Journal of clinical and diagnostic research

Ectopic Hidradenoma Papilliferum of Axilla: A Case Report

Purbasha Misra, Samarth Shukla, Rajesh Godavarthi

A benign adnexal tumour is a non cancerous growth located in the uterine tubes, ovaries, or near the uterus, including the surrounding connective tissue. While adnexal tumours can also be cancerous, they are predominantly benign. Moreover, adnexal masses can be non gynaecological, such as bladder diverticulum, appendicitis, apocrine gland tumours, sebaceous gland tumours, eccrine gland tumours and nerve sheath tumours. These tumours can occur at any age due to various causes. Some adnexal tumours are sporadic, while others may be linked to conditions such as Brooke-Spiegler syndrome and Birt-Hogg-Dubé syndrome. The tumours can be solid or fluid-filled and while some resolve spontaneously, others require therapy or surgical intervention. This case describes one such benign adnexal tumour: hidradenoma papilliferum, or papillary hidradenoma, which is a rare subcutaneous benign adnexal tumour of the apocrine glands in the anogenital regions. It typically occurs in females aged 30 to 50 years but is rarely reported in males. Hidradenoma papilliferum that is localised outside the anogenital region is referred to as ectopic. Ectopic presentations are primarily reported in the head and neck regions, especially on the external ear and eyelid, where modified apocrine glands are present. It is rarely reported in the nose, arm and axilla. This case report details a 53-year-old female who presented to the Surgery Outpatient Department (OPD) with a small swelling in her axilla accompanied by mild pain. Histopathological examination confirmed the nodular lesion as hidradenoma papilliferum. The location of the tumour was extremely rare and is often misdiagnosed as syringocystadenoma papilliferum and trichoepithelioma.

Anaesthetic Management of a Centrally Located Bronchial Carcinoid Tumour: Challenges in Airway Management and Perioperative Care

Shubhangi Humane, Dipti Rana, Shilpa Sarang Kore

Bronchial Carcinoid Tumours (BCT) is a rare form of neuroendocrine tumours with severe anaesthetic challenges since they are centrally positioned in the bronchial tree, which can make them highly problematic in airway management. Even though they are commonly indolent, sometimes they may obstruct the airway, cause bleeding, or occasionally precipitate a carcinoid crisis. Hence, proper preoperative preparation is essential. We present a case report on the anaesthetic management of a 58-year-old female admitted for the removal of a BCT by wedge resection complicated by bronchial asthma. She had a centrally placed endobronchial tumour, as was evident from imaging. To facilitate one-lung ventilation by intubating her with a Double-Lumen Tube (DLT), we utilised a video laryngoscope and a paediatric bougie. A thoracic epidural was placed to provide optimal pain control in the perioperative period. Because of the extensive invasion of the tumour, planned wedge resection was converted into a pneumonectomy. Following surgery, she was extubated on the first postoperative day and made an uneventful recovery without a carcinoid crisis. To manage the complexity of resections for BCTs, this case stresses the versatility of advanced anaesthesia techniques and good perioperative care.

Fibroepithelial Polyp in the Oropharynx: A Case Report

Aishwarya Verma, Mohak Kumar, Paresh Chavan

Fibroepithelial polyps are uncommon, benign hyperplastic lesions resulting from chronic irritation, typically found in the oral cavity but rarely in the tonsillar region. We present the case of a 21-year-old male with an 8-day history of a foreign body sensation in the right throat, insidious in onset and varying in intensity. The sensation was exacerbated by cold weather and spicy or oily foods. On clinical examination, a 1 cm soft, non-tender, fluctuant mass was identified in the right tonsillar fossa. Videolaryngoscopy corroborated the localised nature of the lesion, and a Computed Tomography (CT) scan of the neck and chest revealed no significant abnormalities. Given the benign presentation, surgical excision was performed using a tonsillar snare under general anaesthesia. Histopathological analysis confirmed a fibrovascular polyp lined by hyperplastic stratified squamous epithelium, with no evidence of malignancy. The patient recovered uneventfully post-surgery. Although rare in the tonsillar region, fibroepithelial polyps should be included in the differential diagnosis of benign oropharyngeal masses. Surgical excision remains the definitive treatment, with Histopathological Examination (HPE) essential for diagnostic confirmation.

The Domino Effect: Hyperventilation, Hypocapnia, and Tetany in Airway Management

Subha Teresa Jose Vazhakalayil, Sandeep Veer, Brinda Badam, Jayant Mane

Airway management represents one of the most critical challenges in anaesthesiology, particularly in patients with history of head and neck surgeries due to altered anatomy. Routine procedures like tracheostomy can occasionally present with unforeseen challenges, demanding prompt adaptability. We describe a case involving a 60-year-old female with bilateral vocal cord palsy following thyroidectomy for Hashimoto’s thyroiditis four years ago. The patient had undergone a modified Dennis Kashima procedure, which involves injecting a bulking agent or placing a graft into the affected vocal cord to reposition it towards the midline, improving voice quality and airway protection in cases of vocal cord paralysis. The patient was tracheostomised for the first time under Local Anesthesia (LA) followed by Intensive Care Unit (ICU) stay for recovery two years ago and now came in for microlaryngoscopic biopsy under general anaesthesia in view of new onset persistent hoarseness of voice and progressive dyspnoea. The complication in our case arose due to repeated failed attempts in securing the airway, prompting anxiety and rapid breathing which in no time led to systemic complications like hyperventilation induced hypocapnia and hypocalcaemia which eventually landed patient to present with classical signs of tetany, supported by arterial blood gas analysis, confirmed hypocalcaemia (0.59 mmol/L). The condition was managed successfully with rebreathing using a Bain’s circuit and intravenous calcium gluconate, which restored patient stability. This case shows the importance of the anaesthesiologist in unpredictable airway management scenarios along with neutralising the systemic complications like hypocalcaemia a potentially life-threatening condition that can precipitate neuromuscular irritability, seizures, arrhythmias, and cardiac arrest, if left uncorrected at the same time. Preparation, teamwork, flexibility, and vigilant monitoring in such a difficult situation are far more elemental to the practice of true optimal patient care.

Successful Iohexol Sclerotherapy for Non-parasitic Chyluria: A Case Report

Shashikant Asabe, Onkar Sangha, Vikram Satav, Vilas Sabale

Chyluria is a medical condition characterised by the passing of milky urine due to the abnormal drainage of lymphatic fluid, known as chyle, into the urinary tract. This condition can result from a variety of aetiologies, both parasitic and non-parasitic, with Wuchereria bancrofti being the primary causative agent. Diagnosis includes clinical presentation, laboratory investigations, and imaging studies. Management encompasses a wide array of conservative therapies and surgical interventions. A 60-year-old male presented with chyluria and chyle clots for one year. He had received medical treatment for filariasis and dietary modifications at various hospitals before being referred to this centre. The patient was investigated and diagnosed with non-parasitic chyluria due to a left pyelo-lymphatic fistula and subsequently underwent sclerotherapy with Iohexol contrast, which resulted in complete resolution. This minimally invasive procedure involves the injection of a contrast agent that helps seal affected lymphatic vessels, preventing further chyle leakage into the urinary system. Severe chyluria can be effectively managed with Iohexol contrast sclerotherapy. This case underscores the importance of timely intervention and the use of sclerotherapy with Iohexol contrast as a treatment for severe chyluria, offering a promising therapeutic option for patients with persistent or complicated cases.

Combined Effects of Wall Squat and Treadmill Walking Exercises on Pain and Functional Disability in Non Specific Chronic Low Back Pain: A Case Report

Prem Jiteshkumar Shah, S Aravind

Low Back Pain (LBP) is the most prevalent musculoskeletal condition worldwide, significantly affecting daily functioning and quality of life. It is mostly non specific in about 90% of cases, where there is no identifiable disease or structural reason to explain the pain. Physiotherapists play a key role in managing patients with chronic LBP. They use various strategies to alleviate pain, enhance pain tolerance, reduce stress on the lumbar region, strengthen lumbar stabilisers and improve functional abilities. Numerous studies have demonstrated the positive effects of isometric strengthening and aerobic exercise in chronic pain conditions. In this context, the authors present a case of a 22-year-old female patient, demonstrating the positive benefits of a combination of wall squat and treadmill walking exercises to improve pain and functional disability in a patient suffering from non specific chronic LBP.

A Case of Psychogenic Polydipsia in an Elderly: An Overlooked Diagnosis

Bhumika Vaishnav, Harshitha Ummaleti, Saish Mondkar, Bhavin Sanghani, Kshitij

Primary polydipsia, or psychogenic polydipsia, is characterised by excessive fluid intake without an underlying physiological cause. If left untreated, primary polydipsia may result in life-threatening hyponatremia and can lead to complications such as nausea, vomiting, confusion and seizure episodes, potentially becoming life-threatening if not recognised and managed early. The aetiology of this condition is incompletely understood and is frequently attributed to psychiatric disorders, most commonly chronic schizophrenia. Psychogenic polydipsia occurs in up to 20% of psychiatric patients, and this case serves as a reminder to be cognisant of water overconsumption. This case report presents a 74-year-old male with a three-year history of excessive thirst and polyuria, which worsened following the death of his elder brother. Laboratory investigations showed normal random blood sugar and HbA1c levels, normal renal and liver function tests and mild hyponatremia, while radiological investigations were grossly normal. Ultimately, a water deprivation test ruled out diabetes insipidus, leading to a diagnosis of primary polydipsia. The patient was started on oral medication and psychotherapy after diagnosis, and he improved significantly with treatment. He was discharged on oral atypical antipsychotics, with water restriction and regular psychotherapy sessions for further improvement. This case highlights the importance of a thorough diagnostic evaluation of excessive thirst in elderly patients and the necessity of initiating appropriate treatment, which can prevent complications such as severe dilutional hyponatremia in this population.

Impression Technique for Crafting Precise Cast Metal Posts in Permanent Anterior Teeth: A Report of Two Cases

Joyeta Ghosh, Anandamoy Bagchi, Brahmananda Dutta, Anubhav Roy, Amitava Bora

Restoring endodontically treated young permanent anterior teeth with significant structural loss presents considerable restorative challenges, necessitating durable and well-fitting treatment options such as custom cast metal posts. Achieving precise post space impressions is critical for success; however, conventional methods have limitations. This case report presents two clinical cases involving three anterior teeth with large canals and introduces a direct technique for crafting custom cast metal posts, evaluated for its dimensional accuracy and clinical fit. Three young patients requiring post-and-core restorations following endodontic treatment of anterior teeth were managed using this technique. Subsequent fabrication and cementation of cast metal post-cores resulted in restorations demonstrating satisfactory volumetric accuracy, dimensional stability, and overall fit upon radiographic evaluation by independent examiners. No adverse postoperative signs or symptoms were observed during follow-up periods of three to six months. This technique proved to be a cost-effective, clinically efficient, and accurate method for obtaining post space impressions, particularly suitable for the large, tapered canals often found in young permanent anterior teeth. It offers a viable alternative to traditional materials, although further long-term clinical studies are warranted on different post space impression techniques.

Massive Ovarian Oedema in a 23-year-old Patient: A Case Report

Massive Ovarian Oedema (MOE) is a rare gynaecological disorder that has been rarely reported in our country. Approximately six cases have been reported previously in India. The lesion may either present as a primary disease or develop secondarily, subsequent to an ovarian lesion or pregnancy. Moreover, the primary lesion may induce strangulation of blood vessels and lymphatics, resulting in ischaemia. If abdominal pain persists, the patient may require laparoscopic salpingo-oophorectomy. A 23-year-old female in the reproductive age group developed pain in the lower pelvic region. Upon examination, she exhibited unilateral enlargement of the right ovary. On palpation, an abdominal/pelvic mass was noted. The patient underwent surgery. The ovary was sectioned, and several slices of approximately 1 cm thickness were prepared. A significant amount of water-like serous fluid emerged from the cut surface. A few areas with a gelatinous appearance were also observed. Other findings from the current lesion included necrosis and haemorrhage, along with signs of fibrosis. Extensive fibrosis may lead to strangulation. Most of the cysts contained watery serous fluid. Persistent strangulation of the ovarian pedicle might have resulted in massive oedema. The presence of adult worms of Enterobius vermicularis in the appendix of the patient with MOE might have an aetiological role.

Segmental Spinal Anaesthesia with Sequential Hyperbaric and Isobaric Ropivacaine for Laparoscopic Hysterectomy in a High-risk Kyphoscoliosis Patient: A Case Report

Anupama Kumari, Jigisha Mehta, Sara Mary Thomas

Anaesthesia management in patients with multiple comorbidities and anatomical challenges poses significant perioperative risks when scheduled for complicated surgeries. This case report highlights the successful application of sequential hyperbaric and isobaric ropivacaine in segmental spinal anaesthesia in a 65-year-old female patient with kyphoscoliosis and multiple comorbidities undergoing Laparoscopic-Assisted Vaginal Hysterectomy (LAVH). Her comorbidities included bronchial asthma, type 2 diabetes mellitus, hypertension, hypothyroidism, ischaemic heart disease, and early-stage Chronic Kidney Disease (CKD). Her anaesthetic management was further complicated by a challenging airway (Mallampati grade III, limited mouth opening, and restricted neck movements), uncontrolled blood pressure, elevated blood glucose levels, and compromised renal status. Considering her complex medical profile and anatomical challenges, segmental spinal anaesthesia was chosen as the primary anaesthesia modality, with general anaesthesia as a fallback plan and the necessary instruments readily available. Surgical anaesthesia was achieved with two-drug sequential segmental spinal anaesthesia administered in the T9-T10 intervertebral space using hyperbaric ropivacaine 0.75% (9 mg) and isobaric ropivacaine 0.75% (11.25 mg), with a 60-second interval between the two drug injections. The operative course was uneventful, requiring only mild sedation and analgesia. A single episode of intraoperative hypotension and bradycardia was managed promptly. The patient experienced excellent postoperative analgesia and required intravenous analgesics eight hours after the surgery. She was later discharged uneventfully on the fourth postoperative day. This case demonstrates the feasibility and safety of using sequential hyperbaric and isobaric ropivacaine for segmental spinal anaesthesia in high-risk patients with anatomical challenges, offering a viable alternative to General Anaesthesia (GA) in complex surgical scenarios.

Gingival Depigmentation using Microneedling Technique and Hyaluronic Acid Mesotherapy: A Case Report

N Krithika, H Nilofer Farjana, Anitha Balaji, Ramya Vinayakam, J Angelin fiona

Gingival depigmentation is a common aesthetic procedure. Gingival pigmentation is primarily physiological due to the production of melanin. Various techniques have been practised to treat gingival depigmentation. Invasive techniques, such as the scalpel method, chemical peeling, and gingivectomy, may cause postoperative discomfort, risk of complications, and potential for gingival recession. To overcome these issues, a novel therapeutic modality called Microneedling (MN), utilised in dermatology, has been investigated for gingival depigmentation. Recently, in the field of dermatology, a technique known as MN, which involves repetitive puncturing, has been widely applied. It is simple, economical, and demonstrates good tolerability in patients. Additionally, this technique provides a dual benefit in both cosmetic and therapeutic realms. Hyaluronic Acid (HA) has anti-oedematous and anti-inflammatory effects and accelerates tissue recovery. In the present case, MN-assisted gingival depigmentation was performed in combination with 0.8% HA gel. It was observed that the Dummett-Gupta Oral Pigmentation Index (DOPI) scores gradually reduced on the 7th, 14th, and 21st day, and the results were found to be clinically predictive.

Management of a Complex Urethrovaginal Fistula Post-pelvic Injury in a Young Female: A Rare Case Report

Vilas P Sabale, Amala Anant Ghalsasi, Vikram P Satav

Urethral injuries associated with pelvic fractures in female patients are a rare condition. The diagnosis and management of traumatic injury to the female urethra are not well-understood, as the literature on the subject is very limited. Hereby, the authors present a case of a 29-year-old female patient who presented with continuous incontinence. The patient had a history of trauma while riding a bicycle 18 years ago, resulting in a pelvic fracture, bladder rupture, and urethral rupture. She was managed with fracture fixation, bladder repair, and Suprapubic Catheter (SPC) insertion. Urethral repair was performed after six months, but the patient remained incontinent. Upon presentation to our hospital, the patient was diagnosed with vaginal stenosis and a large urethrovaginal fistula. She was managed with vaginoplasty followed by urethrovaginal fistula repair using gracilis muscle interposition. This procedure failed, resulting in the recurrence of the Urethrovaginal Fistula (UVF) and ongoing incontinence. The patient was re-operated, and fistula repair was accomplished using a local vaginal flap. This case highlights the complex nature of urethral injury in females, the challenges posed by delayed complications, and the necessity for multiple procedures.

Giant Proliferating Trichilemmal Tumour: A Case Report

A Trichilemmal Cyst (TC), which can also be referred to as a trichodermal cyst or trichodermal isthmus-degenerative cyst, is a noncancerous growth on the skin that arises from the outer sheath of hair follicles and is characterised by its rare occurrence and limited documentation. Herein, we report a 54-year-old female who presented with a swelling over her scalp for 15 years, which gradually progressed to a size of 8×5 cm. Computed Tomography (CT) scan revealed an extra-cranial well-defined lobulated heterogeneously enhancing isointense lesion with specks of calcification above the occipital bone in the midline with no intracranial or bony extension, likely benign in aetiology. She underwent surgical excision of the entire swelling, and histopathological analysis confirmed the diagnosis of Proliferating Trichilemmal Tumour (PTT) with squamous differentiation. The wound healed well without any recurrence after a follow-up of one year. Inspite of their enhanced propagation, TCs are usually benign and non-invasive. But in a few cases, these can transform to trichilemmal carcinoma, these carcinomas may cause local invasion, resulting in significant morbidity and mortality.

Creative use of Clear Aligners with Tongue Spikes for Open Bite Correction: A Case Report

Anterior Open Bite (AOB) is a complex dental condition caused by a variety of factors, including genetics, environmental influences, and functional issues. Managing AOB presents considerable challenges due to the high likelihood of relapse, particularly in cases linked to tongue dysfunction. Accurate diagnosis and thorough treatment planning are essential, especially when addressing factors such as tongue posture, which impacts speech, swallowing, and chewing. Achieving and maintaining an ideal overbite is particularly challenging, making it one of the most difficult aspects of orthodontic treatment. This case report demonstrates the effectiveness of using clear aligners with sharpened tongue spurs to address orthodontic relapse, misalignment, and AOB in an adult female patient. The application of a mandibular clear aligner combined with a tongue spike successfully treated the AOB caused by the patient’s tongue rest posture, leading to improved aesthetics, function, and patient satisfaction. The patient’s compliance with the aligner and adherence to proper tongue posture were crucial, similar to the requirements when using Temporary Anchorage Devices (TADs), multiloop archwires, and vertical elastics. Strict adherence to the clear aligner regimen was essential for achieving favourable results. Additionally, while it is generally recommended to consult with a myofunctional therapist before and during orthodontic treatment, in this case, the patient did not attend any such consultations. By combining functional effectiveness with a minimally invasive, aesthetic, and patient-centred approach, this method provides a valuable option for managing AOB associated with abnormal tongue posture. The results from this case highlight the potential for integrating innovative techniques into clear aligner therapy to achieve optimal outcomes in adult orthodontic treatments.

Conservative Treatment of Medial Meniscus Tear through Ayurveda: A Case Study

Mahesh Sharma, Sourabh Deshmukh, Nitika Senger

Meniscal tears are common knee injuries caused by acute trauma in younger individuals and degenerative changes in older adults, often linked to osteoarthritis. The menisci play a crucial role in shock absorption, load distribution, and knee joint stability. In Ayurveda, meniscal tears can be correlated with Sira Snayu Gata Vata (vascular and ligamentous disorder). A 47-year-old male presented with pain, swelling, tenderness, and restricted movement in the right knee for six months. He was advised to undergo Magnetic Resonance Imaging (MRI) investigation by a physician, which revealed a medial meniscus tear in the right knee joint. In clinical examinations, the McMurray test, Apley grind test, and the bounce home test were positive. Ayurvedic treatments, including Shodhan (bio-purification) and Shaman (palliative) therapies, were administered as an alternative to corticosteroids, aimed at reducing potential complications. This study evaluates the effectiveness of Ayurvedic treatment and rehabilitation strategies in improving functional outcomes for meniscal tears. In cases of medial meniscus injury, meniscectomy is often performed surgically. This case study demonstrates significant improvement in the assessment parameters of medial meniscus tears with Ayurvedic treatment and rehabilitation therapies, highlighting their potential as a non-invasive therapeutic approach for meniscal injuries.

Laparoscopic-assisted Open Surgery for Bochdalek Hernia with Gastric Volvulus Involving Multiple Organs: A Case Report

Xinxi Yang, Shihong Li, Pan Nie, Kehao Liu, Kang Hou

Bochdalek hernias are a rare form of diaphragmatic hernia that are usually asymptomatic and typically observed in children. In adults, they are rare and often detected incidentally through imaging. Acute gastric torsion is an uncommon condition in clinical practice, and without timely intervention, life-threatening complications such as gastric strangulation, perforation, and shock may ensue. This case report describes a 74-year-old female patient who presented with abdominal pain and bloating. Following a physical examination and Computed Tomography (CT) scan, the patient was diagnosed with gastric volvulus due to a left Bochdalek hernia. The stomach, spleen, colon, and left kidney were also affected. The patient underwent a successful laparoscopic-assisted open surgical procedure, showing a positive recovery with no complications, and was discharged one week after the operation. At the six-month follow-up, there were no signs of hernia recurrence or other discomfort. During the surgical procedure, it was ascertained that the patient exhibited organ-axial gastric torsion, a condition characterised by the rotation of the stomach around the axis connecting the pylorus and the oesophageal junction. The combination of Bochdalek hernia with gastric volvulus obstruction represents a rare clinical entity, particularly when complicated by the involvement of multiple organs within the hernial sac. Any therapeutic delay in such cases may result in organ necrosis and potentially fatal outcomes. This case emphasises the necessity for meticulous diagnostic and management strategies for Bochdalek hernias, particularly in instances involving multiple organs, to avert complications such as organ necrosis.

Granulomatosis with Polyangitis: Rare Cause of Oral Ulcer in Paediatric Patient

Granulomatosis with Polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is part of a vast spectrum of diseases entitled Anti-Neutrophil Cytoplasmic Antibodies (ANCA)-associated vasculitides. It predominantly presents in adults and is associated with necrotising vasculitis, primarily affecting small to medium vessels. An oral ulcer is one among the myriad clinical presentations of GPA. A long-standing solitary oral ulcer of the oral mucosa can also be the clinical presentation of many different diseases and always poses a significant diagnostic challenge. Appropriate clinical and investigative work-up is required to reach the correct diagnosis. Timely intervention and management are also important in reducing the morbidity and mortality associated with such conditions. Hereby, the authors presents a case of a 13-year-old female patient who complained of a solitary ulcer in the mouth. Additionally, she had a history of recurrent nasal ulcers and epistaxis but did not report any other symptoms. Clinical examination showed nasal ulcers, a solitary ulceroproliferative lesion in the maxillary region and strawberry gingivitis. A systematic investigative work-up was conducted to reach the correct diagnosis and the condition was well-managed with appropriate immunosuppressive therapy.

Chronic Subdural Hygromas, Cerebral Atrophy, and Developmental Delay following Paediatric Traumatic Brain Injury: A Case Report

Damam Sreeharsha, RJ Meshram, Amar Taksande

Traumatic Brain Injury (TBI) contributes significantly to the burden on healthcare systems. The variability in patient profiles and injury mechanisms complicates prevention, diagnosis and treatment, limiting advancements in the field. Although imaging modalities like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are essential in the diagnosis of TBI, they may miss subtle lesions. Children with TBI are at a high-risk of long-term neurological sequelae and these include seizures and developmental delays. This case report presents a six-year-old male child, fifth of birth order born out of non-consanguineous marriage, with developmental delays following history of fall at 2-3 months of age. Initial imaging studies reported bilateral Subarachnoid Haemorrhage (SAH) and inter-hemispheric bleeding. Subsequent scans revealed right-sided subdural hygroma and ischaemic infarcts. MRI brain findings demonstrated gliosis and cystic encephalomalacia. The patient developed Generalised Tonic-Clonic Seizures (GTCS), which were controlled with anticonvulsants. Later anticonvulsants were discontinued after a seizure-free period of two years. Upon recent admission, severe anaemia required blood transfusion and repeat MRI brain showed chronic subdural hygromas and cerebral atrophy. The patient was stabilised and discharged with ongoing developmental and neurological follow-up. This case underscores the significant long-term neurological and developmental consequences of paediatric TBI, highlighting the importance of early diagnosis, regular monitoring, and multidisciplinary management. Non-surgical approaches, combined with appropriate neuroimaging and clinical assessments, can effectively manage complications such as subdural hygromas and anaemia. Further research is needed to optimise care and improve outcomes for children affected by TBI.

Primary Mucosal Melanoma of the Nasal Cavity: A Rare Case Report

Manu S Babu, Saahiti Koppolu, Vinod V Shinde, Gundappa Mahajan, Yash Kalra

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare but increasingly reported malignancy, and typically diagnosed in patients aged 65-70 years. It commonly presents with unilateral nasal obstruction and epistaxis, often originating in the nasal septum or lateral wall. Diagnosis relies on immunohistochemical staining and is usually made at an advanced stage due to the tumour’s aggressive nature. They behave more aggressively than skin melanomas. This case report discusses a 76-year-old female who presented with bilateral nasal obstruction (left>right) for two months, with difficulty in breathing for one month. The examination revealed a bluish bleeding mass in the left nasal cavity. Preoperative endoscopic incisional biopsy revealed non-keratinising squamous cell carcinoma. The patient was subjected to total maxillectomy, and the final histopathological report came as mucosal melanoma. Early suspicion, especially in elderly patients with unilateral nasal obstruction or pistaxis, is critical. Timely biopsy, accurate histopathological diagnosis, and aggressive surgical management with adjuvant radiotherapy can improve local control, though the overall prognosis remains poor. Multidisciplinary follow-up and evolving molecular therapies offer hope for better outcomes in the future.

Unveiling McCune-Albright Syndrome in a Case of Ovarian Cyst with Bony Lesions: A Case Report

Mattummal Navab, Haneena Palakkal, Gomathy Subramaniam, John Paul Davis

McCune-Albright Syndrome (MAS) is a non-inherited disorder caused by missense point mutations in the GNAS1 gene located on the long arm of chromosome 20. It is a sporadic disease characterised by polyostotic Fibrous Dysplasia (FD), café-au-lait lesions, and a variety of endocrine disorders, including gonadal hyperfunction, hyperfunction of the thyroid and adrenal cortex, as well as excessive Growth Hormone (GH) secretion. The diagnostic triad includes polyostotic FD, precocious puberty, and café-au-lait lesions. When at least two of these are present, the diagnosis of MAS is confirmed. We present a case of an 18-year-old girl who presented with abdominal distension and a history of ovarian cystectomy. A detailed history revealed precocious puberty with vaginal bleeding at age three. Imaging showed a large, well-defined ovarian cyst with no solid component or septation. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) revealed multiple expansile lytic lesions with a ground-glass matrix in the pelvic bones, skull, and sphenoid, suggestive of polyostotic FD. Café-au-lait macules and hormonal findings pointed towards MAS. This case highlights the importance of considering MAS in young females with recurrent ovarian cysts, skeletal abnormalities, and early pubertal changes, as ovarian cysts with bony lesions do not always indicate metastasis and require careful evaluation to avoid misdiagnosis.

Pituitary Hyperplasia Secondary to Hashimoto’s Thyroiditis Mimicking Macroadenoma in a Child: A Case Report

Rajshree Uttamrao Dhadve, Bharat Jagdish Jotwani

Pituitary Hyperplasia (PH), which frequently occurs secondary to hypothyroidism, can mimic pituitary adenomas, necessitating accurate differentiation to avoid unnecessary surgical intervention. The present case report outlines the diagnostic journey of a six-year-old female who presented with clinical and imaging features suggestive of a pituitary macroadenoma. Surprisingly, thyroid function testing revealed coexisting Hashimoto thyroiditis and the patient was started on thyroxine replacement therapy for two months. Upon follow-up imaging, the size of the gland was reduced, leading to a revision of the diagnosis to PH. Herein, the authors emphasise the challenges in interpreting pituitary abnormalities in children, as conditions like hyperplasia can mimic tumours on imaging.

An Unusual Case of Sturge-Weber Syndrome with Squamous Cell Carcinoma of Tongue

Rajdeep Guha, Sukanya Naskar, Subhabrata Ghosh, Anannya Tripathy, Arnab Adak

Sturge-Weber Syndrome (SWS) is a rare congenital neurocutaneous syndrome affecting skin and soft tissues in the distribution of cranial nerve V, the ipsilateral cerebral hemisphere, and eye, with an incidence of 1 in 20,000 to 50,000 births, with no overall predisposition to developing cancers. There is a dearth of literature for the use of microvascular free flaps in SWS, and none pertaining to its use in oncological surgery for these patients, to the best of our knowledge. Free flaps have been used to reconstruct port wine stains in such patients. Hereby, authors present a case of a 52-year-old male having SWS who developed a Squamous Cell Carcinoma (SCC) of the tongue and was managed surgically, with the reconstruction being done with a free Radial Artery Forearm Flap (RAFF). The patient complained of ulcer over tongue since three months. He was already diagnosed case of SWS. Patient’s extraoral examination also revealed large hyperpigmented pinkish-brown patch with multiple nodules over the left half of his forehead, extending from hairline till the upper eyelid. The histopathology report showed a moderately differentiated SCC tumour with a maximum dimension of 3.2 cm, for which patient also received adjuvant radiotherapy. This case report demonstrates the safe use of free flaps in patients with head and neck cancers who have a history of SWS.

Ultrasound Imaging of Fournier’s Gangrene with Encased Scrotal Pyocele: A Case Report

Fournier’s Gangrene (FG), also known as necrotising fasciitis, is a rapidly progressive and potentially fatal disease affecting the perineum, as well as the genital and perianal body surfaces. An encased scrotal pyocele, an uncommon type of purulent collection in the scrotum, can be a risk-facilitating factor for FG, particularly in high-risk patients. We present a patient with a 10-year history of diabetes who presented with progressive scrotal swelling and pain for five days, during which he developed an encased scrotal pyocele that subsequently became complicated by FG. Timely surgical intervention was performed in the form of complete excision of the pyocele sac, accompanied by bilateral orchidectomy, followed by serial debridement until the formation of healthy granulation tissue. This case illustrates the rare progression of an encased scrotal pyocele to FG, supported by clinical findings, ultrasound, intraoperative observations, and post-operative imaging, highlighting the importance of timely multidisciplinary management.

Successful Management of Unexpected Massive Blood Loss during Robot-assisted Partial Nephrectomy: A Case Report

Sandip Baheti, Prashant Sakhavalkar, Runjhun Jain, Utkarshini Kedia, M Sharan

Robot-assisted Partial Nephrectomy (RAPN) for Renal Cell Carcinoma (RCC) is a minimally invasive surgery with reconstructive potential. Due to the high vascularity associated with RCC and the steep learning curve of robotic surgery, the risk of vascular injury is elevated. Authors hereby, report a case of a 50-year-old female scheduled for RAPN, which was later converted to open nephrectomy. During the surgery, there was an accidental massive haemorrhage and hypotension due to a sudden iatrogenic rupture of the Inferior Vena Cava (IVC). Although two units of Packed Cell Volume (PCV) and Fresh Frozen Plasma (FFP) had been reserved, massive haemorrhage and hypotension occurred suddenly, and as the blood bank was not in the same building, blood was not readily available. Additionally, managing the massive haemorrhage and hypotension was challenging due to spatial restrictions and the difficulty in accurately judging blood loss during robotic surgery. To maintain cerebral circulation, a head-down position with a left tilt was useful, as this positioned the heart at its most dependent position for maximum venous drainage. To save time and avoid delays in resuscitation authors implemented their implemented our Contact-Act-Coordinate-Correlate (CACC) protocol alongside clinical guidelines. The importance of prompt action and aggressive fluid transfusion until blood became available cannot be overstated; it is crucial not to wait for ideal fluids if they are not readily available, as maintaining microcirculation is a priority. Moreover, frequent laboratory investigations and correlation should not be neglected. However minimally invasive the surgery may be, prior blood grouping and cross-matching are essential for managing unexpected bleeding complications during such procedures.

An Anterior Abdominal Wall Alveolar Soft Part Sarcoma in a Child: A Case Report

Arthi Anandhan, K Chandramouleeswari, Umadevi Srinivasan

Alveolar Soft Part Sarcoma (ASPS) is a rare and aggressive soft-tissue sarcoma, constituting less than 1% of all sarcomas, with a predilection for young adults and occasional paediatric presentations. This case report highlights an eight-year-old girl who presented with a one-month history of a painless swelling in the left anterior abdominal wall. Clinical evaluation and imaging revealed a 4×3.5×2.5 cm enhancing soft-tissue lesion in the left rectus abdominis muscle, raising suspicion of malignancy. Excisional biopsy revealed histological features typical of ASPS, including solid nests of polygonal cells with eosinophilic granular cytoplasm, prominent nucleoli, and pseudo-alveolar architecture. Tumour cells exhibited mild atypia, necrosis, and vascular invasion. Periodic Acid-Schiff (PAS) staining demonstrated intracytoplasmic crystals, and Immunohistochemistry (IHC) confirmed TFE3 nuclear positivity and CD34 expression, confirming the diagnosis of ASPS. ASPS is associated with a specific translocation, der(17) t(x;17)(p11;q25), resulting in ASPSCR1-TFE3 gene fusion, which activates oncogenic pathways such as c-Mesenchymal Epithelial Transition (MET) signalling. The tumour’s propensity for vascular invasion and metastasis contributes to its poor prognosis, with the lungs, brain, and skeleton being the common metastatic sites. Standard chemotherapy is often ineffective, underscoring the importance of early diagnosis and complete surgical resection. This case underscores the diagnostic challenges and emphasises the need for molecular and immunohistochemical studies to distinguish ASPS from mimickers. Furthermore, it highlights the emerging role of targeted therapies and anti-angiogenic agents in improving outcomes for advanced or metastatic disease.

A Case of Sinonasal Neuroendocrine Tumour: Diagnostic and Therapuetic Challenge

Gundappa Mahajan, Megha Doiphode, Manu Babu, Mayur Ingale, Yamini Ingale

Sinonasal malignancies are rare, accounting for only 1% of all neoplasms. These tumours typically arise from the nasal sinuses and the regions of the base of the skull. They make up approximately 3% of all neoplasms in the aerodigestive tract. Sinonasal malignancies with neuroendocrine features are particularly uncommon head and neck tumours, many of which are associated with a poor prognosis. Sinonasal malignancies exhibiting neuroendocrine features require a detailed histopathological examination for accurate differentiation. In present case report, a 46-year-old female presented with a 6-month history of progressive nasal obstruction and open-mouth breathing, along with epistaxis for the past three months and right hemifacial pain for six months. Clinical examination revealed a mass in the right nasal cavity, prompting a biopsy that showed neuroendocrine carcinoma. Patient was subjected to coblator-assisted endoscopic complete excision of the mass, which was then sent for Histopathological Examination (HPE) subjected for Haematoxylin and Eosin (H&E) stains and Immunohistochemistry (IHC) showing Neuroendocrine Tumour (NET) with positive synaptophysin, positive chromogranin: positive, PanCK and CK5/6: Negative and a Ki-67 index of 10-15%, indicating low to intermediate-grade proliferation. Tailoring assessment and treatment strategies based on the tumour’s stage, grade and histopathological characteristics can significantly improve the precision of initial evaluations and enhance the effectiveness of treatments for sinonasal carcinomas with neuroendocrine features. To advance the understanding of treatment outcomes, multicentre research and collaborative efforts with standardised treatment protocols are critical. Although endoscopic resection has shown comparable results to conventional open resections, further long-term follow-up is necessary to understand the sustainability and efficacy.

Rectal Cancer Presenting with Isolated Thyroid Metastasis: A Case Report

Karan Sood, Pratiksha Tyagi, Amol Dongre

A 59-year-old female with chief complaints of white discharge per rectum for one month, pain in the lower abdomen for one month, and neck swelling for six months. She was diagnosed with adenocarcinoma of the rectum with a single site of metastases in the right lobe of the thyroid. The patient was given six months of FOLFOX, following which the rectal primary showed a complete response but stable disease in the thyroid lesion. The patient underwent a thyroidectomy, which confirmed a metastasis from the rectum. She was given radiation to the thyroid bed postoperatively and underwent chemoradiation for the rectal primary. She underwent a wait-and-watch approach and is disease free for two years. Thyroid metastases from Colorectal Carcinoma (CRC) are an uncommon clinical finding, accounting for 2-3% of all malignant tumors of the thyroid. The reported incidence in CRC patients is approximately 0.1%, with most cases involving extensive disease and poor prognosis. In the available literature, only 24 cases of thyroid gland metastases from CRC are reported. However, isolated metastases to the thyroid have been observed, raising diagnostic and therapeutic challenges. Fine-needle aspiration cytology and Immunohistochemistry (IHC), using markers such as Thyroid Transcription Factor-1 (TTF-1), Thyroglobulin (Tg), and CDX2, play pivotal roles in confirming the diagnosis. Advances in imaging, particularly Positron Emission Tomography (PET) scans, have improved detection rates. The vascular and lymphatic systems facilitate metastatic spread, yet the role of thyroidectomy remains controversial due to a lack of survival benefits. Chemotherapy and radiotherapy are typically reserved for palliation in cases of advanced disease.

Surgical Management of Sciatic Schwannoma: A Rare Cause of Sciatica

Saurabh Gawand, Rajesh Gattani, Arvind Chava, Apoorva Pande, Abhiram Chadive

Schwannoma are rare benign tumours of the peripheral nerve sheath, arising from the schwann cells. Sciatic nerve is the largest nerve of the human body, and sciatic schwannoma are rare, with incidence of <1% of total schwannomas. These tumours are often late diagnosed or misdiagnosed in view of varied clinical presentation. This is a case of a 42-year-old male with sciatic schwannoma, which was diagnosed after a year due to the presence of radiating pain moving towards the leg in difficulty in walking. Initial clinical presentation was noted as a small tender mass in the left thigh with progressive growth. The patient was initially managed medically for pain with Gabapentin (400 mg twice a day), but the presence of persistent pain led to surgical intervention by intensive screening using Magnetic Resonance Imaging (MRI) and conclude a diagnosis of sciatic schwannoma. It was successfully managed by surgical resection.

Deep Infrapatellar Bursitis: An Unusual Cause of Chronic Anterior Knee Pain

Knee pain is frequently reported in everyday orthopaedic practice. Inflammation of the bursa is a common and significant cause of knee pain, although the involvement of the Deep Infrapatellar Bursa (DIPB) is comparatively less prevalent. DIPB commonly occurs due to either direct trauma or overuse, but other rare causes have also been reported in the literature, including infection, juvenile idiopathic arthritis, gout, and juvenile ankylosing spondylitis. We present a case of a 25-year-old woman, a homemaker, who presented with complaints of chronic left knee pain on the anterior aspect, persisting for the past 10 months, which was attributed to minor trauma experienced while working at home. Upon clinical examination, mild swelling measuring approximately 5×5 cm was observed on the lower lateral side of the patella, accompanied by mild redness. Further radiological investigations were advised. On a standing X-ray of the knee, soft-tissue swelling in the inferolateral aspect of the patella was observed. On Magnetic Resonance Imaging (MRI), the lesion appeared hypointense on T1-weighted images (T1WI) and hyperintense on T2-weighted images (T2WI), showing no suppression on fat saturation sequences, indicating that it contained clear fluid and no evidence of fat. The patient was initially managed conservatively, but due to a failure to resolve symptoms, a local intrabursal injection of steroids was administered, and she was followed-up for three months. The patient improved post-treatment and reported a complete resolution of symptoms. Early diagnosis and management of this condition can potentially prevent chronic knee pain and improve function and quality of life.

Isolated Testicular Tuberculosis in a Young Male: A Rare Case Report

Vilas P Sabale, Amala Anant Ghalsasi, Nikhar Salvi

Tuberculosis (TB) is a preventable and usually curable disease. Although TB most frequently affects the lungs, it can affect any region of the body. History, physical examination, scrotal Ultrasonography (USG), and fine needle biopsy are important in the diagnosis of suspected cases of testicular TB. Anti-TB therapy is the mainstay of treatment to ensure complete resolution of the lesion. However, in a few cases, orchidectomy is required for both diagnosis and treatment. We report a case of a 24-year-old male who presented with right testicular pain and swelling. The patient also reported a history of low-grade fever with chills. He had a history of treatment with intravenous antibiotics for one week for the same complaint, with no resolution of symptoms. Physical examination revealed an enlarged, firm, and tender testis with a thickened epididymis. USG showed a 21×13×7 mm lesion in the posterior aspect of right testis with increased vascularity, suggestive of acute right epididymo-orchitis with testicular abscess. The patient was planned for a scrotal exploration and it revealed oedematous right scrotal layers adherent to the testis. Pus was drained from the testis. Signs of infarction were noted, and hence, right orchidectomy was performed with consent. Histopathology revealed granulomatous inflammation with abscess suggestive of TB. Patient was started on antitubercular treatment and is under regular follow-up. This case highlights the rare presentation of isolated testicular TB and the need for a high index of suspicion for diagnosis of the same.

Comprehensive Anaesthetic Approach for Paediatric Atrial Septal Defects Closure: A Case Report on One-Lung Ventilation and Epidural Analgesia

Shahbaz Hasnain, Subhashree Jena

Atrial Septal Defects (ASD) is among the most frequent congenital heart defects, commonly seen in children. Such defects also carry risks like pulmonary hypertension, arrhythmias, and failure on the right-side of the heart that require surgical intervention. Though the most prominent conventional procedure used was open-heart surgery, ASD closure through minimal invasive techniques is gradually favoured in recent times. The benefits include shorter recovery times, smaller incisions, and less complications. This is a case report on the anaesthetic management of a nine-year-old child who underwent minimally invasive closure of an ASD. The child had a large ASD, with signs and symptoms such as recurrent respiratory infections and intolerance to exercise. Management strategy for anaesthesia comprised One-Lung Ventilation (OLV) modality, using embolectomy catheter followed by ultrasound guided techniques for vascular access, and epidural analgesia. These techniques provided control over the perioperative period, and promoted quick recovery after the procedure.

Perianal Pilonidal Sinus Mimicking as Fistula-in-Ano: A Rare Diagnostic Dilemma

Pilonidal sinus disease is a common condition that typically presents in the sacrococcygeal region of young adult males. However, its occurrence in the perianal region is exceedingly rare and often mimics more common anorectal pathologies such as fistula-in-ano or perianal abscess. This report describes a 17-year-old male who presented with a two-week history of perianal discharge, itching, and pain during defaecation. Clinical examination revealed an external opening at the 5 o’clock position with active pus discharge and raised sphincter tone. A Magnetic Resonance Imaging (MRI) fistulogram suggested a complex Grade V fistula-in-ano extending into the left supralevator region. Based on imaging and clinical findings, a diagnosis of fistula-in-ano was made. Intraoperatively, a fistulous tract containing hair and purulent material was discovered, raising suspicion for a pilonidal sinus. Histopathological examination confirmed the diagnosis, revealing abundant keratinous debris and hair shafts consistent with pilonidal disease. The patient underwent tract excision and recovered well with regular postoperative wound care. This case highlights the diagnostic challenge posed by perianal pilonidal sinus, which can closely resemble a complex anal fistula on both clinical and radiological grounds. Accurate diagnosis may only be possible intraoperatively and requires a high index of suspicion. Due to its rarity and potential for misdiagnosis, this case underscores the importance of considering pilonidal disease in the differential diagnosis of perianal fistulas, especially in young males, and contributes to the limited literature on this atypical presentation.

Pneumoperitoneum in Ruptured Pancreatic Pseudocyst without Hollow Viscus Organ Perforation: A Case Report

Mahendra Wante, Ankireddypalle Shanmukha Shashank Reddy, Pushkar Galam, A Kavya

Pancreatic pseudocysts are a recognised complication of pancreatitis, often resolving with conservative management. However, spontaneous rupture of a pseudocyst into the peritoneal cavity is a rare and life-threatening event. This is a case of a 64-year-old female with a history of diabetes mellitus, hypertension, Chronic Kidney Disease (CKD), systemic amyloidosis, and recurrent pancreatitis who presented with epigastric pain, shortness of breath, vomiting, and fever. Clinical evaluation revealed peritonitis, leukocytosis, markedly elevated inflammatory markers, and renal dysfunction. Elevated serum amylase and lipase levels supported the suspicion of pancreatitis. A plain Computed Tomography (CT) abdomen, performed due to renal impairment, revealed pneumoperitoneum with suspected gastric perforation and a large intra-abdominal collection. Exploratory laparotomy revealed no hollow viscus perforation but rupture of a pancreatic pseudocyst with approximately 450 mL of purulent fluid in the peritoneal cavity. The pseudocyst wall was partially excised, and intra-abdominal lavage was performed. Drain fluid analysis confirmed high amylase and lipase content. Histopathological examination of the cyst wall confirmed the diagnosis of a pancreatic pseudocyst with acute necrotising inflammation. The patient was managed with octreotide, haemodialysis, and Vacuum-Assisted Closure (VAC) dressing for wound complications. She recovered and was discharged on postoperative day 25 with instruction for follow-up. This case highlights the importance of considering ruptured pseudocyst in patients with a history of pancreatitis presenting with acute abdomen and pneumoperitoneum, especially when imaging mimics gastrointestinal perforation. Prompt surgical intervention and supportive care are crucial for favourable outcomes in such complex cases.

Dose-dependent Clinical Spectrum and Management of Glyphosate-surfactant Herbicide Poisoning: A Case Report

Jaswanth Kumar Pasim, Vignessh Raveekumaran

Glyphosate-Surfactant Herbicide (GlySH) poisoning, though less common than Organophosphate (OP) poisoning, poses significant clinical challenges due to its dose-dependent toxicity and the lack of specific antidotes. This report presents two cases with contrasting presentations. Case 1 involved a 32-year-old male with diabetes who ingested 150-200 mL of GlySH in a suicide attempt. He developed gastrointestinal symptoms, severe lactic acidosis, hypotension, and multiorgan dysfunction, requiring intensive care, intubation, and aggressive treatment. In contrast, in Case 2, a 27-year-old female with no comorbidities, ingested around 20-50 mL of GlySH and exhibited milder symptoms such as throat burning, hypoglycaemia, and tachycardia, which resolved with symptomatic treatment and intravenous fluids. For both cases, the cornerstone of treatment included fluid and electrolyte correction, along with supportive management. These cases underscore the dose-dependent nature of GlySH toxicity. Misdiagnosis is most common, as OP poisoning results in delayed treatment and exacerbation of such conditions. Treatment remains primarily supportive, following poisoning guidelines. Therefore, these cases call for better diagnostic guidelines and preventive measures to reduce the mortality associated with GlySH, especially in agricultural settings.

Hyperparathyroidism: A Hidden Trigger for Recurrent Pancreatitis

Roohi Nanda, Gaurav Jhamtani

It is uncommon to find an association between pancreatitis and Primary Hyperparathyroidism (PHPT), but not unknown. Hypercalcaemia causes acute pancreatitis by initiation of an inflammatory cascade and formation of pancreatic calculi leading to ductal obstruction, causing acute or chronic pancreatitis. We report a unique case of a 51-year-old male who presented to us with recurrent episodes of acute pancreatitis. Biochemical investigations were suggestive of hypercalcaemia. Further evaluation of hypercalcaemia, not only confirmed PHPT by biochemical investigations but also localised a left inferior parathyroid adenoma by nuclear imaging. There were no additional risk factors for acute pancreatitis. The patient was initially managed medically, once the patient was normocalcaemic, he underwent left inferior parathyroidectomy, which led to resolution of recurrent acute pancreatitis. The patient was followed-up for one year and was found to be biochemically normocalcaemic and there was no recurrence of symptoms.

Rare Presentation of Vulvar Carcinoma: A Case Report

Vulvar cancer develops on the outer surface of the female genitalia, often presenting as a lump or sore accompanied by itching. While it can affect women of any age, it is most frequently diagnosed in older adults. Verrucous Carcinoma (VC) is a slow-growing variant of Squamous Cell Carcinoma (SCC) characterised by a warty appearance. It is a rare cancer in women. Author presents a case of a 52-year-old female with a painful lesion on the right vulvar region, initially misdiagnosed as a dermatological condition. Routine investigations were normal; however, suspicion of malignancy prompted further evaluation, including colposcopy and biopsy. Histopathology confirmed a superficially invasive, well-differentiated keratinising SCC (FIGO Stage IB, T1N0M0, Grade 1). The patient underwent wide local excision with right inguinal lymph node dissection. Postoperative recovery was uneventful, and no adjuvant therapy was required. This case was initially misdiagnosed but was correctly diagnosed through a biopsy. Therefore, this case should be considered to help ensure accurate diagnoses in similar cases. Its rarity makes it unique. This case highlights the importance of early detection and diagnosis of vulvar carcinoma, particularly its rare forms, such as VC. Multidisciplinary management, including surgical intervention, is essential for improving patient outcomes in rare malignancies.

Sprengel Shoulder with Omovertebral Bone and Left Renal Agenesis in a Paediatric Patient: A Rare Case Report

A Roshini Suha Cath, V Revathi, S Jagadeeswari, S Sundari

Sprengel shoulder is a rare congenital anomaly caused by disrupted scapular descent during development. It is associated with hypoplastic or absent muscles such as the trapezius, sternocleidomastoid, and serratus anterior, leading to scapular winging. Cavendish grading classifies the severity as very mild, mild, moderate, or severe. Mild cases may appear normal under clothing, while severe cases feature significant elevation, neck webbing, and brevicollis. One-third of cases have an omovertebral bone. Diagnosis is made through chest and shoulder radiography. Treatment is non-operative for mild cases, while moderate to severe cases require early surgical correction to prevent movement restriction. Sprengel shoulder is linked to conditions such as Klippel-Feil Syndrome (KFS), Poland syndrome, and VATER association, necessitating multidisciplinary evaluation. In this case report, a three-year-old girl presented with left shoulder elevation and restricted movement. Prenatal history revealed left renal agenesis. Examination showed an elevated left shoulder, restricted abduction, and apparent limb shortening. A typical Sprengel deformity with an omovertebral bone was diagnosed with the help of Magnetic Resonance Imaging (MRI). The Modified Excision and Reconstruction of Scapula (MEARS) procedure was planned, to improve mobility and quality of life for this patient. Additional evaluation was planned due to associated features such as a low hairline, vertebral fusion anomalies, and spina bifida, suggesting a possible genetic syndrome, most likely KFS. The rarity of Sprengel shoulder with an omovertebral bone and unilateral renal agenesis prompted this report.

A Rare Case of Intestinal Tuberculosis Mimicking Colon Cancer in a Chronic Kidney Disease Patient

Anuja Makan, Pavan Wakhare, Tushar Dighe, Charan Bale, Atul Sajgure

Intestinal Tuberculosis (ITB) is an uncommon form of extrapulmonary TB that poses a diagnostic challenge due to its nonspecific symptoms and radiological resemblance to malignancy. It is particularly rare in patients with End-Stage Renal Disease (ESRD) on haemodialysis, where immunosuppression increases susceptibility to infections. The clinical presentation often mimics inflammatory bowel disease or gastrointestinal malignancy, leading to potential misdiagnosis and treatment delays. Despite advancements in diagnostic techniques, ITB remains a difficult diagnosis, especially in dialysis-dependent patients who may have negative TB screening tests. We present the case of a 47-year-old male with ESRD on haemodialysis who developed progressive weakness, anorexia, and significant weight loss over five months. Imaging studies, including an abdominal CT scan and whole-body Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) revealed a mass in the ascending colon with associated lymphadenopathy, raising strong suspicion for malignancy. Colonoscopy showed mucosal ulceration, and biopsy findings confirmed caseating granulomas, establishing the diagnosis of ITB. Notably, initial TB screening tests, including sputum examination and Mantoux test, were negative. The patient was started on a standard anti-tubercular regimen, leading to gradual improvement in symptoms. This case highlights the diagnostic dilemma posed by ITB in dialysis patients, emphasising the importance of maintaining a high index of suspicion, especially in those with persistent gastrointestinal symptoms. Early recognition and treatment are crucial to preventing complications, as misdiagnosis can result in unnecessary interventions and delayed therapy for a potentially life-threatening condition.

A Case of Conservative Physiotherapy Management of Inferior Shoulder Dislocation: Enhancing Quality of Life, Sleep, Range of Motion, Muscle Strength, Reflexes, and Pain Alleviation

Bhawana Mangla, Bhawna Sharma, Jyoti Yadav

Inferior shoulder dislocation is a rare but increasingly reported condition, frequently associated with rotator cuff injuries, greater tuberosity fractures, and neurovascular deficits. Previous studies have focussed on surgical reduction under anaesthesia; however, conservative management remains overlooked. This case report presents a 28-year-old male who experienced an inferior shoulder dislocation due to a motor vehicle accident, accompanied by a partial supraspinatus tear, subacromial impingement, bursitis, glenohumeral effusion, a Superior Labrum Anterior to Posterior (SLAP) tear, and brachial plexus neuritis affecting the C5-C6 trunk. Initial assessment showed restricted Range of Motion (ROM) (10°-20°), weak muscle strength (Manual Muscle Test; MMT 1/5), absent reflexes, altered sensation, severe pain {Visual Analogue Scale (VAS) 10} and limited functional independence {Shoulder Pain and Disability Index (SPADI) 93%, Disabilities of the Arm, Shoulder, and Hand (DASH) 95%}. A four-month physiotherapy programme designed for pain management, muscle strengthening, scapular stabilisation, and functional recovery resulted in significant improvements, with complete pain relief, improved strength (MMT 4/5), full ROM recovery, and marked functional independence (SPADI and DASH scores reduced from 93% and 95% at the beginning to 40% and 32.5%, respectively, post-treatment, corresponding to a percentage reduction of 57% and 66%, respectively). Conservative physiotherapy effectively addressed both orthopaedic and neurological impairments, restoring mobility, strength, and function without surgical intervention. The aim of this regimen was to conservatively manage the inferior shoulder dislocation of shoulder by reducing pain, improving ROM, muscle strength, quality of life and sleep quality. This report highlights the potential of customised rehabilitation in treating complex shoulder dislocations conservatively, offering an economically viable and patient-preferred alternative to surgery.

A Case Report on use of Topical Insulin Therapy for Persistent Epithelial Defects in Stevens-Johnson Syndrome

Sumit Navneet Toshniwal, Renu Magdum, Rohan Jagadish, Neha Tabassum

Persistent Epithelial Defects (PED) in Stevens-Johnson Syndrome (SJS) pose significant challenges in ophthalmic management. This case highlights the use of topical insulin therapy as a novel treatment for PED in a 59-year-old female with SJS-associated ocular complications. The patient demonstrated significant improvement in visual acuity, a reduction in corneal defect size, and symptomatic relief following topical insulin administration. This report suggests that insulin eye drops may serve as a promising adjunct therapy for PED in patients with SJS.

Function-preserving Surgical Management of Benign Peripheral Nerve Sheath Tumours: A Case Series

Ansar Pullampara Pookunju, Aisel Paul, Mariya Jacob, Manoj Parameswaran

Peripheral Nerve Sheath Tumours (PNSTs) present a unique surgical challenge, requiring a balance between complete tumour removal and preservation of neurological function. Function-preserving excision techniques offer promising solutions, but their implementation demands careful evaluation and surgical expertise. A case series analysis was conducted on seven patients with PNSTs who underwent function-preserving surgical excision at a tertiary care centre between December 2022 and August 2024. Preoperative diagnostic methods, including high-resolution contrast-enhanced Magnetic Resonance Imaging (MRI) and Fine-Needle Aspiration Cytology (FNAC), were critical for differentiating schwannomas from neurofibromas and guiding surgical planning. Intracapsular enucleation was performed for schwannomas, while interfascicular dissection was used for neurofibromas. Patient demographics, tumour characteristics, surgical approach, and postoperative outcomes were assessed through clinical examination and neurophysiological studies. The series included five schwannomas and two neurofibromas, with a mean tumour size of 2.38 cm (range: 1.5-5.0 cm). Tumours were located in the upper extremity (n=3), the lower extremity (n=2), the neck (n=1), and the spinal region (n=1). Complete tumour resection was achieved in all cases. Transient postoperative deficits resolved within one month, and all patients returned to normal activities with no permanent neurological deficits at the six-month follow-up. Function-preserving surgical techniques demonstrate excellent outcomes in PNST management, achieving tumour control while maintaining neurological function. Careful patient selection, precise surgical technique, and appropriate preoperative planning are crucial for successful outcomes.

Aggressive CNS Embryonal Tumours: A Series of Three Cases

Shima Kannadas, Rahila Musthafa

Central Nervous System (CNS) embryonal tumours represent a heterogeneous group of aggressive paediatric neoplasms with variable clinical presentations, histopathological features, and outcomes. This case series presents the clinicopathological characteristics of three distinct CNS embryonal tumour cases diagnosed at our centre. The first child presented with cerebellar signs and symptoms, including gait disturbance and vomiting, at three years of age. Clinical and radiological diagnosis was in favour of medulloblastoma. Histopathological examination revealed anaplastic cells with cell wrapping typical of large cell/anaplastic medulloblastoma, which was confirmed with immunohistochemistry. The second case involved a 10-year-old boy with cerebellar symptoms along with signs of myelopathy affecting the lower limbs. Magnetic Resonance Imaging (MRI) revealed a cerebellar tumour with spinal metastasis, raising the possibility of medulloblastoma, which was confirmed histologically. The last case was a one-year-old infant with rapidly progressive neurological deficits and a large supratentorial mass on MRI, suspicious for Atypical Teratoid/Rhabdoid Tumour (AT/RT). Characteristic rhabdoid cells in histopathology, accompanied by loss of SMARCB1 expression in immunohistochemistry, confirmed the diagnosis of ATRT. This series highlights the diverse clinical and pathological spectrum of CNS embryonal tumours, emphasising the importance of a comprehensive diagnostic work-up, including detailed clinicoradiological assessment, histopathological evaluation, and immunohistochemistry in the management. Further research with larger cohorts is warranted to better understand the molecular underpinnings and optimise treatment strategies for these challenging paediatric malignancies.

Atypical Presentation of Acute Myeloid Leukaemia: A Series of Three Cases

Acute Myeloid Leukaemia (AML) is a haematological malignancy characterised by the infiltration of the blood, bone marrow and other tissues by proliferative, clonal, poorly differentiated cells of the haematopoietic system. Diagnosis can be suspected by the presence of atypical cells on a peripheral blood smear and confirmed by bone marrow aspiration studies and immunohistochemistry. Detection of AML in the first trimester of pregnancy is a rare phenomenon. The rarity of haematological malignancies, especially in the first trimester, poses challenges in the diagnosis, treatment and management of leukaemias during pregnancy. AML masquerading as acute and chronic infections also presents diagnostic and consequent therapeutic challenges. Hence, multidisciplinary treatment is key to the outcomes of these rare presentations. The following is a case series highlighting the varied ways in which AML can present to a physician, often requiring a high degree of suspicion to warrant further investigation. The first case discusses the difficulties encountered in diagnosing and treating a primigravida woman in her first trimester, which ultimately led to the termination of her pregnancy and subsequent chemotherapy cycles. The second case involves a female in her 40’s presenting with complaints of chronic sinusitis, who was diagnosed with AML upon evaluation. This case was challenging as infiltrative lesions of leukaemia were considered during the assessment. The patient was managed with a carefully formulated regimen of chemotherapeutic agents and antibiotics. The third case presented with acute pyelonephritis, illuminating the rapid deterioration associated with the perils of undiagnosed haematological malignancies. Together, these three cases underscore the various presentations of AML, highlighting the necessity for a high degree of suspicion even in seemingly uncomplicated cases such as chronic sinusitis or acute abdominal pain, such as pyelonephritis. Haematological malignancies are commonly suspected when more aggressive symptoms, such as fever, bleeding gums, or generalised lymphadenopathy, are present. This case series aims to draw attention to the simpler presentations that may be overlooked in outpatient settings as benign infections.

Thromboelastography-guided Blood Product Management: A Series of Three Cases

B Megala, A Ashwin, R Krishnamoorty, Niranj Rathan, Sampat Kumar

Thromboelastography (TEG) is a diagnostic tool used to assess blood clotting in real time by measuring the viscoelastic properties of blood. It measures the clot’s strength and stability. It provides a comprehensive view of haemostasis, which includes clot formation, strength, and dissolution. This can be useful in clinical settings by guiding transfusion and anticoagulation therapy in various medical conditions. It can be useful in blood product administration for the patient’s specific needs. TEG can help assess the functional capacity of the liver in relation to clotting factor production and the overall coagulation process. In obstetric patients, particularly during labour and complications during delivery, TEG can help manage and predict bleeding risks associated with conditions like preeclampsia or Disseminated Intravascular Coagulation (DIC). Here, we discussed three separate cases (1 male, 2 females) described, each presenting unique clinical scenarios, including those from Intensive Care Unit (ICU) settings. A case of Postpartum Haemorrhage (PPH) with Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome, a case of haemophilia A, and a case of snake bite with signs of envenomation were managed with TEG to guide component-based therapy, based on the specific needs of each patient.

Therapeutic Leukapheresis in Acute Leukaemia with Hyperleukocytosis: A Series of Three Cases

G Kavinkumar, A Ashwin, R Krishnamoorthy, Niranj Rathan, Sampat Kumar

Acute Myeloid Leukaemia (AML) is a haematological malignancy marked by uncontrolled proliferation of immature myeloid cells, impairing normal blood cell production. Hyperleukocytosis, defined as a leukocyte count >100,000/μL (4000-11,000 cells/μL), increases blood viscosity and causes leukocytes to clump, leading to reduced blood flow and stasis. This leukostasis can result in complications like end-organ damage, tumour lysis syndrome, and disseminated intravascular coagulation. Chemotherapy may exacerbate these issues by triggering tumour lysis syndrome and other severe complications. Therefore, therapeutic leukapheresis can be the treatment of choice in such situations. In this case series, we share our experience in managing three AML cases that presented with life-threatening symptoms. All three patients presented to our centre with signs and symptoms of leukostasis, with hyperleukocytosis evident in their complete blood cell counts. If left untreated, these cases could have led to severe complications and even death. After evaluating the clinical and laboratory parameters, therapeutic leukapheresis was initiated to reduce leukocyte counts, leading to significant improvement in the patient’s condition. This case series emphasises the critical role of leukapheresis as a potentially life-saving intervention.

A Case of Paediatric Linear Morphea with Infraorbital Atrophy: A Clinico-dermoscopic-histopathologic Association

Sandra Arora, Sanjeev B Gupta

An 11-year-old male presented to the Outpatient Department (OPD) of Dermatology with depression and darkness under his right eye for the past two years. He developed a light-coloured lesion as the condition gradually progressed over a span of 1.5 years to involve the left side of the chest. Thereafter, the lesions remained stable, with no new lesions or increase in the size of existing lesions observed. Similar lesions were not noted in family members. His general condition appeared fair, and his build and weight were normal for his age. On clinical examination, he had a 3×4 cm, well-defined, localised, oval depression with hyperpigmentation of the skin surface extending from the infraorbital region of the right eye to the mid-cheek (Table/Fig 1)a,b. He also had a 6×5 cm, ill-defined, oval, non tender, hypopigmented atrophic plaque with surrounding hyperpigmentation present over the left inframammary region extending towards the back (Table/Fig 1)c. No limb length discrepancy, bony abnormalities, tongue atrophy, gingivitis, contractures, nail fold changes, or stiffness of the fingers were noted. X-ray skull, ultrasound, and computed tomography showed no underlying bony abnormality. Routine blood tests and other investigations, including antinuclear antibody and acute inflammatory markers, were within normal limits. Hence, a provisional diagnosis of morphea was established. Differential diagnoses included systemic sclerosis, Parry Romberg syndrome (progressive hemifacial atrophy), focal dermal hypoplasia (Goltz syndrome), linear lichen sclerosus et atrophicus, linear atrophoderma of Moulin, Lupus Erythematosus Profundus (LEP), also known as lupus panniculitis, and hemifacial microsomia. Dermoscopy (80X Polarised) revealed a reticular pigment pattern, homogeneous ivory white structureless areas, linear telangiectasias, and reduced follicular openings (Table/Fig 2). A 4 mm punch biopsy from the lesion on the left side of the chest was performed. Haematoxylin and Eosin (H&E) staining (200X) revealed atrophic epidermis, thickened collagen bundles in the papillary and reticular dermis, and mild perivascular and periadnexal lymphocytic infiltrate. Entrapped atrophic eccrine glands showed loss of surrounding adipose tissue. There was no evidence of panniculitis. Therefore, the features were suggestive of morphea (Table/Fig 3)a. Masson’s Trichrome stain (200X) highlighted thickened collagen bundles in the dermis in blue (Table/Fig 3)b. Verhoeff’s Van Gieson stain (200X) highlighted thickened collagen bundles in red (Table/Fig 3)c. On the basis of the history, clinical examination, dermoscopy findings, and histopathology report using H&E stain, as well as special stains like Masson’s Trichrome and Verhoeff’s Van Gieson, the differentials were ruled out, and a final diagnosis of linear morphea was established. The patient was started on excimer therapy for his chest lesion and was treated with topical tacrolimus 0.1% ointment and oral betamethasone 1 mg OD, taken at 8 am after food on weekends for a period of six months. Regular follow-up showed no further progression. The patient was advised to undergo autologous fat grafting for the under-eye lesion. Morphea is a fibrosing disorder of the skin and subcutaneous tissue, characterised by an increase in collagen production, which progresses through two stages: an active (inflammatory) stage and a “burnt out” stage (1). Treatment is focused on the active phase to stabilise the current lesions and prevent the occurrence of new lesions. Linear morphea is the most common form seen in childhood (1). Its incidence is estimated to be 0.4 to 2.7 per 100,000 population (1). Juvenile Localised Scleroderma (morphea) has five subtypes: circumscribed, linear, generalised, pansclerotic, and mixed. Rarely, systemic sclerosis and localised scleroderma may co-exist in a patient (2). Signs and symptoms of systemic sclerosis include microvascular injury, fingertip ulcers, Raynaud’s phenomenon, telangiectasia, and involvement of the lungs, heart, kidneys, and gastrointestinal tract in addition to skin fibrosis (2). Antinuclear Antibody (ANA) positivity in a patient should therefore alert the physician (2). Clinical scoring tools for morphea disease activity and severity include the visual analogue score, the Dyspigmentation, Induration, Erythema and Telangiectasia (DIET) score, the Modified Rodnan Skin Score (MRSS), and the Localised Scleroderma Assessment Tool (LoSCAT) (3). The most common dermoscopic findings are white clouds, which are small, opaque, poorly demarcated areas corresponding to dermal sclerosis with increased deposition of thickened collagen fibres, and the most common vascular pattern observed is linear branching vessels (4). Homogenisation in dermal collagen, a decrease in skin appendages, and the line sign (for lower extremities) can be used as histopathological clues in the diagnosis (5). In the present case, systemic sclerosis was ruled out as a differential diagnosis due to the absence of Raynaud’s phenomenon, eye changes, dysphagia, dyspnoea, neurological abnormalities, sclerodactyly, and calcinosis cutis, which are diagnosed through serologies, capillaroscopy, and pulmonary testing (6). Parry Romberg syndrome (progressive hemifacial atrophy) was excluded as a differential because there were no neurological signs such as seizures or migraine, no bone and joint involvement, no associated hair loss, or the presence of moderate sclerosis (7). Focal dermal hypoplasia (Goltz syndrome) typically presents at birth and features atrophic lesions that are distributed in a blaschkoid pattern and are not indurated. It is generally associated with other skeletal, ocular, and dental anomalies (8). Linear lichen sclerosus et atrophicus can mimic morphea but is seen more often in the genital area and is characterised by follicular plugging, allowing for differentiation based on histopathology (9). Linear atrophoderma of Moulin can be distinguished from morphea by the absence of dermal fibrosis on histopathology (10). LEP, also known as lupus panniculitis, presents with tender plaques, usually shows cosmetic disfigurement, and is characterised by lobular lymphocytic panniculitis and hyaline fat necrosis on histopathology (11). Hemifacial microsomia is characterised by facial asymmetry, which is not observed in this patient (12). Milder cases are generally addressed with topical therapies, including corticosteroids, tacrolimus, imiquimod, vitamin D derivatives, or phototherapy (13). Moderate-to-severe forms can be treated with immunosuppressive medications, with a methotrexate-based regimen as the first-line therapy (with or without intravenous or oral corticosteroids). Mycophenolate mofetil may be used in relapsing cases or in those that are refractory to methotrexate (13). Cyclosporine, hydroxychloroquine, azathioprine, retinoids, intravenous immunoglobulin, rituximab, and infliximab can be effective agents in the most severe cases (13). However, their routine use requires caution and long-term monitoring. Refractory cases can be managed with tocilizumab, sarilumab, abatacept, imatinib, pamrevlumab, Janus Kinase (JAK) inhibitors, and Autologous Stem Cell Transplantation (ASCT) (13). Albadr F et al., reported a case of linear hypopigmented atrophic plaques in a nine-year-old girl, present over the mid-forehead, left eye, and neck, which was diagnosed at the age of seven and treated with topical tacrolimus and steroids (14). Mendiratta V et al., reported a case of linear morphea with lipoatrophy and segmental vitiligo, which presented as a hyperpigmented plaque over the left lower limb involving the buttock in a 13-year-old girl. For this patient, oral betamethasone at 3-4 mg every week, along with 10 mg of methotrexate per week and hydroxychloroquine at 200 mg twice a day was prescribed for 4-5 years, which led to softening of the plaque with no further lesions (15). Magri F et al., reported a case of segmental morphea in an eight-year-old boy in the left lumbar region, which was histopathologically confirmed, and treatment was initiated with topical vitamin E (16). In conclusion, the most prevalent type of localised scleroderma in children is linear morphea, which necessitates early diagnosis to avoid cosmetic and functional consequences. Diagnosis is aided by accurately distinguishing it from imitating illnesses and using clinical, dermoscopic, and histopathological tools. The severity of the condition determines the course of treatment, which can range from topical agents for mild cases to systemic immunosuppressants for moderate to severe forms. Early, individualised, and multidisciplinary management is key to improving outcomes.

Microabrasion as an Effective Treatment for Severe Dental Fluorosis: Images in Medicine

A 28-year-old male presented to the dental clinic with white and brown discolourations, as well as hard, pitted areas on the enamel (Table/Fig 1),(Table/Fig 2), seeking aesthetic treatment. After obtaining a detailed medical history and performing a clinical examination, including electrical pulp testing and cold testing, a radiographic evaluation was conducted. The radiographs revealed no periapical lesions or caries, and no signs of resorption were observed in the teeth of interest. All the associated teeth were vital, with a healthy periodontium. The patient was diagnosed with severe enamel fluorosis, classified as grade 4 according to the Dean’s Index (1). Treatment options, including veneers, crowns, and macroabrasion, were discussed with the patient and his parents. Ultimately, the enamel microabrasion technique was selected to address the stains and pitted areas on the facial surfaces of the upper incisors, canines, and premolars. After obtaining informed consent for both the treatment and the publication of identifiable images, petroleum jelly was applied to protect the gingival tissues. The operative field was isolated using a rubber dam to shield the gums from the microabrasive compound. All individuals involved in the procedure, including the patient, assistants, and operator, wore appropriate personal protective equipment and eye protection throughout the treatment. For the enamel microabrasion procedure, 6.6% hydrochloric acid was freshly prepared in the biochemistry laboratory. The acid was applied using a rubber cup attached to a low-speed handpiece, with firm pressure applied to remove the stains. Pumice was selected as the abrasive for this case. The compound was applied three times, with each application lasting one minute for six teeth-approximately 10s per tooth- followed by water rinsing between each session. Afterward, the abraded enamel surface was polished with a fluoridated paste, and a neutral 2% sodium fluoride gel was applied for four minutes. (Table/Fig 3) shows the post-treatment appearance of the enamel following the microabrasion procedure. One month later, dental bleaching was performed using 35% hydrogen peroxide (SDI Pola Office Bleaching Material) with the aid of an Optradam. A single 20-minute cycle was performed. To prevent reversal of the process, a polishing kit was used in sequence. Immediate postoperative images are shown in (Table/Fig 4),(Table/Fig 5). Telephonic follow-up was conducted for three days. The patient reported mild sensitivity only on the day of the procedure, immediately following the treatment, which resolved within four hours. No other side-effects or complications were reported during or after the treatment. Three months later, the patient was recalled for a follow-up visit. During this visit, the pits were restored with composite (Dentsply Spectrum Composite, Shade A1). The follow-up image is shown in (Table/Fig 6). (Table/Fig 7) presents a comparison of the pre-operative and postoperative images. The results showed a significant improvement in colour, with the shade lightening from A2 to A1. According to the Dean’s Modified Index, the postoperative image indicated a very mild result, corresponding to grade 1 (2). The microabrasion process, which involves acidic agents and abrasive compounds, helps reduce the whitish appearance of lesions by removing the outer dysplastic enamel layer. A study by Lu Y et al., divided participants into two groups for office bleaching, one of which combined microabrasion using 37% phosphoric acid. The results revealed a significant difference, with the microabrasion group showing better outcomes (3). Similarly, Divyameena B et al., achieved comparable results using Opalustre for microabrasion and observed no postoperative sensitivity (4). However, according to a systematic review, microabrasion is considered effective for mild to moderate cases but shows less promising results for more severe cases (5). A newer treatment modality that has gained acceptance is resin infiltration. In a study by Reddy VN et al., where 37% phosphoric acid with pumice, Opalustre, and resin infiltration were compared, it was concluded that the mean surface roughness was 10.42 for the combination, while resin infiltration had a surface roughness of only 1.99. This suggests that resin infiltration is a less invasive method with reduced post-operative reversal of results (6). This case demonstrates that microabrasion is an effective and conservative treatment option for severe dental fluorosis, offering substantial aesthetic improvements without the need for invasive procedures. By selectively removing discoloured and hypomineralised enamel layers, microabrasion enhanced the patient’s smile, resulting in a more uniform and natural appearance of the teeth.

Supratenorial Haemangioblastoma with Bleed: Imaging Findings

Jaya Selin Praveena Joseph, Pabbisetty Sushma, Senthil Kumar Aiyappan

A 48-year-old male presented with complaints of severe headache for the past two weeks. There was no history of loss of consciousness, vomiting, or seizure episodes. The patient was not a known case of diabetes mellitus, epilepsy, or systemic hypertension. On examination, the Glasgow Coma Scale was E4M6V5. Bilateral pupils were equally reactive to light and extraocular movements were normal. There was no facial weakness. Tone and power were normal in all four limbs, neck, and trunk. The plantar reflex was flexor on both sides. The deep tendon reflexes were normal, and there were no cerebellar signs. The patient had a normal gait. Laboratory investigations, including complete blood count, urea, creatinine, electrolytes, liver function tests, and coagulation profile, were within normal limits. Serology for hepatitis B and C viruses, as well as human immunodeficiency virus, returned negative results. The patient underwent Computed Tomography (CT) of the brain, followed by Magnetic Resonance Imaging (MRI) of the brain with contrast. The CT scan revealed a hyperdense lesion measuring approximately 4.5×3.3×2.9 cm in the left posterior parafalcine region of the parietal lobe, with moderate perilesional oedema (Table/Fig 1)a. The possibility of an intraparenchymal haemorrhage was considered. Since there was no history of trauma and the patient was not hypertensive, a haemorrhagic neoplasm was also considered as a differential diagnosis. The MRI of the brain with contrast revealed a well-defined T2/FLAIR hyperintense, T1 hypointense lesion with a peripheral T1 hyperintense rim showing blooming on gradient images (Table/Fig 1)b, situated in the left posterior parafalcine area, with moderate perilesional oedema (Table/Fig 1)c,d. The lesion measured approximately 4.5×3.3×2.9 cm. There was no significant post-contrast enhancement. Consequently, the possibilities of both intraparenchymal haemorrhage and a haemorrhagic neoplasm were considered. The patient was kept under follow-up, and after four weeks, repeat MRI and CT were performed. The repeat CT showed a decrease in the hyperdensity of the haemorrhage; however, there was a mild increase in the size of the lesion, which measured approximately 4.7×3.5×3.3 cm, along with a mild increase in the surrounding oedema (Table/Fig 2)a. The repeat MRI with contrast indicated a mild increase in oedema with a reduction in blooming, suggestive of a decrease in haemorrhagic areas, with no significant post-contrast enhancement (Table/Fig 2)b-d. The patient subsequently underwent left parieto-temporal craniotomy with excision of the lesion. Histopathological examination of the lesion revealed features of a haemangioblastoma, classified as a WHO grade 1 tumour. The patient did not exhibit any other features to suggest von Hippel-Lindau’s disease. Postoperative CT of the brain showed complete resolution of the lesion with postoperative changes (Table/Fig 3)a,b. The patient is currently under follow-up and is doing well. Haemangioblastomas are vascular tumours classified as WHO grade I, primarily found in the cerebellum and spinal cord (1),(2),(3). They constitute approximately 2% of all intracranial tumours (1). Haemangioblastomas can occur sporadically or as a component neoplasm of von Hippel-Lindau disease. In the present case, there were no features indicative of von Hippel-Lindau disease; hence, this case represents a sporadic haemangioblastoma in a supratentorial location, which is extremely rare. Due to their vascular nature, haemangioblastomas carry a risk of haemorrhage within the tumours (2). This haemorrhage can occur either spontaneously, intraoperatively, or postoperatively (4). In this case, the haemorrhage occurred spontaneously within the tumour, mimicking acute intraparenchymal haemorrhage. The calculated risk of spontaneous haemorrhage in haemangioblastomas is 0.0024 per person per year, with an average diameter of 2.3 to 3 cm (4). In the present case, the tumour size was 4.5 cm. The risk of haemorrhage is influenced by the size of the tumour, as larger sizes are associated with increased blood flow. Increased blood flow can cause partial transmission of arterial pressure to the venous side, resulting in vascular vulnerability due to structural changes (3),(4). Proposed causes for haemorrhage in these tumours include haemorrhagic infarction resulting from vessel occlusion due to endothelial proliferation or tumour emboli, rupture of fragile vessels caused by direct invasion from tumour cells, rupture of vessels due to loss of perivascular support tissue, and rupture of fragile neovascular vessels (4). Haemangioblastomas are least common in the supratentorial region, where they most frequently occur in the frontal lobe and the pituitary stalk; however, in this case, the tumour was located in the left parietal lobe (1). In the literature reviewed by Gläsker S and Van Velthoven V, out of nine studies, only one documented a supratentorial haemangioblastoma, which was situated in the left fronto-temporal region; the remaining cases were in the spinal cord and cerebellum (4). The treatment of choice for haemangioblastoma involves surgical en-bloc resection (5). Radiosurgery ablation is an option for small, solid, and difficult-to-access lesions (5). To conclude, large solid haemangioblastomas can cause spontaneous fatal haemorrhage, and they should be managed with this complication in mind. Supratentorial haemangioblastomas are extremely rare, and to the best of our knowledge, only one case of supratentorial haemangioblastoma with bleeding has been described previously (4).

Kimura Disease of the Parotid Gland in Late Adulthood: Diagnostic and Surgical Insights

Ashray Jain, Tapan Nagpal, Srishti Manoj Balwant, Devyani Bathani, Gaurav Datta

A 60-year-old male presented to the ENT outpatient department with a gradually enlarging, painless swelling in the left parotid region over the past six years. There was no history of trauma, infection, facial nerve weakness, or systemic symptoms. The patient had no significant past medical history and denied any tobacco or alcohol use. On examination, a solitary, diffuse, firm, non-tender, and mobile swelling measuring approximately 10×6 cm was noted in the left preauricular region, as shown in (Table/Fig 1). It extended superiorly to the lateral canthus and inferiorly to the angle of the mandible. The overlying skin appeared normal, and there was no facial nerve involvement. A Computed Tomography (CT) scan of the neck with contrast revealed an ill-defined soft tissue lesion in the subcutaneous plane of the left parotid and temporal region, measuring 6.3×3.4×9.5 cm. The lesion exhibited multiple vascular channels and calcification foci, but did not infiltrate the parotid gland. Multiple enlarged lymph nodes were noted adjacent to the lesion in the left cervical levels Ib, II, III, and IV, with the largest measuring 20×10 mm located inferior to the lesion (Table/Fig 2). The clinical differential diagnoses include lymphoma, metastatic tumour nodes, eosinophilic granuloma, Mikulicz’s disease, and scrofula, with primary consideration given to Hodgkin and non-Hodgkin lymphomas. It may also be mistaken for Angiolymphoid Hyperplasia with Eosinophilia (ALHE). The differential diagnosis also included Warthin’s tumour, lymphoma, chronic sialadenitis, and pleomorphic adenoma. With patient informed consent, the patient underwent surgical excision of the mass under general anaesthesia via a modified Blair incision (1). A superficial parotidectomy was performed with identification and preservation of the facial nerve branches, as seen in (Table/Fig 3). The adjacent enlarged lymph nodes in cervical levels Ib to IV were also excised during the procedure. Histopathological examination revealed lymphoid follicular hyperplasia, dense eosinophilic infiltrate, angiomatoid hyperplasia, and eosinophilic microabscesses, confirming the diagnosis of Kimura disease (Table/Fig 4). At the one-week postoperative follow-up, the suture site was well healed, with no signs of recurrence (Table/Fig 5). Kimura disease is most commonly seen in Asian males between the ages of 20 and 40 years, with a lower occurrence in children (2). It is a benign, chronic inflammatory disorder of unknown aetiology that primarily affects Asian males. It typically presents as painless soft tissue swelling in the head and neck region, often with associated lymphadenopathy, peripheral eosinophilia, and elevated serum IgE levels (3). The condition is frequently misdiagnosed as a neoplastic or infectious process, especially when presenting in older adults or with atypical features. This case is significant due to the patient’s advanced age, the unusually large size of the lesion, and the prolonged course of the disease without systemic involvement. The lesion was confined to subcutaneous tissue, with adjacent lymphadenopathy, without parotid gland infiltration on imaging. Surgical excision remains the mainstay of treatment, although recurrence is possible (3). The inclusion of lymph node dissection helped ensure comprehensive disease clearance and facilitated a definitive histopathological diagnosis. Recent literature supports the variability in presentation. Yorita K et al., reported a young female with a parotid nodule exhibiting squamous metaplasia, complicating the diagnosis (4). Ghafar MHA et al., described a middle-aged male who presented with a painless parotid mass, peripheral eosinophilia, and elevated IgE levels— classical features of Kimura disease—and who was managed with systemic steroids followed by parotidectomy (5). Meanwhile, Kim H et al., documented an atypical presentation without eosinophilia in an elderly female (6). Bouanani O et al., described a rare case of Kimura’s disease with intraparotid localisation, emphasising the atypical anatomical presentation and highlighting the diagnostic challenges associated with its non-specific symptoms. Their review of the literature also pointed to a broad clinical spectrum, suggesting that Kimura’s disease can mimic other parotid and lymphoid pathologies, making accurate diagnosis reliant on histopathological confirmation (7). Similarly, Alanazi F et al., reported cases that reinforced this variability in presentation and clinical course, supporting the view that Kimura’s disease does not follow a uniform pattern and that treatment responses may vary depending on disease location and immune profile (8). This case underscores the importance of including Kimura disease in the differential diagnosis of parotid swellings, regardless of patient age. Histopathology remains the gold standard for diagnosis.

Acquired Unilateral Nevoid Telangiectasia: Dermoscopy and Histopathology Findings of a Rare Dermatomal Vascular Anomaly

Sandra Arora, Sanjeev B Gupta, Nishtha Mishra

A 26-year-old male presented with an asymptomatic red lesion on the right side of his flank for two months. The lesion gradually enlarged over this period without pruritus, pain, or mucosal involvement. The patient denied alcohol consumption, drug use, recent weight changes, visual disturbances, or any history of cold- or stress-induced worsening. There was no history of birth complications or relevant family history. Clinical examination revealed multiple erythematous, blanchable macules and patches over the right flank, distributed along the T9-T11 dermatomes (Table/Fig 1),(Table/Fig 2). The patient’s laboratory investigations, including liver function, thyroid function, and viral serology, were all within normal limits, ruling out common systemic associations. On dermoscopy, accentuation of the skin markings and a reticular pigment network with grouped dotted vessels (Table/Fig 3) were observed. A 4 mm punch biopsy was taken from the right side of the trunk, which showed multiple dilated capillaries lined by a single layer of endothelial cells containing Red Blood Cells (RBCs) within the superficial dermis. Mild perivascular lymphocytic infiltration was present, with no spindle cells, granulomas, extravasated RBCs, or endothelial cell clusters. The overlying epidermis was unremarkable, confirming telangiectasia (Table/Fig 4). Differential diagnoses for Unilateral Nevoid Telangiectasia (UNT) include poikiloderma of Civatte, cutaneous mastocytosis, and Telangiectasia Macularis Eruptiva Perstans (TMEP). However, the characteristic dermatomal distribution and histopathological findings in this case confirmed the diagnosis of UNT. UNT was originally described by Selmanowitz in 1970, although Zeisler and Blaschko first characterised it in 1899. Surface telangiectasias are a characteristic feature of this uncommon vascular disease. Unilateral lesions are distributed in a Blaschkoid or dermatomal pattern (1). Congenital or acquired, UNT is more common in women and usually affects the trigeminal, cervical, and upper thoracic nerve dermatome distributions. Despite the fact that the exact cause of the illness is still unknown, hyperestrogenic situations such as adolescence, pregnancy, and chronic liver disease are thought to be contributing factors (2). Although bilateral occurrences have also been documented, the majority of cases exhibit unilateral lesions along the Blaschko line. The convoluted, dilated capillaries of the upper dermis, without abnormal vascular endothelial cell growth, are among the pathogenic characteristics. When examined under a microscope, UNT typically appears as spherical or dotted vessels on a reddish background (3). The main clinical basis for diagnosis is the distinctive appearance and location of the lesions. Dermoscopy can aid in the assessment by revealing a network of red, tortuous, dilated capillaries that are not melanocytic. Although UNT is benign, it can occasionally be confused with other vascular or dermatological disorders, which emphasises the importance of dermatologists being aware of the condition and making an accurate diagnosis (4). Reported associations include pregnancy, oral contraceptive use, chronic alcoholism, hepatitis B and C, hyperthyroidism, and carcinoid disease. Liver cirrhosis is the most frequent cause in men, although cases have also been reported following chemotherapy for Hodgkin’s disease, even in the absence of liver dysfunction (5). The preferred method of treatment for improving the appearance of the condition is a pulsed dye laser. Other therapeutic modalities that have been tried include cryotherapy, electrocoagulation, radiofrequency, long pulsed Nd:YAG (1064 nm) laser, CO2, and argon laser (1). UNT is not as uncommon as originally thought; despite still being a rare syndrome, it is characterised by asymptomatic superficial dermal telangiectasias that typically affect the cervical and upper thoracic nerve distributions (C3-T2), as well as the trigeminal nerve divisions. These telangiectasias can occur unilaterally or, less frequently, bilaterally in a dermatomal distribution. Numerous individuals present during pregnancy and at the onset of puberty, and a 2:1 female to male predominance is observed, suggesting that hyperestrogenic conditions may be an underlying pathophysiological basis of the condition (6). However, to date, this theory has not been substantiated by any published data. Consequently, UNT remains somewhat of a mystery, and its physiological features are still unclear. More research is required to gain a better understanding of this particular condition.

Navigating Airway Obstruction during Resection of Anterior Mediastinal Mass: An Anaesthetic Perspective

Chhaya Mahesh Suryawanshi, Jekha Mary Babu

Dear Editor, An Anterior Mediastinal Mass (AMM) poses significant challenges for the anaesthesiologist due to its impact on surrounding mediastinal structures (1). They can cause airway and circulatory compression under general anaesthesia, leading to dreaded complications (2). Effective management of AMM resection requires understanding its relationship with cardiorespiratory structures, thorough preoperative evaluation and anticipation of intraoperative complications. Strategies such as awake fiberoptic intubation, spontaneous ventilation, judicious use of muscle relaxants, positional adjustments, access to rigid bronchoscopy and in severe cases, elective cardiopulmonary bypass if available, enhances a safer outcome. This case explores the anaesthetic management and complexities faced in managing the resection of a large AMM. A 19-year-old female presented with cough, dyspnoea which worsened on supine position, chest pain which was gradual in onset, non-progressive in nature, dull and non-radiating, blurring of vision, headache and intermittent low-grade fever for eight months. Computed Tomography (CT) revealed a 15×14.4×12.3 cm thymic mass displacing mediastinal structures and abutting left brachiocephalic vein, aorta, pulmonary trunk, left atrium, and ventricle, with mild left pleural effusion (Table/Fig 1). General examination showed tachypnoea- 32 breaths/min, 94% oxygen saturation, reduced air entry on the left side and bilateral wheeze. She was diagnosed with thymic hyperplasia and scheduled for sternotomy and debulking under American Society of Anaesthesiologists (ASA) III. Preoperative treatment included nebulisations with levosalbutamol, ipratropium bromide, and budesonide twice daily, intravenous hydrocortisone 100 mg twice daily, chest physiotherapy, and incentive spirometry. A comprehensive preoperative evaluation indicated a significant risk of airway compression during general anaesthesia. Consequently, the anaesthetic plan included thoracic epidural anaesthesia and awake fiberoptic intubation with wire-reinforced Endotracheal Tube (ETT) due to anticipated difficult intubation. Strategies included maintaining spontaneous ventilation until airway was secured, and standby rigid bronchoscopy. Difficult airway trolley, inotropes, vasodilators and defibrillator were prepared. Preoperative preparation for awake intubation included nebulisation with 3 mL of 4% lignocaine, oxymethazoline nasal drops in both nostrils and nasal packing with gauze piece soaked with 5 mL of 2% lignocaine with adrenaline and 5 mL normal saline for three minutes. Intramuscular glycopyrrolate 0.004 mg/kg and intravenous ondansetron 0.1 mg/kg were given 20 minutes prior to procedure. In the operating room, standard ASA monitors were connected and epidural catheter was fixed at T6-T7 level. Airway anaesthesia was achieved with bilateral glossopharyngeal nerve block with 2 mL of 2% lignocaine on each side, along with transtracheal injection with 3 mL of 2% lignocaine. The patient was preoxygenated and premedicated with intravenous midazolam 0.01 mg/kg and fentanyl 2 mcg/kg. Nasal intubation was performed with 6.5 mm wire-reinforced cuffed ETT, guided by fiberoptic bronchoscope, the tube was secured at 25 cm and bilateral air entry was confirmed. A 9 Fr Arndt bronchial blocker was subsequently introduced into the right bronchus and the balloon was inflated under fiberoptic guidance after confirming proper ETT placement and achieving effective lung isolation. General anaesthesia was induced with inj. propofol 1 mg/kg and inj. ketamine 2 mg/kg. One-lung ventilation was confirmed, and neuromuscular blockade was achieved with inj. vecuronium 0.1 mg/kg. General anaesthesia was maintained with oxygen, nitrous oxide, and sevoflurane, tidal volume at 6 mL/kg, Positive End Expiratory Pressure (PEEP) of 5 cm H₂O. Post induction, her blood pressure was 124/78 mmHg, heart rate of 74 beats/min, oxygen saturation of 96% and peak airway pressure of 29 cm H₂O. Central venous access was achieved through the right femoral vein, and left radial artery was cannulated for invasive blood pressure monitoring. Dexmedetomidine infusion was started at 0.3 mcg/kg/hour prophylactically, to attenuate sympathetic response, to prevent tachycardia and Ventilation-Perfusion (V/Q) mismatch, and to prevent exacerbation of Superior Vena Cava (SVC) syndrome. Approximately, five minutes after administering muscle relaxant, plateau pressure and peak pressure increased significantly, 38 cm H₂O and 41 cm H₂O, respectively, and patient desaturated to 76%, with sudden onset of hypotension (Table/Fig 2). The bronchial blocker was deflated temporarily to allow both lung ventilation and improve oxygenation. Measures including increasing FiO₂ to 100%, applying PEEP to the ventilated lung, suctioning of the airway was done and dexmedetomidine and inhalational agents including nitrous oxide were discontinued. Manual ventilation was initiated and for haemodynamic stability, phenylephrine boluses and noradrenaline at 0.05 mcg/kg/min were administered, and the patient was positioned to the right lateral decubitus to relieve compression of mass on major vessels and airway and to improve V/Q mismatch. Hydrocortisone 2 mg/kg was administered, along with salbutamol and budesonide metered dose inhalers through the ETT. Manual ventilation was continued till saturation plateaued to 91%, and the airway pressures improved. Repeat auscultation revealed air entry in right upper zones compared to right basal area. Check fiberoptic bronchoscopy revealed that the ETT had been misplaced into the right upper bronchus. The tube was withdrawn by 2 cm guided by fiberoptic bronchoscopy and secured, and recruitment manoeuvre was initiated until saturation improved to 96%. The patient was repositioned to supine and the surgeons immediately preceded with sternotomy and lifting the mass. The surgery lasted approximately 4.5 hours and the tumour weighing 1.5 kg was resected through a median sternotomy (Table/Fig 3), and sent for histopathology. The airway pressure decreased and oxygen saturation improved to 99%. For intraoperative analgesia, 0.125% bupivacaine and 2 mg morphine were administered via the epidural catheter before skin incision. Intraoperative Arterial Blood Gas (ABG) monitoring was done every hourly to assess oxygenation, ventilation status and haemoglobin monitoring. To minimise postoperative airway oedema, intravenous hydrocortisone 2 mg/kg and dexamethasone 0.1 mg/kg were administered. Prior to extubation, cuff leak test was done and volume was noted to be >110 mL, indicating adequate airway patency. After confirming adequate ventilation, oxygen saturation of >98% and protective airway reflexes, patient was reversed with inj. sugammadex 4 mg/kg and was extubated and subsequently transferred to the surgical Intensive Care Unit (ICU) for further monitoring. Emergency reintubation equipments and difficult airway cart were kept ready at the bedside. Post-extubation, the patient received nebulisation with budesonide and salbutamol to reduce airway inflammation. No signs of respiratory distress or airway compromise were observed post-extubation. Recovery period was uneventful in Surgical Intensive Care Unit (SICU) with stable haemodynamics, normal respiratory function, and no signs of airway compromise. Managing intraoperative SVC syndrome during mediastinal mass resection requires optimising venous return and fluid resuscitation, maintaining airway patency and ensuring haemodynamic stability. Induction during mediastinal mass resection may require a semi-erect or sitting position to avoid airway compression and to optimise airway management, as in the index case, where intubation was done in semi-Fowler’s position (3),(4). Awake fiberoptic intubation is the gold standard for securing the airway, as general anaesthesia can cause bronchial smooth muscle relaxation, worsening tracheal compression, elevate airway pressures and difficult ventilation (3). Inhalational induction should be avoided or used cautiously, as partial airway obstruction could also create negative pressures, potentially collapsing a compressed trachea and causing obstruction (5). If ventilation is impaired, steps such as increasing oxygen concentration, both lung ventilation and maintaining functional residual capacity are vital to reduce hypoxaemia (1). Repositioning the patient can help relieve airway obstruction, but care must be taken to avoid or identify ETT malposition. Muscle relaxants should be used only after confirming airway patency and adequate ventilation. Rigid bronchoscopy with a skilled surgeon on standby is essential for airway assessment and management. Large-bore intravenous access and femoral central lines are recommended (4). Post-extubation, ICU monitoring is critical due to risk of emergent reintubation. Constant vigilance and preparedness, and close monitoring of ventilatory and haemodynamic parameters are key to avoiding catastrophic airway or circulatory collapse. Extreme care and vigilance are needed to prevent apnoea, as there exists a significant risk of failing to intubate or establish a patent airway in such patients. In situations of emergency, immediate assistance should be called upon, including notifying the surgeon and arranging equipments for the management of such difficult and challenging airway.

The Silent Heart: Unveiling Mitral Stenosis in the Postoperative Period

Aparna Bagle, Rashmi Kelkar

Dear Editor, Mitral Stenosis (MS) is a valvular heart condition marked by the narrowing of the mitral valve opening. The normal mitral valve area is 4-6 sq cm (1). While rheumatic fever is the most common cause, the stenosis generally does not become clinically important until several decades after the initial infection (2). It usually manifests 20 to 40 years after an episode of rheumatic fever and is more common in females (3). Common symptoms include orthopnea and paroxysmal nocturnal dyspnea (4). As the condition progresses, patients may also experience palpitations, chest pain, hemoptysis, and thromboembolism, particularly with an increased left atrial volume. The case, a 41-year-old female patient with no known co-morbidities was posted for vaginal hysterectomy in view uterovaginal prolapse since last two months which was confirmed clinically and on ultrasonography showing second degree uterovaginal prolapse. Preoperative evaluation showed vitals Non Invasive Blood 163 Pressure (NIBP) of 120/84 mmHg, Pulse Rate (PR) of 96 beats per min with oxygen 164 saturation 98% on room air. Physical examination and laboratory investigations were within normal limits, Chest X-ray (Table/Fig 1) showed increased broncho-vascular markings and the electrocardiogram (Table/Fig 2) showed normal sinus rhythm with a heart rate of 100 per min. There was no history of shortness of breath, orthopnea, or palpitations. A 2D Echocardiogram was not done as patient did not give any positive history and the electrocardiogram was normal. Vaginal hysterectomy under combined spinal and epidural anesthesia was the modality of choice. Preoperatively and intraoperatively, the patient was haemodynamically stable and the surgery was uneventful. The patient was shifted to the post operative recovery unit followed by ward. Postoperative analgesia was given via the epidural catheter with injection Tramadol 50 mg and the catheter was removed on postoperative day 2 as the patient did not complain of pain. However, on the evening of postoperative day 2, the patient had an episode of sudden hypotension (80/40 mmHg) and desaturation (92% on room air) and was promptly shifted to the Intensive Care Unit (ICU) for further management with vitals as shown in (Table/Fig 3). In the ICU, 500 mL colloid and 1000 mL crystalloids were administered. However, the blood pressure continued to remain on the lower side 86/48 mmHg and thus noradrenaline infusion was started. Patient continued to be tachypneic and bilateral crept were present so patient was put on non invasive ventilatory support. A 2D echocardiogram screening was done by the intensivist which showed dilated left atrium and mitral valve thickening. Urgent cardiology referral was done in which the 2D echocardiogram showed an ejection fraction of 60%, rheumatic affection of the mitral valve and moderate MS measuring 1.3 sq cm. Patient was continued on inotropic support of Injection Noradrenaline infusion 0.05 mcg/kg/min and titrated according to blood pressure and diuretic Inj. Furosemide 20 mg i.v. once a day were started to control left atrial pressure and enhance oxygenation. Fortunately, the patient responded favourably to medical treatment, and her respiratory condition improved within 48 hours. This case demonstrates the difficulty of detecting MS in a person who did not have evident clinical symptoms or a history of rheumatic heart disease. Although the patient was asymptomatic prior to surgery, the strain of the procedure and the recovery period possibly made the symptoms of MS worse, resulting in desaturation and congestion of the lungs. Even though cardiac imaging may not always be part of standard preoperative screenings, Point-of-Care Ultrasound (POCUS) may be a useful technique as it can aid in early detection of issues and health care professionals should be familiar with the same. A 2D echocardiogram can be later performed by a cardiologist to confirm. In the absence of overt symptoms, undiagnosed valvular heart disease can cause major consequences, particularly in the postoperative period, when the body’s compensating mechanisms may be overwhelmed. Particularly in patients having major surgery, routine auscultation, careful evaluation of faint murmurs, and, where necessary, additional cardiovascular screening should be taken into consideration.

Hereditary Dehydrated Stomatocytosis due to PIEZO1 Mutation and Potential Therapeutic Target for Sickle Cell Anaemia

Afaq Ahmad Khan, Santosh G Rathod

Dear Editor, A 32-year-old female born out of a third-degree consanguineous marriage presented to the haematology clinic with generalised weakness, pallor, icterus, and pain in the left hypochondriac region. All these symptoms were for six months and progressive in nature. There was no history of similar complaints in other family members. On evaluation, the blood count showed: haemoglobin 9.9 g/L, red blood cell counts 3.37.000/mm³, white blood count of 7.1×10⁹/L, platelets 128×10⁹/L, Mean Corpuscular Volume (MCV) 98.3 fL, Mean Content Haemoglobin (MCH) 29.12 pg, Mean Corpuscular Haemoglobin Concentration (MCHC) 29.80 g/dL. Further evaluation revealed a total bilirubin of 2.4 mg/dL, indirect bilirubin of 2.1 mg/dL, Lactate Dehydrogenase (LDH) 1450 U/L, and haptoglobin of <8 mg/dL. The reticulocyte index on presentation was 9.0%, the electrolytes Na+ was 135 Meq/L, and the K+ was 4.5 Meq/L. The ultrasound of the abdomen showed splenomegaly 6 cm below the left costal margin. To find out the cause of haemolysis, we performed peripheral smear examination that showed numerous stmomatocytes anisopiokilocytosis, macrocytes, microcytes and spherocytes (Table/Fig 1). In order to rule out autoimmune haemolytic anaemia, Antinuclear Antigen (ANA), Anti-ds Deoxyribonucleic Acid (anti-ds DNA), and direct and indirect Coombs tests were performed, and they were all negative. The paraoxysmal nocturnal haemoglobinuria profile was found to be negative. We performed High-Profile Liquid Chromatography (HPLC), showing HbA2 at 5.3%, HbA at 73%, and HbF at 0.5%, ruling out haemoglobinopathy as the cause of haemolysis. Genetic tests encoding the beta and alpha globin chains ruled out structural modifications to haemoglobin. Enzyme activity related to red blood cell metabolism was normal. In order to rule out red blood cell structural defect as the cause of haemolysis, we performed the Eosin-5-Maleimide (EMA) test, which had a value within the normal range of 14% (normal test range >11%), ruling out the spherocytosis. This test is normal in all forms of stomatocytosis. Osmatic fragility test was negative in this patient. We could not do PINK test because of non-availability at our set-up. All these tests were performed to look for the defect in the red cell membrane (1),(2). We performed additional tests, the glycerol lysis test and sodium dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE), for quantification of red blood cell membrane protein that came negative and ruled out hereditary spherocytosis, elliptocytosis and pyro poikilocytosis. In view of dehydrated stomatocytosis, ektacytometry was performed that measured the erythrocyte deformability by subjecting them to osmotic stress, showing a left shift of osmolarity curve, and giving a clue to the Dehydrated Hereditary Stomatocytosis (DHS). The genetic test was performed and results of a targeted-NGS custom panel made up of hereditary anaemias were positive for the PIEZO1 gene’s exon 39 containing a heterozygous missense variant on chromosome 16 (c.5647C>T) that causes Tryptophan to be substituted for Arginine at codon 1883 (p. Arg1883Trp) (3). The Sanger sequence provided evidence for this gene (Table/Fig 2). The variation was identified as pathogenic insilico analysis. The current mutation was completely novel in an Indian population. DHS is brought on by a change in the RBC membrane’s permeability to the monovalent cations Na+ and K+ due to a mutation in the PIEZO1 gene that codes for a mechanoreceptor (3). This affects the intracellular cationic content and results in cell dehydration and volume changes. Invertebrates and vertebrates alike use mechanoreceptors, which are cation channels that are activated by many kinds of mechanical stimuli, as biological pressure sensors (1),(3). The primary causal gene for this condition is PIEZO1, which is located at 16q23–24 and inherited in an autosomal dominant pattern (2),(3). At the RBCs’ plasma membrane, it is highly expressed (3). There is a chance of misdiagnosis since DHS and hereditary spherocytosis share several characteristics, and a sequential diagnostic algorithm is required to diagnose the condition [Table/ Fig-3]. In DHS, haemolysis occurs intravascularly. Hence, splenectomy does not have a role in such patients (1). If splenectomy is done in such a patient, they are prone to thrombosis of the portal vein and pulmonary hypertension. Female patients can develop pseudohyperkalaemia during pregnancy (1),(3). The aim of treatment is to reduce complications from chronic haemolysis and anaemia. If a newborn is suspected of having hereditary dehydrated stomatocytosis, in that case, one should not wait for diagnostic confirmation; start treating hyperbilirubinaemia and, in severe cases, blood transfusion or exchange transfusion should be performed (1),(2). The transfusion of red blood cells may be required for severely affected infants and in aplastic crisis. There is an increased requirement for folate due to stress erythrocytosis. The dose for children with moderate to severe haemolysis is 1 to 2 mg/day (4),(5). Transfusions are required at any time of life in adult patients due to aplastic and haemolytic crises, and iron metabolism should be regularly checked for the risk of developing severe hepatic iron overload (1),(2). PIEZO1 channels have a significant role in sickle cell crisis related to sickle cell anaemia. When HbS (sickle) is deoxygenated in the venous system, it allows sickle cells to become permeable to calcium through PIEZO1 channels, which initiates a dehydration cascade influenced by the outward electrochemical gradient of potassium (6). The deoxygenation of HbS causes PIEZO1 channels to activate, facilitating Ca2+ entry following its steep inward electrochemical gradient. Increased intracellular calcium concentration {(Ca2+)i} activates the calcium-sensitive Gardos channels (KCNN4), resulting in a net loss of KCl and water (6). The irreversibly sickled cells exist in this hyperdense yet volume-stable and pathogenic condition for most of their life cycle in circulation until a decline in sodium pump activity causes sudden rehydration and subsequent cell lysis (6). The patient received guidance about the contraindications of splenectomy, the risks of iron overload, and the necessary follow-up during pregnancy. Currently, she is taking 5 mg of folic acid daily in tablet form. She has been effectively treated for haemolytic anaemia.

Circulating Endothelin-1 as a Diagnostic Marker in Patients with Acute Myocardial Infarction: A Cross-sectional Study

Anitha Rajendiran, S Sumathi, S Giridharan, V Kuzhandaivelu

Introduction: The most common form of Coronary Heart Disease (CHD) is Acute Myocardial Infarction (AMI). When a coronary artery is blocked, it results in a substantial reduction in blood flow, which causes some of the heart muscle supplied by that artery to become infarcted. The development of Myocardial Infarction (MI) is regulated by a variety of complex processes. Vascular blockage and cardiac ischaemia may be exacerbated by endothelial dysfunction, platelet activation, and inflammation. Aim: To investigate the potential role of Endothelin-1 (ET-1) in the diagnosis of AMI. Materials and Methods: This cross-sectional research was carried out at Mahatma Gandhi Medical College and Research Institute in Pondicherry, India over the duration of one year (2023- 2024) with a sample size of n=50 for the AMI group and n=30 for the healthy control group. Ethical clearance was obtained prior to the study. Upon admission, a 5 mL sample of peripheral venous blood was collected, centrifuged, and biochemical parameters such as glucose (random), urea, creatinine, and lipid profile were assessed using standard appropriate methods. The Enzyme-Linked Fluorescence Assay (ELFA) method was used to test troponin I, and the ET-1 immunoassay ELISA kit was utilised to quantify ET-1. Data were recorded and analysed using Statistical Package for Social Science (SPSS) Version 23 software. Categorical variables were analysed using the Chi-square test, whereas non-normally distributed continuous data were assessed with the Mann-Whitney U test. A Receiver Operating Characteristic (ROC) curve was plotted to identify the optimal cut-off value for ET-1 levels in patients with AMI. Bivariate correlation analysis was performed using the Spearman correlation test. Results: Serum ET-1 levels were significantly higher in AMI subjects compared to the control group (14.02±12.2 pg/mL vs. 3.1±2.8 pg/mL, p<0.001). The ROC curve analysis indicated that the serum ET-1 cut-off level was found to be 6.1 pg/mL. Additionally, serum ET-1 levels showed significant correlations with troponin I levels (correlation coefficient: 0.513, p=0.001). Conclusion: Elevated serum ET-1 levels at the time of admission were associated with higher troponin-I levels in patients with AMI. Hence, ET-1 can be a promising diagnostic marker for AMI assisting in early detection and prognosis.

Effectiveness of Tai Chi Exercise on VO₂max in Patients with Cancer after Chemotherapy: An Experimental Study

Seema Das, Somyata C Satpathy Sarma, Subarna Sankar Das, Trishna Kakati

Introduction: Tai Chi, originally a Chinese martial art, is now recognised as an effective form of aerobic exercise beneficial for cardiac rehabilitation and mental well-being. It involves gentle movements, deep breathing, and relaxation, promoting body awareness and focus. Classified as a moderate-intensity exercise (2.6-6.5 MET), Tai Chi has shown clinical benefits, particularly for individuals with chronic conditions. Aim: This study aimed to evaluate the effectiveness of Tai Chi exercises by comparing baseline and post-exercise VO2max scores in cancer patients after chemotherapy. Materials and Methods: A quasi-experimental study commenced in March 2022 and was completed in September 2022, affiliated with the College of Physiotherapy and Medical Sciences under Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India. A total of 30 subjects were assessed, of whom sevenwere excluded, two declined, and 21 participated. After seven dropouts, 15 participants (aged 20-60 years, diagnosed with breast, stomach, or colorectal cancer) at stage II who had completed all doses of chemotherapy completed a 6-week Tai Chi programme (30-minute sessions twice a week). VO₂max was measured pre- and post-intervention. Demographic data (gender, height, weight, cancer type, chemotherapy doses, and vital signs) were considered. SPSS software version 25 was used, the Shapiro-Wilk test for normality was applied, and a paired t-test was conducted for parametric analysis, with statistical significance set at p<0.05, where p<0.001 was considered highly significant. Results: Fifteen post-chemotherapy patients participated in a 6-week Tai Chi programme. Pre- and post-programme VO₂max values were analysed using paired sample t-tests, with the Shapiro-Wilk test for normality. The sample consisted of 33% males and 67% females, with a mean age of 42.8 years (SD=8.41). VO₂max increased from a pre-exercise mean of 32.92 to a post-exercise mean of 36.64. Statistical analysis in SPSS version 25 showed significant improvement (p<0.001). Conclusion: The study indicates that a 6-week Tai Chi exercise programme significantly improves VO₂max in cancer patients post-chemotherapy, suggesting its potential as an effective rehabilitative intervention for enhancing cardiovascular fitness and overall well-being in this population.

Impact of Preoperative Prism Adaptation Test and Patch Test Measurements on Surgery in Concomitant Horizontal Strabismus: A Prospective Interventional Study

Rahul Singh, Disha Chaudhary, Charu Sagar, Vandana Kohli

Introduction: Concomitant horizontal strabismus poses significant challenges in achieving optimal surgical outcomes, with risks of undercorrection or overcorrection remaining a concern. Preoperative assessment techniques, such as the Prism Adaptation Test (PAT) and Patch Test, have been utilised to better estimate the angle of deviation and plan surgeries accordingly. The PAT is thought to refine surgical corrections by revealing the maximum angle of deviation. However, its specific impact on surgical outcomes-especially in comparison to the patch test-remains underexplored. Aim: To evaluate the impact of preoperative PAT and patch test measurements on surgical outcomes in patients with concomitant horizontal strabismus, focusing on their role in optimising surgical corrections and minimising postoperative undercorrection and overcorrection. Materials and Methods: This prospective interventional study was conducted over 15 months at Department of Ophthalmology, Employees’ State Insurance Corporation (ESIC) Postgraduate Institute of Medical Sciences and Research (PGIMSR), Basaidarapur, New Delhi, India, from October 2017 to February 2018 and included 30 subjects diagnosed with concomitant horizontal strabismus. Preoperative deviation measurements were obtained using the Prism Bar Cover Test (PBCT) at three distances: near (33 cm), intermediate (6 m), and far (12 m). These measurements were recorded both before and after a one-hour monocular occlusion (patch test). Following this, participants underwent the PAT. Based on their responses to these tests, subjects were categorised into three groups: non responders, patch test responders, and PAT responders. Surgical corrections were planned and performed using the maximum deviation identified by the PAT. Postoperative outcomes were assessed eight weeks after surgery using Hirschberg’s test and the Prism Alternate Cover Test (PACT). The study’s parameters included analysing preoperative and postoperative deviations, categorisation of test responses, and surgical outcomes. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 17.0, and a p-value of <0.05 was considered statistically significant. Results: The study included a total of 30 participants, comprising 18 males and 12 females, with a mean age of 20.83±12.03 years. Among them, 14 individuals presented with esotropia, while 16 exhibited exotropia. The study found that PAT significantly improved surgical outcomes. The actual residual deviation postsurgery ranged from 0 to 16Δ with PAT measurements, compared to an estimated range of 5 to 25Δ if surgeries were based on PBCT measurements before occlusion and 0 to 21Δ after occlusion. The mean residual deviation was lowest in PAT responders (6.8±6.07Δ) compared to patch test responders (8.5±6.09Δ) and non responders (11.5±7.09Δ) (p-value=0.02). Satisfactory alignment was observed in 90% of PAT responders, 80% of patch test responders, and 50% of non responders (p-value <0.04). Conclusion: The study concludes that the PAT significantly improves surgical precision and outcomes in patients with concomitant horizontal strabismus. By providing a more accurate assessment of deviation angles, the PAT reduces the risk of undercorrection and overcorrection compared to conventional preoperative measurements. These findings highlight the importance of incorporating PAT into preoperative evaluations to achieve optimal postoperative alignment and minimise residual deviations. The study underscores PAT’s value in enhancing surgical planning and outcomes, suggesting its routine use in clinical practice. Further research is warranted to evaluate its long-term effects on binocular vision and overall quality of life.

Trimester Specific Effect of Pregnancy on Maternal Cognitive Function using Critical Flicker Fusion Frequency: A Cross-sectional Study

J Roshni, S Anu, M Ramji

Introduction: Critical Flicker Fusion Frequency (CFFF) measures cognitive function by detecting the threshold at which flickering light appears steady. This threshold reflects neural processing and cortical arousal, making it useful for diagnosing conditions like Alzheimer’s and schizophrenia. During pregnancy, hormonal fluctuations can cause cognitive symptoms (“pregnancy brain”). Monitoring cognition ensures safety, productivity, and early detection of complications like pre-eclampsia. Despite importance, CFFF research during pregnancy is limited, especially across trimesters. Aim: To find out objective cognitive changes in various trimesters of pregnancy using CFFF in primigravid women and compare with non pregnant women. Materials and Methods: The present observational cross-sectional study was conducted from October 2023 to March 2024 in the Department of Physiology of Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India. The study involved 155 primigravid women in various trimesters and 50 non pregnant women in the age group of 21-25 years. The subjects were categorised into three groups. Group A- 1st trimester group with Gestational Age (GA) between 0-13 weeks, Group B - 2nd trimester group with GA between 14- 27 weeks, Group C- 3rd trimester with GA between 28-40 weeks. CFFF was measured in all these groups and the association was analysed. CFFF was measured with CFF M1 model instrument (Mavom Labs, Bangalore) using Netra software. Data were statistically analysed by using Chi-square test. Results: The study included 53 pregnant primigravid women in the 1st trimester, 51 in the 2nd trimester, 51 in the 3rd trimester, and 50 non pregnant samples of similar age, marital status and with the average husband’s income of 42,261.29 with significant variability (SD= 28,048.74). A significant decrease in CFFF values were observed in 1st (p-value <0.001) and 3rd (p-value <0.001) trimesters in pregnant women when compared to non pregnant individuals. The 2nd trimester showed a significant increase in CFFF (p-value <0.001). Conclusion: The CFFF measurements could provide a useful tool for identifying individuals at risk of more severe cognitive decline or sensory processing difficulties during pregancy and take appropriate measures.

Evaluating Objective Structured Practical Examination as a Formative Assessment Tool in Biochemistry: A Cross-sectional Study from a Medical College in Telangana, India

Amtul Rahman Amberina, Ravirala Tagore, B Ramya Sree

Introduction: National Medical Council (NMC) advocates for Competency-Based Medical Education (CBME). This learner-centred curriculum emphasises continuous assessment that measures competencies and provides feedback. Objective Structured Practical Examination (OSPE) provides an improved objectivity and reliability than conventional assessment method. Thus, the present study was focused to assess cognitive as well as psychomotor domains in 1st-year medical students by implementing modified OSPE. Aim: To evaluate OSPE module for the comprehensive assessment of both theoretical knowledge and practical skills among Phase 1 medical students in biochemistry, and to evaluate students’ perception of the OSPE through a structured questionnaire. Materials and Methods: This prospective, interventional cross-sectional study was conducted from November 2024 to January 2025 in the Department of Biochemistry at Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India. A total of 126 students were recruited for the study after obtaining institutional ethical clearance (IEC No: 226/OCT/2024). All the students were taught about diabetes mellitus and estimation of Random Blood Sugar (RBS); the procedure was recorded and the video was shared with students through WhatsApp. OSPE stations were organised to estimate the RBS values and students were assessed using a prevalidated checklist. The student feedback on OSPE was solicited through a standardised questionnaire and analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: All 126 students (100%) agreed that the OSPE instructions were clear and that the procedural video was helpful. A majority, 120 (95.2%), found the time allotted to be sufficient, while 6 (4.8%) did not. Similarly, 120 (95.2%) students confirmed that the OSPE questions were covered in lectures, and 123 (97.6%) students felt that the OSPE was well organised. Overall, 124 (98.4%) students reported that the OSPE was a valuable learning experience and supported conducting similar sessions regularly. The reliability score was 0.94. The student’s performance was very good, with 125 (99.2%) students scored more than 80% in procedure station and more than 75% in response station. Conclusion: The performance of students in the OSPE was very good, as most students scored good marks and their perception towards OSPE was more positive and opted to conduct regularly. So, the OSPE can be used as an assessment tool in formative assessment.

Birth Preparedness and Complication Readiness among Adult Males in Chengalpattu District, Tamil Nadu, India: A Cross-sectional Study

Vaishnavi Nagarajan, Aamina Hussain, VV Anantharaman

Introduction: The active participation of males is vital for enhancing maternal and child health outcomes. Supporting mothers in timely healthcare decisions ensures better access to services and care. The World Health Organisation (WHO) defines maternal mortality as deaths caused by pregnancy-related complications or their management within 42 days of pregnancy termination, excluding incidental causes. Birth Preparedness and Complication Readiness (BPCR) is intended to reduce the three primary delays that lead to maternal mortality: delays in recognising the need for medical care, reaching a healthcare facility and receiving timely and proper treatment. Aim: To assess males’ levels of BPCR and identify the factors that influence their participation in these critical aspects of maternal health. Materials and Methods: A community-based cross-sectional study was conducted in Chengalpattu district of Tamil Nadu, India. The research work was carried out from December 2024 to February 2025. The sample size was calculated as 412, and at the end of the data collection, through simple random sampling, 420 samples were collected. Eligible participants were males aged 18 years and above. After obtaining ethical clearance, data collection was carried out using a validated questionnaire adapted from the Johns Hopkins Programme for International Education in Gynaecology and Obstetrics (JHPIEGO) questionnaire devised by The Maternal and Neonatal Health Programme, affiliated with Johns Hopkins University. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics, Chi-square tests, and logistic regression (both bivariate and multivariate) were applied to assess associations among variables. A p-value of <0.05 was considered statistically significant. Results: Among the 420 individuals, 193 (45.95%) were in the 30-39 years age group. Most participants (267, 63.57%) were first-time fathers. Commonly recognised danger signs during pregnancy include nausea and vomiting and severe headaches, which were recognised by 341 (81.2%) and 249 (59.3%) participants, respectively. Multivariable analysis revealed that cultural influence on decision-making was a statistically significant predictor of BPCR, influencing male participation in maternal health planning (AOR=0.091, 95% CI: 0.057-0.143, p-value <0.001). Conclusion: The study infers that early and informed male involvement in BPCR significantly enhances maternal health outcomes, emphasising the need for targeted awareness and engagement strategies.

Assessment of the Stress Distribution in Internal Resorption Cavities Filled with MTA and Biodentine in Mature Teeth: A Finite Element Analysis Study

Introduction: Internal Root Resorption (IRR) is the gradual deterioration of dentine due to clastic activity, typically appearing as a radiolucent area in the radicular dentine in communication with the root canal. Bioceramic materials such as Mineral Trioxide Aggregate (MTA) and Biodentine are available to restore the resorption cavity, offering biocompatibility and better sealing to the dentine. The present study employs the Finite Element Analysis (FEA) method to simulate stress behaviour, providing valuable insights into the effectiveness of these materials in reducing stress concentrations and reinforcing structurally compromised teeth. The findings aim to support clinical decision-making for achieving long-term restoration success. Aim: To evaluate and compare the stress distribution patterns in tooth models with IRR restored with MTA and Biodentine at the apical, middle and coronal thirds, employing FEA. Materials and Methods: This FEA study was conducted in the Conservative Dentistry and Endodontics department at Sibar Institute of Dental Sciences in Guntur, Andhra Pradesh, India, from June 2024 to August 2024. Seven three-dimensional (3D) FEA models of mandibular first premolars were designed: M1 (IRR at apical third restored with MTA), M2 (IRR at middle third restored with MTA), M3 (IRR at cervical third restored with MTA), M4 (IRR at apical third restored with Biodentine), M5 (IRR at middle third restored with Biodentine), M6 (IRR at cervical third restored with Biodentine) and M7 (control model). A force of 300 N was applied to the buccal side at a 30° inclined angle to the occlusal plane. Linear analysis was conducted to assess the Von Mises stress values along the central XY plane of the tooth model. The maximum and minimum Von Mises stresses were recorded and directly compared for each virtual tooth model. Results: Stress analysis showed maximum stress concentrations near the edges of the resorption cavities for both materials. In MTA-filled models, peak stress values were 73.35 MPa (apical), 104.35 MPa (middle) and 102.79 MPa (coronal), while Biodentine-filled models showed slightly lower peaks at 72.33 MPa (apical), 103.65 MPa (middle) and 101.86 MPa (coronal). Minimum stress values ranged from 0.0002 MPa to 0.0022 MPa across models, primarily in regions distant from the cavities. Conclusion: Biodentine exhibited slightly better stress redistribution than MTA, with lower peak stress values across all resorption levels; however, both materials left the cavity edges as critical stress concentration zones. These findings emphasise the need for additional restorative measures to address structural vulnerabilities.

Knowledge, Attitudes, and Perceptions of Wet Cupping Therapy (Hijamah) among the Public in Northern Saudi Arabia: A Cross-sectional Study

Introduction: Traditional medicine, particularly cupping therapy (Hijamah), is prevalent in both developed and developing nations, especially in the Kingdom of Saudi Arabia. Currently, it provides numerous health benefits, such as the prevention and treatment of various health problems including headaches, fatigue and bone aches. Aim: To explore the knowledge, perceptions and attitudes of the adult population in the Northern Border region of Saudi Arabia towards Hijamah. Materials and Methods: A cross-sectional study design was utilised among the adult general population in the Northern Border region of Saudi Arabia, between 1st March 2024 and 30th September 2024. A self-administered structured questionnaire containing questions about demographics, knowledge, attitudes and perceptions of Hijamah was employed. Qualitative data were presented as frequencies and percentages. Results: The study included 392 participants, whose mean age was 36±11.7 years. The majority of the participants believed that wet cupping is a helpful practice 367 (93.6%). Slightly less than 80% 303 (77.3%) accept it as an alternative therapy. The most frequently mentioned use of wet cupping is for fatigue relief 314 (80.1%), followed by headaches 299 (76.3%), back pain 270 (68.8%) and joint pain. Most people 328 (83.7%) agree that wet cupping remains a conventional therapeutic practice today. Conclusion: The majority of the adult population in the Northern Border Region understands the practice of Hijamah, accepts it as an alternative medicine, believes it has a favourable impact and commonly uses it to relieve fatigue, headaches and bone pains.

A Narrative Review on Factors Affecting Access to Oral Health Services in Türkiye

Onur Bayrakci, Duygu Kalkay, Hazel Celik Guzel

Oral health is an essential public health problem directly affecting people’s general health and quality of life. Rates of utilisation of oral health services in Türkiye are affected by various factors such as people’s socioeconomic status, geographical location, and ease of access to the health system. Low income, inadequate education, and lack of health insurance in private sector coverage are the main barriers in accessing oral health services. Socioeconomic inequalities affect people’s utilisation rates of oral health services and regular care habits, leading to both treatment delays and higher health costs. Increasing preventive oral health awareness and addressing the relationship between access to oral health services and social and economic factors are critical for developing sustainable policies to improve individuals’ quality of life and reduce health inequalities. In recent years, Türkiye has confronted significant challenges with elevated inflation and unemployment rates. These factors have substantially constrained access to healthcare services. Presently, Türkiye ranks sixth with the highest inflation rate globally. This review aimed to analyse the access to oral health services in Türkiye and the factors affecting this access. In addition, solutions to reduce existing inequalities are presented.

Impact of COVID-19 Lockdown on Profile of Ocular Injuries: A Retrospective Cohort Study from a Tertiary Care Centre, West Bengal, India

Trisha Ghosh, Sanjay Kumar Daulat Thakur, Anup Mondal, Sourav Dey

Introduction: Ocular trauma represents a significant yet preventable contributor to visual impairment. The enforcement of lockdown measures during the Coronavirus Disease-2019 (COVID-19) pandemic led to people remaining confined to their homes, which likely influenced both the risk factors and the pattern of ocular injuries during this period. Aim: To determine the characteristics and visual outcomes of patients with ocular trauma during the COVID-19 and post- COVID-19 periods. Materials and Methods: This retrospective, hospital-based cohort study was conducted among patients presenting to the Department of Ophthalmology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India. Data were collected on patient demographics, mode and location of injury, time interval between injury and presentation, presenting Visual Acuity (VA) and the management of ocular trauma. Categorical variables were summarised using frequencies and percentages, while continuous variables were expressed as mean±standard deviation deviation. Group differences were analysed using Pearson’s Chi-square test. Results: A total of 2,010 eyes of 1,940 patients were included in this study. Males were more predominant in both the COVID-19 and the post-COVID-19 lockdown periods. The mean age of the study population was significantly lower during COVID-19 (25.48±20.3 years) compared to the post-COVID-19 period (29.97±17.3 years) (p-value=0.006). Injuries sustained at home were considerably higher than workplace injuries during the COVID-19 pandemic. Patients with ocular trauma during COVID-19 had delayed presentation. The incidence of closed globe injuries was notably higher during the COVID-19 period, with corneal epithelial defects being the most prevalent type, observed in 25.7% of cases (p-value=0.002). Sharp objects were the leading cause of injury during this time, accounting for 21.4% of cases. In contrast, during the post-COVID-19 period, the most common causative agents were plant leaves (20.3%), followed by animal-related injuries (15.3%). Furthermore, the proportion of patients presenting with trauma-related blindness was greater during the COVID-19 period (10.1%) compared to the post-lockdown phase (9%). Conclusion: During the COVID-19 pandemic, the number of patients seeking care for ocular trauma significantly decreased, while injuries occurring within the home environment increased. Enhancing public awareness and implementing preventive strategies could help reduce the risk of eye-related complications and vision loss associated with domestic activities.

Ocular Toxicity Associated with Tamoxifen Administration in Patients with Breast Cancer: A Systematic Review

Introduction: Tamoxifen (TAM), a selective Oestrogen Receptor (ER) modulator, is widely used for treating and preventing ER-positive Breast Cancer (BC). TAM, administered as an adjuvant therapy for hormone receptor-positive BC, reduces recurrence but can cause ocular toxicity, including retinal degeneration, macular oedema, and corneal changes. However, the underlying mechanisms behind these effects remain unclear. Aim: This systematic review aimed to evaluate the ocular toxicity induced by TAM in patients with BC and to assess the reported adverse events. Materials and Methods: A systematic review was conducted which included a comprehensive search of electronic databases and grey literature sources to identify relevant studies published between May 2018 and May 2024. Observational studies (case-control and cross-sectional) published in the English language that detailed the ocular Adverse Effects (AE) of TAM in patients with BC were considered for inclusion. Three reviewers screened the selected studies based on the title and abstract. Disagreements were resolved by discussion with another reviewer. Data extraction included study characteristics, patient demographics, intervention details, and ocular changes. Results: Five studies met the inclusion criteria and were included in the review. The analysis revealed that TAM-induced ocular toxicity results in diverse structural and functional changes within eye tissues, including retinal degeneration, macular thinning, alterations in choroidal thickness, and vascular modifications. The severity of ocular toxicity correlated with cumulative TAM exposure, highlighting the need for long-term eye monitoring in patients receiving extended therapy. Conclusion: This systematic review indicated a possible link between TAM use and ocular toxicity, although the evidence is limited by methodological constraints. These results highlight the necessity of eye monitoring for patients undergoing TAM treatment, especially for those receiving long-term regimens.

Role of One Month Yoga Training on Arterial Stiffness in Young Adults with Familial Hypertension: A Prospective Interventional Study

Introduction: Family history of hypertension is an important non modifiable risk factor that may lead to development of hypertension in otherwise healthy individuals. This is reflected in altered vascular stiffness parameters in these subjects. Yoga has been shown to improve these parameters and may help prevent or at least postpone the future development of hypertension. Aim: To find out the association between family history of hypertension and vascular stiffness and to determine the effect of yoga as a therapeutic tool in subjects at risk of future hypertension. Materials and Methods: This prospective interventional study was conducted from September to November 2023 at Centre for Yoga and Exercise Physiology, Shri B.M. Patil Medical College and Research Centre, Karnataka, India. Study included a total of 126 apparently healthy consenting undergraduate individuals aged between 18 and 30 years. Anthropometric, physiological, as well as arterial stiffness parameters like pulse wave velocity and Arterial Stiffness Index (ASI), were recorded using Periscope preintervention at week zero and post-yoga intervention at week four. Statistical Package for the Social Sciences (Version 20.0) was used to analyse the data. For normally distributed data, an independent t-test was used and for non normally distributed data Mann-Whitney U test was used, with p-value <0.05 considered statistically significant. Results: The study consisted of 46.8% boys and 53.2% girls, with a mean age of 19.94±1.422 years. Significant associations were found between male and females in anthropometric, physiological and arterial stiffness parameters, including Rt. Brachial ASI (p-value=0.002), Rt. Ankle ASI (p-value=0.034), and vascular age (p-value=0.013). At week 0, subjects with family history of hypertension showed appreciable differences in the mean values of vascular parameters, but significant association was only brachial ASI (p-value=0.013). Statistically significant results were observed when the effect of yoga was assessed between week 0 and 4 across most parameters; but group-specific effect of yoga intervention, particularly for subjects with family history of hypertension, was observed only on Rt. Ankle ASI (p-value=0.027). Conclusion: This study revealed a gender difference in arterial stiffness parameters, as well as the significant effect of four weeks of yoga intervention following the prescribed yoga protocol in young adults. Although not statistically significant, differences in mean values also indicate group-specific differences in arterial stiffness parameters favouring stiffer vessels in subjects with family history and the group-specific effects of yoga might warrant further study.

Hepatoprotective Effects of Momordica dioica Against Acetaminophen-induced Liver Damage in Rats: An Experimental Study

Introduction: Hepatotoxicity from acetaminophen is a major contributor to liver damage. Among the most popular analgesics, acetaminophen has few adverse effects when taken in therapeutic dosages; however, acetaminophen abuse frequently results in hepatotoxicity. Aim: The aim of this study is to investigate the histopathological changes induced by a therapeutic dose of N-acetyl-para-aminophenol (APAP) and to explore the hepatoprotective role of the oral co-administration of Momordica dioica fruit extract in mitigating hepatotoxicity induced by APAP in rats. Materials and Methods: The present experimental study was conducted in the central animal facility of Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, between February to April 2024. Thirty-six healthy male albino Wistar rats were utilised in this study, randomised and divided into six groups (G1-G6) of six rats each. The rats were administered APAP (i.p.) and Momordica dioica (MD) orally for 42 days as follows: (G1) Control (normal saline), (G2) APAP (250 mg/kg), (G3) APAP (250 mg/kg)+silymarin (250 mg/kg), (G4) APAP (250 mg/kg)+Vitamin C (200 mg/kg), (G5) APAP (250 mg/kg)+Vitamin C (200 mg/kg)+MD (250 mg/kg), and (G6) APAP (250 mg/kg)+Vitamin C (200 mg/kg)+MD (500 mg/kg). All animals in groups G2-G6 received the respective drug or ally according to their treatment group for 42 days, one hour prior to acetaminophen induction. Results were analysed using one-way ANOVA for statistical significance. Results: The results demonstrated that rats given a therapeutic dose of APAP for 42 days experienced substantial histological alterations alongside elevated blood chemistry indicators. Co-administration of Momordica dioica extract resulted in significantly fewer histopathological lesions and restored or decreased levels of the tested blood chemistry parameters. Rats treated with silymarin exhibited no histological alterations, while liver histology in the Momordica dioica extract group revealed (100%) normal hepatic architecture with minor alterations. According to histochemical staining, APAP-induced hepatotoxicity was characterised by minimal to mild fibrosis (6/6), hydropic degeneration (6/6), necrosis (6/6), and steatosis (6/6). Conclusion: The oral co-administration of Momordica dioica extract possesses significant hepatoprotective properties and mitigates APAP-induced hepatotoxicity by enhancing its antioxidant role and improving tissue integrity. Momordica dioica supplementation could represent an effective treatment against APAP-induced hepatotoxicity.

Correlation of Cartridge Based Nucleic Acid Amplification Test Grading Based on Cycle Threshold Value with Clinicoradiological Profile and Time to Culture Positivity in Pulmonary Tuberculosis Patients: A Cross-sectional Study

Introduction: Tuberculosis (TB) remains a global health challenge, with India bearing the highest burden, including Multidrug-Resistant (MDR) TB. Early diagnosis is critical in controlling transmission, often achieved using GeneXpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF), which detects TB bacilli, RIF resistance and provides Cycle Threshold (CT) values reflecting bacillary load. Correlating CT values with clinical, radiological and microbiological parameters can enhance the evaluation of disease severity and guide management. Aim: To evaluate the correlation of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) CT values with clinical, radiological and microbiological parameters to assess bacillary load and disease severity in pulmonary TB. Materials and Methods: This cross-sectional study was conducted at Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India from April 2023 to April 2024. Patients diagnosed with pulmonary TB based on CBNAAT were enrolled. The study period spanned 12 months. The study included 110 participants (calculated for 95% confidence, 80% power and 7.5% error, based on 62% smear-positive prevalence and 90.5% GeneXpert sensitivity). Eligible participants were adults (≥18 years) providing consent, including all sputum smear-positive cases and smear-negative suspects. Patients with extrapulmonary TB, undetectable sputum CBNAAT-MTB, and pregnant women were excluded. Data collected included name age, sex, symptoms and signs (cough, expectoration, fever, breathlessness, weight loss, chest pain, haemoptysis, clubbing, icterus, pallor, cyanosis, lymph node, oedema, chest examination), vitals (blood pressure, oxygen saturation, heart rate, temperature, respiratory rate, Body Mass Index (BMI), mid upper arm circumference) Bandim scores, co-morbidities and demography, Chest X-ray (CXR) grading, sputum fluorescent microscopy grading and time to positivity in liquid culture. Correlation analyses were performed using Spearman’s rho and Pearson’s tests. IBM Statistical Package for the Social Sciences (SPSS) version 29.0 was used for statistical analysis, and a p-value <0.05 was considered significant. Results: The study included 110 patients, with the largest group (41) aged 21-40 years, followed by 30 patients in the 41-60 years age range. The mean age of the participants was 44.93±18.07 years. It demonstrated significant correlations between CBNAAT CT values and various diagnostic parameters. CBNAAT CT values were inversely correlated with Bandim scores (Spearman’s rho=-0.82, p-value <0.001), chest X-ray grading (Pearson’s r-value=-0.429, p-value=<0.001), and sputum fluorescent microscopy grading (Spearman’s rho=-0.63, p-value=<0.005), indicating lower CT values were associated with higher bacillary loads. Conversely, a positive correlation was observed between CBNAAT CT values and liquid culture time to positivity. Bivariate analysis showed that high bacillary loads were significantly associated with higher Bandim scores, advanced chest X-ray grading and elevated sputum microscopy grading (p-value <0.05). Conversely, low bacillary loads were characterised by higher CBNAAT CT values, milder radiological findings and reduced sputum microscopy grading. These findings underscore the utility of these variables in distinguishing between low and high bacillary load cases. Conclusion: CBNAAT CT values are strongly correlated with clinical, radiological and microbiological parameters in pulmonary TB. Lower CT values are indicative of higher bacillary loads, while higher CT values suggest lower bacillary loads. These findings highlight the potential of CBNAAT CT values as a surrogate marker for bacillary burden in pulmonary TB.

Psychological Risk Factors and Clinical Outcome Variables in Vaginismus: A Systematic Review

Introduction: Vaginismus is a genito-pelvic pain marked by involuntary muscle contraction, pain, and avoidance of vaginal penetration, significantly affecting women’s health and quality of life. Despite its impact, vaginismus remains under-recognised and poorly understood. Aim: This systematic review aims to synthesise recent evidence on psychological, risk, and clinical variables in women with vaginismus. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors searched PubMed, SCOPUS, Web of Science, and Science Direct for English language articles published between Jan 2019 and Dec 2023 using combinations of keywords and MeSH terms related to “vaginismus,” “psychology,” “risk factors,” and “sexual disorders.” Studies were included if they addressed vaginismus concerning risk factors, psychological aspects, or associated variables in human subjects. Two reviewers independently screened and selected studies, with disagreements resolved by consensus. Data extraction, screening, and quality assessment were performed using Rayyan Qatar Computing Research Institute (QCRI). Results: Fourteen studies were included, including 3,086 female subjects. Sexual intimacy, self-image, fear of sex, sexual quality of life, education level, family structure, childhood trauma, cultural ideas about first sexual experiences, and misunderstandings about sexuality were among the several elements linked to vaginismus. Vaginismus is connected to anxiety and depression, underscoring the need for psychotherapy in treatment. Vaginismus was found to increase with grade, potentially lowering success rates and necessitating longer treatment times. Conclusion: This review highlights that vaginismus is a multifactorial disorder best managed through individualised, multidisciplinary care. Early recognition and tailored interventions, particularly combining psychological and physical therapies, are key to improving outcomes and quality of life for affected women.

Comparison of Milligan-Morgan Haemorrhoidectomy versus Laser Haemorrhoidoplasty in Patients with Grade II and III Haemorrhoids: A Prospective Observational Study

Introduction: Haemorrhoidal disease results from abnormal dilation of anal cushions, influenced by dietary habits and pelvic anatomy. Surgical management remains essential for symptomatic cases, with Milligan-Morgan haemorrhoidectomy as the gold standard despite significant postoperative pain. Laser haemorrhoidoplasty has emerged as a minimally invasive alternative with faster recovery and fewer complications. Aim: To compare the clinical outcomes of Milligan-Morgan haemorrhoidectomy and laser haemorrhoidoplasty in patients with grade II and III haemorrhoids, focusing on postoperative pain, hospital stay, complications, and recovery time. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India, from January 2022 to June 2023 (including three months of follow-up). A total of 40 patients were randomly assigned into 2 groups, group A (laser) with 20 patients and group B (Milligan Morgan) with 20 patients. The postoperative outcomes, including duration of intervention, pain, hospital stay, return-to-work time (recovery time) were assessed. Statistical analysis was performed using Statistical Package For Social Sciences (SPSS) software, with p<0.05 considered significant. Results: The mean age of the study participants was 41.35±13.95 in the laser group vs 43.3±12.75 in the open group, with no significant age or sex difference. The laser group had significantly lower postoperative pain {Visual Analogue Scale (VAS) 4.60±1.14 vs. 9.15±0.67 on Day 1, p<0.001}, shorter operative time (19.85 min vs. 54.75 min), reduced intraoperative blood loss (7±2.51 mL vs. 23±5.23 mL, p<0.001), and shorter hospital stay (1.1 vs. 1.85 days, p<0.001). Recovery time was significantly faster in the laser group (7.75±2.40 vs. 21±4.45 days, p<0.01). Complications such as secondary bleeding in 4 (20%) patients, urinary retention in 5 (25%) patients and anal stenosis in 5 (25%) patients occurred only in the open group. Conclusion: Laser haemorrhoidoplasty offers significant advantages over Milligan-Morgan haemorrhoidectomy, including reduced pain, faster recovery, and fewer complications.

Clinical Outcomes of Non Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Non Valvular Atrial Fibrillation Patients: A Cohort Study in a Rural Tertiary Care Hospital, Gujarat, India

Sohilkhan Riyazkhan Pathan, Bharat M Gajjar, Sunilkumar Karna, Kushal Pujara

Introduction: Atrial Fibrillation (AF) is the most common arrhythmia, with an increased risk of ischaemic stroke and subsequent morbidity and mortality. Oral anticoagulants such as Vitamin K Antagonists (VKAs) and non VKA Oral Anticoagulants (NOACs) are effective stroke prevention treatments, when used properly. The CHA²DS²-VASc and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly (age >65 years), and Drugs/alcohol) scores are utilised to guide clinical decision-making in stroke prevention and bleeding risk management for patients with AF. However, real-world evidence on anticoagulation strategies and their effectiveness in rural Indian populations remains limited. Aim: To evaluate the clinical outcomes of NOACs versus VKAs in Non Valvular Atrial Fibrillation (NVAF) patients in a rural tertiary care hospital in India. Materials and Methods: An ambidirectional cohort study, conducted from January 2014 to December 2024, evaluated baseline demographic and clinical characteristics and anticoagulation therapy (NOACs or VKAs) in NVAF patients. Clinical outcomes evaluated encompass major (example: ischaemic or haemorrhagic stroke) and minor bleeding, and all-cause mortality. Fisher’s exact test was used to compare patient and clinical characteristics between the NOAC and VKA groups. The log-rank test and Cox proportional hazards analysis were used to compare bleeding risk and mortality between NOAC and VKA groups. Results: Among the 347 patients with NVAF, those prescribed NOACs were significantly older (median age 74 vs. 58 years, p-value <0.0001) and had higher CHA²DS²-VASc scores (median 4 vs. 3, p-value <0.0001) than VKA users. NOAC users also had a higher prevalence of hypertension, diabetes, ischaemic heart disease, prior stroke and chronic kidney disease (p-value <0.0001). Major bleeding was slightly more common in NOAC patients (2.9 vs. 2.1 events per 1,000 person-months, p-value=0.40). The log-rank test showed no significant difference in major bleeding event between NOAC and VKA groups (p-value=0.10). However, all-cause mortality was higher in NOAC users (11.6 vs. 7.7 per 1,000 person-months). Conclusion: Although NOACs are generally favoured in AF management, this study found higher mortality and bleeding risks among NOAC users in a rural Indian cohort. Older age, higher burden of co-morbidities, being underweight and higher stroke and thromboembolic risk can contribute to adverse outcomes among NOAC users. These findings highlight the need for individualised anticoagulation strategies, particularly in resource-limited settings.

Comparison of Oral Pregabalin and Clonidine Premedication in Attenuating Pressor Response to Laryngoscopy and Intubation: A Prospective Interventional Study

Introduction: Laryngoscopy and intubation during the induction of general anaesthesia can lead to sympathetic system-mediated haemodynamic pressor response, which, if exaggerated, may lead to hazardous complications like myocardial ischaemia, arrhythmias, and cerebral haemorrhage. Although several pharmacological and technical methods are available to attenuate this stress response, the search for an ideal agent continues. Aim: To compare the effects of orally administered clonidine and pregabalin in attenuating the haemodynamic pressor response to airway instrumentation during the administration of general anaesthesia. Materials and Methods: The present prospective interventional study was conducted between June 2020 and July 2021 at Government Medical College, Kozhikode, Kerala, India. A total of 176 American Society of Anaesthesiologists (ASA) Physical Status I patients aged between 18 and 65 years were included. Patients were categorised into two groups: Group P received oral pregabalin 150 mg and Group C received oral clonidine 200 mcg, 60 minutes before the induction of GA. Haemodynamic parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)} and Ramsay sedation scores were recorded at predefined intervals. Statistical analysis was performed using International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) software, with data expressed as mean±Standard Deviation (SD). Differences between groups were assessed using the Chi-square test, independent samples t-test, and Mann-Whitney U test, with a p-value of <0.05 considered statistically significant. Results: Demographic variables and baseline parameters were comparable between the groups. A statistically significant reduction in HR was observed in the clonidine group compared to the pregabalin group (p<0.05) at multiple time intervals post-drug administration. SBP, DBP, and MAP values showed reductions in both groups, with no significant intergroup differences (p>0.05). A higher incidence of bradycardia and hypotension was noted in the clonidine group (p<0.05). Sedation scores, compared using the Mann-Whitney U test, revealed significantly higher sedation in the pregabalin group at one hour after drug administration and 15 minutes after extubation. Conclusion: Both clonidine 200 mcg and pregabalin 150 mg, when administered orally one hour before the induction of anaesthesia, are effective in attenuating the haemodynamic pressor response. Clonidine is superior to pregabalin in reducing tachycardia; however, clonidine carries a higher risk of bradycardia and hypotension, whereas pregabalin results in greater postoperative sedation.

Serum Lipid Profile in Uterine Fibroids Patients Attending a Tertiary Healthcare: A Cross-sectional Study

Introduction: Uterine leiomyoma, also called uterine fibroids, is the most common benign tumour of the female genital tract. Symptomatic uterine fibroids cause significant morbidity and are the most common indication for hysterectomy. Steroid hormones such as oestrogen and progesterone are considered to be the most important links in the pathophysiology of uterine fibroids. Simultaneously, oestrogen affects several aspects of lipid metabolism. Therefore, there might be a possible association between dyslipidaemia and uterine fibroids. Aim: To determine and compare the serum lipid profile in women with and without uterine fibroids. Materials and Methods: The present cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology at the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, from January 2021 to October 2022. Fifty women with uterine fibroids (cases) and 50 women without uterine fibroids (controls), who fulfilled the inclusion and exclusion criteria, were conveniently recruited. Their blood samples were taken and analysed for serum lipid profile. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. For continuous variables, an independent t-test was used, while for categorical variables, the Chi-square test was employed to compare cases and controls. Pearson’s correlation was used to find the correlation between the variables. A p-value of <0.05 was considered statistically significant. Results: The mean age of the cases was 44 years, while that of the controls was 42 years. However, no statistical significance was observed (p-value >0.05) among the groups for age. The mean levels of serum total cholesterol (193.06±18.11 mg/dL), triglycerides (179.70±28.45 mg/dL), and Low-Density Lipoprotein Cholesterol (LDL-C) (152.72±17.70 mg/dL) in uterine fibroid cases were significantly higher compared to the controls (176.60±15.17 mg/dL, 160.96±32.89 mg/dL, 132.04±19.97 mg/dL), respectively (p-value <0.001, p-value <0.01, p-value <0.001, respectively). High-Density Lipoprotein Cholesterol (HDL-C) was significantly lower in cases (38.94±6.53 mg/dL) compared to the controls (45.22±7.76 mg/dL) (p-value <0.001). Conclusion: Dyslipidaemia in women is associated with the risk of uterine fibroids. Hence, early interventions such as dietary lifestyle modifications might help to control dyslipidaemia and prevent uterine fibroids.

Correlation of Core Muscle Strength and Lung Capacity among College-going Students: A Cross-sectional Observational Study

M Chinmayi, SN Tejaswini, Abeeshna Ashok

Introduction: The abdominal muscles play a crucial role in posture, trunk stability, and respiration. They regulate Intra-abdominal Pressure (IAP), support spinal stability, and function as accessory respiratory muscles during increased respiratory demand. Pulmonary Function Tests (PFTs), particularly spirometry, assess lung function by measuring airflow and lung capacity. Given the involvement of abdominal muscles in respiration, their strength may influence pulmonary function. Aim: To explore the correlation between abdominal muscle strength and respiratory function, focussing on the Forced Expiratory Volume in one second (FEV1)/Forced Vital Capacity (FVC), ratio and Maximum Voluntary Ventilation (MVV) in healthy adults. Materials and Methods: A cross-sectional observational study was conducted at JSS College of Physiotherapy, Mysore, Karnataka, India. The study was carried out over a six-month period, from July 2021 to December 2021.Participants were recruited through convenience sampling from the college population. A total of 22 healthy college-going students, aged 18-25 years, were included.Participants were informed about the nature and purpose of the study and provided written informed consent. The procedure included, assessment of abdominal muscle strength using a hand-held dynamometer. The test was performed in a standardised supine position on a treatment table inclined at 30°, with lower limbs strapped for stability. Three trials were conducted with 5 second rest intervals, and the average was recorded. PFT was done using a computerised spirometer (EasyOne PC). Parameters recorded included FEV1/FVC ratio, MVV and Tidal Volume (TV). The Pearson correlation coefficient (“r”) was utilised to determine the relationship between abdominal strength, FEV1/FVC, MVV, TV, age, height, weight, and Body Mass Index (BMI). A p-value of less than 0.05 was deemed significant. Results: A significant positive correlation was found between abdominal strength and MVV in the 6th second (r=0.420, p=0.049) and TV (r=0.506, p=0.016), indicating that individuals with greater abdominal strength exhibited better ventilatory capacity. However, FEV1/FVC (r=0.196, p=0.381) and overall MVV (r=0.354, p=0.106) did not show statistically significant correlations. Conclusion: This study explored the correlation between core muscle strength and lung capacity among college-going students. The findings indicate a significant correlation between core strength and pulmonary function, suggesting that stronger core muscles may contribute to better lung capacity.

Comparison between Combined Spinal and General Anaesthesia versus General Anaesthesia alone for Laparoscopic Gynaecological Procedures: A Randomised Controlled Study

Bhavini Shah, Pragya Pramanik, Brinda Badam, Reshma Salim

Introduction: Laparoscopic gynaecological surgery provides less surgical trauma, shorter recovery, and less postoperative pain. Although General Anaesthesia (GA) is widely used, adding Spinal Anaesthesia (SA) to GA can give better haemodynamic stability and better perioperative outcomes. The current study contrasts SA and GA combination (SGA) with GA alone in laparoscopic gynaecological surgery. Aim: To compare and assess the impact of SGA versus GA alone on intraoperative haemodynamics, Isoflurane and metoprolol needs, recovery time, satisfaction of the surgeon, and postoperative complications. Materials and Methods: This randomised controlled trial was conducted at Dr. D. Y. Patil Medical College, involving 50 laparoscopic gynaecological surgery patients. Patients were divided randomly into two groups. Group SGA was administered both SA and GA, while group GA was administered GA. Haemodynamic parameters, demand for anaesthetic agents, duration of recovery, and surgeon satisfaction scores (NRS) were measured and examined. Side-effects like hypotension, nausea, and vomiting were also evaluated. The gathered data were compiled, entered into Microsoft Excel, and analysed using Statistical Package for Social Sciences (SPSS) version 27.0 and if data were not normally distributed the Mann-Whitney U test was used. For categorical variables, the Chi-square test or Fisher’s-Exact test was used. Results: Demographics and baseline haemodynamic parameters were similar in both groups. Group GA had significantly more isoflurane requirement (0.728±0.0817) than group SGA (0.36±0.08) (p<0.0001). Intraoperative metoprolol was needed in only group GA (3.86±1.35 mg). Recovery time was significantly less for group SGA (3.94±0.14 min) than for group GA (7.35±1.1 min) (p<0.0001). Surgeon satisfaction was greater in group SGA (7.2±0.82 vs. 4.28±1.1, p<0.0001). Duration of surgery and pneumoperitoneum times were comparable in both groups (p>0.05). Side-effects were minimal. Six patients in group GA had nausea and vomiting, while two in group SGA had hypotension. Conclusion: The use of SA and GA together in laparoscopic gynaecological surgery results in improved intraoperative haemodynamic control, less requirement of anaesthetic drugs, shorter recovery time, and increased surgeon satisfaction without adding side-effects. SGA can be considered a more desirable option than GA alone in selected patients receiving such procedures.

Comparative Evaluation of Cytotoxicity of Silver and Zinc Oxide Nanoparticles-based Herbal Oral Rinse and Commercially Available Oral Rinse: An In-vitro Study

Introduction: Oral hygiene is a cornerstone of overall health and its importance in dentistry cannot be overstated. Maintaining good oral hygiene is essential not just for preventing tooth decay and gum disease but also for improving general health and well-being. Commercial oral rinses can be a useful addition to an oral hygiene routine, but they are not a cure-all and should be used with caution. Although many commercial oral rinses are available in the market, the therapeutic effects of these products are questionable. In the present study, a unique oral rinse formulation incorporating African basil and black tulsi herbal extracts, combined with silver and zinc oxide nanocomposites (Ncs), was developed and assessed for its cytotoxic properties using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay, with the aim of determine if the herbal oral rinse served as a safe and effective alternative to commercial oral rinses commonly used for oral hygiene. Aim: To compare the cytotoxic effects of silver nanocomposite-based oral rinse and commercial oral rinse on mouse fibroblast cell viability using the MTT assay across a range of concentrations. Materials and Methods: The present in-vitro study was conducted in the research laboratory of Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, over a period of six months starting from March 2024 and concluding on August 2024. In the present study, the green synthesis of Zinc Oxide Nanoparticles (ZnONPs) and Silver and Zinc Oxide Nanoparticles (AgNPs) was carried out utilising African basil and black tulsi extracts (Ocimum tenuiflorum and Ocimum gratissimum) in the presence of a zinc nitrate solution (30 mM in 50 mL distilled water) and a 1 mM silver nitrate solution, respectively. Following the preparation of 100 mL of nanocomposite-based herbal oral rinse, mouse fibroblast cells were exposed to varying concentrations of nanocomposite-based oral rinse and commercial oral rinse (Listerine oral rinse) and cell viability was assessed using the MTT assay. The test was repeated five times at each concentration and the cytotoxic effects of the oral rinses were compared. The Mann-Whitney U test was used to compare the mean values between the two study groups {commercial oral rinse (group-1), nanocomposite oral rinse (group-2)} and p<0.05 was considered statistically significant. Results: The commercial oral rinse used, Listerine (Listerine Oral Rinse-Johnson and Johnson Ltd., Kolhapur, India, Batch No: MK0068), exhibited a dose-dependent cytotoxic effect, with decreasing cell viability percentages as concentrations increased: 80% at 5 μg/mL down to 30% at 100 μg/mL. In comparison, the nanocomposite-based oral rinse also showed reduced cell viability with increasing concentrations but to a lesser extent: from 85% at 5 μg/mL to 35% at 100 μg/mL. The differences in cytotoxicity between the two oral rinses were evident across all concentrations tested, suggesting a potentially milder impact of the nanocomposite-based oral rinse on cell viability compared to commercial oral rinse. Silver nanocomposite-based oral rinse consistently maintained higher cell viability percentages compared to the commercial oral rinse across all tested concentrations, indicating a potentially milder cytotoxic impact on fibroblast cells. Conclusion: The study demonstrates that nanocomposite-based oral rinse has a less cytotoxic impact on mouse fibroblast cells compared to commercial oral rinse. These results emphasise the potential benefits of nanocomposite-based formulations in oral care products for maintaining optimal cell viability.

A 3D Finite Element Analysis on Stress Distribution of Two Ceramic Materials used for Fabrication of Laminate Veneers using Two Preparation Designs: An In-vitro Study

Introduction: Veneers have been successfully used in cases of aesthetic and cosmetic dentistry. As the thickness of veneers needs to be 0.5 mm to enable bonding to enamel, the preparation of teeth is crucial to ensure longevity. There are numerous incisal preparation designs for veneers, but there is no uniform opinion among various investigators regarding the preferred design parameters. Knowledge of the intensity and distribution of stresses may aid in predicting the failure patterns of veneers with different types of preparations. Aim: To evaluate the maximum principal stresses generated on the model of a maxillary central incisor tooth designed to be restored with veneers made from two different materials: Lithium disilicate and Zirconia, and prepared according to two distinct incisal designs: with “incisal butt-joint” and with “incisal palatal mini-chamfer”. Materials and Methods: This was an in-vitro study conducted at Guru Nanak Institute of Dental Science and Research, Kolkata, India between March 2018 and June 2019. A three-dimensional (3D) Finite Element Analysis (FEA) was employed to evaluate the maximum principal stresses. A virtual 3D model of an extracted maxillary central incisor tooth was obtained using Digital Imaging and Communications in Medicine (DICOM) images from a micro Computer Tomography (CT) scan and assembled using Materialise Interactive Medical Image Control System (MIMICS) software. One model was created for each of the four variable designs and materials. The 3D objects corresponding to the “veneer,” “underlying cement layer,” and “remaining tooth structure” were meshed in the Materialise 3-matic (3-MATIC) software. A single static load consistent with incisal bite force in natural dentition was applied to the tooth in the incisal third on the palatal surface at a 135º angle. The pattern of stresses in the model was calculated in numerical values and depicted in colour coding. The maximum principal stress values were calculated separately for the “veneers,” “underlying cement layer,” and “remaining tooth structure,” and were tabulated. The mean and p-values were calculated. Results: The butt-joint preparation showed less maximum stress on the “veneers” {p-value 0.51 (F1) and 0.01 (F2)}, “cement layer” {p-value 0.0007 (F1) and 0.0004 (F2)}, and “remaining tooth structure” {p-value 0.40 (F1) and 0.47 (F2)} compared to the palatal chamfer preparation. The zirconia-restored veneers with butt-joint preparation {p-value 0.12 (F1) and 0.05 (F2)} and palatal mini-chamfer preparation {p-value 0.05 (F1) and 0.80 (F2)} imparted less stress than the lithium disilicate restored veneers. Conclusion: Butt-joint preparation of the veneers proved to be better than the palatal chamfer, and zirconia proved to be a better restorative material than lithium disilicate for veneers.

Comparative Efficacy of 20-Degree versus 30-Degree Angled Wedges on Inferior Vena Cava Diameter and Haemodynamic Stability during Spinal Anaesthesia for Caesarean Section: A Randomised Controlled Trial

Introduction: Spinal anaesthesia is the preferred method of choice for Lower Segment Caesarean Section (LSCS) and is safe for both the mother and foetus. Spinal anaesthesia also provides adequate pain relief for parturient. The most common condition that occurs during the pregnancy is supine hypotension syndrome, which gets aggravated after spinal anaesthesia. Hypotension can be prevented by fluid preloading, vasopressors, inotropes and by placing the wedge below the right gluteal region. Aim: To know the impact of different angled wedges on Inferior Vena Cava (IVC) diameter and its effect on intraoperative haemodynamic changes. Materials and Methods: This study was randomised controlled single-blinded study conducted at the the Department of Anaesthesiology at Sri Ramachandra Medical College, Chennai, Tamil Nadu, India, from January 2024 to December 2024 done on pregnant patients aged from 20-40 years. In this study, in preoperative area IVC diameter was measured using ultrasound in supine position. After the measurement of IVC diameter, Group A received a standard 20-degree wedge (control) and Group B received a 30-degree angled wedge, both placed in right gluteal region and waited for 10 minutes. After 10 minutes change in IVC diameter was assessed and compared to baseline. All the study participants received same wedges intraoperatively and effect of these wedges on IVC diameter, haemodynamic parameters Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Heart Rate (HR) and rescue phenylephrine requirements were assessed. Data were analysed using independent t-test, Chi-square test and paired t-test, with p≤0.05 considered as statistically significant. Results: Both groups were comparable in demographic characteristics like age and Body Mass Index (BMI). In the present study, the mean IVC diameter in Group A, assessed without wedge at zero minute was 1.25±0.29 cm and after using wedge for 10 min) was 1.40±0.31cm (p-value within the group <0.001). In Group B, the mean IVC diameter assessed without wedge (0 min) was 1.22±0.25 cm and after 10 minutes of using wedge, the mean IVC diameter was 1.48±0.25 cm (p-value within the group <0.001). Patients in Group B required less rescue phenylephrine than those in Group A (p<0.005). Patients in Group A had significantly lower SBP and DBP at 4 min after spinal anaesthesia. Conclusion: The mean IVC diameter after placing the wedge was significantly increased in both groups, but the difference between both groups was not statistically significant. Patients in 30-degree wedge group required lesser amount of phenylephrine than those in the 20-degree wedge group.

Screening Tests to Identify Injury Risk in Competitive Swimmers: A Scoping Review

Dnyanesh Pramod Patil, Ajit Surendra Dabholkar

Introduction: Swimming places unique demands on athletes, encompassing repetitive, high-intensity movements in a challenging aquatic environment, which predisposes them to a higher risk of injuries. Early identification through screening tests is essential for injury prevention in swimmers. Several screening tests are available to assess injury risk in swimmers, highlighting the need to identify effective, clinically relevant tools. Aim: To review existing literature on screening tools that identify the risk of injury in competitive swimmers. Materials and Methods: An electronic search of the PubMed database, as well as secondary sources like Google Scholar, was conducted for relevant studies from the earliest available date until February 2024. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A population, concept, and context framework was used to select and collect data. Peer-reviewed full-text studies involving competitive swimmers across different age categories were included, while studies that were reviews or in non English languages were excluded. Data were extracted using Excel, and the following factors were summarised: study design, population, screening tools, and major findings. A quality rating for the selected studies was conducted using the National Institutes of Health (NIH) study-quality assessment tool. Results: A total of 7,255 articles were identified, from which 16 full-text studies reported the use of various screening tools to assess injury risk. The majority of the studies (n=12) were rated as fair quality according to NIH standards. Shoulder horizontal abduction Range of Motion (ROM), posterior shoulder endurance, and the isokinetic functional strength ratio (EccER: ConIR) were most effective in identifying shoulder injuries. However, limited evidence exists regarding the identification of injury risk in other body regions, such as the knee and spine. Conclusion: Screening tools identified decreased shoulder rotation strength ratio, Posterior Shoulder muscle Endurance (PSE), and shoulder horizontal abduction ROM as causative risks for swimming injuries. However, it is also evident that screening needs to be comprehensive and should include robust outcomes to effectively determine injury risk.

Clinical Profile of Patients with Ischaemic Heart Disease and its Correlation with Rheumatoid Factor: A Cross-sectional Study

Introduction: Ischaemic Heart Disease (IHD) remains a leading cause of global mortality, with increasing evidence suggesting the role of inflammatory markers in its pathogenesis. While Rheumatoid Factor (RF) is traditionally associated with autoimmune conditions, its potential involvement in IHD has gained attention. Aim: To evaluate the clinical profile of IHD patients and investigate its correlation with RF. Materials and Methods: A cross-sectional study was conducted at Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India from November 2023 to October 2024, involving 100 IHD patients. Comprehensive clinical assessments, including detailed history, physical examination, laboratory investigations (including RF testing), Electrocardiography (ECG), and cardiac imaging, were performed. Statistical analysis was conducted using Epi Info software version 7. Results: The study population (52% male, 48% female) showed a high prevalence of RF positivity (70%). Significant correlations were found between RF levels and cardiac parameters: a negative correlation with ejection fraction (r-value=-0.385, p-value=0.002) and positive correlations with the number of vessels involved (r-value=0.412, p-value=0.001) and C-Reactive Protein (CRP) levels (r-value=0.526, p-value <0.001). Traditional risk factors were prevalent: diabetes mellitus (52%), hypertension (40%) and dyslipidaemia (50%). Seventy-five percent of patients showed angiographic evidence of coronary artery disease, with 29% having triple vessel involvement. RF-positive patients demonstrated more severe disease manifestations across multiple parameters. Conclusion: A significant correlation was found between RF and IHD severity, suggesting its potential utility as a marker for risk stratification. The findings support the integration of RF testing in the comprehensive evaluation of IHD patients, particularly for identifying those at risk for more severe disease manifestations.

Prognostic Role of Tumour Stroma Ratio in Oral Squamous Cell Carcinoma Arising in the Background of Oral Submucous Fibrosis: A Retrospective Study

Introduction: Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder with an increased risk of malignant transformation. Oral Squamous Cell Carcinoma (OSCC) arising in the background of OSMF shows distinct clinical presentation and behaviour. The present study was done with the rationale to understand the disease progression and assist in treatment planning using Tumour Stroma Ratio (TSR). Aim: This study aimed to evaluate the role of TSR in OSCC arising in the background of OSMF. Materials and Methods: This retrospective study was conducted in the Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu from January 2024 to June 2024. Only patients reported with conventional OSCC with detailed clinicopathological and survival data were included in this study. A total of 120 slides were retracted from the departmental records and grouped into Group-1- OSCC arising in the background of OSMF (30 cases), Group-2- Well Differentiated OSCC (WDSCC) (30 cases), Group-3- Moderately Differentiated OSCC (MDSCC) (30 cases), and Group-4- Poorly Differentiated OSCC (PDSCC) (30 cases). Group-2, 3 and 4 cases showed no clinical signs or histopathological features of OSMF. The TSR was evaluated at the invasive front of the tumour and recorded as stroma-high and stroma-low. The survival data for these patients were retrieved from the medical records. Kappa statistics, Chi-square and Kaplan-Meier survival analysis were performed to statistically analyse the results. A p-value of ≤0.05 was considered statistically significant. Results: A total of 26 (86.6%) cases of OSCC arising in the background of OSMF showed stroma-low and 4 (13.3%) cases showed stroma-high TSR. The WDSCC group exhibited a predominance of stroma-low tumours with 24 cases (80%) of stroma-low and six cases (20%) of stroma-high TSR. In MDSCC group, 20 cases (66.6%) showed stroma-low and 10 (33.3%) cases showed stroma-high TSR. Notably, the PDSCC group had a significantly higher proportion of stroma-high tumours, with four cases (13.3%) of stroma-low and 26 cases (86.6%) of stroma-high TSR. This difference between the four groups was statistically significant (p<0.001). On survival analysis, it was noted that the stroma-low cases had a better survival rate than stroma-high TSR. Conclusion: OSCC arising in the background of OSMF are low-grade tumours and TSR can be helpful in predicting the survival rate of OSCC patients.

Comparison of Haemodynamic Responses to Video Laryngoscopy versus Flexible Fibreoptic Bronchoscopy for Endotracheal Intubation among Patients undergoing Elective Surgery under General Anaesthesia: A Randomised Clinical Trial

Yoyaphi A Shimray, Seni Potsangbam, Jonan Puni Kay

Introduction: Endotracheal Intubation (ETI) triggers sympathetic stimulation, causing Haemodynamic Stress Responses (HDSRs). Innovations such as video laryngoscopes and flexible fibreoptic bronchoscopes have revolutionised the airway management. Aim: To compare the haemodynamic responses to video laryngoscopy versus flexible fibreoptic bronchoscopy for ETI among patients undergoing elective surgery under general anaesthesia. Materials and Methods: This randomised, single-blinded, clinical study was conducted at the Department of Anaesthesiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India,from September 2022 to July 2024. The present study included sixty patients divided into Group V (video laryngoscope) and Group F (fibreoptic bronchoscope). After a standard intravenous induction, ETI was performed. Haemodynamic parameters were recorded at baseline, at induction, at intubation, and every minute for five minutes. The duration of intubation and postoperative complications were also recorded. Categorical data were presented as frequencies and analysed with the Chi-square test, while quantitative data were presented as mean±standard deviation and compared using an independent t-test. Statistical significance was set at p<0.05. Results: The present study included 30 participants in each of the two groups, giving a total sample size of 60. The mean age and Body Mass Index (BMI) were 40.16±11.50 years and 22.43±2.36 kg/m² in Group V, and 39.13±10.19 years and 22.84±2.13 kg/m² in Group F. A significant difference in the duration of intubation in seconds (38.40±17.65 for Group V and 50.03±11.81 for Group F, p=0.026) was observed. Baseline haemodynamic parameters were comparable. At induction, Systolic Blood Pressure (SBP: p=0.265), Diastolic Blood Pressure (DBP: p=0.159), Mean Arterial Pressure (MAP: p=0.067), and Heart Rate (HR: p=0.433) were comparable between the groups. SBP differed significantly between the groups at intubation (p=0.046), the 1st minute (p=0.001), and the 2nd minute (p=0.014). Significant differences in DBP were observed at intubation (p=0.001), the 1st minute (p=0.001), the 2nd minute (p=0.002), and the 3rd minute (p=0.007). For MAP, significant differences occurred at intubation (p=0.003), the 1st minute (p=0.0001), the 2nd minute (p=0.001), and the 3rd minute (p=0.005). HR differed significantly at intubation (p=0.042). Sore throat was the only postoperative complication in Group V (p=0.038). Conclusion: Video laryngoscopy triggered greater HDSRs to intubation compared to flexible fibreoptic bronchoscopy. While video laryngoscopy required less time for intubation, it was associated with a higher incidence of sore throat than the fibreoptic group.

Association of Placental Morphometry with Neonatal Birth Weight in a Semi-urban Population: A Cross-sectional Study

Hemant Deshpande, Shivani Patel

Introduction: Placental morphometry, including weight, circumference, and cotyledon count, plays a critical role in foetal growth and neonatal outcomes. Understanding the associations between these parameters and birth weight may provide valuable insights for the early detection of growth abnormalities. Aim: To evaluate the relationship between placental weight, circumference, and cotyledon count with neonatal birth weight in a semi-urban population. Materials and Methods: This cross-sectional study included 120 mother-newborn pairs delivering at term at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from October to December 2024. Systematic sampling was used. Placental weight, circumference, and cotyledon count were measured post-delivery. Neonatal birth weight was recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 28. Pearson’s correlation and multiple linear regression were performed, adjusting for maternal age, parity, and Body Mass Index (BMI). A p-value of <0.05 was considered statistically significant. Results: The mean maternal age was 26.5±3.8 years, with a mean BMI of 24.8±2.5 kg/m2. Primiparous women constituted 56.7% of the participants, and 51.7% of the newborns were male. Pearson’s correlation analysis identified that placental weight (r=0.75, p-value <0.001) showed the strongest correlation with birth weight, followed by circumference (r=0.68, p-value <0.001) and cotyledon count (r=0.59, p-value <0.001). Regression analysis identified placental weight (β=0.52, p-value <0.001), circumference (β=0.33, p-value <0.01), and cotyledon count (β=0.24, p-value <0.05) as significant predictors. The mean birth weight to placental weight (BW: PW) ratio was 6.15±1.2. Conclusion: The findings of this study underscore the association between placental morphometry and neonatal birth weight, with placental weight being the strongest predictor. Hence,these findings can contribute in improving neonatal outcomes in semi-urban settings.

Comparison of Intrathecal Nalbuphine vs Intrathecal Clonidine as Adjuvant with Hyperbaric Bupivacaine in Pelvic and Lower Limb Orthopaedic Surgeries: A Randomised Clinical Study

Introduction: Addition of an adjuvants to local anaesthetic like bupivacaine, helps to make sensory and motor blockade better compare to bupivacaine alone. In this study, comparison was done amongst nalbuphine—a mixed opioid with high efficacy as an agonist of kappa receptors—and clonidine, a selective alpha-2 adreno receptor agonist. Aim: To determine the effects of intrathecal nalbuphine and clonidine as adjuvant with hyperbaric bupivacaine 0.5% on onset and duration of sensory and motor block with duration of total postoperative analgesia in pelvic and lower limb orthopaedic surgeries. Materials and Methods: This randomised clinical study was done on 50 patients aged between 18 and 65 years with American Society of Anaesthesiologists (ASA) Grade I or II, of either gender. They were randomly divided 25 in each group as Group BCL (clonidine), containing hyperbaric 0.5% bupivacaine 3.4 mL+30 μg clonidine (total 3.6 mL) and Group BN (nalbuphine) containing hyperbaric 0.5% bupivacaine 3.4 mL+1 mg nalbuphine (total 3.6 mL). Parameters studied were motor and sensory block characteristic like time of onset, duration of sensory and motor block, two-segment regression time, total duration of postoperative analgesia and side-effects. Haemodynamic changes were also noted. Statistical analysis done by using Student’s t-test and Chi-square test. Tests were considered statistically significant if p-value was <0.05. Results: Demographic data, including age, gender, weight, ASA grading and duration of surgery for both the groups, were comparable and statistically non significant. BCL group (4.15±0.57 minutes) had significantly faster onset for motor block than BN (5.06±0.42 minutes) (p-value <0.0001). Group BCL has significantly longer motor block duration (335.2±23.69 minutes) than BN (285.2±23.21 minutes), with significantly longer sensory block duration in group BCL (400.6±30.29 minutes) than BN (357.8±29.51 minutes) (p-value <0.0001). The duration of postoperative analgesia was significantly extended in the BCL group (445.8±33.87 minutes) than BN (410.8±26.56 minutes) (p-value ≤0.0002). Conclusion: Present study concluded that addition of clonidine 30 μg with hyperbaric bupivacaine 0.5% in spinal anaesthesia, compared to nalbuphine 1 mg, shortens the onset time of motor block and prolongs the duration of both sensory and motor block, while also increasing total postoperative analgesia period, all with haemodynamic stability and minimal side-effects.

Morphological Variations in the Greater Palatine Canal and Foramen Assessed using Cone Beam Computed Tomography: A Retrospective Observational Study

Introduction: The Greater Palatine Foramen (GPF), a key structure in the hard palate, serves as a critical anatomical landmark connecting the Pterygopalatine Fossa (PF) to the oral cavity via the Greater Palatine Canal (GPC). The PF contains essential structures, including the maxillary nerve, its branches, the pterygopalatine ganglion and maxillary artery. Aim: To assess the morphological and morphometric variations of GPF and canal by using Cone Beam Computed Tomography (CBCT). Materials and Methods: This retrospective observational study was conducted in the Department of Oral Medicine and Radiology, at Vishnu Dental College, Vishnupur, Bhimavaram, Andhra Pradesh, India in a time of six months, data collection from May 2024 to September 2024 and analysis in October 2024. A total of 100 scans of maxillary arch were analysed. CBCT images covering the full arch maxilla within the age range of 20 to 70 years were included. Parameters such as the shape of the foramen and distance from GPF centre to Mid-Maxillary Suture (MMS) and Anterior Nasal Spine (ANS) in axial sections and shape of the canal in sagittal sections were evaluated on both right and left-sides and compared between genders. Results: A statistically significant differences were observed in the mean distance from the GPF to the MMS on the right-side for both genders p-value=0.001. The most common shape of the GPC was straight with frequency of 22% on both right and left-sides in males and 14%, 17% on right and left-sides respectively in females in the sagittal plane and oval with a frequency of 17%- right, 18%- left-side in males and 13%- right, 11%- left in females in the axial plane. Regarding the location of the GPF in relation to molars, the most prevalent position was E, with a frequency of 24%- right and left-sides in males, 23%- on both right and left-sides in females, where the GPF is distal to the upper third molar. Conclusion: The study emphasises the importance of morphometric variations in dental procedures, using CBCT for accurate assessment and improved surgical precision. CBCT, which offers precise three-dimensional imaging that improves surgical planning, patient safety and diagnostic accuracy, is essential for precisely evaluating these variances.

Computed Tomographic Analysis of Medial Clavicular Epiphyseal Fusion for Age Estimation in Western Indian Population: A Cross-sectional Study

Introduction: Forensic age estimation is important in cases related to sexual assault, murder, skeletal remains, and juvenile crimes, where the age of the suspect or victim is unknown. The literature indicates that the age of fusion of the medial clavicular epiphyseal varies from region to region. Aim: To estimate age from medial clavicular epiphyseal fusion through computed tomographic analysis. Materials and Methods: This was a cross-sectional observational study with a sample size of 384, conducted over 24 months from January 2020 to December 2021 in the Department of Radiology at a tertiary care centre, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. The study population included patients who underwent a Computed Tomography (CT) scan of the chest, aged between 18 and 35 years. They were arbitrarily divided into six age groups: 18-20 years, 21-23 years, 24-26 years, 27-29 years, 30-32 years, and 33-35 years. The Schmeling classification was used for age estimation. Chronological age served as the constant, while the stages of radiological fusion of the medial clavicular epiphyseal were the variables. Age estimation by this method involved observing the chronological age at a particular stage of fusion. The mean age of fusion at each stage was calculated. The association among variables was analysed using the Analysis of Variance (ANOVA) test for definite variables. In the present study, the level of significance was set at 0.05. Results: Of the 384 participants (mean age 26.3±5.1 years; 217 men), 279 (72.7%) showed complete fusion of the medial epiphyses of the clavicle (stage 4 and stage 5). The mean age for medial clavicular epiphyseal fusion in men was 22.66±1.3 years, while for women it was 21.86±1.09 years. The mean age at which stage 5 was achieved was 29.6±3.37 years, indicated by complete fusion without the epiphyseal scar. Conclusion: The study concludes that all men and women with complete fusion of the medial clavicular epiphyseal were older than 22.6 and 21.8 years of age, respectively.

Nomophobia and its Relationship with Depression, Anxiety and Stress among Undergraduate Medical Students in a District of West Bengal: A Cross-sectional Study

Tousif Ahamed, Ritu Ghosh, Malay Kumar Das, Dilip Kumar Das

Introduction: Nomophobia is the fear or anxiety that individuals experience when they are without their smartphones or unable to use them. The implications of nomophobia among undergraduate medical students could be significant, as medical education is demanding and stressful. The extent of nomophobia may affect mental health status. The potential relationship between nomophobia and mental health, particularly depression, anxiety, and stress, is a subject of growing interest. Aim: This study aimed to estimate the magnitude of nomophobia, the prevalence and degree of depression, anxiety, and stress, as well as to assess the relationship between nomophobia and mental health status, and to identify the correlates of nomophobia among undergraduate medical students. Materials and Methods: A descriptive cross-sectional study was conducted at Murshidabad Medical College, West Bengal, India, between September to November 2023, among 222 undergraduate medical students from three consecutive batches (2020-21, 2021-22, 2022-23), selected through stratified random sampling. A self-reported questionnaire comprising the validated Nomophobia Questionnaire (NMP-Q) and the Depression, Anxiety, and Stress Scale (DASS) was used to collect data. Both bivariate and multivariable logistic regression analyses were applied to identify the predictor variables. Correlation analyses were conducted using Spearman’s coefficient. A p-value of 0.05 or below was considered statistically significant. Results: The mean age of the participants was 21.47±1.86 years, with a median age of 21.50 years. Among the participants, 151 (68.0%) were male, 145 (65.3%) were Hindu, and 196 (88.3%) belonged to nuclear families. The distribution of nomophobia among participants was as follows: 29 (13.1%) had mild, 160 (72.1%) had moderate, and 33 (14.8%) had severe nomophobia. Depression, anxiety, and stress were found to be present in 121 (54.5%), 154 (69.4%), and 83 (37.4%) of the participants, respectively. Significant predictors of severe nomophobia included students aged under 21 years (aOR: 6.088; 95% CI: 2.053–18.055), those belonging to joint families (aOR: 6.836; 95% CI: 2.392–19.537), and those who used smartphones for more than five hours daily (aOR: 5.314; 95% CI: 1.919–14.721). Nomophobia was significantly correlated with depression (Spearman’s rho: 0.200, p-value=0.003) but not with anxiety and stress. Conclusion: Nomophobia is universally prevalent among medical students, with varying severity. The findings suggest the need for targeted health education interventions for the holistic well-being of medical students.

Exploring the Outcomes of Gallbladder Perforation: A Retrospective Observational Study

Shaan Hassan, Hemant Purohit, Atia Zaka-ur-Rab, Sayema Talib

Introduction: Gallbladder Perforation (GBP) is one of the most dangerous consequences of acute cholecystitis. It presents in a variety of ways, leading to diagnostic dilemmas and posing management challenges. There is high morbidity and mortality associated with this condition and management is not always straightforward in most cases. Aim: To compare clinical presentation, associated co-morbidities and outcomes in ultrasound-guided open/percutaneous drainage followed by Delayed Cholecystectomy (DC-PCO group) and early laparoscopic/conversion to open cholecystectomy (EC group) for GBP. Materials and Methods: The present study was a retrospective observational study in which case records of 2,366 patients over the last four years (from January 2019 to January 2023) with symptomatic cholecystitis were analysed at a tertiary care centre. A total of 44 adult patients aged over 14 years who had symptomatic cholecystitis on presentation and underwent cholecystectomy due to preoperative diagnosis of GBP were included. Patients with intraoperative findings of GBP, GBP secondary to abdominal trauma and perforation due to gallbladder malignancy were excluded. These 44 patients were classified into two groups. The first group included 24 patients who underwent ultrasound-guided open/percutaneous drainage followed by delayed cholecystectomy, termed the DC-PCO group. The second group included 20 patients who underwent early laparoscopic/conversion to open cholecystectomy, termed the Early Cholecystectomy group (EC). Demographic profile, morbidities and postoperative outcomes were studied in both groups and the significance of differences was analysed using the Mann-Whitney U test and the Chi-square test. Results: The median age was 49 (25-75) years, with a significantly higher proportion of females compared to males. An 86.4% of patients presented with abdominal pain as the most common complaint (38/44). According to Niemeier’s classification, 13 patients had Type I, 27 patients had Type II and four patients had Type III perforation. The median duration of hospital stay was longer for the EC group compared to the DC-PCO group (p-value=0.028). Additionally, 75% of patients in the EC group had a proximal site of GBP (70% body and 5% neck), while 62.5% of patients in the DC-PCO group had fundus perforation (distal location). This suggests that the more proximal the site of perforation, the denser the adhesions, leading to more difficult dissection and increased perioperative complications (such as CBD injury). Conclusion: The GBP is a serious complication of acute cholecystitis. Management in cases of GBP depends on the clinical condition of the patient, associated co-morbidities, type of GBP and imaging findings. The management revolves around the key decision of initial image-guided drainage versus early exploration. Early cholecystectomy is warranted for frank peritonitis, with the open procedure performed when dense adhesions complicate dissection and the risk of CBD injury is high.

Effectiveness of Platelet-rich Plasma Therapy and Limberg Flap Reconstruction in the Management of Pilonidal Sinus Disease: A Prospective Observational Study

Introduction: Pilonidal Sinus Disease (PSD) is a chronic inflammatory condition affecting the sacrococcygeal region, commonly seen in young adults. The ideal treatment remains debated, with surgical techniques such as Limberg flap reconstruction and non surgical approaches like Platelet-Rich Plasma (PRP) therapy being explored for their efficacy in reducing recurrence and improving wound healing. Aim: To compare the wound healing duration, postoperative pain levels, recurrence rates and postoperative complications between PRP therapy and Limberg flap reconstruction in the management of PSD. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at SRM Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India from January to December 2024, involving 62 patients. Adults aged 18 to 65 years with Type I or II PSD, who were fit for surgery and willing to provide informed consent, were included. Patients were randomly allocated into two groups: Group A (PRP Therapy, n=31) and Group B (Limberg Flap Reconstruction, n=31). In Group A, PRP was applied both intraoperatively and during the postoperative follow-up, while Group B underwent excision followed by flap reconstruction using the Limberg flap technique. Data on key outcomes, including wound healing time, pain levels {measured using the Visual Analog Scale (VAS)}, recurrence rates and postoperative complications, were collected over a 6-month period. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 29.0, with a p-value <0.05 considered statistically significant. Results: The mean wound healing duration was significantly shorter in Group A (29.0±7.0 days) compared to Group B (39.0±8.0 days, p-value <0.001). Pain scores (VAS) were similar on Day 2 (p-value=0.358), but Group A experienced significantly less pain from Day 3 onwards (p-value <0.05). Recurrence rates were significantly lower in Group A {4 (12.9%)} compared to Group B {10 (32.3%), p-value=0.029}. Postoperative complications were less frequent in Group A {24 (77.4%) had no complications vs. 19 (61.3%) in Group B, p=0.045}, with Group B showing higher rates of seroma formation {5 (16.1%) vs. 3 (9.7%)} and wound dehiscence {4 (12.9%) vs. 1 (3.2%)}. Infection rates were similar in both groups, at 3 (9.7%). Conclusion: PRP therapy presents a promising and effective alternative for managing PSD, potentially enhancing recovery and minimising complications.

Reversal of Rocuronium Induced Muscle Relaxation with Sugammadex versus Neostigmine in Patients undergoing General Anaesthesia: A Randomised Controlled Trial

Ankur Garg, Kirti Gupta, Richa Chandra, Jyoti Pathania, Malti Agrawal

Introduction: Prolonged effects of neuromuscular blocking medications can lead to complications after surgery or the risk of Postoperative Residual Curarisation (PORC) in the postanaesthesia care unit, which may increase morbidity in surgical patients. To enhance patient safety and comfort, it is essential to completely reverse Neuromuscular Blockade (NMB) before transferring the patient to the Postanaesthesia Care Unit (PACU). Aim: The aim of this study is to compare neostigmine with sugammadex for the reversal of rocuronium-induced muscle relaxation in patients undergoing general anaesthesia. Materials and Methods: This randomised controlled study was conducted in patients undergoing general anaesthesia in Department of Anaesthesiology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, over a period of one year from 1st August 2023 to 31st July 2024. In this randomised controlled study, a total of 98 adult patients of either sex undergoing surgery under general anaesthesia were enrolled and assigned to two groups of 49 each. The patients were reversed with either of the drugs when the Train-of-Four (TOF) ratio reached 40%. group 1 received Inj. sugammadex 2 mg/kg intravenously (i.v), while group 2 received Inj. neostigmine 0.05 mg/kg with Inj. glycopyrrolate 0.01 mg/kg intravenously at the completion of surgery. Once the TOF stimulation reached 90%, the patient was extubated. The time taken to reach the TOF value from 40% to 90% was recorded. Patients were then transferred to the PACU, monitored for any adverse effects, and discharged from the PACU at an Aldrete score of ≥9 to the respective ward. Categorical data were analysed using the Chi-square test, while quantitative data were analysed using the Student t-test. Results: A total of 98 adult patients were included in the present study. The demographic parameters (age, gender, weight, American Society of Anaesthesiologists (ASA) physical status I and II) were comparable between the two groups (p>0.05). The mean time taken to achieve TOF 40-90% was 2.29±1.12 minutes in group 1 and 8.72±1.5 minutes in group 2, respectively (p<0.01). In the study following extubation, none of the patients in either group exhibited any signs of PORC in the PACU. Significant changes in Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were observed post-extubation at 0, 5, and 10 minutes (p<0.05). group 1 had a lower incidence of postoperative nausea compared to group 2 (p<0.05). Conclusion: The study concluded that sugammadex reverses rocuronium-induced muscle relaxation faster and more effectively, with fewer haemodynamic changes and adverse effects compared to the neostigmine-glycopyrrolate combination. Thus, its use can be advantageous in cases involving difficult airways, patients with respiratory co-morbidities, and those with limited myocardial reserve, where even a small increase in HR could be detrimental.

Incidence and Severity of Chemotherapy-induced Mucositis: A Cross-sectional Study

B Prithiha, S Keshavini, MP Ram Prabu, K Dhivya, C Emmanuel

Introduction: Chemotherapy-induced Mucositis (CIM) is a debilitating complication in cancer treatment, affecting patient quality of life and often leading to treatment modifications. This study provides a comprehensive analysis of CIM’s incidence, severity, and associated risk factors in chemotherapy patients. Aim: To assess the incidence and severity of CIM and to determine the association between various risk factors of mucositis with the severity of CIM. Materials and Methods: A cross-sectional study was conducted with 164 adult cancer patients receiving chemotherapy in the Department of Oncology at a tertiary care hospital in Chennai, Tamil Nadu, India from May 2024 to October 2024. Data were gathered on demographics, cancer types, chemotherapy regimens, mucositis grades, and therapeutic interventions. CIM severity was graded as per the Common Terminology Criteria for Adverse Events (CTCAE). Chi-square test was used to analyse the association between the risk factors and the severity of CIM, using Statistical Packages of Social Sciences (SPSS) version 23.0. Results: The CIM developed in 99 patients (60.36%), with 70 (70.70%) experiencing Grade 2 and 3 severity. Mucositis was predominantly observed in the oral 29 (29.29%) and intestinal 25 (25.25%) regions. Middle-aged patients 41-60 years, those with co-morbid conditions, and patients on docetaxel-based regimens were at increased risk. L-glutamine supplementation was used as a preventive and treatment measure for CIM. Conclusion: The CIM is a frequent and severe side effect of chemotherapy, particularly among middle-aged patients and those with specific cancer regimens. Findings emphasise the need for preventive and management strategies to mitigate CIM’s impact, enhance patient outcomes, and reduce the burdens of cancer patients.

Comparative Analysis of Cervical Range of Motion Assessment in Mechanical Neck Pain using Conventional Techniques versus Artificial Intelligence Approaches: A Cross-sectional Observational Study

Sonia Pawaria, Shail Sachdeva, Rahul Bajaj, Priyanka Siwach

Introduction: A significant percentage of the world’s population suffers from Mechanical Neck Pain (MNP), a widespread and incapacitating ailment that highlights the need for precise diagnosis and treatment approaches. In order to manage MNP, cervical Range of Motion (ROM) measurement is essential. The conventional procedures for this are goniometry and inclinometry. However, these techniques often face limitations concerning accuracy and inter-rater reliability. Aim: To compare the efficiency of conventional techniques with Artificial Intelligence (AI)-based technologies while evaluating cervical ROM in patients with MNP. Materials and Methods: This was a cross-sectional observational study where 31 MNP patients participated in a comparative analysis. The duration of study was four months (From March 2024 to June 2024). The study was conducted in Physiotherapy Out Patient Department, SGT Hospital and Research Institute, Gurugram, Haryana, India. Traditional goniometry and an AI-driven system (PhyTrackTM version 1.2) were used to measure cervical ROM. Two sessions of assessment were required for each subject to undergo measurements of flexion, extension, and lateral flexion. Paired t-tests were used to analyse differences between the two methods. Results: A total of 31 MNP patients participated in this study. The results of the ROM assessments for cervical flexion (p=0.133), extension (p=0.876), and lateral flexion (p=0.086) using the manual and AI approaches did not show any statistically significant differences. This implies that assessments conducted using AI are similar to those conducted using manual methods. Conclusion: AI-driven solutions show potential for providing accuracy and reliability comparable to conventional techniques for measuring cervical ROM in MNP patients, although further research with larger sample sizes is needed to confirm these findings. AI integration into clinical practice may improve ROM evaluation accuracy, consistency, and efficiency, which would benefit patients. Future research ought to investigate how AI-based evaluations affect clinical outcomes and decision-making over the long run.

Detection of EGFR Mutations (Ex19Del, T790M, S768I, C797S, Ex20ins, G719X, L858R, L861Q) in Non-small Cell Lung Carcinoma and its Association with Various Clinicopathological Parameters: A Cross-sectional Study

Introduction: Non-Small Cell Lung Cancers (NSCLC) is classified into squamous cell carcinoma and adenocarcinoma. Adenocarcinoma is commonly seen in non smoking females. Epidermal Growth Factor Receptor (EGFR) is a tyrosine kinase receptor which gets mutated in lung cancer. Tyrosine Kinase Inhibitors (TKI) like gefitinib are known to a have a good response in lung adenocarcinoma. Aim: The aim of this study was to detect EGFR mutations in NSCLC and associate the mutation status with clinicopathological parameters. Materials and Methods: The present cross-sectional study was conducted in the Department of Oncopathology and Transplant Immunology Molecular lab at Mahatma Gandhi Hospital, Jaipur, Rajasthan, India, from June 2023 to May 2024. All histopathological diagnosed cases of NSCLC were included in the study. Immunohistochemistry was further applied. EGFR mutation status (19Del, T790M, S768I, C797S, Ex20ins, G719X, L858R, L861Q) was checked using Real Time Polymerase Chain Reaction (PCR). An attempt was made to find out the association between the mutation status and various clinicopathological parameters. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Results: A total of 37 cases were included in the study of which 21 were males and 16 were females. There was near equal distribution when a comparison of smoking status was done. The most common clinical symptom was cough and the most common histological type was acinar adenocarcinoma. Thirteen out of 37 cases showed EGFR mutations. Exon 19 deletion was the most common mutation. EGFR mutation status showed statistical significance with non smokers and acinar adenocarcinoma. Conclusion: Adenocarcinomas are more commonly seen in non smoking females. Exon 19 deletion is the most common type of EGFR mutation seen in lung adenocarcinomas. Mutations in EGFR are associated with good response to TKI.

Morphological and Morphometric Study of Papillary Muscles in Adult Cadaveric Hearts: A Cross-sectional Study from Central India

Geslin Varghese, Mayura Setiya

Introduction: A normal Atrioventricular (A-V) valve complex of the human heart comprises the A-V ring, cusps, chordae tendineae, and papillary muscles. Papillary muscles are small pillar-like myocardial structures that stabilise the position of the tricuspid and bicuspid valves. A detailed understanding of normal anatomy, as well as its possible variations, can help surgeons in various surgical repairs of valve prolapse and regurgitation involving the papillary muscles. Aim: To review the morphology of papillary muscles in both ventricles. Materials and Methods: This descriptive cross-sectional study was carried out on 60 formalin-fixed adult cadaveric heart specimens collected from the Department of Anatomy of Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India from January 2023 to December 2023. These human hearts were carefully dissected to open both the right and left ventricles and expose the anterior, posterior, and septal papillary muscles. Different morphological features of the papillary muscles present in both ventricles were documented and photographed. The details collected were entered into an Excel sheet and analysed. Results: In the present study, there were approximately 33 male adult human hearts and 27 female adult human hearts. The anterior and posterior papillary muscles were present in both the ventricles of all the hearts; however, the right septal papillary muscle was present in only 13 specimens (21.66%). The lengths of the right (15.22±4.642 mm) and left (19.61±5.24 mm) anterior papillary muscles were longer than those of the remaining papillary muscles. The breadths of the right (6.243±2.144 mm) and left (9.992±3.972 mm) anterior papillary muscles were wider compared to other papillary muscles. The anterior and posterior muscles predominantly appeared conical (100%), while the septal muscle was chiefly merged with the septal wall (83.3%). Conclusion: In-depth knowledge of the normal and variable anatomy of the papillary muscles will help cardiac surgeons determine appropriate surgical repair procedures for the valvular complex and helps in dealing with pathological conditions such as valve prolapse or regurgitation.

Exploring the Contribution of Single Nucleotide Polymorphisms in FSHR, LHR, PPAR-γ, and INSR Genes to the Pathogenesis of Polycystic Ovary Syndrome: A Case-control Study

Mohd Noorjahan Begum, A Lalithamma, Vandali Jyothi, Madhan Krishnan

Introduction: Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder influenced by genetic factors. Single Nucleotide Polymorphisms (SNPs) in genes such as Follicle- Stimulating Hormone Receptor (FSHR), Luteinising Hormone Receptor (LHR), Peroxisome Proliferator-Activated Receptor Gamma (PPAR-γ), and Insulin Receptor; Genetic polymorphism have been implicated in PCOS pathogenesis. Aim: To investigate the contribution of SNPs in FSHR, LHR, PPAR-γ, and INSR genes to the pathogenesis of PCOS. Materials and Methods: This case-control study conducted in Malla Reddy Institute of Medical Sciences (MRIMS), Telangana, India. This research included 600 female patients aged 15-45 years seeking care at the Gynaecology Outpatient Department (OPD) from the duration of September 2022 to September 2023. A total of 300 cases (PCOS patients) and 300 controls (non PCOS individuals) were recruited, and Deoxyribonucleic Acid (DNA) samples were collected for genotyping of selected SNPs. Statistical analysis was performed to assess associations between SNPs and PCOS risk. Results: The study identifies potential associations between SNPs in the SHFR (follicle development), LHR (ovulation regulation), PPAR-γ (insulin sensitivity and adipogenesis), and INSR (insulin signaling) genes and PCOS susceptibility. These findings suggest that genetic variations in these pathways may contribute to the hormonal and metabolic dysregulation characteristic of PCOS, highlighting a potential genetic basis for the disorder. However, further studies are required to elucidate the precise functional mechanisms. Conclusion: This case-control study provides insights into the role of SNPs in FSHR, LHR, PPAR-γ, and INSR genes in PCOS pathogenesis, contributing to the understanding of the genetic basis of the disorder. Future studies should also examine the interactions between genetic factors, environmental influences, and hormonal imbalances to fully understand PCOS pathophysiology.

Role of Obstructive Sleep Apnoea in Sensorineural Hearing Loss: A Cross-sectional Study

Introduction: Obstructive Sleep Apnoea Syndrome (OSAS) affects millions globally. The condition significantly impacts the inner ear’s ability to transduce sound due to the essential oxygen supply required for hair cells in the cochlea. Given the increasing prevalence of OSAS, there is an urgent need for greater awareness and research on its implications for hearing health. Aim: To assess hearing functions in patients with OSAS, aiming to elucidate the relationship between the disorder and sensorineural hearing loss. Materials and Methods: A cross-sectional study was conducted at Chettinad Hospital and Research Institute, a tertiary care centre in Chengalpattu district, Tamil Nadu, India, from August 2024 to January 2025. A total of 60 participants with symptoms of Obstructive Sleep Apnoea (OSA) took part in the study. The participants were assessed using the Snoring, Tiredness, Observed apnoea, high blood Pressure, Body Mass Index, Age, Neck circumference, and Gender (STOP-BANG) questionnaire to evaluate the severity of OSA, polysomnography to confirm sleep apnoea, and pure tone audiometry to assess hearing loss. The test for association was performed using Fisher’s Exact test, and correlation was assessed through Spearman’s Correlation. Results: A total of 60 participants with symptoms of OSA took part in the study with an average age of 41.2 years. Approximately 48% of the participants were found to have a high risk of severe OSA according to the STOP-BANG scoring. About half of the participants (53.3%) were found to have sensorineural hearing loss. Only 60% of the participants exhibited symptoms of OSA such as snoring, daytime sleepiness, and tiredness. The Spearman correlation coefficient between the STOP-BANG risk grade and the presence of sensorineural hearing loss was 0.596, and with the severity of hearing loss, it was 0.576, both demonstrating a moderate correlation. Conclusion: The present research shows an association between OSA and sensorineural hearing loss, indicating that individuals with higher OSA risk scores experience more significant hearing impairment. The severity of hearing loss correlates with the elevation of OSA risk levels. Early detection and management of OSA are crucial not only for controlling the condition but also for preventing complications such as hearing loss or progression of its severity, thereby promoting better auditory health outcomes.

Correlation between Stressful Life Events and Suicidal Ideation among Patients with Schizophrenia in Remission Stage: A Cross-sectional Study

Ashok Silamban, Kailash Sureshkumar, Aravindh Manogaran, Shabeeba Z Kailash

Introduction: Patients with schizophrenia often exhibit impaired executive brain function, which disrupts their daily activities. Relapse in schizophrenia has been linked to stressful life events. Aim: To identify the relationship between life event stressors and suicidal ideation among patients with schizophrenia at the remission stage in a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted in the outpatient department of a tertiary care hospital among 120 patients diagnosed with schizophrenia in remission. Screening for eligibility was performed using the Positive and Negative Syndrome Scale (PANSS). Data were collected through a structured questionnaire capturing sociodemographic variables, the Beck’s Suicidal Ideation Scale (BSS), and the Presumptive Life Event Stress Scale (PSLES). Statistical analysis was carried out using IBM SPSS version 23.0. A p-value of <0.05 was considered statistically significant. Results: Age, gender, marital status, education, occupation, religion, and socioeconomic status did not significantly influence BSS scores. Likewise, clinical factors such as frequency of hospitalisation, age of onset, duration of illness, and duration of remission showed no significant relationship with suicidal ideation. Life event stressors were notably prevalent, with marital conflict 65 (54.2%), conflict with in-laws 58 (48.3%), and financial problems 54 (45.0%) being the most commonly reported. Patients experiencing 3-5 stressors and more than 5 stressors had significantly higher mean BSS scores (9.8 and 13.2, respectively) compared to those with 1-3 stressors (6.8), with p-values of 0.008 and <0.001. Pearson’s correlation coefficient (r=0.482, p<0.001) indicated a moderate positive relationship between cumulative stress and suicidal ideation. The regression model further showed that 23% of the variance in suicidal ideation could be explained by life event stress levels. Conclusion: The study found a significant positive correlation between life event stressors and suicidal ideation in patients with schizophrenia in remission. Routine screening for psychosocial stress may aid in early identification and prevention of suicide risk in this population.

Assessment of Food Insecurity as an Indicator of Poverty among University Students Studying in Higher Educational Institutions in Tiruvallur District, Tamil Nadu, India

Gajalakshmi Radhakrishnan, SK Manivannan, Bala Ganesh Pichamuthu

Introduction: Food security mainly affects college students, even though countrywide schemes like the Public Distribution System (PDS) and mid-day meal programmes exist in India. However, students studying in postgraduate educational institutions, especially those from low-income or rural families, are more likely to experience food insecurity, emphasising the significance of targeted interventions and support systems on campus. Aim: To assess the prevalence and determinants of food insecurity among university students in Higher Educational Institutions (HEIs) in Tiruvallur District, Tamil Nadu, India. Materials and Methods: This was a cross-sectional study conducted in five HEIs located in rural areas of Tiruvallur District, Tamil Nadu, India, between January and March 2024. A total of 940 students participated, selected using a stratified random sampling technique. Data were collected using a bilingual (English and Tamil) version of the Household Food Insecurity Access Scale (HFIAS), which had been pretested and found to be reliable (Cronbach’s alpha=0.916). Parameters evaluated included age, gender, marital status, education level, parental occupation, family income, type of accommodation, financial issues at home, and food insecurity score. Data were analysed using STATA software. Descriptive statistics, chi-square tests, and binary logistic regression were applied to identify determinants of food insecurity. Results: The prevalence of food insecurity among the students was 34.1%. Female students or those who had financial stresses at home had higher odds of food insecurity. Living in college-hostel accommodation had significantly lower odds of food insecurity (OR=0.271, p<0.001). Conclusion: A significant number of university students experienced food insecurity, which was considerably linked to female gender, financial hardship, and living arrangements. Interventions, including subsidised meal programmes, campus food banks, and financial literacy education, should be considered moving forward to address this widespread and overlooked public health issue.

Sleep Quality among Medical Students and its Relationship with Self-reported Skin Complaints: A Cross-sectional Study

Introduction: Sleep disturbances are a widespread issue among medical students and have been linked to various negative outcomes, both academically and personally. Sleep plays a crucial role in regulating various aspects of skin physiology, including surface pH, trans-epidermal water loss, blood flow, and skin temperature. Aim: This study aimed to assess the sleep quality and the relationship with skin symptoms among medical students at the College of Medicine, Northern Border University, Arar City, Kingdom of Saudi Arabia. Materials and Methods: The present cross-sectional study was conducted to evaluate the sleep quality of medical students at Northern Border University, Arar, Kingdom of Saudi Arabia, from September 2024 to February 2025. Data included sociodemographic information, including lifestyle factors such as age, gender, academic year, current Grade Point Average (GPA), the self-reported skin complaints questionnaire, which includes skin symptoms commonly reported, and the last section contained the sleep condition indicator for assessing subjective sleep quality. Univariate and multivariate analyses were performed, and statistical significance was set at p<0.05. Results: A total of 317 medical students were enrolled in the study of which 179 (56.5%) were females. The average Sleep Condition Indicator (SCI) of students was 17.7 (±5.7), with 40.4% experiencing insomnia (SCI score <16). Over half reported taking more than 30 minutes to fall asleep, while 219 (70.9%) stayed awake for ≤30 minutes if they awoke at night. About 235 (74.1%) had sleep issues for ≥2 nights a week. The most common skin complaints were dryness in 223 (70.4%) and dandruff 212 (66.9%), with 116 (36.6%) reporting itchiness and 39.7% excoriation. Better sleep quality correlated with never having body odour, burning sensation, dandruff, feeling of disfigurement, ingrown hairs, itching, oily skin, cuticle picking, and tingling skin (p-value <0.05). Conclusion: The current study provided evidence of poor sleep quality among the medical students, especially among medical students in early academic years. There is a strong, positive and significant relationship between many skin symptoms and poor sleep. Medical students need to be taught about good sleep behaviours and get enough sleep to promote healthy skin.

Effectiveness of Solifenacin versus Mirabegron in the Treatment of Overactive Bladder: A Prospective Cohort Study

Introduction: Overactive Bladder (OAB) syndrome is a symptom-complex defined as urinary urgency, usually accompanied by increased daytime frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. Aim: To compare the efficacy and safety between Solifenacin and Mirabegron in treatment of OAB. Materials and Methods: A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Medical College, Kolkata, West Bengal, India from May 2020 to April 2021. The study was conducted on 110 willing patients divided into two groups, with Solifenacin 5 mg given to Group-1 and Mirabegron 50 mg given to Group-2, respectively. The sampling frame was women of age >40 years visiting the hospital’s urogynaecology clinic. Study variables were age, the difference between baseline and post-treatment number of urination episodes in 24 hours and at night, urgency, leakage episodes and side-effects experienced in each group. Mann- Whitney U Test was used for comparison between two groups while Chi-square test was used for side-effect comparison. Results: The mean age of the study population was approximately 61.41 years. After nine weeks of treatment, the reduction in total number of urinations in 24 hours was 54.17% in Group-1 and 9.71% in Group-2, which is statistically significant, reduction in the number of urination at night was 79.53% and 76.79%, the reduction in number of leakage episodes was 78.19% and 75.49%, reduction in urgency episodes was 76.96% and 75%, frequent adverse effects were constipation (43.64% vs 7.27%) and dry mouth (56.36% vs 9.09%). Conclusion: The study showed that both drugs are effective in reducing OAB symptoms. Regarding adverse effects, dry mouth was more common with Solifenacin.

Assessing the Effectiveness of Nutritional Counselling on the Quality of Life in Haemodialysis Patients: An Observational Study

Introduction: Haemodialysis patients frequently experience a diminished Quality of Life (QoL) due to dietary restrictions and associated health challenges. Malnutrition, a common issue among these patients, significantly impacts their overall health and well-being. Thus, the study was conducted to evaluate the potential benefits of individualised nutritional counselling in addressing malnutrition and improving the QoL for patients undergoing haemodialysis. Aim: The study aimed to assess the effectiveness of nutritional counselling in improving the QoL for patients undergoing routine haemodialysis treatment. Materials and Methods: This observational study was conducted at Trust Multispeciality Hospitals in Kakinada, Andhra Pradesh, India, between October 2023 and April 2024. A total of 73 haemodialysis patients were included in the study. The QoL scores were assessed both before and after the nutritional counselling sessions. The Microsoft Excel Analysis ToolPak was used to perform statistical analysis. The Mann-Whitney U test and Z-test for two sample means were applied, with statistical significance set at p<0.05. Results: Out of the total 73 patients enrolled in the study, 44 (60%) were males and 29 (40%) were females. The study revealed significant improvements in the QoL scores after nutritional counselling. There was a statistically significant difference in QoL scores before and after the intervention (U=1691, n1=73, n2=73, p=0.0000453). Conclusion: Nutritional counselling has a substantial positive impact on the QoL of haemodialysis patients. The intervention resulted in marked improvements in their overall well-being, highlighting the critical role of dietary management in patient care.

Transcutaneous Electrical Nerve Stimulation as a form of Labour Analgesia on the Severity of Labour Pain: A Prospective Interventional Study

Sumira Shastry, BG Lepakshi, Geetha Bhaktha, Prashanth Shivappa

Introduction: The increasing demand for effective labour analgesia has led to the rediscovery of Transcutaneous Electrical Nerve Stimulation (TENS) as a non pharmacological pain relief method during labour. TENS involves the application of low-voltage electrical currents to the skin, which is thought to reduce pain through mechanisms such as the gate control theory and endorphin release. This method is considered safe with minimal side-effects, offering a potential alternative to pharmacological analgesia, especially in resource-constrained settings or for women with contraindications. Aim: To compare the effect of TENS on the duration of labour, mode of delivery, pain score and condition of neonates, with those not receiving any analgesia during labour. Materials and Methods: This prospective interventional study at the Department of Obstetrics and Gynaecology (OBG), Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India from August 2022 to December 2023 included 80 parturients (40 in the TENS group and 40 in the no analgesia group). The variables/ outcomes compared included demographic parameters (age, weight, height, educational status), estimated foetal weight, labour duration, mode of delivery, neonatal outcomes and pain scores. Chi-square and t-tests were used for analysis. Results: Demographic parameters (age, education, height, weight and estimated foetal weight) were comparable between the TENS and no analgesia groups (p>0.05). No significant difference was found in labour duration or mode of delivery (p=1). Statistically significant difference was noted in pain scores between the two groups (TENS: 4 and 8 vs. No Analgesia: 7.5 and 9 for the first and the second stages of labour respectively, p<0.001). Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores, Neonatal Intensive Care Unit (NICU) admission were similar (p>0.05). All mothers were healthy at discharge. Conclusion: When used during labour, TENS provides satisfactory analgesia without adversely affecting the duration or outcome of labour. As a safe non pharmacological method, TENS plays a significant role in providing labour analgesia, especially in resource-constrained centres or for women who are unwilling or have contraindications to pharmacological methods.

Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study

Muniba Alim, Shamila Alim, Shahid Siddiqui, Md Asif Khan

Introduction: The gold standard in the management of locally advanced cervical cancer is definitive chemoradiation followed by brachytherapy. Nonetheless, the interdependence of radiation response and immune balance in cancers is debatable. Inflammation markers such as C-Reactive Protein (CRP) and Pro-B-type Natriuretic Peptide (Pro-BNP) have established prognostic value in cancers, but the Neutrophil-Lymphocyte Ratio (NLR) is gaining prominence due to its easy accessibility and strong predictive role in malignancies such as lung, pancreatic and gastric cancers. Aim: To study NLR as a predictor of clinical response to radiation in cervical cancer. Materials and Methods: This cohort study assessed 60 women from a tertiary cancer hospital in Western Uttar Pradesh, catering to many districts in North India, between August 2017 and July 2019. The routine blood investigations during assessment at baseline and NLR were obtained. Pelvic chemoradiation of 50 Gy in 25 fractions was administered over 5 weeks with weekly concomitant cisplatin at 35 mg/m². Tumour response was evaluated and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 to find the association between NLR and Complete Response (CR). Results: Clinical CR was noted in 44 (73.3%) of participants. In the CR group, 10 (22.7%) had baseline haemoglobin levels below 13 g/dL compared to 13 (81.25%) in the Partial Response (PR) group. The majority of patients (39/44) with CRs were noted at NLR levels below 2.9. When the NLR (cut-off 2.9) and response (Complete and PR; CR and PR) were evaluated, the p-value was reported as 0.06, which, although not statistically significant, is encouraging for further investigation towards consensus. Conclusion: These observations suggest that inflammation appreciably influences the intrinsic tumour characteristics in patients with cervical cancer. Hence, the utility of NLR as a marker to categorise the risk of recurrence in patients with cervical cancer presents an intriguing concern for the future.

Chlorhexidine-alcohol versus Povidone-iodine plus Alcohol as Preoperative Antiseptic for Prevention of Surgical Site Infection in Caesarean Section: A Randomised Controlled Trial

Introduction: Caesarean Section (CS) is one of the most commonly performed surgical procedures worldwide, with its incidence steadily increasing. Surgical Site Infection (SSI) remains a significant complication, impacting maternal recovery and healthcare costs. Aim: To evaluate the efficacy of chlorhexidine-alcohol versus Povidone-Iodine (PI) plus alcohol in preventing SSI in patients undergoing CS. Materials and Methods: This Randomised Controlled Trial (RCT) was conducted in the Department of Obstetrics and Gynaecology from April 2024 to April 2025 at a tertiary care centre, Shri B.M. Patil Medical Hospital and Research Centre, Bijapur, Karnataka, India. A total of 208 pregnant women undergoing CS were enrolled and randomly assigned to two groups: Group A received preoperative skin preparation with chlorhexidine-alcohol, while Group B received PI followed by surgical spirit. Postoperative wound assessment was conducted on day 2, and wounds were cleaned and dressed using sterile Sterizone (a transparent film dressing with a silver lining). Follow-up inspections occurred on day 5, day 7, or at discharge whichever was later. In cases of wound discharge, swabs were sent for culture and sensitivity. Outcomes assessed included incidence of SSI, wound discharge, and need for additional interventions. Statistical analysis was conducted using John’s Macintosh Project (JMP)-Statistical Analysis System (SAS) software version 17. Continuous variables were compared using the independent t-test, and categorical data using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: The incidence of superficial SSI was significantly lower in the chlorhexidine group compared to the PI group (1.0% vs. 8.7%, p-value=0.018). Similarly, deep infections were less frequent in the chlorhexidine group (1.9% vs. 2.9%, p-value=0.018). There was no significant difference between groups regarding the types of organisms isolated (p=0.0966). Staphylococcus aureus was the most commonly isolated pathogen (1.9% in both groups). Conclusion: Chlorhexidine-alcohol demonstrated superior efficacy in reducing SSI compared to PI in patients undergoing CS. The present finding supports the use of chlorhexidine-alcohol as the preferred preoperative antiseptic for caesarean deliveries.

Comparison of Gabapentin and Placebo as Pre-emptive Analgesic Agent for Postoperative Analgesia in Patients undergoing Elective Abdominal Hysterectomy under Spinal Anaesthesia: A Randomised Controlled Trial

Introduction: Pre-emptive analgesia is a form of pain management that seeks to prevent alterations in the way the body processes incoming pain signals. Gabapentin is a compound that exhibits structural similarities to gamma-aminobutyric acid. It has been found to possess powerful pain-relieving properties and can also help prevent seizures. Additionally, it is purported to have greater efficacy in reducing the neuropathic component of acute nociceptive pain following surgical procedures. Aim: The purpose of the study was to assess the efficacy of gabapentin and placebo in providing pre-emptive analgesia for postoperative pain management among patients undergoing elective abdominal hysterectomy under spinal anesthesia. Materials and Methods: A single-blind randomised controlled trial was conducted among patients undergoing elective abdominal hysterectomy who had American Society of Anesthesiologists (ASA) physical status I-II. Sixty-eight participants, aged between 35 and 70 years, were randomised into two groups: group G (n=34) was administered 600 mg of gabapentin in tablet form, whereas group P (n=34) received a placebo, two hours prior to the surgery. Participants were assessed for vital signs and pain using the Visual Analogue Score (VAS), while the level of sedation was determined using the Ramsay Sedation Score (RSS). An injection of Diclofenac 75 mg intravenously was administered as an analgesic on an as-needed basis. The requirement for analgesia was monitored over the next 24 hours. Statistical analysis was performed using the independent Student’s t-test, Mann-Whitney U Test, and Chi-square test. Results: Both groups were comparable with respect to demographic profile (age, ASA physical status) and haemodynamic variables {pulse rate, Mean Arterial Pressure (MAP), Peripheral Oxygen Saturation (SpO2)}, with a p-value >0.05. The mean duration of the first rescue analgesic requirement for group G (12.82±4.50 hours) was significantly higher than for group P (8.58±2.54 hours), with a p-value of 0.002. The mean duration of the second and third rescue analgesic requirement for group G was 13.50±2.97 hours and 21±3.00 hours, respectively, while for group P it was 15.78±3.20 hours and 22±2.08 hours, respectively. Therefore, group G experienced a significantly longer duration of analgesia, as evidenced by the mean duration of the first rescue analgesic requirement. No significant side effects were observed in either group. Conclusion: Gabapentin 600 mg when used as a pre-emptive analgesic provides analgesic effects and reduces the requirement for rescue analgesia while maintaining stable haemodynamics perioperatively. Therefore, it serves the purpose of multimodal analgesia for improved anaesthetic management.

Impact of Hepatic Arterial Anomalies on Postoperative Outcomes following Pancreaticoduodenectomy: A Retrospective Case-control Analysis

Introduction: Arterial anomalies are frequent occurrences and pose challenges during major surgeries like Pancreaticoduodenectomy (PD), especially during gastroduodenal artery ligation and lymph node dissection. Aim: To analyse the influence of arterial anomalies on mortality and morbidity, as well as oncological adequacy in terms of R0 rate and lymph node retrieval. Materials and Methods: A The present retrospective analysis included a total of 25 patients with vascular anomalies reported on Computed Tomography (CT) angiography who underwent PD over a period of four years (January 2020-December 2023) and were compared with 25 patients without vascular anomalies. This analysis was conducted from January 2024 to March 2024. Intraoperative events such as blood loss, blood transfusion requirements and operative time were compared between both the groups. Postoperative complications, including pancreatic leak, Hepaticojejunostomy (HJ) leak, delayed gastric emptying, postpancreatectomy haemorrhage, relaparotomy and mortality, were also compared. Fisher’s two-tailed exact test, t-test and Chi-square tests were employed, with p-value <0.05 considered significant. Results: The two groups were evenly matched regarding patient demographics. The most common variation was the Replaced Right Hepatic Artery (RRHA) (48%) arising from the Superior Mesenteric Artery (SMA), followed by the Replaced Common Hepatic Artery (CHA) (20%) arising from the SMA. There was no significant difference (p-value >0.05) in blood loss, the need for blood transfusion, or operative time. Postoperative morbidity due to pancreatic leak, bile leak, postoperative haemorrhage, relaparotomy rate and 30-day mortality was also not significantly different. There was no difference in resection margins (R0) and lymph node yield (10 vs 11) between the two groups. Conclusion: Aberrant hepatic arteries do not significantly increase morbidity or compromise oncological safety in patients undergoing PD by experienced surgeons.

Comparative Evaluation of Infectious Potential, Resistance Patterns and Key Determinants of Escherichia coli in Urinary Tract Infection: A Cross-sectional Study

Kushani Bhaine, Dhara Patel, Artee Tyagi

Introduction: The emergence of Multidrug-Resistant (MDR) Escherichia coli (E. coli) and its opportunistic uropathogenicity complicates the treatment of Urinary Tract Infections (UTIs), consequently increasing healthcare costs and mortality rates. Uropathogenic E. coli (UPEC) is the primary cause of most UTIs, such as cystitis and pyelonephritis. These infections can lead to severe complications, including acute renal failure, affecting both healthy individuals and renal transplant patients. Aim: To scrutinise the infectious prevalence of E. coli and the occurrence of UPEC, with relative proportional scrutiny of the resistance spectrum and determinants associated with UTIs to identify their management strategies. Materials and Methods: This cross-sectional study was conducted between February 2019 and February 2023 at the Microbiology Laboratory of Charotar Hospital and Research Foundation (CHRF), Anand, Gujarat, India. A total of 461 clinical specimens, including 153 urine samples, were processed to determine the infectious magnitude of E. coli and the rate of UPEC. Their resistance spectrum and mechanisms were compared using disc diffusion assays and statistically analysed by Chi-square value, two-tailed p-value, Odds Ratios (ORs) and confidence intervals using Microsoft Excel 2021 and CDC Epi Info™ software by the US Department of Health and Human Services, Centres for Disease Control and Prevention. Results: E. coli was predominant in UTIs, comprising 45% of UPECs. Of the E. coli samples, 62.9% were Extended Spectrum Beta-Lactamase (ESBL) producers, showing complete resistance to penicillins and cephalosporins. Furthermore, ESBL UPEC demonstrated a high level of resistance to carbapenems and fluoroquinolones, but exhibited good sensitivity to Nitrofurantoin (100%) and Fosfomycin (75%). Additionally, 33.3% of E. coli were carbapenem-resistant, with 14.8% found to produce Metallo-Beta-Lactamase (MBL). Hospitalisation in the past year was identified as a significant associated risk factor (p-value <0.05). Conclusion: Nitrofurantoin and Fosfomycin are significant drugs for the empirical management of UTI cases. However, for effective management of Antimicrobial Resistance (AMR), definitive therapy must be continued in a synergistic combination after ensuring regular culture and sensitivity practices. The increasing rate of carbapenem resistance, limited therapeutic options for ESBL and the constrained results of carbapenemase phenotypes necessitate the identification of the precise causes by molecular assay for effective clinical guidance.

Study of CDX2 and E-cadherin Expression in Colorectal Cancer and their Association with Clinicopathological Parameters: A Cohort Study

Surendran Dhanasree Vellikal, Ranjita Panigrahi, Prajna Das, Saroj Ranjan Sahu

Introduction: Colorectal Cancer (CRC) is the third most common cancer worldwide. Inspite of new treatment modalities and early diagnostic tools, 935,000 cancer related deaths are recorded worldwide every year. Among various biological markers caudal-type homeobox 2 (CDX2) and adhesion molecules (E-cadherin, Beta-catenin), are said to be implicated in the invasion and advancement of colon cancer. Aim: To study the Immunohistochemical (IHC) expression of CDX2 and E-cadherin in CRC and their association with various clinicopathological parameters. Materials and Methods: This ambispective cohort study included 51 histologically proven CRC cases in a Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, for four years nine months. IHC for CDX2 and E-cadherin was done. Staining intensity and proportion were noted, multiplied and scored. Immunoreactive Score (IRS) of >3 was considered as positive for CDX2, while E-cadherin expression was categorised as low expression (score 0, 1) and high expression (score 2, 3). Statistical analysis of CDX2 and E-cadherin expression in CRC and association with clinicopathological parameters (age, sex, tumour site, histopathological type, histopathological grade, Lymphovascular Invasion (LVI), Perineural Invasion (PNI) and lymph node status) was done by using Microsoft Excel and IBM SPSS V 26. Chi-square test was done for association and p-value of <0.05 was considered as significant. Results: A significant association was found between CDX2 expression with gender and lymph node status (p-value=0.004 and 0.038, respectively). A linear trend was observed between CDX2 and E-cadherin expression with histological grade. The higher grades of tumours showed negative CDX2 and low E-cadherin expression with p-value of 0.001 for both the markers. Cumulative survival rates for both the markers did not show any significant association statistically (p-value of 0.324 and 0.630, respectively). Conclusion: Higher grades of tumour was associated with negative CDX2 and low E-cadherin expression. Nodal metastasis was linked to negative CDX2 expression. Significant association was observed between CDX2 and E-cadherin. This may help in better understanding and prognostication of CRC when both the markers are studied.

Evaluating Non Enzymatic Antioxidants as Potential Biomarkers for Oxidative Stress in Schizophrenia: A Cross-sectional Study

Hemant Sharad Dahake, Yogesh Ramkrishna Pawade, Jayesh Prabhakar Warade

Introduction: Schizophrenia significantly impacts patients and their families. Oxidative stress is implicated in various neurological disorders, including schizophrenia. By studying the levels of antioxidants and oxidative stress markers in schizophrenic patients, the pathophysiology of the disease can be examined in depth. Aim: To investigate the relationship between non enzymatic antioxidants (albumin, bilirubin and uric acid) and oxidative stress markers {Malondialdehyde (MDA)} in first-episode and chronic schizophrenic patients, compared to healthy controls. Materials and Methods: A cross-sectional study was conducted at Indira Gandhi Government Medical College and Mayo Hospital, Nagpur, Maharashtra, India, from June 2008 to May 2009, with 150 participants, including 50 first-episode schizophrenic patients (Group A), 50 chronic schizophrenic patients (Group B) and 50 healthy controls (Group C). Blood samples were analysed for serum albumin, bilirubin and uric acid using a fully automated clinical biochemistry analyser and plasma MDA levels were measured with a validated biochemical assay. Statistical analyses were performed to explore the associations between antioxidants and oxidative stress markers. Results: The mean age of participants was 30.88±6.50 years in Group A, 32.98±4.36 years in Group B and 33.74±9.14 years in Group C. Significant positive correlations were observed among albumin, bilirubin and uric acid within each group, suggesting their synergistic antioxidant effects. In controls, all three antioxidants showed strong negative correlations with MDA levels (albumin: r=-0.468, p=0.001; bilirubin: r=-0.805, p=0.001; uric acid: r=-0.694, p=0.001), indicating their role in mitigating oxidative stress. This inverse relationship between non enzymatic antioxidants and MDA weakened with disease progression, as evidenced by a decrease in the coefficient of determination (r2) from Group A to Group B for all three antioxidants. These findings highlight the potential of albumin, bilirubin and uric acid as biomarkers for monitoring oxidative stress in schizophrenia. Conclusion: The present study demonstrates significant decreases in serum albumin, bilirubin and uric acid in individuals with schizophrenia, alongside strong inverse correlations between these parameters and MDA, a marker of oxidative stress. Bilirubin’s known antioxidant properties suggest its potential as a valuable biomarker for disease progression. These findings underscore the crucial role of the antioxidant system in mitigating oxidative damage in schizophrenia and highlight the potential therapeutic benefits of targeting this system to alleviate oxidative stress-related symptoms.

INTERNATIONAL CONFERENCE HealthCon 2025 SCHOOL OF HEALTH SCIENCES “Future of Integrated Healthcare: Synergies Across Disciplines”

Adarsh Kumar Srivastav

HealthCon 2025 aims to underscore the crucial contributions of various healthcare disciplines and demonstrate how their specialised expertise collectively enhances patient care. It will highlight the significance of collaboration among helthcare professionals, emphasizing how a unified, evidence based research intergrated approach leads to improved patient outcomes. By showcasing the synergy between physiotherapists, medical laboratory specialist, radiologists, optometrists, nutritionists, and other specialists, the event will illustrate how treatments and interventions can be tailored to meet each patient's unique needs. Addressing the challenges inherent in interdisciplianary care, the conference will identify obstacles such as data silos, communication breakdowns, and resource constraints, which often impede effective collaboration. Through panel discussions and expert presentations, attendees will explore solutions to these issues, focusing on strategies to enhance collaboration, facilitate data sharing, and optimise resouraces. By tackling these barriers, the conference aims to promote a more interconnected helthcare system that benefits both providers and patients. It will offer valuable insights into how collaborative, intergrated care models empowered by evidence based research, technology and innovation can transform healthcare delivery, untimately improving patient outcomes and experiences.

Structural Analysis of Wound Healing with Ehretia Laevis Roxb. Tincture Ointment versus Povidone-iodine Ointment in Wistar Rats: A Research Protocol

Pawan Banduji Itankar, Gaurav Rajendra Sawarkar, Punam Gaurav Sawarkar

Introduction: A wound is an opening in the skin’s epidermis that can lead to infection and sepsis. Individuals who experience injuries often report negative social, psychological, and physical effects as a result of their wounds and the treatment involved. Several factors can influence wound healing, including the site of the wound, medications, nutritional status, and bacterial infections. Ehretia laevis Roxb., a medicinal plant, is particularly beneficial for wound healing. It is commonly used by tribal communities for wound care, and they have reported positive outcomes. Additionally, this plant is also utilised to treat joint pain and minor fractures. Need of the study: Wound infections are frequently treated with potent antibiotics, which often remain inaccessible to rural populations. Furthermore, human resistance to these stronger drugs is increasing at an alarming rate, and patients are compelled to endure the adverse effects associated with such treatments. While povidone-iodine presents non allergic side effects, these cannot be overlooked. Notably, Ehretia laevis tincture ointment has not previously been formulated or employed in Ayurveda for wound healing. This study aims to develop a tincture-based ointment, providing a more standardised and clinically applicable form. Such an innovation may enhance both the practical usability and therapeutic efficacy of this natural remedy in wound care. Aim: To conduct a structural analysis of wound healing with Ehretia laevis Roxb. tincture ointment versus povidone-iodine ointment in Wistar rats, based on the percentage of wound reduction and histological parameters. Materials and Methods: An experimental preclinical study will be conducted in the central preclinical research facility of Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India, from April 2025 to September 2025. The study will employ 12 albino Wistar rats of either sex, weighing between 150 and 200 grams. They will be divided into two groups, with six rats in each group. Each group will be kept in a separate enclosure with a 12-hour dark and light cycle in an animal house. The study will span a treatment period of 15 days, with follow-up assessments conducted on the 7th and 15th days. The outcomes will focus on wound contraction rates, histological evidence of tissue regeneration, and the overall healing timeline. A two-sample t-test will be employed to analyse quantitative data, while comparisons for qualitative data will be made using the Chi-square test. A p-value of less than 0.05 will be considered statistically significant.

Impact of Standardised Order Sets on Functional Outcome of Acute Ischaemic Stroke Patients: A Research Protocol

Sarang Dilip Videkar, Tushar Patil

Introduction: Standard order sets, which are pre-decided measures that guide clinical decisions and treatment, are shown to benefit quality of care in various medical conditions, including stroke. The use of such order sets for stroke management has shown positive outcomes in various studies. The American Stroke Association advises the use of standard order sets to raise the efficiency of acute stroke care. Need of the study: In rural tertiary care hospitals of India, the challenge is due to factors such as late patient presentation, poor infrastructure, and lack of trained staff. These result in reduced stroke care and poorer outcomes. Therefore, introducing standard order sets in such settings could reduce the lacunae in stroke management quality and improve patient care. Aim: To study the impact of implementing standardised order sets on overall outcome of patients of acute onset ischaemic stroke. Materials and Methods: The study will be prospective observational study. This study is designed to know the effect of using standard order sets for study of outcomes of with acute onset ischaemic stroke. The study will be conducted in Acharya Vinoba Bhave Rural Hospital (AVBRH), a tertiary care hospital situated in the rural area of Wardha district. Study will be carried out over the period of two years. The data collection process for this study will be divided into three phases: the pre-implementation phase, the implementation phase, and the post-implementation phase. A total of 600 patients will be included in the study. Qualitative data will be coded into quantitative variables as needed, and new variables will be created based on the collected data to facilitate analysis. For example, age groups may be categorised, and time intervals calculated. These preparatory steps are essential for ensuring that the data is ready for robust analysis, ultimately enabling a thorough evaluation of the impact of standardised order sets on the outcomes of acute ischaemic stroke in a tertiary care rural hospital in India.

Effect of Pain Neuroscience Education versus Conventional Patient Education on Pain, Quality of Life, Kinesiophobia and Pain Catastrophising in Individuals with Post-Stroke Chronic Shoulder Pain: A Randomised Controlled Trial Protocol

Pooja Motar Sublok, Prashant Mukkannavar

Introduction: Post-Stroke Shoulder Pain (PSSP) is a prevalent complication that affects 10-22% of stroke survivors. Research shows that chronic pain is influenced by biological, psychological and social factors and these factors can impact physical function, kinesiophobia, pain catastrophising, disability and quality of life. These elements may contribute to chronic pain in patients with PSSP. Understanding Post-Stroke Chronic Shoulder Pain (PSCSP) is crucial for developing effective interventions and improving the overall wellbeing of stroke survivors. Need of the study: This study seeks to address the gap in understanding PSCSP, particularly the overlooked psychosocial factors in physiotherapy. By integrating the biopsychosocial model with Pain Neuroscience Education (PNE) and conventional physiotherapy, it aims to improve pain management and the wellbeing of stroke survivors. Aim: To compare the effect of PNE versus Conventional Patient Education (CPE) on pain intensity, quality of life, kinesiophobia and pain catastrophising in individuals with PSCSP. Materials and Methods: This research protocol is planned to conduct a randomised controlled trial in Hubballi, Karnataka, India, with 80 participants (40 per group), calculated at 90% power and 5% significance using G-power software. The duration of the study will be approximately four years, from June 2023 to August 2027. Participants aged ≥18 years with PSCSP (≥3 months), first-ever unilateral ischaemic or haemorrhagic stroke and chronic stroke lasting more than six months, meeting cognitive criteria (Mini-Mental State Examination (MMSE) >24), Visual Analogue Scale (VAS) (>1 mm) and Brunnstrom stages (III–V), will be included. Participants will be excluded if they have pre-stroke shoulder/neck pain, have undergone surgery, experienced acute strokes, have severe deficits, uncontrolled conditions, or contraindications to Transcutaneous Electrical Nerve Stimulation (TENS) (e.g., epilepsy, pacemaker). Group A will receive PNE, while Group B will undergo CPE. Both groups will receive graded motor imagery, TENS and task-specific exercises for six weeks, with a two-week follow-up. Outcomes (VAS, quality of life, Tampa Scale for Kinesiophobia, pain catastrophising and disability) will be assessed at baseline, six weeks and eight weeks.

Evaluation of Comparative Efficacy of Goghrita with Saindhava Matrabasti versus Goghrita Matrabasti in Sciatica (Gridhrasi): A Randomised Controlled Trial Research Protocol

Girish Bhupal, Shweta Parwe, Milind Nisargandha, Shalini Pathania

Introduction: Modern lifestyles contribute to nutritional deficiencies and health issues, with low back pain affecting 80-90% of individuals. Sedentary living, poor posture and stress often lead to sciatica, characterised by pain radiating down the leg, which is classified in Ayurveda as Gridhrasi, a Vata disorder. Need of the study: Due to sedentary lifestyles, poor posture and job challenges, sciatica is becoming increasingly common. Traditional therapies have significant disadvantages. While contemporary treatments such as analgesics, physiotherapy, or surgery frequently alleviate symptoms, they do not address the underlying issues. Recurrence and adverse effects are common. Ayurvedic therapies that provide comprehensive and long-lasting relief, such as Matrabasti, require evidence-based acceptance. This treatment reduces pain and stiffness by lubricating the muscles and nerves. Aim: To evaluate and compare the efficacy of Goghrita (cow clarified butter) with Saindhav Lavana (rock salt) Matrabasti (enema) versus Goghrita Matrabasti in Gridhrasi (sciatica). Materials and Methods: A randomised single-blind (assessor) superiority trial will be conducted at the Department of Panchakarma, Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India, from November 2024 to January 2026. Subjects will be divided into two groups of 30 each. In group A (Control), Goghrita Matrabasti 60 mL will be administered after meals for nine days and in group B (Experimental), Goghrita 60 mL with 5 grams of Saindhav Lavana will be given after meals for nine days. The assessment will be based on subjective parameters such as Spandana (Twitching), Ruk (Pain), Stambha (Stiffness), Toda (Pricking pain), Aruchi (Loss of taste), Tandra (Stupor) and Gaurava (Heaviness), as well as objective criteria including the Visual Analogue Scale (VAS) scale, the Straight Leg Raising Test (SLRT), Range of Motion and the Schober test on the 0th, 9th, 18th day. Statistical analysis will be conducted using paired and unpaired t-tests for intra- and intergroup comparisons and a Chi-square test for categorical data. A p-value <0.05 will be considered statistically significant.

Pharmaceutico-analytical Standardisation of Tripurabhairava Rasa and Evaluation of its Acute Oral Toxicity, Antipyretic, and Analgesic Activities in Wistar Albino Rats: A Research Protocol of Experimental Study

Sukeshini Julme, Mujahid Khan

Introduction: Tripurabhairava Rasa, a herbo-mineral compound from Bharat Bhaishajya Ratnakar, is used to treat all types of Jwara (fever). Fever is a natural defence against infections, but elevated temperatures can sometimes cause harm, necessitating antipyretic treatment. Tripurabhairava Rasa is made from Shuddha Vatsanabha (Aconitum ferox), Shunthi (Zingiber officinale), Maricha (Piper nigrum Linn.), and Shuddha Tankan (Borax). Given it composition, especially Vatsanabha, a toxicity study is necessary. In addition to determining the drug’s safety, studies are being conducted to discover any potential side effects. Need of the study: This study is essential because Tripurabhairava Rasa, a traditional Ayurvedic formulation for treating fever, has not been systematically prepared, standardised, or scientifically evaluated. The lack of pharmaceutical and analytical standardisation raises concerns about its safety, consistency, and efficacy. With the growing interest in integrating traditional medicine into modern healthcare, scientific validation is crucial. Evaluating the formulation’s preparation, acute oral toxicity, antipyretic, and analgesic effects in Wistar albino rats will provide the necessary evidence to ensure its safe and effective use in clinical practice. Aim: To conduct pharmaceutical and analytical standardisation of Tripurabhairava Rasa, along with evaluating its acute oral toxicity, antipyretic, and analgesic activities in Wistar albino rats. Materials and Methods: This experimental study is planned to take place from January 2024 to April 2024 at the animal house of Datta Meghe College of Pharmacy, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India. Vatsanabha and Tankan will be collected from Cotex Laxmi Health Care Pvt. Ltd., while Shunthi, Maricha, Nagavalli, Ardraka, and Nimbu will be collected from the local market, with brewers’ yeast of API grade procured from Merck. Raw drugs will be verified and authenticated by the taxonomist/Dravyaguna department, and standardisation will be conducted in accordance with Active Pharmaceutical Ingredient (API) or analytical labs at MGACH and RC. This study will follow Organisation for Economic Co-operation and Development (OECD) guidelines 423 and will involve 54 rats. Further analysis and experimentation will be conducted at a laboratory or research institute of national repute as listed in the DMIHER (DU) profile. The organoleptic and physicochemical characteristics of Tripurabhairava Rasa will be studied.

Efficacy of Gunja Beeja Ointment versus Diclofenac Sodium Ointment in the Management of Avabahuka (Frozen Shoulder): A Research Protocol for a Randomised Controlled Trial

Shreya Parkhi, Sadhana Durgaprasad Misar

Introduction: Avabahuka, primarily caused by vitiated Vata affecting the Amsa Sandhi, manifests as shoulder dysfunction. Acharya Sushruta, categorise Avabahuka as a Vata Vyadhi, recommending Vatavyadhi Chikitsa. Symptoms include loss of upper limb movement, pain, and shoulder joint stiffness. In modern medicine, Avabahuka is analogous to Frozen Shoulder or Adhesive Capsulitis, impacting 2-5% of people in general and 10-15% of diabetics. Charaka Samhita recommends Lepa (paste) for immediate relief. Need of the study: The modern treatment includes analgesics and local intra-articular injections of corticosteroids, and physiotherapy. Nonsteroidal anti-inflammatory drugs have side effects such as nephrotoxicity, infectious arthritis and cartilage damage. There is a need for a safe and effective Ayurvedic herbal drugs which can be beneficial in such cases. Gunja Beeja contains Abrin and Abralin that has analgesic, anti-inflammatory and antimicrobial activities. No randomised controlled trial has been conducted on Gunja Beeja ointment in Avabahuka. Aim: To evaluate the efficacy of Gunja Beeja ointment versus diclofenac sodium ointment in the management of Avabahuka (Frozen Shoulder). Materials and Methods: This single-blind, parallel randomised controlled trial will take place over a period of one and a half years (February 2025-January 2026) at the Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACH & RC), Salod (H) Wardha, Maharashtra, India. The study registered under CTRI/2024/07/070559 involves 60 patients meeting the inclusion criteria, randomly assigned into two groups of 30 each. Group 1 will receive Diclofenac sodium ointment while Group 2 will receive Gunja Beeja Ointment with shoulder exercises in both groups, once daily for seven days. Assessments will be conducted on days 0, 7, and 14, with follow-up on day 14. Outcomes will be measured using range of shoulder movement (Goniometer), pain (Visual Analogue Scale), stiffness (scoring method), muscle atrophy (measured in centimeters), and the Disability of Arm, Shoulder, and Hand (DASH) questionnaire.

Properties, Fabrication Techniques, and Clinical Outcomes of Lithium Disilicate, Zirconia, and Zirconia-reinforced Lithium Silicate Crowns: A Narrative Review

Yousef Tariq Eshmawi

All-ceramic crowns have gained immense popularity in modern day dentistry owing to their enhanced aesthetics, biocompatibility, and durability. Among these, Lithium Disilicate (LS₂), Zirconia (Z), and Zirconia-reinforced Lithium Silicate (ZLS) are three most desired restorative materials, each offering varying benefits. The advances of material science and digital dentistry are constantly refining their clinical behaviour, making material selection a major part of restorative decision making. This review article provides a general summary of these three all-ceramic crown materials and discusses their evolution, specifically the development in the translucency of zirconia and the transformation of ZLS as a hybrid material. It covers the most important properties of each of these materials, such as aesthetics, biocompatibility, strength, and bonding procedures. It also discusses the effect of traditional vs. computerised impression methods on their clinical success. A lot of this review also contrasts traditional and digital impression technology. It discusses how developments such as Intraoral Scanning (IOS) and Computer-Aided Design and Computer-aided Manufacturing (CAD/CAM) technology impact the accuracy, efficiency, and clinical success of crown restorations. Through critical examination of the literature, this review is intended to provide clinicians with information necessary for evidence-based decision making in material selection and impression-taking techniques, which will ultimately maximise patient outcomes and long-term restorative success.

Unravelling the Intricacies of Auto Brewery Syndrome and its Microbial Dynamics: A Narrative Review

Bhagyesh Sapkale, Shreya Singh, Dhruba Chandi

Auto Brewery Syndrome (ABS), often referred to as Gut Fermentation Syndrome (GFS), is a sporadic disorder characterised by the internal production of alcohol, leading to symptoms that resemble alcohol intoxication, including vertigo, slurred speech and confusion. The article explores uncommon presentations of ABS, such as an oral version and a new variation in which endogenous fermentation within the urinary system results in the production of ethanol. One of the main causes of ABS is thought to be a fungal dysbiosis of the gut, which occurs due to an overabundance of yeast. The pathophysiology of ABS is associated with the mycobiome, a component of the gut microbiota that ferments certain carbohydrates into ethanol, mimicking food allergies or intolerances. Using a comprehensive search strategy that includes the PubMed, Science Direct and Google Scholar databases, this review investigates ABS with a focus on recent research published in the last 10 years. The involvement of gut bacteria is emphasised, particularly the abnormal development that results in endogenous alcohol synthesis. Microbiological strains associated with ABS, including high alcohol-producing variant of Klebsiella pneumoniae (HiAlc KPN) and Candida albicans, are examined. The article discusses the challenges associated with diagnosing ABS, including the use of breath analysers, clearance rates and variations in endogenous ethanol production among different ethnic groups. Furthermore, medicolegal issues are addressed, such as the use of ABS as a defence in drunk driving cases. In conclusion, ABS illuminates the intricate relationship between the human body and its microbiota, highlighting the potential consequences of microbial imbalance.

A Narrative Review on Hormonal and Reversible Contraception: Advances, Options, and Implications for Reproductive Health

Krushan Shah, Bhagyesh Sapkale, Rajesh Godavarthi, Kamlesh Chaudhari

This narrative-based systematic review aims to examine contraception, focusing on new developments and alternative techniques. Pregnant teenagers often face challenges regarding their social standing in society. To minimise teen pregnancy, the availability of services in terms of the supply of hormonal contraceptives and Long Acting Reversible Contraception (LARC) must be improved. There are many situations that require the use of Emergency Contraception (EC) to provide preventive measures after risky encounters. As there are currently no other male contraceptive options on the market, a male hormonal contraceptive is necessary. The market is primarily driven by contraceptive biomaterials, most of which are elastomers such as ethylene vinyl acetate and polydimethylsiloxane. Keywords from the Web of Science and PubMed databases included barrier techniques, LARC, contraception, and others. To maintain reliability and academic rigor, the inclusion criteria focused solely on English language research, reviews, and articles published in the last 10 years. Exploring new hormone combinations with better metabolic properties is an important aspect of the advanced conception of contraceptives. Lower androgenicity forms of natural chemicals and progestins are employed in LARC techniques to reduce thrombogenesis. Potential alternatives include transdermal systems and other vaginal rings. The sequelae, particularly the interactions between hormonal contraceptives and antiepileptic drugs, should also be discussed. Some types of contraception include tubal ligation through hysteroscopy, the impact of antiepileptic drugs on the effectiveness of hormonal contraceptives, and improved barrier methods of contraception. In certain medical contexts, Point of Care Contraceptives (POCCs) play important roles. This paper provides a comprehensive overview of contraceptives, their forms, and key considerations. The evaluation of LARC products for patient satisfaction, superior efficacy, and the promotion of condom use for the control of Sexually Transmitted Diseases (STDs) is also illustrated. According to this framework, reversible contraceptives provide people with greater control over family planning; Intrauterine Devices (IUDs) and subdermal implants are among the most effective contraceptive methods. The use of LARC techniques is discussed in this abstract, which underlines their importance and recognises that they are considered the most effective method of contraception when used regularly.

Exploring the Current Applications and Future Implications of Artificial Intelligence in Public Health Dentistry: A Narrative Review

Artificial Intelligence (AI) is transforming healthcare at a rapid rate by enhancing disease prevention, diagnosis, treatment planning and management of health systems. AI technologies such as machine learning, deep learning, and natural language processing have been able to show an enormously huge scale capacity for improvement in oral health outcomes at the population level, particularly among disadvantaged groups. AI based applications in preventive dentistry can identify high risk individuals for dental caries, periodontal infections and oral cancer to allow targeted dental care. Deep learning algorithms can also be applied in imaging diagnostics and dental care can be personalised using patient’s history, habits and genetics. AI applications can also be utilised in epidemiologic surveillance for analysis of health-related information in forecasting disease patterns and drafting evidence based public health policies. AI can enhance dental education and training of new dental professionals through simulation-based education and intelligent tutoring systems. Administrative efficiency can also be achieved using AI based management software for patient scheduling, billing, and resource management which can reduce the workload of the clinician and enhance the functioning of health system. Inspite of the widespread applications of AI in dental public health, ethical issues related to data security, unequal access to technology and regulatory policies need to be addressed. Transparency in AI usage, accountability and equitable incorporation of AI in health systems are required. With a focus on diagnostic tools, epidemiological monitoring, individualised care, and health system management, this review article attempts to investigate the various uses of AI in public health dentistry. In the present review article, future prospects for AI in the public health dentistry field are explored, as well as its possible advantages and difficulties.

Use of Mnemonics as Teaching and Learning Adjuvant for Ayurveda Undergraduate Students: A Research Protocol

Preeti Sujit Borkar, Bharat Rathi, Monika Luharia, Rushikesh Thakre

Introduction: Teaching and learning techniques like mnemonics are beneficial for enhancing recall memory. Mnemonics serve as memory tools, aiding individuals in remembering substantial amounts of information, especially when dealing with names and lists, such as traits, procedures, phases, components, etc. Educational institutions often introduce these techniques to help students learn and retain information, thereby facilitating the process of absorbing large amounts of information about Ayurvedic compendia. Therefore, it is imperative for teachers to strategically plan and incorporate these methods into the Ayurveda education system to enhance students’ academic performance in examinations. Need of the study: Mnemonics prove invaluable for learners in Ayurveda education programmes who grapple with memorising extensive and unfamiliar content that differs from the pre-existing knowledge in Ayurveda compendia. To enhance cognitive development in students, it is crucial to employ adjuvant teaching and learning techniques like mnemonics. This approach facilitates students in memorising significant content from texts related to subjects in Ayurveda education. Aim: To evaluate the role of mnemonics as a teaching and learning supplement to improve the academic performance of undergraduate Ayurveda students. Materials and Methods: This parallel group interventional crossover study will be conducted by the Samhita and Siddhanta department for first-year BAMS students at Mahatma Gandhi Ayurved College in Maharashtra, India, from November 2023 to December 2024. Eighty-four first-year BAMS students will be randomly divided based on odd and even roll numbers into two groups, namely A and B. Participants will be subjected to pre- and post-tests formulated on topics 1 and 2 by providing brief answer questionnaires. The parameters for evaluation will include pretests and post-tests using the traditional teaching and learning method alongside the mnemonic teaching and learning method as its supplement. Crossover intervention and feedback analysis will be conducted using a 5-point Likert scale. Data will be obtained by evaluating the mean differences between pre- and postintervention scores in an Excel spreadsheet. These scores will be utilised to evaluate the learning gains achieved by both approaches in terms of parameters assessed as absolute, relative and class average normalisation. Statistically, t-tests will be employed to analyse the collected data. A p-value <0.01 suggests strong evidence against the null hypothesis and indicates statistical significance.

Postoperative Pseudomeningocele: A Rare Complication of Lumbar Spine Surgery

Tushar Kalekar, Niharika Prasad, Bhavya Dang

A 64-year-old male with a history of chronic lower back pain for the past three years, which had progressively worsened over the preceding month and led to difficulty in walking, presented with associated tingling sensations in the left lower limb for two years and urinary incontinence for one week. He was evaluated clinically and radiologically and diagnosed with multilevel lumbar canal stenosis and degenerative spondylolisthesis. There was no history of trauma, fever, constitutional symptoms, or bowel disturbances. The patient was known to be hypertensive, non diabetic and a non smoker and had no prior history of spinal trauma or tuberculosis. He underwent L2-L4-L5-S1 bilateral pedicle screw fixation, L3 left pedicle screw fixation and L3-S1 laminectomy with bilateral nerve root decompression. Two months after surgery, he presented to the Department of Neurology with complaints of persistent lower back pain and a progressive, fluctuant swelling at the prior surgical site. The pain radiated to both lower limbs and was associated with tingling and numbness in the left lower limb. He denied motor weakness or bowel/bladder dysfunction at the time of presentation and was referred to the Department of Radiodiagnosis for Magnetic Resonance Imaging (MRI) evaluation. On physical examination, a fluctuant, non pulsatile, non tender swelling measuring approximately 6×2.5 cm was noted in the lower lumbar midline scar region. The swelling was oval, non mobile, soft and transilluminant, with no overlying erythema, warmth, or signs of local infection. The neurological examination revealed normal motor strength with decreased superficial sensation in the left L4-L5 dermatomes. Deep tendon reflexes were diminished in the lower limbs. The straight leg raise test was positive on the left and pain was exacerbated by Valsalva manoeuvres, such as coughing and sneezing. A postoperative Magnetic Resonance Imaging (MRI) scan of the Lumbosacral (LS) spine revealed a well-defined Cerebrospinal Fluid (CSF) intensity collection {hyperintense on T2-weighted imaging (Table/Fig 1)a,b and hypointense on T1-weighted imaging (Table/Fig 1)c,d, measuring 21×10×61 mm. This collection extended from L3 to L5, posterior to the dura, consistent with a pseudomeningocele – a rare complication of spinal surgery caused by an unsealed dural defect and persistent CSF leakage. Furthermore, a single-slice MR myelogram (Table/Fig 2) demonstrated the continuity of the pseudomeningocele with the thecal sac (blue arrow), extending from L3 to L5, further confirming the diagnosis. Additional findings included posterior tethering of the cauda equina nerve roots at the L3, L5 and S1 levels, as well as susceptibility artefacts from transpedicular screws at the L1, L3, L4 and L5 vertebrae. The differential diagnoses for postoperative fluid collections include seroma, which appears as a homogeneous simple fluid collection without neural symptoms; haematoma, which is hyperintense on T1-weighted imaging with blooming on Gradient Echo (GRE) sequences and usually has an acute onset; and abscess, which typically shows inhomogeneous signals with rim enhancement and may be associated with discitis or osteomyelitis. Given the absence of significant neurological deficits and the stability of the collection, a conservative approach was adopted. The patient was managed with analgesics, bed rest, lumbar support and clinical monitoring. Over a six-week follow-up period, the swelling regressed and symptoms improved. No surgical reintervention was required. He continues to be followed-up in the outpatient department and remains neurologically stable. A pseudomeningocele, also known as a meningeal pseudocyst, is a fistula or accumulation of CSF that can arise from the extravasation of CSF caused by a dural or arachnoid tear during surgery. Three types of pseudomeningoceles have been reported in the literature: traumatic, postoperative and congenital (1). According to research by Swanson HS and Fincher EF (2) and Teplick JG et al., (3), the incidence of postoperative pseudomeningocele in patients who have undergone lumbar laminectomy varies between 0.07% and 2%. Patients may present with a wide range of symptoms, some of which may not appear for years (1). Usually, a pseudomeningocele presents as low back pain that worsens during coughing and sneezing. When nerve roots in the cyst cavity herniate, patients may also exhibit radicular symptoms. Rarely, individuals may demonstrate sphincter dysfunction and motor impairments. The MRI is the recommended method for detecting pseudomeningoceles in postoperative patients. MRI frequently shows a fluid collection of varying size with CSF intensity along the surgical path, which may or may not be contained by the deep muscle fascia. A pseudomeningocele is characterised by a hypointense lesion on T1-weighted scans and a hyperintense lesion on T2-weighted sequences. Correlation with clinical information is critical for detecting a postoperative pseudomeningocele, since its imaging characteristics are similar to those of a seroma and, to a lesser extent, a growing liquid haematoma or abscess. On MRI, both haematomas and abscesses exhibit complex signals, are inhomogeneous, possess larger enhancing borders or capsules and abscesses are likely associated with discitis and/or osteomyelitis. A haematoma exhibits “blooming” on T2* (GRE) sequences. Up to this day, only a limited number of studies have addressed the occurrence and management of lumbar postoperative pseudomeningoceles (4),(5),(6),(7). The first such report was published by Hyndman OR and Gerber WF in 1946, recognising the complication as a result of unsealed dural tears during spinal procedures (8). Raudenbush BL et al., later described three cases where compressive pseudomeningoceles were associated with neurological deficits; these cases were managed successfully with surgical decompression and dural repair (4). Conversely, Solomon P et al., documented four patients with large pseudomeningoceles that resolved without surgical intervention, highlighting the potential for spontaneous healing in asymptomatic cases (5). Gupta R and Narayan S reported two additional cases where the pseudomeningoceles were managed operatively; in both instances, the dural defects were clearly visualised and repaired during revision surgery, leading to symptom resolution (6). Weng YJ et al., also presented a case series involving eleven patients with giant pseudomeningoceles, each measuring between 8 and 11 cm in length, who underwent successful surgical treatment, further emphasising the variability in size and the need for individualised management approaches (7). Treatment strategies for postoperative pseudomeningoceles continue to be a subject of debate among surgeons. Decisions are largely influenced by the location of the defect, the size of the collection and the presence of associated neurological deficits (9). Surgical options vary and include direct dural repair, the application of autologous or synthetic patch grafts, the use of fibrin glue, CSF diversion techniques such as lumbar shunts or subarachnoid drains and epidural blood patches (10),(11). In some cases, observation remains a valid option, especially for small and asymptomatic lesions. In the present case, conservative management led to resolution without surgical reintervention, consistent with a similar case reported in the literature (5).