Journal of clinical and diagnostic research

Haemorrhagic Cystitis in a Case of Secondary Pelviureteric Junction Obstruction: A Rare Case Report

Haemorrhagic cystitis ranges in severity from a transient condition to a life-threatening condition which may quickly resolve or require intervention on a priority basis. It is characterised by bleeding from the bladder mucosa and diffuse inflammation. Case of fungal haemorrhagic cystitis with secondary Pelviureteric Junction Obstruction (PUJO) is relatively rare. Hereby, the authors present a case of 57-year-old male who presented to Emergency Department with painful haematuria and increased frequency of micturition, found to have bladder clots and right secondary PUJO on diagnostic investigation. Clot evacuation and bleeder fulguration with right Double J (DJ) stenting was done. Urine culture and sensitivity report was suggestive of budding yeasts. Uncontrolled diabetes mellitus, with an HbA1c of 8.1%, could explain it. He was discharged on postoperative day two with oral cephalosporins and oral antifungals with Foley catheter in-situ. It was followed by Diethylene Triamine Penta Acetic Acid (DTPA) scan 15 days later, which revealed an enlarged, poorly functioning hydronephrotic obstructed right kidney with Glomerular Filtration Rate (GFR) of 5.7 mL/min, and satisfactorily functioning hydroureteronephrotic left kidney with GFR of 54.6 mL/min. Right open simple nephrectomy was done through the 11th rib flank incision to prevent future complications. Haemorrhagic cystitis should be kept as a differential diagnosis in patients with haematuria not responding to conservative management with multiple co-morbidities. Management of underlying cause remains the key to treatment.

Familial Occurrence of Mycoplasma-induced Rash and Mucositis: A Case Report of Two Siblings

Mycoplasma pneumoniae is a common pathogen responsible for respiratory infections, including community-acquired pneumonia, and up to 25% of patients develop extrapulmonary complications. Mycoplasma-Induced Rash and Mucositis (MIRM) is a recently identified clinical entity typically preceded by pneumonia-like symptoms such as fever and cough. The differential diagnoses for MIRM include Erythema Multiforme (EM), Stevens-Johnson Syndrome (SJS), Herpetic gingivostomatitis, Kawasaki disease and Toxic Epidermal Necrolysis (TEN). This condition primarily affects children and adolescents, with a mean age of 12 years and shows a male predominance. The authors report a rare occurrence of MIRM in two siblings, underscoring the condition’s rarity and clinical importance. The combination of prominent mucosal involvement at two sites, with sparse cutaneous findings, preceded by a prodrome of respiratory symptoms and the absence of a drug history, raised suspicion of Mycoplasma infection, which was confirmed by positive Mycoplasma IgM antibodies. Both siblings recovered well with a macrolide antibiotic and a short course of corticosteroids. While sporadic cases of MIRM are reported, familial occurrences in siblings highlight a genetic or environmental predisposition. Early recognition is crucial, as demonstrated by its occurrence in siblings, where prompt diagnosis led to favourable outcomes. Increased awareness among physicians can aid in accurate diagnosis, appropriate management and effective counselling.

Anastomotic Strictures after Whipple Procedure: A Report of Two Cases

Whipple procedure is a major surgery performed for periampullary cancers. With improved surgical techniques and intensive care, perioperative mortality has become a rare event, occurring in less than 2% of cases; however, morbidity remains common, occurring in 30-50% of cases. Hereby, authors present a case report of two patients who were operated on for periampullary cancer and have now presented with anastomotic site strictures, hepatolithiasis and pancreatitis. Case 1 was a 58-year-old male who underwent the Whipple procedure with pancreaticojejunostomy 13 years ago for periampullary growth. The patient now presented with pancreatitis, dilated Main Pancreatic Duct (MPD), hepatolithiasis and a peptic ulcer with stricture at all three anastomotic sites. A lateral pancreaticojejunostomy, revision of hepaticojejunostomy with removal of calculi and redo gastrojejunostomy were performed using the same Roux limb. Case 2 was a 58-year-old male who underwent the Whipple procedure with pancreaticogastrostomy four years ago for a serous cystadenoma of the pancreas and presented with pancreatitis, dilated MPD and pleural effusion. The patient was diagnosed with pancreatitis due to anastomotic stricture at the pancreaticogastrostomy site and laparotomy with lateral pancreaticojejunostomy was performed. Both patients were discharged uneventfully. While individual anastomotic strictures and their management have been discussed in the literature following the Whipple procedure, Case 1, which presented with strictures at all three sites simultaneously and Case 2, which presented with pancreatitis, are noteworthy and unique. Surgery is the best approach to managing anastomotic strictures, as it offers a one-time solution.

Thoracic Anaesthesia in a Patient with Mechanical Mitral Valve: A Case Report

Shilpa Sarang Kore, Reem Barkat Khatib, Shubhangi Humane

Oesophageal diverticulum is a rare condition characterised by an outpouching of the oesophageal wall, often associated with dysphagia, regurgitation, and a risk of aspiration. Surgical resection, typically via thoracotomy, presents significant anaesthetic challenges, particularly in patients with pre-existing cardiac disease requiring One-lung Ventilation (OLV). Patients with Rheumatic Valvular Heart Disease (RVHD), Atrial Fibrillation (AF), and prosthetic mitral valves pose additional perioperative risks, including haemodynamic instability, anticoagulation management, and pulmonary complications. Hereby, the authors present case of a 49-year-old male with longstanding RVHD, Mitral Valve Replacement (MVR), and left ventricular systolic dysfunction (ejection fraction 35%) who presented with worsening dysphagia, regurgitation, and dyspnoea. Imaging confirmed a 50×49×86 mm oesophageal diverticulum with bilateral pleural effusion. Preoperative optimisation included anticoagulation management, rate control for AF, and pleural drainage. The patient underwent oesophageal diverticulectomy under general anaesthesia with a left-sided double-lumen tube and thoracic epidural analgesia. Intraoperative challenges included transient AF, hypotension requiring vasopressors and inotropes, and desaturation during OLV, all of which were managed with recruitment manoeuvres and apnoeic oxygenation. Postoperatively, anticoagulation was restarted, and the patient was extubated on day two without complications. The present case underscores the importance of meticulous perioperative planning, haemodynamic monitoring, and multidisciplinary coordination in managing complex cardiac patients undergoing thoracic surgery. A tailored anaesthetic approach focusing on oxygenation, cardiac stability, and balancing anticoagulation is crucial for optimal outcomes.

Chicken Bone in the Oesophagus: A Diagnostic and Therapeutic Challenge

Saahiti Koppolu, Anuja Satav, Rashmi Kelkar, Urmila Phad, Rashmi Prashant

Foreign body ingestion is a frequently encountered medical emergency that requires prompt evaluation and intervention. While many ingested objects pass through the gastrointestinal tract without complications, sharp foreign bodies, such as chicken bones, pose a high risk of perforation. This can lead to severe complications, including mediastinitis and abscess formation, making early diagnosis and a multidisciplinary approach essential for safe removal and improved patient outcomes. In the present case, a 49-year-old male presented to the Otorhinolaryngology {Ear, Nose and Throat (ENT)} Outpatient Department (OPD) with dysphagia, throat pain and changes in voice for two weeks. He was diagnosed with a retropharyngeal abscess, which was managed conservatively with intravenous (i.v.) antibiotics. The patient reported a history of consuming chicken before the onset of symptoms. On examination, he was haemodynamically stable. A Computed Tomography (CT) scan revealed an inverted V-shaped hyperdense foreign body penetrating the right lateral oesophageal wall and extending into the apical segment of the right upper lung lobe. A multidisciplinary team, including a pulmonologist, anaesthesiologist, ENT surgeon and gastroenterologist, opted for endoscopic removal under general anaesthesia. During the procedure, the foreign body slipped into the hypopharynx, posing an airway risk. The anaesthesiologist successfully removed the intact chicken bone using a laryngoscope and Magill’s forceps. Postoperatively, the patient was conservatively managed by ENT, kept nil per oral and discharged a week later in stable condition. The present case underscores the significance of multidisciplinary coordination in managing airway emergencies during foreign body removal.

Navigating Airway Challenges in a Case of Neurofibromatosis: An Anaesthetic Perspective

Sandip Baheti, Supriya Gholap, Amala Kale

Neurofibromatosis type 1 (NF1) often involves multisystem manifestations, including pulmonary fibrosis, hypertension and neurofibromas in the larynx and oropharynx, leading to airway challenges. This case report highlights the anaesthesia and airway management of a 48-year-old male with NF1 and a large parapharyngeal mass causing hoarseness, dysphagia and airway compromise, displacing major neck structures; he was posted for excision of the parapharyngeal mass. Indirect videolaryngoscopy during preoperative evaluation showed a funnel-shaped epiglottis, significant oedema of the surrounding tissues and a fixed left vocal cord, with a Mallampati score of IV. Fibreoptic intubation was initially planned; however, elective fibreoptic intubation might fail even with prior recognition of intraoral pathology due to grossly distorted anatomy and bleeding from trauma. Utilising the airway preparation carried out for fibreoptic intubation, videolaryngoscopy using C-MAC (Karl Storz GmbH & Co. KG, Germany) was performed to assess the feasibility of intubation under sedation and spontaneous respiration, which yielded a Percentage of Glottic Opening (POGO) score of 50%, corresponding to a Modified Cormack and Lehane grade of 2b. The possibility of pressure effects was ruled out, as the tumour was located laterally. After assessing the possibility of intubation with C-MAC, nasal intubation was successfully achieved using a size 6.5 flexometallic tube under deep sedation, following the administration of Inj. Midazolam 1 mg, Inj. Fentanyl 80 μg, and Inj. Propofol 1 mg/kg. The tumour was excised without complications and the patient was extubated uneventfully. This report emphasises the importance of preoperative planning and a stepwise, adaptable approach to airway management in such complex scenarios.

Shoulder Pain: To Think Beyond the Myo-osseous Elements: A Case Report

MJ Abhinand, B Vijayanand, Karthikeyan

Shoulder pain and weakness present a complex clinical landscape, often originating from common aetiologies such as rotator cuff tears, tendinitis and joint osteoarthritis. However, the significance of suprascapular nerve injury, particularly when associated with entrapment by ganglion cysts at specific notches, should not be ignored. This is exemplified by the case of a 22-year-old semi-skilled labourer who presented with right shoulder pain for two years, which began after trauma. He experienced muscle weakness and joint line tenderness and was diagnosed with a ganglion cyst in the spinoglenoid notch, causing suprascapular neuropathy. He subsequently underwent open decompression. This case emphasises the need to consider uncommon causes in shoulder diagnostics. Diagnostic tools such as Magnetic Resonance Imaging (MRI), Electromyography (EMG) and Nerve Conduction Studies (NCS) play crucial roles in identifying and evaluating suprascapular nerve dysfunction. While conservative management involving rest, physiotherapy and Non Steroidal Anti-Inflammatory Drugs (NSAIDs) is often the initial approach, surgical interventions, including percutaneous aspiration, open excision, or arthroscopic decompression, may be warranted in cases of non responsivenes or the presence of space-occupying lesions. This positive postoperative outcome underscores the effectiveness of timely surgical intervention when conservative measures prove insufficient. The case contributes valuable insights into the understanding and management of suprascapular nerve injuries, highlighting the necessity of a comprehensive approach for optimal patient outcomes.

Effect of Medicated Enema and Herbal Formulation over Inflammatory Biochemical Markers in Rheumatoid Arthritis: A Case Report

Vaishnavi Subhash Bodhe, Punam Gaurav Sawarkar, Gaurav R Sawarkar

Rheumatoid Arthritis (RA) is the predominant type of autoimmune inflammatory arthritis, affecting approximately 0.75% of the Indian population. It is a painful condition that impacts an individual’s overall physical and mental well-being, making daily tasks challenging. This is a single case study primarily aimed at investigating the efficacy of a medicated enema (Vaitaran Vasti) and oral herbal formulations on the inflammatory biochemical parameters of RA. The present case involves a 53-year-old female patient who was diagnosed with RA a few months ago based on clinical symptoms, such as multiple joint pain and morning stiffness throughout the body lasting for about 60 to 90 minutes. The patient was assessed based on clinical features and biochemical parameters, which are gold standard measures in conventional medicine for RA. After undergoing treatment, the patient’s quality of life improved significantly due to a substantial reduction in all clinical symptoms, including pain, stiffness, swelling, and bipedal oedema. Moreover, the values of the RA test and CRP levels were significantly reduced from 64 IU/L and 96 mg/L to 16 IU/L and 24 mg/L, respectively, after 15 days. The patient did not require oral pain relievers. Ayurvedic treatment yielded excellent outcomes in this case, especially when conventional medical options were limited. Exploring Ayurveda as a treatment avenue has provided a glimmer of hope.

Management of Chronic Granular Hypertrophic Pharyngitis (Vrunda) through Ayurveda: A Paediatric Case Report

Riya Rajendra Rathor, Renu Bharat Rathi

The inflammation of the oropharyngeal mucous membranes, known as pharyngitis, is typically caused by a bacterial or viral illness but can also be attributed to allergies, trauma, malignancy, reflux, or various toxins. One of the most prevalent causes of paediatric antibiotic prescriptions is acute pharyngitis, which accounts for 2-5% of paediatric ambulatory visits. The primary clinical features of the modified Centor Score and Fever PAIN scoring systems are largely used to diagnose the cause and severity of pharyngitis. In the present case, a 15-year-old female who had been experiencing symptoms of a foreign body sensation, chronic cough, intermittent fever, and difficulty swallowing for a year was diagnosed with chronic granular hypertrophic pharyngitis and was treated with an Ayurvedic treatment protocol. The Ayurvedic therapy used for this patient comprised oral medication, Panchakarma therapy, and Pranayama. Patient follow-up and treatment were conducted consistently on the 7th and 15th days, and dietary modifications were also advised. After following the treatment, the patient showed improvement in chronic symptoms, and Kawala therapy provided relief from the symptoms. This case study aims to demonstrate the effectiveness and importance of Ayurvedic treatment principles in treating chronic granular hypertrophic pharyngitis, or Vrunda, in a paediatric patient.

Case Report on Proliferative Periostitis of the Left Mandible: A Radiographic Diagnostic Dilemma and Work-up

Proliferative periostitis, often referred to as Garre’s osteomyelitis, is a distinct type of chronic osteomyelitis marked by the formation of new bone along the periosteal surface. This condition typically occurs in response to a low-grade, persistent infection or irritation, most commonly associated with dental infections or trauma. Early detection and addressing the underlying cause of the infection are crucial for successful management and positive outcomes. Hereby, the authors present a case of a 13-year-old male diagnosed with proliferative periostitis, in whom no evident source of infection could be identified, presenting a diagnostic challenge. Authors highlight the importance of using various radiographic techniques to facilitate a prompt diagnosis, which prevented unnecessary treatment delays and invasive procedures.

Concurrent Trigeminal Neuralgia and Hemifacial Spasm due to Anterior Inferior Cerebellar Artery Tortuosity: A Rare Case Report

Ankita Thakur, Paresh Korde, Abhiram Sai, Prachi Wankhade

The Anterior Inferior Cerebellar Artery (AICA) plays an important role in the pathophysiology of both Hemifacial Spasm (HFS) and Trigeminal Neuralgia (TN). The AICA follows a tortuous course, which may affect the facial nerve and trigeminal nerve by compressing these structures. This compression is the common underlying aetiology for both TN and HFS. To date, TN remains an idiopathic condition that is hypothesised to be caused by an underlying irritative lesion involving the trigeminal ganglion. TN is characterised by paroxysmal, lancinating, unilateral pain, often localised along the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve. In contrast, HFS manifests as involuntary, irregular, or tonic contractions of the facial muscles. It typically begins in the orbicularis oculi and progressively spreads to involve the perioral, platysmal and lower facial muscles. Unlike TN, HFS persists even during sleep and worsens over time. The present case report discusses a 65-year-old male who presented a rare combination of TN characterised by continuous pain and HFS; the concomitant occurrence of both conditions is unique in itself. The present case demonstrates how a dilated, tortuous AICA loop causes a particularly peculiar presentation in a patient, involving both TN and HFS, along with the surgical management and treatment that facilitated a good prognosis for the diagnosis. Additionally, it highlights the rarity of these manifestations stemming from a single aetiological agent, specifically a dilated Anterior Inferior Cerebellar Artery (AICA) loop. Furthermore, it underscores the importance of early diagnosis, neuroimaging and timely surgical intervention, particularly when addressing uncommon neurovascular conflicts that manifest with overlapping cranial neuropathies.

Beyond Classification: A Unique Case of Mullerian Malformation Featuring a Normal Uterus with the Absence of Unilateral Ovary and Fallopian Tube

Kamlesh Chaudhari, Sravya Gudapati, Apoorva Dave, Deepti Shrivastava

Müllerian malformations represent a range of genetic conditions impacting the female reproductive tract, often posing diagnostic and therapeutic challenges. According to the reports, these anomalies cause the Müllerian ducts to abruptly form during foetal development. Müllerian ducts are related to the normal formation of reproductive internal and exterior organs in the females. This is a case of a 29-year-old female with a major complaint of primary infertility, for the past 10 years. The patient was screened by ultrasonography and hormonal profile along with the husband’s semen analysis. On further evaluation, a unilateral absence of the left fallopian tube and ovary was noted, with the presence of a normal uterus, which defied current classification systems for Müllerian anomalies. This case highlights the complexity and diagnostic dilemmas associated with Müllerian malformations, emphasising the importance of a multidisciplinary approach and personalised management strategies in such cases.

Anaesthetic Considerations in Emergency Lower Segment Caesarean Section in Preeclamptic Parturient with Neurofibromatosis: A Case Report

Charmi Hitenbhai Shah, Upasna Vineet Bhatia, Sara Mary Thomas

Neurofibromatosis type I (NF1) is an autosomal dominant genetic disorder characterised by multiple cutaneous manifestations and potential systemic involvement that can complicate anaesthetic management, especially in obstetric patients. This case report describes the anaesthetic management of a 27-year-old primigravida with NF1 and preeclampsia who presented to obstetric department for emergency cesarean delivery due to foetal distress. The patient displayed classic NF1 features including café-au-lait spots and multiple cutaneous neurofibromas. Airway assessment revealed Mallampati Grade III classification without palpable oropharyngeal masses. Given the emergency situation and potential airway challenges, general anaesthesia was selected using rapid sequence induction with propofol and succinylcholine. Anaesthesia was maintained with oxygen, nitrous oxide, sevoflurane, and atracurium, with fentanyl administered after delivery. The patient maintained stable haemodynamics throughout the procedure despite preeclampsia with baseline blood pressure of 140/100 mmHg. Despite the potential for difficult airway management and cardiovascular complications in patients with NF1, the perioperative period was uneventful with successful mother and baby outcomes. This case emphasises the importance of thorough preoperative assessment, anticipation of potential complications, and a tailored anaesthetic approach in managing parturients with NF1, particularly in emergency scenarios complicated by preeclampsia.

Conservative Management of Tubo-ovarian Abscess through Minimal Invasive Route: A Case Report

Amey Chugh, Janvi Patel, Prashansa Gupta, Varshini Vadithala

Tubo-ovarian Abscess (TOA) is a challenging infectious condition of the adnexa, typically arising from Pelvic Inflammatory Disease (PID). Patients with TOA commonly present with symptoms such as lower abdominal pain, fever and vaginal discharge. Traditionally, cases of TOA have been addressed through total abdominal hysterectomy. TOA typically presents with abdominal pain and fever, which, on imaging, appear as a lobulated multicystic lesion in the adnexa. These cases were managed through transvaginal aspiration, resulting in a satisfactory outcome. The present report of a 45-year-old woman emphasises the efficacy of management through minimally invasive techniques and highlights the role of interventional radiology in managing such cases.

Efficacy of Ayurvedic Treatment in Case of Sensory Neural Hearing Loss: A Case Report

Badhirya, commonly known as deafness or hearing impairment, is a multifaceted condition with various aetiologies and clinical presentations. A significant form of deafness is Sensorineural Hearing Loss (SNHL), defined by impairment to the auditory nerve pathways or inner ear. It may be acquired or congenital and accounts for around 90% of all recorded occurrences of hearing loss. As of now, there is no recommended therapy for it. According to Ayurveda, hearing loss is correlated with Badhirya, and our Acharyas have suggested a variety of therapeutic approaches and formulations to effectively treat this condition. Hereby, the authors present a case report of 42-year-old male patient presented at the Shalakya Outpatient Department (OPD) with a three-month history of tinnitus and decreased hearing in both ears. Consequently, Anutaila Nasya, Bilwadi Taila Karnpoorana, and Saraivada Vati were administered orally to the patient with Badhirya in present study. In present case, it was determined to be clinically successful, and excellent improvement in hearing was observed.

Management of Dentoalveolar Fracture in a Patient with Wilson’s Disease: A Case Report

SB Meghana, N Aishwarya, Somya Sinha

Dental trauma is most common in children as they are involved in a lot of physical activities as they grow up. Most commonly dental trauma is seen in front teeth in the upper jaw. Children with disabilities have to be given more attention as they are more prone to dental injuries and infections. Several genetic disorders affect an individual mentally and physically and make them disabled. One such autosomal recessive inherited disorder is Wilson’s disease. Wilson’s disease is characterised by excessive deposition of copper in the liver, brain and other tissues. It is usually diagnosed between ages 5 to 35 years of age. Dentoalveolar fracture is seen in 17% of children. Dentoalveolar fracture involves the alveolar bone and may extend beyond the alveolus. This article presents a case report of a 10-year-old male, who presented with a dentoalveolar fracture of the lower jaw and was also diagnosed with Wilson’s disease. In this case, dentoalveolar fracture of the lower mandibular anterior region is managed by ribbond splinting as it is free of any metal/copper contents and is most compatible in this case. As paediatric dentists, it is essential to have the skills and techniques to manage patients with special abilities and make the right choice of treatment and materials which adds benefits to patients’ well-being. Patients of such conditions are of utmost importance as they are prone to trauma and infections.

Pilomatrixoma or Sebaceous Cyst in a Middle-aged Woman: A Case Report

Sujal Ramesh Agarwal, Veena KL Karanth, Sarah Johnson, Vidya Monappa

Pilomatrixoma, is a rare benign skin neoplasm originating from matrix cells of hair follicles. Frequently encountered during the first two decades of life, mostly involving the head and neck area. In this report, a woman in her late 40s presented with swelling and associated pain on her right arm. On physical inspection, a hard, non tender mass was found. A provisional diagnosis of a sebaceous cyst was made and she subsequently underwent an excision biopsy for the same. Histopathology of the specimen revealed features of pilomatrixoma. Pilomatrixoma can be confused with other benign skin masses encountered frequently in clinical practice like sebaceous cysts, especially in uncommon age groups and locations. Preoperative diagnosis is difficult to establish and a definitive diagnosis can be made only after histopathological examination. Diagnosis is through histopathology and a thorough understanding of the histological features of other cutaneous conditions is essential.

Cerebral Venous Aneurysm: Microsurgical Management of Two Cases and Literature Review

Vikrant Keshri, Aiman Maidan

Cerebral venous aneurysms are rare vascular anomalies that may present incidentally or with neurological symptoms such as seizures or intracranial haemorrhage. Their diagnosis and management remain challenging due to the lack of standardised guidelines and limited clinical experience. Two rare and clinically significant cases are reported here. The first case involved a 70-year-old male presenting with focal seizures, who was found to have a large isolated cerebral venous aneurysm. The second case concerned a 27-year-old male who developed a frontal intracerebral haematoma associated with an abnormal venous channel. Both patients underwent successful microsurgical treatment with favourable outcomes. These cases underscore the importance of individualised diagnostic assessment and surgical planning when managing cerebral venous aneurysms, especially when they present with symptomatic mass effect or haemorrhage. A comprehensive literature review was conducted to compare conservative, surgical and endovascular management strategies, highlighting the absence of consensus guidelines and the need for case-by-case decision-making. The novelty of these cases lies in their rare presentations and the successful application of microsurgical techniques, which remain underreported in the literature. The authors experience contributes valuable insights into the clinical approach, surgical considerations and outcomes associated with cerebral venous aneurysms, advocating for heightened awareness and reporting to inform future management strategies.

Rhodococcus Hoagii Masquerading as Tuberculosis: A Case Report

A young 35-year-old male presented with a cough, chest pain, breathlessness and bilateral lower limb swelling. He had been an alcoholic for over 21 years and had a history of Antitubercular Therapy (ATT) for six months due to tuberculous pleural effusion, which occurred a year ago. Bronchoscopy and Endobronchial Ultrasound-Transbronchial Needle Aspiration (EBUS-TBNA) revealed granulomatous lesions and acid-fast bacilli, although they were not morphologically similar to mycobacteria or Nocardia. GeneXpert- Mycobacterium Tuberculosis (MTB) and bacterial cultures were inconclusive. He was subsequently started on modified ATT. However, due to clinical worsening, a Computed Tomography (CT)-guided Fine Needle Aspiration (FNA) was performed, which revealed pus; cultures detected Rhodococcus hoagii. The patient was then commenced on rifampicin and ciprofloxacin. Unfortunately, his compliance with the treatment was poor and he ultimately succumbed to the infection. The present case demonstrates that Rhodococcus hoagii infection, a rare cause of fatal pneumonia, can mislead physicians into misdiagnosing tuberculosis.

A Case Report on the Thyroid and Eye Connection: A Deep Dive into Evaluation and Treatment Strategies

Iqra Mushtaq, Kalibo Jakhalu, Tushar Agrawal, Gufran Ali Kamdar

Thyroid-Associated Orbitopathy (TAO), also known as Graves’ ophthalmopathy or Thyroid Eye Disease (TED), is an autoimmune condition often linked to hyperthyroidism, particularly Graves’ disease. It causes inflammation and swelling of the eye muscles and surrounding tissues, leading to symptoms such as proptosis, diplopia, and discomfort. The condition is six times more prevalent in females as compared to males. Among individuals diagnosed with TAO, about 90% have Graves’ hyperthyroidism, while a smaller percentage may have primary hypothyroidism, Hashimoto’s thyroiditis, or normal thyroid function. These patterns emphasise the importance of recognising thyroid dysfunction in orbitopathy management which includes treating the underlying thyroid dysfunction, using corticosteroids to reduce inflammation, and applying artificial tears for symptomatic relief. Severe cases may require orbital decompression surgery, strabismus correction, or eyelid surgery. Smoking cessation and selenium supplementation are recommended for improved outcomes in mild-to-moderate cases. A case involving a 42-year-old man is presented here with a history of hyperthyroidism who demonstrated signs of proptosis, diplopia, and upper eyelid retraction in both eyes. Clinical evaluations confirmed inflammation in the orbital tissues, which was substantiated by imaging studies, culminating in a diagnosis of TAO. The patient received intravenous corticosteroids for 12 weeks, reporting significant symptom relief afterward. This case underscores the effectiveness of tailored treatment strategies that combine medical and supportive interventions for managing severe active TED.

Multidisciplinary Approach in Management of Rhabdomyosarcoma of the Face: A Rare Case Report

Apurva Jarandikar, Priya Elangbam, Mayur Ingale

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children and adolescents. It arises from primitive mesenchymal cells that typically differentiate into skeletal muscle tissue. The causes and risk factors are not well understood, and most cases are sporadic, although some are linked to familial syndromes. A 10-year-old female patient presented with swelling on the left-side of her face. Following a wedge biopsy and histopathological and immunohistochemical analyses confirmed Embryonal Rhabdomyosarcoma (ERMS). Treatment involved a multimodal approach, combining surgical removal of the primary tumour, chemotherapy to address potential micro metastases, and radiotherapy for patients at higher risk. Improved survival rates are attributed to collaborative care and advancements in diagnosis and treatment. This case underscores the importance of coordinated care for timely diagnosis and effective treatment, leading to better patient outcomes and reduced morbidity.

Anaesthetic Management of a Case of Eisenmenger Syndrome undergoing Non Cardiac Surgery: A Case Report

Nanditha Padikkasu, Pushparani Anand, Shalini Thiyagarajan

Eisenmenger syndrome is a severe, irreversible complication of congenital heart defects, resulting in large anatomical shunts and leading to Pulmonary Arterial Hypertension (PAH). Patients with Eisenmenger syndrome are complex; when they require anaesthesia for a surgical procedure, they pose a greater risk and present a challenge for the anaesthetist due to compromised haemodynamics. Hereby, authors present a case of a 31-year-old female with Eisenmenger syndrome, characterised by a large Ventricular Septal Defect (VSD) with bidirectional shunting and severe PAH, who is currently symptomatic and underwent an elective open appendicectomy. The authors utilised various modalities, including appropriate haemodynamic monitoring, smooth induction of general anaesthesia, and a regional block to manage postoperative pain. These strategies were employed to maintain the patient’s baseline homeostasis throughout the preoperative, perioperative and postoperative periods, ensuring that there was no compromise in the patient’s existing condition. Overall, the patient’s duration of hospital stay was uneventful and she was discharged shortly thereafter.

Accessory Cavitated Uterine Mass with Associated Chocolate Cyst and Ureteric Endometrioma: A Case Report

Accessory Cavitated Uterine Malformation (ACUM) is a Müllerian anomaly characterised by a non communicating uterine cavity lined with functional endometrium and surrounded by myometrium. ACUM is an uncommon cause of pelvic pain and dysmenorrhoea. This condition was associated with a ureteric endometrial deposit and endometrioma, highlighting an unusual presentation. A 19-year-old unmarried female patient presented with complaints of right flank pain during her menstrual cycles, as well as irregular menstrual cycles alternating between hypomenorrhoea and polymenorrhagia since the onset of menstruation five years prior. Ultrasound and Magnetic Resonance Imaging (MRI) revealed a well-defined solid lesion on the right lateral wall of the uterine fundic region, located near the attachment of the round ligament. The right ovary displayed a cyst with multiple internal echoes, exhibiting a ground-glass appearance on ultrasound and a T2 shading effect on MRI, suggestive of an endometriotic cyst. Notably, right-sided hydroureteronephrosis was observed due to a hypoechoic solid lesion near the ureterovesical junction on ultrasound, which appeared T2 hypointense on MRI, indicative of an endometriotic deposit. The present case illustrates the utility of ultrasound and MRI in diagnosing ACUM, along with the associated chocolate cyst and ureteric endometrioma, resulting in obstructive uropathy-an exceptionally rare combination.

Syncytial Variant of Nodular Sclerosis Hodgkin Lymphoma: A Case Report on Histological Medley of Morphological Variants

CD Anand, Ruchismita Pal, R Anitha, Kothai Gnanamoorthy, Muthu Sudalaimuthu

There are several histological and morphological subtypes of Hodgkin Lymphoma (HL), a malignant lymphoproliferative disease, and each has distinct prognostic consequences. Syncytial Variants is an unique, uncommon morphological type of Nodular Sclerosis Hodgkin Lymphoma (SV-NSHL). Unlike other subtypes of classical HL, which exhibit a male preponderance, it is more prevalent in females. The most often affected lymph nodes, which can exhibit contiguous spread, are the cervical or mediastinal lymph nodes, or both. Hereby, the authors present a case report of an 18-year-old male patient who has been experiencing intermittent fever, weight loss, neck pain, and gradual enlargement of the neck and axillary lymph nodes over the past two months presented to the Outpatient Department (OPD). Clinical examnation and radiological assessment using plain Computed Tomography (CT) of chest scan showed several enlarged lymph nodes in the mediastinum and anterior chest wall, along with sternum erosion. This led to a differential diagnosis of lymphoma, sarcoidosis, and atypical tuberculosis. Histological analysis {Haematoxylin and Eosin (H&E)} and immunohistochemical profiling of an excised left supraclavicular lymph node rendered the diagnosis of classic HL, and a very rare variant, the SV-NSHL. The present case is being reported for its extreme rarity, diagnostic challenges, and distinct clinicopathological correlation.

Management of a Giant Posterior Uterine Leiomyoma: A Case Report

Sonali Hargunani, Varshini, Poonam Nikam

Uterine leiomyomas, commonly referred to as fibroids, are the most frequent benign tumours of the uterus, primarily affecting women of reproductive age. Although these tumours are generally asymptomatic, their size and location can lead to significant clinical symptoms, including heavy menstrual bleeding, pelvic pain, and reproductive issues. The patient, a 31-year-old woman with a history of three pregnancies, presented with persistent abdominal pain, increased urinary frequency and dysmenorrhea over the past six months. Physical examination revealed an enlarged uterus corresponding to a 16-week pregnancy size, with a palpable mass suggestive of a uterine abnormality. Pelvic Ultrasound (USG) confirmed the presence of a large leiomyoma measuring 10×8.3×9 cm in the posterior uterine wall. Given the tumour’s size and symptomatic presentation, surgical intervention was deemed necessary. The patient underwent a successful myomectomy, during which the leiomyoma was completely excised without complications. Postoperatively, the patient was closely monitored and discharged in stable condition. The surgical removal of the fibroid resulted in significant relief from her symptoms, improving her overall quality of life. This case underscores the importance of individualized surgical planning in the management of large uterine leiomyomas. The successful excision of the leiomyoma not only alleviated the patient’s symptoms but also preserved her reproductive potential, highlighting the efficacy of surgical intervention in complex cases involving large fibroids.

Leukaemia Presenting with Nasal Septal Abscess: A Case Report

Aishwarya Biradar, Ruchir Dashora, Mayur H Ingale, Vinod Shinde, Paresh Chavan

Nasal Septal Abscess (NSA) is a rare but serious condition that typically arises from trauma, infections, or surgical interventions. However, in immunocompromised patients, NSA may develop spontaneously due to underlying haematological conditions. A 28-year-old male with recently diagnosed pre-B-cell Acute Lymphoblastic Leukaemia (ALL) presented with bilateral nasal obstruction and respiratory discomfort. Examination and imaging confirmed an NSA with cartilage erosion. Initial management included aspiration and empirical antibiotic therapy. However, recurrence necessitated incision and drainage, with cultures revealing fungal elements, prompting antifungal treatment. The patient responded well to therapy and no long-term complications were observed. This case underscores the importance of recognising NSA as a potential complication in leukaemia patients, even in the absence of trauma. Timely diagnosis and appropriate management are critical in preventing complications such as nasal deformities and recurrent infections.

A Rare Case of Upper Tract Urothelial Carcinoma with Renal Calculi in a Horseshoe Kidney

Sunil Mhaske, Onkar Sangha, Vikram Satav, Vilas Sabale

Upper Tract Urothelial Carcinomas (UTUCs) are rare renal tumours. A 42-year-old male presented with haematuria and left flank pain, and was diagnosed with multiple left renal calculi in a horseshoe kidney with a left partial duplex system on Computed Tomography (CT) urography. The patient initially had negative urine cytology, which led to a delayed suspicion of malignancy. During the left Percutaneous Nephrolithotomy (PCNL), a pelvic growth was observed after stone clearance; biopsy results confirmed high-grade UTUC. The patient subsequently underwent a left nephroureterectomy and heminephrectomy. Follow-up at six months showed no recurrence. This unusual combination of horseshoe kidney, renal calculi, and UTUC is extremely rare, emphasising the importance of maintaining a high index of suspicion for malignancy in patients with chronic stone disease.

Clinical Profile of Paraquat Poisoning from a Tertiary Care Hospital in Southern India: A Case Series

CH Karthik Reddy, Mahasweta Choudhury, Athul Suresh Rohith Atteparambil

Paraquat is a 1,1´-dimethyl-4,4´-bipyridinium dichloride herbicide widely used in agriculture. It is highly toxic even in a very minimal amount (10-20 mL), which on consumption, is associated with multiorgan failure. Intoxication may be accidental or suicidal, and the route of exposure is oral ingestion, inhalation, or transdermal absorption. Few countries have banned this compound or its use is restricted, but in developing countries like India, its unrestricted availability makes it a popular tool for deliberate self-harm. This case series pertains to an observation of 15 patients admitted to a teaching hospital with paraquat poisoning. The present case series included 15 patients, mostly males 10 (66.6%) in the age group of 18-50 years. Among 15 patients, 12 were suicidal (80%), and gastrointestinal symptoms like vomiting (100%) and difficulty swallowing (66.6%) were the most common initial presentation after intake. Renal involvement was the most common (93.3%), followed by lung (60%) and liver (60%). Patients were treated with corticosteroids, cyclophosphamide, antacids, vitamin C and chlorhexidine mouthwash. Out of total patients, 8 (53.3%) underwent haemodialysis due to acute renal failure and 10(66.6%) patients received N-Acetylcysteine due to acute liver injury. Mortality of patients with paraquat poisoning was 45.45%. Paraquat poisoning is lethal with no effective antidote. Severity of the poisoning depends on amount of compound ingested. Morbidity and mortality are high due to multiorgan failure or respiratory failure due to pulmonary fibrosis. Policymakers should focus on either banning the compound or restricting its availability due to its high toxicity.

Genetic Evaluation of Global Developmental Delay in Children: A Series of Seven Cases

Global Developmental Delay (GDD) is a multifaceted and varied condition primarily linked to genetic factors. Due to its heterogeneous nature, multitiered investigations are typically recommended to identify the underlying causes and create an effective intervention plan. This study evaluated the Single Nucleotide Variants (SNVs) associated with GDD in children from Maharashtra, India. Whole Exome Sequencing (WES) was conducted on blood samples from seven children referred to Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India for unexplained GDD/Intellectual Disability (ID) between January 2020 and March 2022. The ages of the seven patients in this study ranged from three months to 14 years. Out of the seven cases, five exhibited variants in the CHRNG, FUCA1, MECP2, GNRHR, AKT3, and PTCH1 genes. In two instances, novel variants of likely pathogenic or uncertain significance were identified in seven genes involved in neurodevelopment and immunity. These results emphasise the importance of genetic screening in diagnosing GDD, thereby enabling targeted interventions. Additional studies with larger cohorts are required to confirm these findings and determine their clinical relevance.

Evaluation of Effectiveness of Gugguladi Dhoopana as an Adjuvant in Postoperative Management of Fistula-in-ano: A Series of Three cases

Sakshi Ghugal, Sheetal Asutkar, Shubham Bobade, Yogesh Yadav

Dhoopana Karma is one of the traditional Ayurvedic treatments for fumigation, which aids in enhancing wound healing and preventing infections within wounds following surgeries. This treatment can be administered through the fumes produced by herbal preparations, based on their theoretically potent antimicrobial and anti-inflammatory actions, as well as their wound healing properties. Dhoopana Karma utilises the formulation Gugguladi Dhoopana Dravya, which includes Guggul, Nimba, and Sarjaras. These substances are well-known for their tissue regeneration and infection-controlling activities. Hereby, the authors present a case series of three male patients and present study was aimed to determine whether Dhoopana Karma is effective in the treatment of postoperative anal fistula. The present condition requires prolonged care and is often associated with infections and poor healing. Three patients diagnosed with complex anal fistula underwent partial fistulectomy accompanied by Ksharsutra (medicated seton) ligation, followed by daily Dhoopana Karma with Gugguladi Dhoopana Dravya for 10 days. Each session lasted 10 minutes. Pain, wound bed condition, odour, discharge, granulation tissue, and itching were monitored regularly. The fumigation process involved in Dhoopana Karma helps to stimulate blood circulation, promotes the removal of toxins, and reduces inflammation at the wound site. Dhoopana can be utilised as an alternative to the modern concept of sterilisation and has multiple applications in wound management. All cases showed dramatic improvement, with significant reductions in pain, discharge, and odour, along with enhanced granulation tissue formation during the 30-day follow-up period. Dhoopana Karma with Gugguladi Dhoopana Dravya appears to be a beneficial adjuvant treatment for the postoperative management of anal fistula, leading to early recovery and more efficient wound healing.

Rare Non-germ Cell Testicular Tumors: A Series of Three Cases

Testicular neoplasms are the most common malignancy among men aged 20-40 years. More than 95% are germ cell tumours and 5% are sex cord stromal tumours. The most common presentation is a painless scrotal lump. Sometimes, it may present as a painful lump, mimicking an inflammatory lesion. Case 1, a 34-year-old male presented with right testicular pain and a lump for one month, with normal tumour markers. Clinically, it appeared as a testicular malignancy, but with normal tumour markers, it mimicked an inflammatory lesion, creating a management dilemma. A Computed Tomography (CT) scan ruled out retroperitoneal lymph node metastasis. Right high inguinal orchidectomy with frozen section was performed, suggesting malignancy. Immunohistochemistry confirmed leiomyosarcoma. Case 2, an 82-year-old male presented with a painless right testicular lump for one month, with a history of acute urinary retention secondary to benign prostatic enlargement {treated with Transurethral Resection of the Prostate (TURP)}. Clinically, it was a hard lump suggestive of malignancy, confirmed on ultrasound, although tumour markers were normal. A CT scan was negative for lymphadenopathy. Right high inguinal orchidectomy was performed. Histopathological examination showed non-Hodgkin’s lymphoma; the patient subsequently underwent chemotherapy. Case 3, a 29-year-old male complained of right testicular pain. Examination revealed a tender nodule (1×1 cm) on the posterolateral aspect of the right testis, clinically appearing as a firm mass, confirmed on ultrasonography, although tumour markers were misleadingly normal. High inguinal orchidectomy was performed, with histopathological examination positive for intratesticular adenomatoid tumour. High inguinal orchidectomy was the treatment of choice in all three cases, followed by adjuvant chemotherapy or radiotherapy depending on histopathology. Conclusion: Testicular tumours may mimic inflammatory lesions, creating management dilemmas. Thorough clinical examination and investigations are required for planning and management. Normal serum tumour markers and ultrasound cannot rule out malignancy.

Multifaceted Role of the Acellular Dermal Matrix in Novel Wound Healing: A Case Series

Naveen Narayan, Dharini Kishor, Yashas Hosur Ramegowda

Acellular Dermal Matrix, Matriderm®, a collagen and elastin matrix, has emerged as a versatile tool in wound coverage, promoting healing and reducing scarring, thus offering numerous advantages in various clinical scenarios. The varied uses demonstrated here include concomitant application of the acellular dermal matrix while grafting with a full-thickness skin, application over bare bone in Split-Thickness Skin Grafting (STSG) and in the treatment of mucocutaneous fistulae in the oral cavity. The outcome with the use of Matriderm® in all these cases was satisfactory. Hereby, the authors present a case series of four patients that provide an understanding of Matriderm®’s efficacy in promoting healing and regeneration in complex wounds. Matriderm®, an acellular dermal matrix composed of collagen and elastin, supports tissue regeneration and reduces scarring, making it a valuable tool in complex wound management. The present case series highlights its versatility and potential in advancing wound care.

Follicular Carcinoma of Thyroid with Solitary Vertebral Metastasis

Jatin Nehra, Shaik Ishma Mustafa, Kirthi Sathyakumar, Senthil Kumar Aiyappan

A 48-year-old female presented with a one-month history of back pain radiating to both lower limbs, which had worsened over the past three days. The pain had an insidious onset and was gradually progressive, radiating from the upper back to the plantar aspect of the feet. She also reported gait instability for three days, rest pain and sleep disturbances. There was no history of recent trauma, fever, significant weight loss, chronic cough, or night sweats. The patient had a history of thyroidectomy for follicular carcinoma of the thyroid seven years back. The family history was unremarkable. On examination, the patient was conscious, oriented and afebrile. Vital signs were normal. Cardiovascular and respiratory system examinations were unremarkable. Abdominal examination revealed a soft abdomen with normal bowel sounds. Neurological examination showed a positive Straight Leg Raise (SLR) in both lower limbs at 30 degrees. Motor function on the day of admission was rated as 4/5 in bilateral lower limbs. Sensation was impaired, with numbness in both lower limbs. On the second day of admission, the patient developed complete loss of motor function (0/5) in both lower limbs, as well as complete loss of sensation and bowel and bladder incontinence. Laboratory investigations revealed a haemoglobin value of 10.6 g/dL; total leucocyte count of 16,510/cu.mm (Neutrophils: 85.9%, Lymphocytes: 8.8%); and an Erythrocyte Sedimentation Rate (ESR) of 15 mm/hr. Thyroid, renal and liver function tests were within normal limits. The patient underwent a Computed Tomography (CT) scan of the dorsolumbar spine, neck, chest and abdomen. The CT scan of the dorsolumbar spine showed a lytic lesion with complete collapse of the D7 vertebral body, along with destruction of the adjacent endplates of the D6 and D8 vertebral bodies (Table/Fig 1)a. A mild associated soft-tissue component was noted in the bilateral paravertebral region and anterior to the dura at the D7 level (Table/Fig 1)b. CT scans of the neck showed postoperative changes at the level of the thyroid gland, with no significant lymphadenopathy. CT scans of the chest and abdomen showed no significant abnormalities apart from the D7 vertebral lesion. Magnetic Resonance Imaging (MRI) of the dorsolumbar spine revealed partial collapse of the D7 vertebral body with an associated soft-tissue component anterior to the dura, causing focal kyphotic deformity and cord compression, suggestive of a pathological vertebral fracture (Table/Fig 2)a-d. The patient underwent posterior decompression and long-segment stabilisation from D4 to D7 with tissue biopsy under general anaesthesia. The biopsy of the D7 vertebral lesion showed features suggestive of metastatic follicular carcinoma of the thyroid. TrueNat Tuberculosis-Polymerase Chain Reaction (TB-PCR) was not detected. Following surgery, the patient regained bowel and bladder control. She was referred for radiotherapy and is currently receiving it alongside physiotherapy. This case illustrates an unusual presentation of follicular carcinoma of the thyroid with a solitary vertebral metastasis leading to spinal cord compression and paraplegia. While bone metastases are recognised in differentiated thyroid cancer, a solitary vertebral metastasis as the initial manifestation is rare (1). Follicular thyroid carcinoma tends to metastasise haematogenously and when bone metastases occur, they can present with pain, pathological fractures and neurological deficits, as seen in the index case (2). Similar cases have been documented in the literature, highlighting the atypical presentation of solitary spinal metastases in thyroid carcinoma (3),(4),(5). Doe J et al., reported a case series where vertebral metastasis was the first indication of follicular thyroid carcinoma, underscoring the importance of thorough diagnostic evaluations in similar contexts (3). Chen YK et al., described rare instances of thyroid cancer initially presenting as solitary bone metastases, further illustrating these unusual clinical scenarios (4). Additionally, Kumar V et al., provided an analysis of uncommon metastatic patterns in differentiated thyroid cancer, emphasising the importance of recognising such patterns for timely treatment (6). The diagnosis of metastatic thyroid carcinoma in the present case was established through a histopathological examination of the vertebral lesion. Kumar V et al., discussed similar patterns of solitary vertebral involvement in their analysis, supporting the diagnostic process followed in the present case (6). The management of metastatic follicular thyroid carcinoma typically involves a combination of surgery, radioiodine therapy and external beam radiotherapy for the palliation of bone metastases (7). In the present case, surgical decompression and stabilisation were performed to address the spinal cord compression, followed by recommendations for complete thyroidectomy and radiotherapy. Such approaches are supported by Njoum Y et al., who reviewed cases with isolated skeletal lesions, demonstrating successful outcomes with multidisciplinary treatment strategies (5). The present case, along with similar reports, highlights the importance of considering metastatic thyroid carcinoma in the differential diagnosis of patients presenting with vertebral lesions and neurological deficits, even in the absence of obvious thyroid abnormalities. A high index of suspicion and thorough investigation are essential for prompt diagnosis and appropriate management.

Keloid Scarring in the Earlobe: From Piercing to Treatment

Parindita Sarmah, Sagar Gaurkar, Prasad Deshmukh

A 48-year-old female office worker presented in Ear, Nose and Throat (ENT) Outpatient Department (OPD) with a progressively enlarging, painless mass on both her earlobes, which she noticed about eight months ago. Both the lesions started after she had an ear piercing several years ago; and initially were small but have grown over time. The patient reports occasional itching but no pain, drainage, or signs of infection. She is concerned about the cosmetic appearance of the mass. There is no history of recent trauma to the area, and the patient denies any changes in the surrounding skin. She has no significant medical history and no known allergies. Although her maternal aunt has a history of keloids, there is no family history of similar lesions in other areas of the patient’s body. The lesion on the right earlobe measures approximately 2.5×2×2 cm and is raised, firm, and hyperpigmentation, extending beyond the borders of the original piercing (Table/Fig 1)a,b. The lesion on left ear measures approximately 2×2×2 cm and is similar to the lesion on the other ear (Table/Fig 2)a,b. The lesions were well-defined, non tender, and smooth, with no evidence of inflammation, ulceration, or discharge. There is no regional lymphadenopathy. Given the clinical presentation and the patient’s history, the most likely diagnosis was earlobe keloid, a benign fibroproliferative lesion resulting from excessive collagen deposition following trauma or inflammation, such as that caused by an ear piercing. Other differential diagnoses include hypertrophic scars, which also result from excessive collagen but remain within the boundaries of the wound, and infectious granulomas. However, the absence of discharge makes this less likely. Dermatofibromas and molluscum contagiosum, though less probable, are also considered in the differentials. A clinical diagnosis of keloid was made based on the history and appearance of the lesion. For management, conservative measures were recommended initially. These include silicone gel sheets or pressure therapy to help flatten the lesion and reduce further growth. When the conservative treatments failed, the patient opted for surgical excision of both the earlobe keloids. Both earlobe keloids were excised under local anaesthesia (Table/Fig 3), which was followed by bilateral lobuloplasty (Table/Fig 4)a,b. Suturing was done using Vicryl 3-0 Coated Braided (CB) absorbable suture material. Both the earlobes were dressed with mupirocin ointment, and the patient was called for suture removal after seven days. A seven-day course of antibiotic Tablet Augmentin 625 mg BD was given and follow-up after a week was advised. Excision carries a high risk of recurrence, and adjunctive therapies such as post-excision steroid injections, silicone gel sheets, or radiation therapy were explained to the patient. The patient was educated about the benign nature of keloids and the possibility of recurrence after treatment. She was advised to avoid further trauma to the earlobe and not to pierce the area again to prevent the worsening of the keloid. Conservative treatments such as silicone sheets and steroid injections are recommended initially, with follow-up scheduled in 4-6 weeks to assess progress. If there is inadequate improvement, further interventions like surgery or additional steroid injections may be considered. The prognosis for keloids is variable; while treatment can reduce their size and appearance, recurrence is common, and multiple treatments may be required for optimal results. The term keloid originates from the Greek word “chele,” meaning crab’s claw, introduced by French dermatologist Jean-Louis Alibert in 1806. The term reflects the lesion’s tendency to spread irregularly into surrounding tissues, resembling a crab’s claw (1). Keloids are now understood as a pathological response to skin injury characterised by excessive collagen deposition and abnormal wound healing (2). They typically occur following trauma, surgery, burns, acne, ear piercings, or even minor injuries such as insect bites or vaccinations. Unlike hypertrophic scars, keloids extend beyond the original wound margins and do not regress spontaneously over time (3). Keloids are more common in individuals with darker skin tones, such as those of African, Hispanic, or Asian descent, with a peak incidence in the 10-30 years age group. While the precise aetiology is unknown, genetic predisposition and environmental factors (e.g., wound tension and inflammation) are thought to play significant roles in their development (4). Conservative management is typically the first-line treatment, especially for smaller or early-stage keloids. Silicone gel sheets or dressings can help flatten the keloid and reduce redness, though consistent use over weeks to months is necessary for optimal results (5). Intralesional corticosteroid injections, most commonly using triamcinolone acetonide (10-40 mg/mL), are highly effective in reducing keloid size, inflammation, and symptoms such as itching or pain. These injections are usually repeated every 4-6 weeks, often requiring multiple sessions. Pressure therapy, using custom-made pressure earrings or clips, is another effective conservative measure that reduces blood flow to the keloid, thereby limiting its growth (6). For larger lesions or those unresponsive to conservative treatments, surgical excision may be considered. While surgery provides immediate removal of the keloid, it carries a high recurrence risk (upto 70-100%) if not combined with adjunctive therapies. To minimise this risk, postoperative interventions such as steroid injections, silicone gel sheets, and pressure earrings are essential (7). Other treatment modalities include cryotherapy, which is particularly effective for smaller keloids and may be combined with steroid injections to enhance results. Laser therapy, such as Pulsed Dye Laser (PDL) or fractional CO₂ laser, can improve the keloid’s appearance by reducing redness and flattening the lesion (8). For resistant cases, intralesional injections of 5-fluorouracil (5-FU) or bleomycin may be used to inhibit fibroblast activity and collagen production (9). Earlobe keloids, though benign, can significantly impact a patient’s quality of life due to cosmetic concerns, physical discomfort, and the potential for recurrence. Effective management involves a comprehensive approach that combines conservative treatments, surgical options, and adjunctive therapies to address both the keloid itself and the underlying factors contributing to its growth.

Right-sided Bronchial Collapse undergoing Dilation and Stenting

Subha Teresa Jose Vazhakalayil, Sakshi Gupta

Dear Editor, The anaesthesiologist plays a critical role during tracheobronchial stenting in patients under general anaesthesia, as they are responsible for the safe induction and maintenance of anaesthesia, managing a shared airway and treating life-threatening postoperative complications (1). Here, a case of the successful management of anaesthesia during bronchoscopic stenting is discussed. A 60-year-old male patient who experienced severe trauma when a brick wall collapsed on his back. Five days later, he developed multiple rib fractures on the right side, tension pneumothorax, pneumomediastinum and subsequently suffered a cardiac arrest. Following resuscitation and initial Intensive Care Unit (ICU) care, the patient developed bronchial collapse and massive right-sided pleural effusion, confirmed through investigations like Ultrasonography (USG) thorax, chest X-ray, flexible bronchoscopy, and chest Computed Tomography (CT), necessitating bronchoscopic stenting under general anaesthesia (Table/Fig 1). The preoperative assessment showed reduced air entry in the right lung field, with a room air saturation of 96%; however, all other vital signs and investigations were within normal limits. On the day of the procedure, standard American Society of Anesthesiologists (ASA) monitors were attached. Anaesthesia induction was achieved with propofol (2 mg/kg) along with fentanyl (2 μg/kg), and tracheal intubation was performed using a 7.5 mm Endotracheal Tube (ETT) with vecuronium (0.1 mg/kg) as a muscle relaxant. Anaesthesia was maintained with a 50:50 mixture of oxygen and air, along with sevoflurane. After stabilisation, the ETT was removed, and a rigid bronchoscope was inserted (Table/Fig 2). Intermittent positive pressure ventilation was managed through the side port of the rigid bronchoscope using a Bain’s circuit. The patient was cannulated with an intra-arterial catheter for regular analysis of blood gases and management of blood pressure. Initially, with a pulse rate of 70, blood pressure of 146/90, and EtCO₂ of 36, dexmedetomidine infusion (0.5 μg/kg) was administered to maintain blood pressure. Later, due to repeated rigid bronchoscopic attempts, the increase in blood pressure was managed with intermittent boluses of esmolol, followed by an infusion of Nitroglycerin (NTG) which was titrated to maintain stable blood pressure. Towards the end of the procedure, the patient developed severe vocal cord oedema due to repeated attempts with the rigid bronchoscope. Re-intubation was necessary using a smaller ETT (7 mm) after railroading with a bougie. Postoperatively, after successful stenting, air entry improved over the right lung fields, and the patient was transferred back to the ICU for further care, eventually being successfully extubated once the oedema resolved. This case highlights the importance of general anaesthesia, which plays a crucial role in rigid bronchoscopy by ensuring adequate oxygenation in a shared airway, mitigating the pressor response associated with rigid bronchoscopy (Table/Fig 3), and providing anaesthesia without compromising airway patency (2). It also underscores the significance of Total Intravenous Anaesthesia (TIVA) during the procedure due to the impracticality of using inhalational anaesthetics, as there is leakage of the agents from the open end of the rigid bronchoscope (3). Rigid bronchoscopy is an effective tool for managing airway obstruction, whether due to malignant or benign conditions (4). The procedure can be challenging and requires close collaboration between the anaesthesiologist and the proceduralist to ensure optimal conditions for a safe outcome. The choice of ventilation method should be based on expertise, available equipment and patient-specific factors. By reporting this case, authors aim to contribute to the ongoing discussion on best practices for managing anaesthesia in similarly challenging scenarios.

Efficacy of External Beam Radiotherapy with Concurrent Capecitabine versus Radiotherapy alone for the Treatment of Painful Bone Metastasis in Primary Breast Cancer Patients: A Prospective Interventional Study

Introduction: The development of widespread distant metastasis, including skeletal metastasis, is common among breast carcinoma patients, irrespective of multimodal treatment. Symptomatic skeletal metastasis is usually treated with External Beam Radiotherapy (EBRT). Capecitabine can act as a radiosensitiser antineoplastic drug and can be added concurrently with EBRT. Aim: To compare the safety and efficacy of EBRT with concurrent capecitabine against EBRT alone in pain control of painful bone metastasis. Materials and Methods: This prospective interventional study was conducted in the Department of Radiation Oncology at Acharya Harihar Postgraduate Institute of Cancer, Cuttack, Odisha, India from September 2022 to March 2024. Histologically proven breast cancer patients with painful bone metastasis were included and randomly assigned to group A, receiving palliative radiotherapy only (n=20), and group B, receiving palliative radiotherapy with concurrent capecitabine (n=22). Radiotherapy was administered at a dose of 30 Gy in 10 fractions at 3 Gy per fraction over two weeks. The patients were assessed once weekly during the treatment and at the end of the treatment, patients were evaluated every four weeks until 12 weeks. Response to treatment was evaluated using the Visual Analog Scale (VAS) and analgesic score. Statistical Package for the Social Sciences (SPSS) Version 21.0 (Armonk, NY: IBM Corp) was used for data analysis. Results: The mean age was 49.90 years for group A and 46.36 years for group B, respectively. The median pain score was 7 (4-10) in group A and 8 (5-9) in group B at baseline; at the end of 12 weeks, it was 2.5 (0-9) for group A and 0 (0-5) for group B (p-value=0.024). All the patients exhibited some level of response at the end of 12 weeks, with a Complete Response (CR) observed in 4 (20%) patients in group A, whereas it was seen in 14 (63.6%) patients in group B (p-value=0.004). Furthermore, there was a decrease in the consumption of analgesics in both groups from week 0 to week 4, with the median analgesic score changing from 2 (1-4) to 1 (0-3) in group A and from 3 (1-4) to 1 (0-2) in group B, without any significant difference between the groups (p-value=0.786). Conclusion: In comparison to radiotherapy alone, concurrent chemoradiation offers superior pain control and response rates in breast cancer patients with painful bone metastasis. Therefore, capecitabine administered concurrently with radiotherapy is safe for managing painful bone metastasis.

Impact of Clinical Pharmacological Intervention on Treatment Adherence among Adult Patients with Bronchial Asthma and COPD: A Randomised Clinical Study

Agnik Pal, Santanu Munshi, Santanu K Tripathi

Introduction: Adherence to the management of asthma and Chronic Obstructive Pulmonary Disease (COPD) is often suboptimal, which increases morbidity and mortality associated with these chronic respiratory diseases. The effectiveness of asthma and COPD education and self-management programmes on medication adherence and health outcomes is less well evaluated. Aim: To assess the impact of clinical pharmacological interventions, such as counselling and monitoring reinforcement, on treatment adherence in adult patients with asthma and COPD. Materials and Methods: This randomised clinical study was conducted in the Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, Eastern India. Eighty screen-eligible patients were randomly divided into two groups: the Intervention Group (IG) and the Non Intervention Group (Non IG), and were followed-up bimonthly for one year. The intervention consisted of a basic introduction to asthma or COPD, factors causing exacerbations, prevention of attacks, appropriate inhaler use techniques, etc. The appropriateness of inhalation technique was assessed using a structured observation checklist and the Device Appropriateness Index (DAI). An 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess adherence. Additionally, the Adherence Index (AI) of the patients was calculated by multiplying the MMAS-8 score with the DAI score. Results: In the study, there were 29 (52.73%) males and 26 (47.27%) females in the asthma group, while the COPD group comprised 18 (72%) males and 7 (28%) females, with mean ages of 42.86±14.3 years in the asthma group and 51.12±8.6 years in the COPD group. The MMAS-8 score was found to be better in the IG compared to the Non IG, with statistically significant differences observed from the 4th follow-up visit onwards. By the 6th follow-up visit in the IG, 42.5% demonstrated high adherence and 57.5% showed moderate adherence, with no patients falling into the low adherence category. There was significant improvement in the DAI in the IG compared to the Non IG from the first follow-up visit onwards and this improvement persisted across all subsequent visits. Conclusion: The findings of the present study suggest that clinical pharmacological intervention is of great value in optimising treatment adherence among asthma and COPD patients, and it can be routinely incorporated into clinical care.

Insights into Disaster Management among Emergency Paramedical Staffs: A Cross-sectional Study at a Tertiary Care Hospital in Tamil Nadu, India

M Lavanya, K Bincy, Roshni Mary Peter, N Keerthana, MVM Pradeep

Introduction: Disasters can be natural (e.g., cyclones and earthquakes) or man-made (e.g., chemical spills). Unpredictable disasters and multifaceted damage necessitate that healthcare providers be prepared to manage victims with varying skills and care to mitigate the impact of these disasters. Aim: To assess various aspects pertaining to disaster preparedness and management among paramedical staff in the emergency department of a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital in Chengalpattu, Tamil Nadu, India. Seventy paramedical staff members in the emergency department were included in the study and given a pretested semistructured questionnaire. The collected data was entered into Excel, and the associations between demographic factors and insights were measured using the Chi-square test in Statistical Package for the Social Sciences (SPSS) Version 27.0. Results: In this study, 44 (62.9%) participants were female. This study showed that 91.4% of the staff had adequate knowledge, while 82.9% demonstrated adequate practice. In the knowledge domain, there were no significant differences across demographic variables. However, in the practice domain, there was a significant difference based on gender (p-value <0.05). A significant association was found between knowledge and practice adequacy (χ2=26.91, p-value <0.001), indicating that staff members with adequate knowledge are more likely to practice adequately. Conclusion: This study concluded that the levels of knowledge and practice regarding disaster preparedness are adequate among the majority of staff. Management should organise medical education and training programs frequently to achieve standardised levels of preparedness.

Awareness of Stroke among the General Population of Arar City, Saudi Arabia: A Cross-sectional Study

Introduction: Stroke is a critical global health problem. In Saudi Arabia, it is a major cause of morbidity and mortality that is becoming increasingly serious. Considering lifestyle changes that contribute to an increased risk of stroke in Saudi Arabia, a greater community understanding of stroke symptoms and risk factors may influence how promptly patients are treated. Aim: To assess the awareness of stroke symptoms, risk factors and complications among the study subjects. Materials and Methods: A cross-sectional study was conducted, including 500 adults from Arar City, the capital of Northern Saudi Arabia, from November 1, 2023, to April 30, 2024. The study was approved by the local bioethical committee of Northern Border University. Socio-demographic data, along with information on symptoms and risk factors, were collected. Statistical Package for the Social Sciences (SPSS) software version 26.0 was used for data analysis. The data was presented as frequencies and percentages. Results: A total of 500 respondents were included in the study; their mean age was 40.1±11.7 years, with about 299 (59.8%) being males. More than two-thirds were married (359, 71.8%), and the majority were university educated (445, 89%). Most respondents correctly identified that stroke can be haemorrhagic or embolic. Hypertension was the most frequently cited risk factor (456, 91.2%). Speech difficulty was the most reported symptom (359, 71.8%), followed by walking difficulty (358, 71.6%), disturbed vision (301, 60.2%), and sudden severe headache (288, 57.6%). Conclusion: The Northern Saudi population demonstrated a relatively good level of literacy regarding stroke risk factors, symptoms and outcomes. Awareness programs are suggested to improve the control of modifiable risk factors for stroke, such as hypertension, diabetes, obesity and smoking.

Surrogate Markers of Insulin Resistance to Predict the Prognosis of COVID-19 Disease: A Retrospective Analysis

Susmita Banerjee, Shuvankar Mukherjee, Sukla Mitra

Introduction: Coronavirus Disease-2019 (COVID-19) patients exhibit an extensive range of disease manifestations. Disturbances in metabolic and lipid profiles occur due to the release of cytokines. The lipid elements of the COVID-19 virus play a significant role in the fusion of the viral membrane to the host cell, in addition to replication. Although the COVID-19 scenario is multifaceted, high risks are observed in patients with co-morbidities such as Insulin Resistance (IR). Lipid ratios and the Triglyceride-Glucose index (TyG) could serve as simple biochemical markers of IR, thereby aiding in the assessment of prognosis in admitted COVID-19 patients, particularly those with comorbid conditions like IR. Aim: To assess the severity of COVID-19 infection based on lipid ratios and the TyG index. Materials and Methods: This retrospective study was conducted at Diamond Harbour Government Medical College and Hospital, 24 Parganas, West Bengal, India, data from 189 diagnosed COVID-19 patients, aged between 18 and 60 years in and around diamond harbour, were collected after obtaining the necessary ethical clearance. All the patients, including referred cases, were admitted to the COVID-19 ward of Diamond Harbour Government Medical College and Hospital. Data from biochemical tests, such as Fasting Blood Glucose (FBG), Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL) and C-Reactive Protein (CRP), which were analysed using an autoanalyser (Transasia XL 640), were recorded. The lipid ratios and TyG index were calculated. The optimal cut-off values for all the above indices were derived from the point with the maximum Youden index by plotting the Receiver Operating Curve (ROC). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Software version 20. Results: The Fasting Blood Sugar (FBS), TG, TG/HDL, TC/HDL and TyG index levels were significantly higher in the severe COVID-19 patients (p<0.05). The optimal cut-off values calculated for the TyG index, TG/HDL and TC/HDL were 9.34, 3.55 and 3.83, respectively. Conclusion: In COVID-19 patients, a TyG index and lipid ratios of TG/HDL and TC/HDL exceeding 9.34, 3.55 and 3.83, respectively, could serve as early indicators of COVID-19 severity, thus assisting in the assessment of prognosis.

Comparative Analysis of Three Pain Scales for Evaluation of Procedural Pain in Neonates: A Cross-sectional Study

Preethi Subramanian, Sudharshan Raj Chitgupikar, Shreya Jalapu, Takreem Ilyas

Introduction: Neonates frequently undergo painful procedures in the Neonatal Intensive Care Unit (NICU), necessitating reliable Pain Assessment Tools (PAT). While various pain scales exist, no single tool is universally accepted due to differences in validity and clinical applicability. Aim: To compare the validity and internal consistency of Neonatal Infant Pain Scale (NIPS), Premature Infant Pain Profile Assessment Revised (PIPP-R), Douleur Aigue Nouveau-né (DAN) scale, for assessing procedural pain in neonates before, during and after a heel prick procedure. Materials and Methods: A cross-sectional study was conducted among 60 term neonates in a rural teaching hospital. The neonates underwent a heel prick procedure and pain scores were assessed using NIPS, DAN and PIPP-R at four time points: baseline, 30 seconds, two minutes and four minutes postprocedure. Construct validity was evaluated using repeated measures Analysis of Variance (ANOVA), concurrent validity by Pearson correlation and internal consistency by Cronbach’s alpha. Coefficient of variation was analysed to assess scale precision. Results: All three pain scales demonstrated peak pain scores at 30 seconds postheel prick, with a subsequent decline over time. NIPS and DAN exhibited high concurrent validity (r=0.939 at 30s, r=0.860 at 2 minutes). Cronbach’s alpha for NIPS, DAN and PIPP-R at 30 seconds was 0.808, 0.919 and 0.805, respectively, indicating high internal consistency. The removal of physiological parameters (heart rate, SpO₂) from PIPP-R significantly improved its internal consistency (Cronbach’s alpha increased from 0.805 to 0.917 at 30s and from 0.822 to 0.906 at 2 minutes), whereas using only physiological parameters yielded low or negative alpha values. PIPP-R had the lowest coefficient of variation, indicating the highest precision, while DAN had the highest. Conclusion: NIPS and DAN have good concurrent validity between them. PIPP-R had the least coefficient of variation and hence most precise. DAN has high internal consistency across the timelines.

Morphometric Analysis of the Proximal and Distal Ends of Adult Dry Femur Bone: A Cross sectional Study in the Population of North Karnataka, India

Introduction: Orthopaedic surgeons require anatomical knowledge of the proximal and distal ends of the femur when performing knee replacement or knee arthroplasty procedures. The application of morphometric analysis is advantageous to biochemical research. It enhances the understanding of many other factors that influence bone, such as its strength, structural integrity, and functions. Aim: To quantify the morphometric parameters of the proximal and distal ends of the adult femur, including measurements of size, shape, and angular relationships. Materials and Methods: A cross-sectional study on 102 adult dry femur bones of unknown gender and age collected from Department of Anatomy, JN Medical College, Belagavi, Karnataka, India from October 2024 to January 2025. The femur specimens were analysed using different methods. This includes osteometric board, Vernier caliper, Goniometer and thread. The data collected was statistically analysed using software International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) Statistics 27.0. Results: The current study found that the average femur length was 433±31.3 mm. The proximal part of femur showed femoral torsion averages 19.63±4.3 degrees, while the Neck Shaft Angle (NSA) has a mean of 125.35±16.86 degrees. Transverse diameter of head (in mm) measured 39.59±3.78 mm, and neck (mm) 25.65±3.42. Vertical diameter of head (in mm) is 40.01±3.69 and neck (in mm) is 29.44±4.07. The distal part of femur, showed bicondylar width (in mm), 66.41±7.46, intercondylar width (in mm) 21.32±5.03 and intercondylar depth (in mm) 24.97±2.54, medial condyle thickness (in mm) 23.84±3.86 and lateral condyle thickness (in mm) 23.93±3.16, medial condyle length (in mm) 56.06±4.77 and lateral condyle length (in mm) 57.29±4.21. Conclusion: The study’s measurements of the proximal and distal femur revealed population-specific values, particularly for North Karnataka. These findings have significant implications for forensic identification, anthropological studies, and clinical applications. Population-specific morphometric data enhances accuracy and relevance in these fields.

Impact of Intraoperative Colloid versus Crystalloid Administration on Postoperative Outcomes in Major Gastrointestinal Surgeries: An Interventional Study

Introduction: Colloids and crystalloids are frequently used for fluid resuscitation. However, their differing physiological properties may impact postoperative outcomes in distinct ways. Emerging evidence indicates that these variations could play a role in influencing surgical morbidity. Aim: To evaluate the impact on postoperative outcomes using crystalloids and colloids intraoperatively in patients undergoing major surgeries. Materials and Methods: This double-blinded, interventional study was conducted from July 2019 to December 2020 at Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India. A total of 150 patients, aged 16-60 years, American Society of Anaesthesiologists (ASA) Grade I, II and III, undergoing elective major surgery were enrolled in the study and divided into three groups, with 50 patients per group: group RL (n=50), Group Hetastrach and Ringer’s Lactate (HS-RL) (n=50) and Group Tetrastarch and Ringer’s Lactate (TS-RL) (n=50). All patients received Ringer’s Lactate (RL) at a rate of 7.0 mL/kg/hour before induction. Intraoperatively, group RL received Ringer’s Lactate alone at a rate of 8.0 mL/kg/hour, group HS-RL received both Ringer’s Lactate and 6% hetastarch at a rate of 8.0 mL/kg/hour and group TS-RL received 6% tetrastarch and Ringer’s Lactate at a rate of 8.0 mL/kg/hour. The patients were observed for 8 days postoperatively for vital signs, Arterial Blood Gas (ABG) analysis, ambulation, Postoperative Nausea and Vomiting (PONV) and complications. The data were represented as mean standard deviations and percentages and analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. A p-value of <0.05 was considered statistically significant. Results: Two patients were excluded from the study due to missing data in group RL (n=48). The demographic characteristics were statistically not significant among the groups (p-value >0.05). The proportion of patients who could ambulate independently or with assistance was higher in the HS-RL group 23 (46%) patients compared to the TS-RL group 16 (32%) patients, followed by patients in group RL (3 patients, 6.25%) (p-value <0.05). Intravenous fluids were administered to most patients for five days. Statistically, there was no significant difference among the groups (p-value=0.230). The data were represented as mean standard deviations and percentages and analysed using SPSS version 20.0. A p-value of <0.05 was considered statistically significant. Conclusion: Colloids are superior to crystalloids in terms of independent ambulation, ambulation with assistance, temperature regulation and reduction of nausea and vomiting. Overall, the present study concluded that colloids are able to effectively reduce postoperative complications more effectively than crystalloids without any serious side-effects.

Comparative Evaluation of Oral Melatonin versus Oral Alprazolam as Premedication in Patients Undergoing Tympanoplasty: A Randomised Control Study

Nupoor, Shikha Agarwal, Harsh Vardhan, Nikhil Nayar

Introduction: Preoperative anxiety is commonly experienced by patients who are admitted to hospital for any surgery and the role of premedication becomes important from an anaesthetist’s point of view, to relieve anxiety, provide sedation and ensure adequate analgesia. Aim: To compare the effects of oral melatonin versus oral alprazolam as premedication and their impact on postoperative recovery characteristics in patients undergoing tympanoplasty. Materials and Methods: In this randomised controlled study which was conducted from August 2022 to March 2024 at the Department of Anaesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India, a total of 70 adult patients were randomly allocated into two groups. Group M (n=35) received oral melatonin 6 mg and group A (n=35) received oral alprazolam 0.50 mg 120 minutes before surgery. The objectives of the study were to compare anxiety, sedation, cognition and pain using the Visual Analogue Scale (VAS), Ramsay Sedation Score (RSS), Digit Symbol Substitution Test (DSST) score and Numerical Rating Scale (NRS), respectively. The Shapiro-Wilk test, Independent t-test, Chi-square test and Fisher’s-exact test were used for statistical analysis. Results: The age distribution, gender, body mass index, American Society of Anaesthesiologists (ASA) status and mean duration of surgery were comparable between the two groups. Mean VAS scores were significantly lower in group M at 60 minutes (3.03±1.29 vs 3.77±1.21) and at 120 minutes (2.17±1.12 vs 2.91±1.12). Even in the postoperative period, compared to group A, the VAS score was lower in group M after extubation at various time intervals. RSS scores were lower in group M compared to group A at 60 minutes and at 120 minutes of drug administration. In the postoperative period, compared to group A, group M had lower sedation scores after extubation at 30 minutes, 60 minutes, 90 minutes and 120 minutes (p-value <0.0001). Compared to group A, group M had statistically significantly higher DSST scores at various time intervals in both the preoperative and postoperative periods (p-value <0.0001). group M had significantly lower NRS scores after extubation at various time intervals (p-value <0.0001) compared to group A, indicating that pain was significantly lower in the postoperative period with the use of melatonin. Conclusion: Oral melatonin (6 mg) is shown to be an effective alternative to alprazolam (0.5 mg) as a premedication. Oral melatonin offered superior anxiolysis while inducing less sedation compared to alprazolam. In addition, there was better preservation of cognitive function with melatonin compared to alprazolam.

Evaluation of Chlorogenic Acid in Parkinson’s Disease Model: An In-vitro Study in 6-OHDA Induced SH-SY5Y Cell Line

Introduction: Parkinson’s Disease (PD) is the most common neurodegenerative movement disorder. Mitochondrial dysfunction is a key pathological driver of PD. Pharmacological agents used in PD are not disease-modifying therapies and do not influence mitochondrial activity. Diets rich in polyphenols have been shown to prevent pathologies associated with ageing. Aim: To evaluate Chlorogenic Acid (CGA), a phenolic acid, for its neuroprotective effect against PD in a 6-Hydroxydopamine (6-OHDA) induced SH-SY5Y cell line using in-vitro assays. Materials and Methods: An in-vitro study was conducted at the Department of Pharmacology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from September 2023 to November 2023. The human neuroblastoma cell line SH-SY5Y was induced using 6-OHDA. The activity of CGA against cytotoxicity in the 6-OHDA induced SH-SY5Y cell line was evaluated using the MTT assay with different concentrations (3.125 μM, 6.25 μM, 12.5 μM, 25 μM and 50 μM). Mitochondrial Membrane Potential (MMP) was evaluated using flow cytometry and antiapoptotic activity was assessed using Cytochrome C immunofluorescence by fluorescence microscopy. One-way Analysis of Variance (ANOVA) with Tukey’s posthoc analysis was used to identify statistical significance at p-value <0.05. Results: The CGA exhibited the maximum protective concentration on the 6-OHDA induced SH-SY5Y cell line at 25 μM, with a restoration of cell viability of 43.04%. CGA also improved the mitochondrial membrane potential and reduced the levels of cytochrome C release thus maintaining the mitochondrial membrane integrity. Conclusion: The findings provide evidence that CGA may exert an anti-PD effect through its action on mitochondrial dysfunction and the release of pro-apoptotic factors. The observed action on neuronal cells makes CGA a potential candidate for anti-PD treatment.

Effect of Electrical Muscle Stimulation and Resistance Training on the Lipid Profile in Sedentary Type-II Diabetic Individuals: An Experimental Study

Vishwajeet Trivedi, Neelima Mishra, Kamran Ali

Introduction: Diabetes Mellitus (DM) is associated with dyslipidaemia, a major contributor to cardiovascular complications. Resistance Training (RT) is known to improve lipid metabolism, but adherence can be challenging. Electrical Muscle Stimulation (EMS) has emerged as a potential alternative, promoting muscle activation and metabolic improvements. Aim: To evaluate and compare the effects of EMS and RT on lipid profile parameters, including Total Cholesterol (TC), Low Density Liopprotein Cholesterol (LDL-C), High Density Liopprotein Cholesterol (HDL-C) and Triglycerides (TG), in sedentary individuals with diabetes. Materials and Methods: An experimental study with a pretest/post-test design was conducted in the Department of Physiotherapy at GD Goenka University, Gurugram, Haryana, India starting from October 2023 until September 2024. A total of 66 sedentary type II diabetic subjects (both males and females) with a fasting blood glucose level between 100 mg/dL and 250 mg/dL and on oral hypoglycaemic drugs, without any major systemic or diabetic complications, were included in the study. Subjects were assigned to three groups through a convenient sampling method: EMS, RT and a control group. The EMS group, with a mean age of 53.0±3.7 years, received Russian current stimulation on three alternate days per week for 12 weeks. The RT group, with a mean age of 52.0±4.84 years, performed progressive resistance exercises on three alternate days per week for 12 weeks, while the control group, with a mean age of 49.77±6.75 years, received standard patient education on diet and physical activity. Lipid profile parameters, including TC, HDL-C, LDL-C, Very Low Density Liopprotein Cholesterol (VLDL-C), TGs and cholesterol/HDL ratio, were assessed at baseline, postintervention (12 weeks) and after a three-month follow-up. The pre-post data for intervention groups were analysed using Analysis of Variance (ANOVA) at three time points with p-value <0.05. Results: Repeated measures ANOVA showed significant group-time interactions for TC (p-value <0.001, η²=0.348), LDL-C (p-value=0.003, η²=0.120), triglycerides (p-value <0.001, η²=0.213), HDL-C (p-value <0.001, η²=0.162) and cholesterol/HDL ratio (p-value=0.002, η²=0.194), while changes in VLDL were not significant (p-value=0.713). Pairwise comparisons indicated significantly lower TC, LDL-C and cholesterol/HDL ratio in the EMS and RT groups compared to controls (p-value <0.01), with no difference between EMS and RT (p-value >0.05). Triglycerides decreased significantly in both intervention groups (p-value <0.05), with EMS showing a greater reduction, though not statistically different from RT (p-value=1.000). HDL-C changes were minor and nonsignificant across groups (p-value >0.05). These findings suggest that both EMS and RT effectively improve lipid profiles, with RT favouring cholesterol modulation and EMS being more effective for triglyceride reduction. Conclusion: Both EMS and RT effectively improved lipid profiles in individuals with Type 2 Diabetes Mellitus (T2DM), with RT demonstrating superior benefits in reducing cholesterol and LDL-C, while EMS was more effective in lowering triglycerides. EMS may serve as a viable alternative for individuals with exercise limitations, offering a non pharmacological approach in managing diabetic dyslipidaemia.

Socio-demographic, Clinicoaetiological and Treatment Profile of Children with Epilepsy Aged 6 to 15 Years: A Cross-sectional Study from Western Maharashtra, India

Shiji Chalipat, Amodini Arora, Shailaja Mane

Introduction: The International League Against Epilepsy (ILAE) task force proposed that epilepsy be considered a disease of the brain defined by any of the following conditions: 1) At least two unprovoked (or reflex) seizures occurring more than 24 hours apart; 2) One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures occurring over the next 10 years; 3) A diagnosis of an epilepsy syndrome. Aim: To study the sociodemographic, clinicoaetiological and treatment profile among children with epilepsy aged 6-15 years. Materials and Methods: This cross-sectional observational study was conducted in the Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India over a period of 24 months from July 2022 to July 2024. A total of 98 children, aged 6-15 years, diagnosed with epilepsy of any aetiology and with a duration of at least six months, seen in the Outpatient Department (OPD) or admitted in the ward of Dr. D. Y. Patil Medical College, comprised the study population. A detailed medical and neurological history, along with clinical examinations, was documented using a structured clinical proforma. The type of epilepsy and its syndromic classification were also determined. Results: The mean age of the study population was 9.17 years, with a male gender preponderance. Eighty-five (86.7%) children were born preterm. Normal vaginal delivery was the most common mode of delivery, occurring in 63 (64.3%). A total of 69 (70.4%) had a normal weight at birth. Thirty-five (35.7%) of the study subjects required admission to the Neonatal Intensive Care Unit (NICU). Fifty-five (56.1%) exhibited developmental delay, and IQ assessment revealed borderline IQ in the majority, with 58 (59.1%) subjects falling into this category. The commonest age of onset of seizures was greater than 5 years in 43 (43.9%) subjects. Twenty-nine (29.6%) had epilepsy for more than 2-5 years. Focal onset seizures were the most common, occurring in 66 (67.4%), and 14 (14.3%) experienced seizures daily. Fifty-three (54.1%) experienced uncontrolled seizures and belonged to the refractory category. Abnormal neurological findings were seen in 56 (57.1%) subjects. Seventy-one (72.4%) had abnormal Electroencephalogram (EEG) findings. Fifty-eight (59.2%) subjects received polytherapy. One (1.0%) patient underwent epilepsy surgery, 10 (10.2%) were on a ketogenic diet, while 87 (88.8%) subjects were on drug therapy alone. Structural aetiology was identified in a majority, with 49 (50%) subjects, and the most commonly administered Anti-Seizure Medication (ASM) was levetiracetam. Conclusion: Children with epilepsy require prompt stabilisation and resuscitation, along with meticulous history-taking, detailed examination and stepwise implementation of laboratory investigations, EEG and neuroimaging to delineate the underlying aetiology and plan treatment for better prognostic outcomes.

Effect of Oral Clonidine Premedication on Induction Dose of Propofol and Perioperative Haemodynamic Parameters in Patients Undergoing Laparoscopic Cholecystectomy: A Double-blinded Randomised Controlled Study

Introduction: Clonidine increases the effects of anaesthesia and possesses antihypertensive qualities. During laparoscopic cholecystectomy, pneumoperitoneum is created by inflating Carbon Dioxide (CO₂), which stimulates autonomic pathways, resulting in catecholamine release, activation of the renin-angiotensin system and vasopressin release. Clonidine may be an ideal agent for controlling the stress response to pneumoperitoneum during laparoscopic surgery. Aim: To observe the clinical efficacy of two different dosages of oral clonidine premedication on the induction dose of propofol and changes in perioperative haemodynamic parameters in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This randomised, double-blinded study was conducted at the Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, India, from January 2019 to December 2020. The study examined 60 patients with American Society of Anaesthesiologists (ASA) grades I and II who were scheduled for elective laparoscopic cholecystectomy under general anaesthesia. One hour before induction, the patients were randomly assigned to three groups for premedication: Group A (n=20) received a placebo, group B (n=20) received 150 μg of oral clonidine and group C (n=20) received 300 μg of oral clonidine. The patients were managed with standard general anaesthesia. Haemodynamic parameters and the propofol induction dose of the three groups were compared using an unpaired t-test and one-way Analysis of Variance (ANOVA); a p-value of <0.05 was considered statistically significant. Results: A total of 60 patients were included in the study, with 20 patients in group A (Placebo), 20 in group B (150 μg oral clonidine) and 20 in group C (300 μg oral clonidine). When comparing the two different dosages of oral clonidine (150 μg vs 300 μg), it was found that the higher dose (300 μg) was more effective in attenuating the pressure responses to laryngoscopy, intubation, pneumoperitoneum and extubation. In comparing the clonidine groups, group C (1.42±0.14 mg/kg) and group B (1.61±0.02 mg/kg) both exhibited a substantial reduction in the induction dose of propofol compared to the placebo group A (1.84±0.13 mg/kg). Conclusion: Throughout the perioperative periods, the clonidine groups (C>B) maintained haemodynamic variables better than the placebo group (A) and the clonidine groups also experienced a significant reduction in the induction dose of propofol. In comparing the two dosages of oral clonidine, it was found that the higher dose (group C) was superior in attenuating the pressure response to laryngoscopy, intubation, pneumoperitoneum and extubation.

Intralesional Bleomycin in Periungual Warts: A Prospective Randomised Controlled Study

Introduction: Periungual Warts (PW) are difficult to treat because of their challenging location, high recurrence rate and resistance to treatment. Bleomycin is a cheaper and readily available drug that has potential efficacy in treating warts, although limited data on its use are available in the literature. Aim: To study the efficacy and safety of Intralesional (IL) bleomycin in treating PW. Materials and Methods: A prospective randomised controlled study was conducted at the Department of Dermatology, SCB Medical College and Hospital, Odisha, India, from September 2019 to August 2020. A total of 56 patients with PW were randomised equally by block randomisation into two groups: Group A and Group B. Group A received 1 U/mL IL bleomycin, while Group B was given dH2O. Follow-up assessments were conducted at four, twelve and 24-week intervals. All follow-up visits included photographic documentation to confirm the cure rates before and after treatment. To evaluate the treatment’s safety and effectiveness, the number and size of wart lesions, as well as injection side-effects, were noted at baseline and during each follow-up visit. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0 (SPSS Inc., Chicago, IL). The Chi-square test was used to compare the study and control groups and to conduct follow-up analysis. Statistical significance was set at a level of ≤0.05, with a confidence interval of 95%. Results: Group A and B patients had 54 and 42 wart lesions, respectively. The complete cure rate in Groups A and B was 74.1% (40/54 warts) and 4.8% (2/42 warts), respectively, after four weeks. After the second follow-up, at twelve weeks, the cure rate was significantly higher in the experimental group: 97.3% versus 4.76% (p=0.00001). All cases during the IL injection experienced pain at the injection site and haemorrhagic eschar was observed in every case within the first week of the IL injection. No significant systemic adverse effects were noted. Conclusion: Intralesional bleomycin is highly efficacious and safe for the treatment of warts. Systemic side-effects are negligible, making it an effective treatment option for clearing warts in difficult areas, such as PW.

Comparative Evaluation of Two Audio-analgesic Tracks on Reduction of Anxiety Level in Patients Undergoing Root Canal Treatment: A Randomised Clinical Study

Introduction: Patients often experience dental anxiety, which can range from mild apprehension to severe phobia. In addition to pharmacological treatments, methods like sedation, aromatherapy, behavioural techniques, and music therapy have proven effective in reducing anxiety. Music, in particular, has been well-studied in clinical settings. Aim: To compare the reduction in anxiety levels of patients undergoing endodontic therapy with two different audio-analgesic tracks. Materials and Methods: This randomised clinical study was carried out in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from May 2019 to November 2019. A total of 120 patients were enrolled in the study. Before initiating endodontic therapy, patients were assessed for baseline anxiety using the Visual Analogue Scale (VAS), along with measurements of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Pulse Rate (PR). Participants were randomly divided into three groups: Group A: Om chanting music; Group B: weightless music; and Group C: control (no music). Vitals (SBP, DBP, PR) were recorded at three intervals: before treatment, at 30 minutes, and at one hour. The results were then statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0, employing the Analysis of Variance (ANOVA) test and Tukey’s Post-hoc analysis. Results: Out of the 120 patients, 82 (68.33%) were male and 38 (31.66%) were female, with a mean age of 35 years. The results indicated that SBP was significant during (p=0.004) and after treatment (p=0.002). Additionally, DBP was significant after treatment (p=0.037). PR was highly significant before, during, and after treatment (p<0.001 for all). The differences in SBP between groups B and C during treatment (p=0.003), as well as between groups A and C (p=0.004) and groups B and C (p=0.008) after treatment, were statistically significant. Additionally, a significant difference in DBP was observed between groups A and C after treatment (p=0.043). However, no significant differences in Heart Rate (HR) were found before, during, or after treatment among the groups (p>0.05). Conclusion: In the present study, both music tracks demonstrated clinically and statistically acceptable performance compared to the control group, with the Om chanting track having a more substantial influence on anxiety levels, SBP, and DBP than the weightless track. Additionally, there was a significant difference in HR, indicating the efficiency of music in reducing anxiety during dental treatment.

Factors Influencing Binge-watching Behaviour and its Impact on Loneliness among Undergraduate Medical Students: A Cross-sectional Study from Chengalpattu District, Tamil Nadu, India

R Suba Shree, P Kaveri, Roshni Mary Peter, VV Anantharaman, M Logaraj

Introduction: Binge-watching, a common behaviour among youth, is especially prevalent among medical students due to academic pressures and the accessibility of streaming services. This behaviour may lead to potential mental and physical health impacts. Aim: To assess the prevalence of binge-watching and identify associated risk factors among undergraduate medical students. Materials and Methods: A cross-sectional study was conducted among MBBS students in Chengalpattu, Tamil Nadu, India using multistage sampling. A total of 400 students were selected through simple random sampling. Socio-demographic details, including age, gender, family type, residence, year of study and risk factors for binge-watching (such as sleep duration, participation in recreational activities, Over-The-Top (OTT) platform subscription status, the number of OTT platforms subscribed to, frequency of binge-watching, devices used for binge-watching and consumption of snacks or junk food during binge-watching), were gathered using a pretested semistructured questionnaire. The University of California, Los Angeles (UCLA) Loneliness Scale and the Binge-watching Addiction Questionnaire assessed loneliness and binge-watching behaviour. Statistical analysis included mean and standard deviation, independent t-tests for continuous variables, Chi-square tests, univariate regression for categorical variables, and binary logistic regression for significant variables (p-value <0.05) to control for confounders. Results: The participants had a mean age of 20.71±2.04 years, with the majority being females (58.6%) and from nuclear families (86.1%). Most students (84.4%) had subscriptions to OTT platforms, with 50.8% binge-watching more than twice a week. The prevalence of binge-watching was 64% (381 participants). The overall mean binge-watching score was 33.14±13.012. Mild binge-watching was observed in 172 students (70.5%), moderate binge-watching in 53 students (21.7%), and problematic binge-watching in 19 students (7.8%). The overall mean loneliness score was 44.44±9.39. Univariate analysis identified significant associations between problematic binge-watching and being a hosteller, lack of recreational activities, OTT platform subscription and consumption of snacks or junk food. Binary logistic regression revealed significant associations between problematic binge-watching and factors such as the absence of recreational activities (AOR=2.298, p-value=0.012) and consuming snacks (AOR=2.518, p-value=0.006). Higher loneliness scores were significantly associated with problematic binge-watching (46.67±8.85) compared to mild binge-watching (43.51±9.47) (p-value=0.016). Conclusion: The study revealed a high prevalence of binge-watching among medical students, which was linked to loneliness and a lack of recreational activities. This emphasises the need for awareness and interventions to promote balanced media consumption.

Molecular Evidence of the High-risk Human Papillomavirus 56 Genotype in Cervical Abnormalities using Multiplex Nested PCR Assay: A Cross-sectional Study from a Tertiary Care Center in Puducherry, India

Introduction: Human Papillomavirus (HPV) is a group of Deoxyribonucleic Acid (DNA) viruses linked to both benign and malignant diseases. High-Risk (HR) HPV genotypes, especially HPV 16 and HPV 18, are key contributors to cervical cancer. Aim: To determine the prevalence of HR HPV genotypes, including HPV 16, 18, 31, 45, 51 and 56, in cervical abnormalities in women by comparing cytological Pap smear results with in-house Multiplex Nested Polymerase Chain Reaction (PCR) to refine diagnostic protocols. Materials and Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, tertiary care hospital and the Mahatma Gandhi Medical Advanced Research Institute, Puducherry, India over a period of six months, from November 2023 to May 2024. The study included 100 symptomatic women presenting with complaints such as vaginal discharge, abnormal bleeding and pelvic pain. OBG endocervical samples were cross checked against cytological pap smear and multiplex nested PCR. The PCR amplified products were further confirmed by bidirectional Sanger sequencing. The sequenced data were analysed and annotated using MEGA software version 10.0 and submitted to the National Centre for Biotechnology Information (NCBI) database. Results: A total of 100 samples were analysed, with 14 (14%) detected as HPV DNA in symptomatic women. HPV 16 was observed in four patients (28.57%), followed by HPV 56 in four patients (28.57%). HPV 18 and HPV 31 were detected in two patients each (14.29%), while HPV 45 and HPV 51 were observed in one patient each (7.14%). Symptoms such as abnormal vaginal bleeding, pelvic pain and vaginal discharge were predominant with specific HPV genotypes. The detection limit of Multiplex Nested PCR was higher than that of the Pap smear. Co-infections with organisms like Candida albicans and Trichomonas vaginalis were noted in HPV-negative cases. The sequenced samples were published with GenBank accession numbers PQ518860 – PQ518863. Conclusion: While nested PCR exhibited higher sensitivity compared to the Pap smear, this study concludes that routine HPV genotyping and cytology screening for HR HPV strains are essential to improve early diagnosis and prompt treatment outcomes in HR groups.

Assessment of Bite Force in Patients with Periodontitis Before and after Splinting in Anterior Teeth using Computerised Occlusal Analysis System: A Clinical Study

Introduction: Bite force is a measure of the functional status of the masticatory system. It is determined by the combined activity of the jaw elevator muscles, which are influenced by reflex mechanisms and jaw biomechanics. Measuring bite force can yield valuable information for assessing the activity and function of the jaw muscles. Recording devices and techniques are important factors in obtaining bite force measurements. Aim: To compare the occlusal function in terms of changes in bite force parameters before and after the splinting of periodontally weakened anterior teeth using the NUPAI bite scan (Fuji™) method in patients with stage I and II periodontitis. Materials and Methods: This prospective clinical study was conducted in the Department of Periodontology at Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India between May 2023 and February 2024. The bite force parameters assessed included pressed area, average pressure, and maximum pressure using the NUPAI bite scan (Fuji™) in a total of 25 individuals before and after extracoronal splinting of periodontally weakened anterior teeth. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20.0, and data were summarised as mean and standard deviation. A paired t-test was conducted to find significant differences in the various variables within the group. A p-value of less than 0.05 was considered statistically significant. Results: Maximum bite pressure and average bite pressure were found to be greater after the procedure of extracoronal splinting compared to before splinting, with mean values of 26.59±4.32 MPa (before splinting) and 30.45±4.29 MPa (after splinting) (p-value=0.005), and 9.11±1.75 MPa (before splinting) and 9.86±1.83 MPa (after splinting) (p-value=0.015), respectively. However, the mean pressed area before and after the splinting procedure was 22.76±34.49 mm² and 19.00±19.40 mm², respectively, showing no statistically significant difference between them (p-value=0.323). It can be inferred that, without appreciably altering the contact area, the splinting technique successfully increased bite force by improving both maximum and average pressures. Conclusion: The present study concluded that the splinting procedure used in phase I therapy aids in improving the patient’s occlusal function, and the NUPAI bite scan system allows for quantitative recording of this improvement.

Simple and Discriminatory Reaction Times in Preovulatory and Postovulatory Phases of Menstrual Cycle in Healthy Young Females: A Cross-sectional Study

Introduction: The menstrual cycle plays a significant role in the functioning of the cardiovascular and central nervous systems. Cognitive processing is affected differently during the various phases of the menstrual cycle, in addition to emotional processing. Cognitive domains such as attention, awareness, and memory show variations across the phases of the menstrual cycle. However, considerable conflicts exist in the scientific literature regarding the changes in these parameters during the menstrual cycle. Reaction times have been established as an objective measurement of cognitive processing in humans. Aim: To observe and compare simple and discriminatory visual and auditory reaction times in healthy adult females in the pre and postovulatory phases of their menstrual cycles. Materials and Methods: This cross-sectional observational study was conducted in the southern part of India during the years 2018-2024. Interested volunteers were questioned regarding their menstrual history to rule out any abnormalities. Healthy young adult females were included in the study after obtaining their informed consent in writing. Preovulatory reaction times were measured on the 10th or 11th day, while postovulatory reaction times were measured on the 20th or 21st day of the menstrual cycle. Simple and discriminatory visual and auditory reaction times were measured in triplicate at a resolution of one millisecond, with the minimum value included for analysis. The Kolmogorov-Smirnov test was used to analyse the normality of the distribution, and the Wilcoxon signed-rank sum test was used to test the significance of the difference in medians of the paired samples. Statistical Package for Social Sciences (SPSS) version 16.0 was employed for the analysis. Results: Simple Visual Reaction Times (SVRT) significantly differed between the pre and postovulatory phases (p-value 0.048). Simple Auditory Reaction Times (SART) also significantly differed between the pre and postovulatory phases (p-value 0.003). Discriminatory Visual Reaction Times (DVRT) and Discriminatory Auditory Reaction Times (DART) did not statistically differ between the pre and postovulatory phases (p-value=0.938, p-value=0.076, respectively). Conclusion: Simple visual and auditory reaction times were significantly prolonged in the postovulatory phases.

Comparing Abdominal Circumference to Gastric Residual Volume for Assessing Feed Intolerance in Low Birth Weight Infants: A Prospective Cohort Study

B Sunil, R Sushmitha

Introduction: Babies with feed intolerance usually present with vomiting, abdominal distension and the presence of gastric residues. Feed intolerance can be clinically diagnosed through the assessment of prefeed Gastric Residual Volume (GRV), the colour of gastric aspirates, abdominal distension, emesis, bloody stools and increased apnoea and/or bradycardia. Aim: To evaluate prefeed Abdominal Circumference (AC) and GRV for feed intolerance in low birth weight infants and also to assess the time taken to achieve 150 mL/kg full feeds. Materials and Methods: This prospective cohort study was conducted in the Department of Paediatrics at the Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India, from January 2021 to June 2022. A total of 100 neonates weighing less than 2.5 kg were included in the study. Group 1 was subjected to measurement of prefeed AC, while group 2 was subjected to measurement of prefeed gastric aspirate as a measure of feed intolerance. Inferential statistics such as the Chi-square test, t-test and other appropriate tests were used whenever applicable. A p-value of less than 0.05 was considered statistically significant. Results: Between the two groups considered in the study, the mean age of infants in group 1 and group 2 were 34.48 days and 33.04 days, respectively, with a mean birth weight of 1.82 kg and 1.72 kg in group 1 and group 2, respectively. In the present study, nine infants were in group 1 and 14 infants were in group 2, both showing signs of feed intolerance. The mean time required to reach full feeds in infants of group 1 was 8.72 days, while in group 2, it was 10.88 days. Conclusion: Both AC and GRV are useful indicators of feed intolerance; however, AC shows better results in terms of achieving full feeds, feed tolerance and the period of recovery. Nonetheless, the results obtained in the AC group are not statistically significant compared to the results obtained from the prefeed gastric aspirate group.

Absence of Anterior Guidance and its Effects on Early Discal Changes in Temporomandibular Joint: A Cross-sectional Study

Lokesh Sai Karanam, Suresh Venugopalan

Introduction: Anterior guidance plays a crucial role in occlusal harmony and Temporomandibular Joint (TMJ) function. Its absence may contribute to early joint changes, potentially leading to dysfunction. Joint Vibration Analysis (JVA) provides a non invasive method to assess TMJ status and detect subclinical discal changes. Aim: To evaluate the effect of the absence of anterior guidance on TMJ function using JVA and to assess early discal changes. Materials and Methods: This cross-sectional study was conducted at the Department of Prosthodontics, Saveetha Dental College, Chennai, Tamil Nadu, India, over the period of March 2024 to August 2024 total of 30 participants were categorised into three groups based on anterior guidance: Group 1 served as the control group and consisted of participants with intact anterior guidance. Group 2 included participants without anterior guidance who had previously undergone orthodontic or prosthodontic therapy. Group 3 comprised participants without anterior guidance and without any prior history of orthodontic or prosthodontic treatment. JVA parameters, including total integral, integral values greater than 300 Hz and integral values less than 300 Hz, were analysed. Statistical analysis was performed using Statistical Package for Social Sciences (SSPSS) version 23.0, employing One-way Analysis of Variance (ANOVA) and Tukey’s post hoc test for group comparisons. Results: Participants without anterior guidance exhibited significantly higher total integral values (p-value <0.05), indicating subclinical discal changes in the TMJ. A significant difference (p-value=0.02) was observed in maximum mouth opening among the groups. The higher integral values greater than 300 Hz and less than 300 Hz in the groups without anterior guidance further supported the presence of early joint dysfunction. Conclusion: Early subclinical discal changes in the TMJ were noted in patients with an absence of anterior guidance. JVA can serve as an effective diagnostic tool for the early detection of TMJ dysfunction.

Clinical Utility of Serum Lactate and Albumin in Predicting Mortality in Patients with Sepsis Admitted to the Intensive Care Unit: A Prospective Cohort Study

Benjamin Isac John, AS Sathiqali, Rohith George, B Mukhtarahmed

Introduction: Sepsis is a life-threatening condition characterised by systemic inflammation and multiorgan dysfunction in response to infection. Despite the specificity of prognostic scoring systems such as Sequential Organ Failure Assessment (SOFA) and Acute Physiology And Chronic Health Evaluation II (APACHE II), their limited sensitivity and reliance on multiple laboratory parameters highlight the need for simpler, effective biomarkers. Serum albumin, a negative acute-phase reactant and lactate, an organ hypoperfusion marker, are potential biomarkers for assessing the severity of sepsis. Aim: To evaluate the prognostic significance of serial serum lactate and albumin levels, as well as their ratio, in predicting outcomes in Intensive Care Unit (ICU) patients with sepsis. Materials and Methods: This prospective cohort study was conducted in the medical ICU of Yenepoya Medical College and Hospital, Mangaluru, Karnataka, India that included 95 adults admitted to the medical ICU with suspected sepsis, meeting the Sepsis-3 criteria. Serum lactate and albumin levels were measured on days 1, 3 and 5 post-diagnosis. Patient outcomes, including mortality and duration of hospital stay, were documented. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0, which included Pearson’s correlation to evaluate relationships between lactate and albumin levels, Student’s t-test for group comparisons and Receiver Operating Characteristic (ROC) curve analysis to assess the predictive accuracy of the Lactate/Albumin Ratio (LAR). Results: The study included 95 ICU patients with sepsis (mean age: 50.25±14.65 years; 63.16% male). Prolonged hospital stays (>15 days) were noted in 61.06% of patients, with 78.94% recovering. Survivors showed rising albumin levels (day 1: 2.82 g/dL; day 5: 3.43 g/dL) and declining lactate levels (day 1: 2.77 mmol/L; day 5: 1.27 mmol/L), while non survivors exhibited minimal increases in albumin (day 1: 2.87 g/dL; day 5: 3.05 g/dL) and persistently elevated lactate levels (day 1: 3.02 mmol/L; day 5: 3.35 mmol/L). On day 5, survivors had significantly higher albumin levels and lower lactate levels than non survivors. The LAR declined in survivors (day 1: 1.07; day 5: 0.54) and demonstrated marked predictive accuracy for mortality on day 5 (AUC=0.81, sensitivity=68%, specificity=95%), with diagnostic accuracy peaking at 89.21%. Conclusion: The day 5 LAR is a strong predictor of mortality in ICU patients with sepsis. The inverse correlation between lactate and albumin levels underscores their utility for early risk stratification and management of sepsis.

A Study on Plasma Fibrinogen as a Risk Factor for Premature Acute Myocardial Infarction

Maneesha Maniya, Vignessh Raveekumaran, Sethuraj Selvaraj, KS Chenthil

Introduction: Acute Myocardial Infarction (AMI), a significant coronary event, is increasingly prevalent among younger populations, presenting unique challenges in risk assessment and prevention. Premature AMI, defined as occurring before the age of 55, is often linked to non traditional risk factors such as elevated Plasma Fibrinogen (PFg), a key component in atherothrombosis and vascular inflammation. Aim: To determine the prevalence of elevated PFg levels in premature AMI patients (<55 years) and evaluate its association with AMI among patients admitted to a tertiary care hospital in Puducherry, India. Materials and Methods: A hospital-based case-control study was conducted in the Coronary Care Unit (CCU) and Intensive Care Units (ICU) under the Department of General Medicine at a tertiary care teaching hospital in rural Puducherry, India. Over 18 year among 112 patients: 56 with AMI (cases) and 56 age- and sex-matched controls without AMI. Data were collected through clinical evaluations, Electrocardiography (ECG), Echocardiography (ECHO) and biochemical assays. PFg levels were classified as normal (<340 mg/dL) or elevated (>340 mg/dL) and the associations with AMI were analysed. Results: The mean PFg level in AMI patients was significantly higher (409±52.3 mg/dL) than that in controls (226±46.2 mg/dL) (p<0.001). Elevated PFg levels were observed in 48.2% of AMI patients, correlating strongly with traditional risk factors such as smoking and lipid abnormalities. Conclusion: Elevated PFg is a significant risk factor for premature AMI. Incorporating PFg measurement into cardiovascular risk assessments could aid in the early identification and targeted intervention for this at-risk population.

Acoustic and Psychological Effects of Omkar Chanting in Novice Indian Adults: A Quasi-experimental Study

Jayashree Pattanayak, Yamini Belur, Judu Ilavarasu

Introduction: The physiological and psychological effects of Omkar chanting are gaining popularity. However, limited research has focused on the acoustic effects of Omkar chanting and how the produced sounds and vibrations influence both mental and vocal physiological states. Aim: This study explores the effects of 10 days of Omkar mantra chanting on voice quality and psychological well-being in Indian adults without prior regular chanting experience. Materials and Methods: A quasi-experimental study was conducted online in India involving 100 healthy adults (aged 20-45 years) over 10 days in three batches, from November 2023 to December 2023. Participants attended daily 30-minute Omkar chanting sessions. Four participants were excluded due to unclear audio recordings. Voice parameters and psychological well-being were assessed using PRAAT software, the World Health Organisation-Five Well-being Index (WHO-5), and the Subjective Vitality Scale, before and after the intervention. Data were analysed using paired sample t-tests to evaluate changes in voice parameters, vitality, and overall well-being. The level of significance was fixed at 0.05. Results: After 10 days of Omkar chanting, participants experienced significant improvements in their vocal quality, including reduced fundamental frequency (F0) for “A kara” (females: 223.06 to 216.58 Hz; males: 138.65 to 129.23 Hz) and “U kara” (females: 223.40 to 216.22 Hz; males: 138.40 to 131.13 Hz), as well as decreased jitter and shimmer values, reflecting increased vocal stability. There were significant increases in the mean WHO-5 scores (from 15.19 to 21.88) and mean vitality scores (from 23.76 to 35.34), (p-value <0.001), suggesting a positive impact on psychological well-being. These results indicate the beneficial effects of Omkar chanting on vocal health and psychological well-being in adults with no prior chanting experience. Conclusion: Omkar mantra chanting positively improves vocal stability, resonance, and mental health in adults aged 20-45 years. These findings suggest that incorporating mantra chanting into daily routines can be a simple yet effective tool for enhancing both vocal health and mental well-being, making it beneficial for those seeking natural practices for stress reduction and overall well-being.

Effect of Storage Time and Temperature on Important Biochemistry Parameters in Stored Human Blood Samples: A Cross-sectional Study

Tajveer Singh Kanda, Heena Singla, Rajinderjit Singh Ahi

Introduction: Backbone of modern healthcare depends on accuracy of laboratory test results. Sometimes in busy laboratories, samples may have to be stored or transported at different temperatures and for different time periods before they could be analysed. In particularly such samples, validation of test results is very important. Aim: To study the effect of storage time and temperature on important biochemistry analytes. Materials and Methods: It was cross-sectional study, carried out in Department of Biochemistry at GGS Medical College, Faridkot, Punjab, India from January 2023 to December 2023. Total 40 patients’ samples were first analysed immediately (0-hour samples) for important biochemical parameters i.e., glucose, urea, creatinine, uric acid, total bilirubin, direct bilirubin, Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP), sodium, potassium, chloride, amylase, triglycerides, cholesterol, calcium, phosphorus, Creatine Kinase Myoglobin-Binding fraction (CK-MB), Lactate Dehydrogenase (LDH) and N-Acetyl Cysteine Activated Creatine Kinase (CK-NAC). Then samples were stored in two separate aliquots, to be stored at 2-8°C and at room temperature for analysis after 24-hour and 72-hour. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 22 software. If p-value was less than 0.05, difference was considered statistically significant. Results: At 2-8°C, mean values of blood glucose, direct bilirubin, amylase and CK-MB showed statistically highly significant decrease in 24-hour samples, and their mean values were further lower in case of 72-hour samples (all p-values <0.05). Statistically significant increase was noted in mean values of creatinine, uric acid, potassium and phosphorus in samples stored at 2-8°C for 24-hour, which were further higher in 72-hour samples (all p-values again <0.05). In samples stored at room temperature, similar pattern was seen but the changes were more significant as compared to samples stored at 2-8°C. (All p-values again <0.05). Additionally, in samples stored at room temperature, statistically significant decrease was seen in mean values of ALT, while statistically significant increase was noted in mean values of triglycerides, cholesterol, calcium and LDH, while no change was seen in mean values of potassium (p>0.05). Conclusion: Patient samples should be tested as soon as possible to obtain the correct values, particularly for these mentioned parameters.

Comparison between the Clinical Pulmonary Infection Score and Modified Centre for Disease Control Criteria for Diagnosis of Ventilator-associated Pneumonia: A Cross-sectional Study

Aniket Debnath, Saikat Batabyal, Sumit Roy Tapadar, Arunabha Datta Chaudhuri

Introduction: Ventilator-Associated Pneumonia (VAP) is a frequent complication of Mechanical Ventilation (MV). The incidence of VAP is not precisely known and ranges from 13 to 51 per 1,000 ventilator days. A uniform surveillance definition for VAP is not available. The Centre for Disease Control (CDC)/ National Healthcare Safety Network (NHSN) and the Clinical Pulmonary Infection Score (CPIS) algorithms are widely used. Aim: To compare the modified CDC criteria and the CPIS algorithm for VAP. Materials and Methods: A cross-sectional study was conducted at the respiratory care unit of the Department of Respiratory Medicine at RG Kar Medical College and Hospital in Kolkata, West Bengal, India, over a period of 18 months, from January 2021 to June 2022. A total of 60 adult patients on MV for more than 48 hours, with a high index of suspicion for VAP, clinically and radiologically, were included in this study. The microbiological (bacteriological quantitative culture) and radiological profiles {CXR parenchymal opacities, Ultrasonography (USG) and Contrast-Enhanced Computed Tomography (CECT) thorax} of VAP infections were assessed and compared. Statistical analysis was conducted after entering the data into a Microsoft Excel spreadsheet. Results: Among the 60 patients, most were male (76.67%) and aged between 51 and 60 years (40%). A total of 48 (80%) patients had a positive CPIS score, while 42 (70%) had positive modified CDC criteria. A fair degree of concordance was found between the two algorithms. Pseudomonas was the most common organism identified in both early and late-onset VAP. Among all antibiotics, Polymyxin B was found to be sensitive to all the organisms. Conclusion: The VAP is the most frequent infection associated with Intensive Care Unit (ICU) admissions. Polymicrobial aetiology and MDR strains were found in a significant number of cases. In the present study, the CPIS criteria demonstrated a fair concordance with the modified CDC criteria and slightly better sensitivity than the modified CDC criteria in diagnosing VAP.

Comparison of Intranasal Dexmedetomidine with Intravenous Dexmedetomidine as Premedication in Patients undergoing Laparoscopic Surgeries under General Anaesthesia: A Randomised Controlled Trial

Priyanka Gupta, Vandana Koul, Mayank Gupta, Subah Bharaj

Introduction: The sympathetic stress response due to pneumoperitoneum during laparoscopic surgeries necessitates a balanced anaesthesia technique. Dexmedetomidine (DEX) has emerged as a promising option. While intravenous (i.v.) DEX is well established in attenuating the haemodynamic stress response to pneumoperitoneum, the Intranasal (IN) route remains underexplored for this purpose. Aim: To compare the efficacy and safety of IN and i.v. DEX in attenuating the haemodynamic stress response to pneumoperitoneum. Materials and Methods: In this randomised triple-blind controlled trial which was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. A total of 75 adults classified as American Society of Anaesthesiologists (ASA) physical status I or II, scheduled for elective laparoscopic surgery, were randomly allocated to one of three groups (25 in each group): control, IN DEX (IN group), and i.v. DEX (i.v. group). DEX was administered at a dose of 1 μg/kg via the IN or i.v. route before induction. Heart Rate (HR) and Mean Arterial Pressure (MAP) were monitored until 10 minutes postextubation at appropriate time intervals, along with preoperative sedation scores and any side-effects. All statistical calculations were performed using Statistical Package for the Social Sciences (SPSS) 21.0 version (SPSS Inc., Chicago, IL, USA) statistical program for Microsoft Windows. Results: Patients were comparable with respect to age (p-value=0.769), gender (p-value=0.321), and weight (p-value=0.672). HR and MAP were significantly lower in the IN and i.v. groups compared to the control group during pneumoperitoneum, but were comparable between the IN and i.v. groups. Both of these groups had better sedation scores compared to the control group. None of the groups experienced any significant side-effects. Conclusion: Both IN and i.v. DEX have similar efficacy and safety in alleviating the haemodynamic stress response to pneumoperitoneum. Side-effects such as bradycardia, hypotension, nausea, vomiting and shivering were comparable among the three groups. Both IN and i.v. DEX provided comparably satisfactory preoperative sedation, which was significantly better than that of the control group.

Clinical and Biochemical Effects of Preoperative Oral Carbohydrate Loading versus Fasting in Major Abdominal Surgeries: A Randomised Clinical Study

Introduction: Surgery and preoperative fasting result in Perioperative Insulin Resistance (PIR) and can lead to increased postoperative morbidity, mortality and prolonged hospital stay. Enhanced Recovery After Surgery (ERAS) protocols advocate oral carbohydrate loading preoperatively, contrary to conventional fasting practices. Aim: To compare preoperative oral carbohydrate loading with fasting in terms of mean changes in perioperative blood sugar, albumin levels and patient well-being in major abdominal surgeries. Materials and Methods: This prospective randomised clinical study was conducted in the surgical gastroenterology operating theatre of Government Medical College Hospital, Kozhikode, Kerala, India, during 2021-2022 among 54 patients. Patients undergoing elective major abdominal surgeries under general anaesthesia were randomly divided into two groups. One group received preoperative oral carbohydrate loading (CHO) (n=27), while the other group followed conventional fasting (FAST) (n=27). Changes in perioperative blood sugar were the primary objective. Changes in perioperative albumin levels, subjective patient well-being, time for resumption of oral intake and duration of postoperative hospital stay were secondary objectives. Continuous variables were assessed using mean and standard deviation. The Student’s t-test was used to statistically analyse quantitative data and the Chi-square test was employed for qualitative data. Results: There was a significant difference in the perioperative blood sugar values (p-value <0.05) and the albumin levels (p-value <0.001) among patients who received preoperative carbohydrate loading and those who followed conventional fasting. The group that received preoperative oral carbohydrate loading had a significantly lower mean blood sugar value compared to the conventionally fasted group during the perioperative period. Postoperative serum albumin values were significantly higher in the carbohydrate-loaded group compared to the fasted group. The carbohydrate-loaded group reported better subjective well-being, shorter time for resumption of oral intake and a reduced duration of hospital stay (p-value <0.05). Conclusion: Preoperative loading with oral carbohydrates stabilises perioperative blood sugar levels and albumin levels and improves patient well-being in major abdominal surgeries.

Lifestyle Risk Factors in Male Androgenetic Alopecia: A Cross-sectional Study

Introduction: Male Androgenetic Alopecia (AGA) is a prevalent form of hair loss affecting a significant portion of the population worldwide. While genetic predisposition is a primary factor, lifestyle factors such as smoking, alcohol consumption, obesity and psychological stress have been increasingly recognised as potential contributors to the progression and severity of male AGA. This study was conducted to identify these risk factors in male AGA utilising various tools like the Depression, Anxiety and Stress Scale (DASS) 21 scale, Body Mass Index (BMI), smoking index and Alcohol Use Disorders Identification Test (AUDIT) scale. Aim: To identify lifestyle-related risk factors such as smoking, alcohol consumption, obesity and psychological stress in male AGA. Materials and Methods: A hospital-based observational cross-sectional study was conducted in the dermatology department of a tertiary care facility, involving 100 male patients with AGA aged 18 to 55 years. The study utilised consecutive sampling methods for the enrollment of participants. Each patient underwent a thorough clinical evaluation and the severity of alopecia was determined using the Hamilton-Norwood classification. Detailed questionnaires assessed risk factors including smoking history (using the smoking index), alcohol consumption (using the AUDIT scale), psychological stress levels (using the DASS-21 scale) and obesity was assessed by measuring BMI. Data were analysed using statistical software Statistical Package for the Social Sciences (SPSS) version 26.0 (SPSS Inc., Chicago, IL, USA). Results: Among the study population, the mean age was 28.78±5.91 years. Family histories included 12 with maternal AGA, 56 with paternal AGA and 32 with no family history. Significant associations were found between AGA severity and several factors, including higher alcohol screening scores (4.71±5.30) (p-value=0.0006) and a greater smoking index (17.31±15.10) (p-value=0.016). The results for BMI (22.33±3.91) (p-value=0.056) and DASS-21 stress score (14.96±5.9677) (p-value=0.351) were not found to be significant with the severity of AGA. Overall, the findings underscore the multifactorial nature of AGA, influenced by lifestyle, genetic predisposition and anthropometric measures, with implications for clinical management and future research. Conclusion: The study highlights the multifaceted nature of AGA, influenced by lifestyle habits and factors. The findings suggest a strong association between higher alcohol and smoking indices and the severity of AGA. These insights could inform prevention strategies and targeted interventions for individuals affected by AGA.

The effectiveness of an Interactive Toy as an Active Distraction Compared with a Passive Distraction in Alleviating Dental Anxiety and Pain while Administration of Local Anaesthesia in Children: A Randomised Clinical Trial

Pinjari Alam Meerza, SVSG Nirmala

Introduction: Painless dentistry requires Local Anaesthesia (LA), however, due to the pain of the injection itself, it could be a very anxious process. During invasive dental treatments, distraction can be used as a non pharmacological behaviour management technique by diverting the individual’s attention away from painful stimuli. Aim: To evaluate the effectiveness of an interactive toy as an active distraction compared with the colourful headset with music as a passive distraction in alleviating dental pain and anxiety while administration of LA in children aged between 4 and 9 years. Materials and Methods: The trial design was an interventional, prospective, parallel-based block randomisation which was was conducted on 60 children aged between 4 and 9 years, who were randomly assigned into two groups with 30 each. The study was conducted on children who reported to the Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India for six months, from April 2023 to September 2023. Children in Group 1 received interactive toy, whereas Group 2 received colourful headset with music. Using pulse rates and Chotta Bheem Chutki (CBC) scale dental anxiety was evaluated. While pain was evaluated using Faces, Leg, Activity, Cry and Consolability (FLACC) scale and Modified Wong-Baker Faces Pain Rating Scale (MWBFPRS). Paired t-test, independent t-test, Wilcoxon rank test and Mann-Whitney U test was used to quantify anxiety and pain. Results: Anxiety scores were statistically reduced in interactive toy group (p<0.05). The mean pain scores of FLACC and MWBFPRS were lower in interactive toy group compared to colourful headset with music group, showing a statistically significant difference (p-value <0.001). Interactive toy group significantly reduced anxiety and pain in age groups of both (4-6 and 7-9 years) and also among the gender. Conclusion: Interactive toy, as an active distraction technique, was effective in alleviating anxiety and pain compared to colourful headset with music in children while administering LA. Interactive toy group significantly reduced anxiety and pain in both the age groups and also among the gender.

Alteration in Taste Perception among Young Children following the Use of Oral Irrigants in Pulpectomy Procedure: A Randomised Controlled Trial

Praveen Kumar, R Ramesh

Introduction: The impact of oral irrigants on taste perception during pulpectomy procedures focuses on how these sensory experiences affect patient comfort and cooperation. This study aims to identify child-friendly irrigants with natural taste profiles that minimise discomfort and enhance procedural success. Aim: This study evaluated the effects of different oral irrigants-chlorine dioxide, Saline, Chlorhexidine Gluconate, and Sodium Hypochlorite-on taste perception in children undergoing pulpectomy procedures. Materials and Methods: A randomised controlled trial was conducted at Saveetha Dental College and Hospital from July to December 2024, involving 100 children aged 6-9 years undergoing pulpectomy procedures. Participants were randomly assigned to four groups based on the irrigant used: chlorine dioxide, saline, chlorhexidine gluconate, and sodium hypochlorite. The study assessed taste perception using a 5-point Likert scale and a validated questionnaire at baseline and during the second visit. Demographic parameters such as age, gender, and oral health metrics were recorded to ensure group homogeneity. Statistical analysis included paired t-tests, one-way Analysis of Variance (ANOVA), and effect size estimation, with a p-value of <0.05 considered significant. Results: Significant differences in taste alteration scores were observed across the four oral irrigants. Chlorine dioxide exhibited the most substantial reduction in taste alteration scores from T0 (2.96±1.24) to T1 (1.40±0.76), followed by Saline (T0: 3.12±1.01; T1: 2.24±1.27). In contrast, chlorhexidine and sodium hypochlorite showed minimal changes between baseline and follow-up scores. ANOVA revealed statistically significant differences in taste perceptions for chlorine dioxide (p<0.001), Saline (p=0.007), and Chlorhexidine (p=0.033), while Sodium Hypochlorite exhibited borderline significance (p=0.057). Effect size analysis indicated that chlorine dioxide (Eta²=0.398) had the largest impact, particularly influencing sweetness and bitterness perceptions, which played a crucial role in the overall treatment experience. Conclusion: The study underscores the importance of selecting irrigants that balance clinical efficacy with sensory acceptability. Chlorine dioxide demonstrated the greatest impact on taste alteration, necessitating the development of paediatric-friendly formulations to enhance patient cooperation and comfort.

Effect of Sport-specific Polarised Training on Agility in Elite and Subelite Badminton Players: A Randomised Controlled Study

Manish Nagpal, Nitesh Malhotra

Introduction: Training Intensity Distribution (TID) is used by elite athletes prior to their competitions to enhance their performance. It has been employed in various endurance sports like running and cycling, but it is underutilised in sports where other components such as agility, strength and coordination are also part of the training. Badminton is one such game that requires aerobic fitness, skill, coordination, along with agility for rapid changes of direction and movements such as jumping, squatting and lunging. Badminton players need to practise these movement patterns to strike the shuttlecock and keep moving back and forth on the court. Aim: To evaluate the effect of sport-specific polarised training via a badminton field test on agility in badminton players. Materials and Methods: This double-blinded randomised controlled was conducted in an indoor badminton court at Manav Rachna Sports Academy in Faridabad, Haryana, India. Twenty badminton players aged between 15 to 26 years participated in this study, in which players were randomly assigned to two groups: an Experimental Group (EG) (n=10) and a Control Group (CG) (n=10). Over a 9-week period, the EG engaged in sport-specific polarised training via a badminton field test using BlazePod agility lights and an Edge lactate analyser to differentiate between three zones of training, while the CG followed the traditional training prescribed by their coach. In the badminton field test, the speed of the lights was kept at 16 lights per minute for low intensity (zone 1), 20 lights per minute for threshold intensity (zone 2), and above 22 lights per minute up to exhaustion for high-intensity training (zone 3). A four-corner agility test was used to evaluate the agility of the badminton players before and after the 9-week training protocol. Statistical analysis was conducted using a One-way Analysis of Variance (ANOVA). Results: The results showed that an 11.8% improvement was observed in the polarised training or EG, compared to a 3.6% improvement in the CG. This indicates that performing repeated sport-specific movements at different intensities, as done in polarised training, increases aerobic capacity and also improves agility in badminton players. Conclusion: There was an improvement in the agility of badminton players following sport-specific polarised training.

Comparative Study of Intravenous Granisetron against Ondansetron in Preventing Postoperative Nausea Vomiting in Patients undergoing General Anaesthesia: A Double-blinded Randomised Controlled Study

Sufala Sunil Vishwasrao, Sunil Mhatarba Vishwasrao, Amar Nagesh Kumar

Introduction: Postoperative Nausea and Vomiting (PONV) remain a significant issues following general anaesthesia, affecting patients’ comfort and recovery. The choice of antiemetic agents is paramount in minimising these symptoms. Aim: To compare the efficacy and safety of intravenous (i.v.) Granisetron and Ondansetron in preventing PONV in patients undergoing general anaesthesia in a tertiary care hospital in Tamil Nadu, India. Materials and Methods: A double-blind, randomised controlled trial was conducted at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Madhurantagam, Tamil Nadu, India, from December 2021 to March 2023 involving 66 patients aged 18-65 years, scheduled for elective surgeries under general anaesthesia. Participants were randomly assigned to receive either 2 mg of intravenous Granisetron (Group A) or 4 mg of intravenous Ondansetron (Group B) prior to induction. The primary outcome was the incidence of PONV within 24 hours of surgery. Secondary outcomes included the need for rescue medication and the occurrence of adverse effects. Data were analysed using Chi-square and independent t-tests, with a p-value <0.05 considered statistically significant. Results: The majority of participants were between 29 and 48 years of age in both groups. The mean age of the patients in Group A and Group B was 34.61±10.88 and 43.64±13.26 years, respectively. The Complete Response (CR) (no emesis and no requirement for rescue antiemetics) was significantly higher in the Granisetron group, with 28 (85%) compared to the Ondansetron group, which had 19 (58%) (p<0.05). The incidence of nausea and vomiting was lower in Group A throughout all postoperative time intervals. Adverse effects such as headache and dizziness were comparable between the groups and were mild in nature. No serious adverse events were reported in either group. Conclusion: Intravenous Granisetron demonstrated better efficacy in preventing PONV than Ondansetron, with a higher CR rate and reduced need for rescue medication. Both drugs were well-tolerated, with a similar safety profile. These findings suggest that Granisetron could be a more appropriate option for PONV prophylaxis in patients undergoing general anaesthesia. Further multicentre studies are recommended to validate these results across a diverse patient population.

One-Pot Green Synthesis of Strontium and Zirconium Nanoparticles: An In-vitro Study of their Antioxidant and Cytotoxic Activity

Introduction: The one-pot synthesis approach for Strontium and Zirconium Nanoparticles (Sr-Zr NPs) utilises pomegranate (Punica granatum) extract as a natural reducing and stabilising agent. This eco-friendly approach leverages the high antioxidant content of pomegranate to eliminate the need for toxic chemicals in nanoparticle production. Aim: To synthesise zirconium and strontium nanoparticles from the extract of Punica granatum and to assess their antioxidant and cytotoxic properties. Materials and Methods: The present in-vitro study was carried out in the Laboratory, Department of Pharmacology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India over a period of six months from November 2023 to May 2024. Pomegranate peel aqueous extract was prepared by drying and grinding the peels, followed by autoclaving, heating, and centrifugation to extract bioactive compounds. Zirconium and strontium nanoparticles were synthesised by mixing the extract with zirconium chloride and strontium chloride solutions, followed by continuous stirring. The formation of nanoparticles was confirmed by a colour change. The nanoparticles were characterised using Fourier Transform Infrared Spectroscopy (FTIR) and UV-visible Spectroscopy (UV-Vis). Their antioxidant efficacy was assessed using the 2,2-diphenyl-1-picrylhydrazyl (DPHH) assay, while cytotoxicity was evaluated using cell viability assays. Results: The synthesised Sr-Zr NPs were characterised by their structural and optical properties, exhibiting distinct UV-Vis absorption peaks at 286 nm and 371 nm. At the highest concentration tested (100 μg/mL), Sr-Zr NPs exhibited approximately 89% inhibition, whereas L-ascorbic acid showed 92% inhibition, demonstrating the potent antioxidant activity of the nanoparticles. The IC50 value, representing the concentration at which 50% of the cells were inhibited, was determined to be 90 μg/mL. At this concentration, cell viability was reduced to approximately 50%, indicating significant cytotoxic activity. Conclusion: The study highlights the potential of Sr-Zr NPs for biomedical applications, particularly in antioxidant therapies and cancer treatment, due to their potent biological activities and favourable optical properties. The use of pomegranate extract not only enhances the biocompatibility of the nanoparticles but also aligns with sustainable development goals, offering a promising pathway for the green synthesis of biocompatible nanoparticles with therapeutic potential.

Evaluation of Marginal Leakage of Composite Resin Restoration in Cervical Cavities Prepared by Conventional Method versus Er,Cr:YSGG Laser: An In-vitro Stereomicroscope Analysis

Introduction: Modern dentistry emphasises minimally invasive techniques, with Erbium, Chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) lasers gaining popularity for hard and soft tissue preparation. These lasers offer advantages such as smear layer removal and surface modifications that enhance restorative material retention. However, their efficacy in minimising marginal leakage in composite restorations remains underexplored, especially when combined with acid etching. Understanding these effects is critical to advancing minimally invasive restorative techniques. Aim: To evaluate the marginal leakage of composite resin restorations in cervical cavities prepared by conventional methods and Er,Cr:YSGG lasers. Materials and Methods: This in-vitro experimental study was conducted in the Department of Conservative Dentistry and Endodontics at Dr. R. Ahmed Dental College and Hospital in Kolkata, West Bengal, India, from October 2008 to February 2010. Total 45 freshly extracted, caries-free, and restoration-free permanent human molars were selected as the study sample. The primary inclusion criteria included teeth with intact cervical regions and no prior restorations or decay. The teeth were randomly divided into three groups of 15 each. Class V cavities were prepared on the buccal or lingual surfaces of the teeth, with occlusal margins in enamel and gingival margins in dentin or cementum. Group I cavities were prepared using a tungsten carbide bur and restored after acid etching. Group II cavities were prepared with an Er,Cr:YSGG laser and restored without acid etching, while Group III cavities were laser-prepared and restored after acid etching. All cavities were restored using composite resin following the application of an adhesive system. The samples were stored in distilled water, thermocycled, and immersed in a 2% methylene blue solution to assess microleakage. Statistical analysis was performed using the Chi-square test, with the significance level set at p<0.05. Results: The distribution of microleakage scores showed a statistically significant association (p=0.004). Group II cavities exhibited the highest leakage, whereas the group III sample had the lowest. The power analysis demonstrated an achieved power of 87%, confirming that the sample size was adequate. Conclusion: The findings suggest that while laser preparation alone may result in higher leakage, combining laser preparation with acid etching significantly reduces microleakage, achieving outcomes that are comparably better than those of conventional bur-prepared cavities with acid etching. These results emphasise the potential of combining laser technology with acid etching for improved restorative outcomes.

Impact of a Module on Early Clinical Exposure in Pharmacology: A Prospective Interventional Study from a Medical College in West Bengal, India

Sarmila Nath, Kalyan Brata Mandal, Anjana Ghosh Dastidar, Quazi Shabnam Waheed

Introduction: The National Medical Commission (NMC) has introduced the concept of Early Clinical Exposure (ECE) in the undergraduate medical curriculum to provide some clinical relevance to what students are studying in their preclinical years. Past studies conducted across different disciplines have proven the effectiveness of ECE sessions. Against this background, a module on ECE was designed and implemented among Phase 2 students studying Pharmacology at a Medical College in West Bengal, India. The perceptions of participating students and faculty regarding the module were obtained through feedback forms. Aim: To evaluate the impact of a module of ECE for teaching the topic on anaesthetic drugs to undergraduate medical students studying Pharmacology. Materials and Methods: The study was conducted over a period of three months at a medical college in West Bengal. A total of 180 Phase 2 students studying Pharmacology and six faculty members from the Departments of Pharmacology and Anaesthesiology participated in the study. Following informed consent and sensitisation, students were randomly divided into a control group and a study group. The study group was exposed to ECE sessions, followed by lecture classes involving both the study and control groups. The impact of the ECE sessions on knowledge gain was assessed through a formal test one week after the lecture classes. Perceptions from students and faculty were obtained through a Google Form containing semiclosed questions. Quantitative analysis was conducted using the Independent t-test, Chi-square test and percentages as appropriate. Following the entire process, faculty members from both departments held a meeting to discuss the challenges in implementing the module and how to overcome these barriers in the future. Results: There was a significant increase in knowledge among the study group (p-value: 0.0018) compared to the control group. About 155 (86.1%) of students considered the module to be an effective learning tool and 138 (76.7%) students opined that the sessions were well planned. A total of 66.67% of faculty members believed that this module of ECE could be implemented in the curriculum. Conclusion: The current module on ECE had a positive impact on the participating students. With a few modifications, it could be included in the undergraduate Pharmacology curriculum in the future.

Effect of Intrathecal Bupivacaine Kept at Room Temperature versus Body Temperature on Shivering During Lower Limb Orthopaedic Surgery Under Spinal Anaesthesia: A Double-blind Randomised Controlled Trial

Introduction: Perioperative shivering is very common after spinal anaesthesia. Shivering can cause discomfort, interfere with monitoring and lead to serious complications, particularly in patients with cardiorespiratory disorders. Aim: To compare the effect of intrathecal bupivacaine at room temperature and body temperature on perioperative shivering in patients undergoing lower limb orthopaedic surgery. Materials and Methods: This randomised, double-blind study was conducted at Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India, which included 70 patients of either sex, aged 18-65 years, classified as American Society of Anaesthesiologists (ASA) physical status I and II and scheduled for lower limb orthopaedic surgery under spinal anaesthesia. Patients were randomly allocated into two groups. All patients received a subarachnoid block with 3 mL of 0.5% bupivacaine heavy combined with 10 μg of fentanyl. Group W received the study drug stored at body temperature (35±1°C), while group C received the study drug stored at room temperature (20±1°C). The primary outcome measured was the incidence of shivering; the secondary outcomes measured were the onset and severity of shivering and changes in body temperature. Side-effects of spinal anaesthesia, including bradycardia, hypotension, nausea and vomiting, were also noted. Data were expressed as mean and standard deviation for continuous variables and numbers and percentages for categorical variables. An independent t-test was used to compare the means between the groups and a Chi-square test was used for categorical variables. Results: Both groups were comparable in terms of demographic parameters such as age, weight and height (p-value >0.05) as well as haemodynamic status. The incidence of shivering was 11 (31.43%) patients in group W and 25 (71.43%) patients in group C; the difference was statistically significant (p-value <0.001). The onset time of shivering in group W was 13 minutes compared to four minutes in group C (p-value=0.015). In group C, 40% of patients developed shivering of grade more than one, compared to 22.86% in group W. Conclusion: Warming intrathecal bupivacaine to body temperature significantly reduces the incidence, delays the onset and decreases the severity of perioperative shivering in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia, compared to bupivacaine administered at room temperature.

Problematic Smartphone Use and its Association with Sleep Disturbances: A Cross-sectional Study

Ajay Thangaraj, Kamatchinathan Premkumar, Vaishali Shanmugam, G Sheelapriya

Introduction: The widespread integration of smartphones into daily life has raised concerns about their potential impact on Sleep Quality (SQ). Excessive smartphone use, particularly before bedtime, may contribute to sleep disturbances through prolonged screen exposure, cognitive stimulation and night-time interruptions. Given the critical role of sleep in overall health and wellbeing, understanding the association between problematic smartphone use and sleep disturbances is essential. Aim: To examine the association between Problematic Mobile Phone Use (PMPU) and SQ among adults, highlighting its potential impact on sleep patterns and overall wellbeing. Materials and Methods: This cross-sectional study was conducted at Indira Medical College and Hospitals, Tiruvallur, Tamil Nadu, India from January to June 2024. A total of 92 adult participants were included in the study. Problematic Smartphone Use (PSU) was assessed using a modified PMPU Questionnaire, while SQ was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Correlation analysis, multiple regression and logistic regression were performed to examine relationships and identify predictors of SQ. Results: A significant positive correlation was observed between PMPU scores and PSQI scores (r=0.61, p-value <0.001). Multiple regression analysis identified the PMPU score as the strongest independent predictor of poor SQ (β=0.512, p-value <0.001), even after controlling for age, gender and mobile phone use duration. The association was strongest among younger participants (18-25 years: r=0.68, p-value <0.001) and slightly more pronounced in females (r=0.65, p-value <0.001). Logistic regression confirmed that each 10-point increase in PMPU score raised the odds of poor SQ by 2.35 times (OR=2.35, 95% CI: 1.62-3.41, p-value <0.001). Conclusion: This study demonstrates a significant association between PMPU and decreased SQ. Beyond screen time and content, PMPU represents an important factor influencing sleep health.

A Cross-sectional Study on Stature Estimation from Arm Lengths among North Indian Population using Machine Learning

Arunima Dutta, Gyamar Anya

Introduction: During forensic investigations, cases are often encountered where the deceased bodies are in a partially or completely decomposed, charred, or skeletonised condition. In such scenarios, the examination of skeletal remains becomes imperative to establish the identity of an individual. Anthropometric measurements assist in identifying these parameters with accuracy. Aim: To assess the relationship between upper limb dimensions and stature in North Indian adults using regression formulae and a decision forest-based model for stature estimation from these dimensions. Materials and Methods: A cross-sectional study was conducted among 262 (M=120/F=142) students aged between 18 and 25 years using random sampling. This study was carried out in the Department of Forensic Science, Faculty of Applied and Basic Sciences, SGT University, Gurugram, Haryana, India from October 2023 to January 2024. The primary inclusion criteria stipulated that participants should be of North Indian origin (New Delhi NCR, Haryana and Punjab regions) and should not have suffered from any congenital or traumatic deformities of the upper and lower limbs. The stature, forearm length and Total Arm Length (TAL) were measured based on anthropometric points. Descriptive statistics, p-values, t-values and Pearson’s correlation coefficient were studied using Statistical Package of Social Sciences (SPSS) software version 21.0 and a decision forest model was designed on a cloud-based coding platform using Python programming language. Results: The present study depicts a higher mean value of TAL (55.9±4.18) and stature (175.41±5.63) for males in comparison to females. All the measurements were statistically significant, with p-values <0.001. It also reveals a strong positive correlation between TAL and stature for both males (r-value=0.951) and females (r-value=0.975). The decision forest model achieved an accuracy of 0.951 and a Root Mean Square Error (RMSE) of 1.75. Conclusion: The present study suggests that stature shows strong correlations with forearm length and TAL for both sexes. The decision forest model can classify the sexes with an accuracy of 77.5% using TAL. However, demographic variations must be considered when applying the regression formulae. Additionally, such anthropometric data should be updated regularly due to secular and temporal changes within the population.

Frequency of bspA and mutS Genes in Tannerella forsythia Isolated from Patients with Aggressive Periodontitis: A Cross-sectional Study

Introduction: Tannerella forsythia (T. forsythia) is a predominant periodontal pathogen contributing to the progression of periodontitis. Among its virulence factors, the bspA gene, which encodes cysteine protease and the mutS gene, associated with DNA mismatch repair, is considered significant. Aim: To determine the frequency of the bspA and mutS genes in clinical strains of T. forsythia isolated from periodontitis patients and to evaluate their antibiotic resistance profiles. Materials and Methods: This cross-sectional study was conducted at Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, from January 2023 to May 2023, including 45 patients categorised into three groups: Gingivitis (Group I), Periodontitis Stage II (Group II), and Aggressive Periodontitis (Group III). The inclusion criteria were patients aged 18-60 years with periodontal disease, while smokers, pregnant women and those undergoing orthodontic treatment were excluded. Demographic parameters, including age, gender and periodontal health status, were recorded. Subgingival plaque samples were cultured anaerobically to identify T. forsythia, which was confirmed by Polymerase Chain Reaction (PCR). Genomic DNA was extracted for the detection of the bspA and mutS genes. Antibiotic susceptibility was tested using the E-strip method. Data analysis included descriptive statistics, Kruskal-Wallis test and Analysis of Variance (ANOVA) using Statistical Package for the Social Sciences (SPSS) software, with statistical significance set at p-value <0.05. Results: T. forsythia was detected in four out of 15 samples (26.7%) from Group III and in one out of 15 samples (6.7%) from Group II, while no samples from Group I showed its presence. The bspA and mutS genes were detected in three out of four strains (75%) and two out of four strains (50%), respectively. All isolates (100%) demonstrated resistance to metronidazole and clindamycin. Conclusion: This study highlights the prevalence and virulent characteristics of T. forsythia in periodontal diseases, particularly in aggressive periodontitis. The detection of specific virulence genes and the antibiotic resistance patterns observed underscore the pathogenic potential of this bacterium. Regular monitoring of T. forsythia and its antimicrobial susceptibility is crucial for effective periodontal disease management. The findings suggest that targeted treatment strategies, considering the resistance profiles of T. forsythia, are necessary for better clinical outcomes in periodontal care.

An In-vitro Study for Pharmaceutical and Analytical Profile of Herbal Drug: Panchpallav Gargles

Riya Rajendra Rathor, Renu Bharat Rathi

Introduction: Contemporary pharmaceutical analytical methods and standardisation must be employed to examine the composition of various Ayurvedic medications. Panchpallav Gargles (Kavala), which are prescribed for oral cavity ailments, are mentioned in Bhavprakash by Acharya Bhavmishra. This formulation is suggested in the form of decoction (Kashaya Kalpana) for mouthwash (mukha dhavana) in diseases of the mouth and throat (Mukhagata and Galagat rogas). Panchpallav Gargles is recommended due to their ease of preparation, pleasant and palatable taste, longer shelf life, and ease of administration. Aim: To study the physicochemical parameters of Panchpallav Gargles through an analytical investigation aimed at determining the fundamental properties. Materials and Methods: This in-vitro study was conducted at the Dattatraya Ayurved Rasashala of the Mahatma Gandhi Ayurved College and Research Centre, Salod, Hirapur, Wardha, Maharashtra, India over a period of one year and conducted the pharmaceutical manufacture and analytical analysis of the mouthwash. In present in-vitro study, three batches of gargles were prepared following the reference from Bhavprakash by Acharya Bhavmishra. A constant temperature of 90 to 100°C was maintained throughout the procedure, and the average time required for the preparation of Panchpallav gargles was two days. The formulation was tested for physicochemical analysis, microbiological characteristics, and organoleptic criteria, including colour and smell. The analytical testing required 15 days to yield the findings. Results: The analytical standards for the Gargles were 5.2 for pH and 1.45 for refractive index, respectively. No microbial contamination was identified in the gargles. Conclusion: The outcomes of the standardisation meet the requirements specified in the Ayurvedic Pharmacopoeia of India (API). Additionally, its usage showed no Adverse Drug Reactions (ADRs) or side effects in the paediatric population and yielded better results in cases of acute pharyngitis.

Safety and Efficacy of Bedaquiline in Drug Resistant Tuberculosis: A Hospital-based Prospective Observational Study

Introduction: Tuberculosis (TB) is a chronic infectious disease that continues to cause significant morbidity and mortality in developing nations. The emergence of Drug Resistant Tuberculosis (DR-TB) has further aggravated the problem. The treatment of DR-TB is challenging due to poor compliance, stemming from drug toxicity and the long duration of treatment. Bedaquiline (BDQ), a novel drug, has shown promising results in terms of safety and efficacy for the treatment of Multidrug Resistant TB (MDR-TB). Aim: To evaluate the safety and efficacy of BDQ in patients with DR-TB. Materials and Methods: This was a prospective, observational, hospital-based study carried out in the Department of Respiratory Medicine at JNMC, Aligarh, Uttar Pradesh, India, over a period of two years from December 2020 to November 2022. A total of 303 patients were enrolled. BDQ treatment was initiated after satisfying the inclusion criteria and patients were monitored for Adverse Events (AE). The study evaluated outcomes in terms of sputum conversion and clinical improvement. A follow-up was conducted for six months after the completion of therapy. Data entry was performed on Microsoft Excel and the final analysis was conducted thereafter. Results: Out of 303 patients, successful outcomes with BDQ were observed in 272 (89.77%) patients who were cured. Sixteen patients died (5.28%), 10 (3.30%) cases were lost to follow-up and in 5 (1.65%) patients, BDQ was discontinued due to adverse effects. Clinical improvement, in terms of an increase in body weight, improvement in symptoms and radiological improvement, was observed in 265 (97.43%) patients. Conclusion: The study concludes that BDQ demonstrates promising safety and efficacy, establishing itself as a valuable option for the treatment of DR-TB.

Awareness and Consumption of Fortified Foods, Role of Demographic Factors and Associated Barriers among Rural Households in Chengalpattu District: A Cross-sectional Study

Introduction: Food fortification is recognised as a crucial public health measure to combat micronutrient deficiency. In India, food fortification has gained significant attention due to the country’s high burden of malnutrition. Though the government has taken initiatives to decrease the burden of malnutrition through food fortification, the prevalence of micronutrition deficiency is still high. Aim: To evaluate the consumer awareness and consumption of fortified foods, as well as to identify demographic, socio-economic, and cultural factors influencing these behaviours. Materials and Methods: This was a cross-sectional study conducted in the field practice area of tertiary care hospital in Chengalpattu district, Tamil Nadu, India, among 341 participants aged 18 to 65 years, from September 2023 to November 2023. Data was collected through face-to-face interviews using a pretested semi-structured questionnaire covering two domains: (a) sociodemographic details such as age, gender, education, occupation, monthly family income, type of family, socioeconomic status, marital status, religion, and co-morbidities; and (b) a questionnaire assessing consumer awareness and consumption of fortified foods. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Chi-square test was used, and a p-value <0.05 was considered statistically significant. Bivariate logistic regression was done to obtain an unadjusted odds ratio and variables with a p-value <0.05 were added to the multivariate model to obtain an adjusted odds ratio (95% CI). Results: The mean (SD) age of the participants was 44.14 (11.8) years. Among the study participants, 95 (27.9%) (95% CI: 23.2-32.9) were aware of food fortification. Around 109 (32%) understood the benefits of consuming fortified foods, and 103 (30.2%) were aware of their availability. Fortified foods were consumed by 88 (25.8%) of the participants. Factors such as occupation, socioeconomic status, and educational status were significantly associated with awareness of fortified foods (p<0.05). Conclusion: About 27.9% of the study participants have awareness regarding food fortification and consumption of fortified foods. Therefore, it is important to create awareness about the impact and burden of diseases due to micronutrient deficiencies and the importance of consuming and awareness of fortified foods.

Comparative Assessment of Microleakage in Nanohybrid Composite Using Two Different Layering Techniques for Class V Cavities: An In-vitro Study

R Aswathy Raj, Ida De Noronha De Ataide, Rajan Lambor

Introduction: Numerous methods for composite restoration have been developed to mitigate the impacts of polymerisation shrinkage. Research indicates that the incremental technique, along with preheating, is effective in enhancing marginal adaptation by countering the shrinkage stress of resin composites. The purpose of present study was to integrate the layering technique with the preheating method to mitigate polymerisation shrinkage in composite restorations, thereby decreasing microleakage in class V restorations, as there is a paucity of research in this area. Aim: To assess and compare the microleakage of nanohybrid composites following different layering techniques of composite restoration, with and without preheating. Materials and Methods: An in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Goa Dental College, Bambolim, Goa, India, for a duration of four months, from June 2023 to September 2023. A total of 40 premolars were selected, and a rectangular box cavity was prepared on the buccal surface of the cervical third of each tooth. The teeth were then divided into four equal-sized groups and filled with a composite restorative material. The four groups were as follows: Group 1: Mat incremental (without preheating, n=10), Group 2: Oblique layering (without preheating, n=10), Group 3: Mat incremental (with preheating, n=10), and Group 4: Oblique layering (with preheating, n=10). The samples then underwent thermocycling and were submerged in rhodamine dye for 48 hours. Afterward, the teeth were sectioned parallel to the long axis of the tooth and examined under a confocal microscope to assess microleakage. The data were tabulated and analysed using One-way Analysis of Variance (ANOVA) and the Bonferroni Post-hoc test. A significance level of p≤0.05 was considered. Results: The cervical margins showed a higher mean microleakage than the occlusal margins, regardless of the incremental techniques used, with or without heat. The One-way ANOVA test showed a statistically significant difference between and among the groups (techniques) for both occlusal and cervical penetration (p<0.001) of dye. Applying heat resulted in a considerably reduced penetration of dye (p<0.05). Post-hoc Bonferroni analysis revealed that the Mat incremental heat technique exhibited significantly lower levels of dye penetration (p<0.001) compared to the other techniques for both the occlusal and cervical margins. Conclusion: The present in-vitro study demonstrated that the nanohybrid-based resin composite exhibited microleakage, regardless of the incremental technique employed, with or without heat, for class V cavities. Nevertheless, the use of the Mat incremental technique with preheating can significantly minimise the microleakage of restorations for class V lesions.

Clinical Profile and Aetiopathogenesis of Patients with Sodium and Calcium Abnormalities in Tuberculosis: A Cross-sectional Study

Introduction: Tuberculosis (TB) is one of the major public health concerns in India. Hyponatraemia is one of the most common electrolyte abnormalities in TB patients. Calcium abnormalities have also been reported in them. Aim: The study was done to determine the prevalence of sodium and calcium abnormalities in TB patients in the population and to assess the relationship between the type of TB and electrolyte abnormalities. Materials and Methods: A cross-sectional study was conducted at Guru Nanak Dev Hospital, Government Medical College, Amritsar, Punjab, India from June 2023 to May 2024. The study included 60 adult patients with active TB. Measurements of serum electrolytes and serum osmolality were done. Tests like urine sodium were done if hyponatraemia was present. Pearson’s Chi-square test was used to discover if any relationship between two categorical variables, t-test and Analysis of Variance (ANOVA) analysis were used to differentiate means among two or more groups. Results: The mean age in the study was 47±14.7 years and comprised 42 males and 18 females. They were stratified into pulmonary, extrapulmonary, Central Nervous System (CNS) and disseminated TB. A 75% of patients had hyponatraemia and 25% had eunatraemia. Mean serum sodium in patients with eunatraemia was 139.13±2.26 mMol/L and with hyponatraemia was 129.5±4.15 mMol/L. There was a statistically significant relation between hyponatraemia and age group 51-60 years and >60 years (p-value <0.05). Mean age of eunatremic patients were 42.93±16.25 years and of hyponatraemic patients were 48.49±14.08 years. A significant relation between the type of TB (CNS, pulmonary and disseminated) and hyponatraemia was established (p-value <0.05). Euvolaemic hyponatraemia likely due to Syndrome of Inappropriate Anti Diuretic Hormone (SIADH) was found in 73% of cases. A significant relation was established between the frequency of euvolaemic hyponatraemia among CNS vs disseminated TB (p-value <0.05). There were 80% of patients with eucalcaemia and 13% with hypercalcaemia. Mortality was seen in cases of severe hyponatraemia and severe hypercalcaemia but it was not significant. Conclusion: Electrolyte abnormalities like hyponatraemia and hypercalcaemia are common in TB. The most common cause of hyponatraemia is SIADH.

Effect of Smartphone usage on Visual Fatigue Assessed by Critical Flicker Fusion Frequency among MBBS Students Aged 18-25 Years: A Pre-post Experimental Design

SL Bhavisha, K Prabhavathi, D Gunaseelan, A Saravanan, K Thamarai Selvi

Introduction: Prolonged smartphone usage has been linked to visual fatigue, primarily due to continuous exposure to blue light emitted from screens. Critical Flicker Fusion Frequency (CFFF) is a well-established physiological marker for assessing visual fatigue, where a decline in CFFF values indicates increased ocular strain and reduced visual efficiency. Medical students, who extensively use smartphones for both academic and personal activities, are particularly vulnerable to digital eye strain. Understanding the impact of sustained screen exposure on CFFF is essential for promoting visual health and implementing preventive strategies to mitigate screen-induced fatigue. Aim: To assess the effect of one hour of smartphone usage on CFFF as a marker of visual fatigue among MBBS students aged 18-25 years. Materials and Methods: This pre-post experimental study was conducted over a period of six months, from October 2023 to April 2024, at SRM Medical College and Hospital, Kattankulathur, Tamil Nadu, India involving 182 MBBS students aged 18-25 years with daily smartphone usage exceeding three hours. Baseline CFFF values were recorded using a flicker fusion apparatus, followed by one hour of smartphone usage that involved reading text and watching videos. Postexposure CFFF values were then measured under standardised conditions. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 and a paired t-test was performed to assess statistical significance (p-value <0.05). Results: A statistically significant reduction in CFFF was observed following one hour of continuous smartphone usage, indicating increased visual fatigue. The baseline CFFF values averaged 35.46±3.58 Hz, which declined to 25.91±3.50 Hz postexposure. The mean difference in CFFF values was 9.555±4.770 Hz, confirming a notable reduction in visual processing efficiency which was statistically significant (p-value of 0.001) highlighting the impact of prolonged smartphone exposure on visual strain and fatigue. Conclusion: This study demonstrated that one hour of continuous smartphone usage leads to a measurable decline in CFFF, indicating significant visual fatigue. Implementing preventive strategies, such as the 20-20-20 rule, blue light filters and controlled screen brightness, may help mitigate screen-induced eye strain among medical students. Further research is recommended to explore the long-term impact of smartphone-induced ocular fatigue and its potential implications for digital eye health.

Effect of Behavioural Training Programme on Nutritional Factors of Children with Autism Spectrum Disorder: Two Group Pretest Post-test Time Series Design

Introduction: Children with Autism Spectrum Disorder (ASD) are nutritionally vulnerable as they exhibit a selective eating pattern. Evidence shows that 40-85% of children with ASD demonstrate food selectivity, which is attenuated by dietary restrictions such as gluten-free/casein-free diets, imposed as a therapeutic approach to improve their gastrointestinal symptoms. Although inadequate micronutrient and macronutrient intakes are increasingly reported, there are inconsistent results regarding the extent of nutrient deficiencies. Aim: To analyse the effectiveness of a behavioural training programme on the nutritional factors of children with ASD. Materials and Methods: A two-group pretest post-test time series design was adopted for the study. The research was conducted at the Ayurveda and Therapeutic Integration for Developmental Habilitative Intervention (ATIDHI) group in Changaramkulam and the SELF Learning and Counselling Centre in Thrissur, Kerala. The duration of the intervention was six months, with the data collection period occurring between November 2023 and January 2025. A total of 60 parents and their children with ASD were recruited for the study. Parents of children with ASD aged between 3-10 years, who exhibited mealtime behaviours {Brief Autism Mealtime Behaviour Inventory (BAMBI) Score ≥34}, were selected for the study. Demographic parameters of the parents (relation to the child, age, education, occupation and type of family) and demographic data of the children (gender, age, age at diagnosis, gestation, birth weight (kg), birth order and co-morbidities) were collected. A 24-hour dietary recall of the children and their Body Mass Index (BMI) were analysed (O₁). The behavioural training programme was administered to the experimental group and post-tests (O₂ and O₃) were conducted in the 3^rd and 6^th months. Results: Behavioural training was effective in improving the nutrient adequacy of energy, fibre, retinol, calcium and iron in children with ASD compared to the control group. The behavioural training programme was not effective in improving the BMI of the children (p-value=0.866). There was a significant association between age, sex and BMI with total energy consumption in children with autism. Conclusion: The authors concluded that individualised dietary management based on a behavioural intervention approach is essential to maintain the nutritional status of children with ASD. The aim of the study was to analyse the effectiveness of the behavioural training programme on the nutritional factors of children with ASD.

Effects of Brushing Simulation on the Surface Roughness, Microhardness and Colour Stability of Indirect Composite Resin and Polyetheretherketone Polymer: An In-vitro Study

Introduction: Indirect composite and Polyetheretherketone (PEEK) are widely used in restorative dentistry due to their favourable mechanical and aesthetic properties. However, their durability under simulated brushing conditions, which mimic routine oral hygiene practices, remains understudied. Aim: To evaluate and compare the effects of brushing simulation on the surface roughness, microhardness, and colour stability of indirect composite and PEEK materials. Materials and Methods: The present in-vitro study was conducted at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India in the Department of Prosthodontics, in April 2024. Thirty-six samples each of indirect composite and PEEK were fabricated and polished to a standardised finish. The samples were subjected to brushing simulation for 20,000 cycles with a soft bristled toothbrush under a 2 N load using a toothpaste of standardised abrasivity. Surface roughness was measured using a profilometer, microhardness using a Vickers Hardness Tester, and colour stability (?E values) with a spectrophotometer employing the Commission Internationale de l’Eclairage (CIE). Lab* system. Statistical analysis was performed using independent and paired t-tests. Results: The surface roughness (p=0.71) and microhardness (p<0.001) of PEEK decreased after brushing simulation. For indirect composite resin, the surface roughness decreased (p<0.001) while the microhardness increased (p<0.001) after brushing. The difference in colour stability after the brushing simulation was greater in PEEK than in the indirect composite resin group (p<0.001). Conclusion: PEEK was more resistant to surface wear but less colour-stable, while indirect composite resin demonstrated better colour stability and higher post brushing hardness but was more affected in terms of surface roughness.

Consensus on Coping Mechanisms towards Occupational Stress among Psychiatric Nurses using Modified Delphi Technique

Ahmed Hassan Shujaa, Adel Saeed Bashatah

Introduction: Occupational stress is a significant issue in healthcare, particularly in the field of psychiatric nursing. Nurses working in psychiatric settings are often exposed to unique stressors, including managing aggressive behaviours, dealing with complex mental health cases, and navigating emotionally charged situations. These stressors can lead to physical, emotional, and psychological strain, ultimately impacting job performance, patient care, and overall well-being. Coping strategies enable nurses to manage the demands of their roles, maintain their mental health, and provide high quality care to patients. Aim: This study aimed to obtain experts’ consensus on the use of coping mechanisms toward occupational stress among psychiatric nurses in the Eradah Complex and Mental Health, Riyadh, Saudi Arabia. Materials and Methods: This qualitative study was conducted at the Eradah Complex and Mental Health, Riyadh, Saudi Arabia. A three-step modified Delphi panel process, with statements to score in each round, was used to obtain expert consensus on coping mechanisms towards occupational stress among psychiatric nurses. Literature reviews were used to develop statements about coping mechanisms toward occupational stress. Recruited Delphi process psychiatric nurses and faculty rated the extent of their agreement with the statements over three rounds (round 1-3: email survey). Criteria for consensus were applied. Data were collected between September 2024 and December 2024 using an online questionnaire consisting of 110 coping mechanisms developed based on an in depth literature review and statements generated from expert psychiatric nurses and faculty members’ survey. Finally, 42 coping statements were achieved consensus. Analysis rules determined whether a statement progressed to the next round and the level of agreement deemed consensus. Measures of central tendency (mean, median) and variability {Interquartile Range (IQR), cut-off point ≥75%} were reported back to help panellists assess their previous responses in the context of those of the overall group. Results: Three rounds of Delphi surveys were conducted, and consensus was reached at ≥75% agreement from the experts. In round 1, 35 experts reached full consensus on 49 out of the 110 coping mechanisms, while 61 coping mechanisms reached partial consensus. Suggestion from the experts led to reframing of some features, and the 49 revised features were sent to the experts in the second round. In round 2, a total of 42 coping mechanisms reached full consensus, while seven coping mechanisms reached partial consensus. In round 3, all the 42 features reached full consensus based on ≥75% agreement from all the experts. Conclusion: This study highlights the multifaceted nature of coping mechanisms for occupational stress among psychiatric nurses and academics. By implementing these findings, healthcare organisations can create a more supportive environment that enhances the well-being and resilience of psychiatric nurses, ultimately improving patient care outcomes.

Impact of Hypoglycaemia on Heart Rate in Diabetic versus Non Diabetic Patients on Haemodialysis: A Cross-sectional Study

Charan Bale, Atul Sajgure, Shreeharsh Godbole

Introduction: Patients with Chronic Kidney Disease (CKD) on maintenance Haemodialysis (HD) are at risk of hypoglycaemia during HD. This is especially important in patients with diabetes mellitus. Patients with CKD are also known to have heart rate variability during HD. Aim: This study aims to study the impact of hypoglycaemia on heart rate in diabetic versus non diabetic patients undergoing maintainence HD. Materials and Methods: This was a cross-sectional study done at a tertiary care centre in Western India from July 2022 to October 2024. A total of 50 patients of CKD on maintenance HD were enrolled. They were monitored for two consecutive HD sessions, each of four hours. Participants were divided into two groups of 25 participants each- ‘diabetic group’, having patients with diabetes mellitus, and ‘non diabetic group’, comprising of patients without diabetes mellitus. Continuous blood glucose was monitored along with heart rate for the time on HD. Hypoglycaemia was checked for association with heart rate variability at the time of the hypoglycaemic episode. Results: Hypoglycaemia was seen in 7 (28%) of the diabetic group, and in 2 (8%) of non diabetic group (p=0.0657). All hypoglycaemic episodes were asymptomatic. Patients with diabetes have a higher heart rate during a hypoglycaemic event, compared to non diabetic patients (p=0.0002). Conclusion: Hypoglycaemia was more common in patients with diabetes with CKD on HD, though not significant. This hypoglycaemia was also associated with a higher heart rate in patients with diabetes. Hypoglycaemia was also seen in patients not having diabetes mellitus. The study emphasises the importance of monitoring of blood sugar levels along with heart rate variability in patients of CKD during HD.

Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA₂DS₂-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India

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

Introduction: Non Valvular Atrial Fibrillation (NVAF) is one of the most common sustained arrhythmias. The Congestive heart failure, Hypertension, Age, Diabetes, Stroke/TIA (or Thrombembolism), Vascular disease, Age, Sex category (for CHA₂DS₂-VASc) score, which includes Congestive heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65- 74 and Sex category (female), as well as the Hypertension, Abnormal Renal/Liver function, Stroke, Bleeding history or predisposition, Labile International Normalised Ratio (INR), Elderly, Drugs/alcohol concomitantly (for HAS-BLED)-comprising Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly and Drugs/alcohol concomitantly-assists in assessing bleeding risk. However, the outcomes of NVAF have remained underreported in Gujarat, western India. Aim: To characterise thromboembolic and bleeding risks using the CHA₂DS₂-VASc and HAS-BLED scores among NVAF patients receiving oral anticoagulation therapy. Materials and Methods: This ambidirectional cohort study (retrospective and prospective) was conducted over an 11-year period (January 2014 - December 2024) at the Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital and Medical Research Centre, Karamsad, Gujarat, India, a tertiary care hospital in a rural setting. The study evaluated NVAF cases based on age, sex, co-morbidities, anticoagulation therapy {Vitamin K Antagonists (VKA) or Novel Oral Anticoagulants (NOAC)} and clinical outcomes, including stroke and bleeding events. HAS-BLED scores, treatment strategies and clinical outcomes were compared across CHA₂DS₂-VASc risk groups (low ≤3, intermediate 4-5 and high ≥6). Statistical analysis was performed using statistical software Statistical Analysis System (SAS) Viya (SAS Institute Inc., NC, USA). Comparisons of risk groups used the Mann-Whitney U test, Chi-square/Fisher’s-exact test and Kruskal-Wallis test as appropriate. The Cochrane- Armitage trend test evaluated anticoagulant use patterns. A p-value <0.05 was considered statistically significant. Results: Among 347 NVAF patients, CHA₂DS₂-VASc scores were significantly higher in females (p<0.0001), indicating greater thromboembolic risk. Hypertension, diabetes mellitus, ischaemic heart disease, prior stroke, chronic kidney disease and heart failure were strongly associated with risk groups (p<0.0001). High-risk patients were older (median 80 vs. 61 years, p<0.0001) and had higher HAS-BLED scores (p<0.0001). NOACs were more frequently prescribed to high-risk patients than VKAs (p<0.0001), with combination antithrombotic therapy being more common among NOAC users (p=0.001). Major bleeding events, including ischaemic and haemorrhagic strokes, were significantly more frequent in high-risk patients (p<0.0001), while mortality was highest in the intermediate-risk group (25.0%, p<0.0001). Conclusion: The present study observed sex-based differences in CHA₂DS₂-VASc scores and their association with thromboembolic risk. Higher scores were associated with advanced age, multiple co-morbidities, increased bleeding risk and the use of NOACs. Adverse clinical outcomes, including major bleeding, were more frequent in higher-risk groups, indicating the need for personalised anticoagulation therapy based on the patient’s bleeding and thromboembolic risk.

An Experimental Study on the Effect of Thermally Oxidised Ti-6Al-4V Substrate on the Surface Characteristics and Composition of Hydroxyapatite Coatings Produced by Modified Cold Gas Spray

Introduction: Hydroxyapatite (HA) coatings enhance the bioactivity of Titanium-6% Aluminum-4% Vanadium (Ti-6Al-4VTi-6Al-4V). Conventional plasma spraying often results in amorphous HA phases due to high temperatures. To overcome this, HA coatings can be deposited at lower temperatures using a modified Cold Gas Spray (CGS) technique. The present study compared the effects of thermally oxidised and sand-gritted substrates on the properties of HA coatings. Aim: To evaluate the impact of thermal oxidation on surface topography, roughness, thickness, phase composition and the Calcium-to-phosphorus (Ca/P) molar ratio of HA coatings applied via modified CGS. Materials and Methods: An experimental study was conducted at the School of Material and Mineral Resources Engineering, Engineering Campus, Universiti Sains Malaysia (USM), Malaysia, from May 2021 to May 2023. Ti-6Al-4V substrates were sand-gritted and thermally oxidised at temperatures ranging from 450°C to 600°C. HA coatings were applied using the modified CGS. Coatings were analysed using Atomic Force Microscopy (AFM), Backscattered Electron Microscopy (BSEM), X-Ray Diffraction (XRD) and X-ray Fluorescence (XRF) to investigate surface roughness, surface topography, coating thickness and composition. Statistical analysis was performed using the Kruskal-Wallis test for group comparisons, followed by post-hoc Mann-Whitney U tests. A p-value of less than 0.05 was considered statistically significant. Results: Thermally oxidised substrates exhibited increased surface roughness and microhardness compared to the sand-gritted control. The HA coating on sand-gritted substrates had a roughness of 60.43 nm (IQR=37.41 nm), while oxidised surfaces at 500°C and 600°C resulted in roughness values of 27.61 nm (IQR=51.07 nm) and 33.03 nm (IQR=23.19 nm), respectively. A 2D image showed no aggregation of HA particles. Coating thickness was reduced from 109.0 μm (IQR=45.3 μm) on sand-gritted substrates to 48.4 μm (IQR=12.5 μm) on substrates oxidised at 600°C. The thermally oxidised substrate at 500°C produced a coating thickness of 74.2 μm (IQR=9.40 μm) with a Ca/P ratio of 1.83, meeting the Food and Drug Administration (FDA) standard. XRD confirmed that the phase composition of all coatings was consistent with the original HA powder. Conclusion: Thermal oxidation of Ti-6Al-4V substrates influences the roughness and thickness of HA coatings’ surfaces and the modified CGS technique produces HA coatings suitable for biomedical applications.

Assessment of Salivary and GCF pH in Periodontally Healthy and Stage II, Grade B Periodontitis Subjects: An In-vivo Study

Introduction: Oral fluids can be used for the diagnosis of periodontal disease, as they can be easily collected. Saliva is a complex fluid that impacts oral health. Gingival Crevicular Fluid (GCF) is a physiological fluid as well as an inflammatory exudate present in the dentogingival space. It is established that every inflammatory change, along with resultant damage to tissues, leads to altered pH values of these fluids. Periodontal disease is a chronic inflammatory and infectious condition that affects the pH levels of saliva. Furthermore, it is understood that periodontal pathogens grow at acidic pH levels and the growth of these bacteria further contributes to changes in pH levels. Aim: To assess and compare the pH values of saliva and GCF in periodontally healthy subjects and those with chronic periodontitis. Materials and Methods: This in-vivo study was carried out at Outpatient Department of Periodontology, Bharati Vidyapeeth (Deemed To Be) University Dental College and Hospital, Pune, Maharashtra, India, over a period of three months, from August 2024 to October 2024. A total of 30 subjects visiting the department of periodontology underwent detailed periodontal examinations and were categorised into two groups: healthy periodontium (Group I, n=15) and generalised stage II, grade B periodontitis (Group II, n=15). Saliva and GCF samples were collected and analysed for pH levels. An independent sample t-test was applied. The analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 25.0. A p-value of less than 0.05 was considered statistically significant. Results: A total of 30 subjects were studied, of which 20 were females and 10 were males, with a mean age of 32.5 years. In periodontally healthy subjects (Group I), the mean salivary pH was found to be 7.05±0.01, whereas, in stage II, grade B periodontitis subjects (Group II), the mean salivary pH was 6.14±0.60 (p=0.038). The mean GCF pH was 6.73±0.14 in Group I and 8.19±0.29 in Group II (p=0.041). Thus, in chronic periodontitis patients, the salivary pH was acidic and the GCF pH was alkaline compared to periodontally healthy subjects. Conclusion: The present study indicates that subjects with Stage II, Grade B periodontitis have an acidic salivary pH and a more alkaline GCF pH compared to periodontally healthy subjects.

Comparison of Magnesium Sulphate versus Clonidine as Adjuvants to Ropivacaine in Ultrasound-guided Bilateral Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Segment Caesarean Section: A Randomised Controlled Trial

S Mercy Saghana, Joshiah Jeyakumar, B Balamurugan

Introduction: Anaesthesia plays a vital role in providing effective pain relief during surgical procedures while maintaining haemodynamic stability, ensuring maternal and foetal safety and enhancing overall recovery. In obstetric anaesthesia, particularly during Lower-Segment Caesarean Section (LSCS), the choice of anaesthetic agents and adjuvants significantly influences perioperative outcomes such as analgesia duration, haemodynamic parameters and patient comfort. The optimisation of these factors remains a crucial aspect of current research. Aim: To evaluate the difference between the efficacy of Magnesium Sulphate and Clonidine as adjuvants to Ropivacaine in ultrasound-guided bilateral Transversus Abdominis Plane (TAP) block for postoperative analgesia and haemodynamic stability in patients undergoing LSCS under subarachnoid block. Materials and Methods: This study was designed as a randomised, double-blind, controlled trial conducted at Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, involving 60 female patients undergoing elective or emergency LSCS under subarachnoid block. Random allocation was used to assign patients into two groups of 30 each-Magnesium Sulphate as an adjuvant (group RM) and Clonidine as an adjuvant (group RC)-for the ultrasound-guided administration of Ropivacaine in bilateral TAP block. Postoperative analgesia duration, pain intensity (measured using the Visual Analogue Scale (VAS) score), haemodynamic parameters and side-effects were recorded over a 48-hour postoperative period. Statistical Package for the Social Sciences (SPSS) software was used for data analysis. Results: Both groups were comparable in demographic parameters, with mean age, height and weight being 28.3±4.79 years, 160.07±10.57 cm and 70.77±5.29 kg in the RM group (Ropivacaine with Magnesium Sulphate) and 28.67±4.21 years, 161.27±5.06 cm and 69.84±4.81 kg in the RC group (Ropivacaine with Clonidine). The duration of analgesia was similar between group RC (10.53±5.68 hours) and Group RM (9.72±5.186 hours), with a p-value of 0.563, indicating no significant difference between the groups. The duration of analgesia was consistent in both groups, with lower VAS scores recorded at multiple intervals. Haemodynamic parameters remained stable in both groups, with no significant adverse effects or complications observed. Conclusion: Ultrasound-guided TAP block with magnesium sulphate as an adjuvant to ropivacaine demonstrated comparable efficacy to clonidine in providing postoperative analgesia, without compromising haemodynamic stability or causing major adverse effects. Both magnesium sulphate and clonidine are equally effective in enhancing postoperative analgesia in patients undergoing LSCS.

Immunohistochemical Expression of Programmed Death Ligand-1 in Colorectal Carcinoma and its Association with Clinicopathological Profile: A Cross-sectional Study

Introduction: Colorectal Carcinoma (CRC) is usually an aggressive tumour with a high mortality rate. The detection of prognostic and predictive biomarkers for CRC is very important in providing personalised treatment. Checkpoint blockade therapy targeting Programmed Cell Death-1 (PD-1) and its ligand, Programmed Death Ligand-1 (PD-L1), using anti-PD-1 and anti-PD-L1 monoclonal antibodies is under evaluation for treating cancers of the gastrointestinal tract. Aim: To evaluate the Immunohistochemical (IHC) expression of PD-L1 in CRC and its association with the clinicopathological profile of patients with CRC. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, on 39 cases of resected CRC specimens received over a period of one year from January 2023 to January 2024. The IHC expression of PD-L1 in tumour cells and Tumour Infiltrating Lymphocytes (TILs) was analysed and assessed using Tumour Proportion Score (TPS) and Combined Positive Score (CPS). The association between PD-L1 expression and TPS and CPS assessment, as well as the clinicopathological profile of patients, was analysed. Data were presented as frequency and percentage. Categorical variables were compared using the Pearson Chi-square test. Significance was defined by p-values <0.05 using a two-tailed test. Results: PD-L1 expression in the tumour cells was observed in 11 cases (28.21%), while 15 cases (38.46%) showed positivity only in TILs and 11 cases (28.21%) showed positivity in both. Upon correlating PD-L1 expression with clinicopathological parameters, there was a statistically significant association between PD-L1 expression in tumour cells and the histological type of carcinoma (p-value=0.038), Lymphovascular Invasion (LVI) (p-value=0.016), Perineural Invasion (PNI) (p-value=0.05) and tumour budding (p-value=0.046). Additionally, when assessing the association of TPS with the clinicopathological profile, a statistically significant association was found between TPS and histological type (p-value=0.038), LVI (p-value=0.024), PNI (p-value=0.05) and mucin pools (p-value=0.039). A statistically significant association was established between CPS assessment and tumour size (p-value=0.050), histological type (p-value=0.007), LVI (p-value=0.08), PNI (p-value=0.09) and tumour budding (p-value=0.028). Conclusion: PD-L1 expression, along with TPS and CPS assessment, showed a strong association with tumour type, size, LVI, PNI, tumour budding and mucin pools, which are individual prognostic variables in CRC. Thus, PD-L1 is an independent prognostic biomarker in cases of CRC. In developing countries where molecular phenotyping is challenging, PD-L1 IHC can be useful in predicting prognosis and identifying patients who require anti-PD-L1 targeted therapies.

Comprehensive Evaluation of Neuroprotective Effects of Levetiracetam in C57BL/6J Male Mice Model of Parkinsonism: Preclinical Insights

Neeraj Pandey, VP Karthik, Preetha Selva, Philo Hazeena

Introduction: Levetiracetam (LEV), an anticonvulsant used for epilepsy, exhibits neuroprotective effects by stabilising neuronal activity and reducing excitotoxicity. Parkinsonism, caused by the degeneration of dopaminergic neurons, is primarily managed symptomatically. LEV may offer both symptom relief and neuroprotection, presenting a potential alternative therapy. Aim: This study aimed to evaluate the neuroprotective effects of LEV in a mouse model of Parkinsonism. It investigated whether LEV, an antiepileptic drug, can mitigate the neurodegenerative processes and improve motor function and oxidative stress markers in a mouse model induced with Parkinsonism using 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine (MPTP), a neurotoxin that selectively destroys dopaminergic neurons. Materials and Methods: The present experimental study was conducted at the Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India, from October 2023 to March 2024. Thirty-six male mice were divided were divided into six groups: control (vehicle), control (MPTP-treated), LEV high dose, L-Dopa+MPTP, LEV low dose+MPTP, and LEV high dose+MPTP. The mice underwent various behavioural tests, including the Open Field Test (OFT), rota-rod test, and foot slips test. Biochemical assays, such as Superoxide Dismutase (SOD), Glutathione Peroxidase (GPx), and nitrite levels, were performed to assess oxidative stress and antioxidant defences. Results: The LEV-treated groups showed significant improvements (p<0.05) in locomotor activity, motor coordination, and exploratory behaviour compared to the MPTP-treated control group. LEV at a high dose of 54 mg/kg significantly enhanced antioxidant enzyme levels, with SOD at 0.373 U/mg, GPX at 3.436 mcg/mg/min, and Nitric Oxide (NO) at 3.482 mg/mL, indicating its neuroprotective potential. Conclusion: LEV demonstrated significant neuroprotective effects in a mouse model of Parkinsonism. The improvements in both behavioural outcomes and biochemical markers suggest its potential as a therapeutic agent for neurodegenerative diseases.

Lichtenstein’s Open Mesh Hernioplasty versus Desarda’s no Mesh Hernia Repair in Inguinal Hernia: A Prospective Interventional Study

Introduction: Inguinal hernia repair with mesh is a common surgical procedure in the abdomen, involving the implantation of a mesh at the weak point of the abdominal wall. However, due to postoperative complications and a slower recovery rate, alternative methods, like Desarda’s tissue repair method, have been introduced. Aim: To compare the short-term outcomes of Desarda’s no-mesh technique and Lichtenstein’s mesh repair in inguinal hernia patients, focusing on postoperative pain, incidence of complications and recurrence. Materials and Methods: A prospective interventional study was conducted in the Department of General Surgery at the Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from June 2022 to May 2024. The authors enrolled 108 patients with primary uncomplicated inguinal hernias aged over 18 years, of which 54 patients underwent Desarda’s repair (Group 1) and 54 patients underwent Lichtenstein’s mesh hernioplasty (Group 2). Clinico-demographic features, Visual Analogue Scale (VAS) scores for postoperative pain and postoperative complications were compared between both groups. Statistical significance was assessed using the Chi-square test or Student’s t-test. Results: Each group comprised 54 patients, with mean ages of 47.5±16.3 years for Group 1 and 44.2±14.9 years for Group 2. A significant difference (p=0.006) in the incidence of seroma was observed between the two groups. When comparing both groups, Group 1 patients reported significantly less pain on Postoperative Day (POD) 1 (p=0.03). The recovery rate was faster in the Desarda group (7.61±1.21 days) compared to the Lichtenstein group (8.28±1.29 days). Conclusion: The Desarda technique was found to be a more effective method, offering a shorter duration of surgery and faster recovery. Thus, Desarda’s procedure should be considered as an alternative to mesh-based treatments.

Thyroid Hormone Levels in Patients with Head and Neck Cancer undergoing Radiochemotherapy: A Retrospective Study

Nidhi Rohan Purandare, Meenakshi, Shilpa Jain, Neeti Patel, Sarita A Shinde

Introduction: Head and Neck Cancers (HNCs) are a common type of cancer, affecting approximately 6% of the global cancer burden. The treatment of HNC often involves Radiochemotherapy (RCT), which can have adverse effects on the thyroid gland. The present study investigates how RCT impacts thyroid function in patients with HNC. Aim: To determine the effect of RCT on Thyroid Stimulating Hormone, (TSH) triiodothyronine and thyroxine. Materials and Methods: This was a retrospective study conducted in Department of Biochemistry at Medical College and SSG hospital, Baroda, Gujarat, India. Data of patients were collected from radiology department from period of January 2016 to April 2017. Patients who were initially euthyroid were included in present study (N=59). Thyroid levels were tested by immunoassay. Mean and standard deviation were calculated and statistical analysis was done using the Analysis of Variance (ANOVA) test. Results: The mean±Standard Deviation (SD) of various thyroid function levels before and after 1, 3, and 6 months of RCT were; serum T3=1.2±0.4, 1.6±0.5, 1.3±0.6 and 0.7±0.4 ng/mL, respectively, serum T4=9±2, 11±3, 8±2 and 5±1 μg/dL respectively and serum TSH=2.4±1.5, 1.9±1.5, 4.4±1.1 and 6.9±1.7 mIU/mL respectively. Serum T3 and serum T4 increased significantly after one month (p=0.008 and 0.004) and decreased significantly after six months of treatment (p=0.0001) whereas, serum TSH increased significantly after three months (p=0.015) of treatment. Conclusion: It was concluded that treatment of HNC with RCT may affect thyroid functions. There is a tendency to develop hyperthyroidism initially after one month of RCT, but later on, Hypothyroidism (HT) develops. So, it is advisable to test the thyroid profile on regular follow-up to enable early diagnosis and treatment of any thyroid malfunction that can develop after RCT.

Comparison of Dexmedetomidine-bupivacaine Combination versus Bupivacaine Alone for Scalp Block in Attenuating the Haemodynamic Response to Skull Pin Placement during Neurosurgical Procedures: A Randomised Controlled Study

Emin Jimmy, Arpana Kedlaya, Nayanthara Joachim

Introduction: Skull pin placement in neurosurgical procedures can cause acute nociceptive stimuli that may result in an acute haemodynamic response and rise in intracranial pressures. Pain management is crucial to treat this detrimental stimulus. Aim: To compare the effects of dexmedetomidine as a local anaesthetic adjuvant to bupivacaine versus bupivacaine alone in scalp block for attenuation of haemodynamic response to skull pin placement in neurosurgical procedures. Materials and Methods: A double-blinded randomised controlled study was done at St. John’s Medical College Hospital, Bengaluru, Karnataka, India where 70 patients were randomly placed into one of two groups (35 each). Patients in Group D received scalp block with 1 μg/kg dexmedetomidine and 25 mL of 0.25% bupivacaine. Group C received 25 mL of 0.25% bupivacaine alone. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were recorded at baseline and at 1, 3, 5, 10 and 15 minutes post scalp block. Haemodynamic changes were analysed using the unpaired Student’s t-test in both groups. Results: Demographic variables including age, gender, weight and American Society of Anaesthesiologists (ASA) status were comparable between the groups. A significant increase in HR from baseline to one and three minutes after scalp block in both groups (-6.89 beats/min, p-value=0.001 and -4.89 beats/min, p-value=0.049 in Group D; -8.4 beats/min, p-value <0.001 and -7.34 beats/min, p-value <0.001 in Group C, respectively). There was also significant decrease in HR from baseline to 15 minutes after scalp block (4.8 beats/min, p-value=0.006) in Group D. In both groups, there was a clinical increase in BP from baseline to 1 and 3 minutes after scalp block (Group D baseline MAP 86.5±7.1 mmHg, at 1 minute 90.5±7.5 mmHg, at 3 minutes 89.2±6.5 mmHg; Group C baseline MAP 89.5±8.7 mmHg, at one minute 92.7±9.0 mmHg, and at three minutes 92.0±7.9 mmHg). After 10 and 15 minutes of scalp block, the mean BP of the patients in Group D (84.9±5.8 mmHg and 83.9±5.7 mmHg) was significantly lesser as compared to that of patients in Group C (88.9±8.8 mmHg and 87.9±8.8 mmHg). Conclusion: Scalp nerve block is extensively used for intraoperative haemodynamic stability and opioid-sparing effects. It has proven to provide better postoperative analgesia in patients undergoing craniotomies. In present study, the addition of 1 μg/kg of dexmedetomidine with 25 mL of 0.25% bupivacaine for a scalp block minimises the haemodynamic response to skull pin placement when compared to 0.25% bupivacaine given alone in patients undergoing craniotomies for Central Nervous System (CNS) pathologies.

Cervicogenic Headache and Physiotherapy: A Systematic Review of Treatment Modalities

Manali Sanket Chitlange, Pallavi Harjpal

Introduction: A common, but frequently misdiagnosed, condition known as Cervicogenic Headache (CGH) is characterised by pain radiating from the cervical spine to the head. CGH can significantly impact quality of life, leading to disability and reduced productivity. It also provides information regarding the nature of CGH. External pressure on the neck and movements of the neck, such as extension, rotation, or lateral flexion, may trigger the headache, which may then spread to the ipsilateral orbito-frontal-temporal or facial regions. Pain is referred from cervical structures due to the convergence of sensory pathways in the trigeminal-cervical complex. Dysfunction or irritation of cervical joints, muscles, or nerves can contribute to CGH symptoms. Physical therapy targets the cervical spine, which is often involved in CGHs. Techniques aim to improve joint function, reduce muscle tension, and enhance cervical stability. Therapy helps to restore normal cervical function, improve posture, and enhance overall quality of life. Patients also learn about self-management strategies, ergonomic adjustments, and lifestyle modifications to prevent exacerbation. This structured background provides a comprehensive overview of CGHs and the role of physical therapy in their management and effectiveness. Aim: This article aims to provide a thorough overview of CGHs, covering a range of physical therapy treatments. Materials and Methods: In the present systematic review, a literature search was conducted to find pertinent studies and reviews on cervicogenic headache, using the PubMed database. Key search terms included “cervicogenic headache” and “physiotherapy.” Only English-language research published between 2005 and 2024 were included in the search. The platform “RAYYAN” was used for the screening of articles and provides information regarding duplicate and unresolved articles. Results: In the identification phase, a search of databases and registers yielded 40 potentially relevant records. During the screening process, two duplicates were removed, leaving 38 records for further evaluation. Of these, 21 were excluded for reasons such as irrelevance to the research question or differing study types. The remaining 17 records underwent assessment based on predefined inclusion and exclusion criteria. Ultimately, 11 studies met the eligibility requirements and were included in the systematic review. Articles with titles related to CGH and physiotherapy were included. The subjects were children, as well as male and female adults. A Clinical Trial (CT) and Randomised Controlled Trial (RCT) study design including 13 various interventions published from 2005 to 2024 were selected. All studies were written in English and had free full-text availability. Conclusion: Given the complexity of cervicogenic headache, multiple modalities must be used in diagnosis and treatment. To improve patient outcomes and optimise therapeutic techniques, further research is required.

Decellularised Sheep Tendon Derived Extracellular Matrix: An In-vitro Biochemical and Histological Analysis

Vazeeha Afrin Syed, S Balaji Ganesh, Gurumoorthy Kaarthikeyan, S Chitra

Introduction: Demineralised ovine cartilage is derived from sheep cartilage with its mineral content removed, preserving the collagen-rich organic matrix. It provides an osteoconductive scaffold that supports cell attachment, proliferation, and differentiation. Its biocompatibility and structural similarity to human bone Extracellular Matrix (ECM) make it suitable for periodontal, promotes new bone formation and periodontal ligament attachment. Aim: To fabricate decellularised sheep tendon derived ECM and to analyse Deoxyribonucleic Acid (DNA) and Glycosaminoglycan (GAG) content using histological Haematoxylin and Eosin (H&E), Alizarin Red and Alcian Blue staining and DNA quantification. Materials and Methods: This in-vitro study was done in July 2024 at Saveetha Dental College and Hospitals in Chennai,Tamil Nadu, India. Fresh ovine/sheep tendon samples were obtained, cleaned of extraneous tissues, and stored at -20°C. They were then cut into small pieces (1.5×1.5 mm) using a 15-number size BP blade scalpel. The tendon fragments were submerged in a decellularisation fluid consisting of 10% Phosphate-Buffered Saline (PBS), Sodium Dodecyl Sulfate (SDS), and Triton-X. The mixture was shaken at 37°C until foam formed, with the froth being removed and the solution replenished every six hours for three days. After decellularisation, the tendon pieces were thoroughly washed with distilled water, freeze-dried, and the resulting ECM was refrigerated. Morphology of one sample was evaluated using a scanning electron microscope. Histological analysis was performed by Haematoxylin and Eosin, Alizarin Red and Alcian Blue staining to detect GAG content. DNA quantification was done to confirm the remaining DNA percentage. Results: Scanning Electron Microscopy (SEM) image revealed that the ECM exhibited a fibrous shape with a high density of linked fibers. Haematoxylin and eosin staining revealed 90% decellularisation of the sheep tendon. Alizarin red staining showed that almost no mineral content remained after decellularisation. Alcian blue staining is used to detect the presence of GAG and shows that almost 90% of the GAG has been removed from the ovine sheep/tendon by decellularisation. This result is further substantiated by the DNA quantification which shows only around 10-15% DNA remaining in the decellularised tissue. The GAG quantification also gives similar observations which prove the almost complete removal of cells from the sheep tendon (100% naive tendon and 15% decellularised tendon). Conclusion: Decellularised ovine/sheep tendon may prove as a useful material for tissue regeneration as it helps in collagen synthesis, combining effective decellularisation with the preservation of key ECM components. Further studies are needed to evaluate its potential use as a graft material and for various clinical applications.

Evaluation of Peri-apical Healing in Patients of Apical Periodontitis with Mature Necrotic Teeth Treated using A-PRF+versus i-PRF: A Research Protocol

Tejas Suryawanshi, Manoj Chandak, Aditya Patel, Shweta Sedani, Palak Hirani

Introduction: Apical periodontitis is a common consequence of pulp injury, leading to periapical lesions. While conventional endodontic treatment provides mechanical debridement and sealing, it lacks bioactive stimulation to enhance healing. Platelet concentrates, such as Advanced Platelet-Rich Fibrin Plus (A-PRF+) and Injectable Platelet-Rich Fibrin (i-PRF), offer promising potential through the release of growth factors that promote tissue repair. Need of the study: This study will compare injectable PRF and A-PRF+ as scaffolds in non surgical endodontic treatment of mature teeth with non vital pulp and apical periodontitis to identify the most effective platelet concentrate for periapical healing. Aim: To compare the efficacy of A-PRF+ and i-PRF in the periapical healing of mature necrotic teeth with apical periodontitis using radiographic assessment. Materials and Methods: A single-blinded, randomised controlled trial will be conducted at the Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from July 2024 to August 2025. A total of 34 patients with necrotic mature permanent anterior teeth exhibiting periapical lesions will be randomly allocated into two groups: A-PRF+ and i-PRF. Standard endodontic treatment will be performed, followed by the application of A-PRF+ or i-PRF before root canal obturation. Radiographic healing will be evaluated using Intraoral Periapical Radiographs (IOPA) at baseline, 3, 6, and 12 months. Descriptive and analytical statistical analyses will be conducted. Intergroup comparisons will be performed using Student’s t-test, with significance set at p-value <0.05.

Devising and Testing a Comprehensive Physiotherapy Protocol to Improve Muscle Strength, Mass, Function and Quality of Life in Type 2 Diabetic Postmenopausal Women: A Research Protocol

Sonali Guliya, Subhasish Chatterjee

Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic condition that can pose significant challenges for postmenopausal women, particularly in terms of their physical capabilities and overall wellbeing and they are at five times more risk of experiencing a reduction in muscle strength and mass comparison to non diabetic postmenopausal women. It poses significant health risks and requires proper management to prevent complications. Need of the study: Previous literature indicates that postmenopausal women with T2DM undergo transitions such as ageing, inadequate nutrition, sedentary lifestyle, hormonal change, insulin resistance and chronic inflammation, leading to a decrease in muscle strength and mass. Consistent physical activities, such as aerobic exercise and resistance training, have been found to improve these transitions in type 2 diabetic postmenopausal women. Therefore, there is a need to design a comprehensive physiotherapy protocol for evidence-based exercises. Aim: To design and test a comprehensive physiotherapy protocol for muscle strength, mass, function and Quality of Life (QoL) in T2DM postmenopausal women. Materials and Methods: The study will be conducted in MM Super Specialty Hospital, Ambala, Haryana, from November 2024 to June 2026. This Delphi study will be followed by a randomised controlled trial and will be divided into two phases. The first phase includes the formulation and validation of a comprehensive physiotherapy protocol. The second phase includes testing the efficacy of the protocol by conducting a randomised controlled trial on type 2 diabetic postmenopausal. Outcome measures include body composition analyser (InBody 270), back-leg-chest dynamometer, hand-held dynamometer and SarQoL questionnaire (both English and Hindi versions), which will be assessed before intervention and after six weeks of intervention. Content validation will be determined according to the Content Validity Index (CVI) values. Statistical analysis will be done by the Wilcoxon signed-rank test/paired t-test and Mann-Whitney U test/independent t-test. The significance level will be set at p-value <0.05.

Evaluation of the Efficacy of Yavanna (Rajaswala Paricharya diet) versus Routine Care in the Management of Kashtartava (Primary Dysmenorrhoea): A Randomised Controlled Trial Protocol

Niharika Sharma, Pradnya Dandekar

Introduction: Menstrual pain is a common problem among women of reproductive age, negatively affecting their daily activities and quality of life. In Ayurveda, a classic diet and lifestyle regimen is recommended during menstruation, known as Rajaswala Paricharya. Adhering to this diet during menstruation in otherwise healthy women is thought to produce shuddhaartava (i.e., a painless, healthy menstrual cycle). Need of the study: Modern medical treatments for dysmenorrhoea (primary dysmenorrhoea) include Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and oral contraceptives, which may produce certain side-effects such as gastrointestinal disturbances, stomach ulcers, and allergic reactions. Therefore, the present study aims to develop a treatment that is simple to administer, highly effective in alleviating the condition and has minimal or no side-effects, ensuring patient acceptance. Aim: To assess the efficacy of the Rajaswala Paricharya diet (Yavanna – barley porridge diet) compared to routine care (Mefenamic acid) in cases of primary dysmenorrhoea. Materials and Methods: A single-centre, randomised, single-blinded, parallel-group controlled trial will be conducted at MGACH, Wardha, Maharashtra, India, over three consecutive cycles (a three-month period) from July 2024 to March 2025. The subjects will be divided into two groups: the control group and the experimental group. The experimental group will follow the Rajaswala Paricharya diet (Yavanna) by consuming 100-250 grams of barley per day in two divided meals, according to appetite, as the intervention. The control group will take a tablet of mefenamic acid at 250 mg twice daily during menstruation for three consecutive cycles. Patients will be assessed for pain using changes in the Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score and the Visual Analog Scale (VAS) score on the first three days of the menstrual cycle over four consecutive cycles (the first cycle after registration for baseline assessment followed by three consecutive cycles for after-treatment assessment). Statistical analysis will be conducted using a paired t-test and Chi-square test, with statistical significance set at p-value ≤0.05.

Effectiveness of Self-instructional Module on Knowledge Regarding Prevention of Surgical Site Infection among Postoperative Cardiac Patients: A Research Protocol

Shiwani Padmakar Dandade, Arati Raut

Introduction: Heart failure, often known as congestive heart failure or congestive cardiac failure, is a common, expensive, debilitating, and potentially fatal condition that arises when the heart is unable to produce enough pump action to sustain blood flow to meet the body’s needs. An integral part of managing cardiovascular risk is leading a healthy lifestyle. Need of the study: Surgical Site Infections (SSI) in cardiac surgery remain a significant medical problem due to the deteriorated postoperative quality of life, increased mortality, more extended hospital stays, and increased treatment costs. Aim: The present study aims to evaluate the effectiveness of Self-Instructional Modules (SIM) on knowledge regarding the prevention of SSI among postoperative cardiac patients. Materials and Methods: A quasi-experimental research design (one group pretest, post-test research design) will be conducted at AVBRH Sawangi (Meghe), Wardha, Maharashtra, India from March 2024- March 2025. A total of 140 subjects will be included in the study. A structured questionnaire based on the knowledge will be used to assess the effectiveness of the SIM on the prevention of SSI. The tools will consist of Section-I: Demographical data like age, gender, family income, occupation, education, stay in the hospital after surgery, and the type of cardiac surgery. Section-II: Structured knowledge questionnaire on the prevention of SSI among postoperative cardiac patients. A SIM will be provided to the postoperative cardiac patients regarding the prevention of SSI. One-way ANOVA will be applied to statistically evaluate the association of demographic variables with the level of knowledge regarding the prevention of SSI. A paired t-test will be used for the pre and post-test evaluation of the participants. A p-value of <0.05 will be considered significant.

Evaluating the Effect of Bilvadi Jala Nirvishikaran Yoga in Different Samples of Polluted Water: A Research Protocol

Prasad Jagdishbhai Maru, Nilima Wadnerwar

Introduction: Water is essential for life, and managing water resources is crucial in addressing the global issue of water pollution. Water pollution occurs when substances alter its physical, chemical, or biological properties, harming living organisms. Domestic, agricultural, and industrial activities release pollutants into the environment, contributing to this contamination. Ancient texts, such as those by Acharya Sushruta and Vagbhatta, mention various herbal methods for water purification. Specifically, Acharya Vagbhatta highlights a purification technique involving a decoction of herbs like Bilva (Aegle marmelos), Adhaki (Cajanus cajan), Yavakshar (Hordeum vulgare), Patola (Trichosanthes cucumerina), Balhik (asafoetida), Ushan (Piper nigrum), Shreeparni (Gmelina arborea), and Shalmali (Bombax ceiba). This herbal combination is believed to neutralise poisons in water and other substances, rendering them safe. Need of the study: Modern water purification methods often involve chemicals like chlorine, which can produce harmful by-products like Trihalomethanes (THMs) that pose significant health risks, including cancer. To address this, ancient texts, particularly those by Acharya Vagbhatta, suggest natural methods for purifying water. One such method, Bilvadi Jala Nirvishikarana yoga, involves a decoction of plants like Bilva, Adhaki, Yavakshar, Patola, and others, which detoxifies contaminated substances. The present study aimed to evaluate the effectiveness of this traditional purification technique through in-vitro experiments. All results will be evaluated at a 95% significance level to assess their statistical relevance and determine the study outcomes. Aim: To evaluate the effect of Bilvadi Jala Nirvishikaran on different samples of polluted water. Materials and Methods: The experimental in-vitro study will be conducted by the Department of Agadatantra at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India at the National Environmental Engineering Research Institute (NEERI), Nagpur, Maharashtra, India from January 2025 to February 2025. The present study will be completed between January and February 2025. Polluted water samples will be collected from the Pavanar and Dham rivers in the Wardha district. Poisoned water samples will be prepared by adding Dhatura and organophosphorus compound powder to plain tap water. All the samples will be tested for physicochemical parameters before and after the administration of Bilvadi Jala Nirvishikaran yoga. The results will be compared among all samples.

Predicting the Gender-based Aerobic Capacity in Chronic Obstructive Pulmonary Disease Patients with superadded Infection: A Study Protocol

Prachi Rana, Subhasish Chatterjee, Sameer Singhal

Introduction: Chronic Obstructive Pulmonary Disease (COPD), a prevalent respiratory condition, can be prevented and treated. Among various triggers, infections are a leading cause of COPD exacerbations. Assessing aerobic capacity is essential in the management of COPD, as it serves as a fundamental indicator of both quality of life and mortality. However, determining this target value necessitates the estimation of a gender-based predictive aerobic capacity value for each individual. Need of the study: The newly developed gender-based reference equation for aerobic capacity may have the potential to accurately calculate predicted values that assess the individual patient’s aerobic capacity. Aim: To develop a gender-based prediction equation to assess aerobic capacity in COPD patients with infection. Materials and Methods: This cross-sectional study will recruit COPD patients with infections from the In-Patient Department (IPD) at a tertiary care super-specialty hospital (Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India), using purposive sampling be conducted over a period of one year (from July 2024 to June 2025). The Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC) ratio will be recorded using the post-bronchodilator PFT report, while aerobic capacity will be assessed through the Six-Minute Walk Test (6MWT) for 80 participants. Data will be analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Depending on the data type, Chi-square, Spearman’s, or Pearson’s tests will be used to assess the relationship between FEV1/FVC and 6MWT. Multivariate linear regression with a step-wise approach will be employed to create a predictive equation for aerobic capacity. Subsequently, a standardised equation for aerobic capacity will be derived.

Efficacy of Tulsi-Turmeric Oil Pulling versus Sesame Oil Pulling on Temporomandibular Joint Movement in Oral Submucous Fibrosis (Vata Pitta dominant Tridosaja Sarvasara Mukharoga): A Randomised Controlled Trial Protocol

Anshika Kishor Singh, Gaurav Rajendra Sawarkar, Punam Gaurav Sawarkar

Introduction: Oral Submucous Fibrosis (OSMF) is a chronic oral condition characterised by inflammation and fibrosis, leading to restricted mouth opening, burning sensations, loss of taste, and ulcerations. Chewing betel nut is a significant risk factor, and OSMF carries a 2-30% risk of progressing to carcinoma, with a prevalence of 0.5% in the Indian subcontinent, predominantly affecting females. Current treatments are often ineffective and have adverse effects, prompting interest in natural remedies such as Tulsi and Turmeric, which may alleviate symptoms and effectively manage the condition. Need of the study: Current treatments for OSMF are often limited and have adverse effects, instigating interest in natural remedies like Tulsi and Turmeric, which may alleviate symptoms and manage the condition effectively. Exploring alternative therapies such as oil pulling, a traditional practice in Ayurveda, may offer new hope for patients. Oil pulling is a natural, non-invasive, and cost-effective treatment. By comparing two different oils-Tulsi-Turmeric and Sesame-this study aims to identify the most effective oil for improving mouth opening, thus providing evidence-based guidance for practitioners and patients. Aim: The present study compares the efficacy of Tulsi-Turmeric oil pulling versus Sesame oil pulling on Temporomandibular Joint (TMJ) movement in OSMF patients with Vata Pitta dominant Tridosaja Sarvasara Mukharoga (a disease affecting the whole oral cavity). Materials and Methods: A prospective randomised standard control double-blind superiority clinical trial (RCT) will be conducted at the Shalakya Tantra Department of Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod Wardha, Maharashtra, India, from October 2023 to October 2025. Sixty participants will be divided into two groups of thirty participants each. One group will receive Tulsi-Turmeric oil pulling, while the other will receive Sesame oil pulling for thirty days. The TMJ movement assessment will involve the evaluation of the range of movements laterally, anteroposteriorly, and vertically, along with palpation of the TMJ and surrounding muscles to identify tenderness. Other assessments will include IID scoring, cheek flexibility, and Visual Analog Scale (VAS) scores before and after the intervention. Descriptive statistics will summarise demographic data, and results will be expressed as mean±standard deviation for continuous variables and frequencies for categorical variables. The paired t-test and unpaired t-test will be applied for intra-group and inter-group comparisons. A p-value of <0.05 will be considered significant.

Expression of CXCR-4 and CD 133 and it’s Correlation with Prognostic Pathologic Factors in Resectable Oral Squamous Cell Carcinoma: A Research Protocol

Nirlipta Swain, Arvind Shridhar Bhake

Introduction: Cancer Stem Cells (CSCs), known for their self-renewal and resistance to therapy, drive tumour progression, metastasis, and recurrence. Markers such as Cluster of Differentiation 133 (CD133) and CXC Chemokine Receptor-4 (CXCR-4) are linked to poor prognosis in cancers, including Oral Squamous Cell Carcinoma (OSCC). CD133 promotes Epithelial- Mesenchymal Transition (EMT) and chemoresistance, while CXCR-4 enhances invasion via CXCL12 signalling. Their co-expression exacerbates outcomes; however, region-specific data, particularly from high-incidence areas like India, remain scarce. Need of the study: The expression and prognostic correlation of CXCR-4 and CD133 in resectable OSCC enhance early detection, assess tumour aggressiveness, and may identify potential therapeutic targets. Aim: This study aims to evaluate the immunohistochemical expression of CXCR-4 and CD133 in resectable OSCC and analyse their correlation with key prognostic pathological factors, including tumour grade, tumour size (T-stage), Depth of Invasion (DOI), Lymphovascular Invasion (LVI), Perineural Invasion (PNI), lymph node metastasis (N-stage), and Lymph node metastasis and surgical margin status. Materials and Methods: This observational, cross-sectional study will be conducted at Jawaharlal Nehru Medical College, DMIHER. Seventy-five OSCC tissue samples will undergo immunohistochemical analysis using monoclonal antibodies against CXCR-4 and CD133. The expression levels of these markers will be assessed semi-quantitatively. Subsequently, their correlation with key prognostic pathological factors will be analysed. Statistical analysis will be performed using SPSS version 27.0, with a p-value of less than 0.05 considered statistically significant.

Correlation of Preoperative Scoring System with Intraoperative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy: A Research Protocol

Amol Ashok Gupta, Swati Deshpande

Introduction: L aparoscopic Cholecystectomy (LC) is the gold standard of care for benign gallbladder disease. The incidence of conversion from LC to open cholecystectomy is 14.3%. A high degree of anatomical variation exists in the cystic duct, cystic artery and gallbladder, making this surgery challenging at times, even in the hands of the most experienced surgeons. Need of the study: Understanding the correlation between the preoperative score and the intraoperative score early in the disease course can facilitate timely conversion to open surgery, thereby reducing the risk of inadvertent injury. Additionally, this approach can improve the efficiency of operating room scheduling and ensure that a more skilled laparoscopic surgeon is available. Furthermore, it can assist surgeons in managing complications or legal issues that may arise postoperatively. Aim: This study aims to assess the correlation between preoperative grading and an intraoperative scoring system to forecast difficulties in LC and the potential for conversion to open cholecystectomy. Materials and Methods: A prospective observational study will be conducted in the inpatient department of General Surgery at Acharya Vinoba Bhave Rural Hospital (AVBRH) in Sawangi, Wardha, Maharashtra, India, from March 2024 to February 2026. A total of 35 patients with cholelithiasis will be included in the study. Patients will be scored based on a preoperative scale (the Modified Randhawa scoring system) and counselled regarding the difficulty and possibility of conversion, which will then be correlated with an intraoperative score to assess their predictive value for the risk of conversion. The correlation between preoperative and intraoperative scores will be assessed using Pearson or Spearman correlation coefficients. For intergroup comparisons, the t-test or Mann-Whitney U test will be applied with a 5% significance level. Logistic regression models will be evaluated using the Hosmer-Lemeshow test and ROC curve analysis.

Melkersson-Rosenthal Syndrome: A Review of Clinical Presentation, Diagnosis and Management

Megha Tidke, Pramod Borghare, Piyush Pardhekar, Raza Salim Sheikh

Melkersson-Rosenthal Syndrome (MRS) is a rare neuro-mucocutaneous disorder characterised by a triad of recurrent facial palsy, orofacial swelling and fissured tongue. The complete triad occurs in fewer than 25% of cases, complicating timely diagnosis and management. The present review focuses on the clinical features, diagnostic difficulties and management approaches of MRS, hence establishing its clinical relevance and treatment results. A literature survey is conducted based on case reports, clinical trials and MRS reviews. The approach towards the diagnosis and different modes of treatments with multidisciplinary management analysis, is done. MRS is a condition with some diagnostic difficulties because it often presents variably and even mimics other diseases like angioedema, Bell’s palsy and Crohn’s disease. The gold standard of histopathology is the presence of non caseating granulomas. The acute symptoms can be treated with corticosteroids, as early as 30 to 60 mg/day; however, long-term treatment has to be avoided because of complications such as osteoporosis. Immunocompressants, like methotrexate and azathioprine, are used in refractory cases. Some of the considerations and measures would be surgical interventions, cheiloplasty and nerve decompression. However, these are risky to be accompanied by scarring, nerve damage, recurrence of symptoms and so on. A multidisciplinary approach involving dermatologists, neurologists and psychologists is critical for improving patient outcomes and quality of life. In conclusion, MRS remains a diagnostic and therapeutic challenge because of its persistence and various presentations. Accurate and early diagnosis, immediate intervention and a multidisciplinary approach to treatment will be necessary to prevent complications. Future studies on the genetic and immunological basis of MRS will help develop better diagnostic and therapeutic options.

A Narrative Review on Microbial Biofilm Formation in Septicaemia due to Gram-negative Bacteria: A Cause of Concern

Akoijam Nisha Devi, Gargi Mudey, Dipika Shaw, Shahin Vishani, Anjali Patond

Septicaemia, or bloodstream infection, is a serious condition associated with high morbidity and mortality. Gram-negative bacteria, particularly Enterobacterales, are the primary causative agents of septicaemia. Globally, there is an increasing prevalence of antibiotic-resistant gram-negative bacteria reported in bloodstream infections. One of the major mechanisms of antibiotic resistance in gram-negative bacteria is their ability to form biofilms. Biofilms facilitate the transfer of Antimicrobial Resistance (AMR) genes among the bacteria present within the biofilm. Biofilm formation poses a challenge for treatment management; additionally, biofilms protect the bacteria from antibiotics and the host immune response, thus helping the organisms to establish resistance to antibiotic agents. To date, no conclusive strategies or appropriate agents are available to combat bacteria in microbial biofilms formed inside the human host. The best way to fight biofilm-forming bacteria is to prevent infection and eradicate it before biofilms are formed by following proper preventive measures and using appropriate antibiotics. This review article aims to help readers understand the complex relationship between biofilm-forming ability and AMR among gram-negative bacteria causing septicaemia. Furthermore, the review explores the impact of biofilm formation on the pathogenesis of septicaemia and discusses strategies and agents to prevent and combat biofilm formation.

Applicability of Next-generation Sequencing Techniques in Assessing Non-alcoholic Fatty Liver Disease: A Comprehensive Review

Ali Mahzari

Non-alcoholic Fatty Liver Disease (NAFLD) is a burgeoning global health concern, with a spectrum of severity ranging from simple steatosis to Non-alcoholic Steatohepatitis (NASH). While liver biopsy remains the gold standard for diagnosis, the need for non invasive alternatives has spurred interest in Next-generation Sequencing (NGS) technologies. NGS technologies enable the simultaneous sequencing of millions of Deoxyribonucleic Acid (DNA) or Ribonucleic Acid (RNA) fragments, providing a high-throughput approach to analyse genetic variations, gene expression and epigenetic modifications. A comprehensive literature search was conducted to identify studies investigating the use of NGS in NAFLD. Data extraction focused on NGS techniques, study design, key findings and clinical implications. NGS has demonstrated potential in unraveling the complex genetic and molecular underpinnings of NAFLD. The identification of genetic variants, epigenetic modifications and non coding RNA alterations has advanced our understanding of disease pathogenesis. Moreover, NGS-based approaches have shown promise in differentiating NAFLD subtypes and predicting disease progression. However, challenges related to data analysis, standardisation and clinical translation persist. NGS offers a promising avenue for improving NAFLD diagnosis, prognosis and management. While significant advancements have been made, further research is needed to fully realise its clinical potential.

Artificial Intelligence in Paediatric Urology: Transforming Diagnosis and Treatment

Wesam Khan

Artificial Intelligence (AI) is revolutionising healthcare, including paediatric urology. Paediatric urology has played a crucial role in the development of clinically relevant AI models. This narrative review explores the applications, benefits and challenges of AI in paediatric urological diagnosis and treatment. It aims to determine the current state of AI in paediatric urology, identify key applications, evaluate their impact on clinical outcomes and explore potential future directions. The literature search was extensively conducted using the PubMed, Scopus and Web of Science databases. The findings from the literature search indicate that AI has the potential to significantly improve paediatric urological care by providing more accurate diagnosis, optimising treatment decisions and enhancing surgical outcomes. However, challenges such as data quality, model generalisability and ethical implications must be resolved for widespread implementation.

Phytotherapeutics for Wound Healing: A Systematic Review on Effectiveness of Indian Herbal Extracts in Rat Models

Nitesh Laxman Shambharkar, Pramod Khobragade

Wound healing is a multifaceted process that encompasses a coordinated set of chemical and cellular events aimed at restoring the integrity of the skin and underlying tissues. Globally, many individuals turn to medicinal plants as an alternative therapy for this purpose. The present review focuses on evaluating the in-vivo wound healing activity of herbal plant extracts native to India, comparing them with povidone-iodine. Plant extracts show potential as promising wound healing agents due to their rich active compounds, wide availability and low risk of side-effects. Data were gathered from various sources, including scientific databases such as Google Scholar, PubMed and ScienceDirect. Keywords such as “wound healing,” “animal studies,” “herbal,” “Wistar albino rats,” “India,” and “Ayurvedic” were used to identify relevant articles, which were then analysed. The present review compiles data from articles published over the past 14 years on the in-vivo wound healing potential of medicinal plants in rats, with povidone-iodine consistently used as a reference in these studies. The findings highlight the potential of medicinal plants to contribute to drug discovery as effective wound healers, which may lead to the development of new, safe drug molecules. Further research is required, including novel formulations and targeted drug delivery systems, alongside clinical trials, to scientifically validate these findings and transition them from the laboratory to industry for broader societal benefit.

The Upbringing of Children with the Help of Ayurveda Principles: A Narrative Review

Arun Naphe Khatri, Rahul Jumle

In the contemporary world, parenting faces unique challenges due to technological advancements and lifestyle changes, leading to the need for a holistic approach to child-rearing. Ayurveda, an ancient system of natural medicine, offers valuable insights into enhancing children’s physical, mental, and emotional well-being. The present review explores how understanding a child’s Doshic constitution (Prakriti) can guide parents in providing personalised care, including tailored nutrition, daily routines, and activities that support optimal health. Ayurvedic practices, such as herbal remedies and mindfulness techniques, can help address common childhood concerns and promote balance and resilience. By integrating these principles into modern parenting practices, Ayurveda provides a time-tested framework that fosters the overall well-being of children.

Hypotensive Effects of Statins: A Rapid Review

Smruti Besekar, Sangita Jogdand, Satyawan Singh Patel

Introduction: Recently, hypertension has become a major global health concern that plays a substantial role in morbidity and mortality related to Cardiovascular Disease (CVD). Although statins primarily reduce cholesterol levels, they have also been shown to possess Blood Pressure (BP)-lowering properties that may provide further cardiovascular protection. Aim: To explore the hypotensive effects of statins on BP and to determine whether they can serve as an adjunct to antihypertensive drugs. Materials and Methods: This study was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement (PRISMA-S) guidelines. Databases such as PubMed, MEDLINE and Web of Science were employed to conduct a thorough literature search, focusing on research studies published between 2004 and 2024. Search terms such as “antihypertensive effect,” “hypertension,” and “statins” were used to identify relevant studies. The articles included observational studies, pooled analyses, clinical trials, Randomised Controlled Trials (RCTs) and literature syntheses that demonstrated the impact of statins on BP. All three authors contributed equally to this study and independently extracted the data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-S) standards to ensure accuracy and consistency. Results: Eleven studies met the inclusion criteria. The results indicated that statins, particularly lipophilic statins such as simvastatin and atorvastatin, have a slight but noteworthy impact on decreasing BP in individuals with dyslipidaemia and hypertension. Statins exhibit a stronger BP-lowering effect when used in conjunction with other antihypertensive medications, particularly those that target the Renin-Angiotensin-Aldosterone System (RAAS). Additionally, the study emphasised that the effects of statins vary depending on the type and dosage and that the combination of statins and RAAS inhibitors may lower BP more effectively. Conclusion: Statins have a moderate effect on BP, especially when combined with other antihypertensive drugs. Although there is evidence to support their use in improving cardiovascular protection, further studies are required to determine whether statins qualify as antihypertensive medications. These results highlight the potential for statins to be used as an adjuvant treatment to help hypertensive individuals better regulate their BP and reduce their overall cardiovascular risk.

A Review on Navigating Ethical Challenges in Modern Radiology: Balancing Artificial Intelligence Integration and Patient Privacy

Saraswathula Bharadwaj, Shirish Vaidya, Pratap Singh Parihar

Artificial Intelligence (AI) in modern radiology has increased efficiency and accuracy, but it has also raised ethical questions regarding privacy and equitable healthcare delivery. AI systems rely on enormous databases containing sensitive information, making it crucial to ensure data anonymisation and compliance to maintain patient confidentiality. Nonetheless, genuine anonymisation remains challenging, especially with the rising complexity of data reidentification tools. Furthermore, AI systems may unintentionally perpetuate biases present in training datasets, raising concerns about the fairness and veracity of diagnostic results. The opacity and interpretability of AI models hamper ethical decision-making. The present review emphasises the importance of a multidisciplinary approach to addressing these ethical challenges, urging collaboration among radiologists, ethicists, technologists, and lawmakers. Strategies like robust regulatory frameworks, ongoing education, and the development of explainable AI systems are essential for ensuring the responsible integration of AI. By combining innovation with ethical responsibility, radiology can realise AI’s transformative potential while prioritising patient-centred care.

Basal Implants: A Narrative Review on Restoring the Unrestorable Ridges

S Christina, R Kamalakannan, Y Sameera, K Suriyanarayanan

One of the most innovative developments in dental implantology is the basal implant, also known as a bicortical or cortical implant. Anchored in the strong cortical bone, basal implants provide instant loading capabilities and superior primary stability, in contrast to conventional implants that depend on the integrity of the alveolar bone. Basal implants adhere to the principle “Primum nil nocere” which restricts unwanted treatments such as bone augmentation and grafting. Their unique design and placement technique make them suitable for full-arch rehabilitation of edentulous jaws, providing a viable solution where conventional implants might not suffice. The present article explains the history and classification of basal implants, how they work and briefly discusses osseointegration, peri-implant healing, as well as the success of various studies conducted on basal implants.

Wormian Bones Revisited: A Narrative Review

L Daisy, S Surraj

Wormian bones, which are classified as small intrasutural ossicles, may sometimes distort the shape of the skull. They are not included in the conventional count of 206 bones listed in the adult human body. Their emergence and ossification in and around the sutures of the skull have remained controversial to date, with researchers speculating that their origins may be similar to how sesamoid bones arise within tendons at pressure points. The occurrence of wormian bones within the cranial sutures has been met with uncertainty, as it has a role in affecting the shape of the fontanelles. Hence, this review focuses on the morphology, occurrence, and pressure effects of these bones, as well as their implications for skull growth from foetal to postnatal life. The primary objective of this review is to highlight the impact of wormian bones on the surrounding cranium. It also summarises the collaborative findings of various researchers who have studied these bones in the dry skulls of diverse population groups. The prevalence of wormian bones in the general population is estimated to be 35% in adult skulls. A thorough knowledge of the characteristics of these bones may assist neurosurgeons in positioning scalp flaps and cranial sutures correctly in neonatal skulls. This review aims to provide readers with an in-depth understanding of the consequential effects of these miniaturised bones on other bones of the face and skull, due to the ripple-like effects surrounding wormian bones, thus helping to delineate the pathways that cause distortion of joints as a result of these bones.

The Effect of Pain Neuroscience Education in the Treatment of Fibromyalgia: A Narrative Review

H Shrinidhi Hebbar, Ruchita Harish Narsia

Pain Neuroscience Education (PNE) is a widely used approach for educating patients with chronic musculoskeletal conditions. It has shown significant improvements in pain levels, disability and psychosocial outcomes, particularly when combined with exercise and manual therapy. Several studies have emphasised the effectiveness of PNE in reducing pain and enhancing the quality of life in individuals with Fibromyalgia (FM). This literature review aimed to systematically assess the effectiveness of PNE in individuals with FM. A comprehensive literature search was conducted using electronic databases, including Google Scholar, PubMed, ResearchGate and ScienceDirect, to identify studies examining the impact of PNE on FM. The review concluded that PNE alone did not significantly benefit patients with FM. However, when integrated with other group interventions, such as physical therapy or exercise therapy, PNE was more effective in reducing the impact of psychosocial variables and pain intensity compared to either treatment alone.

Emerging Clinical Perspectives of Immunotherapy in Triple Negative Breast Cancer: A Comprehensive Review

A particularly aggressive and metastatic form of Breast Cancer (BC), known as Triple-negative Breast Cancer (TNBC), is characterised by the absence of Hormone Receptors (HR). This subtype is associated with unfavourable outcomes and ineffective treatment options. Conventional treatments and surgical interventions often lead to therapy-induced resistance and suboptimal results. Nevertheless, the inherent immunogenicity of TNBC has paved the way for innovative immunotherapeutic approaches such as Immune Checkpoint Inhibitors (ICIs), cancer vaccines, and Chimeric Antigen Receptors T-cell (CAR-T) therapy. To critically assess the potential of immunotherapeutic strategies in overcoming the challenges associated with treating TNBC, this review includes exploring novel approaches in immunotherapy, identifying mechanisms of immune evasion, and evaluating the effectiveness of integrating biomarkers and multi-omics profiling to tailor therapies. A comprehensive review examined peer-reviewed literature from multiple databases, including Web of Science, Google Scholar, Scopus, and PubMed from 2002 to 2024. The review utilised key search phrases like “TNBC,” “ICIs,” “BC vaccines,” and “CAR-T therapy in BC.” Information on both approved and experimental treatments was obtained from https://clinicaltrials.gov/, https://www.fda.gov/, as well as from FDA and EMA reports. Study selection criteria were based on scientific quality, relevance, and citation impact. Out of 195 articles initially identified, 135 were ultimately included in the review. Recent research suggests that ICIs targeting programmed cell death protein (PD-1)/programmed cell death ligand (PD-L1) and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) pathways enhance progression-free survival in certain TNBC patients, while CAR-T therapy and neoantigen vaccines boost antitumour immunity. Despite encouraging outcomes, obstacles such as tumour heterogeneity, unintended toxicity, and immune escape, largely influenced by an immunosuppressive Tumour Microenvironment (TME), continue to hinder therapeutic effectiveness. Improving TNBC treatment requires tackling immune evasion, enhancing biomarker-guided selection, and incorporating comprehensive multi-omics analysis. Resistance may be overcome through tailored immunotherapies, combined treatment approaches, and innovative drug delivery systems. This article explores ongoing clinical studies and upcoming trials focusing on ICIs, neoantigen-based vaccines, and CAR-T cell therapies, while also examining obstacles and tactics for boosting effectiveness.

The Intersection of Mitochondrial Replacement Therapy and In-vitro Fertilisation: A Review of Emerging Therapeutic Approaches

Sravya Gudapati, Kamlesh Chaudhari, Manoj Kumar

Mitochondrial Replacement Therapy (MRT) is a development in the area of reproductive health, as it provides new possibilities for women who are at risk of transmitting mitochondrial diseases to their offspring. A cell’s powerhouse, known as mitochondria, contains inherited Deoxyribonucleic Acid (DNA) called mitochondrial DNA (mtDNA) and is inherited only through the mother. Changes in specific areas of the mtDNA can lead to severe mitochondrial disorders affecting major bodily processes and might involve metabolic or neurological problems. New In-Vitro Fertilisation (IVF) procedures, incorporated into Pronuclear Transfer (PNT) and Maternal Spindle Transfer (MST), use MRT to transplant mtDNA along with a donor’s mitochondria, thereby reducing the chances of passing on mitochondrial diseases. The advantage of MRT is the ability to minimise mitochondrial diseases, which is achievable through key techniques. However, MRT poses specific technical issues and raises ethical concerns, particularly concerning germline modifications. The following paper examines the clinical, ethical and technical aspects of MRT with regard to IVF compatibility, success rates and resulting health impacts.

Case Report on Epidermalization of Cervix: A Gynaecopathological Conundrum

Chaitanya Indrani, Anjali Antony, Astha Agrawal

The cervix could exhibit changes like adenosis, squamous hyperplasia, hyperkeratosis and parakeratosis which are usually reactionary changes. This is generally found in cases secondary to uterine prolapse where there is scope in the cervix for continuous irritation and epidermoid metaplasia. A young woman (36-year-old Para 3 Living 3) came with complaints of mass per vagina and heavy menstrual bleeding. On examination, she had cervical elongation and histopathology after hysterectomy showed epidermalisation of the cervix. This unfamiliar finding raises the question of ectodermal-type structures in tissue that originated from mesoderm or endoderm. Considering the primary cause that expose the cervix and vagina, like uterine prolapse or cervical elongation, this phenomenon could be a metaplastic change more than a developmental oddity.

Clinical Evaluation of Vajigandhadi taila matrabasti versus Sahacharadi taila matrabasti in the Management of Gridhrasi (Sciatica): A Study Protocol

Anil Ambadas Bhawade, Shweta Dadarao Parwe

Introduction: In Ayurveda, Basti, or medicated enema, is recognised as a crucial component of Panchakarma, constituting half of the therapeutic approach. Matra Basti, a specific form of Basti Karma, is particularly effective in addressing disorders related to the nervous system, neuromuscular conditions and nutritional imbalances. Gridhrasi, commonly known as sciatica, is characterised by pain that extends from the lower back to the legs. These conditions frequently develop due to a variety of factors, such as poor sitting posture, excessive physical strain and a sedentary lifestyle. Need of the study: In Ayurvedic practice, different medicated oils are prescribed based on the patient and the specific disease condition. Both Vajigandhadi oil and Sahacharadi oil are Ayurvedic formulations recommended for the treatment of Gridhrasi (sciatica) through per rectal administration. However, the comparative efficacy of these two oils in alleviating sciatic pain remains unclear. To address this knowledge gap, the present study will be conducted. Aim: To compare the efficacy of Vajigandhadi taila matrabasti (a form of unctuous enema) with Sahacharadi taila matrabasti (another form of unctuous enema) for the management of Gridhrasi (sciatica). Materials and Methods: A randomised controlled clinical trial will be conducted at MG Ayurved College, Hospital and Research Centre located in Salod (H), District Wardha, Maharashtra, India, from December 2022 to December 2025. In this study, a total of 80 participants will be randomly assigned to two groups, each consisting of 40 patients. Participants in group A will receive a Vajigandhadi taila matrabasti (a type of unctuous enema) at a dosage of 72 mL, administered rectally after meals for 14 days. Conversely, group-B will receive a Sahacharadi taila matrabasti (an unctuous enema) at the same dosage and administration schedule. Parameters will be assessed on the initial day, the 14^thday and again after 30 days for follow-up purposes. Statistical analysis will be conducted using R (version 4.3.2) software. Objective parameters will be analysed using Independent t-tests, while subjective parameters will be analysed using Chi-square tests. Results will be presented as mean and standard deviation, with statistical significance at p-value <0.05.