Journal of clinical and diagnostic research

A Case Report on Mucocele of Appendix with Tubo-ovarian Complex and Review of Literature

Abhilasha Bhargava, Chandrashekhar Mahakalkar, Shivani Kshirsagar

Mucocele of the appendix is a rare condition caused by mucus accumulation due to a blocked appendix resulting from inflammation, infection, or faecal matter blockage. It presents as lower abdominal pain, vomiting, nausea, abdominal mass, and distension. It is more common in individuals over 50 years old and is more prevalent in the elderly. Mucocele can be differentiated into mucinous cystadenocarcinoma, mucosal hyperplasia, and mucinous cystadenoma. It is often diagnosed incidentally during radiological, laparoscopic, or surgical interventions. Ultrasound and computed tomography imaging techniques are useful in screening and diagnosing appendiceal mucocele, as they can detect a cystic mass or soft tissue mass and differentiate between a mucocele and other neoplasms. Most cases are reported in older individuals, with few in young adults. In the present case report, the authors present a case of a 34-year-old female with a history of occasional abdominal pain. On investigation, it was found to be an inflamed appendix with a mass in the right iliac fossa for which the patient underwent appendectomy. Due to the involvement of the right adnexa with tubo-ovarian complex and omentum, the present case presents a unique manifestation of an appendix mucocele.

Case of an Intramedullary Ancient Schwannoma of the Brainstem Mimicking Astrocytoma: A Rare Clinical Presentation with a Diagnostic Dilemma

Schwannomas are common benign tumours arising from the myelin sheath of peripheral nerves. These tumours are usually located in the intradural and extramedullary regions. The common sites are cervical (58%) and thoracic region (32%), followed by the lumbar region (10%). Intramedullary location is rare and if present, is usually associated with neurofibromatosis 1 and 2 (NF-1 and 2). Intramedullary brainstem schwannomas without NF are uncommon, and to the best of the authors’ knowledge, only 19 cases have been reported to date. It was first described by James Watson Kernohan, an Irish-American pathologist, in 1931. The rarity of these tumours in this location is due to the absence of Schwann cells in this area. There are several hypotheses postulating the presence of these tumours in this location. The exact cause is not yet known. The authors here present a case of intramedullary brainstem ancient schwannoma with an unusual clinicoradiological presentation, which raised suspicion of Glioma with the possibility of Astrocytoma. The patient presented with right-sided neck stiffness and shoulder pain for a period of four months. Total excision of the tumour was performed, and the postoperative period was uneventful with clinical improvement in the patient. Histomorphology raised the suspicion of a tumour of glial origin with the possibility of Astrocytoma; Immunohistochemistry (IHC) helped in reaching the definitive diagnosis of Ancient Schwannoma. Thus, a combined approach of clinicoradiological, as well as histomorphology and IHC, is essential for a definitive diagnosis of these tumours. Future multicentric studies are required to elucidate the pathogenesis of the location of these tumours.

Spontaneous Perforation of Ascending Colon Presenting as Retroperitoneal Abscess: A Case Report

Davinder Kumar, Ritesh Kumar, Monika Gupta, Piyush Gupta, Sanjay Marwah

Perforation of the colon is frequently encountered in surgical emergencies and requires urgent intervention. Free colonic perforations are diagnosed early due to the development of signs of peritoneal irritation. However, perforation of the posterior wall of the colon into the retro-peritoneal space poses a diagnostic challenge because of the absence of signs of peritoneal irritation and its atypical clinical presentation. The authors reported an unusual case of 42 years old female patient with idiopathic perforation of the posterior wall of the ascending colon that presented as a large retroperitoneal abscess. The abscess was diagnosed based on clinical and Computed Tomography (CT) findings, and the patient underwent incision and drainage of the abscess through a flank incision. There was initial improvement in the patient’s general condition, but on the fourth day, there was faecal discharge through the wound, indicating colonic perforation. The patient was immediately taken for an emergency laparotomy. Intraoperatively, the peritoneal cavity was found to be clean; however, upon mobilisation of the ascending colon, two large perforations on its posterior wall were found with faecal soiling of the retroperitoneal tissues. Right hemicolectomy with end ileostomy and closure of the transverse colonic end were performed. Histopathology revealed the absence of any definite pathology, and a diagnosis of spontaneous perforation was made. This unusual case highlights that this rare possibility should be considered as a differential diagnosis of a retroperitoneal abscess to enable early intervention, which is likely to save the patient.

Intersection of Coeliac Disease and Sjögren’s Syndrome: A Report of Two Cases

Ravi Talapa, Rebecca Hoineikim Baite, Rishabh Rawat, Rohit Saini

Coeliac Disease (CD) and Sjögren’s Syndrome (SS), both autoimmune disorders, are gaining attention for their complex interaction when occurring together. CD involves gluten intolerance and can present with gastrointestinal symptoms, while SS affects various organs, primarily causing dryness of the eyes and mouth. Diagnosis for each relies on specific criteria including serologic testing and histopathology. When these conditions overlap, they create unique clinical challenges, highlighting the need for a thorough understanding of their combined effects on health. This exploration aimed to uncover the intricacies of their relationship, including clinical manifestations and implications for diagnosis and management when dealing with both simultaneously. In both cases (58-year-old female and 47-year-old female), there was gastrointestinal villous atrophy as a manifestation of CD, which improved with simple dietary modification.

A Case of Acute Disseminated Encephalomyelitis in Adults: Unravelling the Influenza B and Leptospirosis Co-infection

Acute Disseminated Encephalomyelitis (ADEM) is a neurological disorder characterised by demyelination, where the immune system targets the Central Nervous System (CNS). This condition typically develops rapidly, with neurological symptoms appearing within days to weeks following viral infections or immunisations. Before the onset of neurological manifestations, patients often experience systemic symptoms such as fever, headache, malaise, and myalgias. The transition from the febrile phase of illness to neurological symptoms generally occurs with a latency period of 7 to 14 days. ADEM is commonly referred to as “post-infectious,” “para-infectious,” “post-exanthematous,” or “post-vaccinal” encephalomyelitis. Recognised as a potential cause of permanent neurological disability, ADEM frequently affects individuals early in life, underscoring the significance of understanding this disease entity, particularly in the context of routine immunisation practices. Herein, the authors present the case of a 28-year-old female, who presented with quadriparesis in a drowsy state following a febrile illness. Upon further evaluation, she was diagnosed with a co-infection of Influenza B and leptospirosis, confirmed by positive serological tests. Magnetic Resonance Imaging (MRI) of the brain revealed hyperintensities suggestive of ADEM in multiple areas of the brainstem and thalamus, while Cerebrospinal Fluid (CSF) examination showed an albumin-cytological dissociative picture, further supporting the diagnosis. Treatment comprised a pulse steroid regimen followed by oral steroid tapering. Subsequently, the patient demonstrated clinical improvement over the course of a week, with progressive enhancements observed during follow-up assessments. The present case highlights the importance of prompt recognition and management of ADEM, emphasising the role of corticosteroid therapy in achieving favourable patient outcomes.

Large Bowel Perforation Resulting from Barotrauma via Transanal Route by Compressed Air Jet: A Case Report

Keval R Dhone, Pravin W Nikhade, Avinash T Rinait

Barotrauma-induced bowel perforation due to high-pressure air jets represents an exceptionally rare clinical entity. The authors present a case involving a 22-year-old male patient, who suffered multiple perforations of the large bowel following accidental exposure to a compressed air gun in an industrial environment. This occurrence, provoked by a co-worker’s irresponsible use of the device, emphasises the need for heightened awareness and stricter safety protocols in similar settings. Upon experiencing severe abdominal pain, the patient was promptly admitted to the hospital where an abdominal x-ray demonstrated significant pneumo-peritoneum. Emergency exploratory laparotomy confirmed extensive damage, including multiple perforations and serosal tears along the descending and sigmoid colon. Surgical management included primary repair of the perforations and the formation of a temporary ileostomy. The successful closure of the ileostomy three months later marks a crucial phase in the patient’s recovery. This case highlights the critical clinical implications of barotrauma in non-traditional settings and underscores the necessity of prompt surgical intervention, which may significantly influence patient outcomes. The novelty of this case lies in the uncommon mechanism and setting of injury, coupled with the extensive nature of the bowel damage, illustrating a rare but serious workplace hazard that necessitates greater preventive measures and awareness.

A Case Report of Palatal Ulcer: First Sign of Occult Tuberculosis

Soumi Ghanta, Jayanta Chattopadhyay

Tuberculosis is a chronic granulomatous transmitting type of disease caused by the Mycobacterium tuberculosis complex. It can affect any part of the body, including the oral cavity. Oral tuberculosis can be primary or secondary, In oral cavity, tongue, buccal mucosa, lip, and palate may involve. Here, the authors present a case of a 50-year-old male patient of tuberculosis of palate, manifesting as a non healing ulcer. The ulcer was present in the middle part of the palate, having undermined edge and a non indurated margin. Though it was tender on palpation, there was no evidence of palatal perforation or bony erosion on radiographic examination. A chest radiograph revealed consolidation in the apex and right upper zone, and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) of sputum was positive, but biopsy of the lesion could not be performed because of problem in patient’s consent. The authors took a chance and started antitubercular drugs. They observed the changes of ulcer at regular intervals. No topical medication was given for the ulcer. After taking antitubercular drugs, the condition improved rapidly and The ulcer healed completely after completing the Intensive Phase (IP) only. Tuberculosis is a transmitting and fatal disease. Early diagnosis with proper treatment can prevent complications and the transmission of the disease to others.

A Sporadic Case of Late-onset Vulvar Steatocystoma Multiplex

Samyak Ganjre, Bhushan Madke, Drishti Bhatt, Shivani Jangid, Shreya Gupta

Steatocystoma multiplex is a benign disorder involving the pilosebaceous unit, characterised by the presence of numerous cutaneous cystic lesions in the dermis. While cases with random occurrence are commonly observed, the condition can also be transmitted genetically in an autosomal dominant fashion. The lesions are frequently seen in body parts with a high number of pilosebaceous units including the axillae, scalp, trunk, thighs, arms, and less frequently occurring on the genitals and breasts. Hereby, the authors present a case report of a 48-year-old female who presented to the Outpatient Department of Dermatology with multiple asymptomatic swellings on her vulva since nine years. On physical examination, the swellings were noted to be calcified nodules. These nodules were excised and sent for histopathological analysis that revealed the diagnosis of steatocystoma multiplex. Steatocystoma multiplex can occur as sporadic, familial, or as a part of a syndrome. Although the lesions themselves are symptomless, their presence in the genital region makes walking difficult, thereby hampering routine work and adversely affecting the quality of life of the patient. There is also a need to educate patients regarding its benign nature and possible treatment options. Hence, the present case report aimes to emphasise the importance of its early identification, diagnosis, and to raise awareness among general practitioners.

Salt and Pepper Pigmentary Retinopathy in Congenital Rubella Syndrome: A Case Report

Raina Jain, Sachin Daigavane

A fatal viral infection called rubella, often known as German or three-day measles, is spread by the Rubivirus genus of the Togaviridae family. The disorder known as Congenital Rubella Syndrome (CRS) has the potential to cause a wide range of multisystem problems. Every organ in the developing foetus can be damaged; the most prevalent involvements are cardiac, ophthalmic, and auditory abnormalities. This is a case report of an 11-year-old patient who was hospitalised at a tertiary care facility with severe signs and symptoms of CRS, which were identified at birth. Ocular abnormalities included congenital cataracts and salt and pepper retinopathy. The lens aspiration and Intraocular Lens (IOL) implantation were done. This case serves as an example of the significance of the rubella immunisation program.

Bilateral Spontaneous Rupture of the Achilles Tendon as an Initial Presentation of Alkaptonuria: A Case Report

Sundara Raja Perumal, K Malathy, CD Anand

Rupture of the Achilles tendon is a common occurrence in the athletic population with a history of injury; however, a complete rupture of both Achilles tendons is uncommon. Spontaneous rupture of the bilateral Achilles tendons is an even rarer phenomenon, usually highlighting an underlying pathological condition. The authors present a 32-year-old healthy male patient with no previous known co-morbidities and radiological evidence of a complete tear of both Achilles tendons. Histopathological examination of resected tendon tissue revealed dark-coloured deposits within, and further investigations established the diagnosis of alkaptonuria. Non traumatic bilateral rupture of the Achilles tendon should raise suspicion of underlying metabolic/genetic disorders like alkaptonuria.

A Rare Case of Epidermodysplasia Verruciformis with Non Syndromic Hearing Loss

Soham Meghe, Al Singh, Yash Kashikar, Sudhir Singh

The onset of Non Syndromic Hearing Loss (NSHL) typically occurs without any other symptoms and can vary from person to person, even within the same family. Hearing loss can be unilateral or bilateral and can range from mild to profound degrees of hearing loss. Epidermodysplasia Verruciformis (EDV) is a dermatologic condition in which patients show reduced immunologic ability to defend and eradicate certain types of Human Papillomavirus (HPV), leading to persistent infection and an increased lifetime risk of developing cutaneous dysplasia and malignancy. Both conditions have a genetic background. However, their concurrent occurrence is very rare. Therefore, a case study is presented of a four-year-old female child who visited the dermatology outpatient department with a chief complaint of hearing loss and white-coloured lesions covering her arms, neck, back, and chest for the last two years. The hearing loss was gradual, not apparent at birth, and progressed slowly to complete hearing loss. A final diagnosis of EDV with Non Syndromic Sensorineural Hearing Loss (NSSNHL) was made based on clinical and histological examination.

Ingestion of Unknown Snake Venom: A Case Report

Utkarsh Gaur, Charuta Gadkari, Aditya Pundkar

Venom from a snake is extremely uncommonly consumed by humans. It can be administered in a variety of ways, including a direct bite on the tongue or other parts of the body, or it can be taken as a venom pill at rave parties. The belief is that upon consumption, it provides virility, a sense of elation, and excitement, among other effects. However, it is more often dangerous to the human body and can even be fatal. Only a very small number of cases have been described in publications. In the present case report, a 36-year-old male patient who was an alcoholic and had a history of psychiatric disease initially arrived with anxiety as a result of having consumed snake venom the day before. As for the patient’s vital signs, they were acceptable. For observation, the patient was admitted to the intensive care unit reserved for medicine. However, antisnake venom was not administered. After 24 hours, he was released from the hospital. This is an unusual case where the patient was relatively unharmed after the consumption and didn’t show any obvious lasting effects on the neurological or haematological systems. If the venom is not effectively broken down in the intestines and is absorbed as such, drinking snake venom can have deadly repercussions. The treatment is determined by the features that the patient presents. In the present case, antivenom was not administered, as the need was not justified. However, there may arise situations in other cases where it should be administered sparingly.

Complete Lung Atelectasis following Caesarean Section in a Case of Imminent Eclampsia: A Case Report

Rajasri Yaliwal, Laxmi Sangolli, Aruna Biradar, Sona Tejaswi, Namita Gupta

In the early postpartum period, acute life-threatening problems can occur and cause maternal morbidity and mortality. In the present case report, a 19-year-old primipara had undergone caesarean delivery following which she developed breathlessness, tachycardia and fall in oxygen saturation after 14 hours of surgery. Her Chest X-Ray (CXR) report confirmed a complete collapse of the left lung. Contrast-enhanced Computed Tomography (CECT) of the thorax showed a complete collapse of the left lung due to obstruction at the level of the proximal main stem bronchus. Medical management with mucolytics was administered. The patient showed improvement clinically and a repeat CXR after 24 hours showed normal lung findings with complete resolution of collapse and medical management was continued. The patient recovered progressively and follow-up of the patient was uneventful. This is a rare case of development of respiratory distress and atelectasis, hence proper diagnosis is essential.

Ayurvedic Management of Avascular Necrosis of head of Femur: A Case Report

Tanika Yadav, Vaishali Kuchewar, Pankaj Yadav

Avascular Necrosis (AVN) is a pathological condition characterised by a reduction in the blood supply to the subchondral bone, leading to the degenerative condition of the bone, marked by the death of cellular components of the bone. It is also known as osteonecrosis. The epiphysis of long bones at weight-bearing joints is typically affected. All of these conditions have a poor prognosis. In Ayurveda, it corresponds to Asthivahastrotodushtivikara (musculoskeletal disorder) as there is kshaya (necrosis) of asthi (bone) and Majja (bone marrow) dhatu (major structural components of the body). In modern medicine, AVN is managed by the use of corticosteroids and many surgical procedures such as drilling, insertion of prosthetics, or bone grafts. Therefore, Ayurveda provides a conservative line of treatment based on the principle of Asthi-majjagatkashaya (decalcification of bone) caused by abhighatajanyavataprakopa (trauma). A case of AVN with the right femoral head was treated with shaman (oral medications), Sodhana (bio-purification), and bruhmana (rejuvenation) procedures. The therapy provided significant improvements in pain and range of movement of the hip joint, based on the patient’s signs and symptoms before and after treatment. Conservative treatment can give outstanding results, improve the quality of life, halt disease progression, and help manage AVN by tissue regeneration without harmful effects.

A Case of Breast Cancer with Neuroendocrine Differentiation

A very uncommon and different subtype of breast cancer with particular morphological and molecular characteristics is Neuroendocrine Carcinoma of the Breast (NECB). A 59-year-old female patient presented to the Department of Surgery with a chief complaint of a lump in the right breast, reported to the Department of Surgery whose breast neuroendocrine cancer was diagnosed. After undergoing imaging tests and presenting with a palpable breast lump, the patient’s lesion turned out to be worrisome. Neuroendocrine cancer was identified by Fine Needle Aspiration Cytology (FNAC) and subsequent histological analysis. The diagnosis was confirmed by immunohistochemical investigation, which revealed positive staining for neuroendocrine markers. As part of a multimodal treatment regimen, the patient underwent surgery, chemotherapy, and hormonal therapy. Follow-up imaging and clinical examination demonstrated a favourable response to medication, with no indication of a return of the illness. The present case study highlights the importance of NECB as a distinct entity requiring specific care and diagnostic methods. More investigation was required to better understand the best management approaches for this uncommon kind of breast cancer. Reviewing the current state of knowledge about the incidence, demographics, diagnosis, histopathology, staining characteristics of NECB, prognostic factors, differential diagnosis, and available treatments is crucial. During the 12-month follow-up, the patient showed improvement in her clinical condition after receiving adjuvant chemotherapy and hormone treatment. The present instance highlights the need for tailored treatment strategies in circumstances like this and highlights the significance of being vigilant in detecting neuroendocrine differentiation within breast cancer.

Physiotherapeutic management of Hydrocephalus-Ex vacuo: A Case Report

Fiona Caroline Dsilva, KM Krishna Prasad

Hydrocephalus Ex-vacuo refers to an elevated volume with no increasing Cerebrospinal Fluid (CSF) pressure, particularly in instances of diminished brain tissue. Since there is no increased intracranial pressure in Hydrocephalus Ex-vacuo, few general symptoms such as irritability, drowsiness, and even larger head presentation can be absent compared to congenital hydrocephalus. The current case study presents a one-year-old male child exhibiting delays in developmental milestones, including poor head and trunk control, associated with a history of prenatal bleeding and subsequent birth complications. Despite a seemingly normal birth, the child experienced postnatal complications such as vomiting, seizures, and abdominal distension, leading to a 15-day Neonatal Intensive Care Unit (NICU) stay. Persistent delays prompted medical consultations, culminating in a referral for physiotherapy following Magnetic Resonance Imaging (MRI) findings indicative of hydrocephalus ex-vacuo. Clinical assessments revealed a restricted range of motion, muscle tightness in the lower extremities, and poor muscle control and reflex persistence. Imaging confirmed ventricular enlargement consistent with Hydrocephalus Ex-vacuo, necessitating targeted physiotherapy interventions. Therapeutic strategies focused on promoting head and trunk control through prone positioning, bolster support, and dynamic exercises utilising physio balls. Progressive interventions facilitated significant improvements within six months, highlighting the efficacy of early rehabilitation and parental involvement in achieving motor milestones. The present case underscores the importance of timely diagnosis, multidisciplinary collaboration, and rehabilitative interventions in optimising outcomes for children with hydrocephalus ex-vacuo. Further research is warranted to explore additional therapeutic modalities and long-term prognostic indicators for this patient population.

Haemosuccus Pancreaticus as an Uncommon Cause of Upper Gastrointestinal Bleeding: A Case Report

Visar Linyu, Shweta Naik, Civona Gomes, Yasmin Fernandes, Kewecho Akami

Haemosuccus Pancreaticus (HP) is a rare cause of upper Gastrointestinal (GI) bleeding. Despite being a rarity, HP should be considered in the differential diagnosis of patients with upper GI bleeding and pancreatitis. This condition commonly occurs secondary to pseudoaneurysm formation in the setting of acute or chronic pancreatitis. Angiographic embolisation remains the gold standard for treatment, and the condition is associated with a high mortality rate, if left untreated. The authors discuss the case of a 40-year-old male who presented with upper GI bleeding secondary to HP. The imaging findings of HP are presented in the present case, including the “sentinel clot sign,” which is seldom seen but establishes the diagnosis of HP. Although HP is a rare and potentially life-threatening cause of upper GI bleeding, prompt diagnosis and effective treatment can reduce the mortality associated with HP.

A Multifaceted Physiotherapeutic Approach for Improving Hand Function in Post-traumatic Fracture Dislocation of Proximal Phalanx of Middle Finger of Left Hand: A Case Report

Shifa Shakeel Sheikh, Swapnil Ramteke, Ashish Keoliya

Hand phalangeal fractures are frequent injuries that present in the clinic and emergency room. Injuries to the phalanx may occur at the proximal, middle, or distal segments of the bone. Depending on the location, proximal phalanx fractures can develop a volar apex angulation. Soft-tissue damage, along with disruption of the finger, accompanies the phalangeal fracture. Treatment of the phalangeal fracture is contingent upon the type of displacement of the fracture. Displaced fractures are reduced by manipulation, followed by immobilisation in an aluminum splint. In later phases, Kirschner wire (K-wire) fixation is performed. The hand is an important functional unit. Hence, post-immobilisation rehabilitation of the phalangeal fracture is essential for everyday activities. In this case report, the multifaceted physiotherapeutic approach is employed in the rehabilitation of a 33-year-old man who presented with multiple bite wounds allegedly inflicted by a wild boar, with chief complaints of injuries on the third digit of the left hand leading to pain and restricted movement. Radiographs revealed a comminuted fracture of the third digit with fracture dislocation of the distal end of the proximal phalanx, requiring K-wire fixation and finger splinting. Post-fixation, finger Range Of Motion (ROM) reduced, and pain arose, prompting physiotherapy. The multifaceted approach in rehabilitation involves a range of interventions, including traditional methods like immobilisation and K-wire fixation, as well as adjunctive physiotherapy techniques such as the finger blocking technique and sensory motor training. This report showcases a successful multifaceted rehabilitation approach for a patient with a traumatic finger fracture, demonstrating the importance of integrating physical therapy and addressing both physical and functional impairments for optimal outcomes.

Management of Hypertrophic Obstructive Cardiomyopathy with Concurrent Hypertension and Intracerebral Haemorrhage: A Case Report

Hypertrophic Obstructive Cardiomyopathy (HOCM) is primarily a hereditary genetic disorder that presents difficulties in managing hypertension using a wide range of antihypertensive medications. It is crucial to steer clear of any substance that reduces preload or afterload in this situation, making beta-adrenergic receptor antagonists the ideal option. Hereby is a case of a 41-year-old who reported to the Medicine Outpatient Department (OPD) with complaints of weakness in the right upper and lower limbs for two days and altered sensorium. The patient was recently diagnosed with hypertension, and a Computed Tomography (CT) scan showed a left gangliocapsular bleed with a 3 mm midline shift. Echocardiography revealed HOCM. The patient was started on antioedema drugs and metoprolol. A repeat CT scan showed a decrease in the size of the bleed and surrounding oedema. The patient’s consciousness improved, and blood pressure came under control. He was discharged with antihypertensives for regular follow-ups. Overall, this case underscores the complex interplay between HOCM and hypertension, the challenges in managing hypertension in HOCM patients, and the critical role of beta-adrenergic receptor antagonists in this setting. It highlights the need for a tailored approach to hypertension management and the importance of early recognition and appropriate intervention in patients with HOCM presenting with complications such as intracranial haemorrhage.

Paediatric Acute Promyelocytic Leukaemia: A Rare Case Report

Siddhi Shringi, Anil Agrawal, Pravin Gadkari, Snehlata Ravindra Hingway

Acute Myeloid Leukaemia (AML) is a malignant disorder of the bone marrow in which there is maturational arrest in blood cell progenitors, resulting in the failure of normal haematopoiesis. Acute Promyelocytic Leukaemia (APML) is a subtype of AML with a defined clinical course and a biology that is distinct from other forms of AML. Morphologically, the most common form of APML shows the presence of heavily granulated cells with folded and twisted nuclei in the bone marrow. Biologically, the cytogenetic changes define the syndrome, and molecular changes in the chromosomes play a critical role in leukaemogenesis. The occurrence of APML in the paediatric population is very rare, accounting for <5%. Here, a case is presented of a four-year-old child who with fever, one episode of non projectile vomiting, and two episodes of loose watery stools. Upon further investigation, the child had immature myeloid series cells in the peripheral blood smear, which on Bone Marrow Aspiration (BMA), flow cytometry, and Fluorescent In Situ Hybridisation (FISH) confirmed a case of APML. A major manifestation of this chimeric Promyelocytic Leukaemia (PML)-Retinoic Acid Receptor Alpha (RARA) protein is a maturation block at the promyelocyte stage of myeloid differentiation, leading to the accumulation of blasts and promyelocytes. Both Fluorescence In-Situ Hybridization (FISH) and Polymerase Chain Reaction (PCR) methods can detect the fusion gene, with PCR having the advantage of detecting the three major fusion transcripts and rare submicroscopic complex translocations. Additionally, quantitative PCR can be used to monitor minimal residual disease in APML following treatment. In this case, the patient survived her first episode of disease emergence, but during her relapse, she could not survive as she developed Disseminated Intravascular Coagulation (DIC), possibly due to chemotherapeutic agents. The patient might have developed differentiation syndrome, in which there is a large and rapid release of cytokines from leukaemic cells affected by chemotherapy agents. The challenge in treating such cases is to overcome differentiation syndrome and find a new therapy options.

Acute Thrombus in the Common Iliac Artery Following Robotic Total Hip Arthroplasty: A Case Report

Vishal Supada Patil, Ayush Taneja

Thrombus formation following robotic Total Hip Arthroplasty (THA) has been documented; however, involvement of the common iliac artery is uncommon, even among the minimal studies available on this subject. The present report provides insight into the diagnosis and management of this rare postoperative complication. A left-sided robotic total hip replacement was performed on a 55-year-old Indian male patient, following which his left lower limb pulses were not palpable. A complete occlusion of the left common iliac artery was noted on a CT angiogram. Embolectomy was performed, after which the patient recovered well. The present report highlights the importance of pre- and postoperative monitoring and the ready availability of angiograms and vascular surgeons. With these systems in place, adequate results can be achieved.

Myoepithelioma of Right Buccal Mucosa: A Rare Case Report

Vaishnavi Sawant, Samkit Sakhariya, Amita Aditya, Pushkar Waknis, Farha Khatoon

Myoepithelioma is a rare benign salivary gland tumour that has been reported sporadically. It is most often seen to be associated with the parotid gland, and the involvement of minor salivary glands remains a rarity. Amongst the minor salivary glands, myoepithelioma has been reported to occur most commonly in the palate, most commonly, followed by the tongue and upper lips. Its occurrence in the buccal mucosa is an extremely rare phenomenon and to date, only a few cases have been reported. This is a rare case of myoepithelioma of the minor salivary gland of the right buccal mucosa, adding to the list. Hereby, the authors present a case report of a 40-year-old female who visited with a complaint of tooth decay and an asymptomatic, long-standing tissue growth was noted in the right buccal mucosa. What was initially and provisionally diagnosed as irritational hyperplasia and was turned out to be rare benign tumour, i.e., myoepithelioma, on detailed investigation. It was successfully managed with surgical excision, and no recurrence has been reported to date.

Case of Malignancy Arising from Giant Cell Tumour of Soft-tissue Involving Thyroid Mimicking Thyroid Carcinoma: A Potential Pitfall

Lekshmi Vijayakumaran Nair Lilly, Deepthi Beena, Rachel Abraham

Giant Cell Tumour of soft-tissue (GCT-ST) is a rare neoplasm which is morphologically similar and genetically unrelated to GCT bone and included under intermediate rarely metastasising category. They are reported predominantly in superficial soft-tissue of the upper and lower extremities and less frequently in head and neck. The authors present a case of malignancy arising from GCT-ST involving thyroid gland mimicking primary thyroid malignancy. An 80-year-old female presented in the Outpatient Department (OPD) with a neck swelling of six months duration and sudden increase in size and hoarseness of voice for two weeks. An upfront surgery was planned with a clinical suspicion of primary thyroid neoplasm. Intraoperatively, the thyroid gland was replaced by multiple nodules, which were seen infiltrating adjacent structures. Due to the invasive nature, only a subtotal thyroid resection was done. The histopathology showed predominantly neoplasm composed of mononuclear cells and sheets of osteoclast like giant cells with foci showing features of malignancy. Histomorphology along with Immunohistochemistry (IHC) confirmed a diagnosis of GCT-ST involving the thyroid gland. Due to the rapidly progressive nature of the disease, the patient succumbed within two months.

Cariprazine Augmentation in Inadequate Clozapine Response: A Case Series

Managing patients with treatment-resistant schizophrenia who do not respond adequately to Clozapine poses a challenge. Cariprazine, with its unique mechanism of action, may be an option for such patients. The additional benefits of using Cariprazine as an augmentation strategy include once-daily dosing, ease of titration, and a favourable side-effect profile. The report outlines the authors’ experience of six patients with treatment-resistant schizophrenia who did not respond to Clozapine. The addition of Cariprazine was tolerated by all the patients. The majority showed improvement with symptom reduction, and in some cases, the dose of Clozapine could be reduced, thereby decreasing the side-effects of Clozapine.

Pregnancy Outcomes among Antenatal Women with Sickle Cell Anaemia: A Case Series

RDN Swetha, Srujana Palavalasa, Jhansi Rani Kathari, Rosemary Penumaka

Sickle Cell Anaemia (SCA) is a common and severe form of an inherited blood disorder known as Sickle Cell Disease (SCD). SCD is a group of autosomal recessive disorders characterised by point mutation resulting in the formation of structurally defective Haemoglobin (Hb), called Haemoglobin S (HbS). SCD is clinically heterogeneous, with variability in manifestation ranging from being asymptomatic to a severe crisis that can be fatal. Pregnancies complicated by SCA are high-risk due to the disease’s heterogeneous manifestations and propensity for maternal and foetal complications. This case series aimed to understand associated maternal and foetal outcomes at a tertiary care hospital. Women presented with a spectrum of clinical presentations from uncomplicated deliveries to cases involving severe acute and chronic sequelae. Preterm birth before 37 weeks, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions were common, reflecting known risks of growth restriction and prematurity. Previous adverse outcomes such as stillbirth and spontaneous abortion highlighted the threat to maternal and perinatal mortality. Acute sickle cell crises and splenic sequestration occurred. Advanced maternal age and comorbidities such as asthma exacerbated the disease burden. Most of the participants suffered from recurrent adverse outcomes with subsequent gestations. As most of the participants belonged to backward communities, targeted screening could help with earlier identification and counselling to reduce disease incidence in vulnerable populations.

A Rare Case of Pachyonychia Congenita in Mother and Daughter

Mayuri Deshpande, Amol Deshpande

Pachyonychia Congenita (PC) is a rare genetic disorder characterised by excessive keratinisation of the skin, nails, and mucous membranes, leading to thickened nail beds and skin on pressure points, notably on the soles of the feet. A 10-year-old girl came to the Outpatient Department (OPD) with her 38-year-old mother. Both of them had same complaints regarding their nails and callous formation over soles. They both had thickened nail plates with thickened pressure points on sole (Table/Fig 1)a-c,(Table/Fig 2)a-c. In PC, oral manifestations are found but on the day of visit they didn’t have any lesion in mouth. Both of them had difficulty and pricking sensation during walking. Both of them had anorexia due to the heinous presentation of the nails. They had taken lots of medicines for the conditions of nails but of no use. Other family members were not affected. Dyskeratosis congenita, pterygium inversum unguis, and onycholysis can be differential diagnosis. The final diagnosis is PC type I. In (Table/Fig 1)a-c,(Table/Fig 2)a,b, onychodystrophy can be seen clearly. In (Table/Fig 2)c, plantar keratoderma can be seen, which are the cardinal features for the diagnosis of PC. The PC is a rare genetic condition present from birth, characterised by excessive keratinisation of the skin, nails, and mucous membranes. It follows an autosomal dominant inheritance pattern and is also referred to as palmoplantar keratoderma. Individuals with PC typically exhibit thickened nail beds, often forming tent-shaped structures. Additionally, there is thickening of the skin at pressure points on the soles of the feet, leading to discomfort and difficulty walking. Leukoplakia, or white patches, may also develop on the tongue (1). It is challenging to determine PC prevalence with accuracy due of its rarity. A total of 774 people with genetically proven PC have been found in 419 households according to the International PC research registry. PC encompasses five subtypes, each associated with mutations in specific keratin genes: KRT6A, KRT6B, KRT6C, KRT16, or KRT17 (2). These mutations disrupt the normal function of keratin proteins, leading to the characteristic symptoms of the disorder. PC is a rare autosomal dominant genetic disease. Munro CS has given mutation and presentation of PC in his article titled PC: mutations and clinical presentations (3). Injections of Botox are among the several PC treatments that concentrate on pain control. Case studies involving small groups of patients have been the only proof of research on treating the underlying problem, which involves things like lowering keratin allele expression. Self-management of symptoms becomes the norm for the majority of patients (4). As per Goldberg et al., in their Best Treatment Practices for PC, mechanical and surgical methods are favoured over medication therapy, as none of the currently available therapeutic alternatives for PC are perfect, despite offering some relief. The need for more effective and focused therapy is highlighted by these results (5).

Multiple Myeloma with Extraosseous Involvement: Imaging Findings

A 50-year-old female patient presented with complaints of backache, occasional on-and-off fever, and wheezing for six months. There was no history of weight loss or other significant complaints. Clinical examination showed tenderness at the mid-dorsal vertebral level. Blood investigations revealed anaemia (Hb: 10 g%), a reversal of the A/G ratio with low albumin levels (3.4 g/dL), and high globulin levels (6.7 g/dL), along with a rise in Lactate dehydrogenase (368 U/L). Alkaline phosphatase was within normal limits at 51 IU/L, and the rest of the investigations were normal. To evaluate the cause of wheezing and pyrexia, a Computed Tomography (CT) chest was performed, which demonstrated infective changes in the left lung field (Table/Fig 1)a and an ill-defined left paravertebral and epidural soft tissue mass at the D5-D6 level with a lytic lesion of the D5 vertebra (Table/Fig 1)b causing mass effect on the cord. Magnetic Resonance Imaging (MRI) of the dorsal spine was conducted for the complaints of backache, which revealed a relatively well-defined lobulated T2 hypointense and STIR (Short Tau Inversion Recovery) hyperintense lesion in the left paravertebral region with involvement of the left pedicle of the D5 vertebral body (Table/Fig 1)c,d. Based on the blood and radiological work-up, multiple myeloma and metastasis were considered as differential diagnosis. The patient then underwent a bone marrow biopsy, which revealed more than 80% plasmablasts. A dedicated comprehensive myeloma panel was conducted, showing positive Ig G and kappa bands, thus confirming the diagnosis. Urine analysis for Bence-Jones proteins also turned out to be positive. All the investigations were consistent with multiple myeloma. The patient was started on injections of bortezomib, thalidomide, dexamethasone, allopurinol, and analgesics in appropriate doses. To assess the response to treatment, a follow-up MRI of the whole spine was performed six months after the initial diagnosis, showing no significant change in the previously described paravertebral lesion. In addition to the paravertebral lesion, there was a new appearance of two intercommunicating large T2 heterointense conglomerate lesions in the right paratracheal and right paraesophageal regions of the mediastinum (Table/Fig 2)a,b and a few large STIR/T2 heterogeneously hyperintense lesions in both lobes of the liver (Table/Fig 2)c,d. Histopathological examination with samples from the liver and paravertebral lesion showed atypical cellular infiltrate with plasmacytoid features, confirming the diagnosis of extraosseous myelomatous deposits. As of now, the patient has completed 16 cycles of chemotherapy and has not shown any significant improvement. Multiple myeloma is a monoclonal gammopathy characterised by the proliferation of plasma cells, typically in the bone marrow. It is defined by more than 10% of clonal plasma cells in the bone marrow or biopsy-proven extramedullary plasmacytoma and by evidence of end-organ damage, including bone lesions and renal insufficiency. It is a common malignancy in patients over the age of 40 years. Patients most commonly present with bone pain, anaemia, renal failure, pathological fractures, and recurrent infections. Diagnostic features include anaemia, hypercalcaemia, renal insufficiency, one or more osteolytic lesions on skeletal radiography (1). Other laboratory findings include Bence Jones proteinuria, reversal of the albumin: globulin ratio, and decreased or normal alkaline phosphatase, as seen in present case. Bone marrow biopsy is the confirmatory tool. Extraosseous myeloma refers to any manifestation of multiple myeloma where there is plasma cell proliferation outside the skeleton. It is more common in younger patients diagnosed with multiple myeloma. The incidence of clinical and radiological extraosseous myeloma is approximately 10-16%. Although multiple autopsy series have noted an incidence of 63% (2). It has been shown that extraosseous manifestations are more common following autologous or allogeneic stem cell transplantation. The hypothesis is that extraosseous sites serve as reserve sites for individuals who do not respond well to stem cell transplantation, resulting in a higher rate of extraosseous recurrence (1). Evaluation with sensitive modalities like MRI/Positron Emission Tomography (PET)-CT is recommended in patients diagnosed with multiple myeloma to evaluate for extraosseous deposits. Extraosseous myeloma occurs as soft tissue homogeneous density masses with no evidence of necrosis or calcification on CT. On MRI, they appear as T2 hypointense lesions and show F-18 Fluorodeoxyglucose (FDG) uptake on FDG-PET (2). The most common sites of extraosseous multiple myeloma are reticuloendothelial system - lymph nodes (5-23%), liver (28-30%), spleen (30-45%), pleura (3-6%), kidney (10-30%), pancreas (4-17%), leptomeningeal involvement (less than 1%) (1),(2),(3). Myeloma involvement of lymph nodes is typically seen as enlarged discrete homogeneous nodal masses that mimic lymphoma (4). Hepatic involvement may be diffuse, unifocal, or multifocal. Diffuse involvement can be due to innumerable lesions and is more common. The multifocal pattern of involvement usually presents with hepatomegaly with innumerable small low-attenuating lesions, which is the appearance most commonly seen. On Ultrasound (USG) imaging, the focal pattern of involvement shows hypoechoic or target/bullseye appearance. On CT, they show low attenuation without calcification or significant contrast enhancement. On MRI, focal lesions may be hyperintense or hypointense on T1-weighted images and hyperintense on T2-weighted images with minimal gadolinium enhancement (1). In present case, liver involvement was multifocal in nature. Extraosseous involvement of the liver is more common in IgA myeloma than in other kinds of myeloma, as described in a study conducted by Oshima K et al., although the cause is unknown (5). But in present case, IgM kappa chain was confirmed by immunohistochemistry with liver involvement. Heckmann M et al., study showed a similar case of pericostal and paravertebral tumour masses besides hepatic, mediastinal, and pericardial tumours. Immunohistochemistry from one of these lesions showed myelomatous origin with IgA expression (6). In present case, although there were hepatic and mediastinal tumours, there was no pericardial involvement, and present case involved IgM kappa chain. Panda S et al., study showed two cases of mediastinal masses that initially presented with mediastinal widening on chest X-ray. Further biopsy of the mediastinal masses turned out to be positive for kappa chains (7). Present case also had mediastinal masses, similar to the cases described by Panda S et al., (7). Extraosseous multiple myeloma is a rare condition that signifies poor survival. It is more prevalent among young individuals and patients who have undergone stem cell transplantation. In a patient with a history of multiple myeloma presenting with an unknown mass, it should be considered as a differential diagnosis. A confirmatory diagnosis by histopathological examination should be made as the imaging features may resemble those of metastasis.

Water Lily Sign: Typical of Ruptured Hydatid Cyst

Souvik Sarkar

A 16-year-old girl presented to the casualty with fever, chills, cough with mucoid expectoration, breathlessness, and left-sided chest pain for two days. She had similar complaints, including several episodes of vomiting associated with nausea, anorexia, and generalised weakness over the past two weeks. The patient had a history of hospital admissions for similar complaints in the past that were not resolved with any medications. On examination, she was cachectic, afebrile, had a pulse rate of 96 per minute, and a blood pressure of 110/70 mmHg. On auscultation, there was reduced breath sounds on the left mammary region, with some fine crepitations heard in the left infrascapular region. A chest X-ray revealed a large thin-walled cavity with an irregular air-fluid level due to folded membranes, appearing as a water lily sign or camalote sign (Table/Fig 1). A Computed Tomography (CT) of the thorax showed a large cyst measuring 9×9 cm in the left lung, with an air-fluid level and crumpled membranes lying inside the cyst in the dependent position (Table/Fig 2). A blood sample was tested for Immunoglobulin G (IgG) antibodies against Echinococcus granulosus, which was positive (1.27). A diagnosis of a pulmonary ruptured hydatid cyst was made. The patient was started on oral albendazole 400 mg twice daily for 21 days. She responded well to medical treatment and was referred to a thoracic surgeon at a higher center for excision of the cyst and lobectomy. A hydatid cyst is an acquired zoonotic disease that occurs due to close contact with infected canines or by consuming food or water contaminated with the larva of Echinococcus Granulosus or Multilocularis (1). These cysts resemble a bunch of grapes and are typically of two types: uncomplicated and complicated (when the cyst ruptures). The most common complication is the rupture of the cyst, which can result from the rupture of the ectocyst (as in the present case), rupture of the pericyst, or rupture of all layers (2). The most commonly affected organs are the liver, lungs, and others (2). Pulmonary hydatid cysts grow almost three times faster than liver hydatid cysts (3). In addition to radiological tests, various serological tests are performed to confirm the diagnosis of hydatidosis by detecting antibodies against E. granulosus, such as immunohistochemistry, indirect haemagglutination, immunofluorescence, immunoelectrophoresis, and latex agglutination (3). Medical treatment typically involves oral albendazole or mebendazole. However, the preferred treatment for most hydatid cysts is careful surgical excision of the cyst due to a high rate of recurrence (4). In the present case, the ectocyst likely ruptured, resulting in the appearance of a “water lily sign,” characterised by the crumpling of membranes leading to a wavy air-fluid level. Shameem M et al., described a similar case, where the patient presented in shock, and the Computed Tomography (CT) image showed a water lily sign typical of a ruptured hydatid cyst (5).

Phenomenon of Dip Effect in Antifungal Susceptibility Testing of Candida tropicalis by using MIC Testing Strips against Echinocandins

Sujata Lall, Vivek Bhat

Dear Editor, Minimum Inhibitory Concentration (MIC) of an antifungal is the minimum concentration that completely inhibits the visible growth of fungi under regulated, uniform and consistent in-vitro conditions. Reporting of antifungal susceptibility testing in Clinical Microbiology laboratories through standardised broth dilution methods by Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility testing (EUCAST) can produce reproducibility within ± one to two-fold dilution, but are labour intensive and resource demanding procedures, requiring accurate training of the concerned personnel for performing and reading of the results. Hence, it becomes difficult to perform them regularly in high throughput laboratories and also in absence of enough trained manpower (1),(2). In such settings the Etest concentration gradient MIC Testing Strips (MTS) provide a valuable and convenient alternative solution, combining the principles of agar based diffusion methods and dilution methods. MTS comes as a ready to use impermeable plastic or paper reagent strips having embedded continual concentrations of antifungal in a predetermined gradient manner, covering a continuous concentration range generally across 15 two-fold dilutions. After application of MTS onto an inoculated agar surface, there is diffusion of preformed antifungal agent into the agar for over an hour. There is a formation of ellipse shaped area of inhibition which is symmetrical and has central part along the strip after 16-20 hours of incubation. The point of intersection of edge of ellipse with the strip is read as MIC in terms of μg/mL. Although convenient to use, it is not a reference method and still lacks the objectivity of reading and interpretation. One of the inhibition patterns posing as a reading challenge and leading to variability in reading is the “dip” effect, corresponding to a narrow inhibition zone at sub-MIC values i.e., ellipse is below the strip (does not intersect the strip). Although manufacturer’s instructions suggest to read below the dip and report the MIC less than the lowest value on the MIC scale, such phenomenon have been scarcely reported in the published literature (3),(4). Isolate 1: Here we would like to illustrate the “dip” effect observed in a Candida tropicalis isolate from percutaneous nephrostomy urine sample using commercially available anidulafungin MTS paper impregnated porous HiMedia® Ezy MIC™ strip; demonstrating narrow, more elongated elliptical inhibition zones and smaller intersection angles at low concentrations next to the strip (Table/Fig 1) (5). MTS was also performed for caspofungin and micafungin which showed an MIC of 0.125 for both without any “dip” effect. Sensititre yeast one broth (6) (SYO; Trek Diagnostic systems, Cleveland, OH, USA) was also performed for the same isolate, which is a commercially prepared 96 well microbroth dilution system, comprising of increasing concentrations of antifungals. It relies on colorimetric change of alamar blue as an indicator of fungal growth. With Sensititre testing, the MIC for anidulafungin was 0.12. The isolate was also tested on Vitek 2 compact with Vitek 2 –YS08 Antifungal susceptibility card. The MIC values of echinocandins performed by three different methods on isolate one are summarised in (Table/Fig 2). The isolate was interpreted as sensitive by all the three methods. Anidulafungin is not included in the Vitek card. Isolate 2: In another isolate of Candida tropicalis retrieved from stool culture (stool culture surveillance is done at our institution every fortnightly for bone marrow transplant patients and haematolymphoid carcinoma patients to predict empirical treatment in case of gut translocation of gut microbiota leading to sepsis), caspofungin HiMedia® Ezy MIC™ strip showed the “dip” effect with the intersection way beyond the lowest point of 0.002 (Table/Fig 3). On testing with Vitek 2 compact, the MIC was ≤0.12. It was Vitek-2 compact ≤0.06, which was also sensitive. Sensititre Yeast One broth could not be performed in this isolate due to non availability of the kit and reagents at that time. Micafungin and anidulafungin MIC E strips were not done for this isolate as the treating physician requested only for caspofungin testing in view of suspect of impending fungal sepsis. Both the isolates demonstrated the result as sensitive. Siopi M et al., using MTS (Liofilchem, Roseto delgi Abruzzi, Italy) and Etest gradient concentration strips (bioMerieux, Marcy l’Etoile, France) in a review have indicated a drug and MIC dependence of this phenomenon and stated its occurrence to be inversely related to the MIC of the isolate as it was observed only with caspofungin. Etest MICs of the isolate with “dip” effect were higher than the Etest MICs of the isolates without the “dip” effect (7),(8). We would like to highlight the occurrence of this phenomenon in our laboratory so that clinical microbiologists can have an observant eye for this phenomenon at their setups as well and hence more number of such isolates will be identified and tested, which will help deducing its objective interpretation and remove the subjective error. Inability to confirm MIC results for isolate 2 by Sensititre testing will remain as the limitation of the study.

Role of Mustard Seed Extract Based Hydrogel as an Adjunct to Non-surgical Periodontal Therapy in Chronic Periodontitis Patients: A Pilot Interventional Study

Devika Bajpai, Sankari Malaiappan

Introduction: Periodontitis is a chronic inflammatory disease that leads to the destruction of both the hard and soft tissues of the periodontium. Various herbal extracts can be used as a Local Drug Delivery (LDD) agent to suppress the inflammation caused by micro-organisms. Aim: To evaluate the effectiveness of a hydrogel based on mustard seed extract as an adjunct to Non Surgical Periodontal Therapy (NSPT) for the treatment of chronic periodontitis. Materials and Methods: This pilot interventional study was conducted at Saveetha Dental College and Hospitals, Chennai between June 2023 and July 2023. The study included a total of 30 participants diagnosed with chronic periodontitis who were divided into two groups: group A (n=15) received only Scaling and Root Planing (SRP), while group B (n=15) received SRP along with 0.5% mustard seed extract hydrogel. Baseline and two-week post-operative assessments included recording of Gingival Index (GI), Plaque Index (PI), and modified Sulcus Bleeding Index (mSBI). The data was analysed by Statistical Package for Social Sciences (SPSS), software version 23.0 for windows. An independent t-test was conducted to assess significance between the two groups, while the comparison of baseline and post-operative variables within each group was done using a paired t-test. A p-value of <0.05 was considered statistically significant. Results: The mean age of study participants was 38.04±8.12 years in group A and 40.36±7.45 years in group B. The group treated with 0.5% hydrogel based on mustard seed extract exhibited a noteworthy enhancement in PI (p<0.05*). Intra-group comparisons revealed a significant difference in baseline and 2-week post-operative values for all parameters except mSBI in group A, although group B showed a significant difference for all the parameters (p<0.05*). Inter-group comparisons at two weeks showed statistically significant improvement in group B for PI but not for GI and mSBI. Conclusion: The supplemental application of 0.5% hydrogel derived from mustard seed extract alongside SRP yielded promising outcomes, suggesting a novel approach in the management of chronic periodontitis.

Improvement in the Outcome of Urolithiasis Patients using Traditional Indian Medicine: A Systematic Review and Meta-analysis

Bharat Rathi, Piyush Chaudhary, Renu Bharat Rathi, Neha Lamba, Mujahid B Khan

Introduction: Urolithiasis (UL) is a prevalent disorder that significantly burdens the global healthcare system. Except for acute surgical conditions, most kidney stones don’t show any symptoms during presentation. Patients with asymptomatic renal calculi frequently seek alternative treatments. Several Ayurvedic preparations mentioned in Ayurvedic compendia have shown encouraging results in patients after long-term use. However, the results of several Randomised Controlled Trials (RCTs) on the effectiveness of Ayurvedic preparations in UL vary. Aim: To conduct a systematic review and meta-analysis to assess the effectiveness of Ayurvedic preparations in patients with UL. Materials and Methods: The electronic databases Web of Science, PubMed, Cochrane Library, Embase, and ARP were searched upto August 2023 to recognise applicable studies. The modified Jadad Scale was used to assess the quality of the studies. The Cochrane Risk of Bias (RoB) tool was used to determine the RoB for randomised trials. Results: The search retrieved 1459 studies, but only 19 studies were found eligible for inclusion in the study. Statistical analysis revealed a substantial decrease in the number and size of calculi in 178 cases in the intervention group compared to only 101 events in the control group (OR: 3.03, 95% CI; 2.00, 4.61). It also showed a significant reduction in the size of stones, a significant improvement in haematuria with p=0.18, a highly significant improvement in dysuria with p=0.04, and highly significant relief in pain with p<0.0001. Conclusion: This review concludes that Ayurvedic drugs have optimistic results in the treatment of UL. More substantial clinical trials with a larger sample size must be conducted to generate stronger evidence for using Ayurvedic Medicines (AyM) as a treatment choice for UL.

Perception of Taste and Smell in Sitting and Standing Posture among Healthy Individuals: A Cross-sectional Study

Suresh Himawani, Rajendran Ramesh, Sengottaiyan Anu, James Vijay Anto

Introduction: Taste and smell are vital senses interlinked to each other that stimulate the desire to eat food. The physiological stress of a standing posture might alter taste and smell sensitivity, compelling individuals to eat more until satiety is achieved. Aim: To determine and compare the perception of taste and smell in sitting and standing postures among healthy individuals. Materials and Methods: This cross-sectional study was conducted in the physiology laboratory of Velammal Medical College, Tamil Nadu, India, over a duration of two months from February 2021 to April 2021. The study included 100 medical students (both genders) aged between 18-21 years. For taste assessment, the Sip spit rinse test was performed, where taste strips were impregnated with sweet and salty solutions of different concentrations (0.05-0.00625 g/mL). Odour threshold was measured with various dilutions of rose water (1:10000 to 1:1) using olfactometer. Taste and smell thresholds in standing and sitting postures were analysed using the Paired sample T-test and Lin’s concordance test, using Statistical Package for Social Sciences (SPSS) version 22.0 A significance level of 0.05 was used to interpret the p-value. Results: A statistically significant difference (p<0.001**) was observed for taste threshold, with a higher mean value in the standing position (0.0108) compared to the sitting position (0.0086). No statistically significant difference was observed for olfactory threshold in both sitting and standing postures (p>0.05). Additionally, no significant gender difference was found for taste and smell threshold values (p=0.418). Conclusion: Standing posture decreases taste sensitivity with no significant change in olfactory sensitivity.

Exploration of Myopia Trends among Medical Students in Saudi Arabia: A One-year Cohort Study

Introduction: Myopia is a prevalent refractive condition associated with higher occupational groups and education. Contributing data from a region like Saudi Arabia adds to the global understanding of myopia progression, potentially uncovering patterns or risk factors that may differ from those observed in other parts of the world. Aim: To estimate myopia progression among junior medical students. Materials and Methods: This was a one-year longitudinal cohort study conducted on 85 students at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Demographics, detailed ocular history, use of electronic devices, and other related risk factors were collected at the start of the study. Students underwent a comprehensive eye examination including visual acuity, autorefraction, ocular biometry, and Spectral Domain-Optical Coherence Tomography (SD-OCT) of the macula and optic nerve at the start and end of the study. Progression of myopia over one year and its associations were assessed using paired-samples t-test for a single group, while ≥two-group comparison was tested with Independent t-tests and one-way Analysis of Variance (ANOVA), respectively. Results: This cohort study involved 85 medical students (41 men and 44 women) aged between 19 and 23 years. Myopia prevalence was 76.5% (65/85) on the first visit. One participant progressed from hyperopia to myopia, five from initial emmetropia to myopia, four from mild to moderate myopia, and one from moderate to high myopia. A significant myopic shift was observed in the second visit in both eyes {Right Eye (RE): -0.3D, p-value=0.001; Left Eye (LE): -0.2 D, p-value=0.015}. The myopic shift in male participants from a mean±SD of -1.1±1.6 D (RE) and -1.0±1.5 D (LE) to -1.5±1.7 D (RE) and -1.4±1.7 D (LE) in the one year follow-up was statistically significant (RE: p-value=0.006; LE: p-value=0.004). Myopia prevalence was significantly related to the hours spent reading for learning/studying and hours spent watching TV at the first visit (p-value=0.023, p-value=0.046, respectively) and total weekly average screen time at the second visit (p-value=0.002). Conclusion: The medical students had a significant myopic shift over one year, which was associated with longer hours spent reading. The factors associated with the rapid refraction change should be identified to reduce myopic shift among medical students.

Effectiveness of Art Therapy and Physical Activity in Improving Quality of Sleep in Children with Hemiplegic Cerebral Palsy: A Quasi-experimental Pilot Study

Introduction: Hemiplegic Cerebral Palsy (CP) is characterised by abnormalities in movement and posture, along with sensory and tone abnormalities. It also represents significant impairments in cognition and sleep quality. Art activity involves playfulness, creativity, improvisation, and brings benefits to cognition and the alleviation of mental suffering. Physical activity shows considerable improvement in sleep quality as it concentrates on cardiorespiratory fitness and increases total energy expenditure. Aim: To evaluate the effect of art therapy and physical activity on sleep quality in children with hemiplegic CP. Materials and Methods: This quasi-experimental pilot study was performed among six ambulant children with hemiplegic CP in December 2022 at MGM School of Physiotherapy, Aurangabad, Maharashtra, India. Both male and female children aged between 4 to 12 years were included in the study. Pretest scores were recorded using the Paediatric Sleep Questionnaire (PSQ). The participants then underwent a physiotherapy protocol lasting one hour, which included art therapy along with upper limb physical activities for four weeks. Art therapy included colouring pictures, drawing geometrical shapes, line-drawing connections, thumbprints, and vegetable prints. The protocol was given for one month, which included three sessions of art therapy and physical activity each week. Parents and children were encouraged to follow the protocol before sleep. At the end of one month, postscoring of all outcome measures was calculated, and statistical analysis was done using the paired t-test. Results: From the results, the median pretest and post-test PSQ scores were 0.68 and 0.49, respectively. Interquartile Range (IQR) value for the outcome measure was 0.0675 and 0.0775, which was significant. Conclusion: Art therapy, along with physical activity, improved sleep quality in children with hemiplegic CP.

Comparison of Immunochromatographic Test and Electrochemiluminescence Assay with PCR for the Detection of Hepatitis B Virus: A Cross-sectional Study

Introduction: Hepatitis B Virus (HBV) infection remains a significant public health concern globally, necessitating accurate and timely diagnostic methods. Immunochromatographic Tests (ICTs) and Electrochemiluminescence Assays (ECLIAs) are widely used assays for HBV detection due to their rapidity and cost-effectiveness. However, their diagnostic performance should be evaluated to ascertain their reliability. Aim: To detect the presence of Hepatitis B Surface Antigen (HBsAg) in the selected samples using ICT and ECLIA and to compare it with HBV Deoxyribonucleic Acid (DNA) using a molecular assay. Materials and Methods: A cross-sectional study was done with serum samples collected from patients visiting the hospital over a period of six months with prior ethical clearance. Serum samples were obtained from 57 patients suspected of HBV infection. The results of ICT, ECLIA, and HBV DNA viral load (by Polymerase Chain Reaction (PCR)) were cross-tabulated and assessed for differences in diagnostic sensitivity. The positivity and correlation of the ICT and ECLIA with PCR were estimated. All statistical analyses were performed using the R programming language. Results: Out of 57 samples, 53 (92.98%) tested positive in the ICT card test, and 54 (94.74%) were positive in the ECLIA method. McNemar’s test showed that the sensitivity of ICT and ECLIA differed significantly compared to HBV DNA PCR. There was a significant positive correlation between ECLIA and HBV-DNA PCR (Spearman correlation, r-value=0.28, p-value=0.035). Conclusion: The findings suggest that in settings where accurate diagnosis is critical, particularly for screening and monitoring treatment efficacy, molecular assays remain the preferred choice despite their higher cost and complexity. However, in resource-limited settings, ECLIAs can still play a valuable role in HBV screening programs.

Complications of Mastoid Surgery: A Descriptive Study from a Tertiary Care Centre, Assam, India

Introduction: Mastoidectomy is a surgical procedure that removes infection, along with cholesteatoma, from the mastoid and middle ear. Cholesteatoma, a progressive disease that erodes bone when left untreated, leads to complications. Aim: To ascertain the most common mastoidectomy-related intraoperative and postoperative complications. Materials and Methods: This study was a retrospective descriptive study of patients who underwent mastoidectomy over one year at a tertiary care hospital in Assam, India between April 2022 to March 2023. All the patients planned for mastoidectomy were evaluated for intraoperative complications like facial nerve injury or postoperative complications immediately after the postoperative period (e.g., wound dehiscence) or between 1-3 months (e.g., Sensorineural Hearing Loss (SNHL), dead ear, etc.). The data collected was tabulated in a Microsoft Excel Worksheet, and the categorical variables were summarised as proportions and percentages. Results: A total of 62 patients underwent mastoidectomy and were reviewed over the one-year period retrospectively. Out of these, 28 (45.16%) developed complications. Two out of 62 patients (3.2%) experienced facial nerve injury intraoperatively. One patient (1.6%) with a high jugular bulb experienced massive bleeding intraoperatively while raising the tympanomeatal flap. Labyrinthine injury, dural plate injury, and sigmoid sinus injury were each found in one patient (1.6%). Eight out of 62 patients (12.9%) developed persistent otorrhea. Additionally, five patients (8%) had wound dehiscence and were treated with antibacterials, antiseptic dressing, and secondary suturing when needed. Two patients (3.2%) experienced SNHL; preoperatively, they had mild conductive hearing loss which postoperatively converted to mild to moderate mixed hearing loss. Postoperative dead ear was observed in one patient (1.6%). There was one patient (1.6%) with an unfavourably displaced pinna, and two patients (3.2%) had recurrent cholesteatoma. Vertigo was seen in two cases of radical mastoidectomy and one case of modified radical mastoidectomy. Conclusion: With proper planning and sound surgical techniques, avoidance of mastoidectomy complications can be achieved.

Iron Deficiency and Hypoferritinaemia in Patients with Subclinical Hypothyroidism: A Retrospective Observational Study

Introduction: Iron acts as a cofactor in Thyroid Peroxidase (TPO) activity, and low iron levels can impact thyroid hormone metabolism. The function of ferritin and iron has been extensively documented in various studies in patients with Overt Hypothyroidism (OH), but their role in Subclinical Hypothyroidism (SH) remains largely unexplored. Aim: To evaluate the serum ferritin and iron levels in patients who have SH. Materials and Methods: A retrospective observational study was conducted between March 2018 and October 2018 at the Biochemistry Department of Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. For the study, a total of 100 cases of SH were enrolled, and these patients were matched in terms of age and sex with 50 healthy controls. A fasting sample was obtained and analysed for serum ferritin, Total Iron Binding Capacity (TIBC), TT3, TT4, and Thyroid Stimulating Hormone (TSH). MedCalc software was used to perform statistical analysis. Results: In the SH group, there were 32 males (32%) and 68 females (68%); in the control group, there were 21 males (42%) and 29 females (58%). The median values of TT3 (nmol/L), TT4 (μg/dL), and TSH (μIU/mL) were 1.55 (1.4-1.95), 7.8 (5.9-9.75), and 3 (1.9-3.75) for controls, and 1.4 (1.1-1.75), 6.85 (5.5-8.15), and 6.2 (4.8-8.05), respectively, for cases. In comparison to controls, the TSH level was significantly higher (p<0.0001) in cases. The median iron (μg/dL), ferritin (ng/mL), TIBC (μg/dL), and % saturation in cases were 56.5 (41.5-82), 110 (31.5-194.5), 329 (258-390), and 19 (11.25-26.75), respectively, while in controls they were 84 (68.5-96.5), 195 (121.5-338.5), 233 (188.5-294), and 25 (18-37.5). There was a significant decrease in iron level (p<0.00001), % saturation (<0.00001), and ferritin level (p<0.00001), and a significant increase in TIBC (p<0.0001) in cases when compared to controls. Conclusion: In conclusion, the present study showed a significant negative correlation between SH and iron deficiency. Patients with this condition should be evaluated for ferritin and iron levels and treated appropriately to prevent hypothyroidism.

Dental Students’ Perceptions of the Current Educational Environment and Readiness for the Simulation-based Teaching Model: A Questionnaire-based Cross-sectional Study from Malaysia

Introduction: To facilitate the advancement of dental education in Malaysia, it is imperative to get insight into the perceptions held by dental students towards the current situation of the Educational Environment (EE). Moreover, in the current evolution of the educational framework, a shift is occurring from the conventional pedagogical approach to the implementation of simulation-based experiences. For a better understanding of virtual learning, it is crucial to determine students’ level of technology readiness. Aim: To identify the students’ perceptions regarding the present dental EE in Malaysia and their technology readiness for a simulation-based teaching and learning model and to verify whether technology readiness influences students’ perceptions of the present EE. Materials and Methods: The study utilised a cross-sectional survey design. A total of 146 dental students enrolled in year 4 and year 5 of three dental faculties in Malaysia were invited to this study from May to June 2023. The survey used the Dundee Ready Educational Environment Scale (DREEM) and the modified Technology Readiness Index (TRI) to measure students’ perceptions of EE and readiness for the new educational model. Mann-Whitney U tests were conducted to explore the differences among different demographic information for both DREEM and modified TRI. Multivariable linear regression analysis was conducted to determine associated factors with the TRI score. Pearson’s correlation coefficient was used to measure the correlation between DREEM and modified TRI. All tests for statistical significance were carried out using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: The overall global score of DREEM was 127.74/200. Comparing the subscale and global DREEM scores between public and private universities, significant differences were found in all dimensions and global DREEM scores except for students’ Social Self-Perception (SSP). Year four Undergraduate (UG) students showed more positivity in Students’ Perception of Learning (SPL) (p=0.020) and Students’ Perception of Teachers (SPT) (p=0.031) than year five students. While the overall mean score of the modified TRI was 3.08/5. The level of technology readiness would not affect the overall global DREEM score. Conclusion: Dental UGs’ perception of the EE is considered to be “more positive than negative.” However, improvements are needed in SPL and SPT. Generally, dental UGs in Malaysia have reached an adequate technology readiness level toward simulation-based teaching and learning.

Normative Data of Maximal Respiratory Pressures in Adult Population of the Himalayan Region: A Cross-sectional Study

Rakhee Khanduri, Aashish Negi, Kanchan Bala, Varuna Jethani, Sushant Khanduri

Introduction: Measurement of Maximal Static Respiratory Pressures (MSRP) is a non invasive tool to determine global respiratory muscle strength. The unique lifestyle factors in the Himalayan region, prompted the need for establishing normative values. Aim: To establish the typical maximum respiratory pressures in the Himalayan region and, secondarily, to develop a predictive equation based on the normative data collected. Materials and Methods: A cross-sectional observational study was conducted at the Department of Respiratory Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India. A total of 101 non smokers (78 males, 23 females) aged from 19-70 years were selected after initial screening by a questionnaire and spirometry from the attendants of patients attending Himalayan Hospital from July 2000 to May 2022. Sustained Nasal Inspiratory Pressure (SNIP), Maximal Expiratory Pressure (MEP), and Maximal Inspiratory Pressure (MIP) values were measured using Micro Respiratory Pressure Meter (RPM) following the American Thoracic Society Technical Statement (ATS) standard protocol. The prediction model for the Maximal Respiratory Pressure (MRP) was obtained using regression analysis. Height, age, weight, and Body Mass Index (BMI) were included as variables in the calculations. The statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) program for Windows (Version 22.0). Results: There was a statistically significant difference observed in MIP among males 91.77±29.41 cmH₂O and females 65.26±19.55 cmH₂O and in MEP among males 86.37±26.96 cmH₂O and females 56.04±18.29 cmH₂O. Both MIP and MEP averages were more in males than in females. In the present study, there was no significant relationship between height, weight, BMI, and respiratory pressure in females. There was no significant relationship between MIP and MEP plus height, age, weight, or BMI. Weight (r-value=0.24), age (r-value=0.27), and BMI (r-value=0.27) all had a significant association in men. Conclusion: Based on these findings, it can be concluded that there are gender-based disparities in MRP in the Himalayan population, with males exhibiting higher average values than females. Additionally, while there was no significant correlation between anthropometric factors and respiratory pressures in females, in males, weight, age, and BMI showed significant associations with these respiratory parameters.

Comparison of Three Different Approaches to Ultrasound-guided Internal Jugular Vein Cannulation: A Randomised Clinical Study

Introduction: The standard approaches to ultrasound-guided central line insertion by Short Axis (SAX) and Long Axis (LAX) have limitations. The Medial Oblique Axis (M-OAX) approach allows visualisation of the length of the needle in real-time along with both the artery and vein. Aim: To compare the three approaches for ultrasound-guided right Internal Jugular Vein (IJV) cannulation with respect to ease of access and complications. Materials and Methods: A total of 171 patients scheduled to undergo right IJV cannulation were divided equally into three groups-SAX (Group-1), LAX (Group-2), and M-OAX (Group-3). They were compared with respect to first pass success, Venous Access Time (VAT), guide wire insertion time, catheterisation time, and complications. Continuous variables were compared with Analysis of Variance (ANOVA) test. Categorical variables were analysed using the Chi-square test. The p-value <0.05 was considered significant. Results: First pass success was 55 (96.49%), 53(92.98%), and 54 (94.74%) in groups 1, 2, and 3, respectively. The VAT, guidewire insertion time, and catheterisation time were significantly lesser in Groups 1 and 3 compared to 2 (p<0.001). Two cases of carotid artery puncture were noted in Group-2, though statistically not significant (p>0.05). Conclusion: The medial oblique approach to IJV cannulation combines the advantages of both LAX and SAX and is a safer alternative with easier and faster venous access.

Memory Impairment and its Impact on Post-COVID-19 Patients among Saudi Population: An Exploratory Study

Introduction: Coronavirus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as a global pandemic in late 2019, quickly affecting millions worldwide. It presents with a range of symptoms, from mild respiratory issues to severe cases requiring hospitalisation. The disease’s long-term effects, especially cognitive impairments post-recovery, remain an area of active research and concern. Aim: To assess the prevalence and severity of cognitive impairments, including memory loss, attention deficits, and executive function disorders, in individuals who have recovered from COVID-19 in Riyadh, Saudi Arabia. Materials and Methods: This cross-sectional study was conducted from May to August 2023 in Riyadh, Saudi Arabia, involving 539 participants confirmed to have recovered from COVID-19 via Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) tests. Cognitive impairments, including memory loss, attention deficits, and executive function disorders were assessed. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 22.0 Chi-square tests and T-tests were utilised to examine the statistical significance of differences between recovered individuals and controls. Results: The study identified significant memory changes in 211 (39.15%) of post-COVID-19 patients, with specific challenges including difficulty recalling names/faces in 146 (27.09%), reduced attention span in 45 (8.35%), and verbal communication issues in 145 (26.9%) study subjects. Demographically, females (n=134, 24.86%) and individuals aged 21-30 reported higher rates of memory impairments compared to males (n=77, 14.29%) or other age groups, challenging prior assumptions about cognitive recovery and age. Further, patients with brain injuries and mental health conditions experienced exacerbated memory issues, underscoring the need for thorough patient assessments. Despite the considerable impact on daily activities reported by 111 (20.59%) of participants, only 17 (3.15%) sought medical help for these memory concerns. The findings highlight the prevalence of memory impairments among Saudi post-COVID-19 patients and call for increased healthcare interventions to manage these long-term cognitive effects. Conclusion: The study conclusively demonstrated that post-COVID-19 memory impairment was prevalent among recovered patients in Saudi Arabia, with significant variations by age, gender, and medical history. This underscored the critical need for healthcare providers to have enhanced awareness and to have developed targeted support services to effectively address and manage the long-term cognitive consequences of COVID-19.

Histomorphological Comparison of Tissues Fixed in Conventional Formalin and Eco-friendly Jaggery Solution: A Cross-sectional Study

Introduction: Tissue fixation is an essential step in the microscopic preparation of tissues to preserve them by preventing autolysis, bacterial putrefaction, and increasing the tissue’s refractive index. The conventional fixative used is 40% formaldehyde. Short-term exposure to formaldehyde can cause irritation to the eyes and respiratory tract, leading to breathlessness and coughing. The International Agency for Research on Cancer (IARC) has classified formaldehyde as a Class 1 human carcinogen capable of potentially causing various neoplasms, including nasopharyngeal carcinoma. Therefore, an innovative approach is being explored to replace formalin with harmless and eco-friendly jaggery. Jaggery possesses cytoprotective, antioxidant, and tissue-preservative properties. At a low pH, the fructose in jaggery breaks down into aldehydes, which cross-link with tissue amino acids, resulting in tissue fixation similar to formaldehyde. Aim: To compare the histological and gross morphological features of tissues fixed in formalin and jaggery. Materials and Methods: This cross-sectional study was conducted in Department of Pathology of a tertiary care centre. Surgical specimens obtained fresh, which were not suspicious of malignancy, were included. A sample size of 23 was selected. Surgical specimens already placed in formalin were excluded. A 30% jaggery solution was prepared by dissolving 300 grams of finely powdered jaggery in 1000 mL of distilled water, which was then filtered using filter paper. A 40% formaldehyde solution was used to prepare a 10% formalin fixative. Tissue bits from each specimen were cut into two halves and placed in formalin and jaggery separately. After 24 hours of fixation, the tissue bits were evaluated for gross morphological features, including tissue shrinkage, consistency, and colour. Tissue shrinkage was classified as mild, moderate, or marked, while consistency ranged from soft to firm to hard. The colour of the specimens varied case by case. Stained slides from jaggery-fixed and formalin-fixed tissues were assessed for histological parameters, such as nuclear details, cytoplasmic details, cellular outline, and overall staining quality. A blinded method was used to compare the stained slides using a microscope. Ratings were assigned to each case on a scale of 1-4. The data were statistically analysed using R software. Results: When comparing the formalin-fixed and jaggery-fixed specimens, no significant differences were observed in gross morphological features. All jaggery-fixed specimens appeared brown grossly. Histological features also showed no significant difference (p-value >0.05) except for cytoplasmic details. Therefore, it was observed that tissue preservation using the jaggery solution was comparable to that of formalin. Conclusion: The tissue-preservative properties of jaggery are on par with formalin. Hence, jaggery solution can be used as an eco-friendly substitute for formalin. Further research with larger sample sizes can pave the way for the effective replacement of hazardous formalin with natural jaggery.

Benefits of Posterior Leaflet Preservation in Patients undergoing Mitral Valve Replacement Surgery: A Prospective Interventional Study

Introduction: Mitral Valve Replacement (MVR), an important treatment for rheumatic mitral valve disease, is being widely promoted worldwide. MVR using the total leaflet preservation technique can produce good results; however, patient-specific factors and anatomical considerations must be taken into account when selecting the appropriate surgical approach. Aim: To investigate the benefits of Posterior Leaflet Preservation (PLP) in MVR in individuals with severe mitral stenosis. Materials and Methods: The current prospective interventional study included patients with Rheumatic Heart Disease (RHD) who had severe mitral valve stenosis and/or regurgitation and underwent MVR between December 2019 and December 2021 in the Department of Cardiothoracic and Vascular Surgery at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. The study included 50 patients with MVR (PLP) to preserve the posterior leaflets and 50 patients with classic MVR (no PLP). Left Ventricular Ejection Fraction (LVEF), Left Ventricular End-Systolic Diameter (LVESD), and Left Ventricular End-Diastolic Diameter (LVEDD) were measured before surgery, one, three, and six months after surgery. Results: The majority of patients in the present study were between 23 and 46 years old. The PLP group consisted of 17 men and 33 women, while the non-PLP group had 16 men and 34 women. The difference in cross-clamp time between Group-A and B was significant (p=0.0001). Cardiopulmonary Bypass (CPB) time was significantly different between Group-A and B (p=0.001). Only 4 (8%) patients in Group-A had low cardiac output syndrome, compared with 8 (16%) of patients in Group-B. Comparison of LVEF between groups over time revealed no significant difference (p=0.05). The mean change in LVEF from pre-operative to six months in Group-A was significant (p=0.004), but there was no significant change in Group-B (p=0.25). Conclusion: PLP had no improved beneficial outcome on left ventricular performance in cases with rheumatic stenosis during the six-month follow-up. Even after long-term follow-up, haemodynamic valve properties do not alter with adequate PLP.

A Prospective Clinical Audit to Strengthen the Clinical Practices Affecting the Incidence of New-onset Atrial Fibrillation after Off-pump Coronary Artery Bypass Grafting

Kartik Dhami, Kunal Soni, Gurpreet Panesar, Manish Tiwari

Introduction: New-onset Atrial Fibrillation (AF) carries significant morbidity and mortality risk for postoperative patients. Clinical practice guidelines aimed at preventing it are beneficial, with protocols in place to prevent deviations from the standard. Aim: To improve or strengthen the clinical practices that impact the incidence of new-onset AF after off-pump Coronary Artery Bypass Grafting (CABG). Materials and Methods: The present prospective clinical audit was conducted in the Department of Cardiac Anaesthesiology, Bhanubhai Madhuben Patel Cardiac Centre, Bhaikaka University, Anand, Gujarat, India, from January 2021 to June 2021. Study included 50 consecutive patients undergoing off-pump CABG surgery. The monitored standards included the continuation of beta-blocker therapy in the preoperative period, restarting them in the immediate postoperative period, and maintaining serum potassium (S.K+) within the range of 3.5-5.5 mEq/L. The incidence of AF was also noted. The data were analysed using Microsoft Excel. Results: The audit included a total of 50 patients, with 36 males with a mean age of 58.72 years, and 14 females with a mean age of 60.07 years. Preoperative beta-blocker/Calcium Channel Blocker (CCB) therapy on the day of surgery was administered to 45 (90%) patients, while restarting beta-blockers in the immediate postoperative period was done for 49 (98%) patients. S.K+ levels were maintained within the range in 31 (62%) patients. The last standard was reaudited, and compliance was achieved in 39 (78%) patients. New-onset AF occurred in 4 (8%) and 5 (10%) patients in the audit and reaudit samples, respectively. Conclusion: Clinical audit is a process that helps to identify the lacunae in clinical practices that affect patient outcomes. In the current study, clinical audits have aided in measuring compliance with different clinical practices, as per Institutional protocols. They have also assisted in increasing compliance with clinical practices where measured compliance was below the targeted goal.

Effectiveness of Intellectual Memory Recall and Multifaceted Distraction Techniques in Reducing Anxiety among Children during Radiovisiography: A Randomised Clinical Trial

Janipalli Nikitha, Pandranki Jayalakshmi, Srinivas Kumar Chandrabhatla

Introduction: Dental anxiety is anticipatory in nature, and the manifestation of the anxiety is due to uncertainty about a future threat and the inability to mitigate or avoid it. Distraction with a multisensory approach aids in better managing the anxious child. Aim: To compare the efficiency of two different play techniques, namely Intellectual Memory Recall (IMR) game and Multifaceted Distraction (MFD) game, in reducing procedural anxiety during Radiovisiography (RVG) among 4 to 10-year-old children. Materials and Methods: It was a randomised clinical study conducted in the Department of Paedodontics and Preventive Dentistry, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India from July 2023 to September 2023 with a sample size of 90 children selected based on baseline anxiety using the Modified Faces version of the Modified Child Dental Anxiety Scale (MCDASf). The children were randomly allocated into three groups: Group IMR (n=30), Group MFD technique (n=30), and the control group-Tell Show Do (TSD) (n=30). The pre- and postprocedural anxiety of the children was measured using the RMS Pictorial Scale. The obtained readings were tabulated, and anxiety variation was statistically analysed using the student t-test (intragroup comparison) and one-way Analysis of Variance (ANOVA) (intergroup comparison). The frequency of anxiety reduction among children was analysed using the Chi-square test. Results: Total 90 chidren {males-38(42.22%) and females-52(57.78%)} with a mean age of 7.09±1.68 years were found eligible and participated in the study. The Multifaceted Distraction (MFD) Technique was the most effective and significantly reduced anxiety in 96.67% of children (n=29), followed by IMR (n=27; 86.67%), and TSD (56.67%). Conclusion: Both the MFD and IMR techniques have been found to be efficient in reducing procedural anxiety compared to the TSD technique. These techniques are cost-effective and easily understood by all children, making them potential alternatives to conventional behavioural guidance methods.

Nebulised Dexmedetomidine versus Nebulised Lignocaine in Blunting the Haemodynamic Response to Laryngoscopy and Endotracheal Intubation: A Randomised Control Study

Anju Rani, Geeta Ahlawa, Amit Kumar, Kirti Kshetrapal Mangal Ahlawat Renu Bala

Introduction: Direct laryngoscopy followed by intubation induces a stress response leading to haemodynamic changes that are often transient, unpredictable, and variable. Both dexmedetomidine and lignocaine have been used in nebulised form successfully to blunt haemodynamic stress response, but they have never been compared previously. Aim: To compare nebulised dexmedetomidine and nebulised lignocaine in blunting the haemodynamic response to laryngoscopy and endotracheal intubation. Materials and Methods: This randomised, double-blinded study was conducted on 135 patients with American Society of Anesthesiologists (ASA) physical Status I and II, aged 18 to 60 years, planned for surgery under general anaesthesia with endotracheal intubation. Patients were divided into three groups of 45 each using a computer-generated random number table. Patients in group D were nebulised with dexmedetomidine 1 μg/kg, with lignocaine 1.5 mg/kg in group L, and with normal saline in group C. The primary objective was to compare nebulised dexmedetomidine and nebulised lignocaine in blunting the haemodynamic response to laryngoscopy and endotracheal intubation with respect to Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure, and Mean Arterial Pressure (MAP). The secondary objective was to study side-effects associated with the use of nebulised dexmedetomidine and lignocaine. Results: The demographic profile was found to be comparable in all three groups. The mean age was 40.44±11.77 years, 40.04±12.33 years, and 42.89±11.57 years in group D, group L, and group C, respectively, with a p-value of 0.4. The rise in HR during intubation and at all later time points was found to be less in group D and group L compared to group C. Additionally, the rise in HR was found to be higher in group L compared to group D. Similarly, the attenuation effect on SBP and Diastolic Blood Pressure (DBP) was greater in group D patients. Conclusion: Both nebulised dexmedetomidine and lignocaine were effective in attenuating the pressor response during laryngoscopy and intubation, with dexmedetomidine being more effective than lignocaine without any adverse haemodynamic effects.

Radiological Study of Ossified Fabella in Indian Knees: A Cross-sectional Study

Sarang Shete, Hemlata Khanapure, Amrit Moulick

Introduction: The fabella is a sesamoid bone found in the posterior and lateral region of the knee, identified on X-rays behind the femoral condyle in a true lateral view. Occasionally, it is a source of knee pain and is associated with radiological evidence of osteoarthritic knees. Due to its uncommon occurrence, there are very few studies related to an ossified fabella. While posteromedial pain and varus are common entities in knee arthritis, attention needs to be given to posterolateral structures like the fabella, as its radiological appearance may indicate the presence of arthritis. Aim: To determine the occurrence of the fabella and its association with arthritis and knee deformities, such as varus or valgus, in Indian knees on X-rays. Materials and Methods: This was a single-centre, X-ray-based, cross-sectional study conducted in the Joint Replacement Unit-II of the Department of Orthopaedics between June 2022 and March 2023 at KLE’s Dr. Prabhakar Kore Hospital in Belagavi, Karnataka, India. A total of 500 knees were radiologically studied using Medsynapse/Picture Archiving and Communication System (PACS), and Cohen’s Kappa Test statistics were employed to measure the agreement between the radiologist and orthopaedician regarding the presence or absence of the fabella interpreted on X-rays. Results: The occurrence of ossified fabella was observed in 87 (17.4%) subjects. Amongst these 27 (31.03%) had bilateral fabella, while remaining 60 (68.97%) had it either on left or right side. There was a high association between the occurrence of the fabella with age, Osteoarthritis (OA), and knee deformity (p-value <0.001), and a significant association with gender (p-value <0.05), while no association was found between the occurrence of the fabella with the side involved or any previous operations performed (p-value >0.05). Conclusion: The study revealed that ossified fabella is significantly associated with knee OA, age, and knee deformities.

Continual Improvement in Clinical Bacteriology Laboratory with Quality Indicators: A Retrospective Observational Study

Introduction: Healthcare management is undergoing significant changes with the evolution of new and re-emerging infections. A clinical microbiologist plays an important role in giving an accurate and timely report to the clinicians. Quality Indicators (QIs) act as a measure of the quality of services offered by the laboratory and are tools to monitor and evaluate the laboratory’s performance throughout the Total Testing Process (TTP). Aim: To measure the performance of the clinical bacteriology laboratory using QIs. Materials and Methods: A retrospective study was conducted in the Department of Microbiology at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India. The study evaluated QIs from the records of 94,624 samples received in the bacteriology section of the clinical Microbiology laboratory between January 2018 and March 2021. Data analysis was conducted over a six-month period from December 2021 to May 2022. In 2018, one QI was identified for each phase, with an additional QI added in each phase to the pre-existing QI in 2019. In 2020, a QI was added in the preanalytical phase only. In 2021, the acceptable limit for one preanalytical QI was reduced from 2% to 1%. Data analysis was performed using an Excel sheet. Results: Data from records of 94,624 clinical bacteriology samples collected over 39 months were analysed retrospectively. The preanalytical indicators included the number of samples rejected (135, 0.14%) and the number of requisition forms with three patient identifiers (59,645, 93.95%). Analytical phase QIs consisted of the average External Quality Assurance Scheme (EQAS) performance score (97.44% from January 2018 to March 2021) and outliers in the Internal Quality Control (IQC) (25 from January 2019 till March 2021). Failures in the IQC were not assessed in 2018. Postanalytical phase QIs included Turnaround Time (TAT) (average of 2.55 days for aerobic growth) and reporting time for critical alerts, which was within 24 hours of alert finding (100% for smear and culture-positive results). Conclusion: Regular monitoring of QIs helps to identify potential errors. This laboratory chose to analyse and monitor its processes using practically feasible QIs. It was found that the laboratory consistently maintained its performance throughout the study period.

Association of Vedic Personality Traits and Empathy among Medical Students: A Cross-sectional Study

Vineeta Chadha, Kaushal Kumar Alam

Introduction: Medical students are expected to provide compassionate and empathic care to their patients. Empathy is a crucial component of the doctor-patient relationship. The Triguna theory is a fundamental concept in Hindu philosophy that describes three inherent qualities of nature: Sattva, Rajas, and Tamas. Each individual has a unique combination of these qualities, which shapes their personality and behaviour. However, the relationship between Triguna personality and empathy in medical students has not been explored in depth. Aim: To examine the association between Triguna personality and empathy in medical students. Materials and Methods: The present study was a cross-sectional questionnaire-based survey conducted among first-phase medical undergraduates in the Department of Physiology, Rama Medical College Hospital and Research Centre, Kanpur, Uttar Pradesh, India from July 2024 to August 2024. A total of 122 medical students participated in the study. The Vedic Personality Inventory (VPI) was used for assessing personality, and the Brief form of Interpersonal Reactivity Index (B-IRI) was used for assessing empathy. Correlational analysis and an unpaired student’s t-test were performed. Results: There were 122 subjects; the proportion of male and female students was 52 (42.6%) and 70 (57.4%), respectively. The mean±Standard Deviation (SD) age was 20.43±1.23 years. Sattva score was positively correlated with Perspective-taking (PT) (r=0.193, p<0.05) and negatively correlated with Personal Distress (PD) scores (r=-0.322, p<0.01). Tamas scores were positively correlated with Fantasy (FT) (r=0.251, p<0.01) and PD scores (r=0.401, p<0.01). Female participants demonstrated significantly higher mean scores as compared to males in Empathic Concern (EC) (16.9±2.681 vs. 14.730±2.951), PT (15.442±2.618 vs. 14.038±2.779), and PD (13.552±2.776 vs. 12.288±3.291) in the present study. There was no significant difference in Sattva, Rajas, and Tamas scores between males and females. Conclusion: The study explores the association between the VPI traits, such as Sattva, Rajas, and Tamas, and empathy measures. Sattva shows a positive correlation with Perspective Taking (PT) and a negative correlation with PD, indicating that individuals with higher Sattva scores are likely to exhibit better social competence and emotional stability. Additionally, gender differences were observed in empathy scores, with females scoring higher than males in PT, EC, and PD, emphasising the relevance of considering personality traits in medical education to foster empathic skills among healthcare professionals.

Relationship of Helicobacter pylori Infection with Various Components of Metabolic Syndrome in Dyspeptic Patients: A Cross-sectional Study from Western Maharashtra, India

Introduction: Helicobacter pylori (H. pylori), despite its high prevalence in the Indian population, has been subjected to limited studies concerning its potential role as a risk factor for Metabolic Syndrome (MetS) and Insulin Resistance (IR). Proposed mechanisms include inflammatory mediators, atherogenic lipid profiles, and vasoconstriction. Aim: To determine the association between H. pylori infection and MetS components, focusing on Highly sensitive C-Reactive Protein (hs-CRP) levels, to enhance understanding and management of these conditions. Materials and Methods: This cross-sectional study was conducted at the Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India spanning from September 2017 to August 2019. This study involved 100 dyspeptic patients aged 18 years or older undergoing upper Gastrointestinal (GI) endoscopy. Data collection included fasting/postprandial blood parameters, serum lipids, hs-CRP, and H. pylori detection via both rapid urease test and Histopathological Examination (HPE). Physical assessments covered height, weight, Waist Circumference (WC), and blood pressure. MetS was evaluated using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Statistical analysis employed unpaired t-tests, Chi-square tests, and Fisher-Exact tests using IBM Statistical Package for Social Sciences (SPSS) version 21.0. Results: The study of 100 dyspeptic patients, predominantly females, revealed a significant association between H. pylori infection and MetS (p-value <0.001). H. pylori infection was associated with elevated fasting glucose (90.24%) and triglycerides (90.24%) (p-value <0.001). Additionally, individuals with H. pylori infection exhibited higher inflammatory markers (p-value 0.0029). Conclusion: The above findings underscore the potential role of H. pylori as a risk factor for MetS and highlight the need for further research to elucidate mechanisms and implications for preventive strategies and clinical management, offering avenues for improved patient care and outcomes, particularly in addressing cardiovascular health.

Effectiveness of Mirror Therapy through Telerehabilitation on Upper Extremity Performance in Hemiparetic Stroke Patients: An Experimental Study

Introduction: A major challenge in stroke rehabilitation is the paresis of the Upper Extremity (UE), resulting in limited functional performance. Recently, motor imagery and Mirror Therapy (MT) have been recommended as an additional rehabilitation strategies that could be beneficial for motor rehabilitation after a stroke. Aim: To determine the effectiveness of mirror visual feedback through Telerehabilitation (TR) on UE functional performance in hemiparetic stroke patients. Materials and Methods: An experimental pretest, post-test study design was conducted at SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, India from January 2021 to June 2021. Total of 60 patients diagnosed with hemiparetic stroke were included in the study through convenience sampling and divided into two groups. The experimental group (n=30) received TR, and the control group (n=30) received face-to-face MT for 12 weeks. A pretest and post-test evaluation were administered using the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for the Upper Extremity (FMA-UE). Within-group analysis was performed using the Wilcoxon Signed-Rank Test, while intergroup analysis was conducted using the Mann-Whitney U Test. Results: The study revealed statistical significance between the pretest and post-test scores of the WMFT-FAS (Functional Ability Score), WMFT-Time (Performance Time), and FMA-UE in the control and experimental groups. The results showed no statistically significant difference between the post-test scores of the control and experimental groups in the FMA and WMFT-FAS. However, there was a statistically significant distinction in the post-test scores between the control and experimental groups in WMFT-Time. Conclusion: The study concluded that mirror visual feedback through TR was an effective treatment method to improve UE functional performance among hemiparetic stroke patients by offering an alternative service delivery model for occupational therapy.

A Prospective Study of Seroconversion Post Covishield Vaccination in COVID-19 Warriors

Introduction: During the Coronavirus Disease 2019 (COVID-19) pandemic in India, two vaccinees were predominantly administered to prevent the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The first vaccine introduced in India was ChAdOx1-nCOV (Covishield), followed by BBV-152 (Covaxin). In the first phase, Healthcare Workers (HCW) were prioritised for vaccination, given their crucial role in the healthcare system. Aim: To assess the antibody response post Covishield vaccination at specific time intervals in HCWs and to determine the correlation of antibody response with age, gender, co-morbidities and blood group. Materials and Methods: This prospective study was conducted at Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India, over a duration of six months from January 2021 to June 2021. A total of 110 vaccinated HCWs who volunteered were included in this study. SARS-CoV-2 antibodies at specific time intervals were assessed using Ortho Clinical Diagnostic’s VITROS 3600 based on the principle of Chemiluminescent Immunosorbent Assay (CLIA). Assessment of anti-SARS-CoV-2 total and IgG antibodies was performed at 15 days, one month, one and a half months, two months, three months, and four months postfirst dose of vaccination, or in other words, 15 days and one month after the 1st dose, and 15 days, one month, two months, and three months post second dose of vaccination. For analysis, Pearson’s correlation and a regression model were performed using GraphPad Prism 8.0.2 version. Results: Fifteen days post second dose, 110 HCWs (100%) and 109 (99.09%) HCWs turned seropositive for total antibodies and IgG antibodies, respectively. It was observed that the majority of participants (33, 30.27%) with peak IgG levels in the medium range were from the age group of 31-40 years. Overall, there was a negative correlation between age and IgG antibody levels for peak IgG values (r-value=-0.224, p-value=0.019). The peak values were achieved in the majority of participants 15 days post second dose (53.6%). The difference in antibody levels based on gender was not significant (Chi-square value=3.387, p-value=0.184). No significant difference in SARS-CoV-2 IgG levels was observed between participants with co-morbidities and those without co-morbidities. Participants who developed SARS-CoV-2 infection during the study period exhibited robust antibody responses after vaccination. Conclusion: These findings help elucidate Covishield vaccine-specific antibody responses in vaccinees of different age groups, genders, blood groups, and with co-morbid conditions. The vaccine has substantially reduced the burden of disease by preventing serious illness in vaccinated HCWs during the second wave of the COVID-19 pandemic.

Comparison of Blood Pressure Variation among Patients Undergoing CECT Thorax and NCCT Thorax: A Cross-sectional Study

Joswita Monteiro, KM Adarsh, Amita Digambar Dabholkar

Introduction: Advancements in Computed Tomography (CT) have been continuously updated with the intravenous administration of contrast media, which enhances the visibility of internal organs and structures in CT scans. Contrast media administration often alters blood pressure. Aim: To observe the blood pressure variations among patients undergoing Contrast-enhanced Computed Tomography (CECT) thorax and Non Contrast Computed Tomography (NCCT) thorax. Materials and Methods: A cross-sectional study was conducted at the Department of Radiodiagnosis and Medical Imaging at Yenepoya Medical Hospital, Deralakatte, Mangaluru, Karnataka, India from February 2022 to August 2022. Patients who underwent examinations of NCCT thorax and CECT thorax within the age group of 20-80 years, involving 62 participants (31- CECT, 31- NCCT) were included. Intravascular contrast material was administered to the patient during a CECT thorax scan. One reader independently recorded the Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) five minutes before and five minutes after the venous phase in the CECT thorax and five minutes prior to and five minutes after in the NCCT thorax group. A paired t-test was used for the comparison of SBP and DBP within the group. Results: The mean SBP before the scan was 120.7 mmHg {Standard Deviation (SD)=13.6} and after the scan was 130.7±12.1 mmHg. The mean DBP before the scan was 78.9±8.9 mmHg, and after the scan was 84.2±12.0 mmHg, respectively, before and after the injection of contrast. Therefore, a significant difference was found in the mean SBP and DBP before and after the injection of contrast within the CECT thorax group. Conclusion: There was an increase in blood pressure in patients who had undergone CECT thorax in both males and females. Hence, evaluating BP will provide awareness of different risk factors that can be caused due to the administration of contrast media.

Effectiveness of Lymph Node Revealing Solution in Estimation of Lymph Nodes Yield in Radical Specimen of Oral Squamous Cell Carcinoma: A Preliminary Histomorphometric Observational Study

S Dharini, Deepak Pandiar, Reshma Poothakulath Krishnan

Introduction: Oral cancer poses a serious health challenge globally, particularly for nations undergoing economic transition. The number and size of lymph nodes obtained, along with nodal involvements, are crucial for proper diagnosis, treatment, and prognosis. Aim: To assess the number of lymph nodes obtained before and after treating the specimens with the Lymph Node Revealing Solution (LNRS) along with staining characteristics. Materials and Methods: The present prospective observational study was conducted at the Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, over a period of six months from January 2023 to June 2023 in a tertiary oral healthcare centre in Chennai. Six histologically confirmed Oral Squamous Cell Carcinoma (OSCC) cases with neck dissection were included in the study, involving 32 lymph node levels. Lymph nodes were grossed using both routine procedures of palpation and visualisation and after treatment with LNRS for two days. The number of nodes obtained through both methods was compared along with the staining characteristics. The data were analysed using Statistical Package for Social Sciences (SPSS) software version 26.0. Chi-square and paired t-tests were used to compare the two groups, and any value less than or equal to 0.05 was considered statistically significant. Results: Out of 134 lymph nodes, 21 were positive with conventional fixation, whereas after the application of LNRS, an additional 41 lymph nodes were retrieved. Two nodes showed metastatic deposits; fortunately, the additional positive nodes did not affect the staging. No statistically significant difference was found before and after immersion in LNRS regarding staining characteristics. The mean area of the yielded nodes was 84.71±4.85 mm2. There was a statistically significant difference between the size of lymph nodes between the manual grossing method and after immersion in LNRS (p-value <0.001). Conclusion: The study confirmed that the LNRS technique identified very small lymph nodes in oral cancer patients, which may contain metastatic deposits. This might change the stage of the disease and influence the mode of treatment.

Development of a Model to Predict the Jumping Performance in Elite Male Volleyball Players: A Cross-sectional Study

Abhimanyu Singh, Pradeep Singh Chahar

Introduction: Vertical Jump Performance (VJP) has been identified as a significant characteristic in elite volleyball players and is an essential component for successful volleyball practice. Aim: To better understand volleyball players’ anthropometric and physical fitness characterstics and to predict jumping performance of the players using these variables. Materials and Methods: For this cross-sectional study, 20 Indian junior male volleyball players were randomly selected from a coaching camp organised at Lakshmibai National Institute of Physical Education (LNIPE), Gwalior, Madhya Pradesh, India from May 2018 to July 2018. All the subjects were measured for VJP, selected anthropometrics {Right Thigh Girth (RTTG), Left Thigh Girth (LTTG), Average Thigh Girth (ATG), Right Calf Girth (RCG) and Left Calf Girth (LCG), Average Calf Girth (ACG)} and physical fitness characteristics {Flexibility (FLEX), Left Calf Strength Endurance (LTCSE), Right Calf Strength Endurance (RTCSE), speed, Core Endurance Abdomen Flexion (CEAF), Core Endurance Back Extension (CEBE), Low Body Explosive Power (LBEP) and Upper Body Explosive Power (UBEP), Cardiorespiratory Fitness (CF), VO₂ max, Abdominal Endurance (AE). The Subset regression analysis method was used to fit the appropriate linear regression model, while R-Square and Akaike Information Criterion (AIC) were used to identify a better model for a proper explanation of the vertical jumping performance of volleyball players, and a level of significance was set at the 0.05 level. Results: The volleyball players included had an average age of 18.05±0.76 years. The results revealed that CEBE (β=-0.1525, p=0.0199), FLEX (β=1.0842, p=0.0001), LBEP (β=8.1636, p=0.0018), right (β=-0.2417, p=0.0125), and LTCSE (β=0.5143, p=0.0012), VO₂ max (β=-9.2467, p<0.001), and AE (β=1.0009, p<0.001) were the variables with the highest predictive power for jumping performance. Conclusion: The current study identifies CEBE, FLEX, LBEP, RTCSE and LTCSE, VO₂ max, and AE as critical factors for improving jumping performance, emphasising the importance of considering multiple anthropometric and physical fitness variables when identifying talent and designing a volleyball training programme.

Health Sciences Students’ Knowledge, Attitudes, and Awareness of the Effects of Sleep Quality on the Brain: A Cross-sectional Study

Introduction: Sleep is a fundamental necessity for the human body, particularly for ensuring optimal brain function, and health science students are predisposed to experiencing lower-quality sleep than the general population. Aim: To assess the knowledge, attitudes, and awareness of health science students regarding the influence of sleep quality on the brain. Materials and Methods: This descriptive cross-sectional study included male and female students from diverse Colleges at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia, encompassing the College of Science and Health Professions, College of Medicine, College of Applied Medical Sciences, and College of Nursing. The study spanned one year, commencing in September 2022 and concluding in September 2023. It included 361 participants who completed a self-administered validated questionnaire. Participants were chosen through non probability consecutive sampling, and the questionnaire covered demographic characteristics, attitudes towards sleep quality, awareness of its importance, and knowledge of its impact on the brain. Data analysis encompassed descriptive statistics and inferential tests, including the Independent t-test, and Chi-square test with a significance level of p-value <0.05. Results: Female students exhibited a higher likelihood of disagreeing (p-value=0.006) with the notion that sleep quality does not impact memory conversion compared to males. Additionally, a significant number of female students (p-value=0.009) acknowledged the correlation between anxiety and insomnia, which was not as prevalent among males. Among the participants, 66.8% were females, and 33.2% were males. Common presleep behaviours included avoiding tea/coffee (76.5%) and using smartphones before bedtime (90.6%). While awareness of sleep quality’s influence on memory recall was high (72.0%), comprehension of its connection with seizures in epilepsy was relatively lower. Conclusion: This study underscores the significance of assessing attitudes, knowledge, and awareness regarding sleep quality among health science students. Notable gender variations were observed, with females demonstrating greater awareness of sleep’s impacts on memory and insomnia related to anxiety. Consequently, sleep education initiatives and fostering healthy sleep habits among students in health science disciplines are essential.

Effect of Single Bout of Exercise with Blood Flow Restriction Training on Muscle Girth and Cardiovascular response: A Pretest, Post-test Quasi-experimental Study

Salma Aboud, Deborah Nartigah, Tanya Gujral, Richa Hirendra Rai

Introduction: Blood Flow Restriction Training (BFRT) was developed by Southeast Asia Treaty Organisation (SATO) in Japan in 1966. BFRT is a method that mimics the effects of high-intensity training by combining low-intensity exercise with blood flow obstruction. It involves limb compression using compression cuffs to limit venous outflow and minimise arterial inflow during rehabilitation training. By allowing individuals to lift smaller loads and increase strength training gains, BFRT can reduce the overall stress exerted on the limb. Aim: To assess the difference in muscle girth and blood pressure after a single bout of BFRT. Materials and Methods: This was a single-blinded, single-site pretest, post-test quasi-experimental study. A total of 30 subjects were enrolled (16 females and 14 males) between the ages of 18 to 25 years. This study was conducted at the Department of Physiotherapy, Galgotias University, Greater Noida, Uttar Pradesh, India. Outcome measures included muscle girth measured using a flexible tape and blood pressure using an automatic oscillometric device (Omron Hem 7113, São Paulo, Brazil). Paired t-test and Wilcoxon test were performed using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: It was found that an acute bout of BFRT caused improvement in all outcome measures. There was a statistically significant increase in muscle girth and blood pressure after BFRT (p-value <0.001). Conclusion: There was a significant increase in blood pressure (both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)) and muscle girth after BFRT with no reported adverse effects.

Diagnostic Accuracy of Cerebrospinal Fluid Procalcitonin and Serum Procalcitonin in Adult Patients with Bacterial Meningitis: A Cross-sectional Study

Introduction: Bacterial Meningitis (BM) is a serious health problem worldwide with high mortality and permanent long-term neurological sequelae. Cerebrospinal Fluid (CSF) analysis is the cornerstone for diagnosing BM, but the lack of specificity creates a difficult clinical scenario for initiating proper treatment. Empiric antibiotic use in patients with suspected meningitis at primary care settings decreases the yield of CSF culture and alters CSF cytological and biochemical findings, making it further difficult to diagnose BM. To overcome this difficulty, there is a need for other biochemical markers with higher sensitivity and specificity. Aim: To determine the diagnostic sensitivity and specificity of Procalcitonin (PCT) in serum and CSF in patients with BM and compare its diagnostic accuracy in both sample types. Materials and Methods: A cross-sectional study was conducted in the Department of Internal Medicine at a tertiary care centre in eastern India from September 2018 to August 2020. A total of 82 adult patients with meningitis were recruited as per the protocol, and CSF analysis was done along with estimation of PCT in serum and CSF. Receiver Operating Characteristics (ROC) curve analysis of serum and CSF PCT was used to determine sensitivity and specificity with a 95% confidence interval. Results: Out of the 82 patients recruited, 30 (36.6%) had BM. CSF PCT with a cut-off value of >0.45 ng/mL had a sensitivity of 86.7% and specificity of 92.3%. The sensitivity of serum PCT with a cut-off value of >0.6 ng/mL was 83.3%, and specificity was 86.5%. There was no statistically significant difference in sensitivity and specificity between CSF and serum PCT in patients with BM (p-value=0.7988). Conclusion: Both serum and CSF PCT were found to have high sensitivity and specificity as markers for diagnosing BM without any statistically significant difference between them.

Evaluation of Anti-inflammatory, Antioxidant and Antimicrobial Activity of Pomegranate Peel Extract: An In-vitro Study

Introduction: Pomegranate fruit contains biologically active compounds that provide anti-inflammatory properties. Byproducts of pomegranate and punicalagins inhibit the growth of pathogens while enhancing the growth of beneficial bacteria. The beneficial effects of phenolic compounds are exhibited in scavenging free radicals. Aim: To evaluate the anti-inflammatory, antioxidant, and antimicrobial activity of Pomegranate Peel Extract (PPE). Materials and Methods: The present in-vitro study was designed and carried out at the Nanobiomedicine Laboratort, Department of Pharmacology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from June 2021 to August 2021. The anti-inflammatory activity was evaluated using the Egg Albumin Denaturation assay (EA) and Bovine Serum Albumin Denaturation assay (BSA). The measurement of antioxidant activity was conducted using the 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) assay, Hydrogen peroxide radical scavenging (H2O2) assay, and Ferric Reducing Antioxidant Power (FRAP) assay. Antimicrobial activity was evaluated using the agar well diffusion method. The microorganisms used to evaluate the antimicrobial effect of PPE were S. mutans, S.aureus, E.faecalis, and C.albicans. Results were analysed using independent t-tests, Analysis of Variance (ANOVA) and Tukey’s Honestly Significant Difference (HSD). Results: Anti-inflammatory activity was observed with high concentrations of 40 and 50 μL in EA (70.06%±0.15, 78.08%±0.21) and BSA (75.50%±3.90, 80.82%±3.38) assays. Pronounced antioxidant activity of PPE was seen with higher concentrations of 40 and 50 μL in DPPH (88.17%±0.69, 92.50%±1.23), H2O2 (78.22%±0.94, 88.99%±1.03), and FRAP (78.43%±1.25, 88.49%±0.67) assays. The antimicrobial activity was highest at 100 μL for S.mutans (38±2.62 mm), S.aureus (36±3.16 mm), E.faecalis (21±1.48 mm), and C.albicans (23±2.36 mm). Conclusion: The study concluded that PPE has anti-inflammatory, antioxidant and antimicrobial properties and these properties are concentration-dependent.

Association of Learning Styles with Academic Achievements in First-year Professional MBBS Students of a Medical College in Eastern India: A Cross-sectional Study

Rituparna Basu, Tapati Roy, Parthapratim Pradhan

Introduction: Research has shown that learning may be optimised by synchronising the learning environment with the learning style preferences of students. First-year medical students face immense stress as they adapt to a new learning environment and curriculum at the onset of their medical career. The simultaneous use of two supplementary learning styles questionnaires, namely, the Visual-Aural/Auditory-Read/Write-Kinesthetic (VARK) questionnaire and the Vermunt Inventory of Learning Styles (Vermunt ILS), would provide detailed knowledge of their instructional preferences, information processing, and cognitive personality learning styles. Judicious use of such information at this stage may guide them towards improved learning and higher academic achievement. Aim: To study the association between learning styles and academic achievements in first-year professional MBBS students of a medical college. Materials and Methods: A cross-sectional study was conducted at Medical College, Kolkata, West Bengal, India over the duration of 10 months from August 2021 to June 2022. Online surveys of 250 first-year MBBS students’ learning styles were conducted using the VARK questionnaire and Vermunt ILS, and the marks of three internal assessment examinations were collected. The data was entered into Microsoft Excel. Group as well as individual scores were analysed, and Pearson’s Chi-square test was used to determine the association between the students’ learning styles and their academic achievement. A p-value of <0.05 was considered statistically significant. Results: Out of the total of 160 submitted questionnaires, 139 (86.8%) students were visual learners, while the rest were multimodal learners. The factor loading of the ILS scales revealed higher alpha coefficients for learning orientations and mental models of learning, with the ‘use of knowledge’ being awarded high scores by the highest number of students, 104 (83.56%). A total 134 learners gave lower scores to processing and regulation strategies, but a significant association was found between 126 (94%) of them and their academic scores of ≥50% (p-value=0.024). Conclusion: Although no positive association was found between learning styles and academic achievement of first-year medical students, the integration of two learning style tests provided educators with comprehensive insight into the learning preferences of their students, enabling them to develop an adaptive curriculum. Students might also utilise knowledge of their learning styles to guide themselves towards self-directed learning, lifelong learning, and higher academic achievement.

Evaluation of Preventive Effect of Zinc Lozenge on Sore Throat after Placement of ProSeal Laryngeal Mask Airway: A Randomised Controlled Study

Introduction: Postoperative Sore Throat (POST) is a known complication after general anaesthesia with an endotracheal tube (14.4% to 50%) and less so with Supraglottic Airway (SGA) devices (5.8% to 34%). Various modalities and drugs can decrease POST. Zinc possesses anti-inflammatory and antioxidant properties and is utilised in oral mucositis and xerostomia. Aim: To evaluate the effect of preoperative administration of a zinc lozenge on POST after the removal of the Proseal Laryngeal Mask Airway (PLMA). Materials and Methods: In this randomised, double-blinded controlled study was conducted at the Department of Anaesthesia at Pt. BD Sharma PGIMS, Rohtak, Haryana, India, over a period of five months from August 2020 to December 2020. 100 patients aged 18-60 years of either sex belonging to American Association of Anesthesiologists (ASA) I and II undergoing elective surgery under general anaesthesia with PLMA placement were randomly allocated into two groups to receive a 40 mg zinc lozenge (Group-I) or placebo (Group-II) and were asked to chew it 30 minutes preoperatively. Patients with upper respiratory tract infections, at risk of aspiration, or with anticipated difficult intubation were excluded from the study. The incidence and severity of POST were assessed on a 4-point scale (0-3) at 30 minutes, 2, 4, and 24 hours postoperatively. The primary outcome of the study was the incidence of POST at four hours postoperatively, and the secondary outcome was the severity of POST at 30 minutes, two hours, and 24 hours postoperatively. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software programme. The Chi-square test and unpaired t-test were used for statistical analysis. Results: The mean age in Group-I was 38.6±12.32 years and in Group-II was 37.90±14.84 years (p-value 0.79). Data regarding the distribution of patients according to sex were comparable with a p-value of 0.31. There was a significantly lower incidence of POST in Group-I (zinc group) than in Group-II (placebo group) at four hours with a p-value of 0.004. Conclusion: The present study has shown that the preoperative administration of a 40 mg zinc lozenge effectively reduces the incidence and severity of POST in the postoperative period, peaking at four hours after general anaesthesia. Zinc lozenges are easy, convenient, non invasive, and successfully prevent POST.

Can Benefits of Fine Needle Aspiration Cytology be Extended up to Community Level as a Baseline Investigation: A Nine-year Experience from a Tertiary Care Institute in Bankura, West Bengal, India

Introduction: Aspiration cytology has recently become the first-line of investigation during the initial assessment of any swelling. It is also an effective tool for the early diagnosis of malignancy. In this study, the feasibility of extending the benefits of this simple, cost-effective procedure to the community level has been assessed. Aim: In the present study, attempts were made to prove that most aspirations and subsequent interpretations of aspirated samples could be accomplished by Junior Residents (JRs) even in a tertiary care centre. Materials and Methods: This cross-sectional study was conducted at Bankura Sammilani Medical College (BSMC), West Bengal, India for a period of nine years (01/01/2014 to 31/12/2022). Conventional aspirations without guidance were included in the study group. The majority of aspirations were successfully conducted by JRs, and only 4.5% (823) of conventional aspirations needed the help and supervision of senior faculties. All adequate aspirations were then independently interpreted by two separate JRs, and the proportion of cases with similar and dissimilar interpretations was duly noted. Finally, all the smears were assessed by senior faculties and compared with the interpretations of JRs. Results: During this study period, a total of 19,743 aspirations were done of which 18,391 were conventional. JRs aspirated 17,568 (95.5%) of these cases. Data analysis revealed that JRs were successful in 16,570 (83.9%) of total aspirations and also correctly interpreted 13,381 (67.8%) of total cases. Conclusion: This study proved that one year of training could be sufficient to achieve a desirable level of competency in aspiration and interpretation of cytological samples. So, willing doctors with the necessary training could perform as Community Cytopathologists (CCPs) to extend the benefits of Fine Needle Aspiration Cytology (FNAC) up to the block level, thus escalating the fight against malignancy.

Can Menstrual Cycle Length Predict Cardiovascular Risk in Healthy Indian Females? A Cross-sectional Study

Introduction: Several studies show that variations in the length of the menstrual cycle significantly affect lipid and C-Reactive Protein (CRP) parameters. There is an acute paucity of literature comparing lipid profiles and CRP in women with short and prolonged menstrual cycle length in the absence of Polycystic Ovary Syndrome (PCOS) and other gynaecological conditions. Aim: To determine the lipid profile and CRP levels in women with short and prolonged menstrual cycle length and compare them with women with a normal menstrual cycle length to identify women at cardiovascular risk. Materials and Methods: The association of lipid and CRP parameters with menstrual cycle length was evaluated in the present cross-sectional study involving 226 women aged 15-45 years selected from GSMCH, Patiala, Punjab, India, from May 2014 to December 2018. Based on a questionnaire about menstrual bleeding, healthy females were divided into three groups: women with short, normal, and long menstrual cycles. A menstrual cycle length of 24-38 days was considered normal. Lipid profile and CRP were analysed during the menstrual phase of the female monthly cycle in women with short, normal, and prolonged cycles, and the results were statistically analysed using one-way ANOVA. A p-value of <0.05 was considered statistically significant. Results: A total of 111 (49%) of the 226 females had a normal menstrual cycle duration, whereas the remaining 38 (17%) and 77 (34%) had short and lengthy cycles, respectively. Mean levels of Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein cholesterol (LDL), Very Low-Density Lipoprotein cholesterol (VLDL), lipid ratio, and CRP increased in women with short and long menstrual cycles compared to women with normal menstrual cycles. This increase was significant for TC, TG, VLDL, TC/HDL, and TG/HDL ratios, while HDL was significantly lower (p<0.05). Conclusion: Women with short and long menstrual cycles have a higher risk of developing Cardiovascular Disease (CVD) in the coming years compared to women with a normal menstrual cycle length.

Clinical Profile and Outcome of Patients using Botulinum Toxin for Cosmetic Purposes: A Cross-sectional Study

Introduction: Botulinum toxin injection has become ubiquitous in the treatment of wrinkles. It is less invasive and easy to perform, with almost immediate effects. Although it is the most common non surgical cosmetic procedure performed in many parts of the world, accurate figures of its increasing trend in India need to be unraveled as well. Aim: To analyse the clinical profile, outcomes, indications, and nature of revisits among patients seeking Botulinum toxin injections for cosmetic indications. Materials and Methods: A cross-sectional observational study was conducted at a tertiary care centre, Department of Dermatology, Cutis Academy of Cutaneous Sciences, Bengaluru, Karnataka, India, for six months between November 2018 and April 2019 among 80 consecutive patients who received Botulinum toxin injection A for cosmetic purposes. The collected data included age, gender, indication, the number of units of Botulinum toxin used, and the profile of patients seeking revisits. The data was recorded and analysed using Statistical Product and Service Solutions (SPSS) version 23.0. Results: The average age for treatment among females was 38 years, while among males, it was 35.5 years. Females, comprising 61 (76%), outnumbered men by a factor of three. The single most common indication for Botulinum toxin injection among females was Crow’s feet, accounting for 26 (43%), and among females below 40 years, it was Masseter hypertrophy in 13 (21%). The most common indication among men was Glabellar line correction in 10 (53%). Other indications included the Nefertiti lift, Marionette lines, Popply chin, Brow lift, and Gummy smile. Women revisited the clinic three times more often than men. Among women, Crow’s feet correction was the most common reason for revisits. The number of units of Botulinum toxin needed was found to be higher in males for Glabellar lines and in older individuals for Masseter Hypertrophy. Conclusion: Women are more receptive to cosmetic facial Botulinum toxin injections and revisit more frequently than men. Adverse effects were mild and self-limiting. Upper-face Botulinum toxin injections appear to be the preferred indication in both genders. More epidemiological studies detailing the profile of patients seeking aesthetic Botulinum toxin injections are needed to better understand patients’ needs and concerns, offer preprocedure counselling, manage their expectations, and provide customised services.

Effect of Rosuvastatin on Oxidative Stress in Patients with Type 2 Diabetes Mellitus: A Prospective Interventional Study

M Keerthi Thej, Aparna R Bitla, PVLNSrinivasa Rao, Alok Sachan

Introduction: Diabetes Mellitus (DM) is an established risk factor for Cardiovascular Disease (CVD). Oxidative Stress (OS) and inflammation are linked to CVD in Type 2 Diabetes Mellitus (T2DM). Rosuvastatin is a statin of choice in patients at high cardiovascular risk due to its pharmacokinetic efficacy as well as patient safety. There is limited data on the effect of rosuvastatin on OS among Indian subjects with T2DM. Aim: To assess the effect of rosuvastatin 20 mg for 12 weeks on oxidant and antioxidant status in patients with T2DM. Materials and Methods: This prospective interventional study was conducted in the Department of Biochemistry at Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2018 to February 2019. A total of 24 patients diagnosed with T2DM were included in the study and were administered rosuvastatin tablets (20 mg/day) orally for a period of 12 weeks. The oxidant markers {Malondialdehyde (MDA) and Protein Carbonyl Content (PCC)} and antioxidant markers {Ferric Reducing Ability of Plasma (FRAP) and protein thiols} were analysed spectrophotometrically using standard methods. Paired samples t-test/Wilcoxon’s signed-rank test was used as appropriate for the comparison of markers at baseline and after 12 weeks of rosuvastatin intervention. The association between markers studied was assessed using linear regression with the Generalised Estimating Equations (GEE). Results: The mean age of the study subjects was 48.04±7.96 years. There were 17 male patients (70.8%). Rosuvastatin 20 mg/day showed a lipid-lowering effect {Total Cholesterol (TC), Triglyceride (TG), Low-density lipoprotein cholesterol (LDL-C)}, an increase in the antioxidant and anti-atherogenic Hi-density lipoprotein cholesterol (HDL-C). It also showed a beneficial effect on OS markers as evidenced by a significant decrease in oxidant markers MDA (-9.06%), PCC (-21.2%) (p<0.05) and an increase in antioxidant markers FRAP (+9.08%) and protein thiols (+11.8%) (p<0.05) 12 weeks after treatment in patients with T2DM. A change in LDL-C was positively associated with a change in MDA and PCC in patients with diabetes postintervention (p<0.001). Conclusion: The findings of the present study suggest that rosuvastatin 20 mg for 12 weeks produces a beneficial effect on CV risk in patients with T2DM. The decrease in OS and the LDL-C levels can thus decrease the formation of oxidised LDL, which initiates the atherosclerotic process.

Chik Sign: A Clinical Clue to Chikungunya Infection- A Case Series

Geo Danny, Shreya Srinivasan, NR Vignesh, Ashok Kumar, S Santhosh

Chikungunya, transmitted by Aedes mosquitoes, manifests with fever, joint pain, and a distinctive cutaneous feature known as the “Chik sign” or “Brownie nose.” The Chik sign is an asymptomatic freckled hyperpigmentation of the tip and ala of the nose and may persist in the post-infective period. This nasal pigmentation can aid in diagnosing this viral infection, especially in resource-poor settings where serological confirmation is not feasible. Pigmentary changes, though asymptomatic, can persist for months and can be managed conservatively with sun protection, topical moisturisers, and depigmenting creams. The present case series describes three patients with nasal pigmentation that developed after an episode of chikungunya fever. The first patient was a one-month-old female neonate who developed fever at 15 days of age, followed by nasal hyperpigmentation, with a positive maternal history of chikungunya. The second case was a 29-year-old female patient, who developed fever and joint pain, followed by nasal hyperpigmentation one week later, and was diagnosed as a case of chikungunya based on clinical and serological evidence. The third case involved a 62-year-old male patient, who developed fever and joint pain two months ago, followed by nasal hyperpigmentation one week later, and was diagnosed as a case of chikungunya based on clinical and serological evidence.

Effectiveness of T-Scan Technology in Identifying Occlusal Interferences and its Role in the Management of Temporomandibular Disorders: A Systematic Review

Introduction: Occlusion is a significant issue that affects the masticatory system’s health. Temporomandibular Disorders (TMD) have long been linked to occlusal interferences. Identification and management of such disorders using a T-scan-guided approach have been gaining popularity; however, the effectiveness is still not established. Aim: To evaluate the effect of T-scan on the reduction of Visual Analogue Scale (VAS) scores of pain and improvement in the symptoms associated with TMD. The benefits of reducing Disocclusion Time (DT) were also evaluated. Materials and Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE) database via PubMed and Excerpta Medica Database (EMBASE) were searched for studies reporting the use of T-scan in Temporomandibular Joint (TMJ) disorders to check the DT and patient-related outcomes. The search was performed from January 1991 to November 2022. A total of 10 studies were included in the systematic review, which includes clinical studies, observational studies, and interventional studies. Data extraction was performed, and risk of bias assessment was done using the Newcastle-Ottawa scale (NOS) for non randomised studies, and the Cochrane tool was utilised for randomised clinical trials. A qualitative analysis of all the studies was carried out. Results: The T-scan-guided occlusal correction or equilibration procedures led to improvement in subjective symptoms and VAS in TMD patients. Reduction in DT positively affected muscle activity, causing relief of chronic symptoms. Conclusion: As per the findings of the present review, T-scan technology can be successfully used in the precise identification and diagnosis of occlusal discrepancies in patients suffering from myofascial symptoms.

Variation in the Formation and Branching Pattern of Brachial Plexus in the Human Foetuses: A Morphometric Cross-sectional Study

Introduction: The brachial plexus is a variable nerve plexus in its formation and branching pattern. Variations in the brachial plexus are not uncommon, and its area of supply and associations with other adjacent anatomical structures require clinical and surgical attention. Aim: To find out any anatomical variations in the formation and branching pattern of the brachial plexus in human foetuses. Materials and Methods: A morphometric prospective observational study was conducted from January 2020 to July 2022, on 30 stillborn or Intrauterine Dead (IUD) human foetuses were taken in the study. Gestation age from 28 to 40 weeks of gestation were included in the study, while those with gross anomalies or morphological anomalies of the cranium and vertebral column were excluded. The dissection includes vertical midline incision of the skin from the external occipital protuberance to the lower limit of the thoracic vertebra (T12). The skin was cut in the midline and reflected laterally. All superficial and deep muscles of the neck were dissect out to clear the cervical and thoracic parts of the vertebral column. The vertebral column was cut and opened to visualise the spinal cord and spinal nerves. Based on gestational age, the foetuses were divided into three groups: four in the first group (28-31 weeks), twelve in the second group (32-35 weeks), and fourteen in the third group (36-40 weeks) were divided for descriptive purposes. The gender of foetuses was determined based on the external genitalia. Results: A total of 60 brachial plexuses were dissected, of which 49 (81.66%) had the usual anatomical formation of the trunks: the upper trunk formed by C5 and C6 roots, the middle trunk by the C7 root, and the lower trunk by the C8 and T1 roots. Eleven (18.34%) plexuses presented variations in trunk formation. Specifically, 8 (13.3%) brachial plexuses were of the prefix type, where the upper trunk was formed by the C5 and C6 roots with an additional contribution from the C4 root; there was inter-branch communication between C6 and C7 in one (1.7%) case; the middle and lower trunks united by C7, C8, and T1 roots formed the lower trunk in another (1.7%) case, and finally, one (1.7%) case exhibited the post-fix type. Conclusion: In this study, out of the 30 foetuses examined, 11 showed variations, which is not uncommon. The prefix type of brachial plexus is quite common among the possible variations, although anatomists and neurosurgeons cannot ignore the possibility of other variations, like post-fix type or communication between the roots of the brachial plexuses.

Learnings and Reflections on Transition to New Competency-based Medical Education, MBBS curriculum in Microbiology: A Cross-sectional Observational Study

Introduction: Conventional teaching in microbiology revolved around the study of microorganisms without clinical relevance. Therefore, a New Competency-based Undergraduate (UG) Medical curriculum (New CBME) was rolled out in the academic year 2019 to make Indian Medical Graduates more clinically competent yet globally relevant. Aim: To assess the impact of the change in curriculum on students’ performance and desired educational outcomes before and after the implementation of the new curriculum. Likewise, the study aimed to analyse the experiences and reflections of medical teachers towards these amendments. Materials and Methods: A cross-sectional observational study was conducted on 82 students from the second year Bachelor of Medicine, Bachelor of Surgery (MBBS) with a traditional curriculum and 74 with the new Competency-based Medical Education (CBME) curriculum at the Department of Microbiology, Smt. B.K. Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India, between February 2020 and November 2021. In both batches, topics from core as well as non core areas of various systems were included along with the Attitude, Ethics and Communication (AETCOM) modules. A comparison of both groups was done, and Chi-square values and p-values were calculated. Results: The batch with the new CBME curriculum was able to provide a provisional diagnosis for a case-based question better than the Traditional batch {n=60/74 (81%) vs n=44/82 (54%), p-value=0.0005, significant}. However, the correct aetiology, pathogenesis, and laboratory diagnosis were written better in the traditional batch compared to the new one, n=44/82 (54%) vs n=24/74 (32%). Regarding the AETCOM skills, the new batch had a better understanding of proper communication and ethics, i.e., 73/74 (99%), p-value <0.00001, Significant, while 66/82 students (80%) of the traditional batch and 67/74 (90%) of the new batch were aware of confidentiality issues. In viva voce, the new batch showed a lot of confusion regarding the names, types of micro-organisms, and the laboratory diagnosis of diseases caused by them compared to the traditional batch (p-value <0.00156, significant). Conclusion: After implementing the new CBME curriculum to undergraduate students and analysing the feedback of teachers and the performance of students, it was felt that an appraisal of the new curriculum is required for a satisfactory outcome in microbiology so that microbiology content can be incorporated with clinical relevance.

Psychiatric Morbidity and Assessment of its Severity in Gynaecologic Oncology Patients: A Cross-sectional Study

NM Meena, S Jennifer Sangeetha, T Amirthamani Ganesh

Introduction: Several psychological and social factors influence the incidence, treatment, and outcome of cancer patients. Depressive symptoms are more common in cancer patients, particularly in late stages. Women in Indian settings often exhibit delayed treatment-seeking behaviour. Aim: To assess the prevalence, type, and severity of psychiatric morbidity as well as the duration, type, and stage of illness in gynaecological oncology patients. Materials and Methods: This cross-sectional study was conducted among 100 gynaecological oncology patients aged 18 to 65 years, who were attending the gynaecologic Outpatient Department (OPD) and ward at a tertiary care hospital. The study took place at Government Rajaji Hospital, Madurai, between May 2013 and November 2013. Data was collected using a semistructured questionnaire from the patient and a reliable informant, after obtaining informed consent. The data was entered into Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) software version 20.0. Central values, dispersion, and Chi-square tests were calculated. Results: The sample comprised 100 gynaecological oncology patients, with 30 (30%) diagnosed with malignancy, 43 (43%) with a benign condition, and 27 (27%) under investigation. Among the 100 patients assessed, 34 (34%) had psychiatric morbidity. There was a significantly higher prevalence among older patients, those with more than six months’ duration of gynaecological morbidity, and those exhibiting non fatal suicidal behaviour. Conclusion: Psychiatric morbidity is highly prevalent in gynaecological oncology patients. Depression was found to be more frequent and severe in patients with cancer. A previous history of suicidal attempts and a family history of psychiatric illness are important predictors of psychiatric morbidity in this population. Future studies on a larger population should explore the biological relationship between gynaecological oncology and psychiatric illness.

Appetitive Traits and its Association with Body Composition, Anthropometric Indices and Appearance Anxiety in Adults: A Cross-sectional Study

Jezreel Francis, Rajalakshmi Rajasegaran, Soundararajan Prabhakaran

Introduction: Obesity, a major health hazard in both developed and developing countries, is greatly influenced by an individual’s eating behaviour or appetitive trait. While eating disorders are known to be associated with abnormal body composition and cardio-metabolic risks, on par with metabolic syndrome, knowledge regarding the relationship between appetitive traits and body composition and anthropometric indices is very limited. Aim: To assess the appetitive traits of young and middle-aged individuals and correlate them with their body composition, anthropometric indices, and appearance anxiety. Materials and Methods: Sixty-eight healthy volunteers aged 19-45 years were included in this cross-sectional study. The appetitive traits, appearance anxiety, and perceived body shape of the study participants were assessed using the Adult Eating Behaviour Questionnaire (AEBQ), Appearance Anxiety Inventory (AAI), and Contour Drawing Rating Scale (CDRS). Body composition was assessed using Bioelectrical Impedance Analysis (BIA). The correlation between appetitive trait scores and the study parameters was assessed using the Pearson or Spearman correlation coefficient test. Comparison of appetitive traits between males and females was done using the Independent t-test or Mann-Whitney U test. A p-value <0.05 was considered statistically significant. Results: There were 43 males and 25 females. Significant negative correlations were observed between food avoidance scores and body composition parameters such as BMI, waist-to-height ratio, lean mass, dry lean weight, body cell mass, basal metabolic rate, and Fat-Free Mass Index (FFMI). While food approach behaviour was similar between females and males, the overall food avoidance behaviour trait (53.4±11.2 vs. 47.26±9.09, p=0.016) and satiety responsiveness (12.28±3.2 vs. 10.51±2.93, p=0.024) were significantly more pronounced in females than in males. Moreover, the food avoidance behaviour of females revealed significant negative correlations with BMI, fat mass, lean mass, body cell mass, basal metabolic rate, Body Fat Mass Index (BFMI), free-fat mass index, and CDRS scores. Conclusion: The food avoidance trait is associated with abnormal changes in specific body composition parameters in adults. Satiety responsiveness and body dis-satisfaction related to being overweight are more common among young females and are associated with abnormal changes in their body composition.

Echographic Optic Nerve Evaluation: A Novel Diagnostic Modality in Glaucoma

Avik Dey Sarkar, Sanchari Sarkar

Introduction: Primary Open-Angle Glaucoma (POAG) is considered a leading cause of blindness among all others. Different technologies such as Scanning Laser Polarimetry (SLP) and Optical Coherence Tomography (OCT) closely correlate in measuring structural parameters of the Retinal Nerve Fiber Layer (RNFL) and Optic Nerve Head (ONH). Visual impairment related to glaucomatous damage is attributed to the RNFL. Earlier studies have shown that retro-bulbar optic nerve thickness is reduced in glaucoma and have suggested that this is also the result of RNFL destruction. Aim: To investigate the correlation between the orbital and intraocular portions of the optic nerve among POAG patients. Materials and Methods: This was a hospital-based cross-sectional study done in a tertiary care ophthalmic institute from October 2019 to February 2021. One eye of 32 volunteers with newly diagnosed POAG underwent optic disc analysis using OCT and echographic measurements of the retrobulbar optic nerve. For statistical calculations, Statistical Package for Social Sciences (SPSS) Statistics version 20.0 software (IBM Corp., Armonk, NY, USA) was used. Spearman’s rho (rs) was used as the index of correlation between retrobulbar optic nerve dimensions and ONH topographical data. A correlation between OCT-based RNFL and optic disc parameters was compared with retrobulbar optic nerve dimensions measured with the help of Ultrasonography- Brightness (USG B) Scan. Results: Orbital Optic Nerve Diameter (OND) and Optic Nerve Cross-sectional Area (ONCSA) significantly and positively correlated with Neuro-retinal Rim (NR) area (OND: p-value=0.00001; ONCSA: p-value=0.00001) and average nerve fiber layer thickness (OND: p-value=0.0001; ONCSA: p-value=0.00002). The Retrobulbar ONCSA-to-disc area ratio (ONCSA/D) was found to have a statistically demonstrable positive correlation with Neuro-retinal Rim Area/Disc area ratio (NR/D) (p=0.00003). Conclusion: This study showed that retrobulbar optic nerve dimensions correlate well with SD-OCT-based ONH parameters. Echographic measurements of the retrobulbar optic nerve add a new biomarker in the diagnosis of glaucoma.

Effectiveness of Ultrasound-guided Percutaneous Catheter Drainage for Pancreatic Fluid Collections: An Interventional Study

Ameer Hussain, Afwaan Faizal, Vishnu Raj

Introduction: Pancreatic Fluid Collections (PFCs) are accumulations of pancreatic fluid or debris contained within a granulation tissue wall. Unlike true cysts, they arise as complications of various conditions like acute pancreatitis, abdominal trauma, pancreatic surgery, or chronic pancreatic duct obstruction. While smaller PFCs (under 4 cm) often resolve on their own without intervention, larger collections exceeding 6 cm or those causing symptoms like infection or bile duct obstruction have significantly lower rates of spontaneous resolution. In such cases, drainage intervention is typically recommended. Aim: To assess the treatment effectiveness of Percutaneous Catheter Drainage (PCD) for PFCs using ultrasound guidance. Materials and Methods: A prospective interventional study was conducted in the Department of Radiodiagnosis, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, from September 2021 to August 2022. The study focused on patients (N=73) with PFC as a complication of acute pancreatitis necessitating ultrasound-guided PCD. The study outcomes were clinical effectiveness, reinterventions, and mortality rates. Additionally, authors investigated the impact of various drainage factors, such as indication, PFC type, location relative to the pancreas, PFC size, Modified Computed Tomography Severity Index (CTSI), duration between symptom onset and PCD initiation, total catheter dwell time, and duration between symptom onset and reintervention. Statistical analyses employed International Business Machine (IBM) Statistical Packages for Social Sciences (SPSS) Statistics. Descriptive statistics and independent samples t-test for continuous variables; Chi-square test for categorical data (p<0.05). Results: In present study, the mean age of the subjects was 47 years. PCD in terms of clinical success was 63% (n=46) and clinical failure was 37% (n=27). Open necrosectomy was performed on 15 patients (20.5%) and open cystogastrostomy was performed on 11 patients (15.1%). Conclusion: The utilisation of ultrasound-guided PCD for PFCs represents a technique associated with relatively low morbidity and mortality rates. This approach can serve as either definitive treatment or a transitional measure before resorting to open surgery.

Oestrogen and Gastroesophageal Reflux Disease Dynamics in Premenopausal and Postmenopausal Women: A Cross-sectional Study

M Praveena, R Nagashree

Introduction: Gastroesophageal Reflux Disease (GERD) is a common clinical disorder characterised by the reflux of stomach contents into the oesophagus, primarily due to the temporary relaxation of the Lower Oesophageal Sphincter (LES). The aetiology of GERD is multifactorial. The prevalence of GERD in females has been found to sharply increase throughout the postmenopausal period compared to the reproductive phase. Aim: To study the relationship between serum oestrogen levels in premenopausal and postmenopausal women with GERD. Materials and Methods: In this cross-sectional study, 60 patients with GERD were divided into 30 premenopausal and 30 postmenopausal groups. The study subjects underwent high-resolution oesophageal manometry. The Cobas e 411 immunoassay analyser was utilised to measure serum oestrogen levels through electrochemiluminescence. The independent, unpaired Student’s t-test was employed to analyse the collected data. Results: The statistical analysis revealed that the mean reduced LES pressure of 9.76±3.80 mmHg and the mean reduced Oesophagogastric Junction Contractile Integral (EGJ-Cl) of 14.503±10.64 mmHg were lower in women with postmenopausal GERD who exhibited lower oestrogen levels compared to those with premenopausal GERD. An increase in LES pressure was also associated with an increase in EGJ-CI, demonstrating a statistically significant positive linear correlation between LES pressure and EGJ-CI. The p-value <0.05 was deemed highly statistically significant. Conclusion: Parameters such as basal LES pressure and EGJ-Cl were observed to be reduced in postmenopausal women with GERD who had low oestrogen levels. This study suggests that oestrogen plays a crucial role in safeguarding the oesophageal epithelium against the reflux of gastric contents.

Study of Serum Uric Acid Levels in Diabetic Kidney Disease and its Association with Left Ventricular Hypertrophy and eGFR: A Cross-sectional Study

Abhilash Narayana, Bhavana Bhagvath, B Sandhya Rani, J Inbanathan

Introduction: Cardiovascular diseases are a major cause of death among patients with Diabetic Kidney Disease (DKD). Left Ventricular Hypertrophy (LVH) is a threatening prognostic sign and an independent risk factor for cardiovascular mortality and morbidity. A number of epidemiological studies have proven that LVH is common in patients with DKD. Aim: To estimate the Serum Uric Acid (SUA) levels in DKD patients and its association with LVH and estimated Glomerular Filtration Rate (eGFR). Materials and Methods: The current study was a cross-sectional study conducted at KR Hospital, Mysuru, a teritary care hospital, in Mysuru, Karnataka, India, during the period from 1st January 2020 to 31st December 2020. which included 53 patients with DKD. The demographic data, relevant investigations like Renal Function Test (RFT), SUA levels, complete haemogram, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), glycosylated haemoglobin, Liver Function Tests (LFT), urine routine, Urine Albumin Creatinine Ratio (UACR), electrocardiogram, 2D echo were done. The results were tabulated, and the patients were classified into those with high and low SUA levels. They were also evaluated for the presence of additional risk factors like hypertension and Ischaemic Heart Disease (IHD). Data obtained was analysed statistically using Statistical Packages of Social Sciences (SPSS) version 21.0 software. Mean, Standard Deviation (SD), Chi-square test, and Fischer’s-exact tests were used where appropriate, with a p-value <0.05 considered statistically significant. Patients were classified into two groups, one with SUA more than 6.5 and the other with less than 6.5, as normouricaemia and hyperuricaemia, respectively. Results: The majority of the cases were in the age group of 51-60 years, accounting for 43.4%. Out of 53 patients, males constituted 60.4% and females 30.6%, with a male-to-female ratio of 1.52:1. Total 33 patients (62.3%) were hypertensive, 32 patients (60.4%) had LVH, and 15 patients (28.3%) had IHD. Among 38 patients with SUA levels >6.5 mg/dL, the mean UACR value was higher (1807.9 mg/gm), the mean eGFR value was 32.4 mL/min/1.73 m2, and the mean Left Ventricular Mass index (LVMI) was 117.1 g/m2, which was statistically significant. Conclusion: In patients with DKD, higher SUA levels were associated with significantly higher values of UACR, lower eGFR values, higher LVMI values, and an increased risk for LVH, hypertension, and IHD. However, there was no significant association between higher uric acid levels and HbA1c.

Evaluation of Faecal Calprotectin S100A8/S100A9 Levels in Patients Suffering from Irritable Bowel Syndrome: A Cross-sectional Study

Ashfaq Ahmed, MD Hamed Altaf Mali, Zeenath Begum

Introduction: Irritable Bowel Syndrome (IBS) is a common functional bowel disorder which remains a clinical challenge with limited therapeutic options. The diagnosis of IBS is made by the Rome IV criteria. Patients suffering from IBS often have impaired poor quality of life. Distinguishing IBS from Inflammatory Bowel Diseases (IBD) can be difficult, especially with mild disease activity. Both conditions share a symptom complex with abdominal pain and altered bowel habits but potentially have different treatments for each disorder. Aim: To evaluate Faecal Calprotectin S100A8/S100A9 Levels (FCL) in IBS patients and compare those levels with patients suffering from the IBD group. Materials and Methods: This was a cross-sectional study conducted for a period of one year from June 2022 to May 2023 at the Department of Pathology in collaboration with the Department of Medicine, Khaja Bandanawaz (KBN) University-Faculty of Medical Sciences, Kalaburagi Karnataka, India. The study included 130 patients aged between 18 and 65 years with chronic diarrhoea, consisting of 90 cases in the IBS group and 40 cases in the IBD group for comparison. After obtaining clinical details, FCL were analysed by Fluorescence Immunoassay (FIA). Patients were subjected to colonoscopic evaluation, and biopsies were taken for processing. FCL, colonoscopic, and histopathological findings were evaluated in IBS patients and IBD patients, respectively. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 24.0 software package. Quantitative data were expressed as mean±Standard Deviation (SD). Qualitative data were expressed using U-test Fisher’s-exact and Chi-square test, where a p-value <0.05 was considered statistically significant. Results: The age range was from 18 to 65 years with a male to female ratio of 1:2 and a mean age of 42.2 years. Among the 90 IBS cases, IBS-diarrhoea predominant was the largest subgroup with 65 patients (72.2%) clinically. Seventeen IBS cases showed elevated FCL levels, with four patients having FCL levels higher than those in IBD cases in a quiescent stage. The mean±SD FCL levels in the IBS subgroup were 80.45±76.4 μg/g Out of the 17 cases with elevated FCL levels, 10 showed features of microscopic colitis {lymphocytic colitis (7), collagenous colitis (2), indeterminate (1)}, respectively. Thirty-seven IBD patients had elevated FCL levels, with a mean±SD FCL level in the IBD subgroup of 180.20 ± 386.4 μg/g, and 12 patients (30.0%) had levels higher than 500 μg/g. Conclusion: The study concluded that FCL levels are elevated in IBS patients also. The FCL levels in the IBS-diarrhoea subgroup were elevated more than the IBD-quiescent subgroup. IBS cases with elevated FCL levels showed positive colonoscopic findings and histopathological features of microscopic colitis on biopsy. These IBS cases require anti-inflammatory treatment as they do not respond to regular anti-IBS treatment. Furthermore, these IBS patients should be followed-up as they may potentially develop into future IBD cases.

Determination of Vertebral Structure using Ultrasound Examination at Manually Identified Midpoint of Intercristal Line in Pregnant Women at Term: A Cross-sectional Study

R Selvakuma, R Arunachalam, DS Sudhakar, K Murugesan, S Shalini

Introduction: Manual palpation has traditionally been used to locate the intercristal line and corresponding vertebral level for administering subarachnoid blocks. However, ultrasound examination provides an alternative approach for accurate vertebral identification. Aim: To determine the vertebral structure using ultrasound at the manually marked midpoint of the intercristal line in pregnant women at term. Materials and Methods: A cross-sectional study was conducted at Government Dharmapuri Medical College Hospital (GDMCH) in Dharmapuri, Tamil Nadu, India from March 20, 2023 to April 18, 2023. It involved 100 pregnant women at term. Two independent observers estimated the vertebral space at the intercristal line– one using manual palpation and the other using ultrasound guidance. The primary outcome assessed was the determination of the vertebral structure using ultrasound examination at the manually marked midpoint of the intercristal line in pregnant women at term. The secondary outcome assessed included evaluating the accuracy of manual palpation in identifying vertebral levels compared to ultrasound examination and assessing factors such as Body Mass Index (BMI) that may influence the accuracy of vertebral level identification. One-way Analysis of Variance (ANOVA) was used to compare the mean±SD of continuous variables among more than two groups. A p-value <0.05 was considered statistically significant. Results: The study included 100 pregnant women with a mean age of 22.91±3.74 years and a mean BMI of 25.87±3.98 kg/m2. The ultrasonographic assessment revealed that the manually palpated intercristal line corresponded to the L4 vertebra level in 50% of cases, the L3-L4 intervertebral space level in 30%, the intended L4-L5 intervertebral space level in 15%, the L5 vertebra level in 3%, and the L3 vertebra level in 2%. Notably, the ultrasound examination showed that the manually palpated intercristal line was higher than the L4 vertebra or L4-L5 intervertebral space in 32% of the pregnant women. Conclusion: The study indicates that ultrasound examination may offer a more accurate method for identifying vertebral structures in pregnant women at term compared to traditional manual palpation.

Carpal Tunnel Syndrome and Associated Factors among Healthcare Practitioners at Vaccine Centres in Saudi Arabia: A Cross-sectional Study

Introduction: Carpal Tunnel Syndrome (CTS) presents with symptoms like numbness, tingling, and weakness along the median nerve pathway. Risk factors include prolonged wrist positions, repetitive muscle contractions, and exposure to vibrations. Aim: To determine the prevalence of CTS among healthcare practitioners at vaccine facilities in Saudi Arabia. Materials and Methods: A cross-sectional study on a total of 150 healthcare practitioners (aged 25-30 years) working in vaccination centres in Riyadh, Saudi Arabia were recruited. The study was conducted from November 2021 to March 2022. The authors collected demographic data, Body Mass Index (BMI) and work shift information, and administered two validated questionnaires, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and the Duruoz Hand Index (DHI). CTS symptoms were diagnosed using Phalen’s and Arm Raising Test (ART). Results: Of the 150 practitioners (aged 25-45 years), predominantly in the 25-30 age group, n=65 (44.0%) tested positive on the Phalen’s test, and n=65 (43.5%) on the ART. Females had higher BCTSQ scores, while DHI scores were similar across genders. Spearman’s correlation analysis showed positive correlations between BCTSQ and DHI, and a moderate negative correlation between ART and DHI. Logistic regression analysed factors affecting the likelihood of CTS diagnosed by ART and Phalen’s Test. Higher BCTSQ and DHI scores increased the likelihood of CTS (ART: BCTSQ OR=0.843, DHI OR=1.064; Phalen’s Test: BCTSQ OR=0.830, DHI OR=1.069). Conclusion: During the Coronavirus Disease-2019 (COVID-19) pandemic, the prevalence of CTS among healthcare practitioners at vaccine centres in Riyadh, Saudi Arabia reached up to 43-44%. The present study highlights that day shift workers face a higher risk of CTS compared to night shift workers, likely due to heavier daytime workloads. This underscores the need for ergonomic interventions and workload management, especially during high-demand periods like the vaccination campaign, to safeguard healthcare workers’ health and productivity.

Eco-friendly Synthesis of Copper Sulphate Nanoparticles using Citrus Sinensis Extract and their Antimicrobial Properties: An In-vitro Study

Annie Sylvea Valan, M Hema

Introduction: The extensive use of nanoparticles underscores the importance of developing sustainable synthesis methods. There is a growing demand for green synthesis, which prioritises clean, safe, and environmentally friendly methods devoid of high temperature, pressure, energy consumption, and toxic chemicals. Aim: To produce copper sulfate nanoparticles through the utilisation of Citrus sinensis extract and assess their antibacterial efficacy against Streptococcus mutans, Staphylococcus aureus and Enterococcus faecalis. This addresses the requirement for innovative and environmentally friendly antimicrobial agents for dental purposes. Materials and Methods: This in-vitro study was conducted at the Department of Conservative Dentistry and Endodontics at Saveetha Dental College, located in Chennai, Tamil Nadu, India, during the timeframe of April 2023 to June 2023 following the acquisition of ethical clearance from the Scientific Review Board Committee. Utilising Citrus sinensis extract, a green synthesis method was employed to synthesise copper sulfate nanoparticles. Characterisation procedures included Fourier-transform Infrared Spectroscopy (FTIR) analysis, Scanning Electron Microscopy (SEM) imaging, Energy Dispersive X-ray Analysis (EDAX) analysis, and antibacterial testing. The antibacterial effectiveness of the nanoparticles was evaluated against Streptococcus mutans, Staphylococcus aureus and Enterococcus faecalis using the agar well diffusion method. The data were subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 23.0 to assess antibacterial effectiveness. Analysis of Variance (ANOVA) was employed to analyse the Zone of Inhibition (ZOI) regarding antibacterial efficacy. Results: The copper sulfate nanoparticles, synthesised through a green approach, displayed a spherical morphology as affirmed by SEM and exhibited characteristic peaks in FTIR spectra. EDAX analysis confirmed the elemental composition of the nanoparticles. Notably, the nanoparticles showcased the most substantial antibacterial activity against Enterococcus faecalis followed by Staphylococcus aureus, and the least activity was seen against Streptococcus mutans. Conclusion: Copper sulfate nanoparticles synthesised through Citrus sinensis mediation show promising antibacterial efficacy against Enterococcus faecalis, highlighting their potential for dental applications. However, further investigations are necessary to assess their cytotoxicity, evaluate their clinical viability, and explore broader applications in antimicrobial contexts.

Assessment of Glu504 Lys Genotype and Single Nucleotide Polymorphisms in Exon 12 and 13 of ALDH2 Gene in Alcoholic Liver Cirrhosis Patients in Northern Karnataka, India: A Cross-sectional Study

Introduction: Alcoholic Liver Disease (ALD) is one of the most significant issues affecting the world today and is the principal cause of atleast 60 of the most significant forms of systemic disorders. The metabolic breakdown of alcohol into acetaldehydes is catalysed by Alcohol Dehydrogenase (ALDH). Aim: To find out the Glu504 Lys genotype and Single Nucleotide Polymorphisms (SNPs) in the exon 12 and 13 of ALDH2 gene in alcoholic liver cirrhosis patients. Materials and Methods: This cross-sectional study was conducted at the Department of General Medicine and Genetics Laboratory of the BLDE (Deemed to be University) Shri BM Patil Medical College Hospital and Research Centre (SBMPMC), Vijayapura, Karnataka, India. The study period was from January 2021 to June 2022. ALD patients were recruited. For the present study, 32 patients with ALD symptoms were recruited, and a total of 32 age- and sex-matched controls were included. Patients with existing or past co-infections with Hepatitis B or C and other causes of chronic liver disease were excluded. Blood samples were collected from all patients and subjected to genetic analysis; Polymerase Chain Reaction (PCR) products were then analysed using Sanger-based Deoxyribonucleic Acid (DNA) sequencing. Results: The mean age of all patients and controls in the present study was 44.06 and 52.09 years, respectively. Out of 32 cases, two mutations were found in exon 13: g.47794 A>T (heterozygous) and g.47854 T>G (heterozygous). These mutations occurred in patients who were younger (mean age 29.5 years) and consumed less alcohol (108 g/day) for a shorter duration (5.5 years) compared to the remaining cases. No SNPs were found in exon 12 of the ALDH2 gene. Conclusion: Mutations in the exon 13 regions of the ALDH2 gene may be responsible for early predisposition to the disease. Early genetic analysis in selected populations to identify these mutations may help prevent the occurrence of the disease. An association study of the ALDH2 gene with ALD will be conducted in larger samples, along with biochemical and other clinical investigations, to determine the association of these gene polymorphisms.

Effect of Preoperative Education about Spinal Anaesthesia on Anxiety and Postoperative Outcomes in Parturients undergoing Elective Caesarean Section: An Interventional Study

Namitha Arun, Veena Nadarajan, Vimal Pradeep

Introduction: Pregnant women often experience anxiety due to myths and worries about surgery, particularly caesarean section, which are common during childbirth. Their anxiety can impact overall satisfaction, recovery, and mental health. Addressing these issues is crucial for improving both surgical outcomes and the childbirth experience. Aim: To assess the effectiveness of a preoperative education program utilising materials and videos on spinal anaesthesia in reducing anxiety and enhancing postoperative outcomes for patients undergoing caesarean section. Materials and Methods: An interventional study was conducted with 64 consecutive parturients who were divided into two equal groups, the study group (group A) and the control group (group B) at Government TD Medical College Alappuzha, Kerala, India. Group A received structured education on spinal anaesthesia, with individual questions and concerns addressed using the video and handbook. Group B received routine preoperative information. Preoperative anxiety was measured using Amsterdam Preoperative Anxiety and Information Scale (APAIS), while postoperative pain was assessed using Visual Analogue Scale (VAS) at 4, 12, and 24 hours after surgery. Data analysis was performed using Statistical Package for the Social Sciences (SPSS). Results were presented as frequencies for qualitative variables and as mean with standard deviation for quantitative variables. Statistical tests included Student’s t-test, Chi-square test, Fisher’s exact test, and paired t-test. Statistical significance was set at p-value <0.05. Results: Preoperative education led to statistically significant reductions in anxiety levels for each individual, pre-educational and post-educational mean APAIS scores were 18.06 and 13.66, respectively, which was statistically significant (p-value <0.001). The post-educational APAIS score (13.66) was lower than the mean APAIS score in the control group (20.31), which was statistically significant (p-value <0.001). Postoperative pain at 12 hours was significantly lower in the group that received the educational session compared to controls (p-value <0.04). Conclusion: Preoperative education on spinal anaesthesia significantly reduced anxiety and improved postoperative outcomes for parturients undergoing caesarean section. These findings highlight how well-planned education can enhance care for expectant mothers during childbirth.

Reliability of Digital Pressure Algometer in Painful Diabetic Peripheral Neuropathy: A Quantitative Cross-sectional Study

Jyoti Sharma, Irshad Ahmad, Arun Kumar Chandresh Singh

Introduction: Painful Diabetic Peripheral Neuropathy (PDPN) is associated with pain and disturbed sensory symptoms. Altered Pressure Pain Threshold (PPT) in PDPN often leads to complications of diabetic foot and consequent amputations. Early detection of altered PPT can prevent future complications and reduce mortality rates. PPT may be determined with a pressure algometer, which measures the pressure and/or force at which the first perception of pain begins. The cost of algometers frequently prevents them from being used in clinical and research settings. An affordable and dependable algometer would be a valuable tool in PDPN, where health costs are already 20% higher than those of diabetic controls. Aim: To evaluate the test-retest and inter-rater reliability of a low-cost digital pressure algometer in individuals suffering from PDPN. Materials and Methods: This quantitative cross-sectional study was conducted for four months at Metro Heart Institute with Multispeciality Hospital, Faridabad, Haryana, India. PPT of 30 patients with PDPN aged 50-70 years (mean age 61.53±5.84 years) was collected twice by one rater (R1) after a gap of 24 hours. Another rater (R2) repeated the first reading at similar points on both feet. PPT was noted at the dorsum, 2nd, and 3rd metatarsal on the plantar surface of the foot. The main outcome measurements were the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and using the Bland-Altman approach, measurement bias was evaluated. Results: The ICC for test-retest reliability for the dorsal right and left foot was 0.85 and 0.83, respectively. The ICC for Plantar 2nd metatarsal right and left was 0.86 and 0.89, respectively. The ICC for the plantar third metatarsal right and left foot was 0.85 and 0.81, respectively. The inter-rater reliability ICC values varied from 0.63 to 0.87. Bland-Altman plots showed acceptable levels of agreement. Conclusion: The digital algometer showed good test-retest and moderate inter-rater reliability in patients with PDPN.

Awareness about Dental Injuries Associated with Contact Sports and Use of Mouthguards in Young Trainees Playing Khokho, Kabaddi and Football in Bhubaneswar City: A Cross-sectional Study

Introduction: Dental trauma sustained while participating in sports is the main element that connects dentistry and sports. Sports involving frequent physical contact with other athletes increase the risk of dentofacial injuries. This association underscores the importance of preventive measures, with well-fitted athletic mouthguards identified as a key intervention to mitigate the risk of dentofacial injuries. Aim: To assess awareness about sports-related dental injuries and mouthguard use among young trainees in three contact sports-khokho, kabaddi, and football. Materials and Methods: A cross-sectional study was conducted from May 2023 to July 2023, which included 226 young trainees from the Government College of Physical Education, Bhubaneswar, engaged in football, kabaddi, and khokho. Data was collected using a self-structured questionnaire and were subjected to analysis employing the Chi-square test. Sports-related dental injury was assessed using the Traumatic Dental Injury codes of the World Health Organisation (WHO) Oral Health Assessment Form for Adults, 2013. Results: Eight (8.3%) football players had the highest incidence of upper left central incisor enamel fracture, as determined by the dental injury codes. The majority of the trainees, 206 (91.2%), were aware of what a mouthguard is. However, 135 (59.7%) agreed that mouthguard use should be mandatory during sports practice. A p-value <0.0001 was considered statistically significant. Conclusion: While most trainees displayed awareness of sports-related dental injuries, familiarity with mouthguards was lacking. Football players exhibited the highest prevalence of sports-related dental injuries, followed by kabaddi players, with the lowest incidence observed among khokho players.

Intratubular Penetration and Push-out Bond Strength of AH Plus, GuttaFlow 2 and GuttaFlow Bioseal Sealers: An In-vitro Study

Introduction: The root canal obturating material provides a three-dimensional fluid-impervious seal. Root canal sealers play a major role in providing a seal between the core material and the tooth for the long-term success of endodontic treatment. Aim: To evaluate the intratubular penetration and Bond Strength (BS) and push-out BS of AH Plus, GuttaFlow 2, and GuttaFlow Bioseal sealers. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2019 to April 2021. A total of 75 human mandibular first premolars were decoronated at the Cemento-enamel Junction (CEJ) with a standardised length of 16 mm. The root canal was prepared using the crown-down technique with HyFlex Electrical Discharge Machining (EDM) rotary files and divided into three groups: Group-I: AH Plus, Group-II: GuttaFlow 2, and Group-III: GuttaFlow Bioseal. 0.1% Rhodamine B dye was added to the sealer and obturated using the single cone technique. These samples were transversely sectioned into beams at the middle third of the root. A confocal laser scanning microscope was used to evaluate the depth of sealer penetration in the dentinal tubule, and a Universal Testing Machine was utilised to measure the push-out BS (MPa). The recorded data were subjected to statistical analysis {one-way Analysis of Variance (ANOVA) test, Tukey’s post-hoc test, and Pearson’s correlation coefficient}. Results: The results obtained indicated that there was a significant difference in the depth of penetration and push-out BS of AH Plus and GuttaFlow 2 sealers (p<0.0001). However, there was no significant difference found between AH Plus and GuttaFlow Bioseal sealers (p=0.206). In addition, there was no significant difference in the correlation between intratubular penetration and push-out BS of the sealers (negative correlation). Conclusion: Considering the results, the GuttaFlow Bioseal sealer was found to have comparable clinical performance with AH Plus sealer; hence, it can be used as an acceptable root canal sealer.

Intra-axial Supratentorial Tumours Resection under Fluorescein Guidance with 560 nm Yellow Filter: A Cross-sectional Study

Introduction: Excision of intra-axial tumours with maximal resection and minimal deficits is one of the intricate procedures in neurosurgery. Fluorescence-guided Surgery (FGS) helps in better identification of tumour tissue and allows Maximal Safe Resection (MSR) of high-grade brain tumours. Sodium fluorescein dye, when injected intravenously, gets concentrated in High-grade Glioma (HGG) tissue due to a disrupted Blood-Brain Barrier (BBB), thus aiding in MSR, Extent of Resection (EOR), and Gross Total Resection (GTR). Aim: To assess the effectiveness of intraoperative use of sodium fluorescein in achieving MSR and GTR. Materials and Methods: This was a cross-sectional study conducted on 30 patients with HGG who underwent surgery between January 2021 and May 2023 at SDM College of Medical Sciences, Dharwad, Karnataka, India. Two groups of 15 patients each were divided into those operated with the use of Fluorescein Sodium (FS) and those without FS. FS was administered at a dose of 5 mg/kg at the time of craniotomy. The primary endpoint was the number of patients with Histopathological Examination (HPE)-confirmed HGGs showing no contrast-enhancing tumour in the immediate postoperative Magnetic Resonance Imaging (MRI). Secondary endpoints included residual tumours on postoperative MRI, Focal Neurological Deficits (FND), and FS-related toxicity. The association between FS status and recurrence at different treatment time points was assessed using the Pearson Chi-square test. Recurrence rates were compared in each FS group using the Cochran Q test. Statistical significance was set at a 5% level (p-value <0.05). Results: Homogeneous or heterogeneous yellow-green fluorescence was observed on the tumour tissue in all 15 patients (100%). Of the 15 patients where FS was used, two showed lesion recurrences at six months, and 13 showed recurrences at 12 months. Among the 15 patients where FS was not used, 11 showed recurrences at six months, and four showed recurrences at 12 months. This indicates that MSR, GTR, and EOR can be improved using FS intraoperatively during tumour resection. Conclusion: Based on the results, fluorescein dye with a 560 nm yellow filter under a highly illuminated microscope can help achieve better tumour resection with minimal injury to surrounding eloquent areas. It can be utilised as an ideal adjunct for tumour resection rather than with a microscope alone.

Association between Cord Blood Haematocrit and Neonatal Outcome among Neonates of Diabetic Mothers: A Cohort Study

Arshad Ali Cherukattil, Menon Narayanankutty Sunilkumar

Introduction: The perinatal mortality rate of Neonates of Diabetic Mothers (NDMs) over the years showed a reducing trend. Polycythaemia is common in NDMs, and such neonates have a risk of hyperviscosity, renal vein thrombosis, cardiac failure, metabolic abnormalities, and necrotising enterocolitis. Aim: To assess the association between cord blood haematocrit and neonatal outcomes among NDMs. Materials and Methods: The present study was a cohort study that included 130 neonates, which was conducted at Amala Institute of Medical Sciences (AIMS), Thrissur, Kerala, India, from December 2019 to June 2021. The primary inclusion criteria were singleton neonates of Gestational Diabetic Mothers (GDM) (diabetes detected after 20 weeks of gestation) and Overt Diabetes Mellitus (ODM) defined under White’s classification (known to be diabetic before the onset of pregnancy or detected in the initial visits). The parameters assessed were the frequency of distribution of hypoglycaemia, hypocalcaemia, and hyperbilirubinemia among the neonates of DM. Statistical analysis was done using Fisher’s exact test and Student’s t-test. Results: Among the 130 neonates, the majority of the mothers had GDM 111 (85.4%) than ODM 19 (14.6%). The majority were delivered by normal vaginal delivery 67 (51.5%). 10 (7.7%) of NDMs had a birth weight >4000 g. Significant associations were noted between cord Packed Cell Volume (PCV) and the presence of hypoglycaemia (p-value=0.003), hypocalcaemia (p-value=0.0001), and Neonatal Hyperbilirubinemia (NNH) (p-value=0.0001) among NDMs. Conclusion: Hypoglycaemia, hyperbilirubinemia, and hypocalcaemia were common complications noted in NDMs.

Prevalence of Paediatric Head and Neck Malignancies in the North Region of Brazil: A Cross-sectional Study

Introduction: Head and Neck Cancer (HNC) ranks sixth among the most common men’s tumours. The prevalence of HNC in children has increased in several countries, and the prevalence varies worldwide. In several regions in Brazil and the world, a lack of epidemiological data records on childhood HNC is observed, demonstrating little knowledge about the demographic profile of these patients. Aim: To determine the prevalence of HNC in paediatric patients over the years at a reference centre in the North region of Brazil. Materials and Methods: A cross-sectional study was conducted with the objective of quantitatively and qualitatively analysing the prevalence of HNC in a reference oncology hospital. The electronic medical records of patients aged 0 to 19 years were reviewed at a referral centre in Northern Brazil from October 2015 to February 2022. Demographic variables, topographic location of tumours, city of origin, patient outcome, and histopathological diagnosis were collected. Results: A total of 4,113 medical records were analysed, and 126 met the criteria for analysis. Males had a higher incidence n=75 (59.52%) of HNC than females n=51 (40.47%). The age group with the highest percentage of HNC was >4 to 9-year-old n=40 (31.74%). The most common diagnosis were lymphoma 78 (61.90%), sarcoma 22 (17.46%); carcinoma 14 (11.11%), and histiocytosis 10 (7.93%). Conclusion: In Northern Brazil, the most common tumour was Hodgkin’s lymphoma, and the most prevalent group affected were males aged >4-9-year-old.

Effect of Topical Application of Tranexamic Acid on Wound Drainage and Seroma Formation after Modified Radical Mastectomy: An Observational Study

Grishma Reba Thomas, PS Rajesh

Introduction: Breast cancer is the most common malignancy detected in the female population in Kerala, India. Seroma formation after Modified Radical Mastectomy (MRM) may lead to a delay in recovery, a prolongation of hospital stay, and can also affect treatment by delaying adjuvant therapy and increasing the risk of infection. Topical Tranexamic Acid (TXA) reduces bleeding, wound drainage duration and seroma formation. Aim: To find the effect of topical application of TXA on wound drainage and seroma formation after MRM. Materials and Methods: The present prospective observational study was conducted in the Department of General Surgery, Government Medical College, Kottayam, Kerala, India, from February 2022 to January 2023. A total of 150 patients who underwent MRM were randomly selected to receive either TXA or a placebo before wound closure. Two groups were formed: Group-1 (interventional group) received 20 mL of diluted TXA (25 mg/mL), while Group-2 (placebo group) received normal saline. Each group consisted of 75 female patients. They were compared based on drain amount, number of days the drain was in place and seroma formation. Categorical parameters like the number of days the drain was kept, cumulative drain amount, and seroma occurrence were expressed as percentages. Statistical analysis was done with Chi-square test with a p-value <0.05. Results: The median age of the patients was 50-60 years. On postoperative day 1, the drain amount in Group-1 was 37.3%, while in Group-2, it was 54.7%, with 1.3% of patients in Group-1 and 6.7% in Group-2 having more than 300 mL drained (p-value=0.001). By postoperative day 7, 21.3% of patients in Group-1 had drained less than 50 mL, compared to only 4% in Group-2 (p-value=0.02). The majority of patients in Group-1 had their drains removed in 5-10 days (97.3%), whereas in Group-2, drains were removed in 11-14 days (56%). Seroma formation occurred in 8% of patients in Group-1 and 5.3% in Group-2 (p-value=0.512). Conclusion: All patients tolerated TXA without any side effects and it effective in lowering the volume and duration of wound drainage following MRM.

A Cross-sectional Study on Anaemia Related Knowledge and Dietary Practices: Insights from School-going Adolescents in Mulshi Taluka, Pune, Maharashtra, India

Neha Rokade, Manisha Gore, Sammita Jadhav, Arti Muley

Introduction: Anaemia is a global public health concern affecting individuals of all ages, particularly adolescents who are in a stage of rapid growth and development, making them more susceptible to iron deficiency anaemia. In India, the prevalence of anaemia among adolescents is high, with significant variations across regions. Literature regarding knowledge about anaemia and related dietary practices is scarce in Pune district, especially in Mulshi taluka. Aim: To study knowledge related to anaemia and assess the dietary practices in terms of consumption of iron-rich foods among adolescents aged between 14 to 17 years enrolled in public schools of Mulshi Taluka, Pune District. Materials and Methods: This cross-sectional study was conducted among school-going adolescents aged 14 to 17 years in Mulshi taluka, Pune district, Maharashtra, India, from June 2023 to August 2023. Data were collected from public schools using a pretested structured questionnaire administered through one-on-one interviews. A total of 285 responses were obtained. Descriptive statistics and the Chi-square test were applied to analyse the collected data using Microsoft (MS) Excel and Statistical Package for the Social Sciences (SPSS). Results: The study revealed that more than half of the adolescents were familiar with anaemia (59.6%). However, a lower percentage considered it a health problem (45.6%). Only a few adolescents had taken Iron-folic Acid (IFA) tablets within the past year (13%), while a higher percentage had consumed deworming tablets in the past six months (70.2%). Adolescents consumed roti or rice daily (90.2%), pulses (54.7%), and Dark Green Leafy Vegetables (DGLV) (73.7%) weekly. Fruits were consumed mainly weekly (46%) and occasionally (39.6%), whereas fried food and aerated drinks were regularly consumed. The findings revealed poor implementation of the National Iron Plus Initiative (NIPI) program. Conclusion: The study highlighted a lack of anaemia-related knowledge and observed inadequate dietary practices among adolescents. Thus, comprehensive efforts are required to bridge the knowledge gaps, improve dietary practices, and strengthen program implementation to ensure the comprehensive health and well-being of adolescents in Mulshi Taluka.

Comparison of Digital and Bougie-aided Technique for Proseal Laryngeal Mask Airway Insertion in Mastoid Surgery: A Randomised Clinical Study

Introduction: While placing the Proseal-laryngeal Mask Airway (PLMA) using the digital technique, there may be failed insertion or inadequate ventilation. Therefore, a placement technique using the Gum Elastic Bougie (GEB)-aided placement was employed. Aim: To compare the clinical efficacy of Proseal Laryngeal Mask Airway (PLMA) insertion by two different techniques viz. Digital and Gum elastic bougie-aided, in mastoid surgery in adult patients done under General Anaesthesia. Materials and Methods: In this randomised clinical study conducted at the Department of Anaesthesiology, R.G. Kar Medical College, Kolkata, West Bengal, India from November 2016 to December 2022. A total of 88 patients of American Society of Anaesthesiologists (ASA) class I and II of either sex undergoing mastoid surgery using the PLMA as an airway management device were allocated to Digital (Group D) and gum elastic Bougie (Group B) techniques. Parameters studied included the percentage of successful insertion of PLMA on the first attempt, number of attempts required and time taken for successful insertion of PLMA and postoperative complications if any. The t-test was used to compare the groups regarding PLMA insertion time, while categorical data such as airway trauma was compared using Chi-square test or Fischer’s-exact test (whichever applicable). Results: In the present study 88 patients were included, with 44 patients in each of the two groups. The difference in Mallampati scoring of both groups was statistically insignificant. In the present study 68.18% patients in Gum elastic bougie group and 70.45% patients in Digital group were of ASA Grade I, showing no statistical significance between these two groups regarding ASA status. In Group B (GEB), PLMA was successfully inserted in 95.45% of cases on the first attempt, and in group D (digital) the corresponding figure was 77.27% and 22.72% of cases required a 2nd attempt, this difference was statistically significant (p-value <0.001). The difference of PLMA insertion mean time was statistically significant between the two groups (24.33±3.209 seconds in gum elastic bougie group whereas in digital group it was 13.42±3.228 seconds) (p-value <0.001). Conclusion: The GEB-aided Proseal-LMA insertion is more successful in the first attempt than in the digital technique. Although GEB-aided insertions of PLMA took longer, they helped achieve higher oropharyngeal leak pressure. With peak airway pressures less than 20 cm of H₂O there was no audible leak from the drain tube and there were fewer failed insertions.

Evaluation of Risk Factors, Clinical and Angiographic Profile of Young Patients with Acute Coronary Syndrome: An Observational Study

Tanmay Mukhopadhyay, Dipankar Ghosh Dastidar, Sandipan Sarkar, Uttam Biswas

Introduction: The incidence of Acute Coronary Syndrome (ACS) in the young population has begun to rise. There is not enough data regarding the characteristics of young patients with ACS. Aim: To evaluate risk factors, clinical and angiographic profile of young patients with ACS. Materials and Methods: A prospective observational study was conducted from December 2017 to December 2020 at SSWH, Burdwan Medical College and Hospital, Burdwan, West Bengal, Kolkata, India among 100 patients. Patients with ACS and aged ≤45 years were enrolled in the study. Patients were divided into two groups: patients with and without obstructive Coronary Artery Disease (CAD). Clinical parameters and coronary angiography data were collected and analysed. The p-value <0.05 was considered significant. Results: The mean age of the study participants was 37.42±5.18 years, and 82 (82%) participants were male. Smoking was the most common risk factor observed in 71 (71%) of the study population, and the majority of these patients had obstructive CAD. The young population suffered more with a high incidence of ST-segment Elevation Myocardial Infarction (STEMI), with 37 (56.06%) had Anterior Wall Myocardial Infarction (AWMI). When analysed angiographically, Obstructive CAD was most commonly found 82 (82%); among those with obstructive CAD, Single-vessel diseases were predominant in 47 (47%) individuals. The percentage of stable angina was significantly higher among patients with obstructive CAD (53.6%) compared to non obstructive CAD (11.1%), (p=0.001). Conclusion: Two leading risk factors, smoking, and tobacco, were significantly associated with the onset of young ACS. The prevalence of single-vessel disease was higher in young patients with ACS compared to double and triple-vessel disease.

Synergistic Potential of Methotrexate and Gefitinib: A Promising Palliative Approach for Advanced and Recurrent Head and Neck Cancers

Tabassum Samani, Arun Kumar Yadav, Deepanshi Jain, Utkarsha Singh, Roopali

Introduction: Head and Neck Cancers (HNCs) in India account for 30% of all cancers, out of which 60-80% of patients present with advanced disease, leaving the patients with limited survival and poor Quality of Life (QoL). Poor nutritional conditions, advanced disease presentation, limited tolerance, and socio-economic constraints necessitate the development of appropriate and effective palliative treatment options that are also easily available. One such palliative approach has been explored, and its relevance and applicability are discussed here. Aim: To study the role of weekly intramuscular injection Methotrexate (MTX) along with oral Tablet Gefitinib in advanced unresectable, recurrent, or residual HNCs. Materials and Methods: A retrospective analysis of 50 patients was carried out in the Department of Radiation Oncology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India. All patients included had advanced HNC and were ineligible for curative treatment. All received weekly intramuscular injection MTX 40 mg/m2 and Tablet Gefitinib administered orally in a dose of 250 mg once daily. These patients were assessed for tumour response, acute toxicities, symptomatic relief, and median survival. All the data were recorded in Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) software version 28.0. Results: This study included 50 patients (45 males, 5 females) with a mean±SD age of 49±8.8 years, all diagnosed with histologically confirmed squamous cell carcinoma, predominantly at stage 3 (six patients) and stage 4 (44 patients). Median survival was 5.9 months. According to RECIST (Response Evaluation Criteria in Solid Tumours) criteria, no complete responses were observed; 18 (36%) had a partial response, 21 (42%) had stable disease, and 11 (22%) had progressive disease. The treatment was well-tolerated, providing notable relief in pain and dysphagia symptoms. In terms of toxicity, grade-3 mucositis was observed in 10 patients, and none had grade-4. Grade-3-4 neutropenia and anaemia were seen in six and eight patients, respectively. Conclusion: The use of MTX and gefitinib combination in advanced HNCs has the potential to substantially alleviate pain, provide symptomatic relief concerning dysphagia and speech, and hence improve the overall QoL.

Development, Validation and Reliability of Comprehensive Primary Dysmenorrhoea Scale: A Research Protocol

Ankita Sharma, Sunita Sharma, Subhasish Chatterjee, Sarita Yadav, Simmanjit Kaur

Introduction: Primary Dysmenorrhoea (PD) is a common disorder in both young and adult females which is characterised by cramps that start immediately before or at the beginning of menstruation in the lower abdomen and are spasmodic and painful in nature, without any pelvic pathology. PD has a serious detrimental effect on quality of life and productivity in terms of health. Need of the study: To the best of author’s knowledge, there is no specific scale meant to extensively assess the overall physical, social, psychological and nutritional status of females with PD and evaluate the quality of life, therefore, a comprehensive tool is required to resolve these issues and capture a comprehensive overview of the typical distress encountered during menstruation. Aim: To develop the items and domains, estimate its content and concurrent validity as well as assess intra-rater and test-retest reliability of the scale, which comprehensively assesses physical, social, psychological and nutritional status of females with PD and determine their quality of life. Materials and Methods: The present study is a cross-sectional study, that will be conducted at General Outpatient Department (OPD), Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India from April 2023 to March 2024. It consists of three phases. First phase comprises of the scale development procedure which includes generation of domains and items. Second phase is to validate the scale. This phase includes content validation through Delphi method as well as evaluation of criterion (concurrent) validity. Third phase consists of assessing intra-rater and test-retest reliability of the scale.

The Effect of Probiotic Supplementation on the Levels of Biomarkers in Diabetic Animal Model: A Research Protocol

Introduction: Type 2 Diabetes Mellitus (T2DM) is characterised by hyperglycaemia, insulin secretion defects, or resistance. Most T2DM drugs help to improve glycaemic status, but the response varies among individuals. The modern lifestyle with unhealthy eating habits leads to gut dysbiosis. Altered gut microbiota can disrupt the host’s metabolic and signaling pathways, intestinal barrier integrity, and function. Probiotics could restore a healthy microbiota in the intestine, thus improving glycaemic status. Need of the study: Probiotics may assist in re-establishing a healthy microbiota composition in the intestine. Limited studies have evaluated the supplementation of probiotics for effectively managing T2DM. Aim: To investigate the effects of probiotics on biomarker levels in type 2 diabetic male Wistar rats. Materials and Methods: This interventional case-control study will be conducted at the Centre for Toxicology and Developmental Research (CEFTE) at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. The study will involve 46 male Wistar rats divided into five groups. Diabetes will be induced by feeding the animals a High-Fat Diet (HFD) and administering a low dose of Streptozotocin (STZ) injection. Groups 1 and 2 will be on basal and HFDs, serving as negative and positive controls, respectively. Groups 3, 4 and 5 will be the intervention groups. The study duration will be four weeks and three days for diabetes induction and six weeks for intervention. Blood samples will be collected periodically to assess biomarkers, and at the end of the study, internal organs will be harvested for histopathological examination. Institutional Ethics Committee (IEC) approval has been obtained. Categorical variables will be analysed using Chi-square or Fisher’s exact test, while continuous variables will be analysed using repeated measures Analysis of Variance (ANOVA). A p-value of ≤0.05 will be considered statistically significant, and statistical analysis will be performed using Statistical Package for Social Sciences (SPSS) version 16.0.

Effect of Proprioceptive Neuromuscular Facilitation Technique on Balance in Stroke Patients: A Narrative Review

Siva Sankar Kalita, BC Sarma, Simi Hazarika, Abhijit Dutta

Stroke, or Cerebrovascular Accident (CVA), is a condition that impairs the brain by rupturing blood vessels or by obstructing blood arteries with blood clots, causing a significant deterioration in the patient’s functioning and worsening their Quality of Life (QOL). Stroke patients are prone to falls and fall-related complications after a stroke, which are associated with balance disorders leading to activity limitations, increased dependency, affecting social and community participation, QOL, longer treatment duration, and slow prognosis. Balance disorders and fall risks after a stroke hinder stroke rehabilitation, so it is essential to improve balance for better results in stroke rehabilitation. Over the last decade, the Proprioceptive Neuromuscular Facilitation (PNF) technique has shown potential for improving balance in stroke patients. A systematic literature search was conducted, and the findings were critically reviewed and thematically analysed.

A Brief Review of Varicose Veins in the Upper Limb from an Ayurvedic Perspective

Shubham Bobade, Sheetal Asutkar, Amar Kadav

Varicose veins typically occur in the lower limbs, caused by valvular insufficiency leading to the swelling and tortuosity of subcutaneous veins. Although rare in the upper limbs, they can be successfully diagnosed and treated. Rare causes include congenital vascular anomalies like Klippel-Trenaunay syndrome and Parkes Weber syndrome, characterised by Arteriovenous (AV) fistulae. Subclavian vein thrombosis-induced venous outflow obstruction is another uncommon cause. Diagnosis involves a thorough history taking with clinical examination, often supplemented by investigations. Invasive procedures are rarely necessary but may be used in unique cases to define the pathology further. Treatment for upper limb varicose veins closely mirrors lower limb approaches. The stab-avulsion technique combined with stripping of lengthier sections yields outstanding cosmetic and functional results. Surgical ligation with stripping effectively eliminates varicosities with a low risk of recurrence. Sclerosing agents like Sodium Tetradecyl Sulphate and Polidocanol are substitutes for surgery. In cases of varicosities resulting from upper limb arteriovenous fistulae, surgical intervention involving ligation of the distal venous limb or division of the fistula is the standard approach. In summary, while upper limb varicose veins are exceptionally rare, they can be accurately diagnosed and effectively treated with surgical interventions similar to lower limb varicose veins.

Harnessing the Power of Ayurveda for Diabetes Management: A Narrative Review

Naveen Singh, Devyani Dasar

Ayurveda, an age-old medical tradition originating from India, provides a comprehensive method for addressing diabetes mellitus. Diabetes, marked by increased blood sugar levels, is a persistent metabolic condition posing a widespread health challenge worldwide. Ayurveda, drawing upon principles of balance and individualised treatment, addresses diabetes through a multifaceted lens. In Ayurveda, diabetes is classified under the term “Madhumeha,” where an imbalance in the body’s doshas (Vata, Pitta, and Kapha) disrupts the normal functioning of the pancreas and impairs insulin production. The approach to diabetes management in Ayurveda involves a personalised assessment of an individual’s constitution (Prakriti) and the identification of imbalances (Vikriti). Lifestyle modifications, dietary changes, herbal supplements, and therapeutic practices like yoga and meditation are integral components of Ayurvedic interventions. Plants like bitter melon (Momordica charantia), fenugreek (Trigonella foenum-graecum), and turmeric (Curcuma longa) are essential components in Ayurvedic remedies designed to address diabetes. These herbs are believed to have hypoglycaemic properties, helping regulate blood sugar levels. Additionally, practices like Panchakarma, a detoxification process, are employed to eliminate toxins and restore balance in the body. Ayurveda emphasises the importance of maintaining a sattvic (balanced) lifestyle, incorporating mindful eating habits, regular exercise, and stress management. While Ayurvedic interventions for diabetes have shown promise, it is essential to consult qualified practitioners to ensure personalised and safe approaches. As the global burden of diabetes continues to rise, exploring complementary strategies like Ayurveda provides a holistic perspective on diabetes management that aligns with the principles of balance and wellbeing.

Recent Trends and Scope of Nanotechnology in Orthopaedic Surgery: A Narrative Review

Shri Hari S Pol

Orthopaedic implants osseointegrate better using nanophase materials because they mimic the natural trabecular bone structure better. Additionally, prostheses with nanophase coatings can lessen bacterial adherence compared to prostheses with traditional surfaces. Improved osseointegration and infection prevention may be possible with nano-coated joint replacement implants. Other potential applications with strong in-vitro findings include rapidly integrating fillers for osteochondral flaws, antitumour selenium-coated endoprostheses, along with potent targeted Drug Delivery Systems (DDSs) for infection prevention and treatment of chronic overuse injuries. It is significant to focus on the use of nanotechnology in artificial joint replacement prostheses, drug delivery utilising nanotechnology, surgical oncology of the skeleton using nanotechnology, bone cell function using nanotechnology, applications in orthopaedic surgery, and, finally, the use of nanotechnology and its potential new fields of study for human welfare. Before nanophase devices are approved for clinical use, significant progress must be made in comprehending the potential health concerns associated with their creation, implantation, and usage habits. However, they have a lot of potential and will probably be helpful to all of us in the future. Nanotechnology is a fast-advancing area, and its applications in orthopaedic surgery are continually expanding. This review article enables academics, clinicians, and other stakeholders to stay up-to-date on the most recent advancements, innovations, and achievements in the integration of nanotechnology into orthopaedic operations. The article also focuses on the challenges of applying nanotechnology in orthopaedics, such as biocompatibility issues, regulatory hurdles, and financial considerations. Simultaneously, it can discuss potential avenues for further research, collaboration, and progress in overcoming these challenges. Discussing the practical applications and clinical consequences of nanotechnology in orthopaedic surgery is crucial. The evaluation can explore on how these improvements will affect patient outcomes, surgical techniques, and overall healthcare practices.

Incidence and Screening of Retinopathy of Prematurity in Africa: A Systematic Review

Elizabeth Ndunge Mutua, Bernard Shibwabo Kasamani

Introduction: Retinopathy of Prematurity (ROP) significantly contributes to the statistics of blindness among babies born prematurely. Population-based studies of the disease in Africa is scanty with many African countries lacking screening guidelines. Aim: To review the current statistics of ROP in Africa and present a summary of the incidence as well as the disease screening criteria within Africa. Materials and Methods: An in-depth literature search was done on various databases following the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for systematic review protocols. Some keywords guiding the search were “ROP,” “Retinopathy,” and “screening.” The International Prospective Register of Systematic Reviews (PROSPERO) registration (522296) was done, and databases were screened from inception up to December 2023 via African Journals Online (AJOL), Science Direct, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Ovid, and Medline. The inclusion criteria were English language studies about disease screening published from inception up to December 2023. Studies that did not include the number of babies screened or ROP screening criteria used, case studies, and duplicated studies were excluded. The Anatomical Quality Assessment tool (AQUA) was applied to confirm any bias and for reporting study results. Results: A total of 15 articles were included, with sample sizes ranging from 33 to 424 participants. Two countries (Kenya and South Africa) have national screening guidelines, while for the rest of the countries in Africa, ROP is screened as per on the agreement of the ophthalmologists at each hospital. Conclusion: The present review highlights the fact that ROP is the leading cause of blindness globally, yet there is little research being done on the statistics and screening of the disease. Many countries in Africa do not have national screening guidelines for the disease, which is a great challenge.

A Complex Interrelationship of Childhood Obesity, Dental Caries and Malocclusion Amidst the COVID-19 Pandemic and Social Media Amplification: A Narrative Review

Swagata Saha, R Manju

Recent research has highlighted the link between childhood obesity, dental caries, and malocclusion, and how the Coronavirus Disease - 2019 (COVID-19) pandemic and social media have worsened these health issues. Increased screentime and decreased physical activity during the pandemic have significantly contributed to these conditions among children. Studies emphasise the need to address common risk factors such as unhealthy diets, limited healthcare access, and poor public health policies to reduce their negative effects. This review explores the complex relationship between childhood obesity, dental caries, and malocclusion, with a focus on their global importance. It examines the connections and shared risk factors between these conditions, particularly in the context of the pandemic and the growing influence of social media on children. The goal is to provide insights for developing effective interventions and management strategies to improve children’s health worldwide. The present review stresses the urgent need for comprehensive strategies that target both individual and collective risk factors, while also considering broader socio-economic and digital influences on children’s health behaviours. Promoting healthy lifestyles, access to nutritious foods, physical activity, and better dental care can help to alleviate these conditions. Understanding the interplay between these health issues and the digital environment is crucial to creating effective and adaptable public health interventions.

Retrievability of Bioceramic Sealers Assessed using Micro-computed Tomography and Scanning Electron Microscopy: A Literature Review

Faisal Alnassar

Endodontic retreatment is a procedure to remove root canal filling material from the tooth, followed by cleaning, shaping, and obturation of the canals. Treatment outcomes may be influenced by incomplete removal of filling materials. The present literature review aimed to identify the techniques and materials used to remove Bioceramic Sealers (BCS) from the root canal system using Micro-Computed Tomography (Micro-CT) and Scanning Electron Microscopy (SEM). A search of the PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases using applicable keywords such as “BCS” and “calcium silicate-based sealer” and “retreatment” and “retreatability” and “micro-CT” and “SEM” identified studies on techniques and materials used to remove BCSs from the root canal system, as assessed by micro-CT and SEM. A total of 46 studies were included in the review. Of these, 32 studies used Nickel-titanium (NiTi) rotary instruments, 11 used reciprocating systems, and three compared continuous nickel-titanium rotary and reciprocating systems with rotary systems and reciprocation in removing filling materials. Apical patency and Working Length (WL) could be achieved in a canal obturated with gutta-percha and a BCS. The review revealed that removing filling materials using various instrumentation protocols can be successful but incomplete. Both rotary and reciprocating systems can efficiently remove root-filling material. Using supplemental techniques can improve the cleanliness of the root canal during retreatment. Solvents require less time to reach the WL and achieve patency; however, they leave a larger amount of residual root canal-filling material than non solvents. Additionally, the formation of dentinal microcracks remains controversial during the non surgical retreatment of canals filled using BCSs.

Exploring the Legitimisation of Cannabis: A Narrative Review of Historical Uses, Legislative Changes and Medical Implication

Priyanshu Raj, Bhagyesh Sapkale, Sangita Jogdand

The exploration of cannabis, particularly its legitimisation and multifaceted uses, is pivotal in understanding its historical significance, chemical composition, therapeutic potential, and societal implications. This narrative review traverses millennia of cannabis usage for medicinal, recreational, and spiritual purposes, juxtaposed with contemporary legislative shifts, notably in the United States. As perceptions evolve, especially with state-level legalisation contrasting federal prohibition, the review scrutinises the burgeoning use of cannabis products, particularly among youth, and the evolving regulatory frameworks. Neurological effects of cannabis use, including impacts on brain structure and function, are examined alongside potential benefits and risks in various medical contexts. Challenges in conducting rigorous clinical research, primarily due to legal and pharmaceutical constraints, are outlined. The review delves into the complexities of cannabis usage during pregnancy and the conflicting scientific data, presenting challenges in advising expectant mothers. Cannabis’ diverse applications in treating various disorders, ranging from chronic pain to neurological conditions, are explored, shedding light on the potential benefits and limitations. The review highlights the pharmacological dynamics and clinical implications of cannabis-based therapies, emphasising the need for further research to elucidate their efficacy and long-term safety comprehensively. Moreover, the review discusses the pros and cons of CB therapy with high-Cannabidiol (CBD) medicinal cannabis, addressing challenges such as product quality, safety concerns, potential psychoactive effects, drug interactions, and limited research. It underscores the importance of informed decision-making and personalised guidance in navigating the complexities of CB therapy. In conclusion, while cannabis exhibits a wide range of potential medical applications, further research is essential to fully comprehend its therapeutic potential and weigh the associated risks. The review contributes to informed discourse and evidence-based policymaking, emphasising the need for continued research to unlock the full potential of cannabis in healthcare.

Artificial Intelligence and Digital Pathology: A Narrative Review on Advancements and Opportunities for Improved Diagnosis and Treatment

Recent advancements in Digital Pathology (DP) have empowered pathologists to provide more accurate diagnosis through digital means. Whole-slide Imaging (WSI) technology has enabled the digital scanning, representation, and preservation of numerous tissue slides, while Artificial Intelligence (AI), image analysis, and Machine Learning (ML) have enhanced disease diagnosis accuracy. There is a growing acceptance of the transition from traditional glass slide histopathological diagnosis to AI-assisted diagnosis using digital slides, driven by the substantial data accumulation that demands computer-aided analysis. Maximising the potential of AI breakthroughs in DP is critical, offering significant research opportunities across related fields. DP offers significant potential for telepathology, second opinions, and educational purposes. Additionally, it presents substantial research opportunities in image computing due to its vast reservoir of data. Pathologists have discerned characteristics beyond the naked eye’s perception by analysing “sub-visual” images using DP. The flexibility of workflow provided by DP will be the main reason for its widespread adaptation and acceptance. DP also has the potential to be an essential tool to maintain operations of the pathology department in case of public health emergencies, which will streamline, fast-track, and improve patient care. Given the expanding accessibility and prevalence of the internet, it is crucial to develop innovations like DP. This technology catalyses enhancing patient care, opening avenues for further advancements in healthcare delivery. The purpose of present review was to bring to light the great potential that DP encompasses to improve diagnosis and treatment planning, which will ultimately lead to better patient care. However, integrating DP systems necessitates collaboration from various stakeholders beyond the Pathology Department. Despite evident advantages, several challenges must be addressed for the successful implementation and mass acceptance. Therefore, this narrative review aimed to illuminate the substantial potential inherent in DP for enhancing both diagnosis and treatment planning processes, consequently fostering improvements in patient care and also understanding DP, highlighting its challenges and opportunities. It also delves into the role of AI, image analysis, and ML in aiding disease diagnosis and reporting. With social distancing measures in place during the Coronavirus Disease -2019 (COVID-19) pandemic, pathologists were able to remotely access and analyse DP images, further cementing the importance of DP in current scenarios.

Clinical Care Pathways for Management of Common Complications of Pregnancy: A Narrative Review

India is a vast and diverse country with a complex healthcare scheme that faces significant challenges in providing quality care to its population. Obstetric care is a complex area of healthcare. The history of clinical care pathways in obstetric care reflects a continued effort to improve the quality and safety of healthcare for mothers and infants. This comprehensive review provides an overview of clinical care pathways in obstetric care. It sheds light on the current evidence supporting the use of clinical care pathways for the management of anaemia during pregnancy, Gestational Diabetes Mellitus (GDM), pre-eclampsia, and Preterm Labour (PTL). The primary aim of this review is to recognise the accessibility and strength of evidence for the use of clinical care pathways in the management of common complications of pregnancy.

Role of FDG-PET Radiomics in the Diagnosis of Cardiovascular Inflammation: A Narrative Review

Nora Almuqbil

Cardiovascular inflammation plays a key role in atherosclerosis and other cardiovascular complications, highlighting the importance of accurate detection methods. While traditional diagnostic tests have limitations in specificity and timing, 18-Fluoro-Deoxyglucose-Positron Emission Tomography (FDG-PET) imaging offers a non invasive approach to visualise inflammation. Radiomics, the extraction of quantitative features from medical images for analysis with machine learning algorithms, presents an opportunity to enhance the diagnostic accuracy of FDG-PET imaging in detecting cardiac inflammation. Studies investigating radiomics in various cardiovascular inflammatory conditions, including Cardiac Sarcoidosis (CS), Infective Endocarditis (IE), and active aortitis, have shown promising results in improving diagnostic performance. The review discusses the challenges and potentials of radiomics in cardiovascular imaging, emphasising the need for standardisation and validation in advancing personalised diagnosis and treatment strategies for cardiovascular inflammation.

Planetary Health Interventions and the Need for a Unified Global Informatics Tool: A Narrative Review

Planetary Health emphasises the sustainability of natural systems for human well-being, linking human health directly with environmental health. This interdisciplinary concept has gained importance as anthropogenic activities have led to climate changes and health impacts. Despite efforts, a cohesive approach to planetary health from local to global levels remains lacking. The present review analysed 24 sources, including grey literature and published studies, identifying 40 interventions aimed at improving planetary health. The majority of research, primarily from the United States, focuses on reducing air pollution and greenhouse gas emissions. Effective strategies highlighted include promoting active transportation, improving diets, increasing physical activity, and engaging with indigenous communities to protect both environmental and human health. However, a significant gap exists in integrating these interventions through a unified informatics tool, which could enhance coordination and implementation of planetary health measures globally. The review underscores the necessity for a more integrated approach and the development of a global database to consolidate and manage planetary health interventions effectively.

A Case of Aneurysmal Bone Cyst of Fourth Metacarpal Bone: A Rare Entity at Unusual Location

Ajit Kumar Singh, Madhusmita Mohanty, Urmila Senapati

An Aneurysmal Bone Cyst (ABC) is a locally aggressive, rapidly growing, rare benign bone tumour that typically occurs in children and early adulthood. It usually occurs in the first and second decades of life, with a female predominance. The long bones of the lower extremities and spine are common sites for ABC, with rare involvement of the small bones of the hand. An 18-year-old female presented to the hospital with progressive swelling over her left hand for 4 to 5 months, associated with pain. Local examination elicits pain and tenderness over the 4th metacarpal bone with restricted movement at the Metacarpophalangeal (MCP) joint. A histopathological diagnosis of ABC was made due to the presence of osteoclastic giant cells lining a cyst, along with areas showing a pool of haemorrhage and stromal cells. The postoperative period remained uneventful, with no complaints of pain and good healing of the operation site noted during follow-up. Metacarpal bones are rare sites for ABCs.

Complex Traumatic Degloving Facial Injury with Multiple Maxillofacial Fractures: A Case Report

Pulkit Khandelwal Harish Saluja, Seemit Shah, Anuj Dadhich

Reconstructing mutilating soft-tissue injuries, lacerations, and extensive degloving injuries of the face is a very challenging and exacting task, It becomes more challenging and difficult if these types of injuries are associated with maxillofacial fractures. Such injuries require meticulous treatment and care; inadequate and poor treatment may lead to grotesque unsightly deformities, with inevitable physiological and psychological ill-effects. It requires a staged treatment method for optimal and successful aesthetic and functional outcomes. Meticulous anatomic repositioning of soft tissues as well as hard tissues, and proper postoperatively gives good aesthetic and functional results. The present article presents a case of 45-year-old male patient of a complex traumatic degloving soft-tissue injury along with multiple facial bone fractures, detailing the measures taken to prevent necrosis and infection through surgical debridement, internal fixation of maxillofacial fractures, and timely restoration of vital soft-tissue elements in position. Following a road traffic accident, the patient was diagnosed with a frontal bone fracture, Lefort-II fracture with a comminuted parasymphysis fracture of the mandible, and a degloving injury to the lower lip. Open Reduction and Internal Fixation (ORIF) were performed for the mandibular fracture, and an autologous cancellous bone graft from the anterior iliac crest was grafted to bridge the gap between fractured segments. Intermaxillary Fixation (IMF) (Closed reduction) was done for the midface fracture. Meticulous multiple-layered suturing was performed for the degloving soft-tissue injury. After three months, there were no complications, and the patient was satisfied with no functional or aesthetic deficits.

Ayurvedic Management of Mansik Avasaad (Depressive Disorder): A Case Report

Annya Gautam, Madhvi Jain, Vinod Ade, Shweta Parwe

Depression is a significant mental health issue that will impact most people’s lives in one way or another. It can diminish someone’s quality of life and have a negative impact on their ability to work and maintain relationships. The worst case scenario for severe depression is suicide. There still exists a societal stigma around depression due to its prevalence, suffering, dysfunction, morbidity, and financial burden. Currently, 80% of individuals with depression are not receiving any treatment. Historical ayurvedic literature sporadically mentions depression as both an illness (manasika vyadhi) and an emotional state. The purpose of the study was to assess the comprehensive Ayurvedic management strategy for depressive disorder. Here the authors discusses a case that involves a 23-year-old male patient presenting with chief complaints of poor concentration, weight loss, and social withdrawal. He was treated using ayurvedic principles such as Sarvang Snehan, Baspa Sweda, Shirodhara, and Shamana Chikitsa. After 15 days, the patient’s symptoms were re-assessed, resulting in a satisfactory outcome and an overall improvement in his life. The combination of snehan, swedana, shirodhara, and Shaman chikitsa significantly facilitated the management of depression.

Endoscopic Findings of Oozing Gastric Hamartomatous Polyps: A Rare Cause of Upper Gastrointestinal Bleeding

Kamlesh Taori, Vijendra Kirnake, Ravi Daswani, Vishal Padwale, Sourya Acharya

Gastric hamartomatous polyps are infrequent benign lesions of the stomach, typically discovered incidentally during endoscopy. Upper Gastrointestinal Bleeding (UGIB) is a commonly encountered medical emergency, often caused by peptic ulcers, esophageal varices, or gastritis. However, in some rare instances, the bleeding source may be attributed to gastric hamartomatous polyps. The authors here present a case of a 64-year-old male patient who presented with generalised weakness, dizziness, loss of appetite, and constipation. Laboratory tests revealed microcytic hypochromic anaemia. Stool for occult blood was positive. Initial evaluation, including laboratory tests and imaging studies, was inconclusive for the source of the UGIB. Therefore, endoscopy was performed, which revealed multiple small sessile polyps of approximately 0.5-1 cm in the body of the stomach along the greater curvature, which were oozing blood spontaneously. Histopathological examination of the polyps revealed their hamartomatous nature. The patient was diagnosed as a case of chronic constipation with microcytic hypochromic anaemia with hamartomatous gastric polyp. The bleeding was successfully controlled through endotherapy with endoscopic injection of epinephrine (1:10,000) injected at the site of the ooze. Due to the rarity of this condition, the diagnosis was challenging and required a high index of suspicion. Physicians should consider this entity in the differential diagnosis of UGIB. This case highlights the importance of considering hamartomatous polyps as a potential source of UGIB and demonstrates the efficacy of endoscopic treatment for both diagnosis and management. Awareness of this rare entity can aid in prompt recognition and appropriate therapeutic interventions to prevent potential life-threatening complications.

Effect of Sodium Benzoate as an Add-on Therapy on the Clinical and Cognitive Symptoms of Schizophrenia: A Case Series

Robin Victor, Priyaranjan Avinash, Rachit Singhania

Schizophrenia is understood as a construct of positive, negative, and cognitive symptoms. There has been considerable proof at a genetic, biochemical, and pharmacological level to support that N-methyl-D-aspartate Receptor (NMDAR) hypofunction is a key factor in the development of clinical and cognitive symptoms of schizophrenia. While most antipsychotics improve positive symptoms of schizophrenia, the negative and cognitive symptoms have usually been much more difficult to treat and have been associated with poor prognosis, poor functional outcome, and long-term morbidity. Sodium benzoate is a molecule that targets D-amino Acid Oxidase (DAAO) and competitively inhibits it, thus acting as an NMDAR agonist. With this background, we started using sodium benzoate as an adjuvant along with the ongoing antipsychotics in certain patients with schizophrenia to observe the change in clinical and cognitive symptoms. The authors have compiled a case series of 12 such patients. They found an improvement ranging from 17% to 21.5% in the Positive and Negative Syndrome Scale (PANSS) score and 19% to 32.5% in the Mini-mental State Examination (MMSE) Score after six weeks of administration of sodium benzoate as an add-on agent. None of the patients reported any adverse effects after six weeks. Thus, sodium benzoate as an add-on treatment can act as a neurocognitive enhancer as well as a novel antipsychotic that can bridge the gap in the treatment of schizophrenia.