Journal of clinical and diagnostic research

Antiphospholipid Syndrome Complicated by Unilateral Pleural Effusion and Deep Vein Thrombosis: A Case Report

Shricha Bhutda, Sourya Acharya, Badal Taori, Sakshi Bhutda, Ritika Sharma

Antiphospholipid Antibodies (APLA) are autoantibodies directed against phospholipid-binding proteins. The development of thromboses in veins/arteries or the incidence of maternal morbidity, particularly miscarriages, in the presence of APLA constitutes Antiphospholipid Syndrome (APS). These Antiphospholipids (APLs) include antibodies against two glycoproteins, anticardiolipin antibodies, and Lupus Anticoagulant (LA). APLs are a diverse group of autoantibodies that have been linked to thrombus development, elevated maternal morbidity and mortality, and other symptoms that collectively constitute APS. Approximately half of APS cases are secondary disorders, while the remaining cases are autoimmune co-morbidities such as Systemic Lupus Erythematosus (SLE). This multisystem disorder mainly causes venous and arterial thrombosis and can also manifest as cutaneous, pulmonary, renal, and haematological involvement. APLA syndrome with pleural effusion is a rare complication. Patients with antiphospholipid syndrome can develop various types of pulmonary disease. The authors present the case of a 38-year-old male patient with a history of Deep Vein Thrombosis (DVT) and psoriasis, a known case of APLA syndrome, who presented with neck pain and breathlessness. Pulmonary embolism was ruled out, and the patient was discharged on oral anticoagulants. The present case highlights APLA as the culprit for the myriad presentations in the present case.

Physical Therapy Management of a COVID-19 Patient on Extracorporeal Membrane Oxygenation: A Case Report

Coronavirus Disease-2019 (COVID-19) can be classified as a respiratory disease that ranges from pneumonia to critically ill cases. Extracorporeal Membrane Oxygenation (ECMO) is a therapeutic procedure that can treat severe cases of respiratory failure. Hereby, the authors present, a 28-year-old case of Acute Respiratory Distress Syndrome (ARDS) young patient with COVID-19 on ECMO therapy, presenting with complaints of weakness, decreased mobility and function, and depression. The patient has received physical therapy interventions during the hospitalisation period. Respiratory, mobility, activity level, and psychological assessments were done before and after treatment using blood gases, the Intensive Care Unit (ICU) Mobility Scale, the University of Michigan scale, and the Hamilton Anxiety and Depression Rating Scale, respectively. There was an improvement in respiratory function, mobility (scores increased from 0 to 1), activity level (scores increased from 0 to 3), and psychological well-being (depression scores decreased from 18 to 15, and anxiety scores decreased from 20 to 14) after physical therapy. The treatment resulted in better recovery and prevented the worsening of the COVID-19 disease scenario.

A Case of Camphor Toxicity in a Toddler: All on Skin is Not Safe

R Ramya, N Harish, S Sundari

Paediatric population is very vulnerable to toxicities resulting from exposure to many traditional medicines, which are often used in our culture as treatments for various ailments. People are unaware of the untoward complications arising from the toxicity of these native medicines, especially camphor. Adding to the problem, parents often believe that native medicines, particularly when applied topically, are safe for children. Here, the author reported a previously healthy 2-year-old child who had multiple episodes of seizures after the mother applied topical camphor oil for five days to relieve the child’s symptoms of nasal congestion. While there is no clear data on the concentration and duration of topical camphor exposure that causes toxicity in children, the case report highlighted the possibility that younger children may develop toxicity in a relatively short period of exposure. In this modern era of evidence-based medicine, it is important to raise awareness among the public, especially parents, that not everything applied to the skin is safe for children, as their anatomy differs from that of adults.

Cholestatic Liver Disease in Late Childhood: A Report of Two Rare Cases

Sangeeta Kini, Azmat Momin, Rima N Kamat, Sameet Patel, Pravin N Rathi

Cholestatic liver disease in late childhood has a comprehensive list of aetiologies, requiring a multidimensional approach. Among these, the genetic aetiology can range from having a self-limiting course to being associated with morbidity and mortality, requiring liver transplantation. Progressive Familial Intrahepatic Cholestasis (PFIC) and Benign Recurrent Intrahepatic Cholestasis (BRIC) are two rare inherited autosomal recessive cholestatic disorders. Both are related to mutations in the bile formation transport system and typically manifest in infancy or early childhood. Among the PFIC types, The PFIC type 3 rapidly progresses to end-stage liver disease, while BRIC follows a benign course with intermittent asymptomatic periods. Here, authors describe two (17-year-old male, 19-year-old male) such unusual inherited autosomal recessive cholestatic disorders in late childhood: PFIC (type 3) and BRIC, which have distinct clinical presentations and liver function derangements.

Streamlining Thyroidectomy Treatment with a Multidisciplinary Approach: A Case Report

Avilash Mohapatra, Deepanshi Vashishtha, Srikanta Padhan

Multiple Endocrine Neoplasia 2 (MEN2) is a rare genetic disorder that affects the endocrine glands and can lead to the development of tumours in the thyroid gland, parathyroid gland, and adrenal glands. Individuals with all subtypes of MEN2 syndrome {MEN2A, MEN2B, and familial Medullary Thyroid Cancer (MTC)} are at an increased risk of developing MTC. In the present case report, authors present the case of a 26-year-old female who presented to the Department of Surgery for family screening due to her mother’s diagnosis of MEN 2A syndrome. During the screening, a swelling was identified in the anterior neck region. The swelling was firm, non tender, and not fixed to the skin. Additionally, the patient had an elevated calcitonin level. Although the patient had no history of voice abnormalities, she occasionally experienced dysphagia. A Contrast-enhanced Computed Tomography (CECT) scan of the neck revealed involvement of both lobes of the thyroid gland. To confirm the diagnosis, a DOTA NOC scan (an imaging procedure involving the injection of a radiotracer dye known as DOTA and NOC, followed by Positron Emission Tomography (PET) or Computed Tomography (CT) scan and ultrasound-guided Fine Needle Aspiration Cytology (FNAC) of the thyroid were conducted. Based on the confirmed diagnosis, the patient underwent surgical management in the form of total thyroidectomy and central compartmental lymph node dissection. However, postoperatively, the patient experienced difficulty in speech and swallowing due to involvement of the Recurrent Laryngeal Nerve (RLN). These issues were managed through physiotherapy and speech therapy as part of a holistic approach, which proved to be crucial in improving the patient’s condition and preventing complications. Therefore, the management of thyroidectomy should adopt a patient-centric and multidisciplinary approach to enhance patient outcomes and minimise complications.

Orthodontic Perspective on Marfan Syndrome: A Unique Case Report

Shiladitya Sil, D Kerthna, Shubhankar Ghosh, Nilanjana Saha

Marfan syndrome is considered a relatively rare genetic disorder that affects the connective tissues in the body. It is caused by a specific mutation in the Fibrillin 1 (FBN1) gene, which is a critical component of microfibrils. The elastic fibres in various connective tissues, composed of microfibrils, are affected in Marfan syndrome. This syndrome is associated with a vast array of clinical features involving the cardiovascular, ocular, musculoskeletal, respiratory, and nervous systems. Skeletal malocclusion is an early and characteristic manifestation of Marfan syndrome. Other cardinal features of the syndrome include tall stature, arachnodactyly, ectopic lentis, and thoracic aortic aneurysm and dissection. Most clinicians fail to correlate the systemic features with the oral features, leading to misdiagnosis or under-reported. Marfan Syndrome requires thorough understanding of the genetic components that directly result in systemic manifestations, eventually leading to skeletal malocclusion, is crucial in managing the syndrome. A multidisciplinary approach is required to assess the condition before planning and implementing appropriate treatment protocols. In the present case report, authors presented a diagnosed case of Marfan syndrome. An 18-year-old female visited the Outpatient Department (OPD) of Oral Medicine and Radiology at a Tertiary Care Centre in Siliguri, West Bengal, India, seeking management for her skeletal malocclusion. After a thorough intraoral and extraoral examination, as well as smile assessment, orthognathic surgery was performed for preliminary tooth alignment using fixed appliances. The patient’s healing process was uneventful, and she is currently being followed-up without any evidence of relapse. Early diagnosis, intervention, and judicious treatment planning with a multidisciplinary approach are key to achieving long-term stable results in correcting skeletal malocclusions associated with Marfan syndrome.

Multiple Over-retained Deciduous Teeth: A Rare Case Report

Nishu Agarwal, Pallavi Daigavane

Over-retained deciduous teeth, characterised by the persistence of primary teeth beyond their expected exfoliation time, present a unique challenge in dental practice. The present case report documents a unique and intriguing clinical scenario involving a 20-year-old female patient undergoing orthodontic treatment for multiple over-retained deciduous teeth. While such occurrences are relatively uncommon in adult patients, the present case underscores the importance of early orthodontic intervention and vigilant monitoring of dental development. The patient presented with nine retained deciduous teeth in the mandibular arch. These retained primary teeth had persisted beyond the expected age, and their presence was causing malocclusion and aesthetic concerns. Treatment planning involved a multidisciplinary approach. Orthodontic goals focused on aligning the permanent dentition while addressing the retained deciduous teeth. Comprehensive orthodontic therapy was initiated with fixed appliances. The present report highlights the importance of early diagnosis and timely intervention to mitigate potential complications associated with over-retained primary teeth in adult patients. The article discusses and focuses on the aetiology of why this type of occurrence can take place, various factors associated with it, the prevalence, and reports a rare type of case.

Paediatric Mandibular Fracture- An Enigma of its Own: A Case Report

Pulkit Khandelwal, Harish Saluja, Seemit Shah, Anuj Dadhich

Mandibular fractures are very rare in the paediatric age group; however, they remain the most common maxillofacial trauma occurring in children. A paediatric mandibular fracture can cause severe pain and discomfort for the patient. Due to the complex anatomy of the developing mandible, such as the presence of permanent tooth buds and its small size, the treatment of mandibular fractures in the paediatric age group differs markedly from that in adults. Treatment of maxillofacial fractures in the paediatric population has always been a challenge for the operating surgeon. Different treatment modalities for managing paediatric mandibular fractures include closed reduction or surgical intervention. Open/closed cap splint provides closed reduction and stabilisation of paediatric mandibular fractures without any risk of damage to permanent tooth buds. It is more commonly preferred over Open Reduction and Internal Fixation (ORIF) of the fractures. However, for highly displaced fractures, ORIF is the preferred treatment. In the present case report, the author present and describe the management of a mandibular symphyseal and medial pole of the right condyle fracture in a seven-year-old patient. Since the bone fragments were highly displaced and occlusion was severely deranged with an anterior open bite, conservative treatment using a cap splint was not considered. ORIF was performed under general anaesthesia. At the one-year follow-up, complete clinical and radiological bone healing was observed. Occlusion was satisfactory, and mouth opening was maintained. There was normal eruption of permanent teeth with no complications or delays associated with the eruption pattern.

Computed Tomography Findings in Traumatic Pneumorachis: A Case Report

Vivek Ramesh Dadaga, Vaishali D Mudabasappagol

The phenomenon of air entering the spinal canal is rare and termed pneumorachis. Due to its rarity, the evaluation and management of pneumorachis have not been well understood. Here, the authors describe a case of pneumorachis associated with pneumothorax, pneumomediastinum, subcutaneous emphysema, and traumatic pulmonary injuries in a 21-year-old male patient following blunt chest trauma after a motor vehicle accident. The patient presented with chest pain and difficulty breathing immediately after the vehicle accident, along with a deformed left arm. A bedside Focused Assessment with Sonography in Trauma (FAST) scan was performed, followed by a non-contrast CT of the thorax, which revealed intraspinal air and multiple fractures. The patient recovered without any adverse outcomes with conservative management of the intraspinal air. Pneumorachis is usually secondary to trauma and typically follows a benign course with spontaneous resolution after conservative management. It is important to be aware of this condition to identify it early and prevent complications.

Use of Red Cell Indices for Screening of Hereditary Spherocytosis in Neonates: A Report of Two Cases Confirmed by Exome Sequencing

Prolonged unconjugated hyperbilirubinaemia is defined as neonatal jaundice persisting beyond 14 days of life. Hereditary Spherocytosis (HS) often remains underdiagnosed and is a notable cause of prolonged neonatal jaundice. Coombs negative haemolytic anaemias are an important cause of unconjugated hyperbilirubinaemia, and HS is one of the most common inherited red cell membrane disorders. Other causes of prolonged unconjugated jaundice include extravasated blood (cephalhaematoma, bruises, intraventricular haemorrhage in preterm infants), haemolysis (blood group incompatibility, red blood cell enzymopathies, and membranopathies), urinary tract infection, congenital hypothyroidism, and rare familial disorders such as Gilbert’s syndrome and Crigler-Najjar syndromes I and II. Herein, the authors present a case report of two male neonates (three week-old and 25dayold) who presented with hyperbilirubinaemia requiring intensive phototherapy, blood transfusion, an exchange transfusion, and were diagnosed with HS. A significant family history suggested haemolytic anaemia, and red cell indices, namely Mean Corpuscular Haemoglobin Concentration (MCHC), Mean Corpuscular Volume (MCV), and the ratio of MCHC/MCV (neonatal HS index), helped suspect HS. Whole exome sequencing identified the specific mutation and confirmed the diagnosis of HS. Both of these neonates presented with prolonged neonatal jaundice, and HS was suspected based on the family history and red cell indices, namely MCHC and MCHC/MCV ratio, as highlighted in the present case series.

Rare Case of Bladder Endometriosis in a Post-hysterectomy Patient

Rajasi Kane Sengupta, Saunitra Inamdar, Surekha Tayade

Bladder endometriosis, a rare but well-known condition with a high risk of morbidity, affects the bladder. A 43-year-old woman presented with a history of recurrent cyclical discomfort during urination. The patient had undergone a non descent vaginal hysterectomy to address the same symptom. Upon examination, a nodule was discovered between the bladder and vaginal vault. The diagnosis of bladder endometriosis was confirmed through cystoscopy and an Magnetic Resonance Imaging (MRI). The nodule was removed via transurethal resection, and histology confirmed it as endometriosis. After 12 months of follow-up, the patient’s postoperative symptoms had completely resolved. Hormonal therapy was initiated, and there were no residual urinary symptoms, chronic pain, or cyclical pain. Women reporting urinary symptoms, particularly those with a history of pelvic surgery, should undergo evaluation for bladder endometriosis. The diagnosis of bladder endometriosis should be considered in women experiencing dysuria and bladder discomfort. A high index of suspicion is required to establish the diagnosis.

Secondary Chondrosarcoma of the Clavicle: A Case Report

Abhimanyu B Punja, DM Vaishali

Chondrosarcomas are uncommon cartilaginous tumours and are the third most common tumours arising from the bone. These tumours are low to high grade malignant chondroid tumours. Most of these lesions arise de novo and are considered primary chondrosarcomas. Tumours that develop from the cartilaginous cap of existing benign tumours like enchondroma or osteochondroma are known as secondary chondrosarcomas. Herein, the authors presented a case of a 41-year-old man who presented with a history of pain and swelling in his left clavicle for a duration of six months. Upon examination, clinicians felt a hard mass in the left clavicle region, prompting them to explore radiological insights. A radiograph revealed a lobulated sclerotic region overlying the medial aspect of the left clavicle. Computed Tomography (CT) further revealed an exophytic lesion arising from the clavicle. Magnetic Resonance Imaging (MRI) further characterised the lesion and raised suspicion of a complex malignant lesion of chondroid origin. Histopathological analysis confirmed it to be a chondrosarcoma of the clavicle. Subsequently, the patient underwent tumour excision with partial claviculectomy. Secondary chondrosarcomas are low to high grade malignant chondrogenic bone tumours that arise in pre-existing benign tumours. They may develop in osteochondromas, enchondromas, fibrous dysplasia, Paget’s disease, irradiated bone, and synovial chondromatosis. Although sarcomatous transformation is common in osteochondromas, secondary chondrosarcomas of the clavicle are extremely rare.

Successful Removal of 147 Fibroids from the Uterus via Abdominal Myomectomy: A Case Report

Nalini Sharma, Ritisha Basu, Subrat Panda, Wansalan Karu Shullai

Uterine fibroids are a common gynaecological condition that can sometimes be large and multiple, significantly impacting the affected woman’s quality of life. Managing multiple fibroids in women who want to preserve their fertility can be complex, as myomectomy is more challenging compared to hysterectomy. A 30-year-old woman was admitted with complaints of heavy menstrual bleeding, severe anaemia, and an abdominal mass equivalent to a 36-week gravid uterus. Ultrasound followed by Magnetic Resonance Imaging (MRI) revealed multiple fibroids. Since she strongly desired to preserve her fertility, an abdominal myomectomy was planned. The present case highlights the removal of 147 fibroids from the patient, along with a discussion on the challenges faced during surgery and the postoperative period. The authors emphasises that such cases require a highly multidisciplinary approach and should be performed in institutions with adequate blood banks and intensive care support.

Agenesis of the Corpus Callosum, Cardiac, Ocular, and Genital Syndrome with Interhemispheric Cyst in an Infant: A Case Report

In rural India, it is fairly common for infants to be brought in with symptoms such as failure to gain weight and a history of recurrent respiratory tract infections. Congenital Heart Disease (CHD) is often associated with various syndromes, including Down syndrome, Turner syndrome, Holt-oram, and others. It is widely understood and practiced to investigate for other systemic and congenital anomalies when a child is suspected or diagnosed with CHD or any other congenital condition. On the other hand, one of the most prevalent malformations of the cerebral cortex involves the corpus callosum. The corpus callosum consists of white matter tracts that connect the left and right cerebral hemispheres. Agenesis of the Corpus Callosum (ACC), which can be partial or complete, may occur alone or in combination with other cerebral abnormalities. It can manifest as hypoplasia or complete absence of the corpus callosum. In the present case report, the authors present a three-month-old infant who presented with complaints of failure to gain weight and a history of convulsions despite being on anticonvulsant medication. Further evaluation revealed complete agenesis of the corpus callosum on Magnetic Resonance Imaging (MRI). Additional examination findings included microcephaly, left-sided microphthalmia, low-set ears, retrognathia, suggesting a dysmorphic facies, and a left-sided inguinal hernia. The patient was also diagnosed with Patent Ductus Arteriosus (PDA) based on a 2D echo. The presence of multiple systemic anomalies in the present case makes it a rare occurrence, with only a few similar cases reported.

Accessory Hepatic Vein Stenting in the Management of Budd-Chiari Syndrome: A Case Report

Sambhaji Pawal, Rahul Arkar, Amarjit Singh, Padma Badhe

The Budd-Chiari Syndrome (BCS) is associated with hepatic venous outflow obstruction. A 22-year-old female patient presented with abdominal pain and backache for 12 days, along with generalised weakness. Physical examination revealed pitting pedal oedema and abdominal distension. An abdominal ultrasound with Doppler Ultrasonography (USG) was performed, revealing liver parenchymal disease with gross ascites and occlusion of all three Hepatic Veins (HV), suggestive of BCS. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the liver, as well as a right hepatic venogram using Digital Subtraction Angiography (DSA), showed chronic total occlusion at the ostium. An Accessory Hepatic Vein (AHV) was identified, joining the Right Hepatic Vein (RHV) to the Inferior Vena Cava (IVC). The accessory RHV exhibited high-grade stenosis (approximately 90-95%) at its junction with the IVC. Recanalisation of the AHV (balloon dilatation/stent insertion) was performed. Post-procedure accessory hepatic venogram showed a patent stented segment with a significant reduction in adjacent venous collaterals. No procedure-related complications were observed. The present case highlights the importance of AHV stenting in BCS patients, as it helps maintain normal physiology, in contrast to Direct Intra-hepatic Porto-systemic Shunt (DIPS), which alters normal physiology by allowing portal venous blood to mix directly into the systemic circulation, bypassing the liver parenchyma.

Chest Physiotherapy as an Adjunct in a Mechanically Ventilated Infant with Atelectasis: A Case Report

R Hemanth Kumar, Aishwarya Nair

Atelectasis occurs due to impaired airway clearance or complete airway obstruction caused by inflammation, leading to the collapse of tiny airways either partially or completely. This results in impaired exchange of carbon dioxide and oxygen. A chest X-ray, Computed Tomography (CT), and/or thoracic ultrasound are helpful in identifying atelectasis. In the present case, a 5-month-old female infant was reported to the Paediatric Department with the chief complaint of seizure and loss of consciousness. An X-ray was performed, revealing complete left lung atelectasis with no air entry. The infant was referred for physiotherapy in addition to medical management. Through seven intensive and regular sessions of respiratory physiotherapy, which included techniques such as percussion, vibration, and postural drainage for more than 30 minutes, there was successful resolution of the consolidation and improvement in presenting symptoms. After the final sessions of physiotherapy, the infant was discharged with physiotherapy home programs. This suggests that physiotherapy is an integral part of paediatric critical care, ensuring a good prognosis and faster recovery.

Pure Embryonal Cell Carcinoma: A Rare Entity

Neha Jaiswal, Anita Sajjanar, Vaishnavi Mishra

Malignancy of the testes constitutes only one percent of all male cancers. Most testicular malignancies are Germ Cell Tumours (GCTs), which are broadly categorised into seminomatous and non-seminomatous types. Non-seminomatous GCTs are further classified into several subtypes based on their histopathological features. This case report presents a case of Pure Embryonal Cell Carcinoma (PECC) of the testes in a 32-year-old male. The diagnostic work-up involved a detailed medical history, physical examination, and imaging tests, including a scrotal ultrasound and Positron Emission Tomography-Computed Tomography (PET/CT) scan. These tests helped identify a testicular mass without metastasis. Additionally, serum tumour markers such as Alpha Fetoprotein (AFP), human chorionic gonadotropin, and lactate dehydrogenase were elevated, further confirming the presence of testicular malignancy. The management of the patient included surgery and chemotherapy. Histopathology and immunohistochemistry were performed, resulting in a diagnosis of pure embryonal carcinoma. This case highlights the significance of timely diagnosis and prompt management in improving the prognosis of patients with PECC.

Aesthetic Rehabilitation with Veneers Using Digital Precision: A Case Report

Sanath Kumar Shetty, Naresh Shetty, K MD Asaraf

Smiling is an essential aspect of daily life, and a confident smile can greatly impact an individual’s self-esteem. Aesthetic correction of the anterior teeth poses a challenge in dentistry, particularly in cases where there is spacing between the teeth. This can lead to a lack of confidence and negatively affect a person’s self-image. Laminate veneers, a cosmetic dental procedure, involve attaching a thin layer of porcelain or resin composite material to the surface of a tooth. Compared to conventional methods, digital technology offers greater precision and efficiency in placing laminate veneers. Computerised templates guide the teeth preparation process, ensuring minimal tooth structure removal and accurate fitting of the veneers. The present report presents a case (43-year-old female patient) of spacing in the maxillary anterior that was corrected using a minimally invasive technique with laminate veneers and a fully digital workflow using lithium disilicate. The use of this material enhances the aesthetics of the patient’s smile, requiring minimal tooth reduction and providing a natural appearance. The paper also includes a nine-month follow-up. Incorporating digital technology in the creation and placement of laminate veneers offers numerous benefits, including improved accuracy, reduced turnaround time, and the ability for patients to preview their enhanced smile.

Calcified False Tendon Linked to Sudden Cardiac Death in a Young Adult: An Autopsy-based Case Report

Left Ventricular False Tendons (LVFTs) are cord-like structures that traverse the cavity of the left ventricle, connecting the left ventricular free wall or papillary muscle and the ventricular septum without attachment to the mitral valve leaflets. They are incidentally found in autopsy heart specimens. False tendons are generally benign anatomic variants and can be associated with functional murmurs and electrocardiographic abnormalities. False tendons can also be a cause of ventricular arrhythmias. Two-dimensional echocardiography serves as a useful imaging modality in detecting false tendons. They should be differentiated from other entities such as thickened ventricular trabeculations, an accessory anterior mitral leaflet, thrombus, vegetation, and ventricular masses or tumours. Most LVFTs are transverse and are located in the apex. They are found to arise from the inner trabeculated layer of the myocardium. The exact prevalence of LVFTs remains unclear. Present report is a case of postmortem findings in the heart of a 34-year-old male who experienced a sudden collapse while walking after lunch. On gross examination, the left ventricular wall and the lower part of the interventricular septum showed focal grey-white areas. A well-defined, grey-white, hard polypoidal lesion was noted in the left ventricle near the apex, attached to the papillary muscles. The left anterior descending artery showed early atherosclerotic changes. LVFT was diagnosed, which could have been the reason for the arrhythmia. Hence, the evaluation of cardiac murmurs and arrhythmias by two-dimensional echocardiography and cardiac Magnetic Resonance Imaging (MRI) serves as helpful parameters in detecting LVFTs.

Ceftriaxone-Induced Acute Hypersensitivity Pneumonitis: A Rare Case Report

Smriti Samiskshya Nayak, Nihar Ranjan Mohanty

Hypersensitivity Pneumonitis (HP), also known as extrinsic allergic alveolitis, is a pulmonary disorder characterised by an inflammatory response of the alveoli and small airways due to exposure to a variety of antigens. HP can manifest as acute, subacute, or chronic, depending on the mode of onset and its duration. A broad spectrum of antigens, derived from fungi, bacteria, mycobacteria, birds, chemical sources, and certain drugs such as cyclophosphamide and sulfonamides, has been associated with the development of HP. However, HP developed by Ceftriaxone is an extremely rare occurrence. Here, the authors presented a case of a 26-year-old male who experienced the onset of HP immediately following the administration of injectable Ceftriaxone. He developed a sudden onset of breathlessness and cough, necessitating Mechanical Ventilation (MV) and steroid support. Radiological imaging indicated pneumonitis, and the symptoms gradually resolved after discontinuing Ceftriaxone. Ceftriaxone-induced acute HP represents an unusual clinical presentation. In the present case report, the authors highlighted the possibility of Ceftriaxone as a potential cause of HP, given its capacity for rapid reversal upon its timely removal.

Acinic Cell Carcinoma of the Breast: A Rare and Diagnostically Challenging Entity

KR Anila, Joy Elsa, Anitha Mathews, Rona Joseph

Acinic Cell Carcinoma (AcCC) of the breast is a rare subtype of invasive breast carcinoma that falls under the category of salivary gland-type tumours of the breast. Histologically, it closely resembles AcCC of the salivary gland. Here, the authors report a case of AcCC of the breast in a 51-year-old woman who presented with a palpable lump in her right breast. Radiological investigation revealed a Breast Imaging Reporting and Data System (BIRADS) score V lesion. A core biopsy was performed, and the histopathological examination revealed relatively bland cells arranged in an acinar pattern within a myxoid stroma, closely resembling adenosis rather than a neoplasm. The diagnosis posed a challenge in the core biopsy due to its close resemblance to adenosis. However, the clinical and radiological findings strongly suggested malignancy. Immunostaining with p63 was conducted, which helped demonstrate the absence of myoepithelial cells around the tumour cell nests and supported the neoplastic nature of the lesion. Despite the bland and low-grade morphology, the tumour was found to be triple negative for Oestrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER2), and it exhibited characteristic positivity for SRY-Box Transcription Factor 10 (SOX 10), S100, and CK7, which aided in making the diagnosis. The authors presented the case report to highlight the rarity of this subtype of breast carcinoma and to emphasise the importance of histomorphology and immunoprofile in reaching a diagnosis. To the best of the authors’ knowledge, the present case was the second reported case of AcCC of the breast from India, adding to the novelty of this case.

Physiotherapy Perspective in the Rehabilitation of Traumatic Brachial Plexus Injury in a Patient with Polytrauma: A Case Report Emphasising an Early Approach

K Suraj Kumar, Seema Sahu, Pallavi Harjpal

Traumatic peripheral nerve damage from Road Traffic Accidents (RTA) can cause severe impairment and loss of function in the upper and lower limbs. A significant portion of acute peripheral nerve injuries affects the upper limb, particularly the brachial plexus. The treatment for complete brachial plexus injury may involve surgery and intensive physiotherapy to help the nerves regenerate and reinnervate the muscles. A 17-year-old male was referred to the Neurology department from a primary healthcare centre after being involved in RTA that resulted in a fall on the right-side. Investigatory findings revealed a head injury with Subarachnoid Haemorrhage (SAH), fractures of the right tibia shaft, right clavicle lateral shaft, and right lower limb. Following surgery, the patient experienced difficulty in performing movements with the right upper limb, along with pain and tingling sensations. As a result, the patient was referred to physiotherapy. During physiotherapy, the patient received sensory re-education sessions lasting 15-20 minutes each, as well as bilateral training sessions lasting 20 minutes each, for a total of four weeks. Over the course of the treatment, the patient demonstrated overall improvement in hand function, including proper grasp and opposition. This improvement was reflected in the brachial assessment tool, Upper Extremity (UE) functional index, and functional independence measure. These positive outcomes underscore the importance of early neuro-physiotherapeutic rehabilitation for patients with brachial plexus injuries, as it can significantly enhance their overall well-being and quality of life.

Campylobacter Infection Associated Intestinal Perforation: A Case Report

Suseela V Kundoly, Deepa Jolly

Campylobacter is an agent of diarrhoeal illness and can potentially lead to intestinal obstruction. This condition manifests as acute abdomen and requires exploration. A 22-year-old male who had been receiving empirical treatment for pulmonary tuberculosis for four days was admitted with severe abdominal pain. Laparotomy revealed intestinal obstruction and perforation. Histopathological examination of the intestinal wall and omentum showed granulomatous lesions suggestive of tuberculosis. On the third day after laparotomy, the patient developed septicaemia. Blood and peritoneal fluid yielded campylobacter on culture. The present case report emphasises the importance of considering campylobacter infection in cases of intestinal obstructions and granuloma formation.

Intra-articular Lipoma in Posterior Compartment of Knee Joint: A Case Report

R Sundara Raja Perumal, Shriram Natarajan, Senthil Kumar Aiyappan

Lipomas are the most common benign soft tissue tumors, occurring in almost any part of the body and prevalent in 2% of the population. The occurrence of intra-articular lipoma is rare and mostly documented in the anterior compartment of the knee joint, like the Hoffman pad of fat and suprapatellar region. The incidence of intra-articular lipoma in the posterior compartment of the knee joint is very rare. Herein, the authors presented a case report of a 21-year-old female with a history of chronic intermittent left knee joint pain for the last two years. Magnetic Resonance Imaging (MRI) revealed a well-defined, encapsulated lesion that was hyperintense on T1/T2 images and hypointense on, located in the intercondylar notch, anterior to the proximal half of the posterior cruciate ligament, and closely abutting the ligament. Computed Tomography (CT) showed a fat density lesion (-82 to -93 HU), indicating a lipomatous lesion. The patient underwent laparoscopic removal of this lesion, and histopathology confirmed the fatty nature of the lesion.

Retroperitoneal Desmoid Tumour Masquerading as Malignancy: A Case Report

Sneha Jawalkar, Archana Perazhi Pulikkal, Surekha U Arakeri

Desmoid tumour is a rare, benign soft tissue tumour. It is noted to be clinically aggressive but pathologically benign, showing a high local recurrence rate; however, it cannot metastasize. Although it is benign, it can impact functionality. The majority of these cases remain sporadic, and the aetiology is unknown. The retroperitoneum is a rare site, and there are few reports of desmoid-type fibromatosis occurring in this region. It is difficult to distinguish from other tumours and to identify the tumour’s origin. Here, the authors present a case of a 36-year-old female who presented with abdominal pain and a mass in her abdomen. Imaging studies revealed a large retroperitoneal mass extending from the L5 vertebral body up to the inferior endplate of the L1 vertebral body. Exploratory laparotomy was performed, and the retroperitoneal mass was resected. Grossly, it was a capsulated dark brown to grey-coloured mass measuring 15×12×10 cm. The mass was sent for histopathology {Haematoxylin and Eosin (H&E)} study and reported as a retroperitoneal desmoid tumour, which was further confirmed on Immunohistochemistry (IHC) by showing immunopositivity for Desmin, Muscle-Specific Actin (MSA), and Beta-catenin. The patient is doing well with no further complaints to date. No disease relapse has occurred. Follow-up has been done every three months till the writing of the present report.

A Case Report on Septic Arthritis caused by Burkholderia pseudomallei

J Priyadharshini, M Marleena Banu, P Smrithi Ramya, Samuel Senita

Melioidosis is an emerging infection in India caused by the environmental saprophyte Burkholderia pseudomallei. It is a gram negative, oxidase-positive bacillus that is intrinsically resistant to gentamycin, penicillin, and colistin. Risk factors for this infection include diabetes mellitus, heavy alcohol use, malignancy, chronic lung infection, liver, and kidney conditions. B. pseudomallei can lead to variable clinical manifestations, ranging from mild localised abscesses to invasive infections. However, a proper identification system for early detection and speciation is not universally available in all laboratories, and it can be easily misidentified as Pseudomonas species due to its unfamiliarity. Consequently, there may be a delay in diagnosis and failure to initiate appropriate and effective treatment, which can worsen the outcome. In this report, the author presents a case of septic arthritis in a 44-year-old diabetic male with clinical symptoms of melioidosis and involvement of multiple organs.

Anteposed Anus with Scrotal Hypospadias in a Three-Year-Old Child: A Case Report

Simran Dhole, Kiran Khedkar, Sham Lohiya

Anteposed anus and hypospadias are both multifactorial and complex diseases that exist on a spectrum. Hypospadias occurs as a result of abnormal penile development in the foetus between 8 to 14 weeks, while anorectal malformations are often associated with other congenital conditions. The co-existence of these two anomalies is rarely documented, and many cases remain inadequately treated due to a lack of understanding of their causes. Here, the author presented a rare case of a three-year-old male child with anteposed anus and penoscrotal hypospadias. The patient’s primary complaints included foecal incontinence, dysuria, irritability, and intermittent abdominal pain. Physical deformities of anteposed anus with scrotal hypospadias were noted since birth. The patient underwent a step-wise approach to management, which involved anorectoplasty followed by Stage-I and Stage-II repair of the hypospadias, with a subsequent colostomy. The patient experienced no adverse events and achieved successful outcomes, including normal passage of urine and stools through the neo-meatus and neo-anus, respectively.

Bacillary Angiomatosis of Lymph Nodes: Unusual Case Presentation in an Immunocompetent Adolescent

Bacillary angiomatosis is a neovascular proliferative condition caused by the Bartonella group of opportunistic bacteria, commonly occurring in patients with advanced Human Immunodeficiency Virus (HIV) and other immunocompromised conditions. However, cases have also been reported to occur rarely in immunocompetent individuals. Skin lesions such as nodules and papules are the most common manifestations, although cases have been rarely reported in other sites such as the oral cavity, respiratory tract, gastrointestinal tract, and bones. Isolated lymph node involvement or systemic manifestations such as fever, chills, anorexia, and weight loss are very rare. Since Bartonella is a fastidious Gram-negative bacterium that is difficult to grow and isolate in culture, diagnosis relies on histological examination of the affected organ/tissue and demonstration of the causative bacteria using special stains such as Warthin-Starry, Giemsa, Gram’s, and silver stains. Herein, the authors presented a case of bacillary angiomatosis in a 14-year-old immunocompetent adolescent male who presented with recurrent fever and painful enlargement of the axillary lymph nodes. The case is notable for its unusual clinical manifestations of systemic symptoms, specifically anorexia and significant weight loss, leading to suspicion of malignancy. Following the establishment of the diagnosis, the boy experienced complete recovery, with regained appetite and weight, following treatment with a long duration of antibiotics.

Malignant Neoplasm of the Tongue Mimicking an Oral Pyogenic Granuloma: A Case Report

Ajit Chandrasekhar, Saurabh Kumar, Rabin Chacko, Arun Paul Charlu

Pyogenic Granuloma (PG) is a benign reactive lesion characterised by tissue hyperplasia caused by local irritants. The gingiva is the most common site of occurrence in the oral cavity, followed by the tongue and buccal mucosa. It typically presents as a pedunculated or sessile mass. Removal of the irritants and complete excision of the lesion from its base usually results in complete resolution. In this case report, the authors present the case of a 44-year-old female patient, who presented to maxillofacial surgeons With complaints of difficulty in eating and speaking due to a large growth on her tongue that had been present for the past year. The mass, which was non-tender and non-indurated, nearly filled the oral cavity. Routine medical examination revealed iron deficiency anaemia, and systemic correction was initiated. Concurrently, the patient underwent surgical excision of the mass, which was initially diagnosed as a PG, under local anaesthesia. However, the final biopsy revealed poorly differentiated Squamous Cell Carcinoma (SCC). Subsequent radiological investigations revealed extensive local and regional disease spread with metastasis to the upper chest wall. As a result, the patient was advised palliative care by the Institution’s head and neck tumour oncology board.

High Intensity Therapeutic Laser Induced Changes in Cross-sectional Area of Hamstring Muscle: A Case Report

Adarsh Kumar Srivastav, Amit Mittal, Faiz Zubair Shaikh, Manu Goyal

Ultrasonography can provide a clear depiction of Muscle Thickness (MT) and Cross-sectional Area (CSA) while monitoring muscle contraction. Estimating muscle contraction through ultrasonography with physiotherapy interventions has shown to be a beneficial method for training tightened muscles. A 26-year-old male patient presented to physical therapy with a diagnosis of acute hamstring tightness in both lower extremities, based on clinical examination. Muscle tightness was confirmed through the CSA of the hamstring muscles using ultrasonography. A total of six sessions over two weeks, three times per week, including High-Intensity Laser Therapy (HILT) on each hamstring muscle using the contact method, were applied. Circumference and area of each hamstring muscle were measured through ultrasonography, along with flexibility using the sit-toe and touch test and the Active Knee Extension (AKE) test, both pre- and post-intervention. At the end of the sessions, the subject reported clinically meaningful improvement in outcome scores. This case illustrates the improvement in hamstring muscle flexibility as observed in radiological ultrasonography findings following HILT intervention in a subject with hamstring muscle tightness.

Anaesthetic Management of Caesarean Section in Asymptomatic COVID-19 Positive Parturients with Abnormal Laboratory Findings: A Series of 15 Cases

M Mohan David, Megha Bharath, Afeefa Abdu Rahman, PM Ajmal

During the Coronavirus Disease 2019 (COVID-19) pandemic, Caesarean Sections (CS) were prioritised over other elective surgeries, leading to the identification and management of asymptomatic COVID-19 positive parturients. The present case series aimed to explore the possibility of laboratory abnormalities and adverse events that can occur in asymptomatic COVID-19 positive cases in the post-pandemic era when routine screening is no longer in place. Out of 141 asymptomatic COVID-19 positive CS patients, 15 cases were selected based on specific criteria. Demographic characteristics and clinical indicators were analysed, including age, gravidity, indications for CS, laboratory values {such as D-dimer, C Reactive Protein (CRP), and platelet count}, blood transfusion requirements, and obstetric outcomes. Indications for CS were predominantly previous CS and failure to progress. Laboratory abnormalities included elevated D-dimer, CRP, leukocyte count, and thrombocytopenia in some cases. Haemodynamic stability was maintained in all patients. The use of prophylactic anticoagulation was noted, potentially offering protection against thrombosis. Asymptomatic COVID-19 positive parturients can exhibit significant laboratory abnormalities. Thromboprophylaxis may play a role in mitigating thrombotic risks. The significance of the present case series lies in the fact that the laboratory abnormalities could only be detected since all positive patients were investigated as per hospital protocol, which will be missed in the post-COVID-19 era where routine investigations are not performed on asymptomatic patients. Therefore, healthcare workers should be aware of this possibility.

Role of Supratrochlear and Supraorbital Nerve Block in Chronic Atypical Facial Pain Management: A Case Series

Sanjay Kumar, Keshav Garg, Anil Agarwal, Anjali Singh, Sandeep Khuba

Chronic Atypical Facial Pain (CAFP) presents a daunting clinical challenge, characterised by persistent, unexplained facial pain that is resistant to conventional treatments. It poses a significant challenge to both patients and healthcare providers due to its poorly understood aetiologies and resistance to traditional analgesic therapies. As a result, novel approaches are sought to alleviate the suffering of affected individuals. Supratrochlear and supraorbital nerve blocks have emerged as promising interventions for CAFP. These nerve blocks target the supratrochlear and supraorbital nerves, which are branches of the ophthalmic division of the trigeminal nerve. These nerves are frequently implicated in the generation and propagation of facial pain. By interrupting the transmission of pain signals along these nerves, supratrochlear and supraorbital nerve blocks offer a targeted and minimally invasive approach to managing CAFP. Furthermore, their relatively low risk profile makes them an attractive option for individuals who have not responded well to other treatments or who wish to avoid more invasive interventions. The present case series (three males and one female) discusses the anatomical considerations, technique, and potential complications associated with supratrochlear and supraorbital nerve blocks. It also reviews the current body of evidence supporting their use in CAFP management, including outcomes such as pain reduction and improved quality of life. Supratrochlear and supraorbital nerve blocks represent a valuable addition to the armamentarium of therapies available for the management of CAFP.

Triple Malignancy: A Series of Three Cases

Occurrence of Multiple Primary Malignancies (MPM) in an individual is an uncommon phenomenon. It can occur synchronously or metachronously, and the incidence ranges from 1 to 16%. There has been a dramatic increase in the incidence of multiple primaries in patients in the last few years. The diagnosis and treatment of these malignancies pose a clinical challenge as there is no consensus on the optimal management of this condition. It is important to distinguish this condition from the metastasis of an existing malignancy as it can alter the treatment and prognosis of these patients. So far, there have been few case reports published in the literature on triple malignancies, and to the best of authors knowledge, no series have been published yet. Here, authors report a series of three patients (one male and two females) who developed three primary malignancies either synchronously or metachronously. The management of all the patients was decided in a multidisciplinary board based on the stage of each disease and patient tolerance. Two of these patients are alive and on regular follow-up, while one patient was lost to follow-up during treatment. These cases highlight the importance of evaluating and closely following up patients, as well as considering histopathological examination of lesions in unusual sites of metastasis.

Spontaneous Iliopsoas Haematoma in Patients Undergoing Haemodialysis- An Enigma: A Case Series

Chronic Kidney Disease (CKD) progression is associated with an increased risk of bleeding due to various reasons, some of which are iatrogenic. Bleeding at unusual sites, such as the iliopsoas muscle, is difficult to suspect as awareness about this condition is sparse, and the literature about the reasons for this condition is unclear. Iliopsoas bleed continues to be an enigma, and herein, the authors present a case series of three cases of spontaneous iliopsoas haematoma. The first case was a 64-year-old male with acute coronary syndrome and CKD on dual antiplatelet agents who had an iliopsoas bleed after dialysis. The second patient was a 51-year-old male with end-stage renal disease on Maintenance Haemodialysis (MHD) who bled into the iliopsoas after anticoagulation for Coronavirus Disease-2019 (COVID-19) related illness. The third patient was a 52-year-old female who had a Catheter-Related Bloodstream Infection (CRBSI) and Atrial Fibrillation (AF) requiring anticoagulation, and she developed an abdominal wall haematoma extending upto the iliopsoas. The authors highlighted the sudden occurrence, challenges in diagnosis and management of iliopsoas bleed in CKD, with a stress on the careful use of anticoagulation.

Neuroleptic Sensitivity in Psychotic Patients on Stabilised Doses of Psychotropics during Coronavirus Infection: A Case Series

Isha Ahluwalia, Neeta Sagar Bobba, Chytanya Deepak Ponangi, MS Reddy

The emergence of the coronavirus pandemic has transformed into one of the significant health crises faced by the modern era. Its effects are not just limited to the respiratory system, but detrimental effects on the cardiovascular and neurological systems are also known to occur. While neurological complications such as encephalopathies and stroke are common, the neuropsychiatric effects are mostly described in terms of psychological effects only. The effect of coronavirus on both the pharmacodynamics and pharmacokinetics of various psychotropic medications remains debatable. The present case series aimed to highlight a rare and novel finding of the occurrence of neuroleptic sensitivity in three patients (three male patients) with psychotic illness who were previously on a well-adjusted dosage of psychotropic medications after they suffered from a coronavirus infection. It is only over the years, in the aftermath of the pandemic, that the serious and long-term neuropsychiatric complications and pharmacokinetic changes associated with coronavirus infection will be realised. Therefore, it is advisable to exercise caution when using higher doses of psychotropic medications, considering the increase in neuroleptic sensitivity.

Clinical Evaluation of Patients with Krait Bites in the Emergency Department: A Series of Three Cases

Envenomation from snakebites continues to be a severe public health issue in many parts of the world, particularly in tropical and subtropical regions. The complex range of envenomation symptoms necessitates ongoing innovative approaches for the effective treatment of snakebite victims, especially those resulting from krait species. The present case series provides a comprehensive clinical assessment of krait bite patients ( three male patients) in the Emergency Department (ED), emphasising the distinct clinical implications, cutting-edge perspectives, and critical requirements for reporting such occurrences. To identify both shared traits and unique attributes among the cases, authors analysed clinical records, laboratory data, treatment methods, and outcomes. Within the case series, three patients exhibited diverse envenomation symptoms. Notably, discrepancies were observed in the timing and severity of conventional neurotoxic indicators. Additionally, some individuals showed unusual coagulopathic symptoms, which posed challenges in diagnosis and treatment decisions. It is noteworthy that one patient demonstrated resistance to traditional antivenom therapy, raising the possibility of the need for individualised treatment plans. The wide range of clinical manifestations emphasises the importance of individualised care strategies and thorough surveillance. By illustrating the diverse clinical course of krait envenomation and the challenges it presents to healthcare professionals, present case series contributes to the current body of knowledge. The need for reporting and further research is particularly urgent, given the emergence of antivenom resistance. Reporting such occurrences becomes crucial in establishing global treatment recommendations and enhancing scientific understanding in the field as snakebite management tactics continue to evolve.

Bilateral Adrenal Masses with Different Aetiologies Presenting as Addisonian Crisis with Acute Kidney Injury: A Case Series

Mohini, Rohit Parsad, Shaveta Dahiya, Diksha Nayak, Manoj Malik

An Addisonian Crisis (AC) is an endocrinological emergency associated with high mortality, resulting from an acute deficit of hormones from the adrenal glands. It can occur either in a patient with known Adrenal Insufficiency (AI) or as the initial presentation of the disease. Primary Adrenal Insufficiency (PAI), which can be caused by autoimmune adrenalitis or tubercular adrenalitis, is the most common cause worldwide and particularly prevalent in developing countries like India. Other causes of PAI include infiltrative pathology, drugs, haemorrhage, or, rarely, malignancy. Secondary Adrenal Insufficiency (SAI) often occurs due to abrupt steroid withdrawal or defects at the level of the pituitary or hypothalamus. The present case series highlights three cases (three male patients) in which patients presented with adrenal crisis despite no prior history of AI. Subsequently, they were diagnosed with bilateral adrenal masses of different aetiologies, including primary adrenal malignancy and granulomatous infiltration of the adrenals due to Tuberculosis (TB). One case involved bilateral primary adrenal malignancy with left perirenal and pararenal space infiltration, while the other two patients were diagnosed with disseminated TB with adrenal gland infiltration. The presentation of all three cases was characterised by non specific symptoms. Initial management for all three patients involved mineralocorticoid and glucocorticoid replacement, and they were discharged with corticosteroid supplements. However, the patient with bilateral adrenal malignancy was referred to the surgery and oncology department for further evaluation and management, whereas the remaining two patients were started on Antitubercular (ATT) drugs for definite treatment.

Analysis of Glycaemic Changes and their Outcome in Critically Ill Non-diabetic Patients Admitted to the ICU: A Cohort Study

Bharat Yadav, Vinod Kumar, Amit Nachankar

Introduction: Critical illness results in physiological and metabolic changes that lead to dysglycaemia, which is associated with morbidity and mortality. There exists a J- or U-shaped relationship between average glucose levels and mortality, emphasising the importance of evaluating glycaemic variability in critical illness. Aim: To assess glycaemic changes in critically ill patients and their association with Intensive Care Unit (ICU) outcomes. Materials and Methods: The prospective cohort study was conducted from August 2018 to August 2019. A total of 100 non-diabetic critically ill patients admitted to the ICU were observed for seven days. The severity of illness was evaluated using the Glasgow Coma Score (GCS) and Sequential Organ Failure Assessment (SOFA) scores. Plasma glucose levels were recorded every four hours in the ICU. Patients were followed for a maximum of seven days or until discharge or death. They were categorised into hypoglycaemia, normoglycaemia, or stress hyperglycaemia groups for analysis. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0. Results: The study included 64 male and 36 female patients, with an average mean age of 55.90±16.51 years (range: 18-86 years). Among the 100 patients, 21 died within the seven-day hospitalisation period. Among these, two were in the hypoglycaemic group, 13 were in the normoglycaemic group, and six were in the stress hyperglycaemic group. The patients had a mean SOFA score of 11.55±2.20, which was significantly higher compared to patients without organ failure (mean score: 2.54±2.55), with a statistically significant association (p<0.01). Similarly, patients who died during hospitalisation had a very high SOFA score (mean score: 9.76±3.36), also statistically significant (p<0.01). Conclusion: Critically ill patients in the stress hyperglycaemia and hypoglycaemia groups during their ICU stay had a worse prognosis compared to patients with normoglycaemia. Hypoglycaemia during the ICU stay was associated with the poorest outcome. Maintaining normoglycaemia can significantly reduce morbidity and mortality in critically ill non-diabetic patients; therefore, considering Continuous Glucose Monitoring Systems (CGMS) for more frequent glycaemic monitoring and reducing glycaemic variability may lead to better outcomes in the ICU.

Association between Serum Uric Acid Levels and Primary Open-angle Glaucoma: A Cross-sectional Study

Vinayak Ganesh Bhat, Rajkumar Patra, CJ Raghuram, Akanksha Giri, N Lakshmana Rao

Introduction: There is an intricate association between serum Uric Acid (UA) levels and Primary Open Angle Glaucoma (POAG). UA levels in the blood are known to be a good indicator of antioxidant function, and a decrease in UA plays a key role in the pathogenesis of POAG. However, the association of serum UA and Uric Acid Creatinine Ratio (UACR) in POAG cases in the Indian population remains unexplored. Aim: To investigate the association of serum UA levels and serum UACR with POAG. Materials and Methods: This cross-sectional study was conducted among patients who attended the Outpatient Department (OPD) of Opthalmology at Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. The duration of the study was one year and six months, from January 15, 2021 to July 15, 2022. The study included 200 recently diagnosed patients with POAG, who were divided into three groups based on Intraocular Pressure (IOP): Group 1 (mild) with an IOP of 21-30 mmHg, group 2 (moderate) with an IOP of 31-50 mmHg, and group 3 (severe) with an IOP greater than 51 mmHg. Age and gender-matched 199 healthy subjects were included as the control group. Blood samples were collected from the study subjects after obtaining informed consent and were tested for serum UA (using the modified Trinder method) and serum creatinine (using Jaffe’s method) in a semiautomatic analyser (Erba chem 7). The data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0 software and MS Excel 2007. Results: The mean age of the study participants of all three groups was found to be 51.19±5.06 years with 46.7% male and 53.3% female subjects. The serum UA levels were 5.55±0.74 mg/dL in the mild POAG group, 4.1±0.5 mg/dL in the moderate POAG group, and 2.67±0.6 mg/dL in the severe POAG group (p-value <0.001). The present study also found that among the three study groups of POAG, UA levels were the lowest in the severe POAG group, followed by the moderate POAG group, and then the mild POAG group. This pattern was observed in both the males and females population. Conclusion: The present study found that serum UA levels were decreased in POAG patients compared to the normal healthy control group. Furthermore, the study revealed a significant negative association between serum UA levels and serum UACR levels with the severity of POAG.

Application of Coblation for Airway Disorder Management in ENT Practice: A Prospective Cohort Study

Introduction: Coblation, a form of radiofrequency surgery, involves using radiofrequency energy to create a plasma field through a conductive medium. This technique dissociates the medium into high-energy ions that break intercellular bonds, leading to tissue dissociation. Coblation is performed at low temperatures, making it less painful and conducive to healing in airway surgeries. Aim: To evaluate the indications, advantages, and outcomes of coblation-assisted airway surgeries. Materials and Methods: A prospective cohort study was conducted from November 2019 to May 2021 at the Department of Ear, Nose and Throat (ENT), Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. Patients with breathing difficulties, voice changes, or airway obstruction symptoms were included. A detailed history, physical examination, and diagnostic procedures were carried out. Coblation was employed under general anaesthesia for laryngeal or tracheal pathology. Data on intraoperative findings, blood loss, hospital stay, and postoperative improvements were recorded in a worksheet-based program, Numbers version 13.1 for macOS. Deductions based on the data were presented using bar charts and diagrams. Continuous variables were summarised using summary statistics, while categorical values were estimated using frequencies and percentages. Results: A total of 15 patients underwent coblation-assisted surgeries. Breathlessness was the most common symptom 11 (73.33%), followed by stridor in 10 (66.67%) and decreased oxygen levels in 8 (53.3%) were observed. Indirect laryngoscopy showed no findings compared to 70-degree scopy in detecting subglottic stenosis. Intraoperatively, 40% had Grade-II, and 27% had Grade-III subglottic stenosis. The average postoperative stay was five days. At one month, 73% showed improvement, particularly those with subglottic stenosis, while no improvement was seen in 27% of cases. Conclusion: Coblation-assisted airway surgeries offer benefits like minimal collateral damage and reduced blood loss. In this study, 73% of patients showed improvement, suggesting coblation’s potential advantages over other modalities. Although cost remains a concern, coblation’s ability to reduce postoperative morbidity and improve healing time makes it a promising tool in airway surgeries.

Burden of Anaemia and its Impact on Lymphoma Patients in Southern Rajasthan, India: A Cross-sectional Study

Introduction: The frequency of lymphoma is progressively rising. A key clinical feature of lymphoid malignancies is anaemia. The impact of anaemia goes beyond physical symptoms and can negatively affect functional capacity and Quality of Life (QoL). The presence of anaemia has been identified as a predictive factor for event-free and disease-free survival in patients diagnosed with lymphoma and is regarded as a significant unfavourable predictor for treatment results. Aim: To investigate the prevalence and impact of anaemia in naive lymphoma patients. Materials and Methods: This hospital-based, cross-sectional study was conducted in the Department of Pathology at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, from January 2019 to December 2022. A total of 66 patients diagnosed with lymphoid malignancies were included in the study. Various parameters of lymphoma cases were assessed to determine the presence of anaemia and its association with demographic features, disease stage, and haematological indices. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 20.0 The Pearson’s Chi-square test was used to analyse the difference in the prevalence of anaemia in different groups. Results: The mean age of the study patients was 47.35±20.60 years. The present study included 66 patients with lymphoid malignancies and revealed a high incidence of anaemia among them, with 38 (57.58%) cases presenting with anaemia. There was a male predominance, with 52 (78.79%) out of 66 patients male. Out of the total number of patients, 36 (54.55%) were classified as having stage I and stage II disease, while 30 (45.45%) had stage III and stage IV based on age, Ann Arbor staging, extranodal involvement, Lactate Dehydrogenase (LDH) level, and lymphoma prognostic score. Differentiation between anaemic and non anaemic patients was made by statistical analysis. Based on the findings from the complete blood count, the patients were categorised according to the severity and type of anaemia. It was determined that 38 out of 66 patients, accounting for 57.58%, had anaemia. Conclusion: Anaemia was more prevalent in younger patients and females. Microcytic hypochromic anaemia and Anaemia of Chronic Disease (ACD) were the most common types observed. Anaemia was associated with bone marrow infiltration and advanced disease stages. The present study emphasised the importance of early diagnosis and appropriate management of anaemia in lymphoma patients, as it can negatively impact treatment outcomes and reduce QoL.

Correlation of HbA1c and Insulin Resistance with Urine Albumin Excretion in Non Diabetic Obese Population: A Cross-sectional Study

Sujaya Pooyath, Sajeevan Kundila Chandran, Shajee Sivasankaran Nair

Introduction: A number of metabolic disorders are linked to obesity, which is a global health concern. Although renal impairment is a serious side-effect of obesity, its connection to insulin resistance is still a subject of discussion. Aim: To assess the correlation between microalbuminuria and HbA1c levels, as well as the association between Insulin Resistance (IR) and renal function in obese individuals. Materials and Methods: The present study was a cross-sectional study conducted in patients attending the obesity clinic, in Endocrinology department, of a tertiary hospital in Kerala, India. A total of 144 obese individuals participated, meeting age, Body Mass Index (BMI), and health-related. Insulin resistance was measured using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), while renal function was measured using the Urine Albumin Creatinine Ratio (UACR). Correlation analysis was conducted to investigate relationships between variables. Results: The study found a weak association between UACR and HbA1c levels and insulin resistance (r-value=0.159, p-value=0.056). Subjects with insulin resistance had significantly higher levels of microalbuminuria. Despite these connections, the mean UACR levels remained within the typical reference range. Conclusion: This study emphasises the importance of early renal health screening in obese individuals, with HbA1c and microalbuminuria measurements as promising methods for preventing kidney impairment. To establish causation in the complex interplay between metabolic variables and renal function in obesity and insulin resistance, future research should focus on understanding the underlying mechanisms and conducting longitudinal examinations.

Clinicodermoscopic Study of Idiopathic Guttate Hypomelanosis at a Tertiary Care Hospital in Central India

Rochit Singhal, Vivek Choudhary, Shyam Govind Rathoriya, Sanskriti Chauhan

Introduction: Depigmented skin lesions are commonly encountered in day-to-day practice and can cause significant social stigma. They are challenging to diagnose clinically and histopathologically. Idiopathic Guttate Hypomelanosis (IGH), a pigmentary condition commonly affecting older individuals, can lead to cosmetic deformity and have a significant psychological impact. Dermoscopic evaluation offers a quick and easy way to resolve diagnostic confusion and prevent unnecessary biopsies. Aim: To study the clinical and dermoscopic features of IGH. Materials and Methods: This cross-sectional observational study was conducted in the Department of Dermatology, Venereology, and Leprosy at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India from July 2021 to June 2022. A total of 180 patients with IGH lesions underwent a detailed clinical history, dermatological and systemic examinations, followed by dermoscopic examination. The collected data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the results were tabulated in terms of distribution, frequency, and mean±Standard Deviation (±SD). Results: Among the 180 patients, the most affected age group was 51-60 years. A total of 108 (60%) were females and 72 (40%) were males. The most common site of involvement was the distal part of the lower extremity in 152 (84.4%) cases, followed by the distal part of the upper extremity in 115 (63.8%) cases. A total of 46 (25.5%) patients had a history of excessive sun exposure. Additionally, 21 (11.6%) patients had other associated features of photoaging, such as xerosis, solar lentigo, seborrhoeic keratosis, freckles, and actinic keratosis. The most common dermoscopic pattern observed was amoeboid in 103 (57.2%) patients, followed by feathery in 41 (22.7%), petaloid in 23 (12.7%), nebuloid in 13 (7.2%), and a combination of patterns in six percent of patients. Conclusion: The IGH was more common in females and older age groups, with the distal parts of the lower extremity being the most frequently involved site. Excessive sun exposure was a common risk factor for IGH, and several patients may have associated signs of photoaging. The most common dermoscopic pattern observed was amoeboid. Therefore, clinical dermoscopic examination can be helpful in identifying IGH and differentiating it from other depigmented lesions.

Association of Glycosylated Haemoglobin and Wound Healing in Diabetic Foot Ulcer: A Prospective Cohort Study

Introduction: Diabetes Mellitus (DM) is a disease that, over time, can affect practically all organ systems in the body, including the skin and circulatory systems. An estimated 15% of all diabetic patients develop a foot ulcer in their lifetime. Although it is clear from the literature review that strict glycaemic control prevents complications, the relationship between Glycosylated Haemoglobin (HbA1c) value and wound healing in diabetic foot patients is less well-defined. Aim: To determine the association between Glycosylated Haemoglobin (HbA1c) and wound healing rate in Diabetic Foot Ulcers (DFUs). Materials and Methods: This prospective cohort study was conducted in the Department of General Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, between August 2018 and July 2020. All patients between 18 and 70 years old, diagnosed with diabetic foot according to the World Health Organisation definition, and presenting with a lower limb ulcer were included as study participants. A detailed clinical history, examination of the patient, limb, and ulcer, and baseline HbA1c assessment were performed. The ulcer wound was graded and staged according to the University of Texas Wound classification system. All selected patients were divided into two groups. Group-A (n=15) comprised patients with HbA1c ≤7%, and Group-B (n=15) consisted of patients with HbA1c >7%. The primary outcome was the wound healing rate per day in relation to HbA1c levels at baseline and subsequent follow-up. The secondary outcomes were the demographic profile and predisposing factors affecting the healing of DFUs. Student’s t-test (two-tailed, independent) and Chi-square/Fisher’s-exact tests were performed for statistical analysis. Results: The mean age of the subjects was 57.33±7.43 years in Group-A and 56.20±7.51 years in Group-B. There was a male preponderance in both Group-A (9) and Group-B (11). A total of 11 (36.7%) patients had a history of smoking, all of them being male. The mean healing rate per day was 0.09±0.02 cm2/day in Group-A patients, which is higher compared to Group-B with 0.02±0.01 cm2/day. Conclusion: Strict glycaemic control is a mainstay in preventing the progression of foot ulcers to gangrene and, therefore, amputation. A lower baseline HbA1c at the presentation of DFU is indicative of a favourable outcome in terms of wound healing, with comprehensive treatment and follow-up efforts.

Effect of Exercise on ECG Components and their Correlation with Body Mass Index among Young Asymptomatic Obese and Non-obese Individuals: A Cross-sectional Study

Sujoy Mukherjee, Goutam Banerjee, Sanhita Mukherjee

Introduction: The worldwide higher prevalence of obesity is currently one of the most important reasons for the occurrence of several health disorders, along with an increased risk of mortality and morbidity. However, the magnitude of the effect of sub-maximal aerobic exercise on cardiac autonomic and electrical function among Indian obese individuals has yet to be established. Aim: To evaluate the effect of exercise on ECG components and their correlation with Body Mass Index (BMI) among young asymptomatic obese and non-obese individuals, in order to assess the risk for developing Cardiovascular Diseases (CVD) in the future. Materials and Methods: An observational cross-sectional study was conducted at the Autonomic Research Laboratory of the Physiology Department at RG Kar Medical College and Hospital, Kolkata, between January 2017 to December 2017. Two hundred healthy medicos were divided into two groups: Obese (BMI ≥25 kg/m²; n=88) and non-obese (BMI ≥18.5 to ≤23 kg/m²; n=112). Resting Blood Pressure (BP) was manually recorded, followed by the recording of long lead-II ECG in the supine posture both at rest and ten minutes after submaximal (50% VO2max) aerobic exercise on a treadmill using the modified Bruce protocol and following the Astrand-Rhyming nomogram. The HR, QT interval, and RR interval were recorded from the lead-II ECG. The measured QT interval was corrected using Bazett’s formula (QTC=QT/vRR). The results were analysed using both unpaired and paired t-tests and the Pearson correlation coefficient in Graphpad-Quickcalc software. Results: Significant prolongation of the QTc interval both at rest (p-value: 0.019) and after exercise (p-value: 0.044), along with delayed Heart Rate Recovery (HRR) (p-value: 0.001), were observed among the obese compared to the non-obese population. Additionally, a significantly positive linear correlation was observed between BMI and ECG components at rest (BMI-RHR: r:+0.293; p: 0.005 and BMI-QTc Interval: r:+0.226; p-value: 0.034) and during the recovery state (BMI-HRR: r:+0.42; p-value: 0.00004 and BMI-QTc Interval: r:+0.365; p-value: 0.0004), only among the obese. Conclusion: At rest, obese individuals had an elevated QTc, which could be due to alterations in cardiac autonomic function, along with a significant positive correlation between BMI and RHR, indicating lower aerobic fitness in this population. Prolongation of the QTc interval, delayed decrease in HR, and a significant positive correlation with BMI after exercise in obese individuals indicated myocardial repolarisation instability, autonomic dysfunction, and an increased risk of out-of-hospital sudden cardiac events in these individuals.

Role of Instrument-assisted Soft Tissue Mobilisation in Text Neck Syndrome: A Quasi-experimental Study

Amita Aggarwal, Anuj Pawan Lahoti, Tushar J Palekar

Introduction: Text Neck Syndrome occurs due to sustained Forward Head Posture (FHP) when smartphones are used constantly without any breaks for more than five hours and with improper posture. Long-term untreated text neck can cause inflammation of the neck’s ligaments, muscles, and nerves, leading to chronic arthritic changes. Literature provides studies evaluating the effects of physical or manual therapy, but there is a lack of studies investigating the effects of Instrument-assisted Soft Tissue Mobilisation (IASTM) treatment in individuals with text neck syndrome. Aim: To determine the added effect of IASTM on text neck syndrome. Materials and Methods: This quasi-experimental study was conducted at Department of Physiotherapy, Dr. D.Y. Patil College of Physiotherapy, Pune, Maharashtra, India, from August 2022 to December 2022. A total of 22 subjects, with a mean age of 21.58±1.18 years, participated in the study. The subjects were then divided into two treatment groups (n=11 each). The experimental group (Group-A) received stretching, strengthening exercises with IASTM, while the control group (Group-B) received only conventional physical therapy (stretching and strengthening). The treatment was delivered for a two-week period. The data were analysed using MedCalc statistical software version 20.210. Significance was set at a p-value less than 0.05. For within-group analysis, Wilcoxon’s signed-rank or paired t-test was used depending on the normality distribution, and for between-group comparisons, Mann-Whitney tests were used for skewed variables. Results: The pain severity (p-value=0.0063) and neck disability (p-value=0.0008) were significantly lower in the IASTM group than the control group. Additionally, the Craniovertebral Angle (CVA) (p-value=0.0001) significantly increased with IASTM (Group-A) compared to the control group. Conclusion: The study concluded that IASTM and conventional therapy are individually effective in improving pain, disability, and FHP in text neck syndrome. However, adding IASTM to routine physical therapy showed statistically more significant results compared to physical therapy alone in reducing neck pain, disability, and FHP.

Modified Lateral Intercostal Artery Perforator Flap in Immediate Partial Breast Reconstruction for Breast Cancer: A Retrospective Cohort Study

Introduction: The primary surgical options for treating breast cancer involve mastectomy or Breast Conservative Surgery (BCS), which may or may not include reconstruction procedures. BCS helps achieve complete tumour excision with an acceptable cosmetic result. Contour deformities and asymmetry are associated with tissue excision in the lateral aspect of the breast. To address this issue, various techniques of volume replacement, such as the modified Lateral Intercostal Artery Perforator (LICAP) flap, can be performed. Aim: To demonstrate the outcomes of a modified LICAP flap when a muscle flap is not available or desired. Materials and Methods: A retrospective cohort study was conducted, reviewing all modified LICAP flaps performed for breast tumours in Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, a tertiary-level cancer centre, from June 2018 to August 2020. Patient demographics, surgical details, histopathology reports, and postoperative complications were collected. Results: Ten patients underwent modified LICAP flaps over a two-year period. All patients had pT2 tumours with margin-negative resection, and the mean resection volume of the specimen was 370 cm3. Intraoperative patient repositioning was not necessary during the modified LICAP flap procedure. One patient experienced marginal wound necrosis, which was managed conservatively. No patients had scars extending beyond the posterior axillary line, and axillary dissection was performed without a separate incision. Conclusion: The present study demonstrates the advantages of using a modified LICAP flap for breast reconstruction. The modified LICAP flap can be considered as an option for tumours located in the outer aspect of the breast, providing good access to the breast as well as the axilla, with an aesthetically acceptable scar.

Combined Cyclin D2 and Protein Convertase 2 Genes in Differentiating Various Follicular-patterned Lesions and Neoplasms of the Thyroid: A Cross-sectional Study

Introduction: A pretherapeutic distinction between benign and malignant thyroid nodules is critical for the clinical management of patients presenting with thyroid nodules. However, certain follicular-patterned lesions, such as adenomatous nodules, follicular neoplasms comprising Follicular Adenoma (FA) and Follicular Carcinoma (FC), as well as the Follicular Variant of Papillary Thyroid Carcinoma (FVPTC), can pose a significant dilemma during pre-therapeutic Fine Needle Aspiration Cytology (FNAC) evaluation. The present (pilot) study explores the possible utility of messenger Ribonucleic Acid (mRNA) and the protein expression of the two relatively less-explored genes, Cyclin D2 (CCND2) and Protein Convertase 2 (PCSK2), in distinguishing various follicular-patterned thyroid lesions and neoplasms by testing these molecular markers initially on histopathological sections. Aim: To assess the RNA and protein expressions of CCND2 and PCSK2 genes in differentiating follicular-patterned thyroid neoplasms. Materials and Methods: This was a cross-sectional analytical study conducted over 6 years, from August 2014 to August 2020, at the Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Real-Time quantitative Polymerase Chain Reaction (RT-qPCR) along with Immunohistochemistry (IHC) was performed on a total of 75 tissue samples from follicular-patterned thyroid lesions and neoplasms, including 19 Follicular Hyperplasias (FHs), 10 Nodular Goitres (NGs), 17 FAs, 8 FCs, and 12 FVPTCs, along with nine Conventional Papillary Thyroid Carcinomas (CPTCs). After confirming the RNA and protein expression levels in each of these lesions, Immunoreactive Scoring (IRS) was performed to assess their IHC expression. The Kruskal-Wallis and Analysis of Variance (ANOVA) tests were used to analyse the mRNA expression data, and Pearson analysis was conducted to correlate the IHC data between the study groups. A p-value of <0.05 was considered statistically significant. Results: Among the 75 thyroid lesions studied, both NG and FA showed a relatively higher cyclinD2 mRNA expression, with fold changes of 1.21 and 1.46, respectively. This was also reflected in IHC, with moderate nuclear expression observed in these cases. The PCSK2 mRNA expression was similar to that of CCND2, with the only difference noted between FH and FA. On IHC, eight out of 75 cases had positive PCSK2 expression, including five FHs, two FVPTCs, and one FA, while the remaining 67 cases were negative. Conclusion: The CCND2 and PCSK2 genes assessed in the present study, regarding their mRNA and protein expressions, were not found to be of any practical value in distinguishing benign and malignant follicular lesions or neoplasms of the thyroid. Introduction: A pretherapeutic distinction between benign and malignant thyroid nodules is critical for the clinical management of patients presenting with thyroid nodules. However, certain follicular-patterned lesions, such as adenomatous nodules, follicular neoplasms comprising Follicular Adenoma (FA) and Follicular Carcinoma (FC), as well as the Follicular Variant of Papillary Thyroid Carcinoma (FVPTC), can pose a significant dilemma during pre-therapeutic Fine Needle Aspiration Cytology (FNAC) evaluation. The present (pilot) study explores the possible utility of messenger Ribonucleic Acid (mRNA) and the protein expression of the two relatively less-explored genes, Cyclin D2 (CCND2) and Protein Convertase 2 (PCSK2), in distinguishing various follicular-patterned thyroid lesions and neoplasms by testing these molecular markers initially on histopathological sections. Aim: To assess the RNA and protein expressions of CCND2 and PCSK2 genes in differentiating follicular-patterned thyroid neoplasms. Materials and Methods: This was a cross-sectional analytical study conducted over 6 years, from August 2014 to August 2020, at the Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Real-Time quantitative Polymerase Chain Reaction (RT-qPCR) along with Immunohistochemistry (IHC) was performed on a total of 75 tissue samples from follicular-patterned thyroid lesions and neoplasms, including 19 Follicular Hyperplasias (FHs), 10 Nodular Goitres (NGs), 17 FAs, 8 FCs, and 12 FVPTCs, along with nine Conventional Papillary Thyroid Carcinomas (CPTCs). After confirming the RNA and protein expression levels in each of these lesions, Immunoreactive Scoring (IRS) was performed to assess their IHC expression. The Kruskal-Wallis and Analysis of Variance (ANOVA) tests were used to analyse the mRNA expression data, and Pearson analysis was conducted to correlate the IHC data between the study groups. A p-value of <0.05 was considered statistically significant. Results: Among the 75 thyroid lesions studied, both NG and FA showed a relatively higher cyclinD2 mRNA expression, with fold changes of 1.21 and 1.46, respectively. This was also reflected in IHC, with moderate nuclear expression observed in these cases. The PCSK2 mRNA expression was similar to that of CCND2, with the only difference noted between FH and FA. On IHC, eight out of 75 cases had positive PCSK2 expression, including five FHs, two FVPTCs, and one FA, while the remaining 67 cases were negative. Conclusion: The CCND2 and PCSK2 genes assessed in the present study, regarding their mRNA and protein expressions, were not found to be of any practical value in distinguishing benign and malignant follicular lesions or neoplasms of the thyroid.

Platelet Count and Platelet Distribution Width: Potential Predictive Biomarkers for Preeclampsia and Eclampsia

Neha, Aseema Das, Amilee Gogoi, Bhargav Chaliha

Introduction: Hypertensive disorders of pregnancy are one of the most common obstetric pathologies, affecting approximately 8-10% of all pregnancies worldwide, including entities like preeclampsia and eclampsia. Preeclampsia increases the risk of maternal morbidity and mortality, foetal mortality, and preterm birth. Early identification of preeclampsia and eclampsia helps in the effective management and favourable outcome of pregnancy. Aim: To determine the relationship between platelet parameters, namely Platelet Count (PC) and Platelet Distribution Width (PDW), with preeclampsia and eclampsia. Materials and Methods: A hospital-based analytical cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology, including 100 pregnant women attending the antenatal clinic in Jorhat Medical College and Hospital, Jorhat, Assam, India, for a duration of one year (from June 2021 to July 2022). Pregnant women meeting the inclusion criteria were selected and divided into two broad groups: a comparison group comprising normotensive pregnant women (n=50) and a study group (n=50), which further included subgroups of preeclamptic women (n=35) and eclamptic women (n=15). A 5 mL venous blood sample was drawn and collected in an Ethylenediaminetetracetic acid (EDTA) vial from both groups and analysed using a six-part fully automated haematology cell counter (SYSMEX XN-550) for PC and PDW. Changes in PC and PDW were compared between the two groups using a student t-test with GraphPad software. A p-value of <0.05 was considered statistically significant. Results: The mean PC in preeclampsia was 185.714±69.56×103/μL, while in eclampsia, it was 147.53±56.927×103/μL. The mean value of PDW in preeclampsia was 18.4314±4.184 fL, while in eclampsia, it was 14.86±3.854 fL. A decrease in PC was found to be statistically significant in eclampsia (p-value <0.001). PDW was statistically significantly different among normotensive, preeclamptic, and eclamptic participants (p-value <0.001). The increase in PDW was higher in eclamptic patients compared to preeclamptic patients. Conclusion: Hence, the estimation of PC and PDW can be used as a screening test for the early identification of preeclampsia and eclampsia. Platelet parameters may act as an indicator of preeclampsia and eclampsia. The prognosis of preeclampsia and eclampsia in pregnant women can also be assessed, making them effective prognostic markers as PDW correlates with disease severity. Moreover, these indices are cost-effective and easily available.

Agreement of Revised Premature Infant Pain Profile Scoring between Healthcare Providers and Laypersons: A Cross-sectional Study

Introduction: The experience of pain during the neonatal period has short and long-term consequences. The Revised Premature Infant Pain Profile (PIPP-R) is a globally accepted and validated tool for assessing pain in neonates. Adequate pain management measures can be implemented using the PIPP-R, even in the absence of consultants. Aim: To assess the agreement among healthcare providers and laypersons in scoring the PIPP-R. Materials and Methods: A cross-sectional study was conducted at Shree Krishna Hospital, a rural Tertiary Care Teaching Hospital in central Gujarat, India. The duration of the study was one year and six months, from January 2021 to June 2022. The study included 12 volunteers from various fields, such as consultant neonatologists, first year postgraduate students in Department of Paediatrics, neonatal nurses, social workers, Bachelor of Medicine, Bachelor of Surgery (MBBS) interns, and mothers of newborns. A neonatology consultant provided training on the PIPP-R scoring system using handouts and a presentation. The volunteers then evaluated 100 prerecorded videos of newborns undergoing painful procedures. Agreement between volunteers for the total PIPP-R score and its subcomponents was assessed using Bland-Altman analysis and Cohen’s Kappa statistics. Results: A total of 100 videos of newborns (51 girls, 49 boys) undergoing painful procedures were evaluated for the PIPP-R score. The mean age, gestational age, and birth weight of the newborns were 2.21±1.55 days, 37±2.44 weeks, and 2.56±0.72 kg, respectively. The procedures included heel prick for Random Blood Sugar (RBS) (44%), intravenous sampling/insertion (34%), and intramuscular vitamin K injection (22%). The mean difference with 95% Confidence Limits (CL) of total PIPP-R scores between the two consultants (neonatologists) was -0.640 (-5.196, 3.916). The length of the CL was -9.112, which fell outside the defined CL of 4.2 (20% of the total score), indicating unacceptable agreement between the two consultants. Similarly, agreement between each consultant and any of the other participants, including residents, nurses, interns, mothers, and social workers, regarding the total PIPP-R score, as well as its subcomponents, was also deemed unacceptable. Conclusion: The present study concluded that the inter-rater reliability of the PIPP-R score and its subcomponents was unacceptable between consultants and with any of the other participants.

Comparison of Safety and Efficacy of Unilateral Spinal Anaesthesia and Ultrasound-guided Sciatic Femoral Nerve Block in below Knee Surgery: A Randomised Clinical Study

Dhara M Shah, Bipin K Shah, Shruti Desai, Sarala C Baria

Introduction: With modern advances, Ultrasonography (USG)-guided regional block techniques have improved nerve blockade with lesser drug usage and maximum safety for patient care. The widely appreciated outpatient surgical care has compelled us to apply the fastest and safest anaesthesia technique. For lower limb surgeries, USG-guided Sciatic Femoral Nerve Block (SFNB) is an emerging alternative to Spinal Anaesthesia (SA). Aim: To compare the safety and efficacy of both techniques in terms of haemodynamic stability, quality of block, and postoperative analgesia. Materials and Methods: A randomised double-blind study conducted at GCS Medical College, Hospital, and Research Centre, Ahmedabad, Gujarat, India, on 80 patients aged 18 to 70 years of either sex, with American Society of Anaesthesiology (ASA) Grade 1 to 3, undergoing below-knee surgeries was divided into two groups. Group A received USA with 1.5 mL hyperbaric inj. ropivacaine 0.75%, and Group B received USG-guided SFB with inj. ropivacaine 0.5% 30 mL (15 mL for sciatic nerve and 15 mL for femoral nerve block). Preparation Time (PT), Surgical Anaesthesia Time (SAT), haemodynamic changes, quality of block, Longevity of Anaesthesia (LoA), time of first rescue analgesia, time of spontaneous urination, readiness to discharge, and patient satisfaction were recorded. The statistical analysis was carried out using Statistical Package for Social Sciences version 23.0 (SPSS Inc., Chicago II, USA). The p-value was derived by unpaired t-test and Chi-square test. Results: PT and SAT were higher in Group B (12.10±2.02 mins and 15.74±1.58 mins) than in Group A (6.15±1.12 mins and 8.23±1.45 mins). LoA time and time to first rescue analgesic were higher in Group B (284.10±54.44 mins and 265.71±33.69 mins) than in Group A (138.75±23.30 mins and 132.40±17.41 mins). Time to first spontaneous urination and readiness to discharge were shorter in Group B (136.42±18.40 mins and 158.39±10.78 mins) than in Group A (162.20±26.54 mins and 181.53±18.18 mins). Haemodynamic stability was excellent in both groups with no significant fluctuation. Motor blockade of Bromage 3 grade was achieved in 40 and 38 patients in Group A and B, respectively. The development of VAS score >3 was faster in Group A than in Group B (35 versus 2) at the end of three hours. No adverse events were observed in any patient. Conclusion: USG-guided SFB offers a safe and efficient alternative to Unilateral SA (USA) with satisfactory blockage, stable haemodynamics, and better postoperative analgesia for below-knee surgeries.

Understanding the Estranged Attitude of Medical Students while Attending Lectures at a Medical College in Eastern India: A Cross-sectional Study

Introduction: Absenteeism among medical undergraduate students during lecture classes is a worldwide problem in medical education. Their disengaged attitude towards attending lectures is associated with poor grades in examinations and contributes to poor professional socialisation. Aim: To identify the different factors responsible for absenteeism among medical undergraduate students during lecture classes and gather feedback that may help improve the content and delivery of these classes. Materials and Methods: This cross-sectional survey was conducted at the Department of Biochemistry, Bankura Sammilani Medical College, West Bengal, India. The study duration was six months, from October 2022 to March 2023. A total of 199 undergraduate medical students from phase-I voluntarily participated in the study out of a total of 200 students. A prevalidated questionnaire using the Likert scale was used as the study tool to determine the students’ perspectives on poor attendance. Additionally, a focused group discussion was held to obtain the students’ opinions on improving the presentation of lectures. The responses were recorded, and the Tastle and Wierman tests were conducted to derive a consensus opinion. Results: Among the participants, 169 (84.9%) strongly agreed and 125 (62.8%) agreed that access to multiple websites and a preference for self-study were factors leading to skipping lectures, respectively. There was a strong agreement, with a consensus score of 0.52, that factors such as the inability of the mental capacity to match the chosen course, poor content, and monotonous presentation were important contributors to absenteeism. A significant correlation was observed between internal assessment scores and lecture attendance (p-value <0.01, r-value=0.4). Approximately 44% of participants believed that a chalk and talk approach followed by small group discussions was the best teaching method. Conclusion: This cross-sectional survey identified multiple factors, such as access to various e-learning platforms, a preference for self/group study, and technical difficulties, as reasons for poor attendance in lecture classes. However, improvements in content, mode of presentation, and clinical relevance of topics may enhance students’ attitudes towards attending regular lectures and improve their performance.

Correlation between Myosteatosis and Liver Fibrosis among Patients with Non Alcoholic Fatty Liver Disease: A Cross-Sectional Study

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is one of the major leading causes of liver diseases, comprising a spectrum of conditions ranging from simple steatosis to cirrhosis. In the era of preventive medicine, it is of utmost importance to recognise the subset of NAFLD patients at high risk of progressing to liver cirrhosis. A newly emerging concept of myosteatosis is now suspected to be an early manifestation of NAFLD disease progression. Aim: To find the correlation between myosteatosis and liver fibrosis among patients with NAFLD. Materials and Methods: This was a cross-sectional study conducted in the Department of Radiodiagnosis and Department of Gastroenterology at Amala Institute of Medical Sciences in Thrissur, Kerala, India, from January 2021 to June 2022. A total of 57 subjects with Magnetic Resonance Imaging-proven (MRI) NAFLD were included in the study. Body weight and height were measured. Liver fat and myosteatosis were measured using the MRI-derived Proton Density Fat Fraction (PDFF) method {Iterative Decomposition of Water and Fat with Echo (IDEAL-IQ sequence)}. Liver fibrosis was assessed using 2D shear wave elastography. The proportion of myosteatosis and liver fibrosis among NAFLD patients was estimated. Partial correlation, controlling for gender, was evaluated using partial Spearman’s rho correlation coefficients. An Reciever Operating Characteristic (ROC) curve was plotted to assess muscle fat fraction in predicting liver fibrosis outcome among patients. Results: Out of the 57 subjects studied, 17 were females and 40 were males. The median Interquartile Range (IQR) age of the subjects was 43.0 (16.5). The median MRI hepatic fat fraction was 10.8. The median muscle PDFF in males was 8.4, and in females, it was 16.9. The median H-PDFF was 18.8. Myosteatosis correlated positively with liver fibrosis (r=0.558; p<0.001). It also negatively correlated with hepatic steatosis (r=-0.321; p=0.02). A statistically significant correlation was not found between liver fat and liver fibrosis. An ROC curve was plotted to predict the liver fibrosis outcome by muscle fat fraction {Area Under Curve (AUC: 0.605; p-value: 0.204)}, which showed a sensitivity of 0.615 and a specificity of 0.389 at a cut-off score of 10.43. Conclusion: Myosteatosis positively correlated with liver fibrosis and negatively with liver steatosis.

Clinical Efficacy of Kedo S Square Files versus Manual K Files in Root Canal Preparation of Deciduous Molars: A Randomised Clinical Trial

Introduction: The conventional approach to root canal preparation in primary molars involves hand instrumentation. However, the disadvantage of longer instrumentation time poses a challenge for dentists treating paediatric patients. As a solution, rotary file systems have been introduced to reduce chairside time and improve patient cooperation. Among the various rotary file systems available, the “Kedo S Square” rotary files are exclusive single files made of Nickel-titanium (NiTi), offering increased flexibility and variable taper to adapt to the curved canals of deciduous molars. Aim: To assess and compare the instrumentation time and obturation quality of rotary “Kedo S Square” files with manual K files in deciduous molars. Materials and Methods: This randomised clinical trial was conducted from July 2022 to February 2023 included 40 primary molars from four to six-year-old children requiring root canal therapy. The teeth were evenly allocated to two groups: Group 1 underwent instrumentation using “Kedo S Square” files, while Group 2 underwent instrumentation using manual K files. The instrumentation time was recorded, and post-treatment radiographs were taken to evaluate the quality of obturation by a single-blinded investigator. Statistical analysis included the Independent t-test, Levene’s Test for Equality of Variances, Chi-square test, and Fisher’s-exact test. Results: The use of Kedo S Square files resulted in significantly less instrumentation time (p<0.001) with a mean time of 3.91±1.462 minutes. There was no statistically significant difference in obturation quality between the two groups, with a p-value of 0.427. Conclusion: Kedo S “Square” files demonstrated comparable obturation quality with shorter instrumentation time compared to manual K files in root canals of primary molars.

Facial Measurements and Their Correlation with Vertical Dimension of Occlusion in Dentate Subjects: An Anthropometric Analysis

Enu Kamboj, Sandeep Garg, Nidhi Mangtani Kalra

Introduction: In the field of prosthodontics, there lies a delicate balance between the preservation of supporting structures and the restoration of physiological function while providing complete denture prostheses to completely edentulous patients. A good prosthesis requires appropriate recording of the proper maxillo-mandibular relationship, including the vertical dimension of occlusion, which is a crucial step in complete denture fabrication. The reliability of anthropometric methods to determine the vertical dimension of occlusion has been widely discussed in the literature. Aim: To evaluate the correlation of various facial measurements with the vertical dimension of occlusion in dentate subjects. Materials and Methods: This cross-sectional study was conducted in the Department of Prosthodontics at a Dental College in Ambala district of Haryana, India, from February 2021 to July 2023. A total of 100 subjects (50 females and 50 males) within the age range of 20-35 years were selected. Five facial parameters were selected to correlate with the vertical dimension of occlusion: the distance from glabella to subnasion, the distance from the outer canthus of one eye to the inner canthus of the other eye, the distance from the outer canthus to the rima oris, the distance from the outer canthus to the External Auditory Meatus (EAM) on the left side of the face, and the Interpupillary Distance (IPD). Facial measurements were recorded using a digital vernier calliper, while IPD was recorded using a PD ruler. Each measurement was made three times and recorded by a single operator. Once recorded, all the measurements were tabulated and subjected to statistical analysis using the Pearson’s correlation coefficient test. Regression analysis was also conducted to formulate a regression equation for determining the vertical dimension of occlusion. Results: The mean Vertical Dimension of Occlusion (VDO) for males was 59.29±6.48 mm, and for females, it was 52.34±5.92 mm. The results showed a positive and significant (p-value <0.05) correlation between the vertical dimension of occlusion and facial measurements such as glabella to subnasion (p-value for males: 0.001, p-value for females: <0.001), outer canthus to inner canthus (p-value for males: 0.01, p-value for females: <0.001), outer canthus to rima oris (p-value for males: <0.001, p-value for females: <0.001), and outer canthus to EAM (p-value for males: 0.007, p-value for females: 0.001) in both males and females. However, there was no significant correlation between IPD and VDO (p-value for males: 0.296, p-value for females: 0.66) in both genders. Conclusion: It can be concluded that facial measurements could be taken into consideration for determining the vertical dimension of occlusion in completely edentulous patients in conjunction with other reliable methods.

Significance of Neutrophil-lymphocyte Ratio, Neutrophil-platelet Ratio, and Neutrophil-to-lymphocyte and Platelet Ratio in Predicting Outcomes in Dengue Patients on Admission in Wardha, Maharashtra, India: A Retrospective Cohort Study

Sachin Agrawal, Sunil Kumar, Dhruv Talwar, Mansi Patel, Harshitha Reddy

Introduction: Dengue is an important viral infectious disease, mostly seen in tropical countries during the rainy season, and is emerging as a public health hazard for healthcare facilities. The most common parameters used to assess the severity of dengue are platelet count and haematocrit. However, new haematological parameters have emerged to predict the severity of dengue fever and assist clinicians, especially in resource-limited settings. Aim: To highlight the significance of Neutrophil-Lymphocyte Ratio (NLR), Neutrophil-Platelet Ratio (NPR), and Neutrophil-to-Lymphocyte and Platelet Ratio (NLPR) in predicting outcomes in patients with dengue infection. Materials and Methods: A retrospective observational study was conducted in rural central India in the Department of Medicine at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. A total of 540 patients infected with the dengue virus between June 2021 and December 2021. Data analysis was conducted from January to April 2022. Neutrophil, platelet, and lymphocyte counts were used to calculate NLR, NPR, and NLPR, and their roles in predicting the final outcome were studied. The final analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 21.0. The p-value <0.05 than 0.05 was considered statistically significant. Results: The mean age of the patients was 29.85±13.40 years, ranging from 18 to 85 years, with a median age of 25 years. A total of 331 (61.7%) patients below 30 years of age were significantly higher than patients aged 30 years or older (38.3%) (Z=3.39; p=0.0007). The Area Under Curve (AUC) for NLR (0.852) was higher than that for NLPR (0.828) and NPR (0.708). Therefore, NLR was more effective in predicting adverse outcomes compared to NLPR and NPR. However, the efficacies of NLR and NLPR seemed to be more or less equal. Conclusion: The NLR was a better predictor of outcome or severity in dengue fever when compared to NPR and NLPR. Hence, it can be a cost-effective tool used by physicians working in rural hospitals with limited resources.

Safety and Efficacy of Lactobacillus rhamnosus GG (ATCC 53103) in Children with Functional Abdominal Pain: A Randomised, Double-blinded, Placebo-controlled Trial

Introduction: Functional Abdominal Pain (FAP) is a major concern in developing countries, especially in school-going children. Recently, some probiotics have shown clinical evidence in managing abdominal diseases. The role of Lactobacillus rhamnosus GG (LGG) (ATCC 53103) for FAP in children has not been studied in India. Aim: To evaluate the safety and efficacy of LGG (ATCC 53103) in children with FAP in terms of frequency, severity, and adverse effects. Materials and Methods: This double-blinded, placebo-controlled study was conducted at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, from February 2021 to July 2022, after obtaining permission from the Institutional Ethical Committee (IEC). Children aged 5-18 years with FAP were included in the study. A total of 82 children were included in the study and were randomised into the LGG group and placebo group. The LGG group received LGG (ATCC 53103), and the placebo group received sugar powder for a period of four weeks. These patients were followed-up after 2, 4, and 8 weeks for evaluation. Student’s t-test (unpaired) was used for quantitative data, and Chi-square test was used for qualitative data. Statistical Package for the Social Sciences (SPSS) PC-20.0 version was used to evaluate the data. Results: Out of 82 children, a total of 77 children were enrolled during the study period, with 38 in the LGG group and 39 in the placebo group. The severity of abdominal pain at four weeks and eight weeks was significantly less compared to placebo (p-value=0.009 and p-value=0.01, respectively). The frequency of abdominal pain at four weeks and eight weeks was also significantly less compared to placebo (p-value ≤0.001 and p-value ≤0.001, respectively). There was no statistically significant difference in adverse effects between the two groups (p-value=0.115). Conclusion: This study concluded that LGG decreases both the severity and frequency of abdominal pain in children aged 5-18 years without any significant side-effects. Thus, it can be safely used in the management of childhood FAP.

Non venereal Female Genital Dermatoses: Beyond Sexually Transmitted Infections: A Cross-sectional Study

Introduction: Genital dermatoses can be categorised as either venereal or non venereal. Non venereal genital dermatoses have various causes, and their presentation may differ from that of cutaneous lesions due to local factors. Therefore, it is crucial to have a proper understanding in order to differentiate non sexually transmitted genital dermatoses from sexually transmitted ones. Aim: To study the clinical patterns of non sexually transmitted genital dermatoses in females aged above 18 years. Materials and Methods: A cross-sectional study was conducted at the Outpatient Department (OPD) of Dermatology at a Tertiary Care Hospital in Chennai, India, over a period of one year and six months. It involved 120 female patients above 18 years of age who were diagnosed with non venereal genital dermatosis. All patients were included in the study after providing informed consent. Patients with a history of significant anatomical alterations due to trauma or surgery were excluded. A detailed clinical history was obtained, followed by a thorough dermatological examination. After diagnosing non venereal genital dermatoses, classification based on aetiology and site of involvement was performed. The presence, distribution, and any associated conditions were also studied. Data was entered into a Microsoft Excel datasheet and analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Categorical data was presented as frequencies and proportions. Results: The mean age of the study participants was 43.08 years. The present study identified 21 different types of non venereal dermatoses, with infectious dermatosis being the most common in 60 (50%) cases, followed by inflammatory dermatosis 33 (27.5%) cases, miscellaneous conditions in 19 (15.83%) cases, benign and physiological conditions in 7 (5.83%) cases, and malignancies in 1 (0.83%) case. Vulvovaginal candidiasis was the most common dermatosis observed in the present study, accounting for 21 cases (17.5%) of the entire study population. Conclusion: Genital diseases can cause significant psychological trauma and anxiety for patients. It is important to note that not all genital dermatoses are sexually transmitted. Non-venereal dermatoses affecting the external genitalia in females encompass a spectrum of diseases with diverse aetiologies. Therefore, accurate diagnosis of these non venereal dermatoses is crucial to alleviate the patient’s concerns regarding sexually transmitted diseases and the associated stigma.

Correlation of Mother’s Knowledge on Child Nutrition, Feeding Practices and Nutritional Status of Children in Karnataka, India: A Cross-sectional Study

Preema Reshma Pinto, Priya Reshma Aranha, Melba Roshini Lobo

Introduction: Malnutrition is a critical health problem in many countries, including India. The main reason for this is incorrect dietary habits that lead to illness and infections in early childhood. Inadequate food intake can hinder the growth and development of children. Childhood malnutrition can impair psychological and intellectual development, which can subsequently result in low school performance and behavioural disturbances. Therefore, child nutrition is of utmost importance. The knowledge and feeding practices of mothers can significantly influence child nutrition. Hence, it is essential to study the knowledge, feeding practices, and nutritional status of children as influenced by their mothers. Aim: To was to determine the correlation between the knowledge of mothers regarding child nutrition, their feeding practices, and the nutritional status of children. Materials and Methods: A cross-sectional correlational study was conducted in a 1050-bed multispecialty tertiary care hospital in Mangaluru, Karnataka, India, from December 30, 2021, to August 30, 2022. A total of 150 children under the age of five, visiting the hospital accompanied by their mothers, were selected as study participants using a non probability convenience sampling technique. Data was collected using a demographic proforma, a structured knowledge questionnaire on child nutrition, a structured checklist on feeding practices, and anthropometric measurements of children, which were taken using a digital weighing scale and stadiometer. Descriptive statistics including mean, frequency, percentage, Karl Pearson’s correlation coefficient, and World Health Organisation (WHO) Anthro software were used for statistical analysis. Results: The majority of the study participants, 96 (64%), had average knowledge regarding child nutrition, while all of them had good child feeding practices. Regarding the nutritional status of the children, the majority fell under the normal category based on weight for height (123, 82%), weight for age (118, 78.67%), and height for age (104, 69.33%). The study also revealed a significant correlation between the knowledge of mothers, feeding practices, and nutritional status of children (p-value <0.05). Conclusion: The study concluded that although majority of the study participants had a normal nutritional status and their mothers had average knowledge, regular awareness programs could be conducted, and the nutritional status of children needs to be regularly monitored.

Diagnostic Value of Applying ACR-TIRADS on Thyroid Nodule Biopsies at a Tertiary Care Centre in the United Arab Emirates: A Prospective Observational Study

Anoop Kumar Pandey, Maneesha Pandey, Arvind Kavishwar, Mani Jain

Introduction: Incidental thyroid nodules are commonly encountered in clinical practice, and only a minority of these are malignant. Suspicious nodules on ultrasound are subjected to Fine Needle Aspiration Biopsy (FNAB) to rule out malignancy and determine appropriate management. In the United Arab Emirates, medical professionals from various countries practice, and there are no well-established local best practice guidelines for thyroid nodule biopsies. Aim: To determine the percentage of thyroid nodules in which FNAB would be considered unnecessary by applying the American College of Radiology (ACR)-Thyroid Imaging Reporting and Data System (TIRADS) 2017 guidelines. Materials and Methods: A prospective observational study was conducted in the Radiology Department of Belhoul Speciality Hospital, Dubai, United Arabs Emirates from January 2018 to December 2019. A total of 142 thyroid nodules were studied, and FNABs were performed. Two experienced radiologists assigned ACR-TIRADS categories to the nodules. The nodules were divided into groups: Fine-Needle Aspiration (FNA) indicated and FNA not indicated. Surgically resected nodules underwent histopathological examination, and benign or malignant categorisation was based on histopathological findings. Cases with Bethesda II cytology were considered benign, Bethesda V and VI were considered malignant, and 35 cases with Bethesda I, III, or IV cytology were excluded from the study. The final study cohort included 107 nodules with available final reference standard diagnoses. Data were analysed using International Business Machine Statistical Package for Social Sciences (IBM SPSS) Statistics 26.0, and sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Diagnostic Odds Ratio (DOR) {each with 95% Confidence Interval (CI)} were calculated. Results: Out of the 107 nodules included in the study, 15 (14%) were malignant, and 92 (86%) were benign. Applying ACR-TIRADS, biopsy was not indicated in 54 out of 107 patients, resulting in an “unnecessary” biopsy rate of 50.5%. Only two out of the 15 malignant cases were assigned to the FNAC not indicated group due to their subcentimetre size. Therefore, the sensitivity, NPV, and false negative rate of these criteria were 86.7%, 96.3%, and 3.7%, respectively. Conclusion: The ACR-TIRADS guidelines are highly reliable, and if strictly followed, almost half of thyroid nodule biopsies can be safely avoided. However, since ACR-TIRADS does not recommend FNA for subcentimetre thyroid nodules, a few small malignancies may experience delayed diagnosis.

Post-traumatic Early Cerebral Infarct: MRI-based Analysis of Incidence and Radiological Distribution

Shashank Sah, Sudarshan Deshmukh, Neeraj Prajapati

Introduction: Traumatic Brain Injury (TBI) is an alteration in brain function brought on by external trauma. Computed Tomography (CT) scanning is the mainstay diagnostic modality for evaluating the primary injury, as well as secondary events such as oedema, mass effect, herniation, infarction, etc., which are often catastrophic and responsible for morbidity and mortality. Early cerebral infarction, unless large and in a defined vascular territory, is quite likely to be missed on CT scans and can even be confused with cerebral oedema. In the diagnosis of early infarctions, especially the lacunar types, the detection rate of lesions with Magnetic Resonance Imaging (MRI) is significantly higher than that of CT. Aim: To observe the incidence, distribution, and pattern of Post-traumatic Cerebral Infarction (PTCI) and its association with neurological deterioration. Materials and Methods: In this cross-sectional study, 55 patients with head injuries admitted to the Department of Neurosurgery were evaluated between 72 to 96 hours post-trauma using Magnetic Resonance Imaging (MRI) of the brain (1.5 Tesla Siemens). Observations were made regarding the presence and pattern of any infarction, as well as its impact on the patients. Results: Post-traumatic early cerebral infarction was detected in 19 out of 55 (34.5%) patients. Infarct distribution was observed in nearly all defined vascular territories, with the most common occurrence in the Middle Cerebral Artery (MCA) territory. Neurological deficit was observed in four out of 19 infarcted cases during the hospitalisation period. Conclusion: Post-traumatic early cerebral infarction is common in head injuries and can lead to neurological deterioration. MRI is sensitive in detecting infarcts, especially the lacunar ones.

Risk Assessment of Type II Diabetes using Indian Diabetic Risk Score in Andhra Pradesh, India: A Cross-sectional Study

Introduction: Diabetes has emerged as a global pandemic of the 21st century, with approximately 463 million adults (aged 20-79 years) living with diabetes worldwide in 2019. Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes compared to Type 1 and other forms. The burden of diabetes in India is expected to increase in the coming years. The Indian Diabetes Risk Score (IDRS) is a validated and cost-effective tool used to identify the risk of developing diabetes among the population. Aim: To estimate the risk of T2DM using the IDRS in adults aged 25 years and above. Additionally, the study aimed to explore the association between the risk of diabetes and other factors. Materials and Methods: An observational, community-based, cross-sectional study was conducted in the field practice area of Kurnool Medical College, Kurnool, Andhra Pradesh, India. Data collection took place from December 2022 to February 2023, using a simple random sampling technique. The study included residents aged over 25. A sample size of 100 participants was selected. The IDRS, developed by the Madras Diabetic Research Foundation (MDRF), was used as a validated tool to screen individuals at high-risk of developing T2DM. Data was collected using a semistructured questionnaire that included socio-demographic information, the IDRS tool to detect the risk of developing diabetes, and other risk factors such as Body Mass Index (BMI), family history of diabetes, physical activity, smoking, alcohol consumption, and hypertension. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23.0. The Chi-square test was used to determine significance, with a p-value of <0.05 considered significant. Results: A total of 100 residents aged over 25 years were included in the study. IDRS categorisation revealed that 14 (14%) were at low risk, 43 (43%) at moderate risk, and 43 (43%) at high-risk for developing T2DM, respectively. A statistically significant association was observed between diabetes risk score and individuals who smoked (p=0.04), consumed alcohol (p=0.04), and had hypertension (p<0.001). BMI showed a positive correlation with IDRS score (p=0.031), family history score (p=0.028), and waist circumference score (p=0.034). Conclusion: Early detection of the risk of diabetes through periodic screening and effective behavioural change communication could be instrumental in controlling the diabetes crisis.

Comparison of Morphometric Data of Upper End of the Tibia between North and East Indian Populations: A Cross-sectional Study

Nidhi Lal, Ankita Saha, Shavi Garg, Prachi Saffar Aneja

Introduction: Knee joint problems, such as Osteoarthritis (OA), primarily affect the upper weight-bearing end of the tibia. Total and unicompartmental knee arthroplasty are commonly performed as treatment options. However, existing studies on morphometric assessment of the knee joint mainly focus on the Western population, with a lack of data among the Indian population. Obtaining such data is crucial for designing tibial components of knee prostheses tailored to the Indian population. Aim: To compare the morphometric data of the upper end of the tibia between the North and East Indian populations. Materials and Methods: A cross-sectional observational study was conducted in the Department of Anatomy at FMHS Medical College, SGT University, Gurugram, Haryana, North India, involving 41 dry tibias, and at Medical College and Hospital Kolkata in East India, involving 43 dry tibias. Measurements of the Anteroposterior (AP) and Transverse Diameters (TD) of the Medial Tibial Condyle (MTC), Lateral Tibial Condyle (LTC), and Total Tibial Condyles (TTC) were performed using digital Vernier callipers with a least count of 0.01 mm. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) (version 21.0), and Student’s t-test was applied, with p<0.05 considered significant. Results: The mean TD and AP diameters of the tibial plateau were found to be greater in the East Indian population (TD: 65.47±5.46, AP: 44.29±4.36). In both samples, the AP diameter of MTC (North Indians: 38.30±3.54, East Indians: 40.63±3.46) was greater than that of LTC (North samples: 35.30±3.51, East samples: 35.70±3.96). When comparing parameters between the North and East samples using Student’s t-test, significant differences were found on the right-side for the mean AP (p-value=0.0065) and TD (p-value=0.0213) of TTC, mean AP (p-value=0.0006) and TD (p-value=0.0219) of MTC, mean TD of LTC (p-value=0.0002), mean AP (p-value=0.0005) and TD (p<0.0001) of the Intercondylar area at anterior ends, and mean AP (p<0.0001) and TD (p-value=0.0017) of the Intercondylar area at posterior ends. On the left-side, significant differences between the North and East population were found for mean TD of LTC (p-value=0.0348), AP (p<0.0001) and TD (p-value=0.0207) of the Intercondylar area posterior end. When comparing the areas between the North and East populations, significant differences were found on the right-side only for the MTC (p-value=0.0013), LTC (p-value=0.0083), and TTC (p-value=0.0055). Conclusion: There are significant regional variations in the anthropometric measurements of the North and East Indian populations, emphasising the need to develop population-specific tibial prostheses for improved surgical outcomes.

Role of Middle Ear Risk Index in the Selection of Middle Ear Surgery and Factors Determining Outcome: A Cross-sectional Study

Manisha Dash, Prasad T Deshmukh

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from co-morbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p<0.05. Results: The MERI was utilised as a tool for assessing surgical outcomes. A lower MERI score indicated a less invasive choice of middle ear surgical procedure and was associated with a better outcome in terms of graft uptake, which was statistically significant. Patients requiring tympanoplasty alone had mild MERI scores (1-3), while more extensive surgeries such as canal wall up or canal wall down were associated with moderate or severe MERI scores (4-6 or 7-12), and this association was found to be significant (p=0.001). Interestingly, out of the total 40 patients, five with Eustachian Tube (ET) dysfunction had severe MERI scores (7-12) and experienced graft rejection. Patients with lower grades of ET dysfunction had higher chances of graft uptake, and this association was statistically significant (p=0.001). Conclusion: This study demonstrated that lower MERI scores were associated with better postoperative outcomes. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making.

The Relationship between Psychological Inflexibility and Academic Anxiety among School Children Preparing for their Board Exams: A Cross-sectional Study

Introduction: Many school children experience psychological inflexibility, which leads to anxiety regarding their academic well-being, subsequently affecting their psychological well-being. The objectives of the present study were to investigate the relationship between psychological inflexibility and academic anxiety among school children, understand the sociodemographic characteristics of the selected participants, and identify significant mean differences in subgroups based on sociodemographic details in relation to psychological inflexibility and academic anxiety. Aim: To examine the relationship between psychological inflexibility and academic anxiety in students who were preparing for their board exams. Materials and Methods: A cross-sectional study involved the selection of 348 school children from 9th to 12th grade in Madurai, Tamil Nadu, India, using simple random sampling. Data collection took place from March 2021 to June 2021. The study employed a 17-item Acceptance and Fusion Questionnaire (AFQ-17), a 25-item academic anxiety scale, and a semi-structured interview schedule. The data analysis was performed using the Statistical Package for Social Services (SPSS) software, version 19.0. Descriptive statistics were used, and the Pearson’s correlation method was employed to determine the relationship between variables. Additionally, a one-way Analysis of Variance (ANOVA) was conducted to identify significant mean differences between demographic variables, with a 95% confidence level and p-value <0.05 considered as statistically significant. Results: Out of the total 348 participants, majority 184 (52.9%) were in the age group of 16 to 18 years. The results indicate a positive correlation (r=0.117, p<0.05) between the level of psychological inflexibility and academic anxiety among school children. Furthermore, significant relationships were found between psychological inflexibility and academic anxiety in terms of age and gender. Conclusion: The present study highlights a positive correlation between psychological inflexibility and academic anxiety. It emphasises the importance of raising awareness, promoting psychological flexibility, and reducing academic anxiety among school children.

Neonatal Screening for Congenital Hypothyroidism through Dried Blood Spots: A Cross-sectional Study

Vipin Kumar, Ashok Kumar, Ankur Singh, Kiran Giri, Kamlesh Palandurkar

Introduction: Congenital Hypothyroidism (CH) is defined as the partial or complete loss of thyroid gland function present at birth. During the first 2-3 years of life, thyroid hormone plays a crucial role in brain development. If a baby is born with a deficiency of thyroid hormone (CH) and is not diagnosed and treated appropriately, it can lead to intellectual disability and growth retardation in the affected child. Aim: To screen newborns for CH using Dried Blood Spot (DBS) sampling. Additionally, the study aimed to compare mean TSH values between two comparison groups based on gender, birth weight, gestational age, and type of delivery. Materials and Methods: This cross-sectional study was conducted at Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from November 2021 to October 2022. A total of 250 live-birth newborns delivered either by Spontaneous Vaginal Delivery (SVD) or Lower Segment Caesarean Section (LSCS) were included in the study after obtaining written informed consent from their parents. Blood samples were obtained on DBS cards through heel prick in all newborns. TSH levels were assessed using a neonatal TSH sandwich ELISA kit. The cut-off value of TSH to label as screen positive was set at >20 mIU/L. A two-tailed Independent t-test was performed to compare mean TSH values between the two comparison groups based on gender, birth weight, gestational age, and type of delivery. Results: Out of the 250 babies, 137 (54.8%) were male and 113 (45.2%) were female. The gestational age ranged from a minimum of 29 weeks to a maximum of 41 weeks in both male and female babies. TSH levels in male babies ranged from 0.16 mIU/L to 10.27 mIU/L, with a mean value of 3.98±2.16 mIU/L. TSH levels were below 20 mIU/L in all 250 newborns, indicating negative screening results for CH in all the neonates. Conclusion: The results concluded that the serum levels of TSH obtained through heel prick were not statistically significant in both term and preterm newborns, as well as in Normal Birth Weight (NBW) and Low Birth Weight (LBW) newborns. Furthermore, there was no significant difference based on the type of delivery (SVD/LSCS) or the gender of the newborn (male or female).

Assessment of Dental Problems and Self-esteem among School Children: A Cross-sectional Study

Introduction: The transitional stage of a person’s physical and psychological development, known as school age, is strongly related to adolescence. An individual’s oral health significantly impacts their general health and happiness. Oral health is a crucial component of overall well-being and can affect one’s level of self-esteem. Even common dental conditions like dental trauma and untreated caries can have an impact on an individual’s self-esteem, which in turn can affect their quality of life. Aim: To explore the dental problems and self-esteem of school-age children. Materials and Methods: A cross-sectional study was conducted in selected schools of Mangaluru, Karnataka, India. A total of 86 school children aged between 10 and 15 years were included using a non probability purposive sampling technique. The study duration was eight months, from February 2021 to September 2021. A self-structured rating scale was employed to assess self-esteem, and a self-structured checklist was used to assess dental issues. Survey participants who scored higher than four on the checklist were invited to complete a self-esteem evaluation scale to gain further insights into their dental concerns. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23.0, applying descriptive and inferential statistics to evaluate the collected data. The relationship and association between the concepts were examined using Karl Pearson’s correlation coefficient and the Chi-square test. Results: According to the study’s findings, 75 (87.2%) school children had moderate self-esteem, while 11 (12.8%) had high self-esteem regarding dental issues. The majority of school children, 52 (60.5%), had moderate dental problems, while 23 (26.7%) had severe dental problems, and 11 (12.8%) had very severe dental problems. The results of the study also revealed a significant relationship between school-aged children’s dental issues and their sense of self-worth. The calculated p-values indicate that there was no significant association between self-esteem and demographic data. However, there was a significant association between dental problems and other demographic variables, such as family income per month. Conclusion: Based on the present study’s findings, school-aged children experienced mild dental issues, and there was a substantial link between these issues and students’ self-esteem. Additionally, the study showed that there was no significant association between self-esteem and demographic data. However, a significant association was found between dental problems and various demographic variables, such as family income per month. Therefore, it is argued that each person’s self-esteem in relation to dental issues may differ.

Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia in Patients undergoing Open Nephrectomy: A Randomised Controlled Study

Soumya Bindra, Deepak Oberoi, Rajat Kumar Agarwal, Rajeev Sarpal

Introduction: Open nephrectomy poses a challenge for the anaesthesiologist due to its large subcostal incision and association with both somatic and visceral pain. While various methods exist for postoperative pain management, a single modality approach remains largely ineffective in adequate pain management. Epidural analgesia, intravenous Patient Controlled analgesia pumps, and ultrasound-guided peripheral nerve blocks are commonly used. Aim: To evaluate the efficacy of ultrasound-guided Erector Spinae Plane Block (ESPB) as a part of multimodal analgesia for postoperative pain in patients undergoing open nephrectomy, to enhance recovery after surgery. Materials and Methods: This randomised controlled study was conducted at Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, on 48 patients undergoing open nephrectomy. They were randomly assigned to two groups: Group I received ultrasound-guided ESPB, while Group II did not receive a block before anaesthesia reversal. In the Post-Anaesthesia Care Unit (PACU), all patients were kept on intravenous Patient Controlled Analgesia (PCA) morphine, and pain was assessed using the Numeric Rating Scale (NRS) scoring. The time of first analgesic requirement and the total morphine consumption in the first 24 hours were recorded. Patient satisfaction and quality of sleep at night were evaluated using a Likert scale. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.0. Categorical data were assessed using the Chi-square test, while the Independent t-test/Mann-Whitney test was used to determine the association between continuous data. A p-value of <0.05 was considered statistically significant. Results: There were no significant differences found between the two groups in terms of age (p-value=0.999) and ASA grade (p-value=0.336). The total morphine consumption was lower in the ESP group (11 versus 17.58 mg, p-value <0.0001) compared to the control group. The NRS scores during the follow-up period in the ESP group were consistently lower compared to the control group. The average number of analgesia attempts and demand for rescue analgesia were higher in the control group compared to the ESPB group. A higher proportion of ESPB patients agreed (p-value=0.002) that the overall pain management was good. More patients in the ESPB group agreed that they had slept well at night (41.7% versus 12.50%, p-value=0.023). Conclusion: Ultrasound-guided ESPB was more effective in reducing postoperative pain, facilitating enhanced recovery, and significantly reducing the requirement for opioids in the postoperative period after abdominal surgery such as open nephrectomy.

Maternal and Perinatal Outcomes in Pregnancies Associated with HIV Infection: A Prospective Cohort Study

Introduction: Human Immunodeficiency Virus (HIV) has persisted as the world’s leading infectious killer disease. Globally, around 19.3 million women in the reproductive age group are suffering from HIV, and most of these women are capable of transmitting this infection to their babies. Although pregnancy does not have an adverse effect on the natural history of HIV infection in women, Acquired Immunodeficiency Syndrome (AIDS) has become a leading cause of maternal and perinatal morbidity and mortality in some areas as the epidemic progresses. Aim: To assess the impact of HIV infection on maternal health, the risk of vertical transmission, and neonatal complications. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India between March 1, 2021, and August 31, 2022. The study population comprised all pregnant patients with a known positive HIV status or those diagnosed newly during routine antenatal screening at the antenatal Outpatient Department (OPD) and Prevention of Parent to Child Transmission of HIV (PPTCT) clinic, or attending obstetric emergency. After registering in the antenatal clinic, they underwent all routine investigations, including baseline CD4 count, husband’s HIV status, screening for other sexually transmitted diseases, and initiation of Antiretroviral Therapy (ART). Maternal and perinatal outcomes, such as maternal complications, risk of vertical transmission, gestational age at birth, and birth weight of the baby, were assessed throughout the antenatal period and up to six weeks post-delivery. Data were entered into a Microsoft Excel datasheet and analysed using Statistical Packages for Social Sciences (SPSS) version 22.0 software. Categorical data were represented in the form of frequencies and proportions. Chi-square test was used for significance testing, with a p-value <0.05 considered statistically significant. Results: Out of a total of 15,087 deliveries during the study period, 55 were HIV-positive cases, with a prevalence of 0.36%. Both vaginal delivery and cesarean section showed almost similar vertical transmission rates in the newborns, i.e., 4 (14%) and 4 (17%), respectively. Opportunistic infection rates were significantly higher in mothers with lower CD4 counts (<200). Mothers receiving regular ART treatment showed a lower incidence of perinatal complications, such as neonatal sepsis, perinatal asphyxia, convulsions, or perinatal death, i.e., 6 (13.63%), compared to those not on treatment, 8 (72.72%) (p-value=0.005475). Higher rates of vertical transmission were observed in patients with significantly lower Cluster of Differentiation 4 (CD4) counts, 5 (71%) versus 3 (6.8%) (p-value=0.00001). Conclusion: Pregnancy outcomes in terms of maternal risks of infection, risk of vertical transmission, preterm births, foetal deaths, and neonatal complications can be significantly improved by early diagnosis and treatment of HIV infection. Proper antenatal care, early detection, initiation of antiretroviral drugs, and patient compliance with the multidrug regimen are the mainstay of feto-maternal well-being.

Association of Obesity with Vitamin-D Deficiency and Anaemia: A Cross-sectional Study

S Deepak Bhat, Swati Hegde, N Srikanth

Introduction: Obesity is a growing health concern, especially in developing countries like India. Overweight and obesity are considered risk factors for numerous diseases, including micronutrient deficiencies. However, there is a lack of data on the association between vitamin-D status and anaemia in obesity. Therefore, this study was conducted in an urban setting where obesity is more prevalent. Aim: To investigate the association between increased Body Mass Index (BMI) and vitamin-D deficiency and anaemia. Materials and Methods: This cross-sectional observational study included 62 healthy overweight or obese adults from Ramaiah Medical College and Hospitals in Bengaluru, South India, from December 2021 to February 2022. Anthropometric measurements were taken, and blood investigations were conducted to estimate vitamin-D levels and haemoglobin levels. Pearson’s chi-square test was used to determine associations between the two groups. Results: The study included (62) healthy adults, of whom 28 subjects (45.1%) were classified as obese (BMI ≥25 kg/m²) and 34 subjects (54.9%) were classified as overweight (BMI 23-24.9 kg/m²). There were 22 males and 40 females, with a mean age of 48.5 years. Vitamin-D deficiency was observed in 50 patients (80.6%). The prevalence of vitamin-D deficiency was higher in the obese group (n=23, 82.1%) compared to the overweight group (n=27, 79.4%), although this difference was not statistically significant. Anaemia was present in 14 patients (22.6%). Overweight males were more likely to be anaemic. Anaemia was observed more frequently in elderly overweight and obese patients and was statistically significant (p-value=0.039). Conclusion: Vitamin-D deficiency and anaemia were seen as common problems in apparently healthy individuals with high BMI. This is a health concern that needs to be addressed, and early screening and appropriate treatment can help improve the quality of life.

Immunoexpression of p53 and p16 in Low and High-grade Serous Ovarian Cancer: A Cross-sectional Study

Introduction: The most common malignancy of the ovary is serous carcinoma, which can be classified as either Low-grade Serous Ovarian Carcinoma (LGSOC) or High-grade Serous Ovarian Carcinoma (HGSOC) and originates from the surface epithelium. However, the overall prognosis for both cancers is very poor. Immunohistochemical analysis of p53 and p16 expression is commonly used to detect mutations. Diffuse and strong mutations (mutant type) are almost always observed in cases of HGSOC, while focal expression (wild type) suggests the absence of mutations in HGSOC. LGSOCs are characterised by a low number or absence of genetic mutations. Aim: To investigate the association between p53 and p16 expression in different grades and stages of Serous Ovarian Carcinoma (SOC). Materials and Methods: This observational cross-sectional descriptive study was conducted on 62 patients diagnosed with ovarian serous carcinoma. The study focused on examining the expressions of p53 and p16 using Immunohistochemistry (IHC) in the Department of Pathology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, over a period of one and a half years (February 2021 to July 2022). The study parameters included clinical features, histological findings, staging, The Federation of Gynaecology and Obstetrics (FIGO), grading, p53 and p16 expression by IHC in all cases, and the association between p53 and p16 expression with the grade and stage of the cancer. Statistical analysis was performed using Analysis of Variance (ANOVA) and Statistical Package for Social Sciences (SPSS) software. A p-value of less than 0.05 was considered significant. Results: A total of 62 cases were included in the study, with 55 cases (88.70%) classified as LGSOC and 7 cases (11.29%) as HGSOC. The mean age for LGSOC was 53.5 years, while for HGSOC it was 54 years. Among the HGSOC cases (n=55), 45 cases (81.80%) showed diffuse positive results (mutant type) for p53. In contrast, there was no diffuse p53 expression in LGSOC cases (n=7), with 5 cases (71.40%) showing focal positivity (wild type). The p-value for comparing p53 expression in both cases was significant (<0.00001). As for p16 expression, among the HGSOC cases (n=55), 31 cases (56.40%) showed diffuse positivity (mutant type), while among the LGSOC cases (n=7), most of the cases, 5 cases (71.40%), showed focal positivity (wild type). The p-value for comparing p16 expression in both cases was significant (<0.003794). Conclusion: In conclusion, p53 along with p16 are good markers for grading SOC, and p53 is highly effective in differentiating HGSOC from LGSOC based on the positivity pattern (diffuse and strong positive for high-grade/mutant type, and focal positive for low-grade cancers). Thus, p53 has become an attractive target for the development of molecule-targeted therapies for this disease.

A Cross-sectional Study on Body Image Perception and Self-Esteem among Adolescent Girls in Urban and Rural Areas of Kolkata, West Bengal, India

Baishakhi Paria, Malvika Dwivedi, Sunetra Kaviraj Roy

Introduction: Adolescence is one of the most important and crucial phases of learning and individual development. Adolescents are particularly vulnerable due to the physiological, social, and psychological changes they undergo. Understanding the factors responsible for the development of body image perception and self-esteem is crucial for adolescent health and well-being. Aim: To estimate the prevalence of body image dissatisfaction among urban and rural girls and its impact on self-esteem. Materials and Methods: A cross-sectional study was conducted in two Government schools located in urban and rural areas of Calcutta National Medical College, Kolkata, West Bengal, India. The sample size of the study was 397, with 206 girls from urban areas and 191 girls from rural areas. The Rosenberg Self-esteem Scale was used to measure self-esteem. The Stunkard Silhouettes Figure Rating Scale (FRS) was used to measure adolescents’ body image dissatisfaction. The height and weight of the participants were measured, and Body Mass Index (BMI) was calculated. Data was compiled, presented in tabular form, and analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Results: A total of 206 (51.89%) study subjects in the present study resided in urban areas, with a mean age of 15±3.32 years. Among the study population, 242 adolescent girls (60.95%) were dissatisfied with their body image. Body image dissatisfaction was higher among urban girls (57.85%) compared to adolescent girls in rural areas. A significant association between self-esteem and body image perception was found. Among the girls in the study population, 126 (52.1%) were both dissatisfied with their body image and had low self-esteem. Conclusion: The present study shows that the majority of adolescent females were dissatisfied with their body image, and a significant association between low self-esteem and body image perception was established.

Microbiological Genus Characterisation, Clinical Features, and Outcome in Patients of COVID-19 Associated Mucormycosis: A Single-centre Cross-sectional Study

Sneha Gupta, Rushika Patel, Nita Gangurde, Ashok Vankudre, Shreeya Kulkarni

Introduction: Mucormycosis is a known invasive fungal infection, its prevalence increased during the Coronavirus Disease-2019 (COVID-19) pandemic, particularly during the second wave. The most common clinical form is rhino-orbital-cerebral, but other forms such as pulmonary, gastrointestinal, cutaneous, and disseminated forms also exist. There have been very few Indian studies exploring the various aspects of COVID-19 Associated Mucormycosis (CAM). Aim: To describe and characterise the genus of the causative agents of mucormycosis, an invasive fungal infection, and to analyse the clinical features and outcomes in the study participants. Materials and Methods: This was a cross-sectional study conducted in a dedicated COVID-19 Care Hospital at Dr. Vasantrao Pawar Medical College in Nashik City, Maharashtra, India. The study duration was one year, from February 2021 to January 2022. The universal sampling strategy included all clinically diagnosed cases of mucormycosis (n=104). The study variables included demographic factors, presence of risk factors, organ involvement, and in-hospital mortality. Diagnosis was based on fungal Potassium Hydroxide (KOH) mount and fungal culture. Genus characterisation was performed using Lactophenol Cotton Blue (LPCB) mount. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 16.0, and the Chi-square test was applied to study the association between qualitative variables. Results: The majority of patients with the disease were male (77, 74%). The most commonly involved site was isolated paranasal sinuses (48, 46.1%), followed by paranasal sinus with maxilla involvement (24, 23.1%). The KOH report was positive in 100 (96.2%) of patients. Fungal growth in culture was reported in 69 (66.3%) patients, among them Rhizopus spp. (66, z95.6%) being the most common fungal genus isolated. Among 25 patients in the age category >60 years, 21 (84%) had a positive culture (p-value=0.041, significant). Diabetic patients had a significantly higher incidence of mucormycosis compared to non diabetics based on culture results (p-value=0.004). The mortality rate in this study was 26 (25%). Conclusion: Mucormycosis was more prevalent in males and predominantly affected the paranasal sinuses. Risk factors such as age category, sex, and a history of diabetes were significantly associated with the presence of mucormycosis. KOH can be used as a quick diagnostic test to initiate prompt treatment.

Comparison of Ascitic Fluid Cholesterol and Fibronectin with Conventional Ascitic Protein Values in Differentiating Malignant Ascites from Non malignant Ascites: A Cross-sectional Study

Introduction: It is a known clinical problem to differentiate between malignant and non malignant ascites because there is no single routine biochemical laboratory test that can completely distinguish between them. The diagnostic sensitivity of cytological examination is 40%-60%. Aim: To establish the correlation and evaluate the levels of ascitic fluid cholesterol and fibronectin in the differentiation of malignant and non malignant ascites, compared to conventional total protein concentration in ascitic fluid. Materials and Methods: A cross-sectional study included 93 patients with clinically detectable ascites, admitted to the Department of Medicine at SCB Medical College, Cuttack, Odisha, India. Patients over 18 years of age presenting with ascites confirmed clinically or by Ultrasonography (USG) were included. Pregnant patients, those with blunt abdominal injury, those previously diagnosed with cancer and having received anticancer treatment, those who failed to give consent, and critically ill patients were excluded. All patients underwent diagnostic paracentesis, and the ascitic fluid was analysed for gross appearance, cytological examination, and biochemical studies. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0. Results: The study group comprised 47 males and 46 females. The mean age of the study group was 52.25±12.74 years, ranging from 20 to 79 years. The mean ascitic fibronectin concentration in patients with malignant ascites was 64.93±21.41 ng/mL. Using various cutoff values, the diagnostic accuracy of ascitic fluid cholesterol, fibronectin, total protein, Serum Ascites Albumin Gradient (SAAG), and Serum Ascites Cholesterol Gradient (SACG) in differentiating malignancy-related ascitic fluid from non malignant ascites were determined as 98.92%, 97.85%, 56.99%, 52.69%, and 67.74%, respectively. Conclusion: Cholesterol and fibronectin estimations present valuable diagnostic features for differentiation, surpassing the conventional protein, albumin, and SAAG determinations in terms of diagnostic accuracy and cost-effectiveness of the assay.

Prevalence of Diabetes Mellitus and its Associated Risk Factors among Tuberculosis Patients in Sonipat District, Haryana: A Cross-sectional Study

Introduction: The global increase in Diabetes Mellitus (DM) is a recognised re-emerging risk and challenge to Tuberculosis (TB) control. The bidirectional association between TB and DM is currently one of the major concerns for clinicians. India has the highest prevalence of TB and the second highest prevalence of DM worldwide. Aim: To estimate the prevalence of DM and its associated risk factors among TB patients in District Sonipat, Haryana, India. Materials and Methods: A cross-sectional study was conducted to determine the prevalence and factors associated with Diabetes among TB patients registered at the Nikshay portal. A total of 400 patients were interviewed using consecutive sampling technique from eight randomly selected Designated Microscopy Centres (DMCs) in District Sonipat, Haryana , India. To identify associations, a multivariable logistic regression model was applied. Results: The prevalence of diabetes among TB patients was found to be 16.25% (65/400). The mean age of the study subjects was 39.9±17.3 years. DM was significantly associated with increasing age, literacy, marital status, occupation, smoking, second-hand smoking, duration of smoking, sputum status at the time of initiation of treatment, pulmonary TB, and other chronic diseases such as hypertension and cardiovascular disease. Conclusion: The present study found a higher prevalence of diabetes among TB patients than in the general population. Therefore, it is recommended to strengthen early bidirectional screening and timely management of TB/DM co-morbidity.

Efficacy of Neem and Cinnamon Extracts in Reducing Bacterial Contamination during Scaling: A Randomised Clinical Study

Introduction: Ultrasonic scaling involves the production of a high amount of aerosols, which combine with oral microbes and become a potential source of airborne contaminants. Chemical antimicrobial agents like Chlorhexidine (CHX) (the gold standard) are known to reduce microbial contamination in dental waterlines. However, natural extracts are gaining popularity as an economical yet effective means of reducing bacterial load. Aim: To compare the efficacy of neem and cinnamon extracts in reducing bacterial contamination during scaling. Materials and Methods: A single-centered, parallel multiple-arm, randomised clinical study was conducted at the Department of Periodontics and Oral Implantology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India from September 2019 to March 2020. Scaling was performed for patients in all four groups (n=128, 32 each group) - Water, 0.2% Chlorhexidine, Neem, and Cinnamon Extract. Two blood agar petri dishes were placed on either side of the patient at a distance of 40 cm from the patient’s head, and one blood agar petri dish was placed on the operator’s chest. The agar plates were then incubated aerobically for 48 hours for Colony Forming Units (CFU) count. Statistical analysis was performed using one-way Analysis of Variance (ANOVA) and Tukey’s posthoc test. Results: Cinnamon showed a 25.2% reduction in CFUs, whereas neem showed an 11.7% reduction compared to distilled water. However, chlorhexidine had the maximum bacterial reduction. The agar plates at the chest position had the highest bacterial growth, while the left position had comparatively fewer microbial colonies. Conclusion: Chlorhexidine exhibited the highest percentage of CFU reduction. However, when used as a Dental Unit Water Line (DUWL) coolant, herbal extracts such as cinnamon and neem caused a significant reduction in CFUs compared to distilled water, with cinnamon performing better than neem. Therefore, herbal extracts like neem and cinnamon can be considered cost-effective alternatives for minimising aerosol contamination in DUWL.

Gender-wise Distribution of Cardiovascular Risk and Its Correlation with Dietary Intake, Physical Activity, and Perceived Stress: A Cross-sectional Study

Ambrin Zenab, Sudhanshu Kacker, Neha Saboo, Munesh Kumar

Introduction: Cardiovascular Diseases (CVDs) are a group of disorders affecting the heart and blood vessels, including Coronary Heart Disease (CHD), cerebrovascular disease, rheumatic heart disease, peripheral artery disease, congenital heart disease, and pulmonary embolism. CVDs contribute to approximately 17.9 million deaths worldwide each year. Risk factors for CVDs can be classified as non modifiable (such as age, gender, ethnicity, and family history) and modifiable (such as obesity, dyslipidaemia, diabetes, hypertension, stress, poor diet, and physical inactivity). Men are more susceptible to CVDs than women. The QRISK3 risk score is an algorithm used to predict an individual’s 10 year risk of developing CVDs. Aim: To assess the distribution of CVD risk among men and women aged 30-70 years using the QRISK3 risk score and its correlation with dietary intake, physical activity, and perceived stress. Materials and Methods: A cross-sectional study was conducted at the Department of Physiology at RUHS-CMS and Associated Hospitals in Jaipur, Rajasthan, India. The study duration was six months, from July 2022 to December 2022. A total of 220 subjects, aged 30-70 years, of both sexes were recruited from the Outpatient Department (OPD) of Medicine, based on inclusion and exclusion criteria. The QRISK3 web calculator was used to calculate the CVD risk, which was then correlated with the Food Frequency Questionnaire (FFQ), Perceived Stress Scale (PSS), and Global Physical Activity Questionnaire (GPAQ). Statistical analysis was performed using the Chi-square test for qualitative analysis, and Pearson’s correlation analysis was used to assess correlations. Results: The mean age of the study participants (males) was 42.75±10.86 years and (females) was 42.82±10.85 years. A total of 220 participants (123 males and 97 females) aged between 30-70 years were included in the study. Among the males, 90 (73.17%) had low CVD risk, 15 (12.19%) had moderate risk, and 18 (14.63%) had high risk. Among the females, 83 (85.57%) had low risk, 9 (9.28%) had moderate risk, and 5 (5.15%) had high risk. There was a significant association between the QRISK3 risk score and gender (χ2=6.14, df=218, p=0.04). Males showed a stronger association with the QRISK3 risk score compared to females within different age groups. Significant positive correlations were observed between the QRISK3 score and FFQ (r=0.28) and PSS (0.42). Additionally, a significant negative correlation was found between the QRISK3 score and GPAQ (-0.24). Conclusion: The QRISK3 score calculator was found to be useful in assessing the 10-year risk of developing CVDs in males and females across different age groups. The association between CVD risk and various scores suggests that perceived stress is strongly correlated with CVD risk.

Influence of Self-efficacy on Strength and Physical Function among Individuals with Knee Osteoarthritis: A Cross-sectional Study

Melrose Barreto, Nityal Kumar Alagingi

Introduction: Knee osteoarthritis affects the elderly, potentially leading to disability, with varying symptoms and fatigue. The hip and knee joints experience discomfort, stiffness, reduced mobility, and depression. Muscle weakness, linked to lower limb atrophy, heightens the risk of falls. Self-efficacy, which is confidence in performing tasks despite discomfort, impacts knee strength and function. Factors such as age, education, depression, and physical decline shape self-efficacy. However, the impact of self-efficacy on osteoarthritis health outcomes is unclear due to reduced activity levels. The present study aims to explore the influence of self-efficacy on knee osteoarthritis function and strength. Aim: To identify the influence of self-efficacy on physical function and muscle strength in individuals with knee osteoarthritis. Materials and Methods: A cross-sectional study was conducted in Department of Physiotheraphy with 73 participants who met the inclusion criteria. The study took place between October 2022 and April 2023, spanning a period of six months, at KS Hegde Charitable Hospital in Mangaluru, Karnataka, India. Hip-knee muscle strength was measured using a push-pull dynamometer, physical function was assessed using the Timed Up and Go (TUG) test, and self-efficacy was evaluated using the Arthritis Self-efficacy Scale-8. All tests were performed once on the same day, with a five-minute rest between each test. Within-group differences were identified using an Independent T-test, and between-group analysis was conducted using Analysis of Variance (ANOVA). Results: The mean age of the participants was 60.2±6.5 years, and the Basal Metabolic Index (BMI) was 25.2±2.0 kg/m2. A statistically significant difference with a p-value of 0.001 was observed in hip abductor, knee flexor, knee extensor, and TUG tests between the high and low self-efficacy grades. The time taken for the TUG test also showed significance with a p-value of 0.001. Individuals with high levels of self-efficacy had better scores in physical function as well as muscle strength. No association was found between self-efficacy and KL grading. Conclusion: Participants with higher self-efficacy demonstrated good muscle strength in the hip muscles and good physical function. The study concluded that individuals with high self-efficacy grades had better muscle strength and mobility compared to those with low scores in both strength and mobility.

Comparison of Shear Bond Strength and Adhesive Remnant Score of Orthodontic Brackets Bonded with Three Different Orthodontic Adhesives: An In-vitro Study

Kavitha Ramsundar, Ravindra Kumar Jain

Introduction: Adequate bond strength between orthodontic brackets and enamel is necessary to withstand masticatory forces. Priming involves applying a primer before using the adhesive as a separate step. To reduce bonding time, manufacturers have introduced self-priming adhesives. Aim: To evaluate the Shear Bond Strength (SBS) and Adhesive Remnant Index (ARI) scores of a Bis-GMA based self-priming adhesive (Orthofix SPA, Anabond) and compare it with a 2-Hydroxyethyl Methacrylate (HEMA) based self-priming adhesive (Aqualine LC, Tomy ortho) and a Bis-GMA containing primer-based orthodontic adhesive (Transbond XT, 3M). Materials and Methods: The present In-vitro study was conducted at the White Lab., Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from December 2020 to January 2021. A total 54 freshly extracted premolar teeth were collected and divided into three groups (Group A - Orthofix SPA, Group B - Transbond XT, and Group C - Aqualine LC) based on the adhesive used. A 0.022 metal orthodontic brackets were bonded, and SBS and ARI scores of the samples were assessed. The Shapiro-Wilk test for normality was conducted. One-way Analysis of Variance (ANOVA) was used to compare the mean and standard deviation of SBS values and ARI scores among the three groups, and a post-hoc Tukey test was performed for inter group comparisons. Results: Significant inter group differences were observed (p=0.004). Group A had lower SBS than Groups B and C. Significant inter group differences (p-value of 0.003) in ARI scores were noted, with Group A having the lowest scores. Conclusion: The Bis-GMA self-priming adhesive (Orthofix SPA) exhibited lower SBS and ARI scores compared to commercially available HEMA-based self-priming adhesive systems and primer-based Bis-GMA adhesive systems.

Comparative Effect of Vagal Stimulation on Heart Rate, Blood Pressure, and Skin Hydration at Different Anatomical Sites in Prehypertensive Individuals: A Pilot Study

Monika Sharma, Maneesh Arora, Shagun Agrawal

Introduction: Prehypertension is the precursor to high Blood Pressure (BP), which can lead to severe consequences such as cardiovascular disease, stroke, acute myocardial infarction, heart failure, peripheral arterial disease, and cerebrovascular complications, ultimately resulting in mortality. Vagal stimulation is frequently employed by therapists, along with various therapeutic exercises, to treat or manage Heart Rate (HR) and BP in prehypertensive individuals. The vagus nerve plays a vital role in maintaining internal physiological balance, known as homeostasis, which includes reflex pathways that regulate cardiac function. Auricular neuromodulation of the vagus nerve can be achieved through stimulation of the ear lobule, cymba concha, or tragus in the outer ear. Aim: To compare and determine the optimal anatomical site for vagal stimulation, specifically the ear lobule, cymba concha, or tragus, to improve HR, BP, and skin hydration in prehypertensive individuals. Materials and Methods: The present pilot study conducted a pre-post comparative analysis in the Outpatient Department (OPD) of Physiotherapy at the Institute of Applied Medicines and Research Centre, Ghaziabad, Uttar Pradesh, India. The study duration was nine months, from January 2022 to September 2022. A total of 30 subjects aged 30-55 years were divided into three groups (10 participants in each group: A, B, and C) using sealed envelopes. Group A received vagal stimulation on the ear lobule, Group B received vagal stimulation on the cymba concha, and Group C received vagal stimulation on the tragus. Baseline measurements were taken prior to treatment, including HR, BP, and skin hydration. Vagal stimulation was administered using a low-frequency Transcutaneous Electrical Nerve Stimulation (TENS) machine at 25 Hertz and a pulse width of 120 ms. The stimulus was continuously applied for 30 minutes, five days a week, for four weeks. After a 10-minute relaxation period, HR, BP, and skin hydration were measured both pre and post-intervention. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 24.0, employing paired t-tests to compare means within groups and Analysis of Variance (ANOVA) to compare between the three groups. Results: There were no statistical differences in the baseline among all three groups. Group C, which received vagal stimulation on the tragus, demonstrated statistically significant improvements in BP and skin hydration. The t-value and p-value for Systolic Blood Pressure (SBP) were 11.513 and p<0.001, for Diastolic Blood Pressure (DBP) were 10.411 and p<0.001, for HR were 15.231 and p<0.001, and for skin hydration were 9.474 and p<0.001, respectively. When comparing HR, BP, and skin hydration among the groups using one-way ANOVA f- value and p-value showed significant difference between the groups in all parameters. Conclusion: The study concludes that vagal stimulation on the tragus is a superior intervention compared to vagal stimulation on the cymba concha or ear lobule for controlling HR, BP, and skin hydration in prehypertensive individuals.

Aetiological Profile and Outcomes of Acute Kidney Injury among Neonates Admitted in a Neonatal Intensive Care Unit at a Tertiary Care Hospital, Northeast India: A Prospective Cohort Study

Dulal Kalita, Mahibur Rahman, Diganta Barman, Sabir Hussain

Introduction: Acute Kidney Injury (AKI) affects approximately 8%-24% of critically ill neonates, with a mortality rate ranging from 10%-61%. Groups of newborns at higher risk for AKI include those with perinatal hypoxia, Respiratory Distress Syndrome (RDS), premature and very low birth weight infants, and newborns with sepsis. AKI is associated with poor short-term and long-term outcomes and has a multifactorial aetiology. Aim: To evaluate the aetiological profile and short-term outcomes of AKI in neonates admitted to the Neonatal Intensive Care Unit (NICU). Materials and Methods: A prospective cohort (descriptive) study was conducted in the NICU at Gauhati Medical College and Hospital, Guwahati, Assam, India, over a period of one year, from September 1, 2021, to August 31, 2022. A total of 100 neonates exhibiting signs and symptoms of AKI according to Acute Kidney Injury Network (AKIN) criteria. Detailed neonatal history, including neonatal resuscitation, history of perinatal asphyxia, signs and symptoms of sepsis, Respiratory Distress Syndrome (RDS), or any other symptoms, were recorded. The course and outcome of the neonates during their NICU stay were noted. Data were presented in terms of frequency (n) and percentages (%). Results: Among the 100 AKI neonates, 58 were males and 42 were females, with a male-to-female ratio of 1.38:1. Out of 100 neonates, birth asphyxia constituted 40 (40%) cases, of cases, followed by sepsis in 30 (30%), RDS 27 (27%), dehydration 2 (2%), and obstructive uropathy in 1 (1%) case. Among the 100 AKI neonates, 64 (64%) cases were discharged, 35 (35%) expired, and 1 (1%) were transferred to the paediatric surgery department. Conclusion: Neonatal AKI is an independent contributor to morbidity and mortality. Therefore, early identification and prompt management are crucial for improving outcomes and prognosis.

Prevalence of Knee Osteoarthritis and its Associated Factors in Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: Knee Osteoarthritis (OA) and Type 2 Diabetes Mellitus (T2DM) are both highly prevalent chronic conditions that lead to significant disability and economic burden on society. This study primarily focuses on the prevalence of knee OA in T2DM, individual risk factors, and their impact on knee OA in T2DM patients. Aim: To estimate the prevalence of knee OA and to determine the factors associated with knee OA among patients with T2DM attending the diabetes clinic. Materials and Methods: This cross-sectional study was conducted at the Department of General Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India among 200 T2DM patients (103 males and 97 females) according to the American Diabetes Association (ADA) guidelines. Demographic data and disease variables were recorded for all patients. Knee OA was assessed using clinicoradiological American College of Rheumatology (ACR) criteria for knee OA, with the right knee considered as the index knee. Radiographs were evaluated using the Kellgren Lawrence (KL) grading system for knee OA. Functional status for knee OA was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Statistical analysis was performed using Epi Info version 7.0 software. Results: A total of 200 patients were included in the study, with 103 (51.5%) males and 97 (48.5%) females. The mean age was 53.93±9.94 years, and the mean BMI was 23.29±3.6 kg/m2. The mean duration of T2DM was 49±52.22 months. The prevalence of knee OA in T2DM patients was 46.3%. Among the disease variables in patients with knee OA and without knee OA, the mean age was 54±10 years and 50±7.9 years, respectively. The mean BMI was 23.29±3.61 kg/m2 and 22.69±3.04 kg/m2, respectively. The mean duration of T2DM was 49±52 months and 30.1±33.33 months, respectively. The mean serum uric acid level was 5.9±1.5 mg/dL and 5.5±1.25 mg/dL, respectively. The mean serum cholesterol was 205.7±75.9 mg/dL and 170.9±51.1 mg/dL, respectively. Conclusion: Knee OA is highly prevalent in patients with T2DM, highlighting the importance of investigating the presence of knee OA in each patient with T2DM. The association of knee OA with patient age and duration of T2DM indicates the need for early intervention, and the significant association with co-morbidities suggests the inclusive management of co-morbidities.

Willingness to Know about Human Immunodeficiency Virus Status in Healthcare Personnel and General Public at a Tertiary Healthcare Centre, North Bangalore, India: A Cross-sectional Study

R Chaitra, R Sharvani, Hemavathi

Introduction: India is a country with a high Human Immunodeficiency Virus (HIV) prevalence rate. To accomplish the target of UNAIDS 95-95-95 by 2030, individuals should know their HIV status to achieve the first 95, which means 95% of Persons Living With HIV (PLWH) worldwide should know their diagnosis, for which testing is a must. Aim: To know the willingness for HIV infection testing among Healthcare Personnel (HCP) and the General Public (GP). Materials and Methods: A cross-sectional study was conducted at Sapthagiri Institute of Medical Science and Research Centre, North Bangalore, Karnataka, India between June 2019 and September 2019. Convenient sampling was done which included 200 subjects (100 HCP and 100 GP). Demographic data such as name, age, sex and address were collected, followed by knowing their willingness to get tested for HIV along with the barriers for not being willing to undergo the HIV test. Tests were performed following the standard National AIDS Control Organisation (NACO) guidelines for those subjects who were willing to know their HIV status. The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 20.0, and the results were expressed in the form of frequency or percentage. Results: Among the 200 subjects who consented to participate in this study, only 39 HCPs (39%) and two GPs (2%) were willing to get tested in order to know their HIV status. Among the 41 individuals who got tested according to NACO guidelines, none tested positive for HIV. The barriers for not being willing to know their HIV status among the 61 HCPs were “it’s not a necessary test” 56 (91.8%), and the remaining 5 (8.2%) stated that the test was not necessary after 50 years of age. Among the 98 GPs, the barriers were “no symptoms or health problems” as cited by 35 (35.8%), followed by “will get tested only on doctor’s advice” 27 (27.6%), and other factors. Conclusion: In this study, the willingness to know their HIV status was found to be very low, especially among GPs, and less than 50% among HCPs. The barriers for not being willing to know their HIV status raise concerns for policymakers to reformulate policies in order to achieve the United Nations Programme on HIV and AIDS (UNAIDS) target of 95-95-95 by 2030.

Determination of the Impact of Various Commonly Consumed Beverages on the Colour Stability of Universal Nanohybrid, Nanofilled, and Microhybrid Composite Resins: An In-vitro Spectrophotometric Study

Introduction: The challenge in restorative dentistry is related to changes in the colour of composite over time when exposed to a variety of common beverages, which necessitates additional expenses for the patients. Aim: To compare the colour changes of various composites currently available on the market after exposure to commonly consumed beverages. Materials and Methods: This in-vitro study was conducted from May 2022 to December 2022 in the Department of Conservative Dentistry and Endodontics at Karnavati School of Dentistry in Gandhinagar, Gujarat, India. A total of 120 disc-shaped composite pellets, with 40 specimens for each type of composite (nanohybrid, nanofilled, and microhybrid), measuring 6×2 mm, were prepared and divided into four subgroups based on the beverages used (Distilled water, coca-cola, Tea, and Coffee). The samples were submerged in the respective beverages and kept at 37°C for seven days. Colour assessment was performed using a spectrophotometer before and after immersion. The obtained Commission International de l Eclairage (CIE) ?E values were recorded after measuring the CIE L*a*b* values. Data analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 20.0, utilising a paired t-test, post hoc Tukey’s test, and one-way Analysis of Variance (ANOVA). A significance level of p<0.05 was used. Results: Among all the beverages, the nanofilled composite showed the highest mean colour change, while the nanohybrid composite exhibited the lowest. Overall, the greatest colour change was observed with tea, followed by coffee, coca-cola, and the least with distilled water. In tea, coffee, and coca-cola, the nanohybrid composite and nanofilled composite showed a statistically significant difference in mean colour change: 16.74 (p<0.001), -7.29 (p<0.001), and -1.02 (p=0.018), respectively. However, the difference between the nanohybrid and microhybrid composite was statistically insignificant. Conclusion: The nanohybrid composite demonstrated the least mean colour change, followed by the microhybrid composite, while the nanofilled composite exhibited the highest colour change.

Big Five Personality Domains and their Impact on Problematic Mobile Phone Use among Medical Students in a Rural Tertiary Care Centre in Tamil Nadu India: A Cross-sectional Study

Introduction: The increasing usage of smartphones across the globe has resulted in considerable changes in people’s daily lives, especially in terms of personality traits among adults. Research shows that the Big Five personality traits influence Problematic Mobile Phone Use (PMPU). Aim: To estimate the prevalence of PMPU using the Mobile Phone Problem Use Scale (MPPUS-10) and to evaluate the personality predictors of PMPU using the Big Five Inventory (BFI) questionnaire. Materials and Methods: A cross-sectional survey was conducted among 289 medical students at a rural tertiary care centre in Tamil Nadu, India from November 2021 to April 2022. The questionnaire consisted of three sections. The first section collected demographic characteristics, the second section included questions on the MPPUS-10, and the third section contained questions from the BFI questionnaire. Reliability analysis was conducted to assess the internal validity of the MPPUS-10 questionnaire. Exploratory factor analysis using principal component analysis with varimax rotation and Kaiser normalisation was performed to measure the structural validity of the MPPUS-10 scale. A multiple linear regression model was applied to determine the relationship between PMPU and the personality domains. Results: The prevalence of PMPU among medical students was found to be 106 (36.7%). Spearman’s rank correlation revealed a negative correlation between agreeableness personality (r=-0.307, p-value <0.001) and conscientiousness personality (r=-0.369, p-value <0.001) with PMPU. Additionally, a positive correlation was observed between neurotic personality and PMPU (r=0.325, p-value <0.001). Multiple linear regression analysis demonstrated that agreeableness, conscientiousness, and neuroticism significantly predicted 44.4% of the scores on the PMPU (F=23.276, p-value <0.001 at the 1% level). Therefore, individuals with lower levels of agreeableness, conscientiousness, and higher levels of neuroticism scored higher on the MPPUS-10 scale. Conclusion: The prevalence of PMPU among medical students was found to be high, requiring attention. Individuals with lower levels of agreeableness and conscientiousness, as well as higher levels of neuroticism, were more likely to exhibit PMPU.

Serum Oestrogen and Progesterone Levels in the Early Luteal Phase as Predictors of Successful In-vitro Fertilisation Outcome: A Prospective Cohort Study

Aishwarya Kapur, Meenakshi Goel, Sudha Prasad

Introduction: The serum levels of oestrogen and progesterone in the luteal phase of In-vitro Fertilisation (IVF) cycles using the long agonist protocol may play a role in predicting the outcome of the cycle. Aim: To determine the levels of oestrogen and progesterone in the early luteal phase of IVF cycles and their association with the pregnancy rate. Materials and Methods: A prospective cohort study was conducted in the IVF centre at Maulana Azad Medical College, Delhi, India, from September 2014 to August 2016. A total of 150 women undergoing IVF were recruited over a period of two years and underwent IVF using the standard long agonist protocol. Luteal phase support was provided according to the Institutional protocol. Blood samples were collected on the day of Ovum Pick Up (OPU) (day 0), the day of embryo transfer (day 3), the day of implantation (day 6), and the day of confirmation of biochemical pregnancy (day 17) to estimate serum Estradiol (E2) and Progesterone (P) levels. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0, and a p-value <0.05 was considered significant. Results: The mean age of patients in the study was 31.17±1.09 years, and the mean duration of infertility was 8.2±4.2 years. Serum E2 (day 6, 1403.23±376.67 vs 1258.98±354.31 pg/mL; p=0.02) as well as P4 levels (day 6, 77.82±21.82 vs 68.90±22.17 pg/mL; p=0.01) were significantly higher on the day of implantation and day of confirmation of biochemical pregnancy (day 17, E2 541.80±498.01 vs 289.34±171.94 pg/mL, p<0.001; P4 70.61±121.47 vs 36.17±16.63 pg/mL, p<0.001) among those who conceived compared to those who did not conceive. Conclusion: Serum E2 and P4 levels in the luteal phase may help guide luteal phase support and serve as predictors of a successful cycle outcome in women undergoing IVF using the long agonist protocol.

Association of BMI with Semen Parameters in the Male Partners of Infertile Couples: A Cross-sectional Study

Onkar Bharat Waghmare, Sudhir Prabhakar Choudhari, Syeda Afroz Fatima

Introduction: In today’s scenario, obesity is increasing in children and young adolescents, and they are more likely to continue as obese adults. Temporal trends indicate that obesity is increasing while fertility is decreasing. Studies worldwide have reported a negative association between obesity and male fertility, but studies from India are scarce. Hence, there is a need to study the extent of the association between obesity and infertility. Aim: To evaluate the association between Body Mass Index (BMI) and semen parameters in the male partners of infertile couples. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology, Government Medical College Aurangabad, Maharashtra, India, from August 2021 to August 2022. On total of 66 participants divided into two groups: Group A consisted of overweight and obese participants (BMI ≥23.0 kg/m2), and Group B consisted of participants with normal BMI (BMI <23 kg/m2). The semen parameters studied were semen volume, sperm concentration, total sperm count, total motility, and progressive motility. Semen samples were analysed according to the WHO 2010 guidelines. Continuous variables were expressed as mean±standard deviation. Unpaired t-test was used to compare the groups. Results: The mean age in Group A and Group B was 30.18±4.5 and 28.27±4.35 years, respectively (p<0.08). The mean BMI in Group A and Group B was 27.01±2.94 kg/m2 and 20.29±1.69 kg/m2, respectively (p<0.0001). The mean sperm concentration in Group A was 37.01±42.6 million, and in Group B, it was 90.24±56.11 million (p<0.0001). Total motility in Group A was 27.8±31.36%, and in Group B, it was 57.9±28.41% (p<0.0001). Progressive motility in Group A was 18.75±24.79%, and in Group B, it was 42.63±26.15% (p<0.0003). Conclusion: In the present study, high BMI (obesity and overweight) was significantly associated with low sperm concentration, count, and motility.

Chemokine Receptor Gene (CCR5) Polymorphism in Acute Coronary Syndrome: A Cross-sectional Study

MR Prashanth, Sharan Badiger, Gurushantappa Kadakol

Introduction: Acute coronary syndrome is a multifactorial disease with a complex pathogenesis, mainly resulting from the interplay of genetic and environmental risk factors. Chemokines and their receptors play crucial roles in the initiation and progression of atherosclerosis. Chemokine Receptor 5 (CCR5) is an important mediator of leukocyte recruitment and leukopedesis. Most studies conducted on the relationship between CCR5 gene polymorphism and coronary artery disease in different regions and populations worldwide show conflicting results. Aim: To investigate the genetic polymorphism of CCR5 genes associated with patients with acute coronary syndrome in the Vijayapura population. Materials and Methods: A cross-sectional study was conducted at BLDE (Deemed to be University) Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India, involving patients admitted for acute coronary syndrome. A total of 100 patients were admitted with acute coronary syndrome. Nineteen patients with diabetes mellitus were excluded from the study based on the exclusion criteria. Clinical history, examination, electrocardiographic assessments, laboratory profiles, and blood samples were taken for the analysis of CCR5 gene polymorphism as part of the work-up. Patients were classified into two groups: one with the presence of CCR5 polymorphism as Group A (n=6), and the other without polymorphism as Group B (n=75). Parameters such as age, sex, occupation, lipid profile, renal function tests, and CCR5 polymorphism were studied between the groups. The data were statistically analysed. Categorical variables between the two groups were compared using the Chi-square test. Normally distributed continuous variables were compared using independent t-test, and non normally distributed variables were compared using the Mann-Whitney U test. Results: In the present study, the most common age group was 50-70 years with a male predominance of 60.7%. Most of the patients in the study group were farmers (34.7%), followed by housewives (32%) and businessmen (14.7%). The most common risk factors observed in both study groups were smoking and tobacco chewing. Gene sequencing revealed CCR5 gene polymorphism in six out of 81 patients who were labelled as Group A, indicating an incidence of 7.5% (p<0.001). Out of the six positive patients in Group A, three were males and three were females. One patient was 45 years old, while the remaining five were above 60 years old. Conclusion: The present study demonstrates a positive association between CCR5 polymorphism and acute coronary syndrome, indicating that the study population is genetically susceptible to the disease. By screening for high-risk individuals, better and more effective early interventions can be planned, thereby reducing the social burden, morbidity, and mortality associated with the disease.

Conventional Adenomatous Polyps: Study of Histomorphological Features Using a Novel Scoring System

Anvita Nilekani, BR Vani, Asma Samreen, V Srinivasa Murthy

Introduction: Conventional adenomatous polyps are dysplastic proliferations that arise from the surface of the mucosa and grow in a top-down fashion. Dysplasia is graded as low-grade and high-grade using a two-tiered grading system. Aim: To grade the dysplasia in conventional adenomatous polyps by applying a novel scoring system. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, ESIC Medical College and Post Graduate Institute of Medical Science and Research (PGIMSR), Rajajinagar, Bengaluru, Karnataka, India. A total of 46 cases reported as conventional adenomatous polyps were reviewed from January 2020 to June 2022. A cytological grading system was applied, evaluating eight parameters consisting of architectural and cytological features. Each parameter was scored, resulting in a total score ranging from 8 to 24. The final diagnosis was determined based on the histological pattern and the total cytological score. The results were tabulated in an excel sheet and analysed using mean, standard deviation, percentage, and frequency tables. The relationship between the independent variables was evaluated using the Chi-square test. A p-value of less than 0.05 was considered significant. Results: Out of the 46 cases, most presented in the 4th decade of life 12 (32.61%) cases. The mean age of presentation was 54.56±11.91 years (mean±SD) with a male to female ratio of 1.4:1. The most common site was the sigmoid colon 17 (36.96%) cases. There were 26 cases of low-grade dysplasia with a mean score of 9.1 and 20 cases of high-grade dysplasia with a mean score of 15.2. The most common type was tubular adenoma with low-grade dysplasia 24 (52.17%) cases and a mean cytological score of 9. The high-grade dysplasia in tubular adenomas 7 (15.22%) cases, tubulovillous adenomas 11 (23.19%) cases, and villous adenomas 2 (4.35%) cases had mean scores of 13.3, 15.2, and 18, respectively. Conclusion: Dysplasia in adenomatous polyps is an independent risk factor for malignancy. The cytological scoring system helps in accurately diagnosing the grade of dysplasia and simplifies the process. The present study emphasises the need for objective criteria, paving the way for implementing relevant surveillance and clinical protocols.

Efficacy of Periotome Versus Conventional Forceps Extraction in Socket Preservation and Reduction of Postoperative Pain: A Randomised Clinical Trial

Introduction: Atraumatic extraction is necessary when a patient undergoes dental implant rehabilitation. Various tooth extraction systems are used and regularly upgraded. The periotome is a tool that severes the Periodontal Ligaments (PDL) and aids in atraumatic extraction while preserving the socket. Aim: To evaluate the efficacy of conventional forceps versus periotome extractions of single-rooted maxillary teeth in terms of socket preservation, procedure duration, and postoperative pain. Materials and Methods: This was a single-blinded randomised clinical trial conducted at Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharastra, India from December 2020 to March 2021 involved 42 patients aged 18-60 years who required extraction of maxillary single-rooted teeth that had failed endodontic treatment. The patients were randomly divided into two groups: a periotome group and a conventional forceps group. Clinical assessment was conducted to evaluate socket preservation, extraction time, postoperative pain, and any complications related to the extraction procedure. Statistical analysis was performed using the Mann-Whitney U test, Chi-square test, and unpaired t-test. Results: The majority of patients were within the age group of 51-60 years, with 13 males and 29 females. The difference in extraction time between the two groups was not statistically significant (p=0.368). The periotome group exhibited a significantly lower incidence of buccal cortical plate fractures compared to the conventional forceps group (p=0.048). Regarding the severity of postoperative pain, the periotome group demonstrated a significantly lower value than the conventional forceps group (p=0.028). Conclusion: The periotome proved to be a more efficient choice for preserving the socket in endodontically non treatable teeth requiring extraction, as compared to conventional forceps.

Managing Carpal Tunnel Syndrome using Neurodynamics: A Narrative Review

Bhoomika Bhat, Saumya Srivastava

Carpal Tunnel Syndrome (CTS) is one of the preeminent types of peripheral neuropathies of the upper limb, where the median nerve is injured in the carpal tunnel, leading to a cascade of symptoms. CTS can cause pain, substantial motor function and sensory impairment, and a weakened ability to perform skilled work. Utilising the Neurodynamic Technique (NDT), a hands-on manual therapy approach can effectively address CTS. This technique focuses on manipulating neural tissues and the adjacent non-neural structures related to the nervous system, to alter pain physiology. The current narrative review aimed to ascertain the effectiveness of NDT in the management of CTS so that it can guide the practitioners in effectively managing and understanding CTS and also help in adding the literature to the existing evidence. The review evaluated outcome measures such as pain intensity, motor issues, physical function, and nerve conduction investigations. The review was done to demonstrate that NDT can offer significant therapeutic advantages and can serve as a practical approach to managing CTS.

Comparison between Ultrasound-guided Pulsed Radiofrequency Ablation of the Medial Calcaneal Nerve and Extracorporeal Shockwave Therapy in Managing Recalcitrant Plantar Fasciitis: A Randomised Controlled Trial

Introduction: Plantar Fasciitis (PF) is one of the most common causes of heel pain, with a prevalence ranging from 3.6-7% in the general population. Approximately 90% of patients with PF respond well to conservative therapy, including rest, stretching, analgesics, physical therapy, shoe modifications, or steroid injections. However, around 10% of patients have recalcitrant cases that require invasive or surgical interventions. Pulsed Radiofrequency Ablation (PRFA) is a non neurodestructive method that provides non surgical pain relief in such cases. Aim: To compare the effectiveness of ultrasound-guided PRFA of the Medial Calcaneal Nerve (MCN) and Extracorporeal Shockwave Therapy (ESWT) in managing recalcitrant PF. Materials and Methods: This randomised controlled trial was conducted at the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India over a two-year period from September 2018 to August 2020. A total of 78 patients with PF were included in the study, divided equally into two groups: a study group and a control group, each consisting of 39 participants. The study group received PRFA of the MCN, while the control group received ESWT of the plantar fascia. The Visual Analog Scale (VAS), Plantar Fascia Thickness (PFT), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were measured at 1, 4, 12, and 24 weeks as outcome variables. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, and statistical tests like Chi-square test, t-test, and repeated measures Analysis of Variance (ANOVA) were used. A p-value of <0.05 was considered significant. Results: Of the 78 patients included in the study, 42 (53.8%) were females and 36 (46.2%) were males, with a mean age of 41.08±10.09 years. The VAS score in the study group improved from 5.51±0.82 at baseline to 1.92±0.80 at 24 weeks, while in the control group, the VAS score improved from 5.36±0.97 at baseline to 2.33±0.66 at 24 weeks. PFT in the study group improved from 4.45±0.374 at baseline to 2.26±0.231 at 24 weeks, while in the control group, PFT improved from 4.42±0.366 at baseline to 2.49±0.357 at 24 weeks. The AOFAS score also improved from 50.49±13.13 at baseline to 74.03±11.53 in the study group, and in the control group, the AOFAS score improved from 49.74±12.26 at baseline to 71.36±10.72 at 24 weeks (p-value <0.05). Conclusion: Significant improvements were observed in all outcome measures in both the study and control groups, with a p-value <0.05. However, the improvements were more pronounced in the study group, with minimal to no side-effects. Hence, ultrasound-guided PRFA of the MCN can be considered an effective minimally invasive treatment modality for recalcitrant PF.

Renal Challenges in Pregnancy: Investigating Acute Kidney Failure and Perinatal Well-being- A Prospective Descriptive Study

Yedla Anitha, Bhashyam Srilakshmi, Poornima Penmetsa, Rose Mary Penumaka

Introduction: Acute Kidney Injury (AKI) poses life-threatening risks in pregnancy, leading to adverse perinatal and maternal outcomes. Aim: To estimate the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) and describe maternal and foetal outcomes in cases of Acute Renal Failure (ARF) at a tertiary care institute. Materials and Methods: A prospective descriptive study was conducted on 104 antenatal women with ARF attending King George Hospital, Visakhapatnam, Andhra Pradesh, India, from January to December 2020. A total of 7,409 deliveries occurred during the study period, and antenatal women with evidence of pre-existing renal disease were excluded. A detailed history was obtained, and evaluation included renal function tests and a total abdominal scan. Mode of delivery, foetal deaths, stillbirths, maternal deaths, and APGAR scores were analysed. Laboratory findings were also reported. Data analysis was performed using coGuide statistical software, and results were expressed in terms of frequency and percentages. Results: The incidence of PRAKI was 14 per 1,000 deliveries (1.4%). The mean age of the participants was 24.05±4.11 years. The majority (78 out of 104, 75%) were in the third trimester. Out of the 104 cases of PRAKI, 77 (74%) were due to hypertension. There were 16 (15.4%) maternal deaths and 19 (21.8%) perinatal deaths. Conclusion: Pregnant women with ARF experienced increased morbidity and mortality. Urgent improvements in antenatal care, early detection of complications, effective management, and timely referrals to tertiary centres are crucial.

Burden of Severe Acute Respiratory Syndrome Coronavirus 2 and its Seasonal Trends in Patients Attending a Tertiary Healthcare Centre in Rajasthan: A Retrospective Observational Study

Introduction: The pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has drastically affected the global population, leading to high rates of morbidity and mortality. This virus originated in China had quickly spread to different countries worldwide, paralysing healthcare systems. Alongside supportive therapy, isolation, and contact tracing, vaccines have also played a crucial role in rescuing the human population from the virus. Aim: To evaluate the burden of SARS-CoV-2 and its seasonal trends. Materials and Methods: This retrospective observational study was conducted in the Department of Microbiology at the Ananta Institute of Medical Sciences and Research Centre in Rajsamand, Rajasthan, India. Data was collected from July 2020 to September 2022 and analysed from January 2023 to March 2023. The study included a sample size of 14,050. Nasopharyngeal and throat swab samples were collected into a single tube of Viral Transport Medium (VTM). Ribonucleic Acid (RNA) was extracted from the VTM, and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was performed using different kits approved by the Indian Council of Medical Research (ICMR). Results were interpreted according to the manufacturer’s instructions. A Chi-squared test was performed using GraphPad Prism version 9.2.0.332. A p-value of <0.05 was considered significant. Results: A total of 14,050 samples were evaluated, of which 2,861 (20.36%) tested positive for SARS-CoV-2. The highest positivity rate of 581 (4.13%) was observed in the age group of 41-50 years (p-value <0.0001). The maximum positivity for SARS-CoV-2 was found among individuals aged 21-60 years, accounting for 2,086 (14.85%) cases. Among the samples obtained from the Inpatient Department (IPD) and Outpatient Department (OPD), 913 (13.83%) (p-value=0.0014) and 1,948 (26.16%) tested positive for SARS-CoV-2, respectively. Male patients accounted for 1,869 (21%) (p-value=0.0194) positive cases, while female patients accounted for 992 (19.26%) (p-value <0.0001) positive cases. The highest positivity rate was recorded in April 2021, with 921 (6.55%) cases. Seasonal trends of SARS-CoV-2 showed two major peaks and a minor peak between July 2020 and September 2022. Symptomatic patients had a positivity rate of 987 (31.75%), while asymptomatic patients had a rate of 1,874 (17.13%) (p-value <0.0001). Conclusion: Enhanced precautionary measures are required for individuals aged 21-60 years, as they are more vulnerable to SARS-CoV-2. Asymptomatic patients had a positivity rate of 17.13%. Given the mixed trend of seasonal transmission of SARS-CoV-2, continuous surveillance of the virus is necessary. The study results will be useful for epidemiological purposes and for planning strategies aimed at reducing the duration of the pandemic.

Breakfast Eating Habits and their Association with Academic Performance: A Cross-sectional Study among Medical Students

Navneet Kumar Kaushik, Swati Mishra, Anju Sharma, Mohita Singh, Shailesh Mishra

Introduction: Breakfast has long been considered the most important meal of the day, yet the frequency of breakfast consumption has declined in recent decades. Adequate breakfast habits are related to optimal physiological, psychological, and social health. Aim: To assess the breakfast eating habits of medical students and find the association between breakfast habits and academic performance. Materials and Methods: A cross-sectional, observational study was carried out in the Department of Physiology at Shaheed Hasan Khan Mewati (SHKM) Government Medical College, Nuh, Haryana, India. The duration of the study was three months from July 2022 to September 2022. A total of 350 apparently healthy medical undergraduates from the second year to final year participated in the study. Breakfast eating patterns and other characteristics of the morning meal consumed by participants were assessed using a structured proforma. Participants were divided into three groups (regular, irregular, and skippers) based on the frequency of breakfast consumption. Academic performance was assessed based on the aggregate marks (%) obtained in the university examination. Data were compiled and analysed using Statistical Package for Social Sciences (SPSS) software version 20.0 (SPSS Inc., Chicago, IL, USA). One-way Analysis of Variance (ANOVA) was used to compare academic performance (% marks) among the breakfast groups, and the relationship between the aforementioned variables was determined using Pearson’s Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The mean age of the study participants was 20.95±1.10 years. Present study showed that only around one-third, 121 (34.6%) students ate breakfast regularly (6-7 days/week), while the remaining either consumed it irregularly or skipped it altogether. A significant association (p=0.02) was found between breakfast habits and academic performance, with regular breakfast eaters performing better compared to skippers. Conclusion: Irregular consumption of breakfast is quite prevalent among medical students. Poor time management emerged as the main reason for this behaviour. Breakfast habits may influence academic performance, but it warrants further investigation using a multivariate approach.

Comparison of Dexamethasone Implant and Anti-VEGF Agents in the Treatment of Naive Diabetic Macular Oedema: A Prospective Cohort Study

Vanaja Iyer, Gayatree Mohanty, CS Lalitha, Manmath Kumar Das, Mehak Sethi

Introduction: Diabetic Retinopathy (DR) is one of the common microvascular complications of diabetes. In patients with DR, the most frequent cause of vision loss is Diabetic Macular oedema (DME). In the present era, anti-Vascular Endothelial Growth Factor (anti-VEGF) agents are the mainstay of treatment for managing DME. A majority of patients show a good response to multiple doses of these agents administered by a pro re nata regimen at regularly spaced fixed intervals. However, the tendency of DME to become chronic and resistant to these agents, as well as the burden of repeated injections, necessitates considering alternative treatment options with similar or better efficacy. As steroids can address these drawbacks of anti-VEGF treatment, the present study compared the efficacy of anti-VEGF agents with dexamethasone implant in the treatment of naïve DME. Aim: To compare the effectiveness of dexamethasone implant with anti-VEGF agents in the treatment of naïve DME. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology at Kalinga Institute of Medical Sciences and Pradyumna Bal Memorial Hospital, Bhubaneswar, Odisha, India from September 2020 to September 2022. A total of 100 eyes with DME, newly diagnosed patients aged 18 years and above, without other macular oedema-causing diseases, were included. A total of 50 eyes in each group were treated with an anti-VEGF agent (Group A) or dexamethasone implant (Group B), and Best Corrected Visual Acuity (BCVA) and Central Foveal Thickness (CFT) were monitored for six months. For statistical analysis, paired t-test and independent t-test were used for within-group and inter-group analysis, respectively. A p-value <0.05 was considered statistically significant. Results: In both groups, post-treatment BCVA showed marked improvement, but there was no significant difference in mean BCVA between the groups (p=0.89) at six months. However, the mean CFT showed significant improvement in Group B at six months. In Group A, the mean CFT reduced from 441.87±54.48 μm to 257.83±25.73 μm, and in Group B, the mean CFT reduced from 464±109.44 μm to 207±22.51 μm at six months (p<0.0001). Adverse events like cataracts and glaucoma were seen in patients treated with the dexamethasone implant and were managed by cataract surgery and topical anti-glaucoma medications, respectively. Conclusion: Dexamethasone implant and anti-VEGF agents are equally effective in improving visual acuity; however, dexamethasone stands superior in reducing macular thickness. Needing fewer injections while treating with a dexamethasone implant improves compliance. The progression of cataract remains a major side-effect with the dexamethasone implant, which is not a concern when treating DME in pseudophakic eyes.

Relationship between Glycosylated Haemoglobin Levels and Macular Thickness on Optical Coherence Tomography in Type 2 Diabetic Patients: A Cross-sectional Study

Introduction: Diabetic Macular Oedema (ME) is the main cause of poor visual acuity due to the breakdown of the inner and/or outer Blood Retinal Barrier (BRB). This can occur at any stage of Diabetic Retinopathy (DR) due to increased vascular permeability from retinal capillaries, as well as from microaneurysms and Intraretinal Microvascular Abnormalities (IRMAs). A high level of Glycosylated Haemoglobin (HbA1c) is a well known risk factor for diabetic ME. Aim: To evaluate the relationship between glycosylated Haemoglobin (Hb) and macular thickness on Optical Coherence Tomography (OCT) in patients with Type 2 Diabetes Mellitus (T2DM). Materials and Methods: A cross-sectional study was in the Department of Ophthalmology at RL Jalappa Hospital, Kolar, Karnataka, India. The study duration was one year and eight months, conducted from January 2021 to September 2022. A total of 162 eyes of 81 patients with Diabetes Mellitus (DM) were included. Patients were assessed for age, gender, duration of diabetes, subfield macular thickness, total macular volume as measured by Optical Coherence Tomography (OCT), and HbA1c levels. Pearson’s correlation and paired t-test were used to identify the mean difference between paired data. A p-value <0.05 was considered statistically significant. Results: Out of 81 patients, 52 (64.2%) were males and 29 (35.8%) were females, with a mean age of 59.36±8.98 years (range 40-81 years) and a duration of diabetes of 14.61±4.2 years. The mean HbA1c level was 8.18±1.47% (range 5.5-12.1). A significant positive correlation was observed between central subfield thickness and total macular volume with HbA1c among both eyes (p-value=0.001). This correlation was more prominent in patients with HbA1c values >8% compared to those with HbA1c values <8% (p-value=0.001). Additionally, a positive correlation was observed between duration of diabetes and right central macular thickness (p-value=0.046) and HbA1c levels (p-value=0.027). Age did not have a major influence on central subfield thickness and total macular volume, but it did show a positive Pearson’s correlation with HbA1c levels (p-value=0.008). Conclusion: A significant positive correlation was observed between central subfield thickness and total macular volume in both eyes with HbA1c levels. Patients with HbA1c levels >8% and a longer duration of diabetes exhibited increased macular thickness and total macular volume as measured by OCT, which was also observed in patients with severe non proliferative DR and proliferative DR.

Comparative Evaluation of the Antimicrobial Efficacy and Abrasivity of a Herbal Dentifrice Formulated with Myristica fragrans and a Commercially Available Herbal Dentifrice: An In-vitro Study

Introduction: Effective plaque control is important for proper oral health maintenance, and the toothbrush-dentifrice combination is essential for achieving this. Recently, herbal toothpastes have gained more popularity amongst people. Aim: To formulate a novel herbal toothpaste containing Myristica fragrans (nutmeg) and compare its antimicrobial efficacy and abrasivity with a commercially available herbal toothpaste. Materials and Methods: This in-vitro study was conducted on 24 non-carious permanent extracted teeth with intact coronal structure. These were equally divided into experimental and control groups (n=12). The nutmeg toothpaste was formulated using nutmeg powder, tulsi leaf powder, and clove powder as the main herbal ingredients. Dabur red was selected as the commercial herbal toothpaste. The zone of inhibition of both toothpastes was evaluated against Streptococcus mutans and Lactobacillus species using the agar well diffusion method. Enamel specimens measuring 5×5×5 mm were mounted on acrylic blocks and brushed for 28 days. Profilometric analysis was conducted on the 1st, 7th, and 28th day. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0 software, and independent t-tests and Analysis of Variance (ANOVA) tests were used. Results: 24 teeth were used. A total of 6 samples of toothpaste were considered for antimicrobial testing. The zone of inhibition for the nutmeg toothpaste and Dabur red was 28 mm and 32.17±0.42 mm, respectively, against both organisms. The increase in surface roughness of enamel was not statistically significant between the two groups (p>0.05). Conclusion: Both toothpastes exhibited antimicrobial activity against the test microorganisms and significantly increased the surface roughness of enamel from baseline to the 28th day. The nutmeg toothpaste caused less enamel abrasion, but the difference was not significant.

Identification of Malocclusion by Dental Undergraduate Students: A Cross-sectional Study

Introduction: Health is multifaceted and influenced by a variety of variables. Along with dental caries, periodontal and gingival disorders, malocclusion is one of the most prevalent dental issues. It can impair oral health by increasing the prevalence of dental caries, periodontal diseases, and temporomandibular disorders, as well as predispose to oral habits in the majority of cases. Hence, knowledge about the need for treatment and the correct time of commencement is essential for treating malocclusion. Aim: To assess the level of understanding of dental undergraduate students in the identification of malocclusion. Materials and Methods: A cross-sectional study was conducted on 150 final-year dental undergraduate students from private dental colleges who were randomly chosen. A pre-tested questionnaire with closed-ended questions was given to every participant, and their knowledge levels were evaluated on the same day after the collection of completed questionnaires. The questionnaire contained intraoral and extraoral photographs of patients with malocclusions. Students were asked questions about the identification of various malocclusions, and the data was analysed as frequency (n) and percentages (%). Results: Questionnaire responses by a total of 150 dental undergraduate students, (48 males and 102 females) with a mean age of 21±2 years were analysed. The majority of students were able to identify Angle’s Class-I (n=139, 92.7%), Class-II (n=103, 68.7%), and Class-III (n=122, 81.3%) malocclusions, as well as canine relationships (n=136, 90.7%). The majority of students had no difficulty in recognising transverse malocclusions, such as posterior crossbite (n=103, 68.7%) and scissors bite (n=99, 66%), as well as common malocclusions like crowding, spacing, midline shift, and deep bite. Conclusion: Most of the students were familiar with the diagnosis of malocclusion. However, knowledge regarding the type of appliance to be used and the age of starting treatment was lacking.

Prevalence of Temporomandibular Joint Pain among Patients who Reported to Dental OPD at a Tertiary Hospital in Pondicherry, India: A Cross-sectional Study

Sajani Ramachandran, K Ravichandran

Introduction: Temporomandibular Joint Disorder (TMJD) is a debilitating condition that affects the quality of a person’s life. However, its aetiology remains controversial. Understanding the signs and symptoms associated with this condition is crucial for better comprehension. Determining the prevalence of TMJD can emphasise the importance of routine Temporomandibular Joint (TMJ) examinations and the implementation of preventive measures. Aim: To determine the prevalence of TMJ pain among patients who reported to the dental Outpatient Department (OPD) between January 2015 and December 2019. Additionally, the study sought to identify potential predisposing factors for TMJ pain. Materials and Methods: A cross-sectional study was conducted in the Dental Department at Pondicherry Institute of Medical Sciences, Pondicherry, India. The study duration was six months, from December 2021 to May 2022. The study was done by examining the medical records of all patients who reported TMJ pain during the specified period. A total of 32,094 patients’ records were reviewed, and 322 patients reported pain in the TMJ region. The patients’ reported signs and symptoms were extracted from their case records and evaluated. Pearson’s Chi-square/Fisher’s-exact test was utilised to determine associations between the factors. Results: The mean age of the participants was 35.4±13.2 years. Out of the 32,094 patients who attended the dental OPD, 327 (1.02%; 95% CI: 0.91-1.13) reported TMJ pain. Among these patients, 207 (63.3%) were females. Joint sounds were the most common symptom, observed in 243 (74.3%) patients, followed by emotional stress or tension, reported by 205 (62.7%) patients. Most symptoms were more prevalent in females than males. Parafunctional habits and stress/tension showed a statistically significant association (p<0.001) with male gender. Additionally, occlusal variation, joint sound, missing teeth, chewing with one side, parafunctional habits, and stress showed associations with age. Conclusion: The TMJ pain was more frequently reported by women than men in the studied population. The most common symptoms reported were pain and joint sounds. The highest number of patients fell within the 30 years-55 years age group. Although the prevalence identified was 1.02%, routine TMJ examination should be conducted as a standard part of oral and maxillofacial examinations to identify any predisposing factors that may lead to TMJD in the future.

Biomechanical Factors Influencing Post-strike Ball Velocity in Football Players: A Cross-sectional Study

Introduction: Optimising post-strike ball velocity is essential for success in football. Biomechanical factors play a significant role in determining ball speed. However, further investigation is needed to understand the specific relationships between the biomechanical factors and post-strike ball velocity in football players. Aim: To identify the key biomechanical factors contributing to post-strike ball velocity and provide insights for enhancing performance in league-level football players. Materials and Methods: A cross-sectional study was conducted in the Department of Arthroscopy and Sports Medicine at the Sri Ramachandra Centre for Sports Science, Tamil Nadu, India. The duration of the study was five months, from January 2022 to May 2022. The study included 25 professional male football players from national-level league teams. Participants performed maximal instep kicks while various kinematic variables were measured using Vicon cameras, Advanced Mechanical Technology Inc., (AMTI) force footplates, and a radar speed gun. Data processing was performed using Vicon Nexus software version 2.7. The data were analysed using R statistical software version 4.0.2. The Analysis of Variance (ANOVA), followed by Tukey’s Honestly Significant Difference (HSD) post-hoc tests, were used to compare the various kick matrices across the players. Pearson’s r correlation analysis was used to check for a correlation between post-strike ball velocity and other kick matrices. Multiple regression analysis was conducted to examine the relative effects of various kick matrices on post-strike ball velocity, with significance set at a p-value <0.05. Results: The mean age of the study participants was 18.8 years. A significant positive correlation was observed between prestrike foot velocity (r=0.58) and training experience (r=0.48) with post-strike ball velocity. Step-wise multiple linear regression analysis revealed that 39% of the variance in post-strike ball velocity could be attributed to training experience and prestrike foot velocity. Conclusion: Training experience and prestrike foot velocity could be the most important factors to consider in order to maximise post-strike ball velocity among league-level football players.

Prediction of Postoperative Pulmonary Complications in Patients Undergoing Functional Endoscopic Sinus Surgery: A Cohort Study

Pallavi Singh, Sarojini Bobde, Hemant Kumar Singh, Varinder Kalra

Introduction: Considering the pathophysiology of nasal obstruction, changes in certain parameters such as Peripheral Blood Eosinophil Count (PBEC), bedside pulmonary function test, Peak Expiratory Flow Rate (PEFR), and Electrocardiography (ECG) may have some correlation with postoperative pulmonary complications such as upper airway obstruction, loss of pharyngeal muscle tone, and postobstructive pulmonary oedema. Aim: To observe and analyse the changes in PBEC, bedside pulmonary function test, PEFR, and ECG in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Materials and Methods: A prospective cohort study was conducted at Bharati Hospital, Pune, Maharashtra, India over a two-year duration from December 2020 to October 2022. A total of 50 patients aged above 18 years undergoing FESS surgery were included in the study. The statistical analysis was performed using the Chi-square test and student’s t-test. After thorough preoperative evaluation, the aforementioned predictors were recorded. General anaesthesia management for FESS surgery was done according to the standard protocol. Vigilant intraoperative monitoring of vital parameters including peak airway pressure and plateau pressure was performed. After shifting the patients to the recovery room, they were observed for: 1) Hypoxia; 2) Hypercarbia; 3) Laryngospasm; 4) Bronchospasm; and 5) Pulmonary oedema. Results: A total of 50 patients aged between 18 years and 65 years with the mean age was 41.7±15.4 years were included in the study, with 32 males and 18 females. Only 24% of the study population showed postoperative hypoxia, while the rest of the complications were not observed in any patient. Changes in eosinophil count, PEFR, and ECG did not have any correlation with postoperative hypoxia and were statistically insignificant. Bedside pulmonary function tests, including the Sabrasez breath-holding test and the Sabrasez single breath count test, showed changes in 30% and 76% of patients, respectively. Forced Expiratory test change was seen in 72% of patients. Among these, 19.4% showed hypoxia. Out of the 12 cases showing postoperative hypoxia, seven had a disease duration of less than six months. Conclusion: The Sabrasez breath-holding test and Sabrasez single breath count are good predictors for postoperative hypoxia in patients undergoing FESS surgery. Shorter duration of nasal obstruction also showed postoperative hypoxia.

Effect of Surya Namaskar on Autonomic Status and Serum Cortisol Levels in Male Medical Students: A Longitudinal Study

Introduction: Stress is an unavoidable and ongoing phenomenon in human life that affects physiological processes in the body. Regular practice of Surya Namaskar, a yogic exercise, has been shown to improve autonomic functions by reducing sympathetic activity, thereby decreasing stress levels and improving cortisol levels. Aim: To evaluate the effects of Surya Namaskar on autonomic status and serum cortisol levels among medical students. Materials and Methods: A longitudinal study was conducted in the Department of Physiology at the Faculty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India. The study duration was three months, from November 2021 to January 2022. A total of 30 male medical students, aged between 18 and 21 years, were included in the study. Blood samples for cortisol estimation were collected before the start of the study and after six weeks of regular yogic practice. Parameters such as mean pulse rate, Blood Pressure (BP), and Low Frequency to High Frequency (LF/HF) ratio were also studied during these two time points. Statistical analysis of Heart Rate Variability (HRV) parameters, including Standard deviation of the N-N interval (SDNN), mean Heart Rate (HR), and pNN50, was performed using Analysis of Variance (ANOVA) at baseline and after six weeks. Comparison of serum cortisol levels within the groups was done using paired t-tests. Results: The mean age of the study participants was 20.37 years. Comparison of HRV frequency domain parameters (LF, HF, and LF/HF ratio) at baseline, day one, and after six weeks of yogic practice showed statistically significant variations in LF/HF ratio after six weeks (p-value=0.001). Baseline serum cortisol levels compared to levels after six weeks of yogic practice were also found to be statistically significant (p<0.001). Conclusion: There is a positive association between cortisol levels and autonomic parameters, as evidenced by the results of the autonomic battery of tests. Incorporating yogic interventions into one’s lifestyle helps reduce sympathetic parameters and shift the balance towards parasympathetic dominance.

Evaluation of Inferior Vena Cava Collapsibility Index as a Predictor of Hypotension Following General Anaesthesia with Thiopentone Induction: An Observational Study

Mayuri Golhar, Manisha, Tarun Yadav, Sanjay Johar

Introduction: Hypotension during surgery can significantly increase morbidity and mortality. Volume depletion poses a major risk for intraoperative hypotension. The role of the Inferior Vena Cava Collapsibility Index (IVCCI) in assessing volume status is crucial, but its utility in predicting hypotension after the induction of general anaesthesia has been less evaluated. Aim: To evaluate the usefulness of IVCCI in predicting post-induction hypotension after general anaesthesia, with the primary objective being to assess the correlation between IVCCI and hypotension. Materials and Methods: An observational study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India. Total 100 patients scheduled for elective surgery under general anaesthesia with thiopentone induction. IVCCI was measured preoperatively in spontaneously breathing patients. The patients were grouped into CI+ (Collapsible) and CI- (Non collapsible) groups based on IVCCI values of ≥ 50% and ≤ 50%, respectively. Haemodynamic parameters were recorded for up to one hour after anaesthesia induction. Hypotension was defined as a fall of more than 20% in Systolic Blood Pressure (SBP) or SBP <90 mmHg or a mean blood pressure of <60 mm Hg. Receiver Operating Characteristic (ROC) curve was used to evaluate the performance of IVCCI, and multivariate logistic regression was employed to identify predictors of hypotension. Independent t-test was used for quantitative associations, while Chi-square and Fisher’s-exact test were used for qualitative associations, with a p-value <0.05 considered significant. Results: The mean age of the patients in the study was 42.11±12.6 years. Out of 100, total 44 patients experienced post-induction hypotension, which was significantly higher in females compared to males (p-value=0.02). The mean Basal Metabolic Index (BMI) of the study population was 21.2±3.06 kg/m2, but hypotension was more common in underweight patients with a BMI <18.5 kg/m2 (p-value=0.0007). The results showed a significant correlation between IVCCI and hypotension (p-value <0.05). The mean value of IVCCI (%) was 47.34±6.96 in hypotensive patients, which was significantly higher than non hypotensive patients with a mean of 28.45±7.05 (%) (p-value <0.0001). The ROC curve demonstrated an excellent representation of IVCCI (%) (Area Under the ROC Curve (AUC) 0.944; 95% CI: 0.879 to 0.980) in predicting hypotension, with a sensitivity of 95.5% and specificity of 94.6% for hypotension. IVCCI (%) was a significant independent risk predictor of hypotension with a cut-off point of >38, as determined by performing multivariate logistic regression. Conclusion: Preoperative assessment of IVCCI is highly sensitive and specific for prediction hypotension induced by general anaesthesia. It is recommended as a screening tool for high-risk patients.

Effect of Isobaric Levobupivacaine and Fentanyl versus Isobaric Ropivacaine and Fentanyl as an Adjuvant in Patients Undergoing Transurethral Resection of the Prostate: A Randomised Clinical Study

Introduction: Ropivacaine is a newer local anaesthetic proven to have a lower systemic toxicity profile, particularly in terms of cardiac and Central Nervous System (CNS) toxicity, than the racemic and levorotatory isomers of bupivacaine, especially in elderly patients. Fentanyl, as an adjuvant, enhances analgesia and promotes early postoperative mobility. Aim: To assess and compare the efficacy and safety of isobaric levobupivacaine and fentanyl versus isobaric ropivacaine and fentanyl in patients undergoing Transurethral Resection of the Prostate (TURP) under Spinal Anaesthesia (SA). Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesia at SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India, from March 2021 to January 2023. A total of 60 patients ranging in age from 40 to 80 years, scheduled for elective TURP, were enrolled in the present study. The selected patients were randomly assigned into two groups, each consisting of 30 patients. Group A received a dosage of 2.6 cc of 0.75% isobaric ropivacaine (equivalent to 19.5 mg) along with 0.4 cc of fentanyl (equivalent to 20 micrograms). In contrast, group B received a dosage of 2.6 cc of 0.5% isobaric levobupivacaine (equivalent to 13 mg) and 0.4 cc of fentanyl (20 micrograms). The primary outcome measures were the onset of action, duration of sensory-motor block, and postoperative analgesia. Data were analysed using Epi Info version 7.2.1.0 statistical software. The quantitative data collected were summarised using the mean and Standard Deviation (SD). A p-value of less than or equal to 0.05 was considered statistically significant. Results: The majority of patients in the present study were elderly males in both groups. The mean age distribution in group A was 64.27±8.17, and in group B, it was 65.13±7.1. Both groups were comparable and not statistically significant (p=0.634). The mean weight of the two groups was similar, with group A at 64.9±7.49 kg and group B at 63.1±6.96 kg. Both groups were comparable and not statistically significant (p=0.334). The mean height of the patients was 165±4.85 cm in group A and 164±3.83 cm in group B, and it was comparable between the two groups without statistical significance (p=0.145). The duration of sensory block was 241.03±18.88 minutes in group A and 181.5±33.42 minutes in group B. The duration of motor block was 210.7±17.93 minutes in group A and 160±14.82 minutes in group B. Group A demonstrated a significant prolongation of sensory (p<0.001) and motor (p<0.001) block, as well as postoperative analgesia, when compared to 0.5% levobupivacaine with fentanyl. Conclusion: The requirement for rescue analgesia occurred earlier in the levobupivacaine group. Therefore, the use of ropivacaine with fentanyl for spinal anaesthesia in TURP cases is a superior alternative compared to levobupivacaine with fentanyl, as it provides satisfactory quality and duration of block, as well as a longer duration of postoperative analgesia, as assessed by the Visual Analogue Scale (VAS) score and Modified Bromage score.

Clinical Performance of I-gel versus Ambu AuraGain in Paediatric Patients undergoing General Anaesthesia: A Randomised Clinical Study

Introduction: Newer second-generation Supraglottic Airway Devices (SADs) are easy to insert and provide a smooth induction of anaesthesia with minimal haemodynamic pressor response. The paediatric I-gel and Ambu AuraGain are newer SADs that are increasingly being used as alternatives to endotracheal intubation in the paediatric population. Aim: To compare the clinical performance of I-gel and Ambu AuraGain in children undergoing general anaesthesia with respect to ease of insertion, haemodynamic changes, and the frequency and severity of postoperative sore throat. Materials and Methods: This randomised clinical study included 100 children aged 2 to 10 years, belonging to American Society of Anaesthesiologists (ASA) Grade I and II, scheduled for elective surgery under general anaesthesia. They were randomly allocated to Group I (I-gel) and Group A (Ambu AuraGain), comprising 50 patients each. The time taken for SAD placement, the number of attempts, ease of insertion, and the requirement of additional airway manipulations during insertion were observed. Haemodynamic Parameters Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), SpO₂, and End-tidal Carbon Dioxide (EtCO₂) during the procedure were observed. The frequency and severity of postoperative sore throat were assessed between both groups. Descriptive statistics were applied to all data and reported in terms of mean, Standard Deviation (SD), and percentages, and appropriate statistical tests of comparison were applied. Results: In this study, the demographic data of patients, such as age, weight, gender, and ASA status, were comparable in both groups. There was no statistically significant difference in the time taken for successful SAD placement and the number of attempts required to do the same. Ambu AuraGain was easier to insert than I-gel (p-value <0.05). I-gel required a significantly higher number of additional airway manipulations during insertion compared to Ambu AuraGain (20% in Group I versus 4% in Group A). Haemodynamic parameters were comparable between both groups at all time intervals. The frequency and severity of postoperative sore throat were statistically non significant between I-gel and Ambu AuraGain. Conclusion: Both the I-gel and Ambu AuraGain are reliable and safe devices for maintaining an adequate airway in paediatric patients. However, Ambu AuraGain was easier to insert and required fewer airway manipulations than I-gel during insertion, making it a favourable choice.

Clinical and Microbiological Profile of Elizabethkingia meningoseptica Bacteraemia: A Cross-sectional Study from a Tertiary Care Centre in Northern India

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is an emerging pathogen that causes bloodstream infections, especially among immunocompromised or critically ill patients. Due to its multidrug resistance, limited antibiotic treatments are available. Therefore, correct identification with a proper susceptibility report is compulsory to reduce mortality and morbidity caused by this rare pathogen. Aim: To analyse the clinical features, underlying co-morbidity, outcomes, and antibiotic resistance potential of E. meningoseptica causing bacteraemia. Materials and Methods: This cross-sectional study was conducted in Department of Microbiology, Rajshree Medical Research Institute (RMRI), Bareilly, Uttar Pradesh, India. The study spanned three years from August 2020 to July 2023. All patients with E. meningoseptica bacteraemia were identified from blood culture reports and included in the study. As it was a duration-based study, all consecutive patients identified with E. meningoseptica bacteraemia were enrolled. The total sample size was 43. Blood samples growing gram negative, non fermenting, non motile isolates that were positive for the oxidase reaction were further identified using the Vitek 2 compact system (Biomerieux, France). All relevant data regarding demographic and clinical characteristics, underlying diseases, and antibiotic treatments were collected from the hospital information system. Patient demographics were presented as mean±standard deviation. Clinical characteristics and co-morbid conditions were presented as frequency and percentages. Results: The majority of patients were elderly males admitted to the Intensive Care Unit (ICU). The most common underlying co-morbidity was malignancy in 12 (27.9%), and pneumonia in 12 (48.8%) was the major diagnosis among these bacteraemic patients. A total of 10 (23.25%) infections were polymicrobial, with common concomitant pathogens being Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus (MRSA). Co-trimoxazole, fluoroquinolones, and Piperacillin/Tazobactam were the most effective antibiotics. Thirty-nine (90.7%) patients recovered completely, while four patients (9.3%) died of complications. Conclusion: Improper antimicrobial therapy increases resistance and mortality among patients with E. meningoseptica infections. It is imperative that clinicians remain vigilant about this rare pathogen and advise antimicrobial susceptibility testing for appropriate treatment, leading to favourable outcomes.

Bacteriological Profile and Antibiotic Susceptibility Pattern in Sterile Body Fluids from a Tertiary Care Hospital in Bhubaneswar, Odisha, India: A Cross-sectional Study

Introduction: Sterile body sites are those where no microorganisms exist as commensals in an otherwise healthy person. Isolation of microorganisms from these sites can indicate either pathological agents or contaminants from the skin. Sterile body fluids are frequently received in microbiology laboratories for culture and sensitivity testing, as the isolation of pathogens from these sites is associated with significant mortality and morbidity. Aim: To assess the current scenario of aerobic bacteriological profiles and their antibiotic susceptibility patterns in various sterile body fluids at a tertiary care hospital in Bhubaneswar, Odisha, India. Materials and Methods: A hospital-based observational study was conducted in the Department of Microbiology at a Tertiary Care Hospital in Bhubaneswar, Odisha, India. The study duration was one year, from January 2022 to December 2022. A total of 450 body fluid samples were collected from 567 patients, of which 117 samples did not meet the inclusion criteria. Out of the 450 samples, 315 were from male patients and 135 were from female patients. All infected body fluids received from clinically diagnosed cases, irrespective of age and gender, were included. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method following the guidelines of the Clinical Laboratory Standards Institute (CLSI). Sterile body fluids were collected with complete aseptic precautions and processed in the Department of Microbiology using standard laboratory procedures. Statistical data analysis was conducted using MS Excel and Statistical Package for Social Sciences (SPSS) version 27.0. A p-value <0.05 was considered statistically significant. Results: A total of 450 clinical samples were processed, of which 153 (34%) were peritoneal fluid, 92 (20.5%) were synovial fluid, 77 (17.1%) were pleural fluids, 118 (26.2%) were Cerebrospinal Fluid (CSF), and 10 (2.2%) were pericardial fluid. In the present study, 126 (28%) pathogens were isolated from the 450 processed samples, with gram negative bacilli being the predominant isolates (88/126, 69.8%), while the remaining 38/126 (30.2%) were gram-positive isolates. Among the 88 gram negative isolates, Escherichia coli was the most common (27, 21.4%), followed by Klebsiella pneumoniae (23, 18.2%), Pseudomonas aeruginosa (14, 11.1%), Acinetobacter spp. (12, 9.5%), Enterobacter spp. (7, 5.6%), and Citrobacter spp. (5, 4.0%). Similarly, among the gram-positive isolates, Staphylococcus aureus was the most common (20, 15.9%), followed by Coagulase-Negative Staphylococci (CONS) (16, 12.7%) and Enterococcus spp. (2, 1.6%). Gram negative isolates showed 100% sensitivity to colistin and polymyxin B, followed by imipenem (90%) and cefepime (80%). Gram-positive isolates exhibited 100% sensitivity to linezolid, followed by vancomycin. Conclusion: Early identification of pathogens from these sites, along with their antibiotic susceptibility patterns, will help clinicians initiate targeted therapy. This approach can reduce hospital stays for patients and minimise the development of drug resistance.

Adequacy of Reversal of Neuromuscular Blockade with or without Train-of-Four Monitoring: A Randomised Controlled Study

Siddesh N Kadur, Gayathri M Devi

Introduction: Adequate reversal of Neuromuscular Blockade (NMB) is essential when using muscle relaxants to avoid residual paralysis postoperatively. Reversal can be achieved using clinical parameters or, alternatively, by Train-of-Four (TOF) monitoring. Aim: To evaluate the adequacy of successful NMB reversal using clinical parameters-based endpoints compared to using TOF monitoring. Materials and Methods: The hospital-based randomised controlled study conducted in the Department of Anaesthesiology, SDM Medical College, Dharwad, Karnataka, India for a peroid of two years from November 2019 to December 2021. Consisted of 120 subjects divided into two groups: Group-C (Clinical parameters) and group T (TOF monitoring), aged 18-60 years of either sex with American Soceity of Anaesthesiologists (ASA) physical status I and II, undergoing elective surgery under general anaesthesia requiring intubation. Extubation was achieved in group C using clinical parameters like return of spontaneous respiratory efforts, adequate Tidal Volume (TV) (≥5 mL/kg), obeying simple commands, absence of excessive secretions, and in group T using TOF monitoring. The t-test was used to compare the difference between the groups. The Chi-square test was done for contingency data. A p-value of less than or equal to 0.05 (p-value ≤0.05) indicates statistical significance. Results: In the study, both group C and group T were comparable in terms of age {(41.15±10.23 years, 41.03±11.9 years) p-value=0.95}, sex (m/f) {(46.6%/53.3% and 63.3%/36.6%) p-value=0.06}, and Basal Metabolic Index (BMI) {≤25=59.1%, 25-30=33.3%, ≥30=7.5%, p-value=0.57}, respectively. Five patients in group C had residual paralysis, whereas none in group T. Reversal-extubation time in minutes (min) in group C {5.9±2.2, 5.4 (2-15.2)} and group T {6.6±1.9, 6.24 (3.3-12.2)} (p-value=0.07), TOF value at the time of extubation in group C {72.1±11.6, 72 (41-91)}, group T {72.75±2.74, 72 (70-79)} (p-value=0.69). TOF value after 10 minutes of extubation in group C {92.5±7.1, 94 (66-100)} and group T {95.6±2.7, 96 (90-100)} (p-value=0.006). Conclusion: The TOF monitoring is better compared to a clinical parameters-based reversal strategy in reducing the incidence of residual paralysis and resulting complications whenever Neuromuscular Blocking Agents (NMBAs) are used. Hence, it is desirable to use Neuromuscular Monitoring with the use of NMBAs.

Choice Reaction Time in Different Phases of the Menstrual Cycle in Healthy Females: A Cross-sectional Study

Introduction: The gonadal hormone output of females fluctuates monthly, and the endometrium, ovaries, and other genital organs undergo physical changes. It is known that women experience fluctuations in mood, energy, and cognitive abilities during different phases of their Menstrual Cycle (MC). Reaction Time (RT) is utilised to measure the ability of brain processing. The present study analysed the effect of various phases occurring in the MC on choice RT. Aim: To determine whether hormonal changes that occur throughout the MC and its phases may have any effect on cognition. Materials and Methods: An observational analytical cross-sectional study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. The study duration was six months, from August 2021 to April 2022. A total of 50 apparently healthy females aged 18-25 years were included in the study. The subjects with a history of normal and regular MC for the last six months were included. The Choice Reaction Time (CRT) with visual and auditory stimuli was analysed using an RT apparatus developed by Anand Agencies, Pune, India. In CRT, random auditory and visual stimuli were given to the subjects, and they had to react accordingly. The RT apparatus timer started when the stimuli were given, and it automatically stopped when the subject reacted, providing the RT. RT was noted in the subjects on four occasions: two days prior to menstrual bleeding (premenstrual), the 2nd day during menstruation, the 8th day (follicular phase), and the 18th day after menstrual bleeding (luteal phase). The average value of each type of Visual Reaction Time (VRT) and Auditory Reaction Time (ART) in the various menstrual phases was noted and analysed. The level of significance in the various menstrual phases was analysed with inferential statistical study using one-way Analysis of Variance (ANOVA) and multiple comparison Tukey’s post-hoc test. Results: In the present study, prolongation of visual and ART was seen in the luteal phase. There was prolongation of VRT when the luteal phase was compared to the menstrual and follicular phase, but the difference was not statistically significant (p<0.05). While in ART, there was prolongation when the luteal phase was compared with the premenstrual, menstrual, and follicular phase, but the difference was not statistically significant (p<0.05). Conclusion: The current study reveals that there was a non significant prolongation of visual and ART in the luteal phase of MC when CRT was analysed. Thus, it was observed that there was no influence of fluctuating levels of ovarian hormones on ART and VRT in various phases of the MC while conducting CRT.

Team-based Learning versus Problem-based Learning among First-year Medical Students in Biochemistry: A Quasi-experimental Study

Introduction: Team-based Learning (TBL) and Problem-based Learning (PBL), both active teaching methodologies, are known for improving problem-solving abilities, clinical reasoning, and motivating students for self-directed studies. Although both active methods, TBL and PBL, differ in methodology and required resources, it is always a challenge to choose active methods that are more feasible and effective in the undergraduate medical curriculum. Aim: To compare two active teaching strategies, viz., the effectiveness of TBL vs. PBL in first-year Bachelor of Medicine, Bachelor of Surgery (MBBS) students in terms of learning outcomes, development of critical thinking skills, and retention of knowledge. Materials and Methods: This quasi-experimental study was conducted at Department of Biochemistry, NKP Salve Medical College and RC Nagpur, Maharashtra, India from August 2017 to October 2017. A total of 150 first-year MBBS students were included in the study. TBL and PBL were performed following the protocols of their respective methodologies, and scores for learning gain and critical thinking were compared between the TBL and PBL groups. Student perception regarding the procedures was collected using a prevalidated structured questionnaire. The retention of knowledge was assessed by comparing scores from a pretest and a test conducted two months later. Data were statistically analysed using the Wilcoxon signed-rank test and the Mann-Whitney U test. Results: In the present study, the mean age of the participating students was 20±2 years. Post-test results, obtained just after the intervention, demonstrated a significant learning gain in students using both methods, with a statistically higher gain in TBL (p-value <0.0001) compared to PBL. PBL was appreciated for providing freedom of learning style and facilitator guidance during discussions. Critical thinking skills improved more in PBL, particularly in terms of drawing inferences and interpretations (p-value <0.001). However, no statistically significant differences were found in knowledge retention when the test was conducted two months later in both groups. Conclusion: Learning gain was higher with TBL compared to PBL, with no difference in knowledge retention and the effect on different parameters of critical thinking skills. Students found TBL to be more beneficial for the undergraduate curriculum.

Role of Real Time Polymerase Chain Reaction Targeting mpb64 Gene in the Diagnosis of Genitourinary Tuberculosis: A Cross-sectional Study

Deepesh Kumar, Anita Pandey, Peetam Singh, Priyanka Chaturvedi

Introduction: Genitourinary Tuberculosis (GUTB) remains an important cause of infertility in India. The clinical manifestations of GUTB are non specific, resulting in delayed diagnosis and initiation of Anti Tubercular Treatment (ATT). This delay can lead to various complications such as kidney dysfunction, ureteral strictures, and a shrunken bladder. Aim: To evaluate the diagnostic importance of Real Time Polymerase Chain Reaction (RT-PCR) targeting the mpb64 gene for the rapid and accurate diagnosis of GUTB. Materials and Methods: A cross-sectional hospital-based observational study was conducted in the Department of Microbiology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital in Meerut, Western Uttar Pradesh, India. The study was conducted over a three-year period, from January 2019 to December 2021. A total of 200 genitourinary samples were collected from female patients with clinical suspicion of Tuberculosis (TB) and subjected to direct microscopy, mycobacterial culture by BacT/Alert 3D (Biomerieux, France), and RT-PCR targeting the mpb64 gene (Qiagen). Demographic details were recorded in a predesigned proforma. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software version 26.0 (IBM Corp., Armonk, NY, USA). The p-value was calculated using the Chi-square test. Results: RT-PCR showed a higher positivity rate of 56 (28.9%) compared to 47 (24.2%) by culture. Acid Fast Bacilli (AFB) microscopy was the least sensitive, detecting only 7 (3.6%) cases. When comparing the results of RT-PCR with conventional methods, RT-PCR had a sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of 91.9%, 99.4%, 85.1%, and 93.8%, respectively. Conclusion: RT-PCR targeting the mpb64 gene is a specific and effective additional test that aids in the early and accurate diagnosis of Extrapulmonary Tuberculosis (EPTB), including GUTB, compared to conventional methods. Early diagnosis facilitates timely initiation of ATT, leading to better clinical outcomes.

Efficacy of Gabapentin versus Combination of Dexamethasone-Ondansetron in Prevention of Postoperative Nausea and Vomiting in Middle Ear Surgery: A Randomised Clinical Study

Introduction: Postoperative Nausea and Vomiting (PONV) is the most common and unpleasant complication with incidence of 30-80% after elective surgery. Dexamethasone and Ondansetron (DO) combination has superior efficacy and is recommended as an ideal choice for prevention of PONV in Middle Ear Surgery (MES). Oral Gabapentin, an anticonvulsant has been introduced as an antiemetic to fast-track bundles and enhanced recovery after surgery. Aim: To compare the efficacy of DO with gabapentin monotherapy in prevention of PONV in patients undergoing MES. Materials and Methods: This randomised, double-blind, parallel group clinical study was done at Department of Anaesthesiology, St. John’s Medical College, Bengaluru, Karnataka, India from November 2018 to March 2020. Sixty-six of patients were randomised to Group DO (Intravenous Dexamethasone at start and Ondansetron at end of surgery, 100 μg/kg each) and Group G (Oral Gabapentin 300 mg one hour prior to surgery). Postoperatively, incidence and severity of PONV, duration of antiemesis and analgesia, total rescue antiemetics and analgesics, along with side-effects were assessed for 24 hour period. Descriptive statistics was summarised for continuous (mean and standard deviation) and categorical (number with percentages) variables. Inferential statistics were depicted using Fisher’s-exact and Student’s t-test. Results: The demographic profile was comparable between the two groups. Incidence of PONV was significantly lesser in Group DO compared to the Group G (12% versus 36%, p-value=0.0129). Duration of antiemesis was four hours in Group DO and two hours in Group G was statistically significant (p-value=0.021). Severity of PONV was significant (p-value=0.033 and 0.009, respectively) at four and six hours between the groups. Duration of analgesia (6.28±5.96 in Group DO versus 5.62±3.63 hours in Group G; p-value=0.252), rescue analgesics and side-effects were comparable between the two groups (p-value >0.05). Conclusion: In MES, DO combination reduced the incidence and severity of PONV and is better prophylactic antiemetic therapy than gabapentin alone.

Comparative Evaluation of the Efficacy of Bromelain with Biodentine and Biodentine as Isolation Materials for Direct Pulp Capping: A Research Protocol

Paridhi Agrawal, Pradnya Nikhade

Introduction: Direct Pulp Capping (DPC) aims to retain the pulp’s health by sealing it against microbes and stimulating the formation of a dentin bridge at the exposure site. It has been proven that natural antimicrobial proteins, when used as therapeutics in conjunction with traditional chemotherapeutic agents, have increased efficacy and presumably diminished the incidence of chemoresistance. Hence, the efficacy of Bromelain with Biodentine and Biodentine as isolation materials for DPC will be evaluated and compared in the present study. The success and durability of DPC depend on the type of material used. Thus, the present study focuses on evaluating and considering a combination of materials for DPC that can be used in clinical practice. Need for the study: By addressing the limitations of current materials and formulating a novel combination, the present study aims to contribute to the advancement of material science, providing solutions that meet the demands of this era. Such a breakthrough would not only enhance the performance and longevity of materials but also have a significant positive impact on the preservation of pulp vitality, promoting overall well-being and improved outcomes in healthcare applications. Aim: To evaluate and compare the efficacy of Bromelain with Biodentine and Biodentine in isolation as DPC materials. Objectives: The study aims to evaluate and compare the setting time, flow, solubility, compressive strength, adhesion, and radiopacity of bromelain with biodentine and biodentine in isolation. Materials and Methods: An in-vitro study will be conducted in the Department of Conservative Dentistry and Endodontics at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, for a duration of nine months from May 2023 to February 2024. Standard discs of freshly mixed materials (n=10 samples per material) will be prepared. Compressive strength, solubility in distilled water, setting time, flow, radiopacity, and adhesion of Bromelain with Biodentine and Biodentine in isolation will be evaluated and compared in accordance with the International Standard ISO 6876:2001. Results will be analysed using Tukey’s Honest Significant Difference (HSD) posthoc test, one-way Analysis of Variance (ANOVA), and student’s t-test.

Expression of PD-1 and PD-L1 in Breast Carcinoma: Research Protocol for a Cohort Study

Introduction: Breast cancer is the most common malignant tumour and the leading cause of cancer-related death in women is breast cancer. The Immunohistochemistry (IHC) method utilised antigens and antibodies to interact to identify cellular or tissue constituents (antigens). This research has been employed as a diagnostic tool for specific cancers. When Programmed Cell Death Ligand 1 (PD-L1) binds to Programmed Cell Death 1 (PD-1), it suppresses the cellular immune response by killing and depleting T-cells. Monoclonal antibodies that block the PD-1/PD-L1 pathway have shown promise as a treatment strategy currently being tested in human cancer trials. Need for the study: Breast cancer is a global issue, and PD-L1 expression is emerging as a promising biomarker for breast cancer prognosis. It can provide valuable information treatment planning. Aim: The current study aims to examine the expression of PD-1 and PD-L1 in breast cancer using IHC in all subgroups of breast cancer patients. Both tests can serve as a biomarkers to guide immunotherapeutic interventions, improving prognosis, and correlating with other clinicopathological individual parameters such as age, tumour size, distant metastasis, lymph node involvement, Estrogen Receptor (ER) and Progesterone Receptor (PR) status, Her2neu expression, histological type, and TNM stage. Materials and Methods: This will be a two-year cohort study conducted in the Department of Pathology, Jawaharlal Nehru Medical College (JNMC), Maharashtra, India. The study will include 70 specimens from all cases with a histopathological diagnosis of breast cancer. The Nottingham variant of the Bloom-Richardson Grading System will be used to determine the histological grade of the tumour, and immunostaining for PD-1 and PD-L1 will be performed to evaluate their protein expression.

Gut-Lung Axis-A Compass to Navigate Microbiome Landscape in COVID-19

Arunava Kali, Pravin Charles

The waves of the Coronavirus Disease 2019 (COVID-19) pandemic have disrupted healthcare systems globally, with a staggering number of confirmed cases reaching 593 million and a death toll of six million. While the primary target organ of COVID-19 is the lungs, the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) also shows a preference for the intestinal epithelium, which expresses Angiotensin Converting Enzyme 2 (ACE2), a receptor necessary for viral entry into host cells. The composition and abundance of beneficial gut microbiota play a critical role in protecting against severe disease and complications, whereas dysbiosis contribute to systemic inflammation and immune imbalances during SARS-CoV-2 infection. Recent insights into the microbiome have emphasised the importance of the gut-lung axis and the microenvironments of the gut and lungs in the context of COVID-19. These findings offer opportunities for the development of new diagnostic and therapeutic strategies. In this review, the significance of the gut-lung axis, as well as the intestinal and pulmonary microbiota, in COVID-19, were explored with a particular focus on their potential applications.

Sports Dentistry- A Review of Prevalence and Awareness of Sports Injuries, Dental Implications and Opportunities in Dentistry

Sports dentistry is a branch of oral sciences concerned with the treatment, management, and prevention of the trauma to the orofacial region sustained while participating in any sports activity. Sports have been frequently reported to be an important cause of overall oral trauma in children, as well as adults. There is an evident lack of knowledge in the general population regarding how sports injuries are to be prevented and dealt with. Dentists, if included in sports teams and schools, can help penetrate this knowledge and awareness barrier. Lifestyle, eating habits, stress, etc., have an impact on the performance of the athletes. Stress in athletes can lead to substance abuse, more precisely, tobacco abuse which can affect their performance. Like physiotherapists, even dentists can be made a part of a professional sports team where they can help prevent the complications arising due to facial traumas by the administration of various protective appliances and handle maxillofacial trauma. The present study aimed to evaluate and comprehend the current opportunities for dentists in the field of sports dentistry, whilst emphasising their significance in the professional sports system.

Three-dimensional Computer-aided Design System used in Orthodontics and Orthognathic Surgery for Diagnosis and Treatment Planning- A Narrative Review

Kushal Prakash Bhuskute, Vikrant Jadhav, Mansi Sharma, Amit Reche

Three dimensional advancements in technology have made a profound impact on various fields, and dentistry, particularly the branch of orthodontics and orthognathic surgeries, which has not been exempt from this transformative influence. Among the cutting-edge technologies that have gained significant traction is Three-Dimensional (3D) printing, which has found its initial applications in orthodontics for producing dental casts. By integrating intraoral scanners, dentists now possess the remarkable ability to obtain dental impressions without subjecting patients to the discomfort associated with traditional methods. Furthermore, 3D planning techniques have emerged as a pivotal element in orthodontics, especially when striving for optimal aesthetic and occlusal outcomes. Precise treatment planning plays a vital role in ensuring successful orthognathic surgeries and other orthodontic interventions. The utilisation of 3D planning techniques facilitates the gathering of comprehensive data, thereby achieving two main objectives: an accurate diagnosis of the dentoskeletal deformity and the formulation of a treatment plan that can be faithfully replicated during the clinical procedure. Even 3D imaging technology, such as Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT), has become an indispensable tool in dentistry. These imaging techniques provide volumetric images of a patient’s facial anatomy, enabling the transformation of intricate details into precise 3D representations of the craniofacial skeleton and soft tissue layers. Consequently, this progress has led to the development of computerised resources dedicated to preoperative planning and the fabrication of surgical splints. The integration of advanced technologies, including 3D printing, 3D planning techniques, and 3D imaging technology, has revolutionised orthodontics, providing dentists with precise tools for accurate diagnosis, treatment planning, and ultimately, enhanced patient care. As this field continues to progress, the potential for further advancements and innovative applications utilising artificial intelligence becomes an exciting prospect in the ever-evolving landscape of modern dentistry.

Visual Impairment as a Learning Disability in Children with Cerebral Palsy: A Narrative Review

Namrata Sant, Vaishnavi A Bhavar, Smita A Nand, Gauri R Joshi, Sakshi Runwal

Cerebral Palsy (CP) is a group of non-progressive brain disorders causing movement, posture, and motor function impairments. Cerebral Visual Impairment (CVI) affects visual pathways, affecting clarity of vision, visual fields, and occulomotor incoordination. Symptoms vary in nature and severity due to the complexity of the visual cortex. Physiotherapy (PT) is essential for treating CP, promoting physical, mental, and social well-being. Physical therapists also teach parents, how to care for their children at home, including feeding, bathing, dressing, and other activities. CVI is often linked to CP and can lead to various visual problems, including reduced visual guidance of movement. To effectively manage this condition, a multidisciplinary approach is required, as children with CVI often have neurological deficits in addition to their visual problems. Visual function assessment involves measuring thresholds or limits for each eye, while functional vision assessment is conducted in the child’s environment with both eyes open. Levels of vision can be classified into light perception, intermittent fixation, reliable focus, constant attention to small objects, and reliable visual acuity. Children with Visual Difficulties (CVI) exhibit distinct visual behaviours and require proper training. Sensory room training improves gross and fine motor abilities, and early intervention reduces issues associated with these diseases. Physical therapy interventions are very important for this population’s health and wellness, which can be focused on acquiring and improving independence in motor abilities, visual function, coordination, balance and general health improvement. Children with CVI are at danger of developing neurological dysfunction. An early intervention and adequate training for young CP children with CVI can improve motor abilities and reduce issues associated with these diseases. The following review will help to understand briefly about visual impairments in patients with CP, mainly focusing on new therapeutic interventions following visual impairments that are effective and easily administered.

Single Dose of Etanercept Injection: A Game Changer in Toxic Epidermal Necrolysis: A Case Series

Rajkumar Kannan, Samuel Jeyaraj Daniel, Parimalam Kumar, Lavanya Kavimani

Toxic Epidermal Necrolysis (TEN) is a rare hypersensitivity reaction to drugs, characterised by widespread erythema, full-thickness epidermal necrosis with mucosal involvement, and extensive apoptosis. It is a dermatological emergency and can be lethal if not promptly treated. The use of steroids in managing TEN is controversial since no gold standard therapy exists. However, a single dose of subcutaneous injection of Etanercept (a Tumour Necrosis Factor-alpha (TNF-α) inhibitor) at a dosage of 50 mg has shown promise in preventing mortality and reducing hospital stay. The authors present a case series of six TEN patients, out of which three received a single dose of Etanercept injection. All patients who received Etanercept showed a positive response, achieving complete re-epithelialisation with a median healing time of nine days. In conclusion, injection of Etanercept, a TNF-α inhibitor, effectively inhibits Fas-Fas ligand activation, thus preventing apoptosis and extensive necrosis.

Atypical Presentation of Recurrent Pterygium Leading to Blindness and its Successful Management: A Series of Three Cases

Babi Das, Preety Rekha Das

Recurrence of pterygium is one of the main concerns in pterygium management. Recurrent pterygium is defined as the regrowth of fibrovascular tissue over the previously excised primary pterygium area, extending beyond the limbus and advancing towards the cornea. In most cases, it is characterised by increased conjunctival inflammation, fibroblast proliferation, and a faster progression towards corneal involvement compared to primary pterygium. This rapid regrowth can lead to irregular astigmatism, symblepharon, corneal fibrosis, severe vision impairment, and rarely, blindness. Incomplete removal of the primary pterygium, excessive suturing, the bare sclera technique, smaller conjunctival grafts, thicker conjunctival grafts with Tenon’s capsule, and poor control of postoperative inflammation are some of the most common surgical factors contributing to recurrence. Among all surgical procedures, the bare sclera technique has the highest recurrence rate. In the present case series, the author presented three cases of atypical recurrent pterygium and their successful management. The first case involved recurrent double-headed pterygium with severe symblepharon, resulting in lower fornix obliteration, shortening, diplopia, and corneal neovascularisation. The second case featured Grade-IV pterygium covering the pupillary area, and the third case involved a kissing type of double-headed pterygium. These cases were complications of the bare sclera technique, leading to blindness. Successful treatment of recurrent pterygium can improve visual and cosmetic outcomes. This case series aimed to highlight the burden and consequences of recurrent pterygium as a cause of avoidable blindness.