and management of different airway disorders and in reconstructive surgery of tracheobronchial tree.

A Nine Years Histopathological Retrospective Study of Retroperitoneal Masses

Kanchana Umashankar Telagavi, Bharati Mohan Bhavikatti, Purushottam Reddy

Introduction: Retroperitoneum is potentially large space that allows both primary and metastatic tumours to grow silently before clinical signs and symptoms appear. However, retroperitoneal masses due to their unhinhibited growth and with no facial boundaries they are often attain large size before the development of symptoms and the establishment of a diagnosis. There are a vast number of neoplasms occurring in this region. Understanding the pathology and lesions is important, for early diagnosis and for treatment of these neoplasms. Aim: To study the overall prevalence of primary and secondary retroperitoneal neoplasms and the varied histomorphological spectrum of retroperitoneal masses. Also to categorise the lesions as benign and malignant tumors of retroperitoneum. Materials and Methods: This retrospective study was conducted in the Department of Pathology, Karnataka Institute of Medical Sciences Hubballi, Karnataka, India from 2011 to 2019. A total of 39,757 speimens were recieved to histopathology section during this period. Among them, 53 (0.13%) were retroperitoneal tumours. Haematoxylin and Eosin stained slides were thoroughly analysed and categorised into non neoplastic, benign and malignant tumours. Further, based on the finer microscopic features, the accurate subtype of the tumour type was made. The descriptive statistics like mean, range and percentage are used. Results: Total 53 cases of retroperitoneal tumours were studied of which 10 (18.9%) cases were primary retroperitoneal masses and 43 (81.1%) cases were secondary retroperitoneal masses. Mean age was 40.7 years with male to female ratio 1.5:1. Malignant lesions were more common accounting to 50.9% cases, followed by benign 22.64% cases, the rest were intermediate grade and inflammatory. Kidney lesions were most common secondary retroperitoneal masses, accounting for 41.5% cases, followed by pancreas 22.64% cases, adrenals 13.20% cases and Lymphnodes 3.7% cases. Primary retroperitoneal masses which accounted for 18.9% cases were, categorised histomorphologically as spindle cell tumours, adipocytic, small round cell tumours, cartilaginous origin and cystic lesions. Conclusion: Diagnosis of retroperitoneal tumours is challenging due to their varied histomorphology and histopathology forms the gold standard for diagnosis.

Exploring the Knowledge, Awareness and Practice Regarding Post COVID-19 Mucormycosis among Dental Professionals in Tamil Nadu, India: A Cross-sectional Survey

Introduction: The incidence of mucormycosis in post COVID-19 cases increased in the second wave. Patients who had COVID-19 infection with pre-existing co-morbidities underwent treatment and resultant immunosuppression made them vulnerable to secondary infections like mucormycosis. Aim: To analyse the knowledge, level of awareness and practice among the dental professionals towards the mucormycosis infection in patients of post COVID-19 disease. Materials and Methods: The cross-sectional survey was conducted from May 2021 to June 2021 among 428 dental professionals residing in Tamil Nadu, India. The 16 item questionnaire consisted of questions about knowledge, awareness and practice regarding post COVID-19 mucormycosis infection by dental professionals and were sent to the dental practitioners through online portals. The responses were tabulated and the results were analysed using Chi-square test. Results: The study participants included 264 (61.68%) females and 164 (38.32%) males dental professionals. The dental professionals who participated were in the age range of 21 years to 45 years with a mean of 29.87±6.52 years. The subjects were categorised under general dental practitioners 254 (59.34%), postgraduate students 96 (22.4%), specialty dental practitioners 78 (18.22%). Total 406 (94.86%) respondents agreed that oral examination is necessary for post COVID-19 patient. Out of 428, 306 (71.49%) of the participants responded that tooth pain associated with headache is a watchful sign in diabetic post COVID-19 patients. Conclusion: This study emphasises the role of dental professionals in diagnosis and management of mucormycosis infection in patients of post COVID-19 disease. Dental professionals demonstrated adequate knowledge about post COVID-19 mucormycosis. This may act as a source of information for the future pandemic crisis.

Assessment of Postoperative Analgesic Efficacy of Ilioinguinal-Iliohypogastric Block as Compared to Caudal Block in Children undergoing Inguinal Herniotomy: A Randomised Clinical Study

Urvi Desai, Ashwini Yadavrao Sontakke

Introduction: An inguinal herniotomy is most frequently performed surgery in children under general anaesthesia along with various regional anaesthesia techniques such as ilioinguinal-iliohypogastric block (hernia block) or caudal block. Aim: To compare postoperative analgesic efficacy of hernia block (anatomical landmark guided ilioinguinal-iliohypogastric block) versus caudal block using bupivacaine as a local anaesthetic in children undergoing inguinal herniotomy. Materials and Methods: This single-centre, randomised clinical study was conducted at Tertiary Medical College and Hospital (Lokmanya Tilak Municipal Medical College and General Hospital), Mumbai, Maharashtra, India, from December 2016 to December 2018. The study included 100 children from age 6 months to 6 years with American Society of Anaesthesiologists (ASA) grade I and II, posted for elective inguinal herniotomy (unilateral). All children were given either hernia block or caudal block, based on computerised randomisation method. Total 55 patients received hernia block (Group H) with 0.3 mL/kg of 0.25% concentration of bupivacaine and another 45 patients received caudal block (Group C) with 0.75 mL/kg of 0.25% bupivacaine. In the postoperative period, mean pain free period and total duration of rescue analgesia were recorded in both the groups. Chi-square test and Fisher’s-Exact test. The p-value <0.05 was indicated as statistically significant. Results: Demographic data was comparable in two groups. The mean drug volume (bupivacaine 0.25%) used in group C was 8.44±3.46 mL and in group H was 4.24±1.6 mL. The mean pain free period, with in the first 24 hours, in group C was 8.80±6.43 hours and in group H, it was 11.77±8 hours. Rescue analgesia and FLACC score (the Face, Legs, Activity, Cry, Consolability scale) at 0 min, 15 min, 30 min and every hour upto 4 hours was comparable in both the groups. Mean time of discharge of patients receiving either of blocks, FLACC score at the time of discharge were comparable in both the groups. Conclusion: Hernia block was more effective than caudal block based on duration of postoperative analgesia. There was higher margin of safety with lower volume of local anaesthetic used.

Anaesthetic Management in a Patient of Goldenhar Syndrome Posted for Drainage of Brain Abscess with External Ventricular Drain Insertion

Shilpa Shankar, Vivek Chakole, Manish Sonkusale, Shivani Dalal, Bhakthi Patil

Goldenhar syndrome or Oculo-auricular Vertebral Dysplasia (OAVD) is characterised by a wide range of congenital anomalies including ocular, auricular, facial, cranial, vertebral and cardiac abnormalities. Facial and oral abnormalities especially mandibular hypoplasia, micrognathia, high arch palate and limitation of neck movements resulting from vertebral anomalies, the difficult intubation, laryngoscopy and mask ventilation were expected. Hereby, presenting the case report of a 6-year-old male child, known to have goldenhar syndrome, who underwent drainage of left sided brain abscess with external ventricular drain insertion. In view of the anticipated difficult airway and cardiac anomalies, careful preoperative evaluation, preparation and well formulated contingency plans for airway maintenance, endotracheal intubation and intraoperative haemodynamic is required to combat the perioperative anaesthetic challenges in all cases of goldenhar syndrome.

Efficacy of Oxygen Delivered through High Flow Nasal Cannula versus Non Rebreathing Mask in Infants with Mild and Moderate Bronchiolitis: An Open-labelled Randomised Controlled Trial

Stalin Selvaraj, Saranya Muthu, Harshitha Chandramouli, Balamurugan Periyasamy

Introduction: Bronchiolitis accounts for substantial portion of infant and paediatric hospital admissions worldwide. High flow nasal cannula is a relatively new, safe, comfortable and well tolerated mode of oxygen delivery for infants and children presenting with respiratory distress in emergency units and general wards. Aim: To compare the efficacy of oxygen delivered through high flow nasal cannula with non rebreathing mask in infants with mild and moderate bronchiolitis. Materials and Methods: This open-labelled randomised controlled trial was conducted among 80 infants under 12 months of age admitted with mild and moderate bronchiolitis in the well-equipped Paediatric Wards of Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from January 2017 to August 2018. Eligible recruited infants were randomised into two groups. First group receiving oxygen through Non Rebreathing Mask (NRM group) and second group receiving oxygen through High Flow Nasal Cannula (HFNC group). All the participants were followed-up with clinical examinations and investigations and outcomes were noted. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software, Chi-square test and student's t-test used, p-value <0.05 was considered as statistically significant. Results: There was a significant reduction in duration of oxygen required in the HFNC group (mean duration in hours: 13.98±6.612) when compared to NRM group (mean duration in hours: 26.70±4.81). The mean length of hospital stay was lesser in HFNC group (3.65±1.460 days) when compared to NRM group (5.35±1.657 days). Comparison of heart rate between the two groups showed a statistically significant decrease in mean heart rate (144.0±7.2) as early as 2 hours (p-value 0.010) after initiation of HFNC when compared to NRM group (148.1±6.5).respiratory rate was significantly reduced when compared from 2 hours (p-value<0.001) of initiation of intervention, with HFNC group showing higher percentage of reduction in respiratory rate than NRM group. Mean SpO₂ levels were higher in HFNC group when compared to NRM group at various time intervals, though not significant statistically. Conclusion: High flow nasal cannula, under monitoring, could safely be used in paediatric wards in infants and children with mild and moderate bronchiolitis.

Effect of Bispectral Index versus End Tidal Anaesthetic Gas Concentration on Time to Tracheal Extubation for Isoflurane Based General Anaesthesia- A Prospective Observational Study

Shalini Jain, Ravina Pandya, Kishore Kumar Arora, Neetu Gupta

Introduction: Modalities like Bispectral Index Monitoring (BIS) and End Tidal Anaesthetic Gas (ETAG) concentration guided anaesthesia have been used to study the intraoperative awareness but their efficacy for achieving early tracheal extubation has not been established. Aim: To compare the effect of BIS monitoring and ETAG concentration guided anaesthesia on time to tracheal extubation and haemodynamics for isoflurane based general anaesthesia. Materials and Methods: This prospective observational cohort study was conducted in the Department of Anaesthesiology at Mahatma Gandhi Memorial Government Medical College and MY Hospital, Indore, Madhya Pradesh, India, from June 2020 to June 2021. Total 60 patients with American Society of Anesthesiologists (ASA) grade I and II who received isoflurane based general anaesthesia were included in study. Depending upon the modality being used by the anaesthesiologist to monitor and maintain the depth of anaesthesia, the patients were allocated in equal numbers into two group. Group B received BIS guided anaesthesia, where BIS value was kept between 40 and 60 and group E received ETAG concentration guided anaesthesia, where Minimum Alveolar Concentration (MAC) was kept between 0.7 to 1.3. Tracheal extubation time was recorded from stopping all anaesthetic agents upto the time of extubation. Unpaired t-test was applied for analysis of data. Results: The mean tracheal extubation time was significantly longer in the BIS group (21.14±2.23 minutes) as compared to ETAG group (15.20±1.27 minutes). All haemodynamic parameters i.e., pulse rate, mean arterial pressure and oxygen saturation remained within normal limits and were comparable between the two groups at all the time intervals. Conclusion: The tracheal extubation time is significantly longer in BIS guided anaesthesia as compared to ETAG guided anaesthesia. The ETAG monitoring promotes earlier extubation of patients as compared to BIS monitoring in isoflurane based general anaesthesia.

Association between Serum Liver Enzymes and Cardiovascular Diseases: A Case-control Study among Adults with Cardiovascular Disease

Introduction: Cardiovascular Diseases (CVDs) are the leading cause of global morbidity and mortality. However, their prevalence is disproportionately distributed, with the highest rate in low-income countries, moderate in middle-income countries, and the lowest in high-income countries. Several studies conducted elsewhere have identified that certain liver enzymes in serum could predict incident CVDs in adults. Aim: To explore the association between liver enzymes and CVDs in adults. Materials and Methods: This was a hospital-based case-control study conducted at Manipal Teaching Hospital, Pokhara, Kaski, Nepal, from January 2018 to December 2021among 400 adult subjects (200 healthy controls and 200 CVD patients). Socio-demographic, physiological, and biochemical variables were collected with structured questionnaires and appropriate standardised and validated measurement methods. The p-value (two-tailed) <0.05 was considered statistically significant. Results: The frequency of smoking (p<0.001 and drinking habits (p<0.001), and mean values of Body Mass Index (BMI) (p<0.001), and Systolic Blood Pressure (SBP) (p=0.006), Wait Hip Ratio (WHR), Aspartate aminotransferases (AST), Alanine aminotransferases (ALT), Alkaline phosphatase (ALP), Fasting Blood Sugar (FBS), Glycated Haemoglobin (HbA1C), Creatine Kinase MB (CK-MB), Troponin I (TpI), Total Cholesterol (TC), and Triglyceride (TG) were significantly higher (p<0.001) in CVD patients than in healthy controls. The High Density Lipoprotein Cholesterol (HDL-C), on the other hand, was significantly lower in CVD patients. Only the AST showed significant correlation with the cardiac markers CK-MB and TpI. Logistic regression analysis revealed that aminotransferases was the best predictor (due to differences in odd’s ratio) than ALP for incident CVDs in the adult population. Conclusion: Present study verifies that aminotransferases, particularly AST, was significantly associated with the incident CVD and thus could potentially be measured together with established cardiac biomarkers for the staging and differential diagnosis of CVDs in Nepali adults.

Knowledge, Attitude and Practice Related to the Use of Nutraceuticals for Prophylaxis against COVID-19 among Undergraduate Medical and Nursing Students in a Tertiary Care Teaching Hospital, Bihar, India

Shruti Singh, Soni, CM Singh, Pallavi Lohani, Sunil Kumar Singh, Pratibha Singh

Introduction: Nutritional supplements modify immune response and protect against viral infections. Health related behaviour of medical and nursing students governs their attitude towards counselling patients. This study assessed the differences in the Knowledge, Attitude, and Practice (KAP) between undergraduate medical and nursing students regarding the role of nutraceuticals in Coronavirus Disease-2019 (COVID-19). Aim: To assess the differences in the KAP between undergraduate medical and nursing students regarding the role of nutraceuticals in COVID-19. Materials and Methods: An analytical cross-sectional study was conducted in a tertiary care teaching hospital, Patna, Bihar, India in September 2020. A questionnaire was administered to assess the KAP of 265 medical and 150 nursing undergraduates regarding nutraceuticals. The total knowledge score varied between 0 and 12. The score of the attitude was based on 5 points Likert scale. The data was collected through self-administered google forms. Chi-square test and Fisher’s exact test was used to compare the difference in categorical data. Results: There were total 273 (65.8%) participants with good knowledge and only 47 (11.3%) with positive attitude. About 68.7% medical students and 82.7% nursing students felt that regular intake of nutraceuticals has a positive role in protecting against COVID-19 (p=0.007). Out of 415, 264 participants (63.6%) had used nutraceuticals. About 156 (58.9%) medical students and 103 (68.7%) nursing students felt that the safety of nutraceuticals is a grave concern. Two- fifth of the participants (202, 48.7%) had consumed a dietary supplement to maintain good health. Conclusion: Although the knowledge score was good, but positive attitude was lacking. Thus, Health Care Personnels (HCP)s should be trained regarding proper usage and recommendations of nutraceuticals.

Rose Bengal Staining, Microbiopsy and Scalpel Biopsy as a Cytology-cum-Histopathology based Diagnostic Scheme for Oral Dysplasias- A Pilot Study

Shilpa Dutta Malik, Upender Malik, MK Sunil

Introduction: Most Oral Squamous Cell Carcinoma (OSCC) is preceded by Oral Potentially Malignant Disorders (OPMDS). These disorders if diagnosed early can be prevented from converting into full blown malignancies. This points towards an ever increasing need for a more accurate, less invasive diagnostic tool to detect these lesions early. Aim: To analyse and compare the accuracy of 1% Rose Bengal (RB) dye and oral microbiopsies (using dermatologic ring curettes) with conventional scalpel biopsy in diagnosing oral epithelial dysplasias. Materials and Methods: This crosssectional pilot study, included a total number of 26 male patients, 40-60 years old, with oral white and red mucosal lesions attending the Outpatient Department (OPD) of Teerthanker Mahaveer Dental College, Moradabad, Uttar Pradesh, India. Thorough clinical examination, 1% RB staining, microbiopsy, and scalpel biopsy was performed on all included participants. Parameters assessed included clinical signs indicative of dysplasia in red and white lesions such as increase thickness, nodularity, atrophic mucosa, erosion,ulcers and change in colour of mucosa with positive history of tobacco smoking. Hyperchromatic areas owing to increase stain intake (due to increased nuclear cytoplasmic ratio) were obtained after staning with RB dye and histopathological indicators of epithelial dysplasia (cellular and architectural changes) were observed after both microbiopsy and scalpel biopsy. Chi-square test was done to compare results of 1% RB staining and microbiopsies with scalpel biopsies. Results: Total 26 male patients were included with a mean age of 50 years. There was no statistically significant difference in the accuracy of microbiopsies (p=0.913) and 1% RB dye (p=0.393) as compared to conventional scalpel biopsy in delineating the epithelial dysplastic changes associated with OPMDS. Conclusion: Oral microbiopsy, is a relatively novel, accurate, and less invasive diagnostic tool. It has proved to be as effective as scalpel biopsy in diagnosing and grading epithelial dysplasia. Through this article, it was proposed that 1% RB staining, microbiopsy, and scalpel biopsy can be used in conjugation as a part of cytology-cum-histopathology based diagnostic scheme for oral clinically suspicious lesions.

Comparison of Risk Scores for Predicting In-hospital Mortality among Patients Presenting with Acute Upper Gastrointestinal Bleed: A Retrospective Study from a Tertiary Care Centre, Chennai, India

Introduction: Acute Gastrointestinal (GI) bleeding results in 5% of admissions to an Emergency Department/Room (ER), with mortality rates ranging from 2 to 15%. To predict the outcomes of these patients, multiple scoring systems have been developed. Early detection of individuals at high risk of mortality could allow for more targeted care including specialised care and early therapies, which could improve outcomes. Glasgow Blatchford Score (GBS), Pre-endoscopy and Rockall score, AIMS65 (Albumin, International Normalized Ratio, Altered Mental status, Systolic blood pressure, Age >65 years), and the recently proposed ABC (Age, Blood parameters, Co-morbidities) score are some of the risk scores that have been devised for risk stratification. According to recent studies, the discriminative performance of these current scores for predicting patient mortality is relatively weak. Aim: To compare the risk scores for predicting in-hospital mortality among patients presenting with acute upper gastrointestinal bleed. Materials and Methods: A retrospective observational study was conducted on patients referred to the Emergency Department/Room of a tertiary care hospital, Chennai, Tamil Nadu, India, with an acute upper GI bleed (characterised as haematemesis, coffee-colored vomitus, or melena) from July 2018 to June 2020. Data collected from medical records included detailed clinical history, vitals, relevant blood investigations, patient requirement for blood transfusion, endoscopic therapy, surgical procedures, radiological intervention along with mortality. The data was analysed using appropriate biostatistics Statistical Package for Social Sciences (SPSS) version 26.0, paired t-tests were performed to calculate the p-values and a p-value <0.05 was considered significant. Results: The study comprised a total of 112 patients. The study population's median age was 53 years, with a male predominance (83.92%). The presenting complaint was haematemesis in 76.79% of the patients and melena in 23.21%. Ischaemic heart disease (10.71%), cirrhosis (25%), and malignancy (2.68%) were the most common co-morbidities. American Society of Anesthesiologists (ASA) grade III accounted for 45.3%, ASA grade II for 25.6%, and ASA grade I for 28.6%. Following endoscopy, the source of upper gastrointestinal bleed was noted to be variceal in 39.3% of cases, gastric/duodenal ulcers in 25.9%, erosive changes in 16.1%, and tumour bleed in 2.7% of cases. Endoscopic mode of treatment was performed in 44.6% and 0.9% required surgical intervention. Mortality occurred in 11 patients (9.82%). Based on Area Under the Receiver Operating Characteristics (AUROC), AIMS65 excelled over other scores in predicting mortality {AIIMS-65 (AUROC; 95% CI) 0.908 (0.85 to 0.97); p-value <0.001, Glasgow-Blatchford score (GBS) 0.818 (0.71-0.93) p-value <0.001, Pre-Rockall 0.756 (0.63-0.89) p-value <0.001, Rockall 0.894 (0.82-0.97) p-value <0.001, ABC 0.778 (0.65-0.90) p-value=0.003}. Conclusion: Systolic blood pressure, heart rate, blood urea, International Normalized Ratio (INR), and albumin showed significant association with mortality. Risk scores encompassing albumin have better mortality prediction. AIMS65 outperformed other risk scores in predicting mortality, even outperforming the postendoscopy rockall score. Hence, AIMS65 can be used to stratify patients in the emergency room early to reduce mortality.

Intubation Performance with Stylet and Preloaded Bougie for Rapid Sequence Intubation in Patients undergoing General Anaesthesia: A Randomised Clinical Trial

Introduction: Rapid sequence induction requires quick and single attempt intubation to secure airway without any untoward complications. As the number of attempts increase, risk of desaturation and aspiration increase which is potentially life threatening. In such circumstances, miscalculation may cost loss of time which may prove fatal. Various adjuncts and techniques have been devised to prevent such calamities. Aim: To compare ease of intubation with angulated stylet versus distally preloaded bougie for rapid sequence intubation in elective general anaesthesia procedures. Materials and Methods: This randomised clinical trial was conducted in 100 patients belonging to 18-60 years of age from November 2019 to October 2020. Patients were intubated using rapid sequence including cricoid pressure by either styletted endotracheal tube (group S) or distally preloaded bougie (group B), for surgeries performed under general anaesthesia. The primary outcome was to determine mean Time to Intubation (TTI) and number of attempts, while secondary outcomes were haemodynamic responses to intubation and complications. Data comparison between independent groups in this normally distributed data was done using student -t test while intragroup analysis was done using chi-square test. Results: A total of 100 patients were randomised into two groups- group S (mean age: 41.12 years) and group B (mean age: 37.34 years), of 50 patients each. Number of intubation attempts with stylet were single in 82%, two in 18% cases while with preloaded bougie, it was 80% and 14%, respectively (p-value=0.196). Time to intubation was 22.16 seconds (group S) versus 33.78 seconds (group B) (p-value <0.05). The haemodynamic assessments revealed that tachycardia, hypertension and increased End tidal carbon dioxide (EtCO₂) was seen for 10 minutes immediately post induction in both the groups, though the intergroup difference was non significant. The incidence of sore throat was higher with stylet than bougie, though non significant (p-value=0.118). Conclusion: Stylet should be preferred for ease of intubation in rapid sequence inductions. However, the insertion and removal of stylet must be done cautiously to prevent post-operative sore throat.

Effects of Intrathecal Dexmedetomidine-Bupivacaine versus Intravenous Dexmedetomidine Plus Intrathecal Bupivacaine: A Randomised Triple-blind Clinical Study

Introduction: For administering Spinal Anesthesia (SA) 0.5% bupivacaine is employed with Dexmedetomidine (DMT) as an adjuvant. Literature review reveals that either intrathecal or low-dose intravenous DMT can enhance the characteristics of SA with bupivacaine Aim: To evaluate the effect of a single bolus intravenous (i.v.) DMT 0.5 μg/kg given either before or after the SA in combination with intrathecal 0.5% bupivacaine compared with intrathecal bupivacaine plus DMT. Materials and Methods: A randomised, triple-blind, single-centre and placebo-controlled study was conducted at Gayatri Vidyaparishad Institute of Health care and Medical Technology, Marikavalasa, Visakhapatnam, Andhra Pradesh, India, from April 2020 to December 2021. Eighty patients were allocated to four study groups of 20 each. Patients of group Intrathecal DMT (ITD) were given SA with 0.5% bupivacaine heavy 3.4 mL+5 μg DMT, patients of group Before Spinal DMT (BSD) were given intravenous DMT before administering the SA with bupivacaine, patients of group After Spinal DMT (ASD) were given intravenous DMT after administering the SA with bupivacaine, and the patients of group Nil DMT (ND) or control group, were given SA with 0.5% bupivacaine heavy 3.4 mL. The primary outcome variable was the difference in the duration of analgesia. The secondary outcome variables were the differences in the onset and duration of the block both motor and sensory. Differences of the parametric data were analysed using Analysis of Variance (ANOVA) and Tukey’s Post Hoc test HSD Beta (Honestly significant difference). For analysis of non parametric data Chi-square test was used and a p-value of ≤0.05 was considered as statistically significant. Results: The mean age of the study participants in group ITD, group BSD, group ASD and group ND was 61.2±9.2, 59.8±10.3, 57.9±10.2, and 60±9.4, respectively. Patients in the ITD group had a longer duration of analgesia of 280.7±5.0 min (vis-a-vis 215±9.34, 210.7±12.0 and 97.9±7.12 min in BSD, ASD and ND, respectively) with a statistically significant difference at a p-value <0.00001. They had a shorter duration of onset of motor block of 3.4±0.49 (vis-a-vis 4.6±0.53, 6.09±0.44 and 6.3±0.65 in BSD, ASD and ND groups, respectively) with a statistically significant difference at a p-value <0.00001. Duration of onset of the sensory block was 2.2±0.37 min in the patients of ITD group (vis-a-vis 3.2±4.76, 3.5±6.71 and 4±0.40 in BSD, ASD and ND groups, respectively) with a statistically significant difference at a p-value <0.00001. Conclusion: Dexmedetomidine used as an adjuvant to intrathecal bupivacaine produces greater augmentation of duration of analgesia, earlier onset of sensory and motor block, more haemodynamic stability and fewer overall side effects compared to its intravenous bolus administration.

Knowledge regarding Snakebite and its Management among Second Year Nursing Students

Rahul Das, Suman Chattopadhyay, Ananya Mandal

Introduction: Snakebite is considered as Neglected Tropical Disease (NTD) by the World Health Organisation (WHO). Nursing personnel are often the first point of contact for snakebite patients and it is imperative that their knowledge about first aid and management is sound and based on standard treatment guidelines. Aim: To assess the knowledge regarding snakebite and its treatment modalities among second year Nursing students. Materials and Methods: This cross-sectional study was conducted among 192 students of 2^nd Year, Bachelor of Science (BSc). Nursing, from Nil Ratan Sircar Medical College and Hospital (NRSMC) and ID and BG Hospital, Kolkata, West Bengal, India. A set of 10 pretested and validated questions was given to them to be filled anonymously answering only one option for each question. Each of the responses were calculated as one for ‘Yes’ option and zero for ‘No’ or ‘Uncertain’responses. The overall knowledge was considered inadequate, if the score was less than 70% (A score of seven and less). Descriptive statistics were used to analyse the data. Results: About 184 (95.84%) students were aware that not all snakes in India are poisonous. However, only 29 (15.10%) were aware of the fact that tourniquet is not a requirement for transport of snakebite patients to referral centers. Among this study population, 121 (63.02%) correctly said that 20 minutes Whole Blood Clotting Time should be performed and 160 (83.33%) correctly said that Adrenaline should be part of the emergency tray during management. Overall, only 89 (46.35%) of the students scored 70% or more and the rest had inadequate knowledge regarding first aid and management of snakebites. Conclusion: The study showed that the knowledge regarding first aid and management of snakebites among second year BSc Nursing students was inadequate. The study participants were not aware of the standard treatment guidelines of snakebite management and there was a need to adequately sensitise them regarding the same during their course of study.

Tear Lactate Levels as a Surrogate Marker of Oxidative Stress in Myopia: A Case-control Study

Introduction: Myopia is most common refractive error leading to visual dysfunctions worldwide. Oxygen deficit due to environmental stress leads to increase in anaerobic glycolysis which results in lactate production. Increase in Reactive Oxygen Species (ROS) and inability of defense system to eliminate them is also responsible for alteration of regulatory pathways. The patient with elevated lactate levels are at significant risk of morbidity and hence, require a prompt treatment. Aim: To estimate and study the lactate levels in tear in various degree of myopia. Materials and Methods: This case-control study was conducted in tertiary care center, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. Twenty five patients each with low, medium, high myopia, age and sex matched healthy controls (i.e, Group 1-4). Diagnosis was established with help of detailed history, clinical and ocular examination. Lactate levels were estimated in tear samples by enzymatic method on autoanalyzer within 30 minutes of collection. Independent Student’s t-test was used to determine the significance between myopia and controls. Results: Out of total 100 subjects, 68% were males and 32% were females. The mean±SD age was 24.56±6.35, 24.12±5.45, and 23.24±5.17, 21.69±3.95 in the Group 1, Group 2, Group 3 and Group 4 respectively in the control group, group with low, medium and high myopia respectively which was statistically not significant. The results of this study showed that lactate levels in tears were significantly higher (p-value=0.013) in myopia patients as compared to controls (1.34±0.46 versus 1.06±0.50). Additionally, the lactate levels increased with the progression of degree of myopia. Conclusion: Increase in the level of lactate in tear was directly proportional to the degree of myopia. Tear lactate levels can be used as a non invasive method to study oxidative stress in individuals. Further studies with more oxidative markers in tears can also be compared with blood values in larger groups of patients with long-term follow-up to validate the finding.

Retinal Manifestations in Rhino-orbito-cerebral Mucormycosis: A Cross-sectional Study

Introduction: Rhino-orbito-cerebral Mucormycosis (ROCM) is an uncommon but devastating fungal infection caused by Mucoraceae family fungi, which are angiotropic and filamentous, with significantly high morbidity and mortality despite treatment. Post Coronavirus Disease-2019 (COVID-19), there was a sudden surge in ROCM cases nationwide due to immunologically and metabolically compromised status. Aim: To describe retinal manifestations in ROCM in a tertiary eye care centre of Northern India. Materials and Methods: An analytic, cross-sectional and hospital-based study was conducted in Regional Institute of Ophthalmology, PGIMS Rohtak, Haryana, India, from May 2021 to September 2021. This study was conducted on 200 admitted patients of RCOM in the institute, which was only designated Nodal centre in Haryana, India. Detailed history was recorded in every patient regarding presenting symptoms, history of COVID-19, hospital stay, oxygen inhalation, steroid intake and immunisation. Thorough ocular examination was done in every patient including visual acuity, ocular movements and pupillary reactions. Dilated fundus examination was done by Indirect Ophthalmoscopy (IDO) for posterior segment evaluation. Contrast Enhanced Magnetic Resonance Imaging (CE-MRI) brain with orbit and Paranasal Sinus (PNS) was done in every patient to see the extent of spread and planning further management. Results: Out of 200 patients of ROCM, majority of patients (64/200) were of 51-60 year age group (32%) followed by 41-50 year age group (28%). Out of 200 cases of ROCM, 146 patients (73%) had history of COVID-19 infection in past and 134 (67%) patients had history of hospital stay during COVID-19 infection. Oxygen (O₂) supplementation was given to 98 patients either at home or during hospital stay. History of steroid intake was present in 34 patients and 46 patients received injection Remedsivir. Only 12 patients had vaccine against COVID-19 and none of them were fully vaccinated. Most common presenting symptom was unilateral nasal stiffness (22%) followed by loss of vision (17%). Most common predisposing factor was Diabetes Mellitus (DM) in 78 patients (39%) followed by steroid intake in 34 patients (17%). Out of 200 patients, only 60 patients had retinal manifestations and most common was Central Retinal Artery Occlusion (CRAO) (35/60) and the main mechanism is the direct infiltration of central retinal artery due to angioinvasion of fungi from the orbit. Conclusion: CE-MRI brain with orbit is an important tool in diagnosing and monitoring progression of RCOM but it cannot provide information regarding retinal findings like CRAO, central retinal venous occlusion (CRVO), disc pallor and optic atrophy. Thus, the fundus examination of every ROCM patient should be emphasised, as it not only helps in categorising ROCM but also tells about the visual potential of affected eye. Patients with CRAO and combined vascular occlusion should be considered for exenteration on urgent basis, so that intracranial spread can be prevented and patient’s life can be saved.

Role of Uterine Artery Doppler at 11-14 Weeks of Pregnancy in Early Prediction of Preeclampsia: A Prospective Cohort Study

Uttara Gupta, Pooja Namdeo, Neelam Patel

Introduction: Doppler ultrasonography, by comparing systolic and diastolic waveforms helps in assessment of uteroplacental circulation. Since preeclampsia has ethnic and geographical variations, it is important to understand the prediction modalities in various populations. Aim: To investigate the role of elevated Pulsatility Index (PI) and presence of diastolic notch using uterine artery doppler in early pregnancy in predicting development of preeclampsia among pregnant women. Materials and Methods: A prospective cohort study was conducted on pregnant females visiting the antenatal clinic or Outpatient Department or admitted in the Department of Obstetrics and Gynaecology at People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India, from November 2019 to October 2021. All cases were subjected to uterine artery doppler study, between 11-14 weeks of pregnancy, to note pulsatility index and diastolic notch. All the participants were then screened periodically during their antenatal visits for development of features of preeclampsia and were followed-up monthly upto 20 weeks, every 15 days upto 32 weeks and then, weekly till delivery. Pregnancy outcome were measured in terms of presence or absence of preeclampsia. Data was compiled using Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) IBM software version 20.0. Categorical data was expressed as frequency and proportions, whereas, continuous data was expressed as mean and standard deviation. Results: The present study was conducted on a total of 116 cases with the mean age of 26.75±4.31 years. Out of 116 cases, 26 cases developed preeclampsia. Diastolic notch was present in 17 cases (65.4%) patients with preeclampsia and 23 cases (25.6%) non preeclampsia patients. Pulsatility index of more than 1.71 was noted in 14 cases (53.8%) cases with preeclampsia, whereas, 87 cases (96.7%) with non preeclampsia had pulsatility index of less than 1.71. The specificity of diastolic notch 74.4% where as that of pulsatility index was 96.7% and the diagnostic accuracy of diastolic notch 72.4%, whereas, that of pulsatility index was 87.1%. Conclusion: Uterine artery doppler is a promising tool for predicting development of preeclampsia by analysing both PI as well as diastolic notch in uterine artery. Doppler had high overall diagnostic accuracy for preeclampsia.

Clinico-pathological and Genomic Characteristics among Children with SARS-CoV-2 Infection

Vivek Gupta, Vinod Scaria, Anurag Srivastava, Akash Raja, Shivani Kalhan

Introduction: There is inadequate information on infections with the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) in children. Their clinical, as well as pathological correlation, is poorly understood. In India, children and adolescents account for 12% of all Coronavirus Disease 2019 (COVID-19) cases reported. Children accounted for roughly 11% of those impacted globally last year. However, this year, we are seeing around 20-40% of youngsters in positive instances over the world. Even babies and infants are testing positive for COVID-19, although their illness is under control and seldom becomes fatal. Children aged 5 to 12 years, on the other hand, are at a higher risk. Aim: To study the clinical, pathological and genomic characteristics among children with SARS-CoV-2 infection. Materials and Methods: This cross-sectional study was conducted among 48 paediatric positive patients for SARS-CoV-2 at Government Institute of Medical Sciences, Noida, Uttar Pradesh, and CSIR-Institute of Genomics and Integrative Biology, New Delhi, India, from 1^st April 2021 to 31^st May 2021. The laboratory testing was done by the real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) method. The patients were classified as mild, moderate, severe, or asymptomatic. Their clinical and pathological findings were recorded in the case sheet. Genomic analyses were done for identifying the genetic variant in the nine selected samples. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 26.0. Chi-square test was used for categorical variables and the t-test was used for continuous variables. Results: The study group has median age of 12 years. Male:Female ratio was 2:3. Most children had acquired infection from the community and 30% had the moderate illness and were admitted. Serum Glutamic-Oxalacetic Transaminase (SGOT) and Glutamic-Pyruvic Transaminase (SGPT) were raised in six patients. Alkaline Phosphatase (ALP) was raised in 21 patients and bilirubin was raised in two patients. The average duration of hospitalisation was six days (range 2-13 days). No mortality among the 48 paediatric patients studied was identified in the hospital. Delta variant (B.1.617.2) was identified in seven patients with D614, P681R, L452R mutations and B.1.617.2 was identified in two patients. Delta variant was present in the paediatric patients, but it did not prolong the hospital stay or cause mortality. Conclusion: The findings of the study suggest that children may be a potential source of infection in the SARS-CoV-2 pandemic while having an asymptomatic to mild illness.

Association of Serum Iron Indices with Insulin Resistance Index in Euglycaemic Offspring’s of Diabetic and Non Diabetic Parents: A Case-control Study

MV Shobha, A Jagadamba, K Prabhakar, KN Shashidhar

Introduction: Altered iron metabolism may be a risk factor for various diseases. There are studies showing that altered iron metabolism is frequently found in type 2 diabetes mellitus patients, but there is lacunae of literature in offspring’s of diabetic parents. Aim: To compare serum iron indices in euglycaemic offsprings of diabetic and non diabetic parents and also to correlate serum iron indices with HOMA-IR. Materials and Methods: This was a case-control study conducted in RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from February 2019 to January 2020. Total 80 euglycaemic healthy individuals were recruited. Out of 80 subjects 40 were cases and 40 were controls. Offspring of non diabetic parents as control group and offspring of diabetic parents as a case group were included in the study. Anthropometric measurements like weight, height was measured and Body Mass Index (BMI) was calculated. Laboratory parameters like complete haemogram, Fasting Blood Sugar (FBS), serum iron markers like serum iron, serum ferritin, serum Total Iron Binding Capacity (TIBC), serum insulin and high sensitive C-reactive protein were analysed and compared between cases and controls. Homeostasis Model Assessment-estimated Insulin Resistance (HOMA-IR) was calculated. Results: Mean age of cases was 34.65±3.06 years and controls was 35.75±3.43 years respectively. Out of total 24 were females and 56 were males. Serum iron markers like serum iron and serum ferritin was significantly increased and serum TIBC was significantly decreased among euglycaemic offspring’s of diabetic parents compared to offspring’s of non diabetic parents. Serum ferritin (r-value=0.389,p-value=0.007) and serum iron (r-value=0.483,p-value=0.001), showed positive correlation with HOMA-IR among euglycaemic offspring’s of diabetic parents. On multiple regression analysis, in model 1 (HOMA-IR as dependent variable and serum ferritin, serum iron and serum TIBC as independent variable) serum iron emerged as a significant predictor of insulin resistance, whereas after adding confounding variables like BMI, high-sensitivity C-Reactive Protein (hsCRP), lipid profile with serum iron markers in model 2, serum iron emerged as independent predictor of insulin resistance though regression equations was not statistically significant. Conclusion: Offsprings of diabetic parents showed iron overload and insulin resistance which predisposes them to develop T2DM and serum iron can be used as one of the marker of insulin resistance among offspring of diabetic parents along with other parameters.

Analysis of Factors Influencing Length of Stay in Hospital among Burns Patients, Pertaining to Blood Transfusion- A Cross-sectional Study

Jeyaraj Ravishankar, Pothipillai Arumugam, M Chitra, Munusamy Sridevi

#b#Introduction: Blood transfusion is an independent risk factor for death and perioperative infection in trauma patients. Hospital Length Of Stay (LOS) is an indicator of morbidity and can be used to assess wound healing in burns patients. Aim: To analyse the factors influencing hospital length of stay in burns patients, with relevance to blood transfusion. Materials and Methods: This was a cross-sectional study on burns patients admitted at burns ward, Government Kilpauk Medical College, Tamil Nadu, India, between September 2014 to August 2015. Patients with age more than 16 years with 15-40% Total Burnt Surface Area (TBSA) and had survived treatment were included after obtaining informed consent. Age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, blood component transfusion, storage age of red cells, surgical procedures and wound infection were studied. Results were analysed using Chi-square test, Analysis of Variance (ANOVA) and Pearson correlation. Results: Of the 122 burns patients studied, mean age was 35.38±12.93 years, 54.09% were males, mean LOS was 22.39±1.23 days, mean TBSA was 26.11±0.40%, mean APACHE II score was 5.02±0.06, 85 (69.67%) patients had received red blood cell transfusion, 59 (48.36%) underwent surgical procedures and 103 (84.43%) developed culture proven wound infections. APACHE II score at admission (r-value=0.260, p-value=0.004), blood transfusions (r-value=0.504, p-value <0.0001), surgical procedures (r-value=0.614, p-value <0.0001) and wound infections (r-value=0.468, p-value <0.0001), were the factors which significantly increased length of hospital stay. Age of the patient (r-value=0.102, p-value=0.265) and storage age of red blood cells (p-value=0.193) did not influence length of stay in burns patients. Conclusion: Minimising wound infection by proper wound care and medications and rational use of blood components help in early healing of burns wound with reduced hospital stay.

Outcomes and Learning Curve in Total Extraperitoneal Hernia Repair: A Cross-sectional Study

Sarvesh Maheshwari, Neelkamal Gupta, Saurabh Jagtap, Brijesh Kumar Sharma

Introduction: A hernia surgery can be performed via the classical open technique, or laparoscopically. However, the later techniques i.e, total extraperitoneal repair and transabdominal preperitoneal techniquesare allied to a steep learning curve. Aim: To define the learning curve associated with a Total Extraperitoneal (TEP) in inguinal hernia repair. Materials and Methods: A cross sectional study was conducted in Department of Surgery at Mahatma Gandhi Hospital, Jaipur, Rajasthan, India, from January 2018 and January 2022. Total 125 patients with inguinal hernia posted for laparoscopic inguinal hernia repair by a TEP technique, to assess the learning curve using the moving average method. Two surgeons i.e, surgeon 1 (assessee, junior surgeon) and surgeon 2 (assessor, senior surgeon) were chosen. The learning curve was assessed for surgeon 1, who was a general laparoscopic surgeon, not performing laparoscopic hernia repair, while surgeon 2 was regularly performing laparoscopic hernia repairs. A direct comparison was made, based on operative time, peritoneal laceration, vascular injury, conversionrates, hospital stay and complications. Results: Out of 125 patients, 50 patients were operated by the surgeon1 and 75 were operated by surgeon 2. Mean operating time by surgeon 2 was 52±4.5 minutes, and 66±4.18 minutes for surgeon 1 with a p-value of 0.0005. This was the only statistically significant variable, while hospital stay and surgical complications like peritoneal laceration, vascular injury or conversions to TAPP were statistically insignificant (p-value <0.05). Surgeon 1 (assessee) required to perform 10 TEP surgeries to overcome the learning curve. Oral intake was started at mean of postoperative day 1.08±0.32 for surgeon 1 and 1.04±0.20 for surgeon 2. Full diet was initiated on postoperative day 1.5±0.5 for senior surgeon, while 2.08±0.8 days for the junior surgeon. Conclusion: Surgeons with a prior experience in laparoscopic surgery needs a shorter learning curve ascompared to a beginner in laparoscopic surgery, when it comes to laparoendoscopic groin hernia repair.

A Prospective Clinical Study of Mesh Size Required for Open Inguinal Hernia Repair

Rahul Choudhary, Dharamanjai Kumar Sharma, Shri Ram, Hina Sharma

Introduction: Inguinal hernia repair by open method is among the most frequently performed surgical procedures. The current standard surgical procedure employed is Lichtenstein’s tension-free mesh repair which requires covering an area defined by anatomic landmarks like Anterior Superior Iliac Spine (ASIS), pubic tubercle, conjoint tendon etc. with a mesh. The distances among these landmarks vary depending upon stature, race and gender of the patients. Aim: To study whether the commercially available mesh size can be reduced specifically for a subset of Indian population by estimating the actual sizes of mesh applied during inguinal hernia surgery. Materials and Methods: In this prospective clinical study, 25 patients undergoing open inguinal mesh hernioplasty were studied at a tertiary care centre, Department of General Surgery, Rabindra Nath Tagore Medical College, Udaipur Rajasthan, India, over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15×7.5 cm2) was trimmed down according to the dimensions and anatomical landmarks that were assessed during surgery in the usual manner. Since, it is difficult to measure size of applied mesh intraoperatively and because it is often irregular in shape, a novel method was adopted to estimate the mesh size applied. The trimmed out portions of the mesh were weighed using a high precision electronic weighing machine. The ratio of weight of trimmed out portion to total weight of the standard sized mesh was used to derive the area of the mesh applied. Statistical analysis and significance tests were performed using spreadsheet software and student’s t-test, respectively. Results: Areas of mesh actually applied in the study- mean (85.26±11.04 cm2), mean+2SD (107.34 cm2), most common (75-97.4 cm2) and maximum (102.75 cm2)- all were found to be less than the standard, commercially available size of mesh. No statistically significant difference was found between areas of mesh applied in patients with indirect and direct hernias using unpaired student t-test (p-value=0.1076). Conclusion: Areas of mesh actually applied in present study were found to be less than the standard, commercially available size of mesh for inguinal hernia repair.

Assessment of Fear of COVID-19 in Pateints Attending the Dermatology Outpatient Department: A Cross-sectional Study

Renu Rattan, Ghansham Kumar Verma, Meena Chauhan, Ajeet Kumar Negi

Introduction: The entire world has been affected by Coronavirus disease 2019 (COVID-19) and experts all over the world are working hard to combat this global pandemic. There is a panic among people with resultant psychosocial consequences. Aim: To evaluate the fear factor of COVID-19 using Fear of COVID-19 Scale (FCV-19S) among two groups of patients, one with dermatological diseases managed with immunomodulators and second with dermatological diseases not requiring immunosuppression and also to counsel both the groups regarding the course of their disease and tailoring their visits to the hospital accordingly. Materials and Methods: This cross-sectional study was conducted from 16^th January 2021 to 30^th April 2021 in the Outpatient Department (OPD) of Dermatology of a tertiary care centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. Consecutive 52 patients meeting the inclusion criteria, with dermatological diseases requiring long-term immunosuppressive therapy and 49 patients with dermatological diseases or cosmetic concerns not requiring immunosuppressive treatment were enrolled for the study. The obtained data was analysed using Epi Info software version 7.2.4.0. Results: A total number of 101 patients were enrolled in the study with a male to female ratio of 1.7:1. Mean age of patients was 41 years (range 18-71 years). Among them, 52 (51.49%) had chronic diseases with relapsing and remitting course requiring immunomodulator drugs and 49 (48.51%) had either cosmetic concerns or diseases not requiring immunomodulation. Seventeen (16.83%) of the total patients had other co-morbidites like diabetes mellitus, hypertension, chronic kidney disease or cardiac diseases. Out of all the study participants, 3 (2.9%) had severe fear, 16 (15.8%) had moderate fear, 36 (35.6%) had mild fear and 46 (45.5%) had no fear of COVID-19. Conclusion: During this pandemic time, patients need to be counselled regarding the course and management of their diseases and stress factor should also be addressed.

Comparative Evaluation of Three Diagnostic Tools for the Detection of Hepatitis C Virus among High-risk Individuals in a Tertiary Care Centre of Northeast India

Introduction: Hepatitis C virus (HCV) has posed a major public health problem globally. Since majority of HCV infected patients are asymptomatic, diagnosis of HCV infection is mainly based on the detection of anti-HCV antibodies by the Enzyme Linked Immunosorbent Assay (ELISA) or Rapid Diagnostic Tests (RDTs) and HCV Ribonucleic Acid (RNA) by real time Polymerase Chain Reaction (PCR) of serum or plasma samples. Aim: To assess the performance of RDT and 4^th generation ELISA against real time reverse transcriptase PCR for the detection of HCV. Materials and Methods: A hospital-based cross-sectional study was carried out in the Virology Section, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, for a period of two years from June 2019 to May 2021. The study included 3,254 plasma samples from suspected cases of HCV monoinfection, and HCV/HIV co-infection. The plasma samples were subjected to anti-HCV antibodies by RDT (SD BIOLINE, South Korea) and 4^th generation ELISA (Monolisa™ HCV Ag-Ab ULTRA, Bio-Rad, France), and HCV RNA by real time PCR. Data analysis was done using descriptive statistics, and performance of the assays was evaluated by using Cohen kappa test (κ) and Receiver Operating Characteristic (ROC) curve. Results: PCR is considered as the gold standard test. HCV was detected by RDT in 453 (13.92%), ELISA in 413 (12.69%) and RT-PCR in 367 (11.28%) samples. The present study demonstrated sensitivity of 97.55% and specificity of 96.71% with Positive Predictive Value (PPV) of 79.03% by HCV-RDT. The 4^th generation ELISA showed high sensitivity of 99.46% and specificity of 98.34%. Using ROC curve, the area under the curve was 81% for ELISA with diagnostic accuracy of 98.46%. Conclusion: 4^th generation ELISA is more sensitive and specific than RDT for the detection of HCV infection. Confirmatory HCV-RNA assay could be performed to clear doubts related to false-positive and false-negative findings of the primary screening assays.

Evaluation of Low-dose and High-dose Intravaginal Misoprostol for Induction of Labour: A Randomised, Double-blinded, Single Centre Study

Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, misoprostol optimal dose required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 μg and 50 μg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. All the selected participants were randomised (1:1) to group 1 which received 25 μg of intravaginal misoprostol (n=70) and group 2 received 50 μg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analyzed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p<0.01). Participants who received misoprostol 50 μg (n=60, 85.7%) has slightly showed higher vaginal deliveries compared to misoprostol 25 μg (n=57, 81.4%). The mean duration of induction time in group 2 was 10.12 hours and group 1 women showed 13.56 hours (p<0.0001). Maternal and neonatal complications were slightly higher in 50 μg misoprostol group. Maternal complications such as uterine tachysystole (n=4), Postpartum Haemorrhage (PPH) (n=3) and uterine hyperstimulation syndrome (n=2). Neonatal complications with 50 μg misoprostol were Apgar <7 at 1 min (n=4), Apgar <7 at 5 min (n=3), Special Care Baby Unit (SCBU) admissions (n=2) and severe birth asphyxia (n=1). Misoprostol with 25 μg has showed Apgar <7 at 1 min (n=2), Apgar <7 at 5 min (n=2), SCBU admissions (n=1). Conclusion: The efficacy and safety results of 25 μg intravaginal misoprostol were comparable with 50 μg of intravaginal misoprostol for labour induction. The advantages of 50 μg misoprostol were it favours the vaginal deliveries, lesser active induction time and decrease number of misoprostol doses required to induce labour. However, higher dose of misoprostol showed higher frequencies of both maternal and neonatal complications.

Comparison between Sevoflurane and Isoflurane for Controlled Hypotensive Anaesthesia in Patients undergoing Craniotomy for Supratentorial Intracranial Surgery: A Randomised Single-blinded Study

Introduction: The controlled hypotensive anaesthesia technique is widely used for decades to create a bloodless surgical field and decrease intraoperative blood loss during neurosurgical procedures. Inhalation agents like isoflurane and sevoflurane provide the benefit of being hypnotic and hypotensive agents at clinical concentrations and predictable dose-dependent effects made them popular in neurosurgery. Aim: To compare the effects of sevoflurane and isoflurane for producing controlled hypotensive anaesthesia in surgeries for supratentorial brain tumours. Materials and Methods: Sixty-six patients of either sex in the age group of 20-60 years, with American Society of Anaesthesiologists (ASA) Grade I and II posted for elective craniotomy for supratentorial brain tumour under general anaesthesia were enrolled for this study. Patients were randomly allocated to two aesthetic regimens: Group I received isoflurane 1 Minimum Alveolar Concentration (MAC), and Group S received sevoflurane 1 MAC. The Systolic Blood Pressure (SBP) was lowered to less than 100 mmHg before the skin incision and was maintained throughout the surgery.If the blood pressure was not maintained within the above-mentioned range, then injection propofol bolus dose of 20 mg was given intravenously. The quality of the surgical field, brain relaxation, blood loss, duration of surgery, and postoperative complications were compared. Time taken for onset and recovery of controlled hypotension and the requirement of propofol for maintaining controlled hypotension in both groups were also compared. Results: The group S had better brain relaxation (N=26 vs N=20), less blood loss (241.5±61.62 vs 380.65±203.9 mL), and a shorter duration of surgery (135.45±25.6 vs 171.4±60.5 minutes) than group I. Group S had a few patients who required propofol (5 vs 17) to maintain controlled hypotension. The mean time to achieve the target Mean Arterial Pressure (MAP) and time to recovery was faster in group S (10.55±2.54 minutes) vs 15.35±0.99 minutes in group I and 12.95±3.24 minutes in Group S vs 17.85±2.21 minutes in Group I, respectively; p<0.001). Conclusion: Sevoflurane is a safer and more potent drug than isoflurane to achieve controlled hypotension during surgery for a supratentorial brain tumour.

Comparison of Motor Nerve Conduction Velocity between Football Players and Sedentary Individuals: A Cross-sectional Study

Gokul Suresh Revathy, Arsha Krishnan

Introduction: Athletic training improves the cardiovascular, pulmonary and musculoskeletal performance. A number of studies have also suggested an improvement in neural capabilities. Nerve sConduction Study (NCS) helps in learning about various electrophysiological parameters of the nerve such as Nerve Conduction Velocity (NCV), latency, amplitude, duration, etc. They influence co-ordination and speed of voluntary activity. Aim: To study the Motor Nerve Conduction Velocities (MNCV) of trained athletes and compare their values with untrained individuals. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology, Government Medical College, Trissur, Kerala, India, from January 2016 to January 2017. The sample consisted of 60 male subjects who included 30 athletes and 30 non athletes between ages 18 to 25. MNCV, latency, amplitude and duration of median, ulnar, and tibial nerves of both sides of the subjects were measured. These were compared using independent t-test, and p-value <0.05 was taken as significant. Results: The MNCV in athletes were found to be faster than non athletes. The mean MNCV of left and right median nerves were 61.5±2.60 m/s and 61.45±2.52 m/s in athletes, and 56.48±2.70 m/s and 56.73±2.51 m/s in non athletes, respectively. The mean MNCV of the left and right ulnar nerves were 61.28±2.64 m/s and 61.58±3.15 m/s in athletes, and 57.87±3.42 m/s and 58.05±3.94 m/s in non athletes. The mean MNCV of the left and right tibial nerves were 46.34±3.44 m/s and 46.37±3.60 m/s in athletes, and 44.74±3.46 m/s and 44.86±3.58 m/s in non athletes. In both tibial nerves, the proximal and distal amplitude was higher, and the proximal and distal duration was lower in athletes. Conclusion: The results indicated MNCV of athletes were higher which could be beneficial in their sports performance.

Multiparameter Flowcytometry for Diagnosis and Subtyping of Mature Lymphocytic Neoplasms in Peripheral Blood and Bone Marrow: A Prospective Observational Study

Introduction: Multiparameter Flowcytometry (MFC) is a high throughput, quick, and practical technique for diagnoses of Chronic Lymphoproliferative Disorders (CLPDs). Indian CLPDs cases have distinct distribution and presentation than the developed world. Moreover, limited studies have confirmed the diagnostic utility of MFC in Indian CLPDs cases. Aim: To evaluate the diagnostic utility of MFC in peripheral blood and bone marrow aspirate of CLPDs cases. Materials and Methods: This was a single-centre, prospective, observational study involving clinico-morphologically suspected or diagnosed 85 CLPDs cases. It was carried out in the Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India, from January 2016 to November 2019. The patients were followed-up for peripheral smear (PS) and Bone Marrow (BM) MFC and staging in nodal or extranodal Non-Hodgkin’s Lymphoma was done. Results: Clinico-morphological examination led to the diagnosis of 74 CLPD cases, while remaining 11 cases were strongly suspected. MFC immunophenotyping was contributory in diagnosing 74 CLPD cases which on further subtyping consisted of B-cell CLPD (N=70), and T-cell CLPD (N=3), while one case of B-NHL could not be subtyped. The most common B-cell CLPD included multiple myeloma (n=27), chronic lymphocytic leukaemia (n=25), diffuse large B-cell lymphoma (n=7). T-cell CLPD included hepatosplenic gamma delta T-cell lymphoma (N=2) and adult T-cell lymphoma, follicular lymphoma (n=3), burkitt’s lymphoma (n=2), mantle cell lymphoma (n=2), pro-lymphocytic leukaemia (n=2), splenic marginal zonal lymphoma (n=2), B-Cell Non-Hodgkin’s Lymphoma (n=1). Finally, 11 suspected cases mostly comprised of reactive lymphocytosis (81.8%). Conclusion: The MFC immunophenotyping led to diagnoses and determination of CLPD sub-class. It also resulted in rapid diagnoses of reactive hyperplasia and non haematolymphoid malignancy which may mimic CLPD on morphology and hence, difficult to diagnose based on morphology alone.

Comparison of Haloperidol and Quetiapine for Treatment of Delirium in Critical Illness: A Prospective Randomised Double-blind Placebo-controlled Trial

Rishabah Garg, Vipin Kumar Singh, Pratishruti, GP Singh

Introduction: Delirium is associated with an increased chance of death, prolonged hospitalisation, higher healthcare costs, and possibly long-term brain damage in survivors. Antipsychotics, both conventional and atypical, are the cornerstone of pharmacologic treatment for delirium in adults. Aim: To find out whether typical and atypical antipsychotic medication would result in a shorter duration of delirium than placebo and would improve other outcomes. Materials and Methods: This is a randomised, double-blind, placebo-controlled trial conducted on patients with delirium in Intensive Care Unit (ICU) of King George's Medical University, Lucknow, Uttar Pradesh, India from February 2021 to February 2022. Out of 45, 15 received enteral haloperidol (maximum dose 30 mg daily), 15 received quetiapine (maximum dose 300 mg daily) and 15 were controls receiving placebo through Ryle’s tube. Delirium was detected with the use of Confusion Assessment Method for the ICU (CAM-ICU), and side effects of the drugs were noted. Dose of a trial drug or placebo was placed halved or doubled at 12-hour intervals using these parameters. The primary end point was the number of days alive without delirium during the 14 day intervention period. Secondary end points included time to freedom from mechanical ventilation, time to ICU, hospital discharge and 30 day and 90 day survival. Results: Out of 45 patients screened, 25 were males and 20 were females with no comparable differences. The mean number of days alive without delirium or coma was 9.45 in the haloperidol group, 8.64 in the quetiapine group, and 8.57 in the placebo group (p-value=0.63) for overall effect across trial groups. The use of haloperidol or quetiapine as compared with placebo, had no significant effect on the primary end point. There were no significant between-group differences in respect to the secondary end points . Conclusion: The use of enteral haloperidol or quetiapine, as compared with placebo, did not significantly alter the duration of delirium in the critically-ill patients admitted in ICU.

Acute Febrile Illness in Immunocompetent Adults with Special Reference to Neutropaenia: A Cross-sectional Study

Introduction: Fever is a common symptom with multifactorial etiologies. In tropical country like India, most of the cases of acute febrile illness are due to seasonal viral diseases and vector-borne infections. Aim: To know the causes of acute onset fever in immunocompetent adults and to study the prevalence of neutropaenia. Materials and Methods: A cross-sectional study was done on 403 patients presenting with Acute Febrile Illness (AFI) of <14 days duration admitted to a tertiary care hospital, Pune, Maharashtra, India from January 2019 to January 2020. Total Leukocyte Count (TLC), Absolute Neutrophil Count (ANC) and investigations for dengue, malaria, leptospirosis, enteric fever, atypical infections like brucella, rickettsia and relevant body fluid cultures were done. The categorical and continuous variables were expressed as frequency, percentage, and standard deviation. Results: Out of 403 patients, 214 were males (53.1%) and 189 females (46.9%) with mean age of 28.57±11.26 years. Cause of fever was found in 254 (63%) patients. Dengue fever was the most common cause in 221 (54.8%) followed by Acute Undifferentiated Febrile Illness (AUFI) in 149 (37%). Transient neutropaenia was present in 38.5% cases, mostly with dengue. Only 5.2% patients with AFI required antibiotics. Conclusion: Dengue fever, the most common cause of AFI chiefly affecting young adults. Neutropaenia in AFI in immunocompetent adult is transient and benign. Antibiotics are not required in majority of the cases of AFI without organ specific aetiologies.

Correlation of Pupil to Limbus Diameter Ratio with Blood Pressure and Heart Rate among Parkinson’s Disease Patients

Introduction: Variation in blood pressure and heart rate is observed in patients with parkinson’s disease. Pupil to Limbus Diameter (PDL) ratio is one of the emerging autonomic functions. The studies measuring the autonomic functions of parkinson’s patients are sparse. Aim: To observe the correlation of the PLD ratio with blood pressure and pulse rate among parkinson’s disease patients. Materials and Methods: This observational study was conducted among 31 parkinson's disease patients attending Outpatient Ward of General Medicine Department at Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India, from 1^st March 2021 to 1^st November 2021. Pupil to limbus diameter ratio was recorded using the two-box method. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Pearson’s correlation was used to observe the correlation. A p-value less than 0.05 was considered significant. Results: The mean age of the participants was 61.9±13.07 years. The mean PLD ratio of the left eye was 0.343±0.042. There was a significant positive correlation between the PLD ratio of the left and right eye with blood pressure in males. There was a positive correlation between pulse rate also with PLD ratio of the left and right eyes. However, it was not significant. Conclusion: There was a significant positive correlation of the PLD ratio with blood pressure and pulse rate in males, but negative correlation was observed between the PLD ratio of the left eye with systolic and diastolic blood pressure in females. The study results support the need for further detailed studies in this area to investigate further details of this correlation observed.

Comparison of Nalbuphine and Dexmedetomidine versus Nalbuphine and Propofol for Monitored Anaesthesia Care in Tympanoplasty: A Randomised Double-blind Study

Monika Gandhi, Shikha Jain, KK Arora, Deepali Valecha

Introduction: Tymanoplasty, a middle ear surgery, is done either under Local Anaesthesia (LA), General Anaesthesia (GA) or sedation with local anaesthesia. It is usually performed under Monitored Anesthesia Care (MAC) providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilisation of the patient. Aim: To study the effect of nalbuphine/dexmedetomidine with nalbuphine/propofol on sedation and analgesia in tympanoplasties performed under MAC. Materials and Methods: This randomised, double-blind, clinical study was conducted from June 2020 to June 2021 in the Department of Anaesthesiology at Mahatma Gandhi Memorial Medical College and MY Hospital, Indore, Madhya Pradesh, India. Total 60 adult patients, of American Society of Anesthesiologists (ASA) grade I and II undergoing tympanoplasty under MAC, were randomly allocated into two groups. All patients received injection nalbuphine 50 μg/kg intravenously (i.v.). Group D received a bolus dose of injection dexmedetomidine 1 μg/kg i.v. over 10 min followed by an infusion at 0.3 μg/kg/h i.v. Group P received a bolus dose of injection propofol 0.75 mg/kg followed by an infusion at 0.025 mg/kg/min i.v. Sedation and analgesia were titrated to Ramsay Sedation Score (RSS) and Visual Analog Scale (VAS) of 3 each. The vital parameters and need for intraoperative rescue sedation/analgesia were recorded and compared. Results: Mean RSS was significantly more in group D (3.11±0.055) than group P (2.80±0.350). Overall, VAS score was significantly less in group D (1.60±0.670) than group P (2.70±0.691). In group D, 2 (6%) patients and in group P, 4 (12%) patients required inj. midazolam. Similarly, the requirement of inj. paracetamol in group D was in 3 (10%) patients, and in group P, it was 10 (33%) patients. Bradycardia (23.3% in group D and 13.3% in group P) and hypotension (20% in group D and 13.3% in group P) were the major side effects seen in the study. Conclusion: The present study concludes that, Nalbuphine/dexmedetomidine is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing tympanoplasty under MAC.

ASTOL Technique: A Novel Method for Localisation of Impacted Mandibular Tooth

Seerab Husain, Arvind Sivakumar

Introduction: Object localisation is one of the challenges encountered in diagnosis of impacted teeth, which requires sophisticated two-dimensional and three-dimensional radiographic techniques. These sophisticated radiographs are not readily available in all clinics, and also they carry the risk of increased radiation exposure and increase burden of care. Aim: To evaluate the accuracy of ASTOL (Arvind-Seerab Transmandibular Object Localisation) technique for object localisation in the dried mandible of a cadaver. Materials and Methods: This cross-sectional study was conducted in Chennai city, Tamil Nadu between March 2021 to April 2021. A dried mandible of a cadaver and an extracted premolar was used to simulate 10 cases scenarios of impacted teeth at different regions of the mandible. Two intraoral periapical (IOPA) radiographs were taken for each scenario, from two different projections: first a conventional IOPA of the impacted tooth was taken and second radiograph was taken with the beam projected from the base of the mandible with the sensor placed on the occlusal surface. Both the radiographs taken for each scenario were incorporated into a questionnaire survey and were circulated to 30 dental practitioners. The results were tabulated and represented graphically. Cronbach’s alpha test and Kappa statistics were done to evaluate the internal and interobserver reliability between the validators and respondents respectively. Results: Out of the 30 dental practitioners, a total of 25 responses (14 Males and 11 Females) were received from dental practitioners across the state. The response rate was 83.33% and the mean age of the respondents were 34±5 years. The vertical position of the crown tip of the impacted tooth had a correct response rate of 85.60% (214/250). Angulation of the impacted tooth had a correct response rate of 75.20% (188/250). Mesiodistal positioning of the crown tip of the impacted tooth had a correct response rate of 78% (195/250). Buccolingual positioning of the impacted tooth had a correct response rate of 92.80% (232/250). Conclusion: The ASTOL technique is a novel radiographic technique which can be used as an accurate, reliable and economic alternative to other sophisticated 2D and 3D imaging techniques for object localisation in the mandibular arch.

Socio-demographic and Clinical Profile of Treatment-seeking Drug Abusers Attending a Hospital in South Kashmir: A Cross-sectional Hospital-based Study

Introduction: Substance abuse is one of the major public health problems in the present world, and so in Kashmir. The geographical location of Kashmir and the prevailing conflict has made the population vulnerable to drug abuse. Data from different areas of Kashmir has pointed out the changing pattern of substance abuse, and the rising trend of opioid use. However, there have been no studies from southern Kashmir. Aim: To study the socio-demographic and clinical profile of treatment-seeking drug abusers attending General Psychiatric Outpatient Department (OPD) at the newly established Government Medical College, Anantnag, Kashmir, India. Materials and Methods: This cross-sectional, hospital-based study was conducted from January 2020 to June 2021. A total of 213 treatment-seeking drug abusers were included in the study. Diagnosis of substance dependence was established by applying the International Classification of Disease version 10. The clinical and socio-demographic variables were studied using a semi-structured proforma, and the variables were presented as frequency and mean. The data were analysed using Epi Info software version 7.0. Results: The mean age of the study population was 23.4 years. Young adults were the most common population using substances. Opioids (25.3%) were the predominantly used drug, although polysubstance formed the majority at 48.8%. More than 60% of patients were intravenous drug users. Peer pressure and curiosity were the most common specified reasons for initiation of substance (47.4% and 12.2%, respectively). More than 50% of cases had past failed attempts at abstinence. Craving was still the most common reason for relapse (42.8%). Conclusion: The present study results reiterate the presence of a hazardous pattern of substance use in the young population. The intravenous drug use and the secondary infections arising out of that are alarming. The results encourage the conduct of large scale community-based studies and robust policy making and law enforcement.

Clinico-radiological Spectrum of COVID-19 Associated Rhino-cerebral Mucormycosis: A Retrospective Cohort Study from a Tertiary Care Hospital

Introduction: Rhino-cerebral Mucormycosis (RCM), in the pre-Coronavirus Disease-2019 (COVID-19) era, was thought to be solely associated with an immunocompromised state. However, an unforeseen outbreak in the number of mucormycosis cases was seen with the increase in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Aim: To study and investigate the clinical characteristics, imaging findings, associated risk factors, and clinical outcomes in COVID-19 associated mucormycosis. Materials and Methods: A retrospective cohort study was conducted comprising 480 cases of COVID-19 associated mucormycosis who presented to the institution between April 2020 and September 2020. The clinical and radiological data were studied and analysed. Results: Out of a total of 480 cases, 443 (92.29%) were found to suffering from diabetes mellitus and 392 patients (81.66%) had a history of steroids intake in the studied population. Facial or per orbital swelling followed by pain were the most frequent presenting complaints found in 188 (39.16%) and 162 (33.75%) patients, respectively. Nasal septum and middle turbinate were the most common sites of disease involvement on nasal endoscopic examination. On radiological imaging, maxillary (438; 91.25%) was the most commonly involved sinus followed by ethmoids (395; 82.29%). Premaxillary/retroantral fat and orbits were the most common sites of extra sinonasal spread of infection found in 278 (57.91%) and 244 (50.83%) patients, respectively. About 238 (49.58%) patients showed bony erosion and dehiscence. Intracranial complications were seen in 73 (15.21%) patients. Glycated Haemoglobin (HbA1c) levels showed significant value with higher disease staging. Oxygen supplementation was frequently associated with extrasinus spread of infection. A total of 44 (9.17%) patients succumbed to death despite aggressive antifungal treatment. Conclusion: COVID-19 associated RCM shows frequent and extensive spread to extrasinus regions, especially with uncontrolled diabetes mellitus, steroid administration, and oxygen supplementation. High clinical suspicion, early imaging, and prompt institution of antifungal therapy can aid in reducing mortality rate.

Breast Self-examination Practice among Medical Postgraduate Female Students of Southern Odisha: A Cross-sectional Study

Durga Madhab Satapathy, Sangeeta Das, Nivedita Karmee, Priyasha Panda

Introduction: Breast cancer is on the rise among females in India. Breast Self-Examination (BSE) is an easy to learn, self-monitoring screening modality which can be done in utmost privacy. A proportionate increase in incidence of breast cancer is now reported among urban educated females. Even doctors neglect their own health and are the at-risk population for Non Communicable Diseases (NCDs). Aim: To assess the knowledge, attitude and practice of postgraduates on BSE. Materials and Methods: This was a web-based cross-sectional analytical study conducted between August 2021-October 2021 at M.K.C.G. Medical College, Berhampur, Odisha, India. Study population included 100 female postgraduate students. A predesigned structured questionnaire was prepared by thorough review of literature and was validated by experts. Data was collected on knowledge, attitude and practice of BSE from the study participants using Google form. Scoring was done and correlation was found out between the parameters. Chi-square test and the Fischers-exact test was used for statistical analysis. Results: About 82 respondents completed the form. About 66 (80.48%) were in age group of 25-29 years, 7 (8.53%) had family history of breast cancer, 8 (9.75%) had discovered abnormality while practicing BSE. The median scores in knowledge of breast cancer and BSE was 36 and 17 respectively. The median scores of attitude and practice were 42 and 13 each. Spearman’s rank correlation between knowledge and attitude was positively correlated (r=0.324, p=0.003), attitude and practice was positively correlated (r=0.317, p=0.004) and knowledge and practice was not correlated (r=0.173, p=0.120). No significant difference in practice was found for participants with family history of breast cancer (p=0.353) and personal history of breast abnormality (p=0.672) and those who had no history. However a significant association was found between knowledge on frequency of BSE and monthly practice of BSE (p=0.003). Conclusion: In this study 50% of the participants did not know about the age of starting BSE as 20 years. All the steps were not followed by those who performed BSE. The most common reason for not practicing BSE was lack of time. Knowledge-practice gaps exist among the future professionals.

Predictive Factors for Preoperative Diagnosis and Management of Cystic Liver Lesions: A Six Years Single Centre Experience

Introduction: Surgical management differs for different cystic lesions of liver. Various clinical, biochemical and radiological features are specific to a particular cystic liver lesion pathology and it’s associated complications. Preoperative diagnosis helps to select appropriate surgical approach and tailoring appropriate management. Aim: To evaluate the clinical, biochemical, radiological predictive factors to differentiate between hydatid diseases, simple cyst of liver and biliary cystadenoma. Also to evaluate appropriate management for hydatid disease with cystobiliary communication. Materials and Methods: A retrospective study was conducted at Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India. Data were collected from 65 patients including 44 patients of hydatid disease, 13 patients of simple cyst, and 8 patients of biliary cystadenoma using a maintained database from January 2014 to December 2019 with a follow-up period up to December 2020 (mean follow-up of 47.06±24.37 months). Various parameters like presence of cholangitis, deranged liver function test, number of cystic lesion, presence of calcification, presence of septation with or without enhancement were assessed. Data were statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. Results: There were 44 (67.69%) females and 21 (32.31%) males in this study with mean age of 50.44±12.23 years. Though multiseptation was associated with 27 (61.36%) of hydatid cysts and 1 (7.69%) of atypical simple cyst, it was more specifically present in biliary cystadenoma 8 (100%). Presence of daughter cyst (n=24, 54.55%) in hydatid disease and multilobulated appearance (n=5, 62.5%) in biliary cystadenoma were strong predictors of diagnosis. Radical surgery was associated with significantly less postoperative bile leak than conservative surgery in patients of hydatid disease with cystobiliary communication. Conclusion: Predictive factors can help to make preoperative diagnosis correctly. Radical surgery reduces postoperative bile leak in patients of hydatid disease with cystobiliary communication.

Public Awareness of Stroke Recognition, Risk factors and Access to Appropriate Treatment: A Hospital-based Cross-sectional Survey from a Tertiary Referral Centre in Southern India

S Deepthi, K Anoop, K Rammohan, B Srikumar

Introduction : Despite recent advances in treatment, awareness regarding stroke remains low. Only a fraction of eligible patients reach hospital within the window period for thrombolysis. Aim: To assess the public awareness of stroke symptoms, risk factors and access to treatment which will help to design effective and targeted stroke education programs. Materials and Methods: This cross-sectional hospital-based survey was conducted in the neurology outpatient department in Government Medical College, Trivandrum, Kerala, India from October 2020 to March 2021. Adult relatives of patients, attending the neurology outpatient department, were included in the study. Relatives of patients who had current or previous stroke and individuals who had a personal history of stroke were excluded. Participants had to fill out a structured study questionnaire adapted to local socio-cultural practices assessing awareness of organ involved in stroke, warning symptoms, risk factors and treatment seeking behaviour. Descriptive analysis, Chi-square tests and logistic regression were used to analyse awareness about organ involved in stroke, signs and symptoms, risk factors and treatment for stroke. Results: A total of 700 completed questionnaires were collected from the respondents. More than 80% of respondents belonged to the low income group and were from rural areas. Overall, 43.3% of the subjects could not identify the brain as the organ identified in stroke, and 28.9% were able to identify only one symptom of stroke. The most common warning symptom of stroke recognised was difficulty in speaking (59.4%). Hypertension was the most common risk factor for stroke identified (77.7%). Total 31.6% were able to identify only one risk factor for stroke, and 82.4% patients were aware that stroke requires immediate treatment with majority preferring to consult the nearest doctor. Only 15.9% of respondents were aware of the stroke helpline. Only 55.9% of respondents were aware about ambulance services in their region. Conclusion: This study demonstrated low awareness regarding common risk factors like diabetes and smoking on increasing stroke risk. Knowledge regarding stroke helplines, ambulance services and need to rush to hospital emergency department was low. Public stroke education programs should focus on reducing the knowledge gap in these areas.

Clinical Profile and Outcome Analysis among Patients with Urosepsis at a Tertiary Care Centre: A Retrospective Cohort Study

P Puvai Murugan, A Bhalaguru Iyyan

Introduction: Urosepsis is a systemic reaction of the body to a bacterial infection of the urogenital organs with the risk of life-threatening complications including septic shock. Aim: To assess the profile of patients with urosepsis and to analyse outcomes in patient management at a tertiary care centre. Materials and Methods: A retrospective cohort, single-centre study was conducted at PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India, between January 2015 and December 2019 including patients of either sex, aged ≥20 to <80 years, with a confirmed diagnosis of urosepsis. Clinical report forms were reviewed to obtain patient characteristics (including age, sex, co-morbid conditions and clinical data). Blood, pus, urine culture data were evaluated to identify the source of infection. Details of upper and lower urinary tract symptoms and their imaging and urological intervention done were also recorded. Analysis of the data was done using descriptive statistics. Results: A total of 582 patients with urosepsis were included in this study. The majority of patients belonged to the age group of 41-60 years (n=315). The most frequent radiological diagnosis was infected hydronephrosis with calculus disease (n=237). The associated co-morbid conditions contributing to the perpetuation of urosepsis were Type II Diabetes Mellitus (T2DM), systemic hypertension, chronic kidney disease, decompensated liver disease, neurological disease, and coronary artery disease. Escherichia coli was the most commonly observed uropathogen (57.90%) in this study. Bilateral Double-J (DJ) stenting was usually preferred in patients with infected hydronephrosis and acute pyelonephritis (n=85, 76.58%). The insertion of a suprapubic catheter was more frequent among patients with obstructive lower urinary tract symptoms. Multivariate analysis showed that urosepsis with emphysematous pyelonephritis, uncontrolled diabetes, and persistent hypotension inspite of inotropic agents had a prolonged intensive care unit and higher mortality rate. Conclusion: Renal salvage is achievable in majority of cases with early surgical intervention, either DJ stenting or percutaneous nephrostomy. Suprapubic catheterisation is indicated in urosepsis patients with predominant lower urinary tract symptoms. An early diagnosis and an appropriate treatment can reduce the costs of hospitalisation, morbidity, mortality and better outcome.

Association of Abo Blood Groups and Rh Factor with Sagittal and Vertical Skeletal Malocclusion- An Observational Study

Introduction: Various studies have proved the association between several disease including dental crowding, malocclusion and craniofacial deformities with blood group. Certain skeletal problems in sagittal plane are heritable and the skeletal muscle volume and strength, a heritable trait varies with different facial patterns. Aim: To evaluate the association between ABO blood groups and Rhesus (Rh) factor with skeletal malocclusions in sagittal and vertical plane. Materials and Methods: An observational study was conducted with a sample of 240 participants who reported to Department of Orthodontics in SRM Dental College and Hospital, Chennai, Tamil Nadu, India seeking orthodontic treatment over a period of two years from September 2018 to December 2020. Participants were assessed for skeletal malocclusion in sagittal and vertical plane and for their ABO and Rh blood grouping. Chi-square test was used for determining the association between sagittal and vertical skeletal malocclusion with ABO and Rh blood grouping. The association of the gender and the malocclusion was determined as a secondary outcome of the study. Results: A total of 240 participants (mean age: 19.81±5.95 years; 95 males and 145 females) were observed and data was analysed. A significant association was found between Rh positive blood group and skeletal class II malocclusion with high angle (p-value 0.025). Skeletal class I malocclusion with high angle was found to be associated significantly with O+ group (p-value <0.001). The female gender was found to be associated significantly with sagittal skeletal class II malocclusion with high angle (p-value 0.049). Conclusion: There is an association between the ABO blood groups and skeletal sagittal malocclusion and vertical skeletal pattern. Skeletal class II malocclusion with high angle pattern was associated significantly with Rh+ blood group and class I skeletal malocclusion with high angle pattern was significantly associated with O+ blood group.

Efficacy of Sodium Fluoride as an Anticoagulant in the Estimation of Glycated Haemoglobin in Diabetic Patients: An Alternative to EDTA

Introduction: Vacutainer used for collecting blood sample for plasma glucose estimation contains sodium fluoride (NaF) as an additive and for Glycated Haemoglobin (HbA1c) an Ethylenediamine Tetraacetic Acid (EDTA) tube. This necessitates additional blood to be collected for testing from the same patient at same period of time. Aim: To evaluate difference in the HbA1c values in blood samples collected in EDTA and NaF coated vacutainers. Materials and Methods: This cross-sectional study was conducted at Biochemistry section of central laboratory, Father Muller Medical College and Hospital, Mangalore, Karnataka, India, for the duration of two months (June to July 2018). The samples drawn for fasting plasma glucose estimation in NaF vacutainer and for HbA1c estimation in EDTA sample of same patients was included in present study. The data were entered in the statistical software Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Samples from 140 patients whose blood had been drawn for fasting plasma glucose levels and estimation of HbA1c in which 80 subjects were males and 60 females with mean age of 54.4±13.6 years. There were no significant changes in the mean levels of HbA1c in EDTA and NaF tubes (8.61±1.93 and 8.64±1.93 respectively). Conclusion: Current results exclude the absolute necessity for the blood collection in EDTA vacutainers for HbA1c estimation.

Comparison of Haemodynamic Response to Endotracheal Intubation with Videolaryngoscopy and Direct Laryngoscopy in Hypertensive Patients- A Randomised Clinical Trial

Anasuya Hegde, Deepak Revadihal Malikarjun, Kumaresan Chinnathambi

Introduction: Cardiovascular responses to direct laryngoscopy and endotracheal intubation have been well documented and are caused by noxious stimuli. A videolaryngoscope facilitates visualisation of the vocal cords with minimal stretch on the airways. Aim: To compare the haemodynamic responses to endotracheal intubation with videolaryngoscopy and direct laryngoscopy in hypertensive patients. Materials and Methods: A randomised clinical trial conducted in 90 hypertensive patients. The patients were divided into two groups- group D in whom conventional (Macintosh) direct laryngoscopy was used and group V in whom (C-MAC) videolaryngoscopy was used. Haemodynamic parameters were monitored postintubation and to also study the number of intubation attempts, total time taken for intubation, assessment of Cormack-Lehane grade (C-L grade) between C-MAC videolaryngoscopy and direct laryngoscopy. Between the group analyses done using student’s t-test. Multiple paired t-test was used for within group data analysis. Chi-square was used to compare categorical data between the two groups. The p<0.05 will be considered statistically significant. Results: The mean age of the participants in group D and group V was 51±8 and 52±7, respectively. There was no significant difference in haemodynamic response to intubation between both videolaryngoscopy and direct laryngoscopy groups after intubation (p>0.05). Glottic visualisation was significantly better in videolaryngoscopy group using C-L grade (p-value=0.0313). There was no significant difference between the two groups with respect total time taken for laryngoscopy (p-value=0.072). Conclusion: Videolaryngocopy does not have any added advantage over direct laryngoscopy as per haemodynamic response is considered. Though the visualisation of the glottis is better with videolaryngoscope, duration of laryngoscopy does not differ from routine laryngoscopy.

Predictors of Inpatient Treatment Completion and Non Completion in Patients with Alcohol Dependence from a Tertiary Care Centre in Central India

Nishant Patel, Vijay Niranjan, Pali Rastogi, Rashmi Pal, VS Pal

Introduction: In India, millions of individuals are affected by alcohol dependence as evident by a recent national survey. Apart from the serious health consequences, the use of alcohol brings significant social and economic losses to individuals and society as well. The early treatment discontinuation for deaddiction of alcohol is a major challenge, therefore identification of predictors of treatment completion could be of use to reorganize treatment programs effectively. Aim: To study the predictors of inpatient treatment completion of subjects with alcohol dependence in the deaddiction ward of a tertiary care centre and to compare the socio-demographic and clinical variables among completers and non completers. Materials and Methods: The cross-sectional study was conducted at the Department of Psychiatry, MGM Medical College Indore, India. The convenient sample of 100 patients was recruited in a period of one year. Selected inpatients were assessed through semi-structured proforma consisting of sociodemographic variables, clinical variables, and clinical rating scales i.e., Severity of Alcohol Dependence Questionnaire (SADQ), Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar), and Readiness to Change Questionnaire (RCQ). CIWA and SADQ scores were compared with student’s t-test and RCQ categories were compared with Chi-square test. To identify the predictors of treatment completion, binary logistic regression analysis was used. Results: The mean age of participants was 36.5 years. All patients were male. The majority of the enrolled participants were urban 80 (80%) and 20 (20%) were rural. Binary logistic regression was performed to identify the predictors of treatment completion and non completion, so the treatment completers/ non completers were taken as dependent variables and other socio-demographic/clinical variables as independent variables. The analysis showed that the education (p=0.01), occupation (p=0.01), history of substance in family (p=0.037) and complicated withdrawal (p=0.024) were the significant predictors in the study. Conclusion: The current study concludes that the education, occupation, history of substance in family, initiation of substance in younger age and complicated withdrawal, were the significant predictors of treatment completion in context of alcohol dependence. It was found that the stated readiness to change and treatment completion did not display a significantly positive correlation.

Knowledge Attitude and Practice among Mothers towards Childhood Obesity: A Cross-sectional Study

Introduction: Obesity is on the increasing trend among children, which leads to many co-morbidities. Obesity which was once a health problem of developed countries has now swept developing countries like India. As the home environment has a powerful influence on the health of a child it is very essential to intervene early in childhood and adolescence to prevent obesity/overweight. Aim: To assess the Knowledge Attitude and Practice (KAP) among mothers regarding obesity in children. Materials and Methods: This was a cross-sectional descriptive study conducted from October 2019 to March 2020. The sample size included 220 mothers with children aged between 6 to 14 years, who have attended the Paediatric outpatient department, Sree Balaji Medical College and Hospital in Tamil Nadu, India. After obtaining ethical clearance from the Institutional ethics committee, a predesigned questionnaire was used to collect the socio-demographic variables which included mother’s education and occupation, residence, family income, and the total number of family members, and for assessing KAP among mothers. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS, version 22.0). Results: The prevalence of childhood overweight and obesity was 52 (23.63%), with overweight representing 23 (10.45%) and obesity 29 (13.18%). There was a statistical significance difference when comparing mother’s knowledge of children with overweight/obesity versus normal weight regarding physical inactivity (p=0.01) and eating unhealthy foods (p=0.01), an attitude that a child being obese was not a problem (p=0.03), the practice of mothers who allowed seeing television while eating (p=0.001), not restricting media usage (p=0.01), not allowing children to play outdoors every day (p=0.001), and allowed children to eat junk foods (p=0.001). Conclusion: Overweight and obesity were significant in children whose mothers were unaware of the risk factors like eating unhealthy foods and physical inactivity. Health education and interventional programs have to be planned to educate mothers as they play a major role in preventing obesity in children.

Incidence of Postoperative Delirium and its Association with Intraoperative Blood Pressure Fluctuation in Elderly undergoing Oncosurgery: A Prospective Cohort Study

Introduction: Postoperative Delirium (POD) is one of the most common complications in geriatric surgical patients. The POD has immense implication because it can initiate a cascade of deleterious events leading to functional decline, reduced cognitive function, prolonged hospitalisation, and death. The risk factors for POD include increased age, cognitive, visual or sensory impairment, functional dependence, infection, and electrolyte abnormalities. Published literature on POD in patients aged >60 years undergoing oncosurgeries are few. According to the American Geriatric Society, evidence for recommendation of intraoperative risk factors is lacking. The relation between intraoperative haemodynamics and postoperative pain with POD is controversial, as studies provide differences in evidence. Hence this relation needs to be studied further. Aim: To find the incidence of POD in patients >60 years of age undergoing oncosurgery, and its association with intraoperative hypotension and blood pressure fluctuations. The secondary objective was to assess the relation of POD with postoperative pain. Materials and Methods: The present study was prospective cohort study which was carried on 50 patients aged >60 years undergoing cancer surgery. Intraoperative hypotension and blood pressure fluctuations were measured based on predefined criteria. Postoperative pain and total opioid consumption were also noted. Delirium was assessed with the short Confusion Assessment Method (short CAM), on the first three postoperative days. The association between hypotension and intraoperative blood pressure fluctuations with POD were analysed with Fisher exact test and Mann-Whitney U test. Association of pain scores and total dose of opioid with POD was performed using Student’s t-test and Mann-Whitney U test. Results: The mean age of the study population was 69.5±2.8 years. The mean preoperative Addenbrook’s Cognitive Examination (ACE) score was 83.78. The incidence of POD was 22%. There was a significant association between intraoperative blood pressure fluctuation and POD. The mean BP variance ranged from 126.89 to 111.13 mmHg. Increased age and more co-morbidities ≥3 (present in 58%) showed an association with POD. Conclusion: The incidence of POD was high (22%) among the elderly requiring oncosurgery. Intraoperative blood pressure fluctuation as well as hypotension was associated with increased risk of POD. Hence in elderly patients, tight blood pressure control is advisable during surgery.

Management of Unicameral Bone Cyst with Pathological Fracture of Proximal Humerus with Curettage, Fibular Grafting and Plate Osteosynthesis: A Retrospective Study

Introduction: Unicameral Bone Cysts (UBC) are benign fluid filled lesions at metaphyseal regions of long bones of immature skeleton. Several treatment options exist but none have proven to be the best. Curettage helps to remove the cyst membrane responsible for lysis of bone and fibular grafting with plate osteosynthesis which gives adequate stability to the fracture and promotes healing of the UBC of proximal humerus with pathological fracture. Aim: To assess functional outcome, pain relief, healing of the cyst and recurrence of lesion with curettage and fibular bone grafting with proximal humerus plating in UBC of proximal humerus with pathological fracture. Materials and Methods: This was a retrospective study done using the medical records of 10 patients with UBC of proximal humerus with pathological fracture treated with curettage and fibular grafting and plate osteosynthesis at Nizams Institute of Medical Sciences, Hyderabad, Telangana, India, between January 2018 to December 2021. Patients were studied for functional outcome by Musculoskeletal Tumour Society (MSTS) score before surgery and one year after surgery. Healing of the cysts was evaluated by using a modified classification system by Chang et al., and pain relief was evaluated with pre and postoperative Visual Analogue Scale (VAS). Paired t-tests were used to compare the MSTS scores and VAS scores. Results: Mean age of the study group was 15.6±2.3 years with range of 11-19 years. The MSTS score increased significantly after surgery from 11.6±2.06 to 27.3±1.6, p<0.0001. Cysts had healed completely in seven cases, partially in three cases and recurrence was seen in three cases at the end of one year. Mean VAS scores decreased significantly from 7.60±0.97 to 1.40±0.97 after the surgery. Among three cases with recurrence of UBC, two cases were diagnosed at eight months and one case at 12 months after surgery. Conclusion: Treatment of UBC of proximal humerus with pathological fracture by curettage, fibular grafting and plate osteosynthesis gives good functional outcome and cyst healing rate. It is a safe and effective procedure without any complications.

Multidetector Computed Tomography Angiographic Evaluation of Anatomical Variations in Popliteal Artery Branching: A Retrospective Study from Northern India

Introduction: The popliteal artery branching pattern has multiple variations which have implications in the outcomes of various surgical procedures. Amongst cadaveric, Computed Tomography (CT) angiographic and Digital Subtraction Angiographic (DSA) studies, Multidetector Computed Tomography (MDCT) Angiography provides a comprehensive, quick and efficient evaluation of the popliteal arterial anatomy along with surrounding structures and related pathologies of the vascular and non-vascular structures. Aim: To evaluate the patterns of popliteal artery division on MDCT angiography of lower limb in patients presenting to a tertiary medical institute in Northern India. Materials and Methods: This retrospective descriptive study was conducted in the Department of Radiodiagnosis at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India (tertiary care medical institute of Northern India). Patients presenting for a period of one year from April 2021 to March 2022 were included in the study. The MDCT angiographic findings of 152 patients who were evaluated for various illnesses, including peripheral vascular disease, popliteal arterial aneurysms, and trauma were analysed. The branching pattern of popliteal artery was evaluated according to the classification system provided by Kim DU et al. Morphometric analysis of popliteal artery, including diameter was also done. The imaging based data was collected and analysed by two radiologists. Chi-square test was used for statistical analysis. Results: The mean age of the patients was 54.18 years with male predominance of 110 (72.37%). Amongst the 304 limbs available for evaluation, the data from six limbs could not be assessed due to atherosclerotic blockage in four patients, extensive calcification in one patient and amputation in one patient. Hence, 298 limbs were evaluated on MDCT angiography for the pattern of branching of popliteal artery. Type IA was the most common pattern of division seen in 268 limbs (89.93%). Out of 298, 30 limbs showed variant anatomy, with unilateral variation in 18 patients and bilateral variation in six patients. Type III pattern (n=12, 4.03%) was more common than Type II pattern (n=11, 3.6%) in the study group. Conclusion: The knowledge of variations of popliteal arterial division and meticulous evaluation is essential to provide a successful roadmap for therapeutic measures.

Effect of Ageing, Staining and Polishing on the Colour Stability of a Single, a Group Shade and Nano Fill Dental Composite: An In-vitro Study

Fatin A Hasanain

Introduction: With the increase in aesthetic requirements, more people are requesting tooth coloured fillings. An anterior restoration is deemed unacceptable if its colour changes significantly. Aim: To assess the colour stability of a single shade, a group shade and a nano fill dental resin composite which comes in multiple shades. Materials and Methods: This in-vitro study was conducted in the month of August 2021 at the Advanced Technology Dental Research Laboratory at the King Abdul Aziz University, Jeddah, Western region, Saudi Arabia. Three composites were tested; a single shade (Omnichroma), a group shade (Optishade Light (OL) and Optishade Medium (OM)) and a conventional nano fill (Z350) 40 cylindrical discs (10 mm in diameter and 2 mm in depth) were fabricated in total. Each material and shade to be tested had 10 samples per group (n=10). The materials were aged in a thermocycler for 5000 cycles then stained with either green tea or coffee for six days. Upon completion of the staining protocol, they were then polished with soflex diamond polishing system. Colour measurements were taken at each stage, calculated and compared. Mixed model repeated Analysis Of Variance (ANOVA) was performed to determine significance of the colour change (?E₀₀) between materials and treatments and Bonferroni test was used for multiple comparison between groups. Results: The effect of ageing varied according to individual material; Z350 had lower ?E₀₀ when compared to other materials. After staining with tea, it was found that Z350 and Omnichroma exhibited a significant change (p<0.05) in ?E₀₀ when compared to OL. Polishing improved the ?E₀₀ in all the materials. All green tea-stained materials with the exception of Omnichroma returned to a clinically acceptable E00 after polishing. After polishing coffee stained samples, OL and OM remained above the clinically acceptable threshold while Z350 and omnichroma were returned to a clinically acceptable level. Conclusion: All the materials showed a change in ?E₀₀ after ageing, with OM and Z350 being the only materials to exhibit a clinically acceptable change. While polishing decreased ?E₀₀ in all the materials, it did not return them all to a clinically acceptable level. Thus, polishing helps improve the appearance of stained restorations but may not be enough to completely remove stains, even in newly introduced direct aesthetic dental materials.

Relationship between Body Mass Index and Physical Fitness among Medical Students of Gujarat, India

Shaily Parekh, Neha Mukkamala, Lata Parmar, Purva Patel

Introduction: Body Mass Index (BMI) is commonly used as a marker for adiposity. Physical fitness refers to a series of physical characteristics that are directly related to the ability of an individual to perform physical activity or exercise. Physical fitness tests measure the efficiency of muscular and cardiovascular systems. Aim: To assess the relationship between BMI and physical fitness in college students of a medical university at Gujarat, India. Materials and Methods: This was an observational study, conducted in the Department of Physiotherapy at Sumandeep Vidyapeeth, India. The study was conducted from September 2019 to January 2020 and included 180 participants of which 105 were females and 75 were males aged between 18 to 30 years. Height and weight were measured and physical fitness tests i.e. push-up test for upper body strength, sit-up test for abdominal strength, queens college step test for cardiorespiratory endurance were performed. Kolmogorov-Smirnov test of normality showed the data to be normally distributed. Association between variables was seen using Chi-square test and correlation was found using Pearson’s coefficient. A p-value <0.05 was considered statistically significant. Results: Out of total 180 students, 26.1% people were underweight and 32.2% were of normal weight. The mean age of the participants was 19.7±1.99 years and mean BMI was 21.9±5.14 kg/m². There was no statistically significant association between BMI and abdominal strength (p-value=0.64), BMI and upper body strength (p-value=0.75) and BMI and cardiorespiratory endurance (p-value=0.47). Males performed better than females in all the tests although it was statistically significant (p-value=0.001) only for the sit-up test and not for push-up test (p-value=0.16) and queens college step test (p-value=0.47). Conclusion: Performances on fitness tests varied with weight status. Higher BMI was generally associated with lower physical fitness. There is a great need to organise fitness programme in colleges on large scale to overcome the health problems in young age.

Application of Principal Component Analysis in Dealing with Multicollinearity in Modelling Clinical Data

Introduction: One of the stringent assumptions about covariates in the Cox hazard and Logistic regression modelling is that they should be independent. Incorporating correlated covariates as such into the model might distort the precision of the estimates due to multicollinearity. One way to deal with multicollinearity is by using Principal Component Analysis (PCA) technique. Aim: To demonstrate the application of PCA in dealing with correlated covariates while modelling time to event and case-control study data. Materials and Methods: This study was conducted at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from February 2021 to January 2022. Two datasets were used for the demonstration i.e., data relates to a time to event outcome and a case-control study with binary outcome in which lipids were the correlated covariates. Three sets of Cox regression models were used to demonstrate change in hazard ratios with 95% Confidence Intervals (CI) for evaluating the effect of intervention at a different time of lipid measurement. Model I has evaluated treatment/Body Mass Index (BMI) effect on the outcome by ignoring the effect of lipid parameters. Model II has evaluated treatment/BMI effect on the outcome by incorporating lipid variables but ignoring multicollinearity. Model III has evaluated treatment/ BMI effect on the outcome by incorporating lipid variables through principal component analysis and thus adjusting for multicollinearity. Similarly, a logistic regression model was performed by using the same three sets of models to evaluate the effect of exposure (BMI). The comparability of lipids between the two groups for both datasets was tested using Hotelling’s T-squared statistic. Results: The lipids measured at 12^th, 24^th and 36^th months between the two groups in the first data set as well as between cases and controls in the second data set were statistically significant. In the first dataset, at baseline, the Hazard Ratio’s (HR’s) were statistically similar irrespective of the models used; while decreasing successively with narrowing 95% CI’s as moving from model I to model III for the lipid measured at 12^th, 24^th and 36^th months. Further, at 24^th and 36^th months, the HR in model-III found to be significant. In the second data set, the Odds Ratio (OR) were significant for all the three models and it was almost similar for model I and II but in model III it was elevated. Conclusion: The multicollinearity issue should be properly addressed before including correlated covariates in the Cox regression hazard and Logistic regression model. The PCA technique would be a favourable method.

Utility of Intracranial Haemorrhage Score in Non Traumatic Intracranial Haemorrhage- A Longitudinal Study

Ashique Hamza, KG Sajeeth Kumar, Danish Ekkalayil

Introduction: Intracranial Haemorrhage (ICH) is any bleeding that occurs inside the intracranial vault, which includes the brain parenchyma and the surrounding meningeal spaces. It is a devastating illness associated with significant morbidity and mortality. The ICH score was developed in 2001 as a predictive tool for mortality. It is a six point score based on five components i.e, age, ICH volume, Intraventricular Haemorrhage (IVH), site of bleed and Glasgow Coma Scale (GCS). Aim: To study the utility of ICH score for predicting 30 day mortality and morbidity and also to determine if ICH calculated 24 hours after admission is a better indicator of mortality. Materials and Methods: This was a longitudinal observational study conducted among 235 patients, with spontaneous ICH, who were admitted in the Department of General Medicine, Government Medical College, Kozhikode, Kerala, India, from January 2019 to December 2019. Data collected included risk factors, clinical features and Glasgow Coma Scale (GCS), and Computed Tomography (CT) findings. The ICH score was calculated at the time of presentation and after 24 hours. Functional status of the patients were assessed using modified Rankin Scale (mRS) on day 30 of the illness. Chi-square test was used to analyse categorical variables. Odds ratio was calculated. Relation between ICH score and mRS on day 30 was analysed using logistic regression. A p-value <0.05 was taken as statistically significant. Results: The mean age of the study population was 61.52±12.67 years. Overall, 136 patients were males (57.9%). Prevalence of hypertension, diabetes mellitus, dyslipidemia, and alcohol abuse were 85.5%, 34%, 31.9% and 17%, respectively. There were 60 deaths (25.5%). All components of ICH score i.e, age (OR=5.39), GCS (OR=488.65), ICH volume (OR=5.519), IVH (OR=29.08), and site of ICH (OR=18.32) as well as newer parameters, like, the presence of hydrocephalus (OR=18.32), midline shift (OR=7.49) and anisocoria (OR=12.25) were significant predictors of mortality (p-value <0.05). Hemiplegia (177, 75.3%) was the most common, and seizure (24, 10.2%) was the least common presentation. Mortality rate was higher in those with higher ICH scores (100% for scores 4 and 5, and 79.3% for score 3). Receiver Operating Characteristic (ROC) curve with ICH score of 3 as cut-off predicted outcome with an accuracy of 94.9% (90% sensitivity and 96.6% specificity). Conclusion: Intracranial haemorrhage score is a practical tool in predicting patient outcome in patients with ICH. The ICH score calculated after 24 hours was observed not to be superior to that calculated at the time of admission.

Brain Natriuretic Peptide Levels in Hypertensive Heart Failure Patients with and without Diabetes Mellitus: A Cross-sectional Study

Introduction: Heart Failure (HF) is a major disorder causing mortality and morbidity in the elderly population. Brain Natriuretic Peptide (BNP) is considered as the gold standard biomarker for diagnosis of HF. Aim: To find the association of plasma BNP levels with heart failure in hypertensive patients with and without diabetes mellitus. Materials and Methods: This cross-sectional study consisted of 35 hypertensive heart failure patients who attended the Outpatient General Medicine Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, between March 2020 to December 2020. The patients who belonged to class IV heart failure of the New York heart association were included. Total 35 HF patients were divided into two groups. Group 1 included 10 patients with hypertensive heart failure without diabetes mellitus. Group 2 included 25 patients with hypertensive heart failure with diabetes mellitus. Parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), waist to hip ratio, Body Mass Index (BMI), Ejection Fraction (EF), transmitral filling velocities (E/A ratio), Left Ventricular Posterior Wall Thickness (LVPW), Left Ventricular Internal Dimension in diastole (LVIDd) and BNP level, random plasma glucose and HbA1c % were assessed in all the patients. Student’s t-test and Mann-Whitney U test were used to statistically analyze the data and p-value ≤ 0.05 was considered statistically significant. Results: Mean age of patients were 65.80±12.72 years in group 1 and 66.56±11.72 years in group 2. All patients in group 1 and most of the patients in group 2 (15,42%) were males. All the patients were in the obese category (BMI>27 kg/m²). Serum BNP level was 1365 (243-3680) ng/L in group 1 and 691 (44.7-4261) ng/L in group 2, but this difference was not statistically significant (p-value=0.23). Echocardiography showed significant differences in left ventricular internal dimension in diastole, left ventricular posterior wall thickness and E/A ratio-integrated between hypertensives and hypertensives with diabetes mellitus. Serum BNP had a significant positive correlation with systolic blood pressure (r=0.33, p-value=0.05). There were highly significant differences in random plasma glucose and glycated haemoglobin between the groups. Conclusion: Plasma BNP levels were associated with systolic blood pressure in heart failure patients with hypertension. The significance of association is the same in hypertensives with diabetes mellitus. Thus, BNP as a biomarker plays a major role in the prediction of heart failure. But BNP could not differentiate whether the heart failure was due to hypertension alone or due to associated metabolic conditions.

High Tibial Osteotomy versus Proximal Fibular Osteotomy in Medial Compartmental Osteoarthritis of Knee: A Longitudinal Study

Tanmay Datta, Kunal Mondal, Avijit Basak, Pinaki Das

Introduction: Osteoarthritis (OA) is a chronic degenerative intra-articular disorder of cartilage and bone. Knee joint is most commonly involved due to its pivotal role in weight bearing as it is constantly exposed to wear and tear. Osteotomy procedures can achieve normal alignment of the weight bearing axis of the lower limbs. Aim: To evaluate and compare the functional outcome of High Tibial Osteotomy (HTO) and Proximal Fibular Osteotomy (PFO) in medial compartmental osteoarthritis of knee joint. Materials and Methods: This prospective longitudinal study was conducted in a tertiary healthcare centre, IPGMER and SSKMH, Kolkata, West Bengal, India from October 2019 to November 2021 for a duration of 26 months, in which 40 osteotomies were performed around the knee. Considering the inclusion and exclusion criteria 20 proximal fibular osteotomies and 20 high tibial osteotomies were operated avoiding the patients with advanced stage or tricompartmental OA. The scoring system considered for evaluation of the functional outcome was Oxford Knee Score (OKS) and Visual Analouge Scale (VAS) Score. The analysis was done through paired t-test with determining of p-value where value ≤0.05 was considered as statistically significant. Results: Majority of the patients in the present study were more than 45 years of age. The most frequent age group was 46-50 years followed by 51-55 years. The follow-up period was atleast 15 months where the OKS score was 39.35±3.51 and 41.20±4.50 with p-value of 0.1556 and VAS score was 5.50±1.10 and 3.80±1.10 with p-value of <0.0001 for PFO and HTO, respectively. Only two of the patients developed surgical site infection in both cases. Conclusion: In long term follow-up the final functional status of both treatment modalities were comparable although HTO was considered superior with significant improvement in pain relief perspective than PTO.

Clinical Pattern of Dermatological Conditions among Paediatric Patients Attending Outpatient Department in a Tertiary Care Centre of Rural Haryana, India

Rachna Verma, Mahesh Kumar, Usha Kataria, Vishwender Dahiya, Rupinder Kaur

Introduction: Skin disorders are common in paediatric age group and are associated with significant morbidity and stress. These differ from adults in clinical presentation, treatment and prognosis. Data on pattern of paediatric dermatoses can be used in planning healthcare programs. Aim: To study the clinical pattern and prevalence of various skin conditions in paediatric age group in tertiary care centre of rural Haryana, India. Materials and Methods: The present cross-sectional observational study was conducted in Bhagat Phool Singh Government Medical College (W) Khanpur Kalan, Sonepat, Haryana, India. A total of 1,003 consecutive Outpatient Department (OPD) patients upto age of 14 years presenting with skin conditions were included in study from a period May 2021 to January 2022. Various parameters like age, gender, pattern of distribution and type of skin lesions were assessed. Results were entered in excel sheet and frequency, percentages were calculated. Results: Out of 1,003 patients 56.53% were males and 43.47% were females. Maximum number (33.20%) of patients were in the age group of 1-5 years. Scabies (24.12%) was the most reported dermatological condition. Majority of dermatoses belonged to infections (32.40%) and infestations (24.83%) followed by eczemas (17.34%). Bacterial infections (15.25%) were most common infections followed by fungal (10.37%) and viral (6.78%) infections. Conclusion: In the present study, infections and infestations were most common dermatological conditions. This study provides insight about the pattern of various dermatoses among children in rural setting.

Impact of Fluoride Mouthwash on Nickel ion Release from Orthodontic Brackets: An In-vitro Study

Prem Vishva Natarajan, Navaneethan

Introduction: In Orthodontic patients, the orthodontic brackets and wires are exposed to the oral fluids for a considerable period of time. Patients use fluoridated mouthwashes to maintain oral hygiene and avoid white spot lesions on their teeth, which can cause release of nickel and chromium from the orthodontic brackets and thus may lead to allergic reactions and cytotoxicity. Aim: To evaluate the amount of nickel ion release from orthodontic brackets on exposure to different fluoride mouthwash. Materials and Methods: This in-vitro experimental study was conducted on seventy-five Orthodontic brackets which were divided into three groups of 25 each and immersed in artificial saliva (group A), Amflor mouthwash (group B) and Zero sense (group C) mouthwash respectively in separate beakers. The temperatures of the solutions in the beakers were maintained at 37 degrees to simulate oral temperatures. The 5 mL of the solutions were drawn from the three breakers at 1 hour, 6 hours, 12 hours and 24 hours respectively and the Nickel ion release from each solution was measured using Optima 5300 Dual View (DV) Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES). One-way Analysis of Variance (ANOVA) with a post hoc test was performed for comparison between the groups and at different time intervals. Results: The highest mean value of nickel release was noted in group C (0.32±0.020156 μg/mL) at the 24 hrs peak time followed by group B (0.24±0.014338 μg/mL). Statistical analysis showed a significant difference between the two experimental groups at all time periods except 1 hour (p-value <0.05). Conclusion: The amount of nickel ion release did not exceed the permissible limit in any of the study groups. However, it can be inferred that Amflor mouthwash can be prefered over Zero sense mouthwash for Orthodontic patients considering the lower nickel ion release.

Diagnostic Characteristics, Histopathological and Aromatase Gene Polymorphism (rs ID-2470152) in Endometriosis Patients: A Case-control Study

Kusum, Ashish, Sangeeta Rai, Sandeep Patel, Radha Chaube

Introduction: Endometriosis is an oestrogen dependent gynaecological disease, having endometrial glands and stromal tissues outside the intrauterine locations. The aetiology and pathogenesis of endometriosis is still unclear and it affects a large proportion of reproductive age women. It’s a heterogeneous disease and is found to be associated with hormonal and histological alterations. Studies indicate that mutation in aromatase (CYP19) gene is involved in a number of inflammatory diseases and CYP19 rs 2470152 site polymorphism may help to find its relation to susceptibility to endometriosis. Aim: To ascertain the relationship between changes in histological architecture in endometrial cells during endometriosis with circulating hormone levels, stress parameters and aromatase (CYP19A1) gene polymorphism {Single Nucleotide Polymorphism (SNP) rs 2470152}. Materials and Methods: This was a hospital-based case-control study where all patients and controls were recruited from the Outpatient Department (OPD) of the Sir Sunderlal Hospital, Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, India from March 2016-March 2019, and a total 300 subjects, 120 endometriosis patients and 180 healthy controls were studied. Histological studies were done by Haematoxylin and Eosin (H&E) staining in the endometrial tissues of patients and controls. Genotyping of SNP rs 2470152 was conducted by Polymerise Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method on genomic Deoxyribonucleic Acid (DNA) isolated from patients and control blood. Student’s t-test was used to compare the mean for the two independent groups. Allele and genotype distribution among groups were evaluated using the Chi-squared test and Fisher’s-Exact test. Results: In the present study, all the subjects were in the age group of 20-50+ years where 20-40 years age group were premenopausal and 40-50+ year were perimenopausal. Significant histological changes were observed in the endometrial glands and stroma of the endometrium tissues of the diseased women compared to the healthy controls. Various pathological entities were altered in circulating blood plasma of patients than to control. For polymorphism studies allele (T,C) (p=0.002*) and genotypic (TT, TC and TT) (p<0.001*) frequencies were found significantly variable in endometriosis patients in comparison of controls. Conclusion: The present study showed that endometrial tissue undergoes a lot of pathological changes during a disease and this may be due to significantly altered expression of aromatase gene leading to higher oestrogen level, causing this disease and its proliferation. Aromatase (CYP19A1) gene polymorphism was found significantly associated, and other factors may be affecting aromatase directly or indirectly in steroidogenic pathway.

Epidemiological and Histopathological Study of Renal Cell Carcinoma: A Retrospective Study

Amit Kumar, Khalid Mahmood, Rohit Upadhyay, Vijoy Kumar

Introduction: The incidence of Renal Cell Carcinomas (RCCs) has increased steadily and they have become the seventh most common histological type of cancer across the globe. Aim: To assess the profile of the patients of RCC with respect to age distribution, sex distribution, clinical presentation, site of tumour, risk factors, staging, histopathological examination, and operative complications. Materials and Methods: A retrospective descriptive study was conducted in Department of Urology, Indira Gandhi Institute of Sciences, Patna, Bihar, India, from January 2019 to June 2020, that included patients with RCC. The pathology specimens and reports of patients with RCC who underwent laparoscopic, open, cytoreductive, and partial nephrectomy were reviewed. Data related to demographic characteristics, site of tumour, risk factors, co-morbidities, clinical features, histopathology, tumour grade and stage, type of surgery, intra-and postoperative complications, and Fuhrman nuclear grading system were recorded. Results: Total 60 patients diagnosed with RCC were included in this study. Of these, majority of patients were men (n=44). Majority of patients belonged to the age group of ≤60 years (n=39). Smoking (n=30), hypertension (n=30), obesity (n=20), and occupational exposure (n=8) were major risk factors associated with RCC. Haematuria (n=36), flank pain (n=24), hematuria and lump, with flank pain (n=18), and weight loss (n=18) were the most common clinical features in patients with RCC. According to the histopathologic type, 30 (50.0%) patients had clear cell RCC, 18 (30.0%) had papillary RCC, 8 (13.3%) had chromophobe RCC and the other four (6.7%) had cystic neoplasm, urothelial, angiomyolipoma, or sarcomatoid. Twenty-four patients underwent laparoscopic nephrectomy while 31 patients underwent open nephrectomy. Cytoreductive and partial nephrectomy was performed in three and two patients, respectively. Conclusion: The present study findings suggest that age has an impact on development of RCC. Also, intraoperative and postoperative complications were more common among patients who underwent open nephrectomy.

Role of Statins on Cognition and Memory: A Case-control Study

S Shanmugapriya, P Karthika, CS Praneetha, G Rajendiran

Introduction: I-gel is the most commonly used, second-generation supraglottic airway device, which plays an important role in modern anaesthesia practice as a rescue device in difficult as well as failed intubation situations and resuscitations. Now-a-days, it is gaining popularity as a conduit to facilitate endotracheal intubation. No Endotracheal Tube (ETT) is designed specifically for intubation through I-gel. The ETT used for routine tracheal intubation are standard Polyvinyl Chloride (PVC) ETT and Flexometalic ETT. Aim: To compare the two different types of ETTs i.e. standard PVC ETT and Flexometatlic ETT for blind tracheal intubation through I-gel. Materials and Methods: The present study was a single-blinded, randomised clinical trial in which 120 patients were randomly allocated into two groups on the basis of the ETT used for intubation through I-gel. In Group P blind tracheal intubation was done using PVC ETT, and in Group F blind tracheal intubation was done using Flexometatlic ETT through I-gel. Time taken for successful intubation, number of successful intubations, ease of intubation, number of attempts,manoeuvers used, and complications were recorded. Results: The mean time taken for successful intubation in Group P was 22.31±3.771 sec and in Group F was 26.51±4.408 sec (p<0.05). Intubation was significantly easy (26/60 vs 13/60) with PVC ETT (p=0.011). More patients were successfully intubated with PVC ETT than Flexometalic ETT (48/60 vs 36/60; p=0.017). Conclusion: PVC ETT is a better choice for blind tracheal intubation through I-gel as compared to flexometallic ETT.

Transaminitis in Dengue: A Retrospective Observational Study in an Intensive Care Unit

Kiran Bada Revappa, Murthy NL Narumilli, Pradeep Rangappa, Karthik Rao

Introduction: Dengue fever, a frequently encountered arbo viral infection is associated with multiorgan dysfunction in its severe form. The involvement of liver characterised by transaminitis is quite prevalent in such cases admitted to Intensive Care Unit (ICU). Aim: To evaluate the occurrence and severity of transaminitis in dengue patients admitted to the ICU. Also to find the association between transaminitis and other severity predictors of dengue (low platelet count, high packed cell volume and organ dysfunction). Materials and Methods: This retrospective observational study was conducted at Columbia Asia Referral Hospital Yeshwanthpur, Bengaluru, Karnataka, India, from October 2019 to January 2020. Total 80 patients of either sex diagnosed with seropositive dengue were included in the study. The parameters like platelet count, packed cell volume, liver enzymes {Serum Glutamic Pyruvic Transaminase (SGPT) and Serum Glutamic Oxalacetic Transaminase (SGOT)} were recorded and followed-up during the ICU stay. Mean with standard deviation were used to represent quantitative variables whereas description of qualitative variables was done with numbers and percentages. The above variables required application of One way Analysis of Variance (ANOVA), post-hoc Turkey test, Kruskal-Wallis one way ANOVA and Chi-square tests. The differences were considered significant at p-value <0.05. Results: Transaminitis was noted in 96.2% of the total patients. The prevalence of grade 1, 2, 3, 4 transaminitis was 21.2%, 30%, 36.2% and 8.7%, respectively. Mean platelet counts in grade 1, 2, 3 and 4 transaminitis were 19.41±13.17×10³/μL, 16.04±11.24×10³/μL, and 14.14±5.19×10³/μL, and 20.57±10.47×10³/μL, respectively. The association between mean platelet counts and grades of transaminitis was not statistically significant (p-value=0.61). Mean Packed Cell Volume (PCV) in patients with grade 1, 2, 3 and 4 transaminitis showed an increasing trend of mean PCV when compared to PCV of 35.67±1.52 in patients with normal SGOT/SGPT levels. The association between different grades of transaminitis and mean PCV values during the course of ICU stay was statistically significant (p-value=0.038). Conclusion: Transaminitis is very common among the dengue patients in ICU and it increases in conjunction with the severity of dengue. It has an association with thrombocytopenia, organ dysfunction and a positive correlation with elevated packed cell volume.

Comparison between Polyvinyl Chloride and Flexometallic Endotracheal Tube for Blind Tracheal Intubation through I-gel: A Randomised Clinical Study

Introduction: I-gel is the most commonly used, second-generation supraglottic airway device, which plays an important role in modern anaesthesia practice as a rescue device in difficult as well as failed intubation situations and resuscitations. Now-a-days, it is gaining popularity as a conduit to facilitate endotracheal intubation. No Endotracheal Tube (ETT) is designed specifically for intubation through I-gel. The ETT used for routine tracheal intubation are standard Polyvinyl Chloride (PVC) ETT and Flexometalic ETT. Aim: To compare the two different types of ETTs i.e. standard PVC ETT and Flexometatlic ETT for blind tracheal intubation through I-gel. Materials and Methods: The present study was a single-blinded, randomised clinical trial in which 120 patients were randomly allocated into two groups on the basis of the ETT used for intubation through I-gel. In group P blind tracheal intubation was done using PVC ETT, and in group F blind tracheal intubation was done using Flexometatlic ETT through I-gel. Time taken for successful intubation, number of successful intubations, ease of intubation, number of attempts, manoeuvers used, and complications were recorded. Quantitative variables were compared using an independent t-test and qualitative variables were compared using the Chi-square test. Results: The mean time taken for successful intubation in group P was 22.31±3.771 sec and in group F was 26.51±4.408 sec (p<0.001). Intubation was significantly easy (26/60 vs 13/60) with PVC ETT (p=0.011). More patients were successfully intubated with PVC ETT than Flexometalic ETT (48/60 vs 36/60; p=0.017). Conclusion: Polyvinyl Chloride Endotracheal Tube (PVC ETT) is a better choice for blind tracheal intubation through I-gel as compared to flexometallic ETT.

Significance of Glomerular C1q deposits in IgA Nephropathy

Divya Radhakrishnan, NK Supriya, M Sreelatha, KP Aravindan

Introduction: Immunoglobulin A (IgA) nephropathy is the most common form of glomerulonephritis in young men, often presenting as gross or microscopic haematuria and accounts for approximately 10% of the patients with End-Stage Renal Disease (ESRD). The contribution of the complement system to amplify tissue injury in IgA nephropathy has been suggested but the precise pathways of complement activation especially the involvement of classical pathway remain largely unknown. Aim: To determine the prevalence of glomerular C1q deposition in IgA nephropathy to delineate the relationship of glomerular C1q positivity and different histological variables indicating disease activity and disease progression and also to determine the relationship of glomerular C1q positivity and the Oxford scoring system in IgA nephropathy. Materials and Methods: This was a prospective study conducted over a period of three years {January 2014- December 2016} in the Department of Pathology with the cooperation of the Department of Nephrology at Government Medical College, Kozhikode , Kerala, India. A total of 44 cases which were both biopsy and immunofluorescence proven as IgA nephropathy were included in the study. For light microscopy, the tissue received in buffered formalin was processed into paraffin blocks, stained with Haematoxylin and Eosin (H&E) and histopathological changes analysed. For immunofluorescence, tissue received in normal saline was frozen in cryostat and 3 μm sections were stained using the Dako polyclonal Fluorescein Isothiocyanate (FITC) conjugated antibodies IgG, IgM, IgA, C3, C1q and studied for pattern of glomerular staining. Chi-square test was used for statistical analysis. Results: The prevalence of C1q deposits was 27.3%. Among histopathological variables, only fibrous crescent was found to have significant relationship with C1q positivity (p= 0.0472). On follow-up, 50% C1q positive patients and 11.76% C1q negative patients who were having normal renal functions at the start of the study went into renal insufficiency. Conclusion: The study revealed that there was a fairly high prevalence of C1q deposits in IgA nephropathy patients. Also, significant association was found between C1q deposits and fibrous crescent. Most significantly the study concluded that there is an increased tendency for the C1q positive patients to go into renal failure.

Predictors of Renal Recovery among Patients of Obstructive Urolithiasis with Renal Failure- A Prospective Observational Study

Vivek Kumar Vijjan, Vimal Kumar Dixit, Vivek Ruhela, Amitav Kumar

Introduction: Timely intervention in patients of obstructive uropathy secondary to renal and/or ureteric stones can reduce the morbidity and mortality in such patients. Aim: To determine the factors predicting recovery in patients of urinary stones and obstructive uropathy. Materials and Methods: This prospective observational study was conducted at Shri Mahant Indiresh Hospital, Dehradun, Uttrakhand, India, between December 2018 and June 2020. All patients with renal failure (serum creatinine >1.5 mg/dL) secondary to urinary stones presenting to the Emergency Department were included in the study. Baseline demographic data, clinical, haematological, biochemical and microbiological parameters were recorded at presentation and after Double J Stent (DJS) insertion at postintervention day 1, 3 and 7. Total 40 patients were divided into two groups i.e., recovered (n=25) and non recovered (n=15) groups. Receiver Operating Characteristic (ROC) curves were used to obtain optimal threshold duration of illness, the values of serum creatinine, serum urea, haemoglobin and serum potassium, and time to nadir creatinine for predicting renal recovery. The graphs were made using both Microsoft Excel and SPSS software. Results: Out of total 40 pateints, 29 were males and 11 were females. The mean duration of symptoms in the recovered and non recovered groups was 4.64 and 15.53 days, respectively (p=0.001). Thirteen out of 15 patients (86.6%) in the non recovered group and 10 out of 25 (40%) in the recovered group had pre-existing co-morbidities (p=0.004). Postobstructive diuresis was present in 84% patients in the recovered and 46.6% in the non recovered group (p=0.016). The nadir serum creatinine level was 1.26 mg/dL in recovered as compared to 6.08 mg/dL in the non recovered patients (p=0.001). The ROC curves were plotted for various parameters in order to find the prognostic accuracy in predicting recovery. The best criteria were symptom duration ≤6 days, serum creatinine at presentation ≤6.2 mg/dL, serum potassium ≤5.5 mg/dL, and haemoglobin level >9.4 g/dL. Conclusion: Short duration of symptoms (≤6 days), lower serum creatinine levels (≤6.2 mg/dL), lower serum potassium levels (≤5.5 mg/dL), and higher haemoglobin level (>9.4 g/dL) were found to predict a greater chance of recovery. These factors can help in formulating treatment protocols for early intervention leading to a better prognosis in this subgroup of patients.

Histomorphometrical Study of Placental Villi in Preeclampsia: A Case-control Study

Saumya Gaur, N Sangeetha, Saranya Bai

Introduction: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. In this disorder, placental morphology and cellular arrangement are altered so that oxygen delivery from mother to foetus is greatly disturbed, which ultimately results in cellular oxidative stress. Morphological and histological changes are both indicative of the pathogenesis of maternal and foetal morbidity and mortality in women with preeclampsia. Aim: To study the gross and histomorphometric features of placenta in patients with preeclampsia. Materials and Methods: This case-control study was conducted from January 2017 to December 2017 at Jawaharlal Nehru Medical College Hospital in Belagavi, Karnataka, India. Total 120 placentas of preeclampsia patients (60) and normal controls (60) were studied, which were received at Pathology Department of the institute. Immediately after delivery, gross parameters were recorded. For histomorphometrical study, full-depth tissue samples of placenta were fixed in 10% neutral buffered formalin solution for 24-48 hours, and then they were processed by graded concentrations of alcohol and embedded in paraffin to make blocks. The 5 μm thick sections were cut and slides were stained with Haematoxylin and Eosin (H&E) and the sections were studied. Values were calculated by mean±SD using Students unpaired t-test and Chi-square test, p-value of <0.05 was considered as significant. Results: The mean maternal age of the study participants was 23.93±4.40 years in preeclampsia group and 23.85±3.44 years in control group. The gestational age was 36.42±2.69 weeks in preeclampsia group and 38.20±2.11 weeks in control group, the difference was statistically significant. Other parameters such as neonatal weight, placental weight, placental thickness and placental diameter had statistically significant difference between both the groups. Morphological findings of placental terminal villi showed that the mean surface area was larger (2500.05±245 μm²) in preeclampsia group compared to control group (1878.01±214.53 μm²) and this difference was statistically significant. Conclusion: The gross reduction of the preeclampsia placenta like decreased placental weight and diameter disturbs the normal placentation and pathologically these results in histological and morphometric changes in the placenta. Due to oxidative stress in preeclampsia placental morphology is altered.

Redefining the Role of Ketamine for Topicalisation and its Comparison with the Legend Lignocaine for Oesophagogastroduodenoscopies- A Randomised Clinical Study

Bhumika Pathak, Nirali Panchal, Sunny R Mevcha, Madhavi Chaudhari

Introduction: Endoscopy is a minimally invasive procedure for visualisation of gastrointestinal tract performed under topicalisation with or without sedation. Lignocaine is one of the most popular local anaesthetic used for topicalisation for endotracheal intubation in different forms like spray, gargles, nebulisation, gel. Recently ketamine has emerged as an effective antinociceptive and anti-inflammatory agent. Aim: To observe and compare the effect of ketamine and lignocaine gargles for decreasing sore throat, coughing and change in voice. Also to observe various side-effects following use of ketamine and lignocaine. Materials and Methods: This prospective double-blind randomised clinical trial was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India, from January 2020 to June 2021. Total 70 patients undergoing oesophagogastroduodenoscopies under sedation were included in the study. They were divided into two groups i.e, 35 patients in each group. Group L received lignocaine 2% viscous gargles 3 mg/kg and group K received ketamine gargles 3 mg/kg ideal body weight diluted in Normal Saline (NS) up to total 30 mL. Sore throat, coughing, change in voice, side-effects were observed. Student’s t-test was used for continuous data. Results: In group L, 11.4% of patients and in group K 22.9% of patients complained of mild sore throat (grade 1) immediate postprocedure but this was statistically insignificant (p-value=0.2). For both the groups, grade 1 coughing was observed in 2.9% patients (p-value >0.995). In both the groups 5.71% of patients complained about change of voice, statistically insignificant (p-value >0.995). Vomiting was observed as a side-effect in 2.9% of patients in both the groups but there were no other side-effects. Conclusion: Gargling with ketamine was as effective as lignocaine for prevention of sore throat, coughing and change in voice in patients undergoing oesophagogastroduodenoscopies and thus improved patient compliance.

Normative Data of Maximal Oxygen Consumption (VO₂ Max) among Healthy Young Adults: A Cross-sectional Study

Karampreet Kour Buttar, Sudhanshu Kacker, Neha Saboo

Introduction: Maximal oxygen uptake (VO₂ max) is the maximum quantity of oxygen a person can consume, and it remains constant over time despite increased exertion. The amount of oxygen consumed by the working muscles is measured by maximal oxygen consumption. The maximal oxygen uptake can be measured using maximal or submaximal tests, by gas analyser or field methods. The estimated VO₂ max can be used to study people’s fitness and raise awareness about physical activity and lifestyle changes. Aim: To determine the VO₂ max values using a direct method and provide normative data of VO₂ max for healthy young adults in the age group of 18-25 years in both sexes. Materials and Methods: This cross-sectional study was approved by the Institutional Ethical Committee of RUHS College of Medical Sciences, Jaipur, Rajasthan, India. A total of 419 healthy young adults (male and female students) were recruited from RUHS-College of Medical Sciences and MNIT College, Jaipur, Rajasthan, India from January 2019 to March 2020. Anthropometric data included age, height, weight according to the National Health and Nutrition Examination Survey (NHANES) and followed by measurement of VO₂ max using a gas analyser of AD-Instrument (model-ML206). Collected data was entered in Microsoft excel. Paired t-test was used to compare mean and Standard Deviation (SD) of variables between male and female participants. The p-value of <0.05 was considered as significant. Results: The study was conducted on 419 apparently healthy college students (275 male and 144 female). The mean VO₂ max value for males was 45.30±7.35 mL/kg/min and for females it was 35.71±5.29 mL/kg/min, which was found to be significantly higher in males than in females. The mean VO₂ max among the largest proportion of the males (27.63%) falls in the ‘Good’ category of cardiorespiratory fitness scale and the largest proportion of the females (32.63%) falls in the ‘Fair’ category of cardiorespiratory fitness scale. Conclusion: The value of VO₂ max was lower in the Indian population than in the western population, when value obtained from this study was compared with the standard normative value of cardiorespiratory fitness. Therefore, the values obtained in this study could serve as a normative for the Indian population.

Efficacy of Low Level Laser Therapy in Reducing Pain, Swelling and Trismus following Impacted Third Molar Extraction Surgery: A Split-mouth Randomised Controlled Trial

Ansari Neelofar, Jagadish Chandra, Joyce Sequeira

Introduction: The use of local or systemic corticosteroids and non steroidal anti-inflammatory drugs are often recommended after surgical extraction of impacted lower third molars to abolish postoperative pain, but some of them may manifest adverse effects such as gastrointestinal irritation, systemic bleeding tendency, and allergic reactions. Aim: To evaluate the efficacy of low level laser therapy in reducing pain, swelling, and trismus following impacted third molar extraction surgery. Materials and Methods: The present split-mouth randomised controlled clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Mangalore, Karnataka, India. The study sample consisted of nine clinically and radiologically confirmed cases of bilateral symmetrical impacted mandibular third molars indicated for extraction. After extraction surgery, low level laser therapy was administered intraorally and extraorally (low level laser group). On the contralateral side (non laser group), extraction was carried out 15 days prior in the same manner except that patient was not subjected to laser therapy. Trismus, pain, swelling and healing were evaluated on 2^nd, 3^rd, 4^th and 7^th day; and were subjected to statistical analysis using Independent t-test and Mann-Whitney U test. Results: The study consisted of nine patients, among which six were males and three were females with mean age of 25.89±6.79 years. Pain intensity was lower in the laser group than in the non laser group at all-time points assessed and was non significant (p-value >0.05). Swelling when assessed was less for laser group than non laser group at all-time points and were statistically significant (p-value <0.05) except on the 7^th day. The extent of mouth opening was greater in the laser group than in the non laser group at all-time points which was statistically significant only on 2^nd day (p-value=0.048). Both laser and non laser group had no statistically significant difference in healing (p-value >0.05). Conclusion: The use of therapeutic laser in the postoperative management of patients undergoing surgical removal of impacted third molars decreases postoperative pain, swelling, and trismus.

Pattern of Bacterial Isolates in Patients with Nasolacrimal Passage Obstruction and their Antibiotic Sensitivity Pattern in a Tertiary Care Teaching Hospital, Pune, India

Introduction: An acquired Nasolacrimal Duct Obstruction (NLDO) can occur at any age, and is classified as either primary or secondary. The nasolacrimal obstruction occurring primarily also known as Primary Acquired Nasolacrimal Duct Obstruction (PANDO) is observed mainly in conditions occurring due to inflammation or fibrosis. Aim: To study the current pattern of bacterial isolates with nasolacrimal passage obstruction and their antibiotic sensitivity patterns. Materials and Methods: This was a cross-sectional study conducted in the Department of Ophthalmology at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, over the period of two years from November 2019 to November 2021. A total of 100 patients were selected for the study. All the patients coming to Ophthalmology Out-patient Department (OPD) with the complaints of epiphora discharge, or both along with regurgitation on pressure over lacrimal sac and mucoid or mucopurulent or clear regurgitant material on sac syringing were taken. Before the beginning of the investigative procedure, informed consent was taken. The Clinical and Laboratory Standards Institute’s (CLSI) standardised Kirby-Bauer disc diffusion test was used to determine antibiotic susceptibility. Results: In the present study, the distribution of patients according to bacterial isolates was as follows, a maximum of 62% of patients were found with no growth, while 18% Methicillin-Sensitive Staphylococcus aureus (MSSA), 10% Coagulase-negative Staphylococci (CoNS), 6% Streptococcus pneumoniae, and 4% Pseudomonas were observed. In the present study, CoNS was observed as the predominant bacterial isolate in the diabetics with a female preponderance followed by MSSA (39%), Pseudomonas (75%), and S. pneumoniae (33%). This study found ciprofloxacin as a broad-spectrum antibiotic that worked against most bacterial isolates. Conclusion: A higher female preponderance was observed in this study with the left side being affected in most of the patients. The pattern of antibiotic sensitivity varies from region to region and thus should be kept in mind while prescribing antimicrobial therapy to the patients.

Substance Dependence and Risk Factors for Suicide Attempt: A Retrospective Study

Maithreyi Poguri, Mubeen Taj, N Nisha, R Jhamuna

Introduction: Suicide is closely linked to substance abuse and it is one of the main component of premature death. Aim: To assess the factors that affect the possibility of suicidal behaviour among persons who abuse substance. Materials and Methods: The present study was a retrospective study which was conducted on 101 substance abuse patients who attempted suicide, and 101 substance abusers who have not attempted suicide. Data were collected regarding socio-demographic variables, legal problems (drunken driving/stealing/perpetrator in domestic violence or physical abuse or sexual abuse or homicide), hereditary and addiction data. The patient was diagnosed with substance dependence syndrome, Anxiety disorders, Depression disorder and Substance-induced psychosis based on The International Classification of Diseases (ICD) 10 criteria. The socio-economic status was assessed using Modified Kuppuswamy Scale. Results: The mean age of the participants who had attempted suicide was 39 years, and those in the other was 43 years. In both the groups all subjects were males. The common abused substance was alcohol. There was a positive association between various demographic variables and attempted suicide, such as socio-economic status, education and place of residence. Early age of onset of substance abuse, abusing more than two substances, co-morbidity of psychiatry illness such as anxiety disorder, depression, and family history of psychiatry illness were the risk factors. In the ‘attempted suicide’ group, 74.2% of the participants abused drugs since more than 10 years, while it was 59.4% in the other group. There was also a positive association between the duration of abuse and attempted suicide. Conclusion: An early age of onset of drug initiation, abusing more than two substances, family history of psychiatry disorders, and co-morbid psychiatric illness increase the risk of suicide. Suicides are preventable, the need to early identification of the risk factors, assess manage and follow-up is the utmost importance of mental health professionals.

Incidence of Microalbuminuria and its Correlation with Ankle Brachial Index, Sugar Levels and Duration of Type 2 Diabetes Mellitus with Special Emphasis to Predict Vascular Complications

K Mamatha, Sanjana Patil, Sneha Jawalkar, Vijayalaxmi Patil

Introduction: Diabetes Mellitus (DM) is a metabolic disorder characterised by persistence hyperglycaemia resulting from the defects in insulin secretion, action or both. Diabetes prevalence is rapidly increasing, especially in urban India. The changing lifestyle has majorly contributed to the increasing prevalence of diabetes. Aim: To determine the incidence of microalbuminuria and its correlation with age, sex, duration, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS) and Body Mass Index (BMI). Also to detect the presence of vascular complications using Ankle Brachial Index (ABI), Pulse Wave Velocity (PWV), Augmentation Index (AI) and microalbuminuria. Materials and Methods: The present cross-sectional study was conducted in Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from March to June 2018. The study included assessment of blood glucose level both FBS and PPBS, microalbumin levels in 100 known diabetic patients and also ABI, PWV and AI were measured using periscope instrument. Analytical test to measure the differences between two means of the two groups independent t-test was applied and multiple regressoon analysis was done. Results: Out of total 100 subjects, 59% were males and 41% were females. The correlation of microalbuminuria with factors like, duration of diabetes, FBS, PPBS, PWV and AI was statistically significant with a p-value of <0.05 in this study. The correlation of duration of diabetes with factors like age, BMI, microalbuminuria was statistically significant with a p-value of <0.05. Conclusion: This study confirmed that incidence of microalbuminuria increases with duration of diabetes, poorly controlled blood sugar levels. Microalbuminuria, ABI, PWV and AI are the reliable, non invasive and simple methods used for the screening of vascular complications.

Assessment of Potential Drug-drug Interactions among Ischaemic Stroke Patients in a Charitable Hospital

Introduction: Incidence of stroke is more frequently found among the elderly who are mostly dealing with co-morbidities and polypharmacy, were found to be significant in high risk of potential Drug-drug Interactions (pDDIs). Aim: To identify potential drug-drug interactions in ischaemic stroke patients. Materials and Methods: This retrospective study was conducted in the General Medicine Department at Justice KS Hegde Charitable Hospital, Mangaluru, Karnataka, India, from January 2018 to August 2020. All the stroke patient’s data were collected based on the inclusion criterion. Prescriptions were obtained from the case sheets and the pDDIs were identified using UpToDate software. Results: The mean age of the study population (N=350) was found to be 61.07±11.460 years, The incidence of stroke was high in males (66%) than in females (34%) from the total of 350 patients. The prescribing patterns were antiplatelet single (69.4%) and fixed-dose combination (1.42%), anticoagulants (11.14%), antihypertensive agents (63.42%), followed by lipid-lowering agents (65.14%) as single and fixed dose combinations (0.85%), gastrointestinal agents (70.57%). The class prescribed the most was antiplatelet agents (aspirin 61.4%). The total number of 402 pDDIs were found among 350 patients. Based on the Lexi-Interact^® severity scale moderate interactions were the most commonly found then followed by the major and minor with 301 (74.87%), 66 (16.41%) and 35 (8.70%) respectively. The most frequent interaction found were clopidogrel with pantoprazole, and atorvastatin with clopidogrel with same incidence of in 44 (12.57%) patients. Conclusion: The majority of the interaction was found to be moderate interactions which were followed by major and minor interactions. The pDDIs mostly occurred among the antiplatelet agents, gastro-intestinal agents and antihypertensives.

Evaluation of Ceftriaxone-Sulbactam-EDTA Adjuvant Combination against Multidrug Resistant Bacteria in Tertiary Care Hospital, Guntur, Andhra Pradesh, India

Shaik Naseema, Y Mano Chandrika, Shaik Moulali, Uma Penmetcha

Psychiatric Morbidity in Migraine and its Impact on Quality of Life: A Hospital-based Cross-sectional Study

Introduction: Migraine is a disabling headache disorder. Many psychiatric disorders co-exist with migrainous headache which largely remain undiagnosed leading to greater risk of morbidity and significantly impacts quality of life. Migraine patients are particularly at risk for mood and anxiety disorders which negatively impact the prognosis and poor headache outcome. Hence, defining the exact nature of underlying psychiatric conditions in migraine are relevant issues in the clinical practice. Aim: To find the association of psychiatric morbidity and quality of life in migrainous (with and without aura) and non-migrainous subjects and to assess the correlation between severity of migraine and quality of life. Materials and Methods: It was a hospital based cross-sectional study conducted amongst the patients and their healthy attendants visiting the Psychiatry OPD of Rajindra Hospital, Patiala from May 2018 to April 2019, after obtaining ethical clearance. A total of 392 subjects of both gender and in the age group 18-65 years, who gave informed consent were enrolled. Group 1 (n=196) consisted of cases i.e., migrainous patients as per International Classification of Headache Disorders 3^rd Edition, β version (ICHD-3) criteria and Group 2 (n=196) consisted non-migrainous controls. Psychiatric morbidity was assessed using Mini International Neuropsychiatric Interview (MINI) and confirmed on International Classification of Diseases 10^th edition (ICD-10). Severity of migraine was assessed on Migraine Disability Assessment Test (MIDAS) and its impact on quality of life (QOL) by using 36 Item Short Form questionnaire (SF-36 questionnaire). Variables were compared using the independent t-test and chi-square test. Pearson correlation was used to study the relationship between severity of migraine with QOL in subjects with and without psychiatric morbidity. Results: Psychiatric morbidity was found among 65.3% (n=128) and 19.9% (n=39) subject in Group 1 and Group 2, respectively. Major Depressive Disorder (37.2%, n=73) was the most common psychiatric morbidity, followed by Generalized Anxiety Disorder (8.7%, n=17), Manic episode and Panic disorder each (5.1%, n=10), Hypomanic episode & Obsessive Compulsive Disorder each (3.1%, n=6), Dysthymia (2%, n=4) and Post Traumatic Stress disorder (1%, n=2). Between groups, the association of migraine with Major Depressive Disorder (p≤0.001), General Anxiety Disorder (GAD) (p=0.024), Manic episode (p=0.005), Hypomanic episode (p=0.048) was statistically significant but more in migrainous patients than non-migrainous subjects. Migrainous patients had lower QOL in physical and psychological health domains of SF-36 than in non-migrainous subjects. Furthermore, migrainous patients with or without psychiatric morbidity had significantly negative correlation in all domains of SF-36. Conclusion: Psychiatric morbidity was significantly higher in migrainous patients than non-migrainous subjects with poor quality of life in migrainous patients causing significant disability with an increase in severity of migraine.

Histopathological Evaluation of Right and Left Sided Colorectal Cancer: A Cross-sectional Study from a Tertiary Care Hospital, Assam, India

Nizam Priya Kalita, Sandeep Khakhlari, Sarat Das, Gautam Boro

Introduction: Colorectal cancer is a heterogeneous disease that can develop in any part of the colon including rectum, with significant differences in clinical features and survival of patient in right sided and left sided colorectal carcinoma. Hence, it is necessary to evaluate the pathological characteristics of these tumour. Aim: To analyse the pathological features of patients with right and left sided colorectal cancer. Materials and Methods: This hospital-based, cross-sectional study conducted in Department of Pathology at Assam Medical College, Dibrugarh, Assam, India, from July 2019 to June 2020. The study included 35 cases of all endoscopic biopsy specimens and surgically excised large specimens of carcinomatous growths of colon and rectum, whereas carcinoma of appendix was excluded from this study. Special stain like Periodic Acid Schiff (PAS) and Alcian Blue, and immunohistochemistry (CK7 and CK20) was done in selected cases. The data is shown in tables and results are expressed in terms of frequency and percentages. Results: Left colon (74.28%) was more commonly involved than right colon (25.72%) and rectum was the most common site (31.43%). The most common gross morphology in right colon was ulcerative growth (16%) and in left colon it was polypoidal growth (28%). On histopathological examination, 27 cases were adenocarcinoma, Not Otherwise Specified (NOS) (six were well differentiated, 20 were moderately differentiated and one was poorly differentiated) and eight cases were mucinous adenocarcinoma. The mean age was 51.54 years with age distribution from 14 years to as old as 80 years. In immunohistochemistry, 9 (90%) cases show CK20 positive/CK7 negative and 1 (10%) case show CK20 positive/CK7 focally positive. Conclusion: Routine microscopic examination of haematoxylin and eosin stained slide was still the commonly performed and vital modality of investigation in majority of the cases. The right and left sided colorectal carcinoma varies according to clinical and pathological features. However, it is still necessary to find other biological dissimilarities of adenocarcinoma located on different sides of colon.

Comparison of Preoperative Magnesium Sulphate and Budesonide Nebulisation in Reducing the Incidence and Severity of Postoperative Sore Throat- A Randomised Controlled Study

Introduction: General anaesthesia with endotracheal intubation, being one of the most commonly performed procedures in clinical anaesthesiology, is not without adverse effects. Postoperative Sore Throat (POST) is one of the common adverse effects with a varying incidence. Prophylactic management of POST is recommended to improve the quality of postanaesthesia care and recovery. Aim: To evaluate the effectiveness of preoperative nebulisation with magnesium sulphate and budesonide in reducing the incidence and severity of POST. Materials and Methods: This randomised double-blinded control study was conducted in the Department of Anaesthesiology at Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India, from September 2021 to December 2021. The study included 120 patients, of either sex, aged between 20-60 years with American Society of Anesthesiologists (ASA) grade I and II posted for elective surgery requiring general anaesthesia with endotracheal intubation. The patients were randomly divided into three groups of 40 patients each. Group M was nebulised with 250 mg magnesium sulphate, Group B with 250 mcg budesonide and Group S was nebulised with normal saline, 15 minutes prior to the induction of anaesthesia. Incidence and severity of POST was documented at 0 hr, 2 hrs, 24 hrs and 48 hrs postextubation on a 0-3 score. Data collected was analysed using Statistical Package for Social Sciences (SPSS) version 22.0 and the results were then statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. Results: The incidence of POST was more in saline group when compared with budesonide and magnesium sulphate group at all points of observation (0 hr, 2 hrs, 24 hrs and 48 hrs). The severity of POST was moderate in saline group while the other two groups experienced mild severity. This was statistically significant at 0 hr, 2 hrs and 24 hrs (p-value <0.05). But at 48 hrs severity of POST among the three groups was not significant. Conclusion: Preoperative nebulisation with magnesium sulphate and budesonide significantly reduces the incidence and severity of postoperative sore throat.

Assessment of Student’s Learning and Perception towards Case-based Learning Supplemented with Laboratory Reports in Biochemistry: A Cross-sectional Study

Tejas J Shah, Dipika P Baria, DVSS Ramavataram

Introduction: Case-based Learning (CBL) is found to be one of the best approaches to promote students’ learning in Clinical Biochemistry which help them to understand clinical diseases. Moreover, exposure of interpreting Laboratory Reports (LR) in CBL session helps students in learning clinical diagnosis, treatment and prognosis of disease. Aim: To assess students’ learning and perception towards CBL supplemented with LR in Biochemistry and also to compare the performance of students with pretest and post-test on a topic taught by Didactic Lecture (DL) and CBL supplemented with LR. Materials and Methods: This cross-sectional study was conducted at Biochemistry Department, Smt. B. K. Shah Medical College and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India from November 2019 to April 2020, after prior permission of Institutional Ethics Committee. Total 60 first year Bachelor of Medicine and Bachelor of Surgery (MBBS) students were enrolled voluntarily and were divided into two groups: Group A (30) and Group B (30) by lottery method. The study process included pretest for all students, DL session for group A and CBL supplemented with LR session for group B on selected topic followed by the post-test after one week. Crossover was done in which group B was exposed to DL and group A was exposed to CBL supplemented with LR. Perception of both groups about CBL supplemented with LR was taken by prevalidated questionnaire based on five-point Likert scale. Data were analysed by Paired and unpaired (independent) t-test. Results: Total 59 students attended teaching sessions, submitted pre and post-test and gave feedback (Response Rate was 98.33%). Out of 59, 24 were males and 35 were females. Statistically significant difference was observed in pre and post-tests performance of students for topics taught by CBL with LR method than DL (p<0.0001). All (100%) students felt that CBL supplemented with LR method was very helpful, interesting and improved their interpretation skills. Conclusion: CBL supplemented with LR proved to be a very good student-centric teaching-learning tool in Biochemistry as compared to DL method. Students who were exposed to CBL supplemented with LR had better understanding of Biochemistry and performed better in post-test than those who were exposed to DL method.

Thyroid Dysfunction in Patients with Liver Cirrhosis and its Association with the Severity of Liver Disease: A Cross-sectional Study

Rukma Jagannath Kolwalkar, Gauri Nilajkar, Samidha Naik, Roma Teles

Introduction: There exists a complex relation between the thyroid hormones and liver physiology in health and disease. The liver along with the thyroid gland play a significant role in the conversion of inactive Thyroxine (T₄) to active Triiodothyronine (T₃). The most common thyroid hormone profile in cirrhosis of liver is a low total T₃ and free T₃, secondary to reduced activity of deiodinase type 1 and increased conversion to rT₃. Aim: To assess the association between the thyroid hormone levels and severity of liver disease, expressed in terms of child pugh score in tertiary care hospital in Goa. Materials and methods: The cross-sectional observational study included hundred patients with liver cirrhosis, admitted at a tertiary care hospital in Goa, from October 2019 to September 2020. The thyroid hormone levels were estimated from an early morning fasting blood sample within 24 hours of admission, once the patient satisfied the inclusion criteria. The Child Turgott Pugh scoring system was used to classify patients as per their severity of liver disease. The data was entered and analysed in Statistical Package for Social Sciences (SPSS) software version 14.0. Results: There were 95 males and 5 females. The study showed low mean levels of total T₄and free T₃ in patients with cirrhosis of liver, which was significantly associated with Child Pugh classes of liver dysfunction. There was an association between levels of free T₃ and the classes of Child Pugh score. The difference in the mean levels of TSH, total T₃ and free T₄ across the Child Pugh classes were not statistically significant. Conclusion: The study showed low free T₃ levels in patients with cirrhosis of liver as seen in similar studies done in various settings. Thus, Thyroid Function Tests (TFTs) especially free T₃ levels have a considerable potential to be used an independent predictor or a proxy to prognosis in patients with liver cirrhosis.

Prevalence and Association of Meibomian Gland Dysfunction with Dry Eye Severity from a Tertiary Care Rural Hospital in Central Gujarat: A Cross-sectional Study

Devanshi Smit Mehta, Sonal Dhruvpal Sisodiya, Harsha Chetan Jani

Introduction: Meibomian glands are holocrine meibum secreting glands driving out the oil from the orifice. It forms the outermost lipid layer of the tear film which prevents overflow of tears because of its hydrophobic properties and reduces their evaporation. The deficiency of oily layer of the tear film leads to evaporative dry eyes and ocular surface diseases. As Meibomian Gland Dysfunction (MGD) is one of the major causes of evaporative dry eye, with the help of this study, prevalence and association of MGD and dry eye can be evaluated and treated. Aim: To find out the prevalence and association of MGD and dry eye as well as asymptomatic individuals having MGD and dry eye in 30 to 80 years age group in the region of central Gujarat, Western India. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department (OPD) of a rural tertiary care hospital in central Gujarat, India between February 2020 to February 2021, after taking approval from Institutional Ethics Committee. Study included 389 subjects representing rural population of Anand, Gujarat, India. Subjects were asked for symptoms of dry eye according to Ocular Surface Disease Index (OSDI) questionnaire and severity of symptoms was assessed. Comprehensive ophthalmic examination including Best Corrected Visual Acuity (BCVA), Schirmer’s test, slit lamp examination including conjunctival and corneal surface staining, Tear Film Break Up Time (TBUT), evaluation of meibomian gland orifices, lid margin anatomy, meibum expressibility, quality of meibum, meibomian gland dropouts were done. On the basis of these parameters, diagnosis and grading of MGD and dry eye was done. Subgroups were made according to age, gender, co-morbidities (diabetes mellitus, hypertension, thyroid disease), cases of any refractive eye surgery, pseudophakic eyes, use of systemic drugs, hormonal pills, topical antiglaucoma drugs and use of contact lens. Data analysis was done by descriptive statistics (using Stata software 14.2 version). Analysis of Variance (ANOVA) were used to assess the association and Pearson test was applied to assess the correlation of MGD scores and dry eye severity with age. Results: Overall prevalence of MGD and dry eye were 97.4% and 88.82% respectively. Out of total 389 subjects, 219 (56.3%) participants were asymptomatic. Age was significantly correlated with MGD and dry eye severity. Higher MGD scores were found with increase with dry eye severity. Highest MGD scores were observed when the tear break up time was ≤5 seconds. Conclusion: The prevalence of MGD and dry eye was high in the region of central Gujarat, India. MGD leads to deficiency of oily layer of the tear film leading to evaporative dry eyes and ocular surface diseases.

Comparison of Transverse Dentofacial Dimensions in Adults with Skeletal Class I and Class II Malocclusion, Horizontal Growth Pattern and Mild to Moderate Periodontitis using CBCT- A Retrospective Study

Introduction: Knowledge of transverse dentofacial dimensions is crucial for accurate diagnosis and treatment planning. Periodontitis can alter the widths of the arches by causing pathological migration of teeth and the concurrent bone loss can affect the transverse width of the arches. Aim: To compare the transverse dentofacial widths in adults with skeletal class I and class II malocclusions with horizontal growth pattern and with mild to moderate periodontitis using Cone Beam Computed Tomography (CBCT). Materials and Methods: This retrospective observational study was conducted in Department of Orthodontics, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India, from January 2019 to January 2021. Total 96 CBCT samples (48 skeletal Class I, 48 skeletal Class II) of patients between age group of 25-35 years, patients having mild to moderate periodontitis based on bone loss seen on CBCT and patients having a horizontal growth pattern with the angle between sella-nasion and mandibular plane less than 32° were included in the study. Transverse dentofacial measurements were made on the coronal plane of the CBCT scans. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test and Student’s t-test were used to compare age, linear measurements and angular measurements between the skeletal class I and skeletal Class II groups. A p-value of <0.05 was considered statistically significant at 95% class interval. Results: In the present study, the mean age of patients with skeletal class I and class II was 30.89±3.23 and 30.97±3.28 years, respectively. There were 24 females and 24 males belonging to class I and class II groups, each. There was a statistically significant difference in the mean interjugal width and the antegonial width. The mean interjugal width in skeletal class I and class II group was 56.95±5.68 mm and 51.28±5.94 mm respectively (p-value <0.001). The maxillomandibular difference (p-value=0.002), the mean maxillary buccal alveolar crest width difference (p-value <0.001) and mandibular buccal alveolar crest width difference (p-value <0.001) was also statistically significant. The palatal height in skeletal class I group (21.77 mm) was significantly higher (p-value <0.001) and the mean maxillary palatal alveolar crest width in skeletal class I (36.47 mm) was lower than in the class II group (37.97 mm). Conclusion: The dentofacial transverse widths such as the interjugal width, antegonial width, maxillomandibular difference, maxillary buccal alveolar crest width and mandibular buccal alveolar crest width were higher in skeletal class I groups compared to skeletal class II groups. The maxillary palatal alveolar crest width was higher in skeletal class II groups compared to skeletal class I group.

Assessment of Anxiety and Depression among Adult Population of Kashmir, India: A Cross-sectional Study

Introduction: Mental health in Kashmir remains a concern and is threatening to become an ever-increasing epidemic. The changing social structure and the low-intensity armed conflict have become the basis of a deteriorating state of mental health among Kashmiris. In addition to this, the other factors are widespread poverty, uncertainty, grief, oppression, fear and high unemployment with limited employment generating sectors. Aim: To assess the depression, anxiety and mental distress among the adult population of Budgam district, Kashmir, India. Materials and Methods: A cross-sectional study was conducted at the community level in District Budgam, Jammu and Kashmir, India, from December 2019 to March 2020. Total three Investigators, one Senior Research Fellow (SRF) and two Junior Research Fellow (JRF) collected the data. The SRF was a Clinical Psychologist while the JRF were trained social workers. A door to door survey was conducted in the villages which were selected randomly from the list of the villages.The probability random sampling technique was used for the research purpose. Hopkins Symptoms Checklist-25 (HSCL-25) was used in the study and whereby after analysing the scores of the scale, results were derived. Chi-square and t-test were applied for statistical comparison. Results: Out of 133 individuals, 55 were males and 78 were females.The age of the sample ranged from 18 to 45 years, with a mean age of 37 years. Total 29.32% of the adults scored above the cut-off for anxiety symptoms and 34.58% scored above the cut-off for depressive symptoms, while 39% of these adults fall above the cut-off for mental distress scores.The validated cut-off score for the anxiety was 1.75 and for the depression was 1.57. Feeling tense, being worried, nervousness and low energy were reported as the symptoms of the mental distress among the people. Females, unemployed and individuals from lower socio-economic status reported higher degree of mental distress than others. Conclusion: Mental health issues in terms of anxiety, depression, and mental distress are found among the adult population in district Budgam. There was a significant mean difference in the mental distress levels concerning various socio-demographic variables. The study concluded that being female, having some medical condition, being unemployed, belonging to lower socio-economic status, belonging to nuclear family predict mental health distress.

Demographic and Clinicoradiological Presentation of Tuberculosis in Patients with Sickle Cell Haemoglobinopathy: A Cross-sectional Study

Introduction: Infectious disease is an important contributor to disability and death in Sickle Cell Haemoglobinopathy (SCH). India has a high burden of Tuberculosis (TB) and SCH is widespread among residents in and around Burla, Odisha. This was the first attempt to find the prevalence of SCH in active cases of TB in Indian adults. Aim: To estimate the prevalence of SCH in TB and to evaluate the demographic and clinicoradiological presentation of TB in patients with SCH in a subset of Indian population. Materials and Methods: A cross-sectional study was done from October 2010 to September 2012 in Department of Pulmonary Medicine of V.S.S.M.C, Burla, Odisha, India. The primary inclusion criterion was patients with TB and SCH. Demographic characteristics, clinical, radiological, microbiological and histopathology data were collected. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) 18.0. Association between categorical data was calculated using Chi-square test and Fischer’s exact test. A p-value of <0.05 was considered to be significant. Results: Out of 1243 TB patients who were screened, 64 TB patients had SCH. The mean age of the patients was 30 (±13) years with female predominance 33 (51.56%). The prevalence of SCH in TB was 51.49/1000, Sickle Cell Anaemia (SCA) was 13.68/1000 and Sickle Cell Trait (SCT) was 37.81/1000. 47 (73.43%) patients had SCT and 17 (26.56%) patients had SCA. Majority of patients with SCA 15 (88.23%) and SCT 35 (74.46%) belonged to the age of ≤40 years. 38 (59.37%) patients had Pulmonary TB (PTB) and 26 (40.62%) had Extrapulmonary TB (EPTB). EPTB 11 (64.70%) was common in patients with SCA than PTB 6 (35.29%) and vice-versa in SCT 15 (31.91% vs 32 (68.08%) (p=0.018). Among PTB patients, cough was the most common symptom seen in 7(10.93%) patients of SCA and in 26 (40.62%) patients of SCT. The mean (±SD) haemoglobin in patients with SCA was 7.270 (±2.007) gm% and SCT was 9.021 (±1.578) gm% (p=0.002). The most common chest radiographic finding was nodules in patients with SCA 9 (52.94%), reticular opacities and pleural effusion 11 (23.40%) each in SCT. Conclusion: In the present study, 5.14% of TB patients had SCH. PTB was more common than EPTB in patients with SCH.

Mycoplasma pneumoniae Infection and Subsequent Wheezing in Childhood Asthma- A Cohort Study

Akansha Mittal, Mohd Kashif Ali, Haris M Khan

Introduction: Prevalence of asthma in children <18 years is approximately 7-8%. Mycoplasma pneumoniae has also been found to be an important trigger of asthma. Many studies have shown the association of Mycoplasma pneumoniae with acute exacerbation of asthma in adults. But the data is limited to determine the role of Mycoplasma pneumoniae in causing subsequent wheezing in children with asthma. Aim: To study the role of Mycoplasma pneumoniae infection in causing subsequent wheezing episodes in asthma in children between 1-14 years of age. Materials and Methods: This was a prospective cohort study conducted from October 2019 to October 2021 at the Paediatric Division of Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. Consecutively 60 patients with bronchial asthma aged between 1 to 14 years were included during the first year of study period. The diagnosis of bronchial asthma was as per Global Initiative for Asthma (GINA) guidelines. Venous sample was tested for Immunoglobulin M (IgM) Mycoplasma pneumoniae antibody with Calbiotech Mycoplasma pneumoniae IgM Enzyme-linked Immunosorbent Assay (ELISA) kit. Clinical follow-up for subsequent wheeze was done at 3 months, 6 months, and 12 months starting after 2 weeks of being declared symptom free. All data were recorded and analysed by Statistical Package for Social Sciences software (SPSS) version 22.0. Results: Out of 60 patients, males comprised of 46 (76.67%) and females 14 (23.33%) with the mean age 5.56±4.21 years. Family history of wheeze was also taken and found to be 38.33% among asthamatics (23/60). Among asthmatics, 23 cases (38.33%) were IgM positive. Episodes of subsequent wheeze were present in all the patients with a mean of 4.5±2.7 episodes in one year. On subgroup analysis, mean wheezing episodes were documented as 5.43±3.00 in IgM positive group which was statistically higher than IgM negative group in which mean wheezing episodes were 3.92±2.42 (p-value=0.036). Conclusion: Subsequent wheeze was observed in all patients with asthma. The mean wheezing episodes were statistically more in Mycoplasma pneumoniae infected asthmatics in comparison to non Mycoplasma pneumoniae infected asthmatics.

Cardiovascular Risk among Healthcare Workers in DCH and DCHC Hospitals during COVID-19 Duty: Correlation of Stress Score with Blood Pressure and Lipid Profile

Jagdish Hundekari, Sanjay Wasnik, Rahul Mittal, Lokendra Kot

Introduction: Healthcare workers (HCW’s) are at the frontline of the Coronavirus Disease-2019 (COVID-19) pandemic, participating directly in the diagnosis and treatment of Coronavirus patients for the past two years. This puts them at a larger risk of causing long-term stress, mental anguish, and other negative psychological impacts. Aim: To evaluate stress score, serum lipid profile and blood pressure in a Dedicated COVID Hospital (DCH) and Dedicated COVID Health centre (DCHC) among HCWs, and to correlate the perception of psychological stress with serum lipid profile. Materials and Methods: This was a hospital-based cross-sectional study conducted from the month of March 2021 to August 2021. Seventy-five HCWs (35 men and 40 women) from DCH and DCHC were included in this study. In these participants, socio-demographic and perceived stress, serum lipid profile was measured. The studied population was divided into two groups: Group A (HCWs in direct contact with COVID-19 patients) and Group B (HCWs not in direct contacts with patients). Stress scores, serum lipid levels, systolic and diastolic Blood Pressure (SBP and DBP) of all the participants were measured and compared with that of controls, using Student’s t-test. Stress scores of HCWs in direct contact with patients were correlated with SBP and DBP and serum lipid profile by using Pearson correlation coefficient (r). Results: Stress levels were significantly higher in Group A (p>0.05), but serum lipid levels were not significant. Stress levels of Group A were found to correlate strongly with blood Total Cholesterol (TC), (p<0.001) serum Triglyceride (TG), (p<0.01) High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL), LDL/HDL, and SBP and DBP (p<0.001). Conclusion: Stress scores were elevated in HCWs in direct contact with patients (Group A) and these strongly correlate with serum lipid levels and BP. The health authorities are responsible for implementation of strategies to manage this psychological stress.

Alarming Rise in Secondary Infections and Antimicrobial Resistance in COVID-19 Patients Admitted at a Tertiary Care Centre in Dehradun, Northern India

Rajender Singh, Nupur Koul, Manish Mittal, Barnali Kakati, Garima Mittal

Introduction: Secondary infections are emerging as a serious threat among hospitalised patients of Coronavirus Disease-2019 (COVID-19). Overuse of antibiotics and inadequate infection control practices due to COVID-19 patients’ workload leads to a sudden upsurge of Multidrug Resistance (MDR) pathogens in healthcare settings attributing to higher mortality rates among the same. Aim: To detect the secondary infection rate among COVID-19 patients admitted to the hospital ward and Intensive Care Unit (ICU), and report the impact on antimicrobial resistance and patient outcome. Materials and Methods: A retrospective study was conducted for a period of three months of the second COVID-19 wave from 15^th April 2021 to 14^th july 2021 in the Department of Microbiology, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Dehradun, Uttarakhand, India. All clinical samples of Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) positive cases of COVID-19 received in the laboratory were cultured and identified using the Vitek-2 automated system and conventional fungal culture. Relevant demographic, characteristics, and clinical outcome data were obtained from records of the patient and recorded in reporting forms and were analysed for the study. Results were analysed with Statistical Package for the Social Sciences (SPSS) version 20.0 and Microsoft Excel 2019. Results: Overall secondary infection rate of 135 (13.6%) was found among COVID-19 admitted patients. The most commonly isolated bacterial pathogens were Coagulase-negative Staphylococcus species (18.52%) and Enterococcus species (8.89%). Whereas the most common fungal isolates were Candida species (20.75%) and Rhizopus (8.15%). In the present study, 60.5% of bacterial pathogens isolated were Multidrug-resistant Organisms (MDRO). Mortality among COVID-19 patients with secondary infection was reported as 53% which was higher than the overall mortality rate of 36% in the same. Conclusion: A high secondary infection rate, MDRO isolation rate, and high mortality among COVID-19 with secondary infection were reported. This shows the urgent need for reinforcement of infection control practices and strict antimicrobial stewardship policies.

Is Habitual Sleep Duration an Important Factor for Face Recognition Memory in Young Adults? A Cross-sectional Study

Introduction: Sleep is integral to the process of maintenance and restoration of physical as well as mental health encompassing intelligence, memory as well as emotions. Face recognition memory is a special form of memory that gives the ability to remember people meaningfully and is instrumental in any individual’s meaningful co-existence in the society. Aim: To determine, if different habitual sleep durations may be associated with difference in unfamiliar face recognition memory and if there are any gender differences in the same, among young healthy individuals. Materials and Methods: This was an observational analytic cross-sectional study conducted over a month in B.J. Medical College, Ahmedabad, Gujarat, India, including 98 healthy young volunteers (39 females and 59 males) among 1^st year students of different professional courses. The participants were subjected to a questionnaire-based interview followed by a face recognition test based on Parkin’s recognition memory test (1995). Mean values and Standard Deviations (SD) were calculated for age, sleep duration, correct and wrong responses in the test and statistical significance was tested by applying t-test with a significance level of p<0.05. Results: The participants were grouped as average-duration (6.6±0.5 hours/day) and long-duration (8.4±1.0 hours/day) sleepers, 53 and 45 in number, respectively, and there was a significant difference in the sleep duration of the two groups (p=8.6×10^-17). No significant difference was seen in the number of correct (p=0.08795) and incorrect (p=0.42205) responses of average-duration sleepers and the long-duration sleepers. Gender differences in correct and incorrect responses of average-duration and long-duration sleepers were also not significant. But there was a significant difference in the number of correct responses by females and males, in general. Conclusion: Habitual duration of sleep may not affect face recognition memory in the young ages.

Comparison between Dexmedetomidine and Propofol for MRI Brain in Paediatric Patients- A Randomised Clinical Trial

Nazmeen Imranali Sayed, Naina Parag Dalvi, Urvi Hemant Desai, Bharati Tendolkar

Introduction: Dexmedetomidine is an α₂ agonist that causes deep sedation after bolus, and can be given as infusion while performing Magnetic Resonance Imaging (MRI) brain in paediatric patients. There are reports of increased incidences of bradycardia and hypotension with prolonged recovery when it was used in high doses of 2-3 mcg/kg bolus. Lower dose of bolus may enhance the recovery profile and reduce the chances of bradycardia, while maintaining the efficacy of sedation. Aim: To compare the induction of sedation, haemodynamics stability, success rate of the scan, efficacy of the drug and recovery profile of low dose dexmedetomidine and propofol infusion for MRI brain in paediatric patients. Materials and Methods: This randomised clinical trial was conducted at Lokmanya Tilak Municipal General Hospital and Medical College, Sion Mumbai, Maharashtra, India, from November 2012 to April 2014. Total 70 American Society of Anaesthesiologist (ASA) grade I and II children aged 1-7 years posted for elective MRI brain were included in the study. Patients were divided into two groups i.e, dexmedetomidine group (n=35) and propofol group (n=35). Intranasal midazolam 0.2 mg/kg was given. Children in dexmedetomidine group were induced with 1 mcg/kg dexmedetomidine given over 10 minutes and maintained with dexmedetomidine at 1 mcg/kg/hr. Patients in propofol group received propofol bolus 2 mg/kg and infusion at 100 mcg/kg/min. Results: The MRI scan was completed in 34 (97.1%) and 35 (100%) of children in dexmedetomidine and propofol group, respectively. Time for complete recovery was 68.9±31.5 and 40.1±23 minutes in the dexmedetomidine and propofol group, respectively. Time for induction was 12.4±3.53 and 6.46±1.9 minutes in the dexmedetomidine and propofol group, respectively. Bradycardia was observed in 8 (22.9%) patients in dexmedetomidine group. Haemodynamic parameters were with 20% of baseline in both the groups. Conclusion: Propofol is a better anaesthetics in terms of recovery and induction time when used as an infussion for MRI brain in paediatric patients. Dexmedetomidine has a high incidence of bradycardia so requires a more vigilant monitoring.

Placental Changes in Perinatal Death- An Observational Study from a Tertiary Care Centre in North Karnataka

Priyadharshini Bargunam, Parvathi S Jigalur, Purusotham Reddy, Jamuna Kanakaraya

Introduction: Placenta is poetically described as a diary which bears the events of intrauterine life; hence examining them, especially in perinatal death can provide valuable information regarding the cause of death and sometimes gives an idea about recurrence of such events. Aim: To describe the various placental lesions in perinatal death and compare them with equal number of normal placentae. Materials and Methods: This prospective, comparative, cross-sectional study was conducted in tertiary care centre, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. All placentae, irrespective of the gestational age, received in the Department of Pathology, from October 1^st 2017 to March 31^st 2019 were collected after taking an informed consent. A total of 539 cases were received in this time frame, of which 121 (22.45%) were dead and included in the study and were compared with 121 normal placentae (alive), without any maternal co-morbidities. The placentae were grossed and assessed according to Amsterdam guidelines. The significance of the difference observed was established by Chi-square test using Statistical Package for Social Sciences software (SPSS) version 21.0. Results: Of these 121 cases, 89 (73.5%) cases had placental changes, whereas 32 (26.5%) cases were devoid of placental changes. Placental infarct and increased syncytial knots were seen contributing maximum to foetal death in 31 (25.6%) cases followed by chorioamnionitis. Rare cases like Twin Reversed Arterial Perfusion (TRAP) syndrome, Persistent Right Umbilical Vein (PRUV), maternal floor infarct were also reported. Conclusion: Despite many antenatal imaging advances, placental examination still remains valuable in diagnosing cause of death and growth restriction in the foetus especially recurrent causes, favouring clinical intervention in those cases.

Comparison of Six Immunoassays for Assaying Levels of Immunoglobulin G against the Nucleocapsid and Spike Proteins of SARS-CoV-2

Introduction: Assay kits for detection of Immunoglobulin G (IgG) against the nucleocapsid protein (anti-nucleocapsid IgG) and spike proteins (anti-spike IgG) of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) were commercially provided by several manufacturers. These assay kits should be verified by measuring the same sample. Aim: To compare the diagnostic value of three Coronavirus Disease-2019 (COVID-19) kits in evaluating six immunoassays developed by three manufacturers (Abbott, Euglena, and Roche) to detect anti-nucleocapsid IgG and anti-spike IgG. Materials and Methods: Present study was an observational cross-sectional study conducted from June 2020 to December 2020. Antibody titers for anti-nucleocapsid IgG and anti-spike IgG among 429 Healthcare Workers (HCWs) in a Tone Central Hospital, Japan where a nosocomial infection of the COVID-19 occurred were measured by six immunoassays with kits developed by three different manufacturers. The sensitivity and specificity of each kit was compared to real-time Reverse Transcription-Polymerase Chain Reaction (RT-qPCR). Results: Six of the HCWs tested positive for SARS-CoV-2 via RT-qPCR, and the rest tested negative. The severity of COVID-19 among these six HCWs ranged from mild to moderate. The sensitivity and specificity values against RT-qPCR were, 100% and 99.5% for Abbott, 83.3% and 100% for Euglena, and 100% and 100% for Roche when using the nucleocapsid protein assay and 100% and 99.8% for Abbott, 100% and 100% for Euglena, and 100% and 100% for Roche when using the spike protein assay kit. Conclusion: The commercial kits provided by three manufacturers reflected the immune status of individuals. There were no major differences in the performance of these test kits. Discordant results with the antibody titer for anti-nucleocapsid IgG and anti-spike IgG were detected by using assay kits provided by Abbott and Euglena. To evaluate the past history of COVID-19, it should be noted that the single measurement of anit-nucleocapsid IgG or anti-spike IgG could not exclude false negative or positives.

Study of Pulmonary Function Tests in Multitransfused Children with Thalassaemia: A Case-control Study

Bhagyalakshmi Swamy, NR Akhila, HM Nanjundaswamy

Introduction: Lung involvement is one of the known complications of thalassaemia. This study was undertaken to assess the predominant type of pulmonary dysfunction. Most studies show pulmonary function abnormalities but the results are conflicting. Aim: To study Pulmonary Function Tests (PFTs) in multitransfused children with thalassaemia and compare them with normal children. Materials and Methods: This was a case-control study conducted from May 2012 to June 2013 at MS Ramaiah Medical College, Bengaluru, Karnataka, India, which included 35 children in the age group of 3-16 years with β-thalassaemia major and on regular transfusion as cases and 35 age and sex matched healthy children participated as controls. PFTs were done in 35 children with β-thalassaemia major, using Spirobank G and within three days of blood transfusion. Following parameters were recorded: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Ratio of Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC), Peak Expiratory Flow Rate (PEFR), and Forced Expiratory Flow (FEF25%-75). Student’s’ test was used for statistical analysis. Results: Percentage abnormalities of PFT in thalassaemia children were observed, 20 (57.14%) children had normal PFTs. Among the remaining children 9 (25.71%), 5 (14.29%) and 1 (2.86%) had restrictive, obstructive and mixed pattern of abnormalities respectively. Conclusion: Pulmonary function appeared to be affected in a majority of subjects with thalassaemia. Abnormal patterns of lung function were common in which restrictive type was predominant. No respiratory symptoms was found in any of these children. Studies are needed to establish the precise cause of pulmonary dysfunction.

Clinicopathology of Middle Ear Tumours: A Retrospective Study from a Tertiary Care Hospital, Hyderabad, India

Narala Srivani, Thamidala Mahitha Joyce

Introduction: Middle ear tumours are rare neoplasms that have non specific clinical presentation, otoscopic and imaging features and pose a diagnostic challenge. Most common neoplasm of middle ear are paraganglioma, schwannoma, haemangioma and middle ear adenoma. Aim: To analyse the relative incidence, clinical presentation and histopathological spectrum of neoplasms in the middle ear at a tertiary care hospital, Hyderabad, Telangana, India. Materials and Methods: This retrospective study was conducted in Department of Pathology at Government ENT Hospital (tertiary referral ENT Hospital), Hyderabad, Telangana, India, from July 2014 to June 2019. Total 26 cases of middle ear tumours both incisional or excisional biopsies of middle ear lesions from all age group of either gender with complete clinical details were included in the study. Clinical and histopathological data were analysed after processing the sections with Haematoxylin and Eosin (H&E) stains examined microscopically. Statistical analysis was done using Statistical Package for Social Science (SPSS) version 20.0 and mean, standard deviation and percentages were calculated. Results: In the present study, maximum patients 11 (42.3%) were in age group of 41 to 50 years with female preponderance 18 (69.2%). Mean age of the patients were 42.92±12.53 years. Out of a total of 26 cases, 20 cases were benign neoplasms and six cases were malignant. Most common side of presentation was right side. Most of the benign tumours occurred in the 5th decade and malignant tumours were common in the 6th decade. Paragangliomas/Glomustympanicum tumours were most common benign tumours followed by schwannoma, haemangioma and middle ear adenoma. Whereas among malignant tumour, squamous cell carcinoma was common. Conclusion: Middle ear tumours are relatively uncommon lesions presenting as mass in the ear, discharge, hearing loss, tinnitus and chronic suppurative otitis media. Benign tumours are more common than malignant tumours in the middle ear. Paraganglioma was the most common benign tumour encountered, followed by schwannomas, middle ear adenomas and haemangiomas. Middle ear tumours are rare and histologic analysis is essential for definitive diagnosis and treatment.

Underweight, Overweight and Anaemia among Persons Aged 60 Years or Older Residing in an Urban Resettlement Colony of Delhi: A Cross-sectional Study

Introduction: Nutritional deficiencies are common among elderly person aged 60 years or older. Elderly persons suffer the dual burden of overnutrition and undernutrition. These nutritional disorders can be corrected if diagnosed and managed at the earliest. Aim: To estimate the prevalence and factors associated with underweight, overweight, obesity and anaemia among elderly persons in an urban resettlement colony of Delhi, India. Materials and Methods: The present study was a cross-sectional survey in which elderly persons who were residents of Dr. Ambedkar Nagar, an urban resettlement colony in Dakshinpuri Extension of Delhi were recruited. The study period was from December 2019 to March 2020. A pretested semi-structured interview schedule was used to collect socio-demographic details. The anthropometric measurements, namely, height and weight were carried out as per standard practice. Capillary blood haemoglobin level was measured by a digital haemoglobinometer. Chi-square test for distribution and multivariable logistic regression for association were performed. Results: Data was collected from 959 participants, with a response rate of 91.2%. The prevalence (95%CI) of underweight, overweight and obesity were 15.5% (13.3-18.0), 21.9% (19.3-24.6) and 9.6% (7.7-11.6), respectively. Persons aged 70 years or older and illiterate persons had increased chance of being underweight. Women had increased chance of being overweight or obese. The prevalence of anaemia among participants was 72.1% (95% CI (69.2-74.9), using the cut-off of anaemia as haemoglobin levels <13 gm/dL in men, and <12 gm/dL in women. Conclusion: The prevalence of underweight, overweight, obesity and anaemia among elderly persons in the study population was high. Community-based measures need to be taken to address them.

Development of Nucleic Acid Based Diagnostic Methods and their Implications in Oral Medicine Practice

Karthikeya Patil, CJ Sanjay, Nagabhushana Doggalli, S Viveka, Barsha Bharadwaj

Disease identification methods based on nucleic acids are commonly employed in medical diagnostic procedures. Nucleic acid detection is a vital technique that identifies specific nucleotide sequences, hence indicating the presence of a pathogen or the onset of an unhealthy condition. The techniques based on them are constantly advancing and there is a certain drive in the scientific community to devise tests that are more rapid, reliable, and economical. Advances in nucleic acid based diagnostics, for instance Polymerase Chain Reaction (PCR) and sequence alignment studies, have transformed the way clinical laboratories presently detect pathogens, allowing for rapid and effective response to infection therapy at an early phase. Nucleic acid detecting might actually be a linkage between oral and systemic diseases since persistent inflammation in the oral cavity is related with systemic diseases. The capacity to distinguish genetically between closely related disorders is especially crucial for bacterial or viral infections, which may rapidly evolve and produce new strains. Another advantage of infectious disease nucleic acid biomarkers being exogenous is that they may be discovered in the body shortly after infection. In principle, this allows for early detection and can be helpful in slowing or stopping disease transmission. This article reviews the evolutionary milestones of its current applications, emerging applications in oral diagnosis and future trends. Over the last decade, molecular biology has evolved at an accelerated pace, enabling the detection and management of a varied range of oral diseases. Understanding the numerous sequencing methodologies and genetic anomalies can assist in clinical application for improved disease diagnosis and prognosis.

Role of Mycobacterial Culture and Drug Sensitivity Testing Laboratory under National Tuberculosis Elimination Program for the Abolition of Tuberculosis in India by 2025

India has made a bold promise to eradicate Tuberculosis (TB) by 2025 five years ahead of the global target. Although, one-fourth of the global burden with highest new cases of TB is shown by the country. So yet, no comprehensive analysis has been published on India’s National Tuberculosis Elimination Program (NTEP) (2017-2025). The current review details the advanced diagnostic methods like Fluorescence Microscopy (FM), culture, nucleic acid amplification test (Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and True Nucleic Acid amplification Test (TrueNAT)) and line probe assay as well as the role and network of Mycobacterial culture and Drug Sensitivity Testing (C and DST) laboratories in national scaling-up of evidence-based policies and facilities, which is a critical component in India's fight against TB. The material of this study was mostly obtained from policy and program making documents of World Health Organisation (WHO) and annual TB reports of India. India’s TB annual report 2021 says that only half of the patients were successfully treated in the period of conventional longer care regimens. The interventions to achieve the factors related patient’s care have been implemented through universal drug sensitivity testing through C and DST laboratories, which has driven therapy with a shorter regimen, newer medications, and social protection. In one hand, the comprehensive monitoring scheme through C and DST laboratories for TB including all possible drug-resistance cases and other hand, patient’s systemic treatment through shorter, more reliable, and safer first- or second-line drug regimens are all necessary milestones to achieve the goal of our government for abolition of TB in India by 2025.

Folate Mediated One Carbon Metabolism in Head and Neck Squamous Cell Carcinoma: A Systematic Review

Sangeeta Jayant Palaskar, Rutuja Narsing Mukkanwar, Kalpana Joshi

Introduction: Head and neck cancer (HNC) is one of the most prevalent cancers of upper aerodigestive tract, with squamous cell carcinomas accounting for the majority of cases. Vitamin B such as folate has been associated with carcinogenesis. Folate is essential for one carbon metabolism, which involves the transfer of one carbon units for Deoxyribonucleic Acid (DNA) and Ribonucleic Acid (RNA) production, amino acid metabolism and methylation. Aim: To evaluate the association of folate mediated One carbon metabolism with Head and Neck Squamous Cell Carcinoma (HNSCC). Materials and Methods: For this systematic review, Electronic bibliographic databases search of PubMed, Google Scholar and Scopus was done. The electronic search was performed between November 15^th to November 30^th, 2020 by two researchers independently. All original research, observational studies, full text articles, in which blood samples or questionnaires or both, focused on the assessment of folate mediated one carbon metabolism in HNSCC, published upto November 2020 were reviewed. Four studies published from 2005 to 2019 were included in which three studies were case-control and one study was a comparative cross-sectional study. This systematic review was carried out by two reviewers, using Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) checklist and the New Castle Ottawa Scale (NOS) for quality assessment. Results: In this systematic review, total of four studies included, had 1504 HNSCC patients and 2970 Controls. One study was reported from Nigeria, one from the European countries, one from Japan, and one from the United States of America (USA). One study had a quality score of 8 whereas 3 studies had 7, considering all the four studies included are of good quality. Conclusion: Significant low levels of serum folate was present in HNSCC when compared to controls. Serum folate levels can differ due to tumor growth and subsequent metabolic changes, or they may precede and accelerate tumor progression.

Unravelling Multifaceted p73: From Cell Kinetics to Therapeutics

Anitha Dayakar, Pushparaja Shetty

The p73 gene is an important member of the p53 gene family, which includes p53, p63, and p73 genes. The p73 gene was identified by McKeon’s group in 1997 and localised to 1p36 region. The p73 shows a complex interplay with both, p53 and p63 genes. Similar to p63, but unlike p53, p73 has an important role in development especially neuronal development, apart from tumourigenesis. The p73 gene plays a vital role in the development of tumours and exhibits both tumour suppressor and oncogenic behaviour. This dual function is attributed to the presence of the two different variants: TAp73 and ΔNp73 with mutually divergent functions. There exists a dynamic relationship between the multiple p73 isoforms. The p73 has a major role in regulating apoptosis, and Deoxyribonucleic Acid (DNA) damage related cell cycle arrest. It can replace p53 in various apoptotic pathways, as it is capable of transcription of p53 responsive genes. The p73 also participates in myriad processes including angiogenesis, epithelial-mesenchymal transformation, senescence, and maintaining genomic stability. The p73 overexpression has been detected in a number of human cancers. Since it is frequently overexpressed rather than mutated, it is a promising potential candidate for developing therapeutic strategies in various cancers as well as, for predicting the prognosis. It is also implicated in the lack of response to chemotherapeutic drugs. However, the entire spectrum of cellular mechanisms with respect to p73 is still not understood clearly. This article explores the multiple roles of p73, especially in tumour development processes, and also, its recent novel applications in therapeutics.

An Outlook on Breastfeeding Assessment Tools- A Review

R Divya, Sachin Damke, Annie Paul, Spandandeep Sarma

Breastfeeding is a biological inheritance shared by women all around the world. It is the ‘natural’ way to feed new born babies, and the best source of nutrition for infants. After birth, loose stools and pneumonia are more frequent and serious in the formula fed babies, and can cause deaths. Otitis media, haemophilus influenza meningitis, and urinary tract infection are less frequent in babies who are fed human milk. Infants who are formula fed have a greater chance of developing chronic illnesses, such as asthma, diabetes mellitus type l, and intestinal diseases like inflammatory bowel disease. Coordination of mother and infant is most important for breast feeding to be successful. Ineffective breast feeding can contribute to mortality among new born babies and infants. Hence various breastfeeding assessment tools have been developed to advise and promote mother’s comfort, motivation, and assess the infant's neurobehavioural development. In this review, the literature to find out the most commonly used breastfeeding assessment tools, their salient features, advantages and disadvantages, acceptability, usage and validation have been reviewed.

Pesticides and Human Health: Antioxidants and Heat Shock Proteins as Modulators of Cell Survival Signal

Tanzeel Ahmed, Priyanka Mishra, Babita Singh, Utkarsh Tyagi, Basu Dev Banerjee

In the modern times, insecticides have grown to be an essential part of the atmosphere. Their full-size use in public health packages and agriculture has ended in capability environmental pollution and health risks, which relies upon their residual quantity and toxicity. The widespread uses cause general population to low dose of continual exposure of insecticides through meals and environment. The residue evaluation of human specimen suggests an increasing trend within the ranges of insecticides in serum, adipose tissue, breast milk, urine and others. Implications of pesticides residues on human fitness following subchronic publicity are but to be comprehensively answered. Subjection to insecticides can be closely associated with neurotoxicity, hepatotoxicity, immunotoxicity, genotoxicity and injurious reproductive effects. Pesticides leads to Reactive Oxygen Species (ROS) generation in significant quantities, resulting in oxidative stress and cellular damages. Findings of research have discovered a concomitant genotoxic and apoptotic effect of the pesticides in Peripheral Blood Mononuclear Cells (PBMCs). Since genotoxic consequences of pesticides on humans cannot be overlooked, therefore identification and implication of protective measures are urgently needed. This have been tested that PBMCs go through dose-structured apoptotic cell demise following pesticide exposure and additionally highlights the effectiveness of various antioxidants in counteracting pesticide-precipitated cytotoxicity. Heat Shock Proteins (HSPs) have emerged as an antiapoptotic molecules which counteract cytotoxicity. The inducible expression analysis of HSPs ought to make contributions to the human PBMCs to get over the toxic results of subchronic pesticide exposure. Though the linkage between cellular events of apoptosis is thought, the molecular mechanism highlighting the precise function of HSP in pesticide-mediated cytotoxicity yet stays to be comprehensively replied. To better understand this mechanism, different antioxidant and HSP inducers have been employed, and also highlighted their attenuating effects towards the apoptotic capacity of such pesticides. This review article therefore, focuses on the fact that antioxidants and HSP inducers efficiently protect cells, emphasizing their role in pesticide-induced toxicity at molecular and cellular level as well as their possible use as therapeutic intervention.

Adverse Drug Reactions and Anaesthesia: A Narrative Review

Ramyavel Thangavelu, RV Ranjan

Adverse drug reactions are defined as the effects created by drugs producing unintended or noxious response in doses normally used for prophylaxis, diagnosis or therapy of diseases. Adverse drug reactions under anaesthesia occur by a number of mechanisms and several risk factors are often involved. The overall incidence of adverse drug reactions to anaesthetic drugs ranges between 1 in 10,000 and 1 in 20,000. Electronic databases were searched to obtain the relevant literature with keywords related to adverse drug reactions and anaesthesia. Total 110 articles were reviewed, bibliography cross-checked and relevant literature was included. This article discusses about the adverse drug reactions to various anaesthetic as well as non anaesthetic drugs used intraoperatively. Anaphylaxis under anaesthesia, its pathophysiology, clinical and laboratory diagnosis, management and prevention has also been discussed in detail. Allergic drug reactions and anaphylaxis in the operating room often presents unique diagnostic concerns as the early signs of anaphylaxis are often masked under general anaesthesia. The use of surgical drapes and use of multiple potential allergen drugs under anaesthesia also make the diagnostic process difficult. Thus, an adequate knowledge, understanding, vigilance and proper documentation with reporting in case of an event is warranted by the attending anaesthesiologist for a good perioperative outcome with decreased morbidity and mortality.

Sexual Health Needs of Women with Breast Cancer: A Rapid Review

Introduction: The number of women diagnosed with breast cancer has been rising globally over the past few decades. Upon hearing of a breast cancer diagnosis, women face many challenges including emotional distress, body image issues and sexual dysfunction. Regarding the importance of sexuality for breast cancer patients, this paper aims to validate the sexual health needs of women with breast cancer. Aim: To assess the sexual health needs of women with breast cancer and a need for further research. Materials and Methods: This research is a rapid review conducted in Iran, in April 2020. Databases of PubMed, Cochrane Library, Scopus and Web of Science as well as the Iranian Scientific Information Database (SID), were searched with mentioned keywords, “Female Breast Cancer”, “Sex Counselling”, “Female Sexual Dysfunction” and “Sexual Health Needs”. Results: This review included 16 studies with one randomised clinical trial, four cross-sectional, four review articles, three qualitative articles, three mixed-method studies and one cohort. This study highlights four major sexuality-related information needs of women with breast cancer including: informational need about sexual activity; informational need about fertility-preserving options before starting breast cancer treatment; informational need about prosthesis or breast reconstruction surgery, and informational need about physical changes caused by breast cancer treatments. Conclusion: This review highlight the importance of sexual health needs for female breast cancer patients. However, little attention has been received from women’s health professionals and researchers and further research on sexuality and breast cancer is recommended to affirm these research findings.

Diagnostic Accuracy of Chemiluminescence for Oral Potentially Malignant Disorders: A Systematic Review and Meta-analysis

Introduction: Biopsy is the gold standard for Oral Potentially Malignant Disorders (OPMD) diagnosis. Chemiluminescence provides promising complementary alternative diagnostic adjunct for its simple non invasive collection and technique and to screen large populations. Aim: To summarise and compare the existing evidence on diagnostic accuracy of chemiluminescence in detecting OPMD. Materials and Methods: The systematic review and meta-analysis protocol was registered at the international prospective register of systematic reviews (PROSPERO- CRD42022306061) and performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy (PRISMA-DTA) checklist. PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2021 to identify the screening potential of chemiluminescence for OPMD. True positive, false positive, true negative, false negative, sensitivity, and specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the sensitivity and specificity and summary points. Summary Receiver Operating Curve (SROC), confidence region, and prediction region were calculated. Results: Twenty-four studies were included for qualitative synthesis and out of that, 14 were included for meta-analysis. Sufficient data for meta-analysis was available only for leukoplakia, oral lichen planus (OLP) and oral submucous fibrosis (OSMF). Sensitivity and specificity were calculated with Area Under Curve (AUC). For leukoplakia, chemiluminescence had sensitivity and specificity of 75% and 98% with 0.74 AUC. For OLP, it was 78% and 60% with 0.70 AUC. For oral submucous fibrosis it was 89% and 76% with 0.69 AUC. Conclusion: Chemiluminescence overall had good sensitivity and specificity values along with good AUC. This strongly supports the fact that it can be used as an alternative diagnostic adjunct to biopsy for various OPMD.

Importance of Family History and Clinical Examination in Evaluation of Paediatric Brain Tumours- A Unique Case Report of Tuberous Sclerosis

Alhad Mulkalwar, Shruti Mondkar, Mukesh Agrawal

Tuberous sclerosis complex is an autosomal dominant neurocutaneous disorder characterised by the development of hamartomas in various tissues. This report describes the case of a 4-year-old male child who was admitted to the Paediatrics Ward with a history of headache and vomiting since two months and weakness in the right upper limb and right lower limb since 15 days. Examination revealed right-sided hemiparesis with facial involvement and signs of raised intracranial tension (papilloedema and hypertension). General examination revealed neurocutaneous markers such as multiple ash leaf macules over forehead, chest, abdomen and dental pits, which were suggestive of tuberous sclerosis. The child’s mother was a known case of focal seizures since childhood, had adenoma sebaceum and Magnetic Resonance Imaging (MRI) brain showed subependymal nodules-suggestive of tuberous sclerosis. Based on neuroimaging {Computed Tomography (CT) and MRI} the child was diagnosed to be suffering from tuberous sclerosis with Subependymal Giant cell Astrocytoma (SEGA) with secondary hydrocephalus. The child underwent resection of the intraventricular tumour (SEGA) with good neurological recovery and is currently asymptomatic. Histopathology confirmed the diagnosis of SEGA. This case emphasises on the significance of a detailed clinical examination and family history which aided neuroimaging in making a diagnosis of tuberous sclerosis in a child who would otherwise be diagnosed only as a case of astrocytoma.

Eisenmenger Syndrome with Unilateral Renal Agenesis: A Rare Case Report

The most advanced form of Pulmonary Atrial Hypertension (PAH), linked with Congenital Heart Abnormalities (CHD), is Eisenmenger Syndrome (ES). This report is about a 26-year-old female who presented with ES treated with Phosphodiesterase type 5 (PDE5) inhibitors, cardiac glycosides, Angiotensin-Converting Enzyme (ACE) inhibitors, loop diuretics, antipyretics, iron and vitamin supplements. Investigations revealed unilateral renal agenesis of left kidney, pulmonary hypertension, ES with large ventricular septal defect and bidirectional shunt. Loop diuretics and PDE5 inhibitors remained the mainstay of the treatment which induced hearing loss and the patient self reported hearing improvement after ceasing furosemide administration. Additional treatment strategy is to be used to improve the symptoms and quality of life of patients.