Journal of clinical and diagnostic research

A Case of Severe Methotrexate Toxicity: Clinical Insights and Management

Methotrexate (MTX), first synthesised in 1947, originated as a derivative of aminopterin, a medication initially used to treat acute leukaemia in children. It shares similar properties with aminopterin and has since demonstrated remarkable efficacy in managing a wide array of complex dermatological and rheumatological conditions. Despite its therapeutic benefits, MTX toxicity, though rare, can lead to severe and potentially fatal consequences. This case report describes a 62-year-old male who developed erythematous lesions over his scalp, face, upper limbs, and torso following an excessive intake of MTX (120 mg/week for one month). The patient exhibited symptoms consistent with severe MTX toxicity, including mucositis, pancytopenia, and neutropenic sepsis. Despite timely initiation of leucovorin rescue therapy, intravenous hydration, urine alkalinisation, and aggressive management of neutropenic sepsis the patient’s condition deteriorated. Respiratory support was provided, but he ultimately succumbed to multi-organ dysfunction, underscoring the challenges associated with managing High-Dose MTX (HDMTX) toxicity. This report highlights the mechanisms of MTX toxicity, including its impact on folate metabolism and cell division, resulting in widespread tissue damage and immunosuppression. It emphasises the critical need for early recognition of toxicity symptoms, such as mucositis and bone marrow suppression, to promptly initiate life-saving interventions. Furthermore, it underscores the importance of patient education on MTX dosing and monitoring to prevent such adverse outcomes, illustrating the necessity for vigilant clinical management in patients receiving MTX therapy.

Alloplastic Reconstruction in Post-ablation Oral Squamous Cell Carcinoma Surgery: A Case Report

Surgical management of Oral Squamous Cell Carcinoma (OSCC) leads to ablative defects. There are various reconstructive options for these defects, such as autogenous grafts from the patient, including local flaps, regional flaps and distant flaps. Harvesting these flaps to reconstruct the defects can cause a significant amount of morbidity. The use of alloplasts in the reconstruction of the head and neck can reduce this morbidity at the donor site and decrease the surgical time required for flap harvesting. The present case of a 45-year-old female patient presented a microinvasive squamous cell carcinoma in whom an alloplast was used to restore the ablative defect following excision. This case report demonstrates the innovative application of alloplastic materials in surgery, eliminating the need for harvesting autologous grafts and minimising pain, recovery time and complications for patients postsurgery. This method reduces operating time, enhances patient outcomes and is flexible enough to meet various clinical requirements. The present case study highlights the challenges of restoring shape and function while considering aesthetic concerns by examining a cutting-edge alloplastic reconstruction procedure used in a patient following OSCC ablation. The surgical technique, materials utilised and results obtained after surgery are described herein, illustrating how alloplastic techniques can successfully overcome the drawbacks of conventional reconstructive methods. The results suggest that, in the context of OSCC, alloplastic reconstruction can improve surgical outcomes and enhance the patient’s quality of life with proper planning and implementation. This instance emphasises the importance of customised treatment programs and the potential of advanced reconstructive methods to address the specific challenges posed by oral cavity abnormalities.

Ileal Neuroendocrine Tumour of Carcinoid Type 1: A Case Report

Saurabh Gawand, Rajesh Gattani, Arvind Chava, Suhit Naseri, Apoorva Pande

Carcinoid tumours are uncommon neuroendocrine growths known for their slow growth, often remaining asymptomatic until they metastasise or cause carcinoid syndrome. Recent studies suggest that their incidence is increasing, challenging their previous perception as benign and highlighting their potential for malignancy. These tumours originate from different parts of the gastrointestinal tract during embryonic development. Foregut carcinoids typically originate in the lungs, bronchi, or stomach; midgut carcinoids arise in the small intestine, appendix, or upper large bowel; and hindgut carcinoids develop in the lower colon or rectum. Carcinoid syndrome, a rare complication, is most commonly associated with midgut carcinoid tumours. The diagnosis of carcinoid tumours frequently occurs unexpectedly during unrelated surgical procedures. The choice of treatment and the prognosis are influenced by where the tumour is located and the extent of metastasis identified at the time of diagnosis. The present case is a case of a 65-year-old female with a major complaint of abdominal pain that had been progressive in nature for 2.5 years. She had a positive history of leprosy and tuberculosis. The diagnosis was confirmed by Contrast Enhanced Computed Tomography (CECT) and she was managed by exploratory laparotomy with ileocolic anastomosis.

Anaesthetic Challenges in Pulmonary Alveolar Proteinosis: A Rare Case Report

Pulmonary Alveolar Proteinosis (PAP) is a rare pulmonary disease characterised by the accumulation of surfactant within the alveoli, leading to impaired gas exchange. This case involves a 31-year-old male presenting with shortness of breath. Fine crackles were heard on auscultation, raising the suspicion of alveolar involvement. High-Resolution Computed Tomography (HRCT) of the chest revealed a “crazy paving” pattern in the bilateral lung parenchyma, a hallmark imaging finding in PAP. Histopathological analysis confirmed the diagnosis, showing alveoli filled with granular, eosinophilic, Periodic Acid Schiff (PAS)-positive material, indicative of surfactant accumulation. The patient was scheduled for Whole Lung Lavage (WLL), the standard therapeutic procedure for PAP, under General Anaesthesia (GA). A Double-lumen Endotracheal Tube (DLT) was employed to facilitate isolation of each lung, ensuring effective lavage of the affected lung while maintaining ventilation in the other. This case highlights the importance of a multidisciplinary approach, integrating clinical evaluation, advanced imaging, histopathology and specialised anaesthetic techniques in managing rare conditions like PAP. This comprehensive strategy aims to restore alveolar function and improve the patient’s respiratory status, underscoring the critical role of timely diagnosis and intervention in rare pulmonary disorders.

Hairy Cell Leukaemia with Leucocytosis: A Rare Case Report with Review of Literature

Ruchi Agarwal, Parul, Monika Gupta, Sunita Singh, Sunaina Hooda

Hairy Cell Leukaemia (HCL) is an uncommon disease that accounts for 2% of all lymphoid leukaemias. It is characterised by the proliferation of lymphoid cells with abundant cytoplasm with circumferential fine hairy projections involving the peripheral blood, Bone Marrow (BM), and expanding splenic red pulp. A 50-year-old male presented to the medicine outpatient department with a history of weakness and breathlessness for three days hampering his daily chores. There was no history of any other chronic illness. The review of the peripheral blood smear demonstrated marked leucocytosis showing lymphocytosis. Some of these lymphocytes displayed hairy cytoplasmic projections. Red blood cells showed a dimorphic blood picture. BM aspiration was performed which was insufficient for opinion. BM cell block revealed mononuclear cells with perinuclear clearing giving a fried egg appearance. BM biopsy revealed a predominance of mononuclear cells with round nuclei suggestive of lymphoid cells. These cells showed an interstitial pattern of infiltration. Clear zones are seen around the nucleus (fried egg appearance). A diagnosis of lymphoproliferative disorder with the closest resemblance to HCL was made which was confirmed on Flow Cytometry (FCM) with these lymphoid cells showing positivity for CD45, CD20, CD25, and CD123. HCL with leukocytosis is relatively a rare presentation. Immunophenotyping plays a crucial role in making its diagnosis.

Tubercular Intramuscular Abscess Mimicking Lumbar Hernia: A Rare Case Report

Abhiram Chadive, Rajesh Gattani, Bhagyesh Sapkale

Tuberculosis (TB) is a worldwide health concern. Although pulmonary TB is common, extrapulmonary TB, such as infections of the musculoskeletal system, poses diagnostic challenges. The present report details a case of a tubercular intramuscular abscess in the lumbar region, which clinically resembled a lumbar hernia. The present report focuses on a 53-year-old male patient with a progressive, severe mass in the mid-lower back that had lasted for several months. The initial clinical assessment and radiography suggested a lipoma, sebaceous cyst, or lumbar hernia. An ultrasonographic examination revealed that the mass was heterogeneously hypoechoic with internal echoes that did not correlate with lipomas or sebaceous cysts. Further systemic cytological and histopathological analysis revealed tuberculous alterations, including caseation necrosis, epithelioid granulomas and Langhans giant cells. Surgical exploration revealed an abscess within the extrinsic muscular plane, which was drained successfully. Anti-tubercular Therapy (ATT) was initiated after surgery and resulted in marked improvement of the patient’s symptoms. At the one-year follow-up, the lesion had not recurred, nor were there any associated manifestations of systemic disease. The present case emphasises the importance of considering tubercular aetiology in unusual complaints of lumbar swellings, particularly in TB-endemic areas. The diagnostic process, based on imaging and histopathological examination, was instrumental in achieving the correct diagnosis and ruling out mimicking conditions, such as lumbar hernia or fat necrosis. Specifically, the early initiation of ATT, combined with surgical intervention, led to a positive outcome. Reporting such cases is essential to raise awareness and provide clinicians with knowledge about rare extrapulmonary TB.

Ayurvedic Management of Ovarian Cyst: A Case Report

Varun Gupta, Dnyanesh Joshi, Bhushan Mhaiskar, Utkarsha Khaire

Ovarian cysts are fluid-filled sacs that develop either on or within a woman’s ovaries, which are part of the female reproductive system. They are frequently encountered and can form at any stage of life, but they are most often detected in women during their reproductive years. According to Ayurveda, ovarian cysts can be correlated to Kaphaja Granthi Roga. A 49-year-old female patient came to the Outpatient Department (OPD), with complaints of pain in the pelvic region, bloating, heaviness in the lower abdomen, and changes in menstrual patterns in the last six months. Her ultrasonography report suggested an ovarian cyst measuring 66.2×44.2 mm. The condition was addressed with a combination of various traditional ayurvedic medicines like Kanchnar guggulu 2 tab twice a day, Chandraprabha vati 2 tab twice a day, Bruhat panchmula kwath 20 mL twice a day, Ajmodadi churna 1 tsf at night, Varunadi kashyam 10 mL twice a day, all medicine were given for six months. The patient was satisfied with the outcomes. According to her Ultrasound (USG) reports, after six months of treatment there was no evidence of an ovarian cyst, and her symptoms also demonstrated improvement. The current case underscores the effectiveness of Ayurvedic treatment in achieving positive outcomes for managing ovarian cysts.

Signet Rings Beyond the Norm: A Report of Two Rare Cases

Pulmonary adenocarcinoma with Signet Ring Cell (SRC) morphology is a very rare and distinct subtype initially classified as signet ring adenocarcinoma in the 2004 World Health Organisation (WHO) classification of lung tumours. In the 2015 classification, however, it was removed as a distinct variant. SRC morphology is characterised by abundant intracellular mucin and a crescentic nucleus and is now considered a cytologic change that may occur in various histological patterns. Here, we present two cases reported over one month. The first case is of a 61-year-old female who presented with shortness of breath, loss of weight and loss of appetite for two months. Positron Emission Tomography-Computerised Tomography (PET/CT) scan showed a well-defined malignant-looking lesion in the right middle lobe with metastasis to the right pleura, lymph nodes, liver and adrenal gland. The core biopsy revealed the diagnosis of lung adenocarcinoma with SRC morphology, which was confirmed by Immunohistochemistry (IHC) which also demonstrated positivity for Anaplastic large cell Lymphoma Kinase (ALK) gene rearrangement. The second case was of a 62-year-old female who presented with breathlessness, cough with expectoration and loss of weight for the past six months. PET/CT done outside showed a Fluorodeoxyglucose (FDG) avid lesion measuring 2.3×1.6×1.0 cm, involving the left lower lobe, favouring lung carcinoma, with multiple enlarged lymph nodes. Core biopsy of the lesion revealed the diagnosis of lung adenocarcinoma with SRC morphology. Further, IHC work-up confirmed the diagnosis. Metastasis from other primary sites should be considered first since SRC carcinoma can commonly appear in various organs, including the stomach, colon, urinary bladder, prostate and breast. The presence of Thyroid Transcription Factor-1 (TTF-1) and Cytokeratin 7 (CK7) positivity supports a primary lung adenocarcinoma diagnosis. This variant is found alongside classic adenocarcinoma and frequently metastasises to lymph nodes harbouring ALK gene rearrangements. This case highlights the importance of recognising this distinct clinical entity within pulmonary adenocarcinoma due to its aggressive behaviour and the necessity for timely and accurate diagnosis for targeted treatment.

Cold Autoimmune Haemolytic Anaemia with Blood Group Determination Challenge: A Case Report

Autoimmune Haemolytic Anaemia (AIHA) is a rare, life-threatening condition characterised by the immune-mediated destruction of erythrocytes. AIHA can be classified as either warm or cold, based on the type of antibodies involved. Although idiopathic in many cases, AIHA necessitates a thorough work-up to exclude secondary causes such as infections, drug reactions, or autoimmune diseases. The present case report documents the presentation, clinical findings, diagnosis, treatment and outcome of a 15-year-old female patient with cold AIHA, who presented with fever and generalised bodyaches. Diagnostic evaluations included a positive Direct Coombs Test (DCT), elevated Lactate Dehydrogenase (LDH) and indirect hyperbilirubinemia, all suggestive of haemolysis. Management involved intravenous corticosteroids and supportive care, resulting in significant clinical improvement. The present report highlights the diagnostic complexity and treatment approach in managing cold AIHA, especially when compounded by challenges in blood typing.

Closure of Oroantral Communication Utilising Buccal Fat Pad without Removing the Implants in Maxillary Sinusitis: A Case Report of Two Cases

Noriaki Aoki, Megumi Matsumoto, Junichi Baba, Soichiro Ishii, Hiroshi Ozawa

Although the sinus lift procedure is relatively safe and well-known for bone augmentation in implant cases, it can occasionally lead to acute and chronic postoperative sinusitis as a complication. Generally, treatment for such complications should involve implant removal and Endoscopic Sinus Surgery (ESS). Two cases with similar complications of sinusitis following a sinus lift were reported in the Department of Oral Surgery, where they were managed with different surgical approaches, excluding implant removal and ESS, which is the standard surgical procedure. In the first case, a 50-year-old male with missing teeth and atrophic alveolar bone underwent a sinus lift, bone grafting, and implant placement. One month post-surgery, he developed chronic sinusitis, leading to persistent symptoms. Similarly, another case involved a 48-year-old man who visited the Department of Oral Surgery with a chief complaint of purulent discharge from his nose. In both cases, after clinical and radiological investigations, a final diagnosis of maxillary sinusitis was made, resulting from complications following the sinus lift and implant procedure. The Buccal Fat Pad (BFP) was successfully used to close the Oroantral Communication (OAC) without the need for implant removal or ESS. No infections were clinically or radiographically observed at six months, 12 months, and 24 months postoperatively, and the recovery course was uneventful without any complications. At the two-year follow-up, the patients expressed satisfaction with the results of the implant treatment, demonstrating appropriate implant stability.

Large Ovarian Microcystic Stromal Tumour: A Report of Rare and Distinctive Pathological Entity

Rhea Sharon Susihar, Kalaivani Amitkumar, Meethu Rappai

Microcystic Stromal Tumours (MCSTs) of the ovary are an exceedingly rare and distinct subtype of ovarian stromal neoplasms, characterised by their unique histopathological features. They were first identified in 2019 as a distinct entity. Hereby, the authors present a case report that focuses on a 48-year-old Indian female patient who presented with complaints of lower abdominal heaviness for the past year. Contrast-enhanced Computed Tomography (CECT) of the abdomen revealed a 29.7×24.4×15.3 cm hypodense lesion extending from the pelvis to the epigastric region, with multiple thick septations, a mural nodule/solid component, and moderate enhancement of the cyst wall. Preoperative blood values for CA 19-9, Carcinoembryonic Antigen (CEA), and CA-125 were 25.3 U/mL, 1.5 ng/mL, and 28.8 U/mL, respectively. Staging laparotomy combined with bilateral salpingo-oophorectomy and total hysterectomy was performed. Microscopic evaluation showed solid areas of spindle-shaped tumour cells intermixed with microcysts, separated by hyalinised fibrous stroma. The tumour cells displayed positive staining for vimentin and CD10 on Immunohistochemical (IHC) examination, but negative staining for calretinin and inhibin. Considering the histopathological features and immunohistochemical marker study, a diagnosis of microcystic stromal tumour was established. To date, approximately 50 cases have been documented worldwide, with only one case reported by an Indian author. This report highlights the importance of considering MCST in the differential diagnosis of ovarian masses and emphasises the role of histopathological and immunohistochemical evaluation in achieving an accurate diagnosis.

Tracheal Compression by Aberrant Innominate Artery: A Case Report

Ankit Agarwal, Nidhi Bedi, Pankaj Abrol, Ankit Parakh, Renu Sharma

The brachiocephalic trunk arises from the convexity of the aortic arch, posterior to the manubrium sterni. In rare cases, the origin of the brachiocephalic trunk is shifted to the left of the midline, crosses the trachea through an oblique course, and rises upwards. Sometimes this aberrant artery due to an anomalous course can cause a triad of symptoms consisting of cough, stridor, and occasional apnoea known as innominate artery compression syndrome. Here one such case is presented in which, a nine-month-old infant presented with complaints of recurrent cough and noisy breathing since 10 days of age. The infant had a history of frequent hospital admissions for cough since one month of age where he was given nebulisation but with only partial response. A bronchoscopy was done which was suggestive of mid-tracheal compression. Contrast-Enhanced Computed Tomography (CECT) chest confirmed the diagnosis and the child was then referred to a cardiac surgeon for further management. It is important to note that compression of the trachea or tracheobronchial tree by congenital vascular anomalies is not an uncommon cause of stridor and should always be considered a differential diagnosis while evaluating such cases.

Management of Ulcerative Colitis with Ayurveda Interventions: A Case Report

Vaishnavi Raut, Punam Sawarkar, Gaurav Sawarkar, Mahima Dubey

Ulcerative colitis is a chronic inflammatory bowel disease affecting the mucosal inflammation of the colon and rectum. This idiopathic disease leads to diffused, superficial erosions on the colonic wall and is often considered autoimmune. In Ayurveda, it correlates with Pittaj grahani, presenting symptoms like bloody diarrhoea, pain during defecation, abdominal pain, constipation, and anorexia. Some patients may exhibit only Gastrointestinal (GI) symptoms. Conventional treatments focus on symptomatic management and immune suppression, often with adverse effects and limited efficacy. Due to these limitations, exploring Ayurveda treatments becomes essential. This case study discusses a 25-year-old male with proctitis, progressing to ulcerative colitis with pancolitis, and symptoms of bloody and mucous discharge during defecation, epigastric pain, tenesmus, acidity, and anorexia for two years. He was treated with Ayurveda interventions including Panchatikta ghrita ksheera basti (medicated enema with milk processed with five herbs), medicated rectal tampon, and oral medications such as Hingwashtak churna, Avipattikar churna, Triphala guggulu, Mahasudarshan vati, Shankha vati, Arogyavardhini vati and Kutajarishta. After eight days, significant symptom relief was observed. This case demonstrates the effectiveness of Ayurveda shodhana (purificatory) and Shaman (therapeutic) treatments in managing ulcerative colitis and enhancing the patient’s quality of life. Ayurveda offers a holistic, sustainable, and side-effect-free alternative to conventional treatments for ulcerative colitis.

Successful Management of Newly Diagnosed Autoimmune Hepatitis in a Long-term HIV Survivor: A Case Report

Autoimmune Hepatitis (AIH) is a chronic inflammatory liver disease characterised by the presence of circulating autoantibodies, hypergammaglobulinemia and interface hepatitis on histological examination. AIH in Human Immunodeficiency Virus (HIV)-positive patients presents a unique diagnostic and therapeutic challenge due to the complex interplay between immune activation and immunodeficiency. Treatment considerations in such cases require a careful balance between immunosuppression for AIH and maintaining adequate immune function for HIV control. A 67-year-old female with a 30-year history of well-controlled HIV infection presented with jaundice and haematemesis. Initial evaluation revealed hypotension and abnormal liver function tests. Imaging studies demonstrated portal hypertension with oesophageal varices, requiring endoscopic variceal ligation. Serological work-up showed positive antinuclear antibodies (1:320), elevated Immunoglobulin G (IgG) levels (2270 mg/dL) and positive Anti-mitochondrial-M2 (AMA-M2), with a normal Cluster Differentiation (CD4) count (802/mm³). A liver biopsy confirmed AIH with advanced fibrosis (score 6/6) and significant portal plasmacytosis. The patient was initiated on steroid therapy, which led to clinical improvement. At the three-month follow-up, liver function tests showed significant improvement, with total bilirubin decreasing from 6.56-3.56 mg/dL, AST from 166-80 U/L and ALT from 152-79 U/L. The patient maintained stable HIV control throughout the treatment period. The present case demonstrates that AIH can be successfully managed with standard immunosuppressive therapy in HIV-positive patients with well-controlled disease, highlighting the importance of considering autoimmune conditions in the differential diagnosis of liver dysfunction in HIV patients.

Pierre Robin Sequence Posted for Palatoplasty: An Anaesthetic and Analgesia Management

Sonal Sagar Khatavkar, Sravya Bejugama

Pierre Robin Sequence (PRS) is characterised by micrognathia, glossoptosis, Cleft Palate (CP) and cardiac defects. The key anaesthetic concerns in managing PRS include the patient’s age, assessment of associated congenital birth defects or syndromes and the potential for a shared airway and anticipated difficult intubation. Intubation should be performed using either a nasal or oral endotracheal tube {Ring-Adair-Elwyn (RAE) or flexometallic} of the appropriate size, with video laryngoscopy or fiberoptic equipment available, if necessary. This toddler, a known case of PRS with a CP, with micrognathia since birth and a history of Dandy-Walker syndrome, presented with complaints of feeding difficulties, growth restriction and recurrent Upper Respiratory Tract Infections (URTIs) since birth. The patient was nebulised and premedicated preoperatively. Induction was achieved with sevoflurane and intubation was performed with a flexometallic tube using fiberoptic guidance due to a Cormack-Lehane grade 3, indicating an anticipated difficult airway. Propofol and the muscle relaxant atracurium were administered and a bilateral maxillary block was provided for postoperative analgesia. The case was managed appropriately throughout induction, intraoperatively and during extubation, with an uneventful postoperative recovery.

Radiological Manifestations of Kimura’s Disease: A Case Report

Bharadwaj Saraswathula, Shirish Vaidya, Pratap Singh Parihar, Gahana Kataria

Kimura disease is a rare and non malignant soft tissue disorder characterised by asymptomatic swelling, predominantly in the craniofacial region. It is commonly associated with elevated eosinophil counts and systemic manifestations. This case study covers a 45-year-old male who presented with substantial right parotid oedema that had developed over five years. He was referred to the Radiology department for Magnetic Resonance Imaging (MRI), which revealed an enlarged superficial lobe of the right parotid gland, hypointense on T1 and hyperintense on T2/FLAIR. Multiple enlarged lymph nodes with diffusion restriction were observed at the right levels Ib, II, and III, with the largest at level II on the right-side. The bilateral lacrimal glands were prominent, with postcontrast enhancement. The postcontrast T1-weighted MRI showed tubular signal-intensity voids, likely representing fast-flowing vascular structures. When an individual of Asian descent presents with a subcutaneous mass that is either partially or poorly delineated, exhibiting high signal intensity on T1- and T2-weighted imaging, accompanied by uniform enhancement, adjacent subcutaneous oedema, and internal flow voids, it is imperative to consider Kimura’s disease, particularly in the presence of peripheral eosinophilia. This article focuses on the essential aspects of the disease and how the diagnosis is determined based on MRI results, supported by histopathologic features.

Ayurvedic Management of Shwitra (Vitiligo) through Shaman Chikitsa: A Case Report

Manisha Vaman Davkare, Ashvini Dinesh Pardhekar

In Ayurveda, all skin disorders are considered under the category of Kushta roga. These skin conditions impact not only an individual’s quality of life but also their psychological state of mind, social welfare, and economic development. Shwitra is one of the prevalent manifestations of skin problems. According to modern medicine, it is correlated with Vitiligo, and as a distributed type, it is categorised under Vulgaris Vitiligo subtype. White discoloured patches on the body are hallmark of Shwitra (Vitiligo). Hereby, the authors present a case report of 43-year-old female who came to Kayachikitsa Outpatient Department (OPD) with the complaints of white discoloured patches over face, majorly periorbital area, associated with mild itching and no burning sensation since 9-10 months. Considering the patient’s symptoms and indicators, the treatment strategy was shown to be successful in reversing the depigmented patches to re-pigmentation; more improvements could be achieved in the future by extending the use of other drug combinations based on various Ayurvedic characteristics. It was revealed that the patient’s condition had significantly improved.

Acute Severe Ulcerative Colitis: A Case Report of Successful Management with Infliximab

Acute Severe Ulcerative Colitis (ASUC) is a critical, life-threatening condition characterised by more than six bloody stools per day, along with systemic signs of inflammation, such as fever, tachycardia and anaemia. Despite advances in treatment, ASUC remains a significant cause of morbidity. Management typically involves corticosteroids as the first line of treatment; however, a substantial proportion of patients are steroid-refractory, necessitating escalation to rescue therapies like Infliximab (IFX) or Cyclosporine (CyA). The present case report presents the successful management of ASUC using IFX in a steroid-refractory patient. Hereby, the authors present a case report of a 23-year-old male patient presented with a 15-day history of increased stool frequency (10-15 times per day) associated with blood, mucus, abdominal pain and fever. Initial investigations, including Computed Tomography (CT) scans, colonoscopy and histopathology, confirmed a diagnosis of ASUC. Laboratory findings were consistent with severe inflammation. The patient was initially treated with intravenous hydrocortisone (100 mg every 6 hours) but showed no clinical improvement. Following this, IFX (5 mg/kg) was administered on day 6, leading to a significant reduction in stool frequency and a decrease in blood and mucus in the stools. The patient exhibited symptomatic improvement and was discharged with a plan for continued IFX therapy. A repeat episode occurred a few weeks later, but further IFX therapy again resulted in improvement. The present case highlights the importance of timely rescue therapy in steroid-refractory ASUC. IFX demonstrated rapid and sustained clinical improvement in a patient with severe disease, underscoring its efficacy as a vital therapeutic option. Close monitoring and early intervention with biologic therapy can significantly reduce the need for colectomy and improve patient outcomes in ASUC.

Management of Concurrent Talar Body and Bimalleolar Fractures in Sagittal Plane: A Case Report

Rohit Varma Kothapalli, Vijayanand Balasubramanian, RS Palanisami

Talar fractures are relatively uncommon, with an incidence of 0.1% to 0.85% of all fractures and 3% to 6% of all foot fractures. Among these, talar neck fractures are more common than those of the talar body, typically occurring in the coronal plane. Restoration of joint congruency is necessary to reduce the incidence of osteonecrosis and post-traumatic osteoarthritis. Most fractures occur in the talar neck or body in the coronal plane. In the present case report, authors present a sagittal plane fracture of the talar body in combination with a bimalleolar fracture in a 45-year-old female, managed with open reduction and internal fixation using screws. In the present case, the dual approach, which is ideal, could not be performed due to the condition of the wound over the lateral aspect of the ankle. Proper planning regarding the timing of surgery, considering the swelling and soft tissue status, alongside proper anatomic reduction and rigid fixation with good surgical technique and postoperative rehabilitation, are key to achieving favourable clinical outcomes.

Double Jeopardy: A Case of Non Operative Management of Simultaneous High-grade Splenic Injury with High-grade Renal Injury

Rajan Vaithianathan, Shankar Karuppusamy

High-velocity blunt trauma to the abdomen can result in multiple solid organ injuries, leading to catastrophic bleeding and mortality. Non Operative Management (NOM) of isolated solid organ injury is well established. NOM ranges from observation and monitoring to angioembolisation, with the aim of preserving the organ and its function. NOM for splenic trauma is considered the first line of management in haemodynamically stable patients. NOM for high-grade renal injury is controversial. NOM for simultaneous multi-organ injuries is challenging and the possible advantages of this treatment pathway are still debated. In the present case report (54-year-old female patient), the patient presented with blunt abdominal trauma and imaging revealed a Grade IV splenic injury along with a Grade V renal injury. As the patient remained haemodynamically stable and imaging did not show any active bleeding, NOM was adopted with intensive monitoring and multiple blood transfusions.

Treatment of Excessive Gingival Display using CAD-CAM Guided Aesthetic Crown Lengthening and Surgical Lip Repositioning as an Alternative to Orthognathic Surgery: A Case Report

Apeksha Annigeri, Abhirami Sureshbabu, Vinayak Kumbhojkar, Nivethitha Divakaran

Excessive Gingival Display (EGD), commonly known as a gummy smile, is a significant aesthetic concern. The factors responsible for EGD include altered passive eruption, a short or hyperactive upper lip, vertical maxillary excess, or a combination of these. The classic treatment for severe cases of vertical maxillary excess and EGD is orthognathic surgery. However, Aesthetic Crown Lengthening (ACL) and Lip Repositioning (LR) can offer a conservative, minimally invasive and reliable alternative for treating EGD. This case report focuses on managing EGD using a conservative, minimally invasive mucosal strip surgical technique for a 23-year-old female patient who presented with a severe gummy smile. Management was planned with a combination of ACL and LR. A CAD-CAM milled surgical guide was designed and printed by superimposing Stereolithography (STL) files of digital impressions, photographs and Digital Imaging and Communications in Medicine (DICOM) files from a Cone-beam Computed Tomography (CBCT) scan to provide a suitable and predictable reference for ACL. The LR was performed by resecting a mucosal strip and coronally repositioning the upper lip, thereby reducing the depth of the upper vestibule to restrict lip elevation during smiling, which in turn reduces the gingival display. A substantial reduction of 4 mm of gingival display was seen post-operatively. ACL and LR aided with CBCT can be considered a safe and conservative treatment option for EGD.

An Atypical Case of Primary Angiitis of Central Nervous System Featuring Normal Cerebrospinal Fluid Analysis and Multiple Cavernomas

Salil Gundewar, Pravin Naphade, Satish Nirhale, Prajwal Rao, Pranit Khandait

Primary Angiitis of Central Nervous System (PACNS) is a rare disease with an incidence of 2.4 cases per 10000 persons per year. Diagnosis of the condition is challenging due to its variable presentation. Delay in treatment may cause irreversible neurological consequences. Evaluation includes laboratory tests such as complete blood count, renal function tests, urine routine microscopy, Erythrocyte Sedimentation Rate (ESR), Anti-Nuclear Antibodies (ANA) by Immunofluorescence Assay (IFA) and blot method, complement (C3 and C4) levels, Cerebrospinal Fluid (CSF) evaluation and neuroimaging, including Magnetic Resonance Imaging (MRI) of the brain. Digital Subtraction Angiography (DSA) and High-Resolution Vessel Wall Imaging (HRVWI) may help establish the diagnosis. The Gold standard investigation for diagnosis of PANCS is histopathology of brain biopsy tissue. Here, a case of a 40-year-old male with acute and chronic infarcts in multiple territories with no prior co-morbid conditions is presented. CSF study was within normal limits. Although, DSA and HRVWI showed inflammation in the walls of the left Middle Cerebral Artery (MCA) (M2, M3 segment) and bilateral Anterior Cerebral Arteries (ACAs). This highlights the extremely rare association of PACNS with normal CSF analysis. Diagnosing PACNS is challenging due to its variable presentation, and CSF analysis is typically abnormal in 80-90% of cases. However, the CSF analysis was normal in this case, underscoring the importance of further evaluation in cases with a high suspicion of PACNS.

Spontaneous Oesophageal Rupture: Anaesthetic Challenges in a case of Boerhaave Syndrome Surgery

Smita Ubhe, Fateh Pal Singh Gill, Priya, Arpith Shenava

Boerhaave syndrome is characterised by a rare but life-threatening spontaneous rupture of the oesophagus, which poses significant challenges in anaesthesia management. This condition typically results from sudden intraluminal pressure elevation within the distal oesophagus and is often associated with forceful vomiting. Boerhaave syndrome carries a high mortality rate, ranging from 20 to 40%, with the majority of ruptures occurring in the lower third of the oesophagus, particularly in the left lateral wall of oesophagus. The diagnosis of this syndrome is often complicated by errors, with common misdiagnoses including perforated ulcers, myocardial infarction, pulmonary embolism, dissecting aneurysms, and pancreatitis. Hereby, the authors present a case report of a 52-year-old male who presented with Boerhaave syndrome, outlining the patient’s clinical presentation, diagnostic journey, surgical intervention, and the comprehensive anaesthesia approach employed during the repair of a 3 cm esophageal perforation. Due to the rarity of Boerhaave syndrome, it is essential to highlight potential anaesthetic considerations, such as managing haemodynamics, securing the airway, ensuring adequate oxygenation during one-lung ventilation, controlling peak and plateau pressures, conducting thorough blood gas analysis, and providing prompt treatment. These factors underscore the critical role of anaesthesia in the successful management of this surgery. The present report sheds light on the multifaceted challenges and strategies involved in providing safe and efficient anaesthesia care to patients with Boerhaave syndrome.

A Case of Splenic Artery Pseudoaneurysm in HIV-TB Co-infection: Rare Cause of Haematemesis

Prakash Shende, Tejas Anil Kore, Vivek Hiteshbhai Lapsiwala, Pranavi Kalakota

Splenic Artery Pseudoaneurysm (SAP) is an uncommon false aneurysm that essentially develops due to the weakening of the vessel wall as a result of various local pathologies. Hereby, the authors present a case report, of a 32-year-old male with Human Immunodeficiency Virus (HIV) and Mycobacterium Tuberculosis (TB) co-infection presented with generalised weakness, vomiting, and a history of fever and cough. After admission, he developed massive haematemesis followed by hypotension; this led to an inconclusive upper gastrointestinal endoscopy. This prompted the authors to perform a contrast-enhanced Computed Tomography (CT) scan with angiography of the abdomen, which revealed an SAP, likely due to tubercular vasculitis. Embolisation of the pseudoaneurysm was performed using coils and N-Butyl Cyanoacrylate (NBCA) glue to stop the life-threatening haematemesis. The present case highlights the importance of considering SAP as a differential diagnosis in cases of unexplained haematemesis and emphasises the necessity of early embolisation as a life-saving measure due to its high fatality rate.

Spindle Cell Carcinoma of Larynx: A Rare Case Report

Tanmay Chaudhari, Priya Elangbam, Mayur Ravindrarao Ambekar, Gundappa D Mahajan

Squamous Cell Carcinoma (SCC) is the most common malignancy affecting the larynx in the Indian population. Spindle Cell Carcinoma (SpCC), representing 2-3% of all laryngeal tumours and 1% of head and neck cancers, is a rare variant of SCC that includes a mesenchymal-like malignant spindle cell component. This tumour predominantly occurs in males over the age of 65 years. Known risk factors include smoking and excessive alcohol consumption. Patients often present with hoarseness, as the glottis is the most frequently affected site in about 70% of cases. The tumour typically appears polypoid. Histopathological examination reveals that laryngeal SpCC is a biphasic tumour, consisting of both SCC and a malignant spindle cell component with mesenchymal characteristics but of monoclonal epithelial origin. The primary treatment for this condition is surgical excision, while radiotherapy is indicated for recurrent or more extensive tumours. In the present case report, the authors discussed a case of 45-year-old male patient who presented with a history of hoarseness of voice for one month. Direct laryngoscopy revealed a growth located on the anterior two-thirds of the right vocal cord, along with reduced mobility of that vocal cord. A biopsy was taken, and histopathology and immunohistochemical analysis reported the diagnosis as spindle cell variant SCC. The diagnosis is confirmed through histopathology and immunohistochemical analysis, where tumour cells express both epithelial and mesenchymal markers. The prognosis for laryngeal SpCC is generally poorer than that for laryngeal SCC, necessitating regular follow-up for affected patients. Benign laryngeal lesions that appear harmless should undergo a thorough evaluation and histopathological examination. This is crucial to identify rare conditions, such as sarcomatoid carcinoma, which can closely resemble benign lesions and require appropriate management.

Behind the Peritoneum: A Case Report of Rare Retroperitoneal PEComa

Vaishnavi Kumar, Kalaivani Amitkumar, Nivethitha Sridharan

The Perivascular Epithelioid Cell tumours (PEComas) are exceptionally infrequent tumours arising from mesenchyme, distinguished by epithelioid appearance and myomelanocytic markers’ expression of the proliferating perivascular cells. These tumours can be found in various locations including the lungs, gastrointestinal tract, kidneys, liver, uterus and retroperitoneum. Documented retroperitoneal PEComas are less than 50 in number. Fewer than five cases have been reported in last eight years. Authors hereby report a case involving 28-year-old female patient who experienced abdominal pain which was intermittent and was subsequently diagnosed with retroperitoneal mass measuring 7×6×5.5 cm. The Magnetic Resonance Imaging (MRI) of abdomen and pelvis revealed a well-defined hyperintense mass present on left side of the pelvis, distinct from the separately visualised uterus and ovaries. Surgical resection of the mass was performed during which it was identified as retroperitoneal mass, and histopathological analysis confirmed the diagnosis of PEComa, with immunohistochemical markers positive for Human melanoma Black-45 (HMB-45) and Vimentin, while Smooth Muscle Actin (SMA), Desmin, SOX10, S100 and Cluster Differentiation 34 (CD34) were negative. Surveillance with routine imaging was advised for the patient. She has been under follow-up for the past four months without any symptoms and continues to be actively monitored. This emphasises importance of PEComa to be considered for differential diagnosis for retroperitoneal masses in young women. It also underscores the critical role of histopathology and Immunohistochemistry (IHC) in reaching an accurate diagnosis. The present case contributes to the limited number of reported retroperitoneal PEComa cases in literature.

A Silent Dissection Complicating Myocardial Infarction: A Case Report

Adithya Shelley, Akshat Sharma, Jostol Pinto

A Left Ventricular (LV) pseudoaneurysm develops when free myocardial wall rupture is contained by an adherent layer of overlying pericardium and scar tissue. It is a rare mechanical complication seen in 0.2% of patients post Myocardial Infarction (MI). Furthermore, it remains a challenge to diagnose and differentiate it from a true aneurysm due to overlapping clinical presentations and echocardiographic findings. A 40-year-old male patient presented with ST Elevation Myocardial Infarction (STEMI) and received guideline directed management. However, he was later found to have a pansystolic murmur at the apex and an early diastolic murmur over the left lower sternal border (to and fro murmur) on auscultation. An echocardiogram had subsequently revealed a dissecting pseudoaneurysm of the left ventricle and Contrast-enhanced Computed Tomography (CECT) confirmed the presence of an anterior dissecting pseudoaneurysm. This is an atypical presentation of a niche post MI complication due to its asymptomatic presentation, atypical location and unique anatomy despite prompt revascularisation. Furthermore, the authors emphasise the importance of cardiac auscultation on a day-to-day basis and high index of suspicion to ensure early diagnosis and management of such a silent, calamitous complication.

Diagnostic Challenge in a Case of Cryptogenic Organising Pneumonia

Cryptogenic Organising Pneumonia (COP) is a rare Interstitial Lung Disease (ILD) characterised by a distinctive histological pattern without a known cause. It was earlier referred to as bronchiolitis obliterans organising pneumonia and is brought on by alveolar damage, which causes organised granulation tissue to form, resulting in the blockage of alveoli and bronchioles. If left untreated, the obstructions may cause progressive respiratory failure. This case report describes a 65-year-old female who exhibited respiratory symptoms like low-grade fever, dry cough, poor appetite and loss of weight for about one month, alongside radiological characteristics resembling lung malignancy. The imaging studies showed a dense, irregular opacity with spiculations in the left lung field, leading to a potential misdiagnosis. Comprehensive evaluation, including fibreoptic bronchoscopy which aided in obtaining a Transbronchial Lung Biopsy (TBLB) sample for histopathological examination, revealed alveolar spaces containing foamy macrophages, neutrophils and intra-alveolar plugs of fibroblastic tissue all typical of COP, leading to its diagnosis. Despite the initial challenges posed by the puzzling radiological features, a prompt and accurate diagnosis rooted in histopathology allowed for timely corticosteroid treatment. This case highlights the diagnostic challenges posed by the overlap of radiological attributes between COP and lung malignancy, emphasising the need for careful assessment to avoid multiple unnecessary invasive procedures and delays in treatment. It also underlines the utility of a nuanced histopathological study. Awareness of COP’s clinical and radiological similarities to malignancy and a comprehensive diagnostic approach in such cases is essential for reliable diagnosis, effective patient management and good prognosis.

A Unique Case of Disseminated Tubercular Lymphadenitis with Recurrent Waxing-Waning Course

Shuvajit Roy, Rakhi Sanyal

Extrapulmonary Tuberculosis (EPTB) is particularly challenging to diagnose and manage due to the wide range of presentations. A 52-year-old male Human Immunodeficiency Virus (HIV)-negative immunocompetent patient presented with recurrent symptoms of low-grade fever, severe weight loss, and anorexia over several years following a recurrent waxing-waning course. The initial clinical examination was non significant. Biochemical investigations were also non conclusive except for a chronic inflammatory state as C-reactive Protein (CRP) levels remain constantly raised throughout the period. Microbiological investigations like sputum for Acid Fast Bacillus (AFB) and GeneXpart were negative for Tuberculosis (TB) but the tuberculin test came as positive. Radiological imaging including Contrast-Enhanced Computed Tomography (CECT) abdomen and Positron Emission Tomography-computed Tomography (PET-CT) revealed conglomerated, metabolically active lymphadenopathy in the abdomen, mediastinum, and neck. Subsequent clinical examination revealed palpable lymphadenopathy in the neck. Histopathological examination of the dissected left supraclavicular lymph node confirmed tubercular lymphadenitis. Incidentally, Upper Gastrointestinal (GI) endoscopy showed fundal ulcers which were positive for rapid urease test. The patient was put on first-line anti-tubercular therapy for EPTB and H. Pylori triple regimen for fundal ulcer. The patient showed significant improvement on follow-up.

Intraoperative Incidental Discovery of Pinworms in Paediatric Appendectomy: A Case Report

One of the most common surgical emergencies worldwide is acute appendicitis. The inflammation of the appendix typically results from luminal obstruction, with faecoliths being the most prevalent cause. However, other aetiologies, such as parasitic infections, tumours, foreign bodies and lymphoid hyperplasia, can also lead to appendicitis. Enterobius vermicularis, frequently referred to as pinworm, is one of the most commonly encountered parasites associated with appendiceal inflammation. The following case report presents a case of acute appendicitis in an eight-year-old boy who experienced pain in the Right Illiac Fossa (RIF). This condition was managed by a laparoscopic appendectomy, during which the presence of pinworms was incidentally discovered intraoperatively and later confirmed by histopathology. This case emphasises the need to include parasitic infections in the diagnostic evaluation of children presenting with acute abdominal pain. The incidental discovery of pinworms during surgery underscores the necessity for thorough intraoperative evaluation and appropriate management to prevent complications.

Challenges and Management of Pregnancy with Ebstein Anomaly: A Rare Case

Sanjay Ponde, Vidya Gaikwad, Pragya Tiwari, Himali Hatwar

Ebstein Anomaly (EA), a rare congenital heart disease, presents challenges during pregnancy, often leading to adverse maternal and foetal outcomes. This case report describes the successful management of a 26-year-old primigravida with EA at 40 weeks of gestation. The cardiac evaluation revealed severe tricuspid regurgitation; however, the patient was stable, with normal vital signs and no cyanosis. Given the condition of the patient, a Lower Segment Caesarean Section (LSCS) was performed, resulting in the birth of a healthy neonate. Pregnancy in women with EA requires a careful and multidisciplinary approach to ensure favourable outcomes for both the mother and child.

A Case of Ewing’s Sarcoma of the Jejunum: A Radiological Perspective on Challenges in Diagnosis

Tushar Kalekar, M Karthik, Bhavya Dang, Pushkar Kumar

Ewing’s Sarcoma (ES) of the jejunum is an exceptionally rare malignancy. It belongs to the family of small round blue cell tumours and primarily affects children and young adults, with gastrointestinal involvement being highly uncommon, particularly in the small intestine. Due to its non specific presentation, including abdominal pain, obstruction, or gastrointestinal bleeding, diagnosis is often delayed, making radiological imaging crucial in differentiating it from other gastrointestinal malignancies such as Gastrointestinal Stromal Tumours (GISTs) and lymphomas. Hereby, the authors present a case report of a 64-year-old male who presented with a three-month history of intermittent abdominal pain, progressive abdominal distension, fever, and loss of appetite. Radiological investigations, including Ultrasonography (USG), Contrast-enhanced Computed Tomography (CECT), and Positron Emission Tomography/Computed Tomography (PET/CT), identified a large circumferential jejunal mass with metastatic involvement of the liver, mesenteric lymph nodes, and peritoneum. Imaging revealed a heterogeneously enhancing mass with central necrosis and high metabolic activity, suggestive of an aggressive neoplasm. Endoscopic biopsy confirmed the diagnosis of ES through histopathological and immunohistochemical markers (CD99, NKX2.2, and synaptophysin positivity). Despite plans for chemotherapy, the patient developed septic shock and multiorgan failure, leading to his death shortly after diagnosis. The present case underscores the critical role of radiological imaging in diagnosing gastrointestinal ES, particularly through CT and Fluorodeoxyglucose-PET (FDG-PET). These imaging modalities help distinguish ES from more common gastrointestinal malignancies, such as GISTs and lymphoma, by identifying characteristic features like heterogeneous masses, necrosis, and metastasis. Early and accurate identification is essential for guiding clinical decision-making and treatment strategies in managing such rare and aggressive tumours.

Outcomes of Persistent Hyperinsulinaemic Hypoglycaemia of Infancy: A Case Series

Hariharasudhan Thiyagarajan, Shajitha Banu, Ravanagomagan

Persistent Hyperinsulinaemic Hypoglycaemia of Infancy (PHHI) is a rare but important aetiology of persistent and severe neonatal hypoglycaemia. Early recognition of this condition is crucial to prevent early brain injury to the developing brain. If PHHI is not recognised and treated promptly, it can lead to neurological impairment, cerebral palsy and epilepsy. PHHI has three subtypes: focal, diffuse and atypical. A total of 12 children were diagnosed with PHHI. Nine children returned for follow-up up to one year after discharge. Among the 12 children managed for PHHI, only three were diazoxide-responsive. Genetic analysis indicated that three children had mutations in the ABCC8 gene, and one had a mutation in the KCNJ11 gene. Among the diazoxide-unresponsive children, five had diffuse disease and four had focal hyperplasia, and they were managed with partial and near-total pancreatectomy, respectively. The mean duration of hospital stay was 41.3 days, ranging from 16-96 days. Eight out of the 12 children contracted nosocomial infections, and five out of the nine children who were discharged experienced repeated hospitalisations for transient hypoglycaemic episodes. Of the 12 children, six had normal development, three faced delays in achieving milestones, and three children died during their hospital stay. Therefore, a high index of suspicion for hyperinsulinism is needed for early diagnosis and prompt treatment, which may decrease the length of hospital stay and thus prevent morbidity due to nosocomial infections. Improved medical treatment is needed, as children rarely respond to diazoxide. Children with focal forms of Hyperinsulinism (HI) have a decreased need for repeated hospitalisation after surgery.

Clinicopathological Spectrum of Leiomyomas at Unusual Locations: A Series of Eleven Cases

Benign smooth muscle tumours of the female genital tract are relatively common lesions, but they are not often encountered in other tissues. All the histopathological specimens received in the Department of Pathology at SCB Medical College, Cuttack, Odisha, India, were examined from March 2023 to March 2024. Cases histopathologically diagnosed as leiomyomas, excluding uterine leiomyomas, were included in the study and analysed. Complete history, clinical and radiological details, and preoperative investigation findings of all cases were collected and analysed. The mean age of the patients was 43.9 years, with male-to-female ratio of 7:4. A 70% of the cases involved skin. A few extrauterine cases were detected in breast, esophagus, colon, and ovary. Majority were solitary, non tender, with gradual course of presentation indicating benign nature, hence requiring no further treatment following surgical intervention. Accurate diagnosis and classification of smooth muscle tumours is important, as they can exhibit a varied range of clinical behaviour and may be associated with underlying syndromes.

Pendular Knee Jerk in a Spastic Limb- Seeking Poetic Justice for Conventional Neuroscience!

Sourya Acharya, Samarth Shukla

In a conventional clinical round, my resident presented a case of a Cerebrovascular Event (CVE) with right-sided hemiparesis and requested me to demonstrate ankle clonus. I demonstrated it for him and the other junior residents attending the rounds [Video-1]. I then asked the senior resident to demonstrate all the deep tendon reflexes, which he did correctly, and we all observed the exaggerated deep tendon reflexes in the right-sided upper and lower limbs. A conventional clinical neurologic question-and-answer session regarding tone and reflexes continued for some time, starting with the definition and classification of tone, causes of hypertonia, and the differences between spasticity, rigidity and paratonia. We also discussed the grades of reflexes, clonus and hyperreflexia. Then, I purposefully stumbled upon the “pendular knee jerk.” I was pleased to hear the response. The senior resident answered, “The pendular knee jerk is seen in cerebellar disease. When we strike the patellar tendon, the leg swings to and fro like a pendulum for more than four times,” and he explained that it is due to hypotonia in cerebellar disease. A “hung-up” knee reflex, which is seen in chorea, also exhibits a pendular quality, again due to hypotonia. In a way, the pendular knee jerk hints at decreased tone (hypotonia). By that time, the 75-year-old patient had gotten up and was sitting at the edge of the bed with his legs dangling down. I struck the patellar tendon on the right-side, and what I observed sparked my neurologic insight. I recorded it [Video-2]. Was this unconventional neurology? A pendular knee reflex with an added rotatory movement that continued for more than six times. There was a silent awe and pause of several seconds; all eyes were on me, and my eyes were on the patient’s knee. I repeated the experiment another three or four times to confirm what I had seen, and it was... pendular... for five to six movements, then it became rotatory/circumducting for another four to five oscillations. Now I pondered upon the explanation. The knee-jerk reflex, or patellar reflex, is a monosynaptic stretch reflex that assesses the integrity of the L2, L3, and L4 segments of the spinal cord. When the patellar tendon is struck with a reflex hammer, it stretches the muscle spindle in the quadriceps muscle. This action generates a signal that travels to the spinal cord and synapses directly (bypassing interneurons) at the L3 or L4 level. Subsequently, an alpha motor neuron transmits an efferent impulse back to the quadriceps femoris muscle, inducing its contraction. This contraction, coupled with the relaxation of the antagonistic hamstring muscles, results in the extension of the leg (1). In neurologic conditions, an exaggerated knee reflex denotes a lesion in the pyramidal tract (upper motor neuron), while a decreased or absent reflex denotes a lesion in the lower motor neuron. A pendular knee reflex, defined as the swinging of the leg more than four times after striking the patellar tendon, is observed in cerebellar disease (2). In patients with cerebellar impairment, hypotonia- characterised by reduced resistance to passive movements—leads to an abnormal dampening of the elicited movement. As a result, following percussion of the patellar tendon, these patients exhibit a pendular knee jerk, where the leg continues to swing more than four times. Thus, a pendular knee jerk is indicative of hypotonia (3). In this case, when we apply the conventional definition of a pendular knee jerk, which is based on the number of oscillations, the criteria for the clinical diagnosis of pendular knee jerk is established. According to the literature, a pendular reflex is associated with hypotonia. However, in this case, it was observed in a hypertonic limb. Clonus is a grade 4 reflex, demonstrated at the knee and ankle as sustained rhythmic contractions upon sudden, sustained dorsiflexion of the ankle or when a sudden downward stretch is applied to the patella. In rare clinical situations, clonus, the hallmark of hyperreflexia, can transform into a pendular quality when the patellar tendon is tapped. Clonus should not be replaced or mistaken for a pendular jerk; rather, when a pendular jerk is seen in a hypertonic, hyperreflexic limb, clonus explains the neurologic basis of the observation. Clonus is a rhythmic, oscillating stretch reflex that is usually elicited at the ankle and patella. The cause of the oscillations is related to lesions in upper motor neurons and is generally accompanied by other signs of upper motor neuron lesions, like hyperreflexia, spasticity, loss of superficial reflexes, and a positive Babinski sign (4),(5). In this case, when the patellar tendon was tapped, the clonus manifested as repeated oscillations that mimicked a pendular knee reflex, and the rotatory oscillations were due to adductor spasticity. To conclude, if we traditionally adhere to the definition of a pendular knee jerk, then it follows that “not all pendular reflexes may signify hypotonia. In a spastic limb with grade 4 hyperreflexia, clonus may manifest itself with multiple oscillations.”

Stanford Type A Acute Aortic Dissection with Left Coronary Artery Involvement: Computed Tomography Angiography Findings

A 48-year-old female presented to the emergency department with complaints of acute onset chest pain radiating to the back and breathlessness for the past 24 hours. The patient reported no significant past medical history but had a family history of hypertension. On examination, her blood pressure was markedly elevated at 200/160 mmHg and she appeared distressed and diaphoretic. Auscultation revealed diminished breath sounds in the left lung base. An Electrocardiogram (ECG) revealed sinus tachycardia. Given the clinical suspicion of aortic dissection, urgent imaging studies were performed. A Computed Tomography Angiography (CTA) of the chest was conducted, revealing a Stanford Type A aortic dissection extending from the ascending aorta to the abdominal aorta. A thin, oblique intimal flap was noted, extending from the aortic root just above the right sinus of Valsalva through the entire course of the ascending aorta, arch of the aorta, descending thoracic aorta and abdominal aorta, up to the common iliac artery (Table/Fig 1)a-d. An extension of the flap transversely into the left sinus of Valsalva, involving the osteoproximal segment of the left main coronary artery, was observed (Table/Fig 2). Diffuse consolidations involving bilateral perihilar regions of both lung fields suggested pulmonary oedema (Table/Fig 3)a. Bilateral pleural effusions were also noted (Table/Fig 3)b. Despite the immediate initiation of antihypertensive therapy and arrangements for surgical consultation, the patient’s condition rapidly deteriorated. She developed profound hypotension and loss of consciousness within two hours of admission. Despite aggressive resuscitative measures, including fluid resuscitation and vasopressor support, the patient could not be stabilised. Cardiopulmonary resuscitation was initiated, but unfortunately, the patient succumbed to cardiac arrest. Aortic dissection presents a significant diagnostic and therapeutic challenge due to its potentially fatal consequences (1),(2). It typically manifests with abrupt onset severe chest pain, often described as tearing or ripping, which can radiate to the back. Although in present case, patient presented with classic symptoms, the clinical presentation can vary widely (3),(4). Diagnostic imaging modalities, particularly CTA, are important diagnostic tools that help determine the diagnosis and the extent of the dissection (5). Aortic dissection with coronary artery involvement is relatively rare. In a study by Saito Y et al., patients with left coronary artery involvement had an augmented risk of death compared to those with right coronary artery involvement (54.3% vs. 31.3%, p-value<0.001) (6). This finding was similar to present case. Sen G et al., described a case of Stanford type A aortic dissection with intramural haematoma extending into the left main coronary artery and left anterior descending artery, which is comparable to the present case (7). However, there was no intramural haematoma in the current case and the left anterior descending artery was not involved. Huang LC et al., described a case of Stanford type A acute aortic dissection with right coronary artery involvement; however, in the present case, the left main coronary artery was involved (8). The prognosis of aortic dissection depends on various factors, including the extent of the dissection, the presence of complications and the timeliness of intervention (7). Unfortunately, the patient succumbed to the condition within hours of admission due to the extent of the aortic dissection extending into the osteoproximal segment of the left coronary artery. Left coronary artery involvement in aortic dissection is critical due to its role in supplying oxygen-rich blood to a large portion of the myocardium (6). This involvement can lead to myocardial ischaemia and infarction, posing a significant threat to the patient’s cardiac function and overall prognosis (6). Involvement of the left coronary artery increases the risk of cardiogenic shock, emphasising the need for prompt diagnosis and aggressive management to prevent life-threatening complications (6). This case underscores the critical importance of early recognition and management of aortic dissection to prevent catastrophic outcomes. Despite aggressive medical intervention and timely diagnostic imaging, the patient’s condition rapidly deteriorated, highlighting the formidable challenges in treating this condition.

Role of Mobile Text Reminders in Improving Medication Adherence among Geriatric Population

Shantanu Shekhar Amin, Sangita Devrao Jogdand

Dear Editor, Mobile messaging is a vital mode of communication for people around the globe. Access to mobile phones is rapidly increasing, particularly in Asia (1). Moreover, using cell phones has been demonstrated to increase service utilisation among young adults, who typically do not engage with healthcare services, by allowing them to access healthcare providers remotely for guidance. However, for older people, few of whom may be less capable or willing to use cell phones, the impact of enhanced service access may be limited (1). Many geriatric individuals live with chronic conditions such as hypertension, asthma, diabetes, or Human Immunodeficiency Virus (HIV). To manage these long-term illnesses effectively, individuals need to monitor their symptoms and adjust their lifestyles consistently. Text messaging, in comparison to other communication methods, offers the benefits of immediate delivery and low expense. The widespread availability, portability, instant access and personal nature of mobile phones make them an effective tool for transmitting health information (2). Mobile messaging has been employed to send appointment reminders, boost geriatric patient adherence to medications, monitor chronic illnesses and offer psychological support. Cell phones have also been utilised in the management of infectious illnesses, such as exposure tracking and notifying partners about sexually transmitted infections, as well as in health promotion efforts (3). Medication non compliance is a significant health concern in the geriatric population in contemporary medicine; inadequate adherence to prescribed treatments is linked to higher rates of morbidity, mortality and healthcare expenses. Enhancing medication compliance among medical recipients could aid in optimising the therapeutic advantages for society (4). Support for adherence provided through a Short Message Service (SMS) can enhance medication compliance and health outcomes. It is user-friendly, broadly available and economical. Furthermore, it acts as an effective intervention for various health behaviour modifications. Poor adherence is the leading cause of resistant hypertension. Missed medication, pickup appointments and difficulties related to lifelong treatment are significant factors contributing to inadequate adherence. Telemedicine offers a chance to improve treatment compliance through reminder tools, which are especially helpful for individuals experiencing lapses or those who are unintentionally non compliant. A model of telehealth is a brief SMS reminder note (5). Following is a case discussion that has directly benefitted from the above method: A 75-year-old male patient with hypertension, Type 2 diabetes mellitus and osteoarthritis was prescribed a regimen of six medications daily. Despite verbal counselling, he frequently missed doses, resulting in poor glycaemic control and uncontrolled blood pressure. A mobile text reminder system was introduced, sending daily alerts tailored to his schedule. After three months, the patient reported a marked improvement in adherence (self-reported adherence increased from 60% to 95%) and experienced better symptom control, reflected in reduced HbA1c (from 8.5% to 7.1%) and stabilised blood pressure levels (from 140/90 mmHg to 130/80 mmHg). Mobile text reminders have emerged as a promising tool for enhancing medication adherence and improving the quality of life in the geriatric population, especially among those managing multiple chronic conditions. Forgetfulness, a primary barrier in this age group, can significantly impact compliance with prescribed regimens. Text-based interventions help address this issue by offering personalised, timely and easily accessible reminders, ensuring minimal disruption to daily routines while promoting self-management behaviours.

Painting the Portrait of Fibro-osseous Lesions: An In-vitro Study on Staining Duel of Modified Gallego versus Hematoxylin and Eosin (H&E) Staining

Introduction: Oral cavity tumours involve a mix of soft and hard tissues, with varying levels of calcification posing diagnostic challenges. Detecting the presence or absence of calcification in connective tissue tumours, whether central or peripheral, benign or malignant, is particularly challenging. Routine stains like Haematoxylin and Eosin (H&E) fail to adequately reveal the specific features of these hard tissues. Alternative histochemical staining procedures, such as Modified Gallego’s Stain (MGS), offer better visualisation of the hard-tissue components in the decalcified sections. Aim: To evaluate and compare the staining efficacy of H&E and MGS to differentiate bone and cemental tissue in histopathologically diagnosed oral and maxillofacial pathologies. Materials and Methods: An in-vitro histochemical retrospective study was conducted at the Department of Oral and Maxillofacial Pathology at MGM Dental College, Navi Mumbai, Maharashtra, India, from October 2018 to January 2021. A total sample size of 60 was chosen using a convenient sampling technique, comprising decalcified tissue sections of normal teeth with periapical bone (n=10), normal bone (n=10) and normal teeth (n=10) as the control group. The study group included pathologies of bone and cemental tissues (cemento-ossifying fibroma, odontome, focal cemento-osseous dysplasia) (n=10), pathological bony tissue (juvenile ossifying fibroma, fibrous dysplasia, aneurysmal bone cyst, peripheral ossifying fibroma, juxtacortical osteosarcoma) (n=10) and pathological cemental tissue (odontome, cementoblastoma) (n=10). Serial sections from each sample were taken. One section was stained with H&E stain and another with MGS. Stained sections were viewed using routine light microscopy and evaluated under 40X, 100X and 400X magnification. Histochemical evaluation was performed for the intensity of stain and its tissue differentiation capability for osteoid, immature bone, mature bone, cementoid and cementum. All statistical analysis were performed using the Statistical Package for Social Sciences (SPSS v 26.0, IBM). The data obtained were presented using descriptive statistics. The Chi-square test was used and statistical significance was set at a p-value of less than or equal to 0.05. Results: The MGS had better efficacy than routine H&E stain in differentiating bone and cemental tissues of decalcified tissue sections from various oral and maxillofacial pathologies. A comparison of the H&E and MGS between various study and control groups showed statistically significant results (p<0.05) in differentiation and intensity. Conclusion: The MGS is a better histochemical stain than the routine H&E stain, with increased differentiation and clarity in identifying bone and cemental tissues; hence, it can be considered a reliable method to differentiate pathological tissues.

Impact of Screen Time and Occurrence of Autism Spectrum Disorder among Toddlers in Field Practice Area at Tertiary Care Medical College of Southern India: A Cross-sectional Study

Pooja S Naik, TR Sunilkumar, GV Kumar, Jamunashree Bettaiah, Vykuntaraju K Gowda

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with multiple causative factors and various symptoms, including impaired social communication, repetitive behaviour and restricted interests. It has a significant impact on early childhood, manifesting as poor schooling and social interaction, which later continues to hamper adult productivity. Increased screen time is one of the important predisposing factors for ASD in toddlers and there is a lack of studies regarding the screening of ASDs in Southern India, especially in rural areas. Aim: To evaluate the impact of screen time exposure on the occurrence of ASD in toddlers. Materials and Methods: This cross-sectional study was conducted from July 2022 to January 2024 in the Department of Paediatrics at Sri Siddhartha Medical College and Research Hospital, Tumkur, Karnataka, Southern India. A total of 600 toddlers aged between 16 and 30 months, visiting the Outpatient Department (OPD), camps, Anganwadi centres and Montessoris from urban and rural areas of Tumkur, were included, provided that informed consent was obtained from their parents. All were assessed using pretested questionnaires regarding screen media use and the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) questionnaire. The Chi-square test, Spearman’s rank correlation coefficient and Analysis of Variance (ANOVA) test were used for statistical analysis. Results: In total, 600 children from both urban and rural communities were assessed using the M-CHAT-R screening tool. Of these, six screened positive. Toddlers with positive screens (M-CHAT-R Score >2) had a significantly higher mean age (29.17±1.33 months) compared to those with negative screens (M-CHAT-R Score ≤2) (22.17±4.07 months), p-value <0.001. The gender distribution in the present study revealed a male-to-female ratio of 1.1:1. However, a significant gender disparity was observed among participants screening positive for ASD, with a male predominance (n=5, 0.83%) and a male-to-female ratio of 5:1 (p-value=0.07). A significant correlation between screen time and ASD was observed (r=0.124, p-value <0.001). Conclusion: Early intervention and education for parents/caregivers should be provided to prevent harmful effects, as screen time is a predisposing factor in toddlers.

Comparative Effectiveness of Myofascial Release and Instrument Assisted Soft-tissue Mobilisation in Improving Flexibility of the Hamstring Muscle: An Experimental Study

Haritima Wadhwa, Megha Nijhawan

Introduction: Hamstring tightness is prevalent among college students, with a reported incidence of 40.17% among adults. This tightness is commonly linked with movement dysfunction in the lumbar spine, pelvis, and lower limbs, which can result in low back pain, gait abnormalities, and other issues. Myofascial Release (MFR) and Instrument Assisted Soft-tissue Mobilisation (IASTM) are commonly used techniques known to release soft tissue. However, no study has compared the effects of MFR and IASTM on the flexibility of the hamstring muscles. Aim: To compare the effectiveness of MFR and IASTM on the flexibility of the hamstring muscles. Materials and Methods: An experimental study was conducted at the Indian Spinal Injuries Centre in Vasant Kunj, New Delhi, India from November 2019 to February 2020. The study included 60 subjects, of which two dropped out due to the onset of the pandemic. Inclusion criteria included asymptomatic healthy individuals aged 18-40 years with a knee extension angle of less than 160 degrees. Demographic parameters such as gender, height, weight, and Body Mass Index (BMI) were considered. The subjects were randomly divided into three groups (using a randomisation table from a third-party generator software): Group 1 (20 subjects) received IASTM, Group 2 (20 subjects) received MFR, and Group 3 (20 subjects) served as a control group. Treatment was administered on alternate days for five sessions. Pretreatment, post-treatment (immediately after), and post-post-treatment (after five sessions) readings of the Active Knee Extension (AKE) test were taken using a digital inclinometer. Statistical analysis was performed using Statistical Package of Social Sciences (SPSS); between-group comparisons were made using Analysis of Variance (ANOVA), and within-group comparisons were made using repeated measures ANOVA. A p-value of less than 0.05 was considered significant. Results: The mean age of the study participants was 25.85±3.422 years. The results showed that there was no significant difference in post-treatment outcomes between groups, with a p-value greater than 0.05. However, the post-post-treatment group showed a significant difference with a p-value of 0.001. Within-group analysis of IASTM and MFR revealed a significant difference, with p-values of 0.020 and 0.001, respectively, at the 0.005 level, indicating a marked improvement in the Range of Motion (ROM). Conclusion: Both MFR and IASTM improve the flexibility of the hamstring muscles, as measured by the AKE test in healthy adults; however, there is no significant difference between the two techniques.

Role of Hope in Promoting Emotional Wellbeing among Women with Cervical Cancer: A Cross-sectional Questionnaire-based Study

Jyoti Rao, Roopali Sharma, Manish Sharma

Introduction: Cervical cancer is a significant health challenge that profoundly impacts the emotional wellbeing of affected women, often leading to anxiety, depression and diminished quality of life. Psychological resources, like hope, play a crucial role in coping and resilience during such adversity. Hope has been identified as a critical factor for mental resilience; yet, its specific impact on women with cervical cancer remains underexplored. Aim: To explore the effect of hope on the emotional wellbeing of women with cervical cancer. Materials and Methods: A cross-sectional study utilising a Likert scale questionnaire, administered to 50 female cervical cancer patients, was conducted from June to August 2023. The questionnaire, consisting of nine items, assessed hope levels, emotional distress and coping mechanisms. Participants responded to items measuring levels of anxiety, depression and perceived social support, data were analysed through frequency distributions and correlation analysis. Results: The demographic data revealed that the majority of the respondents were between the ages of 40 and 49 years (40%), with an average age of 44.5 years. However, the average age for the total population of 50 respondents was 47.3 years. Hope was reported to play an essential role in emotional regulation, as over half of the respondents (58%) indicated that hope helped them manage their emotional responses to their cancer diagnosis. The findings reveal a significant positive correlation (r=0.97, p-value <0.001) between hope and emotional wellbeing, with higher levels of hope associated with reduced anxiety and depression. The results also underscore the importance of external factors, such as personal goal-setting and social support networks, which were found to enhance participants’ ability to sustain hope. A majority of respondents highlighted that support from friends, family and the broader social environment contributed to their emotional resilience during treatment. Conclusion: This study emphasises hope as crucial for the emotional wellbeing of women with cervical cancer, demonstrating its strong positive impact on reducing distress. Integrating hope-building interventions, goal-setting, and social support into cancer care can enhance resilience and improve outcomes. These findings advocate for holistic oncology care that addresses both medical and psychological needs.

The Indian Battle of Selecting a Brand versus Generic Medicine Continues: A Cost Variation Study of Oral Fluoroquinolones

Introduction: According to the World Health Organisation (WHO), the rational use of medicine occurs when the medication received by the patient is appropriate to the clinical need, at the proper dose, for the appropriate duration and at the lowest cost that the patient can afford. Fluoroquinolones are widely prescribed medications in India. After being included in the Drug Price Control Order (DPCO) list and having ceiling prices set for a few fluoroquinolones, there is a need to assess the pricing of fluoroquinolones in the market. Aim: To evaluate the cost variation of different brands and generic medicines of oral fluoroquinolones and their combinations in India. Materials and Methods: A cross-sectional descriptive analytical study was carried out in December 2022 and August 2024 as a follow-up to observe improvements in the situation. Authors from different locations in India (Command Hospital, Air Force, Bangalore; AIIMS Gorakhpur; and INHS Ashvini) collaborated to utilise commercial drug directories for the study. The costs of specific oral fluoroquinolones were obtained from the “Current Index of Medical Specialties (CIMS) April – July 2022 and Drug Today April – July 2022,” as well as the latest CIMS April – July 2024 and Indian Drug Review May – June 2024, which are all authentic commercial drug directories. To compare the prices of branded drugs with the corresponding generics, the prices of the generic formulations available in Jan Aushadhi Kendra (JAK) were used. Results: In 2022, Norfloxacin (400 mg) and Tinidazole (600 mg) had the highest percentage variation (3,233.33%), followed by Ofloxacin (200 mg) and Ornidazole (500 mg) with 2,364.28%. In 2024, the percentage cost variation was highest for Ofloxacin (200 mg) and Ornidazole (500 mg), with 1,029.73%, followed by Norfloxacin (400 mg) and Tinidazole (600 mg). In 2022, 16 out of 25 formulations showed more than 100% variation. Conclusion: A wide cost variation in the formulations of oral fluoroquinolones was noted. There is a need to sensitise all stakeholders to this cost variation in order to achieve the goal of safe, affordable and effective medications for all.

Effect of Training to Hold Paretic Lower Limb on an Unstable Surface on the Lower Extremity Motor Control in Patients with Hemiplegia: A Randomised Controlled Trial

Mishal Devadhanam, Sivakumar Ramachandran

Introduction: Activities on unstable surfaces provoke greater muscle contractions than those on stable surfaces. The literature suggests that the effort to hold the paretic extremity on an unstable surface could stimulate muscle contractions in patients with hemiplegia. In the present study, we tested the effect of training to hold the hemiparetic lower limb over an unstable surface on contractions of selected muscles in the lower extremity of patients in the early subacute phase of stroke. Aim: To investigate the effect of training to hold the paretic lower limb on an unstable surface on motor control in the lower extremity of patients with hemiplegia in early subacute phase of stroke. Materials and Methods: The study is a randomised control trial. Subjects were recruited from an acute stroke care centre affiliated with a university teaching hospital. First-time ischaemic stroke patients admitted to the acute stroke care center were enrolled in the study. Patients who could follow commands and had a Brunnstrom stage 2 or below in the lower extremity were included. A total of 78 patients were screened, and 56 patients were included in the study. Patients were randomised into two groups. The control group received conventional physiotherapy, while the experimental group was asked to maintain their paretic lower extremity on an unstable surface, such as a Swiss ball, as part of their training, in addition to conventional physiotherapy. Surface Electromyography (SEMG) was recorded from the paretic hip abductor, tensor fascia lata and quadriceps femoris before and after 10 sessions of training. Student’s t-test was used to assess the findings, with significance set at p-value ≤0.05. Results: The mean age of participants in the control group was 65.53±8.19 years, while the mean age of participants in the experimental group was 57.96±10.89 years. A total of 28 participants in the control group and 28 participants in the experimental group completed the training. Both groups showed an increase in activity in the tensor fascia lata, gluteus medius and quadriceps femoris muscles after 10 sessions of training. Furthermore, the electromyographic activity in all the tested muscles was higher in the experimental group compared to the control group and the difference was statistically significant (p-value <0.01). Conclusion: Training that involves sustaining the paretic lower extremity on an unstable surface, such as a Swiss ball, provoked muscle activity in the paretic lower extremity. Such training can be utilised to improve motor control in the early subacute phase of stroke, where training with minimal movements will be easier for the patient to perform.

Association of Adenotonsillectomy with Vaso-occlusive Crisis Frequency in Sickle Cell Patients of Eastern Saudi Arabia: A Retrospective Study

Moath Alfaleh, Omar Alanzi, Ali Alaskari, Mohammed Alzamil, Hussain Al-Baharna

Introduction: The Red Blood Cells (RBCs) in Sickle Cell Disease (SCD) are distorted into a crescent shape in conditions of low oxygen because of a mutant type of haemoglobin. Vaso-occlusive Crisis (VOC), a defining symptom of SCD, is acute painful assaults caused by vaso-occlusion in the bone marrow. SCD is substantially more prevalent in some regions of Saudi Arabia than in others, with the Eastern Province having the highest incidence rates, followed by the Southern and Western provinces. A 90% of SCD patients were hospitalised due to a painful crisis, often brought on by several reasons, including infection, dehydration, acidosis, hypoxia and many others. Many childhood infections are linked to tonsil and adenoid infections, often requiring tonsillectomy or adenoidectomy. Aim: To evaluate the relationship between adenotonsillectomy and VOC frequency in SCD patients who underwent adenotonsillectomy. Materials and Methods: A retrospective cohort study was conducted in the Otorhinolaryngology Department in Qatif Central Hospital, Qatif, Saudi Arabia, in June 2023. Data were collected retrospectively from January 2019 and January 2022. Patients diagnosed with SCD and who underwent Adenoidectomy and/or Tonsillectomy was included in the study. Clinical and demographic data, along with co-morbidities and laboratory results, were retrieved from electronic medical records. Intragroup comparison of presurgical and postsurgical intervention variables was done using a paired t-test. A p-value of 0.05 or less was considered statistically significant. Results: A total of 32 patients were included in the study. Among the participants, females accounted for 13 (40.6%) and males accounted for 19 (59.4%) of cases. The mean age at surgery of the participants was 10.16 years. The mean of preadenotonsillectomy admissions was less than that of postadenotonsillectomy admissions in all periods; however, this difference was not statistically significant, with p-values of 0.156 for one year, 0.376 for two years and 0.162 for three years. The mean preadenotonsillectomy VOC was higher than the postadenotonsillectomy VOC for the one-year, two year and three-year periods, with p-values of 0.400, 0.167 and 0.088, respectively. Regarding Blood Transfusions (BT), the mean preadenotonsillectomy value was higher than the postadenotonsillectomy mean; however, this difference was not statistically significant, with a p-value of 0.395 Conclusion: Over three years, Adenotonsillectomy did not affect the frequency of VOCs, BTs and hospitalisations, indicating that these procedures may not be suitable as preventive measures for the majority of patients. Future research with larger sample sizes, preferably randomised controlled trials, is required to confirm the findings and assess whether performing the procedure prophylactically in SCD patients with recurrent tonsillitis lowers the frequency of VOCs, potentially reducing the number of ED visits for pain management and control.

Association between Glycaemia and Neurodevelopmental Outcome at One Year of Age among Term Neonates At-risk for Hypoglycaemia: A Prospective Cohort Study

Introduction: Hypoglycaemia during the newborn period is especially impactful because the brain is dynamically developing. The most common sequelae of hypoglycaemia are disturbances in neurologic development and intellectual function; although minor deficits, especially spasticity, ataxia and seizure disorders, can also occur. Aim: To assess the association between glycaemia and neurodevelopmental outcomes at one year of age among term neonates at-risk for hypoglycaemia. Materials and Methods: This prospective cohort study was conducted at the Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute (a tertiary care hospital), Puducherry, India between November 2020 and July 2022. It involved a cohort of neonates at-risk for hypoglycaemia with a gestational age of ≥35 weeks who underwent intermittent monitoring of Blood Glucose (BG) for up to 72 hours of life. The estimated sample size was 146. Assessment at one year included Developmental Assessment Score for Indian Infants (DASII) scores and Amiel-Tison angles, with the assessor being masked to the neonatal glycaemic status. Results: Of the 146 neonates, 71 were euglycaemic and 74 were hypoglycaemic (57 asymptomatic and 17 symptomatic). The mean birth weights were 2853±0.61 grams for euglycaemic neonates, 2669±0.62 grams for asymptomatic hypoglycaemic neonates and 2965±0.671 grams for symptomatic hypoglycaemic neonates. Three of the 74 hypoglycaemic infants developed cerebral palsy. The mean Motor and Mental Developmental Quotients (MoDQ and MeDQ) were significantly lower at one year in any hypoglycaemic infants compared to euglycaemic infants (p<0.001). A BG level of <40 mg/dL demonstrated 98.9% sensitivity for MoDQ and 100% sensitivity for MeDQ, respectively. The Area Under the Curve (AUC) was 0.958 for MoDQ and 0.812 for MeDQ, respectively. Conclusion: Hypoglycaemia, regardless of whether it is symptomatic or asymptomatic, is associated with poor neurodevelopmental outcomes. All at-risk neonates should be monitored to prevent any episodes of hypoglycaemia.

Comparison of Placental Vitamin D Receptor Target Gene Expression in Idiopathic Foetal Growth Restriction Pregnancy and Gestational Age-matched Healthy Controls: A Case-control Study

Priya Sharma, Richa Aggarwal, BD Banerjee, Priyanka Gogoi, Richa Sharma

Introduction: Foetal Growth Restriction (FGR) is a common pregnancy complication that affects up to 10% of pregnancies and is associated with significant morbidity and mortality in the perinatal period and infancy. Despite extensive investigations, a definite etiology cannot be found in up to 70% of cases of FGR, which are termed idiopathic. One of the causative factors responsible for idiopathic FGR could be altered placental expression of Vitamin D Receptor (VDR) genes. Aim: To estimate placental VDR target gene expression in pregnancies affected by idiopathic FGR and to compare it with gestational age-matched healthy pregnant women. Materials and Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital, New Delhi, India, from November 2019 to October 2021. All pregnant women ≥28 weeks gestation with FGR were evaluated to determine the etiology. Those with a negative work-up were defined as having idiopathic FGR (cases, n=30). Gestational age-matched healthy pregnant women were enrolled as controls (n=30). A maternal blood sample for Vitamin D levels was taken before delivery. After delivery, a small portion of the placenta was collected for Ribonucleic Acid (RNA) extraction to study the relative gene expression of VDR and the downstream target gene in the VDR pathway, Transforming Growth Factor Beta 3 (TGFβ3). Statistical tests used in the study included the Independent t-test and Analysis of Variance (ANOVA) for quantitative variables and the Chi-square test or Fisher’s exact test for qualitative variables. The Pearson’s correlation coefficient was used to correlate maternal Vitamin D level (ng/mL) with VDR messenger RNA (mRNA) expression fold change and TGFβ3 mRNA expression fold change. Univariate logistic regression was used to calculate the odds ratio. A p-value of <0.05 was considered significant. The software used for statistical analysis was Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Both groups were comparable in demographic characteristics such as age, socio-economic status, parity and Body Mass Index (BMI). The mean value of maternal Vitamin D levels in idiopathic FGR was 15.73±7.65, compared to 20.01±5.27 in controls. The majority of the patients in our study had Vitamin D deficiency (<20 ng/mL), with 70% of cases and 60% of controls. The mean VDR mRNA ?ct value in cases was higher compared to controls (5.09±0.86 vs. 4.53±1.03, p-value=0.027), implying reduced VDR mRNA gene expression in cases. The mean TGFβ3 mRNA ?ct value was 8.11±1.81 in cases and 6.73±1.64 in controls (p-value=0.003), suggesting reduced TGFβ3 mRNA gene expression in cases. Maternal Vitamin D levels were not found to have any correlation with VDR mRNA and TGFβ3 mRNA expression (correlation coefficients 0.008 and 0.194, respectively). Conclusion: Women with idiopathic FGR had reduced placental VDR and TGFβ3 mRNA expression. However, no correlation was found with maternal Vitamin D levels, suggesting defects in the placental VDR pathway as an etiological factor in FGR.

Assessment of Antibiotic Prescribing Pattern Using WHO Access, Watch, and Reserve Classification (AWaRe) at a Tertiary Care Centre of Northern India: A Cross-sectional Study

Suraj Kumar, Prerna Siwach, Kanav Mehta, Akanksha Mathur

Introduction: Rapid emergence of antibiotic resistance has rendered the treatment of bacterial infections challenging. This is mainly attributed to irrational use of antibiotics. To address this, the World Health Organisation (WHO) has developed Access, Watch and Reserve (AWaRe) classification of antibiotics as a tool for surveillance. Aim: To evaluate the prescribing pattern of antibiotics at a tertiary care hospital and classify the antibiotic usage as per AWaRe classification. Materials and Methods: This was a cross-sectional study conducted for one year (August 2021 - July 2022) across various outpatient departments. The prescriptions containing at least one antibiotic were analysed for the antibiotic prescribing pattern. Antibiotics were categorised into ‘Access’, ‘Watch’, ‘Reserve’, ‘Not recommended’ groups, in the whole population and in three age groups: children, adults and elderly. Access: Watch index was calculated. Descriptive analysis was performed to assess the pattern of antibiotic prescriptions. Results: Of 800 prescriptions, 402 (50.2%) belonged to women and the mean age of the patients was found to be 32.03±8.45 years. A total of 1,090 antibiotics were prescribed, of which 48.34% were ‘Watch’ drugs, 40.64% were ‘Access’ drugs and 0.82% were from ‘Reserve’ group. 3.7% of antibiotics were not recommended by the WHO. Cefixime (J01DD08) was the most commonly prescribed antibiotic, accounting for 294 (27%) prescriptions, followed by amoxicillin-clavulanic acid (J01CR02) with 258 (23.7%) prescribed and ciprofloxacin (S02AA15) with 95 (8.7%) prescriptions. On average, 1.36 antibiotics were prescribed per patient. Access: Watch index was found to be 0.84. Conclusion: The study found high use of ‘Watch’ antibiotics in general and across different age groups of children, adults and elderly. A lower Access: Watch index suggests the need for rational antibiotic prescribing to tackle the problem of resistance.

Aetiology of Headache: A Prospective Observational Study from Southern India

B Naveen Kumar, J Dianitta Devapriya Veronica

Introduction: Headache is a widely prevalent symptom that greatly affects the quality of life. Yet, the disability caused by headache disorders does not receive the attention it deserves. Identifying the exact aetiology and classifying headaches helps focus on appropriate treatments that can reduce their burden on individuals and society. Aim: To examine the common aetiologies of headaches and estimate the prevalence of rhinologic and non rhinologic headaches. Materials and Methods: The present prospective observational study was carried out in the Otorhinolaryngology Outpatient Department (OPD), Yashoda Hospital, Hyderabad, Telangana, India, between December 2016 and December 2018. The study included 140 patients aged 16-55 years who presented with complaints of headache. These patients underwent a complete general and clinical examination and were subsequently investigated to classify the cause of their headaches as either rhinologic or non rhinologic, as well as, acute or chronic. Those classified under rhinologic headaches who required surgery were subjected to surgical intervention. The other causes of headache were treated accordingly. The treatment response of chronic headache cases was followed-up for a period of six months to observe for complete remission of symptoms. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 27.0, statistics for Windows, (IBM Corporation, New York, United States, 2021). Results: Out of total 140 participants included in the study, 80 (57.14%) were males and 60 (42.85%) were females. The overall mean±Standard Deviation (SD) age of the study population was 34±9.66 years. Of the 140 patients included in the study, 44 (31.42%) had acute headaches and 96 (68.57%) had chronic headaches. Among the acute cases, 22 (50%) were due to acute sinusitis. Among the chronic headaches, 33 (34.37%) were cases of chronic migraine. Conclusion: Headache is a common clinical symptom with different aetiopathogeneses, mandating proper evaluation, which helps in the precise diagnosis of the disease and appropriate management. The study results showed acute sinusitis as the most common cause of acute headache and chronic migraine as the most common cause of chronic headache.

A Prospective Observational Study on Viral Conjunctivitis: An Exasperating Entity

Rupali Tyagi, Priyanka Gupta, Aeshvarya Dhawan

Introduction: The community outburst and rising numbers of viral conjunctivitis cases every year indicate a lack of social awareness, as well as inappropriate diagnosing and treatment modalities. Aim: To analyse the clinical profile of viral conjunctivitis patients attending the Ophthalmic Outpatient Department (OPD) of a tertiary care hospital to appraise clinical practice guidelines. Materials and Methods: This was a prospective observational study conducted in a tertiary care hospital in the Department of Ophthalmology, Dehradun, Uttarakhand, India over a period of three months, from June 1, 2023, to August 31, 2023. A total of 586 patients (time-bound study) were diagnosed with viral conjunctivitis who visited the eye OPD and were enrolled after providing informed consent. Following inclusion, the patients underwent a detailed history and ocular examination. The demographic and clinical profiles were tabulated and analysed. The treatment of referred/already treated cases was also analysed. Categorical variables were presented in numbers and percentages (%). The data were entered into an MS Excel spreadsheet, and analysis was conducted using Statistical Package of Social Sciences (SPSS) version 26.0 software. Results: A total of 586 cases of viral conjunctivitis were reported. Out of these, 263 were newly diagnosed, while 323 cases were already under treatment. The maximum number of cases were between 10 and 20 years of age, with 172 (29.35%) patients. Gender-wise distribution of cases shows that there were 341 (58.19%) males and 245 (41.81%) females. Pain, redness, and watering were the unanimous presenting symptoms. The most common signs were follicles and conjunctival congestion in all 586 (100%) cases, followed by lid swelling. Out of 323 (55.11%) cases already under treatment from elsewhere, 16 (4.95%) cases had been treated by general practitioners. Of these 323 cases, the majority were prescribed a combination of topical antibiotic drops, topical steroids, and topical artificial tear drops in 148 (45.82%) cases, followed by a combination of topical antibiotic drops and topical steroid drops in 65 (20.12%) cases. Conclusion: The essential finding in the current study was that close to 46% of the cases were using a cocktail of medications that included topical steroids. Moreover, 4.95% of cases had been treated by general practitioners. Proper guidelines for diagnosis and treatment are urgently needed. Policy formulation by regulatory health authorities is required. The significance of raising awareness among the general public and school authorities/staff should not be overlooked.

Assessment of HIV-associated Neurocognitive Disorders in HAART-naïve Individuals: A Cross-sectional Study

Ravi Krishnegowda, Chaitra Rao, Sumesh Yadav, Konda Sai Kiran

Introduction: Human Immunodeficiency Virus (HIV)-associated Neurocognitive Disorders (HAND) have emerged as a critical concern in managing HIV infection. HIV-related neurological involvement is frequently linked to cognitive impairment and formal neurocognitive tests conducted on People Living with HIV (PLHIV) yield poor outcomes. Depending on the disease severity, HIV-related neurocognitive impairment can be classified as Asymptomatic Neurocognitive Impairment (ANI), Mild Neurocognitive Disorder (MND) and HIV-associated Dementia (HAD). Aim: To evaluate the cognitive function in Highly Active Anti-retroviral Therapy (HAART) naïve PLHIV using the Modified Mini-mental State Examination (3MS) and to associate their immunological status, as well as to evaluate the prevalence of HAND. Materials and Methods: This cross-sectional study was conducted in the Department of General Medicine hospitals affiliated with Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India, from November 2019 to May 2021. A total of 120 HIV HAART-naïve PLHIV were included. Demographic details and data were collected on co-morbidities, baseline CD4 count, opportunistic diseases and World Health Organisation (WHO) clinical staging. PLHIV were assessed for cognitive function using the 3MS and were staged according to Frascati criteria. The Chi-square test was used for data analysis. Results: Among the 120 cases, the mean age was 41.96±11.01 years, with 77 males, 42 females and one transgender individual. A total of 31 (25.8%) cases had a CD4 count of <100 cells/mm³. The most common opportunistic diseases were oral candidiasis and pulmonary tuberculosis (24.2%) and disseminated tuberculosis (15%). A total of 50 (41.6%) PLHIV with a CD4 count of <250 had a 3MS score of <79. Of the 15 parameters of the 3MS, the maximum decrease from the normal value was seen in similarities (45.85%), mental reversal (43%), read and obey (42.33%), first recall (41.10%) and second recall (40.33%). According to Frascati criteria, the prevalence of ANI was 29%, MND was 35% and HAD was 36%. In people with a lower CD4 count (<100 cells/mm³), 50% had HAD, 17.1% had ANI and 9.3% had MND. There was a significant association between the CD4 count of PLHIV and Frascati classification in the present study (p<0.05). Conclusion: Individuals with higher CD4 counts were found to have lesser neurocognitive impairment. The quality of life of PLHIV can be significantly improved if they are screened and treated early in the course of the disease.

Effectiveness of Self-care Management Program on Glycaemic Control, Level of Knowledge and Anxiety among Adolescents with Type I Diabetes Mellitus: A Quasi-experimental Study

Ochappan Selvarajan, Kannan Rajendran, A Helen Mary Perdita

Introduction: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease that leads to the destruction of insulin-producing pancreatic beta cells. Managing diabetes is a multidisciplinary task that involves keeping the affected person under the care of a comprehensive healthcare system. A self-care management program increases their knowledge and lessens their anxiety. However, there is a research gap, as limited studies focus on self-care management programs regarding glycaemic control, knowledge level and anxiety level among adolescents with type 1 diabetes in India. Aim: To evaluate the effectiveness of a self-care management program on glycaemic control, knowledge level and anxiety among adolescents with T1DM. Materials and Methods: This pretest-post-test quasi-experimental study was conducted from July 2023 to December 2023 at the Diabetology Outpatient Department of Government Rajaji Hospital in Madurai, Tamil Nadu, India. The researchers employed a probability systematic sampling technique to allocate samples to both groups for the study. The control and experimental groups each consisted of 105 samples. In the pretest, Glycosylated Haemoglobin (HbA1C) levels, diabetic knowledge scores and anxiety levels were assessed. Adolescents underwent self-care management training sessions weekly through lectures, video tutorials and informational booklets for a duration of 12 weeks. After the intervention, post-tests were conducted. Results: After the intervention, the experimental group showed significant improvement in glycaemic levels (p-value <0.001), improved knowledge scores (p-value <0.001), decreased anxiety levels (p-value <0.001) and decreased depression levels (p-value <0.001). However, there was no significant difference in the control group regarding HbA1C levels, knowledge scores, anxiety scores, and depression scores (p-value=0.686, p-value=0.043, p-value=0.611, and p-value=0.832, respectively). Conclusion: The diabetic self-care management program implemented in this study successfully controlled glycaemic levels, enhanced diabetic knowledge and decreased anxiety and depression levels among adolescents diagnosed with type 1 diabetes.

Metronome-guided Rhythmic Auditory Stimulation with Visual Feedback for Fall Prevention in Elderly: A Randomised Controlled Trial

Abha Khisty, Zafar Azeem, Tushar Palekar

Introduction: Elderly individuals over the age of 65 years are vulnerable to falls in the community and at home. Fall prevention strategies help reduce the risk of falls by improving muscular strength and efficiency. Rhythmic Auditory Stimulation (RAS), along with Visual Feedback (VF), enhances the effectiveness of maintaining balance and reduces falls and fear in patients with neurological concerns. Aim: To determine the effect of RAS along with VF in healthy elderly individuals to prevent falls in familiar environments. Materials and Methods: This randomised controlled trial was conducted at the Department of Physiotherapy, Dr. DY Patil College of Physiotherapy, Pimpri, Pune, Maharashtra, India, from June to July 2024. A total of 60 samples (n=60) were included in the study. A total of 60 elderly patients were randomly assigned to two groups: Intervention Group (IG) and Control Group (CG). Pre- and post-scoring was obtained on falls-related outcome measures. The IG underwent a 4-week training protocol, while the CG did not receive any treatment. The Tinetti Performance-oriented Mobility Assessment (POMA) scale, Berg Balance Scale (BBS) and Falls Efficacy Scale (FES) were used as outcome measures. Data analysis was conducted using PEPI-for-Windows (WINPEPI) software, with intergroup and intragroup analyses utilising paired t-tests and unpaired t-tests, respectively. Results: The mean age of participants included in the study was 70.5±2.5 years. Post-intervention, significant improvement was observed in the scores of the BBS in both the IG and CG. However, the improvement was significantly greater in the IG (p=0.01). Similarly, significant improvements were noted in the FES and Tinetti POMA Scale in the IG (p<0.05) after four weeks of training. In the CG, a non significant improvement was seen in the scores of the Tinetti POMA Scale post-intervention (p=0.22). Conclusion: The results reflect a significant reduction in the fear of falls and the risk of falls in the elderly population following metronome-guided RAS.

Effect of Betulinic Acid on Diabetes and its Associated Complications: An Experimental Study

Sree Thalir Anbuchezian, Royapuram Parthasarathy Parameswari, Anitha Roy

Introduction: Diabetes Mellitus (DM) is a metabolic disease characterised by elevated blood sugar levels and associated complications, such as inflammation, oxidative stress and tissue damage. Betulinic Acid (BA), a naturally occurring pentacyclic triterpene, has demonstrated potential medicinal benefits, such as anti-inflammatory and antioxidant qualities. Hence, it may be useful to explore BA for its antidiabetic activity. Aim: To assess the impact of BA on diabetes and its related complications using in-vitro enzyme inhibitory assays and a cell line model. Materials and Methods: This experimental study was conducted at the Centre for Global Health Research, Saveetha Medical College and Hospitals, Chennai, Tamil Nadu, India from May 2024 to June 2024. In-vitro enzyme inhibitory assays, such as α-amylase inhibition, α-glucosidase inhibition, Aldose Reductase (AR) inhibition and Advanced Glycation End product (AGE) assays, were performed. A cellular glucose uptake assay was conducted using L6 rat skeletal muscle cells with fluorescent 2-NBDG and glucose. Results: The results demonstrated significant inhibition of carbohydrate-hydrolysing enzymes. The percentage inhibition of α-amylase and α-glucosidase ranged from 0.92±0.02% to 67.64±0.06% and from 7.90±0.02% to 74.02±0.05%, respectively, for BA concentrations ranging from 5 to 100 μM. BA exhibited 71.28±0.06% inhibition of AGE compared to aminoguanidine, which showed 79.24±0.07% inhibition at 100 μM. BA also demonstrated 69.97±0.04% inhibition of AR activity compared to metformin, which showed 76.75±0.05% inhibition at 100 μM. Furthermore, BA increased glucose uptake in a dose-dependent manner, with the 92 μM concentration exhibiting a glucose uptake of 75.32±0.73 compared to metformin. Through increased cellular glucose absorption in-vitro, BA showed strong antidiabetic efficacy. Conclusion: BA demonstrates promising potential as a therapeutic agent for the management of diabetes. Its ability to boost glucose absorption and reduce oxidative stress suggests that it may help improve insulin sensitivity and halt the progression of diabetes-related complications.

Comparative Evaluation of Age Estimation by Pulp Tooth Ratio with and without Grid: A Cross-sectional Study

Introduction: Adult age estimation may be essential in post-mortem identification, and its significance is increasing in the field of forensics for both living and deceased persons. Using forensic odontology, one can accurately identify a person’s race, age, and sex, as well as differentiate one group from another. Aim: To estimate and compare dental age using the mandibular first molar by the Pulp Tooth Ratio (PTR), with and without a grid. Materials and Methods: A cross-sectional study was conducted among subjects in Chidambaram, Tamil Nadu, India from January 2021 to December 2021. The study sample comprised 150 Orthopantamograph (OPGs). The tracing measurements were performed on the Joint Photographic Experts Group (JPEG) images using Adobe Acrobat 7.0 Professional software. A novel method, incorporating a grid in all the Orthopantomograms (OPG), was used to improve the accuracy of image tracing. The measurements were performed with and without the grid; the images were consistently zoomed to 160%, and the grid used was 0.1 cm × 0.1 cm. The tracing values were used to estimate age by the PTR. Statistical analysis was conducted using IBM Statistical Package for Social Sciences (SPSS) Statistics Version 20.0. An Unpaired T-test, Pearson’s Correlation, and linear regression were performed. Results: In the age-wise comparison between the two techniques, the mean dental age of the mandibular first molar using the PTR with and without the grid did not show statistical significance (p-value=0.951). The present study found no difference between the methods with and without the grid, showing highly correlated values using the PTR with and without the grid of -0.671 and -0.744, respectively. These r values are statistically significant (p-value <0.05), reflecting that the estimated age by both methods correlated with chronological age. Conclusion: There was no statistical difference between the dental age estimated using the mandibular first molar by the PTR with and without the grid.

Orthodontic Treatment Stability Evaluation with Two Different Ligation Bracket Systems: An Ambispective Cohort Study

Manjiri Bhate, Ravindra Kumar Jain

Introduction: Orthodontic treatment aims to correct malocclusion and achieve stable occlusal relationships and facial aesthetics; however, the tendency of teeth to revert to their pretreatment positions remains a common challenge. Contributing factors to relapse include continued growth, muscular imbalance, oral habits, the type of retainer used, and Intercanine Width (ICW), with the highest incidence occurring immediately post-debonding. Self-ligating brackets, categorised as active or passive, have gained popularity for their efficiency and reduced treatment time; however, evidence of their impact on relapse compared to conventional brackets is limited. Aim: To evaluate and compare the two-year post-treatment stability of orthodontic treatment using conventional brackets versus passive self-ligating brackets. Materials and Methods: An ambispective cohort study was conducted in the Department of Orthodontics at Saveetha Dental Hospitals, Chennai, Tamil Nadu, India from January 2024 to March 2024. The study included 41 patients, divided into two groups: 20 subjects treated with conventional brackets (group 1) and 21 subjects treated with the passive self-ligating bracket system (group 2). All patients met the eligibility criteria and completed two years (T2) of retention with lower bonded retainers and upper removable Hawley retainers. Digital models and lateral cephalograms were taken pretreatment (T0), at debonding (T1), and at T2. Various parameters including ICW, Interpremolar width (IPW), Intermolar Width (IMW), Arch Perimeter (AP), Little’s Irregularity Index (LII), and cephalometric analysis were measured along with Peer Assessment Rating (PAR) scores. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. A paired t-test was performed to test the differences between the measured parameters at T1 and T2, while an independent t-test was applied to compare differences between groups 1 and 2. A p-value of <0.05 was considered statistically significant. Results: Relapse was observed at T2 in both groups, with self-ligating brackets demonstrating more significant changes in maxillary IPW (p-value <0.001), maxillary IMW (p-value <0.001), and LII (p-value=0.03). The PAR reduction rate from T0 to T1 was 97.15±4.41 for group 1 and 96.85±5.80 when comparing T0 with T2. For group 2, the PAR reduction rate from T0 to T1 was 98.05±2.1 and 93.0±2.1 for T0 to T2. Conclusion: Orthodontic treatment with passive self-ligating brackets results in a higher relapse rate in transverse dimensions and incisor proinclination compared to conventional brackets. Improved retention strategies are necessary to mitigate relapse in patients treated with passive self-ligating brackets.

Association of Clinicodemographic Factors and Vaccination Status with COVID-19 Positivity in a Tertiary Care Hospital in Southern India: A Cross-sectional Study

Soumya Kaup, Soujanya Kaup, Srinivas Roopashree

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has wreaked havoc all over the world during the past three years claiming millions of lives. Though the World Health Organisation (WHO) on May 4th 2023 declared that it is no longer a Public Health Emergency of International Concern, it continues to be a global threat with the possibility of emergence of new variants. Aim: To assess the clinicodemographic factors associated with COVID-19 infection and to determine the correlation between vaccination status and COVID-19 positivity. Materials and Methods: An electronic record-based cross-sectional study was conducted from April 2021 to September 2021 in the Department of Microbiology, Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, Karnataka, India. Data pertaining to demographics, symptoms, presence of co-morbidities and vaccination status were collected from individuals whose samples were received for COVID-19 testing either by Real Time-Polymerase Chain Reaction (RT-PCR) or Rapid Antigen Test (RAT). A bivariate analysis was performed using logistic regression to identify factors that were associated with COVID-19 positivity. Multivariate logistic regression was used to assess the relationship between variables after adjusting for potential confounders. Spearman correlation coefficient was calculated to assess the relationship between vaccination status and COVID-19 positivity. Results: A total of 14,846 patients were included in the study. Having at least one co-morbid condition increased the odds of COVID-19 positivity by 28% (AOR: 1.28; 95% CI: 1.01-1.63, p-value=0.039) whereas female gender had 22% (OR: 0.78, 95% CI; 0.72-0.85, p-value=<0.001) lower risk of association with COVID-19 positivity. A weak negative correlation was demonstrated between COVID-19 vaccination status and COVID-19 positivity (Spearman’s Rho ρs=-0.1209, p=<0.01) showing decreased rate of COVID-19 positivity with increase in rate of vaccination. Bivariate analysis of COVID-19 positivity among vaccinated and unvaccinated individuals revealed a significant reduction in odds of testing COVID-19 positive after vaccination (p-value <0.001). Multivariate analysis after adjusting for the effects of age, gender and time of pandemic, showed that receiving a single dose of COVID-19 vaccine reduced the odds of having a COVID-19 positive status by 32% (AOR: 0.68, 95% CI: 0.56-0.82; p-value <0.001) and receiving two doses lowered the odds by 59% (AOR: 0.41, 95% CI: 0.31-0.53; p-value <0.001). Conclusion: This study shows that vaccination against COVID-19 was associated with decreased rate of COVID-19 positivity and demonstrated that two-doses of vaccination was more effective than a single dose.

Analysis of Clinical Parameters and Histopathological Features of Recurrent and Non Recurrent Odontogenic Keratocysts: A Cohort Study

Manya Nautiyal, Deepak Pandiar, Reshma Poothakulath Krishnan

Introduction: Odontogenic Keratocyst (OKC) accounts for 10-20% of all odontogenic cysts and is characterised by unique clinical and histological features, along with a high propensity for recurrence of around 25% after enucleation. The literature presents varied findings regarding the clinical and histological features depicting the recurrence potential of OKCs. Aim: To analyse and compare the clinical and histological parameters between recurrent and non recurrent OKCs. Materials and Methods: This cohort study included 53 excised cases of OKC retrieved from January 2021 to December 2023 (three years) with a maximum follow-up of 36 months from the Department of Oral Pathology and Microbiology at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. Cases that included only incisional biopsies and any cases with epithelial dysplasia were excluded. There were 36 non recurrent cases (Group I) and 17 recurrent cases (Group II). Data pertaining to age, gender, site, laterality, radiological findings, specific histological features, treatment and follow-up were retrieved for both groups, tabulated and analysed using IBM Statistical Package for the Social Sciences (SPSS) for Windows, Version 26.0. Independent t-tests and Pearson Chi-square tests were used to analyse the data, with any value <0.05 considered statistically significant. Furthermore, the Kaplan-Meier curve was used to plot disease (recurrence)-free survival, where recurrence was considered as the event. Results: The present study included 36 non recurrent and 17 recurrent OKCs. No statistical difference was found between the means of age (p-value: 0.432), gender (p-value: 0.254), location (p-value: 0.892), laterality (p-value: 0.381) and uni-/multilocularity (p-value: 0.348) between the recurrent and non recurrent cases. However, histologically, recurrent cases showed significantly more chronic inflammatory reactions in the wall (p-value: <0.001) and a higher percentage of basal budding in the epithelial lining (p-value: 0.001). No significant difference was noted when comparing the incidence of satellite cysts (p-value: 0.259), mitosis (p-value: 0.701), subepithelial split (p-value: 0.362) and juxta-epithelial hyalinisation (p-value: 0.259). A follow-up period ranging from one month to 34 months was noted, which was plotted on the Kaplan-Meier curve and compared with histological features. The cases managed conservatively demonstrated a higher incidence of recurrence. Conclusion: Basal budding and chronic inflammatory reactions are independent histopathological features associated with a higher recurrence potential in OKCs.

Anterior Segment Optical Coherence Tomography in Pseudoexfoliation Syndrome: A Cross-sectional Study

Naureen Muslia, Krishnagopal Srikanth, Swathi Nagarajan

Introduction: Pseudoexfoliation Syndrome (PXS) is a common age-related disorder of the extracellular matrix characterised by the progressive accumulation and deposition of abnormal extracellular fibrillar and Pseudoexfoliative (PXF) material in ocular and systemic tissues. Ocular involvement is generally bilateral and may be asymmetric, inducing changes in the anterior segment of the eye, particularly in the angle structures. Aim: To study the Anterior Chamber Angle (ACA) parameters using Anterior Segment Optical Coherence Tomography (AS-OCT) in patients diagnosed with Pseudoexfoliation Syndrome (PXS). Materials and Methods: This cross-sectional observational study was conducted at the Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India between January 2023 and July 2024. Atotal of 51 patients with evidence of pseudoexfoliative material at the pupillary border or on the anterior lens capsule in one or both eyes were included in the study. All these patients underwent a detailed ophthalmic examination, including gonioscopy and AS-OCTof the nasal and temporal angles. The Angle Opening Distance (AOD) at 500 μm, the Trabecular Iris Space Area (TISA) at 500 μm and the Trabecular Iris Angle (TIA) at 500 μm were measured from the AS-OCTimages. The angle parameters obtained from AS-OCTwere compared with the gonioscopy parameters. Appropriate statistical tests, including descriptive statistics, the post-hoc test and the one-sample t-test, were performed, with a p-value of <0.05 considered statistically significant. Results: Atotal of 51 patients with PXSparticipated in the study. The mean age was 65.3±6.8 years. The mean AOD500 was 386.9±93.7 μm, the mean TISA500 was 0.13±0.02 mm² and the mean TIA500 was 29.2±5.2°. AS-OCT-measured angle parameters in PXSeyes were found to be significantly reduced. All three AS-OCTparameters correlated well with gonioscopy. Conclusion: Patients with PXSshowed narrower ACAparameters—AOD, TISAand TIA—as measured by AS-OCT. The AS-OCTparameters correlated well with the findings from gonioscopy.

Efficacy of USG-guided Supraclavicular Block with Plain Bupivacaine, Bupivacaine-Dexamethasone and Bupivacaine-Sodium Bicarbonate: A Prospective Interventional Study

Introduction: The brachial plexus block has evolved from a blind technique to ultrasound-guided approaches, becoming the gold standard for upper limb surgeries due to better patient outcomes and fewer complications. Various approaches (interscalene, supraclavicular, infraclavicular, and axillary) can be used, and different adjuncts, such as opioids, steroids, ketamine, α-agonists, and sodium bicarbonate, can be added to local anaesthetic drugs to enhance block effectiveness. Aim: To compare the efficacy of the Supraclavicular Block (SCB) using plain bupivacaine versus bupivacaine combined with either dexamethasone or sodium bicarbonate. Materials and Methods: This was a prospective interventional study at the Department of Anaesthesia and Critical Care, SKIMS Medical College and Hospital, Bemina, Srinagar, India, over a period of 24 months, from January 2021 to December 2023 involving 99 patients (aged 18-80, ASA I/II, BMI ≤35 kg/m²) who were randomly divided into three equal groups of 33 each: Group-PB (plain bupivacaine), group-BD (bupivacaine+dexamethasone), and group-BB (bupivacaine+sodium bicarbonate). The study compared various parameters, including demographics, procedure metrics, block characteristics, pain scores, and patient satisfaction, using specific questionnaire evaluation parameters across these groups. Results: Demographic data showed no significant differences in age (PB: 36.2, BD: 39.5, BB: 37.6 years), gender distribution, weight (PB: 67.1, BD: 69.4, BB: 67.8 kg), or American Society of Anaesthesiologists (ASA) status across groups (p>0.05 for all). For block characteristics, sodium bicarbonate significantly reduced the onset time compared to both PB and BD (p<0.05), while dexamethasone had no significant effect (p=0.367). The duration of analgesia was longest with BD (15.3 hours), compared to PB (8.2 hours) and BB (7.9 hours), with significant differences between PB vs. BD and BD vs. BB (p<0.05). The addition of dexamethasone notably prolonged analgesia compared to both other groups. Conclusion: The present study concludes that adding dexamethasone to bupivacaine significantly prolonged the duration of postoperative analgesia, enhancing its efficacy for SCB. Meanwhile, sodium bicarbonate reduced the onset time of the motor block but did not extend the duration of analgesia, indicating distinct advantages of each additive depending on the clinical goal.

Efficacy of Ultrasonically Activated 12.5% Ethanolic Extract of Salvadora persica, Smear Clear, 0.2% Chitosan, 10% Citric Acid in Elimination of Intracanal Smear Layer: A Scanning Electron Microscope Study

Deeksha Goel, Manoj Kumar, Jagat Bhushan

Introduction: The chemomechanical preparation technique is gaining significant importance. Sodium Hypochlorite (NaOCl) and Ethylenediaminetetraacetic acid (EDTA) are traditional irrigants used, but various studies have shown their deleterious effects on dentin. Nowadays, herbal irrigants are gaining attention, though their efficacy in removing the smear layer is not yet clear. Aim: To compare the efficacy of ultrasonically activated solutions of Salvadora persia extract, chitosan, Smear Clear, and citric acid with saline in removing the smear layer, as assessed through Scanning Electron Microscope (SEM) analysis. Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics, Dr. Harvansh Singh Judge Institute of Dental Science and Hospital, Chandigarh, India over a period of six months from January 2023 to June 2023. Extracted teeth were biomechanically prepared and treated with different irrigants for five minutes before SEM analysis. Root canals were rinsed with 5 mL of distilled water and divided into four groups- Group I (Salvadora persica), Group II (Smear Clear), Group III (Chitosan), Group IV (Citra wash), Group V (Saline). Score tests for the presence or absence of the smear layer were statistically analysed using Kruskal-Wallis Analysis of Variance (ANOVA) with the Post-hoc Conover test. A significance level of p-value <0.05 was considered. Results: The results revealed varying efficacy among the irrigants, with Smear Clear (1.4) demonstrating the most effective smear layer removal. Chitosan (2.7) and citric acid (2.6) exhibited moderate efficacy, while saline showed minimal removal. Salvadora persica (3.80) demonstrated very low smear layer removal efficacy. Conclusion: These findings suggest that Smear Clear is a promising option for enhancing the efficacy of root canal irrigation in smear layer removal. Further research is warranted to establish optimal application protocols and assess long-term effects.

Clinical Evaluation of Lesion Sterilisation and Tissue Repair Therapy using Bioceramic in Deciduous Molars with Chronic Periapical Periodontitis and Pulp Necrosis: A Randomised Controlled Trial

Jin Sun, Jiahui He, Wei Luo, Min Wu, Yun Liu

Introduction: Lesion Sterilisation and Tissue Repair Therapy (LSTR) has proven to be as effective as Root Canal Therapy (RCT) for treating deciduous molars with chronic periapical periodontitis and pulp necrosis. Given the routine use of a three-antibiotic mixture, it is important to investigate a more effective medication that offers antibacterial properties, good biocompatibility, and stable chemical characteristics. Aim: To evaluate the efficacy of LSTR with bioceramic (LSTR-bioceramic) in deciduous molars with chronic periapical periodontitis and pulp necrosis. Materials and Methods: A randomised controlled trial was conducted in the Stomatological Healthcare Centre, Shenzhen Maternity and Child Healthcare Hospital affiliated to Southern Medical University, Shenzhen, Guangdong, China, from January 2022 to December 2023. The study included 88 children aged 3-8 years, all diagnosed with chronic periapical periodontitis and pulp necrosis. These cases were treated according to the study protocol, with 44 subjects receiving RCT and the other half receiving LSTR therapy. The subjects were followed-up clinically and radiologically at six and 12 months. The results were rigorously analysed using a Z-test, with a significance level established at 0.05. Results: At six months, the clinical success rates of LSTR-bioceramic and RCT were 37 (84.09%) and 41 (93.18%), respectively; the radiological success of them were 39 (88.64%) and 37 (84.09%). And at 12 months, the clinical success rates of LSTR-bioceramic and RCT were 31 (73.81%) and 35 (81.4%), respectively; the radiological success of them were 25 (59.52%) and 27 (62.79%). No statistically significant differences were found between the radiological and clinical successes of two groups at six months and 12 months (p=0.093, 0.221, 0.456, and 0.271, respectively). Conclusion: LSTR-bioceramic can be used as an effective treatment for deciduous molars with chronic periapical periodontitis and pulp necrosis.

Analysis of Palatal Rugae Pattern in Angle’s Classification of Malocclusion using Dental Casts in Chengalpattu District, Southern India: A Cross-sectional Study

Introduction: Palatal rugae are uneven, asymmetrical ridges of the mucous membrane that stretch laterally from the anterior one-third of the mid-palatine raphe to the incisive papilla. Rugae are generally unique and stable, suggesting applications in forensics and orthodontics. During the early stages of intrauterine life, the formation of palatal rugae is completed, while dental malocclusion in the permanent teeth develops several years after birth. The objective of the present study was to identify the length, number and orientation of palatal rugae in various malocclusion groups. Aim: To investigate potential correlations between Angle’s classification of malocclusion and the palatal rugae pattern. Materials and Methods: A cross-sectional observational study was conducted in the Department of Oral and Maxillofacial Pathology at SRM Kattankulathur Dental College and Hospital, Chengalpattu, Tamil Nadu, India. Data was collected from the years 2021 to 2024 and data analysis was done from October 2023 to April 2024. Study was carried out on 105 archival pretreatment dental casts, ranging in age from 18-35 years. The samples were categorised into class I, class II and class III according to Angle’s system of malocclusion. Bilaterally, the three most prominent anterior primary rugae were counted, and their pattern, length and orientation were noted. STATA 17 software was used for data analysis. Results: The mean±Standard Deviation (SD) age of the study group was 26.5±23.64 years. According to mean±SD length of rugae significantly more (p-value <0.05) primary rugae were found in class I (1.39±1.34 mm) compared to class II (0.59±1.17 mm) and class III (0.5±0.97 mm). Both wavy and curved patterns showed statistical significance with the type of malocclusion (wavy: p-value=0.0001 and curved: p-value=0.0013) when compared to the straight pattern (p-value=0.1498). Regarding the mode of orientation, converging (0.39±0.6) and diverging (0.29±0.52) patterns were found to be statistically insignificant among the three classes of malocclusion. Conclusion: The study demonstrated slight variations in the palatal rugae pattern between Angle’s malocclusion classes. An additional finding that differed significantly among the malocclusion groups was the length of the rugae. However, the results did not reveal a specific pattern that is unique to any one type of malocclusion.

Reliability of Cephalometric Lines as Indicators for Dentoalveolar Stability in Forensic Identification: A Cross-sectional Study

Introduction: Cephalometric superimposition is an accepted method that has long been considered helpful for evaluating the growth and displacement of facial bones during orthodontic treatment. However, the use of these cephalometric records for individual identification has not been reported until recently. The present study emphasises the use of lateral cephalographs as a forensic tool for the identification of individuals. Aim: To assess the alterations in the measurements of specific cephalometric lines observed in tracings obtained before and after orthodontic intervention. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Pathology, Vishnu Dental College, Bhimavaram, West Godavari District, Andhra Pradesh, India, from September 2024 to November 2024. Study involved 120 participants to assess the stability of cephalometric lines for forensic identification. Standardised lateral cephalometric radiographs, aligned with the Frankfort horizontal plane, were traced on acetate sheets by a single orthodontist to identify the chosen cephalometric lines: Pterygomaxillary fissure (Ptm)-nasion, basion-nasion, sella-nasion, Anterior Nasal Spine (ANS)-sella (anterior cranial base length), Frankfort Horizontal (FH), Posterior Nasal Spine (PNS)-nasion (posterior maxillary height), ANS-nasion (anterior maxillary height), ANS-PNS (maxillary length) and sella-articulare (posterior cranial base length). Pre and post-treatment cephalometric measurements were analysed using a paired t-test. Statistical analysis, performed using Statistical Package for the Social Sciences (SPSS) software version 26.0, deemed changes significant at p-value<0.05. To find significant differences, a paired t-test was used. Results: Among the 120 samples analysed, the gender distribution was equal, with 50% females and 50% males. The results showed no significant change in the measurements of ANS-sella, FH plane, PNS-nasion, ANS-nasion, ANS-PNS and Sella-articulare, with a p-value >0.05, indicating that skeletal and alveolar stability remained unchanged before and after orthodontic correction. Conclusion: The present study concludes that the ten reference lines taken can be used as reliable antemortem landmarks for personal identification. The present study is novel in the field of forensic dentistry and hence there is a need for further studies using a larger sample in order to establish a reliable forensic base.

Outcome of Mathieu Meatal-based Flip Flap Technique for Distal Hypospadias: A Retrospective Cohort Study from a Single Tertiary Care Centre, Bhubaneswar, India

Introduction: Several surgical procedures are used for the correction of distal hypospadias. Institutional protocols vary regarding the ideal procedure. The goal of modern hypospadias surgery is to achieve a functionally and cosmetically normal penis. Mathieu described a technique that utilises the perimeatal skin proximally to create a flap for the repair of distal hypospadias. It is a time-tested method with minimal complications. Aim: To highlight the incidence of complications and the surgical outcomes of distal hypospadias using Mathieu’s meatal-based flip flap technique. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatric Surgery at a tertiary care hospital at the Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India on 55 children aged 2-16 years from January 2021 to August 2024. The study population included children with distal penile hypospadias with or without mild skin-level chordee. Patients underwent surgery using the Mathieu meatal-based flip flap technique. The length of the skin flap was determined by the distance from the meatus to the glans tip, after which a ventral meatal-based skin flap was incised. The maximum flap length used was 2 cm. The proximal flap was dissected from the underlying urethra, flipped distally, and anastomosed to the distal urethral plate with running subcuticular sutures of 6-0 Polydiaxanone. The urethra was stented using an infant feeding tube for eight days, and the dressing with the catheter was removed on postoperative day 9. Postoperative complications were analysed using descriptive statistics of frequency and percentage. Results: The mean age at the time of urethroplasty was 6.6±3.2 years. Out of 55 patients, 1 (1.8%) developed meatal stenosis, 1 (1.88%) developed a urethrocutaneous fistula, 2 (3.6%) experienced meatal regression, and 3 (5.4%) had glans dehiscence. All patients (and their caregivers) were satisfied with the cosmetic and functional outcomes postoperatively during follow-up. Conclusion: In present study, Mathieu’s meatal-based flip flap urethroplasty resulted in successful outcomes with low complications. Thus, Mathieu’s meatal-based flip flap urethroplasty remains a time-tested and effective method for select cases of distal hypospadias.

Comparison between Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery for Single Renal Calculus: A Prospective Interventional Study

Vilas Sabale, Ashish Gavade, Vikram Satav

Introduction: Urolithiasis is one of the most common pathological diseases, which is increasing day by day all over the world. It is important to understand the pathology, risk factors and various treatment modalities to tackle this prevalent disease. The management varies based on factors such as stone size, location and patient preference. Aim: To compare Extracorporeal Shock Wave Lithotripsy (ESWL) and Retrograde Intrarenal Surgery (RIRS) for a single renal calculus of size between 10 and 20 mm. Materials and Methods: A prospective interventional study was performed in the Department of Urology at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from October 2022 to October 2024. The population included individuals aged 18 to 60 years with a single renal calculus of 10 to 20 mm, who were eligible for either RIRS or ESWL. A total of 40 patients were studied and divided into two groups of 20. Various variables, such as duration of the procedure, complications, stone clearance, hospital stay, hospital visits and need for ancillary procedures, were compared. The Chi-square test was used to analyse categorical variables and statistical significance was considered when the p-value was <0.05. Results: The mean age of patients was 38.6±11.29 years for RIRS, while for ESWL, it was 40.3±9.49 years. Thirteen patients (32.5%) were from the 31-40 years age group. Present study had 25 patients (62.5%) with calculus sizes between 10-15 mm, while the rest were between 16-20 mm. Fourteen (35%) had middle calyx stones, 11 (27.5%) had lower calyceal stones, nine patients (22.5%) had renal pelvis calculi, and 6 (15%) had upper calyx stones. All RIRS procedures were completed within 120 minutes, while 9 (22.5%) undergoing ESWL took 150 to 180 minutes. Seventeen patients (85%) in the RIRS group achieved complete stone clearance, while stone clearance in the ESWL group was seen in 12 patients (60%). Both groups had similar complication rates of 25%. Haematuria was observed in three patients (15%) in the RIRS group and in four patients (20%) in the ESWL group. Pain was reported in two patients (10%) in the RIRS group and five patients (25%) in the ESWL group. Although sepsis occurred in one case (5%) of the RIRS group, none was reported in the ESWL group. Ten patients (50%) in the ESWL group did not required a hospital stay, compared to 16 patients (80%) in the RIRS group who required a stay of 3-4 days. All patients of RIRS needed only one visit for treatment, while four patients (40%) in the ESWL group required four visits, three patients (15%) required three visits, five patients (25%) required two visits and only four patients (20%) completed their treatment in one visit. Seventeen patients (85%) in the RIRS group did not required any ancillary procedures, while 12 patients (60%) in the ESWL group did not required any ancillary procedures. Conclusion: Both procedures have their own benefits. RIRS showed better stone clearance but is invasive in nature, whereas ESWL, being non invasive, required multiple hospital visits and could be performed on an outpatient basis. Therefore, the choice of procedure should be individualised for each patient, depending on both surgeon and patient preferences.

Relationship between Lower Limb Flexibility, Power, Agility and Speed in Football Players: A Cross-sectional Study

Tresha Parmar, Neha Mukkamala

Introduction: Football is a complex game characterised by unpredictable movement patterns. 17% of injuries in football have been attributed to tightness in the hamstring muscles and a lack of flexibility. In football, the ability to quickly change direction, produce a high rate of power output, and sprint at high velocity is essential for optimal performance. The effect of lower limb flexibility and its relationship to skills required in football, such as agility, power, and speed, have not been previously studied. Aim: To examine the relationship between lower limb flexibility, power, agility, and speed in football players. Materials and Methods: This cross-sectional study was carried out in the football field of Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India on 30 male football players who played at Sumandeep Vidyapeeth campus from January 2021 to August 2021. Football players aged between 18 to 25 years who had been involved in regular football training sessions atleast three times per week for the past year were included in the study. Participants with a history of musculoskeletal injuries to the back, shoulder, elbow, or lower limb within the past six months, or those with any history of cardiorespiratory or neurological problems that could affect test performance, were excluded. Apart from anthropometric measurements, participants were assessed for flexibility using the Active Knee Extension Test (AKET) and the V-sit and reach test, agility using the Arrowhead Agility Test (AAT), power using the Vertical Jump Test (VJT), and sprinting ability using the 40-yard dash test. Correlations among flexibility, agility, power, and speed were assessed using Pearson’s correlation coefficient. Statistical significance was set at p-value<0.05. Results: Total 30 participants were recruited, with a mean age of 20±1.5 years and a mean Body Mass Index (BMI) of 22±1.7 kg/m². The mean active knee extension angle for the right-side was 25±1.9°, and for the left-side, it was 24.6±8.5°. The mean value for the sit and reach test was 42±1.5 cm, the vertical jump was 44±7.9 cm, the AAT was 9.1±1.5 seconds, and the 40-yard dash test was 6.5±0.91 seconds. A significant positive correlation was found between AKET and AAT (r=0.482, p-value=0.007) and between the V-sit and reach test (VSRT) and VJT (r=0.491, p-value=0.006). However, no statistically significant correlations were found between AKET and VJT, AKET and the 40-yard dash, AAT and VJT, or VJT and the 40-yard dash. Conclusion: A positive correlation was found between hamstring flexibility with agility and negative correlation was found between hamstring flexibility with power. There was no statistically significant correlation found between flexibility and sprint.

Analysing the Effects of Longwave Diathermy on Quality of Life among Patients with Knee Osteoarthritis: A Pilot Study

Bhavna Anand, Pragya Kumar, Chitra Kataria

Introduction: Knee Osteoarthritis (OA) is a chronic degenerative condition that significantly impairs the Quality of Life (QoL) in individuals over the age of 50 years. Longwave Diathermy (LWD), known for its ability to improve circulation, reduce pain and enhance functional recovery, has emerged as a promising physiotherapeutic intervention. Aim: To evaluate and compare the effects of Pulsed Longwave Diathermy (PLWD) and Continuous Longwave Diathermy (CLWD) on QoL in individuals with knee OA, assessed across all domains of the World Health Organisation Quality of Life Brief version (WHOQoL-BREF): physical health, psychological health, social relationships and environmental health. Materials and Methods: A comparative pilot study was conducted in the Outpatient Department, Department of Physiotherapy, Amity Institute of Health Allied Sciences, Amity University, Noida, Uttar Pradesh, India, from January 2023 to May 2023. Study included 30 participants aged ≥45 years, diagnosed with grade 2-3 knee OA (Kellgren-Lawrence scale). Participants were randomly assigned to two groups: grade 1 received PLWD with conventional therapy and grade 2 received CLWD with conventional therapy for eight weeks, three times per week. The WHOQoL-BREF was employed as the primary outcome measure to evaluate QoL across four domains: psychological, social, physical and environmental well-being. Assessments using the WHOQoL-BREF were conducted at three key time points: baseline (prior to intervention), after four weeks of intervention and after eight weeks of intervention. Mann-Whitney U test was employed to compare baseline characteristics and differences between the two groups. Analysis of Variance (ANOVA) was used for significant interactions between time points and groups. Results: Both groups showed significant improvements in QoL across all WHOQoL-BREF domains. However, the CLWD group demonstrated greater improvements compared to the PLWD group. In the physical health domain, mean±Standard Deviation (SD) scores improved from 31.33±0.49 at baseline to 56.13±1.85 at eight weeks (F=2.575, p-value<0.05). For psychological health, mean±SD scores increased from 24±5.86 to 54±0 (F=2.575, p-value<0.05). Social relationships mean±SD scores rose from 39.33±10.77 to 68±0 (F=3.533, p-value<0.05). Lastly, the environmental health domain improved from 31.33±0.49 to 56.33±1.76 (F=17.92, p-value<0.05). Conclusion: The CLWD, when combined with conventional therapy, significantly enhances QoL in individuals with knee OA across all domains of the WHOQoL-BREF. These findings highlight its potential as an effective non invasive intervention for managing knee OA. Further large-scale studies are recommended to confirm these results and explore individualised treatment protocols.

Evaluation of the Antioxidant and Anti-Alzheimer’s Activity of Oleanolic Acid: An In-vitro Study

Viishaal Srikanth Srivatsa, Royapuram Parthasarathy Parameswari, Anitha Roy

Introduction: Alzheimer’s Disease (AD) is a neurodegenerative condition characterised by cognitive decline and memory loss, with oxidative stress and neuroinflammation playing key roles in its pathology. While traditional treatments primarily focus on managing symptoms and slowing disease progression, there is a growing recognition of the need for alternative treatment methods. Oleanolic Acid (OA), a natural triterpenoid, has shown neuroprotective and antioxidant properties. Aim: To assess the effects of OA in reducing oxidative stress and targeting major pathological features of AD, including amyloid-beta plaque accumulation and tau hyperphosphorylation. Materials and Methods: The present in-vitro study was conducted in the Centre for Global Health Research, Saveetha Medical College and Hospitals, Chennai, Tamil Nadu, India, from May 2024 to June 2024. AD models were used to assess OA’s impact on oxidative stress levels and amyloid-beta plaque formation. A series of in-vitro assays, such as the 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) assay, the 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) assay, and the Lipid Peroxidase (LPO) inhibition assay, were performed to evaluate the antioxidant properties of OA. The Acetylcholinesterase (AChE) inhibition assay, amyloid (Aβ 1-42) aggregation inhibition assay, and β-secretase inhibition assay were performed to assess the anti-alzheimer effects of OA. A two-way Analysis of Variance (ANOVA) test was used to assess the differences between means, and the Holm-Sidak test was used to compare the means with the standard group. Results: OA significantly reduced oxidative stress and demonstrated a strong antioxidant effect by scavenging free radicals and inhibiting the LPO enzyme, almost on par with ascorbic acid. At a concentration of 320 μM, OA exhibited an antioxidising effect comparable to that of ascorbic acid. It also decreased amyloid-beta plaque formation in AD models, inhibited AChE at the same level as donepezil at higher concentrations, and inhibited the β-secretase enzyme on par with donepezil at lower concentrations, thereby indicating its strong anti-alzheimer potential. Conclusion: In the present study, OA showed promising antioxidant and anti-alzheimer effects, suggesting its potential as a therapeutic agent for AD. By reducing oxidative stress and addressing key pathological features of the disease, OA may contribute to managing and slowing the progression of Alzheimer’s disease. Further studies are necessary to confirm its therapeutic potential in clinical settings.

Efficacy of Bilateral Transverse Abdominis Plane Block and Ilioinguinal Iliohypogastric Nerve Block for Post Lower Segment Caesarean Section Pain Relief: A Randomised Clinical Study

Jigisha Bharatbhai Mehta, Gayatri Vasagadekar, Sara Mary Thomas

Introduction: Insufficient pain management postcaesarean section causes maternal distress, which impacts mother-infant bonding and breastfeeding. Improving postoperative analgesia not only enhances patient satisfaction but also shortens hospital stay, reduces pulmonary complications, supports early mobilisation and decreases the risk of thromboembolism. Aim: To compare the efficacy of bilateral Transverse Abdominis Plane block (TAP) and Ilioinguinal Iliohypogastric block (II-IH) for postcaesarean section pain relief. Materials and Methods: A randomised clinical study was conducted at Dhiraj Hospital, Piparia, Vadodara, Gujarat, India, on 60 pregnant women, aged between 18 to 45 years, who were posted for elective Lower Segment Caesarean Section (LSCS). They were randomised into Group T (n=30) for TAP block or Group I (n=30) for II-IH block. Both groups received 20 mL of 0.25% bupivacaine on both sides. Patients were assessed for Visual Analogue Score (VAS), pulse rate, blood pressure and oxygen saturation at 1, 2, 4, 6, 8, 10, 12, and 24 hours postoperatively. The duration of analgesia, total analgesic consumption and complications were also noted. Rescue analgesia was administered if VAS was >3, in the form of 75 mg i.v. diclofenac. Data were analysed using the sample t-test and repeated measures Analysis of Variance (ANOVA) test. A p-value of <0.05 was considered significant. Results: Both groups were comparable in terms of demographic data (age, weight, height, Body Mass Index (BMI)) with a p-value of >0.05. The VAS score was not statistically significant for 24 hours postoperatively between the two groups with p>0.05 at each time point. The mean duration of analgesia was 606±35.24 minutes in Group T and 702±40.86 minutes in Group I, which was statistically significant (p-value=0.04). Total i.v. diclofenac consumption was 105±62.07 and 75±45.49 in Groups T and I, respectively, which was statistically significant (p-value=0.014). Pulse rate, blood pressure and oxygen saturation were comparable in both groups with no significant difference at any time point. No complications were encountered in either group. Conclusion: Both TAP block and II-IH block are safe and provide analgesia to parturients postoperatively. However, the II-IH block provides a longer duration of analgesia and reduces the postoperative intravenous analgesic requirement compared to the TAP block.

Prediction of Pulmonary Hypertension in Patients with Diffuse Parenchymal Lung Disease using Forced Vital Capacity/ Diffusion Capacity of Lung using Carbon Monoxide Ratio: A Cross-sectional Study

Introduction: Diffuse Parenchymal Lung Disease (DPLD) comprise a heterogeneous group of diseases that occur when an abnormal healing response is induced by injury to the lungs. The diagnosis of DPLD is based on clinical presentation and radiological features. The initial diagnostic work-up includes Pulmonary Function Tests (PFT), such as spirometry and diffusion tests. Aim: To evaluate the accuracy of the Forced Vital Capacity/Diffusion Capacity of Lung for Carbon Monoxide (FVC/DLCO) ratio in predicting the presence of pulmonary hypertension in patients with DPLD. Materials and Methods: A cross-sectional study was conducted from January 2023 to March 2024 in the Inpatient Department (IPD) and Outpatient Department (OPD) of Nilratan Sircar (NRS) Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 patients underwent High-Resolution Computed Tomography (HRCT) thorax and spirometry with DLCO, along with some other ancillary investigations. The parameters evaluated primarily include a descriptive account of the spirometry values, which were Forced Expiratory Volume in 1 second (FEV1), FVC and DLCO, as well as the 6-Minute Walk Distance (6MWD) for physiological assessment and ECHO 2D for the evaluation of pulmonary hypertension. Simple logistic regression was performed between the FVC/DLCO ratio and the presence or absence of pulmonary hypertension based on ECHO 2D with Doppler as the binary outcome. The Receiver Operating Characteristic (ROC) curve was obtained and the FVC/DLCO cut-off ratio was adjusted to achieve the highest sensitivity for predicting pulmonary hypertension based on this dataset. Results: Out of 50 patients (30 females and 20 males), the most common HRCT thorax pattern was Usual Interstitial Pneumonia (UIP), observed in 19 patients (38%), followed by Non Specific Interstitial Pneumonia (NSIP) in 11 patients (22%). The single most common DPLD was Idiopathic Pulmonary Fibrosis (IPF), with 11 patients (22%), while the most common group was Connective Tissue Disease-related DPLD (CTD-DPLD), comprising 22 patients (44%). An FVC/DLCO ratio of 0.97 was found to have a sensitivity of 81%, specificity of 77%, a Positive Predictive Value (PPV) of 86%, a Negative Predictive Value (NPV) of 70% and a diagnostic accuracy of 80% in predicting pulmonary hypertension. Conclusion: The FVC/DLCO ratio of 0.97 represents a modality that could aid in the diagnosis of pulmonary hypertension.

Efficacy of Whole Body Vibration Training and Yoga along with Resistance Band Exercise for Urinary Incontinence: A Pilot Study

Introduction: Urinary incontinence is the involuntary loss or leakage of urine. It occurs in both sexes but is more frequent in women. The most common subtypes are stress and urge incontinence. A patient exhibiting symptoms of both stress and urge incontinence is said to have mixed incontinence. Whole Body Vibration Training (WBVT) is a novel intervention reported as an effective training method for muscle enhancement and has recently been added as a modality for strengthening the pelvic floor muscles. Pelvic floor exercises performed using a resistance band have been proven to reduce urinary incontinence and improve Quality of Life (QoL). Yoga is a mind-body practice that is increasingly popular in the West, particularly among women, and involves the practice of physical postures. Aim: To assess the efficacy of whole body vibration training and yoga combined with resistance band exercises for urinary incontinence. Materials and Methods: This pilot study was conducted at Dr. MGR Research Institute, Department of Physiotherapy, Chennai. A total of 30 married multiparous women with any subtype of urinary incontinence, aged between 20 and 70 years, were randomly assigned to two groups. The duration of the study included 45-minute sessions three days a week for six weeks, starting in January 2022 and ending in March 2022. Group A (n=15) was assigned to WBVT with resistance band exercises, while Group B (n=15) was assigned to yoga with resistance band exercises. Pre- and post-test measures were taken using Pelvic Floor Muscle strength (PFMs), the Michigan Incontinence Symptom Index (M-ISI), and the Incontinence Quality of Life (I-QoL) questionnaire scores. Data were statistically analyzed using paired t-tests and independent t-tests. Results: In this study, the statistical post-test mean values of Group B (yoga with resistance band exercises) showed significant improvement in pelvic floor muscle strength (24.08±1.70) and M-ISI (12.06±2.52). The Incontinence Quality of Life (I-QoL) scores showed significant improvement in both the groups. Conclusion: This study concluded that yoga combined with resistance band exercises was effective in improving pelvic floor muscle strength and reducing the severity of urinary incontinence symptoms. The quality of life improved in both the groups in patients with urinary incontinence.

T2 Mapping as a Diagnostic Imaging Biomarker for Early Osteoarthritis Degeneration in Patellar Articular Cartilage: A Quantitative Comparison of Healthy Adults and Osteoarthritis Patients with 3Tesla MRI

Manna Debnath, Viral Patel

Introduction: The articular cartilage is one of the primary structures affected by Osteoarthritis (OA) and plays a significant role in the degenerative diseases of knee joints. OA is a chronic rheumatic disease that is the leading cause of disability in many countries around the world. Aim: To evaluate the role of T2 mapping in a standard 3 Tesla Magnetic Resonance Imaging (3T MRI) knee protocol for the early detection of OA by comparing T2 relaxation times and articular cartilage thickness in the patellar compartments of healthy adults and OA patients. Materials and Methods: The present cross-sectional study was conducted in the Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Anand, Gujarat, India, from May 2022 to August 2023. It included 102 patients who were scanned using a 3T MRI with a 16-channel phased array knee coil. Of the 102 patients, 51 were healthy adults and 51 were OA patients. T2 mapping sequences were used to obtain 18 patellar cartilage measurements, including the medial superior patella, medial middle patella, medial inferior patella, central superior patella, central middle patella, central inferior patella, lateral superior patella, lateral middle patella and lateral inferior patella, for both T2 relaxation time and articular cartilage thickness. An independent sample t-test was employed to compare the results between healthy adults and OA patients. Results: The overall mean±Standard Deviation (SD) age of all patients was 39.24±12.285 years. Among them, 64 participants were males and 38 were females. The mean±SD T2 relaxation time of the patella ranged from 23.208±9.9220 ms to 34.842±12.6680 ms, while the mean±SD cartilage thickness ranged from 1.661±0.5025 mm to 2.762±0.9306 mm. When comparing T2 relaxation times between male and female populations, over half of the patellar articular cartilage variables were statistically significant (p-value <0.05). Similarly, comparisons of patellar articular cartilage thickness between males and females indicated a statistically significant difference in all variables (p-value <0.001). The T2 relaxation time of the patellar articular cartilage was significantly higher in OA patients compared to healthy adults (p-value <0.001). Likewise, patellar articular cartilage thickness was significantly different between healthy adults and OA patients (p-value <0.001). Conclusion: The T2 mapping technique is a useful tool and could be employed as an imaging biomarker for detecting early patellar cartilage degeneration.

Serum Selenium Status in Autoimmune Thyroid Disorders: A Case-control Study

Ceema Varghese, B Vijayalakshmi, Vergis Paul, JK Mukkadan, KC Thresiamma

Introduction: Selenium is a trace element essential for normal health, playing a crucial role in thyroid hormone synthesis and metabolism. In Autoimmune Thyroid Disorders (AITD), selenium deficiency can exacerbate inflammation, impair thyroid hormone production and escalate tissue damage. Assessing the selenium status as part of comprehensive management strategies for AITD is crucial. Aim: To evaluate the selenium levels and autoantibody levels in AITD and to establish the risk of AITD among patients with low selenium. Materials and Methods: This case-control study was conducted at the Department of Surgery, Medicine, Biochemistry and Physiology, MOSC Medical College, Kolenchery, Kerala, India from July 2022 to May 2023. A total of 134 participants were enrolled, including 67 cases with AITD and 67 matched controls. Serum selenium levels, thyroid function {Triiodothyronine (T3), Thyroxine (T4),Thyroid Stimulating Hormone (TSH)} and thyroid autoantibodies {anti-Thyroid Peroxide (TPO) and anti-Thyroglobulin (TGO)} were evaluated using blood samples collected in the morning (6-8 AM). Statistical analysis was performed with Pearson’s correlation coefficient to assess relationships and Chi-square tests evaluated the association between selenium status and AITD. Odds Ratios (OR) for AITD in relation to selenium levels were calculated. Results: Study population comprised of 38 hypothyroid and 29 hyperthyroid subjects, along with 67 euthyroid controls. Mean selenium levels among AITDs cases (0.088±0.07 μg/mL) were statistically significantly lower in comparison to controls (0.12±0.01 μg/mL). OR for association between serum selenium and AITD was 8.6 (95% CI 0.619-3.677; p<0.0001). Observed Relative Risk (RR) for low selenium to have AITD was 1.95. The Chi-square value of 8.59 with p=0.0034 indicated a statistically significant association between AITD and low selenium status. Conclusion: Selenium levels among hypothyroid and hyperthyroid subjects were significantly lower comparison to age- and sex-matched euthyroid controls. The calculated OR of 8.60 and an RR of 1.95 highlight selenium's potential role in thyroid health, particularly in regulating immune response and hormone metabolism.

Exploring Student Learning in Team-based Physiology Tutorials: A Quasi-experimental Study

Arun Kumar Mohan, P Srinivas, HS Shruthi, KO Thejaswini, Vivek Veeraiah

Introduction: Team-based Learning (TBL) has gained recognition as an effective pedagogical approach in medical education, particularly within tutorial settings. It fosters individual accountability, as students are required to prepare independently before engaging in group discussions, thereby reinforcing their understanding of the material. Additionally, TBL promotes the development of critical teamwork and communication skills among students, both of which are essential for medical practice. Aim: To explore the implementation of TBL in physiology tutorials for MBBS Phase I students, focusing on its impact on student learning outcomes and critical thinking abilities. Materials and Methods: A quasi-experimental study was conducted with 48 students from the Physiology Department. Participants were informed one week prior to the tutorial about the topics to be prepared for TBL. The individual Readiness Assurance Test (iRAT) was assessed using multiple-choice questions administered through Google Forms. Each group of six students completed a team Readiness Assurance Test (tRAT) and a team Application (tAPP) exercise. Descriptive statistics, such as the mean and standard deviation, were used to represent the scores of the study participants. Results: The performance of eight teams was assessed across the iRAT, tRAT and tAPP components. Team 3 achieved the highest average total score of 36.50±2.88 (77.65±6.13%) out of a possible 47, with a score of 14.50±0.83 out of 17 in the tRAT. In contrast, Team 4 scored the lowest average total of 29.17±3.49 (62.05±7.42%), which associated with their lower individual and team RAT scores, indicating varying levels of engagement and collaboration. Conclusion: The results suggest that TBL effectively enhances learning outcomes; however, variations in team cooperation and comprehension highlight the need for targeted interventions to support teams in achieving consistent academic success.

Impact of Nutritional Education Intervention on Mothers Knowledge, Practices and Nutritional Status of Children Under-Five in Rural Mangaluru, Karnataka: A Quasi-experimental Pilot Study

Savitha Naik, Abhay Nirgude, Priya Reshma Arahna

Introduction: Understanding the effectiveness of nutritional education interventions in rural settings is crucial for developing strategies to combat malnutrition and promote healthy growth in children. Enhancing mothers’ knowledge and practices can lead to better child health and development, and also contribute to more favourable long-term outcomes for both children and their communities. Aim: To implement a Nutrition Intervention Program (NIP) to enhance the nutritional status of children under-five by improving mothers’ knowledge and practices regarding child nutrition, thereby supporting the optimal growth and development of their children. Materials and Methods: A quasi-experimental study was conducted among parents of children under-five in the selected rural areas of Kukkuttu and Bhagambila, Mangaluru, Karnataka, India. The total sample size was 78 participants, with 39 in the intervention group and 39 in the control group. Data were collected using a structured knowledge questionnaire and an observational practice checklist. The parameters studied included height, weight, Mid-Upper Arm Circumference (MUAC), and the anthropometric indicators: weight for height, height for age, weight for age, and Body Mass Index (BMI) for age. These indicators are categorised based on growth and development standards established by the World Health Organisation (WHO). Epi Antro software was used to assess undernutrition, overnutrition and normal nutritional status among children under-five. Statistical analyses, including frequency, percentage, mean and standard deviation, multivariate ANOVA, two-factor repeated measures of ANOVA, Fisher’s exact test, Chi-square test, and post-hoc analysis, were used to analyse the data. Results: The mean age of the children under-five in the intervention group was 26.39±9.43 months and control group 22.74±10.65 months. The mean birth weight of the children in the intervention group was 2.75±0.28 kg and control group 2.64±0.27 kg. The mean birth order of the children in the intervention group was 2.02±1.15 and in the control group 3.10±1.75. There was a significant difference in parental knowledge scores within the groups (p-value=0.001, F=315.439) and between the groups (p-value=0.001, F=20.455). Parental practice scores also showed significant differences within the groups (p-value=0.001, F=333.897) and between the groups (p-value=0.001, F=196.446). There was a significant difference in stunting and underweight between the pretest and post-test (p-value <0.05) among children under-five. Conclusion: The study demonstrates that implementing a NIP effectively enhances mothers’ knowledge and practices related to child nutrition. Therefore, such interventions are valuable for promoting better health outcomes in children by educating and empowering mothers with the necessary knowledge and practices for optimal child nutrition.

Beneficial Role of Imeglimin as Add-on Drug with other Oral Hypoglycaemic Agents for Patients with Type 2 Diabetes: A Single centre Prospective Interventional Study

Naima Parveen, Sachin Chittawar

Introduction: With Type 2 Diabetes Mellitus (T2DM) affecting over 74 million individuals in India alone, achieving glycaemic control remains a persistent challenge, especially in patients inadequately managed with Oral Hypoglycaemic Agents (OHAs). The present study explored the potential of imeglimin, a novel antidiabetic drug targeting mitochondrial function, to bridge this gap. By addressing insulin resistance and β-cell dysfunction, imeglimin emerges as a dual-action therapy tailored for patients who are hesitant to initiate insulin. Aim: To assess the short-term effectiveness and safety of imeglimin in T2DM patients who are inadequately controlled on two or three OHAs and who are hesitant to initiate insulin therapy. Materials and Methods: The present prospective, single-arm, single-centre interventional study was conducted in the Department of Endocrinology, Harmony Dr. Sachin’s 360 Degree Diabetes Care Centre, Bhopal, Madhya Pradesh, India, from January 2023 to June 2023. A total of 75 patients meeting the inclusion criteria were enrolled. Baseline and 12-week post-treatment data were systematically recorded, including demographic variables, anthropometric measurements {height, weight, and Body Mass Index (BMI)}, and glycaemic parameters {Fasting Plasma Glucose (FPG), Postprandial Glucose (PPG), and Glycated Haemoglobin (HbA1c)}. Statistical analysis was conducted using one-way ANOVA to evaluate treatment effects. Results: The study population comprised 75 participants with a mean±Standard Deviation (SD) age of 57±10 years and a duration of diabetes diagnosis ranging from six months to 25 years. Males represented a predominant 54.6% of the study cohort. Following 12 weeks of imeglimin treatment, HbA1c levels demonstrated a mean reduction of 1.1% (p-value=0.004) compared to baseline values. Furthermore, FPG levels decreased by a mean of 49.3 mg/dL (p-value=0.013), while PPG exhibited a mean reduction of 79.4 mg/dL (p-value=0.020). The most frequently reported treatment-emergent adverse events were gastrointestinal in nature. Conclusion: Imeglimin demonstrated short-term effectiveness in enhancing glycaemic control as an adjunct therapy to existing OHAs in T2DM patients who are hesitant to initiate insulin. The treatment was well tolerated, with gastrointestinal issues being the primary adverse effect. Further extensive studies with larger sample sizes are warranted to validate these findings and ascertain the long-term effects of imeglimin in T2DM management.

Hyponatremia among Sepsis Patients in the Critical Care Unit and its Association with the SOFA Score: A Cross-sectional Study

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Trupti Jansari, Amit Chauhan

Introduction: Hyponatremia is a frequent electrolyte imbalance observed in critically-ill patients. The Sequential Organ Failure Assessment (SOFA) score is a tool used in sepsis management to assess the severity of organ dysfunction and predict mortality in critically-ill patients. Thus, establishing an association between hyponatremia and the SOFA score aids in triaging patients at high risk of mortality and enhancing management strategies. Aim: To estimate the prevalence of hyponatremia in sepsis patients hospitalised in the critical care unit and analyse its association with SOFA scores. Materials and Methods: The prospective observational cross-sectional study was carried out at the Critical Care Unit of Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Gujarat, India over a one-month duration in November 2024 on 88 sepsis patients aged over 18 years. Following informed consent, routine investigations such as Arterial Blood Gas (ABG), serum bilirubin, platelet count, creatinine, and sodium levels were performed. SOFA scores were calculated at the time of admission, and the severity of hyponatremia was assessed. Statistical tests for prevalence and associations within the data were applied, and the Chi-square test with a p-value of less than 0.05 was considered statistically significant. Results: The mean age of study patients with hyponatremia was 50.74 years, with a standard deviation of 16.49 years. The majority of study participants were male, comprising 62.32%, while females accounted for 37.68%. Hyponatremia was observed in 78.4% of sepsis patients, with 39.8% exhibiting mild hyponatremia, 25% moderate hyponatremia, and 13.6% severe hyponatremia. A SOFA score of 2 was most frequent in 19 patients (27.5%), and the mean SOFA score was 4.42, with a standard deviation of 2.34. The three most common aetiological diagnoses for hyponatremia were lower respiratory tract infection, followed by decompensated Chronic Liver Disease (CLD) and acute ischaemic stroke with aspiration pneumonia. The association between the SOFA score and the severity of hyponatremia was statistically significant, as indicated by the Chi-square test (p<0.05). Additionally, a statistically significant association was observed between the severity of hyponatremia and specific components of the SOFA score, namely platelet count and serum creatinine. Conclusion: Hyponatremia is highly prevalent in critically-ill sepsis patients. The association between hyponatremia and SOFA scores highlights the need for timely diagnosis and management of hyponatremia to reduce morbidity and mortality.

Airway Exchange Catheter-guided versus Conventional Techniques of Nasotracheal Intubation: A Prospective Interventional Study

Ameena Jabbar, KP Biji, KT Shafna, A Krishna Das, S Syam Kumar

Introduction: The conventional Nasotracheal Intubation Technique (NTI), which involves the blind passage of an Endotracheal Tube (ETT) through the nose, is a potentially traumatic process. Airway Exchange Catheter (AEC) guidance for direct or Video Laryngoscopy (VLS) during NTI is likely to improve the first-attempt success rate, along with a reduced incidence of nasal trauma and bleeding. The primary objective is to assess the ease of ETT insertion into the oropharynx and trachea in terms of the number of attempts, navigability, and time taken for insertion. The secondary objectives are to assess the severity of bleeding, cuff rupture, and any other complications. Aim: To compare AEC-guided NTI with the conventional technique for successful NTI. Materials and Methods: This prospective interventional study was conducted in the main operation theatre complex of Government Medical College, Kozhikode, Kerala, India a tertiary care teaching hospital from January 2020 to August 2021 involving 70 patients who underwent oral and maxillofacial surgery. Patients were divided into two groups: group C (conventional NTI group) and group G (AEC-guided NTI group). The number of insertion attempts of the ETT into the oropharynx and trachea, navigability through the nasal passage, severity of bleeding, time taken for intubation, and incidence of cuff rupture were noted. Independent t-tests and Chi-square tests were used to compare variables. Results: The average age of patients in group G was 57.51±5.6 years, while in group C, it was 59.66±5.8 years. The results showed that ETT navigability was easier when using AEC, with a p-value of <0.01. There was a significant difference in the number of attempts for ETT insertion into the oropharynx and trachea (p<0.001). The total time taken for endotracheal intubation was significantly lower in group G compared to group C (p<0.01). The severity of bleeding was higher in group C, with 28.6% of intubations resulting in severe bleeding requiring suction, while the incidence was nil in group G. Conclusion: The first-attempt success rate was higher for the AEC-guided technique of NTI compared to conventional NTI. The incidence of complications was lower with AEC-guided techniques.

Efficacy of Ropivacaine alone Versus Ropivacaine with Dexmedetomidine in Ultrasound-guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Study

Jampala Gowthami, Nadikuda SunilKumar, G Anand Isaac, T Kiran Kumar

Introduction: The Supraclavicular Brachial (SCB) plexus block for upper limb surgeries has emerged as a rapid and reliable technique compared to general anaesthesia. With the advent of Ultrasound (US), the SCB plexus block has become an easy, accurate and popular procedure to perform. Dexmedetomidine, as an adjuvant to local anaesthetics, has improved the quality of the blocks. Aim: To compare the onset and duration of sensory and motor blockade of 0.5% ropivacaine versus 0.5% ropivacaine with 25 μg dexmedetomidine, as well as to assess the haemodynamic parameters in the SCB plexus block. Materials and Methods: This randomised controlled study was conducted at Osmania Medical College and General Hospital, Hyderabad, Telangana, India which included 60 adult patients {American Society of Anaesthesiologists (ASA) I and II} scheduled for elective upper limb surgery under SCB, according to the inclusion criteria. The patients were randomised into group R (n=30), which received 30 mL of ropivacaine with 1 mL of saline and group RD (n=30), which received 30 mL of ropivacaine with 25 μg of dexmedetomidine. The onset and duration of sensory and motor block, the duration of analgesia, haemodynamic parameters and any complications were recorded, tabulated in an Excel sheet and analysed using an unpaired t-test. Results: The demographic data among both groups were comparable, with a male predominance. The onset of sensory and motor block was faster in group RD compared to group R, respectively (4.78±1.68 mins vs. 7.87±1.98 mins, p-value <0.001) and (8.4±2.34 mins vs. 12.3±2.95 mins, p-value <0.001). The duration of sensory and motor block was longer in group RD compared to group R, respectively (807.5±165.51 mins vs. 485±81.31 mins, p-value <0.001) and (685±62.74 mins vs. 465±72.62 mins, p-value <0.001). Haemodynamic stability was well maintained without any complications in group RD. Conclusion: The addition of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided SCB accelerates the onset of sensory and motor block, prolongs the duration of the block and analgesia, thereby improving the quality of the SCB.

Clinical Profile and Surgical Outcome of Paediatric Patients Diagnosed with Urethrocutaneous Fistula following Circumcision: A Retrospective Descriptive Study

AB Hamid Wani, Gurbir Singh, Davinderpal Singh, Nikhil Arya

Introduction: Circumcision is one of the oldest and most common surgical procedures performed in the world. While circumcision is generally considered a simple and short procedure, it can lead to undesirable complications, such as Urethrocutaneous Fistula (UCF). The repair of UCF is quite challenging for surgeons, with high chances of recurrence, often requiring multiple surgical procedures. Aim: To study the clinical profile of patients with UCF and the outcomes of various surgical repair techniques. Materials and Methods: This retrospective descriptive study was conducted in the Department of General Surgery at Government Medical College, Jammu, Jammu and Kashmir, India, from January 2016 to January 2023. A total of 30 male patients with UCF fistula following circumcision were included. The category of the circumcisionist, site and size of the fistulae, type of repair, and associated complications were recorded. Results were expressed in terms of frequency and percentage. Results: The age of the patients varied from nine months to eight years. Circumcision was most commonly performed by traditional circumcisionists, accounting for 22 (73.3%) subjects. Approximately 18 (60%) of the patients had a coronal fistula. The size of the defect varied from 2 to 9 mm. All patients had a single UCF. Simple closure was performed in 20 patients, while eight patients underwent Tubularised Incised Plate (TIP) repair, and two patients had Mathieu flip-flap urethroplasty. The most common complication was refistulisation, observed in four patients. Conclusion: Public awareness regarding circumcision by trained surgeons and additional training for healthcare providers is essential to prevent the formation of UCF.

Factors Determining Mortality in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: A 10 Year Retrospective Analysis from a Tertiary Care Centre in Southern India

Deepthy V Gopinath, Pradeep S Nair

Introduction: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse drug reactions characterised by high fever, widespread blistering exanthema, and atypical target lesions accompanied by mucosal involvement. SJS/TEN ranks among the leading causes of mortality in dermatology. Adequate management of these conditions requires prompt recognition, identification of risk factors and timely intervention. Due to the rarity of these incidents, their mortality rates and the associated factors are less studied. Aim: To determine the factors contributing to mortality in SJS and TEN, as well as, the mortality rate in a tertiary care centre. Materials and Methods: The present single-centre retrospective observational study was conducted in the Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India, from November 2022 to May 2023. Data were extracted from the case records of patients diagnosed with SJS/TEN over a period of 10 years, from January 2012 to December 2021. The variables studied included patients’ age, gender, suspected drug, interval between drug intake and onset of symptoms, time interval between the development of the rash and reporting to a healthcare facility, associated co-morbidities, involved Body Surface Area (BSA), duration of hospitalisation, laboratory investigations, and complications, including death. The data were analysed using the trial version of Statistical Package for Social Sciences (SPSS) software version 29.0. A Pearson’s two-sided Chi-square test was utilised to determine the statistical significance of the variables between the survival group and the mortality group. Results: A total of 146 cases of SJS/TEN were analysed, of which the mean±Standard Deviation (SD) age in the survived group was 42.07±16.704 years, while in the mortality group, it was 67.83±7.57 years (p-value=0.003). There were eight cases of mortality (5.48%). The most common drug in both the mortality group and the survival group was phenytoin. There was a statistically significant association between age (p-value=0.003), Hypertension (HT) (p-value=0.002), presentation with vesicles and bullae (p-value=0.002), and mortality. TEN was more likely to cause mortality than SJS (p-value=0.001), and urinary microscopy abnormalities were associated with mortality (p-value=0.04). Conclusion: A low mortality rate of 5.48% was observed in the present study. Older age, hypertension, presentation with vesicles and bullae, and urinary microscopy abnormalities contributed to mortality. Phenytoin was more likely to cause mortality than other drugs. Mortality was higher in TEN compared to SJS.

Assessment of Radiological Parameters of Lordosis in Chronic Low Back Pain: A Case-control Study

Sudhir Singh, Sankalp Singh, Vijay Pratap Singh

Introduction: Low Back Pain (LBP) is a global health problem with a multifactorial aetiology. Many clinicians believe that changes in lumbar lordosis contribute to LBP. The normal range of lordosis has not yet been agreed upon; hence, the practice of assessing the parameters of lordosis on sagittal radiographs becomes irrelevant, adding to treatment costs and exposing patients to radiation risk. Consequently, the practice of measuring lordosis needs to be re-evaluated. Aim: To determine the Lumbar Lordotic Angle (LLA) and Lumbosacral Angle (LSA) in individuals with and without LBP. Materials and Methods: This case-control study was conducted from November 2022 to March 2024 at Teerthankar Mahaveer Medical College, a tertiary care hospital, Moradabad, Uttar Pradesh, India. One hundred patients aged between 18 and 50 years with chronic non specific LBP were recruited as cases, matched for age, gender and Body Mass Index (BMI). Similarly, 100 healthy volunteers were taken as controls, also matched for these parameters. LSA and LLA were recorded on sagittal radiographs of all subjects, and the data were analysed statistically. Results: The cases and controls were similar with respect to age (p-value=0.407), gender (p-value=0.315), and mean BMI (p-value=0.239). The mean LSA was 34.17±5.86° (M: 35.19±6.86°; F: 33.55±5.07°) in the case group and 36.69±6.72° (M: 37.68±6.78°; F: 35.87±6.63°) in the control group (p-value=0.001). The mean LLA was 50.04±9.09° (M: 53.99±8.93°; F: 48.25±8.55°) in cases and 49.60±9.77° (M: 48.78±9.69°; F: 50.30±9.88°) in controls (p-value=0.737). LBP cases showed decreased LSA in individuals aged 31-40 years (p-value=0.013), in females (p-value=0.02), and in overweight individuals (p-value=0.002), alongside increased LLA in males (p-value=0.001); however, the difference in angles was only observed in the 20-40 years age range. LLA and LSA did not show any significant association or correlation with age, gender, BMI and VAS. Conclusion: The results indicate that LLA does not vary between those with and without LBP. The LSA was significantly lower in patients with LBP. Both LSA and LLA do not demonstrate a clear association and show an insignificant weak correlation with age, gender, BMI and VAS in both cases and controls.

Translation and Response Validation of Cerebral Palsy Quality of Life Questionnaire for the Child’s Primary Caregiver (Kannada Version): A Cross-sectional Study

KB Komal, Navami Mahaveer, Anvita Shiggavi, Prashanth Mukkannavar, Aditi Prayag

Introduction: Cerebral Palsy (CP) is a collection of long-term conditions that impact posture and movement, frequently accompanied by cognitive, sensory, behavioural and communication abnormalities. Children with CP experience a variety of effects on their Quality of Life (QOL), including social, emotional and physical aspects. The CP-specific questionnaire, known as the CP QOL-Child, has not yet been translated or validated in the Kannada language, limiting its applicability in regions where Kannada is the primary language. Aim: To translate and validate the CP QOL-Child Primary Caregiver questionnaire into Kannada. Materials and Methods: This was a cross-sectional cultural study conducted at Department of Paediatric Physiotherapy, KLE College of Physiotherapy, Hubballi, Karnataka, India, over the course of one month (September 14, 2024, to October 14, 2024). It included 50 children with CP (ages 4-12) and their primary caregivers. The Child Primary Caregivers were given a Kannada-translated questionnaire and the data were collected. The internal consistency was assessed using Cronbach’s alpha. The Gross Motor Function Classification System (GMFCS) levels and CP QOL were evaluated and compared. Cronbach’s alpha coefficient was used to evaluate the internal consistency of CP QOL scores; a value of >0.7 was considered indicative of internal consistency and response validity. Results: The mean age observed was 8.1±2.3 years, with 36 (72%) of the children being diagnosed with spastic quadriplegia. Cronbach’s alpha scores for the items in each quality-of-life area demonstrated very good reliability, ranging from 0.687 to 0.882. Overall, the QOL was found to be 41.8±4.2. QOL significantly decreased as GMFCS levels increased, particularly at levels IV (42.8±1.5) and V (36.8±1.4). Pain and the impact of disability showed no significant differences across the GMFCS levels. Conclusion: The present study concludes that the Kannada-translated CP QOL-Child Primary Caregiver questionnaire (for ages 4-12) is a reliable tool for assessing parent-reported CP QOL in Kannada-speaking primary caregivers.

Diagnostic Performance of Thyroid Imaging Reporting and Data system (TIRADS) and Acoustic Radiation Force Impulse (ARFI) imaging in Detection of Malignant Thyroid Nodules: A Cross-sectional Study

Combination of Whole Body MRI and MY-RADS: A Promising Standardised Approach for Treatment Response Evaluation in Multiple Myeloma Patients

Introduction: Multiple Myeloma (MM) is a malignancy that impacts the bones, kidneys, and immune system. Whole-body Magnetic Resonance Imaging (MRI) is recognised as the most sensitive modality for bone marrow assessment, providing advantages such as enhanced speed, comprehensive coverage, and precise quantification compared to traditional MRI methods. This technique circumvent the necessity for intravenous contrast agents and minimises radiation exposure. The Myeloma Response Assessment and Diagnosis System (MY-RADS) represents a standardised framework designed to evaluate and document the therapeutic response of patients with multiple myeloma through imaging techniques, particularly utilising whole-body MRI. Aim: To evaluate the effectiveness of the MY-RADS scoring system using whole-body MRI for treatment response assessment of patients with Multiple Myeloma. Materials and Methods: A prospective observational study was conducted at Gauhati Medical College and Hospital from April 2021 to September 2022. A total of 50 patients diagnosed with multiple myeloma and undergoing treatment were subjected to whole-body MRI evaluations. All participants adhered to a standardised MRI protocol employing uniform sequence parameters utilising the 3T Siemens Magnetom Skyra technology both pre-and post-treatment, with a burden score allocated to reflect the extent and severity of the disease. Disease progression was subsequently evaluated following MY-RADS guidelines consisting of tumour burden score, Apparent Diffusion Coefficient (ADC), and fat fraction to improve reporting consistency and minimise exposure to ionizing radiation. Statistical analyses were conducted utilising IBM SPSS Statistics version 26.0. Pearson’s correlation test was applied to evaluate the correlation between various parameters assessed. A p-value of less than 0.05 was considered statistically significant. Results: A total of 18 (36%) patients were in the MY-RADS 5 score category indicating extensive disease followed by 13 (26%) patients in MY-RADS 4. The mean ADC seen on follow up was 0.71 +/- 0.08 x 10^-3 mm²/sec in MY- RADS score 5 while it was 1.47 +/- 0.22×10^-3 mm²/sec in MY-RADS score 1. There was a statistically significant correlation between MY-RADS score and clinical biomarkers. Conclusion: MY-RADS along with Whole-body MRI offers a non-invasive, radiation-free modality for assessment of response to treatment for Multiple Myeloma, enabling healthcare professionals to timely adjust treatment and improve patient outcomes.

Efficacy of Double versus Single Homologous Intrauterine Insemination in Mild Male Factor Infertility and Pregnancy Outcome: A Randomised Controlled Trial

M Roopa, Sharath Kumar, Leena Kamath, Voorkara Udayashree, Sahana N Naik

Introduction: Intrauterine Insemination (IUI) is a cost-effective, minimally invasive, and widely accepted Assisted Reproductive Technology (ART) procedure used to treat infertility. Various factors contribute to infertility, which in turn affect the success rate of IUI. To further increase the total concentration of sperm delivered and the window of sperm exposure to the oocyte, performing IUIs on two consecutive days (double IUI) has been proposed to enhance pregnancy rates, especially in cases of oligospermia. Double IUI aims to address the challenge of synchronising ovulation and insemination. Aim: To assess the efficacy of double IUI compared to single insemination in cases of mild male factor infertility. Material and Methods: A randomised clinical study was conducted in the Department of Obstetrics and Gynaecology (OBG), Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital Fertility Centre, Sattur, Dharwad, Karnataka, India from July 2021 to January 2022 on 200 patients. All 200 patients underwent ovulation induction with a sequential regimen using Letrozole or Clomiphene citrate, alongside highly purified Human Menopausal Gonadotropin (75 IU). All women underwent follicular monitoring and received an ovulation trigger. The first group of patients underwent a single IUI 36 hours after the Human Chorionic Gonadotropin (hCG) injection. Patients in the second group, who underwent double IUI, received the first IUI at 24 hours and the second IUI 48 hours after the hCG injection. Serum beta hCG was measured 15 days after the IUI to confirm the occurrence of pregnancy. Results: There were a total of 42 pregnancies (21%). The pregnancy rate for the single IUI group was 20%, while for the double IUI group, it was 22%. There was no significant difference between the single IUI and double IUI groups regarding positive outcomes (Chi-square=0.1210, p=0.7280). Conclusion: Double IUI increases the total concentration and quality of sperm delivered and extends the window of sperm exposure to the oocyte. This additional procedure may translate to increased pregnancy rates. However, in present study, no significant difference was noted in the achieved pregnancy rates. Higher-quality studies with larger populations are required to formulate a hypothesis.

The Effectiveness of Non Surgical Spinal Decompression using Magnetic Resonance in Patients with Lumbar Disc Herniation: A Quasi-experimental Study

Vincenzo Di Modica, Giuseppe J Sciarrone

Introduction: In the majority of patients experiencing symptoms related to Lumbar Disc Herniation (LDH), spontaneous recovery typically occurs within 6-12 weeks after the commencement of conservative therapy. However, if conservative treatments prove ineffective and Magnetic Resonance Imaging (MRI) diagnostics confirm a herniation occupying a substantial portion of the spinal canal, surgical intervention is often recommended. Aim: To assess the efficacy of an intensive, non invasive treatment protocol administered over several months for managing LDH. Materials and Methods: A retrospective quasi-experimental study was conducted in Biosalus Private Clinic, Surdo di Rende, Italy, from November 2022 to September 2024. Eight symptomatic patients with L4-L5 disc herniation confirmed by Magnetic Resonance Imaging (MRI), with an Anteroposterior (AP) length exceeding 6 mm and unresponsive to conservative therapy, underwent an intensive treatment protocol comprising 40 sessions. This regimen included Non Surgical Spinal Decompression (NSSD), High-intensity Laser (HIL) therapy, and Repetitive Peripheral Magnetic Stimulation (RPMS). The efficacy of the intervention was assessed using quantitative analysis of MRI images and monitoring of structural changes in the affected spinal region, including Anteroposterior (AP) length, herniation area, canal AP length, canal area and the Herniation Index (HI). Additionally, an independent neuroradiologist provided an evaluation report, and patients’ symptoms typical of LDH were monitored for three months following the conclusion of the treatment program. The achieved structural changes were evaluated using a paired t-test, with a p-value of less than 0.05 considered statistically significant. Results: Significant statistical improvements of 66.02%, 56.20%, 63.90%, 54.30% and 72.42% were observed in herniation AP length, herniation area, canal AP length, canal area and HI, respectively, surpassing the benchmarks established by existing clinical evidence. The substantial progress noted in reducing HI was particularly noteworthy, with an average improvement exceeding 70%. The observed structural changes were evident in the MRI imaging, as well as, in the clinical presentation of symptoms. Seven out of eight patients experienced complete resolution of symptoms, while one patient exhibited mild residual symptoms, which persisted for up to three months post-treatment. Conclusion: The present study outlined the potential of an intensive non invasive protocol in reducing large-scale LDH in patients with chronic manifestations unresponsive to conventional treatments who opt against or are ineligible for surgical intervention.

Solitary Rectal Ulcer Syndrome: A Cross-sectional Study on Diagnostic Dilemma of the Three-lies Disease

KB Aarthi, Payel Das, Aarti Tyagi, Mini Chaurasia, Priyanka Yadav, Mona Bargotya

Introduction: Solitary Rectal Ulcer Syndrome (SRUS) displays a wide spectrum of clinical manifestations and varied endoscopic presentations. It is a significant imitator of various ulcerative and non ulcerative lower gastrointestinal entities and misdiagnosis has significant implications for both clinicians and patients. Aim: To characterise the clinical, endoscopic, demographic and histopathological features of SRUS for early and accurate diagnosis. Materials and Methods: This cross-sectional study was conducted on all cases diagnosed as SRUS in the Department of Pathology at Rajiv Gandhi Super Speciality Hospital (RGSSH), Delhi, India between July 2018 and July 2023. The parameters taken into consideration included: (a) demographic - age and gender; (b) clinical - symptoms and endoscopic findings (ulceration, mucosal prolapse, polypoidal mass, haemorrhoids, erythematous mucosa, rectal wall thickening, altered rectal mucosa, inflammation); (c) laboratory - histopathological findings. The data was compiled in Microsoft Excel and descriptive statistics were computed and presented in tables and graphs. Results: A total of 43 patients diagnosed with SRUS were reviewed and analysed retrospectively. Of all the cases, 19 were males (44.18%) and 24 were females (55.81%), with a median age of 25 years (range, 8-85 years). Rectal bleeding (76.74%) was the most commonly observed symptom, followed by changes in frequency and mucous discharge (41.86%). Endoscopy revealed ulceration (single or multiple) in 35 patients (81.39%), 10 patients (23.25%) had mucosal prolapse and a polypoidal mass was seen in seven patients (16.27%) with SRUS. Conclusion: Despite its name, there is no true syndromic association, nor do all patients present with ulcers endoscopically. Clinically, it may simulate inflammatory bowel disease or malignancy, which necessitates meticulous evaluation of endoscopic biopsy specimens for accurate diagnosis.

Serum Electrolyte Levels in Children with Febrile Seizures: A Cross-sectional Study

Introduction: Febrile seizures are the most common type of childhood seizure, typically occurring in children younger than 60 months of age. They are categorised into simple and complex febrile seizures. The recurrence of febrile seizures is also high. Among the various known risk factors for recurrence, serum sodium is a quantifiable and correctable factor. However, there are very few studies in this field to determine whether other serum electrolytes at presentation also have any association with the type of seizure or the patient’s gender, which are non modifiable risk factors for recurrence. Aim: To measure serum electrolyte levels (sodium, potassium, calcium, magnesium) in patients with febrile seizures at presentation and to find out its association with the type of seizure and the patient’s sex. Materials and Methods: This cross-sectional study was performed on 76 patients aged six months to five years who were admitted to the Paediatrics Inpatient Department (PIPD), attended the Paediatrics Out-Patients Department (POPD) and visited the Paediatrics Emergency of RG Kar Medical College and Hospital, Kolkata, West Bengal, India, with any episode of febrile seizure between April 2021 and March 2022. The serum electrolyte levels (sodium, potassium, calcium, magnesium) in patients with febrile seizures were measured. Data were analysed using STATA version 16 software, employing Fisher’s exact test, with a p-value of <0.05 considered statistically significant. Results: Out of the 76 study subjects, 55.26% were male and 44.74% were female, resulting in a male-to-female ratio of 1.23:1. Of the subjects, 93.42% had simple febrile seizures, while 6.58% exhibited complex febrile seizures. A statistically significant association was found between the type of febrile seizure and serum magnesium (p-value=0.006), as well as between the sex of the patients and serum calcium levels (p-value=0.012). No statistically significant association was observed between the sex of the study subjects and serum sodium (p-value=0.105), serum potassium (p-value=0.576), or serum magnesium levels (p-value=0.312). Furthermore, the type of febrile seizure showed no statistical significance with serum sodium (p-value=0.284), potassium (p-value=0.820), or calcium levels (p-value=0.373). Conclusion: The present study concluded a significant association between serum magnesium levels and the type of febrile seizure, as well as between serum calcium levels and the sex of the patients. Thus, measuring serum electrolytes in patients with febrile seizures at the time of presentation is beneficial, as it is easy to perform, provides rapid results and identifies correctable and quantifiable issues.

Evaluation of Marginal Fit of Provisional Restoration Fabricated Using Tooth Moulding Acrylic Powder, Bisacryl Composite and 3D Printed Resin: An In-vitro Study

Introduction: Provisional restorations should have a good marginal fit with non impinging margins and ease of cleansability to protect the gingiva and periodontal tissues. Impinging margins can result in gingival inflammation, while an improper marginal fit can lead to microleakage, recurrent caries and postoperative sensitivity. Aim: To evaluate and compare the marginal fit of provisional restorative materials made using Dental Products of India (DPI) tooth moulding acrylic powder, Bisacryl composite (Protemp IV) and 3D printed resin. Materials and Methods: In this in-vitro study was conducted at the Department of Prosthodontics, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India from October 2023 to February 2024, 42 samples were divided into three groups. Group-A samples were prepared using DPI self-cure tooth moulding powder; Group-B samples were prepared using Protemp IV; and Group-C samples were prepared using 3D printed resin (n=14). The provisional crowns were fabricated using a prepared typodont tooth to evaluate their marginal fit. The marginal fit was assessed using a stereomicroscope. Photographs were taken and the marginal gap was measured using Image J software. The results were then tabulated and statistical analysis was performed. Results: The results of the study showed that the marginal fit was better in 3D printed resin (107.97 μm) compared to DPI tooth moulding acrylic powder (192.56 μm) and Bisacryl composite (Protemp IV) (177.67 μm). Conclusion: The marginal fit of the 3D printed provisional restorative resin was significantly better than that of the provisional restorations fabricated with Protemp IV and the DPI self-cure tooth moulding powder.

Oral Health Maintenance and Barriers among Patients Attending Psychiatry Ward of Tertiary Hospital of Bhubaneswar: A Qualitative Research

Payal Dash, Gunjan Kumar, Pranab Mahapatra

Introduction: Individuals with psychiatric disorders often encounter unique challenges that extend beyond mental health concerns, impacting various aspects of their wellbeing, including oral health. Psychiatric patients frequently experience a complex interplay of factors contributing to compromised oral health. To address these barriers, integrated healthcare approaches that incorporate oral health into psychiatric care are proposed. As there is a lack of baseline data on oral health barriers highlighting the intersection of mental health and oral health to inform future interventions and policies, it is necessary to assess the oral health barriers and maintenance in psychiatric patients. Aim: To assess the oral health barriers and oral health maintenance of psychiatric patients of a tertiary hospital in Bhubaneswar, India. Materials and Methods: A qualitative research was conducted in the Psychiatry Ward, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from January 2022 to May 2022. Patients between age group of 16 years and 60 years with psychiatric illness and those who gave informed consent were included in the study. Principle of maximum diversity was maintained to select participants. Hence, the sample size was 13. Data were collected through a semistructured questionnaire that consisted of socio-demographic details (age, gender, education, marital status, diagnosis and duration of illness), health perception (general, oral and mental health), and barriers and facilitators (risk factors and protective factors). The data analysis was done using MAXimum Qualitative Data Analysis (MAXQDA) 2020 software, and various themes were identified and classed at two levels: before illness and during symptomatic illness. Results: The mean±Standard Deviation (SD) age of the study population was 24.77±9.02 years. Among the subjects, the distribution of gender consisted of 4 (30.8%) males and 9 (69.2%) females. Based on education, 3 (23.1%) participants had primary level of education, followed by 6 (46.2%) of secondary education and 4 (30.8%) with graduation degree. Themes were derived from the participant interview following the inductive coding method, concerning both before illness and symptomatic illness. The various sub-themes included previous treatment for psychiatry, barriers to care, delayed care, oral health maintenance, reduced self-care and medicine side-effect. Conclusion: Enhancing oral health and daily self-care among individuals with severe mental illness necessitates further research involving larger and more diverse samples to thoroughly explore perspectives on specific intervention elements. Understanding and addressing the barriers to dental treatment consistent with prior studies is critical. Policymakers and healthcare planners should incorporate these findings into strategies aimed at reducing disparities in oral healthcare access and improving outcomes for this vulnerable population. Tailored, evidence-based approaches are essential to bridge existing gaps and ensure holistic care delivery.

Levobupivacaine and Dexmedetomidine versus Ropivacaine and Dexmedetomidine for Ultrasound-guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Trial

Sofia Batool, Ram Bahadur Rai, Tsering Yougyal

Introduction: The Supraclavicular Brachial (SCB) plexus block is the preferred modality of anaesthesia for upper extremity surgeries. Technical and pharmacological advancements have made these blocks safer and more reliable. Ropivacaine and levobupivacaine are relatively newer drugs that are claimed to have better potency and less toxicity. Adjuvant drugs, like dexmedetomidine, are added to enhance the duration of the block and provide better postoperative analgesia. Aim: To compare the effects of levobupivacaine (0.5%) with dexmedetomidine (50 μg) and ropivacaine (0.5%) with dexmedetomidine (50 μg) when used in the SCB plexus block for upper extremity surgeries. Materials and Methods: A double-blinded randomised controlled trial was conducted from February 2024 to June 2024 at the Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India. Patients undergoing upper extremity surgeries under SCB block were randomised into two groups (LD: 0.5% levobupivacaine + 50 μg dexmedetomidine and RD: 0.5% ropivacaine + 50 μg dexmedetomidine). The onset, completion and duration of the block (both sensory and motor), haemodynamic parameters, time to rescue analgesia and adverse effects (sedation, pruritus, respiratory distress, bradycardia, hypotension) were compared between the two groups using Statistical Package for the Social Sciences (SPSS) software version 25.0. Categorical data were analysed using the χ² test and continuous variables were analysed using Analysis of Variance (ANOVA). A p-value <0.05 or less was considered statistically significant. Results: Thirty-three patients were analysed at the end of the study. Both groups were matched for age and sex, with a mean age of participants of 36.6±14.66 years and a male-to-female ratio of 3.1. The groups did not significantly differ concerning haemodynamic parameters, except for the heart rate at 180, 210, and 240 minutes. The onset (LD: 10.44±4.774; RD: 11.82±5.457 minutes) and completion (LD: 21.38±7.473; RD: 25.59±6.256 minutes) of sensory and the onset (LD: 10.88±5.965; RD: 12.18±5.659 minutes) and completion (LD: 19.63±8.374; RD: 22.35±7.365 minutes) of motor block were comparable for both groups. However, the duration of sensory (LD: 859.38±186.650; RD: 716.12±163.620 minutes; p-value=0.025) and motor block (LD: 865.13±160.404; RD: 730.59±197.227 minutes; p-value=0.040) was significantly longer in the LD group, resulting in a delayed requirement for rescue analgesia (LD: 982.88±215.634; RD: 820.41±183.232 minutes; p-value=0.026). Conclusion: Levobupivacaine and dexmedetomidine have comparable onset times but provide a longer duration of sensory and motor blocks compared to ropivacaine and dexmedetomidine, thus reducing the postoperative requirement for rescue analgesia. The combination of levobupivacaine and dexmedetomidine may be a better alternative for longer-duration surgeries.

Comparison of Diagnostic Accuracy of Digital Mammography, Digital Breast Tomosynthesis and Contrast Enhanced Mammography in the Preoperative Assessment of BI-RADS III and above Lesions in Dense Breasts: A Cross-sectional Study

Jini Joseph, KG Ramakrishnan, Rekha Narayanan

Introduction: Women belonging to breast density category C and D have high mammographic density and are at an increased risk for developing breast cancer. Although mammogram is the gold standard technique for the detection and diagnosis of breast cancer, extremely dense breasts-due to reduced contrast between tumours and surrounding tissue-pose significant limitations in the identification and diagnosis. This limitation has been overcome by introduction of 3D Digital Breast Tomosynthesis (3D DBT) and other newer imaging modalities like Contrast-Enhanced Mammography (CEM), breast ultrasound and Magnetic Resonance Imaging (MRI). Aim: To compare the diagnostic accuracy of CEM, Digital Mammography (DM), and DBT in assessing cancer detection rate in dense breasts. Materials and Methods: A cross-sectional study was conducted with a sample size of 53 patients in the Department of Radiodiagnosis at Malabar Institute of Medical Sciences (MIMS) Calicut, Kerala, India, from October 2022 to September 2023. DM, DBT, and CEM images were taken for each patient and were visually assessed to identify primary and satellite lesions, measure the size of the index lesions and classify them according to Breast Imaging Reporting and Data System (BI-RADS) American College of Radiology (ACR) lexicon category. Results were then compared to histopathology. Categorical variables were summarised in terms of frequency with % and tested using Chi-square test. Continuous variables were summarised as mean±standard deviation or median with interquartile range. Results: A total of 53 subjects were included in the final analysis, with an average age of 51.7±11.5 years. Among three modalities, CEM proved best for maximum Cancer Detection Rate (CDR), accounting for 100% sensitivity, an 81% Positive Predictive Value (PPV), and 81% diagnostic accuracy for detecting malignancy. Whereas DBT had 79% diagnostic accuracy and DM had 73.5% diagnostic accuracy for detecting malignancy. Mean volume of the lesions evaluated by histopathology was 5.6, while those measured by DM, DBT, and CEM were 7.8, 6.4, and 6.2. All three modalities overestimated lesion sizes compared to histopathology, with CEM showing a smaller difference. In case of additional lesion evaluation, CEM detected 16 more cases that were undetected on DM and 12 more cases that were undetected on DBT. Conclusion: CEM is superior diagnostic modality in evaluation of cancer detection in dense breasts and can be a suitable alternative for DM and DBT in dense breasts with certain limitations.

Evaluation of Highest Point of Iliac Crest as a Safety Landmark for Supine Percutaneous Nephrolithotomy: A Retrospective Observational Study

Introduction: Colonic injury is a rare but serious complication of supine Percutaneous Nephrolithotomy (PCNL), traditionally mitigated by using the Posterior Axillary Line (PAL) as a safety landmark. However, since the PAL is an arbitrary and variable landmark, it has several limitations. There is a need for fixed and reliable safety landmark to address these limitations. Aim: To evaluate the highest point of the iliac crest as a potentially reliable alternative safety landmark for preventing colonic injury in supine PCNL. Materials and Methods: This retrospective observational study was conducted at Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India in October 2024. The study included 500 patients with a suspected diagnosis of renal stone disease based on clinical symptoms or ultrasound findings, who underwent Computed Tomography (CT) imaging (CT KUB or CT urography) at the centre between January 2021 to January 2024. The highest point of the iliac crest was evaluated as a potential safety landmark. The incidence of retrorenal and lateral colon positioning and the proximity of the colon to individual renal calyces were assessed. Descriptive statistics were utilised to summarise continuous variables, such as age (mean±SD) and categorical variables, such as colon positioning (frequencies and percentages). Results: The mean age of the patients was 44.5±12.7 years, ranging from 5 to 89 years. Of these, 313 patients (62.6%) were male and 187 patients (37.4%) were female. The colon was posterior to the line drawn at the level of the highest point of the iliac crest in 39 patients (7.8%) on left side and in 19 patients (3.8%) on right side. Retrorenal colon was observed in one patient (0.2%) on right side and in eight patients (1.6%) on left side. Lateral colon positioning was significantly higher on the left-side (178 patients; 35.6%) compared to the right side (131 patients; 26.2%). Additionally, colon proximity was most common to the lower calyx. Conclusion: The highest point of the Iliac crest demonstrates promise as a safety landmark for preventing colonic injury in supine PCNL, offering a reliable alternative to the PAL. Larger multicentre studies are needed for further validation.

Clinicopathological Analysis of Pure and Mixed Subtypes of Mucinous Breast Carcinoma: A Cross-sectional Study

Introduction: Mucinous Breast Carcinomas (MC) are rare, comprising approximately 2% of breast cancers. These tumours are classified into Pure Mucinous Carcinoma (PMC) and Mixed Mucinous Carcinoma (MMC), each with distinct clinical behaviours. Aim: To analyse and compare clinicopathological profiles, hormone receptor status, pathological staging and treatment modalities between PMC and MMC, while studying their prognostic differences by assessing their status of lymph node metastasis, tumour staging and tumour grades. Materials and Methods: A retrospective cross-sectional study was conducted in the Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India, from January 2017 to December 2021. Data from 71 cases of MC were reviewed for clinicopathological parameters, treatment modalities and outcomes. Chi-square test and Fisher’s exact test were performed to compare various characteristic features between patients with PMC and MMC. Results: Out of 71 participants, there were 2 (2.82%) males and 69 (97.18%) females. MC accounted for 3.4% (71 MC out of 2,043 breast carcinomas) of breast carcinomas. Of the 71 cases, 82% were PMC and 18% were MMC. MMCs showed higher tumour grades, lymphovascular invasion (61.5% vs. 10.9%, p-value <0.05), and lymph node metastasis (38% vs. 9%, p-value <0.05) compared to PMCs. Hormonal profiles predominantly exhibited the luminal A type (85.9%), with only 8.4% being Human Epidermal growth factor Receptor 2 positive (HER2-positive) tumours. The median follow-up was 28 months, with excellent survival outcomes for PMCs but a higher recurrence risk for MMCs. Conclusion: The PMCs have favourable outcomes, while MMCs require more aggressive management due to a poorer prognosis. Differentiating between these subtypes is crucial for tailoring treatment strategies.

Recurrent Paediatric Abdominal Pain Associated with ESBL-producing Escherichia coli Attributable to Unscreened use of Empirical Antibiotics: A Cross-sectional Study

Monalisa Subudhi, Sudhanshu Kumar Das, M Padmasree, Uday Kiran Reddy

Introduction: Recurrent Abdominal Pain (RAP) has a devastating impact on children’s activities and mental health. In this context, physicians often empirically start antibiotics with each visit. As a result, the normal commensal Escherichia coli (E. coli), which protects the gut through immunophysiological functions, decreases in number, becomes pathogenic and develops resistance to antibiotics. This imbalance between the host and the gut microbiome presents as abdominal discomfort. Aim: To investigate the response of normal gut flora E. coli to commonly used empirical antibiotics and its association with persistent cases of RAP in children. Materials and Methods: A cross-sectional study was conducted on 64 children under 10 years of age with RAP over a period from March 2021 to February 2022 at the Gayatri Vidya Parisad (GVP) Medical College and Hospital, Visakhapatnam, Andhra Pradesh, India. Stool culture and sensitivity, as well as the empirical use of antibiotics, were recorded. The bacteriological profile and their sensitivity were analysed. The major bacteria, E. coli, that were resistant to third-generation cephalosporins were further processed phenotypically using the disc diffusion method to detect their Extended Spectrum Beta-Lactamase (ESBL) production. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Out of 64 children with RAP, 36 (56.3%) cases were persistent in nature, and 40 (62.5%) were under five years of age, with a predominance of girls 36 (56.3%). Among these 36 (56.3%) RAP cases, 16 (25%) were found mostly around the epigastrium with a periumbilical area. The major bacteria isolated were E coli 27 (87.1%) found in 31 (73.8%) positive stool culture from persistent RAP cases on empirical antibiotics with 22 (81.5%) being resistant to third-generation cephalosporins (Cefotaxime 17 (62.9%), Ceftazidime 12 (44.5%), Ceftriaxone 8 (29.6%)). Out of 22 (81.5%) third-generation cephalosporin-resistant E. coli, 15 (68.2%) were ESBL producers. Conclusion: ESBL-producing E. coli were one of the common causes of persistent cases of RAP, attributed to the empirical overuse of third-generation cephalosporins by health professionals. There is a need for the rational use of antibiotics.

Balance Exercises as a Fundamental Aspect of Functional Recovery in patients with Knee Osteoarthritis: A Systematic Review

Trishna Kakati, Swapnav Borthakur

Introduction: Osteoarthritis (OA) in the knee causes pain, stiffness, and instability, which reduces mobility and quality of life. Exercises for balance are crucial for knee OA because instability caused by OA increases the risk of falls and functional loss. Exercises for balance may help increase mobility, reduce discomfort, and stabilise joints, but traditional therapies may not fully address these issues. Aim: To examine the effect of balancing exercises on functional capacity, a sign of OA in the knee. Materials and Methods: Reputable search engines like Web of Science (WoS), Embase, PubMed and Google Scholar were used to collect academic literature. To find solutions to the study questions, the literature search was conducted using “proprioception,” “pain,” “function,” “knee OA,” “balance training,” and “quality of life” as keywords. A 100 papers were chosen for this systematic evaluation. They were thoroughly examined in accordance with the PRISMA principles. Thirteen studies were included in the final analysis. The Risk of Bias (RoB) in the included studies was assessed using the Quality in Prognosis Studies (QUIPS) instrument and Cochrane risk of bias assessment tool. Results: Exercises for balance can successfully improve functional ability in patients with OA in the knee because they strengthen supporting muscles and enhance postural control. Balance exercises place less load on the knee joint than high-impact workouts while improving muscle activation and proprioceptive sensitivity around it. When treating OA, balance exercises are a safe, non-invasive method to increase a patient’s mobility and quality of life. Clinically, they might reduce the risk of falls and enhance functional outcomes. Conclusion: People with OA in their knees can function better with balance exercises. This training may be an easy and affordable way to improve their functional ability and quality of life.

Genetic Variability of NS5 Gene Sequences amongst Zika Virus Isolates of India, China and Japan

Prakash Tiwari, Priyanka Singh, Amaresh Nigudgi, Himanshu Singh Chandel

Introduction: Zika Virus (ZIKV) infection is transmitted by Aedes mosquitoes, predominantly in tropical and subtropical regions of the world, including India, and can lead to birth defects in humans. Due to genetic similarities among the Flavivirus genus, it may lead to cross-reactivity, especially in diagnostic tests. The ZIKV’s non structural protein 5 (NS5) is a potential vaccine development and diagnosis target. Due to limited studies on NS5 genetic diversity, it needs to be explored. Aim: To investigate the genetic variation in the NS5 region of the ZIKV and phylogenetic analysis among Asian isolates. Materials and Methods: This study is descriptive based on genomics and was conducted from January to June 2024 atViral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Shyam Shah Medical College, Rewa. Madhya Pradesh, India. In this study, bioinformatics approach for the analysis of ZIKV RNA-dependent Ribonucleic Acid (RNA) polymerase (NS5) gene sequences retrieved from the National Centre of Biotechnology Information (NCBI) database. Phylogenetic analysis of the ZIKV RNA-dependent RNA polymerase NS5 gene sequence was performed using MEGA 11. Briefly, NS5 sequences were aligned and compared with ZIKV reference sequences retrieved from GenBank. The phylogenetic tree was constructed using a neighbour-joining method and the Tamura-Nei model, after 1,000 bootstrapped replicates. Results: The NS5 genetic diversity among Indian isolates ranged from 0% to 9.93%. ZIKV isolates from India, China, and Japan showed similarity to KX369547.1_Germany, KJ776791.2_France, and KU940224.1_US sequences. Overall, the highest genetic divergence was observed in MK696551.1_Beijing_China, while the lowest genetic divergence was observed in OK054351.1_Maharashtra_India. Phylogenetic analysis suggests that the recent ZIKV outbreak in India originated from the Asian lineage and may have spread to other parts of the world, including China and Japan. Conclusion: Zika NS5 gene diversity of Asian lineage is the highest among Indian ZIKV isolates, which may affect the efficiency of NS5 gene-based molecular diagnostics. Therefore, an extensive study on NS5 genetic variation and new diagnostic targets for the ZIKV is required from India.

Physiotherapy Interventions and Assessment Tools for Physical Function in Breast Cancer Patients: A Systematic Review and Meta-analysis

Suman Mehra, Pragya Kumar, Abhishek Soni

Introduction: Breast cancer (BC) and its treatment impart a variety of physical impairments in body causing physical functional decline even after the completion of active treatment.Physiotherapy plays an important role in managing physical functional limitations. However, there is lack of data regarding efficacy of physiotherapeutic interventions in improving physical functional impairments and assessment tools used to evaluate Physical Function (PF) in individuals with BC. Aim: To evaluate the efficacy of physiotherapy interventions on PF and analyse the assessment tools used for evaluating PF in BC. Materials and Methods: Randomised Controlled Trials were searched in PubMed and Scopus databases, published from inception to December 2023, in which the effect of physiotherapeutic interventions on PF was evaluated in individuals with BC. Keywords used to search literature were: (BC) AND (physiotherapy intervention) AND (PF). The mean change in PF was primary outcome measure, and tools used to assess PF in included studies were also analysed. The quality of the studies and the risk of bias were evaluated. A meta-analysis of included studies was done using Review Manager (Software, version 5.4). Results: Overall 333 trials were retrieved, of which nine were included in systematic review. Four studies were included in meta-analysis, which used Short Form-36 (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire’s “Physical functioning” subscale as measures to evaluate changes in PF at the end of the study. The meta-analysis revealed statistically significant improvements in SF-36 “Physical functioning” subscale scores (Mean difference=2.87, 95% CI: 0.63 to 5.12, p=0.01) and EORTC QLQ-C30 “Physical functioning” subscale scores (Mean difference=8.77, 95% CI: 3.31 to 14.24, p=0.002), with low heterogeneity in treatment groups when compared to control group. Conclusion: Physiotherapeutic exercise interventions are effective in improving PF in individuals with BC, and SF-36 questionnaire “Physical functioning” subscale was the most commonly used tool to assess PF in BC patients and survivors.

Assessment of Topical Steroid-damaged/ Dependent Face Severity Score and its Impact on Quality of Life: A Cross-sectional Study

Introduction: Topical Corticosteroids (TCS) are injudiciously used by the general population for face dermatosis resulting in constitution of symptoms called topical steroid damaged/dependent face which directly/indirectly affect the mental well-being and self-esteem of patients. Aim: To study dermoscopic features of Topical Steroid-damaged/Dependent Face (TSDF) and measure its severity using dermoscopy-assisted topical steroid damaged/Dependent Face Severity (DATS) score and its impact on Quality of Life (QoL) using Dermatology Life Quality Index (DLQI). Materials and Methods: The study was a hospital-based cross-sectional study conducted at Dermatology Outpatient Department, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India, from June 2023 to May 2024 that enrolled 188 patients aged 16-45 years having clinical features of TSDF. Demographic data like age, gender, residence, occupation, education and details on TCS namely type, indication, frequency, duration and prescriber other than dermatologist were collected, clinical features and dermoscopic findings were evaluated using DATS score and QoL using DLQI score. Fischer’s-exact test was used to compare quantitative variables. Analysis of Variance (ANOVA) was used for more than two variables. The p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 27.1±7.6 years. The mean DATS score was 22.7±8.1. The mean DLQI score was 11.3±3.3. Positive association and correlation were observed between DATS and DLQI scores (p<0.001 and r=0.612). Conclusion: The TSDF affected the QoL in the study participants and DLQI scores helped to segregate patients according to severity so that prompt referral to the specialised clinics could be done.

Knowledge of Stroke Risk Factors and Warning Signs among the Residents of Majmaah, Saudi Arabia: A Cross-sectional Study

Bashayer Abdullah Al-maymuni, Mohamed Sherif Sirajudeen

Introduction: Stroke is a major cause of illness and death in Saudi Arabia and is considered a rapidly growing problem. Timely admission to a stroke care facility and control of stroke risk factors will enhance stroke treatment outcomes and prevention. Reducing the time between stroke onset and presentation to the hospital, as well as mitigating risk, depends on the knowledge of stroke patients, their family members and the general population. Aim: To assess the knowledge of stroke risk factors, warning signs and the level of physical activity of participants, as well as their associations with selected participant characteristics. Materials and Methods: This cross-sectional study was conducted in the rural community of Majmaah, Riyadh, Saudi Arabia. Data were collected using a web-based survey from 392 participants who were 18 years or older and able to read and write in Arabic. The validated questionnaire used in this survey consisted of three parts to determine demographics, knowledge of stroke warning signs, risk factors and physical activity. Binary logistic regression analysis was used to identify the associations between the knowledge components, the level of self-reported physical activity and selected participant characteristics. Adjusted Odds Ratios (OR) and their respective 95% Confidence Intervals (CIs) were calculated. Results: Among the 392 study participants, only 326 (83.2.16%) correctly identified the location of the stroke. Commonly recognised risk factors included stress in 287 (73.21%), smoking in 187 (47.7%) and hypertension in 167 (42.6%). The most frequently recognised symptoms were difficulty in speaking in 210 (53.57%), sudden severe headache in 172 (43.88%) and dizziness in 149 (38.01%). The most common correct response regarding what to do in the event of a stroke was to go to the hospital in 261 (66.58%). Among the participants, only 103 (26.28%) could correctly identify five or more risk factors and 213 (54.34%) could recognise three or more symptoms and warning signs. Conclusion: The majority of the study participants lacked knowledge about stroke risk factors. Nearly half of the participants were unable to recognise stroke symptoms and warning signs. Therefore, there is an urgent need to develop health education strategies to improve public awareness of stroke risk factors, warning signs and prevention among the population residing in rural areas of Saudi Arabia.

Morphological and Morphometric Analysis of Pterion: A Cross-sectional Study from Eastern India

Phalguni Srimani, Mithu Paul, Shukchand Hansda

Introduction: The pterion is an important craniometric point in the norma lateralis that often exhibits interpopulation variations. A precise understanding of the morphology and exact location of this sutural pattern, which may serve as a superficial projection of various deep-seated brain structures, is pertinent to preoperative planning, operative procedures and postoperative outcomes during neurosurgical interventions in the cranial fossae. Aim: To observe the details of the pterion as sutural confluences and its clinicoanatomical associations with the eastern Indian population. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy at Midnapore Medical College, Paschim Medinipur , West Bengal, India from June 2024 to December 2024. A total of 62 adult dry skulls of unknown age and sex were studied bilaterally. Morphological variations of the sutural patterns were noted and morphometric details were recorded, including the distance from the center of the pterion to adjacent anatomical bony landmarks, such as the mid-point of the zygomatic arch, the frontozygomatic suture, the inion, the tip of the mastoid process and the highest point on the suprameatal spine. Chi-square tests and Independent sample t-tests were used for data comparison. Results: Four types of pterion were identified. Based on different combinations of the distribution of these sutural patterns, the skulls were classified into various categories. The most common variant was the sphenoparietal type of pterion, observed in 35.48% of skulls on the right-side and 31.45% on the left-side among the total examined skulls. No statistically significant difference was observed when comparing these morphological variants between the sides (p-value=0.74). The pterion was situated 39±3.52 mm superior to the mid-point of the zygomatic arch and 31.82±5.23 mm posterior to the frontozygomatic suture. Statistical analysis revealed no significant difference between the right and left-sides in all measurements (p-value >0.05). Conclusion: The morphology and morphometric evaluation of the pterion are highly variable, which can have significant implications in the fields of anthropology, forensic medicine and neurosurgery.

Association of Poor Sleep Quality and Reduced Sleep Duration with the Risk of Development of Metabolic Syndrome in Young Adults Attending Medical College in Southern India: A Cross-sectional Study

CS Sruthi, P Renuka, VM Vinodhini

Introduction: Sleep deprivation and metabolic disorders are rising in parallel worldwide. The academic pressures and rigorous schedules associated with the medical curriculum may predispose college students to erratic sleep patterns. Social Jetlag (SJL) is the imbalance between sleep duration on workdays and free days, resulting from the mismatch between a person’s biological rhythm and the daily timing set by social obligations. College students often attempt to compensate for sleep debt during the weekends. Changes in sleep patterns have been linked to the development of insulin resistance, diabetes mellitus and cardiovascular diseases in adults. Aim: To determine the prevalence of sleep disturbances and to evaluate the relationship between sleep quality, SJL and Metabolic Syndrome (MetS) in young adults attending medical school. Materials and Methods: In this analytical cross-sectional study conducted over two months, from August 2022 to September 2022, 153 medical students from SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India participated to evaluate the relationship between sleep disturbances and MetS. Sleep quality and SJL were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Munich Chronotype Questionnaire (MCTQ). The presence of MetS was determined according to the criteria provided by the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III). Descriptive statistics, Chi-square (c2) tests, Spearman correlation, logistic regression analysis and odds ratios were used to analyse the data. Results: The mean age of the study participants was 20.24±1.12 years. The prevalence of sleep disturbance (PSQI score above 5) demonstrated in the present study is 63/153 (41.2%) using the PSQI questionnaire. Nearly 40/83 (48.2%) of the female students had sleep disturbances. Short sleep duration (p-value=0.04) was found to be associated with MetS, with a reduction in sleep duration by one hour increasing the odds by 2.12. Out of the 153 student participants, 9.8% (n=15; 8 males and 7 females) met the criteria for MetS. Conclusion: A reduction in sleep duration was associated with an increased risk of developing MetS.

Heterogeneity in the Histopathological Features of Cystic Lesions of the Kidney with Special Reference to CK7 IHC in Cystic Renal Tumours: A Cross-sectional Study from a Tertiary Care Centre

Introduction: Renal cystic lesions are the most commonly encountered kidney pathologies, which can fall into developmental, acquired, genetic, infectious and neoplastic categories. Prompt histological diagnosis, in co-ordination with radiological findings, is very important for the further management of these lesions. Aim: To study the histopathological features of renal cystic lesions and to examine the immunological expression of Cytokeratin 7 (CK7) in cystic renal tumours. Materials and Methods: The present study is a cross-sectional study conducted in the Department of Pathology, Narayana Medical college, Nellore, Andhra Pradesh, India. Study was conducted over a period of five years, from June 2018 to May 2023, both prospectively and retrospectively. It includes 38 cases of cystic renal lesions out of 147 kidney specimens, which included cyst walls and nephrectomy specimens. Out of the 38 cystic renal lesions, 11 cases of cystic renal tumours were identified. Cytokeratin 7 Immunohistochemistry (IHC) was performed on these 11 cases of cystic renal tumours. Only diffuse membranous or cytoplasmic immunostaining in tumour cells is considered positive, while weak or focal immunostaining is considered negative. The data was entered into Microsoft (MS) Excel sheet and descriptive measures obtained included frequencies and percentages. Results: Among the 38 cases of cystic renal lesions, the most common were 17 cases of simple cysts, followed by 10 cases of clear cell renal cell carcinoma with a cystic component, three cases of acquired cystic disease, three cases of renal dysplasia, two cases of hydatid cyst, one case of mucinous cyst, one case of adult polycystic kidney disease and one case of a cystic renal neoplasm of low malignant potential. All 11 cases of cystic renal tumours exhibited clear cell morphology. Cytokeratin 7 immunostaining was performed on the 11 cases of cystic renal tumours, of which only the lining cells in a single case of cystic renal neoplasm of low malignant potential showed both intense and diffuse cytoplasmic positivity. The remaining 10 cases of clear cell Renal Cell Carcinoma (RCC) were negative, showing no immunoreactivity. Conclusion: Renal cystic lesions encompass a broad range of pathologies that have many overlapping features on histopathology. The use of immunohistochemical markers aids in differentiating low malignant potential cystic renal tumours from malignant ones.

Success of Spontaneous Breathing Trials using Pressure Support Ventilation versus T-piece in Mechanically Ventilated Patients: A Randomised Clinical Trial

Monica Chhikara, Alka, Shilpa Popli, Amanpreet Hira, Manisha Yadav

Introduction: The weaning process in mechanical ventilation is crucial, as it helps patient’s transition from dependence on the ventilator to breathing independently. The method used can impact patient outcomes, including the length of ventilation, complications and overall recovery. Proper weaning reduces the risk of complications such as ventilator-associated pneumonia and muscle weakness while promoting successful extubation and improved patient outcomes. Aim: To compare two methods of Spontaneous Breathing Trials (SBT): Pressure Support Ventilation (PSV) and T-piece trial for successful weaning in mechanically ventilated patients in critical care units. The secondary objective was to assess the attempts of SBT required for weaning in two groups of patients receiving T-piece and PSV. Materials and Methods: This prospective randomised clinical trial was conducted in the Department of Anaesthesia, Pt. BD Sharma Postgraduate Institute of Medical Sciences (PGIMS) (a tertiary care centre), Rohtak, Haryana, India after obtaining ethical approval. A total of 80 patients aged over 18 years who have been mechanically ventilated for a minimum of 24 hours but less than seven days in the Intensive Care Unit (ICU) were enrolled in the present study. After assessing readiness for weaning, patients were randomised to receive SBT via either PSV mode or T-piece and their ventilatory parameters were noted. Based on the success of the SBT, patients were classified into four groups according to the Weaning according to a New Definition (WIND) criteria. Data was analysed using Statistical Package for Social Sciences (SPSS) software version 22.0. Results: The mean age of patients in the pressure support group and the T-piece group was 42.75±18.271 years and 42.20±19.161 years, respectively. Demographic data, such as age, gender and parameters {Acute Physiology and Chronic Health Evaluation (APACHE) score, haemoglobin levels, blood sugar level, temperature, airway in-situ, duration of ventilation}, were comparable in both groups. The number of Separation Attempts (SA) required were significantly lower in the pressure support group, with a p-value of 0.001. The pressure support group had more successful weaning on day 1 compared to the T-piece group (p-value=0.001). Conclusion: The PSV is a better method of SBT for patients who have been mechanically ventilated in the ICU for more than 24 hours. The number of SBTs required for the PSV group was less than that required for the T-piece group.

Effect of Shoulder Rehabilitation on Acromiohumeral Distance in Rotator Cuff-related Shoulder Pain: A Quasi-experimental Study

R Pruthviraj, KU Dhanesh Kumar, Stephiya Davis, Anusha V Shenai

Introduction: Rotator Cuff-related Shoulder Pain (RCRSP) is a common musculoskeletal condition that causes pain and functional limitations. Reduced Acromion Humeral Distance (AHD) is associated with shoulder dysfunction in RCRSP. The Shoulder Symptom Modification Procedure (SSMP) may improve AHD and patient outcomes. Aim: To investigate the effectiveness of a 12-week SSMP on AHD in individuals with Rotator cuff-related shoulder pain. Materials and Methods: A single-blinded quasi-experimental study was conducted in the Department of Musculoskeletal Physiotherapy at RV College of Physiotherapy, Bengaluru, Karnataka, India, involving 60 participants aged 20 to 60 years with shoulder pain. Recruitment took place over six months, from February 2022 to July 2022. The researcher who performed the SSMP assessment and treatment was blinded to the pre- and post-test results of ultrasound imaging for AHD and Shoulder Pain and Disability index (SPaDi) scores. The response-guided treatment based on the SSMP assessment was administered twice a week for 12 weeks, with each session lasting 45 minutes. Pre-assessment of AHD and SPADI scores was conducted by an assessor, who also performed the follow-up evaluation after 12 weeks. Data were analysed using a paired t-test with R Software version 4.1.0, and a p-value <0.05 was considered statistically significant. Results: The mean age was 42.67±11.46 years. At baseline, the mean AHD was 8.54±1.11 mm, significantly increasing to 9.14±1.11 mm after 12 weeks. The pre-test mean SPADI score was 64.77±30.22, significantly reducing to 10.33±6.5 post-intervention. A paired t-test revealed a significant reduction in SPADI scores (t=19.33, p-value <0.0001). The pre-test AHD was 8.54±1.11 mm, and the post-test AHD significantly increased to 9.14±1.11 mm (t=4.19, p-value <0.0001). Conclusion: The 12-week SSMP significantly improved AHD and shoulder function in individuals with RCRSP. SSMP is an effective intervention for enhancing shoulder joint space, reducing pain, and minimising disability. Further studies are required to assess its long-term effects.

Mean Arterial Pressure, Uterine Artery Doppler and Serum Placental Growth Factor Measured in First Trimester for Prediction of Preeclampsia: A Prospective Observational Study

K Geetha, Mamatha, Urvashi, MN Vanitha Gowda

Introduction: Preeclampsia affects 2 to 5% of pregnant women and is a leading cause of maternal and perinatal morbidity and mortality. Aim: To predict the development of preeclampsia during the first trimester by using mean arterial pressure, uterine artery Doppler, and serum placental growth factor. Materials and Methods: A prospective observational study was conducted among women attending the Outpatient Department (OPD) for antenatal care at Ramaiah Medical College hospitals in Bengaluru, Karnataka, India from November 2018 to May 2020. A total of 80 antenatal participants, with singleton pregnancies between 11 and 13+6 weeks, underwent thorough examinations with appropriate investigations. Participants found to have a uterine artery Pulsatility Index (PI) >95th percentile were started on Tablet Aspirin 150 mg once a day. All study participants were followed until delivery to observe the development of preeclampsia and neonatal outcomes. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the Area Under the Curve (AUC) for the three variables and their combination, and sensitivity, specificity, and diagnostic accuracy were determined. Statistical significance was set at p-value <0.05. Results: The mean age of the study participants was 26.54±3.14 years. During the study period, out of 80 women, 5 (6.25%) developed hypertensive disorders; among them, 2 (2.5%) had early-onset preeclampsia and 3 (3.75%) had gestational hypertension. Total 10 (12.5%) women had a uterine artery pulsatility index >95th percentile and were started on Tablet Aspirin 150 mg; among them, 3 (3.75%) developed hypertension and 7 (8.75%) did not. The combined mean arterial pressure, mean uterine artery pulsatility index, and placental growth factor had a sensitivity of 100%, specificity of 87%, Positive Predictive Value (PPV) of 33%, Negative Predictive Value (NPV) of 100%, and diagnostic accuracy of 88%. Conclusion: The first trimester combined assessment of mean arterial pressure, uterine artery Doppler, and serum placental growth factor has proven to be the best screening test for the early prediction of preeclampsia.

Assessment of MRI Changes on Articular Cartilages after Intra-articular Injection of Platelet-rich Plasma in Knee Osteoarthritis: An Interventional Study

Debdipta Das, Srabani Sarker, Amrita Roy, Saumen Kumar De, Dipasri Bhattacharya

Introduction: Platelet-rich Plasma (PRP) therapy has recently become a popular treatment for knee Osteoarthritis (OA), as it helps regenerate joint cartilage. Aim: To investigate the effect of PRP on cartilage characteristics, as evidenced by Magnetic Resonance Imaging (MRI) imaging in knee OA. Materials and Methods: This was an interventional study conducted in the Department of Anaesthesiology and Pain Medicine in collaboration with the Departments of Radiodiagnosis and Orthopaedics at RG Kar Medical College, Kolkata, India from October 2023 to August 2024. Patients with bilateral knee OA of grades 1, 2, and 3 were included. PRP was injected into each knee joint via ultrasound in three sessions, with four-week intervals between sessions. The Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were utilised, and MRI was performed for all patients’ knees before the treatment and two months after the third session. T1-weighted, PD-weighted (fat-saturated), 3D sequence MRI scans were taken, and the thickness of the medial condylar, lateral condylar, and patellar cartilage was measured and compared for both pre- and post-PRP procedures. Statistical analysis was conducted using Student’s t-test to determine statistical significance. Results: In present study, 200 knees (from 100 patients) were included. The mean total KOOS and VAS changes before and after treatment were 32.2±18; 67±22.6 and 3.2±1.6; 1.6±1.1, respectively (p-value <0.05). It was also noted that all the MRI variables (medial condylar, lateral condylar, and patellar cartilage thickness) showed significant improvement (excluding subarticular bone marrow abnormalities) (p-value <0.05). Conclusion: In present study, it was observed that PRP provides significant improvement in the MRI characteristics of knee joint cartilage for knee OA after three intra-articular PRP injections. PRP also significantly improved overall physical outcomes, such as pain, stiffness, and activity in the knee joint.

Male Breast Cancer: An Experience from a Regional Cancer Centre, Tamil Nadu, India

Introduction: Male breast cancer is rare and accounts for less than 1% of all breast cancers. The incidence continues to rise, and most of the existing literature on male breast cancer consists of retrospective studies. Multicentric and randomised studies are scarce, making it difficult to study the biology of the disease and effective therapeutic options. Aim: To investigate the clinicopathologic characteristics and survival outcomes of male breast cancer. Materials and Methods: This was a cohort study involving the retrospective collection of data from 39 male breast cancer patients, who were included for analysis from a total of 1,871 carcinoma breast cases between January 2018 and October 2022 (data obtained from the Hospital Based Cancer Registry of Government Arignar Anna Memorial Cancer Hospital and Research Institute, Karapettai, Kanchipuram, Tamil Nadu, India). Patient variables related to age, family history, pathological details (including tumour grade, Immunohistochemistry (IHC) and stage of the disease), treatment details and follow-up information were collected for the study. Statistical analysis for survival was performed using Statistical Package for the Social Sciences (SPSS) software version 26.0. Results: The majority of patients (20 cases) belonged to the 41-60 years age group, with 10% of patients having a family history of cancer. Stage III was the most common stage of presentation, accounting for 15 (38.5%) cases. Luminal A (46.2%) was the most common molecular subtype, followed by Basal type (23.1%). The median Overall Survival (OS) was 46 months (95% CI: 31-40.5-51.5), and the median Disease-Free Survival (DFS) was 44 months (95% CI: 25.21-62.78). Patients with Luminal A subtype had the highest median OS. Conclusion: Present study concluded that these patients experience an early onset of the disease, with most being hormone receptor positive and commonly presenting in a locally advanced stage. Patients in the Luminal A group have a good prognosis, and survival also depends on the stage of the disease. These groups of patients are unique and heterogeneous among various populations. Although there are many studies comparing male and female breast cancer, the biology of male breast cancer still needs to be studied in detail. There should be a comparison with female breast cancer in prospective randomised multicentric trials to yield therapeutic implications.

Effect of Three Different Concentrations of Sodium Hypochlorite on the Solubility of Bulk Fill Restorative Composite Resin: An In-vitro Study

Introduction: The integrity of pre-endodontic restorations plays a vital role in ensuring the longevity of permanent restorations, particularly in cases involving extensive tooth structure loss. Sodium Hypochlorite (NaOCl) is commonly used as a root canal irrigant due to its antimicrobial properties, but its potential effects on the solubility of restorative materials, such as bulk fill composites, remain underexplored. Understanding how varying concentrations of NaOCl impact these materials is essential for optimising endodontic treatment outcomes and enhancing the durability of subsequent restorations. Aim: To evaluate the effect of three different concentrations of NaOCl as a root canal irrigant on the solubility of bulk fill restorative composite resin. Materials and Methods: This in-vitro study was carried out at the Department of Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India, over a period of nine months from August 2023 till April 2024. Total 24 disc-shaped samples were prepared using polytetrafluoroethylene moulds of 10×4 mm of Tetric N Ceram bulk fill restorative composite resin. Samples were randomly divided into Group I (distilled water), Group II (1% NaOCl), Group III (3% NaOCl), and Group IV (5% NaOCl), with six samples in each group. Solubility tests were performed according to ISO 4049. Analysis of Variance (ANOVA) followed by Tukey’s Post-hoc test was applied to compare solubility between and within groups. Results: The mean solubility values were highest in Group IV (-1.16±0.26 μg/mm³) and lowest in Group I (-0.36±0.13 μg/mm³), with the difference being statistically highly significant (p<0.001). No statistically significant difference was observed between Group I (distilled water) and Group II (1% NaOCl) (p>0.05). There was also no statistically significant difference when Group II was compared with Group III (3% NaOCl) and Group I (distilled water), respectively (p>0.05). Conclusion: Bulk fill composite resin exhibits increased solubility post immersion in higher concentration of NaOCl (5%). To minimise degradation and ensure restoration longevity, 1-3% NaOCl concentration is recommended. However, due to the compromised integrity of the resin, it is recommended to replace the pre-endodontic restoration before proceeding with permanent post-endodontic restoration to prevent potential coronal leakage and ensure the success of the final restoration.

Evaluation of Comparative Efficacy of Trayodashang Guggul versus Asitaka Churna Vati in the Management of Katigraha (Stiffness in Lumbar Region): A Randomised Controlled Trial Protocol

Bhishmani Tarare, Sadhana Misar, Mahesh Sharma, Pankaj Yadav

Introduction: Now-a-days, low back pain is one of the primary causes that affect people frequently and does not discriminate based on gender. Stress, poor eating habits, and the hectic schedules are the most frequent causes of this. The majority of people experience this pain as a result of their hectic schedules at work, which are frequently ignored and eventually result in an irreversible deformity. Since the Nidana of Vatavyadhi (Causative factors of Vata disorders), which has been stated, is comparable to that of Aharaja (Dietary factors), Manasika (Mental/emotional factors), and Viharaja (Lifestyle or activity factors), its administration is also quite detailed. The primary signs and symptoms of Katigraha are pain and stiffness. Several management strategies indicated in the classics of Ayurveda can be beneficial in treating Katigraha. The primary causative cause for the pathophysiology of Katigraha is Vatadosha. Asitaka Churna is suggested in the treatment of Katigraha (stiffness in lumbar region) in Ayurveda classics. Need of the study: In Ayurveda various purification therapies and palliative therapies are mentioned. In purification therapy, small volume enema, decoction enema, oleation enema, medicated fomentation, lumbar basti, bloodletting therapy and pouring therapy are advised. In palliative therapy guggulu preparations are taken into consideration for the acute management of pain and stiffness in lumbar region. Asitaka churna is mentioned for management of Katigraha in Bhavprakash which is herbal formulation hence relatively safe. It has pain relieving, anti-inflammatory, vata regulating, appetizer digestive and rejuvenating properties. Aim: To evaluate comparative efficacy of Trayodashang Guggul vs Asitaka Churna Vati in the management of Katigraha (Stiffness in lumbar region). Materials and Methods: The present study Randomised Controlled Trial (RCT) would be conducted in the Department of Kayachikitsa, Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India, from 1st December 2024 to 31st December 2024. In the present study, 60 patients will be enrolled and divided into two groups. In group A, Trayodashang Guggul 1 gm twice a day after meal with warm water and in group B, Asitak Churna Vati 1 gm twice a day after meal with warm water will be given. Parameters like pain, stiffness would be studied subjectively; and walking time, Range of Movement (ROM), Oswestry Disability Index (ODI) and Schober’s test would be taken as the objective parameters. Statistical analysis would be done using GraphPad Prism 7.0 V software and statistical tests, Chi-square test, Wilcoxon signed-rank sum test and Wilcoxon’s signed rank test will be applied with level of significance as 0.05.

Pharmaceutico-analytical Study of Dhananjayadi Vati and Assessment of its Antihistaminic Activity: A Research Protocol

Puja Maldhure, Anita Santoshrao Wanjari, Anjali S Katore, Kirti Naharwal

Introduction: Histamine is the local hormone synthesised by mast cells in the tissue and basophils in the blood. Histamine and its Receptors (H1R-H4R) have a substantial impact on the onset of many allergic diseases. Allergic diseases, including asthma, pruritus, atopic dermatitis and allergic rhinitis, result from the complex interaction of inflammatory cells like basophils, mast cells, lymphocytes and dendritic cells responding to various environmental and allergic stimuli. Need of the study: An antihistamine is a medication that works against histamines to relieve allergy symptoms. These medications help to address conditions triggered by histamine in the body. However, some non steroidal antihistaminic drugs are proven to be quick-acting but are associated with potential side-effects, such as organ damage. In Ayurveda, several medicinal preparations have been mentioned to combat the allergic condition and the Dhananjayadi tablet (Vati) might also be significantly effective in allergic conditions. Aim: Pharmaceutico-analytical evaluation of Dhananjayadi Vati and assessment of its antihistaminic activity. Materials and Methods: An in-vitro study will be conducted in the Department of Dravyaguna at Mahatma Gandhi Ayurved College Hospital Research Centre, Salod (H) Wardha, Maharashtra, India from August 2024 to March 2025. All herbal drugs will be collected, verified and primarily authenticated by the Department of Dravyaguna and will be prepared as per the references. Organoleptic parameters (touch, appearance, taste, odour) and physicochemical parameters (hardness, pH value, uniformity of weight, loss of drying at 105°C, total ash, acid-insoluble ash, water-soluble extractive values, alcohol-soluble extractive values, disintegration time, friability and High-Performance Thin-Layer Chromatography (HPTLC) of the drug) will be evaluated. The antihistaminic action of Dhananjayadi tablet (Vati) will be evaluated in-vitro while assessing the proportion of contraction of goat tracheal tissue. A paired t-test will be conducted for pre- and postintervention evaluation and a p-value <0.001 will be considered statistically significant.

Determination of Optimal Dose of Gandharva Taila Bhrushta Haritaki Churna Ayurvedic Oral Preparation in the Management of Krura Koshtha (Severe Bowel Movements): A Randomised Clinical Trial Protocol

Nitin Ashok Dhawas, Vaishali Kuchewar, Mohnish Gokhale

Introduction: In Ayurveda, Koshtha is defined as a bowel movement based on an individual’s basic constitution. There are three types of Koshtha-Mrudu (soft stool), Madhyam (moderate), and Krura (harsh or severe gastrointestinal nature). Individuals with Krura Koshtha are more prone to various diseases due to improper Koshtha Shuddhi. Hence, Koshtha Shuddhi (cleansing or purifying the gastrointestinal tract) is an integral part of treatment for most diseases. Virechan (therapeutic purgation or induced bowel evacuation) is advised for Koshtha Shuddhi. Need of the Study: The action of Anulomana Dravyas (the drugs that gently stimulate downward movement in the intestines to facilitate bowel evacuation) affects the entire gastrointestinal tract. Gandharva Taila Bhrushta Haritaki is recognised as the best Anulomaka. The recommended dose of Gandharva Taila Bhrushta Haritaki Churna is described as 5-10 grams at night. Therefore, the present study is planned to confirm the optimal dose of Gandharva Taila Bhrushta Haritaki Churna for appropriate Koshtha Shuddhi in individuals with Krura Koshtha. Aim: To determine the optimal dose of Gandharva Taila Bhrushta Haritaki Churna in the management of Krura Koshtha volunteers. Materials and Methods: This is a three-armed parallel interventional trial, will be conducted in the Kayachikitsa Outpatient Department (OPD) and Inpatient Department (IPD), Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India, from July 2024 to July 2025. A total of 90 participants who meet the inclusion criteria will be identified and randomly enrolled in three groups: Group A, Group B and Group C. Gandharva Taila Bhrushta Haritaki Churna will be administered orally to Groups A, B and C in doses of 5 grams, 7.5 grams and 10 grams, respectively, for seven days, once at bedtime. Daily follow-up will be conducted to assess Koshtha Shuddhi. Data will be analysed using the Chi-square test to find significant differences between the three groups concerning categorical variables of the Bristol stool chart, with a significance level set at p-value <0.05.

Whole Genome Sequencing: Advantages of de Novo Hybrid Approach Utilising Illumina and Nanopore Technologies

Janakiram Bobbillapati, AS Smiline Girija, Jeevigunta Naveena Lavanya Latha

The groundwork for Next-Generation Sequencing (NGS) was laid by pioneering methods developed by Allan Maxam, Walter Gilbert and Frederick Sanger, a Nobel laureate. While the Sanger method remained standard for many years, technological advancements have led to the widespread adoption of NGS in genomics. NGS has revolutionised genetic diagnostics, significantly improving the speed and accuracy of disease detection. First-generation sequencing, which required labourious efforts to sequence small portions of Deoxyribonucleic Acid (DNA), has now evolved into advanced techniques capable of decoding entire genomes within a day. The introduction of second- and third-generation sequencing has further improved cost-efficiency, speed and precision. The vast amount of data produced through NGS requires sophisticated bioinformatics tools for analysis, which has accelerated advancements in NGS technology. This review provides an in-depth exploration of various NGS techniques, highlighting the advantages of a de novo hybrid approach utilising Illumina and Nanopore for bacterial genome sequencing.

Contribution of JSS Academy of Higher Education and Research towards Global Research: Trends and Insights

Rohith Yampati, Chandrika Doddihal, Mallanagouda M Patil, BM Prasanna Kumar

Introduction: JSS Academy of Higher Education and Research (JSSAHER) has a long-standing tradition of promoting interdisciplinary research and fostering global collaborations. The institution has made significant strides in health sciences, particularly in areas such as pharmacology, public health and clinical medicine. JSSAHER, a health sciences-oriented institution in India, has consistently emphasised research and global collaboration. This study evaluates its contribution to global research. Aim: This study used the Web of Science database to analyse the research output, growth and international collaboration of JSSAHER from 1996 to 2023 through scientometric analysis. Materials and Methods: This bibliometric study was conducted at JSSAHER, Mysuru, India, between January and June 2024, using data from the Web of Science database. A total of 4,680 publications were analysed based on specific inclusion and exclusion criteria. Parameters such as publication trends, citation metrics, international collaborations and keyword analysis were assessed using tools like Biblioshiny, VOSviewer, CiteSpace and MS Excel. Ethical clearance was not applicable, as this study involved secondary data analysis. Results: JSSAHER’s research output demonstrated an annual growth rate of 13.87%. In 2023, 649 papers were published, and 5,665 citations were recorded in 2022. Prominent keywords included “in-vitro,” “prevalence” and “oxidative stress.” Collaboration networks revealed partnerships with various countries. Conclusion: The analysis highlights JSSAHER’s growing influence in scientific research, marked by sustained publication output, impactful collaborations and diverse research themes. These insights guide the institution’s future research endeavours.

A Review of Geographic Tongue Journey: From Diagnosis to Therapeutic Considerations

Kaushal Mangtani, Sachin Tote, Shobha Rawlani, Bhagyesh Sapkale

Geographic Tongue (GT) affects the mucous membrane of the tongue and is a non cancerous condition that causes smooth, reddish regions resemble maps. Despite its widespread incidence, the cause of GT is still unknown; it has been linked to allergies, asthma and psychological stress. A thorough literature evaluation synthesises information about the visual and sensory features of GT, such as atrophic mucosa, serpiginous white regions and dynamic lesion migration, using reliable databases. Hormonal causes, psychological stress, parafunctional behaviours and possibly hereditary predispositions are all contributing factors. Genetic insights that disclose mutations in IL36RN and variances in human leukocyte antigens highlight the significance of immunological markers. Clinical features are used to diagnose and a thorough examination is required to differentiate GT from similar lesions. Although biopsies are not always required, they can validate clinical diagnoses. Management focuses on assurance because GT is a self-resolving condition, with each symptomatic case handled separately. There isn’t a single, widely acknowledged gold standard for treatment; alternatives include topical anaesthetics, corticosteroids, anxiolytics and antihistamines. The review was kept coherent and with considerable depth in its coverage of GT, including its clinical features, visual and sensory characteristics, contributing factors including genetic and immunological markers, diagnostic criteria and management strategies.

Unraveling the Mysteries of Exploding Head Syndrome: A Narrative Review

Smit Firke, Bhagyesh Sapkale, Gargi Mudey, Sachin R Gedam

Exploding Head Syndrome (EHS) is a rare parasomnia characterised by the perception of loud, abrupt auditory hallucinations during sleep-wake transitions. Even though EHS is not associated with any physical pathology, it may cause substantial sleep disturbances and interruptions. To address these questions, the present narrative review synthesises the current knowledge and consensus on the nature of EHS, including its symptoms and possible causes, existing classification systems, and available interventions. Other frequent complaints include rhythmic noises in the ears, difficulty seeing and somatic sensations, such as electrical buzzing in the head. Stress or anxiety may potentially precede an episode, and dysfunction in the brainstem reticular formation and mild temporal lobe seizures have been suggested as possible neurological causes. EHS falls under the category of parasomnias within the International Classification of Sleep Disorders Third edition (ICSD-3) and is classified as an unspecified sleep-wake disorder under the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5). Current intervention strategies are still scarce; while topiramate has been shown to lessen the intensity of symptoms, no trials on this possibility have been conducted so far. Education and reassurance may be useful in alleviating these symptoms. More studies are required to increase knowledge about the underlying processes and to establish specific therapeutic strategies. The present review alerts readers to the growing evidence for EHS, which remains a condition that is not frequently identified, and urges investigators to conduct randomised controlled therapeutic trials.

Ustrakantaka (Echinops echinatus Roxburgh) from Folklore Field Practice to Therapeutics: A Narrative Review

Monika, Dattatray Sarvade, Rajkumar Gupta

“Ustrakantaka,” the botanical source of which is Echinops echinatus Roxb., is a wild branched xerophytic herb. It has a long history of use in traditional medicine, primarily valued for its stimulant properties in addressing sexual dysfunction and debility. The roots (mula), leaves (patra), flower (pushpa) and bark (twak) are frequently employed in folklore and Ayurveda. This plant exhibits multifaceted therapeutic potential, addressing urinary, liver and gynaecological disorders while also demonstrating antimicrobial, analgesic, antioxidant and anti-inflammatory properties. The plant’s pharmacological activities are rooted in its diverse phytochemical profile, featuring the flavonoid apigenin and apigenin-7-O-glucoside, the phenolic compound Echinacin and the alkaloid Echinopsine. The present literature review provides an in-depth examination of Echinops echinatus, synthesising contemporary research on its historical context, ethnomedical application, pharmacognosy, phytoconstituents, pharmacological action and biological activity of the plant.

Research beyond Randomised Controlled Trial: The Importance of Pragmatic Clinical Trials for Generating Real-world Evidence in Current Healthcare

Sangita Jogdand, Smruti Besekar, Satyawan Singh Patel

The potential of Real-world Evidence (RWE) to provide valuable insights from Real-world Data (RWD) has drawn a lot of attention recently. This shift focuses research from controlled conditions to real-world, everyday healthcare settings. The shortcomings of conventional Randomised Controlled Trials (RCTs) and Experimental Controlled Trials (ECTs) have led to the emergence of Pragmatic Clinical Trials (PCTs), which emphasise real-world, everyday healthcare settings. The various studies argues that PCTs can bridge the gap between efficacy and practical application in clinical research by incorporating diverse patient groups, adaptable procedures and outcome measures relevant to daily clinical practice. Therefore, this current study highlights the potential of PCTs to connect RCTs and clinical practice by examining the concept of RWE and the tests’ distinguishing features.

Kocuria Rosea-induced Infective Endocarditis in a Immunocompetent Patient: A Rare Case Report

Vignessh Raveekumaran, Prince Vijayraj, Valentina Yogamoorthi, Sethuraj Selvaraj

Kocuria Rosea (K. rosea) a non pathogenic bacterium presents as normal flora in human skin, reported as an opportunistic infection in K. rosea, a non pathogenic bacterium that presents as normal flora on human skin, has been reported as an opportunistic infection in immunocompromised people and causes Infective Endocarditis (IE). Here, we present a case of a 42-year-old female non immunocompromised patient with symptoms of palpitations, persistent fever and shortness of breath, with nighttime increase in temperature and considerable weight loss for two months. Her clinical examination indicated pallor and clubbing. Interestingly, her left brachial and radial pulses were not felt but in vascular Doppler both arteries had normal blood flow. Blood cultures revealed bacteraemia caused by the uncommon pathogen K. rosea, which was sensitive to most antibiotics. Echocardiography showed aortic valve vegetation and other abnormalities. She was treated with antibiotics for the bacterial infection and other medications to stabilise her haemodynamic state. The present case report highlights the challenges in diagnosing and treating IE caused by K. rosea, emphasising the need for sustained microbiological assessment and multidisciplinary approach in treating such rare and unusual cases.

Cutaneous Metastasis of Squamous Cell Carcinoma of the Tongue as Bilateral Neck Nodules: A Case Report

Sheeja Sainulabdeen, CK Anju, Suraj Madhavan Nair, TV Murali

Squamous Cell Carcinoma (SCC) of the oral cavity is one of the most common malignancies in the head and neck region. Although lymphatic spread is the most common mode of metastasis, it can also metastasise via the haematogenous route to internal organs such as the lungs, liver and bones. While cutaneous metastasis has been reported in SCC of the oral cavity, metastasis presenting as subcutaneous nodules on both sides of the neck is extremely uncommon. Hereby, authors present a 66-year-old male with a history of smoking and diabetes, diagnosed with well-differentiated SCC of the tongue. He underwent wide local excision, selective neck dissection and adjuvant radiation therapy. He developed a recurrence in the level V cervical lymph nodes after one year, which was surgically excised. Histopathology confirmed metastasis in all the nodes, with two showing extranodal extension. A few weeks later, patient presented with painful, umbilicated skin nodules on both sides of the neck. A biopsy confirmed these as cutaneous metastasis from SCC. This case details a unique presentation of SCC of the tongue, which relapsed as painful subcutaneous nodules on both sides of the neck, highlighting the varied clinical presentation, diagnostic approach and pathological findings.

Impact of a Structured Educational Programme on the Knowledge of Antibiotic Usage and Resistance among Undergraduate Non Medical Students: A Research Protocol

Lalhmachhuani Hmar, Ruchira Ankar

Introduction: One of the most widely used medications to treat infections in a variety of medical specialities is an antibiotic. While their names are well known and they are widely used, there is insufficient education in the community, especially in developing countries, regarding the appropriate administration of antibiotics, antibiotic resistance, and its effects. As the demand for antibiotics increases day by day, the need for awareness and education becomes increasingly crucial. Need of the study: Global health is seriously threatened by bacteria resistant to the drugs used to treat them. We call this resistance to antibiotics. This can lead to infections that are difficult or impossible to treat, as well as an increased risk of death and morbidity. Research on antibiotic resistance and public and healthcare provider awareness of these issues is essential to prevent Antimicrobial Resistance (AMR) and guarantee that antibiotics are used appropriately. Aim: To assess the efficacy of a structured educational intervention in raising undergraduate non medical students’ knowledge of antibiotics and their resistance. Materials and Methods: A quasi-experimental study will be conducted at the Indian state of Maharashtra’s Indraprastha New Arts Commerce and Science College, Wardha from August 2024 through December 2024. A quantitative method will be used to assess how well the structured teaching programme has affected students’ knowledge of antibiotics and their resistance. A total of 65 students will participate and a structured questionnaire will be used for data collection. The tools will consist of- Section I: Demographic data like age, gender, types of family, resident and socioeconomic status. Section II: Structured knowledge questionnaire on the knowledge of antibiotics and their resistance. Descriptive and inferential statistics will be used to classify and analyse the participant data to meet the study’s objectives. Frequency, mean, standard deviation, mean percentage, and structured questionnaires will be used to explain demographic variables. A paired t-test will be applied to ascertain the significance of the variation in the knowledge score between the pre and post-test. The Chi-square test will be applied to determine the association between the knowledge level and demographic variables.