Journal of clinical and diagnostic research

A Case Report on the Rehabilitation of an Ear Deformity using an Implant Supported Auricular Prosthesis

Smruti Gujjelwar, Mithilesh Dhamande, Seema Sathe Kambala, Ankita Pathak

Extraoral implant retained prostheses have been shown to be a reliable therapy choice for maxillofacial rehabilitation. The clinical and laboratory steps for creating an auricular prosthesis are described in this case report. A 27-year-old male patient met with a road traffic accident, lost his left ear, and developed an ear deformity. The patient then sought out rehabilitation. Extraoral implants and Hader bar-and-clip retention were used to ensure that the auricular prosthesis was properly connected to the implant. The patient was satisfied with the prosthesis remarkable support, retention, and aesthetic abilities. Treatment success depends on factors like patient acceptability, aesthetics, compatibility, durability, and prosthetic considerations like material availability, processing ease, and ease of duplication that make the prosthesis look natural and give the patient social confidence.

Positive Outcome in Traumatic Brain Injury with Haematoma and Fracture: A Case Report

Anjali Khotle, Akhilesh Singh Parihar, Ibrahim Bombaywala, Charuta Gadkari

Traumatic Brain Injury (TBI) is described as the break in natural functioning of the brain caused due to any kind of trauma to the head. The injury to head can cause distinctive types of haemorrhages namely, Epidural Haematoma (EDH), subdural haematoma (SDH), Subarachnoid Haematoma (SAH) and Intra-Parenchymal Haematoma (IPH), SAH and SDH being the more common ones. Acute subdural haematomas often occur in patients suffering from falls and motor vehicle crashes, resulting in compression, and swelling of the brain that increases the intracranial pressure. When both compression and swelling occur, mortality and morbidity can be high. In the following case, the patient presented with both intracranial as well as extracranial haematomas in moderation and got cured during a week of hospital stay with almost minor functional and neurological disability as indicated by the Glasgow Coma Scale (GCS) and other variables. As per current evidence the best way to minimise long-term disability in moderate and severe TBI is extensive multidisciplinary post TBI rehabilitation.

Co-existence of Obstructive and Septic Shock in a Patient Identified by Point of Care Ultrasonography: A Case Report

Shock is a state of acute circulatory failure leading to decreased organ perfusion, inadequate delivery of oxygenated blood to tissues, and resultant end-organ dysfunction. A 45-year-old male patient a known case of Diabetes Mellitus (DM) presented to the Emergency Room (ER) with a complaint of fever for four days and shortness of breath for one day. The patient had a wound discharging pus over the dorsum of the right foot for two weeks following trauma. On examination, the patient’s vitals were: pulse rate-88 Beats Per Minute (bpm), respiratory rate-26 breaths per minute, Oxygen Saturation (SpO2)-78% room air, Blood Pressure (BP)-82/40 mmHg mean arterial pressure- 54 mmHg. As a protocol of shock evaluation, Point of Care Ultrasonography (POCUS) showed a distended Inferior Vena Cava (IVC), dilated right atrium and ventricle, and good left ventricular systolic function. Given the presence of right leg swelling, ultrasound was done, which showed a thrombus in the popliteal vein. Noradrenaline infusion was started to maintain a mean arterial blood pressure of 70 mmHg. A diagnosis of obstructive shock due to pulmonary embolism was strongly suspected, and thrombolysis with injection streptokinase was done. After two hours of thrombolysis, Two-Dimensional (2D) Echocardiography (ECHO) revealed normal right atrium and ventricle size and IVC collapsibility index of 70%, but the patient’s blood pressure didn’t improve significantly. So, adequate intravenous fluid was given as per the septic shock protocol. But, the noradrenalin requirement didn’t improve. The patient was put on broad-spectrum antibiotics. Blood culture showed growth of Pseudomonas aeruginosa. So, a diagnosis of co-existing septic shock with obstructive shock was made. The patient improved and discharged in stable condition. The present case report highlights the co-existence of septic shock and obstructive shock and the usefulness of POCUS in differentiating and managing various shocks.

Prosthetic Rehabilitaion of an Exenterated Defect with a Magnet Retained, Customised Stock Eye Two-piece Hollow Orbital Prosthesis: A Case Report

Sukrit Taneja, Arun Khalikar, Sattyam Wankhede, Suryakant Deogade, Vinay Dutta

Loss of the eye results in a functional impairment, disfigurement of the face and long-term psychological effects on the patient. Coronavirus Disease-2019 (COVID-19) pandemic was accompanied by an increase in the number of patients reporting with mucormycosis. The treatment often involves widespread excision of the involved area, leading to gross facial deformity. Rehabilitation of the orbital defect is a complex task and requires a thorough treatment planning. It has always been challenging for a prosthodontist to create an orbital prosthesis for an exenterated defect brought on by post-COVID mucormycosis because it is difficult to meet the patient’s expectations. It is a time-consuming process requiring multiple appointments with every appointment being an important one. The advent of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology has made the fabrication simple, but not all have access to the required infrastructure. The conventional and economical silicone prosthesis still is a popular choice among clinicians. A 52-year-old male patient reported to the Department of Prosthodontics for an artificial substitute of his missing left eye, which was exenterated in the surgical treatment of mucormycosis. The present case report describes the fabrication of a two-piece magnet retained hollow orbital prosthesis with a “customised stock eye”. The prosthesis is designed in such way that, it utilises the natural undercut in the defect and a magnet between the conformer and the prosthesis. This yields in better maintenance and limiting the contact of silicon with the body fluids, thereby, enhancing the long-term use.

A Rare Presentation of Adrenal Leiomyoma Arising in a Ganglioneuroma: A Case Report

M Anjana, KR Anila, Anitha Mathews, Abinaya R Nadarajan, Siva Ranjith

Leiomyomas are benign tumours of smooth muscle origin and can occur in any part of the body with adrenal gland being an uncommon site. Ganglioneuromas of adrenal gland are benign neural crest-derived tumours. Both of these tumours are usually detected incidentally. Hereby, the authors report an unusual case of a 31-year-old woman, who presented with paroxysmal attacks of headache, palpitations and flushing pointing towards a hormone secreting adrenal tumour. However, functional adrenal markers were normal. Radiological investigations revealed 8×3 cm heterogeneously enhancing left suprarenal mass with calcification and extension to left renal vein. Patient underwent left nephrectomy and adrenalectomy with a high clinical suspicion of malignancy because of tumour extension to the renal vein. The histopathological examination revealed a leiomyoma arising in a background of ganglioneuroma which was later on confirmed using immunohistochemistry. Authors have presented the present case because of atypical presentation as a hormone secreting adrenal tumour with radiological features of malignancy and the unique histomorphology of the combined occurrence of leiomyoma and ganglioneuromatous area in the adrenal gland. To the best of author’s knowledge, this is the first case report of such an occurrence in the adrenal gland.

Intramuscular Hemangioma of the Forearm with Phleboliths: A Case Report

Muniswamy Reddy Archana, Archana Shivamurthy, Sunil Shivanna

Intramuscular hemangiomas of the forearm are rare. Patients typically present with pain, discomfort, and progressive enlargement of the lesion. Diagnosis is often difficult due to their infrequency, deep location, and unfamiliar presentation. In this case report, we present a 47-year-old woman with an intramuscular hemangioma with phleboliths involving the forearm. The patient reported swelling in the right forearm for the past 20 years, which was insidious in onset, gradually progressive in size, and associated with dull aching pain. Upon examination, a soft 20×4 cm swelling was present over the right forearm involving the ulnar aspect, with a positive Tinel’s sign at mid-forearm level. Clinical differential diagnosis included lipomatosis, neurofibroma, and intramuscular hemangioma. On Magnetic Resonance Imaging (MRI), a heterogeneously enhancing serpentine lesion was noted involving the flexor compartment muscles of the right forearm. The patient underwent excision of the lesion, and histopathological examination confirmed intramuscular hemangioma. During the postoperative recovery period, all range of movements at the elbow joint and wrist were normal. No recurrence was noted up to two years of follow-up.

Venolymphatic Malformation over the Left Elbow and Left Breast: A Rare Case Report

Dakshayani Satish Nirhale, Mahendra Wante, Vijetha Bandla, Anoop Burra

Venolymphatic malformations occur due to dysplasia of lymphatic and venous vessel structures. These tumour-like lesions cause tissue abnormality with impaired function and have aesthetic importance when involving the craniofacial region. Vascular lesions are classified as haemangiomas and other vascular malformations. They are named after the vessels involved in malformation like arterial, venous, lymphatic, or mixed types. The present study represents a rare case report of a 23-year-old patient, who presented to the surgery Department with swelling over the left elbow and a lump over the left breast, which was diagnosed as venolymphatic malformation involving the left breast and left elbow joint, which is an unusually affected anatomical region by this congenital anomaly. Ultrasonography (USG), the primary tool for diagnosis, was performed. Later, the patient underwent Magnetic Resonance Imaging (MRI) for confirmation and to determine the extent of the lesion. Excision of the lesion was done over left elbow completely with a wide margin and histopathology confirmed the final diagnosis. Venous malformations (VM) are the most common among these congenital malformations, with an incidence of over 50%. Lymphatic Malformations (LM) have a much lower incidence than VM, but the combination of venous and LM has a very low incidence.

Klippel-Trenaunay Syndrome of the Extremities- A Report of Two Cases

Yashaswini Basaboina, Rohini Avantsa

Klippel-Trenaunay Syndrome (KTS) is a rare disorder, with an incidence of one in 100,000 people worldwide. The hallmark features of the KTS include venous malformations, capillary malformations and soft tissue hypertrophy. There is no gender or racial predilection and it manifests in childhood. It usually involves one limb, predominantly the lower limb. But, in rare incidences, upper limb involvement is also reported. The common presentation of KTS is pain with spontaneous cutaneous haemorrhage, soft tissue enlargement, venous thrombosis, leg length discrepancy, cortical thickening, macular patches and phleboliths. The present case report described two patients (both females) with KTS, who visited the hospital. One of them was an adult female, presented with left lower limb swelling. Computed Tomography (CT) showed, multiple dilated lower limb veins, draining into the internal iliac and deep femoral veins. Following this, the patient had undergone one cycle of Ultrasound Guided Sclerotherapy (UGS) and was advised to follow-up. The patient underwent subsequent two cycles of UGS at an interval of three months. Another patient was of the paediatric age group, presented with swelling and pain in the left lower limb. Magnetic Resonance Imaging (MRI) revealed, multiple veno-capillary malformations with a Persistent Sciatic Vein (PSV). Liposuction of the bilateral gluteal region was performed with the application of topical Neosporin and was advised to follow-up. After five months, Ultrasonography (USG) of the bilateral gluteal region was done, which was normal with no obvious residual disease.

Cupping Therapy versus Myofascial Release for Mechanical Low Back Pain: A Report of Two Cases

Kunal Setia, Sunita Sharma, Rahul Kumar

Inherent abnormalities with the spine, the intervertebral disks, or the surrounding soft tissues are the source of mechanical Low Back Pain (LBP). The present case report presented two cases of mechanical LBP in a 27-year-old and a 26-year-old female, as they complained of LBP that typically began due to prolonged sitting and has lasted for atleast two months. The Numerical Pain Rating Scale (NPRS) indicated a pain intensity of seven out of 10 for LBP for both the patients and Modified Oswestry Disability Questionnaire (MODQ) indicated that disability was 54%; consequently. The 27-year-old female patient was provided with a two-week supervised static cupping therapy protocol and 26-year-old female patient was provided with a Myofascial Release (MFR) protocol. After treatment, the NPRS revealed a remarkable reduction in pain intensity to two out of 10 for LBP for cupping therapy intervention and for MFR intervention reduction in pain intensity was marked four out of 10 for LBP. Disability was reduced to 14% for cupping therapy intervention and for MFR intervention disability was reduced to 22%. As static cupping therapy is used to target the deeper musculature of the lower back and MFR treatment used for overall release of fascia, the purpose of the case report was to illustrate the comparison in the effects of cupping therapy and MFR on mechanical LBP in reducing pain intensity and disability.

A Case of Renal Sarcoidosis: A Diagnostic Dilemma

Aravind Bhagavath, GR Pramod, Kamalesh Tagadur Nataraju, Srimannarayan Reddy

Sarcoidosis is a multi-system disease of unknown aetiology, characterised by non-caseating granulomas. It can involve any organ in the body, but commonly affects the lungs and lymph nodes. The worldwide prevalence of sarcoidosis is 20-60 per/100,000 and people, while in India, it is 61.2 per 100,000. The probable cause is an inflammatory response triggered by various environmental agents in genetically sensitive individuals. Approximately one-third of patients with sarcoidosis remain asymptomatic. Typical symptoms include non-specific pulmonary symptoms such as cough, dyspnoea and chest pain. Cutaneous or ocular manifestations may include malar rash, erythema nodosum, keratoconjunctivitis, anterior uveitis and chorioretinitis. The presence of hilar lymphadenopathy on chest X-ray is highly suggestive of sarcoidosis. In this case, a 68-year-old female patients, presented with complaints of anorexia and fatigue for the past three months. She was found to have anaemia, hypercalcaemia, and abnormal renal function. Abdominal ultrasonography (USG) showed normal findings. The patient was initially evaluated for Tuberculosis (TB) and started on empirical Anti-Tubercular Therapy (ATT). However, as the patient did not show any improvement, further evaluation was conducted, leading to a diagnosis of sarcoidosis. Treatment options for sarcoidosis include systemic steroids, immunosuppresants, and cytotoxic drugs. Biologics such as anti-Tumour Necrosis Factor (TNF) agents (etanercept, golimumab, and infliximab) have also been considered in the treatment. Sarcoidosis can present a diagnostic dilemma as seen in this patient who initially had features resembling disseminated TB. This highlights the importance of strong clinical suspicion by the treating physician and thorough evaluation.

A Novel Approach for Treatment of Two Adjacent Gingival Recession Defects using Modified Bilateral Pedicle Flap and Tunnel Technique combined with Titanium- Prepared Platelet Rich Fibrin

Nasreen Ansari, Archita Datta, Arundeep Kaur Lamba, Farrukh Faraz, Shruti Tandon

Gingival recession being the most common mucogingival problem among adult patients is often associated with root hypersensitivity, erosion, root caries, and compromised aesthetics. The primary goal of treating gingival recession include complete root coverage along with improving gingival biotype to facilitate proper plaque control, improve patient aesthetics, and to prevent further periodontal breakdown. Although numerous root coverage techniques and regenerative materials are available, a novel technique involving the bilateral pedicle flap with subperiosteal tunnel in interdental papilla along with use of Titanium Prepared Platelet-Rich Fibrin (T-PRF) has been described in the present case report. A 20-year-old male patient reported with the chief complaint of teeth sensitivity in lower front teeth. Intraoral examination revealed Recession Type 1 (RT-1) defects in mandibular central incisors which were treated using modified bilateral pedicle flap and tunnel technique combined with T-PRF. This technique allowed excellent blood supply at recipient site along with complete coverage of T-PRF membrane and root surfaces. The subperiosteal tunnel created in between the two affected teeth, allowed better stabilisation of membrane and inhibited apical retraction of flap during healing phase. Using this novel technique, complete root coverage was achieved along with gain in gingival thickness hence, it can be considered as a predictable approach for the treatment of RT-1 defects involving two adjacent teeth.

Oral Rehabilitation of Segmental Mandibulectomy with Extensive Fibrosis- A Daunting Obstacle for the Maxillofacial Prosthodontist

Raisa Natasha Chodankar, Aditya Acharya, Raghunath Patil

The fifth most frequent malignancy worldwide is head and neck cancer. Following surgical removal of lesions of the oral cavity, mandibular resection can result in undesirable effects, such as altered mandibular movements, disfigurement, dysphagia, impaired speech, and deviation of the mandible in the direction of the resected site. After a marginal or segmental mandibulectomy, prompt rehabilitation is preferred since aesthetic and functional deficiencies impair a patient’s quality of life. The contribution of maxillofacial prosthodontists safeguards the prosthetic viability, driven by a prosthetic proposed plan. Maxillofacial prosthodontists should be included from the start, and they play a crucial and directing role in this procedure. The present case report specifies the treatment of a 52-year-old male patient with extensive fibrosis who had a reduced mouth opening as a result of right-side segmental mandibulectomy. The mandible was difficult to manipulate into occlusion due to considerable fibrosis that had formed over time, thus a guiding flange prosthesis was not employed in the present case. To address the patient’s inability to chew food, a double occlusion table was designed using the remaining maxillary teeth. A 3-month follow-up was performed, as well as the Oral Health Impact Profile-14 (OHIP-14) was done prior to and following the treatment.

Mapping and Ablation of Premature Atrial Contractions Originating from the Posterior Mitral Annulus: A Case Report

Cismaru Gabriel, Puiu Mihai, Gusetu Gabriel, Pop Dana, Rosu Radu Ovidiu

Premature Atrial Contractions (PAC) are frequent arrhythmias. Previously, regarded as a benign electrocardiographic finding, they are now linked to adverse outcomes such as, stroke and all-cause mortality. Furthermore, a high burden of PACs >1.500/24 hours has a predicted probability of atrial fibrillation occurrence. Herein, the authors presented a case of a 35-year-old male patient, with high burden PACs, originating in the posterior mitral annulus. Treatment with class IC (flecainide, propafenone) antiarrhythmic drugs and beta blockers (bisoprolol) was ineffective in controlling the tachycardia, therefore, catheter ablation was performed. The procedure was performed using the Three-Dimensional (3D) Biosense Webster CARTO 3 electroanatomical mapping system. The area of the earliest atrial signal was located at the posterior mitral annulus. Successful elimination of the ectopy was obtained with Radiofrequency (RF) application on the posterior mitral ring. A single RF application of 30 W for 60 seconds abolished PACs, with no further recurrence. Holter Electrocardiogram (ECG) showed, no PACs at one, six and 12 months follow-up. Catheter ablation remains an effective approach to cure the arrhythmia, when medical treatment with antiarrhythmic drugs is ineffective or undesirable in patients with high burden PACs.

Clinico radiological Presentation and Management of Giant Cell Tumour of Calcaneum: A Case Report

Ram Rodge, Shubham Rodge, Arun Kumar Rao, Tejas Gadekar

Giant cell tumours of bone are typically benign tumours composed of mononuclear and multinucleated giant cells that are osteoclastically active. They typically develop in long bones but can also appear in unexpected locations. In this case report, a 36-year-old man presented to the orthopaedic OPD with complaints of right heel pain and swelling. The swelling was firm, painful, and adhered to the calcaneus. Radiographs revealed a well-defined, expansile, lytic lesion of the calcaneus with no extraosseous dissemination. After surgery, tissue was sent for histopathological examination, which showed multinucleated giant cells amid numerous mononuclear stromal cells, raising the possibility of a giant cell tumour. During anaesthesia, the bony recess was corrected and filled with bone cement. Patient was ambulatory after three months of the procedure and showed no clinical and radiographic evidence of recurrence even after two years of follow-up. Aggressive characteristics of giant cell tumours can include cortical growth or destruction with a soft tissue component. In certain instances, fluid-filled levels suggestive of subsequent aneurysmal bone cyst development are also visible. Since there are no clinical, radiological, or histological factors that allow one to precisely anticipate the trend of a single lesion to recur or to metastasize, treating bone giant cell tumours remains difficult. Therefore, the surgeon must be well-informed and complete a thorough preoperative work up, including a biopsy, before moving forward with the lesion’s final therapy. Early intervention is required due to its potential local aggression. Regular follow-up with the patient is necessary to spot any early signs of metastasis or recurrence.

Breast Carcinoma Metastasis to Thyroid Gland Masquerading as Nodular Goitre: A Case Report

Anita Nangia, Shruti Chauhan

Thyroid gland, despite being a highly vascular organ, is an extremely unusual site for metastasis from primary carcinoma like breast. We, hereby, report a case of metastatic lesion in the thyroid with breast carcinoma as a primary, in a 55-year-old postmenopausal female. The metastatic focus had masqueraded as nodular goitre, thereby, creating diagnostic difficulty. The case was suspected on Fine Needle Aspiration (FNA) and confirmed by immunocytochemistry on cell block with progesterone and Her2neu positivity. Also, we have attempted to review the literature reporting similar occurrences. Although breast cancer is less frequent to metastasize to thyroid, it is advised to always exclude metastasis from breast carcinoma especially if new thyroid lesions occur in patients with this malignancy. Such cases create diagnostic dilemma on cytology due to morphologic similarities between primary and metastatic thyroid lesions. Cell block is a crucial technique where ancillary techniques like immunocytochemistry can be applied and help in early and timely diagnosis, hence, rendering better prognostic outcome.

Parathyroid Adenoma Associated with Granulomatous Inflammation- A Case Report

Shyama Manojkumar Chag, Keyuri Bharat Patel, Krishna Maheshkumar Panchal

Parathyroid adenoma is a benign neoplasm derived from the parenchymal cells of a parathyroid gland. Most patients present with unknown aetiology. Inflammatory disorders of the parathyroid gland are poorly defined and necrotising granulomatous inflammation of the parathyroid gland is very rare and its co-existence with a functioning adenoma of the parathyroid is indeed a unique presentation. Hereby, the author presents a case of a 47-year-old female who presented with generalised weakness and joint pain with radiological and biochemical evidence of hyperthyroidism. The patient had undergone a nuclear Tc-99m sestamibi parathyroid scan which was suggestive of parathyroid adenoma and was operated for the same. Routine histopathological examination was suggestive of parathyroid adenoma with chronic granulomatous inflammation. However, diagnostic possibilities of inflammatory aetiologies are numerous and each has presented its characteristics, and theories have always focused on disorders of the parathyroid gland which can occur probably due to autoimmune and non infectious aetiology. Hypercalcaemia can be caused by many causes. However, parathyroid adenoma with co-existent granulomatous inflammation is a rare finding. Sometimes it is not possible to find the exact cause of granulomatous inflammation as in the present case.

A Rare Case of Aerococcus viridans Meningitis in a Patient with Trigeminal Nerve Schwannoma

Mitra Kar, Ashima Jamwal, Akanksha Dubey, Sangram Singh Patel, Chinmoy Sahu

The genus Aerococcus spp. comprise microaerophilic, catalase-negative, Gram-positive cocci that show alpha-haemolytic growth on blood agar. They have a tendency to divide on two planes at a 90° angle, and rapid multiplication leads to the formation of Gram-positive cocci in tetrads and irregular clusters. Aerococcus spp. are capable of causing invasive and fatal systemic illnesses, such as endocarditis, bactereamia, arthritis, and meningitis. Due to evolving diagnostic tools, it is now identified as a pathogen in a variety of disorders instead of being considered a contaminant. Most isolates are susceptible to penicillins, but there is increasing resistance to cephalosporins, ciprofloxacin, cotrimoxazole, clindamycin, vancomycin, and tetracycline. Here, authors present a rare case of Aerococcus viridans meningitis in a patient who underwent surgical excision of a left trigeminal Schwannoma, along with the drug susceptibility pattern resistant to most first-line antibiotics used against isolates from Streptococci spp., except doxycycline.

Mucinous Cystadenocarcinoma Coexisting with Invasive Ductal Carcinoma of the Breast: A Rare Case Report

Sandeep Mani, Swetha Lakshmi Narla

Mucinous Cystadenocarcinoma (MCA) of the breast is a rare variant of primary breast cancer with an unknown aetiology and pathogenesis. It resembles MCA of the ovary and pancreas and accounts for about one to four percent of primary breast cancers. Less than 25 cases of primary breast MCA have been reported in the literature. These tumours belong to the family of mucin-producing carcinomas of the breast, which includes mucinous carcinoma, signet ring cell carcinoma, columnar cell mucinous carcinoma, and MCA. MCA presents as a well-circumscribed, solid, and cystic mass. It contains large cystic spaces filled with mucin and is lined by atypical columnar cells with intracytoplasmic mucin. In addition to routine examination of Haematoxylin and Eosin (H&E)-stained slides, immunohistochemistry is necessary for the accurate diagnosis of primary breast MCA and to differentiate it from pure mucinous carcinoma. These tumours typically do not express hormonal receptors, making them triple-negative. The authors report a case of a 49-year-old woman who presented with a lump in her left breast. Ultrasonography (USG) suggested the possibility of carcinoma or atypical fibroadenoma. Fine Needle Aspiration Cytology (FNAC) indicated features suggestive of carcinoma. A trucut biopsy revealed infiltrating ductal carcinoma with mucinous features. Subsequently, a left-modified radical mastectomy was performed, and the patient was diagnosed with mixed-type carcinoma, comprising an 80-85% MCA component and a 15-20% invasive ductal carcinoma component.

Cephalhaematoma Mimicking an Extradural Haematoma due to Mirror-Image Artifact on Sonography in a Term Neonate: A Case Report

Laxman Basany, G Naga Karthik, G Naga Priyanka, RK Abhishek

Cephalhaematomas and subgaleal haematomas are among the most common birth injuries and are associated with birth trauma, forceps, and vacuum-assisted deliveries. They present as scalp swelling and are usually identified shortly after birth. During sonographic examination, if an ultrasound beam scatters off a mirror-like interface, it creates mirror-image artifacts that can cause a diagnostic dilemma. In this case report, a six-day-old neonate presented with a right-side parietal cephalhaematoma that appeared to resemble an epidural haematoma on routine sonographic examination. Gray scale ultrasound revealed an anechoic structure resembling an epidural haematoma in the right parietal region. However, a non-contrast-enhanced computed tomography (NECT) scan of the brain showed a cephalhaematoma without an underlying epidural haematoma. Further evaluation using colour Doppler sonography revealed normal vascular findings within an anechoic space, and gray scale imaging in the sagittal plane showed normal cerebral parenchyma without midline shift. These findings helped identify the observed structure as a mirror-image artifact. It is important to note that these artifacts can lead to diagnostic errors, resulting in additional investigations and causing anxiety for parents. Understanding and being aware of these artifacts can help avoid unnecessary imaging and reduce radiation exposure.

Bilateral Aspiration of Pleural Fluid in a Case of Contarini Syndrome

K Balaji, K Vignesh, S Chandrasekar

Contarini syndrome refers to the presence of bilateral pleural effusions with different characteristics resulting from distinct aetiologies on each side. The syndrome was named after Francesco Contarini, the 95th Doge of Venice, who had right-sided transudative effusion possibly due to heart failure, and left-sided exudative effusion due to parapneumonic effusion. While bilateral pleural effusions typically exhibit similar characteristics and are secondary to the same underlying cause, such as heart failure or malignancy, there have been rare reports of bilateral effusions with different characteristics. In this case report, we present the case of a 53-year-old female with known breast carcinoma who presented with right-sided exudative pleural effusion and left-sided transudative pleural effusion, each with distinct aetiologies, thus establishing Contarini syndrome. This report highlights the importance of considering the possibility of two separate aetiologies for bilateral pleural effusions, which should not be overlooked in clinical practice.

Graded Epidural Anaesthesia with Low-Dose Phenylephrine Infusion for Management of Caesarean Section Complicated with Severe Mitral Stenosis: A Case Report

Kritika Yadav, Bonchanpalli Mohan Kumar, Shirin Parveen

A pregnant patient with a heart condition poses a unique challenge for the obstetrician and anaesthesiologist. Understanding the physiology of pregnancy and the pathophysiology of primary heart disease is important when providing anaesthesia for these high-risk patients during childbirth. A 32-year-old primigravida at 35 weeks and two days of gestation was diagnosed with Rheumatic Heart Disease (RHD), severe Mitral Stenosis (MS), moderate Mitral Regurgitation (MR), mild Atrial Regurgitation (AR), moderate Tricuspid Regurgitation (TR), Pulmonary Arterial Hypertension (PAH), Atrial Fibrillation (AF), and Grade-II New York Heart Association (NYHA). The patient underwent an Elective Lower Segment Cesarean Section (LSCS) performed under epidural anaesthesia, and complications were satisfactorily managed.

Conjunctival Ocular Surface Squamous Neoplasia with Spheroidal Degeneration: A Rare Case of UV-B Associated Ocular Neoplasia and Keratopathy

Ocular Surface Squamous Neoplasia (OSSN) is an umbrella term that includes a broad spectrum of conjunctival and corneal malignancies, ranging from mild epithelial dysplasia to invasive squamous cell carcinoma. These are uncommon ocular surface lesions but harbour the potential to cause significant ocular morbidity and rarely mortality. Human Papilloma Viruses (HPV) and Ultraviolet-B light (UV) have been identified as important risk factors in aetiopathogenesis. The present OSSN patient is a 48-year-old male with redness, growth, and a foreign body sensation in his left eye over the past four months. Examination of the left eye revealed a growth in the nasal limbus with a feeder vessel measuring 0.9×0.3×0.1 cm in size. Diagnosis was confirmed by anterior segment Optical Coherence Tomography (OCT). The patient was admitted for an excision biopsy accompanied by intraoperative Mitomycin-C. The lesion’s histopathology revealed grade 2 in situ carcinoma with spheroidal formation. This case is considered rare due to the infrequent association between Conjunctival Intraepithelial Neoplasia (CIN) and spheroidal degeneration.

Heterotopic Ossification with Bone Marrow Elements in an Incisional Hernial Sac: A Rare Entity

Salapathi Shanmugam, B Rajeshwari, K Ramkumar, Mitra Ghosh

Heterotopic Ossification (HO) is usually seen in laparotomy wounds following gastrointestinal surgeries. The presence of marrow elements in an area of HO is very rare. A 57-year-old male with a history of omento-myelo-synangiosis for syringomyelia was admitted with an incisional hernia. A calcified nodule was detected in the wall of the hernia sac on Computed Tomography (CT). Histopathology of the excised nodule showed HO with marrow elements exhibiting trilineage haematopoiesis. HO is commonly an incidental finding during abdominal imaging for another condition. The presence of trilineage haematopoiesis within HO is extremely rare. As most of these patients are asymptomatic, conservative management is sufficient. Surgical excision is indicated, if any associated complications arise.

Low-grade Appendiceal Mucinous Neoplasm: A Series of Four Cases

Low-grade Appendiceal Mucinous Neoplasm (LAMN) is a rare malignant neoplasm seen in less than 0.3% of appendectomy specimens. Patients with LAMN can present with abdominal pain, mimicking appendicitis clinically. In later stages, it can rupture, leading to Pseudomyxoma peritonei (PMP). Therefore, a high clinical suspicion is needed for correct diagnosis and management. The prognosis of LAMN depends on the presence or absence of mucin/neoplastic epithelium outside the appendix. For LAMN confined to the appendix, appendectomy alone is sufficient for management, with conservative follow-up. For LAMN with extruded acellular mucin localised to the appendiceal serosa, management involves appendectomy and PMP surveillance. For all mucinous lesions of the appendix, it is essential to submit the entire appendix for histopathologic examination, thoroughly evaluating the presence of mucin/neoplastic epithelium involving the serosa/extra appendiceal tissue for accurate staging and to predict the risk of recurrence and determine further management. Here four cases of LAMN due to their rarity and clinical importance is presented. This study of four cases emphasises that the clinical diagnosis of this rare malignancy is difficult, and radiological investigations were not available as these patients presented with clinical features mimicking appendicitis. Emergency appendectomy was performed in all cases. LAMN should be considered as a differential diagnosis because if not diagnosed and treated in the early stages, it can lead to dreaded complications like PMP. The histopathological examination of all four cases of LAMN showed dissecting acellular mucin in various stages of progression in the appendicular wall, but none involving the serosa. This highlights the importance of timely surgical intervention and histopathological examination for an exact diagnosis and staging of LAMN for further follow-up or treatment.

Oral Squamous Cell Carcinoma Metastasising to Unusual Sites: A Case Series of Four Cases

Oral cancer ranks as the sixth most common malignancy worldwide, with Squamous Cell Carcinoma (SCC) being the predominant type observed in the head and neck region. Incidence and mortality rates of SCC have significantly increased over the past few decades. Smoking and tobacco chewing are the most common aetiological factors, predominantly affecting elderly males. Distant metastasis at the time of diagnosis is a rare occurrence, typically disseminating through blood vessels or lymphatics. The lungs are the most frequent site for distant metastasis, followed by bone, mediastinal nodes, and occasionally the liver. However, in our cases, we observed metastasis to uncommon sites, excluding the liver. Accurate diagnosis necessitates the correlation with clinical history, radiological, histopathological, and immunohistochemical findings. Despite employing various surgical and radiotherapeutic modalities, distant metastasis diminishes the chances of survival, successful treatment, and worsens the prognosis. This article presents four cases of oral SCC that exhibited metastasis to unusual sites. Two cases had a primary tumour in the left lateral border of the tongue, with distant metastasis to the breast and skin (chest wall), while the other two cases had a primary tumour in the left buccal mucosa and left mandibular region, with distant metastasis to the kidney and liver.

Bartter Syndrome Presenting with Metabolic Alkalosis: A Case Series

Gulam Mohammed

Bartter Syndrome (BS) is a rare, inherited renal tubulopathy characterised by hypokalaemic, hypochloraemic metabolic alkalosis. Children present with the complaint of polyuria, dehydration, failure to thrive and normal blood pressure despite hyperreninemia and hyperaldosteronism. This is a series of eight children (2 months -1 years of age, 5 males and 3 females children) diagnosed with BS. Mean age of onset was five months with male predominance. Most common presentation was failure to thrive and polyuria. All children showed metabolic alkalosis with hyponatraemia, hypokalaemia and hypochloraemia. Urinary losses of sodium, potassium and chloride were noted in all the eight children. Diagnosis was based on clinical manifestation and electrolyte abnormalities. All children were started on indomethacin and positive response was noted. On follow-up correction of electrolyte abnormalities along with adequate weight gain was seen. Although, it is a rare disease requiring high index of suspicion, but with prompt clinical diagnosis and early treatment, morbidity and mortality can be significantly reduced.

Partial Nephrectomy for Renal Cancer- A Phoenix Risen from the Ashes: A Case Series on Totally Laparoscopic Partial Nephrectomy with Review of Literature

Vishal Chawda, Abhijit Joshi, Prakash Shetty

Partial Nephrectomy (PN), also called Kidney-sparing Surgery (KSS) or Nephron-sparing Surgery (NSS), is an operation wherein, only a cancerous renal tumour or diseased renal tissue is surgically removed; leaving behind as much healthy renal tissue as possible. Understandably, it was initially preferred in patients with solitary kidney and those, with concurrent bilateral tumours. Over the first two decades of the 21st century, PN has become the standard procedure for many renal tumours; even in unilateral disease. This is because of early pick up due to significant developments in imaging modalities and also, due to better understanding of the biology of renal tumours. With advances in minimal access surgery, partial nephrectomy too has come under its ambit. In the present case series, it’s fascinating journey has been discussed- its exciting rise, subsequent downfall and then its unique rise again; as the preferred surgical therapy for many renal tumours, around the world. The purpose of reporting the present case series on Laparoscopic Partial Nephrectomy (LPN) performed for renal cancer, was to share the authors’ early experience and results on the topic and to compare them with the world literature. Also, the aim was to underscore the fact that, in an advanced laparoscopy set up, with optimum patient selection and availability of advanced laparoscopic skills, it is an effective and feasible operation. Herein, the authors have described three cases of totally LPN and review of literature on the same. Over an average follow-up period of 23 months, all three patients continue to be asymptomatic and disease free.

Lucio Leprosy in Neglected Cases of Hansen’s Disease: A Series of Three Cases

Rajkumar Kannan, Parimalam Kumar, Bhackiya Shree Vijayan, B Yuvapriya

Lucio Leprosy is a rare form of Lepromatous leprosy, which normally occurs in chronic untreated patients of Hansen’s disease. Lucio Leprosy, was first reported from Mexico and henceforth commonly known as Mexican leprosy, but is now being increasingly reported sporadically across the globe. Lucio leprosy presents as slowly progressive diffuse infiltration of skin all over the body with shiny waxy thickened skin, loss of body hair including eyebrows and eyelashes, puffy hands and sensory loss due to involvement of dermal nerves. There will be thickening of upper eyelids that gives the patient a sleepy look (Melancholy look). This case series pertains to three such patients (58 year and 63 year old females and 55 year old male) of chronic lepromatous leprosy who had features suspicious of Lucio leprosy. Each case of the present series had a unique clinical presentation like diffuse infiltration of skin, total loss of eyebrows, oedema of hands, characteristic triangular ulcers with jagged borders and was posing challenge to the treating Dermatologist. Heavy colonisation of Mycobaterium leprae was observed in the endothelium of small capillaries in the superficial dermis. Involvement of these capillaries manifested as haemorrhage and infarction of the overlying epidermis. As this unusual variant of untreated chronic lepromatous leprosy leads to potentially lethal complications, which are irreversible therefore the present study has been designed to highlight the factors predisposing to Lucio leprosy and its impact on the quality of life.

Varied imaging manifestations in EFEMP2 Related Cutis Laxa Associated Arterial Tortuosity

Jini Joseph, Sujith Janardhanan

Case 1 An eight-month-old male baby was brought to the hospital by his parents due to poor weight gain, lower respiratory tract infection, and exertional dyspnoea (noticed by the parents) for one month. During the clinical examination, a grade-III ejection systolic murmur and end diastolic murmur were observed. A hyperdynamic apex and mild tachypnoea were also noted. Echocardiography (ECHO) was performed to investigate the suspicion of cardiac disease. The ECHO revealed aneurysmal aortic dilatation, moderate to severe aortic regurgitation, and was suggestive of Arterial Tortuosity Syndrome (ATS). Subsequently, a Computed Tomography (CT) pulmonary angiogram was conducted (Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8). At the time of discharge, the baby was stable and able to tolerate feeds. The caregivers were counselled regarding the progressive nature of the disease, its genetic aetiology and the prognosis. Case 2 A 10-month-old female baby, who was developmentally normal, presented with complaints of breathing difficulty that worsened in the lying down position and improved in the sitting position, as well as decreased urine output for the past two weeks. There was no significant antenatal, natal or postnatal history. The baby had a history of head sweating and a suck-rest-suck cycle. There was no history of cough. Upon clinical examination, cutis laxa was observed along with a hyperdynamic apex, cardiomegaly, an ejection systolic murmur, an end diastolic murmur, tachypnoea and subcostal retractions. ECHO showed dilated aorta from the sinuses to the proximal arch, aneurysmal dilation of the ascending aorta, tortuous descending aorta, severe mitral regurgitation, aortic regurgitation and pulmonary artery hypertension. Multidetector Computed Tomography (MDCT) pulmonary angiogram was advised to further assess the anatomy of the vessels (Table/Fig 9),(Table/Fig 10),(Table/Fig 11),(Table/Fig 12). Initially, the baby was stable and able to tolerate feeds. However, four months after the diagnosis, the patient developed severe respiratory distress. Venous blood gas analysis showed severe respiratory acidosis. The baby was intubated and started on inotropes and diuretics. While being extubated, the patient was unable to tolerate Bilevel Positive Airway Pressure (BiPAP) and experienced bradycardia, desaturation, and ultimately succumbed to death despite resuscitative measures. Case 3 A male baby, born at term and appropriate for gestational age, was referred from an outside hospital at 78 hours of life (HOL) due to respiratory distress. Clinical examination at 48 HOL revealed a systolic murmur. Chest X-ray showed well-expanded lung fields and normal cardiac shadows. Sepsis screen and blood culture were negative. ECHO was performed, which revealed a dilated main pulmonary artery and ascending aorta, myxomatous Arteriovenous (AV) valve leaflets, severe bilateral peripheral Pulmonary Stenosis (PS), turbulent flows across the arch vessels and descending aorta, Right Pulmonary Artery (RPA) stenosis, and moderate Pulmonary Arterial Hypertension (PAH). Due to suspicion of ATS, a CT pulmonary angiogram was conducted. The CT pulmonary angiogram showed levocardia, mild tortuosity and elongation of the aortic arch, tortuosity of the origin and course of bilateral common carotid and left subclavian arteries, tortuous aberrant right subclavian artery, dilated main pulmonary artery (12.8 mm) with narrowing of the origin of the left pulmonary artery (3.4 mm), and mild tortuosity of the descending thoracic aorta and inferior mesenteric artery was (Table/Fig 13),(Table/Fig 14),(Table/Fig 15). The baby remained haemodynamically stable and had good oral feeding tolerance, leading to his discharge. Genetic testing revealed that all of these babies had a similar genetic result, with a mutation in the Epidermal Growth Factor-containing Fibulin-like Extracellular Matrix Protein 2 (EFEMP2) gene causing Autosomal Recessive Cutis Laxa type 1B (ARCL1B) associated with arterial tortuosity. Specifically, a homozygous missense variation in exon 7 of the EFEMP2 gene (chr11:65637447T>G; c.608A>C) resulting in the substitution of alanine for aspartic acid at codon 203 (p.Asp203Ala) was identified, confirming the diagnosis of ARCL1B (Table/Fig 16).

Needs and Barriers to Access Oral Healthcare Services among the Rural Population in Chengalpattu, Tamil Nadu, India: A Cross-sectional Study

S YogaAbirami, S VishnuPrasad, K IndraPriyadarshini, J Mahesh, R Karthikayan

Introduction: Disparities in dental service utilisation are substantial and pervasive worldwide. The healthcare services required to address health concerns and the services actually offered are at odds. Rural residents have poor oral health, and they frequently neglect to adopt good oral hygiene habits. Aim: To assess the oral health needs and barriers in accessing oral healthcare services among the rural population in Pulipakkam, Chengalpattu district, Tamil Nadu, India. Materials and Methods: A cross-sectional door-to-door study was conducted in Pulipakkam, Chengalpattu district, in association with Karpaga Vinayaga Institute of Dental Science, Madhuranthagam, Tamil Nadu, India. The study duration was six months, from March 2022 to August 2022. A total of 436 subjects from the rural population were included, and a structured questionnaire consisting of two domains, totalling 27 questions (24 closed-ended and three open-ended questions), was prepared and distributed among the study participants to assess the need (15 questions) and barriers (12 questions) in accessing oral healthcare. The questionnaire was administered in the local (Tamil) language. Additionally, seven demographic data questions were included, and descriptive statistics were performed for the demographic variables. Inferential statistics were used to assess needs and barriers. The World Health Organisation (WHO) oral health assessment questionnaire 2013 was used to assess dental caries and periodontal disease. The Chi-square test was carried out using Statistical Package for the Social Sciences (SPSS) version 20.0 for inferential statistics. The p-value <0.05 was considered statistically significant. Results: The mean age of the study participants was 53.6±2.02 years, and 402 (92%) were married, while 34 (7.8%) were unmarried. Among the total population (N=436), the perceived need was 217 (49.8%), and the barrier was 399 (91.5%). There was no statistically significant difference in the distribution of dental caries among the population with and without perceived need (p=0.909) and with and without barriers to accessing oral healthcare (p=0.542). The majority (N=261, 89.4%) of the population with periodontal diseases (N=292) reported having barriers in accessing oral healthcare services, and there was a statistically significant difference in the distribution of periodontal diseases among the rural population with and without barriers to accessing oral healthcare (p=0.027*). Conclusion: According to the study findings, oral diseases affect individuals who have no needs or barriers, suggesting that they are unaware of their oral health. It is therefore important to increase oral health awareness among rural people.

Prevalence of Coronary Artery Anomalies and Associated Complications during Catheter-guided Angiography: A Retrospective Study

Sibaram Panda, Sunil Kumar Sharma, Mayadhar Panda

Introduction: Coronary Artery Anomalies (CAA) refer to very uncommon and unusual morphological features of the epicardial coronary artery that account for 1/5th of deaths in athletes. Patients with CAA are also prone to developing significant Coronary Artery Disease (CAD). Identifying such arteries during catheter-guided angiography is very challenging and is associated with many devastating complications, such as arrhythmia, heart failure, Contrast-Induced Nephropathy (CIN), bleeding, cardio-embolic events, and mechanical injury to the coronary artery, among others. Aim: The aim of this study is to describe the prevalence of various types of coronary anomalies and the complications that arise during catheter-guided angiography. Materials and Methods: A retrospective study was conducted between February 2022 and October 2022, enrolling a total of 2849 patients who underwent angiography for angina or angina equivalents at the catheterisation laboratory, VIMSAR, Burla, Odisha, India. Angiographic records and videos of patients were noted. Coronary anomalies were detected based on quantitative and qualitative criteria provided by the American Heart Association in 2007. The anomalous coronary arteries were classified into three groups: Group A- anomalies of origin and course, Group B- anomalies of intrinsic coronary arterial anatomy, and Group C- anomalies of coronary termination. Data regarding baseline characteristics and procedure-related complications were collected, compiled, and tabulated to determine the prevalence of different types of coronary anomalies and the arising complications during catheter-guided angiography. Results: Among the 2849 enrolled patients, CAA was identified in 64 (2.24%) patients. Of these, CAA with abnormal origin and course (Group A), abnormal termination (Group B), and intrinsic coronary arterial anatomy (Group C) were detected in 36 (1.26%), 4 (0.14%), and 24 (0.84%) patients, respectively. Out of the 64 cases, a total of 13 (20.3%) patients developed different types of complications, including mechanical 2 (3.125%), embolic 1 (1.56%), and arrhythmic 3 (4.68%) complications, bleeding 2 (3.12%), angiographic 3 (4.68%), and left ventricular failure 2 (3.12%), among others. In Group A, complications were more commonly observed in 10 (15.6%) of the cases. Conclusion: CAA with an abnormal origin and course is the most common type of coronary anomaly. Engaging such an artery and detecting its abnormal course are more commonly associated with life-threatening complications. The use of appropriate maneuvers, types and sizes of catheters, and CIN views can help avoid disastrous complications.

Comparative Evaluation of Topical Betamethasone Dipropionate Lotion 0.05% versus its Combination with Intralesional Triamcinolone Acetonide Injection in Alopecia Areata: A Randomised Controlled Trial

Amit Kumar Tiwari, Pooja Ameta, Pradeep Garg, Naushin Aara

Introduction: Alopecia Areata (AA) is non-cicatricial patchy hair loss, which is fairly common and may evoke feelings of vulnerability and loss of self-esteem in patients. Many different treatment modalities have been recommended, including topical, systemic, and intralesional corticosteroids (ILCs). However, no treatment has consistently produced satisfactory results, and various topical therapies used in the past have shown limited effectiveness. ILC is the most commonly used treatment for AA, especially in patients with <50% area involved. Despite this, there is a lack of adequately powered randomised controlled trials assessing the efficacy, safety, and duration of response. Aim: To compare the efficacy of intralesional triamcinolone acetonide injection, topical betamethasone dipropionate lotion 0.05%, and their combination in treating AA. Materials and Methods: This randomised controlled trial was conducted at the Department of Dermatology, SMS Medical College, a Tertiary Care Hospital in Jaipur, Rajasthan, India, over a one-year period from August 2012 to July 2013. The study included patients aged 11 to 50 years who were willing to provide informed consent. A total of 120 patients were randomised into two groups (Group A and Group B) of 60 patients each. Twenty patients did not follow-up, leaving 53 patients in Group A and 47 patients in Group B who completed the study were 53 in group A and 47 in group B. Group A received topical betamethasone dipropionate lotion 0.05% with single-night application and intralesional triamcinolone acetonide 10 mg/mL at baseline, 4, 8, and 12 weeks. Group B received topical betamethasone dipropionate lotion 0.05% with single-night application and intralesional normal saline at the same intervals. Patients were followed-up for an additional 12 weeks. Responses were evaluated using the Hair Regrowth Grade (HRG) scale, and statistical analysis was performed using the Chi-square test. Results: Among the study population, the majority of patients (49, 41%) were in the age group of 21-30 years, with 91 males and 29 females. At the end of the 12-week treatment and 12-week follow-up period, Group A showed greater improvement, with 62% of patients achieving hair regrowth grade scale S-IV (76-100%), and 87% {S-IV (76-100%)} respectively, as compared to only 13% in Group B. Similarly, in the follow-up period, Group A had a higher percentage of patients with S-IV (76-100%) regrowth (87%) compared to Group B (32%). Conclusion: This study concludes that intralesional triamcinolone acetonide 10 mg/mL is an effective and safe treatment option for AA. The addition of single-night application of betamethasone dipropionate 0.05% lotion yields better results than using either treatment alone.

Functional Outcome in Children with Hirschsprung’s Disease after Modified Duhamel’s Procedure: A Longitudinal Study

Introduction: The classical surgical treatment of Hirschsprung’s Disease (HD) is performed by resection of the aganglionic segment of the distal intestine and bringing down the ganglionic segment by Modified Duhamel’s procedure or other pull-through operations. The assessment of the postoperative functional outcome and continence scoring systems are important considerations during follow-up of these children. In the present study, a scoring system was used to analyse the postoperative functional outcome of HD as there are very few studies, that have objectively assessed the same. Aim: To assess the functional outcome in children under six years of age, who underwent Modified Duhamel’s procedure for HD. Materials and Methods: This longitudinal study was conducted in the Tertiary Teaching Institution at Government Medical College, Thiruvananthapuram, Kerala, India. The duration of the study was one year and nine months, from February 2017 to November 2018. Forty cases of biopsy proven HD, who underwent Modified Duhamel’s procedure were analysed. Postoperative follow-up was done at one, two, and three years after the definitive surgical procedure. Patients were classified as good, fair and poor outcome groups based on the Taylor-Duthies-Zachary continence scoring system. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 22.0. Pretest comparison of scores and p-value were analysed by Wilcoxon signed-rank test. A p-value <0.05 was considered as statistically significant. Results: The mean age of the study participants was 12.7±4.1 months and age ranges from three to 25 months. Median stool frequency per day after one, two, and three years of surgery, was 6.0, 4.0, and 3.0, respectively. The observed difference in median frequency between one and two year, one and three, and two year and three year was statistically significant (p<0.05). Median continence score to assess the anal sphincter control at one, two and three years after surgery were 2.3, 4.0 and 4.5, respectively. The observed difference in scores over successive years, was statistically significant (p<0.05). Conclusion: The functional outcome in patients, who underwent Duhamel’s procedure was good and the postoperative issues like increased stool frequency, and sphincter control improved over successive years.

Association of Baseline Levels of C-Reactive Protein and Neutrophil to Lymphocyte Ratio in Assessing Severity and Mortality among COVID-19 Patients in Three Waves: A Cross-sectional Study

Introduction: The Coronavirus Disease 2019 (COVID-19) infection has experienced three peaks in India, with possibilities of reinfections and future peaks. A comprehensive understanding of the disease, particularly in terms of inflammatory markers, is crucial. Neutrophil-to-Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP) have been established as markers of disease severity in COVID-19 during the first wave, but limited data exists regarding these markers in the second and third waves. Aim: This study aims to investigate the association between baseline levels of CRP and NLR with disease severity and mortality among COVID-19 patients in three waves. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Bangalore from March 2020 to March 2022. The study included clinical data from 1485 patients with COVID-19. CRP and NLR levels were measured on the day of hospital visit, and their association with severity and mortality was assessed. Continuous variables were compared using independent t-test, one-way analysis of variance (ANOVA), or Kruskal-Wallis test as appropriate. Categorical variables were compared using the Chi-square test. Results: Wave 1 demonstrated a significant increase in CRP and NLR values among patients with critical illness (mean±SD: 11.96±11.9, 12.41±13.7) compared to other categories. The values of these two parameters in other categories of wave 1 were as follows: asymptomatic (2.28±6.0, 3.17±2.0), mild (1.67±3.4, 2.41±2.7), moderate (1.07±1.7, 3.71±2.4), and severe (6.47±7.2, 4.39±4.3). In wave 2, critical illness (10.52±8.9 and 10.73±7.8) showed elevated values compared to other categories (0.957±1.1, 2.61±1.7), (4.90±5.9, 4.27±4.1), (4.84±4.8, 4.03±2.4), (7.35±6.7, 7.10±6.7). In wave 3, the two parameters in critical cases (15.0±17.3 and 16.47±7.6) were elevated compared to other categories (3.67±2.9, 16.44±10.3), (3.3 and 13.9), (3.7±5.9, 19.10±1.6). Conclusion: CRP and NLR were found to be useful early markers for assessing disease severity and mortality in COVID-19 patients across all three waves.

Utility of Various Clinical Samples in the Diagnosis of Neonatal SARS-CoV-2 Infection: A Retrospective Observational Study

Introduction: Coronavirus Disease-2019 (COVID-19) in pregnancy was thought to be associated with an increased risk of stillbirth, Intrauterine Growth Restriction (IUGR), and preterm birth. The current study was undertaken to assess the burden of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection in neonates born to COVID-19-positive mothers. Aim: To assess the role of various clinical samples in the diagnosis of perinatal transmission of SARS-CoV-2 in all three waves of the pandemic. Materials and Methods: A retrospective observational study was carried out in a COVID-19 dedicated tertiary care hospital in Pune, Maharashtra, India from April 2020 to February 2022. Swabs from the umbilical stump and nasopharynx of neonates were collected after birth from neonates born to mothers who were COVID-19 positive at the time of admission for delivery, along with the mother’s placental swab. Results: Over a period of two years, a total of 360 neonates born to 351 COVID-19 positive mothers were included. Thirty neonates showed evidence of SARS-CoV-2 infection. The maximum rate of infection was in the first wave (10.86%). Among the three types of swabs, the umbilical cord sample showed more COVID-19 Reverse Transcription Polymerase Chain Reaction (RT-PCR) positivity (4.88%), followed by the nasopharyngeal swab (4.72%) and placental (3.64%) swab. Conclusion: In the present study, the nasopharyngeal and umbilical swabs were found to be better clinical samples than placental swabs in the diagnosis of SARS-CoV-2 infection in neonates. The rate of perinatal transmission was 8.5%, providing strong evidence of perinatal transmission.

Psychological Well-being of Late Adolescents in Urban Karnataka and Tamil Nadu during the COVID-19 Pandemic: A Cross-sectional Study

Anjali Maria Augustine, Nidhi Kamath, Keshava Pai Kota

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic and prolonged lockdown had impacted the mental health of adolescents. Late adolescence is an age peculiarly vulnerable to mental health issues, and very few studies have exclusively focused on this age group during the pandemic. Aim: To evaluate the presence and severity of anxiety and depression symptoms among late adolescents (15-18 years), taking into account their socio-demographic variables and additional stressors like board exams during the pandemic in India. Materials and Methods: A cross-sectional questionnaire-based study was conducted in High schools in Urban Karnataka, India and Urban Tamil Nadu, India from October 2020 to December 2021 with snowball sampling. An online form was given to 104 students, which included socio-demographic data, the Patient Health Questionnaire (PHQ-9, adopted for adolescents), and the Generalised Anxiety Disorder Assessment (GAD-7) questionnaires. The participants were divided into two groups for subgroup analysis. Group-1 constituted standard X and XII and Group-2 constituted standard XI. Unpaired t-tests, Spearman’s correlation, and univariate analysis of variance were used for data analysis. Results: A total of 104 late adolescents from an urban setting participated in the study. A total of 24% had significant clinical depression, and 20.2% had significant anxiety levels. Board exams did not influence the presence of depression or anxiety. Among the socio-demographic variables, presence or absence of pets caused significant differences in PHQ 9(A) levels between the two groups (p=0.01). The PHQ-9(A) scores for Group-1 (p=0.031) and Group-2 (p=0.001) showed a significant correlation with increased social media usage. GAD-7 scores also showed a significant correlation with increased social media usage in both groups (Group-1, p<0.001 and Group-2, p=0.018) and the presence of siblings in Group-2 (p=0.010). No other variable showed a significant correlation with PHQ-9(A) and GAD-7 scores in the groups. Suicide risk and ideation were seen in 17.7% of the cohort. Conclusion: The study revealed the negative impact of the COVID-19 pandemic on the mental health of late adolescents. The increased usage of social media impacted depression and anxiety levels.

Cell Block versus Cytospin in the Detection of Malignancy in Body Fluids: A Cross-sectional Study

Denish Mashru, Amit Nisal, Rachana Lakhe, Smita Mulay, Ravindra Nimbargi

Introduction: Cytological examination of body fluids is a commonly performed investigation that provides information about inflammatory and malignant lesions, aiding in the diagnosis of effusion aetiology and potential differential diagnoses. The cell block technique, combined with cytospin study, offers an additional advantage in such cases. Aim: To compare the diagnostic utility of cell block method and cytospin method in detecting malignancy in body fluids. Materials and Methods: This cross-sectional observational study was conducted for a period of two years at Bharati Vidyapeeth (DTU) Medical College Hospital and Research Centre in Pune, Maharashtra, India. A total of 100 body fluid samples were analysed, including 73 pleural fluids, 24 ascitic fluids, and 3 pericardial fluids. Each fluid sample was divided into two equal parts: one processed for cytospin (CYTOTEK), and the other processed to create a cell block. Four Immunohistochemistry (IHC) markers (Thyroid Transcription Factor-1 (TTF-1), Cytokeratin 7 (CK7), Cytokeratin 20 (CK20), and Calretinin) were applied as needed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 25.0, and results were calculated using the Chi-square test. Results: Of the total 100 fluid samples, 65 were negative, 17 were positive, and 18 were suspicious for malignancy using the cytospin method. In comparison, the cell block method identified 63 samples as negative, 29 as positive, and 8 as suspicious for malignancy. The cell block method exhibited a higher sensitivity (100.00%) and specificity (94.03%) than the cytospin method (81.82% and 88.06%, respectively) in this study. Conclusion: Cell block method accurately diagnosed 10 cases as positive for malignancy that were initially deemed suspicious on cytospin smear. Therefore, the cell block method proved to be a superior diagnostic tool for malignancy compared to cytospin smear. Given that cell blocks allow for longer storage and additional analysis such as IHC and microarray, they should be adopted in addition to cytospin for effusion cytology.

Estimation of Prevalence and Patterns of Thyroid Dysfunction in a Tertiary Care Centre in Uttarakhand, India: A Cross-sectional Study

Kailash Gairola, Kingshuk Lahon, Bhupender Singh Mingwal, Pallavi Rawat

Introduction: Thyroid dysfunction is a common endocrine disorder, defined as the altered serum Thyroid Stimulating Hormone (TSH) levels with normal or altered FT3 and FT4 (triiodothyronine and thyroxine) levels. The spectrum of thyroid disorders includes hypothyroidism, hyperthyroidism, goiter/iodine deficiency disorders, autoimmune thyroiditis, thyroid cancer, as well as subclinical hypothyroidism or hyperthyroidism. However, further research is required on the spectrum of thyroid disorders, apart from goiter/iodine deficiency disorders in the study population mentioned. Aim: To investigate the prevalence and patterns of thyroid disorders in the clinical biochemistry laboratory of a tertiary care hospital in the hilly region of Uttarakhand, India. Materials and Methods: Present cross-sectional study was conducted in the clinical biochemistry laboratory of Veer Chandra Singh Garhwali (VCSG) Govt. Institute of Medical Science and Research Centre, Srinagar Garhwal, Uttarakhand, India. The study population consisted of 950 subjects who underwent Thyroid Function Test (TFT) panel investigation from January 1, 2018 to December 31, 2020. The collected data were analysed using descriptive statistical tools (mean, frequency, percentage) and correlation analysis of thyroid disorder with age and gender using Spearman’s rank correlation test. Results: Among 950 TFT panel reports, thyroid dysfunction was prevalent in 386 (40.63%) patients, of which 307 (79.53%) were females and 79 (20.47%) were males. The mean age±SD of the 386 patients with thyroid dysfunction was 32.24±8.77 years. Among these 386 thyroid dysfunction patients, the majority, 264 (68.39%) were in the 19-39 years age group. A very weak statistical correlation was observed between thyroid dysfunction with age and with gender among the 386 patients. Out of the total number of patients (950), 156 patients had euthyroid hyperthyroxinaemia (16.42%), 101 had subclinical hypothyroidism (10.63%), 74 had euthyroid sick syndrome (7.78%), 42 had subclinical hyperthyroidism (4.42%), 10 had primary (overt) hypothyroidism (1.05%), one had primary (overt) hyperthyroidism (0.11%), and two had secondary hyperthyroidism (0.21%). Conclusion: The prevalence of thyroid dysfunction in the present study was high, with a greater proportion in females and the 19-39 years age group. The most common disorders observed were euthyroid hyperthyroxinaemia, subclinical hypothyroidism, and euthyroid sick syndrome.

A Comparative Evaluation of Surface Roughness of Ceramics after Immersion in Different Oral Rinses: An In-vitro Study

Introduction: The novel Coronavirus Disease-2019 (COVID-19) spreads through respiratory droplets, and various strategies have been developed to reduce its spread. One of these strategies is the use of oral rinses, such as chlorhexidine, povidone iodine, and hydrogen peroxide (H2O2), to reduce the viral load. However, while these rinses have advantages in preventing the spread of the virus, they may also have adverse effects on restorative materials in the oral cavity, particularly dental ceramics. The usage of mouthwashes during the pandemic may affect the surface roughness of dental ceramics, leading to plaque accumulation. Aim: The aim of this study was to evaluate the surface roughness of ceramics after immersion in different oral rinses for seven, 15, and 30 days. Materials and Methods: An in vitro study was conducted in the Department of Prosthodontics at Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. The study was conducted over a period of four months, from October 2021 to January 2022. A total of 51 specimens of dental ceramics were fabricated using a mold with dimensions of 10 mm diameter x 2 mm height. These specimens were randomly divided into three groups based on the immersion solution: distilled water, hydrogen peroxide, and povidone iodine. Each immersion cycle lasted for one minute, and the immersion was performed for 30 days. Surface analysis was carried out using a Surftester at intervals of seven, 15, and 30 days. The data were statistically analysed using the Statistical Package for Social Sciences (SPSS) version 26.0. Intergroup comparison (>2 groups) was performed using the Kruskall-Wallis test, and Analysis of Variance (ANOVA) followed by pairwise comparison using the Mann-Whitney U test. A p-value of <0.05 was considered statistically significant. Results: The mean values of surface roughness for povidone iodine were 0.641, 1.569, 2.5047, and 3.4447 at 0, seven, 15, and 30 days, respectively. The mean values of surface roughness for hydrogen peroxide were 0.681, 2.360, 4.0324, and 5.7035 at 0, seven, 15, and 30 days, respectively. The mean values of surface roughness for distilled water were 0.747, 0.994, 1.3312, and 1.6088 at 0, seven, 15, and 30 days, respectively. Conclusion: The surface roughness of ceramics was significantly higher with the use of hydrogen peroxide as a mouthwash, with mean values of 0.681, 2.360, 4.0324, and 5.7035 at 0, seven, 15, and 30 days, respectively, compared to povidone iodine and distilled water. Povidone iodine can be used as a prophylactic oral rinse compared to hydrogen peroxide.

Expression of IDH1, ATRX, p53 in Diagnosis of Gliomas as Per 2016 WHO Classification

Lokesh Kumar, Manjiri Karandikar, NS Mani, RC Nimbargi

Introduction: The 2016 World Health Organisation (WHO) classification of tumours of the Central Nervous System (WHO CNS 2016 classification) is used to classify diffuse gliomas as astrocytoma, Oligodendroglioma (ODG), glioblastoma which are three prognostically distinct groups based on Isocitrate Dehydrogenase (IDH1), alpha thalassaemia/mental retardation, x-linked (ATRX) mutations, p53 and 1p/19q co-deletion status. Although WHO CNS 2022 classification has been brought in use, it is based on molecular studies. In a resource limited setting like in many Indian diagnostic centres it’s difficult to apply the WHO CNS 2022 classification. It is felt that WHO CNS 2016 classification has not lost its utility. Aim: To investigate the Immunohistochemistry (IHC) status of IDH1, ATRX, p53 in diagnosis of diffuse glial tumours and to classify them according to WHO 2016. Materials and Methods: The present cross-sectional study was conducted at Department of Pathology, Bharati Vidyapeeth Medical College, Hospital and Research Centre, Pune, Maharashtra, India for two years and six months (July 2020 to December 2022). Thirty-two diffuse glioma cases and IHC markers IDH1, ATRX, p53 were evaluated. Ki-67 index was additionally done. Results: Total 32 cases were studied, 19 cases were male. Mean age of the patients was 40.13 years. Fourteen patients belonged to WHO Grade-II, six to Grade-III, and 12 to Grade-IV. As per the IHC findings and histopathological features, there were 16 (50%) patients with diffuse astrocytoma, while 12 (37.5%) and 4 (12.5%) patients were diagnosed as glioblastoma and ODG, respectively. Reclassification of these cases was done depending on IHC results where IDH1 was positive in 71.9% cases, ATRX was positive in 40.6% cases and p53 was positive in 15.6% cases. This result includes all the cases where these IHC markers showed reactivity. The diagnosis of four patients was modified based on findings of IHC markers. Conclusion: The study demonstrates subgrouping of gliomas based on IDH1, ATRX, p53. There was no significant association between grade of tumour and Ki-67 expression.

Assessment of Knowledge, Attitude and Practice among Dental Professionals in Central India regarding Amalgam Restoration and Composite Restoration as Posterior Restorative Material: A Questionnaire Based Study

Anjali E Mule, Manjusha M Warhadpande, Darshan M Dakshindas

Introduction: The restoration of teeth, which are most often damaged by trauma or dental caries, remains the majority of general dentists’ main area of focus on a daily basis. A major cause of concern in dental practice is the failure of dental restorations. Dental practitioners tend to employ dental amalgam and composite restorations more commonly. Aim: To evaluate the preference of amalgam or composite as a posterior restorative material among different groups of dental professionals in central India. Materials and Methods: This questionnaire-based cross-sectional study was conducted in Central India (Nagpur region) by the Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India. It was performed among 153 dental professionals including general dentists, Endodontists, other specialists and postgraduate students in central India between July 2021 to December 2021. Questionnaire containing 15 close-ended and two open-ended questions assessing different methods of restoring posterior teeth in different conditions of tooth, choice of patient, physical properties and future scope of restorative material. Following validation, the questionnaire given to targeted population. Data was collected and statistically analysed using Statistical Package for Social Sciences (SPSS) software version 20.0. Comparison between different dental professional groups was performed using Chi-square test. Results: A 76.9% Endodontists and 83.5% postgraduate students preferred composite in routine dental practice. A 76.9% Endodontists and 70.9% postgraduate students opted for restorative material depending on clinical indications. A 46.2% Endodontists choose amalgam restoration as posterior restorative material in patients with poor oral hygiene. A 52.6% general dentists preferred amalgam as restorative material in large cavities over composite restoration. Most of the Endodontists, general dentists and postgraduates choose composite as restorative material due to aesthetic, less enamel removal during cavity preparation and patient’s request. Post-restoration sensitivity after amalgam restoration was stated by 64.9% general dentists. Conclusion: Composite restoration was the most preferable posterior restorative material in routine dental practice among different groups of dental professionals. The ultimate decision on the best material for patients based on their clinical circumstances, teeth, and patient requests was a desirable approach to embrace.

Comparison of Four Rotary NiTi Files on Vertical Root Fracture Resistance of Endodontically Treated Teeth: An In-vitro Study

Introduction: There are several reasons associated with vertical root fracture, from which biomechanical preparation can be considered as one of the predisposing factors which can increase the susceptibility to vertical root fracture. It depends upon the amount of forces used during the preparation and taper of the file systems used for the preparation. Aim: To compare vertical root fracture resistance of teeth prepared by four different rotary NiTi file systems. Materials and Methods: This was an in-vitro study conducted on 150 extracted mandibular premolars from September 2022 to November 2022 in the Department of Conservative Dentistry and Endodontics, Karnavati School of Dentistry, Karnavati, Gandhinagar, Gujarat, India. All the teeth were decoronated keeping the remaining root length of 13 mm. The roots were divided into five groups of 30 each. Group-1: Vortex blue, Group-2: Edge File X7, Group-3: Hyflex EDM, Group-4: ProTaper Gold, Group-5: Control Group. The roots were placed in silicon impression material to resemble periodontal ligament. All the root canals were negotiated to their terminus with stainless steel K Files except the control group. All teeth from each group were then prepared with their respective file systems and were obturated and sealed with composite. All the samples were then tested with a universal testing machine to evaluate the vertical root fracture. Compressive force was applied and the load necessary to fracture was recorded in Newton. Statistical analysis was done using one-way Analysis of Variance (ANOVA) followed by post-hoc Tukey test. Results: Fracture resistance of Group-5 (Control group) was the highest (522.789±98.79215), followed by Group-1 (Vortex blue) (457.964±37.75982) whereas Group-4 (ProTaper Gold) showed least resistance (349.445±33.62643). The fracture resistance of Vortex blue file system showed significant difference when compared to Hyflex EDM and ProTaper Gold file systems (p<0.001). Conclusion: The maximum amount of force needed to fracture the samples were prepared with Vortex blue file while ProTaper Gold file shows minimum amount of force needed to fracture the sample.

Use of Augmented Reality in Alleviating Dental Anxiety among Paediatric Patients: A Randomised Control Study

Gilman Yucel, Burcu Demir, Ferruh Semir Smail, Pinar Selcik Yayim

Introduction: The management of anxiety and fears in patients receiving medical treatment has always been a significant issue. Patients with dental anxiety are challenging to manage in dental offices, as they may require more time for treatment and are often dissatisfied with their dental care, especially among paediatric dental patients. Although Augmented Reality (AR) has not been widely used in dentistry, it is theoretically believed to have a role in alleviating dental anxiety among paediatric patients. Aim: The aim of this study is to explore the level of dental anxiety among children aged 6-14 years, based on age, gender, and treatment status. Additionally, the study aims to investigate whether the preoperative use of AR can alleviate anxiety. The effect of AR on anxiety was evaluated using Corah’s Dental Anxiety Scale (DAS). Materials and Methods: This randomised controlled study was conducted at a private clinic in Bahcesehir, Istanbul, Turkey. The study duration was two months, from March 2021 to May 2021. The study design aimed to compare the level of anxiety among paediatric patients in an AR exposure condition with those in a control condition. A total of 511 paediatric patients were randomly assigned to either the control group or the intervention condition (i.e., preoperative AR experience versus no preoperative AR experience). A questionnaire survey, including demographic questions and the DAS, was conducted to compare the DAS scores between patients who engaged in the AR experience and those who did not. The data were analysed using the Chi-square test, the Kruskal-Wallis test, and the Mann-Whitney U test. Results: The control group consisted of 134 females and 118 males, while the experimental group consisted of 139 females and 120 males. The mean DAS scores differed based on age (p<0.001). The median DAS score of the 10-14 years age group was lower than that of the 6-8 years age group. The mean DAS score was significantly lower in the group that received AR intervention compared to the control group (p<0.001). The median DAS score was 6 for those with AR experience, while it was 10 for those without it. Conclusion: The preoperative use of AR applications was found to be effective in reducing dental anxiety among children in this study. AR shows promise as a tool that has not been sufficiently utilised among anxiety-relieving techniques for paediatric patients.

Social Phobia, Hospital Phobia and Hospital Anxiety among Transgender Individuals at a Community Centre in Chennai, South India: A Mixed Method Study

R Divya, Aparna Menon, S Abeetha

Introduction: Stigma and discrimination within the healthcare sector in general may impact transgender people’s desire and ability to access appropriate medical treatment. The transgender community have specific healthcare needs which may go untreated leading to increased disease burden in the community. In India there is a gap in understanding the factors affecting utilisation of health services by transgender community. Aim: To determine the factors affecting presence of social, hospital phobia and anxiety among transgender individuals at a Transgender Community Centre in south India, and to understand the perspective of the community members on using healthcare services. Materials and Methods: The present quantitative component embedded within a qualitative study was conducted in the Department of Physiology, Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH) (Community Centre), Siruvachur, Perambalur, Tamil Nadu, India for two days, during the month of August 2022 among 24 transgender adults. Semi-structured in-depth interviews were conducted with the group for the qualitative part of the study during two consecutive days in August 2022, and quantitative part was analysed within the same group using three questionnaires for social phobia, hospital phobia and hospital anxiety. Age-wise and gender-wise distribution of scores in social phobia, hospital phobia and hospital anxiety were analysed using Mann-Whitney U tests as the data was not normally distributed. Results: Out of the 24 participants, 20 (83.33%) were in the age-group of 18-35 years and 18 (75%) identified themselves as transfemales. Qualitative analysis of semi-structured interview found prevalence of gender-based discrimination and mistreatment at hospitals faced by transgender individuals leading to fear of hospitals. Out of 24, nine participants had hospital-related anxiety score more than four out of nine. Social phobia score out of 36 was given and the highest score was 27, with a mean score of 11.416±8.445. Hospital phobia score out of 32 was given and mean score was 13±6.041. Conclusion: Transgender individuals feel hesitant to approach hospitals due to the discrimination they have faced and continue to face at hospitals. There is a need to make the hospitals a more inclusive space for them.

Effects of Kegel and General Fitness Exercises in Reducing the Severity of Urinary Incontinence- An Interventional Study

K Vijayakumar, Daksha Dixit, Supadevi Sundarasamy

Introduction: The involuntary flow of urine from the bladder is known as Urinary Incontinence (UI). Men and women of any age can experience incontinence, but it is more prevalent in older women. Several chronic illnesses and environmental variables increases incidence of UI in elderly adults. Most people in this modern era avoid seeking medical intervention early, due to financial worries as the current diagnostic and intervention methods are expensive. Aim: To use low-cost urinary diaper method for assessing the severity of UI and to study the effect of Kegel and therapeutic exercises in reducing the severity of UI in elderly women. Materials and Methods: This interventional study was conducted in an Inshape Physiotherapy Centre in Chennai, Tamil Nadu, India. The duration of the study was five months, from August 2021 to December 2021. A total of 36 women with UI aged 55-75 years were included. The severity of UI among the participants was assessed using one-hour Diaper Test (DPT), Hamilton Anxiety Rating Scale (HAM-A) and their level of fitness was evaluated using Senior Fitness Test (SFT). Kegel exercise, pelvic floor exercises were implemented following American College of Sports Medicine (ACSM) standards. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 20.0, and data collected was subjected to descriptive statistics and paired t-test. Results: The mean age of the study participants was 69.43±3.4 years. As a result of the intervention, 13 out of 36 participants, who initially had severe UI showed improvement (10 participants improved to moderate UI and three participants improved to mild UI). Out of seven participants, who initially had moderate UI, three participants improved to mild UI. Eight out of the 36 participants showed no UI after intervention, indicating complete recovery. There is an association between the Body Mass Index (BMI), HAM-A and UI, the intervention results in the changes of BMI, and HAM-A thus, reducing the severity of UI. Conclusion: The present study showed that, cost-effective diagnostic and non invasive intervention methods reduced the severity of the UI. The study also recommends regular physical activities to reduce stress and anxiety levels, which in turn helps to improve UI.

Correlation between Nutritional Status and Neutrophil/Lymphocyte Ratio in Patients being Treated for Head and Neck Cancer- A Prospective Observational Study

Anshika Arora, Sunil Saini

Introduction: It is a well known fact that diverse nutritional issues are associated with advanced Head and Neck Squamous Cell Cancer (HNSCC). In addition to poor nutrition, varying degrees of immunocompromisation has been noted in these patients and hence is important to study malnutrition and systemic immunity together. Aim: To determine correlation between nutritional status and systemic immunity in patients being treated for HNSCC. Materials and Methods: A prospective observational study was conducted at Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India for a period of 30 months (December 2018 and June 2021). A total of 159 HNSCC patients planned for treatment, were enrolled in the study. Data was collected pre and post-treatment for disease based on the parameters- Performance Status (PS), nutritional status (weight, Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC) and haemoglobin. Subjective Global Assessment (SGA) Score and systemic immunity {Neutrophil/Lymphocyte Ratio (NLR)} were measured too. Analysis was planned for node negative (N-) and node positive (N+) groups. One-sample Kolmogorov-Smirnov test was used to check for normality of data, parametric and non parametric tests were used for association, Cochran’s and Mantel-Haenszel Statistic was used to calculate Risk Ratio (RR), Pearson’s and Spearman’s coefficient test was used to assess the correlation. A p-value <0.05 was considered significant. Results: Total 159 patients were analysed, 72 in N- and 87 in N+ group. Mean age was 56.3±13.27 years, 142 (89.3%) patients were males, 57 (35.8%) patients were cT1/2, 97 (61%) cT3/4 and 5 (3.2%) cTx stage, 146 (92%) were PS 0-2 and 104 (65.4%) received multimodality treatment. In pretreatment, malnutrition was found in 75 (47.2%) patients and median NLR was 3 (range 1-37). In N+ patients, median NLR was significantly higher in patients with ≥10% pretreatment weight loss, low MUAC and high SGA score pretreatment; in N- patients this association was present with only PS. A mild but statistically significant linear correlation was found for NLR with % pretreatment weight loss, BMI, haemoglobin; moderate correlation with weight, MUAC and SGA score in N+ group, but not in N- group. Conclusion: Poor nutritional status was significantly associated with raised NLR in node positive HNSCC patients with mild to moderate correlation, but this was not found in the node negative group.

Acceptability, Safety and Compliance of Copper T 380A as a Postpartum Intrauterine Contraceptive Device Inserted via Vaginal or Intracaesarean Route: A Cohort Study

Introduction: Considering the high unmet need for family planning in India, especially in postpartum mothers, there is a necessity for reliable, long-term, highly efficacious, safe and reversible contraception like Intrauterine Device (IUD) in these women. Copper T 380A (CuT 380A) as a Postpartum Intrauterine Contraceptive Device (PPIUCD) can reduce maternal and perinatal mortality by decreasing unintended and closely spaced pregnancies in the postpartum period. Despite many advantages, the acceptability and utilisation of PPIUCD still remain very low due to lack of information about it. Aim: To determine the acceptance, safety, and efficacy of Copper T 380A; its association with socio-demographic factors and to compare the clinical outcomes between vaginal and intracaesarean insertions of this device. Materials and Methods: A hospital-based prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, India, from February 2021 to July 2021 among the cohort of 210 consecutive eligible postpartum mothers delivered either vaginally or by caesarean section. Primarily, acceptance rate was assessed. Postinsertion follow-up was done till six months after delivery to note various clinical outcomes and complications measuring safety of the device in terms of cramping pain abdomen, irregular vaginal bleeding, abnormal vaginal discharge, string problems, and perforation; compliance in terms of pregnancy and expulsion; and continuation of the device. All the follow-up results were compared between two modes of insertions. Comparison between categorical variables was done by Chi-square test. Results: Out of 210 counselled mothers, Copper T 380A insertions were done in 178 (84.8%) postpartum mothers. The acceptance rate was slightly higher in intracaesarean group (n=87, 85.3%). The mean±Standard Deviation (SD) age of acceptance of IUCD in partcipants was 25.62±4.09 years with the highest rate observed in the age group of 21-25 years (n=98, 46.7%). Acceptance of the device was significantly associated with multipara and the clients completed primary education (p-value <0.05). On follow-up, overall complications are low. No case of perforation was reported. Significantly higher incidences of abnormal vaginal bleeding, foul smelling vaginal discharge, string problems, and expulsions were observed in the vaginal group (p-value <0.05). Pregnancy was recorded in five (5.5%) clients and all of them were in the vaginal group. Out of 178 acceptors, compliance-continuation of the device was shown by 151 (84.8%), with significantly higher in the caesarean group (p-value <0.000051). A significantly higher continuation rate was observed among the clients of low socio-economic status (p-value <0.000207). Abdominal pain (33.33%) was reported to be the most common reason for discontinuation of Copper T 380A. Conclusion: Regardless of the mode of delivery, Copper T 380A is quite an acceptable, safe, effective, and convenient contraceptive method with a good continuation rate in the immediate postpartum period.

Comparison of P6 Acupoint Stimulation, Ondansetron and Dexamethasone for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Surgeries: A Randomised Clinical Study

Krishnaraj Nivatha, Ramamurthy Balaji, Kanthan Karthik, Balasubrmaniam Gayathri

Introduction: Non pharmacological techniques have an established role in treatment of chronic pain and related conditions. A few non pharmacological techniques have been employed to avoid the adverse effects of drugs. They have also proven to be cost-effective. Liberal fluid administration is the most common non pharmacological methodology used for the prevention of Postoperative Nausea and Vomiting (PONV). However, the associated volume overload can be detrimental. Aim: To compare the efficacy of P6 acupoint stimulation, ondansetron and dexamethasone in the prevention of PONV in laparoscopic surgeries. Materials and Methods: This was a randomised clinical study, conducted in the Department of Anaesthesiology, SRM Institute of Science and Technology, Tertiary Care Medical College and Hospital, Chennai, Tamil Nadu, India. The duration of the study was five months, from June 2022 to October 2022. A total of 120 patients posted for laparoscopic surgeries were divided randomly into three groups, group A, group O and group D. Patients were allocated by computer-generated randomisation. Patients in group A received capsicum plaster at P6 point. Patients in group O received 4 mg of ondansetron and patients of group D received 8 mg of dexamethasone. They were given 30 minutes before induction. Postoperatively, patients were extubated and shifted to postanaesthesia care unit for further monitoring. The demographic data, baseline vitals, surgical procedure, duration of surgery and duration of Carbon Dioxide (CO₂) insufflation were noted intraoperatively. Additional fentanyl requirement, total analgesic requirement, postoperative heart rate, Mean Arterial Pressure (MAP), the incidence of PONV, nausea and vomiting score, number of episodes the requirement of rescue antiemetic, postoperative complication, adverse reactions and patient satisfaction score were all recorded postoperatively and was compared between the three groups using one-way Analysis of Variance (ANOVA). The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the study participants for group A was 40.42±11.05 years, group O was 40.92±10.49 years and group D was 40.30±10.01 years, respectively. The three groups were comparable with respect to the demographics, baseline vitals, surgical procedure, duration of surgery, duration of CO₂ insufflation, additional fentanyl requirement, total analgesic requirement, postoperative heart rate, and MAP. The incidence of PONV was insignificant between the groups with p-value=0.866. The p-value of nausea and vomiting scores were insignificant. The number of episodes of nausea and vomiting was also comparable between the groups p-value=0.880 and 0.375, respectively. The requirement of rescue antiemetic vomiting was insignificant with p-value=0.810. Conclusion: Ondansetron, dexamethasone and P6 acupoint stimulation are equally effective as prophylaxis for the management of PONV. It can be concluded that, P6 acustimulation can be used as an alternative to pharmacological agents for the management of PONV.

Histomorphological Spectrum of Adnexal Tumours of the Skin: A Descriptive Study from a Tertiary Care Centre in Karnataka, India

Apoorva Pandit, MS Siddegowda, Y Muralidhar Bhat, Chaithanya Krishnappa

Introduction: Skin Adnexal Tumours (SAT) are a category of rare and most uncommon tumours. They could display multiple lines of differentiation such as follicular, eccrine, apocrine, sebaceous, and sometimes mixed differentiation, generating a mistaken diagnosis that might lead to unwarranted and unnecessary interventions. Aim: To describe the types and microscopic features of adnexal tumours. Materials and Methods: The present study was a retrospective study on SAT received for histopathology at the Department of Pathology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India, from January 2018 to June 2022 during the study period of September 2022 to March 2023. The records of patients including age, gender and site were retrieved from the registers maintained at the department and Haematoxylin and Eosin (H&E) stained slides were examined and the data was analysed by descriptive statistics. Results: A total of 62 cases were included in the study out of which, 59 (95.2%) cases were found to be benign and 3 (4.8%) cases were malignant. The mean age was found to be 43.87 years. A total of 28 (45.1%) cases were seen in the age group of 21 to 40 years. Females outnumbered the males with 32 cases (51.6%). A maximum number of cases belonged to the group of sweat gland tumours (29/62, 46.8%) followed by hair follicle tumours (21/62, 33.9%) and sebaceous gland tumours (12/62, 19.3%). Nodular hidradenoma was the commonest sweat gland tumour (12/29, 41.4%), pilomatricoma was the commonest hair follicle tumour (10/21, 47.6%) and sebaceous adenoma was the commonest sebaceous gland tumour (10/12, 83.3%). The most common malignancy was sebaceous carcinoma (2/3, 66.67%) in females. The male-to-female ratio was found to be 1:1.06. Conclusion: The incidence of SAT was low with the majority being benign tumours. Malignant tumours are even rarer and are often mistaken for cutaneous epithelial malignancies. These lesions may prompt the clinician towards unwanted surgery or treatment for the patient. They exhibit a wide variety of morphological patterns which may be confused for primary from other sites. In such cases, histopathological examination becomes necessary. Hence, a combination of good clinical expertise and histopathological confirmation by the Pathologist helps appropriately to manage the patient.

Breast Cancer Awareness in Urban and Rural Females of Uttarakhand, India: A Cross-sectional Study

Introduction: The second most frequent cancer in women worldwide is breast cancer, which is also the most common cancer among Indian women. Unlike other cancers, breast cancer is eminently treatable, if detected at an early stage. Nevertheless, the need for culturally appropriate breast cancer education and intervention measures remains. Aim: To compare breast cancer awareness in urban and rural females of Uttarakhand, India. Materials and Methods: The present cross-sectional research was carried out in the Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, between January 2017 and October 2017. The survey sample comprised 400 participants, 200 from cities and 200 from the countryside. All eligible participants were approached by briefing them about the study and providing them with the participant information document. A validated questionnaire divided into four parts was used for the present study. The first part consisted of demographic questions, the second part consisted of questions regarding knowledge of breast cancer, the third part comprised significant risk factors and the fourth part was about early warning signs and symptoms related to breast cancer detection. For gathering data, simple random sampling was used, and participants from both urban and rural locations were included with no prior breast problems ruled out from history. The data was analysed using International Business Machines Statistical Package for Social Science (IBM SPSS) Statistics for Windows, software version 25.0. Results: There were a total of 400 participants; 200 from the city and 200 from the countryside. The mean±Standard Deviation (SD) age of participants of rural areas was 33.4±2.1 years and of urban areas was 37.6±2.4 years. Living in an urban setting was associated with greater awareness of risk factors, such as breast lump (42%), nipple discharge (47.5%), and not breastfeeding (35%), in comparison to rural areas 39%, 46.5% and 21%, respectively. However, there were some misconceptions about a few risk factors, such as the use of oral contraceptives (6%), having children earlier in life (13%), and having more children overall (10%), that were linked to urban living. Conclusion: The understanding of breast cancer risk factors was lower among rural women. However, the present study demonstrates a general lack of breast cancer awareness among female populations in both rural and urban areas. Therefore, the current study strongly advises starting vigorous campaigns to raise awareness of breast cancer in both the educated and uneducated female population.

Computed Tomography Angiography versus Magnetic Resonance Angiography of Brain in Evaluating Cerebrovascular Diseases: A Cross-sectional Study

R Sarvesh, T Shriram, Jayakrishnan Jayakumar

Introduction: In India, Cerebrovascular Disease (CVD) remains to be one of the leading causes of mortality and morbidity. In recent times, the imaging of cerebrovascular disorders has undergone various advancements with the advent of digital technologies. Two novel imaging modalities include Magnetic Resonance Angiography (MRA) and Computed Tomographic Angiography (CTA). Aim: To assess and compare Computed Tomography Angiogram (CTA) brain vs non contrast MR angiogram brain in evaluation of CVD. Materials and Methods: A cross-sectional observational study was conducted in the Department of Radiology, Arupadai Veedu Medical College and Hospital, Puducherry, India, from November 2020 to July 2022. All suspected cases of cerebrovascular accidents who were above 18 years of age were screened for the study. Finally, a total of 60 patients were recruited for the study. Demographic parameters like age, gender and occupation were collected. Past history of chronic illness, vitals, serum urea and creatinine were also assessed. MRA findings including stenosis, occlusion, and irregularity of vessels and features of stroke were assessed and compared to the findings on CTA images. Data was compiled and analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0. Results: A maximum of 26 (43.3%) participants were in the age group of 61-70 years of age and, 60% of the cases were males and 40% of the cases were females. Out of the 60 patients, 40 (80%) had characteristics of CVD based on CTA, and 47 (78.3%) of the individuals indicated of CVD based on MRA results. The differences between MRA and CTA for CVD alterations were significant (p-value <0.0001). MRA had a diagnostic efficacy of 95% and had a sensitivity and specificity of 95.8% and 91.7% respectively, with Positive Predictive Value (PPV) of 97.9%, and Negative Predictive Value (NPV) of 84.6% as compared to CTA. Conclusion: The results of the present study demonstrate that MRA is equally effective as CTA in diagnosing cases with CVD.

Practice of Ocular Hygiene and Risk for Ocular Disorders among Undergraduate Students of Mangaluru, Karnataka, India: A Cross-sectional Study

MK Arun, Hezil Reema Barboza, K Pavithra, PS Sreekanth

Introduction: The eyes are the most precious human organ for the function of vision, expression and beauty. Good vision contributes to improved athletic ability, better driving skills, improved learning, comprehension and better quality of life. Eye helps to participate in occupation, hobbies, and even to perform most everyday tasks. Aim: To assess the practice of ocular hygiene and the risk for ocular disorders among undergraduate students in a selected college in Southern India. Materials and Methods: A cross-sectional study was conducted in Department of Medical Surgical Nursing, Yenepoya Nursing College, Mangaluru, Karnataka, India from October 2021 to September 2022. It was conducted among 178 subjects recruited by convenience sampling technique. Undergraduate students between the age group of 18-24 years were selected as study participants. Students who underwent special training in ocular hygiene were excluded from the study. One time data was collected using demographic proforma, ocular hygiene practice scale and risk assessment checklist for ocular disorders. Participants were required to take 30 minutes to complete the data collection questionnaires. The collected data was coded and transformed into a master data sheet for statistical analysis. Data was analysed by descriptive and inferential statistics. Results: The results of the present study showed that 47 (26.4%) of the students had very good practice and 124 (69.7%) of them had good practice of ocular hygiene. The results of risk assessment for ocular disorders showed that 146 (82%) had low-risk and a very less percentage 3 (1.7%) of them had a high-risk for the development of ocular disorders. There was a significant association between practice scores and demographic characteristics such as age (p-value=0.04) and using eye accessories (p-value=0.03). Conclusion: In this study, there was a negative correlation between practices of ocular hygiene and risk for ocular disorders among undergraduates. Vision impairment and eye conditions are associated with poor quality of life. An initiative can be taken to improve the practice of ocular hygiene to reduce the risks for ocular disorders among undergraduates.

Online Learning Among Primary and Middle School Children in Rural Chennai, Tamil Nadu, India- A Story of Inequitable Distribution

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has disrupted education and has resulted in a lot of educational losses which is bound to be more exaggerated in the rural areas. The present study was done to assess the availability of prerequisites for online learning among a rural population. The study also looks at the school dropout rates due to the COVID-19 pandemic in a rural population in Tamil Nadu, India. Aim: To estimate the access to digital devices and school dropout rates in a rural population, to find the hassles faced due to online learning and to identify the risk factors for dropping out of school. Materials and Methods: The present community-based cross-sectional study was conducted in the rural field practice areas of Karpaga Vinayaga Medical College (KVMC) situated in Chinna Kolambakkam beyond Chengalpet, Chennai, Tamil Nadu, India and data collection was done between June 2021 and August 2021, using a semi-structured proforma. Data was collected from 256 children between the ages of 6-14 years residing in a rural area in Tamil Nadu, to learn about their transition in education during the pandemic and to identify the factors determining dropping out of school. Associations between school dropouts and socio-demographic factors were found using Chi-square test. Results: Out of total study participants, 131 (51.2%) belonged to primary school and the rest belonged to the middle school category and there were 138 (53.9%) boys and 118 (46.1%) girls. Of all the study participants, 39 (15.2%) had dropped out of school. Dropouts had a statistically significant association with lower socio-economic status (p-value=0.00000007), lower educational status of the father (p-value=0.043), male gender (p-value=0.037) and belonging to a private school (p-value=0.045). Only 25 (9.7%) owned the gadget, they were using to attend online classes. Conclusion: The current study has revealed high school dropout rates (15.2%) than rural primary and middle school children with inadequate access to digital devices.

Role of Ki-67 in Carcinoma Breast as Predictive Marker of Pathological Response to Neoadjuvant Chemotherapy: A Cross-sectional Study

Mathew Mary Vinie, Unnikrishnan Anjit, Lovely Jose

Introduction: Breast carcinoma is the most common invasive cancer in female gender. Neoadjuvant Chemotherapy (NAC) helps to achieve resectability. The pathological response to NAC is classified as a pathological Complete Response (pCR), pathological Partial Response (pPR) and pathological No Response (pNR). Aim: To evaluate the role of Ki-67 as a predictive marker of pathological response and to find the optimum percentage of Ki-67 positivity that can be associated with pCR. Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Government Medical College Thrissur, Kerala, India, between March 2021 and January 2022, which involved 50 breast carcinoma patients. Fifty patients who had undergone mastectomy post-NAC were selected. Ki-67 immunohistochemical staining was done on the initial trucut biopsy sample of the patients. Post-NAC mastectomy specimens were evaluated for tumour clearance. Association of Ki-67 score with pathological response in the mastectomy specimen was studied. Percentage cut-off for Ki-67 in initial trucut biopsy of breast, that could effectively predict pCR in the post-NAC mastectomy specimens was derived by Receiver Operating Characteristic (ROC) curve analysis. Results: Total 50 cases of breast cancer were studied with mean±Standard Deviation (SD) age of 53.3±10.3 years. Eight (16%) out of 50 patients had achieved pCR while, 18 out of 50 patients (36%) showed pPR and 24 out 50 patients (48%) had pNR. Significant association between Ki-67 score and pathological response (p-value=0.03) was found. Optimal percentage cut-off for Ki-67 that could predict pCR was found to be 40% (p-value=0.023). Conclusion: The Ki-67 can be used as an independent predictive marker of pathological response in patients undergoing NAC. Ki-67 value of more than 40% shows strong association with pCR.

Functional and Radiological Outcome of Conservatively Managed Fracture of Radius and Ulna Forearm Bone in Paediatric Population- A Longitudinal Interventional Study

Mayank Mahendra, Prakash Gaurav Tewari, Ajai Singh, Devarshi Rastogi

Introduction: Fractures of the shaft of both bones of forearm are one of the most common fractures in the paediatric age group. There is often a difference of opinion regarding the management of these fractures. Though, there has been an increasing inclination towards surgical correction of these injuries, conservative management is still very popular because of the advantage of good bone remodelling potential in children. Loss of reduction is a known complication of conservative method of treatment. Assessment of the cast index can serve as a tool for the prediction of failure of the conservative management. Aim: To analyse the functional and radiological outcomes of both radius and ulna forearm bones shaft fractures. Materials and Methods: This longitudinal interventional study was conducted in the Department of Orthopaedic Surgery, at King George’s Medical University, Lucknow, Uttar Pradesh, India. The duration of the study was one year 11 months, from June 2017 to May 2019. A total of 196 (156 males and 40 females)patients were included in the study, who presented with closed diaphyseal fractures of the radius and ulna, and were managed conservatively. The patients with acceptable reductions were followed-up at three weeks, six weeks, three months and six months. The functional and radiological parameters were assessed, analysed and the cast index was estimated at each follow-up visit. Chi-square test was performed on the numerical/frequency displays of the dichotomous variables. Student’s t-test with a 95% confidence interval was performed to compare the means of the two groups. Results: The changes in angulation for Anteroposterior (AP), as well as, lateral view of both radius and ulna were significant at each follow-up (p<0.001), but the fracture reduction was found acceptable as per protocol. The loss of reduction was seen equally in male and female patients, only on the left-side and only in the middle third of both bone forearm fracture, but no significant association was found between sex, laterality, site and loss of reduction. The final Range Of Motion (ROM) obtained at elbow, forearm and wrist were all in the functional range at six months follow-up. There were two cases of failure, both above 10 years of age having high cast index and greater angulation in ulna in the prereduction phase. Conclusion: Conservative treatment remains the gold standard for management of paediatric bones forearm fractures with very good functional outcome. A high cast index can be used to predict failure of the conservative management.

Factors Affecting Quality of Life among Caregivers of Cancer Patients in Rishikesh, Uttarakhand, India: A Quantitative Study

Introduction: Cancer impacts not only people living with cancer but also their caregivers. In hospital, caregivers always have pressure on them and their personal and private lives are disrupted during the caring process. Aim: To identify the various factors affecting the Quality of Life (QoL) among caregivers of cancer patients. Materials and Methods: This quantitative study with an exploratory research design was conducted in Oncology Outpatient Department (OPD) of All India Institute of Medical Sciences, Rishikesh, India, from November 2019 to February 2020. A total of 256 caregivers of cancer patients, who were visiting various oncology units were included. Data regarding caregiver’s sample characteristics, clinical variables and Caregiver’s Oncology Quality of Life questionnaire (CarGOQoL) were collected. Statistical analysis was done using Chi-square test and Fischer’s-exact tests were used to study variables. Results: Majority, 94 (37%) belonged to 41-50 years age group, 143 (56%) were females, and 142 (56%) lived in rural areas. Patients’ diagnoses were breast cancer in 94 (37%), Stage-III in 133 (52%), symptoms lasting more than 6-12 months in 103 (40%), and were partial dependent in 172 (67%). A total of 123 (48%) of caregivers scored less in the CarGOQoL questionnaire, so about half of the caregivers had a poor QoL. Caregiver coping (43%) and the private life domain were enormously affected in 193 (37%). Significant relationships with caregivers’ QoL were seen for variables like female gender (p-value=0.037), educational level of patients (p-value=0.018), caregivers with co-morbidities (p-value=0.05), and the number of earning members in the family (p-value=0.022). Conclusion: Care burden always has an impact on the caregiver’s overall QoL. It mainly affects their psychological well-being, burdens, and private lives. Therefore, comprehensive attention should be given to patients as well as caregivers.

Clinical Correlates of Acute and Chronic Pulmonary Complications in Children with Sickle Cell Disease from Madhya Pradesh, India: A Cross-sectional Study

Megha Yadav, Anjali Bharani, Dharmanshu Chaube, Preeti Malpani

Introduction: Sickle Cell Disease (SCD) is one of the most common hereditary haemoglobinopathies globally. Patients with SCD are at a high risk of pulmonary complications. However, there have been very few studies in literature regarding the spectrum of pulmonary involvement and its association with clinicotherapeutic parameters in Indian patients. Aim: To study the incidence of acute and chronic pulmonary complications in children with SCD and to estimate the association of various risk factors with pulmonary complications. Materials and Methods: The present observational cross-sectional study was conducted in the Department of Paediatrics, Mahatma Gandhi Memorial Medical College (tertiary care hospital) and Maharaja Yeshwantrao (MY) Hospital, Indore, Madhya Pradesh, India, from June 2021 to July 2022. A total of 100 patients with SCD below the age of 18 years attending sickle-thalassaemia Outpatient Department (OPD) and Inpatient Department (IPD) with pulmonary symptoms admitted were enrolled in the study. Clinical history, physical examination and laboratory findings were noted as per the preconstructed proforma. Data were statistically analysed with unpaired t-test and Pearson’s Chi-square test. Results: A total of 100 patients with SCD were enrolled and the mean age of the study subjects was 9.27±3.39 years. Nearly equal distribution of males (n=52) and females (n=48) were seen with male to female ratio of 1:1.08. Incidence of complications was seen very high in homozygous sickle disease (63%) followed by only 40% in Haemoglobin S (HbS) beta thalassaemia. Most common complication noted in the patients was Acute Chest Syndrome (ACS) (57.7%), followed by pneumonia (20%), sympneumonic effusion (15.6%) while only 6.7% had pulmonary hypertension. A statistically significant association (p-value <0.05) was found between compliance to Hydroxyurea therapy and frequency of Vaso-occlusive Crisis (VOC) episodes with pulmonary complications status. Conclusion: In the present study, most frequent acute pulmonary complication noted was ACS followed by pneumonia and sympneumonic effusion. Frequency of VOCs episodes was significantly associated with increased risk of developing pulmonary complications.

Association between Admission Blood Glucose Levels and Clinical Outcomes among Diabetic Adults Admitted to a Tertiary Care Hospital in Chennai, India: A Retrospective Study

Dineshkumar Saravanan, Seethalakshmi Avudaiappan

Introduction: Admission blood glucose levels have an impact on hospitalisation and Length Of Stay (LOS). Uncontrolled blood glucose levels have been found to affect patients’ outcomes. Elevation of the initial blood glucose level during critical diagnosis was identified as an independent risk factor for in-hospital mortality in critical cases. Aim: To examine the association between admission blood glucose levels and clinical outcomes in adult diabetic patients. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Chennai, Tamil Nadu, India. Data were collected between July 1, 2021, and August 31, 2021, using non-probability convenience sampling from 522 records of adult diabetic patients admitted between January 2019 and March 2020. Capillary random blood glucose levels at the time of admission and their effects on LOS, both in the hospital and Intensive Care Unit (ICU), readmission, and mortality data were collected. Statistical analysis was performed using the Chi-square test. Results: Analysis of the records of 522 adult diabetic patients revealed that the mean and standard deviation (SD) of admission Capillary Blood Glucose (CBG) level were 177.46±49.42 mg/dL, and the mean LOS in the hospital was 4.54±3.89 days. It was found that 340 (65.1%) patients had an admission duration of ≤4 days. There was a statistically significant association between admission blood glucose levels and LOS in the hospital (p-value=0.01), LOS in the ICU (p-value=0.008), readmission to the hospital (p-value=0.001), and mortality rate (p-value=0.0001). Conclusion: The study demonstrates that admission blood glucose levels are associated with the clinical outcomes of patients. These findings substantiate the need for maintaining normal glycemic levels through patient education and a proactive team approach to improve patient outcomes.

Distribution and Aetiology of Thrombocytosis in Inpatients Setting of a Tertiary Care Hospital: A Cross-section Study from Western Maharashtra, India

Introduction: Thrombocytosis is characterised by an increased platelet count in the blood, defined as a count greater than 450,000 cells/μL. The incidental discovery of thrombocytosis often leads to unnecessary investigations and referrals, causing anxiety among physicians. Aim: This study aims to examine the presence, frequency, and etiological distribution of thrombocytosis in various disease conditions. Materials and Methods: This cross-sectional observational study was conducted at the Central Clinical Laboratory of MIMER Medical College and Dr. BSTR tertiary care hospital in Talegaon Dabhade, Pune, Maharashtra, India, from June 1st, 2021, to August 31st, 2021. Clinical and laboratory data were collected from adult patients with a platelet count greater than 450,000 cells/μL and entered into a Microsoft Excel sheet. The parameters studied included age, sex, clinical diagnosis, platelet count, Total Leucocyte Count (TLC), absolute neutrophil count, Neutrophil Lymphocyte Ratio (NLR), haemoglobin levels, and C-reactive protein (CRP). Pearson’s correlation coefficient was calculated using Statistical Package for the Social Sciences (SPSS) software version 26.0. Results: A total of 194 patients with a platelet count greater than 450,000 cells/μL were included in the study. The frequency of thrombocytosis was 8.50% (194 patients), with 113 cases in the Medicine Inpatient Department (IPD) and 81 cases in the Surgery IPD. The lowest platelet count observed was 454,000 cells/μL, while the highest was 855,000 cells/μL. Primary thrombocytosis was found in 2 (1.03%) patients, while secondary thrombocytosis was found in 192 (98.96%) patients. A statistically significant association was observed between thrombocytosis and ferritin (p-value=0.032). Additionally, significant associations were found between thrombocytosis and absolute neutrophil count (p-value=0.023) and NLR (p-value=0.047). Conclusion: Elevated platelet counts, discovered during routine blood examinations, carry diagnostic, prognostic, and therapeutic implications as they can be indicative of various clinical situations with diverse underlying aetiologies. It is essential to rule out secondary thrombocytosis before further investigating for primary thrombocytosis. Thrombocytosis warrants thorough investigations and careful clinical correlation.

Prevalence of Impulsive Behaviour among Students in a Medical College: A Cross-sectional Study from Southern India

Karthikeyan Kulothungan, K Nawin Jai Vignesh, M Tamilarasan, JV Gnanagurubharan

Introduction: Impulsive behaviour is the urge to act without thinking in any critical situation. Impulsive behaviour and risk-taking behaviour in adolescence have the chance of disrupting the balance of their entire lives. Studies and research related to impulsive behaviour are minimal and remain a blind area for any effective interventions to be applied. Aim: To study the prevalence of impulsive behaviour and to determine the factors associated with impulsive behaviour among Medical College Students in Perambalur, Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted among 133 medical students of Dhanalakshmi Srinivasan Medical College and Hospital in Perambalur, Tamil Nadu, India, from January 2022 to April 2022. All undergraduate students, present in the college at the time of the study, were enrolled in the study. A pre-tested, validated, semi-structured questionnaire was used and the data was collected during the break hours in the morning and afternoon during the college working hours on the weekdays. The obtained data were analysed using statistical tests like paired t-test, unpaired independent t-test and Analysis of Variance (ANOVA). Results: Total of 133 Medical students (mean age: 21.21±1.58 years, 66 (49.6%) males and 67 (50.4%) females) were included in the study and analysed. The factors such as age (M&±SD: 21.21±1.58 years with p-value 0.01), Usage of mobile phone (M±SD: 4.94±2.31 hours with p-value 0.01), fear for exam (M±SD: 2.20±0.58 with p-value 0.03), sleeplessness (M±SD: 2.89±0.59 with p-value 0.001) were associated with impulsive behaviour. Conclusion: The impulsive behaviour of a student is influenced by his fear of exams, his lack of sleep, and his usage of mobile phones. Assessment of a person with impulsive behaviour could help in the better prognosis and early intervention of young adult mental disorders.

Efficacy of Ultrasound Guided Single Level Paravertebral Block vs Transmuscular Quadratus Lumborum Block (III) for Postoperative Analgesia after Percutaneous Nephrolithotomy Surgeries- A Randomised Clinical Study

Introduction: Pain control forms an essential component of enhanced recovery after surgery. Regional nerve blocks forms the mainstay of pain relief now-a-days. Pain after Percutaneous Nephrolithotomy (PCNL) surgeries is always distressing to the patient due to injury to the renal capsule. Aim: To compare the efficacy of Ultrasonography (USG) guided Paravertebral Block (PVB) versus Quadratus Lumborum Block (QLB) for postoperative analgesia following PCNL surgeries. Materials and Methods: This randomised clinical study was done between February 2021 to August 2022 at Narayana Medical College and Hospitals, Nellore, Andhra Pradesh, India. Sixty patients of American Society of Anaesthesiology (ASA) I and II between 30-60 years age group undergoing PCNL surgeries were divided into two groups. Group P received USG guided PVB at T9-T10 level with 20 mL of 0.25% Levobupivacaine with 8 mg Dexamethasone whereas group Q received QLB (III) with 20 mL of 0.25% Levobupivacaine with 8 mg Dexamethasone. Visual Analogue Score (VAS), time for first rescue analgesic and number of patients requiring rescue analgesic in first 24 hours were measured. The unpaired t-test was used to compare continuous variables whereas the Chi-square test was used to compare the categorical variables. Results: There was no statistical difference in terms of sex, age, weight, height or American Society of Anaesthesiology (ASA) grade (p>0.05). The mean time required for rescue analgesia in group P was around 478 minutes compared to group Q with 346 minutes which was statistically significant (p=0.001). Mean tramadol consumption in group Q was significantly high (155 mg) compared to group P (125 mg). VAS was significantly better in group P. Conclusion: The USG guided single level PVB provides superior analgesia compared to transmuscular QLB for postoperative analgesia after PCNL surgeries which helps in enhanced recovery after surgery.

Diagnostics Role of Haematological Parameters in Benign and Malignant Breast Lesions: A Retrospective Observational Study from a Tertiary Healthcare Centre in Tamil Nadu, India

Parvesh Anwer, Priyadarshini Kumaraswamy Rajeswaran

Introduction: Breast cancer is the most common malignancy diagnosed in women, and despite advancements in diagnosis and treatment, it still leads to significant morbidity and mortality. Distinguishing between benign and malignant breast disease is clinically challenging, and there is currently no serum biomarker available for early breast cancer detection. As part of the preoperative work-up for breast lesions, a Complete Blood Count (CBC) analysis is typically performed. Aim: This study aimed to evaluate the utility of CBC parameters in diagnosing malignant breast lesions and to analyse the diagnostic role of haematological parameters within benign and malignant breast lesions, as well as different histological breast cancer stages. Materials and Methods: This retrospective observational study was conducted for one year, from January to December 2021, at the Department of Pathology of PSG Institute of Medical Sciences and Research in Coimbatore, Tamil Nadu, India. The study included 60 female patients with both benign and malignant breast lesions. Histopathological examination confirmed the diagnoses of these lesions. CBC parameters, including haemoglobin, Total White Cell Count (TWBC), neutrophil count, lymphocyte count, monocyte count, platelet count, and Mean Platelet Volume (MPV), were collected from a total of 120 cases. Additionally, the Neutrophil-Lymphocyte Ratio (NLR), Monocyte-Lymphocyte Ratio (MLR), and Platelet-Lymphocyte Ratio (PLR) were calculated from the obtained CBC parameters for all cases. The values were expressed as mean and standard deviation, and an independent t-test was used to compare the two groups. A p-value less than 0.05 was considered significant. Results: Malignant breast lesions showed a significant increase in neutrophils (64.1±8.4%) and a significant decrease in lymphocytes (25.9±8%) and MPV (7.6±0.76 pg) compared to benign breast cases. The calculated ratios, such as NLR (2.9±1.7), MLR (0.32±0.2), and PLR (14.4±8), were also found to be increased in malignant cases. However, there were no significant variations in CBC parameters across the various stages of breast malignancy. Conclusion: Among the CBC parameters evaluated, neutrophil count, lymphocyte count, MPV, NLR, MLR, and PLR were significantly altered in breast malignancy compared to benign breast masses. Measuring CBC parameters and their derived ratios are fast, simple, inexpensive, and readily available method that can assist physicians in predicting breast malignancy.

Effect of Home-Based versus Clinic-Based Exercise Training on Balance and Function in the Geriatric Population with Knee Osteoarthritis: A Non Randomised Controlled Trial

Chirag Jeram Parmar, Trupti Kavit Munshi

Introduction: Knee Osteoarthritis (OA) affects 30-40% of the population worldwide by the age of 65 years and is associated with proprioception loss, postural instability, and fall risk. Strengthening and balance exercises at home can prevent these issues. The Otago home exercise program is commonly used for fall prevention in the elderly. Aim: To compare the effects of home-based and clinic-based exercise training on balance and function in geriatric individuals with knee OA. Materials and Methods: A non randomised controlled trial (NRCT) was conducted from October 2017 to December 2017 at an old age home and residential zone of Ahmedabad city. Nineteen participants were divided into two groups: group A (home-based exercise) with nine participants, and group B (clinic-based exercise) with ten participants. The exercises were based on the Otago program. The study duration was eight weeks, and outcome measures included the Berg Balance Scale (BBS) for static and dynamic balance, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for physical function, the Timed Up and Go (TUG) test for dynamic balance, and the Visual Analog Scale (VAS) for knee pain. Data analysis was performed using Statistical Package for the Social Science (SPSS) version 22.0, employing the Wilcoxon and Mann-Whitney tests for within group and between group comparisons, respectively. Results: Group A (home-based exercise) showed significant improvements in BBS (p-value=0.007), WOMAC (p-value=0.007), and TUG (p-value=0.027). Group B (clinic-based exercise) also showed significant improvements in BBS (p=0.005), WOMAC (p=0.005), and TUG (p=0.041). When comparing the two groups, significant differences were found in BBS (p=0.013) and WOMAC (p=0.039), but not in TUG (p=0.864) and VAS (p=0.908). The clinic-based exercise group demonstrated greater improvement, as indicated by higher pre and postintervention readings. Conclusion: This study concludes that both home-based and clinic-based exercises are effective in improving balance and physical function in geriatric individuals with knee OA. However, clinic-based exercise interventions showed greater improvement, as evidenced by higher pre and postintervention readings in the clinic-based exercise group.

Dentists’ Knowledge, Attitude, and Perception Regarding Robotics and Artificial Intelligence in Oral Health and Preventive Dentistry: A Cross-sectional Study

Introduction: Robotics (R) is concerned with the linkage between perception and action, and Artificial Intelligence (AI) plays a significant role in enabling this intelligent relationship. In dentistry, AI has primarily been utilised to enhance diagnostic procedures, which are crucial for achieving favorable treatment outcomes and providing excellent patient care. Aim: The aim of this cross-sectional study was to assess the Knowledge, Attitude, and Perception (KAP) of dentists towards R and AI in oral health and preventive dentistry. Materials and Methods: The study was conducted at the Department of Public Health Dentistry, Yenepoya Dental College, Mangalore, Karnataka, India. The duration of the study was three months, from March 2022 to June 2022. A closed-ended, self-administered questionnaire using Google Forms was distributed among 161 dental professionals in South India. The questionnaire included items related to KAP towards the use of R and AI in preventive dentistry and oral health. Descriptive analysis was performed, and one-way Analysis of Variance (ANOVA) was used to compare mean values. Tukey’s post-hoc test was employed for group comparisons. Results: The mean age of the participants was 30.17±9.18 years. Out of the 161 participants (70 males and 91 females), 133 (82.6%) had heard about R and AI in dentistry, but only 78 (48.4%) were aware of the differences between R and AI. Among the dentists, 74 (46%) believed that AI might have a future in India, and 145 (90.6%) responded that R and AI were useful during the COVID-19 pandemic. Additionally, 97 (60.6%) participants expressed willingness to be treated by R and AI if necessary, and 107 (66.9%) would prefer to receive lectures or workshops from a robot. Tukey’s post-hoc test revealed that the staff’s knowledge and attitude were significantly higher than those of interns, postgraduates, and private practitioners (p<0.05). Conclusion: The findings of this study indicate that the majority of dentists have a negative perception of R and AI. Despite having a generally positive attitude, dentists have limited to no utilisation and application of R and AI. It is crucial to raise awareness of this concept in the near future, as it has the potential to enhance treatment effectiveness and efficiency.

Comparison of Minimum Muscular Fitness of Congenital Hearing Loss and Normal Children using Kraus-Weber Test: A Cross-sectional Study

John Britto, Senthil Kumar, Rajesh K Sasidharan

Introduction: Muscular Fitness (MF) is a potent indicator and reliable marker of children’s and adolescents’ general health and well-being. Further, MF is a significant predictor of bio-psychosocial well-being among children. Aim: To compare Hearing Impaired (HI) and normal hearing childrens’ minimum MF utilising the Kraus-Weber (K-W) test. Materials and Methods: This was a cross-sectional study conducted at Holy Cross School for the Hearing Impaired and Sacred Heart High School at Vellore, Tamil Nadu, India. The duration of the study was from 10th July 2018 to 20th December 2018. A total of 167 children of both genders aged 12 to 16 years, from a boarding school in Southern India with congenital hearing loss (n=82) and normal hearing (n=85) children were included in this study. The demographic information of the participants, anthropometric measures, and six subtests of the K-W tests for minimum MF were evaluated. Jeffreys’s Amazing Statistics Program (JASP) version 0.16.1 was used for all statistical analyses. Descriptive statistics and Chi-square test compared K-W test item success and failure rates. Mann-Whitney test evaluated physical differences. The level of significance was fixed at 0.05. Results: The current research found that children with HI had a significantly lower minimum level of MF than children with normal hearing on K-W Test-3 (Abdominal minus psoas), K-W Test-5 (Lower back muscles), and K-W Test-6 (Back and Hamstrings) (p-value <0.001). Conclusion: The outcomes of this study revealed that HI children had lower minimal MF as measured by the K-W test than normal-hearing children. It highlighted the need for enhanced physical activity as well as education about the importance of maintaining minimum physical fitness.

Comparison of Student Performance in Online versus Offline Teaching: A Case-control Study in Obstetrics and Gynaecology Lectures in the Qassim Region, Saudi Arabia

Zaheera Saadia, Hossam Omar Hamid

Introduction: During the Coronavirus Disease 2019 (COVID-19) pandemic, there was a global need for online learning. Numerous publications were observed both in favour of and against online platforms, but most of them were qualitative. Now that the pandemic is over, we aimed to explore the effectiveness of online teaching compared to offline teaching. Aim: This study aimed to descriptively compare the performance of medical students in online versus offline class teaching of the Obstetrics and Gynaecology course. Materials and Methods: This quantitative retrospective case-control study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine, Qassim University, from July 2022 to January 2023. The academic year 2018/2019 was considered the control group (August 2018 to June 2019, offline teaching), and the year 2020/2021 was considered the case group (online teaching, August 2020 to June 2021). A total of 123 students had the Obstetrics and Gynaecology course delivered online, compared to a control group of 115 students who had the same course offline. Chi-square test was applied to analyse categorical variables, considering a p-value <0.05 as significant. Results: The measured outcomes included overall students’ performance in terms of marks and grades, as well as performance in relation to gender and attendance rates. Overall, students’ grades and attendance were higher in the online group (p=0.004 and p=0.03, respectively), which was more evident among male students (p=0.009). Conclusion: The findings suggest that medical students’ performance in online learning is comparable to or better than face-to-face teaching. Further research is needed to explore the performance of male students compared to female students.

Correlation of LDL Cholesterol Calculated by Friedewald’s, Puavilai’s, Vujovic’s, de Cordova’s and Martin’s Formulae with Directly Measured LDL Cholesterol: A Cross-sectional Study

Sudha Ambiger, Fatima Farheen, Kamarudin Jaalam, Javali Shivalingappa

Introduction: Measurement of Low Density Lipoprotein Cholesterol (LDL-C) carries high importance in the management of Cardiovascular Disease (CVD). Direct LDL-C measurement is preferred method but this is expensive and inconvenient for the routine laboratories. To date, various types of formulae have been introduced. However, accurate estimation of LDL-C by formula is a challenge. Aim: To determine that which of these calculated formulae (Friedewald’s, Puavilai’s, Vujovic’s, de Cordova’s and Martin’s formulae) show maximum correlation with directly measured LDL-C at different serum triglyceride levels. Materials and Methods: The present cross-sectional study was conducted in the Department of Biochemistry, KLE Centenary Charitable Hospital and Medical Research Centre, Belgaum, Karnataka, India, from December 2020 to December 2021. A total of 280 outpatient fasting complete lipid profiles of patients, aged between 18-50 years were included in the study. LDL-C measured by Friedewald’s formula, Puavilai’s formula, Vujovic’s formula, de Cordova’s formula and Martin’s formula were compared with directly measured LDL-C. Comparison of calculated LDL-C with directly measured LDL-C was done at following Triglyceride (TG) ranges as group 1: <200 mg/dL, group 2: 200-300 mg/dL, group 3: >300-400 mg/dL and group 4: >400 mg/dL. Data analysis was done using Pearson’s correlation coefficient and two paired t-test. Results: Of total 280 samples, 124 participants were in group 1, 91 participants in group 2, 36 participants in group 3 and 29 participants in group 4, and there were 130 males and 150 females. The mean age in group 1, 2, 3 and 4 was 40.9±8.0 years, 38.8±9.2 years, 39.1±10.0 years and 39.8±8.2 years, respectively. Martin’s formula showed maximum correlation with r-value of 0.9979 compared to Friedewald’s formula, Puavilai’s formula, Vujovic’s formula and de Cordova’s formula. The mean difference was least for Martin’s formula 0.31±3.53 compared to other formulas. Percentage of error was least for Martin’s formula (0.23%) in total study sample and in all groups. Martin’s LDL-C shows highest concordance (90.90%) compared to Frielwald’s (79.60%), Puavilai’s (86.00%), Vujovic’s (83.88%) and de Cordova’s formula (82.76%). Conclusion: In the present study, Martin’s formula showed highest correlation, least mean difference, highest concordance and low percentage of errors in all the groups compared to Frieldwald’s formula, Puavilai’s formula, Vujovic’s formula and de Cordova’s formula.

Functional Outcome of Acute Minimally Displaced Scaphoid Waist Fractures Treated with Percutaneous Headless Compression Screw Fixation: A Prospective Cohort Study

Introduction: Scaphoid fracture incidence has increased recently due to increased participation of people in sports and increased road traffic accidents. Availability of diagnostic tools like Computed Tomography (CT) help in easy diagnosis of scaphoid fractures, which may be missed on routine radiographs. Aim: To evaluate the functional outcome of surgical intervention with percutaneous headless compression screw fixation for acute minimally displaced scaphoid fractures. Materials and Methods: The present study was a prospective cohort study in which patients with acute fractures of scaphoid bone managed with percutaneous headless compression screw fixation were included between January 2020 to December 2022 and were evaluated using the Modified Mayo Wrist Score (MMWS) and Disabilities of Arm, Shoulder and Hand (DASH) score. The data obtained was entered into a Microsoft Excel sheet, and statistical analysis was performed using a Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: The study included 55 patients with a mean age of 32.9 years, out of which 43 were males and 12 were females. Road traffic accident injuries were in 19 patients, 17 were sports injuries and 19 were due to direct trauma. All patients were managed by percutaneous headless compression screw fixation. Among these, 27 patients showed excellent outcomes, 24 showed good outcomes, and four showed fair outcomes. Conclusion: The present study shows that percutaneous fixation of minimally displaced scaphoid fractures results in early symptomatic relief and functional recovery. It also shows that percutaneous fixation using a headless compression screw has similar functional outcomes and less hospital stay and patient scarring than in open fixation methods. Functional recovery is faster with percutaneous fixation than in non operative and open fixation.

Various Prognostic Factors in Metastatic Brain Tumours: A Cross-sectional Study

TP Jeyaselva Senthilkumar, K Madhusuthanan, R Yamunadevi

Introduction: The most common type of intracranial neoplasms seen in neurosurgical practice is metastatic brain tumours. Adults with cancer have an 8-10% lifetime risk of developing symptomatic metastases. Breast cancer and lung cancer are the commonest to give brain metastases. However, the number of reported cases in India is still a portion of the true prevalence of brain metastases. In order to better understand the clinical presentation of brain metastases, their distribution, and other variables that impact their survival, the present research was planned and conducted. Aim: To analyse the distribution of metastatic brain tumours, their primary source, characteristics of imaging, the different modalities of treatment and the factors which affect their survival like Karnofsky performance score, time interval between diagnosis of primary and metastasis, treatment method adopted. Materials and Methods: The cross-sectional study was carried out in the Department of Neurosurgery, SRM Medical College Hospital and Research Centre a tertiary care hospital in Chennai, Tamil Nadu, India during the period from June 2018-May 2021 and included 102 metastatic brain tumour patients with proven biopsy of either of the primary or secondary lesions. Individuals who neither had the main nor the secondary lesion verified by biopsy were excluded. Among these patients, the parameters studied were incidence of various primary tumours, demographic profile, clinical features, imaging characteristics, performance status of the patient, treatment options, patient survival in relation to performance status, pathology, time interval between diagnosis of primary malignancy and the onset of secondary lesions. The results were analysed for the factors which affect survival like nature of systemic disease, source of primary, number of metastatic lesions, treatment methods adopted. Results: The commonest age group involved was 40-69 years 81 (79.41%). Female to male ratio of 4:1 in the age group of less than 40 years and the overall male to female ratio was 1:1.04. Lungs being the commonest primary source (42%) followed by breast and unknown primary. Ring lesion was the commonest appearance of metastasis 51 (50%), followed by cystic lesions 8 (7.84%) and haemorrhagic secondaries 3 (2.94%). Breast primary had a survival rate of 58.3% with better prognosis. Good karnofsky performance score, longer interval between diagnosis of primary and secondaries brain, combining surgery along with radiotherapy were also found to have good prognosis. Conclusion: Metastatic brain tumours are the commonest intracranial tumours. The favourable prognostic factors are the breast primary, younger age patients with good karnofsky score. Surgery along with radiation shows promising results than radiation alone even in poor grade patients.

Effectiveness of Recorded Video Lectures vs Live Online Lectures as Teaching Tools among Phase 1 Medical Students- A Prospective Study

Keba Jeeva, Himiki Selvindev

Introduction: During the pandemic, there were a lot of challenges for offline medical education. To overcome those challenges, online teaching methods were introduced for undergraduate medical education. Live online lectures (synchronous teaching) and recorded video lectures (asynchronous teaching) were the two commonly utilised teaching mediums of online education. Aim: To determine the effectiveness of recorded video lectures versus live online lectures and to analyse the students’ perception regarding these two teaching methods. Materials and Methods: The present prospective interventional study was conducted in the Department of Physiology at Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum, Kerala, India. The duration of the study was six months, from March 2021-August 2021. A total of 150 students (97 girls and 53 boys) in two groups of 75 each were selected as study population and four topics were taught to them. If, one group was taught via live online lecture, the same topic was given as a recorded video to the other group and after three days, an assessment was done. For the second topic, the method of lecture delivery was changed between the groups, while the rest of the methodology was the same. Topics 3 and 4 followed same pattern. Unpaired t-test was done to compare the scores and the data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the study participants was 18.5 years. The results showed that, the recorded video lectures were equally effective as live online lectures. While analysing the students’ perception, it showed that students, to an extent, preferred recorded lectures to live lectures. Conclusion: The present study concluded that, the recorded video lectures are equally effective as live online lectures as a teaching tool, among phase 1 Bachelor of Medicine and Bachelor of Science (MBBS) students.

A Prospective Study on Fetomaternal Outcomes in Asymptomatic Chronic Hepatitis B Pregnant Women in a Tertiary Level Hospital

Introduction: Hepatitis B surface Antigen (HBsAGg) prevalence among pregnant women in India is between 0.9-3.1%. The most important factor in determining the prevalence is transmission from asymptomatic chronic Hepatitis B Virus (HBV) mother to newborn. The present study was done to observe antiviral treatment and fetomaternal outcome in asymptomatic HBV mothers. Aim: To study fetomaternal outcomes in asymptomatic chronic hepatitis B pregnant women. Materials and Methods: This prospective cohort study enrolled 125 HBsAg seropositive singleton pregnancy over a period of 18 months from October 2020 to March 2022 in Department of Obstetrics and Gynaecology and VMMC and Safdarjung Hospital, New Delhi, India. Chronic Hepatitis B (CHB) was diagnosed when HBsAg, HBeAg or HBV DNA was present and IgM anti-HBc was absent. Tenofovir was started in consultation with the gastroenterologist in women with HBeAg positivity or with high HBV DNA titre ≥200,000 IU/mL or Alanine Transaminase (ALT)> two times the Upper Normal Limit (UNL). All women were followed with Liver Function Test (LFT) till delivery and six weeks postpartum and their fetomaternal outcome were noted. The p-value < 0 .05 was taken as significant. Descriptive statistics was analysed with Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: Tenofovir was started in 26 (20.8%) women. LFT flare was seen in 15.15% (15/99) women who were not on treatment and 0% in women on treatment. In women without treatment, log HBV DNA level was significantly increased while it was reduced in the women who received tenofovir and the reduction was significant (p-value <0.05). HBeAg was positive in 61.5% women on treatment and 0% in untreated women. No significant association was found in maternal outcomes i.e., Gestational Diabetes Mellitus (GDM), Antepartum Haemorrhage (APH), Preeclampsia, Premature Rupture Of Membrane (PROM), Preterm labour, Postpartum Haemorrhage (PPH) and High Dependency Unit (HDU) stay, in treated and untreated women. Foetal outcomes such as birth weight, APGAR score, Neonatal Intensive Care Unit (NICU) admission, prematurity, Foetal Growth Restriction (FGR) and neonatal jaundice also showed no significant association between antiviral treated and untreated women. Conclusion: There was no significant association of antiviral treatment with maternal and foetal outcome. Tenofovir is safe and reduces the LFT flare in CHB mothers. HBV DNA levels were reduced in treated women which may have reduced the incidence of Mother To Child Transmission (MTCT), which was not studied in the present study. HBeAg seropositivity and ALT >2 times the ULN can replace the need of HBV DNA titres for initiation of antiviral therapy in India.

Efficacy of Mid-Second-Trimester Serum b-HCG Levels as a Predictor of Hypertensive Disorders of Pregnancy: A Longitudinal Cohort Study

Kada Vishnu Priya, Shilaja Rajendra Bidri, Sangamesh Mathapati

Introduction: Hypertensive Disorders of Pregnancy (HDP) affect up to 10% of pregnancies worldwide, despite improvements in maternal and neonatal care. HDP and its sequelae are a dreaded complication of pregnancy. If prediction becomes possible, prevention will follow naturally. Aim: To study the efficacy of mid-second trimester serum b-hCG levels in the prediction of HDP. Materials and Methods: This was a longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at Shri BM Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India, between December 2020 and June 2022. All women with gestational age between 16-20 weeks were screened, and 163 pregnant women were enrolled in the study. Serum β-hCG levels were measured at enrollment, and values were followed-up until delivery. The development of HDP was evaluated using statistical analysis, including Chi-square, Independent t-test, Receiver Operating Curve/Area under the ROC Curve (ROC/AUC), sensitivity, and specificity. A p-value of <0.05 was considered significant. Results: Of the 163 pregnant women enrolled, 49 (30.1%) developed HDP, while 114 (69.9%) remained normotensive. The mean age of the study population was 24±4 years. The mean serum β-hCG level in the normotensive group was 55666 mIU/mL, while in the HDP group, it was 100124 mIU/mL, with a statistically significant p-value of 0.001. A cut-off value of 77817 mIU/mL showed 83.7% sensitivity and 92.1% specificity. Conclusion: This study suggests that serum b-hCG levels between 16-20 weeks can be used as a non-invasive predictor of HDP. It is a good predictor of HDP and could potentially improve prevention strategies.

Symptomatic Gallstone Disease and Associated Upper Gastrointestinal Pathologies-A Prospective Cohort Study

Haresh Kumar Gobu, Dinker Ramananda Pai

Introduction: Gallstones Disease (GSD) is one of the common medical problems leading to surgical intervention. The gold standard treatment for cholelithiasis is cholecystectomy. Co-existence of concurrent Upper Gastrointestinal (UGI) problems in GSD patients have attributed to the Post-cholecystectomy Syndrome (PCS). PCS consists of a group of abdominal symptoms, that recur and/or persist after cholecystectomy. The associated upper Gastrointestinal (GI) pathologies are identified by UGI endoscopy. Helicobacter pylori (H.pylori) infection has been implicated in many GI and extra-GI diseases. This aspect of identifying associated pathologies in symptomatic gallstone disease and identifying H.pylori infection using gene-sequencing method has not been studied in Indian population. Aim: To study the associated UGI pathology detected by preoperative UGI endoscopy in symptomatic GSD and to compare the outcome based on the trend of PCS overtime. Materials and Methods: The present prospective cohort study conducted in the Department of Surgery at Mahatma Gandhi Medical College and Research Insititute, Puducherry, India. The duration of the study was 18 months, from January 2019 to July 2020. The individuals over 18 years of age, who were symptomatic and ultrasonographically proven to have cholelithiasis formed the study group. The sample size was calculated to be N=50 (reduced to N=30 due to Coronavirus Disease-2019 (COVID-19) pandemic). Patients underwent UGI endoscopy prior to surgery, to assess for associated pathology including H.pylori. They were followed at regular intervals postoperatively and assessed based on questionnaire for the occurrence of PCS. The quantitative and qualitative variables were summarised as frequency, percentage and Pearson’s Chi-square test and Fisher’s-exact test, respectively. The sensitivity and specificity of H.pylori positivity by Histopathological Evaluation (HPE) in biopsy samples was compared to Polymerase Chain Reaction (PCR) as the gold standard. The significance level was set at p-value <0.05. The trend of the symptoms was also studied overtime. Results: The mean age of the study population was 39.4±11.93 years. UGI abnormalities were present in 89.7% of the study group. H.pylori was identified in eight patients by histopathology examination while PCR detected 16 patients to have H.pylori. Sixteen out of 30 patients (53.3%) had PCS. It was also noted that, early PCS numbers tend to reduce over time, but the overall and late PCS numbers tend to increase over time. Although, a statistical analysis could not be performed, a graph was drawn to study the symptoms over the study period allowing observation of vital relation to gallstone disease. UGI pathology and H.pylori infection had a significant association with overall PCS with p-value=0.022 and 0.026, respectively. Conclusion: The present study recommends the use of preoperative UGI endoscopy in symptomatic GSD. The identification of H.pylori by PCR using population-based gene-sequences has a role in treatment of gallstone disease. The trend shows difference in behaviour of PCS overtime.

Spectrum of Colorectal Polyps in Southern India: A Twin Centre Ambispective Study

Afshan Jabeen, V Vijay Sreedhar

Introduction: Intestinal polyps are grossly visible tumours which protrude (into lumen of gastrointestinal tract). Majority of the polyps are benign in the paediatric age group. However in adults, they may be harbingers of more serious genetic, familial or developmental disorders and some of them may be premalignant. Aim: Our aim was to study the distribution, histological varieties of colorectal polyps and to examine dysplasia in adenomatous polyps and its determinants. Materials and Methods: This is a four years retrospective and one year prospective study from June 2017 to May 2022 conducted at Upgraded Department of Pathology, Osmania General Hospital and a tertiary care centre, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India. A total of 110 cases of polyps were studied which included 62 cases in adults and 48 cases in children (0-12 years). Predictors of dysplasia in adenomatous polyps were studied. Results were analysed using PSPP software. Results: There were 62.73% (69) males and 37.27% (41) females. The commonest clinical presentation was bleeding from rectum 64.54% (71) cases. Rectosigmoid was the commonest site in 83.64% (92) cases. Juvenile polyps were the commonest in children and constituted 89.58% (43 cases). In adults, there were 63.07% (41) adenomatous polyps. A statistically significant association has been observed between high grade dysplasia and size (p-value 0.015) and villous architecture (p-value 0.02). There was no statistically significant association with site (p-value 0.2). Conclusion: A rising incidence of Colorectal Cancer (CRC) has necessitated identification of preneoplastic Adenomatous polyps which may progress to carcinoma via the Adenomacarcinoma sequence. Polyps occurring as part of polyposis syndromes have increased neoplastic potential. Their detection and treatment carries significant implications both for the patients and their families. In India, there is a need for screening colonoscopy in asymptomatic individuals which can be a potential cancer prevention tool.

Risk Stratification of COVID-19 Patients based on Proposed Simple Clinical Parameters Score: A Retrospective Observational Study

Introduction: India has impacted severely by multiple waves of Coronavirus Disease-2019 (COVID-19) and still struggling with limitation of resources to cater such a huge population. Available triage methods to treat COVID-19 are either too complex to use or time-consuming. A triage score, that should be independent of any laboratory investigations and exclusively based on clinical parameters was required, so that the healthcare provider at the first contact can segregate patients on the basis of intensity of care required to save, as many lives as, possible. Simple Clinical Parameters (SCIP) score may be a useful tool for fast triage of patients at the point of care and can help to screen patients, who will benefit from early hospitalisation, from those, who can be managed as outpatients. Aim: To validate the usefulness of SCIP score in triage of COVID-19. Materials and Methods: This single-centre, retrospective, observational study was conducted at a Tertiary Care Hospital. The duration of the study was six months, from November 2021 to May 2022. A total of 945 patients were involved in the present study. SCIP score was formulated using basic clinical parameters like Pulse Rate (PR), Respiratory Rate (RR), and arterial oxygen saturation at room air (SpO2). The risk score ranges from 1 to 10. The lower the score, more severe the disease and hence, more intense care is warranted. All the parameters required for calculating the SCIP score are continuous variables, expressed in mean±Standard Deviation (SD) and categorical data of patients in specific levels of care are represented as proportions. Data was collected and analysed using Microsoft Excel 2007 and the Python statistics module. Results: The mean age of the study participants was 49.7±16.5 years. A total 945 patients were included in the study, out of which 552 (58.4%) were males and 393 (41.6%) were females. In more than half patients, the Level of Care (LOC) predicted by the proposed SCIP score, matched the actual LOC received. The mean scores were within the proposed score ranges. SCIP score was 97% sensitive in detecting the patients, who can be managed at Outpatient Department (OPD) and 99% specific in detecting those, who did not require intensive treatment at Intensive Care Unit (ICU). SCIP score showed the need for ICU with 92% accuracy and the patients, who can be treated at OPD, without requiring hospitalisation with 90% accuracy. Conclusion: SCIP scoring system based on routine clinical parameters, is helpful in early detection of severity of the disease and in making a fast decision to predict the LOC required. A score based on clinical parameters ensures the availability of a fast and simple triage method to ensure optimal utilisation of available resources and help healthcare provider to make quick decisions.

Prospective Study Evaluating the Association between Time since Scorpion Bite and Spinal Anaesthesia Outcomes

Introduction: The drug mainly used in Spinal Anaesthesia (SA) is Local Anaesthetic (LA) agents. It acts via sodium channel by reversibly inhibiting the nerve transmission. Scorpion venom causes mutation in receptors of sodium channel that leads to LA resistance which results in failed SA. Although, there are few studies and many case reports, which shows direct association of scorpion bite with failed SA, but association of duration since, scorpion bite on outcome of SA is still not known. Aim: To evaluate the association between time since scorpion bite and multiple bites and outcome of SA on patients posted for elective lower abdominal and lower limb orthopaedic surgeries. Materials and Methods: This monocentric, prospective, single blind observational study was conducted in the Department of Anaesthesia at Rajarshi Dashrath Autonomous State Medical College (RDASMC), Ayodhya, Uttar Pradesh, India. The duration of the study was two years, from December 2019 to December 2021. A total of 33 patients of any gender and age between 18-70 years were taken and divided into three groups of 11 each. Groups were divided on the basis of history of duration since scorpion bite/sting. Group A included patients with history of scorpion bite being less than eight months, group B from 8-14 months and group C more than 14 months. SA was provided with 15 mg 0.5% hyperbaric bupivacaine. The pin prick method and Bromage scale were used to detect the onset of sensory (T1), onset of motor (T2), peak of sensory (T3) and peak of motor block (T4). General Anaesthesia (GA) was given if the SA was found inadequate or failed. The mean±Standard Deviation (SD), Student’s t-test and Chi-square test were used for statistical analysis of data. Results: The mean age of the study participants of group A was 49.27 years, group B was 50.27 years and group C was 52.18 years. Demographically, all the three groups were comparable. The authors have found that, block failed completely in group A. There was statistically significant increase of T1, T2, T3 and T4 in group B than group C (p<0.05). Statistically significant difference were not found between single scorpion bite and multiple scorpion bite in group B and group C in terms of SA characteristics T1, T2, T3 and T4 (p>0.05). Conclusion: The present study concludes that, the duration of scorpion bite is a significant factor on the effect of SA in terms of sensory and motor block, but number of stings does not determine the sensory and motor characteristics of SA. The SA should not be given if, the history of scorpion bite is recent (less than eight months).

Knowledge and Attitudes of Parents Regarding Digit Sucking Habit in Children in Pune: A Questionnaire-based Cross-Sectional Study

Haniya Ali Khan, Aditi Mathur, Sneha M Nair, Samiksha Shetty

Introduction: Digit sucking is a most common oral fixation observed in children, which involves placement of thumb or fingers into the mouth. Knowledge of the risk factors for the presence of this habit helps to provide a better understanding of the phenomena and is of great significance to the establishment of preventive measures, which can avoid the damage caused by the persistence of these habits. Aim: To evaluate the knowledge and attitude of parents of children aged between 3-6 years regarding digit sucking habit. Materials and Methods: A cross-sectional study was carried out in the Department of Paediatric and Preventive Dentistry, belonging to urban and semi-urban area of Pune, Maharashtra, India from December 2020 to May 2021. A total of 310 parents of children, aged between 3-6 years were included. A close-ended questionnaire was administered to parents to assess their knowledge and attitude regarding digit sucking habit in children. Completely filled questionnaires were considered for result synthesis. The data obtained was tabulated and descriptive data were statistically analysed using software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Although 229 (73.9%) of parents agreed that for achieving good oral health prevention of digit sucking habit is essential, but 197 (63.5%) parents were unaware of the predisposing factors for digit sucking habit. A total of 195 (62.9%) parents did not agree that inadequate parental attention may lead to thumb sucking habit. A total of 197 (63.5%) parents agreed that prolonged digit sucking can cause misaligned teeth but majority of the parents 205 (66.1%) and 166 (53.5%) disagreed on its effects on facial growth and speech, respectively. A total of 219 (70.6%) parents did not receive any scientific information or counselling from healthcare worker regarding sucking habit. A total of 299 (96.5%) of parents agreed that guidance from healthcare workers is needed regarding oral habits in children. Conclusion: Present study concluded that the attitude towards learning about digit sucking habit was good the knowledge of the study participants was poor.

Effectiveness of Family Centered Art Intervention on Anxiety among Hospitalised Children in a Tertiary Care Hospital, Mangaluru, India: A Quasi-experimental Study

K Navitha, Renita Priya D’Souza, Benazeera

Introduction: Children become fearful, frightened, or unhappy when they attend the hospital. Art ntervention can support their capacity to take responsibility and make decisions. It assists children and their families to explore and express their emotional reactions to the hospital admission, which can be difficult to explain. Aim: To find the effectiveness of family centered art intervention on anxiety among hospitalised children in selected tertiary care hospital, Mangaluru, Karnataka, India. Materials and Methods: A quasi-experimental study was conducted in Department of Paediatric, Yenepoya Medical College and Hospital, Mangaluru, Karnataka, India, from December 20, 2021, to April 10, 2022. A non probability purposive sampling technique was used to enlist study participants, who were then divided into the intervention (n=35) and control (n=35) groups. The level of anxiety was assessed on the first day of admission. Diversional activities were given to the hospitalised child in interventional group, for the first three days of admission, for a duration of 35-45 minutes per day and control group received routine care. The data was collected using the demographic performa, RMS (Raghavendra, Madhuri, Sujatha) pictorial scale and a parent report on their child’s anxiety. A post-test was done each day 30 minutes after the intervention. Analysis of Variance (ANOVA), Bonferroni posthoc test, Independent t-test and Chi-square test were used for statistical analysis. Results: A total of 70 hospitalised children, aged between four to eight years, were split into two groups. There were 35 participants per group. The majority of the intervention group (25.7%) were seven-year-old, while the majority of the control group (34.3%) were four-year-old. A 60% of the intervention group participants and 74.3% of the control group participants were males, respectively. A comparison of anxiety scores at different points in the intervention group showed a significant decrease from pretest to post-test (p-value <0.05). The control group showed no difference (p-value >0.05), while at all the post-tests, the difference in the anxiety level of children between groups was significant (p-value <0.05) Conclusion: In present study, family centered art intervention significantly reduced the anxiety among children in intervention group as compared to control group.

Graph Constructors vs Graph Interpretors vs Non Graphers: A Search towards Better Cognitive Performers in Biochemistry among First Year Medical Undergraduates

K Gunanithi, J Rathi Roopavathy, S Birundha

Introduction: Didactic lectures for medical undergraduates are usually presented with more text based factual contents with less room for visual representation. They contribute less for improved cognitive performance. Graphs are visually appealing for presentation of data and are a common means to illustrate data relationships. Graph literacy involves both graph creation and graph interpretation, benefits of which might well contribute to better cognitive performance. Aim: To compare the cognitive performance of graph interpretors, graph creators and non graphers in biochemistry among 1st year medical undergraduates. Materials and Methods: A Medical educational study with an analytical cross-sectional design was conducted during February 2023-March 2023. Total 150 students of both gender aged between 17-21 years, were included and divided equally with 50 subjects in each group (group I (non graphers), group II (graph creators), group III (graph interpretors). Lecture discussion was conducted on the topic of enzyme activity using textual contents for group I, Graph creation based teaching for group II and Graph interpretation based teaching for group III. Prior to lectures, priming session on graphing literacy using four stepped 20 point rubric based teaching was conducted for group II and III. Cognitive performance assessment was done at both lower and higher cognitive domain levels for all three groups. The scores obtained were analysed using one-way Analysis of Variance (ANOVA) and Chi-square test as tests for significance and odds ratio by logistic regression as test for outcome association. Results: The mean age of the participants were 17.82±0.873 years for group I, 17.78±0.954 years for group II, 17.70±0.814 years for group III, along with gender ratio (female:male) distributed at 1.9:1, 1.7:1, 1.9:1 for group I, II and III, respectively. The results of the present study showed that the graphers {group II (graph creators) (12.24±1.02) and group III (graph interpretors) (11.06±1.03)} had significantly higher total cognitive performance scores compared to non graphers (group I) (9.34±1.64). Though the logistic regression model for graphing exposure to improved cognitive performance outcome showed no significant association with total cognitive performance, but statistically significant association was found at higher cognitive domain performance scores with positive B (2.819) (slope of regression coefficient) and odds of occurrence for higher cognitive performance increased by 16.75 times on graphing exposure when compared to non graphers. Conclusion: The study concluded that graphs are superior over textual contents and graph creation is marginally but superior to graph interpretation in terms of comprehension and improving performance especially at higher cognitive levels.

Role of Iron Deficiency Anaemia in First Febrile Seizures in Six Months to Six Years of Age at a Tertiary Care Hospital, Southern India

Introduction: Febrile Seizures (FS) are the most common neurological disorders among infants and young children, occurring in 2%-5% of children younger than five years of age. Iron deficiency is reported as a commonest micronutrient deficiency, that has been associated with FS. Aim: To find out the cause of fever and the role of Iron Deficiency Anaemia (IDA) and its outcome in first FS in six months to six years of age. Materials and Methods: This was a hospital-based prospective observational study, conducted in the Department of Paediatrics at King George Hospital, Visakhapatnam, Andhra Pradesh, India. The duration of the study was one year and seven months, from December 2019 to July 2021. A total of 130 children (six months-six years) were included in the study. A total of 65 cases had a febrile seizure and the rest 65 controls had a history of Febrile Illness (FI) without seizures. Anaemia was defined as the decrease of Haemoglobin (Hb) <11 gm%. Among the Red Blood Cells (RBC) indices Mean Corpuscular Volume (MCV) <70 femtolitres (fL), Mean Corpuscular Haemoglobin (MCH) <27 picograms (pg), plasma ferritin <12 μg/dL, and serum ferrous <60 μg/dL, Total Iron Binding Capacity (TIBC) >450 μg/dL, transferrin <250 mg. Discrete variables are expressed as counts (%) and compared using the Chi-square test, quantitative variables were expressed as mean and Standard Deviation (SD) and compared using t-test and Statistical significance was set at p-value <0.05. Analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean age of the study participants (cases) was 2.57±1.5 years for cases and 2.56±1.35 years for controls. In the present study, male:female ratio was 1.24:1. In the present study, positive family history of seizures is an important risk factor for FS. The observations came 43 (66.2%) cases were IDA with FS 22 (33.8%) cases, were, with only FS 23 (35.4%) of controls were, with IDA and FI 42 (64.6%) of controls with the FI, which is statistically significant, p-value=0.001. Conclusion: The IDA is one of the major risk factors for FS in the paediatric age group. Early identification and treatment of iron deficiency may prove helpful in preventing FS in paediatric patient.

The Corticosteroids in Paraquat Poisoning- Are They the Sole Life-saving Drugs?: A Prospective Cohort Study

HA Krishnamurthy, S Bharathi, Vijay Sai Bhangari

Introduction: Paraquat poisoning has the highest mortality rate, as high as, 50%-90% due to multiorgan failure, inspite of early interventions by symptomatic medications in the best intensive care settings. The high degree of acute inflammation was found in the subjects of paraquat poisoning with multiorgan failure. There are no specific antidotes at present for the paraquat poison. Aim: To know the role of corticosteroid as a life-saving drug in paraquat poisoning. Materials and Methods: This prospective cohort study was conducted in the Department of Internal Medicine at KR Hospital, Mysuru, Karnataka, India. The duration of the study was eight months, from August 2022 to March 2023. A total of 108 subjects suffering from paraquat poisoning and were divided into two arms, arm one constitutes 70 (64.8%) subjects, they were given 1 gm of methylprednisolone, intravenously for five days with haemoperfusion. The arm two constitutes 38 (35.2%) subjects, they were treated with symptomatic drugs with haemoperfusion. Both the groups were followed-up during the hospital stay, to look for the outcome. The Chi-square test was applied to assess the association between two variables. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Chicago). Results: The present study was done on 108 subjects, 43 (39.81%) were females and 65 (60.18%) were males. The majority of subjects showed high level of acute inflammatory mediators with multiorgan dysfunction. The subjects on corticosteroids (i.v. methylprednisolone) with haemoperfusion showed low mortality 12 (17.14%) and high survival rate 58 (82.85%) (p-value=0.001) as compared to the subjects on symptomatic treatment with haemoperfusion, with mortality of 36 (94.73%) (p-value=0.01). Conclusion: The early administration of high doses of corticosteroids in subjects with paraquat poisoning had been shown to provide tangible and measurable mortality benefits as compared to the symptomatic medications.

Introducing Case Study-based Panel Discussion as an Effective Means of Self-Directed Learning in Phase 2 MBBS Students: A Cross-sectional Study

Introduction: The introduction of Competency Based Medical Education (CBME) curriculum in 2019 in India has endorsed many new concepts like Early Clinical Exposure (ECE), Self-Directed Learning (SDL) etc. SDL is an active learning approach in which case-based scenarios are provided and learners are guided by questions, leading them to answers using recommended learning resources. Aim: To evaluate the outcome of introducing case study-based panel discussion as SDL and analyse student and faculty perception. Materials and Methods: This was a cross-sectional study conducted in Department of Pathology at ESIC Medical College, Faridabad, Haryana, India from May 2021 to October 2021 on 100 Bachelor of Medicine and Bachelor of Surgery (MBBS) phase 2 students. First, Didactic Lecture (DL) was taken on Diabetes Mellitus (DM). Then case study-based panel discussions were done during the practical classes assigned for SDL. Students were divided into five cohorts of 20 students each. Two faculty members were assigned for each cohort of 20 students. The assigned faculties observed and gave their inputs to their respective cohorts. Data from pre and post-test questionnaires having 15 Multiple Choice Questions (MCQ’s) both theory (n-7) and problem based learning questions (n-8) was analysed statistically. Feedback from students and teachers was collected using a questionnaire in the five-point Likert scale format. Results: The pre (8.43±1.79) and post-test (12.53±1.46) scores comparison revealed statistically significant (p<0.001) improvement in the post-test scores. An 89% of students opined that Case-Based Learning (CBL) improved their clinical, logical, analytical and communication skills and 92% students found the whole experience of CBL enjoyable. A 100% of the faculty felt the whole experience was motivating (25% strongly agree and 75% agree) and 33.34% of faculty strongly agreed that CBL helped in bridging the gap and 41.67% strongly agreed that it improved student involvement. However, all faculty found it to be time consuming (25% strongly agree and 75% agree) and 83.34% felt it was an extra burden for them. Conclusion: Students reported an improvement in their learning, interaction, communication and analytical skills through the introduction of this innovative method of teaching Pathology using case study-based panel discussion as a means of SDL.

Opioid-based Anaesthesia versus Opioid Free Anaesthesia in Laparoscopic Cholecystectomies: A Randomised Clinical Study

Rashmi Pal, Santosh Rajput, KK Arora

Introduction: Intravenous opioids have been frequently used to provide analgesia and supplemental sedation during general anaesthesia or monitored anaesthesia care. Opioid Free Anaesthesia (OFA) is a multimodal approach which combines different drugs likes lignocaine, dexamethasone, paracetamol and dexmedetomidine with different techniques- such as hypnosis, sedation, analgesia and sympatholysis. Thus, reducing and avoiding opioids perioperatively will lead to decrease in opioid related adverse effects with better postoperative outcomes. Aim: To compare OFA and Opioid-based Anaesthesia (OBA) in terms of haemodynamic stability, speed and quality of recovery, postoperative pain score and analgesic requirement. Materials and Methods: The present study was a randomised study conducted in the Department of Anaesthesiology, Mahatma Gandhi Memorial Medical Colledge, Indore, Madhya Pradesh, India, from June 2021 to September 2022. The study has enrolled 90 patients of American Society of Anaesthesiologists (ASA) Grade I, II, 20-60 years of age undergoing elective Laparoscopic Cholecystectomy (LC) were divided into OBA fentanyl and OFA-lignocaine and dexmedetomidine. A standard general anaesthesia protocol of the institute was followed. OBA group received fentanyl (2 μg/kg) over 10 minutes before induction of anaesthesia and OFA group received lignocaine (2 mg/kg) and dexmedetomidine (0.5 μg/kg) both intravenously over 10 minutes before induction of anaesthesia. In OFA group analgesia was maintained by infusion of lignocaine 2 mg/kg/hr and dexmedetomidine 0.5 μg/kg/hr, whereas in OBA group fentanyl 0.5 μg/kg was given whenever required till the gall bladder was resected. Postoperative intraperitoneal instillation of gall baldder fossa was done with 20 mL 0.5% bupivacaine. Intraoperative mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were recorded. Postoperative speed and quality of recovery, pain score, analgesic requirements and incidence of Postoperative Nausea and Vomiting (PONV) were noted. Paracetamol 15 mg/kg was given intravenously whenever Numerical Rating Scale (NRS) score was ≥6. Comparison of means between the two groups was done using unpaired t-test, association between two non parametric variables was done using Pearson Chi-square (χ2 test) test. Results: The mean age, sex, weight, ASA and duration of surgery were comparable in both the groups. The mean HR was significantly lower in OFA group compared to the OBA group at all the time points (p-value ≤0.05). The mean MAP was significantly lower in OFA group at induction, after trochar insertion, after abdominal deflation and after extubation. Although, postoperative speed of recovery was slower in OFA group, the overall quality of recovery was better. The postoperative pain score, analgesic requirement and incidence of nausea and vomiting were all significantly less in OFA group as compared to OBA group with p-values of 0.02, 0.001 and 0.02, respectively. Conclusion: OFA is new anaesthetic approach that provides better perioperative haemodynamic stability, postoperative pain control with less PONV and thus can be used safely and successfully.

Comparison of Respiratory Proprioceptive Neuromuscular Facilitation and Segmental Breathing on Pulmonary functions, Dyspnoea and Exercise Tolerance in COPD Patients: A Comparative Study

Pankaj Prajapati, Sonia Pawaria, Neha Reylach

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease marked by airflow limitation, destruction of lung parenchyma and other associated respiratory symptoms (e.g., dyspnoea and coughing). Pathological changes and symptoms do not appear altogether, symptoms may not appear but pathological changes are likely to be present. Segmental breathing and Proprioceptive Neuromuscular Facilitation (PNF) techniques are both effective techniques in improving pulmonary functions in COPD patients. Aim: To compare PNF and Segmental Breathing with respect to pulmonary functions to relieve dyspnoea and improve exercise capacity in COPD patients. Materials and Methods: A comparative study conducted in Department of Physiotherapy at SGT University, Gurugram, Haryana, India, from July 2020 to June 2021. On 30 in-patient aged between 40-60 years with Forced Expiratory Volume in 1st second/Forced Vital Capacity (FEV₁/FVC) <0.7, hospitalised clinically stable patients. Out of these, 15 were allocated in the segmental breathing group and another 15 participants were allocated into the respiratory PNF group through the sealed envelope. The session was of 10-15 minutes under the protocol of 18-20 repetitions of each technique in segmental breathing and respiratory PNF in either respective group. The dyspnoea was assessed by Modified Borg Scale, pulmonary functions was done with spirometry, followed by the 6-Minute Walk Test (6-MWT). The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Paired t-test was used to compare the means of measurements within the groups. The independent t-test was used to compare the means of all the variables between the groups. Results: Both of these techniques improved SpO₂ (change in mean from 81.27 to 86.20 and 82.13 to 90.67 days in segmental and PNF group, respectively) and relieve dyspnoea post-exertion (8.33 to 6.60 and 8.0 to 5.67 in segmental and PNF groups) within 1-week of intervention (p <0.01). There was improvement seen in pulmonary functions (FEV₁ from 0.87 to 0.95 and 0.78 to 1.02 in segmental and PNF groups) and exercise tolerance 6-MWT from 149.47 to 204.80 and 151.77 to 242.20 in segmental and PNF groups) as well. And out of both, respiratory PNF is more efficient in improving pulmonary function, dyspnoea and exercise tolerance in a week (p<0.01) which makes the master improvement and pulmonary rehabilitation can proceed with further advancement. Conclusion: Segmental breathing and respiratory PNF are effective techniques for patients with COPD admitted to hospital whose modified Borg’s dyspnoea score is higher even at rest and intolerant to physical exercise and peripheral capillary oxygen saturation is lower than 88%.

Role of Chest X-ray, Inflammatory Markers and Blood Gases for Diagnosis and Assessment of Severity in Childhood Pneumonia: A Cross-sectional Study

Shibani Pal, Pradip Paria, Malay Kumar Dasgupta

Introduction: Pneumonia is one of the leading causes of morbidity and mortality in under-five children. The utility of simple clinical signs forms the basis of early diagnosis and treating children with pneumonia. Inflammatory markers along with chest X-rays further help to differentiate between viral and bacterial causes and also help in the assessment of the severity of infections. Aim: To find out the clinical spectrum, haematological and radiological parameters of the children admitted with Community-Acquired Pneumonia (CAP) and to correlate the findings with the disease severities. Materials and Methods: The present study was an observational, cross-sectional study done for the period of one year i.e. from July 2017 to June 2018 in the Department of Paediatrics, of RG Kar Medical College, Kolkata , West Bengal, India. A total of 100 children aged two months to five years suffering from severe pneumonia and very severe pneumonia according to World Health Organisation (WHO) definition. They underwent a complete physical examination. Routine radiological and haematological investigations were done. The children were managed using a standard protocol. They were closely followed-up for the need for change in antibiotics, prolonged hospital stay, need for mechanical ventilation, and mortality. All data were collected and subjected to statistical analysis with the help of Statistical Package for the Social Sciences (SPSS)Software (version 17.0). A p-value <0.05 was considered to be statistically significant. Results: Out of 100 children, bronchopneumonia (72%) was the most common clinical diagnosis made at admission. Hurried breathing, cough, and fever were presenting features in most of the cases. According to WHO, the Acute Respiratory Infection (ARI) control program, 62% had severe pneumonia and 38% had very severe pneumonia. On investigation, radiological findings had high sensitivity and specificity to clinical findings. Inflammatory markers {C-Reactive Protein (CRP) >15.7 mg/dL and Erythrocyte Sedimentation Rate (ESR) >20 mm/hr} were a good tool for diagnosing the disease severity. Raised CRP was also associated with multiple antibiotics use and prolonged hospital stay. Increased platelet count >2.45 lacs, decreased pH, and increased PCO₂ at the time of admission were associated with the requirement for increased ventilatory support in the children. The median duration of hospital stay was 8 (6) days. Conclusion: Bronchopneumonia is the predominant form of ARI in infants and toddler age group. Inflammatory markers provide valuable information regarding disease severity. Chest X-ray is important in the diagnosis of pneumonia and evaluation of the treatment response.

Evaluation of Bacterial Contaminants on N95 FFRs after Reuse in Hospital Personnels: A Prospective Study in the Era of COVID-19 Pandemic

Introduction: N95 Filtering Face-piece Respirators (FFRs) prevent the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. It is considered as one of the essential protective equipment. An increased demand for N95 FFRs during the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in shortage crisis for the care of cases arising in hospitals. Therefore, this situation generated the need to implement alternatives like four mask policy that allows reuse of N95 FFRs in settings with limited resources. Aim: To find out the burden of bacterial isolates on N95 FFRs after reuse. Materials and Methods: The present study was a prospective study conducted at Government RDBP Jaipuria Hospital, Jaipur, Rajasthan, India, from May 2021 to October 2021 on 526 used N95 FFRs after multiple or extended use by 96 hospital personnel who attended Outpatient Department (OPD) services. Swab samples were collected from both external, as well as, internal surface of the mask after each use and further subcultured to identify any microorganism present on them. Results: Growth of gram positive bacilli, and micrococci were found on 362 samples out of total 526 samples. Other bacteria like Pseudomonas spp. and other gram negative were also observed in 19 samples. Furthermore, it was also observed that bacterial load on reused N95 FFRs was mainly commensal flora. Conclusion: Mainly commensal floras were found over internal and external surface of used N95 FFRs. This proves that four mask policy is optimum for judicious use of N95 FFRs and resulted in saving of funds for other more emergency works mainly in OPD settings.

Electrolyte Abnormalities in Patients Hospitalised with COVID-19 in the Southern Gaza Strip, Palestine: A Retrospective Case-control Study

Mahmoud I Elhabiby, Ayman Abu Mustafa, Abdelmarouf Hassan Mohieldein

Introduction: Coronavirus Disease-2019 (COVID-19), has caused, nearly 18 million deaths worldwide, many more hospitalisations, and severe economic and social disruption, as of March 2022. Malnutrition and electrolyte imbalance can lead to immune system dysfunction, which can increase the risk of infection. Aim: To evaluate the electrolyte imbalance and other biomarkers in COVID-19 patients and also, to compare these parameters with healthy individuals. Materials and Methods: A retrospective case-control study was conducted in the Department of Medical Laboratory Sciences at European Gaza Hospital, Southern Gaza Strip, Palestine. The duration of the study was four months, from February 2022 to May 2022. A total of 200 participants were included in the study, out of which 100 patients were diagnosed with COVID-19 infection by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test and 100 healthy individuals were recruited from blood bank donors and comprehensive Screening Department. Biochemical profile; Fasting Blood Glucose (FBG), urea, Creatinine (Cr), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), total Creatinine Kinase (CK-total), Creatine Kinase (CK) isoenzyme CK and electrolytes (Na, K, phosphorous, and Mg, ionised calcium, total calcium, and Cl) were assayed. Data were statistically analysed using Student’s t-test and Chi-square test. Results: The mean age of the study participants was 54.1±12.2 years for cases and 54.3±12.4 years for controls. A total of 200 subjects, both the groups had 34 (34.0%) males and 66 (66.0%) females, which was not statistically significant (p-value >0.05). COVID-19 patients had significantly higher values of Na (141.9±4.6 vs 139.7±3.1; p<0.001), K (4.6±0.9 vs 4.3±0.5; p-value=0.001), Cl (108.7±5.3 vs 101.1±4.0; p<0.001), P (4.6±0.6 vs 4±1.4; p<0.001), and Mg (2.1±0.2 vs 1.7±0.3; p<0.001). However, they had lower Ca ionised (1.0±0.1 vs 1.1±0.1; p<0.001) and total Ca (8.4±0.9 vs 9.1±1.1; p<0.001). Furthermore, COVID-19 patients had significantly higher levels of biomarkers of other biochemical profiles compared to healthy controls. Conclusion: As compared to healthy individuals, patients hospitalised with COVID-19, exhibited alterations in their electrolyte balance and other biochemical markers. Management of these parameters to get homeostasis warrant opportunities to reduce morbidity and mortality of disease.

Assessment of QRISK3 Score in Normoglycaemic, Prediabetic and Diabetic Subjects: An Observational Study

Aayushee Rao, Sudhanshu Kacker, Neha Saboo, Munesh Kumar

Introduction: Cardiovascular Disease (CVD) and diabetes mellitus have a high correlation. Compared to individuals without diabetes, adults with diabetes have a greater prevalence rate of CVDs. This risk steadily increases along with Fasting Blood Glucose (FBG) levels, even before they are high enough to be classified as diabetes. One of the factors contributing to death among people with diabetes mellitus is CVD. QRISK3 algorithm calculates a person’s risk of developing a heart attack or stroke over the next 10 years. Aim: To assess the QRISK3 cardiovascular risk score in normoglycaemic, prediabetic and diabetic subjects. Materials and Methods: The present analytical observational study was carried out in the Department of Physiology and Medicine, RUHS College of Medical Sciences and associated Hospital, Jaipur, India, from November 2021 to April 2022. A total of 200 subjects were recruited with >20% QRISK3 CVD risk scores out of 7154 screened patients. Subjects were categorised into three groups (normoglycaemic, prediabetics and diabetics) according to American Diabetes Association criteria. The following parameters were recorded for data collection: anthropometric {Body Mass Index (BMI) Waist Hip Ratio (WHR)}, blood pressure and biochemical {Fasting Blood Glucose (FBG), Glycated Haemoglobin (HbA1c) and lipid profile parameters). All data collected was entered into Microsoft excel sheet 2019 and was analysed with help of Statistical Package for the Social Sciences (SPSS) software version 21.0 and tests of significance considering level of significance as p-value <0.05. Data was analysed by applying Analysis of Variance (ANOVA). Results: Out of the total 200 high-risk subjects, according to the American Diabetes Association (ADA) for Diabetes Classification, there were 44 (26.19%) normoglycaemic, 21 (12.5%) prediabetic and 103 (61.31%) diabetic subjects and 32 were excluded. The mean age was 49.06±9.65 years, 51.15±11.05 years and 51.02±9.74 years for normoglycaemic, prediabetic and diabetic subjects, respectively. There was significant difference of mean values of FBG, HbA1c, total cholesterol, High Density Lipoprotein (HDL), Cholesterol (Chl)/HDL ratio, Low Density Lipoprotein (LDL), Triglycerides (TG) and QRISK3 score in three groups. But there was no significant difference in following parameters i.e., age, weight, height, Body Mass Index (BMI), waist-hip circumference, WHR, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). There was hypertriglyceridaemia and low HDL level in prediabetic and diabetic subjects. Conclusion: The present study showed that the cluster of risk factors for CVD also grows as FBG levels and HbA1c levels increase. This study could also assert that these risk factors also increases with progression of diabetes, which eventually results in increase in risk of CVDs.

Evaluation of the Type and Authenticity of Information on Instagram Posts Related to Hepatitis: A Cross-sectional Study

Gayatri Ghadwaje, Alexis Tressa Babu, Anna Mary Jose, Japleen Kaur

Introduction: Hepatitis is a major public health concern. The social media platform, allows for the unregulated dispersion of information related to many public diseases, even by unverified accounts that are easily accessible to the population. Dispersion of unverified and unregulated information about major health conditions like “Hepatitis” by Instagram, an easily-accessible and popular social media platform, can put public health at risk. Aim: To evaluate the type and authenticity of the information available on Instagram related to the disease “Hepatitis”. Materials and Methods: A cross-sectional observational study was conducted virtually over a period of 10 days in August 2022. Top four “Hepatitis” related hashtags on Instagram identified by the maximum number of posts- (#hepatitis, #hepatitisawareness, #hepatitistreatment, and #hepatitisa) were taken in the present study. Posts in language “English” or “Hindi” and containing information about the disease “Hepatitis” were included in the study. A questionnaire was made for assessment of these posts based on various pre-determined categories- type of post, type of information circulated and to assess if it is “true”, “false” or “cannot be determined” using World Health Organisation (WHO) factsheet on hepatitis and Centres for Disease Control and Prevention (CDC) guidelines. Results: Out of the top 400 posts analysed, 388 (97%) were found relevant to the study. These posts had information related to the description {274 (70.62%)}, prevalence {95 (24.48%)}, aetiology {233 (60.05%)}, prevention {172 (44.33%)}, treatment {75 (19.33%)} and mortality {72 (18.56%)} of the disease “hepatitis.” A large number of posts {314 (80.93%)}, had authentic information about the disease. Conclusion: Although, a large number of Instagram posts related to the disease “Hepatitis” has authentic information and were posted by doctors and the health and wellness industry, these accounts could not be verified. Government and the national medical association should join hands to create a platform to deliver authentic information to the population related to “Hepatitis” and verify the already available information.

Effectiveness of Nurse-Directed Exercises on Pelvic Girdle Pain and Functional Status among Antenatal Mothers in Tertiary Care Hospital- A Quantitative Research

S Thamizhselvi, V Poongodi, M Annie Annal, S Lavanya, R Umamaheswari

Introduction: Pelvic Girdle Pain (PGP) is a common musculoskeletal disorder that leads to significant disabilities in day-to-day activities during pregnancy. PGP increases with advancing pregnancy. Aim: To evaluate the effectiveness of nurse directed exercises on PGP and functional status among antenatal mothers. Materials and Methods: A quantitative research approach (two group pre-test post-test) was adopted for the present study. By simple random sampling technique, with permuted block method, 108 antenatal mothers who attended the antenatal Out Patient Department (OPD) in Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India, at 27 weeks of gestation were selected. The study has been carried out from 30th March 2022 to 14th May 2022. The numerical pain rating scale and pelvic girdle questionnaire was used. Group-I received nurse directed exercises such as diaphragmatic breathing, Kegel’s exercise, squatting exercise, child pose exercise etc., Group-II received routine care such as diet counselling, personal cleanliness, care of breast, immunisation, rest and sleep, dental care, and avoidance of travelling. Post-test was done at 31 weeks of gestation. Descriptive statistics such as frequency, percentage, mean, and standard deviation and inferential statistics like Independent t-test, Spearman correlation coefficient, Kruskal-Wallis test was used. Results: Nurse directed exercises were more effective method in reducing the PGP level (4.26 vs 3.02) and improving the functional status (61.059 Vs 55.680) among antenatal mothers with PGP. There was a significant association between the PGP with nature of work (p-value-0.001) and previous history of abdominal or pelvic surgery (p-value 0.0102). Conclusion: Nurse directed exercises were more effective in alleviating the PGP level and helps in improving the normal daily activities of antenatal mothers with PGP.

Efficacy of Prophylactic Norepinephrine and Phenylephrine Infusions against Spinal Hypotension during Lower Segment Caesarean Section- A Randomised Clinical Study

Introduction: Hypotension after Subarachnoid Block (SAB) can affect mother and foetus and can be prevented by prophylactic use of vasopressors. Phenylephrine (PE) has been a popular and effective drug as prophylaxis against hypotension. Norepinephrine (NE) is recently tried for this purpose. Aim: To compare PE infusion with NE infusion prophylactically against SAB induced hypotension during Lower Segment Cesarean Section (LSCS). Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesiology at a Tertiary Care Hospital, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka, India. The duration of the study was 12 months, from December 2018 to November 2019. A total of 156 primigravida and multigravida with singleton term pregnancy, posted for caesarean section under SAB received prophylactic infusions of either NE 5 μg/minute (group NE) or PE 50 μg/minute (group PE) immediately after SAB till end of the surgery. The primary outcome of the study was to assess the incidence of hypotension. The secondary outcomes included incidence of nausea, vomiting, hypertension, tachycardia, bradycardia and the neonatal outcomes. Related categorical and numerical variables were subjected to suitable statistical tests and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of the study participants of group NE was 24.47±2.52 years and group PE was 23.91±2.63 years, respectively. The age, parity and surgical duration was comparable between the groups. The incidence of hypotension was 17.9% in group NE and 26.8% in group PE (p-value=0.182). No significant differences in total doses of vasopressors used were noted. The incidence of bradycardia in group NE was 3.8% and 21.8% in the group PE (p=0.053). No adverse events or neonatal outcomes were observed. Conclusion: The incidence of hypotension and the total dose of vasopressors administered were similar in the two groups receiving prophylactic infusion doses (NE or PE). Incidence of bradycardia was greater in the parturients receiving PE infusion.

Prediction of Semitendinosus Graft Length and Girth using Anthropometric Parameters: A Prospective Study in North Kerala Population

Jipin Gopi, Mahesh Anil, Krishna Prabhash, Aarabhy Jayan

Introduction: Semitendinosus, Gracilis and Bone-Patellar Tendon-Bone (BPTB) graft are the most popular grafts for Anterior Cruciate Ligament (ACL) reconstruction. Although bone-to-bone patellar tendon grafting improves knee stability and healing rates, there are drawbacks, including donor site morbidity, patellar tendinopathy, anterior knee pain, flexion contracture, and patellar fracture. The advantages of semitendinosus graft include preservation of bone stock, the ability to triple graft length when needed, and the ability to take Gracilis graft through the same incision, if graft diameter is too small. Aim: To predict the semitendinosus graft length and diameter using anthropometric parameters (height, weight, Body Mass Index (BMI), waist circumference, thigh circumference and thigh length). Materials and Methods: This prospective descriptive study was conducted in the Department of Orthopaedics, Malabar Medical College, Calicut, Kerala, India for a period of one year (from October 2021 to October 2022). A total of 50 patients in the age group 15-60 years with ACL insufficiency planned for hamstring autograft reconstruction were examined. A number of preoperative factors, including age, gender, height, weight, BMI, thigh length, thigh circumference and waist circumference were assessed. A 2-tailed test and Pearson’s correlation was used to identify relationships between outcome variables (semitendinosus graft length and quadrupled tendon diameter) and predictor variables (age, gender, height, weight, BMI, thigh length, thigh circumference and waist circumference). Results: A total of 32% of patients had a semitendinosus graft diameter ≥8 mm, while 68% were <8 mm. Compared to males, females had a lower body weight and height and their hamstring grafts were shorter with smaller diameter. Correlation analysis indicated that there was a significant positive relation between height and weight on graft length and diameter (p<0.005). Conclusion: The study concluded that both hamstring diameter and length was related to height and weight of the person. Patients who were taller and heavier might be anticipated to have grafts with longer length and larger diameter. Also, thigh and waist parameters had no impact on hamstring tendon size.

The Relationship between Breast Cancer Prevention and Breast Cancer Screening Behaviours in Tehranian Women: A Structural Equation Modeling Analysis

Introduction: Breast cancer is the most commonly occurring cancer in women. It is also one of the most important health issues in many countries. Its high prevalence in women makes it necessary to encourage breast cancer screening behaviours. Aim: To investigate the relationship between breast cancer prevention behaviour and its screening behaviour in Tehranian women. Materials and Methods: This was a cross-sectional study conducted on 859 women from November 2019 to December 2019 by the Iran University of Medical Sciences in Tehran, Iran. These women were selected by the multistage cluster method among five socio-economic classes living in different districts of Tehran. Structural Equation Modeling (SEM) was used to determine the relationship between breast cancer prevention behaviour and its screening behaviour. Data were analysed by Statistical Package for Social Sciences (SPSS) version 22.0 and Analysis of Moment Structures (AMOS) software. The level of significance was set at 0.05. Results: The mean age of the participants was 42±6.94 years. Also,137 (15.9%) of the participants were single, and 604 (70.3%) were married, 78 (9.08%) were divorced and rest widow. Among the studied subjects, 510 (57%) had unfavourable breast cancer screening behaviour. In Pearson’s correlation test, there was a direct and significant relationship between the mean score of breast cancer prevention behaviour and its subscales with breast cancer screening behaviour, except for the dimension of information-seeking (r=0.35, p=0.007). In other words, with the increased breast cancer prevention behaviour, breast cancer screening behaviour also increased. The results of SEM analysis showed that breast cancer prevention behaviour was positively correlated to breast cancer screening behaviour (p<0.001), and about 41% of changes in the breast cancer screening behaviour could be explained by the breast cancer prevention behaviour (β=0.41, p=0.01). Conclusion: Based on the results, it seems vital to take measures to inform and educate women about breast cancer and its complications, problems, prevention, screening, and diagnostic methods. The findings of the present study can be used to increase motivation in the design of interventions in order to improve attitude, strengthen self-efficacy, reduce stress, and improve breast cancer screening behaviour.

Functional Outcome Analysis of Cubitus Varus Deformity Treatment in Children undergoing Modified French Osteotomy with Technical Modification: A Retrospective Cohort Study

Introduction: Lateral closing wedge osteotomy is an accepted correction method for cubitus varus deformity. The techniques used to fix the osteotomy mostly lead to either angulation or loss of correction during the final tightening of the Stainless Steel (SS) wire at the osteotomy site. The records for patients undergoing two modifications in a conventional modified French Osteotomy were analysed. Four wires, two proximal and two distal to the osteotomy site for precision and guided compression over the other additional Kirschner wire (K-wire) at the osteotomy site, were the two modifications in these patients. Aim: To analyse the functional outcome of cubitus varus deformity in children treated with technical modifications of modified French osteotomy. Materials and Methods: The present study was a retrospective cohort study conducted in the Department of Orthopaedics at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. The study duration was three years (from April 2019 to April 2022). A total of 34 cubitus varus deformity patients were included in this study who were operated with lateral closing wedge-modified French osteotomy with technical modification by K-wires. The patients were followed-up for a minimum of six months. The results were analysed using Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Flynn’s criteria. Statistical Package for the Social Sciences (SPSS) version 21.0 was used and p-value <0.05 was considered statistically significant. Results: Twenty-three (67.65%) cases were male, and 11 (32.35%) were female. Twenty-eight (82.4%) patients were children aged five to 10 years, 20 (58.8%) cases involved a right-sided deformity, while the remaining 14 (41.2%) had left-side involvement. The mean age was 7.58±2.49 years (ranging from 3 to 12 years). The mean time since they had initial trauma was 2.42±1.28 years. The preoperative mean cubitus varus angle was 11.73±2.39°, the mean hyperextension was 13.27±2.69°, and the mean internal rotation was 36.48±5.01°. Postoperative six months’ corrective mean carrying angle (valgus) was 5.79±2.46°, corrective hyperextension was 2.18±1.06°, and corrective internal rotation was 5.39±2.74°. Out of 34 cases, all had excellent results as analysed by Quick DASH and Flynn’s criteria. Conclusion: The technical modifications by K-wires in conventional modified French osteotomy provided guided compression over the osteotomy site, ensured perfect implant placement without cutting out the screw, and improved three-dimensional (3D) correction of cubitus varus deformity. So, it is safe, simple, and effective.

Modified Coronally Advanced Tunnel Technique in the Treatment of Multiple Gingival Recessions Associated with and without Non Carious Cervical Lesions- A Prospective Clinical Study

Introduction: Gingival Recession (GR) can be associated to periodontal disease-causing dentinal hypersensitivity, root caries and even aesthetic problems. A combination of the Modified Coronally Advanced Tunnel Technique (MCAT) with Subepithelial Connective Tissue Graft (SCTG) can be considered an option for treating multiple GR. Aim: To evaluate the effectiveness of root coverage using MCAT along with SCTG in multiple GR with and without Non Carious Cervical Lesions (NCCL). Materials and Methods: The present prospective clinical study was conducted in Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from June 2018 to December 2019. A total of 24 patients seeking treatment for multiple GR in which 12 patients with recessions alone and 12 patients associated with NCCL were included in the study. Clinical measurements of Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Recession Depth (RD) and Recession Width (RW), Width of Keratinised Tissue (KTW), Gingival Thickness (GT), Pink Aesthetic Score and hypersensitivity scores were determined at baseline and six months. Descriptive statistics, Independent samples t-test, repeated measures Analysis of Variance (ANOVA), and paired t-tests were used in data analysis. The p-value <0.05 would be considered statistically significant. Results: The mean age of the patients was 30±10.16 years. The study group comprised of 18 males and six females, constituting male to female ratio as 3:1. A statistical significance in reduction of recession was seen from baseline to six months in both control and test groups which are (9.67±1.15 mm to 0.92±1.67 mm) and (10.92±0.99 mm to 0.67±1.23 mm) respectively and increase in KTW was seen from baseline to six months in both groups which are (1.58±0.66 mm to 3.2±0.75 mm) and (1.75±0.45 mm to 3.50±0.67 mm), respectively. However, a statistically significant decrease in hypersensitivity was observed in the MCAT+SCTG+NCCL group. Conclusion: The results of the present study suggested that MCAT could be opted as a treatment of choice for multiple GR associated with non carious lesions, as well in terms of aesthetics and hypersensitivity.

Clinical Profile of Type 1 Diabetes Mellitus in Children less than 18 years age, in a Tertiary Care Centre, Bhilai, Chhattisgarh, India: A Cross-sectional Study

Shantanu Vijay Gomase, PK Biswal

Introduction: Type 1 Diabetes Mellitus (T1DM) is a very common paediatric endocrine disorder and is increasing each year, particularly in younger children. The T1DM presents as Diabetic Ketoacidosis (DKA) in a significant number of patients. Race, ethnicity, age, and parent education plays an important role in the glycaemic control of the disease. Conflicting data are available about the age of onset, gender predominance, family history, and growth in various international and national studies. Aim: To study the clinical presentation of T1DM in children aged less than 18 years. Materials and Methods: The observational cross-sectional study was conducted from April 2011 to March 2013 at Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh, India. Total 46 patients with T1DM, aged less than 18 years were included in the study. Socio-demographic data, clinical presentation, age, insulin dose, anthropometry, and laboratory investigations were collected using semi-structured performa. Statistical analysis was done by using Statistical Package for Social Sciences (SPSS) version 26.0. Results: Total 46 patients with T1DM attended the hospital with 24 (52.8%) boys and 22 (47.2%) girls. A 28 (60.8%) of patients presented with DKA. 16 (34.8%) of patients were less than five years of age. The youngest patient was of 2.5 years of age. In the present study, stunting was noted in 12 (26.08%) patients. Polyuria (85%) was the most common presenting complaint in newly diagnosed diabetes patients and pain in the abdomen (50%), breathlessness (46.8%) were the most common presenting complaint in established diabetics. Patients with poor control (HbA1c- >8.5%) had significantly higher mean age (12.3±4.01) compared to the group with good control (HbA1c <8.5%) which has mean age (8.5±3.54 years). Availability of medical facilities, higher socio-economic status, and parents’ education was found to be significantly associated with good glycaemic control. Conclusion: Polyuria was the most common symptom in newly diagnosed diabetics. Higher age was a significant risk factor for poor control of diabetes. DKA may present with respiratory distress in a significant number of patients.

The Effect of Aerobika Device and Acapella Device on Rehospitalisation and Pulmonary Functions in Patients with Chronic Obstructive Pulmonary Disease-A Systematic Review

Vishakha Tayade, Vishnu Vardhan

Introduction: Controlling and preventing symptoms of exacerbations, shortness of breath, cough and mucus in the lungs are important goals of Chronic Obstructive Pulmonary Disease (COPD) treatment. Oscillating Positive Expiratory Pressure (OPEP) devices have been shown to improve clinical results. The conservation of energy and oxygen, as well as, the prevention of lung infections and reducing rehospitalisation may be facilitated by clearing the lungs. There are several airway clearance devices, that can be used to help clear excessive sputum. Aim: To identify the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Materials and Methods: This systematic review was conducted in the Department of Physiotherapy at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India. The duration of the study was three months, from March 2022 to June 2022. Five databases (PubMed, scopus, web of science, google scholar) were searched from 2012 to 2022. Inclusion criteria consisted of studies on the effect of aerobika device and acapella device on rehospitalisation and lung functions only in COPD patients. Data extraction included baseline features, treatment intervention, training frequency, supervision level, breathlessness, acute exacerbation, and outcomes. High quality experimental trials and comparative studies were chosen for the study. Results: A total of 20 articles were extracted; five were utilised for the purpose of writing the review, emphasising the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Studies had showed inconsistent results on the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Conclusion: Rehospitalisation, readmission and length of the stay can be reduced by using both, aerobika and acapella devices. Both devices are effective in improving lung function in COPD patients.

Physico-Mechanical Characteristics of Ormocer and Bulk Fill Composite Resin Restorative Materials: An in-vitro Study

Introduction: Bulk Fill (BF) resins and Ormocers are recently introduced composite restorative materials in order to overcome the disadvantage of polymerisation shrinkage exhibited by most of the conventional resin-based composites. Aim: To evaluate the physical and mechanical properties of Organically Modified Ceramics (Ormocers) in comparison with BF composite resin restorative material. Materials and Methods: The current in-vitro research was conducted from June 2021 to July 2022, in the Department of Pedodontics at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. This in-vitro study, 20 human extracted premolars were allocated into two groups of 10 each. ORM (Group-1 Admira fusion, n=10) and BF (Group-2 Filtek BF, n=10) composite materials were used to prepare and restore Class-V cavities. The teeth were subjected to thermocycling and immersed in 1% methylene blue dye solution. Along the lateral walls of each sectioned specimen, depth of dye penetration was measured under the stereo microscope. A total of 20 rectangular (25×2×2 mm) and 20 disc (10×2 mm) shaped specimens of the above-mentioned materials were fabricated. Specimens of Flexural Strength (FS) were tested with the universal testing machine and Vickers hardness tester used for Surface Hardness (SH) evaluation. The data was statistically analysed using an unpaired t-test. Results: Total of 20 extracted premolars were analysed. On inter-group comparison, it was observed that mean dye penetration was lowest for Group-1 (0.6±0.69) compared to Group-2 (2±0.81) and the difference observed was statistically significant (p=0.001). BF exhibited a lower FS of 211.69±43.9 compared to Ormocer 326.19±90.3, the difference is statistically significant (p=0.001). However, BF exhibited a higher SH of 38.731±1.15 compared to Ormocer 33.774±0.869, and the difference is statistically significant (p-value <0.001). Conclusion: Ormocer exhibited improved marginal integrity and also higher FS compared to BF resin restorative materials. However, BF exhibited higher SH values compared to Ormocer.

Fifteen Years Audit of Endometrial Cancer Referred for Adjuvant Treatment to a Tertiary Care Hospital in Northern India

Pramod Kumar Gupta, Shalini Singh, Rupali Gupta, Punita Lal, Neeraj Rastogi

Introduction: Endometrial cancer is the seventh most common cancer in women worldwide with Age Standardised Incidence Rate (ASIR) of 8.4 per lac. In Indian subcontinent, the incidence is lesser and the ASIR is 2.1/100,000 women. However, its incidence is on the steady rise in developing part of the world including India. Surgery is the primary treatment and adjuvant radiotherapy is given in patients with high-risk of recurrence and significant change has happened in the management in the last 20 years. From India limited literature is available for management practices for endometrial cancer. Aim: To assess the referral patterns, demography, staging, surgical practices, adjuvant treatment and follow-up policies for endometrial cancer in a tertiary care hospital in northern India. Materials and Methods: A retrospective cross-sectional study was done for patients having endometrial cancer treated between January 2000-December 2015 in a tertiary care hospital in northern India in January 2022. A total of 93 patients having endometrial cancer were referred for radiotherapy. For these patients, their referral patterns, demography, staging, surgical practices, adjuvant treatment and follow-up policies were analysed, retrospectively. Disease Free Survival (DFS) and Overall Survival (OS) were computed by Kaplan-Meier method. Results: The median age at presentation was 55 years. Postmenopausal vaginal bleeding was the commonest symptom 78 (83.87%). Ultrasonography 23 (24.73%) was the preferred first imaging modality. Type 1 endometroid carcinoma was 75 (80.64%) and total abdominal hysterectomy with bilateral salpingo-oophrectomy was done in 82 (88.17%). Adjuvant External Beam Radiotherapy (EBRT) with Brachytherapy (BT) was given in 61 (65.59%), EBRT alone in 7(7.52%) and BT alone given in 11 (11.83%). Median EBRT dose was 50.4 Gy. Vaginal cylinder applicator was used in 69 (95.83%) out of 72 patients receiving BT. A 6.0 Gy/# to a total of 2 fractions were given in 57 (79.16%). Median treated length of vagina was 3 cm (range 2-8 cm). Five year DFS and OS was 25% and 25% and 64% and 62% respectively in worst and best case scenario. Ten (10.75%) patients, all having high-risk had multiple visceral and local recurrence. Conclusion: In patients with endometrial cancer, total abdominal hysterectomy with bilateral salpingo-oophrectomy is commonest surgical practice with adjuvant radiotherapygiven in patients with high risk of recurrence. In a developing country like India, assuring uniformity of treatment protocols is a challenging task.

Evaluation of Stability of Implants Placed Simultaneously with Lateral Window Sinus Augmentation using Putty Alloplastic Bone Substitute: A Prospective Interventional Study

Chander Prakash, Nishi Tanwar, Subramony Bhagavatheeswaran

Introduction: Lateral window sinus augmentation is done to augment the vertical sinus height for implant placement. Putty alloplasts have been used due to their longer resorption time and provide resistance to implant insertion. Although, widely used, the stability and bone loss around implants placed simultaneously following sinus augmentation with putty bone graft has not been evaluated. Aim: To evaluate the effect of putty alloplastic bone substitute on implant stability. Materials and Methods: A prospective interventional study was conducted in the Outpatient Department (OPD) of Oral and Maxillofacial surgery at SGT Dental College and Research Institute, Gurugram, Haryana, India. The duration of the study was two years and 11 months, from December 2014-November 2016. A total of 15 implants were placed simultaneously after lateral window sinus augmentation. Primary implant stablity measurements were done using Resonance Frequency Analysis (RFA). Vertical Bone Height (VBH), Maximum Insertion Torque (MIT) and Crestal Bone Loss (CBL) were measured till six months of follow-up. The data was analysed using standard statistical analyses with Shapiro-Wilk-test, Wilcoxon signed-rank test and Spearman’s correlation co-efficient. Results: The mean age of the study participants was 58±3.04 years. A total of 15 implants were placed in 12 patients. Adequate primary stability was achieved with MIT >36 N/cm2 in 9/15 patients whereas, in 6/15 patients the MIT was ≤36 N/cm2. The implants showed 100% survival rate. Postoperative bone gain obtained was in the range of 7.89 mm to 11.9 mm, with a mean of 9.92 mm. Acceptable levels of implant stability were obtained after six months. Conclusion: Within the limitations of the study, it can be concluded that, putty bone alloplast can serve as an adequate bone substitute in simultaneous implant placement after lateral window sinus augmentation and help in achieving stability.

Histiocytic Sarcoma of Submandibular Gland: A Rare Case Report

Maneesh Kumar Vijay, Neha Sethi, Lalit Mohan Sharma, Sanjay Sharma

Histiocytic Sarcoma (HS) is a rare malignant neoplasm characterised by the neoplastic proliferation of cells showing morphological and immunophenotypic features of mature histiocytes. Majority of the reported cases present in extranodal sites, such as the head and neck, thyroid, duodenum, small intestine, colon, urinary bladder, spleen, and leptomeninges. This report documents a case of primary involvement of the salivary gland by HS. A 77-year-old male patient presented with a firm swelling in the left submandibular region for the last three months. Multiple lymph nodes, along with the presence of lung and liver nodules, were seen. Thus the final diagnosis of HS was made based on histopathology and IHC. Palliative chemotherapy was given to the patient, responded well, and has been well for the last year. The present study is probably the first case of HS involving the submandibular gland.

Incidentally Detected Anaemia in Elderly: A Cross-sectional Study from a Tertiary Care Hospital, Pune, Maharashtra, India

Ajinkyaraj Jayaji Pandhare, Shilpa Sule, Sujata Khatal

Introduction: Iron Deficiency Anaemia (IDA) is most prevalent nutritional deficiency observed worldwide. The elderly population is particularly susceptible. It is a significant risk factor for increased mortality and morbidity, reducing mobility and quality of life. Currently, less Indian data is available for incidentally detected anaemia in elderly. The known causes of anaemia in elderly are nutritional, anaemia of chronic disease and malignancy. Aim: To evaluate the haematological profile and to identify potential aetiologies of anaemia in elderly who had an incidental diagnosis of anaemia. Materials and Methods: This was a prospective cross-sectional hospital-based observational study, which included 90 incidentally diagnosed patients with anaemia above 60 years of age, admitted in Department of General Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Hospital and Research Centre, Pune, Maharashtra, India during March 2021 to September 2022. Complete Blood Counts (CBCs) with peripheral blood smear, Haematocrit (Hct), reticulocyte counts, Red Blood Cells (RBC) indices like Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH) and cell morphology were all examined for each patient. The statistical programme Statistical Package for the Social Sciences (SPSS) (version 26.0) was used to analyse the data. The Chi-square test was used to evaluate the qualitative parameters. Results: The mean age was 66.44±5.87 years; 52 (57.8%) were men, and 38 (42.2%) were women. The most prevalent co-morbid conditions were diabetes and hypertension. The common clinical signs observed were pallor, oedema, knuckle pigmentation. In the present study, IDA was the most frequent aetiology 53 (58.9%), second being megaloblastic anaemia 24 (26.7%), followed by dimorphic anaemia 13 (14.4%). Gastritis was commonest finding on gastroscopy. Conclusion: Anaemia is a common finding amongst elderly population which remains undiagnosed and is ignored. The main cause is nutritional deficiency leading to IDA, megaloblastic anaemia or dimorphic anaemia. Hence, geriatric population should undergo regular screening for early recognition of anaemia. Further large population studies are required for detailed evaluation to determine the causes of anaemia in elderly.

Gastrointestinal Manifestations and Liver Abnormalities in COVID-19: A Real-World Experience and a Novel COVID-19 Prognostic Index

Introduction: Gastrointestinal (GI) manifestations and liver function abnormalities have been reported in Coronavirus Disease-2019 (COVID-19). However, data is variable and lacking from the Indian Population. Moreover, the prognostic implication of these manifestations has not been well-defined. Aim: To determine the impact of COVID-19 on the gastrointestinal tract and Liver Function Test (LFT) and develop a prognostic model for mortality Materials and Methods: An observational descriptive study was conducted in the Department of Internal Medicine at a temporary dedicated COVID-19 centre in a Tertiary Care Cardiothoracic Centre, Western Maharashtra, India. The hospital records of all the patients admitted from July 2020 to September 2020 were analysed. Clinical details and laboratory details were obtained from 589 Reverse Transcription- Polymerase Chain Reaction (RT-PCR) confirmed patients. The data was analysed and a prognostic scoring system was developed. Patients with positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RT-PCR on nasopharyngeal or oropharyngeal swabs were enrolled. The data was entered in Microsoft Excel 2010 worksheet and t-test or Mann-Whitney test was also applied to compare the mean of variables being studied by separation of living and deceased patients based on the normality of the quantitative data. Results: The mean age±SD of the study participants was 44.74±19.61 years. The majority {127/589 (21.56 %)} of the patients were in the age group of 51-60 years. A total of 5 (0.84%) out of 589 patients had diarrhoea, and 3 (0.51%) had vomiting at the time of admission. Elevated Aspartate Aminotransferase (AST), Alanine Transaminase (AST), Alkaline Phosphatase (ALP), Gamma-glutamyl Transferase (GGT), Lactate Dehydrogenase (LDH), Creatine Kinase Myocardial Band (CK-MB) was reported in non survivors in 45 (90%), 39 (78%), 15 (30%), 28 (56%), 48 (96%) and 49 (98%) out of 50 cases, respectively. The prognostic scoring system was developed with the following variables: age, Diabetes Mellitus (DM), symptomatic, breathlessness, albumin, AST, ALP, LDH, Prothrombin Time (PT), and D-Dimer. The area under the curve, came out to be 0.91 and a cut-off value of three in the scoring system was able to predict death at a sensitivity of 85.5% and specificity of 79.6%. Conclusion: GI manifestations and abnormalities in LFTs are important extrapulmonary manifestations of COVID-19. Patients with abnormal liver tests had higher risks of progressing to severe disease. Hence, LFT should be monitored and evaluated frequently during hospitalisation for COVID-19.

Importance of Phenotyping Minor Blood Group Antigen in Renal Transplant Donors: A Retrospective Cohort Study

Sujata Mallick, Mahasweta Mallik, Puskar Shyam Chowdhury

Introduction: Various studies have implicated minor antigens with increased graft rejection in the long term, especially in alloimmunised patients. Recipient’s antibody testing is done exhaustively during each case of rejection. However, without data on donors’ minor antigen profile, this significant cause of graft failure may be overlooked. Aim: To highlight the necessity of testing and creating a database by documenting the prognostically important minor blood group antigen in kidney transplants donors. Materials and Methods: This was a retrospective cohort study done on 650 kidney transplant donors from Kolkata, West Bengal, India. Data was collected from August 2014 to July 2022, a period of 10 years and analysed from August 2022 to December 2022. Blood group antigens were identified by immunoserological tests and the phenotypes were recorded with specific importance to minor blood groups. Genotype confirmation was done, where possible. The prevalance percentage of minor blood group phenotype was analysed using statistical analysis {Statistical Package for the Social Sciences (SPSS) build 1.0.0.1275 version 26.0}. Results: In 650 donors, mean age was 33±7 years and male: female ratio was 1.1:1. The prevalence of clinically important minor blood group phenotypes like Kidd {Jka-499 (76.8%), Jkb-449 (69.1%)}, Duffy {Fya-559 (86%), Fyb-396 (60.9%)}, Lewis {Le-a-112 (17.2%), Le-b-402 (61.8%)} and MNS {M-567 (87.2%), N-266 (40.9%), S-375 (57.7%), s-572 (88%)} in the kidney transplant donor group was documented. Lewis Le(a-b+) -402 (61.85%), Duffy Fy(a+b+) -306 (47.08%), Kidd Jk(a+b+) -298 (45.84%) and MNS (M+N+) -301 (46.30%), (S+s+) -298 (45.85%) were the most prevalent minor antigens. The phenotypes Lewis Le(a+b+), Kidd Jk(a-b-) had null percent in population and Duffy Fy(a-b-), MNS(S-s-) were present 0.15% and 0.15%, respectively in the population. Conclusion: The result of the present study emphasises the importance of testing, registering a database for immunogenic significant minor blood group antigens in transplant donors. This will aid in investigation of graft failure in alloimmunised patients.

Clinico-Histomorphological Spectrum and CD34 in Gastro-Intestinal Stromal Tumours: An Experience from Tertiary Care Centre, Kolkata, India

Sarbashis Hota, Sukanya Ghosh, Tushar Kanti Das, Anjali Bandyopadhyay

Introduction: Gastrointestinal Stromal Tumours (GISTs) are an important subcategory of mesenchymal tumours of gastrointestinal tract. The discovery of c-kit mutation in a subset of GIST has made amenable the treatment of this entity by targeted therapy. Although, Cluster of Differentiation 34 (CD34) is a well-established marker aiding in diagnosis of GIST, recent development of novel markers like Discovered on GIST1 (DOG1), CD117 have undermined its value. Still it’s a frequently used marker in the resource poor settings. Aim: To study the expression of CD34 immunomarker with respect to site, grade, stage, histomorphological type and risk category of GIST specimens received in the stipulated time period. Materials and Methods: An observational retrospective cross-sectional study was conducted in the Department of Pathology at R G Kar Medical College and Hospital, Kolkata, West Bengal, India. The duration of the study was three years and 11 months, from September 1, 2019 to August 31, 2022. All the samples diagnosed as GISTs within the study period, were taken from the received specimens in the department and immunohistochemical examination was done on the selected samples using monoclonal antibodies against CD34 after obtaining thin sections from formalin fixed paraffin embedded blocks and retrieval of antigen. The data was interpreted by light microscopy using a semi-quantitative method with respect to prefixed parameters, where 50% proportional positivity of CD34 in the tumour cells was considered as positive. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Mean age of the study participants was 49.78 years. A total of 8 (34.7%) cases originating from stomach and 13 (56.5%) from intestine. Eight out of 23 (34.7%) cases showed positive expression of the marker. Six out of eight cases of gastric GISTs were found to be positive and 66.6% cases of high grade GISTs were positive for CD34. Statistically significant association was found between expression of CD34 and the site of tumour-GISTs arising from stomach, particularly of spindle cell type, showing strong expression (p=0.003). It was found that, high grade GISTs are more likely to be positive for CD34. None of the epithelioid GISTs have shown positivity, neither any significant association was evident between expression of this marker with tumour stage or risk category. Conclusion: The GISTs arising from stomach, particularly of spindle cell type, are more likely to show strong CD34 expression. Higher grade GISTs were found to be associated with positive CD34 expression in the present study, but no significant association was evident between expression of this marker.

Comparative Evaluation of Mandibular Endosteal Margin Erosions on Panoramic Radiographs in Dentulous and Edentulous Elderly Population: A Retrospective Study

Kavita Badi, Rashmi Venkatesh, Chandramani B More, Palak H Shah

Introduction: The mandibular bone is an important component of the facial bone and this bone shows the measurable osteoporotic changes on radiographs. One of the changes shown is mandibular endosteal margin erosions and on panoramic radiograph the changes are seen as cortical cavities and cortical residues. Aim: To evaluate and compare mandibular endosteal margin erosions on panoramic radiographs in dentulous and edentulous elderly population. Materials and Methods: This retrospective study was conducted on 611 panoramic radiographs of elderly population for mandibular endosteal margin erosions using Mandibular Cortical Index (MCI), devised based on appearance of lower border of mandibular cortex distally from mental foramen as viewed on panoramic radiograph. Data collected was tested statistically using Chi-square test. Results: The mandibular endosteal margin erosions were more severe in edentulous group. The difference between the groups was found to be statistically significant (p<0.05). As age increased, the likelihood of the C3 category increased and mandibular endosteal erosions were more pronounced among females in both dentulous and edentulous group (p<0.05). Conclusion: Mandibular Cortical Index is simple index to determine osteoporosis and the severity of osteoporosis is directly related with edentulousness or increased tooth loss.

Evaluation of Salivary Lactate Dehydrogenase Level as a Biomarker for Early Detection in Oral Cancer and Potentially Malignant Disorders: A Systematic Review and Meta-analysis

Arunima Sarma, Sunil S Mishra, Sukanya Das, Harshawardhan Sawane, Trupti Gaikwad

Introduction: Saliva diagnostics are emerging tools which are being explored as a non invasive method for early detection of oral premalignant lesions and Oral Cancer (OC). Salivary Lactate Dehydrogenase (LDH) is one such promising biomarker which has shown potential to be utilised in future for detection of premalignant lesions and conditions. The rationale behind this systematic review was to evaluate whether salivary LDH can be considered as biomarker for OC and Oral Potentially Malignant Disorders (OPMDs). Aim: To review the literature for levels of salivary LDH in patients with OC and OPMD. Materials and Methods: A comprehensive search was done and this systematic review was conducted in the Department of Oral Medicine and Radiology, Dr. DY Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India, following (Preferred Reporting Items for Systematic Reviews and Meta-analyses) PRISMA guidelines. Literature search was done for the period of 10 years from 2012-2022, while the study duration was 18 months, from January 2021-July 2022. The International Prospective Register of Systematic Reviews (PROSPERO) registration Identity Document (ID) was (CRD42022366117). Electronic data was searched through the database PubMed, ScienceDirect and Cochrane Library from 2012-2022. Observational and analytical studies, original longitudinal or case-control, randomised clinical trials, prospective controlled clinical trials with the inclusion of cases diagnosed with oral leukoplakia, Oral Lichen Planus (OLP), Oral Submucous Fibrosis (OSMF), OC and having salivary LDH levels were included. The data was collected from the studies that were included based on study design, eligibility criteria, histological differentiation, collection method, LDH level and the data were subjected to meta-analysis. Results: A total of 16 articles were included. The meta-analysis showed increased salivary LDH levels between cases with OC and Control Group (CG). The pooled estimate was 5.71 (95% CI: 3.89-7.53) with statistical significance of <0.05. In OSMF and controls the levels of salivary LDH was significantly increased. The pooled estimate was 30.38 (95% CI: 15.82-44.94) with statistical significance of <0.05. The level of salivary LDH among cases with premalignant lesions and controls was increased. The pooled estimate was 9.10 (95% CI: 3.45-14.75) with statistical significance of <0.05. In case of OLP and controls, the levels of salivary LDH were seen elevated. The pooled estimate was 6.76 (95% CI: 6.86-20.38) with no statistical significance of p-value <0.05. Conclusion: To sum up, the results of this systematic review showed that levels of salivary LDH were higher in OC and OPMD patients than in healthy patients. Furthermore, the levels of salivary LDH are more in OC than OPMDs.

Correlation between Temporomandibular Joint Disorders, Sleep Quality and Stress among Dental Students: A Cross-sectional Study

Shamali Gaikwad, Manjushri Waingade, Raghavendra S Medikeri, Daya K Jangam

Introduction: Dental students are subjected to high levels of stress during their academic performance. The quality of sleep could also be affected in those with increased stress levels. Stress and sleep quality could be considered as risk factors in Temporomandibular Joint Disorders (TMD). Identification of the risk factors in TMD at the initial stages can lead to minimising the long term effects. Aim: To investigate the relationship between TMD symptoms, sleep quality and stress among dental students. Materials and Methods: A cross-sectional questionnaire-based survey was conducted in the Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India, from November 2021 to December 2021 among 255 dental students. Fonseca Anamnestic Index (FAI) questionnaire was used for evaluation of TMD, while Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess stress scores and sleep quality, respectively. The students were surveyed to categorise them, if they were showing any symptoms of mild, moderate or severe TMD. Similarly the sleep quality and stress scores were assessed. The relationship between TMD with stress and sleep quality was also evaluated. Data analysis was done using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 26.0. Comparison of frequencies of scores of PSS, PSQI and FAI within groups was done using Chi-square test. Bivariate correlation between PSS/PSQI, PSS/FAI ad FAI/PSQI was assessed using correlation coefficient. Results: Out of 255 participants, 182 were females and 73 were males. It was observed that 221 (86.7%) students reported moderate stress levels, 21 (8.2%) students showed mild and 13 (5.1%) subjects showed high stress levels. Temporomandibular symptoms were reported as mild, moderate and severe in 130 (51%), 21 (8.2%) and 9 (3.5%) students, respectively. A total of 229 (89.8%) students showed poor sleep quality and 26 (10.2%) students showed good sleep quality. Moderate stress was correlated with poor sleep quality and mild TMD. Conclusion: The stress levels were significantly correlated with sleep quality and TMD symptoms. Thus, increased stress and poor sleep may be considered as risk factors of TMD. However, longitudinal studies in large samples are required to determine the cause and effect relationships between sleep quality, stress levels and TMD.

A Comparative Analysis of Mandibular Ramus and Maxillary Sinus in Sex Determination among the Population of West Godavari, India: A Tool in Forensic Identification

Introduction: The application of dental principles to legal issues is known as forensic dentistry. Among the skull’s various bones, mandible is the strongest and most diverse bone and is crucial in determining sex. It has been reported in many studies that maxillary sinus seems to be intact, although other bones may be severely deformed and can be applied to determine sex. Aim: To assess, analyse and compare the morphometric analysis of maxillary sinus and ramus of mandible for gender determination using digital Orthopantamograph (OPG). Materials and Methods: A cross-sectional study was conducted in Department of Oral Medicine, Radiology and Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The study comprising of 64 individual radiographs (32 men and 32 women) were measured for mandibular ramus (maximum ramus width, condylar and coronoid height) and maxillary sinus length, width and compared bilaterally. The results were tabulated and statistically analysed using discriminant functional analysis after the mean values were calculated. Results: The mean age of study population was 34.67±5.78 years. In the present study, the overall measurements of mandibular ramus were more in males than females whereas maxillary sinus measurements were more in females when compared to males. Condylar length (right and left), width of ramus (right) and width of maxillary sinus (left) were found to have statistical significance in determining the gender (p-value <0.001, 0.024, 0.024). Length of the condyle showed highest accuracy of 73.8% in gender determination. Conclusion: The present study suggests that the mandibular ramus and maxillary sinus measurements using OPG are helpful in dealing forensics, with condylar height being the most accurate indicator for gender determination.

Complementary Value of Tissue Doppler Imaging in Dobutamine Stress Echocardiography: A Prospective Cohort Study

V Sudha Kumary, Jayaprakash Kesava Pillai, KJ Raihanathul Misiriya

Introduction: In patients with Coronary Artery Diseases (CAD), the presence of viable myocardium predicts the recovery of Left Ventricular (LV) systolic function after revascularisation. The identification of myocardial viability during dobutamine stress echocardiography is subjective and with observer bias. Tissue Doppler Imaging (TDI) echocardiography has opened new possibilities for non-invasive quantification of myocardial function by directly interrogating myocardial velocity with high temporal and spatial resolution. Aim: To determine the baseline regional myocardial and mitral annular Maximum Systolic Velocities (MSV) in patients with LV dysfunction and to compare the MSV values in viable and non-viable myocardium. Materials and Methods: In this prospective cohort study, TDI of regional and annular LV myocardial velocities was performed at the baseline (at rest) in 352 patients with CAD and LV dysfunction who were referred for dobutamine stress Echocardiography. Viability assessment by 2 Dimensional (2D) methods was done simultaneously using routine dobutamine stress protocol. Patients were grouped in two groups based on the presence or absence of viability with 2D stress echocardiography. TDI velocities were compared in the two groups of patients with and without myocardial viability. Measurements of regional wall thickness, Ejection Fraction (EF) and Wall Motion Score Index (WMSI) were done to assess the regional and global LV function in these patients. Those patients who underwent revascularisation were subsequently assessed for functional recovery by 2D and TDI echocardiography before discharge from the hospital. Analyses were conducted using Statistical Package for Social Sciences (SPSS) version 16.0. Results: The mean age of the patients was 58.2±8 years. Among 352 patients studied (124 females and 228 males), mean age 58 years (range 36 to 75 years). A total of 243 patients (69%) with viable myocardium as per 2D echocardiography had higher cut-off Baseline Regional Maximum Systolic Velocity (BRMSV) >0.03 m/s and baseline mitral annular systolic velocity >0.06 m/s with high sensitivity and specificity compared to patients with severe contractile dysfunction and non-viable myocardium. Conclusion: Tissue doppler parameters like regional myocardial systolic and mitral annular velocities have shown significantly higher cut-off values in those patients with ischaemic and viable myocardium compared to non-viable myocardium.

Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study

Mohit Mittal, Raghav Talwar, Ananya Dutta, Abhishek Kumar Shukla

Introduction: Benign Prostatic Hyperplasia (BPH) is mainly managed with alpha-blocker and 5 alpha reductase inhibitors. Non responders are offered surgery. To wait for the drug response is sometimes cumbersome for the patients with bothersome symptoms and may also lead to complications. On the other hand, some have minimal symptoms on drugs but silently develop obstructive complications. Aim: To understand the role of sonographic parameters of prostate and bladder of BPH patients in predicting and assessing response to medical treatment. Materials and Methods: This prospective cohort study was conducted in the Department of Urology at Army Hospital Research and Referral, New Delhi, India. The duration of the study was 15 months, from October 2017 to January 2019. A total of 100 consecutive patients of BPH with Prostate-specific Antigen (PSA) <4 ng/mL and prostate of >35 cc were given three months of alpha-blocker and dutasteride. Based on there subjective response, they were grouped into Symptomatic Improved (SI) and Not Improved (NI) group. Values of sonographic parameters including Prostate Volume (PV), prostatic capsular artery Resistance Index (RI), Intravesical Protrusion of Prostate (IPP), Detrusor Wall Thickness (DWT) and Post-void Residual volume (PVR), as well as, International Prostate Symptom Score (IPSS) and Uroflowmetry (UFM) at baseline and after three months of treatment were analysed and compared in both the groups. The significance of change in parameters was analysed using paired t-test and two sample Student’s t-test. Results: The mean age of the study participants was 64.8±5.86 years. There was an association between IPSS and flow with initial reading of PV, PVR, DWT, RI and IPP. Post-treatment both, SI (n=74) and NI (n=26) group showed valuable difference in DWT, PV and PVR but it was significantly more in improved group. Significant change in RI was observed only in SI group and IPP did not change in either group. Area Under Curve (AUC) under Receiver Operating Characteristic (ROC) was suggestive of higher sensitivity for IPP in predicting drug outcome. Conclusion: Combined use of Ultrasonography (USG) and Kidney, Ureter, and Bladder (KUB) parameters as described above like RI, DWT, PV and IPP can be used to predict and assess the objective response to drug in BPH. This helps in determining therapeutic plan and the need for further medical therapy or surgical intervention.

Comparison of Forced Oscillometric Technique and Spirometry in Stable Asthmatic Patients in Central India: A Cross-sectional Study

Introduction: Asthma is an airway disease, the diagnosis of this disease still continues to be clinical based. Although, there are several tests that can be useful for asthma, but no one can be considered as a standard test and search for better test is still on. Spirometry being the most commonly used test but it involves effortful manoeuvre, whereas Forced Oscillometric Technique (FOT) is a lesser studied technique with no special manoeuvre. Aim: To compare between spirometry and FOT in adults asthmatic patients for assessing the utility of FOT. Materials and Methods: The present cross-sectional study was conducted at School of Excellence in Pulmonary Medicine at Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India, in 50 clinically diagnosed bronchial asthma patients between August 2020 to July 2021. These patients were sequentially assessed with spirometry and FOT. The patients were categorised into clinical severity and airflow limitation severity on spirometry. The baseline parameters Forced Expiratory Volume (FEV)1, Forced Vital Capacity (FVC), FEV1/FVC, Forced Expiratory Flow (FEF) 25-75, R5, R20, R5-R20, X5, Z5 were obtained by both the tests were analysed and compared for detecting the utility of FOT by using BlueSky statistical software- 10.0.0-Beta2 version. Results: Among 50 enrolled patients (21 males and 29 females) with asthma, 42 (84%) were mild and 8 (16%) were moderate. The mean age of patients was 27.5±6.6 years. The total airway resistance (R5) was the most consistent FOT parameter that was statistically different in asthma severity groups as well as in spriometry severity group (p-value=0.01). Peripheral airway resistance (R5-R20), and impedance Z5 were other variables that were significant between airflow limitation groups with a p-value of 0.01. A significant correlation was found between spirometry and FOT parameters including FEV1, FVC, FEV1/FVC with R5 (r>-0.5 at p-value of <0.01 for each parameter) and R20 (r>-0.5 at p-value of <0.05). Area Under Curve (AUC) was not able to differentiate between severity groups using FOT parameters with p-value of >0.05. Conclusion: The FOT parameters correlated with spirometric indices therefore this technique may be a useful measure in asthma diagnosis. Further studies are needed to derive cut-off values of FOT parameters.

Comparative Evaluation of Placement of Auragain, ProSeal and Protector Laryngeal Mask Airways using Fiberoptic Bronchoscopy: A Randomised Clinical Study

Introduction: Supraglottic Airway Devices (SAD) can be used instead of endotracheal intubation in both regular and complicated airway situations. Auragain, ProSeal and Protector Laryngeal Mask Airways (LMA) are second generation LMAs. They have a separate provision for gastric drainage. Auragain LMA is a recent second-generation Supra Glottic Airway device (SGA) with a preformed curved shaft and a double lumen having wider airway path to aid endotracheal intubation. ProSeal LMA also has a double cuff for better sealing to prevent gastric insufflation and aspiration. Protector LMA has two large-volume gastric drainage channels and an integrated cuff pressure indicator called the cuff pilot which enables application of higher respiratory pressure. Aim: To compare the adequacy of placement of Auragain, ProSeal and protector LMAs by vocal cord visualisation using fiberoptic bronchoscopy. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesiology, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from October 2021 to October 2022 among 120 patients. They were allocated by computer-generated random numbers into three groups namely Auragain, ProSeal and Protector LMA group. The adequacy of placement of LMA through Fiberoptic Bronchoscopy (FOB) using Brimacombe and berry scoring, Oropharyngeal Leak Pressure (OLP), time of insertion of LMA, number of attempts for insertion, ease of insertion of LMA, Ryle’s tube insertion success rate and postoperative complications were recorded immediately, after an hour and at 24 hour, respectively. Statistical analysis was performed using International Business Machines-Statistical Package for the Social Sciences (IBM-SPSS) software version 21.0. Results: The mean±Standard Deviation (SD) of age in Auragain group, ProSeal and Protector LMA groups were 41.35±12.96 years, 36.58±12.62 years and 36.65±12.50 years, respectively. The demographic data, procedures and duration of anaesthesia were comparable between the three groups. The mean insertion time (in seconds) was lower in the Auragain LMA group (16.80±3.66) when compared to protector LMA (20.20±6.93) and ProSeal LMA (21.68±4.44) with statistically significant difference (p-value <0.0001). The OLP (in cm H₂O) was more with ProSeal LMA (34.43±5.26) than Protector LMA (32.60±3.45) and Auragain LMA (28.55±1.85) with statistically significant difference (p-value <0.0001). The fiberoptic view was better with ProSeal LMA and statistically significant with grade 4 (p-value <0.0001) and grade 3 (p-value=0.007). The three devices were comparable in terms of ease and success of insertion of LMA, ease of placement of gastric tube and postoperative symptoms. Conclusion: It can be concluded that the ProSeal LMA offers better airway access and safety, despite being slightly difficult to insert compared to Ambu Auragain or Protector LMA.

Glycaemic Control of Type 1 Diabetes Mellitus Paediatric Patients before and after the Use of Telephonic Reinforcement: A Prospective Interventional Study at a Tertiary Care Hospital, Western India

Introduction: Type 1 Diabetes Mellitus (T1DM) is one of the most common paediatric endocrine illnesses. It is a chronic condition that involves regular administration of insulin, meal planning, strict adherence to physical activity and home-based sugar monitoring. Regular follow-up is essential to prevent short-term and long-term complications. Telemedicine has been extensively used in the management of multiple chronic conditions in adults. However, there are limited studies showing the impact of telemedicine in T1DM in paediatric patients in the Indian population. Aim: To compare the glycaemic control in paediatric T1DM patients, before and after the use of telephonic reinforcement. Materials and Methods: A prospective, interventional study was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India, with no sub-specialty clinic. The duration of the study was one year and five months, from November 2017 to April 2019. Paediatric patients upto the age of 18 years, diagnosed with T1DM (by paediatricians/physicians) were included in the study. The records of 64 patients were traced, 27 were enrolled prospectively for the study (who could be contacted and consented to the present study). The baseline data like weight, height, age, duration of T1DM, insulin dosage and baseline Glycosylated Haemoglobin (HbA1c) were recorded. After receiving due consent, the patients/parents were provided telephonic reinforcement by a paediatrician to ensure regular sugar monitoring, solve queries of parents and to ensure regular follow-up. The clinical profile and parameters were repeated at three monthly intervals and compared. A paired t-test was used with a p-value <0.05 as a cut-off to compare data before and after intervention. Results: The mean and median ages of the study participants at diagnosis were found to be 8.9 years and 10.5 years, respectively. Average duration of T1DM was six years. On telephone, three things were reinforced: 1) To take insulin regularly as advised; 2) To come for follow-up regularly and 3) If any difficulties faced by them while taking insulin or coming for follow-up then to contact us. The patients were followed-up as per routine, diabetic care protocol every three months and value of HbA1c was reduced significantly during follow-up. The (p-value <0.001) showed a significant difference after telephonic reinforcement. Conclusion: Telephonic reinforcement improves control of T1DM, by improving laboratory parameters and compliance with regular follow-up.

DECAF Score and BAP-65, the Tools for Prognosis in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Shyam Bihari Meena, Pranavkumar Bhat, Hijilo Magh, A Akhil

Introduction: Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) result in significant morbidity and mortality. It is 3rd most common cause of death worldwide. Still, there is no proper prognostic scoring system available. The increasing mortality has been attributed to the smoking, epidemic and the advanced age of the world’s population. Exacerbations are uncommon in early COPD and are more common in moderate-to-severe disease. Aim: To validate and compare the Dyspnoea, Eosinopaenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) score and Blood Urea Nitrogen (BUN), Altered mental status, Pulse-age 65 (BAP-65) as tools of prognostication in AECOPD. Materials and Methods: A hospital-based prospective, observational study was conducted in the Department of General Medicine at Government Medical College Kota, Rajasthan, India. The duration of the study was two years, from December 2020 to December 2022. A total of 100 patients (84 males and 16 females), who were admitted with AECOPD were included. DECAF and BAP-65 scores, length of hospital stay, need for mechanical ventilation and mortality was recorded on a proforma and later analysed using Statistical Package for Social Sciences (SPSS) version 22.0. A Receiver Operating Characteristic (ROC) curve was drawn for comparison of the accuracy of both the scoring systems. Results: The mean age of the study participants was 64.91±11.78 years. Analysing the data statistically, the BAP-65 class and DECAF score with mortality, need for mechanical ventilation, and duration of hospital stay showed a significant association. Comparing DECAF with BAP-65, DECAF showed higher predictive accuracy in mortality {Area Under Curve (AUC)- DECAF=0.933 BAP-65-0.929) and duration of hospital stay (AUC-DECAF=0.753 BAP-65=0.929}) whereas, BAP-65 showed higher accuracy in predicting the need for mechanical ventilation (AUC-DECAF=0.851 BAP-65=0.916). Conclusion: Since, there was a good association between BAP-65 classes, as well as, the DECAF score and outcomes in AECOPD, these can be used as an assessment tool in predicting outcomes in patients presenting with AECOPD. It is better to use DECAF for predicting the length of hospital stay and mortality and BAP-65 for predicting the need for mechanical ventilation.

Association of Dry Eye with Vernal Keratoconjunctivitis: A Hospital-based Cross-sectional Study

Challapalli Himabindu, Niharika KriShna Shetty

Introduction: Vernal Keratoconjunctivitis (VKC) is a common allergic disease seen in children. The allergic component is caused by Immunoglobulin E (IgE) and mast cell-mediated pathway. It is proposed to be a combination of immune system, genetic, and environmental factors. Secondary dry eye develops secondary to inflammatory disease namely vascular, allergic, environmental conditions like allergens, cigarette smoke, hormonal changes, systemic disorders, such as diabetes mellitus, eye surgeries such as refractive surgery and systemic medications, such as diuretics and antihistamines. Co-existence of dry eye and VKC can worsen the symptoms of the patient and may also lead to prolonged and unnecessary treatment of the disease. Aim: To study the association of dry eye with VKC by Schirmer’s test and Tear Film Breakup Time (TBUT). Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Opthalmology, Sri Siddhartha Medical College and Research Centre, Tumkur, Karnataka, India, from December 2020 to June 2022. Thirty-three patients of age group between 5-20 years with symptoms of VKC were evaluated for dry eye using Schirmer’s test and TBUT, respectively. Each patient was subjected to detailed history taking, followed by ocular examination as per the predesigned proforma. The patients were subjected to the tear film analysis using Schirmer’s test and TBUT. The data was compiled and the association between categorical variables were analysed using Chi-square test. The data was analysed using Statistical Package fot the Social Sciences (SPSS) software version 21.0. The parameters compared were the type of dry eye with the type of VKC. Results: The mean±Standard Deviation (SD) age of the study group was found to be 11±1.5 years. Out of 33 patients, 69.69% of all the cases were seen in the 5-12 years age group. There was male preponderance in the present study with 63.63% of patients being male child. VKC was most commonly seen as mixed accounting for 57.57% of cases. In the current study, it was discovered that 60.6% of cases showed no sign of dry eye, whereas 39.82% of cases had dry eye. The dry eye was more commonly seen in mixed type of VKC. The p-value was statistically significant (p-value <0.001) for association of dry eye with mixed type of VKC. Conclusion: The present study highlighted the co-existence of dry eye with VKC. There was a significant association of dry eye with VKC and type of VKC as well, which might have long-term effects on the ocular surface. These ocular surface alterations exist during active and the quiet phase of VKC. The patients of VKC may need a long-term follow-up and treatment for this ocular surface alteration.

Risk Factors Associated with Female Suicide Attempts: A Cross-sectional Study

G Sundaravalli, M Priyasubhashini, R Priyadharshini

Introduction: Attempted suicide, both fatal and non fatal, is a challenging public health issue. In India, suicide attempts are more frequent in females than in males. Gender-related vulnerability to psychopathology and psychosocial stressors pose women with increased vulnerability to suicidal behaviour. Studies suggest that each prior attempt among women increased risk of future suicide threefold. More is known about differences in males and females in conditions like depression and schizophrenia than suicide. Remarkably few studies have focused upon suicidal behaviour in women or attempted to explore the complex relationships between various risk factors and suicidal behaviour in women. Such studies can provide useful information for understanding the risk factors associated with female suicide attempts and can help in developing suicide prevention strategies catering to the needs of women. Aim: To study the risk factors associated with female suicide attempts in patients admitted in a medical college hospital in South India. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Psychiatry, Stanley Medical College Hospital, Chennai, Tamil Nadu, India, from October 2021 to March 2022. Based on convenience sampling method, 170 female patients admitted for attempted suicide above 18 years of age who were referred for psychiatric counselling services to the Outpatient unit were considered for the study. Data on socio-demographic details including age, education status, marital and employment status, type of family and socio-economic status was collected. In addition, data on clinical variables like suicide and mental illness in the family, mode of attempt, number of past suicide attempts, co-morbid physical illness were collected from the participants. Beck’s suicide intent scale was used to assess the severity of suicide intent. Presumptive Stressful Life Events Scale (PSLES) was used to assess the stressful life events. For analysing the factors associated with severity of suicide intent, inferential statistics (Pearson’s Chi-square test) was used. Results: Of the 170 women who attempted suicide, 79 (46.5%) were between age group 18 and 25 years. A total of 71 (41.8%) participants were employed and 111 (65.3%) were married. A total of 48 (28.2%) participants had co-morbid physical illness. Suicide ideation in the past 30 days were reported by 43 participants. The most common method of suicide attempt was self-poisoning (91.8%). A total of 65 participants (38.2%) had a current diagnosis of depression, 25 (14.7%) participants had one or two suicide attempts in the past, 99 (58.2%) women who attempted suicide had medium suicidal intent and in 30 participants (17.7%) the severity of suicide was high. The most common stressful life event was marital conflict. The severity of suicide intent was associated with age, past history of suicide attempt, suicide ideation in the past 30 days and current psychiatric diagnosis. Suicide intent was high in older age group patients and in those who had suicide ideation in the previous 30 days. Among the psychiatric diagnosis patients with diagnosis of depressive disorder had higher suicide intent. The mean±Standard Deviation (SD) stressful life event score was 115.93±36.50 in patients with high suicide intent. Conclusion: The study highlights the various risk factors associated with female suicide attempts. The association between suicide intent and underlying psychiatric disorder in female suicide attempted patients insist the need for prompt diagnosis and management of psychiatric illness in preventing suicide behaviours in women. Suicide prevention programs should incorporate women-specific strategies. Multisectoral collaboration is needed to empower women with a good family, social support and foster socio-emotional life skills in women.

Screening and Re-screening of Gestational Diabetes Mellitus at 24-28 Weeks and 32-34 Weeks of Gestation and Evaluation of Foetal Maternal Outcome: A Longitudinal Study

Rupali Modak, Sarabindo Mondal, Amitava Pal, Dilip Kumar Biswas

Introduction: Gestational Diabetes Mellitus (GDM) has a great impact on maternal and foetal outcome. Timely diagnosis and proper management have immense importance to prevent adverse outcomes. Aim: To determine the incidence rate of GDM, and its risk factors and also to determine the importance of re-screening for detection of GDM at 32-34 weeks. Materials and Methods: A hospital-based longitudinal study was conducted from April 2020 to June 2021 in the Department of Obstetrics and Gynaecology, Burdwan Medical College, Burdwan, West Bengal, India. Screening and diagnosis for GDM were performed by estimating a 2-hour blood glucose level after intake of 75 gm of glucose, irrespective of the meal at 24-28 weeks by one-step procedure i.e., Diabetes in Pregnancy Study groups in India (DIPSI). A total of 300 antenatal mothers were selected serially from antenatal OutPatient Department (OPD). All the screen-negative pregnant women were re-screened again at 32-34 weeks. Demographic variables and maternal risk factors like age, parity, Body Mass Index (BMI), family history of diabetes, previous GDM, previous history of foetal loss macrosomia and polyhydramnios were noted. Foeto-maternal complications like hypoglycaemia, Intrauterine Foetal Death (IUFD), preeclampsia and sepsis were recorded. Frequency and percentage of each parameter was calculated. The risk estimates between GDM and without GDM were analysed by odds ratio with 95% confidence interval and p-value were calculated. The p-value <0.05 was considered significant. Results: The screen-positive cases for GDM were 26 (8.7%) at 24-28 weeks and 8 (2.9%) at 32-34 weeks of gestation. Preeclampsia was noted in 5 (14.7%) cases and 4 (11.8%) GDM mothers suffered from Postpartum Haemorrhage (PPH) (p-value <0.0001). Rate of caesarean section was high 76.5% among GDM mothers (p-value <0.0001). Average birth weight of new born baby of mothers with and without GDM were 2.5324±0.6503 kg and 2.7297±0.2145 kg, respectively (p-value=0.0003). IUFD was noted in 2 (5.9%) cases. Preterm delivery was observed in 25 (73.5%) cases and admission to Neonatal Intensive Care Unit (NICU) was 11 (32.4%) (p-value <0.001). Out of 274 pregnant mothers who had blood sugar <140 mg/dL by DIPSI method at 24-28 weeks were designated as screen negative and they were re-screened at 32-34 weeks of gestation. Eight cases (2.92%) were found screen positive after re-evaluation (odds ratio, 3.1551, 95% CI, 1.4033-7.0938, p-value=0.00358). Conclusion: Pregnancy in women with GDM has an increased risk of maternal and perinatal complications. Timely screening and diagnosis of GDM and appropriate treatment can reduce adverse foeto-maternal outcomes. Re-screening of initial screen negative women is very important, otherwise significant number of cases will be missed.

Histopathological Evaluation and Analysis of Immunohistochemical Markers p53 and CD44S in Renal Cell Carcinoma: A Cross-sectional Study

Shivani Gupta, Clement Wilfred Devadass, Shubham Varshney, SML Prakash Babu

Introduction: Renal Cell Carcinoma (RCC) is the 9th and 14th most common cancer in men and women, respectively, and among the most lethal urological cancers. Upto 30% of patients experience recurrence within five years postnephrectomy. Therefore, the predictors of disease survival and molecular markers associated with clinical prognostic parameters should be identified. Aim: To examine the histopathological features of RCC and investigate the association of Tumour protein p53 (p53) and Cluster of Differentiation 44S (CD44S) expression with prognostic factors. Materials and Methods: The present prospective cross-sectional study was conducted in the Department of Pathology, M.S Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India, from June 2017 to May 2019. Radical and partial nephrectomy specimens of RCC patients were obtained for the study. In each case age, tumour histologic type, tumour size, Fuhrman nuclear grade, rhabdoid features, necrosis, tumour stage and p53 and CD44S status were evaluated through Immunohistochemistry (IHC). The Chi-square test was used to evaluate differences in CD44S and p53 expression among different groups. Data were entered in Microsoft (MS) excel version 11 and was analysed using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 20.0. Results: The study included 50 RCC patients with a mean age of 56.64 years and male:female ratio was 2.8:1. CD44S and p53 positivity were noted in 33 (66%) and 27 (54%) patients, respectively. Weak, moderate, and strong CD44S expression were observed in 13 (26%), 8 (16%) and 12 (24%) patients, respectively and those of p53 in 9 (18%), 14 (28%) and 13 (26%) patients, respectively. Patients with higher Fuhrman nuclear grades exhibited stronger CD44S (n=24, 72.7%) and p53 (n=19, 70.3%) expression than did those with lower grades. Conclusion: The clear cell carcinoma is the most common histologic subtype. Presence of rhabdoid features and necrosis is seen with advanced Tumour, Nodal and Metastasis (TNM) stage. A significant association between p53 and CD44S immunohistochemical expression and higher Fuhrman nuclear grade suggests increased expression of p53 and CD44S and indicates an aggressive clinical course that can be used as a marker of poor prognosis.

Analysis of Diffuse Large B-cell Lymphoma using Immunohistochemical Algorithm: A Cross-sectional Study

Jasmin Scaria, ER Jyothi Rani, PP Sathi

Introduction: Diffuse Large B-cell Lymphoma (DLBCL) is the most common Non-Hodgkin’s Lymphoma (NHL). Using Gene Expression Profiling (GEP) DLBCL has been subtyped into two groups of prognostic importance, Germinal Center B-cell (GCB) like and activated B-cell like. GCB DLBCL has a better survival and can be identified using Hans algorithm with three immunohistochemical markers Cluster Differentiation (CD10), B-cell lymphoma 6 (BCL6) and Multiple Myeloma Oncogene-1 (MUM1). Aim: To analyse DLBCL using Hans algorithm as both GCB lymphoma and non GCB lymphoma have different treatment and prognosis. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India, from January 2019 to December 2020. A total of 97 DLBCL cases received in the Department of Pathology, from January 2016 to December 2019 were included in the study were subtyped using Hans algorithm. CD10, BCL6 and MUM1 were considered positive, if more than 30% of the tumour cells showed staining by the respective antibodies. The relation between DLBCL subtypes and the age, gender, symptoms, site of initial involvement, organomegaly, Ann Arbor stage, treatment response and overall survival. Findings in the patients were analysed using Chi-square test. Statistical Package for Social Sciences (SPSS) software version 18.0. Overall survival was estimated using Kaplan-Meier method. Results: The median age of study population was 60 years (age range: 31-85 years) and there were 55 (56.7%) males and 42 (43.3%) females. Out of the 97 DLBCL cases 47 (48.5%) were GCB and 50 (51.5%) were non GCB subtype. Statistical analysis was done only in 88 patients (excluded nine recurrent lymphoma patients, which may have a different outcome). There was significant association (p-value=0.003) between stage and subtypes as majority of the non GCB cases presented in an advanced stage. The rate of complete remission with Rituximab Cyclophosphamid Hydroxydaunorubicin Oncovin Prednisone (RCHOP) chemotherapy was higher in GCB (58.75%) compared to non GCB (15.25%) subtypes (p-value=0.001). Overall survival rate of GCB was 74.4% and non GCB was 31% with a p-value of 0.001. There was no statistically significant relation between DLBCL subtypes and other clinicopathological factors. Conclusion: In the present study, the patients within the GCB subtype had better treatment response and overall survival rate compared to non GCB subtype. Non germinal center subtype presented in advanced stage and had a worse prognosis. Therefore, it is essential to subtype DLBCL in all cases to identify non GCB subtype, which may need additional treatment after RCHOP chemotherapy.

Haemogram and Iron Profile in Children Suffering from Severe Acute Malnutrition at a Tertiary Care Centre, Bhopal: A Cross-sectional Study

Naina Rose, Manjusha Goel, Rajesh Patil, Bhavesh Motwani, Jyotsana Shrivastava

Introduction: There is a high global prevalence of malnutrition in India, with anaemia and infection being the major co-morbidities in these patients. Iron deficiency is one of the most common causes of anaemia worldwide, which has its complications. However, data regarding haematological and iron profiles among Severe Acute Malnutrition (SAM) children in India is very limited. Aim: To study the iron profile and haemogram in children with SAM and its comparison with various associated complications. Materials and Methods: This observational cross-sectional study was conducted in the Department of Paediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from March 2021 to September 2022. Children aged between six months to five years, fulfilling the World Health Organisation (WHO) criteria of SAM in the present study were included and clinical and haematological data were collected, including growth parameters, haemogram, peripheral smear, Red Blood Cell (RBC) indices, reticulocyte counts, and iron profile. Categorical variables were analysed using the Chi-square test or Fisher’s-exact test. Continuous variables were assessed using the Analysis of Variance (ANOVA) or t-test. Results: Total of 175 children (80 girls and 95 boys) with SAM were enrolled in the study and data was analysed. Anemia was observed in 87% of study population. Most SAM children with complications had severe anaemia (51.9%) with a higher prevalence of microcytic anaemia followed by macrocytic anaemia compared to SAM without complications with normocytic anaemia. On comparing the haemogram, it was revealed that Hemoglobin (Hb), Packed Cell Volume (PCV), Red Blood Cells (RBC), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were significantly low in SAM patients with complications. While the iron status of SAM patients with complications revealed low serum iron levels and transferrin saturation while ferritin and Total Iron-Binding Capacity (TIBC) were increased. Conclusion: Anaemia was observed to be highly prevalent in SAM children with complications. The most common type of anaemia was microcytic hypochromic, followed by macrocytic type. Serum iron levels were significantly lower in SAM patients with complications (p-value <0.001).

Renal Complications of Benign Tertian Malaria: A Case-control Study from South Delhi, India

Introduction: Plasmodium vivax (P. vivax) malaria is a major public health problem worldwide, particularly in the tropical and subtropical regions. Although P. vivax malaria is generally considered less severe than Plasmodium falciparum (P. falciparum) malaria, it can still cause severe illness, including severe anaemia, respiratory distress, and cerebral malaria, which can be fatal. Additionally, due to its relapsing nature it can further complicate treatment. Despite being a significant cause of morbidity and mortality, P. vivax malaria has received relatively less attention than P. falciparum malaria. Therefore, present study was designed to evaluate renal complications. Aim: To study the prevalence of renal involvement and its associations with clinical manifestations, laboratory parameters, and other complications in monoinfection of P. vivax malaria. Materials and Methods: This was a retrospective case-control study done over three years duration between April 2017 to March 2020. A total of 380 patients data were taken from hospital records of Hakeem Abdul Hameed Centenary (HAHC) Hospital, New Delhi, India admitted with a diagnosis of P. vivax infection. Renal complications were assessed in all patients admitted with the diagnosis of P. vivax. Renal involvement was defined as per Acute Kidney Injury Network (AKIN) criteria for Acute Kidney Injury (AKI). For statistical calculations, data was analysed into two groups i.e., AKI and non AKI. Clinical, laboratory and other complications were assessed for statistical significance by t-test/Mann-Whitney test and for correlation between AKI and these variables univariate analysis was done initially followed by multivariate analysis. Results: Male to female ratio in present study was 1.8:1. The prevalence of AKI was 22.59% with a male: female=2.1:1. Mean age in the AKI group was 35.89±14.69 years as compared to the non AKI group was 29.40±12.44 years (p-value=0.019). Renal involvement was significantly associated with rising hepatic transaminases (p-value=0.02, 0.018 for each variable). Leukopenia was protective for AKI; however rising leukocyte count was associated with increasing odds of renal involvement with Odd Ratio (OR) of 7.486 (p-value=0.001). AKI was strongly associated with increasing age, leukocytosis, and hyperbilirubinaemia. Whereas hepatic transaminases, hyponatraemia, cerebral malaria, acute respiratory distress syndrome, and thrombocytopaenia were weakly associated with AKI. Conclusion: P. vivax is not benign malaria anymore; complications should be anticipated and treated at an early stage.

S100 Beta as a Marker of Hepatic Encephalopathy: A Case-control Study

Manish Chandey, Parminder Singh, Sahiba Kukreja, Gurinder Mohan

Introduction: Hepatic Encephalopathy (HE) is a term used to describe a reversible syndrome of impaired brain function involving a complex spectrum of non specific neurological and psychiatric manifestations occurring in patients of severe acute or Chronic Liver Disease (CLD). The current clinical standard employed is psychometric analysis by computing Psychometric Hepatic Encephalopathy Score (PHES), which is cumbersome to perform. Hence, this necessitates the requirement of a serum biomarker which could correlate with the grades of HE. Following a metabolic injury, the earliest response involving the glial response and astrocyte activation results in the secretion of S100 Beta. Hence, estimation of serum S100 beta levels is considered as a strong marker of Central Nervous System (CNS) injury. Aim: To verify S100 Beta as a marker of HE. Materials and Methods: This was a case-control study conducted from 1st April 2021 to 31st July 2022. All diagnosed cases of cirrhosis of liver in the Department of General Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amristar, Punjab, India. A total of 40 age and sex-matched healthy controls were recruited after due consent. They were subjected to psychometric analysis (Five pen and paper tests) and on basis of PHES were divided into four groups on the basis of grades of encephalopathy. Serum samples of patients were run for all routine biochemical parameters in line with Child Turcotte Pugh (CTP) score and S100 Beta levels estimation. Statistical analysis was done to find correlation between S100 Beta levels, PHES and CTP score. Results: A total of 150 patients and 40 controls were recruited in the study. A progressive deterioration of PHES score was found in the various groups of the study population with worsening of grade of HE. S100 Beta levels correlated with the PHES and also Receiver Operating Characteristic (ROC) curve analysis showed that the sensitivity of the marker stood at 92.7% and specificity at 84.8%. S100 Beta levels could fairly differentiate between patients with and without HE. Hence, S100 Beta levels correlated more with grades of HE than with hepatic functional status (CTP Score). At higher grades of HE when it becomes more clinically apparent, S100 Beta levels would help, when other causes of behaviour changes like psychiatric illness coexist or cannot be ruled out. In the diagnosis of low-grade HE whenever neuropsychometric tests are suboptimal, or when competing psychiatric differential diagnoses are in place, S100 beta levels would have a role over and above the PHES score. Conclusion: Currently, psychometric analysis holds to be the best clinical standard for diagnosis of HE. S100 Beta holds promising results as a marker for establishing a liquid diagnosis of HE.

Central Corneal Thickness and Endothelial Cell Changes after Phacoemulsification in Patients with Diabetes Mellitus: A Prospective Study

Hans Raj Sharma, Anureet Kaur, Ashok K Sharma, Asma Jabeen, Rohini Choudhary

Introduction: Diabetes Mellitus (DM) has emerged as a significant cause of ocular morbidity. The toxic effects of hyperglycaemia spare no cell in the body and cornea, has also revealed certain changes in diabetic patients. Higher phacoemulsification time and power effect corneal endothelial cells. This can inflict an additional stress on the altered diabetic corneal endothelium. Aim: To compare the Central Corneal Thickness (CCT) thickness and endothelial Cell Density (CD) and morphology in Type 2 Diabetes Mellitus (T2DM) patients undergoing phacoemulsification with age-matched non diabetic controls undergoing phacoemulsification. Materials and Methods: A prospective, hospital-based, interventional study was conducted in the Department of Ophthalmology, Government Medical College, Jammu, Jammu and Kashmir, India. The duration of the study was nine months, from April 2021 to December 2021. The study included 50 patients with T2DM and 50 non diabetic controls. All patients underwent phacoemulsification performed by a single surgeon. The CCT and endothelial cell parameters were measured preoperatively and postoperatively at one week, six weeks and three months using Topcon specular microscope. Postoperative changes in the corneal endothelial cells were compared between the two groups for a period of three months. Statistical analysis was done by using the Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Corp. Released 2017. Armonk, NY, USA). Categorical variables were analysed using Chi-square test and the groups were compared using Student’s t-test. Results: The mean age of the study participants was 63.22±7.52 years in diabetic group and 64.52±7.29 years in non diabetic group. Diabetic patients showed significantly greater corneal thickness than non diabetic controls (p=0.034). This pattern was observed till the last follow-up at three months. The endothelial cell parameters were comparable between diabetic and non diabetic patients. There was a fall in endothelial cell count in all patients postoperatively, but it was significantly higher in the diabetic patients at three months (p=0.048). Postoperatively, Coefficient of Variation (CV) was significantly higher in diabetic patients (p=0.001) accompanied by a decreased hexagonality (p=0.039) at the end of three months. Conclusion: A diabetic cornea is different than a non diabetic cornea at the cellular level. Diabetics show accelerated corneal endothelial cell loss and greater variation in cell morphology in response to surgical stress. Diabetes mellitus is a risk factor for endothelial cell loss in patients undergoing cataract surgery.

Immunohistochemical Analysis of Paediatric Small Round Blue Cell Tumours at the Tertiary Care Centre, Ludhiana, India

Introduction: Small, undifferentiated cells with high nuclear-to-cytoplasmic ratios predominate in Small Round Blue Cell Tumours (SRBCT) and are characterised by their monotony. The classification of small round-cell tumours is further facilitated by Immunohistochemistry (IHC). Determine the line of differentiation using IHC, which also acts as a proxy for underlying molecular genetic changes. To identify the presence of a particular protein marker that can help with accurate cancer categorisation and diagnosis, histology uses IHC. In light of this, SRBCT are a subgroup of highly aggressive malignant neoplasms that are primarily comprised of monotonous, small, undifferentiated cells with high nuclear-to-cytoplasmic ratios. Aim: The study is aimed to analyse the role of IHC in the SRBCT to differentiate and accurately diagnose the tumour cells using molecular markers. Materials and Methods: This ambispective cohort study was conducted from August 1st, 2010 to 31st July 2015, a total of five years in the Pathology Department of Dayanand Medical College and Hospital (DMCH), Ludhiana, Punjab, India. All specimens of SRBCT less than 18 years of age were analysed grossly and microscopically. The study covered patients who were in the paediatric age range. The SRBCT were distinguished and categorised using immunohistochemical staining. CD99, CD20, CD15, CD30, CD3, desmin, CD45/LCA (the Lymphocyte Common Antigen), chromogranin, Myogenin, Synaptophysin (SYP), Cytokeratin (CK), and Epithelial Membrane Antigen (EMA) were among the immunomarkers used in this investigation. The results were presented using percentage and frequency statistics. Results: Total 54 cases of SRBCT were analysed. This included 12 cases of Non Hodgkin’s Lymphoma (NHL), 10 cases of Ewing’s/Primitive Neuroectodermal Tumours (PNETs), 12 cases of Hodgkin’s Lymphoma (HL), nine cases of rhabdomyosarcoma, four cases of neuroblastoma, two cases each of Langerhans Cell Histiocytosis (LCH) and synovial sarcoma, and one case each of olfactory neuroblastoma, sarcoma and ganglioneuroblastoma. Conclusion: The present study shows that utilising IHC in challenging circumstances is incredibly helpful and crucial where clinical-histomorphological findings are not sufficient for arriving at the final diagnosis. The majority of SRBCT developed in younger age groups, with lymphoma being the most prevalent type.

Evaluation of Antidiabetic and Antioxidant Activities of L-carnosine using Enzyme Inhibition and Free Radical Scavenging Assays: An In-vitro Study

D Malathy, D Anusha, K Karthika, K Punnagai

Introduction: Diabetes is a chronic disease that causes dysfunction of various organs and tissues resulting in end organ damage and premature mortality. Oxidative stress is a main factor of diabetic complications. There is a need for the development of safer therapeutic agents for diabetes, due to the adverse effects of conventional drugs. L-carnosine is a dipeptide synthesised by the body from β-alanine and L-histidine. It is reported to have heavy metal chelating, pH buffering, anti-inflammatory property and neuroprotective effect making it a prospective drug target for chronic diseases like diabetes. The antidiabetic property of L-carnosine and its free radical scavenging potential have not yet been fully explored. Aim: To evaluate the in-vitro antidiabetic and antioxidant activities of L-carnosine. Materials and Methods: The present in-vitro study was conducted in the Department of Pharmacology at Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India. The duration of the study was one month, done in December 2020. The in-vitro antidiabetic property of L-carnosine was evaluated using α-glucosidase and α-amylase inhibition. About 20, 40, 60, 80, 100 μg/mL concentrations of L-carnosine and acarbose were used for the study wherein, acarbose was used as the standard. The absorbance values were taken in spectrophotometer at 405 nm and 540 nm for α-amylase and α-glucosidase enzyme, respectively. Further, the antioxidant activity of L-carnosine was determined at the same concentrations using 2,20-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) assay with Butylated Hydroxytoluene (BHT) as standard. The spectrophotometric absorbance was read at 734 nm. The data analysed was presented as percentage inhibition. The percentages of enzyme inhibition for various concentrations were compared between the standard and L-carnosine. Results: The inhibitory percentages for α-glucosidase enzyme at concentrations of 20,40,60,80 and 100 μg/mL of L-carnosine were 28.61%, 36.01%, 45.33%, 53.05%, 62.70% respectively. The percentages for α-amylase inhibition at concentrations of 20, 40, 60, 80 and 100 μg/mL were 18.18%, 31.81%, 45.45%, 59.09% and 72.12%, respectively. The free radical scavenging activity by ABTS assay for 20, 40, 60, 80 and 100 μg/mL concentrations of L-carnosine were 34.40%, 36.65%, 38.04%, 40.51% and 43.30%, respectively. L-carnosine exhibited significant inhibition of α-glucosidase and α-amylase enzyme in dose-dependent manner. The result of the ABTS assay showed that L-carnosine possessed significant free radical scavenging property in a concentration-dependent manner. Conclusion: Results showed L-carnosine had considerable α-glucosidase inhibitory activity, α-amylase inhibitory activity, as well as, ABTS radical scavenging activity. The present findings indicate that L-carnosine has in-vitro antidiabetic and antioxidant activity. Hence, the present study supports further evaluation and use of L-carnosine for the management of diabetes and as an antioxidant in nutraceuticals.

Effects of Immobilised Stress on Neuronal Plasticity of Pyramidal Neurons in Prefrontal Cortex of Female Wistar Rats- An Experimental Study

Introduction: Stress is a normal response of an organism to any threat which can be physical, emotional or psychological. Positive stress is called eustress whereas negative stress is distress. Neuronal plasticity is a term which indicates the changes in brain. There can be structural and functional neuroplasticity. Aim: To study the neuronal plasticity (dendritic branching pattern and their lengths) of pyramidal neurons in Prefrontal Cortex (PFC) of female wistar rats after immobilised stress. Materials and Methods: It was an experimental study conducted in Nepalese Army Institute of Health Sciences, Kathmandu, Nepal, from May 2021 to July 2022. Based on the age, 24 female rats were divided into three groups; group A more than 12 weeks, group B 8 to 12 weeks and group C 3 to 7 weeks. Each group contained eight rats, of which, four were control and four were experimental. Experimental rats underwent immobilised stress. After stress protocol, rats were sacrificed and PFC was taken out and stained. The images of neurons were taken by confocal microscope. The neuronal reconstruction was done using Interactive Microscopy Image Analysis (IMARIS) software for dendritic lengths. The parameters in apical dendrite category-length of principal dendrite, branch points and lengths of different branches were compared between control and stressed groups. In basal dendrite category-number of basal dendrites, lengths of different basal dendrites and branch points were compared between control and stressed groups using unpaired t-test. The data was analysed with Statistical Package for Social Sciences (SPSS) version 20.0. Results: It was observed that there was a statistically significant increase in all basal dendrite parameters in experimental category as compared with controls in group A with p-value <0.001, and in group B, significant increase in branch points with a p-value <0.001 in experimental category, and significant increase in branch length of basal dendrites in group C of experimental rats with p-value <0.001. The parameters related to apical dendrites of pyramidal neurons also showed significant shrinkage in experimental rats as compared to control groups. Especially in group C, all the apical dendrite parameters were significantly decreased compared with control group (p-values 0.013, 0.001 and 0.006 for principal dendrite’s length, branch points and branch lengths, respectively). Conclusion: Stress induces neuronal plasticity in pyramidal neurons of PFC of rats. Findings of this study suggest stress induces significant increase in the basal dendrite parameters of pyramidal neurons of PFC of all age group of rats, especially in the rats of more than 12 weeks age and significant shrinkage of apical dendrites was seen in all age group of rats and more so in the rats between 3 to 7 weeks of age.

PTEN Immunoexpression in Atypical Endometrial Hyperplasia and Endometrioid Endometrial Carcinoma: A Research Protocol

Garima Akhil Chandrakar, Arvind Bhake, Sunita Vagha

Introduction: One of the major cancers affecting women is of Endometrial Carcinoma (EC). Therefore, its molecular characterisation remains important. Phosphatase and Tensin Homolog (PTEN) gene defects are one such molecular pathology commonly seen in lesion of atypical endometrial hyperplasia and EC. However, studies on PTEN immunoexpression in India are scarce. Aim: To study immunoexpression of PTEN and its correlation with various clinicopathologic parameters in lesion of atypical endometrial hyperplasia and EC. Materials and Methods: The study will be conducted in Department of Pathology for duration of two years from April 2022 to March 2024. It will be carried out as a cross-sectional study with prospective and retrospective design with sample size of 20 cases each in two groups- cases diagnosed on biopsy or surgical specimen of atypical endometrial hyperplasia and endometrioid endometrial carcinoma type -1, dividing them into sample size of 20 for each group. PTEN immunoexpression will be observed by immunohistochemical method on paraffin section of the tissue. The study would make the observation on the PTEN positivity by IHC in atypical endometrial hyperplasia and type-1 EC. The positive research of IHC will be compared for various other clinicopathologic parameters will be included in the study for both the endometrial lesion. The statistics of comparison will be drawn by using standard statistical test.

Effect of Injectable Platelet-Rich Fibrin and Micro-Osteoperforation on Accelerated Orthodontic Tooth Movement: Protocol for a Split-Mouth Randomised Clinical Trial

Kushal Taori, Priyanka Niranjane

Introduction: Orthodontic treatment is often perceived as time-consuming by patients. Various techniques have been developed to accelerate treatment and reduce its duration, but there is limited literature supporting their efficacy and advantages. This study aims to compare the effectiveness and acceptability of two methods in accelerating orthodontic tooth movement, providing valuable insights for clinicians. Need for the study/Rationale: Injectable Platelet-Rich Fibrin (i-PRF) and Micro-Osteoperforation (MOP) are two modalities known to accelerate tooth movement. i-PRF is a chemical modality, while MOP is a minimally invasive mechanical procedure. Both stimulate osteoclastic inflammatory cytokines, facilitating rapid tooth movement. However, there is limited evidence comparing the efficacy of these two methods. By comparing the mechanical i.e. MOP and chemical i.e. i-PRF modes of accelerated orthodontics, this planned protocol will study to determine the most feasible treatment modality based on objective patient outcomes, rate of tooth movement, and advantages/disadvantages. Aim: To evaluate and compare the effects of i-PRF and MOP on accelerated orthodontic movement in a young adult population. Materials and Methods: This split-mouth prospective randomised study will involve 10 participants selected from the departmental Out Patient Department (OPD) based on inclusion and exclusion criteria. Informed consent will be obtained. The participants will be divided into two groups: Group A: Undergoing MOP Group B: Undergoing i-PRF Group allocation (left or right side) will be randomised. The rate of maxillary canine retraction will be measured after intervention in both study groups. Expected results: Both i-PRF and MOP are expected to accelerate orthodontic tooth movement, with MOP being more effective in this regard.

Ocular Exercises as a Non Conventional Approach towards Tension-type Headache: A Narrative Review

Pranali Mahendra Pachkhede, Rajat Manoj Singh

Tension-type Headaches (TTH) are the most prevalent type of headache, with upto 78% of people experiencing them at some point in their lives. In comparison to migraine, TTH is more incapacitating and results in more lost workdays. TTH has multifactorial aetiology which is thought to involve both, hereditary and environmental elements. There are three types of TTH: episodic, chronic, and frequent episodic. Patients describe their headache as tightness around the head, pressing, and dull. Studies on the impact of eye movement have been conducted and only top-notch experimental trials were applied in the study. Physiotherapy is one of the most effective method but at the same time, not much preferred by people due to lack of awareness. By the present review, it would be helpful, as people will start to use physiotherapy approaches. A moderate risk of bias was detected in the quality critical appraisal. With the information at hand, only a narrative description could be included. The present research only identified a few low quality studies, but its results imply that, ocular exercises can effectively alleviate primary headache and symptoms. More rigorous methodological standards and high quality Randomised Control Study (RCTs) are needed to validate and further understanding of the effects of organised workouts aiming to reduce pain intensity and frequency, symptoms, and medication use, among other things, in the treatment of primary headaches.

Treatment of the Cubital Tunnel Syndrome of the Ulnar Nerve in the Elbow Area: A Review Article

Saran Malisorn

The common neuropathy Cubital Tunnel Syndrome (CuTS) causes sensory impairment. Numerous patients also exhibit muscle atrophy as a symptom of severe and persistent nerve damage, which typically portends a poor prognosis. In the majority of individuals with minor nerve dysfunction, nonsurgical treatment aimed at reducing both compression and traction on the ulnar nerve at the elbow is successful. The optimum care for a patient with this pathology requires prompt and accurate evaluation, diagnosis, and testing, as well as evidence-based therapy choices. The goal of this review article was to offer an updated summary of the most recent research on the results of several surgical procedures for CuTS. A clinician must use the available information to develop a diagnosis and treatment plan that are unique to the patient. The most effective surgical methods for CuTS need to be discovered through more in-depth scientific investigation.

Prevalence of Neck Pain in Car and Motorcycle Drivers: A Comprehensive Review of Primary, Secondary, and Tertiary Care

Car and motorcycle drivers frequently experience neck pain, which may have an impact on their quality of life and productivity at work. Understanding the prevalence of neck pain in this population and identifying effective interventions was essential for developing targeted healthcare strategies. The purpose of this review was to determine the prevalence of neck pain among car and motorcycle drivers and assess the effectiveness of primary, secondary, and tertiary care interventions in managing and preventing this health issue. A comprehensive literature search was conducted to gather relevant studies on neck pain prevalence and interventions among drivers. The collected data was analysed and synthesised to provide an in-depth understanding of the issue. The result of this review reveals a significant prevalence of neck pain among car and motorcycle drivers, highlighting the need for targeted interventions. Primary, secondary, and tertiary care strategies are essential in addressing neck pain in this population. Primary care interventions focus on preventing the onset of neck pain, while secondary care aims to manage existing symptoms and prevent their worsening. Tertiary care interventions involve rehabilitation and long-term management of chronic neck pain. The present review concluded that a multi-faceted approach, encompassing primary, secondary, and tertiary care interventions, is necessary to prevent and manage neck pain in drivers. However, the current evidence base has limitations, and further research is required to enhance our understanding of effective interventions for this population.

Pulp Stones as a Warning Sign for Coronary Artery Disease- A Narrative Review

Globally, Coronary Artery Disease (CAD) has been the main factor in both morbidity and mortality. However, Pulp Stones (PS) that span the entire dentition are uncommon and require additional analysis to determine the likelihood of other related disorders. PS formation is more likely to occur in individuals with systemic illnesses including diabetes mellitus and cardiovascular disease. Calcifications of dental pulp may have a similar pathogenesis as calcified atheromas. When compared to diabetic and healthy people, patients with systemic disease in the cardiovascular group had a higher probability of developing PS. More than half of the teeth in early adolescents have localised pulp calcifications that may be seen under the microscope. The detection of PS in a patient with unidentified systemic disorders can serve as an early diagnostic sign.

Neuroscience of Cognitive Adaptations in Space: A Review Article

Harshita, Sourya Acharya, Samarth Shukla, Mansi Khare, Ankita Sachdev

The brain can continuously adapt to changing circumstances and environmental needs. Astronauts must adjust to a brand-new, weightless environment in space. Numerous space mission-specific environmental factors may impact neurocognitive function. Previous research has found that multiple psychomotor functions, such as postural control, accuracy of movement patterns, internal synchronisation, spatial orientation, and the neurological management of ongoing work, have deteriorated during space flight. Apart from disease and injury, toxic radiation, decompression mishaps, pharmaceutical side-effects, and excessive radiation exposure may all impact neurocognitive performance in space. Computerised exams and exercise equipment are just a couple of the instruments developed to evaluate and address these deficiencies and issues. How the brain will adjust to extended space travel is still a mystery. This review article thoroughly analyses state-of-the-art and upcoming challenges in cognitive neuroscience in space, from analog missions and computer simulations to orbit around the Earth and beyond. Thus; the aim of this review is to provide a better understanding of the various phases that our brain undergoes while exposed to entirely different environments.

Treatment Modalities of Cutaneous and Genital Warts: A Narrative Review

Nidhi Pugalia, Adarsh Lata Singh, Meenakshi Chandak

Human Papillomavirus (HPV) are non enveloped Deoxyribonucleic Acid (DNA) viruses, sized between 50-55 nm, that form two distinct groups to cause epithelial proliferation at cutaneous and mucosal surfaces, which are mostly benign. With more than 100 different HPV types, estimated 30-40 strains affect human genital tract. Of which, 16, 18, 31, 33, 35, 39, 45, 51, 52, and 5 are the oncogenic (high-risk) types associated with cervical, vulvar, vaginal, and anal cancers, and 6, 11, 40, 42, 43, 44, and 54 are non oncogenic (low-risk) types and are associated with genital warts. HPV 6 and 11 are more commonly associated with genital warts and are also responsible for approximately 90% of these lesions. Despite a series of modalities available to treat HPV, that range from topical to immunotherapeutic modalities to surgically destructive procedures, there is no promising, stand-alone modality which still is a cause of dilemma for dermatologists while treating warts. The present article reviews all the treatment modalities commonly applied in practice and also the areas less explored by their level of evidences.

A Case Report of Ring Tourniquet Syndrome: A Paradigm of Danger

Ring Tourniquet Syndrome (RTS) is a rare but potentially serious condition that occurs when a small, tight object such as a hair, thread, or string becomes wrapped around a finger, toe, or other body part, creating a tourniquet-like effect. This can lead to tissue damage, swelling, a bluish colour of the finger, and in severe cases, loss of the affected digit or limb. Here, we present a case of an 11-year-old female patient who was diagnosed with RTS due to a metallic latch on the left index finger. The patient was managed with the removal of the latch under local anaesthesia in the operating theatre and regained full range of motion without any signs of ischaemia on a 2-week follow-up. This case report highlights the successful salvage of a finger affected by RTS through prompt recognition and appropriate intervention.

The Effect of Dynamic Neuromuscular Stabilisation on Core Strength: A Literature Review

Purva Gulrandhe, Rakesh Krishna Kovela

Training to improve the stability of the core is a routine component of the injury prevention regimen in the musculoskeletal conditions. The strength of the core muscles is significantly impacted by obesity. Obesity is linked to several physiological changes that reduce flexibility and cardiovascular fitness and slow down a person’s activities. Dynamic Neuromuscular Stabilisation (DNS) which is an approach for optimising the movement system is a rehabilitation approach founded on the original concept of developmental kinesiology. The DNS therapy method is based on a thorough analysis of the quality of stability and/or movement, to restore the integrated spinal stabilisation system through specialised functional exercises. All elements of the integrated spinal stabilisation system are co-activated in this, making it a holistic approach to treating any ailment. It’s been tried and tested for a variety of neurological and musculoskeletal problems. The approach of DNS has recently gained popularity. This method is mostly used to strengthen the core. The aim of the review is to find out effect of DNS on core strength in various neurological and musculoskeletal conditions. Further research is mandated in terms of interventional studies to prove its efficacy in various orthopaedic and neurological conditions.

A Case of Disseminated Tuberculosis Presenting as Scrotal Swelling

Revathi Rajagopal, Senthil Kumar Aiyappan

A 28-year-old male patient presented with right-sided scrotal swelling and pain for the past two months. He had a history of loss of appetite and weight, as well as fever for the past 10 days. He had no co-morbidities. Complete blood count and blood chemistry, including fasting blood glucose, renal, and liver function tests, were normal. Scrotal Ultrasonography (USG) revealed an enlarged right testis and epididymis with heterogeneous echotexture in the right testis and multiple small hypoechoic lesions within it. There was also a focal fluid collection with septations in the right scrotal sac, adjacent to the epididymis (Table/Fig 1)a,b. Increased vascularity in the testis and epididymis indicated inflammation. These ultrasound findings suggested right epididymo-orchitis with an abscess in the extratesticular space of the right scrotal sac, near the epididymis. Abdominal ultrasound was normal. Chest X-ray revealed multiple miliary nodules in both lung fields and a small left-sided pleural effusion, which was confirmed on chest CT (Table/Fig 2)a,b. Contrast-enhanced Magnetic Resonance Imaging (MRI) of the brain showed multiple small enhancing lesions in the bilateral cerebral and cerebellar hemispheres, as well as the brainstem, with smooth leptomeningeal enhancement. These findings were suggestive of multiple tuberculomas with meningitis (Table/Fig 2)c,d. The patient later underwent drainage of right scrotal abscess and right epididymo-orchidectomy, as the epididymis had sloughed-off due to infection (Table/Fig 3). Mycobacterium tuberculosis was detected in the pus sample using the Mycobacterium tuberculosis Deoxyribonucleic Acid (DNA) test, with no resistance to rifampicin. The patient responded well to antitubercular therapy and is currently being followed-up.

Correction: 2021 June:15(6): DC27-DC29

Rokkam Meher Krishna Priyanka, Devnikar V Anushka, Subramani Parimala, Seenappa Hariprasad Microbiological Profile of Pin Tract Infections due to External Fixators (Published in Journal of Clinical and Diagnostic Research. 2021 Jun,15(6): DC27-DC29 ) There was a correction in the Second author's designation.

Neonatal Dengue- A Case Series

Priya Margaret Alen, M Renumaheswari, MG Ravanagomagan, Ramitha Enakshi Kumar

Dengue is one of the commonest arboviral infections seen in children but in neonates, it is a disregarded entity. It can be acquired either through vertical (transplacental) or horizontal transmission (mosquito bite). It usually presents with fever, lethargy, poor feeding, and thrombocytopenia which can be accompanied by hepatosplenomegaly, transaminitis, fluid leak, petechiae, bleeding, Acute Respiratory Distress Syndrome (ARDS), shock and Acute Kidney Injury (AKI). Dengue shock in neonates responds well to dopamine if used early. A retrospective review of case records of five neonates admitted with dengue fever from October 2021 to October 2022 showed the neonates average age was 10 days and male:female ratio of 3:2. Three cases had horizontal and two cases had vertical transmission. All neonates presented with fever and were admitted within one week of illness. Petechial rashes and refusal of feeds were observed in two cases. Four cases had leukopenia whereas, all cases had thrombocytopenia. Sepsis was ruled out. Dengue Nonstructural protein 1 (NS1) antigen was positive in four cases. Immunoglobulin GM (IgM) antibody was positive in all while Immunoglobulin G (IgG) was negative in all cases. None of the cases had hepatic derangement except for mild transaminitis in three cases. Only two cases had severe thrombocytopenia requiring platelet transfusion, but none developed bleeding, plasma leakage, shock requiring inotropes or fluid overload. Mortality due to neonatal dengue was nil and the duration of hospital stay ranged between 6-12 days. In the vertically transmitted cases, isolation of the virus from the breast milk or cord blood was not done due to logistics. Therefore, dengue fever can be suspected as one of the differentials in any neonate presenting with fever, leukopenia, and thrombocytopenia mimicking sepsis, especially during the epidemic season.