Journal of clinical and diagnostic research

Vanishing Non-immune Hydrops in Giant Chorioangioma of Placenta

Sunita Dubey, Aayushi Kaushal, HN Pavithra

Giant Chorioangioma of placenta is a rare nontrophoblastic tumour of placenta. It may lead to various maternal and foetal complications like massive antepartum haemorrhage, sudden intrauterine foetal demise and non-immune hydrops, although in few cases mother and the foetus remain unaffected. This report is of a 35-year-old G3P1L1A1, presented to hospital at 32 weeks gestation with pain abdomen followed by watery discharge from vagina. Ultrasonography at 30 weeks revealed a huge mass on anterior wall with placenta on posterior wall of uterus although her previous antenatal sonography did not reveal any abnormality either in the foetus or in placenta. Diagnosis of preterm rupture of membranes was confirmed. Hence, she was kept on conservative management; received antibiotics and steroids for foetal lung maturity. Subsequently, the foetus developed mild, steady non-immune hydrops probably due to high output cardiac failure as Values of Middle Cerebral Artery’s Peak Systolic Velocity (MCA-PSV) were within normal limits. Biophysical profile and nonstress test were normal. Guarded foetal prognosis was given due to non-immune hydrops but she delivered a normal female baby with good Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score with huge chorioangioma of placenta. Although rare, chorioangiomas of placenta should be kept in differential diagnosis of non-immune hydrops that needs regular foetal surveillance and timely intervention in affected foetuses to increase survival after birth.

An Infrequent Adenosarcoma Mimicking other Uterine Rhabdoid Tumours

B Archana, Sandhya Sundaram, Lawrence D Cruze, KS Rajeshwari

Uterine sarcomas are relatively rare and account for only 1-3% of all malignancies in the Female Genital Tract (FGT). Adenosarcomas of the uterus are uncommon accounting for only 5% of uterine sarcomas. They are considered less recurrent and less metastatic. However, those with sarcomatous overgrowth and heterologous differentiation are very rare, considered aggressive and need to be differentiated histologically from other sarcomas that mimic the same clinically and histologically. In the index case, a 50-year-old female presented with symptoms of pain in the abdomen and bleeding per vagina. Magnetic Resonance Imaging (MRI) showed a large polypoid solid mass in the endometrium, suggestive of a sarcoma. Positron Emission Tomography (PET) scan showed an Fluorodeoxyglucose (FDG) avid lesion in the endometrial cavity (SUV max-13.33). Total abdominal hysterectomy and salpingooophorectomy was performed. Histology showed a biphasic tumour (benign glands and malignant mesenchymal component) with rhabdomyoblastic differentiation and sarcomatous overgrowth. Presence of rhabdoid cells raises the possibility of other sarcomas with these features making the diagnosis challenging. Immunohistochemistry (IHC) confirmed it to be a high grade adenosarcoma with sarcomatous overgrowth. Desmin positivity was noted in the rhabdoid cells. Majority cases of adenosarcoma are low grade, the index case was however high grade with presence of heterologous elements and sarcomatous overgrowth. Neither radiology nor clinical features can reliably differentiate adenosarcomas from other uterine sarcomas. A definitive diagnosis can be made by understanding the overlapping morphological features and correlate it with IHC to reliably differentiate it with other similar looking uterine sarcomas.

Locally Advanced Bladder Paraganglioma Managed with Robot-assisted Radical Cystectomy with Intracorporeal Neobladder- A Case Report

Anoop Handa, Sharat Chandra Dash, Nimit Solanki, Gagandeep Singh

Paragangliomas are neuroendocrine tumours of extra-adrenal origin. Primary bladder paragangliomas are rare and have variable functional status, which presents a challenge in their management by minimally invasive surgery. Surgical resection necessitates minimal intraoperative handling of tumour, minimising physiological deterioration. Here in, a case is reported of incidentally detected locally advanced bladder paraganglioma which was managed successfully with robot-assisted radical cystectomy and intracorporeal ileal neobladder formation.

Isolated Fallopian Tubal Torsion Complicated by a Large Hydrosalpinx in a Perimenopausal Woman

Masanori Kanemura, Atsushi Yoshida, Akihiko Toji, Yumi Murayama, Emi Iwai

Adnexal torsion frequently causes acute pelvic pain in women. Ovarian tumour torsion is common; twisting and torsion of a fallopian tube are rare. This report presents a rare case of fallopian tubal torsion requiring the management of a large hydrosalpinx with laparoscopic surgery. A 48-year-old woman reported with acute abdominal pain and lower abdomen tenderness. Transvaginal ultrasonography and Magnetic Resonance Imaging (MRI) showed a cystic mass on the anterior uterine surface. Emergency surgery was performed for a suspected torsion of the left ovarian cyst. In the abdominal cavity, the left fallopian tube was enlarged (neonatal head size), dark purple coloured, and exhibited a 180° torsion; the left ovary was normal. Laparoscopic left salpingectomy was performed and the postoperative course was uneventful. Surgical pathology revealed hydrosalpinx with torsion. As diagnosing isolated fallopian tube torsion before surgery is difficult, laparoscopic surgery is useful in diagnosing and treating isolated tubal torsion.

Anaesthesia for Caesarean Section of Primigravida with Idiopathic Thrombocytopenic Purpura

Malini Mehta, D Chandini, Jigisha Mehta, Tejash Sharma

Idiopathic Thrombocytopenic Purpura (ITP) is a rare auto-immune disorder that causes low platelet levels. In this condition, platelets are prematurely destroyed by reticuloendothelial system. Here, authors report a case of 27-year-old primigravida of 38 weeks pregnancy with history of ITP was posted for elective caesarean section. Her platelet count was 25000/mm3 which increased to 78000/mm3, after treatment with 30 gm Intravenous (IV). immunoglobulin for three days and three units of pooled platelet suspension. Thereafter, caesarean section was conducted under general anaesthesia without any complication. Regional anaesthesia is a relative contraindication in obstetric patients with thrombocytopenia. To avoid the complications of neuraxial blockade, general anaesthesia was preferred and is safer in a patient with ITP during pregnancy with low platelet count.

Non-Hodgkin Lymphoma Presenting with Recurrent Pleural Effusion: A Rare Case Report

Kusum V Shah , Jerin James Dsilva , Saket Kumar , Arti D Shah , Yash Rana

Non-Hodgkin lymphoma (NHL) is a type of carcinoma which usually begins with lymph nodes. Pathogenesis of pleural fluid formation and reabsorption is also associated with pulmonary lymphatic system. Usually pleural effusions are encountered as complications due to infective aetiologies and non-infective causes. Pleural fluid formation and reabsorption in pulmonary lymphatic system are associated with pathogenesis. Authors present here a case report of a patient who presented with left sided severe chest pain investigated to have recurrent pleural effusion, and different clinico-radiological presentations. Computed Tomography (CT) scan showed a mediastinal mass from which CT guided biopsy was done and suggestive of Lymphoma. The patient responded to pleurodesis and chemotherapy.

Sciatic Nerve and Lumbar Plexus Block for Below Knee Amputation- Newer Approach for Better Haemodynamic Stability and Patient Safety

Jigisha Bharatbhai Mehta, Ganesh Naik, Dinesh Chauhan

Patients undergoing lower extremity amputation may have multiple co-morbid conditions like diabetes, cardiovascular, hepatic and renal disorders and are at risk of perioperative mortality and morbidity. Peripheral nerve blocks are associated with minimal haemodynamic changes, improved regional blood flow and are ideal for high risk patients who cannot tolerate slightest attenuation in haemodynamic response. The present report is of a 50-year-old female patient admitted for below knee amputation surgery. Sciatic nerve and lumbar plexus block were the mode of anaesthesia. It was found that regional anaesthesia in the form of nerve block provided adequate anaesthesia and analgesia, provided greater haemodynamic stability and patient safety.

A Rare Case of Pericardial Tuberculoma with Impending Tamponade in a 52-Year Old Woman: A Case Report

Clement `C Kabakama, Zahra Daudi Khan, Pilly Chillo, Amos Rodger Mwakigonja

Pericardial tuberculoma is a rare complication of tuberculous pericarditis. It may mimic a compressive mediastinal mass, often misinterpreted as a mediastinal tumour. Since, it arises from the pericardium, pericardial tuberculoma invariably compresses structures of the heart and may present with features of either-sided heart failure depending on the side of the compression. Hereby, the authors present a case of a 52-year-old woman with progressive difficulty in breathing and symptoms of right-sided heart failure as well as clinical signs of impending cardiac tamponade following a history of extra-pulmonary tuberculosis. Echocardiogram examination revealed a mass compressing the right side of the heart but was inconclusive of the mass origin. CT-Scan of the chest showed a mass arising from the pericardium. The mass was later surgically excised. Histopathology confirmed pericardial tuberculosis and a diagnosis of a pericardial tuberculoma was reached. Patient’s heart failure symptoms regressed after surgery and she was discharged to continue with anti-tuberculosis regime. This report discusses the inclusion of pericardial tuberculoma in the differential diagnoses of cardiac compressing masses, particularly in tuberculosis-endemic areas and emphasize on prompt CT-scan imaging when echocardiogram is inconclusive.

A Rare Case of Malignant Transformation of Keratinous Cyst in Gluteal Region

Keratinous cyst (Epidermoid cysts) is more common and frequently encountered. It is one of the commonest benign lesion. Malignant transformation of keratinous (epidermoid) cyst is very rare. Epidermal cyst is noted as non-malignant condition. Few cases have shown malignant transformation of keratinous cyst into Squamous Cell Carcinoma (SCC). Here, authors report a rare case of 49-year-old male who presented with long standing keratinous cyst in gluteal region which turned out as SCC 35 years after intial presentation of the leison, and here authors have discussed the clinicopathological features of this rare entity. Hence, any swelling which is long standing, showing sudden increase in size, progressing symptoms, more than 2 cm in diameter, cyst content seen as heterogenous pattern on imaging should be highly suspicious of malignancy.

Role of Physical Therapy and Rehabilitation in SAPHO Syndrome- A Rare Condition

Shail Sachdeva, Sonia Pawaria

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is heterogenous, rare entity with manifestations of Pustulo-Psoriatic Hyperostotic Spondyloarthritis (PPHS) and Chronic Recurrent Multifocal Osteomyelitis (CRMO). It can occur in all the age groups with unknown etiology. Hereby, author presents a case of 37-year-old female who reported with the complaint of bilateral knee pain and lower back pain. Laboratory investigations revealed elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels. Bone scintigraphy and Magnetic Resonance Imaging (MRI) showed bone lesions, The diagnosis of SAPHO syndrome was made. The present article highlights the role of physical therapy as a non-pharmacological treatment modality to reduce pain, the intensity of which was measured by Numeric Pain Rating Scale (NPRS). The Range Of Motion (ROM) was measured by digital inclinometer and her Quality of Life (QoL) was measured by the 36-item short form health survey (SF-36) scale. Eight weeks postprotocol showed significant improvement in pain, ROM and QOL. This suggests a positive outcome of rehabilitation in SAPHO syndrome.

A Rare Case of Hypothenar Hammer Syndrome Triggering Guyon’s Canal Syndrome

In certain occupations, injuries and microtrauma are commonly encountered by the soft tissues of the hand in the adult population, which may, however, less frequently lead to arterial occlusion. One such example is that of the Hypothenar Hammer Syndrome (HHS). It is a rare traumatic disease of the hand, caused by blunt traumas to the heel of the hand that may damage the ulnar artery at the level of hypothenar eminence. This results in occlusion or aneurysm of the vessel. It is of clinical importance due to the risk of loss of limb function following digital ischemia. The ulnar nerve barely gets compressed in the Guyon’s canal, which may in turn cause Guyon’s canal syndrome. This is a case of a 43-year-old male patient who presented with painful swelling of the right hand, which was diagnosed as a bizarre presentation of a bilobed and partially thrombosed pseudoaneurysm of the ulnar artery producing Guyon’s canal syndrome that had to be surgically excised. The objective of this case is to highlight the clinical presentation of HHS for early diagnosis and treatment.

Unpredictable Outcome of Large Traumatic Oesophageal Injury: An Experience and Challenges

Oesophageal injury following blunt or penetrating injury due to road traffic accidents is a rare cause of morbidity and mortality. The outcome of delayed diagnosis of oesophageal injury is mostly life threatening conditions. A 23-year-old female presented with respiratory distress, fever, chest pain and facial deformity, following road traffic accident 15 days back. After evaluation, the patient was diagnosed with septicaemia due to large thoracic oesophageal perforation with left pyothorax. The patient was managed by Video Assisted Thoracoscopic Surgery (VATS) decortication with feeding jejunostomy followed by diversion cervical oesophagostomy. The patient was planned for oesophageal reconstructive surgery electively in follow-up period. After six weeks in the follow-up period, surprisingly large thoracic oesophagus perforation and cervical oesophagostomy was healed spontaneously which was confirmed by gastrograffin study. Spontaneous closure of large thoracic oesophageal perforation is the rare outcome of this injury.

Effect of Kapalabhati in a Patient with Polycystic Ovarian Syndrome- A Case Report

AP Rashmitha, KU Dhanesh Kumar, P Shilna Rani, GS Pooja

An eight-week Kapalabhati practice was given to a female aged 19 years who was diagnosed with bilateral Polycystic Ovarian Syndrome (PCOS). Kapalabhati is one of the simplest yet important parts of Shatkarmas in Yoga, which is known to improve metabolic fitness. The PCOS is a complex hormonal disorder with metabolic derangements and insulin resistance as an integral part, which also plays a significant role in its aetiology. The condition can be exacerbated by the co-existence of obesity. Hence, improvement in the metabolic profile is the key step in the management of PCOS.

Haemoglobin Olympia {β Codon 20 (B2) GA, ValMet}: A Silent Haemoglobin Variant

Abhay A Bhave, Lakshmi Iyer, Nawal Kazi, Manju Gorivale, Anita Nadkarni

High oxygen affinity haemoglobin variants are rare and often underdiagnosed in persistent erythrocytosis with no apparent aetiology. Here the author present a 29-year-old Indian male patient with a long-standing history of erythrocytosis which was incidentally detected. The proband had a prothrombotic family history of cerebral vessel stroke in his paternal grandfather at a young age and unexplained erythrocytosis in his father and brother. A review of his haemograms showed persistent high haemoglobin values. Routine tests did not reveal any specific aetiology and haemoglobin electrophoresis by High-Performance Liquid Chromatography (HPLC) showed absence of any abnormal peak or unstable haemoglobin. DNA sequencing of the β globin gene revealed heterozygosity for codon 20 {GTGATG, Valine (Val) Methionine (Met)} mutation confirming the presence of an electrophoretically silent Hb variant - Haemoglobin Olympia in him and his extended family members. This case study emphasises importance of this rare entity of high oxygen affinity haemoglobin variant as a differential diagnosis while screening for erythrocytosis. This is the first case report of Haemoglobin Olympia from India reported in the literature.

Rare Association of Semilobar Holoprosencephaly and Frontonasal Encephalocoele in a Neonate of Twin Pregnancy

Varsha Rangankar, Anmol Singh, Sanjay Khaladkar

Holoprosencephaly is a rare intracranial malformation seen in newborns, resulting from a failure of separation of the forebrain into separate cerebral hemispheres. It is divided into three subtypes-alobar, semilobar and lobar. Encephalocele is a rare neural tube defect characterised by a defect in the cranial vault with herniation of brain parenchyma along with the overlying meninges. Author has reported a case of a male neonate born of a twin pregnancy to a 29-year-old primigravida presenting with a midline swelling in the frontal region. On imaging studies, the patient was diagnosed with semilobar holoprosencephaly and frontonasal encephalocele with dural arteriovenous fistula. Holoprosencephaly and encephalocoele are important congenital malformations; however association of the two conditions has been rarely described in the literature.

Concurrent Occurrence of Cytomegalovirus Retinitis and Oesophagitis in an Immunocompromised Male Patient

Cytomegalovirus (CMV) is a double-stranded Deoxyribonucleic Acid (DNA) virus which causes severe disease in immunocompromised individuals. Chorioretinitis accounts for 80-90% of CMV infection in patients with Acquired Immunodeficiency Syndrome (AIDS) having CD4 (Cluster of Differentiation) counts <50 μ/mL, and rarely in those with CD4 counts more than 100 μ/mL. In developing countries, CMV infection is known to cause blindness in 5-25% of Human Immunodeficiency Virus (HIV) infected individuals. After colitis, oesophagitis is the most common Gastrointestinal Tract (GIT) manifestation of CMV in immunocompromised individuals. In immunocompetent individuals the disease associated with CMV is often self-limiting. So, authors presented a case report of 40-year-old HIV infected male, with CD4 count of 75 μ/mL, having complaints of dysphagia and concomitant blindness. On the basis of an array of investigations, he was diagnosed as having CMV retinitis with oesophagitis. He had a predictable outcome after treatment with Gancyclovir (GCV). Thus, in immunocompromised individuals, especially with a CD4 count <100 μ/mL, surveillance of oesophagitis and retinitis with endoscopic and fundoscopic interventions, respectively, must be done. This can help in improving life expectancy in such individuals.

Carcinosarcoma Stomach with Biphasic Nodal Metastasis: A Rare Entity

Renu Sukumaran, Jayasree Katoor, Arun Peter Mathew

Gastric carcinosarcoma is an extremely rare, aggressive, biphasic tumour composed of a mixture of carcinomatous and sarcomatous elements. Clinical symptoms and imaging studies of carcinosarcoma are not different from that of carcinoma. Biopsy of the lesions may not include both components. Thus, a diagnosis of carcinosarcoma is often rendered in surgical specimens. Immunohistochemistry will help to identify the various components. The relative proportion of the carcinomatous and sarcomatous elements is variable. One of the components may dominate the histologic picture. The common carcinomatous component described is adenocarcinoma with rare cases, showing neuroendocrine and squamous elements. The sarcomatous elements include spindle cell sarcoma which was Not Otherwise Specified (NOS), leiomyosarcoma, fibrosarcoma, osteosarcoma, chondrosarcoma, liposarcoma, undifferentiated sarcoma, myxoid sarcomas, and rhabdomyosarcoma. Herein, the authors are reporting the case of a 62-year-old female patient who presented with abdominal pain and vomiting of three-month duration. Endoscopic examination revealed a large polypoidal mass lesion in the body of stomach. Subtotal gastrectomy was done which showed large polypoidal mass lesion measuring 12×9.5×6 cm. Histopathological examination revealed a biphasic neoplasm with close intermingling of malignant epithelial and mesenchymal elements. Carcinoma component showed glandular, squamous and neuroendocrine areas. The sarcomatous component was spindle cell sarcoma, NOS. On immunohistochemical examination, epithelial component showed cytokeratin positivity. The neuroendocrine component was positive for synaptophysin, chromogranin A and CD56. The p40 positivity noted in the squamous component. The mesenchymal component showed positivity for vimentin. The nodal metastasis showed admixture of carcinoma (glandular and squamous components) and sarcoma.

Cerebral Cysticercosis Masquerading as Eclampsia: A Case Report

Amanjot Kaur, Beant Singh

Neurocysticercosis is a preventable parasitic disease of nervous system caused by Taenia solium. It may present with seizures, focal neurological deficits, decreased visual acuity and altered mental status. Eclampsia is a neurological manifestation of hypertensive disorders of pregnancy presenting as seizures. In common obstetric practice, all cases of unexplained seizures are managed as eclampsia unless proven otherwise. Neurocysticercosis presenting first time in pregnancy with seizures can be confused with eclampsia. The index case was referred to us in a similar manner in the second trimester of pregnancy with a diagnosis of eclampsia. Patient was evaluated further for the cause of seizures and was found to have neurocysticercosis on imaging. She was then conservatively managed and the pregnancy was continued till term rather than termination of pregnancy which is the standard management of eclampsia.

Isolated Fracture of the Corpus Spongiosum- A Rare Case with Atypical Presentation and Diagnostic Role of MRI

Selvin Theodore Jayanth, Vivek Venkatramani, Rajiv Paul Mukha

Penile fractures occur due to rupture of the corpora cavernosum or tunica albuginea secondary to blunt or sexual trauma to the erect penis. They typically present with rapid detumescence of the penis, with pain, swelling and ecchymosis. Approximately 10-20% of penile fractures involve the urethra. The report presents a 28-years-old male patient that complained of per-urethral bleeding, following an injury to an erect penis. With the help of MRI and intra-operative cystoscopy, found that the injury exclusively involved corpus spongiosum. He subsequently underwent a penile exploration and repair of the spongiosal defect. At one year follow up, he had normal erections with no per-urethral bleed. This is a rare form of presentation of penile fractures with only a few cases reported in literature. Surgical exploration remains the gold standard and early exploration is recommended to avoid erectile dysfunction, corporal fibrosis and urethral strictures and MRI is an useful adjunct.

Diminished Bone Marrow Oedema and Healing of Insufficiency Fractures in a HIV Patient after Switching Antiviral Therapies

Sebastian Radmer, Julian Ramin Andresen, Reimer Andresen

This is a case report about the recurrent onset of bone marrow oedemas and insufficiency fractures in a 64-year-old male Human Immunodeficiency Virus (HIV)-patient, who was going through an antiviral treatment. The patient experienced stress-related pain and swelling in both ankle joints and feet, and was treated antivirally with Atripla® for several years. Therapeutically, conservative treatment as well as a therapeutic trial with bisphosphonates were performed. As a result of developing renal insufficiency, antiviral therapy was switched to a combination of Prezista® and Norvir®. Only after switching the antiviral therapy, there was a clear clinical improvement of the symptoms. The clinical symptoms correlated well with Magnetic Resonance Imaging (MRI), the features of which are detectable regressive bone marrow oedemas and the healing of insufficiency fractures. The impaired renal function improved to a compensated retention. In the case of HIV patients with unclear joint complaints, the presence of bone marrow oedema should be considered.

Pulmonary Lymphangioleiomyomatosis and Role of Pleurodesis: Rare Case Reports

Kusum V Shah, Sonal Goyal, Saket Kumar, Arti D Shah, Yash Rana

Pulmonary Lymphangioleiomyomatosis (LAM) is a rare disease, mostly seen in women of reproductive age group. Most common presentation is dyspnoea on exertion, may be associated with haemoptysis and chest pain. LAM is a cystic lung disease, with a poor prognosis and is difficult to treat. In this case reports, we discussed two patients who presented with dyspnoea and chest pain due to pneumothorax and were later diagnosed as case of LAM on clinical and radiological basis. Intercostal Chest tube Drainage (ICD) was inserted for resolution of pneumothorax and subsequently pleurodesis was done to prevent recurrent pneumothorax. In case of recurrent pneumothorax, LAM should be considered as a differential diagnosis. Pleurodesis can be considered to prevent recurrent pneumothorax.

Spontaneous Rupture of Spleen in Acute Pancreatites: A Rare Case

Sharvari Shashikant Gulve, Pratap Singh H Parihar, Rutuja Pratap Singh Parihar

Spontaneous rupture of the spleen is a rare disorder and has been reported to occur due to Haematological, neoplastic and infectious diseases involving the spleen. We present a case of 25 years young male who presented with epigastric pain and fever since four days. The contrast-enhanced computed tomography scan showed complete distortion of splenic architecture with perisplenic mixed density collection that suggested splenic rupture. Pancreas was bulky in the tail region with adjacent fluid density collection. The peripancreatic fluid in the tail region eroded the splenic capsule and penetrated into splenic parenchyma causing spontaneous rupture of the spleen. It also eroded the vessel and caused haematoma. Splenic artery embolisation was done and later managed conservatively.

Central Acetabular Roof Defect-More than Just a Normal Variant?

Central acetabular defects are rare, and have been described using various terminologies (notches, fossae, pits). They are generally regarded as normal variants and often overlooked. This case series reviews five cases (age range 9-14 years) where presentation included hip pain and no alternative pathology was found. The defects tend to be bilateral but not symmetrical, and often just the side with the largest defect is symptomatic. The aetiology is unknown but there was no recollection of prior trauma. The literature suggests they are developmental in nature. The cases series highlights that these anatomical variants should not be entirely disregarded when imaging is reviewed.

Glomus Tumour- Knowledge Update and Issues

Sharat Agarwal

Correspondence: CT Imaging in Gastrointestinal Stromal Tumour: A Case Series

Ram Gopal Karumuri, Harshavardhan Balaganesan, Anila Punchiry

Dear Editor, Authors read with great interest the recent case series titled “CT Imaging in Gastrointestinal Stromal Tumour: A Case Series (1) in the reputed journal. The article has very well-outlined, the importance of Computed Tomography (CT) in imaging the Gastrointestinal Stromal Tumour (GIST). As a resident in a tertiary care centre in the tropical parts of southern India, authors had witnessed numerous cases of GIST on a daily basis. The abstract was well written giving a short idea on the genetical basis of GIST, along with the imaging modalities available and the treatment response and outcome. However, a few points needs to be added to the already well framed case descriptions. In case-1 the authors have mentioned; the tumour showed areas of necrosis. In our institute we employ the addition of oral contrast images to ascertain the organ of origin. If in case the tumour bed showed communication with the gastric lumen, contrast opacification is noted within, indicating the gastric origin of the tumour. In the article, the differential diagnosis is well written with emphasis on absence of lymphadenopathy which aids in differentiating GIST from its differential contenders. It would have been beneficial to the readers, if other accessory imaging findings of GIST such as an ulcerated mass with internal air-fluid level depicting Torricelli-Bernoulli sign (2) was mentioned. Although the article is centered mainly around the CT imaging of GIST, a word or two about the added advantage of Magnetic Resonance Imaging (MRI) like diffusion (3), dynamic contrast enhancement pattern could have been included in the discussion part. GIST is one of the well-studied tumours whose genetical basis is completely understood. With advent of Radiomics, the fusion of genetical and imaging features has helped for quantitative evaluation, risk stratification, mutational assessment, malignant potential (4), treatment outcome and response. Authors would like to congratulate the authors (1) for their successful publication. We understand the limitations of writing the article by keeping within the word limit but, it is our suggestion that with the addition of few above detailed points, the case series would have added more information to the readers.

Bone Mineral Density in Stroke Survivors: An Observational Study

Sujatha Gorle, BD Athani, Sakshi Jain, Shweta Jain

Introduction: Stroke is frequently followed by bone loss, causing increased fracture risk in patients. Bone loss starts within days of vascular brain injury, progresses till fourth month and then lowers until the end of first year after stroke. Aim: To assess the Bone Mineral Density (BMD) in hip, spine and wrist and its difference between paretic and nonparetic side in ambulatory stroke survivors. Materials and Methods: This hospital-based observational cross-sectional study was conducted on 40 subjects, from January 2015 to June 2016 in the Department of Physical Medicine and Rehabilitation, VMMC and Safdarjung Hospital, New Delhi. Biochemical markers, x-rays and BMD were recorded in all patients along with demographic profile in a pre-structured proforma after taking informed consent. Statistical analysis was done using SPSS Software version 14.0. Results: Out of 40 subjects (mean age: 53.9±10.9 years), 82.5% were males with nearly equal distribution in 41-50, 51-60 and 61-70 years age groups. Around 65% stroke survivors presented within 1-3 years of stroke with 68% having right sided involvement. Bone mineral densities over hip with a mean of -2.14±1.57 and lower end of radius with a mean of -4.85±2.01 were less on paretic side as compared to the nonparetic side. DEXA scanning of spine showed 52.5% subjects were osteopenic and 37.5% were osteoporotic. Conclusion: BMD over hip and lower end of radius was less on paretic side as compared to the nonparetic side but it was insignificant statistically.

Circulating MicroRNA-29a: An Evolving Biomarker for Diagnosis of Pulmonary Tuberculosis

Jaya Garg, Atul Garg, Anand Kumar

Introduction: Tuberculosis (TB) is global health problem threatening millions every year. There is urgent need of effective biomarkers for its diagnostics and circulating microRNAs (miRNAs) have recently emerged as novel and non-invasive molecular markers in blood. Aim: To evaluate serum miRNAs as a potential biomarker for the diagnosis of pulmonary mycobacterium tuberculosis infection. Materials and Methods: In this prospective cross-sectional study, acute pulmonary TB patients were recruited based on positive Mycobacterium tuberculosis Polymerase Chain Reaction (PCR) in sputum samples and Microarray expression profiling was performed on blood of these patients to study differentially expressed miRNAs. The results were validated by Real-Time Polymerase Chain Reaction (RT-PCR) on pulmonary TB cases and healthy controls. Student’s t-tests and Analysis of Variance (ANOVA) tests were used for statistical analysis. The p-value <0.05 was considered statistically significant. Results: Results of microarray expression profiling showed 75 differentially expressed miRNAs in cases of pulmonary TB; among these 5 upregulated and 2 downregulated miRNAs were evaluated by RT-PCR. miRNA 29a exhibited good distinguishing efficiency; followed by miRNA 384. Receiver Operating Characteristic (ROC) curve of expression data for miRNA in cases and control groups showed that Area Under the Curve (AUC) of miRNA-29a was 0.8268 (sensitivity=80%, specificity=82%). Conclusion: This study suggests that altered levels of serum miRNAs have great potential to serve as non-invasive biomarkers for detection of Mycobacterium tuberculosis infection. MicroRNA29a can be used as an effective biomarker for diagnosis of pulmonary TB.

Relationship of Bone Marrow Plasma Cell Morphology with Cytogenetic Abnormalities in Patients with Multiple Myeloma

Vikram Narang, Maneet Luthra, Avantika Garg, Amit Dhiman, Neena Sood

Introduction: Cytogenetics has become an integral part of Multiple Myeloma (MM) diagnosis and prognostication. A combination of conventional cytogenetics and interphase Fluorescence In-Situ Hybridisation (FISH) is currently used to stratify tumours into high, intermediate and standard risk disease. Aim: To compare the morphological details of plasma cells with cytogenetic abnormalities. Materials and Methods: The present retrospective crosssectional study was conducted at Department of Pathology Dayanand Medical College and Hospital, Ludhiana in three and a half year duration (1st January 2014 to 30th June 2017). All the diagnosed MM patients in whom cytogenetic was available were included and descriptive analysis was done using ChiSquare test and relevant statistical analysis using SPSS 21 version. Correlation was done with various morphological pattern (plasmacytic, plasma blastic). Results: Cytogenetic studies were performed on 42 cases using FISH technique (n=31, 81.6%) and GTG (Giemsa) banding (n=4, 10.5%). Three (7.9%) patients were tested with both methods. In the present study, all the patients (n=2,100%) with plasmablastic morphology who got tested with cytogenetics had del13q14.3 and none of the patients with normal genome (n=22) had plasmablastic morphology. Conclusion: Morphologic patterns of plasma cells and cytogenetic studies correlate well and can together help in better prognostication of MM patients.

Correlation of Body Mass Index, Mean Arterial Pressure with Peak Expiratory Flow Rate in Healthy Individuals- A Descriptive Study

Tanuj Mathur, Dileep Kumar Verma, Sunita Tiwari, Narsingh Verma, Ranjana Singh

Introduction: Modern lifestyle has resulted in an increased prevalence of cardiovascular and respiratory diseases along with being overweight. An interaction between the three factors has also been demonstrated. Aim: The study aimed to assess the relationship of Body Mass Index (BMI), Mean Arterial Pressure (MAP) and Peak Expiratory Flow Rate (PEFR) in healthy individuals. Materials and Methods: This cross-sectional, observational study was done in the Department of Physiology, KGMU, Lucknow from 30th July 2019 to 30th July 2020. Forty healthy individuals, aged 18-35 years were assessed for height, weight, blood pressure and spirometric parameter of PEFR. PEFR was chosen as it was a reliable representative of airways functioning. PEFR reflects proximal airway calibre changes which might be due to effect of airway geometry. A correlation test was run to test the relation between BMI and PEFR and MAP and PEFR. Results: A weak negative correlation (r=-0.136) was noted between BMI and PEFR indicating that as BMI increased, PEFR compromised. A linear correlation was observed between MAP and PEFR. Conclusion: The present study confirms a weak association of BMI with PEFR, however strong association of MAP with PEFR was noticed.

Estimation of Calcium and Iron Levels in Gingival Crevicular Fluid and Serum in Periodontal Health and Disease

Introduction: Gingival Crevicular Fluid (GCF) has been referred to as a promising medium for detection of markers for periodontal disease activity. Analysis of GCF shows minute changes in biomarker levels well before the onset of clinical signs and symptoms; which helps to even predict a person’s predisposition towards periodontal disease occurrence. The elemental analysis of human blood serum is noteworthy in routine clinical practice as well as in medical research. Aim: This study was done to determine the changes in calcium and iron levels in GCF and serum in human subjects with normal periodontal health and those with disease. Materials and Methods: This was a cross-sectional study conducted from March 2019 to December 2019. Eight study subjects (four healthy subjects and four periodontitis cases) were selected from the patients reporting to the Department of Periodontics at Tagore Dental College and Hospital, Chennai. The subjects were chosen based on inclusion and exclusion criteria and all patients were subjected to a clinical examination wherein the Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded by a single examiner using William’s Periodontal probe. The GCF samples were collected by Capillary Tubing method. Blood was collected by venipuncture and centrifuged to provide serum samples. Dual viewing Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) was used to estimate Calcium and Iron in GCF and serum. SPSS version 21.0 was used for statistical analysis. Mann Whitney U test was used for comparing the groups. A p-value less than 0.05 was considered statistically significant. Results: Serum iron levels were significantly less in periodontitis patients than healthy subjects (p-value 0.043). GCF iron level (p-value 0.386), GCF calcium level (p-value 0.149) and serum calcium level (p-value 0.564) did not show any major variation among subjects with normal periodontal health and those with disease. Conclusion: The findings of this study showed that iron and calcium are present in GCF and serum samples of healthy persons and patients with chronic periodontitis which can be detected using ICP-OES. A significant difference in serum iron levels between health and disease could indicate a patient’s predisposition towards developing periodontitis. Calcium levels in GCF and serum do not point towards periodontal disease activity.

Analysis of Scoring System to Identify High Risk Patients and their Outcome in Isolated Blunt Chest Trauma- A Prospective Observational Study

Annrish Tan Baby, Anuraj Appukuttan, Harihara Jothi, Reema Sajan

Introduction: Chest trauma is a major cause of mortality accounting for a substantial proportion of all trauma admissions and death. In India, the reported mortality range is between 4-60% and no current national guidelines exist to assist the management of this patient group unless patient has severe immediate life threatening injuries. A scoring system for identification of patients at higher risk for development of morbidity and mortality will allow early selection of vulnerable patients, choice of an appropriate treatment protocol and therapeutic interventions. Aim: This present study aims for the analysis of a scoring system to identify patients with isolated blunt chest trauma at higher risk for morbidity and mortality, in order to prioritise intervention and improve the outcome. Materials and Methods: This was a prospective observational study conducted at the Departments of Emergency Medicine and General Surgery of a Tertiary Care Teaching Hospital in South India over a period of 18 months. The study included 85 isolated blunt chest trauma patients. We utilised a Chest Trauma Score (CTS) composed of patient factors like age, smoking, lung disease and severity factors like rib fractures, parenchymal and pleural involvement, partial pressure of oxygen/ fraction of inspired oxygen (PaO₂ /FiO₂ ) ratio. CTS were applied at the time of admission after detailed assessment of all injuries. Patient was followed-up at regular intervals upto 30 days. The CTS and outcome measurements were analysed using logistic regression analysis. Results: The area under Receiver Operating Characteristic curve (ROC) was found to be 0.979 (p-value <0.001). The CTS cut-off value was ≥11.5 with 89% sensitivity and 95% specificity. In patients with CTS ≥11.5, 98.3% had associated morbidity and complications whereas only 25.9% with CTS <11.5 had associated morbidity (p-value <0.001). Number of rib fractures, pulmonary contusion and PaO₂/FiO₂ ratio (odds ratio 10.632, 6.007, 12.859, respectively) were found to be significant independent predictors of morbidity and complications. Conclusion: In summary, CTS ≥11.5 has shown a significant association with poor outcome. Patients who sustained isolated blunt chest trauma and together with increasing scores, had increasing incidence of morbidity and complications. The scoring system used in this study proved that it makes a useful tool to predict the outcome in thoracic trauma.

Orthodontic Practice in the Times of COVID-19 Pandemic: An Online Survey
Introduction: Coronavirus Disease 2019 (COVID-19) pandemic is not the first one which the globe has faced but never came across a health crisis that moved so quickly across continents. COVID-19 outbreak presently posed a very serious threat to the existence of mankind on earth. The massive impact of COVID-19 pandemic was evident in all aspects of life-personal, social as well as professional. The field of dentistry including orthodontics was no exception to this. Aim: To describe the impact of COVID-19 pandemic on orthodontic practice, exploring the basic sterilisation protocols being followed during COVID-19 pandemic and to predict the future of orthodontics in post-COVID era. Materials and Methods: The Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, conducted this questionnaire based cross-sectional survey in May 2020 over a time span of 20 days. A web-based questionnaire of 15 multiple choice questions in English was created as a Google Form in Google Documents. The link to this form was shared online with the orthodontists and postgraduate students (Orthodontics) of dental colleges situated in the National Capital Region (NCR) through WhatsApp groups and e-mails. A total of 254 responses were received. Results: A 97.6% of respondents agreed that COVID-19 affected their orthodontic practice. The odds ratio between those not likely to resume practice and those likely to resume practice taking educational qualification as the significant predictor was calculated to be 8.976 at 95% confidence intervals. There was wide variation in the selection of the safety protocols by the orthodontists in the present study (p<0.01). Increased digitalisation in orthodontics (45.7%) followed by less demand of orthodontic treatment (18.5%) were opted as the future in post-COVID era (p<0.01). Conclusion: The present survey found that orthodontic community as a whole was affected greatly by COVID-19 pandemic and is quite apprehensive. The future of orthodontics in the post-COVID era is unpredictable presently. Digitalisation in orthodontics is the key option to have minimum physical contact with the patients. The study suggested the need and importance of basic sterilisation protocols and a training program for dental settings during COVID-19 for patient’s as well as clinician's safety.

Effectiveness of Self Instructional Module on Knowledge Regarding Vision Hazards while Playing Online Games among Junior College Students
Introduction: Playing online games has become a most popular leisure activity in many parts of the world, which may impact people's health as a result of excessive gaming, most commonly among students. Some computer-related and vision-related researches have measured the physical and ocular effects and binocular vision separately. India has second largest number of users of cell phones. In India, few studies conducted to assess its impact on health. Presently, the incidence of internet gaming disorder among the adolescent group was between 1.3% to 19.9%. Aim: To determine the effectiveness of self-instructional module on knowledge regarding vision hazards while playing online games among junior college students. Materials and Methods: A pre-experimental pre-test, post-test research design was used to conduct this study. The study was conducted during September 2019 to February 2020 and was selected in the New English Junior College, Wardha (Maharashtra) after getting Ethical permission. (Ref. No.: DMIMS (DU)/IEC/Sept-2019/8494). Purposive sampling was the sampling method used to collect data from junior college students (11th standard students) on the basis of structured knowledge questionnaire. After collecting pre-test data, self-instructional module was given for intervention of vision hazards while playing online games to junior college students. Seven days were provided to the samples for utilising self-instructional module which was organised for 45-50 minutes. Post-test information was gathered after seven days from the day of intervention. The data were described by frequency, percentage and t-test was used to describe the difference between pre-test and post-test knowledge score. Chi-square test was also used to find out the association between knowledge of junior college students regarding vision hazards while playing online games and selected demographic variables. Results: There was a significant difference between pre-test and post-test knowledge scores which interpreted that self-instructional module on knowledge regarding vision hazards while playing online games among junior college students were effective. Mean value of pre-test was 7.82 and post-test was 15.62 and standard deviation values of pre-test was ±1.88 and post-test was ±0.58. The calculated t-value was 39 and p-value was <0.001. Conclusion: The study was effective because the post-test knowledge score improved than the pre-test knowledge score. So, the self-instructional module has proved to improve junior college student's knowledge regarding vision hazards while playing online games.

Histopathological Study of Lower Gastrointestinal Tract Biopsies in 600 Cases

Jasmin Haridas Jasani, Shivani Bhaveshbhai Vora, Nidhi Amrutlal Patel
Introduction: Broadly the whole gastrointestinal tract can be divided into upper and lower segments by taking the insertion of ligament of Treitz as a landmark. The disorders of Lower Gastrointestinal Tract (LGIT) are responsible for a great number of morbidity. The microscopic analysis and the determination of histological types are thus helpful in deciding treatment options, predicting prognosis and conducting epidemiological studies and research. Delay in diagnosis causes direct as well as distant metastasis leading to advanced stage of the disease. Aim: To emphasise the usefulness of LGIT biopsy in diagnosing the conditions, thus helping the surgeons to decide further management prior to resection, especially in malignant cases. Materials and Methods: An observational retrospective study of various LGIT biopsies was done at Pathology Department of Sumandeep Vidyapeeth, Vadodara, Gujarat, India. The study was based on the HPE of lesions received in the duration from June 2019 to September 2020. In this study, the records of LGIT specimens including small intestine, large intestine, rectum and anus were included. Due importance was paid to brief clinical history with patient’s age, inpatient number and presenting signs and symptoms. A total of 600 specimens were analysed. Results: Non-neoplastic lesions were more common than neoplastic lesions (570 out of 600). Lesions were more common in 2nd to 5th decades with male preponderance. Among nonneoplastic lesions, majority of non-neoplastic lesion were of appendiceal lesion (247) followed by non-specific inflammation (138). Out of 30 neoplastic lesions; most common were of adenocarcinoma (15 cases). Conclusion: A wide variety of neoplastic and non-neoplastic lesions were diagnosed in the present study. In small intestine, non-neoplastic lesions were common while most of the malignant lesions were common in large intestine. The most common non-neoplastic lesion was appendicitis followed by non-specific inflammation and the most common neoplastic lesion was adenocarcinoma.

Mantle Cell Lymphoma: An Immunomorphologic Study with SOX11 from a Tertiary Care Cancer Centre in Southern India
Introduction: Mantle Cell Lymphoma (MCL) is a relatively rare Non-Hodgkin Lymphoma (NHL) of mature B cells forming 5-7% of NHL. SOX11 has emerged as a useful antibody in the diagnosis of MCL with prognostic significance. Aim: To evaluate the immunomorphologic features and significance of SOX11 expression in MCL at a tertiary care cancer institute. Materials and Methods: This was a descriptive study which was conducted at a tertiary care cancer centre in Southern India over a period of five years from January 2013 to December 2017. Seventy six cases of newly diagnosed MCL with paraffin blocks were included in the study. Immunohistochemistry (IHC) with a panel of antibodies including SOX11 was carried out on Formalin Fixed Paraffin Embedded (FFPE) sections. Morphologic, immunologic findings were analysed and correlated with clinical data and survival, using Chi-square and Independent sample t-test to compare data and Kaplan-Meir method with Log Rank test for survival analysis. Results: Mantle Cell Lymphoma (MCL) formed in 5.8% of NHL with a striking male predominance (M:F ratio, 4.4:1), with mean age of 58 years at presentation and females at a younger age. Nearly 80% of patients presented at an advanced stage. Cervical lymphadenopathy was the most common presenting feature, followed by involvement of the gastrointestinal tract. There were 59 cases of classic and 17 cases of blastoid and pleomorphic MCL, with diffuse pattern being the most common in 36 (47.4%) cases. In the present study, 64 (92.8%) cases expressed SOX11 and showed heterogeneous staining with high expression in 34 (53.1%) cases and low expression in 30 (46.9%) cases. Ki-67 proliferation of more than 30% was seen in 52 (68.4%) cases and 30% or less in 24 (31.6%) cases. None of these findings had statistically significant correlation with survival, though high Ki-67, high MCL International Prognostic Index (MIPI) and blastoid/pleomorphic cases had relatively worse Overall Survival (OS). Conclusion: MCL is a disease of the elderly and in the present study it affected females at a slightly younger age as compared to males. SOX11 expression was heterogeneous in neoplastic cells and was complementary to cyclin D1 for diagnosis of MCL however, the staining intensity had no effect on survival.

Effect of Carotid Stenting on Neurocognitive Function in Patients with Atherosclerotic Carotid Stenosis

Brijesh Kumar Soni, Rajneesh Kumar Patel, Rochan Pant, Mukesh Khatri
Introduction: Stroke is among the leading cause of death worldwide. Carotid stenosis has been identified as a risk factor for stroke. The prevalence of carotid stenosis increases with age in both women and men. To reduce the risk of stroke, Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) are performed. Aim: To find the effect of carotid stenting on neurocognitive function in Atherosclerotic Carotid Stenosis. Materials and Methods: This prospective observational study was carried out at a tertiary care teaching hospital, over a 12-months duration. Twenty five patients were included in the study, after getting their informed consent. The patients underwent Addenbrooke's cognitive examination preoperatively and were reassessed on 28 days and three months, postoperatively. The pre and postoperative scores were compared with the help of the paired t-test. Qualitative data were analysed with the help of frequency and percentage tables. Association among the study groups was assessed with the help of Bivariate analysis and Chi-square test and a p-value <0.05 was taken as significant. Results: The mean age of the patients was 65.52±9.34 years. Twenty two patients in the study group were male and three were female. Addenbrooke's Score improved at 28 days and three months, postoperatively. There was a positive and significant correlation between preoperative Addenbrooke's Score and postoperative Addenbrooke’s Score (r=0.748 and r=0.442, respectively). However, there was no statistically significant correlation noted with age, sex, and co-morbid condition like diabetes and hypertension and postoperative Addenbrooke's score. Conclusion: The study showed that stent placement for patients with carotid stenosis improved the cognitive function.

Foetal Nasal Bone Length Measurement and Evolving Normogram in Southern Indian Population in Normal Pregnancies: A Cross-sectional Study

RB Prakash Jain, Sanket M Kotnis, HN Roopa
Introduction: Assessment of the foetus to detect aneuploidies between 12 to 24 weeks of gestation is an integral part of the ultrasound scanning. Absence or hypoplastic nasal bone is a very important marker of foetal aneuploidy. Thus, identifying the range of foetal Nasal Bone Length (NBL) in normal gestation is very important to screen for aneuploidies. Aim: This study aimed at ascertaining the reference range of foetal NBL between 11 to 24 weeks of pregnancy. Materials and Methods: A multicentre, cross-sectional study was conducted from 2018 to 2020. After obtaining Ethical approvals from each centre, NBL was measured in 826 patients between 11-24 weeks of pregnancy. Transabdominal scans were performed and the data was used to construct the NBL normogram for this Gestational Age (GA). Linear regression analysis was used to analyse the relationship between NBL and Gestational Age. Scatter plots for NBL as function of GA was constructed. The 5th and 50th percentile values were calculated for each gestational week. Results: With one unit increase in GA (weeks), NBL increased by 0.402 times (r=0.897, p<0.001). Mean NBL was 4.05 mm. The medians NBL for 12-14 weeks were 2.1-2.5 mm, 15-18 weeks was 3.0-4.6 mm, 19-21 weeks was 5.3-5.8 mm, 22-24 weeks was 6.0-6.6 mm. Conclusion: This study highlights the importance of nasal bone evaluation in the second trimester of pregnancy to detect foetuses with Down syndrome. Since NBL increases linearly with GA, it aids detecting the hypoplastic nasal bone at different GA.

Effectiveness of Hot Pack with Caudal Glide and Antero-posterior Glide Mobilisation to Improve Shoulder Abduction Range in Adhesive Capsulitis

Ramamurthy Raja, Mitali Shekadar, VN Ravish
Introduction: Adhesive capsulitis is a self-limiting regional skeletal condition of uncertain aetiology characterised by a progressive loss of both active and passive mobility of the glenohumeral joint in the shoulder complex. It begins insidiously with shoulder pain and dysfunction in middle aged and elderly population. Adhesive capsulitis predominantly affects the older population, affecting both the sexes; however, female patients are affected more. Aim: To find the effect on pain, Range of Motion (ROM) and disability in subjects with adhesive capsulitis treated with hot pack along with caudal glide versus hot pack along with anteroposterior glide mobilisation. Materials and Methods: The study, quasi experimental, was conducted on 80 subjects which were further divided into two groups with 40 subjects in each groups. Subjects were evaluated for pain, ROM and disability index. Group A received antero-posterior glide mobilisation with the hot pack, whereas Group B received caudal glide mobilisation with hot pack for thrice a week for total three weeks completing a total of nine sessions. The statistical analysis was done using one-way ANOVA and post-hoc analysis and Independent t-test was used for calculating within and between group differences. The parameters that were measured were Visual Analogue Scale (VAS), ROM, Shoulder Pain and Disability Index (SPADI). Results: The p-value after three weeks between the groups was 0.02, 0.0001, and 0.014 for VAS, ROM and disability. There was significant difference in the pre and post values in both Group A and Group B. Post-treatment values of VAS (p=0.0001), ROM (p=0.0001), and SPADI (p=0.0001) in Group B were showed more improvement than the post-treatment values of VAS, ROM and SPADI in Group A. Conclusion: Caudal glide mobilisation is more effective in improving pain, abduction ROM and SPADI index in patients with adhesive capsulitis.

Sonographic Measurement of Visceral Fat Thickness as a Correlate of Existing Metabolic Syndrome- A Cross-sectional Study

Deep Yadav, Akhilesh Rao, Aneesh Mohimen, Yayati Pimpalwar
Introduction: Metabolic syndrome is a well-known disease of multiple risk factors that has at its core, insulin resistance accompanying abnormal adipose deposition and function. Multiple studies demonstrate a potential relationship between Visceral Fat Thickness (VFT) and metabolic syndrome. Ultrasound provides a radiation free low-cost alternative, which is high reproducible in the quantification of visceral fat and can act as an effective screening modality. The simplicity of the method combined with its objectiveness makes it advantageous for accurate measurement of VFT. Aim: To correlate of sonographic measurement of VFT with existing metabolic syndrome. Materials and Methods: This cross-sectional study was conducted on all patients that underwent ultrasound at the study center between August 2016 to August 2019 and were clinically suspected of suffering from metabolic syndrome at the Endocrinology Outpatient Department (OPD). Collation of data into three categories based on VFT (<7 cm, 7 to 10 cm and >10 cm) was done. The patients in each category underwent further testing and metabolic syndrome was either ruled out or diagnosed. Results: The study cohort comprised of 2022 patients. The VFT ranged between 4 and 16 with a mean value of 10.8 and standard deviation of 2.8. The percentage of patients with metabolic syndrome increased in proportion to the increased VFT. VFT >10 cm was found to have specificity and Positive Predictive Value (PPV) 92.52% and 92.53% respectively while VFT <7 cm was found to have a sensitivity and Negative Predictive Value (NPV) of 95.11% and 95.10%, respectively. Conclusion: Ultrasound seems to be the best screening tool for the assessment of intra-abdominal fat deposition as the number of VFT subjects with metabolic syndrome in Category 1 was higher.

Efficacy of Priming Principle in Propofol Induction-A Randomised Controlled Trial

Sri Sowmiya Dhanapalan, Manisha B Vyas
Introduction: Priming refers to administration of a small calculated dose of a drug before giving the total induction dose. Priming principle is well-documented with the use of non-depolarising muscle relaxants. Over the years, propofol has emerged as an effective alternative to thiopentone for intravenous induction. Aim: To evaluate whether priming with propofol reduces the total induction dose of propofol. Materials and Methods: Fifty patients with American Society of Anaesthesiologists (ASA) I and II grades, aged 18-55 years, and undergoing elective surgical procedures under general anaesthesia were randomly allocated into two groups; with 25 patients each. Patients in Control Group (CG) received calculated induction dose of injection propofol 2 mg/kg whereas patients in Study Group (SG) received 20% of total calculated induction dose of propofol 2 mg/kg as a priming dose and remaining dose after 30 seconds titrated till the loss of the eyelash reflex. The total induction dose and the associated haemodynamic parameters were noted. The data thus obtained was then analysed using Chi-square test and Student’s t-test. Results: The CG required a higher dose of inj. propofol (2.15 mg/kg) as compared with the SG (1.77 mg/kg), i.e., there was 17.43% reduction of the total dose in the SG. The preoperative baseline vitals {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)} in both the groups were comparable. The changes in HR, at 1 minute and 3 minutes after induction were higher in CG than SG, which was statistically significant. The MAP at 1 minute and 3 minutes after induction was higher in SG than CG and was statistically significant. Conclusion: The priming principle when applied to induction with propofol reduces the total dose requirements of propofol and reduces the hypotension that it causes, thereby proving a stable haemodynamic state.

Sigma Metrics: A Powerful Tool for Performance Evaluation and Quality Control Planning in a Clinical Biochemistry Laboratory

Trupti Diwan Ramteke, Anita Shivaji Chalak, Shalini Nitin Maksane
Introduction: Any error in the laboratory testing processes can affect the diagnosis and patient management. Six Sigma is a data driven quality management system for identifying and reducing errors and variations in clinical laboratory processes. Aim: This study was carried out to estimate Sigma metrics of various biochemical analytes in order to evaluate performance of quality control and implement optimum quality control strategy for each analyte. Quality goal index (QGI) was also calculated to identify the problems of inaccuracy and imprecision for parameters having lower sigma values. Materials and Methods: This retrospective, observational study was conducted at the Central Clinical Biochemistry Laboratory of Seth GS Medical College and KEM hospital in Mumbai for a period of six months (July 2019 to December 2019). Sigma metrics for 20 analytes was calculated by using internal quality control and external quality control data. Further, QGI was calculated for analytes having sigma value of <4 to identify imprecision or inaccuracy. Statistical analysis was performed using Microsoft office excel 2010 software. Results: Total protein, Glucose, Urea, Triglyceride (TAG), High Density Lipoprotein (HDL), and Low Density Lipoprotein (LDL) for normal (L1) and pathological (L2) controls achieved excellent performance (>6 sigma). Westgard rule (1_3s) with two control measurement (N2) per QC event and run size (R1000) i.e. 1000 patient samples between consecutive QC events was adopted for these analytes. For analytes with sigma value of 4-6, more rules (sigma 4-5: Westgardrules-1_3s/2_2s/R4s/4_1s, N4 and R200 and for sigma value 5-6: 1_3S/2_2s/R_4s, N2 and R450) were adopted. The sigma values of six analytes (Creatinine, Sodium, Potassium, Calcium, Chloride, Inorganic phosphate) were <4 at one or more QC levels. For these analytes, strict QC procedures (Westgard rules-1_3s/2_2s/R_4s/4_1s/6x, N4 and R45) were incorporated. QGI of these analytes was <0.8 which indicated the problem of imprecision. Staff training programs and review of standard operating procedures were done for these analytes to improve method performance. Conclusion: Sigma Metrics estimation helps in designing optimum QC protocols, minimising unnecessary QC runs and reducing the cost for analytes having high sigma metrics. Focused and effective QC strategy for analytes having low sigma helps in improving the performance of those analytes.

Evaluation of Efficacy of Femoral Nerve Block on Pain and Anxiety in Acute Fractures of the Femur in the Emergency Department
Introduction: Fractures around the hip and fractures of the femur are commonly encountered in the Emergency Department (ED). Effective control of pain in these fractures is of critical importance for proper radiography, reduction and splintage. Traditionally, systemic analgesics have been used for pain relief which had its own limitations both in terms of pain relief and relaxation. Use of Femoral Nerve Block (FNB) in acute fractures around the hip and femur has been a challenge and, evaluation of this procedure has been the subject of research recently in ED. Aim: To evaluate the efficacy of FNB in decreasing pain and anxiety in acute fractures of the femur. Materials and Methods: Prospective interventional study was conducted at a tertiary care centre with well-defined inclusion and exclusion criteria. Eighty four patients with fractures around the hip, fractures of the shaft and distal femur underwent ultrasound guided FNB for performance of retrieval procedures. Visual Analog Scale (VAS) score for pain and Hamilton Anxiety Score (HAM-A) score for anxiety were used as parameter both for pre and postblock to assess the effectiveness. Subjective assessment of the patients comfort level was also done. Statistical analysis of all data obtained was done using SPSS 21.0. Results: Study group (n=84) included in the evaluation were homogenous in terms of age and sex distribution. The mean±SD VAS score preoperatively was 72.93±10.91. At 30 minutes and 4 hours postblock,the mean±SD VAS scores were 18.65±5.25 and 13.88±6.05, respectively. There was statistically significant difference in VAS score at 30 minutes (p=0.004) and 4 hours (p=0.015). The mean Hamilton Anxiety score at preblock and 4 hour postblock was 27.05±5.94 and 8.07±3.7, respectively. The overall HAM-A score comparison showed that there was statistically significant change after 4 hours postblock (p=0.013) showing significant decrease in anxiety levels. All patients were satisfied by the comfort and ease of shifting after block. Intergroup analysis of fractures around the hip (Neck femur, Trochanter) and fractures of the shaft (Shaft femur and distal femur) revealed equal efficacy of the femoral block. Conclusion: Ultrasound guided FNB is an easy and safe means of providing pain and anxiety relief to patients with the fracture of the femur (neck femur, per-trochanteric femur, shaft femur or distal femur) in the ED. At the same time, it decreases the need of systemic analgesia.

Chronic Pain and Depression: A Community Based Study in a Rural Area of West Bengal

Niladri Banerjee, Rajesh DE, Rivu Basu
Introduction: Chronic pain is one of the most neglected health problems throughout the world. A close association of depression with chronic pain adds to the burden. There is severe dearth of epidemiological studies regarding depression in chronic pain among general population in India. Aim: To evaluate the prevalence of chronic pain among the selected rural population and to find out association between chronic pain and depression, if any. Materials and Methods: This cross-sectional study was done with the objective of studying the relationships between sociodemographic factors, depression with characteristics of chronic pain among adult population in a community setting. Data was collected from 697 adult (>18 years) chronic pain (>12 weeks duration) sufferers chosen randomly with proportionate representation from all 81 villages of Amdanga block, West Bengal, through a household-based survey in cross-sectional design. A pre-designed, pre-tested structured questionnaire containing socio-demographic information where Brief Pain Inventory (BPI), Patient Health Questionnaire-9 (PHQ-9) and Physical Functional Ability Questionnaire (FAQ-5) were used. During analysis, indices representing perceived pain, impairment and functional ability were generated from the questionnaire by principal component analysis. Results: Low Back Pain (LBP) was found to be significantly higher among females that is 57.7% (p-value=0.022), followed by knee pain (54.8%). Age (p<0.001), Educational level (p<0.001), Income (p<0.001) were found to be significantly associated with perceived pain, impairment, and functional ability, which again show significant monotonic relationship with severity of depression. Major Depressive Disorder (MDD) is found in 9.04% (95% CI: 7.95%-10.13%) of chronic pain sufferers. Conclusion: Frequency of knee pain increases with aging, this points towards its degenerative nature. Perceived pain and impairment get higher while functional ability gets lower as the severity of depression increases.

A Prospective, Longitudinal Study on Effectiveness of King Vision® Video Assisted Laryngoscope and McCoy Laryngoscope in Patients with Simulated Restricted Neck Mobility
Introduction: Successful airway management in patients with restricted cervical spine movement is always very challenging as there is no consensus regarding management of difficult airway in such patients with limited or no cervical spine mobility. Aim: To assess whether the King Vision® Video Laryngoscope (KVVL) provides a better view of the glottis and has higher success rate of tracheal intubation than McCoy laryngoscope in patients with simulated difficult airway. Materials and Methods: A prospective, longitudinal, comparative study was conducted with prior approval from Institutional Ethics Committee, 100 patients were divided equally (n=50) into group V {Video Laryngoscope (VL)} and group M (McCoy laryngoscope). Time required for laryngoscopy and intubation, any damage to teeth or soft tissue injury was noted and view of the glottis was graded using a modified classification reported by Cormack and Lehane. Qualitative data (sex, American Society of Anesthesiologists (ASA) physical status, Mallampati classification, Cormack and Lehane glottis view grade, number of laryngoscopic attempts, number of optimisation maneuver required etc.,) were compared between the groups. Chi-square test (χ2 ) and Fisher-exact test were used. Results: The success on first attempt of laryngoscopy was significantly greater (p=0.014), time taken to do the procedure of laryngoscopy (p<0.001) and duration of intubation (p<0.001) was significantly lesser in the group V patients as compared to group M. Incidence of procedural dental injury was totally absent in group V, whereas four cases were recorded in group M. Optimisation maneuver was required in 50% of the group M patients as compared to 10% of group V (p<0.001). Changes in baseline parameters like pulse, Blood Pressure (BP) was noted more in group M (p<0.01) probably owing to the greater mean duration of intubation. Conclusion: KVVL appears to possess more advantages over the McCoy laryngoscope in respect to ease of viewing glottis, reduced duration of laryngoscopy and intubation, lesser complications and haemodynamic instability.

Spectrum of Clinical Presentation and Surgical Outcome in Patients with Chronic Subdural Haemorrhage: A Retrospective Study
Introduction: Chronic subdural haematomas are one among common neurosurgical emergencies especially affecting elderly male. Usually, presents with subacute Cerebro Vascular Accident (CVA), impaired higher mental function and sometimes with reversible dementia. Rarely, it presents with end stage herniation. Burr Hole Drainage (BHD) is the most popular and worldwide procedure of choice and it successfully address the problem in majority of cases. However, in a small group of patients it needs a wider craniotomy to deal with the subdural membrane which is mainly associated with recurrence of the entity. Aim: To evaluate the comparative incidence of various clinical presentation and analysing the outcome of different treatment modalities in different subgroups of patients with chronic subdural haemorrhage with respect to complication and survivality. Materials and Methods: This retrospective study enrolled data of 100 consecutive patients of subacute (n=30) and chronic subdural haematoma (n=70) who were admitted and undergone neurosurgical management of Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Odisha between September 2018 to September 2020. Variables were collected from patient’s records at discharge and analysed with respect to spectrum of clinical presentation and surgical outcome of different treatment modalities and problems associated with it. Results: The mean age group was 57.39 years and headache was the most common clinical presentation in the present study (86%) followed by hemiparasis (74%). BHD was carried out in 94 patients (94%). Primary craniotomy and membrane excision was carried out in 5 patients. Secondary craniotomy was performed in 1 patient after early re-accumulation and clinical deterioration. The outcome was assessed utilising Glasgow outcome scale with total five deaths in the series. Conclusion: Chronic Subdural Haemorrhage (CSDH) a problem of late adulthood (5th to 6th decade) which mostly follows two to three weeks after trauma. It needs proper preoperative assessment and requires timely intervention with skilled nursing care for early recovery. Post-traumatic subacute subdural haematoma in young subject and alcoholics needs special attention during course of their treatment. Bilateral puppilary failure, low Glasgow Coma Scale (GCS) and seizure association are risk factors for poor outcome.

Analysis of Caesarean Section Rates Using the Robson Ten-group Classification at a Tertiary Care Teaching Hospital in Eastern India: A Cross-sectional Study

Hiralal Konar, Madhutandra Sarkar, Sisir Kumar Chowdhury
Introduction: The Robson ten-group classification identifies the women’s groups that make the greatest contribution to the overall rate of Caesarean Section (CS), and thereby helps to optimise CS rates. It also helps to ensure optimum maternal and perinatal outcomes. Aim: To examine the rates of CS using the Robson ten-group classification, and also to identify the women’s groups that contribute most to CS rates in a tertiary care teaching and referral hospital in Kolkata, India. Materials and Methods: This cross-sectional observational study was conducted over a period of one year from May 2012 to April 2013. All pregnant women admitted under the supervision of a particular unit of the Department of Obstetrics and Gynaecology and delivered in that hospital during the study period were included. Necessary data collection was done on the following parameters, i.e., previous obstetric history, category of pregnancy, course of labour and delivery, and gestational age. The women were categorised into the ten Robson groups. For each group, the CS rate, relative size of the group, and the percentage contribution made by the group to the overall CS rate were calculated and expressed in percentages. Chi-square test, Z-test and the trial version of Statistical Package for Social Sciences (SPSS) version 20.0 were used to analyse the data. Results: The CS rate in the present study was 43.13% (735 out of 1704 deliveries). Not only the largest group in terms of relative size 649 (38.08%), the Robson group 1 had a CS rate of 41.75% (271/649), as well as the largest absolute number of caesarean deliveries. The group 1 made the largest contribution (271) to the overall CS rate (15.9%). The group 5 was the second largest contributing group 155 (9.09%), followed by group 3 96 (5.63%) and group 2 69 (4.04%). In the present study group 5 showed the CS rate of 95.67%, group 3 with CS rate of 24.48% and group 2 with CS rate of 60.52%. Conclusion: The Robson groups 1, 2, 3 and 5 were found to be the major contributors to the overall CS rate. These groups may be targeted for effective interventions to reduce the CS rate. Active management of labour in a primigravida with spontaneous onset, reduction of primary caesarean delivery, promoting vaginal birth after CS, and careful assessment of cases before induction of labour in nulliparous women, are likely to be few effective strategies.

Sexual Practices and Misconceptions Regarding Condom Usage and Status of Voluntary HIV Testing among Truck Drivers Employed in Transport Sector of Haryana- A Cross-sectional Study

Pooja Goyal, Mitasha Singh, Abhishek Singh
Introduction: Truck drivers serve as a bridge population between high risk group and general population. Their nature of job demands travelling for days which compromises their lifestyle and health needs. Aim: To describe the sexual practices and misconceptions regarding condom usage and the status of voluntary Human Immunodeficiency Virus (HIV) testing among truck drivers and helpers. Materials and Methods: This was a cross-sectional study conducted during a health screening camp, conducted by team from a tertiary care centre of district Faridabad among truck drivers employed in a transport company. All the participants were interviewed by a trained counsellor using a structured, closed ended questionnaire. Data was analysed by using SPSS version 21. Fischer’s-exact and Chi-square tests were applied to test differences in proportions. Student t-test was applied to test the differences in mean between two groups. A p-value <0.05 was considered statistically significant. Results: Total 117 male truck drivers and helpers participated in the study, of which 87.2% were sexually active with condom usage rate of 41.2%. Majority of the sexually active participants (92.8%) had more than one sexual partner in the last year. Condom usage was significantly higher among those having multiple partners than single partner (p<0.001). Having sex with wife (36.4%) and preferred sex without condom (21.1%) were two major reasons elicited for non-usage of condoms. Almost half (46.2%) preferred to buy condoms from chemist shop. Only 14.7% of all the sexually active participants were ever tested for HIV. Conclusion: Truck drivers with multiple sexual partners were prevalent; however, usage of condoms was high among them.

Decreased Serum Cholinesterase Activity- A Reliable Diagnostic Aid for Tuberculosis

Dipak Kumar Chattopadhyay
Introduction: Siderophore, the low molecular weight ferric iron chelator, is secreted extracellularly by Mycobacterium tuberculosis, an obligate aerobe. The pathogenic mycobacteria need iron as co-factor for the extracellularly secreted enzyme Superoxide Dismutase (SOD) for its pathogenicity as well as it requires iron for its metabolic functions like reduction of oxygen for synthesis of Adenosine Triphosphate (ATP), etc. The termination of impulse conduction is endorsed by the rapid hydrolysis of Acetylcholine (ACh) by Acetylcholinesterase (AChE) in the central as well as peripheral nervous system (cholinergic pathway). The inhibitors to Cholinesterase (ChE) might lead to accumulation of ACh, hyper stimulation of nicotinic and muscarinic receptors and also disruption of neurotransmission. Possibility of an inhibitor substance for AChE in Tuberculosis (TB) patients interestingly correlates with the symptom of night sweating in those subjects. Aim: To assay the level of serum ChE in normal control, lung disease control and tubercular subjects;circumvent the serum ChE level as a diagnostic potential in TB at an early stage. Materials and Methods: The study was conducted on total 124 subjects, and were divided into three groups: Group 1: normal control (n=31), Group 2: lung disease control (n=31) and Group 3: patients suffering from TB {3A: pulmonary TB (n=31) and 3B: extrapulmonary TB (n=31)}. Serum ChE activity for all the subjects were measured according to the method of Hestrin S. Serum ChE level was assayed for group 3 subjects after additional one month’s anti-TB drug treatment and also for group 2 subjects after one month with usual treatment. The level of significance was assessed using Student’s t-test. Results: There was a significant inhibition of serum ChE activity in both pulmonary and extrapulmonary TB patients in comparison to that of in normal control as well as lung disease control subjects (p<0.01). With the anti-tubercular drug therapy for one month, there was significant recovery in the serum ChE activity in pulmonary as well as extrapulmonary tubercular subjects (p<0.01). Conclusion: It appears that the high level of hydroxamate type of siderophores (secreted by Mycobacterium tuberculosis for acquiring iron) might form ACh ferric hydroxamate complex binding more strongly with serum ChE resulting in inhibition of serum ChE activity in tubercular subjects. With anti-tubercular drug therapy, there was decrease in serum ACh ferric hydroxamate complex level resulting in recovery of serum ChE activity.

Introduction and Evaluation of Objective Structured Practical Examination as an Assessment Tool in Pharmacology for Second Year Medical Students

Shipra Jain, Ruchika Kalra, Pushkar Mani, Prerna Shiv Goswami
Introduction: Assessment is an integral part of teaching and learning. Practical examination in pre and para clinical subjects lacks objectivity and carries risk of bias. This has been revamped with introduction of Objective Structured Practical Examination (OSPE) in several medical colleges. It comprises of structured questions with defined marking system thus ensuring holistic learning for students. Aim: To evaluate perception of second year undergraduate students towards OSPE in the subject of Pharmacology, in a tertiary care teaching hospital situated in Northern India. Materials and Methods: The present cross-sectional study was conducted on second professional MBBS students of 2018 batch in the Department of Pharmacology of a tertiary care teaching hospital. After sensitisation of students towards OSPE, the second year medical undergraduates were divided into four batches with each batch comprising of about 30 students. The assessment was conducted for four consecutive days by the faculty and staff in Department of Pharmacology. The OSPE questions along with the answer key and checklist were prepared. OSPE comprised of 10 stations out of which five were procedure stations (Observed) while the other five stations were unobserved in the form of spotters. The time assigned for each station was five minutes. The effectiveness of OSPE was evaluated through a feedback questionnaire. Cronbach’s alpha was applied to check the internal construct reliability and Pearson's coefficient of correlation was applied to check the test-retest reliability. Results: The Pearson's coefficient of correlation showing the test-retest reliability was 0.976. Cronbach's alpha for the feedback questionnaire was 0.79 which showed high internal construct reliability. For the cognitive domain, 112 (91.82%) students favoured that the questions were quite clear. In the psychomotor domain, 76 (62.30%) students responded in favour of its usefulness in skill development. For affective domain, 95 (77.87%) students said that it was not stressful. Regarding the assessment method, 114 (93.44%) students favoured that instructions were clear and adequate. A statistically significant difference (p<0.001) was observed in the perception of students towards OSPE as compared to Conventional Practical Examination (CPE). Conclusion: The feedback received from students was encouraging. OSPE helped students in better learning and acquisition of practical skills as compared to CPE. The study highlighted the need to revise the existing methods of practical examination.

Lipid Accumulation Product as a Marker of Cardiovascular Disease Risk among Women with Polycystic Ovarian Syndrome- A Hospital Based Case-control Study

Roshni H Babu, Rakhi S Nair, Neelima Chakrapani
Introduction: Polycystic Ovarian Syndrome (PCOS) is the most frequent gynaecological endocrinopathy characterised mainly by anovulation and hyperandrogenism. Women with PCOS are at higher risk of developing Cardiovascular Disease (CVD) due to a number of risk factors associated with this disease. Obesity, especially central adipose tissue accumulation, plays a major role in the pathophysiology of this disease. Lipid Accumulation Product (LAP) is a simple, inexpensive index to estimate cardiovascular risk and is based on fasting triglyceride and Waist Circumference (WC). Aim: To find out the association between LAP and cardiovascular risk factors in women with PCOS. Materials and Methods: This case-control study was conducted in the Department of Biochemistry and Department of Gynaecology, Government Medical College, Thiruvananthapuram, Kerala, India. Study subjects included 48 women with PCOS and 48 age and Body Mass Index (BMI) matched controls. Clinical and demographic data and medical history were evaluated. Duration of the study was six months. Anthropometric measurements, Blood Pressure (BP) and biochemical parameters like Fasting Plasma Glucose (FPG), lipid profile were recorded. LAP was calculated using the formula-Female LAP= {waist (cm) -58} × Triglyceride (TG) concentration (mmol/L). The quantitative variables were expressed as mean and standard deviation. Comparison of continuous variables between two groups was analysed by unpaired t-test. Categorical variables were analysed by Chi-square test. Correlations between continuous variables were tested using the Pearson correlation or Spearman correlation coefficient (r) analysis. The p-value <0.05 was considered as statistically significant. Variables which were statistically significant in univariate analysis were subjected to multivariate analysis. Results: The results of this study showed that the PCOS group had significantly higher WC than BMI matched control group. PCOS group had significantly higher mean TG level (p<0.05), mean FPG level (p<0.05) and lower mean High Density Lipoprotein (HDL) level (p<0.05) than the control group. LAP value (p<0.001) was significantly higher in PCOS group compared to control group. The prevalence of Metabolic Syndrome (MetS) was higher in women with PCOS. LAP values too were significantly higher in PCOS women with MetS. All CVD risk parameters except age showed a significant relationship with LAP values. Multiple linear regression model was done and LAP (p<0.001) was found to be an independent risk factor for CVD, adjusting for other factors. Conclusion: The study results shows that there is a significant association between LAP and cardiovascular risk markers. High LAP index is associated with cardiovascular risk markers in PCOS women irrespective of obesity.

Volumetric Modulated Arc Therapy for Head and Neck Cancer: A Dosimetric and Treatment Planning Comparison with Intensity Modulated Radiotherapy Techniques

Brijesh Goswami, Suresh Yadav, Rakesh Kumar Jain, Pradeep Goswami
Introduction: Traditional Intensity Modulated Radiotherapy (IMRT) techniques used many beam angles; the result of this is significant increase in beam on time as well as Monitor Units (MU) also. Due to all of these there is a need of faster treatment modality to increase the patient comfort and lesser organ movement. Aim: To compare the triple arc RapidArc technique with nine field IMRT techniques for different head and neck cancer, focusing on target coverage and dose received by the Organs At Risk (OARs). Materials and Methods: Retrospectively, Computed Tomography (CT) datasets of 20 patients of Squamous Cell Carcinoma (SCC) of the Oro-pharynx and Hypo-pharynx treated during January 2019 to December 2019 were chosen for this study. For every patient, two different treatment plans were created, one by using the triple arc RapidArc technique and others by using nine fixed fields IMRT technique. For Planning Target Volume (PTV), the dose volume parameters D98% and D2% (dose received by the 98%, and 2% of the volume), homogeneity index, and Conformity Index (CI) were evaluated for dosimetric comparison. For OARs, the analysis included the mean dose, the maximum dose expressed as D2%. Additionally, the Beam On Time (BOT) and the number of MUs were analysed. A paired two-tailed t-test was performed to compare the RapidArc technique with the IMRT technique for radiotherapy treatment of different head and neck cancers. The p-value <0.05 was considered for the significance of statistical inferences. Results: Comparable target coverage and better sparing of OARs were achieved with the RapidArc technique in comparison to IMRT. Homogeneity and conformity were also in favour of the RapidArc plan. The dosimetric results with I'MatriXX measurements of RapidArc plans were similar to IMRT plans. All detector points passed 3 mm and 3% gamma criteria for IMRT plans and also for RapidArc plans. Conclusion: RapidArc is a faster and precise treatment technique. RapidArc provides better target coverage with good OARs sparing. Most significant change occurs in the number of MUs and treatment time, which is much lesser in RapidArc.

Clinical and Diagnostic Profile and Management of Inferior Vena Cava Obstruction- A Descriptive Study at a Tertiary Care Centre, Hyderabad
Introduction: Obstruction to hepatic venous outflow is a rare disease with a potentially fatal outcome, if not recognised and managed promptly. The level of obstruction can vary, anywhere from the small hepatic venules to the entry point of the Inferior Vena Cava (IVC) into the right atrium. The original patients that Budd-Chiari described had acute hepatic vein thrombosis but this syndrome now encompasses various hepatic venous outflow blocks, of which a membrane in the IVC is the most common anatomical form of obstruction. Pure IVC obstruction is commonly seen among Asians. Aim: To study the clinical and diagnostic profile of patients presenting with IVC obstruction and to evaluate the treatment efficacy and safety of percutaneous transluminal angioplasty. Materials and Methods: For this prospective, descriptive study, from November 2015 to August 2019, a total of 21 patients were admitted with obstruction of hepatic venous flow. Most of the patients were young adults. Clinical features, aetiologies and coagulation profiles were studied. Ascites, pain abdomen and pedal oedema were common presentations. Diagnosis was established by clinical examination and was confirmed by ultrasound-doppler study, computed tomography and conventional angiography. Statistical analysis was done by using statistical package for social sciences IBM SPSS statistics for Windows, version 20.0. The data were expressed as percentages of study population while, continuous data were expressed as mean±standard deviation. Results: The mean age of the population was 24.7±2.9 years, with a female preponderance. (male: female=1:2). IVC angiography was done in 15 patients. Seven of the 15 patients had diffuse narrowing of IVC. Eight patients had focal or segmental narrowing of IVC, among them seven patients underwent Percutaneous Transluminal Angioplasty (PTA) with stenting. The venous access was obtained from femoral vein. The stenoses were crossed with either guide wire or Brocken brough needle with Mullins sheath. Three patients did not need predilatation. In four patients, obstructed IVC was dilated with Inoue balloon and then self-expanding stents were placed. Success was achieved in all cases, with significant drop in the pressure gradients from 20±5 mmHg before procedure to 3±2 mmHg immediately after the procedure. After PTA, all seven patients had either total relief or decrease of symptoms and clinical signs of hepatic venous obstruction. No major complications were observed and no repeat interventions were required. The mean postprocedural follow-up was six months that showed good outcomes with good stent patency. Conclusion: Chronic obstruction of IVC presents with abdominal pain, progressive ascites and portal hypertension in young adults, with mild abnormality of liver function tests. The IVC obstruction can be due to an obstructive membrane or segmental stenosis or diffuse narrowing of IVC. PTA with stenting can be done safely and it effectively relieves the symptoms and venous congestion and can be considered as the first line decompressive procedure in patients with IVC stenosis.

Prevalence of Metabolic Syndrome in Chronic Obstructive Pulmonary Disease in Rural Population of Developing Country- A Cross-sectional Study

Atul Tiwari, SK Piruwa, SK Agrawaal, GN Srivastava, Deepak Shah
Introduction: Metabolic Syndrome (MetS) is characterised by the clustering of central obesity, hypertension, dyslipidemia, and hyperglycemia that predisposes patients to Cardiovascular Disease (CVD). It is a representative group of conditions with systemic inflammation, which is a potential mechanism responsible for both Chronic Obstructive Pulmonary Disease (COPD) and MetS. Aim: To detect incidence of MetS in COPD patients and its correlation with severity of COPD. Materials and Methods: The present study was an observational cross-sectional study which was conducted on 62 COPD patients in SS Hospital, BHU, Varanasi, Uttar Pradesh, India, from June 2015 to June 2017, diagnosed on basis of Global initiative for Lung Disease (GOLD) guidelines. 62 age and sex matched control having no cardio-respiratory history were included. All relevant investigations were done for all selected subjects and modified Medical Research Council (mMRC) dyspnoea grading was done in all the subjects. Standardised treatment modules were followed and spirometry and post-bronchodialater spirometry was performed 15-30 mins after inhalation of 400 mcg Salbutamol. Patients obstruction was classified according to the severity of airflow limitation based on post-bronchodilator Forced Expiratory Volume in one second (FEV1) as follows: mild (≥80% predicted); moderate (80>FEV1 ≥50% predicted); severe (50%> FEV1 ≥30% predicted); very severe (<30% predicted). Complete work-up and data collection were analysed by using Statistical Package for the Social Sciences (SPSS) version 23.0 software, descriptive cross tables, univariate and multivariate analysis. Independent Student’s t-test was used to compare the means of cases and controls. The p-value <0.05 was considered statistically significant. Results: Total 62 patients along with age and sex matched 62 healthy control in 1:1 ratio have been taken in the study, majority were in age group of 50-70 years. On comparing the mean values of different parametres of MetS in COPD cases and controls, significantly raised triglyceride level and fasting blood sugar in COPD cases (p-value <0.001 and 0.005 respectively) were observed. MetS was present in 29 cases (46.8%) of COPD whereas in healthy control population only 19 people (30.6%) were positive for MetS. Total of 55.2% cases of COPD with MetS was in group D whereas 84.8% cases of COPD without MetS were in group B of GOLD staging. Statistically significant (p<0.001) higher incidence of acute exacerbation was observed in cases of COPD with MetS. Conclusion: MetS was more prevalent among the COPD patient in 50-70 years age group with mild to moderate airflow limitation. More waist circumference i.e., central obesity, impaired fasting glucose, dyslipidemia, increases the risk of cardiovascular complication in these patients. MetS is an important co-morbidity in patients of COPD which fasten the natural course of disease by increasing the frequency of acute exacerbation.

Risk Factors, Epidemiological and Clinical Outcome of Close Contacts of COVID-19 Cases in a Tertiary Hospital in Southern India
Introduction: The knowledge of epidemiologic characteristics and transmission dynamics of a novel pathogen, such as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) among close contacts can help in planning and development of effective control policies in different parts of the world. Aim: To assess the epidemiological and clinical outcome of close contacts of Coronavirus Disease (COVID-2019) cases admitted in a tertiary COVID hospital and to assess the role of risk factors in predicting the epidemiological outcome of these contacts. Materials and Methods: The current retrospective cohort study was conducted among 1286 close contacts of COVID-19 patients admitted to Government Medical College, Thrissur, Kerala. The data collection was done by a semi-structured telephonic interview by the contact tracing team. The questions included the type of exposure to the index case, symptoms if any, date of last exposure with COVID-19 positive patients, and final COVID-19 status of the contact at the end of 14 days. The association of risk factors of COVID-19 positivity was done using binary logistic regression. Results: Proportion of close contacts of COVID-19 who developed the disease was 24.2% (21.87-26.52%). The mean incubation period was found to be 4.22 days (C.I-3.71-4.65). The serial interval mean was found to be 5.24 days (C.I 4.764-5.716). The proportion of household contacts of COVID-19 cases who developed the disease was found to be 26% (C.I-23%-29%). The majority (52.4%) of infections among contacts were asymptomatic. Most common symptom among the COVID-19 positive was fever (32.8%) followed by cough (16.1%). The most common risk factors of infection among primary close contacts were sharing the same room (adjusted odds ratio-2.394) and common use of fomites (adjusted odds ratio-1.953) while use of a mask was found to be protective (adjusted odds ratio-0.570). Significant factors associated with the type of contact with infection were workplace-related contact (adjusted odds ratio-6.629), household contact (adjusted odds ratio-4.856), and travel-related contact (adjusted odds ratio-2.899). Conclusion: The study concludes important risk factors of transmission among close contacts of COVID-19 as being in a household, workplace and travel related contact where the use of mask was found to be protective. The study also concludes that most of the COVID-19 infections in close contacts are asymptomatic.

Emotional Intelligence Assessment in Undergraduate Medical Students: A Cross-sectional Study
Introduction: In 21st century, Physicians has to deal with both technical and emotional component associated with doctor patient relationship, technical aspects are taught but emotional aspects are not taught. Aim: To evaluate Emotional Intelligence (EI) in undergraduate medical students of different academic years. Materials and Methods: A cross-sectional study was conducted on 200 undergraduate medical students from medical college and tertiary care hospital for two years from January 2018 to February 2020. Demographic information was collected on separate annexure. EI in the study was assessed using emotional quotient self-assessment checklist devised by Sterrett. The validity and reliability of the questionnaire was tested. Emotional quotient self-assessment checklist consists of 30 statements, five each for the six areas. Each question was based on a 5-point Likert scale scoring from 1 to 5 (virtually never=1 to virtually always=5). Results: Out of 200 students, only 16 (8%) could correctly describe about EI. Out of total, 89 (44.5%) felt EI very important, 92 (46%) students felt important while 185 (92.5%) students desired to learn about EI. The EI score in Ist year MBBS was 103.45±13.73 which increased in IInd year MBBS (108.02±12.2) and had statistically significant increase in IIIrd year (111.74±13.86) and IVth year (115.02±14.79). Empathy and motivation were the EI components that decreased from Ist year MBBS to IVth year. Empathy component negatively correlated with social competency component. Conclusion: Emotional Intelligence (EI) has become a crucial element to be inculcated in a competency based curriculum for all academic years. There is a need of EI training in medical curriculum.

Expression of HER2/neu and Ki-67 in Urothelial Carcinoma and their Relation to Clinicopathological Data: An Egyptian Study

Badawia B Ibrahim, Samira A Mahmoud, Alzahraa A Mohamed, Hala M El hanbuli
Introduction: Bladder cancer is the most common malignancy involving the urinary system and the ninth most common malignancy worldwide. Ki-67 is a nonhistone cellular marker for proliferation. HER2/neu is an oncogene that plays an important role in the pathogenesis of many cancer types. In bladder carcinoma, its clinical significance remains under-investigated and poorly linked to the patients’ clinicopathological features especially with no reported Egyptian study. Aim: The aim of this work was to study the expression of HER2/ neu and Ki-67 in urinary bladder carcinoma to evaluate their role in tumourigenesis and their correlation with other available clinicopathological variables associated with urothelial carcinoma. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Faculty of Medicine, Cairo University, Egypt. Samples were paraffin blocks from 60 cases diagnosed with urothelial carcinoma underwent radical cystectomy. Ki-67 and HER2/neu immunohistochemical staining was done and of Ki-67 and HER2/NEU Immunostaining was recorded. The associations between Ki-67, HER2/neu expressions and clinical and histopathological parameters of urothelial bladder carcinoma was evaluated. Results: The Ki-67 expression had significant association with tumour histological grade and lymphovascular invasion (p-value <0.05). The association of HER2/neu expression had significant association with perineural invasion (p-value <0.05). Conclusion: HER2/neu immunostaining was not associated with most of the clinicopathologic prognostic factors in urothelial bladder carcinoma.

Myeloid Sarcoma: Evaluation of Histopathology, Immunoprofile and Cytogenetics

Sanjiban Patra, Biren P Parikh, Kanwalpreet Kaur
Introduction: Myeloid Sarcoma (MS), an uncommon tumour of immature myeloid blasts at extramedullary sites can be diagnostically challenging, if it is present de novo, precedes Acute Myeloid Leukaemia (AML) or Myeloproliferative Neoplasm (MPN). There are a few studies in literature with a substantial number of cases on clinicopathological, Immunophenotypic (IPT) and Immunohistochemical (IHC) characteristics of MS. Aim: This study was aimed to analyse myeloid sarcoma in Indian population according to the age, gender, site of involvement, differential diagnoses, IHC, IPT and cytogenetics and to add some to the existing knowledge. Materials and Methods: The present cross-sectional study was conducted at Gujarat Cancer Research Institute, Ahmedabad, with a total of 38 patients, diagnosed over past three years (January 2017 to December 2019). Clinical, morphological, IHC, IPT and molecular data of those 38 patients were retrieved and analysed. Results: Out of 38 cases, 16 (42.1%) and 13 (34.2%) cases were previously diagnosed cases of AML and Chronic Myeloid Leukaemia (CML) respectively. Nine patients (23.7%) presented as de novo. Most common site was lymph node (12/38, 31%), followed by breast, vertebra and other unusual sites. Myeloperoxidase (MPO) (31/38, 81.5%), CD117 (25/35, 71.4%), CD45 (21/23, 91.3%), CD43 (14/22, 63.6%), CD68 (12/28, 42.8%), CD34 (15/37, 40.5%), CD33 (14/14, 100%), CD13 (15/16, 93.7%), HLA-DR (11/12, 91.6%), CD99 (3/29, 10.3%) and Terminal deoxynucleotidyl Transferase (TdT) (1/9, 11.1%) were expressed by tumour cells. However, epithelial mesenchymal, B and T lymphoid markers were negative. The present study found inv(16) and t(8;21) in MS in known AML patients. Among the known CML patients, two had variant positive for t(9;22) {t(2;9;22) (p23;q34;q11.2)}. Conclusion: Results of present study depicts that considering MS in differential diagnosis in its de novo presentation is necessary to prevent wrong diagnosis and help early treatment of these patients.

Nurses’ Challenges in Wound Care Management- A Qualitative Study

Nahla A Tayyib, Pushpamala Ramaiah
Introduction: Decision-making process of healthcare professionals in an acute care setting is inevitable that necessitates a balancing paradigm of clinical knowledge with the practices of evidence-based implementation. Nurses face contextual challenges in managing the issues of decision-making intervening domains of cognition, skills, and values. Aim: This study was implemented to determine the decision-making processes used by registered nurses in wound care management in acute care settings. Materials and Methods: A qualitative method was adopted using a thematic analysis approach. Fifteen nurses involved in the management of wound care unit were purposefully included in the interview from 23rd May to 15th July 2020. The semi-structured face-to-face interview was conducted, and the collected data was analysed through inductive thematic analysis. Results:Conclusion: Nurses demonstrated that wound care management requires the practice of decision-making that requires multidisciplinary and holistic approaches tempered

Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Gujarat, India
Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) are major cause of community as well as healthcare associated infections and have limited treatment options. Measuring the magnitude of the problem of CRE, it is important for making strategies to lower its spread. Aim: To assess the incidence and prevalence rate of CRE in a tertiary care hospital of Gujarat, India. Materials and Methods: Retrospective data was collected for a period from 2014 to 2018 using Laboratory Information System (LIS). Prevalence of CRE was determined as number of CRE isolated per 100 Enterobacteriaceae isolated during the study period whereas incidence rate was determined as number of CRE cases per 1000 patient-days. Consumption of Carbapenems was calculated as Defined Daily Dose (DDD) per 1000 patient-days. Demographic data including age, gender, location in the hospital and sample type from which CRE was isolated was also analysed using Microsoft Excel. Results: The incidence of CRE cases per 1000 patient-days in 2014 to 2018 was 1.66, 2.11, 1.90, 2.26 and 1.91, respectively with an overall incidence of 1.99 per 1000 patient-days. The overall prevalence of CRE over a period of five years was found to be 29.07%. Klebsiella sp. was the most common CRE and had the highest percentage of Carbapenem resistance among all Enterobacteriaceae. Conclusion: The rate of CRE in present study was high and worrisome. Screening of the patient for CRE, source isolation and stringent implementation of infection control practices is required to confine the spread of CRE in this institute.

Dental Practice during COVID-19 Pandemic: An Observational Study

Aalap Sureshkumar Prajapati
Introduction: Occupational Safety and Health Administration (OSHA) classified health care professionals and exposure risk to Coronavirus, identifying Dental Professionals in very high risk group due to specificity of dental procedures and instrumentations used. As per guidelines from relevant bodies to provide only emergency and urgent dental treatment has led majority of dental practice to stop, instilling apprehension in profession and fear in public. Aim: To narrate the experience from Department of Dentistry, on how to safely and effectively practice dentistry that would provide guidance to practicing dental professionals without major environment alteration and capital items requirement. Materials and Methods: This was an observational study from Department of Dentistry from May to August 2020, attached to a rural tertiary care medical teaching institute, following customised protocol after reviewing available guidelines in relation to Coronavirus Disease-2019 (COVID-19) and dentistry. Data collection was done from Institutional Electronic Medical Record System for patients receiving dental treatment during the study period. It used descriptive narrative analysis to provide chronology of experiences for practicing dentistry as per various unlock phases declared by Government of India. Results: The Department of Dentistry was able to manage four Non-Aerosol Generating Procedures (Non-AGP), three Aerosol Generating Procedures (AGP) and eighteen Outdoor Patient Department (OPD) consultations on an average for a working day, from May to August 2020. During the tenure while providing dental care, none of the member of dental team was detected COVID positive. The result was achieved by simple alteration done by patient, man-power, practice and environment management. Conclusion: A simple alteration in practice and practice area ensuring safety of all members of dental team was made by department. It included the effective use of Personal Protective Equipment (PPE) during all dental procedures including oral examination. Special emphasis on history of patients, facility and environment management along with regular training for hand hygiene, donning-doffing, aerosol appointment and practice was given. An attempt to provide prophylactic and elective dental need of patients were done and department was successfully able to treat seven patients per day on an average during May to August, 2020.

The Effects of Ovulation Documentation before Insemination on Intrauterine Insemination Cycle Outcomes: A Retrospective Analysis

Sujata Pradhan, Padmalaya Thakur
Introduction: Ovulation is the key event in Intrauterine Insemination (IUI) cycles. Monitoring ovulation prior to insemination will help to alter insemination time to improve pregnancy rate. Aim: To compare pregnancy rates and live birth rates in presence and absence of ultrasonographic features of ovulation before insemination in IUI cycles. Materials and Methods: This was a retrospective cohort study conducted in a Institute of Medical Sciences and SUM Hospital, Bhubaneswar. Three hundred eighty eight IUI cycles performed in the period of January 2017 to December 2018 were analysed. On the day of IUI prior to insemination, transvaginal ultrasonography was done 36-38 hours after ovulation trigger to document ovulation. Presumptive signs of ovulation were documented in 201 cycles (Group A) and there was no feature suggestive of ovulation in 187 cycles (Group B). In all the cycles, single insemination was performed at 38-40 hours after ovulation trigger. Baseline characteristics were compared. Mann-Whitney U test was used to compare continuous variables. Chi-square test and Fisher's-exact test were applied to find out the differences in the categorical variables as well as the pregnancy outcomes among the groups. Pregnancy rate and live birth rate were considered as the primary outcomes. Results: Pregnancy rate (17.9% vs 18.2%, p-value=0.945) and live birth rate (17.9% vs 16.0%, p-value=0.625) were similar irrespective of ovulation status documented in ultrasonography performed before insemination. Conclusion: IUI cycle outcomes are independent of the ovulation status documented before insemination.

Association between Lifestyle Factors and Oral Potentially Malignant Disorders among People of Bangalore: A Case-control Study

Jyoti Raghavendra Byakodi, Pushpanjali Krishnappa
Introduction: The increase in prevalence of oral premalignant lesions and oral cancer in India is due to cultural, ethnic, geographic factors and varying lifestyle factors like consumption of tobacco, alcohol and standard of living. Some of the risk factors are modifiable and emphasises the need for detailed assessment of these modifiable risk factors and increasing awareness among general public and policy makers. Aim: The present study was conducted to assess the association between lifestyle factors and Oral Potentially Malignant Disorders (OPMDs). Materials and Methods: A case-control study was conducted where 154 cases and controls were selected from MS Ramaiah Dental College and Hospital, Bangalore and peripheral outreach centers of MS Ramaiah Dental College and Hospital, Bangalore. Cases diagnosed as oral leukoplakia, erythroplakia and Oral Submucous Fibrosis (OSMF) based on the World Health Organisation (WHO) criteria (1980) were included in the study group. Age and sex (1:1) matched controls without OPMDs were included in control group. The data was collected regarding socio-demographic factors, blood group and lifestyle factors using specially designed proforma. Chi-square test and odds ratio were utilised to association and strength of association between various lifestyle factors and development of OPMDs. Univariate logistic regression test was done followed by multiple logistic regression for identifying the risk factors. The p-value <0.05 was considered as statistically significant. SPSS version 11.0 was used for data analysis. Results: Out of 154 cases, 84 (54.5%) cases were leukoplakia, 2 (1.3%), cases were erythroplakia, 53 (34.4%) cases were OSMF and 15 (9.7%) cases were with multiple potentially malignant disorders (leukoplakia+OSMF). In univariate analysis, OR for tobacco smoking in individuals who smoked more than 20 times a day was 2.56 (95% CL 1.19-5.5) compared to non-smokers, tobacco chewing who chewed more than 10 times a day was 43.03 (95% CL-17.2-107) in comparison to non-chewers and alcohol consumption who consumed alcohol daily was 3.2 (95% CL 0.6-16.3) in comparison to non-alcoholics. Following multiple logistic regression analysis occupation, smoking, chewing tobacco and vegetable intake was found to be statistically significant as independent risk factors p<0.05. Conclusion: Occupation, smoking, chewing tobacco and vegetable consumption were identified as independent risk factors for the development of OPMDs. Identifying the risk factors and OPMD at an early stage is important for prevention of oral cancer.

An Observational Study to Assess Anxiety Disorder among Women during COVID-19 Pandemic

Sonali Sain, Indira Dey
Introduction: World Health Organisation (WHO) declared 2019 Coronavirus Disease (COVID-19) infection as a pandemic. Government of India imposed a nationwide lockdown to break the chain of transmission in the community to halt the pandemic. The unprecedented measure led to severe emotional distress among the general population, especially women. Aim: To assess the burden of anxiety disorder perceived by women during the COVID-19 pandemic and their precipitating factors. Materials and Methods: An observational cross-sectional study was conducted among the women residing in West Bengal for more than six months and has access to electronic media, internet services, and/or with an account in any social media. The online survey was conducted via electronic communication and the snowball sampling method was used to recruit 980 study participants. An electronic version of a semi-structured questionnaire was developed with a consent form attached to it and the link of the questionnaire was sent through e-mails, WhatsApp, and other social media to the contacts of the researcher. A self-administered questionnaire obtained information regarding socio-demographic features, personal history, past history of chronic morbidity, family history, and anxiety disorder by Generalised Anxiety Disorder-7 item (GAD-7) scale. Chi-square test and multiple logistic regression were used as a test of significance. The data was compiled, analysed, and presented. Results: Around 203 (20.7%) adult women were suffering from reasonable anxiety. Socio-demographic factors like residence, religion, education, and profession were more significantly associated but age, family type, and marital status were not significantly associated. Addiction, chronic morbidity, and experience of recurrent non-specific signs and symptoms had a significant association with reasonable anxiety. The regression model explained that working women had less chance and those with recurrent non-specific symptoms had more chance to suffer from reasonable anxiety. Conclusion: The study assessed the burden of anxiety disorder faced by women during the pandemic. It has provided further insight into the risk factors associated with it and a person’s vulnerability to anxiety disorder. Thus, it helped in developing targeted intervention strategies for the vulnerable segment of the population.

Gastric Schwannoma: The Masquerader amongst Gastric Mesenchymal Tumours

Rijo Issac, Dipti Masih, Betty Simon, Inian Samarasam, Anna Benjamin Pulimood
Introduction: Gastric Schwannoma (GS) is a rare gastrointestinal mesenchymal tumour and needs to be distinguished from other common mesenchymal tumours like Gastrointestinal Stromal Tumour (GIST). GS is composed of Antoni A areas with peritumoural lymphoid cuff unlike conventional schwannomas. GS are difficult to differentiate from other mesenchymal submucosal tumours like GIST. The histological features and strong positive immunostaining for S100 protein along with CD117 (Cluster of Differentiation) and Discovered on GIST 1 (DOG1) immunonegativity is required to confirm the diagnosis. Aim: To analyse the histopathological, immunohistochemical, radiological characteristics and follow-up data of GS. Materials and Methods: This was a retrospective descriptive study conducted in a tertiary care hospital in Southern India. There was a total of eight cases of GS retrieved from the Pathology archives from January 2010 to December 2019. The clinical information along with radiology reports were retrieved from the electronic database. The retrieved slides were analysed for clinicopathological features. The descriptive analysis of the data was done, and the results were presented as mean, frequencies, and percentages. Results: All eight cases of GS presented in the fifth to eighth decade of life with a female preponderance (male to female ratio of 1:3). Six out of eight cases were symptomatic (75%). Radiologically, a differential diagnosis of GIST was considered in all 8 cases (100%). Microscopically, all 8 cases (100%) exhibited fascicles of spindle cells with mild nuclear pleomorphism, prominent peritumoural lymphoid cuff, and few secondary changes. S100 immunohistochemistry was done in six cases of GS and all showed diffuse strong positivity. The remaining two cases were positive for SRY-related High Mobility Group (HMG)-box 10 (SOX). Conclusion: Preoperative diagnosis of GS is difficult due to non-specific endoscopic or radiological findings. In gastric submucosal tumours, GS should be considered as one of the differential diagnosis. The histopathological and immunohistochemical features are considered the gold standard to diagnose GS.

Urinary Effects of Routine Urethral Catheterisation during Elective Caesarean Section in Enugu, Nigeria: A Randomised Controlled Study
Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities. Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria. Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention. Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p-value=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p<0.001). There was neither a case of accidental cystostomy nor postpartum haemorrhage in either group. Conclusion: Non-catheterisation of the urinary bladder during elective caesarean section had no significant relationship with the incidence of significant bacteriuria in Enugu, Nigeria. Rather, it was associated with postoperative urinary retention when compared to women who had a urinary catheter

Comparison of Visual Inspection using Acetic Acid and Liquid Based Cytology for Cervical Cancer Screening in Rural Area: A Cross-sectional Study

Pragya Shree, Nupur Mittal, Vandana Verma
Introduction: Cervical cancer is the primary malignancy in Indian women. The most significant method for untimely diagnosis of cancer cervix is cytology screening, but it is not possible to launch nationwide cytology screening programme of cervical cancer. So, this has lead to the development of low cost technology e.g., visual inspection of the cervix after application of acetic acid. Aim: To compare Visual Inspection using Acetic Acid (VIA) and Liquid Based Cytology (LBC) in evaluation of abnormal cervical lesions. Materials and Methods: This was a cross-sectional study conducted on 1600 women who fulfill selection criteria. Patients attending Gynaecology Outpatient Department (OPD) with the following signs and symptoms like vaginal discharge, abnormal uterine bleeding, lowback pain, contact bleeding, and lower abdominal pain were included. After taking informed consent, the participant was subjected to detailed history, physical examination, LBC, VIA and Colposcopy followed by biopsy (if required). The sensitivity and specificity of each test are determined and compared. Data entry and analysis were done using SPSS Inc., version 11.0. Results: In present study, VIA was more sensitive (92.06%) than the LBC (68.25%) for the detection of dysplasia. However, the specificities of VIA (56.76%) and LBC (54.05%) had not much difference. Positive Pedictive Value (PPV) of VIA was 78.38% and Negative Predictive Value (NPV) of VIA was 80.77% while PPV of LBC was 71.67% and NPV of LBC was 50%. The accuracy of VIA (79%) is higher than LBC (63%). Conclusion: The VIA is more sensitive screening modality than LBC. The accuracy of VIA is higher than LBC in detecting premalignant lesion which makes it a suitable and valuable alternative screening method to cytology in poor resource setting.

Psychometric Analysis of Undergraduate Nursing Students using Depression, Anxiety and Stress Scale: A Cross-sectional Study

Sunil Chouhan, Akriti Gupta, Ruchi Singh, Anzar B Alvi
Introduction: Students at nursing colleges encounter not only issues associated to individual life, but also learning difficulties. The rigor in professional training may predispose them to depression, anxiety and stress. Aim: To investigate the prevalence and psychometric condition such as depression, anxiety, and stress symptoms in undergraduate nursing students. Materials and Methods: This was a cross-sectional study on 387 female nursing students, aged between 18-27 years (21.16±1.52) from AIIMS, Bhopal and Gandhi Medical College, Bhopal, Madhya Pradesh, India. They were analysed using Depression, Anxiety and Stress Scale-42 (DASS-42). This self-administered anonymous questionnaire was distributed through 'WhatsApp' web and e-mail, in the form of "Google form" to all the enrolled students. The Microsoft Office Excel 2010 and Statistical Package for The Social Sciences (SPSS) software was used to analysed the data using percentages. Results: The questionnaire was filled by 223 out of 387 students. The response rate was 57.62 percent. The mean age of the respondents were 21.16 years (±1.52 years). The prevalence of depression, anxiety and stress prevalence were 36.7%, 49.33% and 34.98%, respectively. In the depression and anxiety traits, majority of students were in moderate stage (14.35%, 21.08%), while in stress, majority (17.04%) of students were in mild stage. Spearman correlation found a significant moderate positive relationship between depression and anxiety (r=0.592, p<0.001), depression and stress (r=0.578, p<0.001), anxiety and stress (r=0.652, p<0.001). Conclusion: Among the undergraduate nursing students, depression, anxiety and stress was found to be remarkable. Hence, it is necessary to enhance mental well-being among nursing students. The results allow for anxiety control screening measures and expanded rehabilitation and treatment to be initiated for the students.

Role of Helicobacter pylori Infection on Diabetic and Lipid Profile in Pre-diabetic Patients

Akash Chaudhary, Abdullah Ansari
Introduction: H.pylori (H.pylori ) infection is related to gastritis, peptic ulcers, gastric cancers and Mucosa Associated Lymphoid Tissue lymphomas (MALT). It is also associated with several extra-gastrointestinal pathologies owing to its association with increased production of proinflammatory cytokines, bacterial virulence factors and environmental factors. It may have an effect on onset of diabetes mellitus and alter lipid profile. Aim: To find the effect of H.pylori infection on diabetic and lipid profile in pre-diabetic patients. Materials and Methods: A single centre, cross-sectional study was conducted over a period from January 2019 to June 2020, on pre-diabetic patients (HbA1c 5.7-6.4%.). A total of 118 patients were recruited in the study and divided into two groups based on the H.pylori positive (group A) and negative (group B) results. HbA1c, Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL) were investigated at baseline, six months and 12 months and the results of the two groups were compared using student’s t-test. Supply Support Planning and Execution (SSPE) Software version 20.0 were used for analysis of the collected data. A p-value<0.05 to be considered significant. Results: Of the 118 patients, 96 (mean age 48.3 years) completed the study. There 59 (61.5%) were males and 37 (38.5%) were females. A total of 54 (56%) of the study population tested positive for the H.pylori colonisation. The study showed that patients infected with H.pylori (group A) had comparative rapid increase in the HbA1c levels (p-value=0.048) when compared with the non-infective group (group B). The group A also had statistically significant increase in the LDL cholesterol levels (p-value=0.032) and decrease in HDL cholesterol levels (p-value=0.02) than group B. Conclusion: Infection with H.pylori is associated with increase in the level of HbA1c in pre-diabetics. It is also associated with increase in the LDL cholesterol levels and decrease in the HDL cholesterol levels. Eradication of the pathogen may help in preventing or delaying the progression of pre-diabetes and dyslipidemia. However, larger studies without any confounding factors are needed to establish the association between H.pylori infection and its effect on diabetic and lipid profile.

Clinical Significance of Hypocalcaemia in Malaria: An Experience from Coastal Karnataka, India

Avinash N Shetty, Akshatha Rao Aroor, Archana Bhat
Introduction: Malaria is a major public health problem leading to significant morbidity and mortality in endemic regions. Malaria is a major public health problem in India, which contributes significantly to the overall malaria burden in Southeast Asia. Data on significance of hypocalcaemia in malaria is scarce. Aim: To correlate hypocalcaemia with the complications in malaria. Materials and Methods: This cross-sectional, observational study was conducted at Father Muller Medical College in Coastal Karnataka between January 2018 to June 2019. Patients diagnosed as malaria by peripheral smear were included. Serum calcium level was measured in all the patients and calcium levels <8.4 mg/dL was considered as hypocalcaemia. This was correlated with the complications such as jaundice, acute kidney injury, cerebral malaria, shock, multiorgan dysfunction and Acute Respiratory Distress Syndrome (ARDS) in malaria. Data were analysed using frequency, percentages, Chi-square test, student t-test, relative risk estimation and Receiver operating Characteristic (ROC) analysis. Results: A total of seventy five patients with malaria were included in the study. Majority were in the age group of 21-30 years (30.6%), with a male predominance (53 patients, 70.67%). Among these patients, complications were documented in 18 (24%) of them. Hypocalcaemia was seen in 25 patients (33.3%) among whom 13 (52%) had complications. The association of hypocalcaemia with the complications was statistically highly significant (p=0.001). Patients with hypocalcaemia had a relative risk of 9.75% (2.901-32.766, 95% CI) for developing complications. With ROC analysis, the calcium value cut-off for complications was 8.25 with a sensitivity of 72% and specificity of 86%. Calcium reverted to normal in all patients after recovery from complications. Conclusion: Hypocalcaemia had a significant association with high specificity for complications in malaria.

Development of Quality of Life Tool for Children Diagnosed with Epilepsy- A Pilot Trial

Vipin Vageriya, Anil Sharma
Introduction: Epilepsy is a neurological condition in which child has a recurrent seizure. It results in imbalance of neurotransmitter. It has an impact on various aspects of a child like physical, social, behaviour, psychological and intellectual. Epilepsy is one of the common disease which present among children. Existing Quality of Life (QOL) tool do not cover the issues significant to Indian children. Aim: To develop a QOL tool for children diagnosed with epilepsy. Materials and Methods: This study was a sequential exploratory mixed method study. It included qualitative and quantitative study. In qualitative phase, the information was collected by using in-depth interview of participants. Interview data were analysed by using conventional content analysis method and themes, subthemes were created. On the basis of it, a pool of items for the questionnaire was developed. In quantitative phase, psychometric property of the questionnaire was evaluated by using face, content and constructs validity. The reliability of tool assessed by internal consistency and Cronbach’s alpha. Total 15 and 20 subjects were involved in qualitative and quantitative phase respectively. Results: Qualitative method consist of 3 steps- in-depth review of literature, participant’s interview and expert opinion. At the end of phase I, a draft of 84 questionnaires as item pool generation developed. In phase 2, an expert panel reviewed 84 items for relevance, language, wording and duplication. 30 items were deleted on the basis of expert opinion, Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI). Now, 54 items were administered to 20 participants. Based on the participants responses investigator draw a scree plot based on eigen value of above 1. These 5 domains explained 76.42 % of the total variance. Total 9 items were deleted from pool of 54 items on the basis of item total correlation coefficient and inter-item correlation. Final 45 items were classified as per specific domain. The final draft had a Cronbach’s alpha value of 0.876. Conclusion: Majority of QOL tool are not applicable to Indian population due to geographical and cultural differences. So the aim of this study was to develop a tool which benefited to Indian population. In this study, the final draft consists of 5 components with 45 items as per analysis. This newly developed tool will help the health care provider to assess the QOL of epileptic children.

Determination of Combination Factor as an Aid in Orthodontic Treatment Planning in Western Region of Saudi Arabian Young Male Population- A Retrospective Cephalometric Study

Raghu Devanna, Nayef H Felemban, Yousef Althomali, Puneet Gupta
Introduction: Diagnosis and treatment planning in orthodontics determines the treatment outcome and long term stability. Cephalometric radiography is an essential diagnostic aid in orthodontics and hence numerous studies have been carried out in the past. Aim: To determine the Combination Factor (CF) through evaluation of the mean Overbite Depth Indicator (ODI) and Anteroposterior Dysplasia Indicator (APDI) values in western region of Saudi Arabian young male patients which would act as an aid in orthodontic treatment planning. Materials and Methods: A retrospective cephalometric study was conducted on 80 Saudi Arabian young male patients ranging in age from 7 to 14 years. Data collected from records derived from the University Dental Hospital. Patients (n=80) were divided into four age groups: ages 7 (n=20), 8-9 (n=20), 10-11 (n=20), and 12-14 (n=20) years. Lateral cephalometric images were hand-traced and measured by one standardised and calibrated investigator. Statistical analysis was done with significance level set at 0.05, assuming that the length of the 95% confidence interval was two. One-way analysis of variance, followed by the Tukey test used to compare the mean ODI and APDI values of different groups. The statistical data were analysed through SPSS version 24 for Windows (IBM SPSS, Chicago, IL, USA). Results: The mean ODI value was 69.2688 degrees and standard deviation 4.66670 degrees, respectively. The overall APDI mean value was 81.7063 degrees and standard deviation 4.18987 degrees, respectively. There were no significant differences in the mean ODI and APDI values among different age groups (p>0.05). Conclusion: This retrospective cephalometric study determined the CF for Western region of Saudi Arabian young male population to be 150.96 degrees. This factor can be used as a diagnostic aid for planning orthodontic treatment. When the CF, is under the norm (150.96°), the skeletal pattern tends to improve with dental extractions. A CF higher than the norm (150.96°) will maintain a better relation with a nonextraction treatment.

Effect of Anaesthesiologists’ Experience on Preferred Technique and Volume of Local Anaesthetic Administered for Brachial Plexus Nerve Block: A Retrospective Observational Analysis

Depinder Kaur, Reena Mahajan, Shiv Kumar Singh, Suchitra Malhotra
Introduction: Faculty and Residents are trained in peripheral nerve blocks guided by blind technique, Peripheral Neuro Stimulator (PNS) or Ultrasound (USG) guided technique. But due to unavailability of USG machine in all institutes and requiring special training, techniques used for peripheral nerve blocks vary from institute to institute. Aim: To analyse the effect of anaesthesiologists' experience on preferred technique and Local Anaesthetic (LA) volume used for brachial plexus nerve block retrospectively. Materials and Methods: In this retrospective observational study, 129 adults American Society of Anesthesiologists (ASA) grade I and II patients requiring brachial plexus nerve block for upper limb orthopaedic surgical anaesthesia for both elective and emergency surgery were divided into three groups for each year depending on technique for nerve block used. Group A: Received USG guided (Micromaxx Sonosite Inc, USA) brachial plexus nerve block. Group B: Received peripheral nerve stimulator (Inmed) guided brachial plexus nerve block. Group C: Received brachial plexus nerve block by traditional anatomical landmark based paraesthesia elicitation blind technique. Patients with inadequate surgical analgesia were given general anaesthesia and were categorised as failure rate. Year wise demographic data, type of technique used for giving brachial plexus nerve block, volume of drug used, failure rate, complications observed were collected and analysed by Student's t-test and Chi-square test. Results: USG guided technique was the most prefered technique in both years (57.6%, n=38 in year 2018 and 49.2%, n=31 in year 2019). In remaining nearly half of the patients PNS and blind technique was used (PNS 24.2%, n=16 in year 2018 and 20.6%, n=13 in year 2019; blind technique 18.2%, n=12 in year 2018 and 30.2%, n=19 in year 2019). Significantly, less volume of LA drug (mL) was used in group A in year 2019 (16.43±6.07) than in year 2018 (22.34±4.75) (p<0.001). Failure rate in group A in year 2019 (3.2%) was significantly less than in year 2018 (5.2%), but the difference was insignificant in all three groups. In group A, no complications were observed in year 2019 while one incidence of hemidiaphragm paralysis was observed in year 2018, while in group B and C, complications were observed in both years. Conclusion: USG guided nerve block was the most preferred technique for nerve block in the study institute. In 24 months observation period, with increasing experience with USG there was significant increase in success rate and decrease in the volume of LA administered and complications.

Epidemiological and Microbiological Study of Onychomycosis

Sunita Kabi, Bichitrananda Swain, Swati Jain
Introduction: Onychomycosis is a common fungal infection of nail. It may be caused by dermatophytes, non-dermatophytic moulds or yeasts involving nail bed, nail plate or matrix of nail. As the fungi show variable susceptibility to antifungal drugs and treatment requires long duration of antifungal therapy, so it’s prevalence as well as proper laboratory diagnosis and antifungal susceptibility testing is essential for effective therapy. Aim: To find the prevalence of onychomycosis with demography along with various aetiology and the suitable antifungal drugs used for treatment. Materials and Methods: For this prospective study, over a period of two years a total of 300 nail samples were processed in the Department of Microbiology at IMS and SUM Hospital, Bhubaneswar, Odisha, India. The wet mount for microscopic examination was prepared using 20% Potassium Hydroxide (KOH) and examined after overnight incubation. Culture was done in duplicate in Sabouraud's Dextrose Agar (SDA) tubes; one with actidione and another without it and both were incubated at 25°C in Biological Oxygen Demand (BOD) incubator. Culture tubes growing yeasts were further subjected to speciation by germ tube test, culture on Chromogenic (CHROM) agar and on cornmeal agar. In-vitro antifungal susceptibility testing was performed against Candida species using disc diffusion method on Muller Hinton agar. Chi-square test was used for statistical analysis of the results. Results: Onychomycosis can affect a wide age group though seen commonly at 31-40 years equally in both male and females. Fingernail infection was observed mostly in female cases. It was caused by Candida species (66%), moulds (24%) and dermatophytes (10%) and out of Candida sp. C.albicans was the main culprit. Although all the Candida strains were susceptible to amphotericin B, still some of them showed resistance to the commonly used antifungals like fluconazole and itraconazole. Conclusion: Candida albicans was the most common aetiological agent which contributed for onychomycosis and showed a variable resistance pattern to the commonly used antifungals. Proper laboratory diagnosis and selection of antifungal drug is essential prior to institution of therapy for successful treatment of this disease.

Clinico-Biochemical Study of the Safety and Tolerability of Selective Serotonin Reuptake Inhibitors (SSRI) with Special Reference to SSRI Induced Hyponatremia in Humans and Animals
Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are recommended as first-line anti-depressants in Major Depressive Disorder (MDD) because of their relatively benign safety profile. Hyponatremia is under reported and notorious adverse effect of SSRIs shown by few Randomised Clinical Trials (RCTs). There are only few published studies of SSRIs on serum sodium level in human and animal model. Aim: To determine SSRI induced hyponatremia in human and its correlation with age. Materials and Methods: The clinical part is a prospective cohort study whereas second part is experimental study involving animals. In clinical part-Patients of either sex, aged above 18 years, attending the Out-Patient Department (OPD) of Psychiatry of a tertiary hospital and diagnosed as MDD Diagnostic and Statistical Manual (DSM) V with the help of a senior psychiatrist, were screened and recruited in the study after satisfying the inclusion and exclusion criteria by consecutive sampling. Patients were prescribed fluoxetine (n=90), sertraline (n=55), paroxetine (n=30) and escitalopram (n=25). Parameters recorded (serum sodium) at baseline, 4th week, 8th week and 12th week. Symptoms due to hyponatremia and Adverse Drug Reactions (ADR) were also checked. Multiple group comparison at different visits for sodium level was done using one-way ANOVA and repeated measures ANOVA test and relationship of blood sodium level with age were estimated with bivariate correlation. Animal experiment was done in Pharmacology Department, animals were randomised into 5 groups control, fluoxetine, sertraline, paroxetine and escitalopram (n=6). Blood sodium checked at baseline, 2nd week and 4th week. Kruskal Wallis test and Friedman’s test done to detect changes in sodium level in follow-up period. Results: Mean age ranged between 40-50 years with equal gender distribution. Both within group and between group analysis revealed significant difference in blood sodium level (p-value< 0.0001). Hyponatremia was strongly correlated with age (correlation coefficient >-0.783). Most participants (184 out of 200) developed asymptomatic hyponatremia. Two among sertraline developed seizure leading to discontinuation to therapy. About 72 (38.09%) ADRs belonged to probable, mostly belonging to fluoxetine and sertraline group, developement of hyponatremia was 9 days (median) from starting SSRI. In animal part within group analysis revealed significant change of sodium from baseline in all drug treated animals (p-value<0.0001). Conclusion: SSRI is associated with hyponatremia and is common in elderly patients. Monitoring of serum sodium is necessary for patients on SSRI.

Mortality Rates of EUS-Guided Biliary Drainage (EUS-BD) in Malignant Biliary Obstruction Patients in EUS-BD Era versus Non-EUS-BD Era: A Retrospective Cohort Study
Introduction: Most of the Cholangiocarcinoma (CCA) patients are commonly found in an advanced stage and often presents with Malignant Biliary Obstruction (MBO). Palliative treatment using biliary drainage plays a major role in the treatment modalities. However, only a few studies with small number of subjects have reported their long term outcomes. Aim: To compare the mortality rates of MBO patients in Endoscopic Ultrasound-guided Biliary Drainage (EUS-BD) era versus non-EUS-BD era. Materials and Methods: The present study was a retrospective cohort study which enrolled 132 MBO patients who had received palliative treatment between January 2014 to August 2020 at Thabo Crown Prince Hospital, Nong Khai, Thailand. The patients were treated either with EUS-BD (group l, n=30) or non-EUS-BD (group ll, n=94). Due to imbalance of follow-up time between two groups, the Overall Survival (OS) rates were compared using parametric survival analysis with restricted mean difference at 12 months follow-up, adjusted by other covariates, and presented in term of Kaplan-Meier curve, Hazard Ratio (HR) and 95% confidence interval. Results: Most of the patients (99.19%) were having CCA. The clinical characteristics between the two groups showed no significant difference, except the mean follow-up time that group II was shorter than group I (2.43 vs. 7.12 months; p<0.001). At 12 months after treatment, the OS rate of group I remained significantly higher than group II (mean difference=2.23; 95%CI: 0.54-3.92; p=0.010). The parametric-Cox proportional hazard model showed that the 1-year mortality of patients in group I were 63% less than those in group II, the parametric model between two groups showed statistical significance with p-value=0.043. Conclusion: From present study it can be concluded that EUS-BD in MBO patients achieves lower mortality rate at one year follow-up. For conclusive findings of the benefit of EUS-BD, a prospective long term study with larger numbers of subjects should be performed.

COVID-19 Pandemic: Assessment of Stress and Perception of E-Learning amongst First Year Undergraduate Medical Students

Shikha Gautam, Salamah Parveen Imteyaz, Mohammed Iqbal Alam
Introduction: The coronavirus pandemic has involved nearly all the countries of the world. The lockdowns and closure of educational institutes to reduce the risk of disease transmission has brought a change in the medium of teaching as most educational institutes have moved to the online mode. There is a widespread increase in stress as the number of cases and mortality associated with Coronavirus 2019 disease (COVID-19) continue each day. Aim: To assess the stress status of first year undergraduate medical students in reference to the coronavirus pandemic and the perception of first year undergraduate medical students in reference to the E-learning being carried out during the coronavirus pandemic. Materials and Methods: This was a cross-sectional web-based online survey that was conducted using a questionnaire in August 2020 at Hamdard Institute of Medical Sciences and Research, New Delhi, India. The questionnaire was prepared and reviewed by the involved faculty members of the project and it was approved by a faculty from Department of Psychiatry. Reliability of questionnaire was measured using Cronbach’s alpha (0.89). A questionnaire with 20 questions was administered via Google forms to all 100 students of first year MBBS course. Some of the questions in the questionnaire were framed to assess the stress status of the students; some were designed to study students’ perception of E-learning. Data was represented as the percentage distribution of response for each question. Results: Ninety five responses were received, after accounting for exclusion factors; data was compiled for 91 respondents. Out of the 91 participants in the study, 48.4% were males (n=44) and 51.6% were females (n=47). Most of the students in this study (84.6%) felt that online teaching had helped in learning Physiology theory; around 43% students found online practical teaching useful. Around 39% students have reported internet connectivity issues all the time while 59% faced problem sometimes. Total 51.6% of students had difficulty in accessibility to devices. Due to coronavirus pandemic, 37.4% of students have reported to be under stress. Around 33% reported feeling unsafe all the time while 39.5% felt unsafe some of the times. Conclusion: Students found online teaching more helpful in learning Physiology theory than practical. Majority of class reported internet connectivity issues. All the responders agreed that this pandemic affected their regular life. Most of the students felt that online classes have helped them to remain positive and motivated towards study.

Prevalence of Dental Caries and Periodontal Diseases among Secondary School Students in Duhok, Kurdistan Region, Iraq

Nasreen Hamarash Hamonari, Samim Ahmed AL Dabbagh, Anees Mahmood Mudhir
Introduction: A healthy oral cavity is a vital state for a healthy living, which can be influenced by oral cavity diseases such as dental caries and periodontal disease. Dental caries and periodontal disorders are the major oral health problems and indicators of the oral health burden worldwide. Aim: The study aimed to evaluate the prevalence of dental caries and periodontal diseases among secondary school students and their association with socio-demographic factors in Duhok, Kurdistan Region, Iraq. Materials and Methods: A cross-sectional study was conducted on a randomly selected sample of 809 high school students (395 females and 414 males) aged 14-20 years from eight secondary schools using multistage random sampling in four quarters of Duhok city from December 2018 to May 2019. The dental caries status was assessed by the Decayed, Missing, and Filled Teeth (DMFT) Index and periodontal status was assessed by using the Gingival Index (GI) and Plaque Index (PI). Results: The prevalence of dental caries was significantly higher (p=0.002) among males (93.5%) in comparison to females (86.8%). Also, the DMFT ≥5 among males (62.6%) was significantly higher than that (40.8%) among females (p<0.001). No significant association was detected between DMFT ≥5 and the socio-economic status (p=0.090). Likewise, the prevalence of moderate to severe gingivitis was significantly higher among males (63.5%) than females (55.2%) (p=0.016). However, the prevalence of moderate to severe gingivitis was higher among those living in low socio-economic quarters (63%) compared with those living in high socio-economic quarters (56.2%) of Duhok city (p=0.049). Conclusion: The results of this study provide evidence of a high prevalence of caries and periodontal diseases among secondary school students aged 14-20 years in Duhok city. Mean caries and gingival indices were significantly higher in males in comparison to females.

Behavioural Changes in the Personal and Professional Lives of Doctors during COVID-19 Pandemic: A Cross-sectional Observational Study

Vivek Parasher, Kamlesh Kanwar Shekhawat, Sonal Bhati, Mansi Sharma
Introduction: During the Corona Virus Disease (COVID-19) pandemic, Health Care Workers (HCWs) have experienced an unexpected increase in workload which leads to feelings of uncertainty, anxiety, and isolation. Furthermore, they are more vulnerable to contract the infection and transmit it to their family and colleagues. Aim: To evaluate the effect of COVID-19 pandemic on doctors life in term of personal and professional changes. Materials and Methods: The present observational, cross-sectional study was conducted on doctors in various institutes of Udaipur, Rajasthan, India. The study comprised an online questionnaire survey which consisted of three parts; the first part constituted demographic data, the second one constituted questions on the personal life status and changes, and the third part constituted questions regarding the professional life and some miscellaneous questions gauging the doctor's knowledge of the current scenario. The collected data were entered in a Microsoft excel sheet, and the results were calculated. Results: Most of the participants were between 25-34 years (47.8%) and male (71%). A majority of the doctors had a family with children (44.2%) and a spouse who was a HCW too (59.8%). A majority of the practitioners worked with patients with coronavirus (52.3%) and thus felt worried about their family members (93.3%). Although most participants knew about telemedicine (89.3%), most of the practitioners did not practice it (76.8%). Conclusion: Although HCWs do not face harassment, they suffer anxiety regarding contracting COVID-19 themselves and transmitting it to their family members.

Radiological Red Flags of Triple Negative Breast Cancer on Mammography and Ultrasonography: A Case-control Study
Introduction: Breast cancer is the most common cause of cancer related mortality in Indian women. Aim: To evaluate the imaging characters of Triple Negative Breast Cancer (TNBC) on Mammography and Ultrasonography (USG), with the major goal of identifying imaging predictors of TNBC. Materials and Methods: The present retrospective case-control study was conducted at AIIMS, Rishikesh, Uttarakhand, India, over a period of one year from September 2018 to August 2019. The imaging findings of 50 cases of histopathologically proven TNBC were retrospectively evaluated by two breast radiologists. This was compared with 50 age matched blindly chosen cases of non-TNBC. The statistically significant imaging characters of TNBC were identified by Chi-square test. The imaging predictors of TNBC were identified by regression analysis. Results: The most common mammographic presentation of TNBC was mass without calcification (64%) with round/oval shape (54%) and lobulated margins (38%). The most common ultrasonographic presentation was hypoechoic mass (76%) with round/oval shape (52%) and lobulated margins (44%) with Posterior Acoustic Enhancement (PAE) (54%). PAE (p<0.0001: Area Under Curve (AUC): 0.6200) on USG was the single strongest imaging predictor of TNBC, followed by lobulated margins on mammography (p<0.001: AUC: 0.6300). On multivariate analysis, a lobulated, hypoechoic mass with PAE was found to be the most statistically confident predictor of TNBC on imaging. Conclusion: TNBC has specific imaging features on both mammography and USG which may be used as utility tools in early diagnosis. A round, lobulated mass on both modalities with hypoechogenicity and PAE on USG are definite red flags for TNBC on imaging.

A Structured Maternity Case Record to Improve Quality of Documentation in a Tertiary Care Hospital, Delhi

AG Radhika, Chetna Dengri, Abhishek Kumar, Shalini Singh
Introduction: India contributes to about 18% of global maternal deaths and 22.6% of still births. Efforts to improve the quality of care are challenged by the lack of reliable documentation of data. Hence, a concise, structured maternity case sheet (PrasavRecord) was designed with the aim to bring about an improvement in documentation of treatment and events related to woman in labour from the time of admission till her discharge from the hospital. Aim: To study the improvement in quality of documentation from the time of admission till discharge of a woman in labour with the help of structured format i.e., PrasavRecord. Materials and Methods: The study was conducted in February 2017. A quasi experimental study design was used, and the completeness of data recorded by the resident doctors in the existing hospital case sheet (control group) with those recorded in PrasavRecord (intervention group) were assessed in a total of 65 deliveries in each arm. Details of the patient from admission to the labour room followed by the entire sequence of events during labour as well as hospital stay in postpartum period were recorded over 130 parameters under different sections in PrasavRecord. Statistical analysis was done by using SPSS version 21.0. Results: Completeness of the documentation in terms of history, investigations and findings at examination including those at labour, nearly, 92% of the doctors rated PrasavRecord as “good and very good” for appearance, recommended its routine use, and 75% agreed that the format will be useful for conversion to electronic medical record. There was highly significant difference between the average percentage of completeness in PrasavRecord 75.8 {95% CI (74.2-77.4)} and hospital case sheets 42.2 {95% CI (40.9-43.6)} i.e., z=5.38 p-value <0.001. Conclusion: PrasavRecord is a simple, acceptable and user-friendly data entry format which improves the quality of documentation of the processes and practices during childbirth. Larger trials are required to finetune it to facilitate its widespread use thereby, ensuring a uniform documentation process of labour and postpartum.

Prevalence and Susceptibility Profiles of Methicillin Sensitive Staphylococcus aureus from Community and Hospital Associated Infections

Preeja, Sanath Kumar, Veena A Shetty
Introduction: Methicillin Sensitive Staphylococcus aureus (MSSA) is a significant human pathogen, involved in both hospital and community associated settings. MSSA, being more susceptible to antibiotics compared to Methicillin Resistant >Staphylococcus aureus (MRSA), is found to acquire Multidrug Resistance (MDR) and with the presence of virulence factors can pose difficulty in patient treatment. <Aim: To study the prevalence and antibiotic resistance profile of MSSA from community and hospital associated infections. Materials and Methods: The present cross-sectional study was conducted in tertiary care hospital in Mangalore, Karnataka, India from January 2015 to February 2017. Three hundred and five Staphylococcus aureus were isolated from various clinical specimens and tested for methicillin susceptibility using cefoxitin disc. Antibiotic resistance profiles against 23 antibiotics were determined by disc diffusion method. The difference was compared for antibiotic sensitivity with respect to Community Associated Methicillin Sensitive Staphylococcus aureus (CA-MSSA) and Hospital Associated Methicillin Sensitive Staphylococcus aureus (HA-MSSA) and Chi-square test was used for statistical analysis. Results: Of 305 MSSA isolated, 219 (71.8%) were CA-MSSA and 86 (28.2%) were HA-MSSA. S. aureus was isolated mostly from Skin and Soft Tissue Infections (SSTI, 61.3%). Resistance was observed against ciprofloxacin (64.6%), erythromycin (43.9%), ofloxacin (42.3%), clindamycin (20.7%), ampicillin (100%) and penicillin (90.5%). There was a significant difference (p<0.05) between the resistance of CA-MSSA and HA-MSSA against cefotaxime and co-trimoxazole. Conclusion: The present study showed the increasing prevalence of MSSA in the community and hospital settings with the emergence of MDR which has to be dealt immediately with appropriate control measures.

Prevalence of Seropositivity to SARS-CoV-2 among Health Care Workers in Tertiary COVID-19 Hospital, Ahmedabad, Gujarat

Jemil S Makadia, Mukesh G Gohel, Chandan Chakrabarti, Jayshree D Pethani
Introduction: Healthcare Workers (HCW) are at increased risk of Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) infection due to occupational exposure to infected patients and contaminated surfaces. Aim: To determine the prevalence of seropositivity against SARS-CoV-2 among HCW in a tertiary COVID-19 designated hospital in Ahmedabad, Gujarat. Materials and Methods: This cross-sectional study was conducted between 1st July to 31st July, 2020 on 1333 HCWs. HCWs included doctors, nurses, lab personnel, general service assistants and ancillary staff who work in hospital. Anti SARSCoV-2 total antibodies were measured in serum sample by chemiluminescent technique. Results: Prevalence of seropositivity was found in 27.76% (370 out of 1333). It was highest among general service assistant 34.76% (especially among house keeping staff, 43.44%) and lowest among doctors (19.33%). The percentage of seropositivity among asymptomatic HCWs was 24.84%. Conclusion: The percentage of seropositivity among asymptomatic HCWs indicates that a large amount of infection passes asymptomatically. The discrepancy between various job categories might be due to differential occupational exposure and risk, lack of awareness and seriousness regarding transmission and risk of getting infection, various demographic factors like literacy, residential environment, community prevalence etc.

Quantification of Musculoskeletal Discomfort among Automobile Garage Workers: A Cross-sectional Analytical Study in Chetla, Kolkata, West Bengal
Introduction: The automobile industry is a large and growing industry in India and this industry employs many workers as manufacturers, distributors, retailers, and automobile garage workers. Automobile garage workers suffer from many health problems among which Musculoskeletal Discomfort (MSD) is very common. Aim: To find the proportion of MSD among automobile garage workers in Chetla, Kolkata and to describe the factors associated with the musculoskeletal discomfort. Materials and Methods: The study was a work place based, observational study with cross-sectional design. The study was conducted among 101 automobile garage workers at nine automobile garages of Chetla, Kolkata. A pre-designed, pre-tested structured schedule was used to collect data. The outcome variable was MSD and it was assessed using Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). MSD score was categorised into mild, moderate and severe discomfort. Data was analysed using IBM SPSS Software version 16. Results: Around one-third (30.7%) study participants belonged to the age group 41-50 years with mean (SD) age 43.35 (13.46) years. Knee discomfort was present among 42% study participants while 21% had low back pain according to CMDQ tool. Around three fourth (73.3%) study participants had at least one kind of MSD and around 46.6% had moderate to severe musculoskeletal discomfort. MSD was significantly associated with increasing age and increasing duration of working hours per week in univariate and multivariable logistic regression. Conclusion: The proportion of musculoskeletal discomfort among automobile workers was quite high. Early diagnosis and regular screening of MSD is very much needed to introduce appropriate preventive and treatment measures at appropriate time.

Effect of Bleaching with Strawberry Extract and Hydrogen Peroxide on Colour Change, Surface Morphology and Micro-Shear Bond Strength of Resin Composite to Enamel Surface

Rajith Radhakrishnan, Ravikumar Nesamani, Kavitha Sanjeev, Mahalaxmi Sekar
Introduction: The search to replace the chemical bleaching agent namely the Hydrogen Peroxide (HP) with a natural substance to whiten the discoloured tooth is a need of the hour, due to the severe roughing and compromised bonding of resin composite to enamel surface by this agent. Aim: To evaluate and compare the colour and surface changes in enamel surface, and the micro-shear bond strength of resin composite to enamel following bleaching with 35% HP and 2% Strawberry Extract (SE). Materials and Methods: In this in-vitro study, 30 bovine maxillary central incisors were decoronated and allocated randomly to two groups: group 1 (negative control) (n=15) and group 2 (experimental) (n=15). To evaluate the bleaching efficacy, group 2 specimens were experimentally stained with tea. Baseline colour coordinates (pre-bleach values) (L*, a*, b*) (∆E) were recorded. The crowns were sectioned to obtain four equal parts to obtain 60 specimens and these were allotted randomly to 4 subgroups a, b, c, d (n=15 each) based on the bleaching protocol. Subgroup a, Hydrogen Peroxide (HP). subgroup b, Strawberry Extract (SE); subgroup c, HP+SE (HPS); subgroup d, HP/P (HP/ Proanthocyanidin). Following bleaching, colour coordinates (post-bleach values) (L*, a*, b*) (∆E) were measured as mentioned before. Qualitative analysis of the surface (n=2) for each group was performed using scanning electron microscopy. Micro-shear bond strength of resin composite to the treated specimens (n=13) was determined using universal testing machine at a crosshead speed of 1 mm/min. Kruskal-Wallis one-way Analysis of Variance (ANOVA) was used to calculate the p-value and Post-Hoc Tukey Honest significant Test (HSD) was used to identify the significant groups, p-value (<0.05). Results: All the post-bleach specimens showed significantly higher mean ∆E (more whiter) values compared to their respective pre-bleach specimens (baseline values) (p-value -<0.05). Among the post-bleach groups, highest ∆E values (more whiter) were observed in subgroup 2c (HPS) (p-value=0.029). Similarly minimal morphological surface irregularities were observed in HPS. Group 1 (negative control) had the highest micro-shear bond strength compared to the experimental groups (group 2). Significantly, higher micro-shear bond strength was observed in subgroups 2b,c,d (SE, HPS, HPP) compared to subgroup 2a (HP) (p-value <0.001). Conclusion: SE alone or in combination with HP is an efficient and effective dental bleaching agent.

Changes in Inspiratory and Expiratory Flow Rates with Sustained Hand Grip and their Correlation with Fat Free Mass Index in Healthy Young Adults

Aparajita Priyadarshini, Snigdha Prava Mishra, Akshaya Kumar Mishra
Introduction: Aerobic exercises which are isotonic in nature have been proved to be beneficial in a number of cardiovascular and lifestyle diseases. But the effect of isometric exercises on cardiovascular and respiratory system is not fully evaluated. Existing literature on effect of isometric exercise on respiratory flow parameters are scanty and needs to be studied. Further, the impact of muscle mass on respiratory flow parameters need to be evaluated. Aim: To investigate the change in respiratory flow parameters (Peak Inspiratory Flow (PIF), Maximal Inspiratory Flow (MIF) 50, Peak Expiratory Flow (PEF), Maximum Expiratory Flow (MEF) 25-75, MEF 25, MEF 50 and MEF 75) in response to Sustained hand grip exercise and to find out any correlation between these flow parameters and Fat Free Mass Index (FFMI). Materials and Methods: A cross-sectional study was conducted at Department of Physiology, MKCG Medical College, Berhampur University, Odisha between October 2011 and August 2014. A total of 150 healthy volunteers aged between 17 to 25 years were included in the study. Anthropometric measurements were recorded using standardised instruments. Body fat percentage was measured by Bioelectric Impedance Analysis technique and then Fat Free Mass (FFM) and FFMI were calculated using standard formulae. Respiratory Flow parameters were assessed using Flow handy Spirometer as per the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. Sustained hand grip exercise was performed with Physilab Grip Dynamometer. IBM SPSS Statistics Version 24.0, was used for statistical analysis. Paired sample t-test was used to compare lung volumes at baseline and after 3 minutes of sustained hand grip exercise. The p-value <0.05 was considered statistically significant. Karl Pearson Correlation coefficient was used to study the linear relationship between FFMI and various inspiratory and expiratory flow rates. Results: The mean values of all respiratory flow parameters under study decreased at 3 minutes of sustained hand grip exercise as compared to baseline values. This change was statistically significant for PEF (p-value 0.012), MEF 25-75 (p-value 0.041), MEF 50 (p-value 0.001), MEF 75 (p-value 0.012) and MIF50 (p-value 0.004) (p<0.05). All the flow rates studied except MEF 25 showed significant positive correlation with FFMI (r-values between 0.231 to 0.380, p<0.05) but the strength of association was low. Conclusion: There was a statistically significant reduction in both inspiratory and expiratory flow parameters with isometric sustained hand grip exercise. So, isometric exercises should be avoided in patients with obstructive airway diseases. But muscle mass should be improved for better ventilation as authors observed a positive correlation between FFMI and respiratory flow rates.

Comparison of MGIT 960 with Lowenstein Jensen Media for Recovery of Mycobacteria from Extrapulmonary Specimens in Southern India
Introduction: Prevalence of Extrapulmonary Tuberculosis (EPTB) due to Mycobacterium tuberculosis and Non-Tuberculous Mycobacteria (NTM) are on the rise especially in a developing country like India. Smear Microscopy (SM) is commonly used for detection of mycobacteria. Due to the paucibacillary nature in the extrapulmonary specimens SM pose a problem in detection. Though molecular methods are increasingly used now-a-days but there are possibilities that these reactions may get inhibited due to the presence of inhibitors in the extrapulmonary specimens. Aim: To compare Mycobacterium Growth Indicator Tubes (MGIT 960) with Lowenstein Jensen (LJ) medium for the detection of mycobacteria. Materials and Methods: The current prospective study was conducted on 1879 extrapulmonary specimens collected from a tertiary care hospital during the study period from July 2018 to March 2020. Specimens were subjected to Ziehl Neelsen (ZN) staining and Auramine Phenol (AP) staining. Culture was done in both LJ media and MGIT 960 culture. Positive mycobacterial cultures were subjected to MPT64 Immunochromatographic Test (ICT). Data were analysed using the Statistical Package for Social Sciences (SPSS®) for Windows® release 21.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 129 (6.9%) and 105 (5.6%) mycobacteria was isolated by MGIT 960 and by LJ culture respectively among 1879 extrapulmonary specimens. MGIT 960 identified 118 (91.5%) as Mycobacterium tuberculosis complex and 11 (8.5%) as NTM among the total mycobacteria isolated. Out of 105 mycobacteria grown by LJ culture, 95 (90.5%) and 10 (9.5%) were identified as Mycobacterium tuberculosis and NTM, respectively. The rate of contamination associated with MGIT 960 and LJ culture was 4.6% and 4.3% respectively. The Time to Detection (TTD) was found to be significantly shorter for isolation of Mycobacterium tuberculosis by MGIT 960 culture compared to LJ culture. Conclusion: In the current study, authors compared MGIT 960 with solid LJ culture for recovery of both Mycobacterium tuberculosis Complex and NTM from extrapulmonary specimens and authors found increased recovery by MGIT 960 compared to LJ culture and also shorter duration of detection for Mycobacterium tuberculosis by MGIT 960 with comparable contamination rates.

Demystifying Breast FNAC's Based on the International Academy of Cytology, Yokohama Breast Cytopathology System- A Retrospective Study
Introduction: Breast cancer affects 2.1 million women each year and is the most common cancer among females, followed by lung, colorectum, uterus, and cervix. Breast cancer accounted for 6,26,679 (6.6%) deaths in 2018. Breast cancer incidence is on the rise in every part of the globe, including developed countries. Fine Needle Aspiration Cytology (FNAC) shows high sensitivity, specificity, and accuracy in evaluation of breast lesions. FNAC is part of the triple test and is the gold standard for assessment. The new reporting system for breast FNAC, proposed by the International Academy of Cytology (IAC) Yokohama Breast Cytopathology System, has standardised the reporting system to categorise breast lesions and as unmasked the diagnostic dilemma faced by reporting cytopathologist. Aim: The study aimed to categorise the samples according to IAC Yokohama Breast Cytopathology System and assess the Risk of Malignancy (ROM) for each category and increase the diagnostic yield of breast FNAC. Materials and Methods: A retrospective cohort study included 1,467 breast FNAC cases, which were retrieved and reclassified based on the newly proposed IAC Yokohama System into five categories during January 2017-December 2018 in Kidwai Memorial Institute of Oncology (KMIO), Bangalore. Histopathology correlation was done, and the Risk of Malignancy (ROM) was assessed whenever possible. The study results were analysed using Microsoft excel 2007, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy ratios were calculated using the MedCalc diagnostic test evaluation calculator, keeping histologic diagnosis as the gold standard. Results: Re-categorisation of 1,467 cases was done according to the Yokohama breast cytopathology system as insufficient material, benign, atypical, suspicious for malignancy, and malignant. The histopathology diagnosis was available in 1,069 cases. The respective ROM for each category was, 7.6% for category 1 (Insufficient), 15.26% for category 2 (Benign), 65.38% for category 3 (Atypical), 83.33% for category 4 (Suspicious) and 99.18% for category 5 (Malignant). Considering malignant cases as positive, sensitivity-86.75%, specificity-97.32%, PPV-99.19%, NPV-66.06% and accuracy of 88.96% was deduced. Conclusion: It is recommended to incorporate the IAC Yokohama system to categorise breast cytopathology with uniform terminologies. This will help diagnose breast lesions more consistently and accurately, which in turn helps the clinician manage the disease and predict the ROM and the patient outcome.

Exposure of 4-Nonylphenol: Effect on Physiology and Reproductivity of Male Mice

Kusum Kusum, Ashish Ashish, Royana Singh, Radha Chaube
Introduction: The number and accumulation of hazardous chemicals are increasing gradually in the environment. These chemicals directly or indirectly affect the human health, and now-a-day’s these mostly include Endocrine-Disrupting Chemicals (EDCs). These EDC’s interfere with the normal hormonal signaling, leading to reproductive or physiological imbalance causing different diseases. Studies suggest that in these EDCs, 4-Nonylphenol (4-NP) is most commonly used after industrialisation and it is hazardous for all of us. But the complete or detailed studies regarding its effects on reproduction and physiology, mode of action, pathway followed and other related causative factors are yet to be studied. Aim: To examine the multigenerational effects of environmental EDC 4-NP on reproductive, histological and hormonal fitness of male mice exposed for 21 days. Materials and Methods: Male mice were given oral doses 21.25 and 85.0 mg/kg Body Weight (BW) of 4-NP for 21 days. After 21 days BW, organ weight, sperm viability tests were done to analyse the difference with respect to control group. Further histopathological [via Haematoxylin-Eosin (H&E), Periodic Acid Schiff (PAS) stain and Immunohistochemistry (IHC) techniques]and stress parameters (Superoxide Dismutase (SOD) and Lipid Peroxidation (LPO)) examinations were done in different organ tissue samples for detailed study. Results: The results showed that in male mice, 4-NP had a significant negative effect on the weight of its body organs. It further has an adverse effect on spermatogenesis and sperm quality with a resultant impact on male mice fertility with hormonal imbalance. Histopathological examination of the liver and testes biopsy samples illustrates that exposure to 4-NP at high doses induces occurrence of anomalies. 4-NP also causes decrease in SOD and increase in LPO, a parameter for increasing toxicity in the organs. Conclusion: Exposure to 4-NP induces reproductive and physiological toxic effects on male mice by causing hormonal imbalance.

A Cross-sectional Study of Antipsychotic Drugs Induced Sexual Dysfunction among Married Males with Remitted Schizophrenia Attending Tertiary Health Care Centre from Central India
Introduction: Schizophrenia is a chronic debilitating disease having a major impact on the sufferers’ lives. Antipsychotic drugs are the mainstay of the treatment of schizophrenia. But, antipsychotics can lead to a variety of sexual dysfunctions among the males with schizophrenia, which may affect their treatment compliance. Aim: To assess the prevalence and the types of sexual dysfunctions among married males with remitted schizophrenia who were on a single oral antipsychotic drug from either class (i.e., typical or atypical type). Materials and Methods: The present cross-sectional study was conducted in a tertiary health-care centre from Central India, with a sample size of 100 married males with schizophrenia who were in the remission phase on a single oral antipsychotic drug. Data were collected by using a convenient sampling method. Socio-demographic profile and clinical variables were recorded in a specific case report form prepared for the study using the Arizona Sexual Experiences (ASEX) scale and the Udvalg for Kliniske Undersogelser (UKU) side-effect rating scale to assess the prevalence and the types of oral antipsychotic drugs induced sexual dysfunctions among study participants. Results: The prevalence of antipsychotic drug induced sexual dysfunction was 54%. The most common type of sexual sideeffect of oral antipsychotic treatment was Decreased Sexual Desire/Drive (DSD) as assessed by both ASEX (94.4%) and UKU (63.0%) scales. Sexual dysfunctions like DSD and Ejaculatory Dysfunction (EJD) were associated with the treatment of schizophrenia with typical antipsychotic drugs. Conclusion: The present study shows that the treatment with typical antipsychotics was significantly associated with sexual side-effects. So, routine inquiry during the follow-ups should be done regarding the evaluation of sexual side-effects of antipsychotic agents in order to improve treatment compliance and disease prognosis.

Role of HRCT Chest and Artificial Intelligence in Evaluation of COVID-19 Patients: An Observational Study
Introduction: An early diagnosis of Coronavirus Disease (COVID-19) is of utmost importance, so that patients can be isolated and treated in time, eventually preventing spread of the disease, improving the prognosis and reducing the mortality. High Resolution Computed Tomography (HRCT) chest imaging and Artificial Intelligence (AI) driven analysis of HRCT chest images can play a vital role in management of COVID-19 patients. Aim: To explore the various HRCT chest findings in different phases of COVID-19 pneumonia and to assess the potential role of AI in quantitative assessment of lung parenchymal involvement in COVID-19 pneumonia. Materials and Methods: The present retrospective observational study which was conducted between 1st May 2020 to 13th August 2020. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) positive 2169 COVID-19 patients who underwent HRCT chest were included in the study. Presence and distribution of lesions like: Ground Glass Opacity (GGO), consolidation and any specific patterns like septal thickening, reverse halo, sign, etc., were noted in the HRCT images. HRCT chest findings in different phases of disease (Early: <5 days, Intermediate: 6-10 days and Late phase: >10 days) were assessed. CT Severity Score (CTSS) was calculated based on the extent of lung involvement on HRCT, which was then correlated with the clinical severity of the disease. Artificial Intelligence powered "CT Pneumonia analysis" algorithm was used to quantify the extent of involvement of lungs by calculating Percentage of Opacity (PO) and Percentage of High Opacity (PHO) in lungs. Tests of statistical significance, like Chi-square, Analysis of Variance (ANOVA) and Post-hoc tests were applied depending on the type of variables, wherever applicable. Results: Radiological findings were seen in HRCT chest of 1438 patients. Typical pattern of COVID-19 pneumonia, i.e., bilateral, peripherally located GGO with or without consolidation was seen in 846 patients. About 294 asymptomatic patients were found to be radiologically positive. HRCT chest in the early phase of disease mostly showed GGO. Features like increased reticulation, predominance of consolidation, presence of fibrous stripes indicated late phase. About 91.3% of cases having CTSS ≤7 were asymptomatic or clinically mild whereas, 81.2% cases having score ≥15 were clinically severe. The mean PO and PHO (30.1±28.0 and 8.4±10.4, respectively) were remarkably higher in clinically severe category. Conclusion: Progression of COVID-19 pneumonia is rapid, so radiologists and clinicians need to get familiarised with the typical CT chest findings, hence patients can be treated on time, eventually improving the prognosis and reducing the mortality. Artificial Intelligence has the potential to be a valuable tool in management of COVID-19 patients.

Prevalence of Dry Eye Disease in Medical Students in a Tertiary Care Hospital: A Cross-sectional Study

Rajni Sethia, Samiksha Modi, Aarushi Shah, Jay Mehta
Introduction: Dry eyes is a chronic disorder affecting the ocular surface causing tear film instability, visual problems, redness and a feeling of irritation in the eye. It is an emerging preventable health hazard among the young individuals. Aim: To find the prevalence and risk factors of Dry Eye Disease (DED) in the medical field amongst the postgraduates in a tertiary care hospital. Materials and Methods: The present study was a cross-sectional observational study. All participants were assessed on a number of variables, which included duration of residency, smoking, use of cosmetics, screen time and distance of screen from eyes. The present study enrolled 132 students (264 eyes), out of which 66 students were (132 eyes) from surgical field and 66 students were (132 eyes) were from non-surgical field. They were examined for a panel of tests for DED, i.e., Schirmer Test, Tear Break Up Time (TBUT) Test, Meibomian Gland Dysfunction (MGD) grading and Conjunctival Staining. Statistical Package for the Social Sciences (SPSS) v20 was used for statistical analysis. All the qualitative data were analysed by using Chi-square test. Results: Overall prevalence of DED was 56.81% in the medical field amongst residents. Based on the results of all the conventional test performed, most of the residents belonged to the mild category followed by moderate and least in the severe category. Based on TBUT, prevalence of DED was more in surgical (62.67%) compared to non-surgical (37.33%) residents with an Odds Ratio (OR) of 3.35, p-value <0.0001 and risk ratio of 1.67. Residents who spend more screen time (>4 hours/day) and use screen at a distance more than arm-forearm length have more prevalence of DED (p-value of 0.001 and 0.002, respectively). Conclusion: Overall prevalence of DED was 56.81% in the medical field amongst residents. It is concluded that surgeons have a 3.35 chance greater than non-surgical residents for development of DED. Early diagnosis and curbing the modifiable risk factors can reduce the burden of DED and improve the quality of life.

Diagnostic Value of Circulating MicroRNAs for Middle Aged Coronary Artery Disease Patients: A Case-control Study
Introduction: Coronary Artery Disease (CAD) remains a major problem worldwide. New and useful biomarkers for early diagnosis are necessary. MicroRNAs (miR) are short, non-coding RNAs that post transcriptionally regulate gene expression through degradation and translational repression of mRNAs. Aim: The current case-control study was designed to assess strength and relevance of diagnostic miR-126, 122 and Vascular Endothelial Growth Factor (VEGF) level in the diagnoses of angiographically proven CAD cases. Materials and Methods: Circulating levels of miR-126 and miR122 and VEGF levels were measured in serum from 100 middle aged 46-58 years patients with CAD and 100 patients without CAD through quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Results: Circulating miR-122 level was significantly higher in CAD cases compared to control (1.60±1.06 and 0.93±0.43, p=0.001), however miR-126 was significantly lowered in CAD cases compared to control (0.82±0.51 and 1.01±0.47, p=0.02). Circulating VEGF level was significantly higher in CAD cases compared to control (182.97±156.49 and 105.49±103.88, p=0.02). Circulating miR-122, 126 and VEGF level did not show any association with demographic and clinical parameters. Area Under the Curve (AUC) for circulating miR-122, 126 and VEGF were 0.700, 0.644 and 0.649 with sensitivity and specificity of 66.67%, 56.41%, 61.18% and 70%, 60% and 64%, respectively. The combined diagnostic efficacy of miR-122 and 126 showed higher sensitivity and specificity. Conclusion: Circulating miR-122 and 126 might be novel, noninvasive biomarkers for early diagnosis of CAD. Further exposition of the role of miR-122, 126 and VEGF in the progression of CAD will add to the understanding of the disease process leading to a new diagnostic approach. However, further studies on larger patient cohorts are required to validate the findings.

Oestrogen Receptor Alpha, Beta Genes and CYP17A Gene Polymorphism Analysis in Women with Uterine Leiomyoma

Ravindra Goswami, Sukanya Gangopadhyay, Bhaskar Charana Kabi
Introduction: Uterine Leiomyoma is a highly morbid condition with an increasing incidence in the Asian Indian ethnicity. The pathogenesis is multifactorial and not clearly delineated, making non-surgical treatment of limited success, thus making surgical intervention prevalent. Derangement of endocrinological parameters is the most evident aspect and cause of this condition. But the root genetic cause of this hormonal imbalance has seldom been explored in Indian women suffering from uterine leiomyoma. Aim: To explore the association of Single Nucleotide Polymorphism (SNPs) rs3020449, rs4986938 and rs743572 of ER alpha, ER beta and CYP17 genes respectively in women having uterine fibroid visiting a Tertiary Care Hospital in North India. Materials and Methods: Hundred patients diagnosed with uterine leiomyoma were selected from Gynaecology Out Patient Department (OPD) of a Tertiary Care Hospital in North India and equal age matched healthy women were taken as controls randomly, with a condition that they have no close blood relative with uterine leiomyoma. The blood was collected for DNA extraction and RFLP based polymorphism detection. Bands were visualised in agarose gel for Estrogen Receptor alpha (ER alpha), ER beta and CYP17 genes. Statistical analysis was performed using Graph Pad Prism 6.0. Hardy Weinberg equilibrium was tested using Chi-square goodness of fit test. Nominal variables were analysed using Fisher-exact test. Data is presented as Mean±SEM and p-value of <0.05 was considered significant. Results: Early age at menarche (cases vs control 11.51±0.19 year vs 12.04±0.12, p=0.03) and less number of previous pregnancies (cases vs control 1.06±0.09 vs 1.41±0.12, p=0.01), which are known risk factors for the uterine fibroids, was reconfirmed in this study. The genotype distribution of all subjects studied in above genes followed Hardy Weinberg equilibrium and there was no significant difference in genotype frequencies between cases and controls [ER alpha rs9322331 C allele (cases vs controls; 62% vs 64%), T allele (38% vs 36%); ER beta rs4986938 G allele (64% vs 59%), A allele (36% vs 41%); CYP17 rs743572 T allele (44.95% vs 46.53%), C allele (55.05% vs 53.47%) p-value not significant in any]. However, there was an increased propensity of TC genotype of CYP17 rs743572 towards obesity (p<0.05). Conclusion: The allelic frequencies of all the three SNPs were similar in cases and controls indicating that they do not affect susceptibility to disease. However, the association of TC allele of CYP17 SNP with higher BMI needs further analysis.

Bronchodilator Response in Airflow Obstruction after Treatment of Pulmonary Tuberculosis- A Retrospective Analysis
Introduction: Pulmonary Tuberculosis (PTB) is a risk factor for the development of Obstructive Ventilatory Disorder (OVD). Evaluation of the response to the bronchodilator in patients with OVD, as the exclusive consequence of the PTB sequel, has not been studied. Aim: To evaluate response of Bronchodilators (BD) in patients treated for PTB with airflow obstruction and without any previous pulmonary diseases or smoking history. Materials and Methods: A retrospective analysis of data (n=60) was done from February 2014 to February 2015, from a previous multicentric study that used 378 participants. There were data of 60 patients without any previous pulmonary diseases, smoking history, and with OVD or OVD with reduced Forced Vital Capacity (FVC). The participants performed spirometry under BD. The BD response was considered positive when an increase in Forced Expiratory Volume in the first second (FEV1) and/or FVC ≥12% was observed (as a percentage of change from baseline) and ≥200 mL (in absolute values) after administering salbutamol. To verify association between variables and response to BD, the Fisher-Exact Test was performed (p≤0.05 were considered statistically significant). The variables were analysed using SPSS version 22.0. Results: Of the 59/60 patients that underwent spirometry before and after the use of BD, 13/59 (22.03%) presented a positive response. Among those, 7/59 (11.87%) had FEV1 response, 5/59 (8.47%) FVC response and 1/59 (1.69%) presented a simultaneous response in FEV1 and FVC. Association between socio-demographic, clinical and radiological variables and BD response were not significant. Conclusion: The response to BD was observed in a quarter of patients with OVD,

From Knowledge to Practice: Are we Prepared to Handle COVID-19 Pandemic? A Health Centre Based Cross-sectional Study

Surinderpal Singh, Anurag Chaudhary, Mahesh Satija, Pranjl Sharma
Introduction: Knowledge is the beginning of prevention, and transformation of knowledge into preventive practices. Knowledge, attitude and practice surveys among populations provide useful information about community behaviour in prevention and control of infectious diseases like Coronavirus Disease 2019 (COVID-19). Aim: To assess the knowledge, perceptions and practices of patients about COVID-19 visiting Outpatient Department (OPD) of a health training centre during lockdown period. Materials and Methods: A health centre based cross-sectional study was conducted from 1st to 15th May 2020 for 15 days in Rural Health Training Centre (RHTC) of Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. All patients (18 years and above) who visited the healthcare facility for the first time (visit) during the study period were included in the study. A total of 485 participants recruited through consecutive sampling were interviewed using adapted World Health Organisation (WHO) and previously published questionnaire on knowledge (15 questions), perceptions (2 questions) and practices (3 questions). Knowledge score ranged from 0 to maximum 15. Analysis was performed using SPSS 20.0 statistical software. Descriptive statistics, t-test, one-way analysis of variance (ANOVA) and Chi-square test were used to determine the difference between the groups for different variables at 0.05 level of significance. Results: Mean knowledge score of the participants was 10.6±2.1. Out of 485 participants (mean age 48.8±16.2 years), majority 425 (87.6%) knew about main clinical symptoms and 448 (92.4%) knew isolation and treatment of COVID-19 infected persons as an effective way of prevention and control of COVID-19. However, 284 (58.6%) and 276 (56.9%) participants knew about transmission through respiratory droplets and by touching contaminated surfaces, respectively. Educational status showed an independent association with higher knowledge. Total 190 (39.2%) of the participants agreed on stigma against specific individuals. Regularly washing of hands (77.7%), three layered masks (29.9%) and physical distancing (33.2%) were commonly followed practices. Higher knowledge score was significantly associated with regular handwashing practices (p<0.001) and wearing of three layered masks (p<0.001). Conclusion: Results highlighted good knowledge about COVID-19 of study participants. However, continued efforts over time are required to increase the COVID appropriate behavior regarding usage of face mask and physical distancing.

Diagnostic Validity of Computed Tomography Thorax in Comparison with Fibreoptic Bronchoscopy for Endobronchial Lesions

S Mamatha, Alamelu Haran, S Ashwini, Ranganath T Ganga, H Ajit
Introduction: Fibreoptic Bronchoscopy (FOB) is the gold standard for diagnosis of endobronchial diseases, an invasive procedure not without risks. Computed Tomography (CT) illustration of thoracic anatomy provides guidance in sampling procedure for diagnosis of endobronchial disease through FOB. Yet, in real life scenario, we find discrepancy between findings of CT and bronchoscopy which necessitates the patients to undergo second invasive procedure for a definitive diagnosis. Aim: To assess the diagnostic validity of CT imaging in diagnosing endobronchial diseases by comparing with FOB findings and to correlate FOB findings with pathological results. Materials and Methods: This was a cross-sectional retrospective analysis over six years in a tertiary care centre from January 2012 to December 2018. The findings on CT and FOB were classified as normal, abnormal mucosa, mass and extrinsic compression. FOB samples were sent for pathological examination. Results: A total of 426 patients were included in the study. The sensitivity of CT for presence of normal bronchus, abnormal mucosa, mass and extrinsic compression was 93.03%, 27.50%, 89.00% and 59.52% and specificity was 91.76%, 98.45%, 89.88% and 94.79%, respectively. Pathological diagnosis was obtained in 135 (97.12%) out of 139 cases. Squamous cell carcinoma was the most common 62 (41.01%) histological diagnosis. Conclusion: Computed Tomography (CT) thorax imaging has good sensitivity and specificity to detect endobronchial mass but has poor sensitivity for detection of extrinsic compression and mucosal abnormalities in bronchi. Squamous cell carcinoma was the most common pathological diagnosis.

Effect of Type of Malocclusion on the Surface Pattern of Caries on Molars and DMFT Index in Primary and Mixed Dentition Period- A Pilot Study
Introduction: Caries pattern is multifactorial in context to the type of diet, tooth structure, time of insult, microflora and salivary contents (salivary pH, buffering action, salivary flow, etc.). Craniofacial relationship may be a contributing factor in the site of occurrence of caries i.e., mesial, distal, occlusal, palatal/lingual and buccal surfaces of primary and permanent molars. Aim: The aim of the study was to find out the effect of the type of malocclusion in primary dentition and mixed dentition period on the surface distribution of caries with respect to their molars along with overall DMFT (decayed, missing and filled teeth index) of the patient. Materials and Methods: A pilot study was conducted in Government and Private schools of district Gurugram, Haryana. Hundred children between 3-5 years of age with primary dentition and 8-10 years of age in mixed dentition period as per inclusion and exclusion criteria were included. Type of terminal plane relationship, according to Baume's classification, i.e., Flush terminal/mesial step/distal step and affected carious site in all primary molars were examined in 3-5-year-old children. Similarly in 8-10-year-old, type of malocclusion according to Angle’s Classification and its association with carious sites in permanent first molar were examined. Decayed, missing and filled teeth index, DMFT/dmft (i.e., dmft=0-1, 1-2, ≤3 and DMFT+dmft (DMFT+dmft=0-1, 1-2, ≤3) was analysed in both groups, respectively. Results: The mesial step molar relationship was the most common malocclusion (93%) in primary dentition whereas in mixed dentition Angle's Class I was the most common (84%) malocclusion. Caries occurrence was more in maxillary molars as compared to mandibular molars. The order of caries occurrence in primary and permanent dentition was occlusal surfaces>mesial surfaces>distal surfaces>buccal surfaces>palatal/lingual surfaces. The caries occurrence according to dmft index in primary dentition was not associated with any type of malocclusion, though it was more in mesial step molar relationship. Angle’s Class II malocclusion contributed significantly high DMFT+dmft index with p-value of 0.020. Conclusion: Type of malocclusion does not affect with surface pattern of caries on molars in primary and mixed dentition period. Decayed, missing and filled caries index may be significantly associated with Angle's Class II malocclusion according to the present study.

Clinical and Endoscopic Profile of Upper Gastrointestinal Bleed: A Cross-sectional Study from a Tertiary Care Hospital in Southern India

Manju Surendran, K Sunil Kumar
Introduction: Acute Upper Gastrointestinal (UGI) bleed is a common potentially life threatening emergency. The aetiological profile of bleed and prognosis varies according to geographical region and availability of endoscopic facilities. Aim: To determine the clinical and endoscopic profile of UGI bleed, risk factors and prognosis in the patients. Materials and Methods: This was a cross-sectional study conducted over a period of 12 months at a tertiary care centre in Southern India. Patients admitted with history of hematemesis and melena, satisfying the inclusion criteria was taken consecutively. Clinical and endoscopic profile were noted and followed-up for six weeks. Statistical analysis was performed using chi-square test for qualitative variables and independent t-test for quantitative variables. Significance level was fixed as p-value of <0.05. Results: A total of 138 patients were studied in this period. The male to female ratio in the study was 3.5:1. The mean age was 53.5±13.17 years. The most common clinical presentation was hematemesis in 57 patients (41.3%) followed by haematemesis and melena in 46 patients (33.3%). The most common cause on endoscopy was portal hypertensionrelated oesophageal and gastric varices (51.4%) followed by antral gastritis (15.2%). The cause of UGI bleeding could not be identified in 5.1% in which the endoscopy was normal. Haemogram, platelet count and serum albumin were significantly lower in variceal bleed group, compared to non-variceal group. Eleven patients succumbed to death secondary to UGI bleed. Conclusion: The most common causes of UGI bleed are portal hypertension related gastric and oesophageal varices. The inhospital mortality in the study was 7.9%.

A Study on Immunisation Coverage among Children in Hosakote, Mysuru

Harshini Suresh, Mansoor Ahmed
Introduction: Immunisation coverage is a vital strategy adopted by most programs on child survival globally. A robust immunisation coverage program goes a long way in controlling the Vaccine Preventable Disease (VPDs). It is very important to analyse the factors which are detrimental in achieving 100% immunisation among children. Aim: To find the extent of immunisation coverage and to identify the factors for failure of immunisation among children in the rural field practice area of Mysore Medical College and Research Institute, Mysuru. Materials and Methods: A cross-sectional was carried out from November 2019 to January 2020 on children between 0-2 years of age using the World Health Organisation (WHO) thirty clusters sampling method. The sample size was estimated to be 210. Identification of clusters was done as per the WHO manual on 30×7 cluster survey. Interview was conducted using a structured interview format in selected households with study subjects. Data was entered in Microsoft Excel sheet and analysed using chi-square test. Statistical Package for Social Sciences (SPSS) software version 23.0 was used for analysis of data. Results: Among the study participants, 131 (86%) were fully immunised and 29 (14%) were partially immunised (those who did not receive all the due vaccines till two years of age). Religion, educational status of parents and the presence or absence of immunisation card had significant (p-values=0.01, <0.05, <0.05 respectively) association with the immunisation status. The main reasons for partial immunisation were: parents being unaware of the need for returning for subsequent doses 13 (44.8%), fear of side-effects 12 (41.3%), and vaccine not being available 7 (24.1%). Coverage of all individual vaccines among the children (0-2 years) were mostly above 199 (95%). Conclusion: This study observed higher immunisation coverage as compared to that of the national immunisation coverage of 62%. In spite of efforts to increase the immunisation coverage in the country there are regional differences in the extent of this coverage which points to the need for better strategies to tackle this problem.

Comparison of Levobupivacaine and Levobupivacaine with Dexmedetomidine for Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries-A Randomised Controlled Trial
Introduction: Brachial plexus blockade at the supraclavicular level delivers an excellent regional anaesthetic technique with unmatched effectiveness for upper limb surgeries. Levobupivacaine, a safer alternative to the commonly used bupivacaine for regional anaesthesia and addition of a2-agonists like dexmedetomidine further improves the quality of regional anaesthesia. Aim: To evaluate the efficacy of levobupivacaine in combination with dexmedetomidine for supraclavicular brachial plexus block. Materials and Methods: This randomised controlled study enrolled 50 American Society of Anaesthesiologist (ASA) grade I and II patients aged between 18-60 years posted for elective upper limb surgeries. Randomisation was done and the patients were divided into two groups with 25 each, to receive either 39 mL of 0.5% levobupivacaine and 100 µgs (1 mL) of dexmedetomidine in group LD (Levobupivacaine with Dexmedetomidine) and 39 mL of 0.5% levobupivacaine and 1 mL of normal saline in group LS (Levobupivacaine with Saline). The onset and duration of sensory and motor blockade along with duration of analgesia were observed. All Quantitative data were compared and analysed using student’s unpaired t test while qualitative data were analysed using Chi-square test. A p-value of less than 0.05 was considered to be statistically significant. Results: The onset of sensory and motor blockade in group LD was significantly faster when compared to group LS (p<0.001). group LD had a longer mean duration of sensory and motor blockade along with duration of analgesia when compared to group LS (p<0.001). There was a better hemodynamic stability in group LD when compared to group LS. Conclusion: Dexmedetomidine added to levobupivacaine provides significantly shorter onset times, greatly prolongs the duration of sensory and motor blockade along with duration of analgesia without any systemic side effects.

Comparison between Nebulised versus Intravenous Lignocaine to Suppress the Haemodyamic Response to Laryngoscopy and Tracheal Intubation: A Randomised Control Study

Om Prakash Kashyap, Atit Kumar, Dheer Singh, Swati Srivastava
Introduction: During general anaesthesia, prevention of reflex sympathetic responses following direct laryngoscopy and intubation remains an important clinical goal during airway management. Aim: To compare efficacy of nebulised lignocaine and intravenous lignocaine to suppress haemodynamic response to laryngoscopy and tracheal intubation. Materials and Methods: This randomised control study was conducted, during January 2018 to June 2019, on 90 American Society of Anesthesiologists (ASA) grade I and II patients in the age group of 18 to 45 years of either sex, undergoing elective surgeries under general anaesthesia. Patients were randomly allocated into three groups with the sample size of 30 each. Group A was nebulised with Normal Saline (NS) 0.075 mL/kg and 10 mL NS intravenous (iv) given and served as control. Group B was nebulised with 3 mg/kg (0.075 mL/kg) of 4% lignocaine and iv normal saline 10 mL given. Group C was nebulised with 0.075 mL/kg of normal saline and iv 2 mg/kg of 2% lignocaine diluted to 10 mL. Descriptive statistical analysis was carried out in the present study. Analysis of variance (ANOVA) has been used to find the significance of parameters between three groups. Chi-square test was used to find the significance of parameters on categorical scale between three groups. Results: Statistical evaluation between the groups showed that the increase in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) observed at 1 minute after intubation in control group was highly significant (p<0.001) when compared to increase in group B and C. Both groups B and C were comparable in terms of SBP, DBP and MAP post-intubation. Increase in Heart Rate (HR) was statistically significant (p<0.05) between group C and group B during 7 seconds to 15 seconds post-intubation. Conclusion: It can be concluded that nebulised lignocaine can be an effective alternative to intravenous lignocaine in attenuating the cardiovascular responses to laryngoscopy and intubation. It is also a simple and safe technique to be used.

Ocular Parameters Evaluation in Relation to the Refractive Error using Optical Coherence Topography

Farah Maqsood, Menwah Al-Matrafi, Nourah Al-Muaither
Introduction: The increasing prevalence of myopia has become a major public health impact due to its potentially blinding ocular complications. This study was done to evaluate the choroidal and retinal thickness, depth of the anterior chamber and the curvature of the cornea using 3D Optical Coherence Topography (OCT) and Optical Coherence Biometry instrument (Zeiss IOLMaster 700) among Saudi female adults with emmetropia, low and moderate myopia. Aim: To evaluate the choroidal thickness, foveal retinal thickness, depth of anterior chamber, Axial Length (AL) and curvature of the cornea between myopic and emmetropic individuals. Materials and Methods: This cross-sectional study was done in the female section of Department of Optometry, College of Applied Medical Science, King Saud University (KSU), Riyadh, in Saudi Arabia. Hundred and four eyes of healthy females between the ages of 19-26 years who fulfilled the inclusion criteria were selected. There was no gender preference; only female subjects were included because this study was done in the female college. The subjects were categorised into emmetropic groups (Spherical Equivalent (SE) ≤ -0.25 D), mild myopic groups (SE between -0.50 to -3.00 D) and moderate myopic groups (SE between -3.00 to -6.00 D). The foveal retinal and subfoveal choroidal thickness was measured using 3D OCT, however AL, Anterior Chamber Depth (ACD) and corneal radius were measured using IOL master. Results: The foveal retinal thickness of moderate myopia (205.55±15.35 μm) was found the same as in emmetropia (204.12±15.44 μm) and mild group (204.64±14.29 μm) with p>0.05. The significant difference was not found in the subfoveal choroidal thickness between these three groups. The mean AL of moderate myopia (25.03±0.75 mm) was significantly higher than mild myopia (23.99±0.74 mm) and emmetropia group (23.15±0.98 mm). There was highly significant difference in the ACD between the emmetropic and myopic groups. However, no significant difference was observed in the mean of corneal radius (K-reading) among the three groups (p>0.05). The corneal radius in total myopic eyes had a weak negative correlation with the AL. Conclusion: This study demonstrated that the foveal retinal and subfoveal choroidal thickness did not differ significantly in emmetropic and myopic groups. Also, positive correlation was noted between the ACD and AL. Pearson’s correlation coefficient (r) in ACD and AL for emmetropic group was found 0.28 and 0.48 for the moderate myopic group.

Incidence of Malignant Diseases in Punjab: A Retrospective Study in a Tertiary Level Government Hospital in Punjab

Deeksha Singla, Anand Singla, Manpreet Kaur, Darshanjit Singh Walia
Introduction: Cancer is a grave problem with increase in incidence of various malignancies at an alarming rate in Punjab. Crude annual incidence rate of all cancers in Punjab has increased from 58.0 in 1990 to 85.5 in 2016 while crude mortality incidence ratio of all cancers in Punjab is 0.61 in females and 0.81 in males. Not only it is increasing mortality and morbidity, but it is also increasing the economic burden on a state already facing financial crisis. The exact burden of malignancies is not well-known, although many local surveys have been done. Aim: To know the accurate burden of malignant diseases in patients presenting to a tertiary level government hospital in Punjab, India. Materials and Methods: A retrospective observational study in which data of all cases diagnosed to have malignant disease on histopathology at Government Medical College and Rajindra Hospital, Patiala, Punjab, from January, 2006 to December, 2015. The data was retrieved on yearly basis and total of each malignant disease was done to know the exact incidence of various malignancies over the decade by the measure of relative frequency. Results: A total of 4270 patients (41.65% in age group 41 to 70 years) were diagnosed to have malignant disease on histopathology out of which 2341 (54.82%) were females and 1929 (45.18%) were males. Leading causes of malignancy were the cancers of the female genital organs i.e., 20.05%, followed by breast cancer i.e., 18.17% and cancers of lip, oral cavity and pharynx i.e., 15.36%. Conclusion: Maximum incidence was seen in carcinoma breast followed by carcinoma cervix and carcinoma larynx. Early screening, timely diagnosis and management along with regular scrutiny of records should be done in routine to know the actual burden of cancer in the society.

A Retrospective Observational Study for Prediction of Stone Free Status after Single-session of Retrograde Intrarenal Surgery for Renal Stones
Introduction: Retrograde Intrarenal Surgery (RIRS) is a preferred minimal invasive treatment modality for renal stones with advantages of being effective and having lower morbidity rates. Aim: To predict the Stone Free Rate (SFR) after RIRS with lower pole and non-lower pole stones. Materials and Methods: The records of 85 consecutive patients who underwent unilateral RIRS from September 2016 to July 2019 were retrospectively analysed. The studied parameters included patient demographics, stone characteristics (size, volume, and attenuation, Lower Pole Infundibulopelvic Angle (LP IPA) and operative time, presence of preoperative Double-J Stent (DJS) and Stone Free Status (SFS). Standard statistical tests were applied with level of significance as p<0.05. Results: Overall success rate was 83.5% (71 cases) while 14 cases had Residual Stones (RS) at 1 month. The mean age of the patients was 41.07±12.25 years. The mean operative time was 68.85±22.3 minutes. Mean stone size and stone volume were higher in the RS group compared to SF (Stone free) group, 15.07±1.5 mm vs. 12.28±1.6 mm, 1187±145 mm³ vs.680.67±289 mm³ respectively (p<0.001; p<0.001). In RS group, 93% (13) cases had IPA <45°, while 80% cases with IPA >45° were stone free. Patients with non-lower pole stones has SFR 2.8 times compared to LP stones (p<0.001). On linear regression analysis, only LP IPA and LP stone location predicts SFS after RIRS. Conclusion: Retrograde Intrarenal Surgery (RIRS) is effective procedure for renal stones. Stone size, stone volume, Lower Pole (LP) stone location and LP IPA effectively predict SFR. However, LP IPA and LP stone location are the most significant predictor of SFS, after single session RIRS for solitary renal stone.

Association and Determinants of Decision Delivery Interval of Emergency Caesarean Sections and Perinatal Outcome in a Tertiary Institution
Introduction: A Decision to Delivery Interval (DDI) of 30 minutes for emergency caesarean section has been widely recommended but there is little evidence to support it. This target may not be practicable in a busy maternity unity and therefore, the anticipated beneficial effect on neonatal outcome requires re-evaluation. Aim: To determine the association between decision-delivery interval and perinatal outcome of emergency caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a period of four years. Materials and Methods: This was a retrospective observational study of the cases in emergency caesarean sections performed at the Department of Obstetrics and Gynaecology, AEFUTHA from 1st January 2012 to 1st January 2016. Hospital records of the women with singleton pregnancy at term who delivered through emergency caesarean sections were retrieved. Data extracted include socio-demographic and obstetric characteristics, duration between decision for caesarean section and intervention, indications for the caesarean section, reasons for delay in DDI, association between booking status and DDI and association of DDI and foetal outcome, APGAR score at 1st and 5th minutes and admission to NICU. Data were analysed with IBM statistics version 20. The p-value <0.05 were regarded as statistically significant. Results: A total of 638 emergency caesarean sections involving singleton pregnancies at term, 522 (81.8%) of which had complete records and were analysed. The mean age of participants was 27.8±5.1 years, 89.3% were para 1-4 and 55.0% were unbooked. Only 6 (1.1%) of the emergency caesarean sections were performed within the recommended 30 minutes of DDI. The mean DDI was 189±124 minutes with range of 25 minutes to 1220 minutes. Two cases performed within 25 minutes were cases of foetal distress and cord prolapse while only a case of reduced foetal movement was delayed to 1220 minutes. The most common indications for emergency caesarean section were cephalopelvic disproportion 129 (24.7%) and foetal distress 65 (12.5%). The major cause of delay was delay in cross-matching of blood for surgery 136 (26.1%) while delay in giving informed consent contributed 67 (12.8%). There was no correlation between DDI of 75 minutes or above and the 1st minute APGAR score (AOR=2.48, CI=0.86-7.16, p-value=0.09), 5th minute APGAR score (AOR=3.08, CI=1.55-6.11, p-value=0.09), foetal outcome (AOR=0.82, CI=017-3.79, p-value=0.08) and admission to Newborn Intensive Care Unit (NICU) (AOR=2.08, CI=0.77-5.56, p-value=0.14). Conclusion: This study showed that there was no correlation between DDI>75 minutes and poor perinatal outcome. Efforts should be made to strengthen the health system and improve the quality of care in order to keep DDI within this time limit for improved perinatal health outcome and indices.

Effectiveness of Short Form-36 Health Status Questionnaire Versus WOMAC Arthritis Index Questionnaire on Chronic Knee Osteoarthritis Patients

Ankita Jain, R Raja, K Santosh Kumar
Introduction: Osteoarthritis is a common disease of aged population and one of the leading causes of disability. Key causes include obesity or overweight along with ageing. Knee osteoarthritis can cause significant pain and functional loss. As the disease progresses, it can cause chronic knee joint pain, muscle weakness, joint deformity and functional deficiency which leads to decreased quality of life. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) is a 24-item questionnaire with 3 sub-scales measuring pain (5 items), stiffness (2 items) and physical function (17 items). Health related quality of life is measured using Short Form-36, used to examine health status in following eight domains: bodily pain, physical function, role limitations due to social problems, physical problems, general health, vitality, social function, mental health, role limitation due to physical problems. Aim: To find the effect of Short Form-36 Health Status Questionnaire versus WOMAC Arthritis Index Questionnaire to measure the pain, Range of Motion (ROM) and disability in subjects with chronic knee osteoarthritis patients treated with Contrast Bath and Knee Exercises. Materials and Methods: This was a longitudinal cohort study. A total of 90 patients were divided into two groups of 45 each. Each patient was given treatment for four weeks. Each patient was treated with Contrast bath and Knee Exercises. Group A patients were instructed to fill the Short Form-36 Health Status Questionnaire and Group B patients were instructed to fill the WOMAC Arthritis Index Questionnaire and outcome measures were collected on day 1, at the end of 2nd week and at the end of 4th week. Data from study were analysed using the statistical package SPSS 19.0 (SPSS Inc., Chicago, IL) and level of significance was set at p<0.05. Results: Group B shows a mean of the total score of WOMAC Arthritis Index Questionnaire which was 74.66 (SD 10.01) on Day 1; mean of 49.02 (SD 12.08) at the end of the 2nd week and a mean of 20.68 (SD 12.23) at the end of 4th week. The p-value was found to be 0.0001. The percentage disability evaluated by the WOMAC Arthritis Index Questionnaire shows a mean of 78 (SD 10) on Day 1; mean of 51 (SD 12) at the end of 2nd week and a mean of 22 (SD 13) at the end of 4th week. On day 1 Short Form-36 Questionnaire, total score of group A was 88.24 (SD 6.72) and at the end of 2nd week and 4th week, the mean score was 94.06 (SD 5.10) and 98.72 (SD 4.55), respectively with statistically significant difference p-value (0.0001). Conclusion: The present study showed that the WOMAC Arthritis Index Questionnaire had superior sensitivity in reducing pain and increasing range of motion and thus by decreasing the disability.

Postoperative Analgesia with Epidural Infusion of Buprenorphine Versus Transdermal Buprenorphine in Total Abdominal Hysterectomy: A Prospective Observational Cohort Study

Anju Krishnan, Binu Sajid, Rekha Krishnan Kutty
Introduction: Transdermal Buprenorphine (TDB) patches have recently gained popularity owing to its non-invasive dosing, minimal side-effects and longer duration. Epidural opioids provide excellent analgesia thus permitting early ambulation. Aim: To compare the efficacy of epidural buprenorphine infusion and TDB to relieve postoperative pain following total abdominal hysterectomy. Materials and Methods: In this prospective observational cohort study, 116 patients undergoing total abdominal hysterectomy in a tertiary care institution, were divided into two equal groups. All patients were given subarachnoid anaesthesia using 3.4 mL 0.5% bupivacaine heavy with 60 µg buprenorphine. Group T patients had TDB (10 µg/h) patch applied 12 hours prior to procedure; while Group E patients received epidural buprenorphine infusion (10 µg/h) postoperatively. Postoperative analgesia was assessed using Numerical Rating Scale (NRS) at 2 hours, 4 hours, 24 hours, 36 hours, 48 hours, 60 hours, 72 hours after surgery. Inj. diclofenac 75 mg IV or Inj. paracetamol 1 gm Intravenous (IV) infusion were given as rescue analgesic. The requirement of rescue analgesics was also recorded every 24 hours. Occurrence of adverse effects like sedation, respiratory depression, hypotension, bradycardia, nausea, vomiting, pruritus, headache, dizziness etc., were observed and compared between the two groups. Chi-square and Independent t-test were used for categorical and continuous variables, respectively. Results: Better postoperative analgesia with lower NRS scores were seen in Group E when compared to Group T at all the measured intervals (p-value <0.001). The median rescue analgesic requirement was significantly higher in Group T {Diclofenac 75 (0, 150) mg, Paracetamol 2 (1, 2) g} than Group E {Diclofenac 0 (0, 75) mg, Paracetamol 1 (0, 1) g}. Sedation was more for epidural buprenorphine at 2 hour, 24 hours, 36 hours and 48 hours. The occurrence of nausea and vomiting was more with TDB (p-value <0.001). There were no other significant adverse effects in both the study groups. Conclusion: Epidural infusion of buprenorphine is safe and more effective than an equal dose of TDB in postoperative analgesia for abdominal hysterectomy.

Coronary Angiogram using Distal Radial Access: A Retrospective Observational Study

S Lalitha, Vijay Sai, Siddarth
Introduction: Transradial access has become gold standard for percutaneous coronary catheterisation procedures. As the learning curve overcomes, safe alternative access sites such as Distal Radial Artery (DRA), ulnar artery have been tried. Aim: The aim of this study was to generate best evidence for using right DRA for coronary angiography. Materials and Methods: In this retrospective study, a novel route in addition to radial artery was studied. A total of 150 cases who underwent the angiogram by the DRA technique were included in the study, preserving the radial artery for various procedures. DRA was punctured in anatomical snuffbox by standard techniques and coronary angiography was performed. The evaluated parameters included the characteristics of patients (gender and age distribution), blood pressure (systolic and diastolic), mean arterial pressure, flouro time, puncture time, Dose Area Product (DAP) and cumulative air kerma. Fisher’s-exact test was used to find out the association between the gender, hypertension, diabetes and the success of puncture. Results: There was 93.4% successful puncture rate for distal radial access. There was no influence of age on the success of puncture. The association of success of puncture with gender, hypertension and diabetes was not statistically significant. Conclusion: This study presents that the distal radial approach is feasible and relatively safe. Further randomised controlled trials may be required to establish this relatively new approach as the standard care.

Adaptation to Online Technology for Learning during COVID-19 Pandemic: An Observational Study of Effectiveness and Student’s Perception in Various Universities

Saurabh Kumar, Ankush Sharma, Shveta Sharma, Sajjan Pal, Anand Kumar Singh
Introduction: COVID-19 is a newly discovered infectious disease caused by a virus named 'coronavirus'. To control the rapid spread of the virus, Indian government announced lockdown in whole country. The lockdown has largely affected the lives of students because education was shifted from traditional classroom learning to online learning. After COVID 19 pandemic the online teaching-learning has become more prevalent in India, it becomes particularly important to know its effectiveness and to know whether it’s actually helping the students to achieve what they expect. Aim: The present study was designed to understand the effectiveness, student’s perspective, attitudes and readiness about online classes being conducted at the University level. Materials and Methods: An observational, descriptive study was conducted with a total sample size of 400. Students studying in four different universities were included in the study. The data was collected using a Questionnaire. A semi structured, self-administered questionnaire was prepared on Google Forms with open and close ended questionnaire and was circulated among university going students via WhatsApp and e-mail. The data was tabulated by Google spreadsheet. SPSS version 20 was used for data analysis. Results: Out of 400 students, who participated in the study, 55.25% students liked and 44.75% disliked online teaching during the lockdown period. However, 90.5% said that classroom was an effective platform for learning in comparison to online learning. Total of 6.5% subjects were completely satisfied, 24.5% somewhat satisfied and 8.25% were completely unsatisfied with online learning experience. A 44.75% student also felt difficult to spend several hours on mobile or computer. Conclusion: After analysing the results, it was concluded that the students liked the online classes but are not interested in continuing the same way after the lockdown. They felt that classroom teaching was more effective than online learning due to issues related to topic understanding, net connectivity, and lack of practical and/or demonstrations. Hence, certain improvements must be made to increase its acceptability amongst students.

Impact of Electrotherapy or Muscle Training on Quality of Life in Urinary Incontinence of Male Geriatric Population- A Protocol

Ashish Wasudeorao Bele, Mohd Irshad Qureshi
Introduction: Urinary Incontinence (UI) is the involuntary loss of urine with social alienation, loss of sexual activity and other psychosocial issues which may affect the Quality of Life (QOL) and psychosocial well-being of patients. Electrotherapy may play an important role in the treatment of incontinence by means of stimulating the weakened structures which helps in control of micturition. Various electrotherapeutic currents including Faradic, Galvanic, Inferential Therapy (IFT), Russian currents along with the pelvic floor muscles strength training may be helpful in UI. Aim: To find the impact of electrotherapy or training of muscle on QOL in male geriatric population of incontinence of urine. Materials and Methods: This randomised controlled trial will be carried out on geriatric male patients attending Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha as well as on patients from geriatric homes and nearby PHCs. They will be screened for UI. The participants will be divided into three groups each of which will receive Faradic stimulation, Russian current stimulation and Pelvic Floor Muscle Training (PFMT) exercises respectively. The study will be carried out between October 2020 to October 2022. The data will be collected and analysed utilising inferential and descriptive statistics by using Chi-Square test and student’s t-test (unpaired and paired) and software for analysis will be SPSS 22.0 version and Graph pad prism 6.0 version and level of significance will be considered as p<0.05 and results will be obtained. Conclusion: In male geriatric population, muscle strength training or electrotherapy can reduce urine incontinence.

Ten Challenges Associated with Management of Paracetamol Overdose: An Update on Current Practice and Relevant Evidence from Epidemiological and Clinical Studies

Ahmed Ibrahim Fathelrahman
Paracetamol is a commonly used medication all over the world. Although it is relatively safe, it results in serious toxicities requiring emergency department visits and hospitalisations, and may cause death. Toxicity can be predicted from drug blood concentration using Rumack-Matthew nomogram or from the ingested amount per body weight. Patients with expected toxicities are treated with activated charcoal if presented within two hours and N-acetylcysteine besides symptomatic and supportive measures. The present review represents a compilation of ten common challenging situations associated with management of paracetamol overdose. They include high risk patients, hypersensitivity reactions to the antidote, massive ingestions, late presentations, multiple ingestions of immediate release formulations, modified release ingestions, repeated supratherapeutic ingestions for therapeutic purposes, paediatric exposures, toxicity during pregnancy, and co-administered medications. Medical practitioners, who treat the patients presenting with paracetamol overdose and pharmacists working with drug or poison information centers, would benefit from having all ten challenging scenarios presented together in one place.

Current Status of Y Chromosome Microdeletions: Prevalence, Distribution, Implication and Association with Male Infertility in Indian Men- A Review
Introduction: Infertility affects about 15% of couples attempting pregnancy and in approximately 50% of these cases, male factors are responsible. Male infertility is clinically characterised by azoospermia and oligozoospermia depending on the amount of loss of genetic material and the size of the affected region on the Y Chromosome Microdeletions (YCM). The majority of genes located in the Y chromosome are involved in male related functions such as spermatogenesis in human, in addition to other endocrine and physiological factors. These microdeletions are located on q arm of Y chromosome, specifically Azoospermia Factor (AZF) region, hence called Yq microdeletions. These deletions are in form of complete/incomplete, recombination; mutations and Copy Number Variations (CNV) and vary in frequency depending on region, ethnicity, lifestyles and other epigenetic factors. Hence, this study is well reviewed in Indian men with infertility caused by AZF a,b,c and other partial deletions. So, it is important to the one who is affected by these mutations and infertile couples who adopt Assisted Reproductive Technologies (ARTs) after counseling. It is further useful for prediction of testicular sperm retrieval chances. Aim: To review the current status of Yq microdeletion frequency in infertile Indian men with the available data and their correlation with testicular phenotypes as well as other factors. These would also reckon as a supportive to other clinical findings for diagnosis of specific deletion of infertility to adopt ARTs to the infertile couple. Materials and Methods: Various studies including our data were collected to European Molecular Genetics Quality Network (EMQN) as well as analyse these Yq microdeletions screened using specific Sequence Tagged Sites (STS) of available kit like European Academy of Andrology (EAA) and non-EAAs using Polymerase Chain Reaction (PCR) technology. Various researchers from various zones of India contributed to microdeletion screening of Y chromosome using various STS to AZF locus. These data from 30 study groups were compared to geographical areas/zones, Indian populations, environment, selection criteria and other factors in this review. Results: The data on thousands of Y chromosome analysis confirmed that the frequency of microdeletions are affected by sample size, selection criteria of subjects, different geographical regions, ethnicity, Oxidative Stress (OS), Deoxyribonucleic Acid (DNA) fragmentation and food styles in addition to genetic defects. In Indian subcontinent, these deletions contribute to 8.33% from screening of 5435 Y chromosomes (453/5435). Lower percent (5.37%) of Yq microdeletions in Western India than other parts was observed, being highest in South East (20.52%) and North East zones (17.77%) as mentioned in the present study. These variations in Yq microdeletions are attributed to geographic region, foodstyle, other environmental factors and others. AZFc deletions were more prevalent and correlated to azoospermia (referred/ selected, 66%; deleted 61%) from 30/15 citations respectively in present cohort over oligospermic and/or severe oligospermic men followed by b and a sub-regions including b+c, a+b and others in AZF locus. Amongst 30 study groups, 27 exhibited AZFc deletions at higher rate. Conclusion: From these data in India, it was hence noticed that screening of Yq microdeletion is an important criterion and its correlation with spermeograms is very necessary to infer degree of infertility in men. Such cases are strongly suggested to undergo genetic counselling before adoption of ARTS as deletions increase risk of genetic anomalies, low birth weight and congenital malformations in New Births (NB) of Intracytoplasmic Sperm Injection and Testicular Sperm Ejaculates (ICSI/TESE) adopted cases. Thus, Y deletion evaluation reckons the diagnosis of type of male infertility and its prevention in the next generation propagation through ARTs adopting infertile couples after counselling.

Prediction of the One Repetition Maximum to Design Strength Training Protocol

Swapna Sugat Jawade
Accurate measurement of muscle strength is essential to design proper strength training protocol and to find out the efficacy of prescribed strength training protocol on muscle performance. One Repetition Maximum (1RM) is a reliable mean for the measurement of muscle strength. Primary goal of this review article was to explore the methods used in various articles of research databases that investigate the accurate way of estimation of 1RM before the design of strength training protocol. Wide range databases were searched to address articles on prediction of 1RM mentioned in Scopus, Pubmed, MEDLINE, Web of science, Google scholar databases, Wiley online library. Accurate determination of 1RM is based on various variables like gender, age, familiarisation of exercises, selection of predicted load, parts of body assessed (upper or lower limbs), rest interval given between exercise attempt and number of repetitions with percentage of predicted load. Prediction of 1RM varies significantly across different research studies. Based on the articles reviewed, it can be concluded that accurate prediction of 1RM is important to quantify current muscle strength level before one begins with strength training protocol. Many research articles mentioned that calculation of 1RM consists of trial and error, and it can also result into delayed onset of muscle soreness of particular tested muscles. Accurate Prediction of 1RM is important to design strength training protocol and it is also used to find out the efficacy of strength training protocol on muscle performance.

Varieties of Mushrooms and their Nutraceutical Importance: A Systematic Review

Debasmita Chatterjee, Dipankar Halder, Satadal Das
Introduction: Around 2000 species of mushrooms exist in nature, of which hardly 25 varieties are accepted as edible in nature. “Nutraceuticals” are food substances that are associated with immense health benefits and also hinder the development of several maladies. Aim: This review article aims to explore the nutritional contents/composition of the varied types of mushrooms and their clinical importance for the human being. Materials and Methods: The methodology adopted is a comprehensive systematic literature review. The suitable electronic databases sources that were reviewed were Google Scholar, PubMed, PsycINFO, Medline, and Grey literature databases namely GreyNet International, Open Grey, and Med Nar. The literatures were screened by customising the databases based on the pre-determined inclusion and exclusion criteria and up to the most recent contents of the year, 2019. In total, 63 articles were considered for the systematic literature review. Results: The findings of the selected pieces of evidence were critically appraised and thematically presented. Mushrooms serve as a great nutritional source; as they are rich in proteins, contain essential amino acids, fibre, and an excellent source of fatty acids but poor in fat content. Their nutritional significance increases due to the presence of vitamins B1, B2, B12, C, D, and E. Significant content of carbohydrates are present in an edible variety of mushrooms. Trehalose, glucose, and mannitol are among the abundant sugars present in the cultivated edible mushrooms that are responsible for different categories of medicinal properties for instance immunomodulating properties, antitumour properties by modulating the immune response of the host. The distinguished protein substances present in mushrooms are specific immunomodulatory proteins, lectins, antimicrobial proteins, ribosome-inactivating proteins, ribonucleases, and laccases that have interesting biological activities. Mushrooms contain significant amounts of polyunsaturated fatty acid that contribute to the reduction of cholesterol levels in the serum and also certain essential fatty acids such as oleic acid, linolenic acid, arachidonic acid, palmitic acids. Conclusion:Mushrooms can thus be considered to be a reservoir of varied significant dietary composition contributing to a healthy diet and their daily consumption may hinder any development of maladies within our physiological system.

A Sneak Peek into COVID-19 Vaccines-Present Status

Swathi Gurajala
The Coronavirus Disease 2019 (COVID-19) pandemic has taken a toll on all of us for one year with more than 1.94 million deaths. Despite many educational interventions and precautionary measures, there is increasing number of cases with rising mortality. The only ray of hope in this uncertain situation is the development of “vaccines” against the disease. Several pharmaceutical companies across the world have started vaccine production which are in different phases of clinical trials. Till date only four vaccines, Pfizer/BioNTech, Moderna, Oxford-AstraZeneca and Gamaleya Sputnik V, have completed the Phase 3 trials, received Emergency Use Authorisation (EUA) and two Indian vaccines-COVISHIELD and COVAXINTM have received restricted use approval and are ready to be given according to the priority list given by the Centers for Disease Control and Prevention (CDC). Several countries have started the process of vaccination to their high risk population above the age of 16. In this review, authors have listed the various vaccine options available till the time this article is written, their route of administration, dosage with few concerns related to the storage and safety of the vaccine. Let’s hope that atleast one of the vaccines in the pipeline will give promising results and help us to overcome the pandemic.

Review of Latest Potential Treatment Modalities in SARS-CoV-2

Pratyush Kumar, Shivani Tyagi
The ongoing Coronavirus Disease-2019 (COVID-19) pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can cause illnesses that vary from asymptomatic or paucisymptomatic conditions to Acute Respiratory Distress Syndrome (ARDS) or respiratory failure requiring ventilator support or sepsis and multiple organ dysfunction syndromes. Timely treatment and appropriate management of COVID-19 diseased patients is crucial to curb the morbidity and mortality rates. Much of the research is focused on formulating preventive and therapeutic strategies based on the complex pathophysiology of this disease. New drugs targeting viral entry into host cells, inhibiting viral Proteases, viral RNA Polymerases (RdRp), transport channels, and the drugs with multicentric action, immunomodulators and adjuvants are being researched upon. Other management modalities like regenerative medicine and the use of convalescent plasma therapy have been explored. This review is aimed at the therapeutic aspects of the treatment and management modalities.

Obesity, Cardiovascular Diseases and COVID-19

Utpal Jagdish Dongre
Obesity is a metabolic disorder which is emerging as a worldwide epidemic. It is often associated with diabetes, hypertension and Cardiovascular Diseases (CVDs). High calorie intake/nutrition causes excess deposition of Free Fatty Acids (FFA) in adipose tissue, which later transports those FFA to the liver for further metabolic activities, resulting in dyslipidemia. However, altered secretion of adipokines plays an important role in the pathophysiology of obesity related complications via low grade chronic inflammation. Adipokine like Interleukin-6 (IL-6) favour endothelial dysfunction by stimulating monocyte to macrophage differentiation using adhesion molecules. Secretion of the Renin Angiotensin System (RAS) components and angiotensin-II activity promotion are considered the additional functions of adipose tissue. Indeed, all these aspects of adipose tissues have been evidenced for the development and the progression of CVDs. Coronavirus Disease (COVID-19) is a worldwide pandemic affecting millions of people. Pre-existing obesity and CVDs have been suggested as a potential risk factor for increased severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in patients. Therefore, this review focuses on the possible role of obesity related CVDs as a significant risk factor for COVID-19 severity.

Dorsolumbar Vertebroplasty- A Retrospective Study

Murat Yilmaz, Nihat Acar, Ahmet Aybar, Ahmet Karakasli
Introduction: Percutaneous Vertebroplasty (PVP) is a procedure frequently performed to obtain pain relief and mechanical strengthening of the collapsed vertebral body which may be caused by variant reasons. Aim: To assess frequent complications commonly encountered during vertebroplasty procedure. Materials and Methods: A retrospective study was conducted on 1375 patients followed from January 2005 and June 2012 in Department of Neurosurgery, Faculty of Medicine, Dokuz Eylül University. Severe vertebral fracture collapse (vertebra plana), vertebral metastasis, quadriplegic patients and bedridden patients were excluded from this study, whereas active mobile patients without associated severe co-morbidities were included in the study. Pain, pattern of cement leakage and associated complications had been assessed. Results: Total 601 patients who fullfilled the inclusion criteria {244 (40.5%) males, 357 (59.5%) females}, average age was 63.04±7.4 (range 34 to 90) years, had undergone the PVP procedure. Mean preoperative Visual Analog Scale (VAS) was 8.51±1.5, whereas after one and six months, the mean postoperative VAS were 1.94±1.0 and 2.53±2.2, respectively. Central spinal canal leakage has been observed in four cases. Three patients had developed transient monoparesis and radiculopathy symptoms. Whereas, the fourth patient developed paraplegia. Cement leakage had been tolerated well by one patient, where symptomatic resolution occurred within one month. However, decompressive foraminotomy had been performed for two patients on the 24th and 38th days postoperatively due to intractable radicular pain. Immediate total laminectomy and decompression surgery had been performed for removal of the cement leakage to the spinal canal for the patient who developed total paraplegia. Asymptomatic leakage had been recognised beneath the posterior longitudinal ligament in 42 patients (6.9%), beneath the anterior longitudinal ligament in 18 patients (2.9%) and into disc space in 31 patients (5.1%). Venous leakage occurred in four patients (0.6%) and was asymptomatic in all of them. Conclusion: Vertebroplasty should be performed in a fully equipped operation theatre in order to be able to revert quickly to open surgery in case of cement leakage into the spinal canal.

Development Across the World on Vaccines for COVID-19: A Primer for Primary Care Physicians

Rahulkumar Jiteshbhai Amrutiya, Somashekhar Marutirao Nimbalkar
The current Coronavirus Disease-2019 (COVID-19) pandemic needs no introduction. To save lives and revive the global economy, the need of the hour is a safe and effective vaccine which does not enhance viral disease. Scientists are using traditional, modern, and novel platforms to develop their vaccine candidates. Each platform has its pros and cons. Novel platforms will shorten our response time against biohazards of the future. Vaccine development is being rushed and we are optimistic that we will have a vaccine as early as mid-2021. World health organisation, governments, pharma giants, researchers, private companies, and philanthropists have joined their hands to fund the vaccine hunt and to ensure an equitable Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccine access to people all across the world. Our review highlights potential problems in vaccine development, plans for vaccine allocation, and hurdles for vaccine uptake. It also throws light on vaccine delays due to a lack of confidence in the safety and effectivity of the vaccine, along with difficulties to access a shot.

Awareness and Practices about Skin Care among Medical Students: A cross-sectional study

Henil Upadhyay, Charmy Parikh, Pragya Ashok Nair
Introduction: Skin care is defined as practices that help in maintaining the structural and functional integrity of the skin. Routine skin care focuses on keeping it clean, balanced, protected and free from irritation. This can be achieved with a simple regimen including gentle cleansing, moisturising and protecting the skin from UV rays. Aim: To evaluate the awareness and practices regarding skin care among medical students. Materials and Methods: This was a cross-sectional study involving medical students studying at a medical college in Western India. A questionnaire consisting of close-ended questions regarding skin care awareness and practices was used as study tool. Data was analysed using the STATA14 software. Results: The study group comprised of 300 participants of which 201 (67%) were females and the rest 99 (33%) were males. The age of participants ranged from 17 to 23 years. Ninety-three (31%) felt that ideally face should be washed twice in a day, while 153 (51%) students were having the awareness regarding makeup removal before sleep. The ideal sunscreen SPF was not known by 211 (70.3%) students while 47 (15.7%) knew that it should be 30-50. Awareness regarding physical exercise, yoga and meditation improving the skin health was seen in 201 (67%) and 235 (78.3%), respectively. Awareness regarding adequate sleep and healthy diet necessary for healthy skin was reported by 261 (87%) and 250 (83.3%) students, respectively. Total 129 (43%) students used Over-The-Counter (OTC) products or face wash to wash their face, 167 (55.7%) used some or other cosmetic products, 226 (75.3%) students didn’t share their cosmetic products with others while 277 (92.3%) students didn’t use sunscreen routinely. Conclusion: Medical students need to be aware about skin care practices, so that they can educate the general public about its importance particularly in country like India where most of the general population is under the influence of advertisements in newspaper and television about routine skin care.

Estimation of Total Fluoride Concentration, Total Soluble Fluoride Concentration and pH among Various Brands of Toothpastes

Praneetha D Rani, Vijaya Hegde
Introduction: Fluoride toothpastes are a major reason for the decline in dental caries globally. For fluoride toothpaste to be effective, an adequate amount of Total Soluble Fluoride (TSF) must be available in the toothpastes. Aim: To determine and compare the Total Fluoride (TF), TSF and pH among various toothpaste brands. Materials and Methods: An in-vitro study was conducted during October 2019 on 20 toothpaste samples, which belonged to four groups namely, herbal toothpastes group, nonherbal toothpastes group, medicated toothpastes group and kids toothpastes group. Analysis of the samples was done at the Department of Environmental Engineering Laboratory, National Institute of Technology, Surathkal, Karnataka, India. The TF and the TSF concentration was determined using fluoride ion electrode. The pH was determined using pH meter. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 19.0). Analysis of variance (ANOVA) was used by Tukey’s post-hoc test to determine the difference between groups. The level of significance was kept at 0.05. Results: The results showed that there was a significant difference between the toothpaste types for mean TF concentration (p=0.004). The post-hoc test showed that there was a significant difference between herbal and nonherbal toothpastes (p=0.041) where the mean TF concentration for nonherbal toothpastes was 1095.20 ppm when compared to herbal toothpastes was 704.40 ppm. The results showed that there was a siginificant difference between the toothpaste types for Mean TSF concentration (p<0.003). There was a significant difference between medicated and kids toothpastes (p=0.024) where the mean total soluble fluoride concentration for medicated toothpastes was 938.60 ppm when compared to the kids toothpastes was 521.20 ppm. Conclusion: The present study showed that pH of all the toothpastes were either neutral or alkaline and the TSF concentration was less when compared to TF concentrations.

Evolution of Objective Structured Clinical Examination- Actual to Virtual

Tripti K Srivastava Waghmare, Lalitbhushan S Waghmare
Objective Structured Clinical/Practical Examination (OSCE/OSPE) has come a long way since its inception by Harden RM in 1975. Literature offers many studies and reviews about its applicability in assessment and impact in learning outcomes. The present review traces the variants of OSCE as it has evolved over time with need and contextual variations, though still being sought after as one of the most valid tools in assessment of clinical and professional skills. The article reviews various forms viz., Group OSCE, Team OSCE, Objective structured assessments of technical skills, Shadow OSCE, Inter-professional OSCE, Inter-professional OSCE with Allied Embedded Actors, Reverse OSCE, Culture OSCE, e OSCE, Tele OSCE and Virtual OSCE in terms of the method and utility. Inspite of numerous variations, the principle of OSCE remain intact i.e., an effective tool to foster learning and attainment of clinical/practical competencies by direct observation of skills, timely and developmental feedback. The manuscript also gives an example of blueprint for assessment of skills wherein such OSCE variations can be planned depending on the nature and objective of assessment.

Conflict between Patient and Health Care Professionals: Identify and Resolve: An Indian Perspective

Nitish Kumar, Anu Shree, Atil Kumar Lal, Sudhir Shyam Kushwaha, Ajay Bharti
Conflict between patient and health care professionals is increasing over time. Traditionally, the medical profession has been considered the most honourable profession and the professionals are held with great esteem as they are considered next to God. Unfortunately, there seems to have been developed a distinct discord between the patient and the health care professional relationship with disturbing incidents catching the headlines. These conflicts range from simple disagreements to major violence against the very people who are trying to undertake patient’s care. Ultimately, it is in the best interest of both the patient and the health care professional to have a harmonious relationship based on utmost trust which is the very keynote of mutual understanding resulting in the benefit both of them. Authors are now trying with deep sincerity for mitigation of distrust and exploring possible resolution strategies to apply in clinical practice in order to overcome them.

Diffuse Idiopathic Skeletal Hyperostosis: An Anatomical Case Report

Anjali Singal, Tulika Gupta, Daisy Sahni
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a noninflammatory disease of unknown cause characterised by osteophytic calcification or ossification of ligaments and enthesis; especially spinal. Authors hereby present a case report of a 65-year-old male cadaver, in whom the fusion of contiguous nine vertebrae from fifth thoracic to first lumbar vertebrae, because of ossification of the Anterior Longitudinal Ligament (ALL) was noticed. The tenth and eleventh thoracic vertebrae seemed to be affected worse, as maximum osseous anterior outgrowth (12 mm) of ossified ALL, ossification of Ligamentum Flavum (LF) and supraspinous ligament was also observed at this level. The Ossification of Anterior Longitudinal Ligament (OALL) along with the involvement of LF has not been classically reported. Ossification of spinal ligaments may cause local thoracic pain, stiffness and slowly progressive myelopathy. Ossified LF at the level of joint between tenth and eleventh thoracic vertebrae may result in compression of spinal cord at this level.

Journal of clinical and diagnostic research

Vanishing Non-immune Hydrops in Giant Chorioangioma of Placenta

An Infrequent Adenosarcoma Mimicking other Uterine Rhabdoid Tumours

Locally Advanced Bladder Paraganglioma Managed with Robot-assisted Radical Cystectomy with Intracorporeal Neobladder- A Case Report

Isolated Fallopian Tubal Torsion Complicated by a Large Hydrosalpinx in a Perimenopausal Woman

Anaesthesia for Caesarean Section of Primigravida with Idiopathic Thrombocytopenic Purpura

Non-Hodgkin Lymphoma Presenting with Recurrent Pleural Effusion: A Rare Case Report

Sciatic Nerve and Lumbar Plexus Block for Below Knee Amputation- Newer Approach for Better Haemodynamic Stability and Patient Safety

A Rare Case of Pericardial Tuberculoma with Impending Tamponade in a 52-Year Old Woman: A Case Report

A Rare Case of Malignant Transformation of Keratinous Cyst in Gluteal Region

Role of Physical Therapy and Rehabilitation in SAPHO Syndrome- A Rare Condition

A Rare Case of Hypothenar Hammer Syndrome Triggering Guyon’s Canal Syndrome

Unpredictable Outcome of Large Traumatic Oesophageal Injury: An Experience and Challenges

Effect of Kapalabhati in a Patient with Polycystic Ovarian Syndrome- A Case Report

Haemoglobin Olympia {β Codon 20 (B2) GA, ValMet}: A Silent Haemoglobin Variant

Rare Association of Semilobar Holoprosencephaly and Frontonasal Encephalocoele in a Neonate of Twin Pregnancy

Concurrent Occurrence of Cytomegalovirus Retinitis and Oesophagitis in an Immunocompromised Male Patient

Carcinosarcoma Stomach with Biphasic Nodal Metastasis: A Rare Entity

Cerebral Cysticercosis Masquerading as Eclampsia: A Case Report

Isolated Fracture of the Corpus Spongiosum- A Rare Case with Atypical Presentation and Diagnostic Role of MRI

Diminished Bone Marrow Oedema and Healing of Insufficiency Fractures in a HIV Patient after Switching Antiviral Therapies

Pulmonary Lymphangioleiomyomatosis and Role of Pleurodesis: Rare Case Reports

Spontaneous Rupture of Spleen in Acute Pancreatites: A Rare Case

Central Acetabular Roof Defect-More than Just a Normal Variant?

Glomus Tumour- Knowledge Update and Issues

Correspondence: CT Imaging in Gastrointestinal Stromal Tumour: A Case Series

Bone Mineral Density in Stroke Survivors: An Observational Study

Circulating MicroRNA-29a: An Evolving Biomarker for Diagnosis of Pulmonary Tuberculosis

Relationship of Bone Marrow Plasma Cell Morphology with Cytogenetic Abnormalities in Patients with Multiple Myeloma

Correlation of Body Mass Index, Mean Arterial Pressure with Peak Expiratory Flow Rate in Healthy Individuals- A Descriptive Study

Estimation of Calcium and Iron Levels in Gingival Crevicular Fluid and Serum in Periodontal Health and Disease

Analysis of Scoring System to Identify High Risk Patients and their Outcome in Isolated Blunt Chest Trauma- A Prospective Observational Study

Orthodontic Practice in the Times of COVID-19 Pandemic: An Online Survey

Effectiveness of Self Instructional Module on Knowledge Regarding Vision Hazards while Playing Online Games among Junior College Students

Histopathological Study of Lower Gastrointestinal Tract Biopsies in 600 Cases

Mantle Cell Lymphoma: An Immunomorphologic Study with SOX11 from a Tertiary Care Cancer Centre in Southern India

Effect of Carotid Stenting on Neurocognitive Function in Patients with Atherosclerotic Carotid Stenosis

Foetal Nasal Bone Length Measurement and Evolving Normogram in Southern Indian Population in Normal Pregnancies: A Cross-sectional Study

Effectiveness of Hot Pack with Caudal Glide and Antero-posterior Glide Mobilisation to Improve Shoulder Abduction Range in Adhesive Capsulitis

Sonographic Measurement of Visceral Fat Thickness as a Correlate of Existing Metabolic Syndrome- A Cross-sectional Study

Efficacy of Priming Principle in Propofol Induction-A Randomised Controlled Trial

Sigma Metrics: A Powerful Tool for Performance Evaluation and Quality Control Planning in a Clinical Biochemistry Laboratory

Evaluation of Efficacy of Femoral Nerve Block on Pain and Anxiety in Acute Fractures of the Femur in the Emergency Department

Chronic Pain and Depression: A Community Based Study in a Rural Area of West Bengal

A Prospective, Longitudinal Study on Effectiveness of King Vision® Video Assisted Laryngoscope and McCoy Laryngoscope in Patients with Simulated Restricted Neck Mobility

Spectrum of Clinical Presentation and Surgical Outcome in Patients with Chronic Subdural Haemorrhage: A Retrospective Study

Analysis of Caesarean Section Rates Using the Robson Ten-group Classification at a Tertiary Care Teaching Hospital in Eastern India: A Cross-sectional Study

Sexual Practices and Misconceptions Regarding Condom Usage and Status of Voluntary HIV Testing among Truck Drivers Employed in Transport Sector of Haryana- A Cross-sectional Study

Decreased Serum Cholinesterase Activity- A Reliable Diagnostic Aid for Tuberculosis

Introduction and Evaluation of Objective Structured Practical Examination as an Assessment Tool in Pharmacology for Second Year Medical Students

Lipid Accumulation Product as a Marker of Cardiovascular Disease Risk among Women with Polycystic Ovarian Syndrome- A Hospital Based Case-control Study

Volumetric Modulated Arc Therapy for Head and Neck Cancer: A Dosimetric and Treatment Planning Comparison with Intensity Modulated Radiotherapy Techniques

Clinical and Diagnostic Profile and Management of Inferior Vena Cava Obstruction- A Descriptive Study at a Tertiary Care Centre, Hyderabad

Prevalence of Metabolic Syndrome in Chronic Obstructive Pulmonary Disease in Rural Population of Developing Country- A Cross-sectional Study

Risk Factors, Epidemiological and Clinical Outcome of Close Contacts of COVID-19 Cases in a Tertiary Hospital in Southern India

Emotional Intelligence Assessment in Undergraduate Medical Students: A Cross-sectional Study

Expression of HER2/neu and Ki-67 in Urothelial Carcinoma and their Relation to Clinicopathological Data: An Egyptian Study

Myeloid Sarcoma: Evaluation of Histopathology, Immunoprofile and Cytogenetics

Nurses’ Challenges in Wound Care Management- A Qualitative Study

Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Gujarat, India

Dental Practice during COVID-19 Pandemic: An Observational Study

The Effects of Ovulation Documentation before Insemination on Intrauterine Insemination Cycle Outcomes: A Retrospective Analysis

Association between Lifestyle Factors and Oral Potentially Malignant Disorders among People of Bangalore: A Case-control Study

An Observational Study to Assess Anxiety Disorder among Women during COVID-19 Pandemic

Gastric Schwannoma: The Masquerader amongst Gastric Mesenchymal Tumours

Urinary Effects of Routine Urethral Catheterisation during Elective Caesarean Section in Enugu, Nigeria: A Randomised Controlled Study

Comparison of Visual Inspection using Acetic Acid and Liquid Based Cytology for Cervical Cancer Screening in Rural Area: A Cross-sectional Study

Psychometric Analysis of Undergraduate Nursing Students using Depression, Anxiety and Stress Scale: A Cross-sectional Study

Role of Helicobacter pylori Infection on Diabetic and Lipid Profile in Pre-diabetic Patients

Clinical Significance of Hypocalcaemia in Malaria: An Experience from Coastal Karnataka, India

Development of Quality of Life Tool for Children Diagnosed with Epilepsy- A Pilot Trial

Determination of Combination Factor as an Aid in Orthodontic Treatment Planning in Western Region of Saudi Arabian Young Male Population- A Retrospective Cephalometric Study

Effect of Anaesthesiologists’ Experience on Preferred Technique and Volume of Local Anaesthetic Administered for Brachial Plexus Nerve Block: A Retrospective Observational Analysis

Epidemiological and Microbiological Study of Onychomycosis

Clinico-Biochemical Study of the Safety and Tolerability of Selective Serotonin Reuptake Inhibitors (SSRI) with Special Reference to SSRI Induced Hyponatremia in Humans and Animals

Mortality Rates of EUS-Guided Biliary Drainage (EUS-BD) in Malignant Biliary Obstruction Patients in EUS-BD Era versus Non-EUS-BD Era: A Retrospective Cohort Study

COVID-19 Pandemic: Assessment of Stress and Perception of E-Learning amongst First Year Undergraduate Medical Students

Prevalence of Dental Caries and Periodontal Diseases among Secondary School Students in Duhok, Kurdistan Region, Iraq

Behavioural Changes in the Personal and Professional Lives of Doctors during COVID-19 Pandemic: A Cross-sectional Observational Study

Radiological Red Flags of Triple Negative Breast Cancer on Mammography and Ultrasonography: A Case-control Study

Haemoglobin Olympia {β Codon 20 (B2) GA, ValMet}: A Silent Haemoglobin Variant