Journal of clinical and diagnostic research

Fibrodysplasia Ossificans Progressive: A Case Report on Rare Musculoskeletal Disorder

Manoj Arya, Rajendra Shakunt, Anoop Raj Singh, Shipra Verma, Vinay Kanaujia

Fibrodysplasia Ossificans Progressive (FOP) (also known as Myositis ossificans progressiva/Stone man disease/Munchmeyer’s disease) is one of the unfamiliar congenital disorders affecting the musculoskeletal system. It is characterised by extraosseous progressive heterotrophic osteogenesis in muscle, tendon, and ligament and associated deformities in toes. It starts around the age of 3-5 years and aggressively involves the musculoskeletal system; the affected child becomes immobile in the early twenties. The early phase of the disease is often misdiagnosed by medical experts due to its rarity and unfamiliarity. This was a case of FOP in a 5-year-old female child from western Uttar Pradesh. The presenting complaints were swelling in the lower back region, which was gradually increasing in size, and bilateral foot deformity. The diagnosis of FOP was based on elaborated history, clinical examination, and radiological investigation of the skeletal malformations. The child was provided with symptomatic treatment and her parents were counselled regarding the disease course.

Novelty in Exercise Regimen towards Bilateral Training in a Patient after a Cerebrovascular Event

Ischaemic stroke is caused by a sudden decrease in blood flow to the areas of the brain that leads to severe impairment if left untreated. The impairments include contralateral loss of motor and sensory functions, along with affection on the ipsilateral side. There is a reduction in strength on the unaffected side of stroke, due to the fact that only 75-90% of corticospinal fibres cross from the medulla to the contralateral side. A 45-year-old male, factory owner came with a chief complaint of sudden onset of weakness on the left side of the body for 11 days with a history of hypertension. Investigations revealed a large block in the right Middle Cerebral Artery (MCA). Medical management was provided with thrombolytics, anticoagulants, and antihypertensives. Thereafter, the patient was referred for physiotherapy. Physiotherapy assessment revealed left hemiplegia with more affection of upper extremity, spasticity grade 1+. He also had reduced gripping and grasping. A tailor-made protocol was formulated which focused on task and approach-oriented training with bimanual activities along with consideration of the less affected side was provided to the patient helped in early recovery and made him go back to his occupation. There are many studies on hand rehabilitation, but this is one in its kind that will add to the available literature on the positive effects of strength training on the unaffected side to be considered in rehabilitation.

Neck Dermoid Cyst with Rare Imaging Appearance on Ultrasound, Elastography, and Computed Tomography

Dermoid cyst is a type of inclusion cyst and a benign cystic teratoma containing two or more germ cell layers. It can show variable appearance on ultrasound and Computed Tomography (CT) as it is derived from squamous cell epithelium (ectoderm) and contains dermal-derived elements such as skin appendages, hair follicles, sebaceous and sweat glands. It is uncommon for a dermoid cyst to occur in the neck region during old age. The present case report highlights a rare imaging appearance of a dermoid cyst, presenting in a 65-year-old elderly male as a midline neck swelling, displaying a rare “coin in sack” appearance on ultrasound, “sack of marbles sign” on Contrast-Enhanced CT (CECT). On strain elastography, it showed characteristics of a hard mass. Diagnosing this type of large dermoid cyst with its radiological appearance is challenging. Multimodality imaging is often needed for early intervention, to prevent its rupture and transformation into malignancy. The dermoid cyst was surgically excised, and the patient was symptomatically normal on follow-up.

Amelanotic Malignant Melanoma of Buccal Mucosa: A Case Report

Amelanotic melanoma is an atypical variation from pigmented malignant melanoma. The clinical lack of pigment compromises the physician’s clinical diagnosis of the lesion. Presence of certain features like red hair, freckles, photosensitivity, previous history or family history predispose the possibility of occurrence of amelanotic melanoma. As the name suggests, the lesions lack pigmentations clinically and mimic many benign and malignant lesions which can be life threatening and thus, cause a diagnostic challenge. Hence, clinicians are expected to have a high suspicion on such lesions, and also judiciously employ biopsy, thus eluding the possibility of emerging of lethal lesions. About 50% of head and melanomas occur in the oral cavity. Of all the melanomas, 2% are amelanotic and majority of them occur in oral cavity. These lesions pose a greater degree of threat, because of the possibility of delayed diagnosis. The timely clinical and laboratory diagnosis favours the patient prognosis. No specific aetiologic factors or risk factors have been recognised for oral melanomas. Hereby, the authors present a case of 60-year-old female patients with ulceroproliferative growth in the left cheek region, which was provisionally diagnosed as malignant ulcer, immunohistochemical investigation of the biopsied sections revealed the diagnosis of amelanotic melanoma. The present case report illustrates the need of addition of a panel of Immunohistochemistry (IHC) markers in the routine diagnosis. The application of such panels avoid the delay in diagnosis and scale-up the prognosis.

Right-sided Congenital Diaphragmatic Hernia (Morgagni Hernia)- A Rare Clinical Manifestation in an Adult

Megha Dhirendrakumar Saxena, K Senthil Kumar, R Anantharamakrishnan

Congenital Diaphragmatic Hernia (CDH), usually presents in the childhood period. It presents as an idiopathic human malformation. It is a condition, where the organs of the abdomen enter the thorax due to a defect in the diaphragm, that is, herniation from the pleuroperitoneal fistula. Morgagni hernias are commonly incidentally diagnosed on a chest radiograph or a patient may have cardiorespiratory or abdominal symptoms. Repair of hernia without the use of mesh is advised in asymptomatic cases also due to feared complications like strangulation and incarceration. The treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally. It is advised that, surgical repair should be done even in asymptomatic cases. The present case report is about a 66-year-old female patient with a right-sided Morgagni hernia, who presented with abdominal pain and vomiting. Since the patient was symptomatic, surgical approach was preferred and she underwent laparoscopic abdominal surgery which was converted to open abdominal approach. Postoperatively, the patient recovered from her symptoms and had no complications.

Late Diagnosed Hirschsprung Disease: A Case Report

Shrayash Khare, Omaira Tejada, Magda Mendez

Hirschsprung Disease (HD) is mainly a diagnosis of the neonatal period. It is mostly suspected within the first few days of life, the classical telltale sign is an infant not passing meconium. Paediatricians continue to encounter cases of late diagnosed HD. A late diagnosis of Hirschsprung poses an unnecessary burden and suffering on the child and family and increases the likelihood of long-term health complications for the patient. Hirschsprung-Associated Enterocolitis (HAEC) is one of the acute serious complications of late diagnosed HD. It is the leading cause of morbidity and is responsible for half of the deaths associated with HD. Hence, HAEC should be kept in mind as a probable diagnosis by evaluating physicians particularly when making assessments for a child with possible necrotising enterocolitis or distal bowel obstruction with loose stools. The present case report highlights the importance of keeping HD on the differential diagnosis of an ill-appearing child presenting with growth faltering below growth curve for age and in settings of chronic constipation. The patient discussed in the present case report was a 14-month-old female infant, evolved from an admission due to poor weight gain and fever to concerns for paediatric surgery evaluation. Her symptoms progressed to include not just clinical changes, but also physical examination reflected worsening abdominal exams. Patient underwent biopsy which showed aganglionic bowel segment which resulted in surgical resection. Patient had complete recovery without major complications at two weeks postsurgery.

Synchronous Tumours: A Combination of Carcinoid and Adenocarcinoma

Synchronous tumour refers to cases in which the second primary cancer is diagnosed within six months of primary cancer. Carcinoid tumours are innocuous at time of presentation, emphasising the need for multidisciplinary approach for the diagnosis. A 80-year-old male patient came with complaints of cough with expectoration on and off for three years, with occasional minimal haemoptysis, haematemesis on and off for two months, loss of weight and loss of appetite for the past two months and complaints of increased cough for the past one week. Chest X-ray showed ill-defined opacity in the left lower zone. Contrast enhanced computed tomography showed two well defined heterogenous enhancing lesion in the superior and lateral basal segment of left lower lobe. Bronchoscopy guided biopsy revealed typical carcinoid. In view of recurrent diarrhoea, patient underwent endoscopy which revealed poorly differentiated adenocarcinoma. Gastrointestinal symptoms along with lung symptoms can be attributed to disseminated carcinoid or carcinoid syndrome. Carcinoid syndrome occurs in fewer than 5% of cases. It presents with symptoms like diarrhoea, wheezing, palpitations, hypotension. In the present case authors were attributing the gastric symptoms to carcinoid syndrome. Endoscopy was done in view of diarrhoea which revealed a second malignancy. Multiple tumours diagnosed have to be evaluated and staged separately and the treatment should be decided on staging to attain maximum clinical response. Patient condition worsened and patient expired in two weeks. All symptoms in a tumour patient should not be attributed to paraneoplastic syndromes and metastasis, further workup should be done using a multidisciplinary approach.

Classical Hodgkin’s Lymphoma Presenting as Erythroderma

Hodgkin’s Lymphoma (HL) with direct cutaneous involvement is uncommon, unlike non specific paraneoplastic skin changes, which can occur during the course of the disease. Direct cutaneous infiltration commonly affects the chest and manifests as papules and plaques. Nodules in some patients may ulcerate. Paraneoplastic manifestations can be eczematous itchy papules or lichenified plaques adjacent to the affected lymph nodes. Authors’ reported a case of a 31-year-old female with erythroderma, of four months duration, who did not respond to treatment with corticosteroids and cyclosporine. Skin biopsy showed minimal epidermotropism without mitotic cells. Immunohistochemistry (IHC) showed CD3, CD4, CD5 and CD8 positivity and CD15, CD 20 negativity. She had frequent exacerbations while on treatment with steroids. Amongst this confusing clinical picture, it was the emergence of an axillary lymph node, after two months of initiating treatment which on histopathology was compatible with HL and on IHC positive for CD3, CD20 and CD30 and negative for CD15. These findings confirmed the diagnosis as classical HL. The present case is being reported to highlight the importance of thorough clinical examination with particular reference to lymph node screening.

A Holistic Physiotherapeutic Approach to Manage a Patient of Hemangiopericytoma Followed by Amputation

Manali Anil Boob, Prasad Dhage, Shubhangi Patil

Hemangiopericytomas are atypical malignancies that arise from the pericytes that surround blood arteries. Mechanical injuries, severe traumatic injuries, infective illnesses, vascular diseases, peripheral neuropathy, cancers, and hereditary diseases are all major reasons for amputation. It is also used to get rid of ulcerated, ischaemic, or necrotic tissue. In amputation certain body parts tends to be removed to save individuals’ life. Hereby, the authors present a case of a 35-year-old male, who presented with the history of oedema in the posterior portion of his right knee. He was eventually diagnosed with a tumour following diagnostic tests, and the patient under went an above-knee amputation of the right side. The outcome measures were used to evaluate patients’ recovery before and after rehabilitation. A robust therapeutic regimen was planned which included appropriate stump caring, enhanced strength and flexibility, quality enhancement, equilibrium, balance, coordination, and optimal locomotor training. Gait rehabilitation benefited the patient in maintaining a normal gait cycle, and weight transfer. Upper limb strength is vital for crutch walking, which allowed him to participate in every day activities and enhance overall well-being.

Ethiodised Oil Lymphangiography in the Management of Chyluria

Vishal Nandkishor Bakare, Pratiksha Yadav, Krishna Teja Nerella

Chyluria is clinical condition in which there is excretion of chyle in urine. The most common cause of chyluria is lymphatic filariasis. This case report (67-year-old female) describes imaging findings of non filarial chyluria due to retroperitoneal lymphatic cyst and its successful management by minimally invasive percutaneous lymphangiography procedure. The patient presented with complaints of passing milky white urine which was confirmed to be chyluria. After a non successful trial of conservative approach in form of high-protein and low-fat diet, percutaneous ethiodised oil lymphangiography was performed, which resulted in immediate symptomatic improvement and no recurrence on follow-up.

Aesthetic and Functional Rehabilitation with Prosthetic Approach and Vertical Dimension Occlusion Increase: A Case Report

Özlem Özişçi

Prosthetic rehabilitation of severely worn teeth with loss of vertical dimension is difficult due to limited space and the need for complex treatments. To improve aesthetics, maintain anterior tooth relationships, and provide space for the prosthesis, effective treatment alternatives are needed to increase the Occlusal Vertical Dimension (OVD). This will reduce the need for invasive procedures and endodontic treatments. For optimum treatment, accurate measurements of the OVD, interocclusal resting area, and central relationship recordings are needed. The contours of the facial soft tissues should be examined. Before beginning the full mouth rehabilitation, it should be kept in mind that severe abrasion does not always result in the loss of vertical dimension, and it does not necessarily eliminate all defective occlusal interactions. In preventive and restorative dentistry, managing tooth wear and attrition is a fascinating subject. One of the treatment alternatives after a confirmed diagnosis is full mouth reconstruction along with identifying the sources. It is complex and difficult to manage dental attrition. A clinical evaluation of the patient following the cementation of temporary fixed restorations or the use of a diagnostic splint or temporary removable prosthesis can assist in determining the OVD. It is recommended to utilise fixed restorations rather than a removable appliance to increase OVD since patient adaptation is predictable. In the present case (57-year-old female patient), the vertical dimension was restored with an improvement in both function and aesthetics, providing a satisfactory clinical outcome.

Sialadenoma Papilliferum of Hard Palate Mimicking Squamous Cell Carcinoma: A Case Report

The occurrence of unusual ulcers in the oral cavity has fundamental value regarding oral and systemic diseases and abnormalities, as it can show clinical evidence that differs from other lesions, contributing to the diagnosis process. A 64-year-old female patient reported with a non healing of an oral lesion since two months (seeking clinical treatment for an atypical hard palate ulcer). Her medical record indicated past smoking habits and hypertension. During clinical evaluation, an exophytic ulceration located at the left posterior hard palate, with a rounded form and elevated edges, was observed. An incisional biopsy was performed to confirm the diagnosis. Histopathological complementary exams revealed biphasic papillary projections, extending from the epithelium through the connective tissue, that are considered ductal structures. The final diagnosis was sialadenoma papilliferum, and total surgical excision was performed as a treatment. Follow-up showed no recurrence over 14 months. Sialadenoma papilliferum is a rare benign salivary gland tumour, mostly known for its papillary aspect and categorised as a ductal papilloma. Sialadenoma papilliferum origin is not precisely defined, nor associated with a single cause, given that different investigators pointed to multiple variables to Sialadenoma papilliferum origin. Being one of the rarest salivary gland tumours, SialP’s clinical aspects and its resemblance to other benign salivary gland tumours can lead to a wrong diagnosis if not properly and microscopically analysed, hence the importance of knowing its features.

Coronary Cameral Fistula

Coronary Cameral Fistulas (CCFs) are rare arteriovenous malformations, defined as a connection between a coronary artery and a cardiac chamber or any segment of the systemic or pulmonary circulation. These may be congenital or acquired, and show a low incidence in both angiographic studies, and the general population. The presentation of CCFs varies depending upon their size and location. These can be majorly asymptomatic or show symptoms and complications like congestive heart failure, myocardial infarction, and bacterial endocarditis. Although percutaneous closure with embolisation can be done, surgical closure of CCF is a gold standard of treatment. The authors reported a case of a 57-year-old male patient who presented with exertional chest pain and dyspnoea. Coronary angiography revealed the presence of dilated tortuous Left Main Coronary Artery (LMCA), Left Anterior Descending artery (LAD), Left Circumflex artery (LCX) and CCF between LAD to Right Ventricle (RV), Obtuse Marginal (OM) to RV and Posterior Left ventricular Branch (PLB) to RV. No significant obstructive coronary artery disease was present. Coronary artery calcium score was 15. The patient was managed conservatively with antiplatelets, statin, and heparin and responded well to the treatment.

Rare and Aggressive Primary Amelanotic Melanoma in Anorectal Region: A Case Series

M Elancheran, K Siva Kaliyamoorthy, V Sriram, V Archana, S Ragavendran

Anorectal amelanotic melanoma is a rare and aggressive disease with high morbidity and mortality. A conclusive diagnosis of anorectal amelanotic melanoma poses a challenge to pathologists and clinicians due to the protean nature of this entity, be it in its initial clinical assessment appearing as non pigmented polypoidal growths usually mistaken for haemorrhoids or anorectal polyps. Histomorphologically, these entities get categorised in bewildering array of diagnoses like spindle cell carcinoma, Gastrointestinal Stromal Tumour (GIST), High-grade sarcomas and even lymphoma. Thus, Immunohistochemistry (IHC) remains a vital tool for conclusive diagnosis. The purpose of the present case series is to discuss in detail about the three patients all aged above 55 years and clinically assessed with anorectal polypoidal growths. All three cases on histopathological evaluation were diagnosed as spindle cell neoplasm with no discernible melanin pigments. The IHC performed on all three cases turned positive for S-100 and Human Melanoma Black 45 (HMB45). The present case series highlights the challenging and bewildering nature of presentation of anorectal amelanotic melanomas, by virtue of its rarity and hence, justifies the need for it to be considered as a possible differential diagnosis.

MDCT Evaluation of Celiac Axis Compression Syndrome- A Rare Case Series

Celiac axis compression syndrome is an uncommon entity of abdominal vascular compression syndrome which results from the compression of the proximal celiac artery by the hypertrophied median arcuate ligament. The patients present clinically with postprandial abdominal pain predominantly in the epigastric region and weight loss. The use of thin-section Multidetector Computed Tomography (MDCT) and 3-Dimensional (3D) image reconstruction has greatly improved the ability to obtain detailed images and helped to assess the abdominal vascular system non invasively. Five cases of celiac axis compression syndrome with its characteristic MDCT imaging features like hooked appearance, thickened median arcuate ligament more than 4 mm, poststenotic dilatation and posterior and inferior displacement of celiac artery with indentation on aorta have been described in the present case series and the imaging findings described by other authors in their reported studies have also been compared.

Erotomania: A Rare Psychiatric Condition- A Case Series

Amritha Chandrasekaran Sashikar, Nivetha Vasanthan, Priya Subhashini

Erotomania is a rare psychiatric condition which is characterised by the delusion that a person who is of a higher social status is in love with them. Three cases of secondary erotomania have been discussed which includes a 26-year-old female patient who had a delusion that a well-known actor was in love with her. The second patient was a 23-year-old female patient who harboured a delusion that a popular guy from her school was in love with her. Another patient was a 38-year-old female patient who was deluded that a church personnel was in love with her. All three patients shared similar features that they all developed symptoms of schizophrenia during the course of the illness following the delusion, had poor insight, had poor compliance to treatment and follow-up. Management was resorted to pharmacotherapy and psychosocial rehabilitation in all cases, which yielded improvement although there was no complete remission of the delusion in a two year follow-up in either of the cases. Since erotomania is a rare and unique phenomenon, discussion about the presentation of erotomania in association with schizophrenia, provides a knowledge regarding the condition and management.

Awake Fiberoptic Intubation in Vocal Cord Palsies

Neeta Santha, Diksha Dmello, Pakhi Sharma

Respiratory distress associated with vocal cord palsy can be attributed to recurrent laryngeal nerve injury. Bilateral vocal cord palsy can cause adduction of cords and respiratory distress. Airway, in these patients, can be compromised and result in unanticipated difficult intubation. The time frame to pass tube in such situations are less. This is a case series on successful airway management of three patients (71-year-old male, 37-year-old female, 70-year-old female) who presented with recurrent nerve palsy and airway obstruction. Thus the “cannot intubate-cannot oxygenate” situation was avoided in all the patients.

Rare Neurological Presentations of Paediatrics COVID-19 Cases Reported at a Tertiary Care Hospital in Mizoram, India

Apart from the regular respiratory symptoms, neurological manifestations like headache, encephalopathy, encephalitis, seizure, coma, demyelinating disorders, and aseptic meningitis has been seen in paediatric Coronavirus Disease-2019 (COVID-19) positive cases. The present case series is about three children, of age range 9 to 15 years, who presented with encephalitis between January 2022- February 2022. All the children tested positive for COVID-19, either by Rapid Antigen Test (RAT) or by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One patient had necrotising encephalitis like changes in the MRI neuroimaging of the brain, but negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) PCR in Cerebrospinal Fluid (CSF). The second patient’s Magnetic Resonance Imaging (MRI) brain was suggestive of acute encephalopathy, but with normal CSF analysis. The third patient presented with clinical findings suggestive of encephalitis with normal CSF study and normal MRI. The children were managed with antipyretics, antiepileptics, antibiotics, and antiviral, injection mannitol, and steroids. After the completion of the treatment, all the children were alive and were discharged from the hospital.

Wickham Striae- A Characteristic Dermoscopy Finding in Lichen Planus

Sivaramakrishnan Sangaiah, N Ashok Kumar, C Geo Danny, K Manoharan, NR Vignesh

Perplexity in Diagnosing Pleomorphic Adenoma of Minor Salivary Gland with Plasmacytoid Cell

Cheshta Walia, Sudip Roy

A Case of Laser Assisted Surgery for a Large Gingival Fibroma

Deepika Ajit Masurkar, Priyanka Jaiswal, Bhairavi Kale, Aishwarya Rathod

Bezold-Jarisch Reflex after Bone Cement Application during Total Hip Replacement

Vipin Kumar Singh, Akanshita Tewari, Fatima Khan

Serum Adiponectin as a Diagnostic Marker of Nephropathy among Patients with Type 2 Diabetes Mellitus: A Cross-sectional Study

Ganesh Veluri, M Murugan, Siva Prasad Palem, Vijay Kumar Gangannagari

Introduction: Diabetic Nephropathy (DN) is the leading cause of End-Stage Renal Disease (ESRD) among Type 2 Diabetes Mellitus (T2DM) patients and it is diagnosed by laboratory investigation like albuminuria. Albuminuria is a conventional and not a sensitive, specific marker for diagnosis of nephropathy. Additionally some of the patients shows advanced renal pathological changes without albuminuria and some of the patients with microalbuminuria revert back to normoalbuminuria. However, there is need for early detection, sensitive and specific marker for nephropathy. Serum adiponectin is an adipocytokine synthesised from adipose tissue, liver, kidney, heart, salivary glands. This has physiological properties like antidiabetic, antioxidative and anti-inflammatory properties beneficial for particularly in patient with T2DM. Adiponectin activates Adenosine Mono Phosphate (AMP) Kinase and Nicotinamide Adenine Dinucleotide Phosphate (NADPH) pathways results in improved insulin sensitivity and prevent albumin excretion in urine. Increased adiponectin levels are beneficial to patients with T2DM and its complications. Aim: To determine serum adiponectin levels for the prediction of early onset of nephropathy in patients with T2DM. Materials and Methods: This cross-sectional study was conducted from March 2018 to May 2019 at the Department of Biochemistry and Endocrine at the Basaveshwara Medical University Hospital and Research Centre in Karnataka, India, with a total of 120 subjects. Out of the 120 subjects, 80 were T2DM subjects and 40 were age, gender and Body Mass Index (BMI) matched controls (group 1). Eighty T2DM subjects were further categorised into two groups based on urinary Albumin-to-Creatinine Ratio (ACR) levels, such as 40 T2DM with normoalbuminuria [(Group 2), Urine ACR: <30 mg/g], and 40 T2DM with microalbuminuria, [(Group 3) urinary ACR: 30-299 mg/g]. Comparisons were made between groups based on socio-demographic and clinical parameters. Pearson’s correlation was used to test the relationship between estimated Glomerular Filtration Rates (eGFR), Glycated Haemoglobin (HbA1c), urine ACR, and serum adiponectin. The Receiver Operating Characteristic (ROC) curve was used to test the sensitivity and specificity of a marker for nephropathy. The Statistical Package for the Social Sciences (SPSS) version 20.0 and Medcalc Software were used to analyse data. Results: The mean values of serum adiponectin were significantly higher in patients with T2DM 11.92±3.86 mg/dL when compared to controls 3.84±1.98 mg/dL. The serum adiponectin had a significantly very high positive correlation with HbA1c, urinary ACR r=0.726, 0.642, p-value=0.0001 and also a significantly very high negative correlation with estimated glomerular filtration rate, r=-0.399, p-value=0.0001 was observed. In ROC analysis serum adiponectin was found to be proportionately elevated in T2DM with normoalbuminuria and it was statistically significant, with a sensitivity of 92.5% and specificity of 87.50, p-value=0.0001. The urinary ACR also has shown significance with low sensitivity of 62.5% and specificity of 80%, p-value=0.0250. Conclusion: The serum adiponectin might be a sensitive and specific marker to predict the early onset of nephropathy in T2DM patients and therefore can be used as a diagnostic marker for DN. These concentrations were positively correlated with urinary ACR and negatively correlated with eGFR.

Assessment of Knowledge and Attitude of Pregnant Women towards Dental Diagnostic Radiation Hazards: A Cross-sectional Study

T Sivasankari, Jagat Reddy, Kaviya, Ezhumalai

Introduction: Pregnancy is associated with reduced immunity and greater susceptibility to infection than any other population. According to the International Commission on Radiological Protection (ICRP), thousands of pregnant women are exposed to diagnostic medical ionising radiation each year. The effects of radiation exposure can be classified as deterministic or stochastic. The deterministic effects occur principally above a threshold dose, reflecting cell death. The stochastic effect occurs sometimes after exposure and is mainly represented by radiation-induced cancer. Aim: To evaluate the knowledge and attitude towards dental radiation hazards among pregnant women visiting a tertiary healthcare centre. Materials and Methods: A cross-sectional, self-designed and structured 15-item questionnaire study was conducted among 84 pregnant women to assess their knowledge and awareness about radiation hazards at Mahatma Gandhi Medical College, Puducherry, India, from January 2021 to June 2021. The data was collected and statistically analysed using the Chi-square test. The percentage, mean, and standard deviation were calculated for each participant. Cronbach’s alpha test was used to assess the reliability of the questionnaire and inter-item statistics. Results: The study population consisted of pregnant women with an age range of 20-35 years, with a mean age of 27.7 years. The result showed 15 (17.9%) of pregnant women knew that X-rays are harmful to the foetus and 10 (11.9%) of pregnant women were aware that they should reveal their pregnancy status before undergoing dental radiographic procedures. Conclusion: On an average, 40-80% of pregnant women had a lack of knowledge about dental radiation hazards and their effects, which clearly shows that there is a need for educating pregnant women about the hazards and risks associated with radiation exposure.

Correlation of Motor and Functional Recovery with Neuroimaging in Ischaemic Stroke: An Observational Study

Nitish Dhiman, Nonica Laisram, Deepthi S Johnson, Suman Badhal, Amita Malik

Introduction: Stroke is a leading cause of long-term disability worldwide. Neuroimaging plays a critical role in diagnosing and planning the treatment of stroke. Early prognostic markers help in predicting the prognosis after stroke. Aim: To correlate the motor recovery and functional outcome with Computed Tomography (CT) brain findings using Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) in patients with ischaemic stroke. Materials and Methods: This observational cross-sectional study was conducted in Department of Physical Medicine and Rehabilitation at Vardhman Mahavir Medical College and Safdarjung Hospital (tertiary care centre), New Delhi, India from October 2016 to March 2018. A total of 45 patients diagnosed with Middle Cerebral Artery (MCA) territory Ischaemic Stroke were included. Motor and functional assessment were done using Fugl-Meyer Assessment (FMA), and Barthel Index (BI). FMA and BI were correlated with the radiological assessment using ASPECTS on Non Contrast Computed Tomography (NCCT) of head. Results: The mean age of the study population was 60.98±8.61 years. The mean BI score was 70.34±25.2, and FMA score was 61.56±32.8. The mean ASPECTS was 7.5, with 26 patients having ASPECTS 8-10 and 19 with ASPECTS 0-7. Patients with higher ASPECTS (8-10) had moderate to no dependence in Activities of Daily Living (ADL) and mild to no motor impairment respectively (p-value <0.0001). Patients having lower ASPECTS (0-7) had severe dependency in ADL and motor impairment (p-value <0.0001). Conclusion: Alberta stroke programme early computed tomography score has a significant correlation with motor and functional recovery and is a strong predictor of outcome after ischaemic stroke. The higher the score on ASPECTS, the better will be the motor and functional outcome. The computed tomography findings of brain will help in stroke rehabilitation by enabling to set realistic goals at an early (acute) stage poststroke.

Bidirectional Recurrent Neural Network based Early Prediction of Cardiovascular Diseases using Electrocardiogram Signals for Type 2 Diabetic Patients

T Tamilselvan, Om Prakash Sharma

Introduction: The electrocardiogram (ECG) signal is important for early diagnosis of heart abnormalities. Type 2 diabetic individuals’ ECG signals provide pertinent data about their heart and are one of the most important diagnostic techniques used by doctors to identify Cardiovascular Disease (CVD). Bidirectional Recurrent Neural Network (RNN) classifies the features linked to normal and abnormal stage ECG signal. Aim: To analyse ECG signals of type 2 diabetic patients for early prediction of CVDs using feature extraction and bidirectional RNN based classification. Materials and Methods: This was a secondary data-based modelling study at Shri Ramasamy Memorial University Sikkim, India from December 2020 to January 2022. Different noises were removed by hybrid preprocessing filter made up of a Median and Savitzky-Golay filter. Undecimated Dual Tree Complex Wavelet Transform (UDTCWT) along with Detrended fluctuation (DA) analysis and Empirical Orthogonal Function (EOF) analysis were then used to extract features. These features were classified with Bidirectional RNN. Results: The proposed method was tested on the MIT-BIH, Physionet and DICARDIA databases, and the findings showed that it achieves an average accuracy of 97.6% when compared to the conventional techniques. Conclusion: The proposed method proves to be the most effective way for detecting anomalies in ECG signals in both the early and pathological stages. This method is also effective to diagnose the early intervention of cardiovascular symptoms.

Neutrophil to Lymphocyte Ratio among Acute Ischaemic Stroke Patients

Introduction: Finding potential prognostic indicators for Acute Ischaemic Stroke (AIS) may help to increase the accuracy with which outcomes can be predicted, and implementing early therapies may help to improve the prognosis as well. Recently, Neutrophil Lymphocyte Ratio (NLR) was shown to predict short-term outcome in patients with AIS. Aim: To determine whether NLR is useful in detecting length of stay, complications in the hospital and three months outcome of a patient admitted with AIS. Materials and Methods: This was a prospective cohort clinical study that was conducted in the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, a tertiary care hospital, Pillaiyarkuppam, Puducherry, India where 62 AIS patients were enrolled between December 2019-May 2021. All the routine blood investigations and NLR was calculated during admission and on day five, The patients were followed-up for the next three months. During the course of their stay in the hospital, patients were assessed daily using the National Institutes of Health Stroke Scale (NIHSS). Results: The mean age of the study population was 67.48±11.29 years, with 37 (59.68%) males and 25 (40.32%) females. The mean NLR on day 1 and day 5 were 5.42±2.85 and 3.51±1.97, respectively. There was a positive correlation between NLR and length of hospital stay (r=0.9661; p<0.0001). Patients having NLR >8, were observed to have complications such as aspiration pneumonia 3 (33%), seizures 2 (22%), and urinary tract infection 1 (11%). Conclusion: NLR is useful marker in detecting length of stay, complications in the hospital and three months outcome of a patient admitted with AIS.

Histomorphological Changes in Pancreas and Liver among Chronic AlcoholicsAn Autopsy Study

Danish S Shaikh, Shailesh Vartak, Urmi Vartak

Introduction: The clinical and pathological association between pancreatitis and alcohol abuse is well recognised, however the concurrence of prevalence of alcoholic related pancreatitis and liver disease is less well studied. Aim: To evaluate frequency of histomorphological changes in pancreas and liver among patients with history of alcohol abuse and observe the prevalence of co-existence between chronic pancreatitis and liver cirrhosis. Materials and Methods: This was observational cross-sectional study conducted in Department of Pathology at Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India, from July 2013 to July 2018. The study included 1917 autopsies and 107 cases with a documented history of chronic alcohol abuse. Haematoxylin and Eosin (H&E) staining was done on all sections and special stain like Masson’s trichrome was performed as per indication. Gross and microscopy were studied under variable defined parameters. Data was entered in Microsoft Excel sheets. Results: Histomorphologically, 12 cases (11.21%) were diagnosed as pancreatitis; 10 cases (9.34%) were of acute pancreatitis and 2 (1.86%) cases were of chronic pancreatitis. Total 21 cases were diagnosed as liver cirrhosis. The most dominant pattern of fibrosis seen in pancreatitis was perilobular and interlobular periductal fibrosis. The frequency of pancreatitis (14.28%) and pancreatic fibrosis (38.09%) was found to be more in cirrhotics. Chronic pancreatitis was commonly seen in cirrhotics than in non cirrhotics. Similarly, liver cirrhosis was more commonly observed in cases of chronic pancreatitis. Conclusion: The frequency of histomorphological changes seen in pancreas and liver was observed considerably among patients giving history of alcohol abuse. The prevalence of co-existence of chronic pancreatitis and liver cirrhosis was 50%.

Efficacy of Clonidine versus Dexmedetomidine as Adjuvants to 0.5% Ropivacaine in Nerve Stimulator Guided Supraclavicular Brachial Plexus Block- A Randomised Clinical Study

Reema Aggarwal, Roma Sharma, Pramod Mangwana

Introduction: Supraclavicular brachial plexus block is used for providing pain relief in upper limb surgeries and has many advantages over general anaesthesia. Alpha-2-adrenergic agonists are chosen with local anaesthetics for their sedative, analgesic and antihypertensive properties. Aim: To compare the efficacy of clonidine and dexmedetomidine when added to 0.5% ropivacaine in nerve stimulator guided supraclavicular block when performed for upper limb surgeries. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesia Mata Chanan Devi Hospital, New Delhi, India (tertiary care center), from September 2015 to September 2016. Total 90 patients were randomly allocated into three groups. Group A {Inj. ropivacaine 0.5% (29 mL)+normal saline 1 mL to make 30 mL}, group B {Inj. ropivacaine 0.5% (29 mL)+clonidine 1 μg kg-1 to make 30 mL) and group C {Inj. ropivacaine 0.5% (29 mL)+dexmedetomidine 1 μg kg-1 to make 30 mL}. Parameters observed included onset of sensory and motor block, total motor duration, postoperative analgesia as primary outcome; and intraoperative haemodynamic parameters and side effects as secondary outcome. Results: All the three groups were found to be similar with demographic profile. Patients in dexmedetomidine group showed faster onset and longer duration of sensory and motor blocks (p-value <0.01). The mean onset of sensory block in minutes was 12.03±2.20, 8.20±1.40, 6.80±1.35 in groups A, B and C, respectively (p-value <0.001). The mean onset of motor block in minutes was 18.47±2.78, 13.37±2.86 and 11.30±2.04 in group A, group B and C, respectively (p-value <0.001). The mean duration of analgesia in group A, B and C was 555.17±65.36, 710.00±73.58 and 902.67±116.65 minutes, respectively (p-value <0.001). The mean duration of motor block in group A, group B and group C were 330.00±51.78, 418.17±38.29 and 516.83±50.33 minutes, respectively (p<0.0001). The duration of postoperative analgesia and total motor duration were significantly prolonged in dexmedetomidine group than group A and B. Conclusion: It can be concluded that both clonidine and dexmedetomidine increases the total motor duration and postoperative analgesia when added to ropivacaine, but dexmedetomidine is a better choice when used in supraclavicular block, without any significant side-effects.

Household Survey on the Role of Social Norms in Defecation Practices in Aurangabad, Bihar, India

Imteyaz Ahmad

Introduction: In the recent decade, the study of social norms has become popular as it can explain and change harmful social behaviours, such as Open Defecation (OD). Open defecation is a threat to public health. It can cause diarrheal infections. Households formed the unit of study as they constitute an essential social institution to adopt and use latrines. Aim: To compare the social norms of the latrine user and OD practitioners of households with regard to disgust, purity and pollution, latrine and OD beliefs, and the preference for latrines that differ in cost. Materials and Methods: The cross-sectional study was conducted among 486 participants at Aurangabad district, Bihar, India, from July 2019 to January 2020. The district is one of the worst performers in latrine adoption in the country, according to the census of India 2011, Swachh Bharat Mission 2016, and NFHS-5 2019-21 data. A pretested questionnaire prepared by Research Institute for Compassionate Economics (RICE) was used as a tool for data collection. Data collected were entered into Statistical Package for Social Sciences (SPSS) version 25.0. Descriptive data analysis was performed and represented in tabular forms. The categories of households were made on the basis of the defecation practices (latrine user and OD practitioners). Results: The study found that social norms regarding purity and pollution were the same across the two groups. Both the groups (latrine user and OD practitioners) agreed that OD was disgusting and polluting behaviour. The two groups were coherent in the preference for latrines based on cost. Conclusion: The social norms are evolving in the study setting. Households have recognised the relevance of latrine use in contemporary times. The gap in practice is the only difference between the two groups of households.

Aerococcus viridans Bacteraemia in a COVID-19 Positive Patient: A Rare Case Report from Northern India

Mitra Kar, Akanksha Dubey, Romya Singh, Chinmoy Sahu, Sangram Singh Patel

Aerococcus viridans is a rare Gram positive microorganism identified largely as environmental or skin contaminants. With the advent of an increase in the immunosuppressed population due to diabetes, the use of steroids and the Coronavirus Disease 2019 (COVID-19) pandemic, this bacteria caused a variety of infections like bacteraemia, urinary tract infections, and endocarditis. The use of Matrix-Assisted Laser Desorption Ionisation Time-of-Flight Mass-Spectrometry (MALDI-TOF MS), a unique technique of microorganism identification, has placed Aerococci among human pathogens, capable of causing infection among immunocompromised patients. The present case was of a 48-year-old female presented with dry cough, high-grade fever associated with chills and rigors, and generalised body ache and weakness for the past one week. She was a known case of bronchial asthma. She tested positive for COVID-19 and over the course of hospital stay, her BACTEC blood culture performed due to high fever which flagged positive indicated her as a case of Aerococcus viridans bacteraemia. Despite of all the efforts she developed respiratory distress followed by an episode of asystole following which she could not be revived.

Metagenomics Comparison of Buruli and Non Buruli Ulcer Skin Wound

Anushka Singh, Ruchi Yadav

Introduction: Buruli Ulcer (BU) is caused due to mycobacteria, namely Mycobacterium ulcerans. Buruli ulcer is caused by the mycolactones that are secreted by the Mycobacterium ulcerans which results into the tissue necrosis. Metagenomics is a branch of genomics that deals with the study of uncultured microbial genomes present in natural samples like human body parts, environmental samples, food and dairy, disease conditions. Metagenomics branch has enabled us to explore and elucidate the importance of microbial genomes in healthy and infected samples. Aim: To evaluate metagenomic and microbial analysis of buruli and non buruli ulcer skin wound samples along with structural and functional analysis of MUL_3720 protein. Materials and Methods: The present analytical study was conducted from May 2021 to January 2022 at Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India. European Nucleotide Archive (ENA) database was used to retrieve metagenome data of BU and non BU skin lesions with the project id PRJEB14948. Galaxy server was used for the metagenomics analysis from quality control to identification and classification of microbial community in the samples. Different tools from the Galaxy like FASTQC, Trim Galore, KRAKEN2, convert kraken, Krona pie chart tools were used for metagenomic analysis and for taxonomic classification of microbes. Finally, Krona pie chart was generated that gives an elaborate understanding of the different microbes and their percentage in the BU. Complete annotation like protein structure prediction, domain analysis of MUL_3720 protein of Mycobacterium ulcerans was also done as potential drug target against BU. Statistical analysis was done using Krona pie chart generation and prediction. Results: Metagenomic analysis shows that there is difference in microbiome of BU and non BU samples. Differential microbes identified were Mycobacteriacae 1-2%, Sporomusa species 18-22% and Desulfovibrio halophillus 24-25%. Bacteria which were present in both the samples are Actiniidae, Desulfovibrio halophillus, Sphingomonas, and Mycobacteriacae. Structural and functional annotation of MUL_3720 protein of Mycobacterium ulcerans shows that MUL_3720 protein can be potential drug target for drug discovery. Conclusion: This study highlights the metagenome of Buruli Ulcer skin wound and can be used to identify potential drug targets for Buruli Ulcer. Metagenomic analysis of BU and non BU skin wound shows that there is difference in microbial community hence this information can be used in proper diagnostic and medication to combat Buruli Ulcer disease.

Effectiveness of Active Learning Methods as a Supplementary Measure to Routine Didactic Amphibian Experiments in Physiology

Dipali Krishnarao Chatur, Jayshri Rambhauji Ghate, Nishant Vitthalrao Bansod

Introduction: Animal experiments are banned but it is still a part of first year MBBS curriculum and is well assessed in the examination. Most of medical teachers use the traditional chalk and board method for teaching these experiments where students are passive learners and face difficulty in knowledge gain and recall. In this context, Active Learning Methods (ALM) can be a helpful student-centric approach. Aim: To assess the effect of ALM in addition to the traditional chalk and board method on the performance of students and also to assess their perception regarding ALM. Materials and Methods: This cross-sectional analytical study was conducted in Department of Physiology, Pravara Institute of Medical Sciences (DU), Rural Medical College, Loni (BK) Maharashtra state on first year medical students of batch 2013-14 from August 2013 to December 2013. Total of 64 students were included and divided into two batches A and B with 32 students each. Initially, for four Skeletal Muscle (SKM) sessions, ALM was introduced to batch B as revision in the second hour of practical class, following teaching by chalk and board method in the first hour, while batch A had routine tutorial. Thereafter, crossover of batches was done. Student’s performance was assessed by Multiple Choice Questionnaire (MCQ) tests at the end of each section of experiments and also the perception for ALM was recorded by Likert’s scale. Unpaired t-test was used to compare between groups. Results: In batch A, there were 14 females and 18 males with mean age 18.06±0.56 years and in batch B, 10 females and 22 males with mean age 18.06±0.24 years. Batch B students with implementation of ALM scored significantly higher (7.62±1.26) compared to batch A (6.41±1.99) without ALM, for SKM section, with p-value of 0.004. After crossover of batches, score of batch A with ALM (8.31±1.17) was significantly higher compared to batch B (5.84±1.56) without ALM with p-value of <0.001 for cardiac muscle experiments. Total of 96.87% of the students strongly agreed that ALM created a safe learning environment as well as they learned with fun. Conclusion: The ALM supplementing with the traditional chalk and board method in small groups should be incorporated to improve understanding of amphibian experimental physiology.

Proportion and Pattern of Chromosomal Abnormalities in Primary Amenorrhoea in Kerala, India- A Retrospective Study

Introduction: Primary amenorrhoea may be due to chromosomal abnormalities and identification of these abnormalities is important for counselling and management of these individuals. Aim: To identify the prevalence of chromosomal abnormalities in a cohort of primary amenorrhoea patients and to evaluate the various pattern of chromosomal abnormalities. Materials and Methods: This retrospective study was conducted at Government Medical College, Thiruvananthapuram, Kerala, India (serves as a referral centre for most of south Kerala and adjoining districts of Tamil Nadu), from January 2013 to December 2020. All phenotypically females (n=150), in the age group of 15-30 years, attending the Genetic clinic with a diagnosis of primary amenorrhoea were evaluated with karyotype from peripheral blood as per the standard protocol. An abstraction proforma was used to collect the data from the master case sheet available in the genetic laboratory. Cytogenetic abnormalities were described as per the standard International System for Human Cytogenomic Nomenclature (ISCN). For statistical analysis, proportion of cases with chromosome abnormality in the cohort was described as percentage. Results: Chromosomal analysis revealed 25.5% (38 out of 149) with abnormal karyotype. Among the abnormalities, the most common abnormality was 45, X (12, 31.6%) Turner’s syndrome. Other abnormalities included sex reversal female (46, XY) in 6 (15.8%), isochromosome Turner’s syndrome in 5 (13.1%), partial deletion in X chromosome in 3 (7.8%) and various combination of mosaic pattern in 9 (23.7%) cases. Hypergonadotropic hypogonadism was significantly associated with chromosomal abnormality. Conclusion: Cytogenetic abnormality is a cause for primary amenorrhoea in a significant proportion of cases and karyotype should be an integral part of evaluation in such cases. In resource limited settings, karyotype is having more clinical utility in cases with hypergonadotropic hypogonadism.

Effect of COVID-19 Pandemic on Career Choice among Medical Postgraduate Aspirants in Chennai: A Cross-sectional Study

Raghul Saravanan, NB Swetha, Stephen Thatiparthi, VM Anantha Eashwar

Introduction: Many frontline workers including doctors and nurses have succumbed to the Coronavirus Disease-19 (COVID-19) pandemic. In the COVID-19 pandemic, medical postgraduate (PG) aspirants had to deal with a variety of problems, including an increased workload, delay in National Eligibility cum Entrance Test (NEET) PG test and counselling. Aim: To assess the effect of COVID-19 pandemic and various factors influencing career choice among medical PG aspirants in Chennai. Materials and Methods: The present cross-sectional questionnaire-based study was conducted in the Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from August 2021 to September 2021 among 272 medical Postgraduate (PG) aspirants. A Google form questionnaire was sent to students who were in an internship in the past six months or had completed their internship in the past one year. There were 28 multiple choice questions comprising of socio-demographic details (with exception of age) and various factors related to career choice. Five questions were scored yes/no, and 15 questions were scored using 5-point Likert scale. Results: The mean age of the participants was 24.41±1.81 years and there were 129 males and 143 females in total among the study participants. Change in career choice was observed in 39.33% of the participants. The top two choices prior to and during the COVID-19 pandemic was General Surgery and General Medicine. Among the participants who had a change in career choice, the mean score of four questions in COVID-19 pandemic domain was higher when compared with participants who had no change. Conclusion: Most of the participants believed that the COVID-19 pandemic limited the learning opportunities for postgraduates and the violence against doctors had an impact on their decision to pursue a particular career. Due to the present pandemic, participants interest in community medicine and infectious diseases has increased.

Clinicopathological Profile of Prostate Cancer Patients: A 10 years Retrospective Study from a Tertiary Care Centre, North East India

Stephen Lalfakzuala Sailo, Laltan Puii Sailo, Veracious Corner Stonewann

Introduction: Prostate cancer is the second most common cancer and ranked fifth among the top causes of death among men. There is limited data on the clinical profile of prostate cancer in India, especially from North East India. Aim: To determine the clinicopathological profile of prostate cancer patients treated at a tertiary care centre in North East India. Materials and Methods: This retrospective hospital-based study was conducted in the Department of Urology, North-eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India from January 2006 to January 2016. It included 66 consecutive prostate cancer patients treated over 10 years. Relevant information regarding age at presentation, presenting symptoms, investigation, stage of the disease, histological report, treatment, follow-up and death were collected from hospital records and analysed using Microsoft excel software 2019. Continuous variables were presented as mean and standard deviation or range while categorical variables were expressed as frequencies and percentages. Results: The mean age of the patients was 70.7 years, the majority (81.8%) were in the age group of ≥61 years. All patients except one were symptomatic at presentation. The mean Prostate Specific Antigen (PSA) was high (264 ng/mL). Histologically, 65 tumours (98.5%) were adenocarcinoma and Gleason score between 8-10 was the most common. A total of 51 patients (77.3%) had stage IV prostate cancer. Total bilateral orchidectomy was the most common treatment, performed in 84.3% of stage IV patients. Nine patients died during the study. Conclusion: Prostate cancer was uncommon in the present study population but a majority of the patients presented with metastatic disease. Adenocarcinoma was the predominant histological type and total bilateral orchidectomy was the most common treatment, performed in the majority of the patients with stage IV disease.

Status of Mast Cells in Autopsy Specimens of Prostate: A Cross-sectional Study

Introduction: Mast cells are found in areas rich in connective tissues and beneath epithelial surfaces. Mast cells have been extensively studied for their orchestration of allergic reactions and autoimmunity. Mast cells infiltrate various prostatic lesions in varying concentrations. Autopsy specimens had not been investigated extensively in the previous literature. Aim: To find out a quantitative estimation of mast cells and the association of the number of mast cells in various prostatic lesions that included both inflammatory and neoplastic lesions in autopsy cases. Materials and Methods: A cross-sectional, analytical study was carried out in the Department of Pathology, R.G. Kar Medical College and Hospital, Kolkata, India from April 2017 to March 2018. Sixty autopsy specimens of the prostate were dissected from the deceased males above 30 years of age. Four to six paraffin embedded sections from different lobes and peri-urethral areas were taken. Haematoxylin and Eosin (H&E) stained sections for histopathological diagnosis and toluidine-blue stain after water mounting to demonstrate mast cells by its metachromasia were performed. Mast cell densities were estimated by a light microscope under high power magnification (400X) on an average of 100 fields. Gross and microscopic findings were recorded. Data analysis correlation was done using Statistical Package for the Social Sciences (SPSS) software version 18.0. Mean and standard deviations were determined for different prostatic lesions. Group means were compared using the student’s t-test. For statistical significance p-value of less than 0.05 was considered. Results: A total of 60 autopsy specimens of the prostate were studied comprising 8 (13.5%) specimens of normal prostate, which acted as a control, 6 (10%) specimens of prostatitis,27 (45%) specimens of Benign Hypertrophy of Prostate (BHP), 12 (20%) specimens of BHP with Prostatic Intraepithelial Neoplasia (PIN), 3 (5%) specimens of prostatitis with focal PIN and 4 (6.5%) specimens of prostatic adenocarcinoma. Mast Cell Density (MCD) was higher in prostatitis {6-8 per High Power Fields (HPF)}, compared to normal (1-3/HPF) and BHP (3-5/HPF), lowest in adenocarcinoma (1-2/HPF) and intermediate in PIN (2-4/HPF). Conclusion: Mast cell density was the lowest in prostatic adenocarcinoma and significantly higher in prostatitis, probably due to a lack of antitumour immunity in higher grades, whereas it was significantly higher in chronic non specific prostatitis possibly because of inflammatory response.

Utility of Abraham Lens in YAG Laser Capsulotomy: A Prospective Study

Introduction: Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy remains the safest treatment for Posterior Capsular Opacification (PCO). The use of capsulotomy lens has some benefits to offer especially when learning the procedure and in uncooperative patients. With changing curriculum in medical teaching which focusses more on practical aspects it will serve as an asset for the trainees. Even if not used routinely, its importance cannot be altogether undermined. Aim: To assess the utility of Abraham capsulotomy lens in YAG laser capsulotomy procedure and compare it with capsulotomy performed without lens. Materials and Methods: This was a prospective, longitudinal study conducted in the Department of Ophthalmology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from June 2020 to February 2021. A total of 79 patients who developed PCO after more than six months of cataract surgery and had decrease in visual acuity on Snellen’s chart by two or more lines from baseline were included. Visual acuity, Intraocular Pressure (IOP) measurement, fundoscopy, Ocular Coherence Tomography (OCT) was done for Central Macular Thickness (CMT) in all patients at presentation, one and three months following YAG capsulotomy. Nd-YAG laser capsulotomy was then done with and without the use of Abraham capsulotomy lens in two groups. Parameters such as visual acuity change, IOP, CMT, energy used in capsulotomy, type of PCO were then compared between the two groups. Independent t-test, repeated Analysis of Variance (ANOVA) and Spearman’s correlation tests were used to analyse the data. Results: Of the 79 patients, 40 underwent capsulotomy without the Abraham lens (Group 1) and 39 with Abraham lens (Group 2). Females were more than males in both the groups. The improvement in visual acuity was statistically significant in both groups. There was statistically significant difference in CMT in both groups at each visit. The average energy used for dealing with fibrous type of calcification was significantly more than that used in elsching pearls (13.96 mj). Complications like Intraocular Lens (IOL) pitting, raised IOP, cystoid macular oedema, uveitis and retinal detachment were encountered which were managed by appropriate medical and surgical therapy. Conclusion: Use of capsulotomy lens decreases the amount of energy needed for capsulotomy and helps to stabilise the eye and to focus better especially for ophthalmologists in their initial training days.

Evaluation of Histopathological Findings in Lymph Node Lesions

Introduction: Enlargement of lymph nodes is one of the most common presentations in inflammatory and neoplastic disorders. Persistent enlargement of lymph nodes requires detailed investigations to reveal an underlying pathology. Clinical features and radiology images may not be sufficient for diagnosing lymph node lesions. Hence, histopathology has become a mandatory tool to arrive at a definitive diagnosis. Aim: To evaluate histopathological patterns of various lymph node lesions. Materials and Methods: The present prospective study was undertaken in the Department of Pathology, Maharashtra Institute of Medical Sciences and Research, Latur, Maharashtra, India, from October 2016 to September 2018. Information regarding clinical history, and examination was noted from case sheet of patients. Total 104 lymph nodes were grossly examined and processed in routine paraffin technique and then stained with Haematoxylin and Eosin (H&E). Meticulous histopathological examination was done in each case to arrive at correct histopathological diagnosis. Special stains and immunohistochemistry were performed wherever mandatory or indicated. Qualitative data was presented as frequency and percentages. Results: Total 104 patients were studied, majority were males {n=56 (53.8%)} and mean age was 46 years. Reactive lymphadenitis was the most common cause of lymphadenopathy forming 60 (57%) cases. The metastatic lesions were in 23 (21.1%) cases. Other lesions encountered were tubercular lymphadenitis in 15 (14.3%) cases, diffuse large B-cell lymphoma in 3 (2.9%) cases, 58 (55.7%) patients had cervical lymphadenopathy and 35 (33.6%) patients had axillary lymphadenopathy. Conclusion: Reactive lymphadenitis was the most common cause of lymphadenopathy in present study. Causes of lymphadenopathy can be suspected on clinical grounds, but histopathological examination is gold standard for early diagnostic and prognostic purpose. Special stains and immunohistochemistry should be done, wherever mandatory, or when indicated.

Assessment and Evaluation of Diabetic Foot using Biothesiometry and Artificial Neural Networks

R Sundareswaran, Mahesh Veezhinathan, M Shanmugapriya, R Dhanush Babu

Introduction: Diabetes is a common disorder that is prevalent in the general population. As it advances, it causes a multitude of consequences, some of which are fatal. Diabetic Neuropathy (DN) is one such illness that causes nerve damage, and it is quickly recognised and diagnosed using a technique known as biothesiometry. Aim: To create an assessment tool based on an Artificial Neural Network (ANN) that evaluates diabetic foot based on Vibration Perception Threshold (VPT) values. Materials and Methods: This experimental and predictive study was conducted at Sri Sivasubramaniya Nadar College of Engineering, Chennai, Tamil Nadu, India, from January 2022 to March 2022 and was done using VPT values for 696 controlled and diabetic groups selected by purposive sampling. The VPT was measured by a biothesiometre. A metal probe was placed under the foot of the person and the voltage was increased gradually from zero and the transition from no vibration to the point of vibration is marked as VPT. Average of three measurements were taken to calculate the VPT value of the given patient. This involves the VPT value which helps in the assessment of severity of the condition. The recorded data was fed as an input to the ANN model which predicted the average VPT value of the left and right foot. Furthermore, the ANN model was assessed my means of statistical measures and parameters. Results: The results of the study, confirmed the correlation between the values of VPT acquired at different points of the foot and the coefficient for the left and right foot was found to be 0.99549 and 1.0000 respectively. Furthermore, the efficiency of the proposed ANN model was assessed using statistical measures like Mean Square Error (MSE), Mean Absolute Error (MAE), Square Sum Error (SSE) and Coefficient of determination (R2). The predicted values were very close to the experimental VPT results, and the correlation coefficient R are 0.99549 and 0.99975 for the left and right feet, respectively, which shows the best settlement. Conclusion: The study concluded that VPT acquired from the foot of diabetic patients is useful in categorising the level of severity of DN. Furthermore, the results of ANN model proved that, there exists a strong correlation between the average VPT values of left and right foot and those that are acquired from different points of the foot such as big toe, first metatarsal, third metatarsal, fifth metatarsal, In step and heel, which concluded the study to be effective in the assessment and diagnosis of DN.

Quantitative Definition of Fever Needs a Change: A Longitudinal Study from the Hospital Workers and their Family Members

Introduction: The age-old definition of fever was derived using cross-sectional population surveying utilising old techniques without considering symptomatology. However, the diagnosis of fever must be made only in the presence of associated symptoms that can distinguish it, from the mere asymptomatic physiologic rise of temperature. Aim: Analysis of symptoms to redefine the cut-off of fever based on symptomatology. Materials and Methods: A longitudinal study on the healthy population of Uttarakhand, India was conducted and the population was followed-up from July 2019 to September 2020. Healthy staff and students of All India Institute of Medical Sciences (AIIMS), and their family members between 4-100 years of age were chosen. Participants were advised to self-monitor oral temperature with a standard digital thermometer in either left or right sublingual pocket and record it in the thermometry diary. The study was considered complete, if the participant had all the three phases of the study (i.e., prefebrile, febrile, and postfebrile phases) or completed the duration of the study. The febrile phase was defined when the participants subjectively ‘felt feverish’. Associated symptoms like fatigue, warmth, headache, and feeling malaise were also recorded. Results: Mean age of the participants was 24.24±5.92 years, and 52.1% (75) were males. Per protocol analysis was done for febrile participants (n=144, temperature recordings=6544). The mean febrile phase temperature was 100.25±1.44°F. A temperature of 99.1°F had maximum diagnostic accuracy for feeling feverish (98.2%), along with 1 (98.3%) or 2 (99%) associated symptoms. Summer and spring months showed higher temperatures (100.38±1.44 vs 99.80±1.49, p-value <0.001), whereas no significant temperature difference could be noted amongst the genders. Conclusion: Based on the findings of the present study, the revised temperature cut-off to define fever should be 99.1°F along with one or two associated symptoms.

Prevalence of Major Depression and Assessment of Burden among Caregiver’s of Intellectually Differently Abled Persons: A Cross-sectional Study

Introduction: Intellectual Disability has major negative impact on the lives of the person and their families as they experience psychological distress and burden while providing care to them. Families while engaging in the caregiving process are said to experience psychiatric morbidities such as depression and anxiety more commonly. Identifying those helps in the holistic management of intellectually differently abled persons together with caregiver’s. Aim: To assess major depression and assessment of burden among caregiver’s of intellectually differently abled persons and their association with each other. Materials and Methods: This cross-sectional, observational study among 220 caregiver’s were conducted at Psychiatry Department of Pandit Deendayal Upadhyay Government Medical Hospital, Rajkot district, Gujarat, India, from June 2018 to May 2019. Socio-demographic details of caregiver’s and intellectually differently abled persons were obtained after taking into consideration inclusion and exclusion criteria. Zarit scale of caregiver burden was used for burden assessment and its severity. Depression was screened by Patient Health Questionnaire. Those screened positive were evaluated in detail for major depression and diagnosed based on Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria. Severity was assessed by Hamilton Depression Rating Scale (HAM-D). Data was analysed to find out statistical significance with the help of t-test, Chi-square test, Fisher’s-exact test and non parametric tests (Wilcoxon-Mann-Whitney U test and Kruskal-Wallis test). Probability value less than 0.05 was considered statistically significant. Results: Out of 220 caregiver’s, prevalence of major depressive disorder in caregiver’s as per DSM-5 was 56 (25.45%). A 51 (23.18%) caregiver’s had severe burden, 100 (45.45%) moderate to severe burden, 61 (27.72%) mild to moderate burden, 8 (3.63%) caregiver’s had little or no burden. Association between Intellectually differently abled persons with psychiatric and non psychiatric co-morbidities and caregiver’s depression were statistically significant (p-value=0.030). Association between intellectual disability severity (p-value=0.031), affected sibling of intellectually differently abled person (p-value <0.001) and caregiver’s burden was statistically significant. Conclusion: The study emphasises that even though there is vast body of literature addressing psychological distress and suffering of caregiver’s of intellectually differently abled persons, it still remains a prominent challenge to manage it effectively. Thereby, treatment providers should shift their focus on the mental health of caregiver’s along with that of persons with intellectual disability as having healthy caregiver’s cannot only maximise the chances of intellectual disability persons’ successful re-establishment in society but can themselves lead a psychologically healthy life.

Effect of Brisk Walking and Moderate Resistive Exercises on Physical Fitness Level in Middle-aged Women: A Randomised Clinical Trial

Reema Joshi, Parita Mishra, Manisha Rathi

Introduction: Insufficient physical activity is considered as one of the leading risk factors for global mortality and morbidity. American College of Sports Medicine recommended an engagement of minimum 150 minutes per week of moderate physical activity. Physical fitness gradually declines with aging. Low muscle strength and decline in the ability to produce force quickly (power) are associated with low walking speed and further, with mobility limitations. In India, women are more physically inactive than men. Women shows more rapid decline in physical activity than men in middle age. This sex difference may be due to the hormonal changes and barriers such as lack of time, lack of motivation, lack of energy, self awareness and health problems. Aim: To evaluate the effect of brisk walking and moderate resistive exercises on body weight, body fat percentage (Skinfold Caliper), six minute walk distance covered and Physical Fitness Index (PFI) in middle-aged women. Materials and Methods: A randomised clinical study was conducted in Outpatient Department at Dr. D.Y. Patil College of Physiotherapy, India, from November 2021 to January 2022. Total 40 subjects, between age group of 40-60 years with low physical activity, assessed by International Physical Activity Questionnaire, were included in the study. Subjects were divided into two groups with simple random sampling using lottery method. Group A (experimental group; n=20) brisk walking with moderate resistive exercises were given. Group B (conventional group; n=20) includes only brisk walking. The protocol was given for four days a week for four weeks. The outcome measures taken were body weight, body fat percentage, physical fitness index and six minute walk distance. The statistical analysis was done using Medcalc software 18.2.1. Results: The mean age was 45.55±5.73 for group A and 43.30±4.62 for group B. The mean difference of Body Weight (BW), Body Fat percentage (BF%), 6 Minute Walk Distance (6MWD) and Physical Fitness Index (PFI) was 1.56, 1.98, -18.82, and -182.34, respectively for group A and 0.23, 1.22, -8.23, -126.16 for group B. On intergroup comparison, the mean difference of BW, BF%, 6MWD and PFI was 1.33, 0.76, -10.59 and -56.18. This shows significant difference between the groups. Conclusion: Brisk walking and moderate resistive exercise can be used as effective treatment in weight management to improve physical fitness level in middle-aged women.

Liposarcoma of Spermatic CordEncountered While Operating the Inguinoscrotal Hernia

Liposarcomas in the spermatic cord are rare and difficult to diagnose preoperatively, since they present as inguinal or scrotal masses which are frequently evaluated only by ultrasonogram, and other imaging modalities. This case report is about a 48-year-old male, who presented with a painless swelling in the right inguinal region extending to the scrotum, since two years. Upon inguinal exploration, a single irregular fatty mass, arising from the cord, which was found in addition to a small inguinal hernia. En-bloc resection of the mass with inguinal orchidectomy was done and histopathology proved it to be a well-differentiated liposarcoma. A rare malignancy with a deceptive presentation must be taken into account while evaluating scrotal masses, particularly in patients with suspected recurrent hernias of the inguinal region.

Ideal Timing of Prostate Operation in Chronic Urinary Retention due to Benign Prostatic Hyperplasia by Serial Urodynamic Study: A Prospective Longitudinal Study

Kasim Mainoddin Atar, Krishnendu Maiti, Dilip Kumar Pal

Introduction: Chronic Urinary Retention (CUR) due to prostatomegaly causes impaired detrusor function, secondary to obstruction-related changes in the bladder wall. Urodynamic study is the “gold standard” to determine detrusor function in CUR patients. Traditional management of all CUR patients due to Benign Prostatic Hyperplasia (BPH) is temporary catheter drainage of the urinary bladder, so that detrusor impairment may be corrected. There is no consensus regarding the ideal timing of prostate operation in Bladder Outlet Obstruction (BOO) patients presenting with CUR due to BPH. Aim: To assess the ideal timing of Transurethral Resection of the Prostate (TURP) in chronic urinary retention patients due to BPH. Materials and Methods: This was a prospective, longitudinal study of 57 eligible patients with non neurogenic lower urinary tract symptoms, who presented with chronic urinary retention due to benign prostatic hyperplasia and attended the Department of Urology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital (IPGME&RSSKM), Kolkata, West Bengal, India from August 2019 to July 2022. Four serial Urodynamic Studies (UDS) were performed after initial catheterisation in sterile urine culture on the day 5, day 14, day 30, and at 6th week. As per UDS findings, patients were classified into Preserved Detrusor function group (n=18),at peak flow rate (Qmax) {Detrusor Pressure (Pdet) at peak flow rate} >30 cm H₂O and Impaired Detrusor function group (n=39), Pdet at Qmax ≤30 cm H₂O. Descriptive statistics were performed as means, standard deviations and ranges using Microsoft Excel software. For categorical variables, percentages were used. The Student’s paired-test and Chi-square test were used for statistical analysis. The p-value <0.05 was considered statistically significant. Results: In the present study, mean age of preserved detrusor function group was 56.17 years and impaired detrusor function group was 67.08 years. In preserved detrusor function group (n=18), 83.3% patients had upper urinary tract changes and in impaired detrusor function group (n=39) only 15.4% patients had upper tract changes (p-value <0.05). On the urodynamic study done at 6^th week after initial catheterisation, in impaired detrusor function group, n=36 (92.30%) patients had Pdet at Qmax >30 cm H₂O and only n=3 (7.7%) patients had Pdet at Qmax ≤30 cm H₂O(p-value <0.001). Conclusion: Urodynamic study is the gold standard to determine detrusor function in chronic urinary retention patients. It is ideal to wait, till six weeks or beyond, for TURP in chronic urinary retention patients due to BPH after initial catheterisation.

Supraclavicular Brachial Plexus Block by Nerve Stimulator or Ultrasound: An Observational Cross-sectional Study

Sarath Surendran, Dhanya Rajeev, Raju Rajan

Introduction: Supraclavicular approach to the brachial plexus block is considered to be one of the most effective anaesthetic procedures for upper limb surgeries. Peripheral Nerve Stimulation (PNS) has traditionally been used as the gold standard technique for nerve location. More recently, Ultrasound (USG)-guided single injection supraclavicular block is used which allows direct visualisation of nerve, but its use is limited by cost constraints and the level of expertise needed. Aim: To compare the efficacy of USG and PNS in supraclavicular brachial plexus block, especially the onset of motor block in orthopaedic forearm surgeries. Materials and Methods: An observational cross-sectional analytical study was conducted from January 2019 to January 2020 on 60 patients attending emergency operation theatre for orthopaedic forearm surgeries. They were allocated alternatively to one of the two groups (30 in each group) based on the technique of nerve block, either using USG or PNS. Block execution time (puncture time), the number of needle passes, time of onset of sensory block, time of onset of motor block, quality of sensory block, quality of motor block, the intraoperative requirement of opioids, complications, success, and failure were the exposure variables. The qualitative data were compared using Chi-square test and for comparison of the continuous variable, the student’s t-test and Fisher’s-Exact test were used. The p-value <0.05 was considered statistically significant. Results: Patients in both groups were comparable concerning demographic parameters like age, sex, and American Society of Anaesthesiologists (ASA) physical status. The mean time of onset of a motor block using the USG-guided technique was 8.6±1.0 minutes, and using a PNS was 11.1±1.0 minutes (p-value <0.01). There was a 93.3% success rate in the USG-guided technique, compared to an 83.3% success rate in the PNS method (p-value of 0.222). No complications were seen in the USG-guided group. In the PNS-guided group, four complications were noted among 30 patients, the most common being vascular puncture (two cases). Conclusion: USG-guided supraclavicular block was superior to PNS technique in terms of rapid onset motor and sensory block, block quality, improved success rate, and fewer complications.

Knowledge, Attitude and Practice Regarding Dental Stem Cells and Tooth Banking among Dental Professionals: A Questionnaire-based Cross-sectional Study

Arohi V Desai, Pratik B Kariya, Barkha Bansal

Introduction: Stem cell therapy is new revolutionary technique which can repair many defects of human body. There are two sources of stem cells, one is embryonic and postnatal. Postnatal sites are the ones from which procuring stem cells is easiest. Dental stem cells from exfoliated deciduous teeth are also obtained from these sources. Dental health professionals must have understanding about dental stem cells for its application. Hence, there is need to evaluate knowledge, attitude and practice of dental professionals regarding dental stem cells. Aim: To evaluate Knowledge, Attitude and Practice (KAP) regarding dental stem cells and tooth banking among dental professionals of Gujarat. Materials and Methods: The study was a questionnaire based cross-sectional study conducted in the Department of Paediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India from December 2020 to March 2021. Total of dental health professionals participated including undergraduate (interns) and postgraduate students, dental practitioners and faculty members of dental colleges. Participants received the questionnaire in the form of a google form through email and whatsApp. The data was analysed using percentages of total and Chi-square test for statistical analysis. Results: Out of 711 participants, 410 were students, 44 faculties, 207 practitioners and 50 faculties and practitioner both. Among the faculty, knowledge on types of dental stem cells was significantly associated with the years of experience (p-value <0.001). Among the students, first year postgraduate students and interns had significantly less knowledge regarding various applications of dental stem cells (p-value <0.001). Among them, 52.9% participants were aware of stem cell banks in India and 55.5% were aware of names of stem cell banks. Participants suggested that seminars, journals, academic curriculum, conferences or Continued Dental Education (CDE), and advertisement and public notice all should be used to increase awareness of dental stem cells among dental professionals. Conclusion: There was adequate awareness among dental health professionals regarding dental stem cells and their applications but were unaware about tooth banking and its procedure. The study also found that there was lack of knowledge regarding steps of preservation of dental stem cells and their ethical concerns. Therefore, the topic of dental stem cells should be included in dental curriculum.

Assessment of Rate of Laryngeal Preservation in Patients undergoing Radiotherapy with Concurrent Chemotherapy for Advanced Squamous Cell Carcinoma of Larynx: A Prospective Interventional Study

Devika Saseendran, Shehna Abdul Khader, Ajithkumar Vilasini Raghavan

Introduction: Advanced laryngeal cancer carries significant morbidity with deterioration sinquality of life. The Radiation Therapy Oncology Group (RTOG) 91-11 study found that in the management of advanced laryngeal cancers, Concurrent Chemotherapy and Radiation (CCRT) produced significant organ preservation compared with other treatment modalities without compromising locoregional control and survival outcomes. These studies lead to the employment of CCRT for advanced laryngeal cancer with the aim of organ preservation. Aim: To assess the rate of laryngeal preservation in patients undergoing CCRT in a tertiary care centre. Materials and Methods: The present prospective, interventional study was conducted in the Department of Radiotherapy, Government Medical College, Thrissur, Kerala, India comprising the newly diagnosed patients with locally advanced laryngeal cancers from July 2019 to August 2020. Conventional radiotherapy with a dose of 66 Gray in 33 fractions over 6.5 weeks was given concurrently with injection cisplatin 100 mg/m² intravenously every three weeks and periodically followed-up for one year. Results: Out of 50 study participants, 40% of the target population were between 51-60 years of age and 90% of the cases were males. The rates of laryngeal preservation were found to be 88% according to this study. The study proved that laryngeal preservation was significantly lower in cases with age 61-70 years, with those with Eastern Cooperative Oncology Group (ECOG) performance score of 2, nodal stage N3 and stage IV disease and in those with fewer chemo cycles. There was no relationship between laryngeal preservation sex, tumour stage, composite stage. Conclusion: These results show that the rates of laryngeal preservation were found to be higher in advanced laryngeal cancers undergoing radiotherapy with concurrent chemotherapy. Locoregional control was higher without causing severe toxicities. This study shows that higher rates of laryngeal preservation could be achieved with good locoregional control thereby leading to organ preservation and avoidance of severe morbid surgical procedures.

Aetiology and Clinical Profile of Infectious Causes of Febrile Jaundice at a Tertiary Care Hospital in Eastern Odisha- An Observational Prospective Study

Introduction: Fever with jaundice is one of the most common presentations seen in both outdoor and indoor patients. This manifestation is seen in many individuals infected with hepatotropic viruses (A to E), bacteria, protozoa, fungi, and non hepatotropic viruses. In viral hepatitis due to hepatotropic viruses the patient presents with a short febrile prodrome followed by jaundice, and is often self-limiting without any treatment whereas in patients other than viral hepatitis the patients present with ongoing fever and jaundice and need specific treatment. Aim: To evaluate clinical profile of patients presenting with febrile jaundice and finding the infections agent responsible for fever with jaundice baring viral hepatitis (A to E). Materials and Methods: This observational prospective study included 107 patients admitted in the Kalinga Institute of Medical Sciences, from September 2019 to August 2021, who were found to have febrile jaundice after initial evaluation, based on liver function tests and hepatotropic viral markers {hepatitis B surface antigen (HBsAg), Immunoglobulin M antibody against hepatitis C virus (Anti-HCV IgM), Immunoglobulin M antibody against hepatitis A virus (Anti-HAV IgM), Immunoglobulin M antibody against hepatitis E virus (Anti-HEV IgM)}. Routine laboratory parameters, chest radiograph, and electrocardiogram were performed in all cases. Appropriate investigations like specific serological, radiological investigations and cultures were performed to identify the causal pathogen. Statistical analysis of categorical variables was conducted by Statistical Package for Social Sciences (SPSS) 26.0 version. Results: Out of 107 patients, 25 (23.3%) patients were found to have scrub typhus. Dengue was found in 23 (21.4%) patients (three had dengue associated with scrub typhus). Coronavirus Disease 2019 (COVID-19) was found in 11 patients (10.2%) of study population. Malaria, tuberculosis, S. typhi, K. pneumonia, E. coli, B. cepacia, E. feacalis were isolated in other individuals. Among these, 41.12% patients had associated transaminitis, whereas, 16 had elevated aspartate transaminase/alanine transaminase (>3 times of ULN). Overall, 18.4% patients had hepatomegaly, and 6.5% were found to have splenomegaly. Eight patients had septic shock, and associated Multiple Organ Dysfunction Syndrome (MODS) was seen in six patients. No definitive aetiology was found in 25 patients. Conclusion: The study identified a variety of organisms in sera from the patients presenting with febrile jaundice. The most common clinical feature was anorexia followed by headache. The common aetiology for febrile jaundice was viral infections {barring viral hepatitis (A to E)} followed by bacterial Infections.

Quality Improvement Initiative for Neonates: Use of In-line Endotoxin Filters in Central Venous Catheters: A Prospective Interventional Study

Nikhita Mirle, Aswathy Rajan, Ashvij Shriyan, Santosh Soans

Introduction: Sick newborns often require central venous catheters for prolonged periods of time when admitted to the Neonatal Intensive Care Unit (NICU). These central lines, hence, raise the problems of sepsis, thrombus and other potential line-related complications. In-line endotoxin filters are found to be an effective intervention to remove potential sepsis causing bacteria, endotoxins and other particulates there by reducing the mortality and morbidity of these newborns. Aim: To determine the effect of in-line endotoxin filters on mortality and occurrence of venous thrombosis, sepsis and Necrotising Enterocolitis (NEC) in sick newborns with central venous catheters. Materials and Methods: This single-centre, prospective interventional study was conducted over a period of 12 months, where, all sick babies admitted to the NICU for more than 24 hours with a central venous catheter were eligible for the study. They were grouped into those which received the in-line filters (study group) and those with standard care without filters (control group). The primary outcome variables studied were sepsis, thrombus formation, NEC, ventilator days and death. Secondary outcomes were days of hospital stay, line days, and length of ICU stay. Results: Out of 137 eligible neonates, 127 were finally included in the study; 66 were in the control group while 61 in the study group, seven were excluded and a total of 54 in the study group were included. A total of 20 cases developed NEC in the control group while only six in the study group (p-value=0.03). Thrombus formation was lesser in the study group 3 (5.6%) compared to the control group 14 (21.2%). Thrombus formation was also found to be less likely to occur when an in-line filter is attached as compared to not using one (OR 0.232; 95% CI 0.628-0.858; p-value=0.02). The odds of occurrence of NEC (OR=0.307; 95% CI=0.113-0.834) also were found to be significantly less in the study group. Conclusion: A simple intervention like addition of in-line endotoxin filters to the central venous catheters in sick newborns in NICU decreases the risk of thrombosis, risk of NEC and overall complications, in critically-ill NICU patients.

Comparison of Laser-assisted and Conventional Flap Surgery with Hydroxyapatite Crystals in the Treatment of Intrabony Defects under Magnification- A Randomised Clinical Trial

Introduction: Achieving regeneration of the lost periodontal structures after surgical approach plays a major role. This healing can be interrupted due to the presence of invasive bacteria which is present in the periodontal tissues. Aim: To compare laser-assisted and conventional flap surgery using microsurgical instruments and under surgical operating microscope with hydroxyapatite graft in the treatment of intrabony defects. Materials and Methods: This prospective randomised split-mouth clinical study was conducted in Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from June 2020 to December 2021. A total of 24 bilateral intrabony defects were selected for the study. Control sites (n=12) received the graft after conventional open flap debridement. In the test group (n=12), graft placement was done followed by laser irradiation with diode laser (980 nm, power: 3.0 W; frequency 2.5 KHz) for 30 seconds. The entire flap surgery procedure was performed under Surgical Operating Microscope (SOM). Clinical parameters such as plaque index, gingival index, probing depth, relative attachment level, were assessed at 3 months and 6 months. Healing index was assessed after 7 days of surgery. Radiographic parameters were assessed at baseline and 6 months using Cone Beam Computed Tomography (CBCT). Descriptive statistics, Independent samples t-test, repeated measures analysis of variance and paired t-tests were used in data analysis. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Intragroup comparison showed statistical significance in all clinical and radiographical parameters (p-value <0.001). Intergroup comparison between the test and control group did not show any statistical significance in terms of plaque index, gingival index, relative clinical attachment level, probing depth (p-value ≥0.05). Intragroup comparison of the depth of defect was statistically significant in both test (p-value=0.011) and control groups (p-values=0.002). Intergroup comparison did not show any statistical significance in linear bone fill (p-value=0.1). Intergroup comparison did not show any statistical significance in defect angle (p-value=0.773). No statistical significance was obtained in percentage fill (p-value=0.074). Intergroup comparison did not show any statistical significance in the clinical and radiographical parameters. Conclusion: The additional laser irradiation at the test site did not exhibit any significant benefits in the bone regeneration. All the outcomes were similar in test and control group.

Effect of Maternal Age and Anaemia on Auditory Brainstem Response of Preterm Infants in a Tertiary Care Hospital of Kolkata, West Bengal: A Cross-sectional Study

Sonali Majumdar (Das), Hiya Bhattacharya, Malay Kumar Dasgupta

Introduction: Adolescent pregnancy and maternal anaemia have a detrimental effect on infant growth and development. They are associated with greater risk of premature births and Low Birth Weight (LBW). Wave Interpeak Latencies (IPLs) of infant Auditory Brainstem Response (ABR) indicate the degree of maturation of brainstem auditory pathways among preterm infants. Previous studies indicated that preterm infants show prolonged wave IPLs. Whether maternal parameters like age and haemoglobin level contributes to the changes in infant ABR is debated. Aim: To study the effect of maternal age and anaemic status on Brainstem Evoked Response Audiometry (BERA) changes among preterm infants. Materials and Methods: An observational, descriptive study of cross-sectional design was undertaken in the Neurophysiology laboratory of Department of Physiology, RG Kar Medical College and Hospital, Kolkata from December 2019 to December 2022. Total of 119 mother-preterm infant dyads were included. Click BERA was performed on the babies aged between three months to one year. Absolute and IPLs of wave I, III and V were obtained. Mothers were assigned anaemic status {Haemoglobin (Hb) level <9 gm/dL} based on the information in their antenatal card. Student’s t-test, Fischers-exact test, one way ANOVA test were used for data analysis. A p-value less than 0.05 was considered significant. Results: Out of 76 adolescent mothers (age between 10-<18 years), 43 (56.6%) were anaemic. Out of 43 adult mothers (with age ≥18 years), 33 (76.7%) were anaemic. Mothers were divided into four groups, namely adolescent anaemic (n=43) and adolescent non anaemic (n=33), adult anaemic (n=33) and adult non anaemic (n=10). Distribution of data with respect to education years, social class and occupation among four mothers’ group was comparable (p-value >0.05). Preterm infants born to both anaemic adult (Hedges g=2.51) and anaemic adolescent mothers [Hedges g=1.06] showed dyssynchronous shortening of wave latencies compared to non anaemic counterparts (p-value <0.05). Magnitude of difference with respect to infant ABR for non anaemic adolescent mothers vs non anaemic adult counterparts was large (Hedges g=1.05) with p-value <0.05. While maternal anaemia showed either shortening or prolongation of IPLs, adolescent maternal age was related with prolongation of the wave I-V. Effect size of maternal anaemia on infant ABR was more than for adolescent maternal age. Conclusion: Maternal anaemia may exaggerate abnormal maturation of the brain stem pathways in preterm infants irrespective of maternal age.

Knowledge and Attitude Towards Radiation Hazards and Protection among Dental Students in Latur, Maharashtra, India: A Cross-sectional Study

Priyanka Baswaraj Lasune, Laboni Ghorai, Sukanya Subhash Vyavhare

Introduction: In our day-to-day clinical practice, X-radiation plays a vital role in oral diagnosis and treatment planning in dentistry. However, radiations are harmful and cause biological damage to the human body. Hence, to have the benefits outweigh the risks, it is essential to inculcate awareness regarding radiation protection measures among the dental students. Aim: To evaluate the knowledge and attitude towards radiation hazards and protection among the dental students. Materials and Methods: A cross-sectional study was conducted on 200 randomly selected undergraduate including final year and third year dental students and interns, who had completed their 30 days rotatory posting in the Department of Oral Medicine and Radiology in Maharashtra Institute of Dental Science and Research, Latur, Maharashtra, India from the month February to July 2021. A prevalidated close ended questionnaire consisting of 25 questions was distributed among the students and data were collected and analysed using the Chi-square test. The p-value was set significant at 0.05. Results: Out of 200 student participants, 91 (45.5%) were interns, 71 (35.5%) were final year students and 38 (19%) were third year students. The response of these participants was found to be non uniform and the knowledge and attitude towards radiation hazards and protection was highest in dental interns followed by final and third year students. Conclusion: It is the need of hour to create awareness among dental students about radiation protection and safety in day-to-day clinical practice and update their knowledge by conducting relevant workshops.

Effect of Benincasa hispida Fruit Dry Powder on Behaviour Changes and Antioxidants Levels in Adult Wistar Rats: An Experimental Study

Umamaheswari Anbarasu, K Jayagowri, K Bhuvaneswari

Introduction: Chronic stress has been implicated to be the important aetiological factor involved in several pathologies. Antioxidants play major roles in the maintenance of good health in the cellular level. Various studies have shown the anxiolytic, muscle relaxant, antidepressant, and antioxidant effects of Benincasa hispida (B.hispida) (white pumpkin). There is no available literature exploring the effects of this B.hispida dry powder on food intake, body weight, behavioural changes and antioxidant levels in whole animal model. Aim: This study aimed to understand the protective effects of the B.hispida dry powder in overcoming stress induction by analysing the pattern of food intake, behavioural changes and body weight and the change in blood levels of Superoxide Dismutase (SOD) and Malondialdehyde (MDA) in adult wister rats. Materials and Methods: This experimental study was conducted in the Department of Pharmacology, PSG Institute of Medical Sciences and Research, Tamil Nadu, India, for the duration of three weeks during the month of March 2020. Six male wister rats were obtained from the central animal house and assessed for baseline values of parameters including body weight, food intake, behaviour changes, blood levels of SOD and MDA and they were used as controls (without treatment) later. Then another 12 animals, matched for age and weight were selected and divided into two test groups (six in each). The animals in test groups 1 and 2 were pretreated with dry powder preparation of B.hispida at a dose of 250 mg/kg and 500 mg/kg orally and once daily, respectively. The entire study population of 18 animals (control, group 1 and group 2) subjected to stress in a restrainer for two hours per day for seven days. The study parameters were repeated at the end of 24 hours and at the end of seven days. Results were analysed using Analysis of Variance (ANOVA) in Statistical Package for Social Sciences software version 24.0. Results: The results were 500 mg/kg dose of B.hispida helped in overcoming stress induction by giving the statistically significant (p-value <0.05) results of increase in body weight, food intake pattern and normalised general behaviour after 24 hrs and 7 days of repeated stress induction. But no significant changes were seen in blood levels of SOD (p-value >0.05) and MDA (p-value >0.05). Conclusion: Based on the previous literatures, it was stated as “sparing effect of the powder” that is, exogenous supplementation is likely to suppress its endogenous production of antioxidants. This mechanism could attribute to the potential beneficial effect of B.hispida on the outcomes, despite having no significant alterations in blood levels of SOD and MDA. Further studies are needed to confirm the effects B. hispida in overcoming stress induction.

Efficacy of 70% Glycolic Acid Peel versus 30% Salicylic Acid Peel in the Treatment of Mild to Moderate Acne Vulgaris: A Retrospective Study

S Pavithra, K Gopalakrishnan, Jeevithan Shanmugam

Introduction: Chemical peels have become a useful modality in the management of acne in addition to topical and systemic medications. Studies done to evaluate the effectiveness of peels have compared only lower concentration of Glycolic Acid (GA) (35%) and Salicylic Acid (SA) peels. Higher concentrations of glycolic acid i.e., (70%) are reported to be safe and more effective than lower concentrations. Despite reported advantages of higher concentration of glycolic acid peel, no published data is available regarding its efficacy, safety and tolerability in comparison with other peels. Aim: To compare the effectiveness of 70% GA peel with 30% SA peel in the management of mild to moderate acne. Materials and Methods: The present study was a cross-sectional retrospective study conducted from December 2021 to April 2022 in which, 60 participants were enrolled. They were diagnosed with mild to moderate acne, based on the Indian Acne Alliance (IAA) grading system and all of them underwent chemical peel treatment. Among them, 30 had received 70% GA peel (group 1) and 30 had received 30% SA peel (group 2). The number of sittings and the individual lesional count at baseline and at each sitting were recorded. Acne lesional count (sum of comedones, papules, pustules, and nodules) was recorded at baseline, and at two, four, six and eight weeks. Categorical variables were presented as frequency and percentages. Continuous variables were presented as Mean±Standard deviation. Results: There was a significantly greater decrease in mean acne lesional count in group 2 from the baseline of 25.73 to 13.83 at the end of 2nd week in comparison to group 1, wherein the values reduced from 26.30 to 17.73 (p-value of 0.003). At the end of eight weeks, the mean acne lesional count of both groups (group 1-2.17 and group 2-1.50, p-value of 0.097) were comparable. Conclusion: Higher concentration of GA (70%) has comparable effectiveness to 30% SA peel in management of mild to moderate acne. SA peel has an advantage of earlier decrease in lesional count.

Knowledge and Antibiotics Self-medication Behaviours among Students of Non Medical Background: A Questionnaire-based Cross-sectional Study

KR Vidya, MK Sagar, S Sowmya, K Lohit

Introduction: Antibiotics are the life saving therapeutic agents used worldwide from neonates to geriatric patients for the treatment and prevention of bacterial infections. Antibiotics Self-medication (ASM) is a major public health problem due to irrational and inappropriate use of antibiotics as a routine practice among public. Aim: To assess the knowledge and ASM behaviours among Bachelor of Science (BSc) degree students and also to estimate the prevalence of ASM among students of non medical background. Materials and Methods: This cross-sectional study was conducted from April to November 2017 in Tumakuru, Karnataka, India, using a validated questionnaire. A total of 152 degree students were enrolled in the present study. The questionnaire consisted of 28 questions based on knowledge and behaviour towards self antibiotic medication practice was used to collect data from face to face interaction. Data were entered into MS excel and were analysed using Statistical Package for the Social Sciences (SPSS) 19.0. Results: Out of 152 students, 93 (61.2%) were treated with antibiotics and among them 64 (42.1%) were self-medicated with antibiotics. Students self-medicated with antibiotics, due to convenience 32 (50%), lack of trust in doctor 9 (14.1%). Selection of antibiotic were maximally from the previous doctor’s prescription 30 (46%), followed by opinion of family members 16 (25%). Around 50% and 22% of the students obtained antibiotics from community pharmacist and from the left over from previous prescription, respectively. Conclusion: The ASM was practiced among students and was encouraged by the community pharmacists and family members. Even without the proper knowledge, due to convenience the ASM has increased among the students.

Correlation of Serum Leptin with Body Mass Index and Insulin Resistance in Polycystic Ovarian Syndrome in a Tertiary Care Centre of Southern Odisha, India

Prachi Jena, Rasmita Kumari Padhy, Devi Prasad Pradhan, Nirupama Devi

Introduction: Leptin is an adipocyte derived hormone encoded by ob gene which serves as a relay link between metabolic signals and brain that regulate the hypothalamic pituitary ovarian axis. Leptin is related with obesity, which is a most important cause of Polycystic Ovarian Syndrome (PCOS) in women of reproductive age group. Aim: To evaluate leptin concentration and to analyse its correlation with Body Mass Index (BMI) and insulin resistance in PCOS. Materials and Methods: This case-control study was conducted from December 2018 to December 2019 at Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 60 PCOS subjects, aged between 15-30 years (30 obese PCOS and 30 lean PCOS) and 30 age-matched, normal ovulatory healthy controls were included in the study. Parameters such as serum leptin, fasting plasma insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), Fasting Plasma Glucose (PPG), Postprandial Plasma Glucose (PPPG) were estimated using commercial kits. One-way Analysis of Variance (ANOVA) test was used for data analysis and the Pearson’s correlation method was used to find the correlation between the parameters. Results: The mean age of women in all the three PCOS groups was found to be 22.4±3.13 years. The BMI of obese PCOS patients (31.9±4.7 kg/m²) and lean PCOS patients (21.4±2.2 kg/m²) were higher than that of healthy controls (20.7±1.8 kg/m²) which was statistically significant (p-value <0.001). The serum leptin in obese PCOS were significantly higher (28.0±17.8 ng/mL) than lean PCOS (5.8±2.2 ng/mL) and fasting plasma insulin in lean PCOS were (10.9±2.4 μIU/mL) significantly lower than obese PCOS (30.2±14.8 μIU/mL). Mean serum leptin levels had significant positive correlation with BMI in lean and obese PCOS and insulin resistance in obese PCOS. Conclusion: In the present study, high leptin concentration was observed in PCOS patients and there was positive correlation of leptin with BMI in both lean and obese PCOS groups and leptin was positively correlated with insulin resistance in obese PCOS.

Ocular Manifestations in Patients Diagnosed with Rosacea: A Cross-sectional Study from a Tertiary Care Centre in Northern India

Vishal Sharma, Shikhar Gaur, Vivek Sharma, Rahul Ashok Thombre

Introduction: Rosacea is a chronic inflammatory disease that affects the facial skin with eye involvement, that remains underdiagnosed. It is generally noticeable in fair skin people and often missed out in people with darker skin. Aim: To study the prevalence of ocular rosacea in patients of rosacea in a tertiary care centre. Materials and Methods: The present study was a cross-sectional study conducted at two tertiary level hospitals from January 2020 to December 2021. Cases of rosacea diagnosed were referred from the Department of Dermatology to the Department of Ophthalmology for ocular evaluation. A total of 400 patients were included in study in a multicentric setting. For ophthalmic evaluation, Ocular Surface Disease Index (OSDI) questionnaire was used. Results: Total 29 cases (7.25%) had ocular rosacea, out of 400 dermatological confirmed cases of rosacea. Amongst confirmed ocular rosacea, 12 (41.4%) were males and 17 (58.6%) were females. Most manifestations were noted in 41-60 years age with an average age of 52.2 years. Most of the cases presented with multiple symptoms and signs, 19 presented with features of dry eyes,16 had features of conjunctivitis, six had blepharitis, and seven had recurrent chalazions. Conclusion: Ocular rosacea is a diagnostic enigma to clinicians as it is underdiagnosed because of overlapping sign and symptoms. The present study emphasises ocular examination in all cases of rosacea.

Serum Procalcitonin Correlation with Sepsis Severity and Patient Outcomes: An Observational Study

Sirisha Jujjuru, Gautam Panduranga, Shivaraju Kanugula

Introduction: Sepsis is a life-threatening condition of human body. It is caused by improper response of host immune system to various infective conditions. Procalcitonin (PCT) has been a promising biomarker for aiding early diagnosis, risk stratification and treatment in patients with sepsis and septic shock. Aim: To study correlation of serial serum procalcitonin (day 1, 3 and 7) with severity of sepsis and patient outcomes (in-hospital stay or mortality). Materials and Methods: The study was a descriptive, observational study conducted at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India, on 100 patients admitted to Medical Intensive Care Unit (MICU), both males and females of age more than 18 years, with sepsis or septic shock, from August 2019 to January 2021. Serum procalcitonin was measured by BRAHMS PCT-Q immunochromatographic assay using a commercially available test kit. Blood, urine and wound cultures were performed to confirm specific infection. The Chi-square test, Fischer’s-exact test and Pearson correlation tests were used to calculate association and correlations amongst qualitative data. Results: Total 100 patients (mean age was 49.9±17.0 years; 62 males and 38 females) were included in the study. A total of 74 patients were observed to be have sepsis and 26 patients had septic shock. Mortality was 36%. There was a positive correlation with Sequential Organ Failure Assessment (SOFA) score on day 1 and 3, but not day 7. PCT was high in 85% of patients on admission (day 1). Higher levels of PCT was observed both in patients with sepsis (82.4%) and septic shock (92.3%), suggesting that it is a good diagnostic marker in these patients. Mean PCT was higher in death patients compared to discharged patients on day 1,3 and 7 (p-value <0.05). Majority of patients (71.8%) with higher PCT on admission stayed in ICU for less than 5 days, whereas over half (53.3%) with normal PCT had a short ICU stay (p-value=0.18). Conclusion: Procalcitonin is a useful marker for early diagnosis of sepsis and septic shock and also severity of infection on admission to ICU. High procalcitonin also predicts mortality and can be a useful tool for rational use of antibiotics in patients admitted to ICU.

Determination of C,c,E and e Antigens Section Prevalence in Rh D Negative Individuals: Is it Good Exercise with Utilities in Clinical Blood Transfusion Practices?

Manoj A Kahar

Introduction: Besides D antigen, C,c,E and e antigens of Rh blood group system are the most important antigens involved in alloimmunisation. The prevalence of C,c,E and e antigens in Rh D negative individuals in local population has many utilities in transfusion medicine practice. Aim: To determine the prevalence of C,c,E and e antigens in Rh D negative individuals. Materials and Methods: This prospective observational study was performed at Bhanumati clinical laboratory, Navsari, Gujarat, India, from January 2020 to January 2022. A total of 270 Rh D negative samples irrespective of ABO blood group status were typed for C,c,E and e antigen using monoclonal reagents from two different manufacturers using conventional tube technique. The most likely phenotype and genotype were determined using reference textbooks. Possibility of weak D in these 270 samples was ruled out using polyspecific Antihuman Globulin Reagent performing test for weak D antigens. Results were analysed using Excel spread sheet. Results: Prevalence of C,c,E, and e antigen in the 270 Rh D negative samples were, C (17, 6.29%), c (267, 98.88%), E (1, 0.37%) and e (270, 100%). Most probable genotypes were dce/ dce(rr), dCe/dce(r’r), dCe/dCe(r’r’) and dcE/dce(r”r). Conclusion: Data obtained of C,c,E and e antigen prevalence in Rh D negative individuals is having varied utilities in blood transfusion services such as formulating rare blood group registry, preparing in house screening and panel red cells, and maintaining inventory of rare blood group units using freezing technology, if available.

Detrimental Effects of Traffic Noise in Traffic Policemen as Assessed by Auditory Brainstem Evoked Response: A Cross-sectional Observational Study

Manoj Kumar, Abhishek Saini, Nivedita Gupta, Sangeeta Vyas

Introduction: Loud noise is a global occupational health hazard with substantial social and physiological impacts, especially pronounced in traffic policemen who are engaged at heavy traffic junctions. Apart from its overt effect on sensorineural hearing, loud noise has been also implicated, albeit covertly, as a causative factor for disturbances in sleep, learning and depression. Due to the insidious nature of hearing impairment, manifestations are often masked and hence testing through Auditory Brainstem Evoked Response (ABER) should be resorted to, for assessment of functional status of auditory pathway objectively. Aim: To assess and compare the effect of traffic noise in traffic policemen with age-matched apparently healthy males using ABER. Materials and Methods: The present study was a cross-sectional, comparative type of observational research conducted in the Department of Physiology, SMS Medical College, Jaipur, Rajasthan, India, from June 2019 to May 2020, on 45 apparently healthy male traffic policemen, aged 25-40 years, engaged at heavy traffic junctions of Jaipur city, with an average field posting of five years or more. An equal number of age and sex matched apparently healthy subjects living in Jaipur city, were recruited as controls. Before commencing with the test procedure, ethical clearance was obtained from the Institute’s Ethics Committee and Research review board and written informed consent was obtained from all the participants. ABER assessment was done via RMS EMG SALUS 2C machine on each subject using click stimuli presented mono-aurally via an overhead headphone resulting in harvest of variables in form of absolute wave latencies (I-V) and Interpeak Latencies (IPL) (I-III, I-V and III-V). Unpaired Student’s t-test was used to derive the level of significance using Statistical Package for the Social Sciences (SPSS) version 16.0. Level of significance was set at p-value <0.05. Results: The results obtained in the present study demonstrated pronounced delay (p-value <0.01) in all absolute wave latencies (I-V) in both ears in traffic policemen. A statistically significant delay was also observed in IPL I-V (p-value <0.01) when a comparison of left ABER was made between traffic policemen and controls. Conclusion: The findings of the present study indicate that the hidden footprints of loss in auditory acuity in traffic policemen exposed to traffic noise can be unearthed objectively via using ABER assessment and therefore periodic ABER assessment along with usage of preventive equipment should be the strategy for prevention of imminent hearing loss.

Lifestyle Modifications on the Expression of TCF7L2 Gene Polymorphism: A Cross-sectional Study

Geetha Bhaktha, Divya Dattaprasad, Prashanthkumar Goudappala, Shivananda B Nayak

Introduction: Type 2 Diabetes Mellitus (T2DM) is the result of the clustering of factors along with the communication between environmental factors and a strong hereditary component. In this modern age of investigation, molecular mechanisms of Transcription Factor 7 Like 2 (TCF7L2) linking with the physiological functioning in pancreatic and intestinal endocrine cells are explored. Hitherto few studies have been done in the Indian population with regard to gene polymorphism in TCF7L2 and T2DM concerning family history. Aim: To study effect of lifestyle modifications on the expression of TCF7L2 gene polymorphism in subjects with family history of diabetes. Materials and Methods: This was a cross-sectional study, conducted over a period of 14 months September 2020 to November 2021) with 121 subjects from Shimoga district at Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India. The study was conducted after the approval by the Ethics Committee and subjects volunteering for the study have signed the informed consent. The study comprised of two groups. Both the groups had family history of T2DM, eventually persons who had not developed diabetes and had changed their lifestyle were grouped I (n=56) and subjects who had developed diabetes without any changes in their lifestyle were considered as group II (n=65). Fasting insulin, and fasting blood glucose was estimated along with the anthropometric variables like height, weight, waist circumference, hip circumference. Two Single Nucleotide Polymorphism (SNP) (rs7903146 and rs1225372) of TCF7L2 gene was genotyped using Tetra-primer Amplification Refractory Mutation System (T-ARM) protocol. Differences in clinical parameters and genotypic variants between groups, was calculated using the independent t-test and Chi-square test, a p-value of <0.05 was considered statistically significant. Results: Only fasting insulin and Waist Hip Ratio (WHR) parameters were weakly significant in the study population. The risk allele frequency (T) was seen to be higher in the group I and the chances of getting diabetics was 2.02 times higher than the subjects of group II for rs7903146. This substantiates that the group I subjects were more predisposed to diabetes genetically. Since subjects with heterozygous genotype (CT or GT alleles) has been associated with the highest risk of developing T2DM, the association of heterozygous genotype was high in the group with lifestyle modification and was highly significantly associated with risk of being diabetic by 7.50 times for rs7903146 and 6.10 times for rs1225372. Further risk analysis of variants according to a model of inheritance was analysed and was observed that the co-dominant and overdominant models best fitted the association with an OR above 6 for both the polymorphism. Conclusion: This study depicts that lifestyle modification masks the effect of risk variants for rs12255372 and rs7903146. The confounding nature of the influence of environmental factors over predisposition to inheritance is well depicted for the manifestation of T2DM among the genetic variants of TCF7L2.

Assessment of VO_{2#sub3 Max among Female Workers of Cotton Textile Industry at Visnagar, North Gujarat Region: A Cross-sectional Study}

Introduction: Occupational lung illness is a significant problem among textile factory workers. Occupational cotton dust exposure has been linked to lung involvement in many epidemiological studies of cotton industry workers. The maximum oxygen intake is one of the measures used to estimate functional capacity (VO₂ max) of cardiopulmonary efficiency. The integration of the ventilatory, cardiovascular and neuromuscular system is necessary for attainment of VO₂ max. Aim: To assess the VO₂ max among women employees in cotton textile industry and to study the correlation between VO₂ max and anthropometric parameters like Body Mass Index (BMI), Body Surface Area (BSA), fat percent (fat %) and Lean Body Mass (LBM). Materials and Methods: This cross-sectional study was conducted from January 2021 to June 2021 at Nootan Medical College and Research Centre/Nootan General Hospital, Visnagar, Dt. Mehsana, North Gujarat, India, which included study and control group which comprised 50 female workers of cotton industry and 50 age matched females, respectively (n=50 each) who had never worked in the cotton industry or been exposed to cotton dust. The labourers of cotton industry were chosen from the Mehsana district’s numerous cotton factories. Physical examinations (resting heart rate, resting systolic and diastolic blood pressure) and a standardised proforma were used to gather data. VO₂ max and anthropometric measurements such as BMI, BSA, fat % and LBM were measured by standard procedure. The statistical analysis was done by using Student’s t-test and Pearson correlation test. The correlation between BMI, BSA, fat percent and LBM with maximal oxygen consumption (VO₂ max) was assessed by using Karl-Pearson’s correlation with level of significance was considered statistically significant if p<0.05. Results: The mean value of VO₂ max in study and control group was 35.62±0.34 mL/kg/min and 36.80±0.58 mL/kg/min, respectively. It was decreased significantly (p<0.001) in study group. The r-values of BMI, BSA, LBM and body fat % were 0.262, 0.132, 0.236, 0.224, respectively. In the present study correlation between BMI, BSA, LBM, body fat % with VO₂ max was reported as weak positive correlation which was not statistically significant. Conclusion: VO₂ max was significantly decreased in cotton industry workers compared to non exposed control subjects. More studies on the effects of cotton dust on VO₂ max should be conducted in future in both genders.

Successful Isolation of Burkholderia pseudomallei from Soil by Extended Incubation of Ashdown’s Agar: A Cross-sectional Study

Sruthi Raj, Sujatha Sistla, Rajesh Amberpet, Sreeram Chandra Murthy Peela

Introduction: Melioidosis is an infectious disease of humans and animals caused by an environmental saprophyte Burkholderia pseudomallei. Although the organism is associated with soil and water, environmental isolation is rarely successful which could be due to the existence of viable but non culturable forms. Aim: To isolate B. pseudomallei from the soil to detect the environmental presence of this organism in and around Puducherry, India. Materials and Methods: A descriptive cross-sectional study was carried out from July 2018 to January 2021 at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. A total of 473 soil samples were collected from areas surrounding the residence and workplaces of seven culture-proven melioidosis cases, from Puducherry and three districts of Tamil Nadu (Cuddalore, Nagapattinam and Villupuram) during the dry and wet seasons. Soil samples were enriched in Ashdown’s broth and cultured on Ashdown’s agar. The plates were incubated at 37°C and examined daily for seven days with a further extended period of incubation till the tenth day for samples that did not show growth. Suspected isolates were subjected to Vitek 2 system for biochemical identification. Confirmation of the isolates was carried out by antigen detection and Polymerase Chain Reaction (PCR). Results: From 473 soil samples processed, bacteria with colony morphology similar to B. pseudomallei were isolated in 56 (11.83%) samples. Only one isolate, which was detected on the tenth day of incubation was confirmed as B. pseudomallei using antigen detection and PCR. This sample was collected during the wet season (December 2020) from Endur, in the Villupuram district of Tamil Nadu, India. Conclusion: The study findings highlight the importance of extended incubation of culture plates at 37°C for up to ten days to improve the chances of isolation from the soil.

Efficacy of Nucleic Acid Extraction by Manual versus Automated Magnetic Bead-based Method to Detect SARS-CoV-2

Introduction: In December 2019, a rapid spread of highly infectious, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was reported in Wuhan, China. The gold standard for diagnosis of SARS-CoV-2 infection is nucleic acid amplification technology by detecting its viral Ribonucleic Acid (RNA) from respiratory swabs (oropharyngeal and nasopharyngeal) by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) whose specificity is approximately 95%. Magnetic bead RNA extraction was benchmarked against the commercial QIAcube extraction platform. Aim: To compare the efficacy of nucleic acid extraction by manual method and automated magnetic bead-based method to detect SARS-CoV-2. Materials and Methods: The present cross-sectional observational study was conducted in the Department of Microbiology, Autonomous State Medical College, Firozabad, Uttar Pradesh, India. Duration of the study was from February 2022 to March 2022. A total of 470 oropharyngeal and nasopharyngeal samples were included in the present study to observe the efficacy of nucleic acid extraction by manual extraction and automated extraction for SARS-CoV-2. Data were entered in Microsoft Excel software and analysed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: During the present study period, a total of 470 individual samples were tested in 94 pools. Out of these 470 individuals, 331 were males (70.5%) and 139 were females (29.5%). All 94 pools were found negative by both automatic and manual extraction methods. Envelope (E) gene was found in one pool (1.06%) by the manual RNA extraction method. The E gene was absent in 93 pools (98.94%) by manual method. Internal control was found highest in 88 pools (93.62%) by the automated extraction method. Conclusion: Automated workflows avoid human error from the sample processing pipeline and also ensure as well as enhance the meaningful output, diagnostic precision, and testing capacity. Automated instruments are in wide usage because of their capability of processing thousands of samples per day with the support of minimal staff.

Echocardiographic Evaluation of Diastolic Dysfunction among Menopausal Women: A Cross-sectional Study

Introduction: Heart Failure with Normal Ejection Fraction (HFNEF), also known as Diastolic Heart Failure (DHF), has been well-studied since the past two decades. The signs of HFNEF are signs of heart failure and abnormal ventricular filling pressure with normal systolic function. A Metabolic Syndrome (MS) is a clustering of metabolic risk factors. Cardiovascular disease caused by metabolic syndrome includes vascular and myocardial abnormalities such as diastolic dysfunction and relaxation abnormalities. Aim: To study the assosciation between the timing of menopause and Left Ventricular Diastolic Dysfunction (LVDD) in those with and without MS. Materials and Methods: This cross-sectional study was conducted in the period between December 2021 to June 2022 at the Department of Cardiology in A.C.S Medical College and Hospital, Chennai, Tamil Nadu, India. All female patients that underwent a medical examination were selected for the study. Postmenopausal women without overt heart diseases (such as a history of heart valve disease or myocardial infarction, or a prior LV ejection fraction >50%) were included. The present study included 80 patients grouped into two: those with and without MS. The MS group included 30 subjects, divided into two subgroups: those who experienced menopause at or before 50 years of age (early menopause group) and those who experienced menopause at or after 50 years of age (late menopause group). Out of 80, 50 participants were divided into early menopause and late menopause groups among women without MS. The present study analyse the evolution of LVDD, assessed by transthoracic echocardiography (TTE), in 80 postmenopausal women with and without MS. Independent t-tests was applied to assess the association between the timing of menopause and LVDD. Results: The mean age was 60±7.3 years in women with MS and 62±8.8 years in women without MS. There were no significant differences in the duration, since menopause between the postmenopausal women with and without MS. No significant difference was found between the two groups (early vs late menopause group) with respect to any diastolic parameter, including Early (E) and Late (A), E/A ratio, and E/e in women with MS. In postmenopausal women without MS, there was a significant difference in diastolic parameters including the A, early diastolic annular velocity (e’), ratio of early diastolic transmitral flow velocity to annular flow velocity was calculated (E/e’) between the two groups (early vs late menopause group). In comparison to patients with MS, patients without the condition had significantly lower early peak mitral inflow velocity (E, p-value=0.019), early diastolic mitral annulus motion velocity (e’-septal, p-value=0.05), late peak mitral inflow velocity ratio (E/A, p-value=0.07), and LV filling pressure values (E/e, p-value=0.02). Conclusion: Early menopause impacts diastolic function in postmenopausal women and LVDD progression in women without MS. LVDD progression in women with MS was unaffected by early menopause.

Prevalence of Congenital Colour Vision Deficiency in Belagavi, Karnataka, India: A Hospital-based Cross-sectional Study

Chethana Warad, Radhika Wani, Ruchi Singh

Introduction: Colour vision deficiency is a common ocular disorder, but it often goes unnoticed due to lack of awarenessand screening programmes. If detected early in life, it can help people choose suitable career paths and genetic counselling can help reduce the birth of colour-blind children and future disappointments in life. Aim: To determine the prevalence of congenital Colour Vision Deficiency (CVD) among the general population in Belagavi at a tertiary level hospital and to spread awareness regarding CVD. Materials and Methods: This was a hospital-based cross-sectional study, conducted at Jawaharlal Nehru Medical College, Belagavi, Karnataka, India (tertiary care hospital), from February 2022 to July 2022. The study population constituted 3131 people, who visited the Ophthalmology Outpatient Department (OPD) for routine eye examinations. A detailed ophthalmological examination was done, and colour vision was tested using Ishihara’s (38-plate) pseudoisochromatic test. Data was analysed using statistical software version 4.2.1 and Microsoft excel. Results: The mean age of the study population was 40.74±15.86 years. The overall prevalence of congenital CVD was 150 (4.79%). The prevalence of congenital colour vision defects was 13 (0.9%) in females, and 137 (8.12%) in males (p-value <0.001). Deuteranomaly was the most common type of congenital CVD, found among 88 (58.67%), followed by protanopia among 28 (18.67%), followed by protanomaly and deuteranopia, each accounting for 17 (11.33%) participants. Conclusion: The prevalence of CVD among people belonging to the Belagavi district was remarkable. The prevalence rate was higher in males compared to females.

Ocular Manifestations in Psoriasis Patients Attending a Tertiary Care Centre, Srikakulam, Andhra Pradesh, India: A Cross-sectional Study

Introduction: Psoriasis is known to be proliferative, relapsing inflammatory disorder affecting mainly skin and other parts of body. There are several co-morbidities associated with psoriasis, of which ocular findings go unnoticed. Aim: To study the spectrum of ocular manifestations in psoriasis patients in Srikakulam, north coastal region of Andhra Pradesh, India and also to identify relationship between frequency of ocular involvement in psoriasis patients with age, gender, type and severity of psoriasis. Materials and Methods: The present cross-sectional study was conducted from March 2019 to March 2021 at Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh, India. The study included 80 psoriasis patients attending Dermatology Outpatient Department (OPD) to know various ophthalmological manifestations. Detailed dermatological examination was done followed by ophthalmological examination. Clinical types of psoriasis, site of involvement, and the severity of the disease using Psoriasis Area and Severity Index (PASI) were noted. Statistical analysis was done using Z test, Pearson’s correlation coefficient and linear regression coefficient. Results: Out of 80 patients with psoriasis, 51 (63.75%) were males and 29 (36.25%) were females. Out of total 80 patients, 56 (70%) patients had ophthalmic manifestations. The mean age of presentation was noted to be 49.22±8.53 years with range from 18-76 years. Most of the patients i.e. 30 (54%) had bilateral manifestations in both the eyes. A total of 10 (18%) of psoriasis patients had multiple ocular manifestations. The p-value was calculated based on PASI score and with ocular manifestations which was found to be 0.0485 and was statistically significant. Conclusion: Regular screening of psoriasis patients is useful in identification of ocular problems, which may not be noticed by the patients until symptomatic.

Comparison of Ultrasound and CT Findings of Pelvic Masses with Histopathology: A Cross-sectional Study

Yashi, Manoj Mathur, Manpreet Kaur, Arshdeep Kaur

Introduction: Benign and malignant pelvic masses can occur in different age groups, primary diagnosis and choosing the appropriate surgical procedure is very important. Ultrasound (USG) is the diagnostic test of choice in evaluating pelvic masses, while Computed Tomography (CT) scan is most helpful as a second-line study, for in-depth evaluation of the abdomen and pelvis. Aim: To compare the findings of ultrasound and CT scans of pelvic masses with definitive histopathological or laboratory findings. Materials and Methods: A cross-sectional study was conducted at Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from December 2014 to September 2015. Sixty patients from Outpatient and Inpatient Department, with clinical suspicion of pelvic pathology, were evaluated sonographically and then by CT scan. Ultrasound characterisation of mass as high or low risk was done based on septae and solid part echogenicity. CT findings used to diagnose malignancy were cystic solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa, and/or papillary projections. The presence of ascites, lymphadenopathy, omental cake, peritoneal deposits, mesenteric deposits was noted to diagnose metastasis. Data was analysed using Statistical Package for Social Sciences (SPSS) version 16.0. A p-value was calculated using Chi-square test. For finding, the level of agreement between USG/CT scan and histopathology, Kappa statistic was applied. Results: Ultrasound had sensitivity of 73.7%, specificity of 80.3%, Positive Predictive Value (PPV) of 53.8% and Negative Predictive Value (NPV) of 90.7%. Computed tomography scan had a sensitivity of 78%, specificity of 95.08%, PPV of 83.3%, and NPV of 93.5%. Kappa statistics showed moderate level of agreement between USG and histopathological findings (k=0.47,p-value=0.017) and good level of agreement between CT scan and histopathological findings (k=0.68, p-value=0.001). Conclusion: Ultrasound with its good sensitivity can be used as an effective screening modality for pelvic masses. Computed tomography scan has better specificity than USG and should be used as a confirmatory investigation.

Concordance between Radiological Features and Histopathological Diagnosis of Cartilaginous Lesions of Bone among Patients at a Tertiary Care Centre, Trivandrum, Kerala

Jayasree Kattoor, Balaji Radhakrishnan, Sindhu Nair, M Venugopal

Introduction: Cartilaginous tumours comprise a large, heterogeneous group of mesenchymal neoplasms. They pose a challenge in terms of accurate diagnosis and management. Histopathological findings have direct implications for treatment outcomes. Aim: To determine the concordance between the radiological features and the histopathological diagnosis of cartilaginous lesions of bone. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India, among 109 patients with histopathologically proven benign and malignant cartilaginous tumours, received in the laboratory between January 2012 and December 2021 for a duration of 10 years, were analysed. The study was conducted between September 2019 and January 2022. The demographic data for the study, including age, tumour site, clinical findings, and radiological diagnosis, were obtained from medical records. The cases were histopathologically graded based on the World Health Organisation 2020 classification of tumours of soft tissue and bone. The concordance between histopathological diagnosis and radiological features was assessed. The Chi-square test was used to find the association between two categorical variables, and the Independent sample t-test was used to find the difference between two groups with respect to mean and standard deviation. Results: There were a total of 109 cases of cartilaginous tumours, out of which 82 cases (75.22%) were diagnosed as malignant and 27 cases (24.77%) were diagnosed as benign. Among benign neoplasms, chondroblastoma and osteochondroma were the most common, with 10 cases (37.03%) each. Among malignant chondroid tumours, 73 (89.02%) were diagnosed as conventional chondrosarcoma. There were five cases (6.09%) of secondary chondrosarcomas (malignant transformation of a benign cartilaginous lesion). Among the secondary chondrosarcomas, three cases (60%) were malignant transformation in osteochondroma, 1 (20%) in enchondroma, and 1 (20%) in synovial chondromatosis. Among the 91 cases for which radiology was available, 86 (94.50%) had a concordance between radiological and histopathological diagnosis. Five cases (5.49%) had a discordant radiological diagnosis. Conclusion: For histologically benign tumours, the radiological findings in the study were identical and concordant. For histologically malignant tumours, there were discrepancies with radiological findings in this study when the lesion had an associated cyst, absence of cortical destruction, or absence of a clear cartilaginous component and extra cortical expansion. For histologically suspicious cases in the study, the final diagnosis was made based upon radiological findings, with a particular interest in cortical destruction.

COVID-19 Vaccine Hesitancy among the Non Medical Adult Population Attending a Tertiary Care Hospital of Kolkata, India: A Cross-sectional Study

Atanu Roy, Oyimang Paloh, Saikat Bhattacharya, Soumitra Mondal

Introduction: Vaccines play an important role in the fight against diseases whose cure is unavailable. In the battle against pandemics such as Coronavirus Disease 2019 (COVID-19), the vaccine is the only available course of prevention. The hesitancy has been found all over the world, while some find it against their religious values, others are concerned about safety, or have doubts about its efficacy. Some are hesitant due to fear of needles while some show brass negligence. Being the second most populated country globally and a developing nation, India had faced its fair share of struggles with her citizens vaccinated. Even a minute percentage of people accounts for millions; hence, it is of utmost importance to get to the root of the causes of delay in vaccination. Aim: To find the causes of delay or hesitancy among the people attending COVID-19 vaccination centre of a tertiary care hospital of Kolkata, (a year after vaccines were introduced to the general population). Materials and Methods: A cross-sectional study was performed in the COVID-19 vaccination centre of Medical College Kolkata, West Bengal, India, from 14^th January 2022 to 14^th April 2022. Total 74 non medical (not related to healthcare work) people who had come for 1^st or 2^nd dose of COVID-19 vaccination were included in the study. A prestructured, pretested, prevalidated questionnaire was used to collect data from the participants of the study. The Likert scale comprising of nine questions were used to assess hesitancy. Data were analysed using Chi-square test. Binary logistic regression was done to confirm any predictability of occupation, literacy rate, age and gender on vaccine hesitancy. Results: The participants comprised of 45 (60.8%) females and 29 (39.2%) males, aged between 18 to 60 years with the mean age of 33.75±11.06 years. The participants included 22 (29.7%) people, who had just taken their first dose. Twenty six (35.1%) participants were hesitant. The most common causes of hesitancy were individuals’ fear of the vaccine and its impact on general health, unavailability of slots for vaccination and reluctance. Out of total, 58 (78.4%) people had faith in vaccines made in India and 48 (64.9%) persons believed that the vaccine would provide complete protection against COVID-19. Conclusion: People were mainly concerned about safety issues as adequate and reliable information was not available to them. Some of them ignored the importance of vaccination, while some could not get vaccinated due to the unavailability of slots.

Intraparotid Branching Pattern of Facial Nerve- A Cadaveric Study from Tamil Nadu, India

S Suganya, Amudha Govindarajan

Introduction: Facial Nerve (FN) is the main motor nerve of muscles of facial expression. As it courses, within the parotid gland, the FN divides into divisions and then into terminal branches. Various surgical procedures of this region may inadvertently injure the FN owing to its variant branching pattern, resulting in facial asymmetry. Aim: To analyse the branching pattern of FN in the parotid region of Indian origin. Materials and Methods: This was a descriptive, cross-sectional study done on 50 embalmed cranial halves, in the Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India from October 2020 to March 2022. Well-embalmed and preserved adult cadavers irrespective of age, sex and side were included. After piece meal dissection of the parotid gland, the Facial Nerve Trunk (FNT) was identified and its branching pattern studied and classified according to Davis RA et al., classification. The data thus, obtained was analysed using statistical software Statistical Package for the Social Sciences (SPSS) 21.0. Results: The FNT bifurcated in 98% and trifurcated in 2% specimens. The branching pattern of FN based on Davis RA et al., system showed a frequency as follows: Type I: 0%, Type II: 8%, Type III: 26%, Type IV: 16%, Type V: 48% and Type VI: 2%. Conclusion: Type V branching pattern showed the highest frequency. Results inferred from this study might help surgeons in anticipating the variant course, branching and interconnections of the FNT in the parotid region and thus, may aid in minimising iatrogenic nerve injuries to avoid unnecessary facial disabilities.

Kangaroo Mother Care versus Prone Position in Preterm Neonates: A Non Randomised Clinical Study

Arghya Roy Naskar, Prativa Biswas, Neha Karar, Dipanjan Halder

Introduction: One of the major problems of preterm neonates is immature alimentation. This may lead to inadequate weight gain, higher chances of sepsis and increased mortality. Positioning during and after feeding affects nutritional tolerance. Kangaroo Mother Care (KMC) is a method of skin-to-skin contact between mother and neonate, claimed to improve infant outcomes. Aim: To compare prone and Kangaroo Mother Care positioning of preterm neonates of 28-32 weeks gestational age during orogastric tube feeding. Materials and Methods: The study was a single-centre Institution-based, non randomised cross-over clinical study, carried out at Sick Newborn Care Unit and Neonatal Intensive Care Unit (NICU), Department of Paediatrics, R.G. Kar Medical College and Hospital, Kolkata, India, from April 2020 to March 2021. The studied parameters included gastric residual volume (three hours postprandial), vital signs like respiratory rate, heart rate, SpO2 level, body temperature, Capillary Blood Glucose (CBG), also comfort scores using a comfort scale. Total 110 preterm neonates of 28-32 weeks gestational age were sampled as per inclusion criteria and divided into two groups. Each group was fed by orogastric tube feeding in its respective position, in which they were kept for three hours. Vital signs, comfort scores and gastric residual volume were re-assessed. Groups were crossed over on the next day. Statistical analysis was done by t-test. Results: Of the total 110 neonates, KMC sample and prone position sample were compared after three hours. Heart rate was 147.5±4.3 and 151.08±9.1 beats per minute and respiratory rate 52.8±2.9 and 55.6±4.9 cycles per minute, which were lower in KMC than in prone position. There was better glycaemic control {n=107 (97.27) and 80 (72.73) mg/dL}, higher comfort scores (11.2±1.1 and 10.1±2.0) and minimal to negligible gastric residuals (0.03±0.05 mL and 0.13±0.12 mL) in KMC position, when compared to prone position, respectively. Conclusion: Kangaroo mother care produced more stable physiological indices, and was more comfortable for preterm neonates and resulted in better feeding, absorption and metabolism.

Efficacy of Intratympanic Dexamethasone Injection in Subjective Idiopathic Tinnitus- An Interventional Study

KR Radhakrishnan, D Ranjit Kumar, J Balasubramani, E Selvapriya

Introduction: Tinnitus is a common and annoying symptom characterised by the perception of sound without any corresponding external stimulus. Subjective idiopathic tinnitus is a subjective form of tinnitus where the perceived sound originates from the auditory nervous system, without both aberrant aetiology and external stimuli. Intratympanic injection of steroid (Dexamethasone) is used for the treatment of subjective idiopathic tinnitus by introducing the drug through the tympanic membrane, resulting in reduced systemic toxicity and a higher perilymph steroid level. Aim: To evaluate the efficacy of intratympanic dexamethasone injection in the treatment of subjective idiopathic tinnitus. Materials and Methods: This prospective interventional study was carried out at Madurai Medical College, Madurai, Tamil Nadu, India, from March 2021 to March 2022. A total of 30 patients with subjective idiopathic tinnitus were subjected to intratympanic dexamethasone injection, once per week for three weeks. Improvement in the symptom of tinnitus was assessed by means of subjective evaluation with the help of Tinnitus Handicap Inventory (THI) before and after one week, one month and three months of last injection. Data were statistically analysed using Student’s paired t-test. Results: The results of this study showed that, 53.33% of the population belonged to the age group of 31-40 years. There was 16 females and 14 males. There was a significant reduction in the mean grade of THI at one month and three months after the treatment. The mean THI score was significantly reduced from 50.067 before treatment to 35.733 in one month and 26.933 in three months after the treatment. Conclusion: The intratympanic injection of dexamethasone was found to be effective in the treatment of subjective idiopathic tinnitus. Intratympanic treatment was demonstrated to improve tinnitus scores in the study population.

Impact of COVID-19 Pandemic on Dental Practice: A Questionnaire Survey

Shivani Kondhalkar, Daisy Happy

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic had unprecedented health and economic consequences. Dentists encounter maximum aerosol production due to frequent use of ultrasonic and polishing devices or other surgical interventions, thus increasing the risk of nosocomial infections. The situation had caused drastic change in the clinical routines including modifications in infection control strategies, managing of minimally invasive procedures, reducing the patient visits and updating themselves to use telecommunication to cater to the need of patients. Aim: To evaluate the consequences and impact of COVID-19 pandemic by conducting an online survey using questionnaire amongst dentists as healthcare providers in the country of India. Materials and Methods: This was a questionnaire-based, cross-sectional survey conducted using online platform in India with a sample size of 225 participants, who were practicing dentists, either graduates or postgraduates, and agreed to give an informed consent. The questionnaire consisted of six segments: participants demographics, changes in clinical routine of the respective dentist, upgrading facilities in clinic, infection control measures, telecommunication and impact on financial aspect of the practitioner. Open-ended questions were also included giving an opportunity to the participant to share his or her perspective. Chi-square test of proportion was performed to assess the difference in proportion of the responses. A p-value <0.05 was considered statistically significant. Results: The present study has shown that the pandemic has impacted negatively on financial status, patient flow and daily practice. Total 221 (98.2%) clinicians agree to the fact that, COVID-19 has affected their clinical routine, 203 (90.2%) clinician were aware of the aerosol generating procedures and 95 (42.2%) practitioners have installed devices for air purification. A 209 (92.8%) emphasise on the use of Personal Protective Equipment (PPE) kits and majority 84 (37.3%) were delaying elective procedures. About 184 (81.7%) have experienced decrease in number of patient flow and 104 (46.2%) practitioners agreed that their emotional and psychological well-being is affected due to drastic changes made in their practicing protocols due to COVID-19. Conclusion: The COVID-19 pandemic has affected the social, economic, physical as well as mental well-being of practioners all around the world. More or less the practice is hampered causing frustration and instability. Focusing the light on practicing dentists, they have seen to make significant changes in their zone of practice and have updated to the new normal version of practice.

Complete Blood Count (CBC) and CBC derived Ratios in Early Diagnosis of COVID-19: A Retrospective Single-centre Study

Introduction: Abnormalities in Complete Blood Count (CBC) are frequently observed in Coronavirus Disease-2019 (COVID-19) infection. So, CBC can serve as a simple tool for the early diagnosis of COVID-19. Aim: To evaluate the diagnostic ability of CBC test in COVID-19 infection. Materials and Methods: In this retrospective observational single-centred, data were collected from 102 adult non critical care patients who presented with acute fever between May 2020 and December 2020. Among 102 patients’ data, 48 were found Reverse Transcriptase-Polymerase Chain Reaction (RTPCR) positive (‘cases’) and 54 were RT-PCR negative (‘controls’). Non parametric Mann-Whitney test was used to compare the differences in CBC. The p-value <0.05 was considered statistically significant. Receiver Operator Characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of CBC tests in COVID19. For this, RT-PCR was used as the ‘gold standard’ and CBC as the index test. Area Under Curve (AUC) was determined for each of the CBC tests. All statistical analysis were done using Medcalc software. Results: The mean age of cases was 48±14 years (62% males; 38% females) and controls was 45±15 years (55% males; 45% females). Median values for haemoglobin, haematocrit, Red Blood Cell (RBC) count and Red cell Distribution Width (RDW) were significantly higher (p-value <0.05) and total White Blood Cell (WBC) count, eosinophil differential count, absolute eosinophil count, lymphocyte count, absolute lymphocyte count, immature granulocyte count were significantly lower in COVID-19 patients as compared to controls. Significant differences were observed for eosinophil (differential% and absolute) count. Almost all the platelet parameters were lower in COVID-19 patients (except Neutrophil Lymphocyte Ratio {NLR}), although the platelet count was only mildly reduced in the RT-PCR positive cases (133-475×103/μL;median-227.98×103/μL). Higher AUC values were observed with Eosinophil-differential%, Eosinophil-absolute count, Eosinophil Lymphocyte Ratio (ELR) and NLR. Conclusion: Eosinophil count and associated ratio (Eosinophil Lymphocyte Ratio) are diagnostically useful and can serve as biomarkers for COVID-19. Further larger studies are needed to unravel the underlying mechanism and their clinical utility.

Association between Thyroid Function and Ovarian Reserve in Infertile Women: A Cross-sectional Study

Sandeep Singh Soam, Sonali Chaturvedi, Shruti Singh

Introduction: Thyroid dysfunctions are among the most common diseases in women of reproductive age group. Thyroid hormone receptors are present on oocytes which indicate that thyroid hormones may influence ovarian functions. Serum Anti-Müllerian Hormone (AMH) is secreted from growing granulosa cells of ovaries. Serum AMH concentrations are used to evaluate ovarian reserve in females. Aim: To find the association between ovarian reserve, measured by AMH concentration and thyroid functions in women with infertility. Materials and Methods: This cross-sectional study was conducted on a total of 78 infertile females, in Department of Biochemistry at Government Medical College, Badaun, Uttar Pradesh, India, from July 2021 to December 2021. The involved women with infertility in the age group of 20-40 years attending the infertility clinic, were included in the study. Participants were divided into two groups based on whether the serum AMH value was <1 ng/mL (lower than low normal ovarian reserve) or ≥1 ng/mL (low normal to normal ovarian reserve). The blood samples were processed for Serum Thyroid Stimulating Hormone (TSH), free Triiodothyronine (fT₃), free Thyroxine (fT4), Prolactin and AMH. The median values of TSH and fT4 levels were compared in the subgroups of patients defined by the level of serum AMH i.e., serum AMH value <1 ng/mL, and serum AMH value ≥1 ng/mL. Chi-square test was used to establish the association between the categorical variables. Results: Based on serum AMH values, 22 (28%) females had below normal ovarian reserve i.e., serum AMH value <1 ng/mL, and 56 (72%) females had low normal to normal ovarian reserve i.e., serum AMH value ≥1 ng/mL. The mean age of participants with AMH <1 ng/mL was 33.23±4.28, which was significantly higher than those with AMH value ≥1 ng/mL (p-value=0.002). Serum TSH value was significantly higher in the subgroup of participants with AMH <1 ng/mL, the value being 4.75 mIU/L and was lower (2.8 mIU/L) in the subgroup of participants with AMH ≥1 ng/mL (p-value=0.002). Conclusion: In conclusion, the present study found the highly significant difference in serum TSH values in the two groups based on whether the serum AMH value was <1 ng/mL and ≥1 ng/mL suggesting that subclinical hypothyroidism has negative impact on the female fertility. Increasing age of the females was negatively correlated with the ovarian reserve.

Effectiveness of Proximal Fibular Osteotomy as an Alternative Treatment Modality for Pain Relief and Functional Improvement in Medial Compartment Knee Osteoarthritis

Pratik Ramesh Gandhi, Sumeet Sharad Patil, Maroti Raghoji Koichade

Introduction: Medial compartment knee Osteoarthritis (OA) is a painful and debilitating disease that hinders an individual’s day-to-day activities physically and psychologically. Therefore, amelioration of pain is of utmost importance, which can be achieved by decompressing the medial compartment by Proximal Fibular Osteotomy (PFO). PFO is a simple, novel surgical technique that leads to significant pain relief and functional improvement in patients with knee OA. Aim: To assess the effectiveness of PFO in patients with primary medial compartment OA of the knee joint in terms of pain relief and functional outcome. Materials and Methods: A prospective and interventional study was carried out in the Department of Orthopaedics at Indira Gandhi Government Medical College, Nagpur, Maharashtra, India, during the period from November 2017 to October 2020. A total of 58 patients with moderate to severe symptoms of medial compartment knee OA underwent PFO. Visual Analogue Score (VAS score), Knee Society Score (KSS), and Femoro-tibial Angle (FTA) were assessed preoperatively, postoperatively, and during follow-up visits at 1, 3, 6, and 12 months. These parameters (VAS score and KSS) were also compared with groups based on Body Mass Index (BMI) and Kellgren-Lawrence (K-L) grading. Paired-t test was used. A p-value of <0.001 was considered statistically significant. Results: Remarkable pain relief was observed by the significant decline in mean VAS score from 8.04±0.68 to 2.65±1.14 at the final follow-up. Mean KSS at final follow-up was 69.82±3.03, which was significantly higher than the preoperative score of 43.38±2.39 (p-value <0.001). A change in mechanical alignment was seen with a decrease in mean FTA from 183.38±1.29° to 179.84±1.83° (p-value <0.001) at the final follow-up. Also, it was observed that results were much more encouraging and consistent in patients with BMI ≤24.99 unit kg/m² and K-L grades 1 and 2. Conclusion: The PFO is a simple, safe, reasonable, and effective surgical modality of treatment in patients with primary medial compartment knee OA that provides good pain relief and functional improvement. PFO can be an alternative treatment modality for pain relief in patients with medial compartment knee OA.

Variations in the Ventral Branches of Abdominal Aorta by Computed Tomography: A Cross-sectional Study

Tajinder Pal Kaur, Monika Gupta, Manjot Kaur

Introduction: Computed Tomography is an advanced imaging technique of radiography which gives good information regarding vascular anatomy. Abdominal aorta and its branches show variations in their origin. The present study may facilitate the clinicians and surgeons for planning treatment and thus, post-treatment complications may be reduced. Aim: To find out the variations in the origin of ventral branches of abdominal aorta in relation to vertebrae and diameters of these arteries at their level of origin. Materials and Methods: A descriptive cross-sectional study was done on Contrast Enhanced Computed Tomography scan films of abdomen of 300 patients. The duration of study was of two years and four months, from September 2020 to January 2022. To determine the level of origin of ventral branches of abdominal aorta, every branch was divided into four types (Type I to IV) depending on the level of origin in relation to intervertebral disc, upper 1/3^rd, middle 1/3^rd and lower 1/3^rd of body of corresponding vertebra. Diameter of each branch was measured at its level of origin. Results: Statistical analysis of data had shown that the most common origin of Celiac Trunk (CT) was at the level of T12 vertebra (44.33%), for Superior Mesenteric Artery (SMA), the most common origin was at the level of L1 vertebra (64%) and for Inferior Mesenteric Artery (IMA), the most common origin was at the level of L3 vertebra (68.67%). Mean diameter of CT, SMA and IMA was 5.91±0.48 mm, 5.86±0.40 mm and 3.13±0.44 mm, respectively. Variations in the level of origin have significant correlation to vertebra (Pearson’s correlation coefficient=0.01). Conclusion: The CT, SMA and IMA have shown variations in their level of origin and significant correlation with each other in relation to corresponding vertebra. This knowledge can be helpful to the clinicians and surgeons while planning treatment of abdominal organs.

Efficacy of Probiotic and Herbal Chewing Gums on Salivary pH in 6-11 Years Age Group Children: A Randomised Clinical Trial

Introduction: Saliva is a crucial diagnostic tool to evaluate oral health. Chewing sugar-free gum is an effective method to increase salivary flow and can also be employed a medium for the administration of medicinal ingredients. Aim: To evaluate and compare the effect of chewing xylitol, herbal and probiotic chewing gums on salivary acidogenicity levels. Materials and Methods: A single centre, randomised, double-blind, multiple arm parallel clinical trial was conducted on 60 children aged between 6-11 years. Baseline salivary pH was recorded with the pH meter and then the participants were asked to consume chocolate and salivary pH was recorded at an interval of 5, 30, and 60 minutes. Then children were randomly allocated to Group A-Xylitol chewing gum (control group, n=20), Group B-Herbal chewing gum (n=20), and Group C-Probiotic chewing gum (n=20) and instructed to chew gum according to their assigned group and salivary pH was again recorded at an interval of 5, 30, and 60 minutes. The change in salivary pH was evaluated using one-way Analysis of Variance (ANOVA) and Post-hoc Bonferroni’s test. Results: The mean age of the study population was 9.23±1.38 years. Statistically significant (p<0.001) increase in pH was recorded post consumption of probiotic, xylitol and herbal chewing gums and the mean salivary pH values recorded at 60 minutes were 7.20±0.21, 7.01±0.23 and 6.43±0.22, respectively. Conclusion: The observations of the study showed that xylitol, herbal and probiotic chewing gums reversed the fall in salivary pH, after an acidogenic challenge with probiotic being better among the three groups.

Ropivacaine versus Bupivacaine-lidocaine Mixtures used in Peribulbar Blocks for Cataract Surgery: A Randomised, Triple-blind Clinical Study

Introduction: Till recently, for providing anaesthesia for cataract surgeries peribulbar blocks were most commonly employed using various proportions of 0.5% bupivacaine and 2% lidocaine mixtures. As both these anaesthetic agents were reported to produce cardiovascular and Central Nervous System (CNS) side-effects, safer agents like levobupivacaine and ropivacaine are being introduced into clinical practice. Aim: To make a comparative evaluation of the characteristics of peribulbar blocks with 0.75% ropivacaine vis-à-vis the popularly used bupivacaine plus lidocaine mixtures. Materials and Methods: A randomised, single centre and triple-blind clinical study was undertaken between August 2021 and December 2021 comparing ropivacaine versus bupivacaine-lidocaine mixtures. A total of 90 patients attending the hospital for cataract surgeries were allocated into three groups of 30 each. Peribulbar blocks were given with 6 mL of 0.75% ropivacaine in group R, 6 mL of 1:1 mixture of 0.5% bupivacaine and 2% lidocaine in group BL, and 6 mL of 1:1 mixture of 0.5% bupivacaine and 2% lidocaine with adrenaline in groups BLA. The primary outcome measure was the total duration of analgesia (pain in the eye of grade >2). The secondary outcome measures studied were the time to onset of the motor and sensory blocks, the total analgesic requirement in the first 24 hours after surgery and changes in the Intraocular Pressures (IOP) after administration of the block. For statistical analysis, Analysis of Variance (ANOVA) and posthoc test of Tukey’s Honestly Significant Difference were used for parametric data and Chi-square test was used for non parametric data and a p-value of 0.05 was considered statistically significant. Results: The demographic characteristics and the baseline vital signs were comparable in all the three groups. Duration of the analgesia of the block was 4.2±0.79 hours, 3.6±1.08 hours, and 3.8±0.55 hours in groups R, BL and BLA, respectively. The total duration of analgesia was significantly longer in group R. The total analgesic consumption was 58.3 ±18.9, 75±25.42 and 68.3±24.5 and patients of group R had a significantly decreased consumption. There was a significant reduction in IOP in the patients of group R compared to other groups and the differences observed at 5 minutes,10 minutes and 25 minutes intervals were found to be statistically significant. Burning sensation in the eyes while injecting the drug for the peribulbar block was reported by 2, 10 and 12 patients, respectively in groups R, BL and BLA and the patients of group R were found to have less number of burning sensation episodes which was statistically significant (p-value=0.0084). More number of patients and surgeons in groups R had greater satisfaction levels. Conclusion: In peribulbar blocks, 6 mL of 0.75% ropivacaine produces satisfactory block characteristics with prolonged analgesia, reduced IOP, stable haemodynamics and optimal surgical operating conditions and patient satisfaction levels.

Association of Bleeding Patterns with Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding: A Prospective Cross-sectional Study

Introduction: Excessive menstruation outside the normal parameters is one of the most common manifestations of hypothyroidism affecting the females. Thyroid disorders, such as hypothyroidism and hyperthyroidism are associated with late onset puberty, anovulatory cycles and abnormally high incidence of foetal morbidity and mortality. Aim: To study the association of bleeding pattern with thyroid dysfunction among patients with Abnormal Uterine Bleeding (AUB). Materials and Methods: This was a prospective cross-sectional study carried out in the Department of Obstetrics and Gynaecology at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from October 2012 to June 2014, among 140 females with a provisional diagnosis of abnormal uterine bleeding were subjected to testing for serum Triiodothyronine (T3), Thyroxine (T4), Thyroid Stimulating Hormone (TSH) and Thyroid Peroxidase (TPO) antibodies estimation in their serum. Data was analysed using Chi-square test and the p-value <0.05 was considered significant. Results: Total of 140 patients, with maximum number of patients in the study belonged to the age group 31-40 years, 57 (40.71%) and 46 (32.8%) patients were para 2. Among different bleeding patterns observed, most common was menorrhagia, 62 (44.28%). The prevalence of subclinical hypothyroidism was 10 (7.14%), there were five hypothyroid cases (3.5%), and two hyperthyroid cases (1.4%) among 140 cases. The total thyroid disorders associated were 17 (12.14%). Conclusion: In the present study, association of thyroid dysfunction with AUB has been noted. With early diagnosis of thyroid disorders in AUB patients, followed by appropriate treatment, the menstrual irregularities can be resolved and major surgical procedures can be avoided.

Evaluation of Shear Bond Strength of Incremental Layer of Self-etch Self-adhesive Novel Flowable Composite after Salivary Contamination: An In-vitro Study

Introduction: Contamination of composite restoration during incremental placement leads to decrease in the incremental bond strength. Adhesive application on freshly contaminated resin surface increases the bond strength but is a complex and time-consuming procedure. Recently composite systems combining etchant, bonding agent and flowable composite into a single component have been introduced to simplify bonding and save time. In this study incremental layer shear bond strength is utilised to assess bond stability at resin-resin interface after salivary contamination. Aim: To evaluate shear bond strength of incremental layer of self-etch self-adhesive novel flowable composite after salivary contamination. Materials and Methods: The present in-vitro experimental study included 55 acrylic resin cylinders (2×2.5 cm) with square shaped cavity (5×5 mm, thickness 2 mm) restored with DMGTM Constic flowable composite that were randomly divided into five groups with eleven specimens per group. Group I: No salivary contamination, Group II: Salivary contamination followed by air drying, Group III: Salivary contamination followed by rinsing and air drying. Group II and III were subdivided into subgroup a: application and brushing of 0.5 mm of Constic followed by light curing and filling of rest of mold by Constic, subgroup b: direct application of 2 mm of Constic. Shear bond strength between increments of composite was determined by universal testing machine. Data were analysed using One-way ANOVA test and Independent t-test. Level of significance was kept at 5%. Results: Incremental shear bond strength (MPa) was highest for group I (12.09±1.99) followed by group IIIa (10.21±3.49), group IIa (10.08±3.21), group IIb (7.59±2.31) and lowest for group IIIb (7.35±3.06). Conclusion: Active application of self-etch self-adhesive flowable composite successfully restores the incremental shear bond strength after salivary contamination.

Correlation of 25-Hydroxy Vitamin D and Serum Lipid Profile amongst Asymptomatic Adults in Mumbai City: A Cross-sectional Study

Introduction: Deficiency of 25-Hydroxy Vitamin D (25-OH Vitamin) is prevalent globally. Vitamin D and cholesterol metabolism are known to be linked with each other. Few International studies have attempted to relate low Vitamin D level and altered serum lipid levels. However, Indian studies are lacking, hence there is a need to conduct the studies in Indian population. Aim: To study the correlation of the serum Vitamin D level with lipid profile amongst asymptomatic Indian adults in a tertiary care hospital, Mumbai, India. Materials and Methods: This cross-sectional study was conducted in SevenHills Hospital, Mumbai, Maharashtra, India (tertiary care hospital), from December 2016 to August 2017. A total of 243 asymptomatic adults, visiting the wellness clinic for routine assessment of health status were randomly selected. Study participants were divided into two groups based on Vitamin D levels. Group A (n=139) with Vitamin D level <20 ng/mL, group B (n=104) with Vitamin D ≥20 ng/mL. Group B was further segregated into sub group B1 (n=60) with Vitamin D level ≥20 ng/mL to <30 ng/mL and sub group B2 (n=44) with Vitamin D level ≥30 ng/mL. Fasting blood samples were collected to measure levels of serum Vitamin D and lipid profile. The measured values of Vitamin D and serum lipids were statistically analysed for any significant relationship using Chi-square test and Unpaired t-test and Pearson’s correlation. Results: Mean age of the participants of group A was 39.94±11.59 years and group B was 47.78±11.53 years. The difference in gender distribution and average BMI of both groups was not statistically significant (p-value=0.8599 and p-value=0.4497, respectively). On comparison of group A and group B2, average High Density Lipoprotein Cholesterol (HDL-C) level was comparatively higher amongst group B2 (52.18±11.87 mg/dL vs 45.81±12.76 mg/dL; p-value=0.0038) and average Triglyceride (TG) level was higher amongst group A (104.58±70.35 mg/dL vs 129.38±64.34 mg/dL; p-value=0.0308). There was no statistically significant linear correlation found between lipid profile parameters and Vitamin D. Conclusion: In present study, no significant correlation between Vitamin D deficiency and serum lipid profile was found. However, a statistically significant difference was found in average levels of HDL-C and TG amongst adults with adequate Vitamin D and those with Vitamin D deficiency.

Baska Mask in Patients undergoing Elective Breast Surgeries under General Anaesthesia: An Observational Study

ND Rachana, NS Shruthi, Vijay Mahantesh, CS Sumitha, VB Gowda, Namrata Ranganath

Introduction: Supraglottic airway devices are newer safer alternative devices to endotracheal intubation during General Anaesthesia. The Baska mask is a novel third generation Supraglottic Airway Devices (SADs) with an added advantage of silicon self-recoiling, non inflatable cuff. Postgraduate trainees will need hands on training in all available airway securing devices and have experience in using the Baska mask and also complications associated with it. Aim: To assess the successful insertion of Baska mask by postgraduate trainees, and its placement in 50 low-risk female patients posted for breast surgeries, and also to determine the correct placement using fibreoptic bronchoscope. Materials and Methods: The present study was an observational study conducted at Kidwai Cancer Institute, Bangalore, Karnataka, India from January 2019 to January 2020 in which a total of 50 study participants were selected, and Baska mask was inserted by postgraduate trainees in all patients. The placement of the mask was assessed by fibreoptic bronchoscope using Brimacombe scoring. Ease of insertion, time required for insertion and attempts required for the insertion of the mask was assessed along with postoperative complications. Student’s t-test and Chi-square test were used to study the parameters on continuous scale and categorical scale, respectively. Results: The mean age of the study population was 46.9±7.8 years. The overall success rate for device insertion was 96%, while the success rate for the first insertion attempt was 60%. The device was ‘easy’ to insert among 48% of patients, and mean time required for insertion was 20.54±10.7 sec. The mean airway leak pressure was 39.17 cmH₂O. Postoperative complications were notably less with sore throat seen in 20.8%, and the incidence of other side-effects like laryngospasm was nil. Conclusion: Baska mask can be successfully and safely used by postgraduate trainees as a tool for securing the airway. As learning curve for Baska mask is short, it can be used safely for training postgraduate trainees and to improve their expertise in using the Baska mask.

Red Blood Cell Morphology in Diabetic Patients: A Case-control Study

Anmol Taneja, Miheer Jagtap, Samarth Shukla, Sunita Vagha

Introduction: According to earlier studies, patients suffering from diabetes frequently experience haematological changes. India is the diabetes capital, with 69.1 million residents suffering from the disease. Aim: To study Red Blood Cell (RBC) morphological changes and grading on percentage of cells that differ in size and shape from normal erythrocytes in diabetic patients. Materials and Methods: The case-control study was conducted at Division of Central Clinical Laboratory in Department of Pathology in coordination with Department of General Medicine at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, from October 2019 to October 2021. Total 90 known cases of diabetes mellitus, aged between 18-80 years and 90 subjects (control group) with normal blood glucose levels were included for the study. Demographic details, anthropometric, parameters i.e, Fasting Plasma Glucose (FPG), Random Blood Sugar (RBS), Glycated haemoglobin (HbA1c) and morphology of blood smear were assessed. Results: The mean age of study group was 54.98±2.31 years and control group was 50.45±17.94 years (p-value=0.0004). The mean random blood sugar of study group was 163.92±91.31 mg/dL and of control group was 96.92±22.31 mg/dL (p-value=0.0001). Mean HbA1c for the study group was 7.73±1.71%, while in control group was 5.24±0.62% (p-value=0.0001). In the study group, 9 (10%) cases showed a slight anisocytosis (1+) and 3 (3.3%) cases showed moderate anisocytosis (2+), 2 (2.2%) cases showed marked anisocytosis (3+) (variation in size of RBCs with respect to normal) in respect to Mean Corpuscle Volume (MCV), and 11 (12.2%) cases showed MCV <80 fL, 2 (2.2%) cases showed MCV >80 fL, while majority of the cases; 77 (85.5%) had normal sized RBCs, had MCV between 80-99 fL. Conclusion: The findings of the study suggest that there is need for some simple and effective techniques like ectocytometry, micropore filtration for routine haematological tests in type 2 diabetes mellitus.

Effect of Teneligliptin versus Glimepiride on Tumour Necrosis Factor Alpha and High Sensitivity C-Reactive Protein in Type 2 Diabetes Mellitus Patients Treated with Metformin: A Randomised Double-blind Parallel Group Study

Maleha Butul, Pingali Usharani, MVS Subbalaxmi

Introduction: Inflammatory markers like Tumour Necrosis Factor-α (TNF-α), C-Reactive Protein (CRP), and Interleukin-6 (IL-6) play intermediary role in insulin resistance, pathogenesis of Type 2 Diabetes Mellitus (T2DM) and its complications. Hence, antidiabetic drugs having anti-inflammatory effects may play an important role in management of T2DM and prevention of its complications. Aim: To study the effect of glimepiride versus teneligliptin on TNF-α, high sensitivity C-reactive Protein (hsCRP) and Diabetic Peripheral Neuropathy (DPN) in T2DM patients on metformin. Materials and Methods: The randomised, double-blind, parallel group study was conducted in Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2018 to October 2019. Total 44 participants were screened and 40 participants of either gender, age range of 35-65 years, Body Mass Index (BMI) ≥25-≤35 kg/m² and Fasting Blood Sugar ≥126 to ≤200 mg/dL, and glycosylated-haemoglobin (HbA1c) 7.0 to ≤10.0% were included into the study. The T2DM patients (N=40) on metformin (1500-2500 mg/day) were randomised to receive glimepiride (2 mg/day) and teneligliptin (20 mg/day) in group A and group B for 12 weeks, respectively. TNF-α, hsCRP and Vibration-Perception Threshold (VPT) at baseline, 4 weeks and 12 weeks were evaluated for all participants. FBS, HbA1c, Adverse Drug Reactions (ADRs) were also recorded. Unpaired t-test and repeated-measures Analysis of Variance (ANOVA) for normally-distributed variables using Shapiro-Wilk’s test was done. Mann-Whitney and Friedman’s test for non normally distributed variables; for between-group and within-group analysis, respectively were done. Results: Forty T2DM patients (17 males and 23 females) with mean age of 49.45±6.8 and 50.3±7.9 years, were studied. The mean TNF-α level reduced significantly, in group B (159.25±58.58 to 83.15±26.18 pg/mL; p-value<0.001) from baseline to 12 weeks. Similar significant reduction was seen in the group A (175.2±66.13 to 116.15±63.32 pg/mL; p-value<0.05). There was significant reduction observed in mean VPT-scores (25±6 to 18.0±5.22 V; p-value <0.001) and (26±12.11 to 25±12 V; p-value <0.05) in group B and group A, at 12 weeks, respectively. However, both study groups showed non significant decrease in mean hsCRP levels at 12 weeks. There was a non significant reduction in all study parameters at four weeks. Mean percentage reduction of 34% and 44% in TNF-α, 13% and 11% in hsCRP and 7% and 27% in VPT-scores was observed in group A and group B, respectively at 12 weeks. Improvement in FBS and HbA1c levels (p-value <0.001) was observed in both study groups. Both treatments were tolerated well and no serious adverse drug reactions were observed. Conclusion: Teneligliptin by reducing TNF-α level, demonstrated modest anti-inflammatory activity along with metformin, by 12 weeks. It also improved VPT-scores. Glimepiride showed lesser degree of anti-inflammatory activity compared to teneligliptin. Both study drugs did not affect hsCRP levels.

Assessment of Intraoperative Blood Transfusion Practices during Elective Surgeries in a Tertiary Care Hospital: A Prospective Cross-sectional Study

Mansi Uday Vaidya, Prerana Nirav Shah

Introduction: Blood transfusion remains the cornerstone of managing volume depletion and blood loss during surgeries. There are always patients and situations which clearly benefit from blood transfusion intraoperatively. Crystalloids and colloids cannot replace blood, as a substitute when the patient’s oxygen carrying capacity has been compromised. Anaemia in acute and chronic conditions is associated with increased risk of morbidity and mortality. Thus, blood transfusion has a very important role in the perioperative management of the patient. Aim: To ascertain the common indications for which anaesthesiologists start perioperative blood transfusion, the rates of intraoperative overtransfusion, and to assess the variation in the blood transfusion practices at the study Institution from standard guidelines. Materials and Methods: A prospective cross-sectional study was conducted on 168 patients patients operated at Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India, from February 2017 to July 2017. The patients were adult American Society of Anaesthesiologists Physical Status (ASA-PS) I and II, undergoing elective surgeries and required transfused blood intraoperatively. Operating room anaesthesiologists completed a record form for each of the patient. The form included details of the patient like age, gender, weight, type and duration of surgery, preoperative haemoglobin (done within 48 hours preoperatively), intraoperative blood loss, fluids and blood, and blood products transfused intraoperatively. The postoperative Haemoglobin (Hb) levels (done between 6 hours-24 hours postoperatively) were also recorded. Results: The study showed that, 76 out of the 168 (45.2%) patients, who were transfused blood intraoperatively had been overtransfused, i.e., their postoperative Hb values were more than 10 g/dL. Blood loss was the sole indication for transfusion in 41 out of 168 (24.4%) patients. Blood was transfused in patients with low preoperative Hb in 21/168 (12.5%) patients, while it was done on surgeon’s request in 13/168 (7.7%) cases. Pallor, hypovolaemia and haemodynamic instability as sole indications included only 4.8%, 2.4% and 1.2% cases, respectively. Conclusion: The present study revealed that a significant number (45.2%) of patients were overtransfused. A wide variation exists from the standard guidelines among anaesthesiologists. Implementation of restrictive transfusion strategies and a protocol-based intraoperative transfusion is required to optimise patient outcome.

Role of Telemedicine in Otorhinolaryngology during COVID-19 Pandemic in a Tertiary Care Centre of Tamil Nadu: A Prospective Cohort Study

S Prabakaran, SR Karthika, RB Namasivaya Navin, S Rajasekaran

Introduction: Telemedicine is the practice of using telecommunication technology to provide healthcare services to patients in remote areas. Teleconsultation is used in various specialties of medicine, especially during the COVID-19 pandemic situation. But in developing countries like India, it is less practicable in surgical specialties like Otorhinolaryngology. Aim: To determine the eligibility and effectiveness of telemedicine practice in otorhinolaryngology during the COVID-19 pandemic in a tertiary care centre of Chengalpattu district, Tamil Nadu, India. Materials and Methods: A prospective cohort study was conducted at Chettinad Hospital and Research Institute, Tamil Nadu, India from September 2021 to February 2022 which involved 90 patients who requested a consultation for various ear, nose, and throat complaints. Based on history, a provisional diagnosis was made and treated. Feedback forms contained 11 questions were sent during the revisit and analyses were made. Statistical analysis were done using mean, proportion and Chi-square test. Results: This study included 49 (54.4%) male and 41 (45.6%) female patients with a mean age of 40.68 years. Only 23 (25.6%) patients had no problem seeing the doctor clearly and 19 (21.1%) had no trouble hearing the doctor. Only 4 (4.4%) patients accepted teleconsultation and will use teleconsultation services again. Conclusion: This study concluded that teleconsultation practice was not satisfactory for the majority of patients in the field of otorhinolaryngology. The inability to arrive at the definitive diagnosis and subsequent therapeutic procedures by using telemedicine was the limitation.

Analysis of Water, Sanitation and Hygiene in an Urban Community of Koppal, Karnataka, India: A Cross-sectional Study

Smita M Nimbannavar, Vijaykumar P Mane

Introduction: Water, Sanitation and Hygienic (WaSH) practices are the major predictors of morbidity, mortality as well as nutritional status and are highly cost-effective. Their adequate implementation contributes to overall improvement of the population. Many communicable diseases can be effectively managed by improving the sanitation, hygiene and water usage practices. Globally, limited access to water and low level of sanitation and hygiene practices are responsible for 90% of diarrhoea-related mortality. Aim: To estimate the proportion of population having access to safe water, adequate sanitation and practice of hand hygiene among people at Koppal, Karnataka, India and also to determine their association with occurrence of diarrhoeal episodes. Materials and Methods: This community-based cross-sectional study was conducted in the field practice area of Urban Health Centre (UHC), Koppal, Karnataka, India, from March 2019 to July 2019. Simple random sampling technique was used for sample selection and a total of 410 households were included in the study. Data about source, availability, accessibility, treatment methods of water, availability of toilet, details about domestic hygiene, hand hygiene practices and also history of diarrhoeal episodes among members of the household were collected through interviews using pretested and semi-structured questionnaire. Statistical analysis was done using Epi info software version 3.5.4 {Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America}. WaSH practices were presented as percentages and Chi-square test at 5% level of significance was applied to test the association between the occurrence of diarrhoeal episodes and the various environmental factors. Results: The primary source of drinking water in majority (314, 76.58%) of households was piped corporation water and majority (309, 75.36%) of households had individual toilets. Majority (390, 95.12%) of the respondents practiced to wash hands after using toilet followed by 349 (85.12%) respondents admitted to wash hands before taking meals. Diarrhoeal episodes among household members, were found to be significantly associated with piles of solid waste around their households. Conclusion: The present study finds that three out of four households had access to safe water and one out of three households treated water before drinking. More than nine among ten households had access to either individual or community toilet facilities. Similarly, nine out of ten participants admitted to wash their hands after using toilet and eight washed before taking meals. Solid waste piles around households were identified as risk factors for occurrence of diarrhoea both among adults and children.

Antiplatelet Efficacy of 75 mg Aspirin Once a Day versus Twice a Day Dosing in Type 2 Diabetes Mellitus Patients- A Longitudinal Open Label Study

Mayur B Phulpagare, Smita A Tiwari, Rajesh S Hiray

Introduction: Patients of Type 2 Diabetes Mellitus (T2DM) characteristically have platelets hyper-reactivity and accelerated turnover rates leading increased adhesion, aggregation and procoagulant activity. Half-life of aspirin is only 20 minutes and it, therefore, irreversibly inactivates limited number of platelets over this short duration, when given as a once-daily dose. Newly generated-active platelets enter circulation, thereafter, and weaken antiplatelet effect of aspirin. Therefore, single daily dose of 75 mg aspirin may be insufficient to provide 24 hours protection against cardiovascular events, in these patients. Aim: To study and compare antiplatelet efficacy of 75 mg aspirin twice a day (75 mg BD) versus 75 mg aspirin once a day (75 mg OD) in patients of T2DM and to study the effect of variation in glycated haemoglobin (HbA1c) levels on antiplatelet efficacy. Materials and Methods: This was a longitudinal, open label, comparative trial conducted at tertiary care hospital for a period of nine months. A total of 129 subjects, diagnosed with T2DM according to American Diabetes Association (ADA) criteria 2018 (N=129) were enrolled in the study, of which nine were lost to follow-up and antiplatelet efficacy of aspirin dosing was examined at baseline and three-monthly intervals thereafter, till nine months, using colorimetric method. Results: Mean age of enrolled patients was 62 years (Interquartile Range (IQR) 57-66). HbA1c levels of both the groups were comparable (p=0.77) at baseline. At the end of nine months, percentage platelet aggregability of the 75 mg B.D. group (29.30±10.39) was significantly lower (p<0.00001) than that of 75 mg OD (38.20±10.36). There was no correlation observed between HbA1c variation and percentage platelet aggregability for entire study population. Conclusion: Present study concludes that, 75 mg OD aspirin as a strategy for secondary cardiovascular disease prevention is advocated, but not adequate in T2DM patients. Splitting a dose of 150 mg/day aspirin as 75 mg twice is more effective, due to increased platelet turnover in diabetic patients.

Immunofluorescence on Formalin Fixed Paraffin Embedded Renal Tissue Sections: A Retrospective Study

Renuka Malipatel, Gnanapriya Vellaisamy, Pritilata Rout

Introduction: Direct Immunofluorescence (DIF)/Routine Immunofluorescence (R-IF) on frozen sections is vital in the work-up of renal diseases. Sometimes, the unfixed sample may not be available for DIF or the sample may be inadequate. Paraffin Immunofluorescence (P-IF) can be used as a salvage technique in these situations. R-IF is more sensitive than P-IF in detecting Immunoglobulins (Ig) and complements. P-IF detects characteristic immunoglobulins and complements in the majority of glomerular diseases. Aim: To evaluate the sensitivity of the P-IF in comparison to the gold standard R-IF in renal biopsies with proliferative and non proliferative glomerular diseases. Materials and Methods: The present study was a retrospective study done on 52 selected cases, at St. John’s Medical College, Bangalore, Karnataka, India, data collected from January to December 2016. Based on the clinical differential diagnoses, light microscopy and R-IF findings; selected panels of immunostains (IgG, IgA, IgM, C3, C1q) were done. Proteinase K was used for enzymatic digestion. Immunofluorescence intensity was scored by two pathologists independently. Any specific pattern of staining of atleast 1+ intensity was considered as positive on P-IF. Sensitivity, specificity and confidence intervals were estimated for P-IF. Results: P-IF was done on a total of 52 selected cases. In this study P-IF showed 100% sensitivity for diagnosis of lupus nephritis, infection related glomerulonephritis, Henoch-Schönlein Purpura (HSP) nephritis and 78% for IgA nephropathy. Overall sensitivity in the diagnoses of common glomerular diseases studied was 90% (95% CI=78.97-96.80, p-value=0.025). It was less sensitive for detecting C3. Conclusion: This retrospective study demonstrated that, P-IF has a good sensitivity for diagnosing common glomerulopathies like IgA nephropathy and lupus nephritis. P-IF is a good adjunct to R-IF testing with 100% specificity.

Assessment of Mesiodistal Angulation of Maxillary Lateral Incisors: A Cross-sectional Study

Neha Hajira, HS Shashi Dhara, Pulkit Khandelwal

Introduction: Idealistic prosthodontic treatment goals differ for different ethnic groups around the world. Dentogenic concept provides a quality of treatment and a more natural, harmonious and pleasing prosthesis as desired by patients. Providing natural and satisfactory aesthetics is especially important for anterior tooth prosthesis. Various degrees of crown angulation, have significant effect on attractiveness of smile. Aim: To study the degree of mesiodistal angulation of maxillary right and left lateral incisors in both genders of different age groups, to guide in the arrangement of teeth fulfilling the fundamentals by providing a functionally and aesthetically satisfactory denture. Materials and Methods: This cross-sectional study was conducted in Department of Prosthodontics at College of Dental Sciences, Davangere, Karnataka, India, from June 2012 to May 2015. A total of 500 patients with normal maxillomandibular relationship (250 males and 250 females) were included in the study and were divided into three age groups i.e, group A (21-30 years), group B (31-40 years), group C (41-50 years). Clinical examination of patients was performed and dental casts of these patients were studied. A custom-made positioning jig was used to measure the mesiodistal angulations of maxillary right and left lateral incisors. The results were obtained by statistical analysis using paired-t test, One-way Analysis of Variance (ANOVA) and Tukey’s Post-Hoc tests. Results: The mean value for mesiodistal angulation of maxillary right and left lateral incisors in males was found to be 6.648±0.9889 and 6.704±1.0042 degrees, respectively. The mean value for mesiodistal angulation of maxillary right and left lateral incisors in females, was found to be 6.592±0.8296 and 6.580±0.8381 degrees, respectively. Conclusion: The mesiodistal angulation of maxillary lateral incisors was comparatively greater in males than in females and the variation in the angulation was slightly more for maxillary left lateral incisors. The values for mesiodistal angulations of maxillary lateral incisors can serve, as guidelines for the arrangement of teeth and help in achieving desired aesthetics, provide adequate lip support and restore required functions.

A Cross-sectional Observational Study on Distal Femoral Morphometry in West-central Maharashtra, India

Anil Kumar Dwivedi, Niyati Airan, Rajan Bhatnagar

Introduction: Femur or thigh bone is the longest bone of the human skeleton. The lower end of the femur articulates with the tibia to form the knee joint. Femur shows morphometric variations in relation to geography, race, ethnic group, and gender. Aim: To measure various dimensions of the lower end of the femur in West-central Maharashtra, India. Materials and Methods: A cross-sectional observational study was conducted in the Department of Anatomy, Armed Forces Medical College, Pune, Maharashtra, India from May 2010 to May 2013 on 280 adult dried femora (136 Right and 144 Left). The lower ends of the femora were evaluated for bicondylar width (BCW), anteroposterior diameter of both medial and lateral condyles, the transverse diameter of both medial and lateral condyles, intercondylar notch width, notch width index, and femoral aspect ratio. All the measurements of the right and left femur were obtained by Vernier caliper and recorded separately. The data was analysed statistically using student’s t-test. The p-value <0.05 was considered statistically significant. Results: The mean bicondylar width for the right and left-side were 72.83±5.09 mm and 71.83±5.65 mm, respectively. Medial condyle anteroposterior diameter (MCAPD) for right and left femur were 56.99±3.79 mm and 55.20±4.35 mm. Lateral condyle anteroposterior diameter (LCAPD) for right and left femur were 57.48±4.96 mm and 56.37±4.55 mm. Medial condyle transverse diameter (MCTD) for right and left-side were 23.68±2.68 mm and 23.63±2.40 mm. Lateral condyle transverse diameter (LCTD) for right and left-side were 25.26±2.56 mm and 25.24±2.62 mm. Intercondylar notch width (ICNW) for right and left-side were 21.06±2.45 mm and 21.00±2.62 mm. Notch width index for right and left femur were 0.29±0.03 and 0.29±0.03. The Femoral Aspect Ratio (FAR) for right and left-side was 1.27±0.07 and 1.28±0.05, respectively. In this study, there were no statistically significant differences between values of right and left-sides except, medial condyle anteroposterior diameter showed a statistically significant difference between the two sides (p=0.0002). Conclusion: The morphometric data collected from the lower end of the femur indicated ethnic variations with a different populations in India and abroad. Values obtained in the present study were less than the dimensions of commonly available femoral implants because the design of most of these implants is based on dimensions of foreign populations, indicating size mismatch. These data will aid in the decision-making and implant design, suitable for local population.

Prevalence of Endometrial Polyp by Office Hysteroscopy at a Tertiary Care Centre in Western Maharashtra: A Prospective Cohort Study

Bidhan Roy, Aruna Menon, Soumen Das Poddar, Ritam Bhattacharya

Introduction: Endometrial polyps occur in different reproductive age groups and make it a distinct pathological entity with diverse clinical manifestations. Aim: To determine the prevalence of endometrial polyp detected by office hysteroscopy, among different cohorts of patients attending the Gynaecology outpatient department at a tertiary care centre in western Maharashtra, India. Materials and Methods: A prospective cohort study was conducted in women who underwent office hysteroscopy, in view of infertility and Abnormal Uterine Bleeding (AUB) at a tertiary care centre in western Maharashtra, India from November 2020 to October 2021. The study included a total of 227 patients which were divided into four cohorts of women namely, infertility patients (aged 25-35 years) (N=115), AUB patients (aged 40-44 years) (N=29), AUB patients (aged 45-50 years) (N=49) and in postmenopausal women (aged more than 51 years) (N=34). Results were expressed in terms of frequency and percentages. Results: Endometrial polyp was detected among 45 patients (19.82%) out of a total 227 patients who underwent office hysteroscopy. The prevalence rate was 16 (13.9) among women with infertility, 5 (17.2) among 40-44 years old women with AUB, 15 (30.6) among 45-50 years old women with AUB and 9 (26.5) among postmenopausal women. Conclusion: Endometrial polyp has a significant prevalence in patients with infertility as well as in patients with AUB. It can be easily detected by diagnostic office hysteroscopy, which should be included in the work-up of such patients.

Clinical Evaluation of Intradermal Platelet Rich Plasma Administration along with Oral Biotin Supplement for the Management of Androgenetic Alopecia in Adult Males: A Randomised Clinical Trial

Neha Gupta

Introduction: Androgenetic Alopecia (AA) is characterised by progressive-patterned hair loss from the scalp affecting males and females alike. Miniaturisation of the hair follicle with associated hereditary tendency is one of the major primary causal factors for the pathogenesis of AA. Various treatment modalities have been proposed for the management of AA including minoxidil, finastride, etc.; however, they are associated with known side-effects. Aim: To evaluate the effect of intradermal Platelet Rich Plasma (PRP) administration, along with oral biotin supplement for the management of AA in males. Materials and Methods: The present randomised clinical study was conducted at Department of Dermatology, B.J. Medical College and Hospital, Ahmedabad, Gujarat, India from January 2012 to May 2013. A total of 40 healthy adult males of Indian origin, with a history of hair loss, completed the 12 month trial. They were equally randomised into two groups. Subjects enrolled in group A (n=20) received intradermal administration of autologous PRP, every 15 days for three months along with oral biotin tablets, once daily for three months, while those in group B (n=20) received oral biotin tablets, once daily for three months. Hair regrowth was evaluated using a standardised 7-point rating scale at 3, 6, 9 and 12 months intervals, by the same investigator. Chi-square test was used to statistically assess the data. The p-value for significance was established at <0.05. Results: Individuals in group A had mean age of 32.3±6.1 years and showed statistically significant (p-value <0.05) increase in hair regrowth at 6 months, 9 and 12 months; compared to Group B with mean age of 30.7±5.2 years. Conclusion: Intradermal administration of PRP along with oral biotin tablet supplementation resulted in a statistically significant increase in hair regrowth, without any remarkable side-effects. PRP is a safe and effective treatment modality in adult males, with AA.

Incidence of Intraoperative Hypotension and Bradycardia in Spinal Anaesthesia with 0.5% Bupivacaine alone and 0.5% Bupivacaine with Fentanyl for Abdominal Hysterectomy: A Cross-sectional Study

Swathy Sudan, Remani Kelan Kamalakshy, Sunil Raveendran, Ranju Sebastian

Introduction: Bupivacaine hydrochloride, when used for spinal anaesthesia, is associated with varying degree of hypotension and bradycardia. Intrathecal opioids provides haemodynamic stability and improves quality of perioperative analgesia. Aim: To compare the incidence of intraoperative hypotension, bradycardia and its side-effects when using 0.5% hyperbaric bupivacaine alone and with 25 μg fentanyl added to it for subarachnoid block for abdominal hysterectomy. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Thrissur, Kerala, India from June 2019 to May 2020 on 96 American Society of Anaesthesiologists Physical Status (ASA-PS) I and II patients posted for total abdominal hysterectomy under lumbar subarachnoid block. They were divided into Group A and B, carrying 48 patients in each group. Group A received 3.3 mL of 0.5% hyperbaric bupivacaine alone. Group B received 3.3 mL of 0.5% hyperbaric bupivacaine and 25 μg fentanyl. Haemodynamic characteristics, analgesic properties and side-effects were compared between Group A and Group B. Data were entered in Microsoft Excel Software, and analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0 and p-value <0.05 was considered as statistically significant. Results: The incidence of hypotension in group A was 41.7% and in group B was 39.6%. Incidence of analgesia was significantly higher in group B (group A- 181.2±4.9, group B- 220.9±13.9). In group A, no one had nausea and vomiting. In group B, 8.3% experienced nausea and vomiting and none in both groups experienced pruritus. Conclusion: There was no difference in the development of hypotension and bradycardia when fentanyl was added to bupivacaine for spinal anaesthesia and had the advantage of increased duration of postoperative analgesia.

Effectiveness of COVID-19 Vaccination against COVID -associated Mucormycosis

Rohit Mahla, Saurabh Shrivastava

Introduction: Coronavirus Disease-2019 (COVID-19) infections may be associated with a wide range of opportunistic bacterial and fungal co-infections. Both Aspergillus and Candida have been reported as the main fungal pathogens for co-infection in people with COVID-19. During the COVID-19 pandemic, another threat has emerged as a challenge to India was in the form of COVID-associated mucormycosis. Aim: To study the incidence of COVID-associated rhino-orbital mucormycosis in vaccinated and unvaccinated patients. Materials and Methods: A prospective observational study was carried out at Gajra Raja Medical College and Jay Arogya Hospital, Gwalior, Madhya Pradesh, India, over a period of two months (May to June 2021). A total of 94 patients with post-COVID rhino-orbital mucormycosis were reported in the institute during the study period. Biopsy or postoperative surgical specimens were received for histopathological examination with a proper history of diabetes mellitus, steroid intake, and vaccination status. Histologically confirmed COVID-associated rhino-orbital mucormycosis cases were included in the study and its incidence was compared in vaccinated and unvaccinated patients. Results: Total 94 patients were confirmed histopathologically, with mucormycosis. It was noted that mucormycosis was more common in males as compared to females. Of the total number of cases, 71 (75.5%) cases had a history of diabetes mellitus and 73 (77.7%) had a history of steroid intake. Eightysix (91.5%) cases were unvaccinated while only 8 (8.5%) were either completely or partially vaccinated. Incidence of mucormycosis was found to be more amongst unvaccinated patients as compared to vaccinated patients. Conclusion: Mucormycosis is one of the major post-COVID threats. Diabetes mellitus and steroid intake were found to be the main risk factors for post-COVID mucormycosis. However, it has also been noted that mucormycosis can occur without a previous history of diabetes and steroid intake. Incidence of mucormycosis was found to be higher amongst unvaccinated patients as compared to vaccinated patients. Hence, vaccination against COVID-19 is likely to be effective in the prevention of COVID-associated mucormycosis.

Assessment of Potential Risk Factors, Characteristics, and Outcome of Pneumothorax and Pneumomediastinum in Patients with COVID-19: A Retrospective Case-control Study

T Prasanna Kumar, K Madan, AS Arjun, N Monica

Introduction: Pneumothorax (PTX) and/or Pneumomediastinum (PMD) are rare complications of Coronavirus Disease-2019 (COVID-19) and are linked to high mortality. Incidence rates vary between 0.56-2.01% in the reported literature. With clinical examination being hampered in the current pandemic setting, there is a delay in the diagnosis. There is a need to identify and establish potential predictive factors, that may aid in identifying patients with a high-risk of developing PTX and/or PMD. Aim: To identify potential risk factors and thus, explore their association with PTX and/or PMD among patients with COVID-19. Materials and Methods: A retrospective case-control study was conducted at MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India, over a six-month period. A total of 130 patients diagnosed with COVID-19 were recruited in a 1:3 ratio as cases and controls, respectively. The study included 31 consecutive patients with PTX and/or PMD (cases) and 99 consecutive patients serving as controls, Cases were patients, diagnosed radiologically with PTX and/or PMD, and controls were, matched individuals without PTX and/or PMD. Patient’s clinical and laboratory parameters (complete blood count, renal and liver function tests, serum levels of inflammatory markers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-Dimer were tested for potential association with PTX and/or PMD. Student’s t-test, Chi-square test, multivariate and univariate logistic regression analysis were performed. Results: During the study period, there was a total of 3,251 COVID-19 admissions at the centre, with 976 patients requiring Intensive Care Unit (ICU) admission. The overall incidence of PTX and/or PMD during the study period was (31/3251) 0.95%. The previous history of COVID-19, non vaccination with COVID19 vaccine, cough as a predominant symptom, high values of baseline CRP, total bilirubin, Aspartate Transaminase (AST), and total leukocyte counts had a positive association. In-hospital mortality (54.8% vs 33.30%) and 28-day mortality (35.7% vs 7.6%) following discharge, were higher among those with PTX and/or PMD. Conclusion: Patients with a history of previous infection with COVID-19, non vaccination/incomplete-vaccination with COVID-19 vaccines, and patients with increasing total leukocyte counts and AST levels, high baseline total serum bilirubin were at increased risk of a detrimental clinical course and may indicate, the possibility of development of PTX and/or PMD in COVID-19 disease.

Effect of ACEi and ARBs vs Non ACEi/ARBs in Hypertension with Respect to Renal Outcomes in COVID-19 Infection: A Retrospective Cohort Study

S Ravitej, HA Krishnamurthy

Introduction: The Acute Kidney Injury (AKI) is one of the most common complications following Coronavirus Disease-2019 (COVID-19) infection. The presence of high density of Angiotensin Converting Enzyme 2 (ACE2) receptors in type 2 alveolar epithelial cells, vascular endothelium and proximal convoluted tubules explains the involvement of systemic organs in COVID-19 infection. Systemic hypertension is one of the most common co-morbidities associated with COVID-19 infection with high mortality, especially in patients of severe disease with AKI. The antihypertensives, which work by Renin Angiotensin Aldosterone System (RAAS) inhibition like ACE inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs) can upregulate the enzyme ACE2, so, the incidence and risk of AKI in hypertensive patients, who have COVID-19 infection is common. Aim: To determine the risk of developing AKI and mortality in hypertensive patients, with COVID-19 infection, on ACEi or ARBs as compared to non ACEi and non ARBs. Materials and Methods: This was a retrospective cohort study conducted on 116 admitted hypertensive patients, who were positive for COVID-19 infection from the month of April 2021 to September 2021. The study patients were divided into two groups- group A and group B. The group A was on ACEi or ARBs and group B was on non ACEi/ARBs. The patients baseline history, clinical examination and the blood investigations like Renal Function Test (RFT), Liver Function Test (LFT), Echocardiography (ECG), Chest X-ray, 2 Dimensional-ECHO (2D-ECHO), Arterial Blood Gases (ABG) were done for all the patients. The normal Blood Pressure (BP) was less than 140/90 mmHg. The normal creatinine was 0.6 to 1.5 mg/dL and normal urea was 19 to 45 mg/dL. The RFT was repeated on every day of hospital stay duration. The patients were followed-up for one month from day of starting the study. The parameters were recorded, assessed on day 7th and day 30th, of the study. All parameters were compared between the final outcome of the patients by 30th day of study and the class of antihypertensives used to control hypertension. The Pearson’s Chi-square test, Fisher’s-Exact and one-way Analysis of Variance (ANOVA) were used for testing the significance of relationship and outcome between group A and group B study patients. Results: The mean duration of hypertension in both the groups was 7.6 years. In group A 53 (45.7%) were on ACEi and ARBs, in group B, 63 (54.3%) were on non ACEi/ARBs. In the group A, the serum creatinine of more than >1.5 mg/dL at 7th day of study was found in 28 (52.8%) patients and on 30th day, it was found in 8 (15.09%) patients (p-value=0.065). Again in the group A, blood urea of more than 45 mg/dL on 7th day of study was found in 30 (56.6%) patients and on 30th day it was found in 9 (16.98%) patients (p-value=0.064). In group B, the serum creatinine >1.5 mg/dL on day 7th of study was found in 36 (57.14%) patients and on day 30th, it was in 24 (38.09%) patients (p-value=0.061). Again in group B, the blood urea of >45 mg/dL on day 7th was found in 35 (55.55%) patients and on day 30th it was found in 16 (25.39%) patients (p-value=0.074). Of the patients on group A (ACEi and ARBs) 28 (52.83%) were on supplemental oxygen, 12 (22.6%) were on Non Invasive Ventilation (NIV), one was intubated and 12 (22.6%) did not require oxygen (p-value=0.727). Of the patients on group B (non ACEi/ARBs) 33 (52.4%) were on supplemental oxygen, 12 (19.04%) were on NIV, 5 (7.93%) were intubated and 13 (20.63%) did not require oxygen. In the patients of group A, 35 (66.03%) were recovered and 18 (33.96%) died, in the group B 40 (63.49%) cases were recovered, while 23 (36.50%) died (p-value=0.781). Conclusion: There was no significant and demonstrable association between specific groups of antihypertensives with renal outcomes and mortality in hypertensive patients with COVID-19 infection. By above observations, the present study concluded that, there is no specific role of ACE2 receptors in renal outcome and mortality in hypertension with COVID-19 infection.

Molecular Typing of Methicillin Resistant Staphylococcus aureus using coa Gene Polymerase Chain Reaction-Restriction Fragment Length Polymorphism: A Cross-sectional Study

P Hema, B Appalaraju, R Someshwaran

Introduction: Methicillin Resistant Staphylococcus aureus (MRSA) are the most important multidrug resistant pathogen of humans causing a wide array of infections. Polymorphic Coagulase gene (coa) could be targeted for specific typing of Staphylococcus aureus isolates. ‘Possible source’ can be identified and discriminated rapidly for control and prevention of Staphylococcus aureus infections especially in case of suspected outbreaks. Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) have high discriminatory power and enhanced reproducibility. Mutation and variation in number of short sequence repeats lead to distinct amplification of this region of coa gene by PCR. Deoxyribonucleic Acid (DNA) fragments of different sizes obtained by digestion with specific restriction enzymes like Arthrobacter luteus I (AluI) help to discriminate various types based on the patterns produced as a result of PCR-RFLP. Aim: To determine molecular typing of MRSA by coa gene PCR-RFLP. Materials and Methods: A cross-sectional study was done in the Department of Microbiology involving 150 clinical isolates of Staphylococcus aureus obtained from various clinical specimens. Genotypic identification of MRSA was done by detecting coa gene and mecA gene by PCR. Molecular typing of MRSA was done by coa gene PCR-RFLP. Results: Coa gene PCR identified six Genotypic codes (Code I to Code VI) ranging from 300 bp-800 bp size. Restriction digestion of the amplicons of the coa gene by PCR-RFLP using the enzyme AluI provided 17 unique restriction patterns among MRSA isolates in toto. The predominant coa gene PCR Genotype code was “Type IV” which was 600 bp size and predominant RFLP fragment for Genotype code “Type IV” was RFLP Pattern ‘b’ (500 bp, 240 bp and 140 bp fragments) among the study population. Conclusion: Genotype code ‘IV’ and RFLP pattern ‘b’ was found to be predominant coa gene type among MRSA in this study.

Designing a Pharmacy Accreditation Programme to Improve the Quality of Service Delivery in Pharmacies

Shahram Akbari, Kamran Hajinabi, Leila Riahi

Introduction: Improving service delivery has become a major goal in all healthcare settings. Accreditation can play an important role in improving service delivery, but few studies have been done on the development of pharmacy accreditation models. Aim: To design a pharmacy accreditation programme, develop accreditation models and provide a suitable tool for improving the quality of service delivery in the pharmacy. Materials and Methods: This study was a mixed-method study conducted from March 2019 to December 2020. A scoping review was undertaken for this study. PubMed, Google Scholar, World Health Organisation (WHO) and other related databases (like Web of Pharmacy Accreditation Organisations) were used as sources of databases, used following keywords to search documents according to MeSH terms i.e, health services administration, delivery of healthcare, accreditation and pharmacy. A structural equation modelling method was used. Based on the data extracted from the databases, a questionnaire was designed and was administered on stakeholders. The collected data was analysed using confirmatory factor analysis. Model parameters were estimated using the Full Information Maximum Likelihood (FIML) method. The model was revised on inspection of modification indices and fit statistics and experimented for construct validity, construct reliability and measurement invariance. Results: The findings of this study were the design of a pharmacy accreditation programme that includes five dimensions of quality and safety, management and performance, training and development of human resources, procedures and environmental and equipment factors. The quality and safety dimension with a correlation coefficient of 0.92 had the greatest impact on the accreditation programme, the environmental and equipment factors had the least effect with a correlation coefficient of 0.73. Conclusion: Simultaneous use of valid global models, the views of experts and stakeholders in this model, has provided a powerful and novel tool to improve the performance of pharmacies.

Quality of Life Before and After Orthodontic Treatment in Adult Patients with Malocclusion: A Quasi-experimental Study

Introduction: In adult patients seeking orthodontic treatment, some common reasons include unesthetic appearance and functional impairment such as difficulty in speaking or breathing. Thus, malocclusion and orthodontic care have become a Quality of Life (QoL) issue. Aim: To investigate the oral health-related quality of life in adults before and after orthodontic treatment. Materials and Methods: This quasi-experimental study was conducted in Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bangalore, India over a two year period from December 2014 to October 2016. Finally, 34 patients were included in the study. Longitudinal data which included OHRQoL (Oral Health-Related Quality of Life) and study casts for assessing the outcome by the Peer Assessment Rating (PAR) index was collected from two periods: (i) pretreatment data (T1), and (ii) post-treatment data (T2) collected one month after fixed orthodontic appliance debonding. Pretreatment and post-treatment Oral Health Impact Profile (OHIP-14) and PAR scores were compared using Paired t-test. Correlations between occlusal indices (PAR) and OHRQoL (OHIP-14) were determined by Spearman’s rank correlation coefficient. Results: Total of 42 patients were included in the study, out of which 34 patients responded to the questionnaire in which 11 were males and 23 females in the age range 18-30 years. From pre to postorthodontic treatment mean OHIP-14 summary score had significantly improved (score reduced) from 30.3 to 16.0. Similarly, mean PAR scores had reduced from 17.62 to 3.44. Significant correlation (p-value <0.05) existed between improvement in OHRQoL scores and improvement in occlusion after orthodontic treatment. Conclusion: The present study concluded that there was an improvement in oral health following fixed orthodontic treatments which were associated with changes in OHRQoL, PAR scores and changes in occlusion.

Diagnostic Accuracy between CBNAAT, TrueNat, and Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Doda District of Jammu and Kashmir- A Comparative Study

Introduction: The need for fast, precise diagnostic tests to identify active tuberculosis is essential, mainly in endemic nations such as India. An automated real-time Polymerase Chain Reaction (PCR) method for pulmonary tuberculosis (TB) detection known as the Cartridge Based Nucleic Acid Amplification Test (CBNAAT) or GeneXpert assay shows great promise as a complement to the TrueNat and conventional sputum microscopy techniques. Aim: To compare sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of CBNAAT with TrueNat and smear microscopy in the detection of Mycobacterium tuberculosis. Materials and Methods: A cross-sectional comparative study on 175 patients with suspected pulmonary TB was conducted from June 2021 to November 2021 in a tertiary care hospital at Government Medical College, Doda District of Jammu and Kashmir, India. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for the diagnosis of tuberculosis were calculated for Acid Fast Bacilli (AFB) smear microscopy, TrueNat, and the GeneXpert and compared with each other. Statistical analysis of the data was conducted with Statistical Package for the Social Science (SPSS) version 20.0. Results: Out of the total 175, 168 (96%) patients were TB positive by CBNAAT, 162 (92.6%) by TrueNat, and 148 (84.6%) as per smear microscopy. Sensitivity, specificity, PPV, NPV, and accuracy of Ziehl-Neelsen (ZN) stain in the detection of pulmonary TB in sputum samples were 86.31%, 57.14%, 97.97%, 14.81%, and 85.14%, respectively. Whereas in the case of the TrueNat technique sensitivity, specificity, PPV, NPV, and accuracy were 94.05%, 42.86%, 97.53%, 23.08%, and 92.00%, respectively. In the case of CBNAAT sensitivity, specificity, PPV, NPV, and accuracy in the detection of pulmonary TB in sputum samples were 97.02%, 28.57%, 97.02%, 28.57%, and 94.29%, respectively. Conclusion: In respiratory samples, CBNAAT is more sensitive than ZN smear microscopy and TrueNat. Positive CBNAAT, but TrueNat and AFB microscopy negative results should be read cautiously and be well correlated with the clinical and treatment history of the patient.

Postoperative Hyponatraemia following Major Orthopaedic Surgeries: Incidence and Risk Factor Assessment

SG Thejaswi, Karma Uden Bhutia, Ujjawal Pradhan, Sundar Dewan, Priya Saikia

Introduction: Postoperative Hyponatraemia (POH) commonly goes unrecognised and untreated. Previous studies have shown that POH is fairly common following orthopaedic surgeries. However, there are very limited prospective studies to estimate the incidence of POH, especially in the Indian scenario. Aim: To evaluate the serum sodium level change postoperatively in patients undergoing major orthopaedic surgeries and to evaluate its risk factors for the same. Materials and Methods: A prospective longitudinal study was conducted for a period of six months (September 2019 to February 2020) at a tertiary hospital in Sikkim, India. A total of 98 adult patients undergoing major orthopaedic surgical procedures of the lower limb and spine (fixation of long bones, joint replacement surgeries, spine fixation surgeries), were observed for development of early (day 1) and delayed (day 5) POH. Various risk factors (such as age, gender, preoperative sodium level, type of surgery, duration of surgery, co-morbidities, and perioperative fluid used) were analysed for the development of POH and were evaluated. Results: The study found that 17 (17.3%) out of the total 98 patients, developed POH within 24 hours of surgery and no delayed POH was observed. Those who developed early POH started with low serum Na levels preoperatively and the mean change in Na level was significantly higher among them (5.42±1.4 mmol/L, p-0.001) as compared to postoperative normonatraemia patients (4.3±1.2 mmol/L). Increasing age, diabetes mellitus, preoperative sodium (Na) level, duration of surgery, and use of dextrose fluid intraoperatively were found to be significantly associated with developing early POH. After adjusting for the factors which showed a significance of p<0.1 in the univariate analysis, low preoperative Na (mmol/L) (AOR=0.48; 95% CI=0.32-0.72; p<0.001) and duration of surgery (in hours) (AOR=1.8; 95% CI=1.04-3.2; p-0.035) were found to be the most statistically significant risk factors for POH. All of 17 patients with POH had normal sodium levels by postoperative day five, showing the transient nature of the drop in Na level. Conclusion: According to the present study result the POH was fairly common after orthopaedic surgeries (17.3%), it is early and transient in nature and easily correctable. Preoperative sodium level, duration of surgery are the major risk factors for POH.

Effect of 30% Grape Seed Extract on the Shearbond Strength of Orthodontic Adhesive Resin: An In-vitro Study

Arpitha Eshwar, Poornima R Jnaneshwar, Krishnaraj Rajaram, Ravi Kannan

Introduction: Grape Seed Extract (GSE) contains Proanthocyanidins (PA) which have been shown to cross-link and strengthen demineralised dentin collagen. There is paucity of research to evaluate, if grape seed extract increases the Shearbond Strength (SBS) of orthodontic resin when bonding to enamel. Aim: To evaluate the SBS and Adhesive Remnant Index (ARI) scores of enamel surface bonded with orthodontic resin after immersing in 30% of grape seed extract and compare the same with that of control group. Materials and Methods: This in-vitro study was conducted in SRM Dental College, Ramapuram, Chennai, India, from January 2021 to August 2021, in which 72 extracted teeth samples were divided into two groups. The two groups, each with 36 specimens, included Group I (Control), Group II (Test). Teeth in the test group were soaked in 30% grape seed extract for 10 minutes before bonding and teeth in the control group were bonded directly without soaking in grape seed extract. SBS were measured using a universal testing machine. To evaluate the amount of resin left on the enamel surfaces after debonding, ARI scores were used. The samples were subsequently evaluated using Scanning Electron Microscope (SEM) to study the surface characteristics of enamel after immersion in grape seed extract. Student’s t-test was used to assess the difference between two groups in SBS and Chi-square test was used for ARI scores. Results: Total of 72 teeth were analysed, 36 extracted teeth in each group. The mean SBS in group I was 78.9 Newton (N), 59.03 N in group II. There was a stastistically significant differences in the mean scores of SBS between the groups (p-value=0.0024). The SBS of control group was significantly higher than the test group. Significant difference (p-value=0.016) found in ARI scores between the two groups. In SEM analysis, after grape seed extract conditioning followed by acid etching, pronounced cobble stone appearance was noticed, indicating a type II etching pattern. Conclusion: Adhesive failure occurred at the resin and bracket interface indicating that SBS reduces, when teeth were immersed in grape seed extract.

Knowledge, Attitude and Practice in Medical Management of Glaucoma: A Cross-sectional Study from a Tertiary Care Hospital at Uttarakhand, India

Introduction: Glaucoma is most common cause of irreversible blindness in the world. Hence, awareness about the disease, importance of drugs effect and its side-effects and accurate method of eye drop instillation is very crucial. Aim: To assess Knowledge, Attitude and Practice (KAP) at the medication, doctor and patient level in clinical practice. Materials and Methods: It was a cross-sectional, descriptive, questionnaire based study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, for duration of two years from July 2020 to June 2022. It included 290 patients diagnosed with glaucoma. They were asked to demonstrate method of instillation of eye drop to assess correct method and to cover a few aspects of questionnaire regarding medication instillation. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21.0. The p-value was determined for questions in the questionnaire using Chi-square test. The p-value <0.05 was considered significant. Results: About 88 (30.34%) patients were educated about the nature and progression of glaucoma. Punctal occlusion was explained to 40 (13.79%) patients and assisted instillation to 25 (8.62%) patients. Approximately 62 (70.45%) patients were educated about their disease. About 244 (84.14%) patients noticed that their ophthalmologist clinic had a television in Outpatient Department (OPD). Family screening was advised in only 67 (23.1%) of the patients. Only 53 (18.28%) patients were emphasised on strict control of associated systemic illness. Conclusion: Proper patient education about glaucoma and treatment by healthcare provider plays a crucial role. Most of the patients were not educated about method of instillation of drops. Correct instillation of drops was crucial to achieve target Intra Ocular Pressure (IOP), minimising side-effects and reducing the cost of treatment. Family screening and control of associated systemic conditions were often missed by majority of ophthalmologists however, it is important to keep in mind.

Loneliness and Social Support Experienced by COVID-19 Patients Attending a Telemedicine Centre of a Tertiary Care Hospital in Kolkata: A Cross-sectional Study

Introduction: Telemedicine acted as one of the biggest medium in treating Coronavirus Disease-2019 (COVID-19) patients during the second wave of the still ongoing pandemic. Although the symptoms were taken care of and treated through teleconsultation, the loneliness and social support system of these patients went largely unrecognised. The morbidity pattern, effect of self-isolation and quarantine, uncertainties in social support were major contributors to loneliness among patients suffering from COVID-19. Aim: To estimate the proportion of loneliness and level of social support experienced by COVID-19 patients seeking advice from a telemedicine centre of Kolkata and to find out their socio-clinical profile and the associated relationship. Materials and Methods: An observational study with cross-sectional design was conducted on 403 COVID-19 patients, who had taken advice from the telemedicine centre of Institute of Post Graduate Medical Education and Research (IPGME and R), Kolkata for a period of 12 weeks (May-July 2021). Loneliness was assessed by the 11-item De Jong Gierveld Loneliness scale, whereas social support was assessed using 12-item Multidimensional Scale of Perceived Social Support scale through telephonic interview. Data were tabulated in the Microsoft Office Excel 2019 (Microsoft Corp, Redmond, WA, USA) and the analysis was performed using Statistical Package for the Social Sciences (IBM, New York City, USA) version 25.0. Results: Out of 403, more than half of the study population, 194 (48.2%) belonged to 18-35 years of age. Of the total, 235 (58.3%) were males, 319 (79.2%) were currently married and 300 (74.4%) were Hindus. About 142 (35.2%) respondents had experienced severe loneliness, while 297 (73.7%) had experienced high social support. There was a significant negative correlation found between loneliness and social support (r=-0.495, p-value <0.01). It was found that being male, belonging to nuclear family, education upto higher secondary level, being addicted, loneliness due to physical distancing, and those who had socialised frequently had higher odds of loneliness, whereas unemployed, unskilled, semi-skilled and skilled occupation, having one chronic disease had lower odds of social support. Conclusion: About 338 (84%) patients had experienced loneliness which was strikingly high. This shows a deeper aspect into the actual picture of how COVID-19 impacts mental health of those who are affected. Future interventions are needed to address loneliness and develop social support system along with addressing healthcare needs of COVID-19 patients.

Effect of Postmenopausal Symptoms on Health-related Quality of Life among Women Residing in Rural Areas of Central Gujarat and Saurashtra: A Cross-sectional Study

Bhoomi Manishkumar Bavda, Sapna Bhavin Patel, Anjali Pushkar Tiwari

Introduction: Menopause means permanent cessation of menstruation at the end of reproductive life. With the increase in life expectancy, women spend one-third of their life in menopausal period. Menopausal women face problems like hot flushes, feeling accomplished, poor memory, tiredness, joint pain, weak physical strength, lack of energy, avoiding intimacy, and vaginal dryness. Due to these the physical, psychosocial, and sexual health-related aspects get deteriorated. Aim: To assess the effect of postmenopausal symptoms on health-related quality of life among women. Materials and Methods: A cross-sectional research design was used, and 168 postmenopausal women, were selected following home visits at selected rural areas of Central Gujarat and Saurashtra, India. Women in the age group of 40-60 years, who had completed seven years of natural menopausal period were eligible for the study. The Menopause Specific Quality of Life Questionnaire was used and statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20.0. Results: Mean age of the postmenopausal women was 76.93 years. The majority 85 (50.6%) had completed their primary education. The most commonly found postmenopausal symptoms were feeling tired 153 (91.07%), loss of physical strength 153 (91.07%), and lack of energy 153 (91.07%). The mean score for vasomotor domain was 5.34±1.91, sexual domain 4.31±1.69, psychosocial domain 4.07±1.44, and physical domain was 3.85±1.10. The majority of the postmenopausal symptoms were related to the vasomotor domain. Conclusion: The present study findings concluded that all domains’ symptoms negatively impacted a women’s quality of life.The majorly affected domain was vasomotor, while least affected was physical domain.

Outcome Analysis of Intravenous Thrombolytic Therapy in Patients with Acute Ischaemic Stroke and its Association with Critical Time Intervals: An Ambispective Study

Syama Viswanath, Susan Tharian, Mathew Pulicken, Sethu Babu

Introduction: Intravenous thrombolytic therapy has become the standard of care in patients with acute ischaemic stroke. The success of this therapy depends on achieving the shortest time between the onset of stroke and reperfusion. Many clinical tasks like neurological assessment, imaging and its interpretation, exclusion of contraindications and informed consent must be taken care of, prior to administration of thrombolytic therapy. As this is a time sensitive intervention, it may have variable outcomes in different settings. Aim: To evaluate the immediate and 90-day neurological outcome of the patients who had received intravenous thrombolytic therapy in acute ischaemic stroke and to evaluate its association with stipulated critical time intervals. Materials and Methods: This was an ambispective observational study conducted for a period of 18 months (April 2018-October 2019) in the Emergency Department of Pushpagiri Institute of Medical Sciences, Thiruvalla, a tertiary care hospital in central Kerala, India. For the prospective arm of the study, data were collected from the patients who came to the Emergency Department with acute ischaemic stroke in the window period (three hours) or in the extended window period (3-4.5 hours). Onset to door time, door-to-imaging time, door-to-needle time and onset-to-needle time were assessed and recorded. National Institute of Health Stroke Scale (NIHSS) score at presentation and at 24 hours post-thrombolysis was noted. Magnetic Resonance Imaging (MRI)/Computed Tomography (CT) brain report 24 hours post-thrombolysis was followed-up. The functional outcome at 90 days was assessed using Modified Rankin Scale (MRS) score. For the retrospective arm of the study, the relevant data were collected from the hospital records and the patients were followed-up. The association between the stipulated critical time intervals and 24 hours post-thrombolysis NIHSS score, as well as MRS score at 90 days were calculated using the statistical analysis tool STATA v.14. Statistical comparisons were performed between subgroups using the Chi-square (χ2) test, Fischer’s-exact test, Wilcoxon signed-rank test, and Mann-Whitney U-test as indicated for dichotomous or continuous variables. For all statistical analyses, a p-value of <0.05 was taken as statistically significant. Results: Of the total 110 patients, 105 patients (95.5%) reached the hospital within three hours (window period), and five patients (4.5%) reached within 4.5 hours (extended window period). A total of 58 patients (52.7%) received thrombolytic treatment within three hours and 52 patients (47.3%) within 4.5 hours. After 24 hours of thrombolysis, improvement in neurological function, as defined by an improvement in NIHSS score by 4 or more was found in 73 patients (66.4%). At 90 days follow-up, 76 patients (69.1%) became functionally independent with an MRS score of 0-2. There was a significant association between NIHSS score 24-hours post-thrombolysis and the functional outcome at 90 days. Of the various stipulated critical time intervals, a significant association was seen only with onset-to-door time and NIHSS score 24 hours post-thrombolysis. Conclusion: A total of 69.1% of the patients who have received intravenous thrombolytic therapy for acute ischaemic stroke in this study have shown favourable functional outcome at 90 days. The NIHSS score 24 hours post-thrombolysis compared to baseline is a good predictor of the neurological outcome at 90 days.

Measurement of Filum Terminale in the Foetuses of Third Trimester Gestational Age: An Observational Study

Nand Kishor Gupta, Hetal Vaishnani, Preeti Gupta, Achleswar Gandotra

Introduction: The covering of spinal cord is same as that of brain. The pia mater, arachnoid and dura mater covers the spinal cord from inside out. The pia mater extends from cephalic end of spinal cord upto terminal portion i.e., conus medullaris. Beyond the conus, the pia mater extends in the form of filum terminale. The filum terminale extends beyond the conus medullaris and attaches upto dorsal aspects of coccyx to stabilise the spinal cord in its position. Aim: To study the length of filum terminale in the foetuses of third trimester gestational age. Materials and Methods: The present cross-sectional observational study was carried out in 30 foetuses collected from museum of Department of Anatomy and Department of Obstetrics and Gynaecology. The permission and approval from University Ethical Committee was taken before starting the study. The foetuses were divided into three groups taking into consideration their gestational age (four foetuses in 1st group 28-31 weeks, 12 foetuses in 2nd group 32-35 weeks and 14 foetuses were in 3rd group 36-40 weeks gestational age). Also, the gender-wise variation (11 male and 19 female foetuses) was taken into account. All the data were recorded in Microsoft excel sheet and Statistical Package for the Social Sciences (SPSS) 23.0 software was used for statistical analysis. Numerical values were reported as the mean±standard deviation. Results: In this study, the mean length of filum terminale was 4.35±1.04 cm with range minimum 2.31 cm to maximum 5.90 cm. The length of spinal cord and length of filum terminale measurements significantly increased with increasing gestational age (p<0.001). The length of spinal cord, length of filum terminale measurement and ratio of length of filum terminale to length of spinal cord (FT/SC) were significantly higher in male foetuses (p<0.05). Conclusion: The association between gestational age (weeks), length of filum terminale, and length of spinal cord among all foetuses, and male and female separately were statistically significant.

Antioxidant and Antibacterial Properties of Chicory (Cichorium intybus L.) Root and Leaves Extract- An Experimental Study

Akansha, Mayuri Rastogi, Bushra Shaida

Introduction: Cichorium intybus (C. intybus) is a scientific term used for chicory plant. The medicinal plants have immensely contributed to health needs of humans throughout their existence. Aim: To study the phytochemical constituents, antioxidant and antibacterial properties of the methanolic root and leaf extract of C. intybus. Materials and Methods: This experimental study was conducted at Sharda University, Noida, Uttar Pradesh, India from January 2022 to March 2022. Phytochemical, antimicrobial and antioxidant activities of methenolic extract of C. intybus both leaves and roots were assessed using different methods. Antibacterial activity was done using Well Diffusion Method against Staphylococcus aureus, Pseudomonas aeruginosa, E. coli and Salmonella Typhimurium. Results: The results for antioxidant activity was found better in leaves of C. intybus when compared with its root. The IC50 value for the leaves was found to be 63.8±1.4 μg/mL whereas root showed 76.1±1.2 μg/mL. Further, the samples were tested for antibacterial activity against both gram positive and gram negative bacteria using Well-diffusion method against given microorganism Staphylococcus aureus (MTCC 87), Pseudomonas aeruginosa (MTCC 424), E. coli (MTCC 68) and Salmonella Typhimurium (MTCC 68). With zone of inhibition 25.24±0.34 mm, 18.78±1.12 mm, 20.1±0.4 mm and 24.8±0.5 mm respectively, while on comparison with standard drug. Conclusion: The methanolic extract of both roots and leaves have good antioxidant and antibacterial properties, thus, will help to protect against many diseases and will enhance the immune system for maintaining good health.

Efficacy of Orange Oil, Lemon Oil and Xylene as Solvents in Removing Gutta Percha from Curved Root Canals: An In-vitro Study

Introduction: Root Canal Treatment (RCT) is the most common and effective treatment for saving natural tooth. Despite of modern technology and progress in the materials, failures in endodontic treatment still remains. Microbial infection majorly bacteria in the root canal is the prime cause of reinfection in root canal treatment. Endodontic instruments, solvents, lasers are the different techniques that can be used for removing gutta percha from the root canal. Aim: To compare the efficacy of orange oil, lemon oil, and xylene as solvents in removing gutta percha from curved root canals. Materials and Methods: This in-vitro study conducted in Sharad Pawar Dental College and Hospital, Sawangi Meghe, Wardha, Maharashtra, India, for three months and 24 freshly extracted teeth including incisors, premolars and molars having curved root will be taken. Then, RCT would be performed in all the extracted teeth by using cold lateral compression obturation method. Then all teeth would be divided in three groups (n=8). After one month, the Gutta Percha (GP) would removed by ProTaper Universal system. First group will use orange oil as solvent, second group will use lemon oil as solvent and the third group will use xylene as a solvent. The micro-Computed Tomography (CT) images prior to the application of solvent and after application of solvent will be taken and would be evaluated to check the percentage of filling material remaining. Results: The expected outcome is orange oil and lemon oil to act as a better root canal solvent, as compared to xylene. Conclusion: The determination and comparison of the efficacy of orange oil, lemon oil and xylene as GP solvents from the present planned study will help the clinicians during re-RCT treatment.

Evaluation of Resistin and Fascin-1 Expression and their Correlation with Recurrence in the Patients of Oral Squamous Cell Carcinoma

Fatema Saify, Minal Chaudhary

Introduction: Squamous cell carcinoma is the most common epithelial malignancy of the oral cavity. The five years survival rate is approximately 50% and is even lower i.e, 30% in the patients with recurrence of this disease. Since recurrence has a major influence on five years survival, it becomes imperative to identify the molecular elements responsible for recurrence of oral squamous cell carcinoma. Aim: To evaluate the expression of resistin and fascin-1 and their correlation with recurrence in the patients of oral squamous cell carcinoma. Materials and Methods: A cohort study will be conducted in the Department of Oral Pathology, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India. The duration of the study will be 24 months. A 4 μm thick section from paraffin embedded blocks of formalin fixed biopsy tissues of 60 cases having primary oral squamous cell carcinoma will be processed and stained for mouse monoclonal resistin (clone C-10) and mouse monoclonal fascin-1 (clone 55k-2) antibodies. Results: The results will be analysed by the correlation tests, Pearson and Spearman correlation coefficient. Conclusion: Local recurrence is influenced by site of tumour, depth of invasion, resection margins and lymphovascular spread. As recurrence is directly related to the poor prognosis and survival rate in the patients of oral squamous cell carcinoma, so it is essential to identify molecular markers indicative of recurrence. Fascin and resistin markers could be used to identify a subset of oral squamous cell carcinoma patients which are prone to recurrence.

Incidence of Metastasis of Oral Squamous Cell Carcinoma in Submandibular Gland among N+ Cases of Neck Dissection: A Research Protocol

Amjad Munir Shaikh, Rajiv M Borle, Nitin Bhola

Introduction: Oral Squamous Cell Carcinoma (OSCC) is one of the most common malignant diseases of head and neck region. Management of OSCC involves removal of the Submandibular Gland (SMG) along with lymph nodes. The submandibular salivary gland is routinely removed, considering metastatic involvement from OSCC. Many studies showed there is no or rare involvement of the submandibular gland. Aim: To find the incidence of metastasis of oral squamous cell carcinoma in the submandibular salivary gland during neck dissection. Materials and Methods: This cross-sectional, observational, descriptive study will be conducted in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi, Maharashtra, India. The research started from November 2018. Data will be compilated in tabular form in term of descriptive statistics with frequency and proportion of submandibular gland involvement. It will be conducted on 90 operated cases of OSCC in whom one or both the submandibular glands will be removed during neck dissection. The outcome parameters will be the nature and site of lesion, clinical nodal status, clinical stage of disease, preoperative and postoperative histopathological examination of lesion, histopathological examination of resected lymph nodes and proportion of involvement of submandibular gland.

Netiquette and Ethics Regarding Digital Education Across Institutions: A Narrative Review

Arti Gupta, Surendra Singh, Rajeev Aravindakshan, Rakesh Kakkar

Information Technology (IT) has made rapid advancement since the turn of this century. Ergo, the scope and extent of IT has also grown, resulting in increase in the number of internet users, who have different reasons for using the IT resources. The users of this IT revolution include students worldwide; who interact with technology based on their needs, with relative ease and have found the whole experience enriching. Progress in IT has not only changed the way humans interact with technology but has also influenced the way of interaction between the people. The interaction online is mostly informal and comes without set guidelines and compounded with the relative anonymity provided by internet, also it has complicated an individual’s ability to interact in a respectful and responsible way. The problems relating to internet safety arise from such interactions. Flame wars and cyberbullying are some of the other risky behavioural interactions displayed online and can lead to severe consequences. The unethical use of IT resources in the form of plagiarism, piracy, identity theft etc also questions the moral of an individual. Whilst there may be some idea, multitude of issues regarding Netiquette and ethical use of IT resources are often poorly understood and the knowledge imparted is also fragmented. Moreover, contemporary educators are much in need of such information. Thus, there is a need to include and summarise current priority areas that relate to etiquette and ethics in digital education.

Role of Mitochondrial Dynamics in Type 2 Diabetes Mellitus Dysfunction

Type 2 Diabetes Mellitus (T2DM) is influenced by the action of both hereditary and environmental factors. These factors are comprehended in the disease interaction with β cells and insulin sensitivity to the receptors.The main cause of T2DM development is ageing, obesity, and oxidative stress. The dysfunction of the β cells of the pancreas leads to insulin insensitivity in the liver, muscle and fat metabolism. These occur due to the result of oxidative stress. Lipid peroxidation is a key initiating factor in the development of oxidative stress, which results in T2DM and its related micro-and macro-vascular problems. These are initially compensated for the generation of excess insulin synthesis, thus ensuring normal glucose tolerance. When these compensatory processes are disrupted, the majority of persons develop T2DM. Although the gene is the primary cause of T2DM, the environment also plays an important role in the disease’s progression. Particularly, a sedentary lifestyle characterised by excessive food consumption and physical inactivity is a known risk factor for obesity and type 2 diabetes. This review has briefly discussed the significance of numerous causal factors, and genomic and biochemical pathways which are responsible for increasing the production of oxidative stress, a crucial component for the etiology and development of T2DM. The conclusion drawn was that the analysis of oxidative stress markers may be one of the potential methods for the diagnosis and prognosis of T2DM. Furthermore, this review will be helpful to establish the broaden conceptual framework for future studies on oxidative stress with relation to etiology of type 2 diabetes and therapeutic development.

The Futuristic Era of Paediatric Dentistry: A Review

Over the past few years, paediatric dentistry has made significant advancements. Paediatric dentists may not have as many cutting-edge equipment or therapies as their dental colleagues, but improvements in technology have nonetheless greatly enhanced their practises in recent years. The way dentistry is practised is changing as a result of new technology. New imaging technologies, restorative techniques, the use of the internet and powerful electronic gadgets, and other innovations are examples of developments that have had a significant impact on dentistry. It is a fundamental necessity for all the dentists, to know the advancements in their field in order to incorporate them into their day-to-day practice. So, in the present review, authors discusses various recent advancements in the field of Paediatric Dentistry, that can aid the dentist to deliver better treatment and to obtain the patient’s satisfaction. In the last few years paediatric dentistry has come a long way. Despite the fact that, children’s dentists may not have as many creative treatment alternatives as their dental colleagues, advancements in recent years have greatly improved their practices. As a result of new technologies, the practice of dentistry is evolving.

COVID-19: Lifestyle, CoVesity and Exercise Time to Identify and Defeat the Real Culprits with Clinical Physiological Interventions

Hanjabam Barun Sharma

Coronavirus Disease-2019 (COVID-19) is a global pandemic. Morbidity-mortality is related with hyperimmuno-thrombo inflammation. Unhealthy lifestyle and obesity with high inflammation, should be prone for increased morbidity-mortality in COVID-19. Hence, physical activity, exercise and positive lifestyle are beneficial. The review explored this relationship. Literature search was done for association of physical inactivity, obesity, fitness, exercise and other lifestyle factors with COVID-19. Relevant articles (~43) were selected, the core information was then incorporated. The complications of COVID-19 are associated with modifiable lifestyle risk factors: physical inactivity, obesity and low fitness etc., which are the real culprits. There is bi-directional, reciprocal and positive association between pandemic of physical inactivity/obesity and that of COVID-19. Obesity and inactivity are associated with high COVID-19 incidence, viral shedding duration, vaccine inefficiency; hospital and Intensive Care Unit (ICU) admission, duration of stay and death. These real culprits need effective management using various Clinical Physiological Interventions (CPIs) including fitness, nutritional and lifestyle improvement. Cardiorespiratory Fitness (CRF), physical activity and exercise have protective role in COVID-19. Moderate aerobic exercise of ≥150-300 minutes/week, or ≥75-150 minutes/week of vigorous aerobic-activity (or equivalent combination), with ≥2 days/week of moderate or higher intensity strength-training should be done. Unexplained alterations in physical activity Ratings of Perceived Exertions (RPE) may indicate Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Early mobilisation from passive-to-active movements to light-to-moderate activity should be part of multidisciplinary, phase-wise, and symptom-led rehabilitation. Asymptomatic positives should restrain from intense-exercise for ≥2 weeks. Return-to-Play (RTP), with ≥2 weeks of minimal exertion reaching preCOVID activity after ≥4-5 weeks, may be done for recovered players (no symptoms for ≥7-10 days and ≥10 days of symptoms-onset). There should be no sports for ≥3 and ≥6 months for players with pericarditis and myocarditis respectively, ≥4 weeks for pneumonia, and ≥2-4 weeks for symptomatic players with no myocarditis and pneumonia. Medical evaluation/examination and, when required, relevant cardiac, pulmonary, ergometry, biochemical and other investigations are needed before RTP. Optimal, individualised, nutrient dense, natural and whole food based chrono-nutrition with no metaflammation is a must. Good sleep, healthy circadian rhythm, limiting sedentary behaviour, coping skills with no mental/psychological/emotional stress and addiction, meditation, healthy relationship and positive social connections are other key lifestyle factors to be prioritised.

Is Alar Cinch Suture Effective in Controlling Alar Base Widening in Le Fort I Osteotomy?

Gaurav Kumar Jha, Rajesh Kshirsagar, Vikram Singh, Vivek Nair, Daksh Kedia

Le Fort I osteotomy causes nasolabial alterations that may be unattractive, such as expansion of the alae and alar bases and thinning of the upper lip. After maxillary impaction, there is a propensity for the tip to elevate, and in some circumstances, this may even become excessive. The nasolabial angle closes and similar alterations are observed with maxillary advancement. When Le Fort I impaction or maxilla advancement occurs, the alar base cinch suture is frequently utilised to reduce the unfavourable rise in nasal width. There are significant changes in the nasolabial morphology associated with Le Fort I osteotomy. Numerous changes occur after the surgical intervention in the maxilla namely- widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip and down turning of the commissures. Widening of the alar bases of the nose appears to be the most common undesirable outcome. Some people may benefit aesthetically from nasal widening. For instance, the long face syndrome is frequently characterised by a narrow nose with a large dorsum. In these situations, superior maxillary relocation typically improves the look of the nose by enlarging the bases of the arches. However, excessive alar base broadening and superior retraction would cause the alar-facial groove to aesthetically deepen, giving the patient an older appearance, and may cause asymmetry in the alas. It is crucial for the surgeon to comprehend the preoperative aesthetic facial linkages and anticipate any potential impact the surgical operation may have on the nasolabial region before performing maxillary surgery. To control the width of the alar base after maxillary osteotomy clinicians have advocated the placement of cinch sutures, reduction of the anterior nasal spine and use of V-Y closure technique. There are inconstant opinions on the effect of the cinch suture.

Factors Influencing Drug Adherence among Different Patient Populations in India

Drug adherence is an important problem faced worldwide by patients of all age groups. This article aims to address the factors hindering patient adherence to a proper medication regime. Numerous studies have demonstrated that complex dosing schedules and polypharmacy along with financial constraints are the main problems faced by patients. The problems also tend to vary among different patient populations such as diabetics, hypertensives, Chronic Kidney Disease (CKD) patients, and Chronic Obstructive Pulmonary Disease (COPD) patients, posing different challenges in each of the chronic diseases. Multifactorial solutions are needed to improve medication adherence including efforts to improve a patient’s understanding of medication benefits, trust in their doctor and health system, and improving the physician’s recognition and understanding of patients’ beliefs, fears, and values to achieve increased medication adherence.

Early Onset Sarcoidosis/Blau Syndrome: Disguising as Juvenile Idiopathic Arthritis

Bharat Kumar Singh, Seema Singh, Savita Singh

Blau Syndrome (BS) is a rare autoinflammatory granulomatous disorder which mostly develops at an early age (less than four years) and is described by granulomatous dermatitis, symmetric arthritis and recurrent uveitis. Hereby, the authors present a case of a 5-year-old female child with joint pain and swelling since four years. Initially, her diagnosis was made as juvenile idiopathic arthritis-polyarticular Rheumatoid Factor (RF) negative and was initiated on methotrexate along with bridge steroids (prednisolone). When she presented to the hospital, she had skin coloured micropapular rashes, mostly non follicular over body, from last nine months and after skin and synovial biopsy, the diagnosis was reviewed as early onset sarcoidosis/BS-sporadic type. The present rare report highlights that, BS is an under-recognised and reported childhood arthritis which may have multisystem involvement. The onset of arthritis without ocular or skin manifestations may be mistaken as juvenile idiopathic arthritis.

Hypokalaemia in Type-4 Renal Tubular Acidosis: A Rare Presentation

Shanjitha Hussain, T Saravanan, S Nirmala

Proximal/Type-2 Renal Tubular Acidosis (RTA) occurs due to impairment of bicarbonate absorption in the proximal tubule and is mainly characterised by hypokalaemia and metabolic acidosis. There are various causes of proximal RTA like genetic, cystinosis, Wilson’s disease, drugs and toxins, vitamin D deficiency, hyperparathyroidism, amyloidosis. Vitamin D deficiency is one of the uncommon causes and is more common in elderly. Hereby, authors present a case report of a diabetic and hypothyroid 30-year-old female, who presented with chronic limb weakness, myalgia and bilateral leg swelling. After detailed history taking, clinical examination and laboratory investigations, she was diagnosed with nephrotic syndrome and proximal RTA associated with vitamin D deficiency. She had hypokalaemia with acidosis initially and was managed with diuretics, Angiotensin Converting Enzyme (ACE) inhibitors, vitamin D and potassium supplementation, after which, she developed hyperkalaemia with acidosis. She was evaluated for hyperkalaemic RTA and its common causes and was diagnosed with hyperkalaemic RTA associated with diabetes. Thus, treatment of type-2 RTA due to vitamin D deficiency, led to unmasking of underlying type-4 RTA due to diabetic nephropathy.

Physiological Cost Index of Walking among Non Smokers, Smokers and Smokers with Chronic Obstructive Pulmonary Disease- An Observational Study

Parkavi Kumaresan, Umarani Ravichandran, John William Felix, Karthik Vijayan

Introduction: Most of the Chronic Obstructive Pulmonary Disease (COPD) patients are smokers and their disease progresses with increasing age. The energy cost of walking has strong association with aging and cigarette smoking. Its implication in COPD remains unclear. Aim: To evaluate the Physiological Cost Index (PCI) of walking among non smokers, smokers and smokers with COPD and to find its association with age and duration of cigarette smoking. Materials and Methods: The cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation (PMR) at Rajah Muthiah Medical College and Hospital, Annamalai University at Chidambaram, Tamil Nadu, India, from November 2019 to February 2020. The PCI was carried out in 77 males, aged between 50-75 years with body mass index between 18.5-24.9 kg/m2. There were 24 smokers with COPD, 27 were smokers and 26 were non smokers. The evaluation of six minute walk distance, resting, and post walk heart rate was applied in MacGregor’s equation to estimate the PCI. Results: The mean PCI of smokers with COPD was 0.67±0.3 which was significantly (p-value=0.001) higher than those of smokers (0.22±0.07) and non smokers (0.14±0.04). The smokers and non smokers had no significant variation in PCI (p-value=0.122). Age had no association with PCI (p-value=0.213) whereas the duration of smoking years was found to have significant association (p=0.014). Conclusion: The PCI was found to be significantly higher in smokers with COPD and a significant association was established with years of smoking rather than age.

Artificial Intelligence and Healthcare

Harish Rangareddy, Shashidhar Kurpad Nagaraj