Journal of clinical and diagnostic research

Disseminated Tuberculosis Presenting Primarily as Amenorrhoea- A Case Report

Mrinmayee Vijay Mayekar, Pankaj Wagh, Babaji Ghewade, Ulhas Jadhav

Mycobacterium Tuberculosis (MTB) primarily infects the lungs and spreads throughout the body after the initial infection. This dissemination occurs through the reactivation of a dormant focus, which is preceded by lymphohaematogenous spread. It can also spread through the bloodstream from active lung or miliary tuberculosis. Tuberculosis is the leading cause of amenorrhoea in young females in developing countries like India. Although disseminated tuberculosis with osteoarticular involvement is a rare occurrence, a 20-year-old female presented to Acharya Vinoba Bhave Rural Hospital (AVBRH) with primary complaints of amenorrhoea and swelling in the right knee joint, which were the primary symptoms of disseminated tuberculosis. The present case is exceptional because it lacks the typical pulmonary symptoms. The predominance of gynaecological symptoms over pulmonary involvement may have led to an incorrect diagnosis of malignancy instead of tuberculosis. Additionally, the suspicion of tuberculosis was delayed due to elevated ovarian tumour markers.

A Case Report of Diabetic Striatopathy: Rare and Unusual Complication of Hyperglycaemia

Mary Jacob, Karthik Reddy

Non-Ketotic Hyperglycaemic (NKH) Hemichorea-Hemiballismus Syndrome/Diabetic Striatopathy (DS) is a rare neurological complication of diabetes mellitus. Hemichorea can present as a manifestation of diabetes mellitus or occur in patients with poorly controlled diabetes. This case report highlights the importance of differentiating this syndrome from other intracranial pathologies, as adequate glycaemic control can lead to complete resolution of the symptoms. The authors present a case of a 65-year-old female who presented to the Emergency Department (ED) with a sudden onset of involuntary movements in the left upper and lower limbs for 30 minutes. The patient was conscious and oriented, with a General Random Blood Sugar (GRBS) of 502 mg/dL, and ketone levels of 0.1 mmol/L (normal value: less than 0.6 mmol/L). The Computed Tomography (CT) scan revealed high attenuation in the right basal ganglia, and the Magnetic Resonance Imaging (MRI) of the brain indicated T1 hyperintensity in the right basal ganglia. The patient was managed with insulin infusion and hydration. Involuntary movements completely resolved after blood sugar levels were controlled with insulin. Hyperglycaemia should be considered as a differential diagnosis in patients presenting to the ED with hemichorea.

Pancreatic Malignancy Masquerading as a Splenic Lesion: A Case Report

PS Sreejith, Saravanan Janakiraman, T Selvaraj, S Jeswanth, KA Siva Subramanian

Splenic metastases are rarely encountered in routine clinical practice, and they may be due to various reasons, such as anatomical or immunological factors. Splenic metastasis is usually seen in the setting of disseminated disease. It is rare for pancreatic malignancy to present as a predominant splenic mass. Hereby, the authors present a case of 65-year-old female who presented with a painful lump in the left hypochondrium, along with loss of appetite and weight loss over the past two months. Preoperative Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans diagnosed patient with a primary splenic tumour. She underwent en-bloc resection of the spleen and adherent pancreatic tail, along with station 9d and 10 lymph nodes. Histopathological Examination (HPE) with Immunohistochemistry (IHC) revealed a small subcentimeter primary lesion in the pancreatic tail region with splenic extension and multiple metastases, including areas of central necrosis. Patient was then put on gemcitabine-based chemotherapy. Preoperative imaging modalities such as CT and MRI scans, as well as tumour markers, also failed to reveal the pancreatic lesion. The present case highlights a rare clinical scenario of a hidden pancreatic lesion with large and multiple splenic metastases. Splenic lesions can create diagnostic confusion between benign and malignant lesions on imaging, and it can be challenging to differentiate between primary or secondary lesions. When there is suspicion of splenic metastasis, particularly isolated secondaries, the pancreas should also be considered in the differentials, especially when no other primary is identified on routine imaging.

Chronic Ectopic Pregnancy Masquerading as Ovarian Cystadenoma: A Case Report

The term ‘chronic ectopic pregnancy’ refers to a type of tubal pregnancy in which a pelvic mass frequently develops as a result of repeated small ectopic ruptures or abortions, rather than a single episode of bleeding. Chronic ectopic pregnancy can often present with vague symptoms, making it susceptible to misdiagnosis and delaying treatment. In this case, a 27-year-old woman with para 2 and 2 live births presented with complaints of on-and-off abdominal pain in the right inguinal region for the past two months. During the clinical examination, a substantial, firm mass measuring 6×6 cm was palpated in the right adnexal region, not associated with any adnexal tenderness. Transabdominal sonography suggested an empty uterus with a solid cystic mass, round/oval in shape, located in the right adnexal region measuring approximately 6.9×6.4 cm. The ultrasound findings in these patients can either show an amorphous, avascular mass or a highly vascular complex. The diagnosis can be mistaken for endometriosis, acute pelvic inflammatory illness, vascular tumours, pelvic abscess, or, in this instance, a cystadenoma. In most cases, radiologic findings are essential in the differential diagnosis, but it is mostly confirmed through surgery, as in this case. A laparotomy was performed, which revealed a chronic ectopic pregnancy, and a salpingo-oophrectomy was performed.

Acute Unilateral Parotid Gland Swelling following General Anaesthesia for Arthroscopic Shoulder Surgery: A Case Report

Saiesh Narayan Raut Dessai, Sanjot Ninave, Amol Bele

Acute enlargement of the parotid gland following general anaesthetic administration is an uncommon, harmless, and self-limiting complication. The most likely cause was thought to be anaesthesia mumps, which involves a complex interaction of multiple factors, including factors such as direct trauma, patient position leading to altered salivary flow along with an increase in viscosity due to dehydration, its occurrence following arthroscopic shoulder surgery under general anaesthesia is relatively rare. It is usually a self-limiting disease and requires only follow-up observation, and in a few case reports, evaluation with imaging studies has been performed. However, severe complications may sometimes occur. If upper airway obstruction develops as in the present case, then emergency airway management must also be considered. Several surgical subspecialties, including orthopaedics, obstetrics and gynaecology, neurology, and spinal surgery, have recognised this uncommon postoperative syndrome. The present case report describes the medical condition of a 50-year-old female patient who experienced postoperative parotitis and underwent arthroscopic shoulder surgery for rotator cuff repair involving general anaesthesia.

Fibrolipomatous Hamartoma of the Median Nerve: A Case Report

Fibrolipomatous hamartoma, also known as fibrofatty overgrowth or perineural lipoma, or neural fibrolipoma, is a rare, benign, congenital lesion that occurs due to an abnormal overgrowth of mature fat and fibroblasts within the perineurium. This leads to the expansion of the nerve and separation of fascicles. It is more commonly observed in the median nerve at the wrist or hand level. Here, the authors presented the case of a 32-year-old female patient, who complained of swelling in the left wrist region for the past two years. The swelling gradually increased in size over one year and caused pain and paresthesia. Magnetic Resonance Imaging (MRI) of the left wrist revealed fibrolipomatous hamartoma of the median nerve. Surgical management was advised, but the patient declined and opted for conservative treatment for two months. Knowledge of this rare condition helps radiologists make an accurate diagnosis and may eliminate the need for invasive biopsy.

An Innovative Approach in the Fabrication of a Hollow Vaginal Stent using Ice in a Gender Dysphoria Patient: A Case Report

Gender dysphoria is the term used for individuals who are unhappy with their assigned gender at birth. They experience a strong desire to have the body of the opposite gender or to be socially recognised as a person of the opposite gender. Gender dysphoria can occur in both genders, but it is more prevalent in males, ranging from 0.005% to 0.014%. In females, the prevalence rate is lower, ranging from 0.002% to 0.003%. This case report highlights the prosthetic management of a 31 years old male patient with gender dysphoria after undergoing surgical intervention to remove male genitalia and create a neovagina. The patient underwent multiple surgeries to fulfill their gender transition desires. The patient initially visited the Department of Prosthodontics before vaginoplasty, where a custom-made hollow vaginal stent was planned and fabricated using a novel technique. In addition to prosthetic treatment, the patient also required hormonal therapies and psychological counseling, both of which were provided.

Surgical Success in Peri-implantitis Management using Guided Bone Regeneration: A Case Report with 2-Year Follow-up

Baskaran Shivakumar, Kulandaivelu Gayathri, Arumuganainar Deepavalli

Dental implant-supported restorations have become a potential treatment option for edentulous patients. However, complications may arise due to an inappropriate selection of patients and/or inadequate treatment planning, along with irregular maintenance. In such scenarios, peri-mucositis and Peri-Implantitis (PI) may occur as sequelae to dental implants. The prevalence rates of these complications are reported to be high. Inflammation of peri-implant soft tissue and resorption of supporting bone are significant features of PI. Routine evaluation should include Probing Pocket Depth (PPD) measurement and radiographic assessments to determine pathological changes in the peri-implant tissue. Treatment modalities for PI include non-surgical therapy, local drug delivery, anti-infective therapy, and surgical management focused on regenerating the lost peri-implant tissue. This case report demonstrates successful surgical management of PI in a 22-year-old male patient who presented with exudate in relation to an endosseous implant in the 12 region, with a PPD of 7 mm and peri-implant bone loss. Meticulous planning and comprehensive management led to the implant finally being restored to a healthy and fully functional status.

Mediastinal Pseudocyst in a Case of Chronic Pancreatitis: A Rare Presentation

Arjun Heda, Ruchita Kabra, Sourya Acharya, Shaina Dutta

Pancreatic pseudocysts are collections of fluid localised within the pancreas or in the peripancreatic space, which can occur following acute pancreatitis or in patients with a history of acute pancreatitis and chronic pancreatitis. They are well-known complications of pancreatitis. The pathogenesis of pancreatitis depends on its etiology, where enzyme-rich fluid and products of autoregulation accumulate in acute pancreatitis, and cysts are formed due to obstructed ducts in chronic pancreatitis. The development of pancreatic pseudocysts is more commonly associated with chronic pancreatitis than acute pancreatitis. Unless ruptured, pancreatic pseudocysts are usually not hazardous. Diagnosis of pseudocysts has become easier with advanced diagnostic techniques such as ultrasound and Computed Tomography (CT) scans. Patients presenting with abdominal pain and elevated pancreatic enzymes should be suspected of having pseudocysts. Approximately one-third of these cases resolve spontaneously. In the past, surgery was the only management method, but recently, with newer techniques such as percutaneous drainage and endoscopic cyst enterostomy, management has become easier. Percutaneous drainage, performed under local anaesthesia, is a cost-effective procedure with very low complications. The recurrence rate is higher with single-needle treatment, so catheters are used to decrease recurrence. Drainage should be the first choice of management, but with advancing technology and endoscopic techniques, it may become more useful in the future with skilled practitioners. In this case report, we will examine the case of a 30-year-old male who presented with symptoms of pain in the epigastric region and was diagnosed with a pancreatic pseudocyst. This case demonstrates a rare presentation where the pseudocyst extends into the mediastinum and thorax.

Multiple Penile and Pelvic Schwannomas in an Adult Male: A Case Report

Sweta Swaika, Udit Mishra, Sanjay Parashar

Schwannomas are relatively common benign tumours that gradually increase in size and develop in the peripheral nerve sheaths of adults. However, they are exceptionally rare in the penile and pelvic regions. Hereby, the authors present a case report of an extremely rare case of concomitant multiple schwannomas in the penis and pelvis. A 32-year-old adult male presented with complaints of multiple small swellings on the penile shaft, which were associated with episodes of severe pain. Clinically, there were multiple small, firm to hard, tender nodular swellings on the penile shaft. Ultrasound and Magnetic Resonance Imaging (MRI) revealed six well-marginated lesions in the penile areolar tissue and two lesions along the course of the left sciatic nerve in the left hemipelvis. Surgical excision followed by histopathological evaluation confirmed the diagnosis of multiple schwannomas. Due to their rarity and non specific presentation, most of these lesions are not diagnosed clinically. Therefore, presurgical imaging is necessary to evaluate their anatomical and morphological features. Although imaging findings in schwannomas are not always precise, Histopathological Examination is required for a definitive diagnosis. Histopathology typically shows the mixed presence of Antoni A and Antoni B bodies containing spindle cells arranged tightly and loosely, respectively, in a collagenous matrix. Immunohistochemistry (IHC) typically shows positivity for S-100 protein, which is characteristic of schwannomas. They are also positive for neuron-specific enolase and vimentin, but negative for Cluster of Differentiation (CD) 117 and Smooth Muscle Actin (SMA). Schwannomas are treated by complete surgical excision with preservation of the nerve axon, and they have a good prognosis with a low chance of recurrence.

A Simplified Technique to Treat Bimaxillary Protrusion using Micro-osteoperforation: A Case Report

Anjali Sudhakar Kathade, Shruti Rathi, Rizwan Gilani, Ranjit Kamble

In Asian population, bimaxillary protrusion is a prevalent malocclusion characterised by protruding and proclined upper and lower incisors, as well as increased lip procumbence. A 25-year-old female patient presented with a chief complaint of forwardly placed teeth and bimaxillary protrusion and required fixed mechanotherapy with all four 1st premolar extractions. The patient also desired that the treatment be completed in a short period of time. Since sliding or loop mechanics alone take longer to close extraction spaces, authors chose Micro-osteoperforation (MOP), a minimally invasive procedure used to accelerate orthodontic tooth movement. MOP involves drilling or perforating distal to the canine for en-mass retraction, causing the alveolar bone to release inflammatory cells that accelerate tooth movement. This non invasive technique was used for the treatment. The average rate of tooth movement in each quadrant was 1.7 mm per month. Taking the procedure into account, the patient reported no side-effects during or after drilling, but mild discomfort was felt. The entire space closure took four months. At the end of space closure, a Class I molar and canine relationship was preserved with normal overbite and overjet, with very minimal anchorage loss on the molars. An extraoral improvement in profile from convex to straight was seen. The treatment was completed within 14 months. The novelty of MOP includes faster treatment times and less discomfort during orthodontic treatment. However, like any medical procedure, MOP does carry some risks, such as infection or damage to surrounding teeth or gums. It is important to discuss the risks and benefits of MOP with your orthodontist before deciding whether to undergo the procedure.

Novel STXBP2 Mutation Causing Familial Haemophagocytic Lymphohistiocytosis Type 5 in a Preterm Neonate with Fatal Outcome: A Case Report

Familial Haemophagocytic Lymphohistiocytosis (FHL) is an autosomal recessive disorder characterised by a hyperinflammatory state due to widespread infiltration of organs with macrophages and lymphocytes. Haemophagocytic Lymphohistiocytosis (HLH) presents with fever, hepatosplenomegaly, cytopenia, hyperferritinemia and haemophagocytosis in the reticuloendothelial tissues causing multi organ failure with fatal outcome. HLH is rare in neonates with an incidence of 1 in 50,000 to 1 in 150,000. FHL is diagnosed based on clinical criteria, biochemical abnormalities, and genetic mutation. Mutations involving the gene STXBP2 contributes to around 10% of cases of FHL and there are only a few cases of FHL5 reported from India. A six-week-old neonate presented with sepsis which was unresponsive to antibiotics. Persistent fever, bicytopenia, hepatosplenomegaly and laboratory tests made us suspect HLH, and evaluate further with whole exome sequencing. FHL5 was diagnosed based on the identification of homozygous missense mutation in exon 3 of STXBP2 gene (chr19: 7642803_7642803delA). The baby succumbed to sepsis and multi organ failure. HLH should be considered in the differential diagnosis of any sick infant who presents with prolonged fever, sepsis unresponsive to antibiotics and an unusual clinical course.

Giant Cell Fibroma of the Tongue: A Rare Entity

Giant cell fibroma is a rare entity classified as a benign tumour of the oral cavity, accounting for 2% to 5% of all oral benign fibrous growths. It can occur at various sites in the oral cavity, such as the tongue, palate, lip, and buccal mucosa, with the gingiva being the most common site. As the growth is self-limiting, it has been concluded that its recurrence is negligible. The aetiology of the growth has not been clearly known, but the fibrous proliferation suggests that chronic irritation or trauma to the tissue can give rise to such lesions. The growth is generally described as a dome-shaped nodule, either sessile or pedunculated, with an average diameter of 1cm. Usually, the lesion is asymptomatic unless it becomes secondarily infected. The present article presents the diagnosis and surgical management of a giant cell fibroma localised to the lateral border of the left-side of the tongue, corresponding to the occlusal surface of the molar teeth. Hereby, the author presents a case of a 58-year-old-male patient reported to the Department of Oral and Maxillofacial Surgery (OMFS) with a chief complaint of a growth on the left lateral border of the anterior region of the tongue for 2 to 3 years. On intraoral clinical examination, a dome-shaped, pedunculated mass measuring 1cm in diameter was observed. The lesion was asymptomatic and self-limiting. A provisional diagnosis of irritational fibroma was made. After a thorough history taking and clinical examination, surgical excision through an intraoral approach under local anaesthesia was performed to remove the lesion. The histopathological reports confirmed the diagnosis as giant cell fibroma. Rigorous clinical and histopathological examination has proven to be significant in making a precise diagnosis and planning accurate treatment for the uneventful elimination of lesions like giant cell fibroma. It is also essential to differentiate it from other pathologies to prevent complications.

Death due to Dengue Encephalitis: A Rare Case Report

Aniket Kurhade

Dengue is a global public health concern, affecting around 50 million individuals and causing mortality in 20,000 patients per year. It is an arboviral disease caused by a single-stranded Ribonucleic Acid (RNA) virus belonging to the Flavivirus group and is transmitted by mosquitoes, specifically Aedes aegypti or albopictus. It comprises four serotypes, DENV1 to DENV4, and infection from one serotype only provides lifelong immunity for that subtype. Due to antibody-dependent enhancement, past infection with one serotype increases the prevalence of dengue haemorrhagic fever. The disease spectrum can range from asymptomatic infection to fever, fatal dengue haemorrhagic fever, or dengue shock syndrome. Due to improved disease knowledge, its involvement in the neurological system has been explored. Neurological abnormalities in dengue infection are rare and can be misdiagnosed due to other causes. Present case is of a young 23-year-old male with a history of fever 3-4 days prior, which later manifested with seizures and drowsiness. Despite emergency treatment, encephalitis and viral myocarditis developed, eventually leading to brain death within 24 hours of admission.

Sphingobacterium multivorum Meningitis in an Immunocompetent Patient with Pituitary Macroadenoma Apoplexy: A Case Report and Review of the Literature

Akanksha Dubey, Chinmoy Sahu, Shailesh Sengar, Mitra Kar

Sphingobacterium multivorum is a Gram-negative bacterium previously classified as a Flavibacterium. It produces non lactose fermenting colonies and is capable of producing oxidase and catalase enzymes. It is found ubiquitously in the environment and has been isolated from food, plants, soil, and aquatic environments, including hospital water supplies. Only a few cases of clinical infections caused by Sphingobacterium multivorum have been reported. Most cases of infection have been demonstrated in immunosuppressed patients. This case report presents the case of a 23-year-old immunocompetent woman with pituitary macroadenoma haemorrhage who developed Sphingobacterium meningitis following neurosurgery and subsequently died from cardiac arrest.

Hypoglycaemic Encephalopathy following Coronavirus Disease in a Six-month-old Infant: A Rare Case Report

Hypoglycaemia refers to a state when the blood sugar level drops below the normal range of 70-110 mg/dL. Blood sugar level, or glucose in the blood, is responsible for various vital functions. A decrease in blood glucose levels causes a wide range of clinical presentations, from tremors to coma and even death. Long-term hypoglycaemia can lead to extensive neuronal damage due to apoptosis and energy failure. Additionally, authors discuss a rare case of a six-month-old male neonate who presented with fever, diarrhoea, and two episodes of convulsions over the last two days. The movements started with an ictal cry and were followed by micturition and defecation. Nasal and throat swabs were positive for SARS-CoV-2 viral antigen. A plane Magnetic Resonance Imaging (MRI) of the brain was performed, which revealed evidence of altered signal intensity in the cortical and subcortical areas of the right frontal-temporal-parietal-occipital region, suggesting hypoglycaemic encephalopathy. The patient was given a breastfeeding trial and managed with 25% dextrose initially at a rate of 0.2 g/kg for 48 hours, as the patient was symptomatic, followed by an infusion of dextrose normal saline. After ruling out all possibilities of hypoglycaemic encephalopathy, the diagnosis of hypoglycaemic encephalopathy secondary to Coronavirus Disease (COVID-19) was made.

Conservative Management of Osteoarthritis with Hypertension and Ischaemic Heart Disease through Ayurvedic Treatment: A Case Report

Satyajit Pandurang Kulkarni, Pallavi Satyajit Kulkarni

The ayurvedic management of osteoarthritis is well known, but the management of arthritis with co-morbidities such as hypertension, ischaemic heart disease, obesity, and lumbar spondylosis through Ayurvedic treatment is yet to be discovered. In the present case, a 50-year-old female presented with complaints of mild to moderate pain in the lower back region, legs, knee joints, and swelling over both knees for five years. She also had a history of hypertension and IHD for 10 years and had been taking Non Steroidal Anti-inflammatory Drugs (NSAIDs) without any relief. Seeking Ayurvedic treatment, the patient discontinued NSAIDs and underwent Panchakarma for four weeks. The treatment resulted in significant pain relief, improved VAS score, and increased walking distance. The present case report provides a detailed ayurvedic treatment protocol for managing arthritis with co-morbidities such as hypertension, ischaemic heart disease, obesity, and lumbar spondylosis.

Non-Surgical Treatment of Class II Division 1 Malocclusion in an Adult Patient with a Missing Lower Lateral Incisor Tooth: A Case Report

Mohsin Aslam Wani, Ram Autar, Shiraz Siddiqui, Mohd Amir, Shashank Trivedi

Class II Division 1 malocclusion is clinically more widespread than any other form of malocclusion and can be managed in a variety of ways, taking into account variables such as patient compliance, age, and anteroposterior disparity. Orthodontic camouflage treatment, aimed at masking the underlying skeletal discrepancy, is an acceptable option for most patients. This typically involves the extraction of two maxillary premolars in cases without mandibular arch crowding, or the extraction of two maxillary and two mandibular premolar teeth when crowding is present. The present case report aimed to discuss the successful treatment of a unique case involving a 19-year-old adult female patient with Class II Division 1 malocclusion, a missing mandibular left lateral incisor, and an overjet of 7 mm. Since the patient declined surgical and prosthetic treatment, an alternative, novel, and unorthodox method of camouflage treatment was employed, which involved the extraction of maxillary first premolars combined with symmetrical incisor space closure. The achieved treatment outcomes included a functionally and aesthetically acceptable occlusion, reduced overjet, and an improved soft tissue profile.

Cutaneous Horn Arising from an Inverted Follicular Keratosis: A Rare Case Report

K Manoharan, S Gayathri, Sivaramakrishnan Sangaiah, Aswin Senthilvel

In the present case report, a 61-year-old male presented with a slowly progressing conical keratotic growth measuring 2.5 cm over the right ear. The lesion, which was non-tender on palpation, resembled a cutaneous horn or cornu cutaneum-an outgrowth made of compact keratin that rises above the skin’s surface. Since the clinical appearance of this uncommon benign tumour, known as Inverted Follicular Keratosis (IFK), is difficult to distinguish from other conditions, histopathology is the only method that can establish the diagnosis. No abnormalities were detected during general and systemic examination. The lesion was excised, and histopathological examination confirmed it as a case of IFK.

Meningitis in a Neonate Caused by Salmonella enterica Subspecies Enterica: A Case Report

Aarthi Sundaresan, Srujana Prabhala, Ami Yeshwant Varaiya, Avinash Walawalkar

A 14-day-old female baby was admitted to the neonatal Intensive Care Unit (ICU) with complaints of fever for one week, along with reduced intake of feeds and weight loss. Routine investigations, blood culture, Cerebrospinal Fluid (CSF) routine analysis, and CSF culture were performed. Both cultures grew non typhoidal Salmonella enterica subspecies enterica. Magnetic Resonance Imaging (MRI) brain with contrast revealed leptomeningeal enhancement and basal exudates, both suggestive of meningitis, as well as ventriculitis and arachnoiditis. The baby was treated with intravenous Ceftriaxone and Meropenem. Follow-up CSF analysis showed improvement, and the cultures were sterile.

Gastric Candidiasis Leading to Gastric Perforation: A Case Report

Mareedu Sri Hari Rao, Himanish Sen, Mareedu Radhika Rani, Mareedu Suhas

Gastric candidiasis is commonly seen in immunocompromised patients with malignant conditions and patients who have undergone gastrectomy. It is also observed in patients who frequently use antacids. The most common presentation of gastric candidiasis is single or multiple ulcerations, with perforation being an infrequent occurrence. The present case report describes a 38-year-old male with a known history of peptic ulcer disease, who presented with abdominal pain and shortness of breath for the past two days. The patient had been using antacids and Proton Pump Inhibitors (PPIs) for two years. Chest and abdomen radiographs revealed an air shadow under the right diaphragm. Emergency surgery was performed, revealing two stomach perforations. The patient underwent primary repair and a Modified Graham’s patch repair. Histological examination of the perforation margin showed invasive candidal colonisation. The patient experienced a series of postoperative complications during their hospital stay, all of which were successfully managed. The patient was discharged on the 40th postoperative day. Therefore, it was concluded in this case that the chronic use of antacids and PPIs may have created an alkaline environment, facilitating candidal colonisation of the stomach, ultimately leading to ulceration and perforation.

Three Dimensional Analysis of Root Development and Bone Formation in an Immature Non Vital Permanent Molar using Regenerative Endodontic Procedure: A Case Report

Shivani Gupta, Shalini Garg, Preeti Mittal, Vishal Sharma, Sumit Garg

The Regenerative Endodontic Procedure (REP) is one of the latest biological procedures for successfully treating immature non vital teeth. Treating non vital immature teeth in children with associated bone resorption poses a challenge. In the present case, a 10-year-old male patient presented with an immature pulpally involved right permanent first molar, exhibiting a periapical radiolucency measuring 2×3.2×10.5 mm (distal root) and 4.4×5.2×10.5 mm (mesial root). The molar was non-surgically treated using a minimally invasive REP approach, aiming for anatomical healing and root completion. Mineral Trioxide Aggregate (MTA) was applied over a blood clot used as a scaffold. The radiolucency decreased significantly to a size of 0.9×1.3×0.2 mm (distal root) and 1×0.4×0.2 mm (mesial root). Continuous root formation was also observed, resulting in complete resolution of the Apical Bone Defect (ABD). The mesial and distal roots progressed from Nolla stage 8 (2/3rd of root formation) to Nolla stage 9 (root formation complete) over a twelve-month period. Three-dimensional (3D) analysis was employed to explain pathosis and the healing of lesions from every aspect. The present case demonstrates that REP may be the treatment of choice for managing non vital immature permanent posterior teeth with severe ABD in a paediatric patients, particularly when the surgical approach is contraindicated due to the presence of other developing structures. Furthermore, long-term follow-up is required, and the type of healing and root completion may vary depending on the stage of root formation, disinfection, and coronal seal achieved.

Pilomatricoma with Osseous Metaplasia in the Shoulder Joint: A Common Lesion with Rare Differentiation

Khan Sanober Muzammil Mir, Bharat Sonwane, Vijaya Wane

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a tumour that shows differentiation towards hair cortex cells. It was first described by Malherbe and Chenantais in 1880. It most commonly occurs in the first two decades of life, with a female preponderance, and accounts for 1% of all benign skin lesions. Pilomatricoma undergoes calcification and ossification, but ossification is rare and poorly documented. The head and neck region, as well as the upper extremities, are the most common sites. Here, the authors present a rare case of pilomatricoma with osseous metaplasia in a 15-year-old male who presented with shoulder swelling for one year. The patient had a firm to hard, mobile swelling over the right shoulder, which was not fixed to the overlying skin or underlying structures. Clinically, calcified epidermal cysts were considered. Excision was performed in a minor operation theatre, and the specimen was sent for histopathological examination. On gross examination, the specimen was a firm to hard, globular 1×0.8 cm tissue that was difficult to cut. Microscopic examination revealed a lesion composed of two types of epithelium: inner shadow cells and outer basophilic cells. Bony trabeculae with osteocyte rimming were present around the shadow cells, and giant cells were also observed. Based on the histopathological examination, the diagnosis of pilomatricoma with osseous metaplasia was made. The patient was discharged after one week and followed-up for three months, during which satisfactory wound healing and no local recurrence were observed. Pilomatricoma with osseous metaplasia should be considered as a differential diagnosis when a patient presents with a firm to hard nodule.

Spectrum of Growth Hormone Disorders in Children: A Case Series of 5 Cases

Anshuman, Amit Kumar, Rakesh Kumar, Rizwan Ahmar, Jayant Prakash

Growth Hormone Deficiency (GHD) is one of the most important treatable endocrine causes of short stature. A problem anywhere in the Growth Hormone (GH) - Insulin-Like Growth Factor-1 (IGF-1) axis can lead to short stature. Childhood GH deficiency can be congenital, acquired, or idiopathic. Hereby, the authors present a case series consisting of five cases of short stature, aimed to provide an overview of the spectrum of GH-related disorders. All five patients presented to the Paediatric Endocrinology Outpatient Department of a tertiary care Institute with complaints of not gaining height. The patients in present case series had significant short stature (Z score for height <-3 SD (Standard Deviation) in each case). These patients were suspected of having GH deficiency based on clinical presentation and investigations. After a proper diagnostic work-up and GH stimulation tests, cases 1 to 4 were found to have GH deficiency. The 5th case was suspected of having Laron Syndrome based on high GH levels and low IGF-1. There were subtle differences in the spectrum of GH deficiency. The 1st case had Multiple Pituitary Hormone Deficiency (MPHD). Cases 2 to 4 had Isolated Growth Hormone Deficiency (IGHD). Case 2 had findings of pituitary stalk interruption on brain imaging. We found a genetic association in the 3rd case, while the 4th case had almost normal brain imaging. Cases 1 to 4 received GH therapy, and all showed appreciable height gain. These subtle differences can sometimes make the diagnosis difficult, and often a different approach to treatment is required.

Role of Interventional Radiology in the Management of Vascular Lesions around the Knee Joint: A Series of Four Cases

Vishal Nandkishor Bakare, Pratiksha Yadav, Ravi Arya, Ritesh Sahu

The soft tissue lesions around the knee range from congenital, traumatic, and vascular to neoplastic in aetiology. The various imaging modalities employed for diagnostic work-up include plain radiographs, ultrasonography, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI). Based on the peculiar imaging findings, the differential diagnosis can be narrowed down; however, the final diagnosis relies on histopathological findings. Some of the highly vascular lesions are arteriovenous malformation, malignant fibrous histiocytoma, haemangiopericytoma, and synovial sarcoma. The abundant neovascularity within these lesions poses a major problem during surgery due to potential blood loss. Presurgical interventional management in the form of endovascular embolisation significantly reduces intraoperative blood loss. Here, four different cases, one of each type, presenting as highly vascular lesions around the knee joint, were successfully managed with endovascular embolisation.

Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases

Geetha Soundarya Udayakumar, Haanah Mounika Nunna

Traumatic diaphragmatic hernia is relatively uncommon and occurs most commonly after a road traffic accident (5%). Diaphragmatic rupture is mostly associated with vital organ injuries such as the liver, spleen, lungs, bones, pelvis, and brain, which can be severely damaged. The anaesthetic management of a patient presenting with traumatic diaphragmatic hernia depends on any associated vital organ injuries. Hereby, the author present a case series of three patients with traumatic diaphragmatic hernia with different presentations managed accordingly. In the first case, a 37-year-old male presented with diaphragmatic hernia and cervical spine fracture following a road traffic accident. Awake fibreoptic intubation was performed with utmost care to avoid further injury to the cervical spine. After intubation, positive pressure ventilation was given with low tidal volume to avoid barotrauma and to expand the atelectatic lung. The second case involved a 48-year-old male with a history of falling from a height one week prior, who presented with right-sided diaphragmatic rupture and a liver contusion. Intubation was performed using a left-sided double-lumen tube, and one-lung ventilation was applied to facilitate thoracotomy. A thoracic paravertebral block was administered to alleviate postoperative pain, providing good pain relief. In the third case, a 56-year-old male with a known case of Chronic Obstructive Pulmonary Disease (COPD) presented to the hospital following a road traffic accident. The patient had lung contusion and haemopneumothorax with poor pulmonary reserve, and required emergency surgical repair. Combined spinal-epidural anaesthesia was preferred over general anaesthesia, as intubation may cause bronchospasm and life-threatening complications in COPD patients.

“Detubularised Non Augmented Urethroplasty”- A Promising Option for Pananterior Urethral Stricture: A Case Series

Pananterior urethral stricture involving the penile and bulbar urethra is a challenging urological condition in the Indian population. In India, Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus (LS) is the most common cause of pananterior urethral stricture. Various surgical techniques have been described in the literature for present condition, with varied outcomes. However, there is still a need for a simple and effective procedure to address this problem. Hereby, the authors present a case series that included five male patients with BXO and pananterior urethral stricture who underwent Detubularised Non Augmented (DNA) urethroplasty between January 2022 and December 2022. The median age of the patients was 45 years, with a mean stricture length of 13 cm. The median follow-up period was 11 months. During the procedure, a scroto-perineal incision was made, and the anterior urethra was ventrally cut open from the meatus to the junction of the stricturous and normal urethra. A right-sided Tunica Vaginalis (TV) flap was raised (left is left), and the cut-open anterior urethra was wrapped with the TV flap, creating a “controlled fistula” at the proximal end of the detubularised urethra. The average operative time was 1.5 hours. The success of the procedure was determined by a postoperative peak flow rate of 12 mL/sec or more, with no further need for urethral dilatation or direct vision internal urethrotomy. The procedure was successful in 4 out of 5 cases (80%). One patient developed a narrowed urethra during follow-up and required serial catheter upgradation for urethral dilatation. In conclusion, DNA urethroplasty was found to be a simple and effective treatment option for the notorious pananterior urethral stricture associated with BXO.

A Case Series of Cutaneous Lupus Erythematosus Progressing to Systemic Lupus Erythematosus in a Lightning Phase

Rajkumar Kannan, Parimalam Kumar, Samuel Jeyaraj Daniel, Mayuri Chandrasekhar

Discoid Lupus Erythematosus (DLE) is a chronic, disfiguring, inflammatory skin disease characterised by erythematous, indurated, well-defined scaly plaques of varying sizes that resolve with atrophy, scarring, and pigmentary changes. Although discoid cutaneous lesions are typical of DLE, they are also seen in as many as 14% of patients with Systemic Lupus Erythematosus (SLE). The aetiopathogenesis of Cutaneous Lupus Erythematosus (CLE) is thought to be related to the same autoimmune abnormality responsible for the systemic components of LE. The key feature in the pathogenesis being upregulation of Interferon-α (IFN-α) signaling. Hence, the morphology and associated clinical features of DLE can be considered as a forerunner in assessing the development of SLE. This case series highlights some potential risk factors to watch out for in the progression to SLE in patients with DLE. Some parameters that are likely to predict early progression towards SLE from DLE are: early age at diagnosis (<25 years), female gender (2:1), Fitzpatrick skin type V and VI, presence of disseminated DLE lesions, arthralgia, anaemia (Hb-<10 g/dL), lymphopenia (lymphocyte count-<20%), isolated lesions at photoprotected sites, average disease duration ranging from 5.7 to 8 years, elevated ESR, high baseline ANA titres ≥1:320, anti-ds-DNA, anti-SS-A, and anti-Sm antibody positivity. Hence, assessment of the above-mentioned parameters in initial and follow-up visits might aid in the early diagnosis of SLE. This case series consists of four patients (33 years old female, 54 years old female,34 years old female and 49 years old male patients, all married), all of whom had multiple potential risk factors indicating rapid progression towards the development of systemic symptoms. Hence, this shifts the prior paradigm that DLE patients do not typically develop severe SLE. Risk score analysis may be a helpful tool in assessing ongoing subclinical inflammation and aiding in the early diagnosis of SLE. Appropriate therapeutic intervention could be key in stemming disease progression, reducing morbidity and mortality, and improving the patient’s quality of life.

Pyogenic Granuloma Treated with Topical Timolol: A Case Series

Manjeet Naresh Ramteke, Usha Naraindas Khemani

Pyogenic Granulomas (PGs) are benign vascular tumours primarily treated with surgical procedures. Recently, topical Timolol, a beta-adrenergic receptor antagonist, has been used for the treatment of PG due to its vasoconstrictive, anti-angiogenic, and wound healing properties. Herein, the authors presented a case series of 12 patients (10 males and two females) with red papules and nodules that spontaneously bleed. The age of the patients ranged from 7-51 years, and the duration of lesions ranged from one week to nine months. The lesions were located on the face, neck, hand, and mucosa. All patients were treated with topical Timolol maleate 0.5% drops twice daily for four weeks and followed-up weekly for four weeks. The treatment efficacy was evaluated based on complete response, partial response, or no response. Changes in colour, size, bleeding tendency, and adverse events were also assessed. Two patients showed complete resolution, while the bleeding tendency improved in the other patients. No side effects were encountered, except in one patient where the lesion increased in size and became secondarily infected. Thus, topical timolol appeared to provide symptomatic improvement by reducing bleeding and lesion size without any side effects. It can be considered as an alternative therapeutic option for small, uncomplicated classical PG.

Clinical, Laboratory, and Radiological Findings in Acute Necrotising Encephalopathy of Childhood: A Case Series

RN Karthik, K Vidya, K Pushpalatha, S Lavanya

Acute Necrotising Encephalopathy of Childhood (ANEC) is a fatal disease diagnosed on basis of clinical and typical Magnetic Resonance Imaging (MRI) findings. The prognosis of this encephalopathy is generally poor, with fewer than 10% of cases recovering completely. Patients with a favourable outcome had reversible neuroimaging findings. Long-term sequelae commonly include neurologic deficits such as spasticity, epilepsy, and involuntary movements. In this case series, five cases of ANEC were reported. The children included in this series ranged in age from nine months to 16 years. All the children were female, and their presenting symptoms included seizures (n=5), altered sensorium (n=5), features of raised intracranial pressure (n=5), and posturing (n=1). Neuroimaging revealed characteristic lesions in the thalamus with varied involvement of other parts of the brain in all cases (n=5). Cerebrospinal Fluid (CSF) analysis was normal in the majority of children. Four out of five cases survived and responded to early steroids, intravenous immunoglobulin, physiotherapy, and rehabilitation. One child had complete recovery, with three children experiencing disabilities and one child succumbing to the disease.

Steamed Whole Potato as an Oesophageal Foreign Body

S Ravi, T Chandramohan, S Parthasarathy

Dear Editor, A 77-year-old, 75 kg male presented to the Emergency Outpatient Department (OPD) with difficulty swallowing since, the previous night. The symptoms began after consuming a meal consisting of Pooris and mashed steamed potatoes (a traditional South Indian recipe). The patient reported experiencing a sensation of obstruction and dysphagia since the previous night. There was no history of fever, cough, or any other underlying medical conditions. The patient had no previous history of oesophageal disease. Upon clinical examination, the patient appeared otherwise healthy with normal vital signs. No abnormal cardiorespiratory signs were observed, and there was no evidence of cranial nerve palsy. Significant drooling of saliva was noted, but no other abnormalities were observed during throat endoscopy. The patient underwent oral gastrointestinal endoscopy under local anaesthesia. During the procedure, a round yellow object obstructing the oesophagus was discovered (Table/Fig 1). Attempts to grasp the foreign body with forceps were unsuccessful as it became crushed. It was determined that the foreign body was a whole potato, which was then crushed into pieces and pushed into the stomach [Video-1]. The procedure was successfully completed and explained to the patient. Follow-up was conducted through a telephonic conversation for a week, during which the patient remained completely asymptomatic. An array of objects, including food bolus (mostly meat), fish or chicken bones, prosthetic teeth, and coins, are among the most commonly ingested accidental oesophageal foreign bodies (1). In the present case, the authors decided against interventional radiology due to concerns about potential barium aspiration and uncertainty regarding its use. Therefore, they proceeded with endoscopy. Since the patient presented with drooling, the decision to proceed with endoscopy before considering radiological investigations was made. The types of objects consumed may vary across different regions and ethnicities. In southern China, fish bones are the most prevalent oesophageal foreign bodies. Given the patient's age of 77 years, the possibility of an additional luminal compromise caused by a potential malignant lesion was considered. However, no abnormalities were observed during endoscopy that warranted a biopsy. Foreign bodies in the oesophagus can lead to complications such as perforation in certain cases, but this was not the case here since, the foreign body was a vegetable (2). Typically, foreign bodies in the oesophagus are removed under local anaesthesia (3). Some patients may require sedation, but in present case, the procedure was performed under local anaesthesia. In adults, the most common cause of oesophageal foreign body obstruction is a meat bolus impacted over an existing distal oesophageal ring, peptic or malignant oesophageal stricture, or eosinophilic oesophagitis (4). Apart from the common coins and batteries, food impaction has been reported as foreign bodies in the oesophagus. These are usually crushed and removed. The occurrence of a complete obstruction caused by an organic, steamed whole potato without any pre-existing oesophageal disease is rare (5). In present case, no evident disease in the oesophagus was observed. The present case is presented as the first reported instance of oesophageal obstruction caused by a steamed whole potato. Even in old age, foreign bodies should be suspected in cases of acute-onset dysphagia.

Unusual Presentation of Multifocal Tubercular Osteomyelitis

Linnet Prabakaran, Senthil Kumar Aiyappan, Harshika Mittal

Rehabilitation of a Patient with Combined Hemimaxillectomy-hemimandibulectomy Defect using Unilateral Implant-supported Magnet-retained Prosthesis: A 3-year Follow-up

Ramya Srinivasan, Saumyendra Vikram Singh, Deeksha Arya, R Rohini, Mayank Singh

A 60-year-old patient presented with complaints of difficulty in chewing and deteriorating systemic health (Table/Fig 1). The medical history revealed squamous cell carcinoma affecting the right part of the maxilla and mandible, which was surgically treated 15 years ago. The surgical intervention involved the removal of the maxillary alveolus, tuberosity, mandibular condyle, and coronoid process, extending up to the mandibular midline. Soft tissue reconstruction was performed to address the maxillary defect. There was a recurrence of the carcinoma, which was managed through radiotherapy. The patient had controlled diabetes and hyperthyroidism and was on medication for these conditions. On examination, a hemimaxillectomy without oronasal fistula and a hemimandibulectomy that included the condyle were observed. Decayed root stumps with periapical radiolucencies (Table/Fig 2) were extracted. The presence of a scar band in the right cheek ruled out the possibility of placing zygomatic or pterygoid implants. Furthermore, the patient expressed unwillingness to undergo an extensive and invasive reconstructive surgery due to personal reasons. The patient was capable of guiding the mandible into an almost un-deviated closure and, therefore, did not require a mandibular deviation correction appliance. The option of unilaterally functioning rehabilitation on one side was suggested and consented to by the patient. After the healing of extraction sockets, Cone Beam Computed Tomography (CBCT) was taken with a surgical stent containing radiopaque markers in the proposed implant region and assessed (Table/Fig 3). The interarch distance was found to be less than 12 mm. A total of three implants were planned in both the upper and lower arches with delayed loading, along with an RP5-type prosthesis (1). Antibiotic prophylaxis was initiated a day before the implant surgery following routine blood investigations. The procedure involved crestal incision, mucoperiosteal flap reflection, and sequential drilling for osteotomies. Implants (Superline, Dentium, USA) measuring 4.5×10 mm, 5×10 mm, and 4.0×10 mm in the maxilla, and 4.0×12 mm, 4.0×12 mm, and 5.0×10 mm in the mandible, were placed according to the CBCT assessment (Table/Fig 4), and the flaps were sutured. After three months, evidence of osseointegration was observed (Table/Fig 5), and second-stage surgery was performed, with healing caps placed. The decayed broken maxillary central incisors underwent endodontic treatment and were submerged to preserve alveolar bone (Table/Fig 6)a. After one week, open tray impressions were made using addition silicone and poured with die stone, ensuring intimate contact with the residual ridges and stability of the impressions (Table/Fig 6)b. Magnetic keepers with a thickness of 1 mm and a collar length of 1 mm (MKP 45 10 D, Superline, Dentium USA) were screwed onto implant analogs, and magnets were incorporated opposite the analogs in the trial denture base (Table/Fig 7)a,b. The habitual horizontal maxillo-mandibular relation was recorded at the vertical relation determined by phonetics and aesthetics, using interocclusal registration medium. Mandibular denture stability during functional movements was improved by incorporating an outrigger zone in the anterior mandibular region, which also enhanced aesthetics. Teeth selection, setting, and the incorporation of a Lingualised occlusal scheme were performed to ensure aesthetics, phonetics, and function without disruptive eccentric interferences. Each of these steps was critical as the patient could not establish a true centric relation due to the absence of the right part of the mandible. The acrylic resin was packed into the molds after dewaxing, ensuring precise placement of magnets over the keepers. The dentures were processed with magnets (MGT 45 20 D, Retention force 350gf, Superline, Dentium USA) in place and delivered (Table/Fig 8). Post-insertion instructions were given, and follow-up appointments were scheduled at six month intervals (Table/Fig 9). During the three year follow-up period, an improvement in mandibular deviation was observed. Clinical signs and examinations, peri-implant probing, and panoramic radiographs revealed no pain or 2signs of implant-related complications. Oral and denture hygiene, as well as magnetic retention, were found to be satisfactory. In patients with hemimandibulectomy, the remaining segment of the mandible is retruded and deviates towards the resected side, causing functional disability that is exacerbated in edentulous patients. The closure of the maxillary defect using a soft tissue flap prevents the fabrication of a prosthesis in the defect area. Therefore, the use of soft tissue flaps for maxillary defect reconstruction is discouraged, as they do not provide prosthetic support. The combined defect of the maxilla and mandible makes rehabilitation more challenging, as restoring a deficient arch opposing a normal dentition provides some reference for rehabilitation. Reconstructing the resected maxilla and mandible has been successful but requires multiple surgeries and may lead to donor site morbidity. Osseointegrated dental implants have been recommended for rehabilitating such patients as they aid in prosthesis retention, support, and stability. However, the loss of normal hinge movement, the angular path of opening and closing of the mandible, lack of cross-arch stability, and uncoordinated mandibular movements at the surgical site (2) exclude the use of fixed implant prosthesis. The magnet-retained implant prosthesis allows prosthetic movement in four directions (3) without causing horizontal stresses on the implants and bone. The magnetic retention and support provided by both the implants and tissues are crucial for the functioning of this unilateral prosthesis. The usage of ball/bar retained removable implant prosthesis was not considered due to the reduced interarch distance (12 mm) (4). As a result, magnetic keepers with a 1 mm collar length and 1 mm thick magnets were used to accommodate the necessary thickness of the denture base. The concept of achieving function on one side is still controversial but may be employed in cases where multiple surgeries or zygomatic/pterygoid implants are not feasible. Sahu SK et al., reported the successful rehabilitation of a completely edentulous hemimandibulectomy patient with a removable prosthesis featuring a twin occlusal table. This approach improved denture stability, masticatory efficiency, and aesthetics over a 6 month follow-up period (5). However, in present case, the usage of an implant-supported magnet-retained prosthesis could have further enhanced retention and stability. Another study reported notable functional benefits from promptly performing surgical closure of a significant palatal defect following hemimaxillectomy, combined with an osseointegrated implant-supported prosthesis (1). Authors team achieved successful rehabilitation of a debilitated patient with a combined hemimaxillectomy-hemimandibulectomy defect, where a soft tissue flap was used to mask the maxillectomy. This was accomplished without the need for additional surgeries. The magnet-retained removable unilateral implant prosthesis aided in achieving functional occlusion and aesthetics. In the future, the use of precision attachment-retained prosthesis may be considered for this patient to effectively limit prosthesis movement.

A Conversation with ChatGPT about the Treatment of Obstructive Sleep Apnoea

Amir Mikhael

Dear Editor, The widespread popularity of Chat Generative Pretrained Transformer (ChatGPT) (1), an Artificial Intelligence (AI) programme capable of generating text based on written instructions, is evident through its availability on the web, facilitated by OpenAI, located in San Francisco, California, United States of America (USA) (2). The programme possesses the capacity to comprehend the context of a conversation and proficiently produce suitable responses in various styles, including formal, informal, and humorous tones (3). The utilisation of ChatGPT in medical research has sparked a debate, raising notable concerns primarily revolving around privacy and security. Furthermore, another significant concern that necessitates attention is the potential for misuse and excessive reliance (3). While AI systems such as ChatGPT exhibit impressive capabilities, they are not devoid of limitations, as they can generate responses but do not provide references that can be verified. Medical professionals may fall into the trap of over-relying on AI systems, unquestioningly trusting their decisions, and neglecting to sufficiently consider the inherent limitations and potential errors of this technology (3). Obstructive Sleep Apnoea (OSA) is characterised by recurrent occurrences of obstructive apnoea and hypopnoea throughout the sleep cycle. Clinical inspection of the patient, usage of a sleep questionnaire, cardiorespiratory polygraphy, or, if essential, overnight polysomnography is required for the diagnosis of OSA (4). During an interaction with ChatGPT, the AI displayed dependable and comprehensive information regarding treatment options for OSA. It commenced with the gold standard treatment, which is Continuous Positive Airway Pressure (CPAP), and then progressed to surgical interventions and the use of inspire implants. However, the AI did not mention any new pharmacological options. Additionally, ChatGPT offered detailed insights into lifestyle modifications for managing OSA. To date, the most effective pharmacotherapy for OSA has been the combination of atomoxetine (a norepinephrine reuptake inhibitor) and oxybutynin (a muscarinic receptor antagonist) (5). Although ChatGPT provided extensive information, it strongly advised seeking medical advice whenever there is a suspicion of OSA. The conversation with ChatGPT is illustrated in (Table/Fig 1). The unfavourable perception of early ChatGPT publications in all academic fields may be explained by restrictions in present research or ethical issues with the application of Generative Pretrained Transformer (GPT) technology. Because ChatGPT is still relatively new, many unanswered concerns regarding its potential and limitations need to be investigated by academics from other sectors (6). Although ChatGPT generated realistic-sounding responses for user-generated questions about OSA, the major limitation is that it does not generate references or sources of this information. This can pose a challenge in healthcare because it is crucial that the public receive accurate and verified information about healthcare. Doctors and healthcare organisations can play a great role in training future versions of such software that can generate verifiable and correct information.

Reply to “Letter to the Editor: Coronal Microleakage of Resilon and Gutta-Percha Obturation Materials with Epiphany SE Sealer: An In-vitro Study”

Arwa Ahmed Al-Maswary, Hatem Abdel Hameed Alhadainy, Sadeq Ali Al-Maweri

Dear Editor, We would like to respond to the points raised by Balasubramanian and Sivakumar in their “Letter to the Editor: Coronal Microleakage of Resilon and Gutta-Percha Obturation Materials with Epiphany Self-etch (SE) Sealer: An in-vitro study”, which was published in your esteemed journal (J Clin Diagn Res. 2016 Dec;10(12):ZL01) (1). We are the authors of the article titled “Coronal Microleakage of Resilon and Gutta-percha Obturation Materials with Epiphany SE Sealer: An in-vitro study” (2). Comment 1: “The results of this study indicated that a complete seal was not obtained with any of the tested specimens. One of the reasons attributed to this leakage was incomplete infiltration of resin into the demineralised dentin, as a result of difficulty in achieving the ideal ratio between the degree of dentin demineralisation and the ability of resin infiltration (3) which has been mentioned by the authors in the discussion. However, this could have been explained further by addressing the fact that the chelating agent {17% Ethylenediaminetetraacetic Acid (EDTA)} employed in this study might have led to the collapse of demineralised collagen matrices left in the root canal walls, impeding sealer infiltration. This is in accordance with Garcia-Godoy F et al., who reported that both EDTA and Mixture of Tetracycline, Acid, Detergent (MTAD) caused a collapse of the dentin matrix structure, preventing sealer infiltration and interfering with the formation of high-quality hybrid layer bonding (3).” Response: We appreciate the effort to provide an additional explanation for the incomplete sealing between obturation materials and canal walls in our study. Achieving a complete seal between obturation materials and canal walls remains a challenge, as no current obturation material or technique can achieve an absolute seal or prevent leakage (4),(5),(6). Similar studies investigating Resilon and gutta-percha have also reported a lack of complete seal (6),(7),(8), which confirms our results. While we mentioned the “incomplete infiltration of resin into the demineralised dentin, as a result of difficulty in achieving the ideal ratio between the degree of dentin demineralisation and the ability of resin infiltration” as one of the possible explanations for the incomplete sealing in the discussion section, we do not believe that it can be solely attributed as one of the reasons. This is because similar methodological studies employing a “smear-layer removal technique” have shown extensive resin infiltrations into dentinal tubules (9),(10). In addition, 17% EDTA is a commonly recommended chelating agent for removing smear layer in root canals [11,12]. Garcia-Godoy F et al., reported that the collapse of the dentin matrix occurs when EDTA is used as a final irrigation with a 5-minute exposure (3). In our study, EDTA was not used as a final irrigation and the exposure time was no more than 2 minutes. Garcia-Godoy F et al., also reported that the effects of EDTA and MTAD on dentin structure can be mitigated by a rinse of sodium hypochlorite (NaOCl) followed by water, which was conducted in our study (EDTA followed by NaOCl irrigation and finally distilled water) (3). Therefore, we believe that the further explanation provided by the authors cannot be a possible reason for incomplete sealing in our study. Comment 2: “In addition, the raw material of Resilon i.e., polycaprolactone is biodegradable under microbial attack (13). An enzyme lipase is released by these microorganisms, which is capable of cleaving the ester bonds of polycaprolactone, making it more susceptible to alkaline and enzymatic hydrolysis (14). These factors are also to be taken into account while employing Resilon/Epiphany (SE) sealer in clinical practice where the human oral cavity is comprised of a wide variety of microbial flora.” Response: We thank the authors for raising this point. In our study, the incubation period was seven days with methylene blue, the dye used, which has been reported to have antimicrobial activity (15),(16),(17) and is considered a disinfectant (18),(19) that might inhibit microbial growth and the production of lipase enzyme by microorganisms. Additionally, all procedures were conducted with sterilised instruments and materials under aseptic conditions to mimic clinical situations. Furthermore, our study was an in-vitro study and saliva, which is “comprised of a wide variety of microbial flora,” was not used. Therefore, it is highly unlikely that hydrolysis by microbial enzymes or attack is one of the possible explanations for the incomplete sealing in our study. Comment 3: “Also, this study employed dye penetration methodology for the assessment of coronal microleakage. However, the validity of dye leakage studies has been questioned because of the possible effect of entrapped air on the ingress of the dye solution (20). Spangberg LS et al., demonstrated that dyes such as methylene blue and crystal violet could not penetrate an entire artificial void by passive diffusion alone and also reported that the voids could be filled with dye by applying a vacuum during this method, thereby inferring that dye leakage studies can be conducted under vacuum pressure (21).” Response: It has been reported that entrapped air may interfere with the penetration of the dye tracer, and consequently it is recommended to conduct dye studies under vacuum pressure (21). However, other studies have reported no significant difference in the dye penetration of 2% methylene blue dye in filled root canals between vacuum and passive methods (22),(23). Additionally, it has been noted that air elimination in root canal fillings may result in either overestimation of leakage (24) or complete dye penetration along the root canal surface (25), which may be suitable for tooth and canal anatomy studies rather than leakage studies. Consequently, the use of vacuum with dye penetration studies is controversial for leakage assessment. We appreciate the authors’ concerns and acknowledge the limitations of dye leakage studies. However, it is important to note that dye penetration studies, including the methodology employed in our study, are widely used and provide valuable information on the sealing ability of obturation materials. Further research and standardisation of methodologies are necessary to address the limitations and improve the accuracy of leakage assessment.

Evaluation of Protein Adsorption and Osseointegration Potential of Polyetheretherketone versus Titanium Dental Implants: A Systematic Review

Seema Patil, Paresh Gandhi, Aditi Kanitkar, Rupali Patil, Bhagyashree Kalsekar

Introduction: The success of implant therapy depends on a number of parameters, including bone volume implant shape, surface topography, the patient’s overall health, and local factors. Despite the fact that Polyetheretherketone (PEEK) implants have undergone a lot of alterations, only a small number of studies have examined the bioactivity and osseointegration of PEEK implants with titanium. Aim: To summarise and evaluate protein adsorption and osseointegration capacity of PEEK and titanium dental implants. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used and PROSPERO (CRD42023415494) registration was done. Electronic databases were searched for studies assessing the outcome in terms of protein adsorption and osseointegration capacity of PEEK and titanium dental implants. Quality assessment of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Results: Depending on inclusion and exclusion criteria, seven studies fulfilled the eligibility criteria and were included in qualitative synthesis. Risk of bias assessment revealed that all the included studies were largely comparable in methodological quality. All the included studies had moderate to low-risk of bias with all the respective domains. All the included studies revealed that PEEK with optimal surface roughness might hold great potential for protein adsorption and osseointegration capacity. Conclusion: Within the limitations of the study, it was found that compared to titanium, PEEK is less osseoconductive and bioactive. PEEK is therefore unsuitable for use as a dental implant in its unmodified form. Implantitis and implant failure occurs from improper osseoconductivity and bioactivity of dental implants.

Clinical, Biochemical, and Outcome Profile of Hyponatremia in Geriatric and Non-geriatric Individuals Admitted to a Tertiary Care Centre: A Prospective Cohort Study

Swati K Ashok, Bhargav Kiran Gaddam, Tumbanatham Appikatla, S Sumathi

Introduction: Hyponatremia is one of the most common electrolyte disturbances encountered in medical wards, occurring in up to 22% of hospitalised patients. Timely recognition and correction of hyponatremia in hospitalised patients may help decrease in-hospital mortality and symptom severity, reduce the need for intensive hospital care, decrease the duration of hospitalisation and associated costs, and improve the treatment of underlying co-morbid conditions and patient’s quality of life. Aim: To compare the clinical presentation, aetiology, biochemical profile, management strategies, and outcomes of hyponatremia in geriatric and non-geriatric individuals admitted to a tertiary care centre. Materials and Methods: This prospective cohort study was conducted in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute, Pondicherry, India, from March 2021 to September 2022. A total of 166 subjects (83 geriatric and 83 non-geriatric patients) receiving inpatient services with hyponatremia were enrolled in the study by consecutive sampling. Patients over 18 years of age admitted to the Department of General Medicine with serum sodium levels below 135 mEq/L were included. Comparison of both the groups were done based on clinical presentation, laboratory values, co-morbidities, prescription drugs taken, aetiology, treatment given, and outcomes. For quantitative variables, mean, standard deviation, and independent t-tests were used, while percentages were used for qualitative variables. Results: The majority of subjects in the non-geriatric group belonged to the age group of 50-59 years, with a mean age of 50.7 years. In the geriatric group, most subjects were in the age group of 65-74 years, with a mean age of 74.5 years. The most common cause of hyponatremia in both groups was Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), with 32 (38.6%) cases in the non-geriatric group and 27 (32.5%) cases in the geriatric group. This was followed by volume overload in the non-geriatric group, with 14 (16.9%) cases, and drug-induced hyponatremia in the geriatric group, with 22 (26.5%) cases. The most common drug causing hyponatremia was furosemide in both groups. In non-geriatric patients, the most common symptom was giddiness, with 28 (34.1%) cases, while in geriatric patients, it was nausea/vomiting, with 25 (30.1%) cases. Tolvaptan was the most common treatment used in both groups, with 12 (92.3%) of patients with mild hyponatremia receiving it in the non-geriatric group (p=0.042), and 46 (55.4%) patients in the geriatric group, with most of them having moderate hyponatremia (26, 86.7%, p<0.001). Conclusion: The results of the non-geriatric and geriatric groups were similar in terms of clinical presentation, biochemical parameters, management strategies, and outcome of hyponatremia. However, the aetiology of hyponatremia appeared to be different. The most common cause of hyponatremia was SIADH in both groups, followed by volume overload in the non-geriatric group and drug-induced hyponatremia in the geriatric group.

Online Learning Self-Efficacy during an Emergent Transition: A Cross-sectional Survey among Undergraduate Students in Saudi Arabia

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic significantly affected higher education, necessitating a sudden shift to virtual classes in response to COVID-19 restrictions in the Kingdom of Saudi Arabia (KSA). This transition has highlighted the importance of exploring factors that may influence students’ Self-Efficacy (SE) in online learning. Aim: To identify the dimensions of perceived SE in online learning during the COVID-19 pandemic and examine the association between demographic characteristics and SE levels. Materials and Methods: A cross-sectional, questionnaire-based research design was conducted at the Department of Nursing, University of Tabuk, Tabuk, Saudi Arabia from January 2022 to May 2022, spanning a duration of five months. Data was collected through an online structured questionnaire, which included a demographic section and the Self-Efficacy Questionnaire for Online Learning (SeQoL). A total of 250 complete responses were received. Data analysis was performed using Statistical Package for Social Sciences (SPSS) Version 23.0. Mean and standard deviation were used to identify the mean SE in online learning. The Chi-square (χ2) test was used to explore the association between SE and demographic variables. Results: Out of the total 250 students, the majority were females, 184 (76%), with age range of 20-21 years. The study found that nearly half of the participants had a high level of SE (119, 47.6%), one-fourth had moderate SE (64, 25.6%), and 67 (26.8%) had a low SE level. The mean SE in online learning among the students was 150.8 with a Standard Deviation (SD) of 77.43, corresponding to a mean percentage of 60.3%. The sub-sections of the SE scale related to interacting with classmates and instructors scored lower than other sub-sections. The level or year of education (p<0.001), the device used for online learning (p=0.031), previous online education exposure (p=0.038), and hours of online learning (p=0.036) were significantly associated with participants’ online SE. However, age (p=0.187) and gender (p=0.609) did not have a significant effect on online SE. Conclusion: In the present study, the majority of participants exhibited high or moderate SE in online learning. However, one-fourth of them had low SE levels, indicating the need for improvements in the online learning framework at the University of Tabuk. The study recommends enhancing learning support systems, technical support systems, and interaction to develop SE in online learning, thereby improving the overall quality of the online learning experience.

Assessment of Tumour Budding in Colorectal Carcinoma and its Correlation with Pathological Staging among Patients undergoing Resection at a Tertiary Care Hospital in Kerala, India

Neha Mohan, KV Kalaranjini, Limi Mohandas

Introduction: Colorectal Carcinoma (CRC) is one of the most commonly diagnosed carcinomas and a significant cause of cancer-related deaths worldwide. The prognosis and treatment decisions rely on the Tumour, Node, Metastasis (TNM) Staging system. However, some tumours are classified as low-risk based on TNM stage exhibit adverse outcomes. Therefore, the search for additional prognostic factors is necessary. Tumour budding is an established independent prognostic factor, with high-grade tumour budding consistently linked to lymph node metastasis, local recurrence, and distant metastasis. Aim: To assess and grade tumour budding in CRC cases and examine its correlation with pathological staging. Materials and Methods: A cross-sectional study was conducted on 95 patients between December 2019 and December 2021 at Sree Gokulam Medical College and Research Foundation, Venjaramood, Trivandrum, India. Resected specimens from CRC patients were processed, and Haematoxylin and Eosin (H&E) slides were examined for tumour budding assessment. Ten individual fields were scanned under a 10x objective to locate the hotspot area with the maximum number of tumour buds. Tumour buds were then counted under a 40x objective in the selected hotspot area. Tumour budding was categorised as low (0-1 bud), intermediate (2-4 buds), or high (5 or more buds). Immunohistochemistry (IHC) analysis with Pancytokeratin was carried out when assessment with H&E slides alone was difficult. The correlation between tumour budding and pathological staging was evaluated, along with its association with various histopathological parameters. Results: The study included 95 patients, with a mean age of 68.22 years, comprising 58.95% males and 41.05% females. Low-grade tumour budding was observed in 42 (44.21%) cases, intermediate-grade budding in 34 (35.79%) cases, and high-grade tumour budding in 19 (20%) cases. There was a significant correlation between tumour budding and pathological staging (r-value=0.39) as well as the number of metastatic lymph nodes (r-value=0.34). The presence of lymph node metastasis and Lymphovascular Invasion (LVI) showed a statistically significant association (p-value <0.01). Conclusion: Tumour budding grading is a valuable histopathological finding, as it increases with higher T stage and presence of nodal metastasis, aiding in the prediction of nodal metastasis and recurrence. It is positively correlated with pathological staging and the number of metastatic lymph nodes. Including tumour budding grade in the histopathology report can assist clinicians in assessing prognosis and making treatment decisions.

Comparison of Serum Calcium, Magnesium, and Zinc amongst Preeclampsia and Normotensive Pregnant Women attending a Tertiary Care Teaching Hospital in Tripura, Northeast India

Dipanwita Roy, Sutapa Das, Jayanta Ray, Partha Sarathi Pal

Introduction: Preeclampsia is one of the most frequently encountered medical complications of pregnancy. If left untreated, it exerts serious medical complications for both the mother as well as baby. As a multifactorial progressive disease, identifying potential biomarkers for predicting preeclampsia is crucial for disease stratification and targeted therapy. There is a growing interest in early detection of micronutrient deficiencies, such as calcium, magnesium, and zinc, to understand the causes of preeclampsia development. Aim: To compare the serum levels of calcium, magnesium, and zinc in women with preeclampsia and normotensive pregnant women attending Agartala Government Medical College and Govind Ballabh Pant Hospital, Agartala, Tripura, India. Materials and Methods: This cross-sectional observational study was conducted at Agartala Government Medical College, Agartala, Tripura, India, from January 2020 to December 2021. The study included primigravida women aged between 18 and 35 years, in their third trimester of pregnancy, with a singleton pregnancy. Sixty preeclampsia patients and 60 normotensive pregnant women were enrolled, and various biochemical parameters like serum calcium, magnesium, zinc, uric acid, urea, creatinine, Alanine Transaminase (ALT), and Aspartate Transaminase (AST) were analysed. Data were statistically analysed using the student t-test and Chi-square test. Results: The mean age (in years), gestational age (in weeks), and Body Mass Index (BMI) (Kg/m2) of the study subjects and control group were 26.02±4.69 and 23.4±3.81, 34.78±2.41 and 33.51±2.79, and 27.97±3.82 and 26.03±4.26, respectively. The authors observed that the levels of biochemical parameters like serum creatinine, AST, ALT, and uric acid were increased in preeclampsia. Furthermore, the serum concentrations of calcium, magnesium, and zinc were significantly decreased in preeclampsia. Conclusion: This study demonstrated that preeclamptic women have reduced levels of serum calcium, zinc, and magnesium compared to normal pregnant women. Therefore, dietary supplementation of these essential nutrients, either individually or in combination, may help prevent preeclampsia at an early stage and improve foetal outcomes.

Effectiveness of Mindfulness Meditation on Depression, Anxiety, and Stress among Undergraduate Nursing Students: A Quasi-experimental Study

Ajantha Antony, C Viji Prasad

Introduction: High levels of stress and anxiety are usually experienced by students as a result of peer pressure and concerns about college. Students who struggle to control their stress and anxiety may experience mood swings, behavioural changes, and even depression. Aim: To assess the effectiveness of mindfulness meditation on depression, anxiety, and stress among undergraduate nursing students. Materials and Methods: This quasi-experimental study was conducted at Yenepoya Nursing College, Yenepoya (Deemed to be University), and Zulekha Nursing College, Mangaluru, Karnataka, India for a duration of five weeks from April 2022 to May 2022. A total of 84 study participants were enrolled and divided into two groups: the intervention group (n=42) and the control group (n=42). The intervention group received mindfulness meditation for 15 minutes, twice a day in the morning and evening for four weeks. The Depression Anxiety and Stress Scale (DASS-42) was used to assess depression, anxiety, and stress in both groups. Data were analysed using Statistical Package for the Social Sciences (SPSS) Version 23.0. Baseline data were presented using frequency and percentage. Two-factor repeated measures Analysis of Variance (ANOVA) and Bonferroni post-hoc tests were adopted to assess the difference between pre and post-test scores for stress, anxiety, and depression in repeated intervals. The level of significance was set at p-value <0.05. Results: A comparison within the intervention group at different time points showed a significant difference in the reduction of stress, anxiety, and depression from the pretest after the administration of mindfulness meditation (p-value <0.05). The reduction of stress, anxiety, and depression in the intervention group was significantly different from the control group (p-value <0.05). Conclusion: Mindfulness meditation significantly reduces stress, anxiety, and depression among students. Hence, it can be incorporated into daily life to help individuals deal with a variety of stressful events.

Efficacy of Oral Doxycycline versus Intravenous Doxycycline for the Treatment of Uncomplicated Scrub Typhus in Children: A Prospective Interventional Study

Introduction: Orientia tsutsugamushi causes acute febrile illness known as scrub typhus, which is spread by the bite of the trombiculid mite. Doxycycline is the first-line treatment for clinically diagnosed cases of scrub typhus. If not diagnosed and treated early, it can lead to complications such as acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure. However, there have been no trials comparing the effectiveness of oral and Intravenous (i.v.) doxycycline for scrub typhus treatment. Aim: To assess the efficacy of intravenous versus oral doxycycline in managing uncomplicated scrub typhus. Materials and Methods: This prospective interventional research was conducted in the Paediatrics Department at Maharajah’s Institute of Medical Sciences, Vizianagaram, India, from June 2021 to July 2022. Out of a total of 178 children diagnosed with scrub typhus during the study period, 102 children who received either oral or intravenous doxycycline as monotherapy were included. The primary outcome measures studied were the incidence of delayed defervescence and the time of defervescence. The t-test or Mann-Whitney test was applied for continuous data, and the Chi-square test or Fischer’s-exact test was used to compare dichotomous variables. Results: The mean age of children treated with oral doxycycline was 9.5±2.7 years and with i.v. doxycycline was 8.2±2.4 years. Among the 178 children diagnosed with scrub typhus, 102 (57.3%) children treated with doxycycline alone were included in the study. Out of these, 78 (76.4%) cases received oral doxycycline, while 28 (27.4%) cases received intravenous doxycycline. There was no statistically significant difference in the response rate between the two groups. The p-value for time to defervescence was 0.672, and the p-value for the incidence of delayed defervescence was 0.9845. Conclusion: Both oral and intravenous forms of doxycycline demonstrated similar efficacy in the treatment of scrub typhus. Nearly all children in both groups became afebrile within 72 hours after starting treatment.

Evaluation of Late Toxicities in Postoperative Cases of Oral Cavity Cancer Treated by Intensity-Modulated Radiotherapy (IMRT): A Retrospective Cohort Study

Introduction: Surgical intervention serves as the primary treatment modality for operable oral cavity cancer. However, patients with locally advanced disease or unfavourable prognostic factors often require adjuvant Radiotherapy (RT) with or without concurrent Chemotherapy (CT). Advanced radiation techniques, such as Intensity-Modulated Radiotherapy (IMRT), have shown potential in minimising radiation-related toxicities while ensuring effective tumour control. Aim: To assess common late toxicities, namely xerostomia, dysphagia, and hoarseness, in patients with postoperative Squamous Cell Carcinoma (SCC) of the oral cavity, who received adjuvant RT or concurrent Chemo-Radiotherapy (CRT) utilising IMRT with a Simultaneous Integrated Boost (SIB) approach. Materials and Methods: A retrospective cohort study was conducted in the Department of Radiotherapy at IMS, BHU, Varanasi, Uttar Pradesh, India, from June 2018 to December 2021. Study was done using the medical records of 62 patients with SCC of the oral cavity and received adjuvant radiation by the IMRT technique with or without concurrent CT. Late toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0). Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 28.0, and a logistic regression model was used to establish the association between Organ-At-Risk (OAR) doses and the development of late toxicities. Results: The median age of the study participants was 45 years (range: 25-68), and 95.2% (n=59) of the patients were male. A total of 62 patients (59 male, 3 female) were included. The median follow-up duration was 21.5 months. At two years, the cumulative incidence of xerostomia, dysphagia, and hoarseness was 28.5% (n=8), 21.4% (n=6), and 28.5% (n=8), respectively. Logistic regression showed that both the D mean of >26 Gy to the contralateral parotid (HR=4.32; 95% CI, 1.03-18.05; p=0.045) and the D mean of >26 Gy to the contralateral Submandibular Gland (SMG) (HR=6.41; 95% CI, 1.48-27.81; p=0.013) were significantly associated with the incidence of xerostomia. The D mean of >47 Gy to the pharyngeal constrictors (HR=17.89; 95% CI, 3.15-101.62; p=0.001) and the D mean of >50 Gy to the larynx (HR=5.77; 95% CI, 1.82-18.24; p=0.003) had a significantly high risk of dysphagia and hoarseness, respectively. Conclusion: Adjuvant IMRT resulted in acceptable rates of late toxicities in oral cancer. Doses to the contralateral parotid and SMGs, pharyngeal constrictors, and larynx had a significant impact on late xerostomia, dysphagia, and hoarseness, respectively.

Comparison of the Retention Rates of Pit and Fissure Sealants Placed on First Permanent Molars Treated with Air Abrasion and Acid Etching: A Split-mouth Randomised Clinical Trial

Introduction: Pit and fissure sealants are a reliable and safe method of occlusal caries prevention. Accurate preconditioning of the enamel surface is essential for long-term sealant retention. Aim: To assess the retention rate of pit and fissure sealants applied to first permanent molars treated with air abrasion and acid etching in children aged 6 to 9 years. Materials and Methods: This split-mouth randomised study was conducted in the Department of Paediatric Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India from March 2019 to March 2020. The study included 45 children aged 6-9 years with 180 completely erupted maxillary and mandibular first permanent molars. The children were randomly divided into two groups: Group-I (Air Abrasion) and Group-II (Conventional Acid Etch). After pretreatment of the enamel surface with either air abrasion or acid etching, sealant was applied. Sealant retention was evaluated at 6- and 12-month intervals using Tonn and Ryge’s scoring criteria under a dental operating microscope. Statistical analysis was performed using the Wilcoxon Signed-rank Test and the Mann-Whitney U Test. Results: The mean age of the study participants was 7.6±0.5 years. At the 12-month interval, complete sealant retention was observed in 23% of teeth in the air abrasion group and 21% in the acid etch group. The p-value of 0.657 indicates that the difference was not statistically significant. The comparison of sealant retention rates in maxillary and mandibular molars treated with both air abrasion (p=0.191, p=0.881) and acid etching (p=1.000, p=0.574) showed no statistically significant differences at both the 6- and 12-month intervals. Conclusion: The retention rate of fissure sealants on enamel surfaces treated with air abrasion was comparable to acid etching. There was no difference in sealant retention rates between maxillary and mandibular molars in both the air abrasion and acid etch groups.

Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies

Introduction: Small skin biopsies offer a cosmetic advantage to the patient but may provide limited information for making a diagnosis. Non specific and overlapping microscopic features often seen on superficial histopathology sections contribute to this challenge. In such cases, the use of step deeper and reverse embedding (re-embedding) sections has utility in improving diagnostic accuracy in dermatopathology practice. Aim: To examine the use of prospective step sectioning and reverse embedding in skin biopsies to improve diagnosis. Materials and Methods: This prospective, cross-sectional study included 200 consecutive skin biopsies received in the Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India, over an eight-month period from June 2022 to January 2023. Only skin biopsies smaller than 5 mm were included, while large punch biopsies (larger than 5 mm) were excluded. For each sample, a superficial section, step deeper section, and reverse embed section were taken. The pathologist reviewed the microscopic findings and rendered a diagnosis on the first slide. The other two slides were then reviewed, and the information provided by slides 2 and 3 was categorised as either no new information, additional information to make a diagnosis, or a change in diagnosis. Any change in diagnosis based on the information from slides 2 and 3 was noted and analysed. Results: Out of the 200 skin biopsies studied, 32 cases (16%) were non diagnostic on the first slide. Step deeper sections helped in making a diagnosis in 16 (8%) cases, and reverse embedding aided in the diagnosis of 9 (4.5%) cases. For the remaining seven cases where no additional information was obtained even after deeper and reverse embed sectioning, a descriptive report was provided. In eight (4%) cases out of the 200 biopsies where a diagnosis was made on the first slide, deeper/reverse embedding led to a change in diagnosis. Thus, deeper sectioning and reverse embedding improved diagnostic accuracy in 33 cases out of the total 200 skin biopsies studied (16.5%). Conclusion: This study highlights the utility of step deeper and reverse embed (re-embedded) sections in increasing diagnostic accuracy in small skin biopsies. Therefore, implementation of standardised protocol for studying multiple sections of small skin biopsies before rendering a diagnosis can significantly reduce diagnostic errors and aid in providing appropriate treatment to patients.

Knowledge, Attitude, Symptoms, and Management Practices among Middle-aged Menopausal Women: A Cross-sectional Study

Vijaya S Dandannavar, Seem Doe, Harpreet Kour, Mubhashir Angolkar

Introduction: Menopause is defined as the permanent cessation of menstrual periods following the loss of ovarian follicular activity. It typically occurs between the ages of 45 and 55. Almost all women experience this phase and undergo various symptoms. However, menopause and its symptoms are often perceived as a normal phenomenon by women. Therefore, it is necessary to educate women about the complications of menopause and strategies to cope with them. Aim: To assess knowledge and attitude on menopause and management practices of menopausal symptoms among women aged 40-55 years. Materials and Methods: A cross-sectional observational study was conducted for seven months, from June 11, 2019, to December 31, 2019, among 196 naturally menopausal women aged between 40 and 55 years residing in Ashok Nagar, Belagavi, Karnataka, India. Data were collected using a pretested questionnaire that included information on socio-demographic profiles, Knowledge, Attitudes, and Practices (KAP) towards menopause. Descriptive statistics were used to analyse the data using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Of the study participants, 109 (55.6%) were found to have average knowledge regarding menopause, 176 (89.8%) had a neutral attitude towards menopause, and approximately 173 (88.3%) had average practices towards managing menopausal symptoms. Conclusion: The study participants exhibited average knowledge and neutral attitudes towards menopause. Their management practices for menopausal symptoms were also found to be average. There is an urgent need to raise awareness among women regarding knowledge about menopause.

p63 as an Ideal Diagnostic Marker for Pleomorphic Adenoma: An Immunohistochemical Study

Anju Devi, Anjali Narwal, Mala Kamboj, Shruti Gupta, Deepak Pandiar

Introduction: Pleomorphic Adenoma (PA) histopathologically represents a heterogeneous lesion with a varying proportion of epithelial and mesenchymal components. Due to its morphological diversity, a diagnostic dilemma often arises when identifying its various patterns. This diverse morphology is considered to be a function of the neoplastic myoepithelium. Tumor protein 63 (p63) is expressed in stratified epithelia and in the basal cells of salivary glands. Aim: To investigate the immunoreactivity of p63 as a reliable myoepithelial marker in PA. Materials and Methods: A cross-sectional study was performed in the Department of Oral and Maxillofacial Pathology at PGIDS, Rohtak, Haryana, India. The duration of the study was 14 months, from March 2015 to April 2016. A total of 15 tissue blocks of histopathologically diagnosed cases of PA were included from departmental archives and subjected to Immunohistochemistry (IHC) using a monoclonal p63 antibody. The myoepithelium was classified as myoepithelial-like (abluminal and spindled), modified myoepithelium (myxoid and chondroid), and transformed myoepithelium (solid epithelioid, squamous, and basaloid cribriform). IHC for p63 was assessed in each myoepithelial component, as well as in non neoplastic Myoepithelial Cells (MEC) and inner tubular epithelial cells. Only nuclear staining for p63 was considered positive. The obtained data were subjected to statistical analysis, and the Chi-square test was applied. Results: The PA samples subjected to IHC showed 100% p63 reactivity. Transformed MEC, abluminal, and modified MEC revealed variable immunostaining with a significant difference (p=0.049). There was no immunostaining in luminal/inner layer cells in all cases of PA. p63 was also expressed in the nuclei of MEC of acini and intercalated ducts of normal salivary gland tissue. Conclusion: p63 is a sensitive and specific myoepithelial marker to identify MEC in PA. Additionally, the expression of MEC-associated markers in acini and intercalated ducts of normal salivary glands has confirmed their role in the histogenesis of this tumour.

Effects of Resistance Exercise Using Thera-band with Weighted Cuff Resistance on Fall Risk and Balance among the Geriatric Population: A Randomised Controlled Trial

Ghazala Khan, Meena Gupta, Altaf Hussain Mir

Introduction: Balance impairments and an increased fall risk are common concerns among individuals with various health conditions. Resistance exercise has shown potential in improving balance and reducing fall risk. Aim: To determine the effects of home-based Thera-Band resistance training in reducing the risk of falls among the geriatric population and to compare it with weight-cuff resistance training. Materials and Methods: A Randomised Controlled Trial (RCT) was conducted at the Amity Institute of Health and Applied Science, Noida, India, from November 2022 to April 2023. The intervention period spanned four weeks, and a total of thirty-three subjects were enrolled in the study. The participants were divided into three groups: Group A, Group B, and Group C. Group A performed resistance exercises using weight cuffs combined with standard balance training, Group B performed resistance training with Thera-Band combined with standard balance training, and Group C received standard balance exercises alone. The effects of the interventions on fall risk reduction were assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG), and Fall Efficacy Scale (FES) among the geriatric population. Paired t-tests were employed to compare pre- and post-intervention data within each group, determining significant changes within each group over the intervention period. Analysis of variance (ANOVA) was utilised to assess between-group effects of the different interventions. Results: The FES scores were assessed pre- and post-intervention for each group. Group B (Thera-Band) demonstrated significantly better outcomes in fall efficacy compared to Group A (Weight-cuff) (p<0.01) and Group C (p<0.01). For balance assessment using the BBS, both Group A and Group B showed better results compared to Group C (p<0.01). In terms of mobility assessed through the TUG test, Group B exhibited substantial improvement compared to both Group A and Group C (p<0.05). Improvements in fall efficacy, balance, and mobility were seen in Group B (Thera-Band). Conclusion: Home-based resistance training using Thera-Band was found to be the most effective method for reducing the risk of falls in the geriatric population, followed by weight-cuff resistance training in combination with conventional balance training. Thera-Band is not only effective but also more convenient, hassle-free, and cost-effective. The geriatric population should be provided with more multi-mode exercises that are easy to perform and have been found to be effective and helpful at their advanced age.

Comparison of Mechanical, Antibacterial and Morphological Properties of Silk Sutures Coated with Silver Nanoparticles and Aloe Vera Herbal Extract: An In-vitro Study

Introduction: Surgical sutures play an important role in wound healing at surgical sites, which are susceptible to microbial infections. These sutures need to prevent bacterial adhesion and proliferation, particularly in areas exposed to oral fluids, to avoid contamination inside the wound. Antibiotic-coated sutures have shown effective antibacterial properties, and silver has emerged as a promising antimicrobial agent. Additionally, Aloe vera, a natural source of bioactive compounds, has been extensively studied for its antibacterial, antiviral, anti-tumour, and anti-inflammatory activities. Aim: To analyse the morphological, mechanical, and antibacterial properties of plain silk sutures compared to silk sutures coated with silver nanoparticles (AgNPs) and silk sutures coated with AgNPs and aloe vera extract. Materials and Methods: This in-vitro study was conducted in the White Lab of Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, over a one-month period from September 2022 to October 2022. The study included three groups, with three samples in each group. Group A consisted of plain silk sutures, Group B consisted of silk sutures coated with AgNPs, and Group C consisted of silk sutures coated with AgNPs and Aloe vera extract. Morphological and microanalytical characterisation was performed using Scanning Electron Microscopy (SEM) images and Energy-Dispersive X-ray Spectroscopy (EDS). Tensile strength was determined using straight-pull and knot-pull tests, following the Instron® method, and knot efficiency. Antibacterial efficacy was evaluated using antimicrobial culture tests for the three groups. Statistical analysis was performed using the Shapiro-Wilk test to assess normality of continuous variables, followed by parametric tests of significance including paired t-tests and Analysis of Variance (ANOVA). Results: The tensile strength, as determined by the straight-pull test, knot-pull test, and knot efficiency, was highest in Group C, followed by Group B and Group A (statistically significant, p-value <0.001 for straight-pull test, 0.038 for knot-pull test, and 0.002 for knot efficiency). Group B exhibited the highest antibacterial efficacy, followed by Group C, while Group A showed no antibacterial efficacy (statistically significant, p-value <0.001). Conclusion: This present pilot study suggests that both AgNP-coated and Aloe vera-coated sutures hold promise in preventing Surgical Site Infections (SSI) and promoting wound healing.

Correlation of Global DNA Methylation with Symptom Severity in Drug-Naïve Bipolar Disorder Patients: A Cross-sectional Study

Deepak Kumar Rout, Mihir Ranjan Nayak, Roma Rattan, Snigdha Awasthi

Introduction: Bipolar disorder has emerged as a significant health problem in India. Global Deoxyribonucleic Acid (DNA) methylation studies could provide a significant clues toward the early identification of high-risk individuals. Aim: To estimate the levels of global DNA methylation in drug-naïve bipolar disorder patients and healthy controls and to correlate the global DNA methylation levels with the severity of the disease. Materials and Methods: A cross-sectional study was conducted in the Department of Psychiatry at SCB Medical College, Cuttack, Odisha, India, from January 2019 to March 2020. A total of 50 bipolar disorder patients and 50 age-matched healthy adult controls were recruited from the Outpatient Departments (OPD) of the hospital, and the severity of bipolar disorder was assessed using Young’s Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HAM-D). DNA methylation levels were estimated from serum samples of the subjects using a methylated DNA quantification kit. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The Kruskal-Wallis test was used to compare the DNA methylation scores, and the Pearson’s correlation test was used to correlate DNA methylation levels with disease severity. A p-value <0.05 was considered significant. Results: The mean age of the study participants was 34.44±12.45 years. A total of 100 subjects were included in the study, with 50 being bipolar disorder patients and the remaining 50 in the control group. Bipolar cases, particularly depression, had higher levels of DNA methylation than controls (p=0.0001). On correlation analysis, patients with Bipolar Depression (BD) had a significant correlation with DNA methylation (p-value <0.001) compared to patients with mania and controls. Conclusion: Bipolar patients, especially those with BD, exhibit higher levels of global DNA methylation in genes compared to healthy control groups. Global DNA methylation can serve as an important early disease marker for bipolar patients, aiding in prevention and early detection efforts.

Clinicoepidemiological Profile and Diagnosis of Severe Acute Respiratory Syndrome Coronavirus-2 and Influenza Viruses in Patients with Severe Acute Respiratory Illness by Real-time Reverse Transcription Polymerase Chain Reaction: A Cross-sectional Study

Maasha, Shailpreet Kaur Sidhu, Kanwardeep Singh, Satpal Aloona, Loveena Oberoi

Introduction: Severe Acute Respiratory Illness (SARI) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and influenza viruses represent a significant global public health concern. The disease spectrum ranges from mild to life-threatening conditions. Surveillance of hospitalised SARI patients is an essential public health tool used to identify cause of the disease, track changes in circulating viruses and serve as an alert mechanism for potential pandemic viruses. Aim: To determine the rate of SARS-CoV-2 and influenza virus positivity among SARI cases and to investigate the epidemiological and clinical characteristics of the patients. Materials and Methods: A cross-sectional study was conducted on 400 SARI patients admitted to Guru Nanak Dev Hospital, Amritsar, Punjab, India between February 2021 and June 2022. The clinical, demographic, and epidemiological data, as well as co-morbidities of all patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2, Influenza A, Influenza A (H3N2), Influenza A (H1N1) pdm09-pandemic 2009, and Influenza B using real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 for Windows. Results: Out of the 400 SARI patients, 117 (29.25%) tested positive for SARS-CoV-2, 14 (3.5%) for Influenza A, 7 (1.75%) for Influenza A (H1N1) pdm09, and 4 (1%) for Influenza A (H3N2). The majority of cases in both SARS-CoV-2 and influenza were in the 41-60 years age group (47.86% and 57.14%, respectively). Males were predominantly infected in SARS-CoV-2 positive patients (62/117, 52.99%), while females were more infected in influenza positive cases (9/14, 64.28%). The most common presenting symptoms were fever, cough, dyspnoea, and sore throat in both cases. Hypertension, diabetes mellitus, Chronic Obstructive Pulmonary Disease (COPD), and coronary artery disease were the most common co-morbidities observed. Conclusion: Evaluation of clinical and epidemiological profiles of SARI patients can aid in better understanding and management of outbreaks. Close monitoring and quarantine measures will be necessary to prevent extensive transmission within the community.

A Cross-sectional Survey of SWOT Analysis on Online Teaching Methodology during COVID-19 Pandemic among Undergraduate Students at a Tertiary Care Teaching Hospital

P Kala, B Kiran, R Jamuna Rani, Jerin James

Introduction: The outbreak of Coronavirus Disease-19 (COVID-19) was a global disaster that greatly impacted the education system. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis can be used to identify favourable and unfavourable factors and conditions in offline and e-learning systems, and to address problems in a targeted manner. Aim: To evaluate the understanding and perception of students regarding the online learning system through SWOT analysis. Materials and Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in the Department of Pharmacology at a tertiary care teaching hospital in Tamil Nadu, India for a duration of one month in October 2021. The study included 589 undergraduate students from medical, dental, and allied health sciences. A preformed questionnaire using Google Forms was used to assess the students’ perception of the online teaching methodology during the COVID-19 pandemic. Data was assessed using a five-point Likert scale, and results were expressed as numbers and percentages. Results: The present study reported that 52.46% of the study participants had a strong positive opinion about the convenience and flexibility of online learning methods, as they can be accessed from anywhere and at any time. However, 214 (36.33%) participants agreed that monitoring students during online teaching was more difficult compared to classroom teaching. During the pandemic, when all educational institutions were closed, 412 (69.95%) students felt that completing a course within a stipulated period was made possible by the online method. On the other hand, 401 (68.08%) students believed that some countries do not recognise certificates from online learning systems, as they may not provide sufficient practical experiences compared to classroom teaching. Conclusion: The current study showed that more than half of the study participants had a very favourable assessment of the portability and adaptability of online learning techniques. However, they also strongly felt that it was more challenging to keep track of students during online learning compared to traditional classroom methods. Online learning has both benefits and drawbacks, and it is important for individuals to decide how best to utilise it for their own gain while avoiding any negative side effects. Based on the experiences of the pandemic, it is crucial to find innovative solutions that are appropriate for different learning contexts.

Active Drainage versus Passive Drainage after Modified Radical Mastectomy in Patients with Breast Carcinoma: A Randomised Controlled Trial

Introduction: Postoperative seroma formation is a common complication following Modified Radical Mastectomy (MRM), with an incidence ranging from 15-60%. There is a hypothesis that the negative pressure created by the suction drain used in MRM opens the damaged capillaries, preventing them from spontaneously closing and thereby increasing postoperative secretions. Aim: To compare active suction drains with passive drains in MRM in terms of postoperative outcomes. Materials and Methods: A randomised controlled trial with two arms, consisting of 15 patients in each arm, was conducted from November 2018 to March 2020 at the Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital in New Delhi. Patients diagnosed with localised breast carcinoma and scheduled for MRM were invited to participate. Pregnant females, patients with metastatic disease, those lost to follow-up, recurrent breast cancer patients, and those taking anticoagulants and antiplatelet agents were excluded from the study. The outcomes measured were drain output and duration of hospital stay, and postoperative morbidity, including flap necrosis, surgical site infection, seroma, and volume of seroma aspiration. The data acquired was analysed using the Statistical Package for Social Sciences (SPSS) version 21.0. Quantitative variables were compared using the Independent t-test and Mann-Whitney test as appropriate. Nominal categorical data was compared using the Chi-square or Fisher’s-exact test as appropriate. Results: Drain output was higher in the active group than in the passive group, but there was no significant difference in the average daily drain output and the average total output (652 mL versus 540 mL), except for the first two postoperative days. There was no statistically significant difference between the two groups in terms of hospital stay (6.67 days and 6.27 days), duration of drains in situ (6.67 days and 6.27 days), flap necrosis (13.3% vs. 13.3%), seroma formation (26.67% vs. 20%), and surgical site infection (26.67% vs. 20%). Conclusion: The use of suction in drains during MRM surgery is not compulsory and can save costs in resource-poor settings. However, larger sample size studies with multicentre participation should be undertaken before making any recommendations.

Comparative Evaluation of the Accuracy, Operator Comfort and Time Taken for Implant Placement among Different Practitioners under Dynamic Navigation

Sahana Selvaganesh, Thiyaneswaran Nesappan

Introduction: Dynamic Navigation (DN) can be an effective alternative in cases where there are anatomical limitations. It can serve as an advanced training tool for young practitioners in implantology. The learning curve with the DN system can be steep; however, with practice and proper protocol implementation in an institutional set-up, DN can become an invaluable tool for implant placement in challenging situations. Aim: To evaluate operator comfort, accuracy, and time taken for implant placement among different practitioners using DN. Materials and Methods: This prospective cohort study was conducted at the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from October 2022 to February 2023. Three groups, each consisting of five practitioners, were included: Group 1 (experienced practitioners), Group 2 (intermediate practitioners), and Group 3 (beginners in the field of implantology). The practitioners underwent orientation to the DN system through lectures and digital planning sessions. They performed hands-on in-vitro implant placement on 3D printed models and one implant placement each on live patients. Surgical time, operator comfort, and accuracy of implant placement were assessed among the three groups. Statistical analysis was performed using the Kruskal-Wallis test. Results: In comparison to the digitally planned position, beginners in implantology showed the least variation in implant placement position. The apico-coronal variation was 0.494±0.428 mm in implant placements for patients in the beginners group, while the maximum variation was 2.140±1.355 mm in the experienced practitioners group. There was a sequential increase in accuracy and lesser deviation from the originally planned implant sites when comparing the virtual simulation device, model, and patient implant placement. Beginners took significantly less time for implant placement in patients (p=0.004). Conclusion: There was a sequential improvement in the accuracy in implant angulation from virtual simulation to placement of implants in patients. The beginners group exhibited the shortest implant placement time in patients.

Evaluation of Intracanal Smear Layer Removal after Passive Microvolume Irrigation with Sodium Hypochlorite and Rotary Nickel-Titanium Instruments: An In-vitro Study

Introduction: Passive Microvolume Irrigation (PMI) with Sodium Hypochlorite (NaOCl) has been proposed as a new method for root canal disinfection. It is based on the concept that irregular surface characteristics of endodontic instruments can carry NaOCl into the canal space with controlled fluid volume, without applying any pressure. Aim: To compare and evaluate the efficacy of 3% and 5% NaOCl PMI, Saline PMI, and 3% NaOCl Standard Irrigation (SI) in removing the Smear Layer (SL) from the root canal walls at the cervical, middle, and apical thirds of single-rooted teeth. Materials and Methods: This study was conducted in the Department of Conservative Dentistry and Endodontics at Vishnu Dental College, Andhra Pradesh, India. The study was conducted in February 2018. Forty maxillary central incisors with a single canal, extracted within three months of the study, were collected. The teeth were divided into four groups (n=10) based on the irrigation method: Group-1 (3.0% NaOCl SI), Group-2 (3.0% NaOCl PMI), Group-3 (5.0% NaOCl PMI), and Group-4 (Saline PMI). All samples were instrumented upto F4 size with Protaper rotary files, and a final rinse of 17% Ethylenediaminetetraacetic Acid (EDTA) was used. SL removal was evaluated using Scanning Electron Microscope (SEM). The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0. Statistical tests used were Kruskal Wallis and Mann-Whitney-U tests. A p-value of <0.05 was considered statistically significant for all comparisons. Results: There was no significant difference (p>0.05) in SL removal between 3.0% NaOCl SI, 3.0% NaOCl PMI, and 5.0% NaOCl PMI in the middle and apical thirds of the root canals. However, 5.0% NaOCl PMI showed significantly higher efficiency in SL removal at the cervical third compared to the other groups (p<0.05). Conclusion: Passive microvolume irrigation with 3% and 5% NaOCl showed comparable efficacy to 3% hypochlorite SI in the middle and apical thirds of the root canal.

Effect of Electromagnetic Radiation on the Mechanical Properties of Orthodontic Elastics: A Preliminary In-vitro Study

Niharika Bhatia, Saravana Dinesh, Shweta Nagesh

Introduction: The use of mobile phones has considerably increased, and the Electromagnetic Radiation (EMR) caused by these devices may influence intraoral appliances. Intraoral elastics are commonly employed in orthodontics and require periodic changing by the patient to be effective. Unfortunately, changes in mechanical properties are one of the biggest drawbacks of using elastics. Aim: To evaluate the effects of Radiofrequency Electromagnetic Radiation (RF-EMR) on the mechanical properties of intraoral orthodontic elastics under in-vitro conditions. Materials and Methods: This in-vitro study was conducted in the Department of Orthodontics at Saveetha Dental College, Chennai, Tamil Nadu, India, from February 2022 to June 2022. A total of 300 elastics with different diameters and force-exerting abilities were selected and divided into five categories (n=60). The five elastic groups were yellow, blue, green, red, and pink. These elastics were then exposed to EMR emitted from a cellular device for 1.5 hours per day over two days. The mechanical properties of the elastics were tested before and after exposure to EMR. Analysis of variance was used to determine if a significant difference existed between the groups, and Tukey’s post-hoc test was used to determine significant differences in the mean (p-value <0.05). The analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 (SPSS Inc., Chicago, IL, USA). Results: The results of the present study showed a statistically significant difference in rupture strength (p<0.001) and force decay (p<0.001) of the intraoral elastics before and after exposure to EMR. However, there was no change in the thickness and optical properties of all the elastics after exposure. The average remaining force of the intraoral elastics after exposure to EMR emitted from a cell phone device was 41.1% after force decay, and red elastics were the least colour stable, while green elastics were the most colour stable. Conclusion: EMR emitted from mobile phones and other devices can influence the mechanical properties of intraoral elastics in terms of rupture strength, force decay, and colour stability.

Harmonic Scalpel versus Electrocautery and its Outcome in Laparoscopic Cholecystectomy: A Prospective Interventional Study

M Sai Manoj, PK Debata, Ipsita Debata, Sushanta Kumar Das

Introduction: Laparoscopic cholecystectomy can now be performed safely and effectively due to various surgical tools that have significantly reduced intraoperative and postoperative problems. The Harmonic® Scalpel (HS) is a superior option to more conventional Electrocautery (EC) because it reduces temperatures, smoke, and lateral tissue damage. The Harmonic® Scalpel also lowers the risk of injury due to minimal heat dispersion. Due to less trauma, there is a decrease in both moderate and severe bleeding. It is hypothesised that the HS might be a more cost-effective alternative to employing a variety of disposable tools, such as scissors, a clipper, an EC hook, and a grasper. Aim: To compare the effectiveness and safety of the HS compared to traditional EC in achieving complete dissection and haemostasis during laparoscopic cholecystectomies. Materials and Methods: A prospective interventional study was conducted with 300 patients diagnosed with chronic calculous cholecystitis, admitted to a tertiary care hospital under Department of General Surgery, from November 2020 to October 2022. Patients were allocated to two groups, and the outcomes of laparoscopic cholecystectomy were compared between the usage of a HS and EC in Calot’s triangle dissection and Gallbladder (GB) dissection from the GB fossa. Descriptive data were represented through frequencies and percentages. The means of the two groups were compared using t-test, and categorical variables were compared using chi-square test. Results: The mean age was 46.53±13.740 years in the HS group, while it was 45.3±13.961 years in the EC group. The average duration of dissection with a HS was 52.84±6.167 minutes and 56.79±5.582 minutes in the EC group (p-value 0.001). A total of 67 (44.7%) patients in the HS group had minimal or no bleeding, while it was 23 (15.3%) patients in the EC group. GB perforation occurred in 13 (8.7%) patients in the HS group and in 26 (17.3%) patients in the EC group. Liver injury occurred in 2 (1.3%) patients in the HS group and in 6 (4%) patients in the EC group. Postoperative nausea and vomiting were reported in 20 (13.3%) and 72 (48%) patients in the HS and EC groups, respectively, in the first 48 hours. All these associations were found to be statistically significant (p-value 0.001). Conclusion: The present study found that the HS offers a hassle-free dissection without much incidence of intraoperative bleeding or surrounding tissue damage.

Evaluation of the Fracture Resistance Offered by Three Different Intraorifice Barriers on Obturated Teeth: An In-vitro Study

Introduction: The mere placement of a restoration after obturation carries the risk of the presence of voids between them. These voids reduce overall strength and allow for leakage. The placement of Intraorifice Barriers (IOB) between the restoration and the obturated material has been known to have several advantages, including the prevention of microleakage, enhancement of strength, and improvement in Fracture Resistance (FR). Aim: To evaluate if, Smart Dentin Replacement (SDR) flow plus, Resin Modified Glass Ionomer Cement (RMGIC), and Biodentine increase the FR of Endodontically Treated Teeth (ETT) as IOB. Additionally, the study aimed to compare the FR between roots sealed using Endosequence and AH Plus sealers. Materials and Methods: This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India over a period of four weeks, from October 2020 to November 2020. The study sample consisted of 160 mandibular premolar roots instrumented using ProTaper gold rotary files. These roots were obturated with Gutta Percha (GP) and divided into two groups based on the sealer used (Group I=Endosequence; Group II=AH Plus). Each group was further divided into four subgroups, including a control group, with each subgroup receiving an IOB. FR was tested using a universal testing machine, and the forces were statistically analysed using Two-way Analysis of Variance (ANOVA), One-way ANOVA, and posthoc Bonferroni tests. Results: SDR offered the greatest FR values of 583.08 N and 612.13 N in groups I and II, respectively. Roots sealed with AH Plus showed greater FR than those sealed with Endosequence. In both groups, the differences between IOB and the control group in terms of FR were found to be highly significant (p<0.001). Conclusion: SDR showed the greatest FR when compared with RMGIC and BD as IOB in ETT. Teeth restored with SDR and sealed with AH Plus offered the greatest FR.

Role of Serum β-hCG and First Trimester Ultrasonographic Parameters in Predicting Mid-trimester Pregnancy Outcomes: A Prospective Cohort Study

Introduction: One of the concerns in pregnant women is the risk of miscarriage and the psychological sequelae that follow. Screening in early pregnancy can identify future miscarriages in asymptomatic pregnancies. Aim: To study the role of serum Beta-Human Chorionic Gonadotropin (β-hCG) doubling and ultrasonic parameters like Yolk Sac Diameter (YSD), Gestational Sac Diameter (GSD), and Crown-Rump Length (CRL) in predicting mid-trimester pregnancy outcomes. Materials and Methods: A prospective cohort study was conducted at SRM Medical College and Hospital in Tamil Nadu, India, among 381 antenatal women between 6-10 weeks of gestation for a period of two years from December 2017 to July 2019. At baseline, parameters like serum β-hCG doubling titer at 48 hours and ultrasound parameters like YSD, GSD, and CRL were evaluated. The participants were followed-up until 20 weeks of gestation. The results were statistically analysed using sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Results: The mean age of the women included in the study was 25.89±4.2 years, with the majority of women belonging to the 21-29 years age group. Among the enrolled pregnant women, 347 had normal outcomes while 34 experienced pregnancy failure. The results indicated that β-hCG was the strongest predictor of pregnancy outcomes with a sensitivity of 52.9%, specificity of 100%, PPV of 100%, and NPV of 95.6%. YSD predicted loss rates with a sensitivity of 50%, specificity of 97.1%, PPV of 62.9%, and NPV of 95.2%. GSD predicted miscarriage with a sensitivity of 17.6%, specificity of 97.4%, PPV of 40%, and NPV of 92.3%. CRL predicted miscarriage with a sensitivity of 30.5%, specificity of 97.9%, PPV of 61.1%, and NPV of 93.2%. Conclusion: β-hCG, YSD, GSD, and CRL were found to be statistically significant in predicting abnormal pregnancy outcomes. Among the four, β-hCG proved to be the best predictor.

Versatility of Radial Forearm Free Flap in Reconstruction of Different Defects: A Cross-sectional Study

Rojalin Mishra, Rasmi Ranjan Mohanty, Bibhuti Bhusan Nayak

Introduction: The Radial Forearm Free Flap (RFFF) is a commonly used flap for soft tissue reconstruction, offering several advantages despite sacrificing the radial artery in the forearm. Understanding the anatomy of radial artery perforators, including their distribution, territory, and flow is crucial for reliable and safe flap harvest and design. Aim: To describe the versatility and applications of RFFF in reconstructing defects in various body parts. Materials and Methods: This cross-sectional study was conducted in the Department of Plastic and Reconstructive Surgery at SCB Medical College and Hospital, Cuttack, between January 2019 and January 2021, on 39 cases (age group: 20-70 years) who underwent RFFF. RFFF was utilised for reconstruction of the lip, palate, buccal mucosa, tongue, foot, nose, and phallus. Preoperative evaluation included assessing the vascular status of the non dominant hand using the Allen’s test. Results: RFFF was used for postcancer resection reconstruction in 11 cases of buccal mucosa (28.2%), 7 cases of the lip (17.9%), 6 cases of the tongue (15.3%), 2 cases of the palate (5.1%), 2 cases of phallus reconstruction (5.1%), 1 case of post-traumatic nose defect, and 1 case of 1st web space of the hand (2.5%). In 26 cases of postcarcinoma resection reconstruction, RFFF was used for buccal mucosa, lip, tongue, and palate. The patients were followed-up for 2-8 months. Conclusion: RFFF fulfills most of the anatomical prerequisites for an ideal flap, providing a microvascular reconstructive option for patients with large defects in the head and neck, foot and ankle, and phallus. It exhibits a high success rate, good aesthetic and functional outcomes, allowing for the reconstruction of various defects. This study confirms the reliability of the radial free flap as a method for reconstructive surgery.

Histomorphological Spectrum of Various Systems in Sudden Deaths: An Autopsy Study at a Tertiary Care Centre in Gujarat, India

Introduction: The phenomenon of sudden death is a concern, despite tremendous technological advances in healthcare. Sudden death in adults without any past history of chronic illness is increasing worldwide and is a significant issue for medical professionals. In this modernised medical world, diagnostic tools lack precision in comparison to autopsy cause of death when it comes to finding the clinical cause of death. The World Health Organisation (WHO) defines sudden death, according to the International Classification of Diseases, version 10 (ICD-10), as non violent death occurring less than 24 hours from the onset of symptoms, without any other explanation. Aim: To examine the different histomorphological changes observed in autopsy specimens of sudden deaths. Materials and Methods: This retrospective descriptive cross-sectional study was conducted in the Department of Pathology at a Tertiary Care Hospital affiliated with a Medical College in South Gujarat, India. Data was collected from autopsies performed between January 2018 and December 2019, and the study was conducted from January 2020 to December 2021. A total of 430 cases of sudden death were systematically examined during the study period. The autopsy forms were used to retrieve the history, and all slides from the 430 cases were reviewed. The history, gross findings, and microscopic features were noted and entered into an Excel sheet. Results: A total of 1671 autopsies were performed during the study period, out of which 430 were sudden deaths. The most commonly affected age group was 41-50 years, with 114 cases (26.51%), followed by the 31-40 years age group with 101 cases (20.16%). Among the cases, 387 were males and 43 were females, resulting in a male-to-female ratio of 9:1. The most common cause of sudden death was cardiovascular pathology 267 (62.10%). Non cardiac causes were attributed to respiratory system involvement 79 (18.37%), followed by cases where no specific cause was identified 43 (10%), multiple system involvement 28 cases (6.51%), hepatobiliary causes 7 (1.62%), genitourinary system causes 4 (0.94%), and Central Nervous System (CNS) causes 2 (0.46%). Conclusion: The present study revealed a significant number of cases of sudden natural death. Cardiac causes were found to be the major contributor to sudden death, posing a health concern in our society. Atherosclerosis was identified as the main culprit in causing myocardial infarction. Sudden death remains a significant concern, and a meticulous postmortem and histopathological {Haematoxylin & Eosin (H&E)} examination are necessary to determine its cause. To prevent sudden natural deaths, it is essential to educate the population about the importance of undergoing annual health check-ups for early diagnosis and treatment.

Pooled Sera as an Alternative to Commercial Internal Quality Control in Clinical Laboratories

Anita Devi, Anjana Negi

Introduction: Internal Quality Control (IQC) is run to assess the day-to-day performance of an analytical process, ensuring the reliability of patient results. However, commercial internal quality materials can be expensive and inaccessible for many laboratories. Therefore, there is a need for an effective and economical alternative to commercial IQC. Aim: To evaluate the effectiveness and stability of pooled sera as an IQC material. Materials and Methods: A laboratory study was conducted over a period of 50 days, from January 10 to February 28, 2023, in the Department of Biochemistry at Dr. Rajendra Prasad Government Medical College (DRPGMC), Kangra, Himachal Pradesh, India. Serum samples (150 μL) were collected from 100 leftover samples over a span of 10 days. The serum was thoroughly mixed and distributed into 75 aliquots. Commercial IQC was also reconstituted and distributed into 75 aliquots. Both the commercial and pooled sera IQC were stored at -20°C. One aliquot of pooled sera was analysed daily for 16 routine biochemistry parameters, along with the commercial IQC, for the entire 50-day period. The results from both materials were interpreted using L-J chart and Westgard multirule. The stability of pooled sera for these routine parameters was assessed by comparing the mean values of the biochemical parameters on day 1 and day 50. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0 software, and a paired t-test with a p-value <0.05 was considered statistically significant. The bias percentage for each pooled sera parameter was calculated and compared with the desirable bias for clinical significance. Results: Analytical errors were observed during the study period for Alkaline Phosphatase (ALP), urea, sodium, potassium, and chloride. The nature and number of analytical errors observed with both materials were the same, with Westgard rule 1_3s detecting random errors for ALP and rule 2_3s detecting systematic errors for urea and serum electrolytes (sodium, potassium, and chloride). Difference in the mean value of alanine transaminase, aspartate transaminase, and bilirubin, on day 1 and day 50 was statistically significant with p-values 0.035, 0.04, and 0.024, respectively. When these parameters were assessed for clinical bias, they were found to be clinically insignificant. Conclusion: Pooled serum is an effective and stable alternative IQC material for daily performance assessment of analytical processes. In-house IQC or pooled sera not only reduces the cost of quality control but also helps maintain continuity in the absence of commercial IQC, preventing any disruptions in the control system over an extended period.

Effect of Body Fat and BMI on Muscle Strength and Endurance in Young Adults: A Cross-sectional Study

Dipak Kumar Dhar, Brijesh Purwar

Introduction: Muscle strength and endurance are key determinants of physical fitness, cardiometabolic profile, and overall health. Clinically, they are tested by estimating Handgrip Strength (HGS) and Handgrip Endurance (HGE) through an isometric contraction of the flexors of the forearm and hand. Body Mass Index (BMI) and body fat content can both influence muscle performance, but there are wide variations regarding their effects. BMI and body fat also do not show unequivocal similarity to each other. Aim: The aim of this study was to determine and compare the effects of BMI and body fat on muscle strength and endurance. Materials and Methods: A descriptive cross-sectional study was conducted at the Department of Physiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun from April 2019 to March 2020. A total of 100 subjects who fulfilled the selection criteria were included. BMI and body fat were measured, and HGS and HGE were recorded using a handgrip dynamometer. Statistical analysis was performed using SPSS version 17.0. Descriptive statistics, independent sample t-test, and one-way ANOVA were used for comparison. Pearson’s correlation coefficient and linear regression were used to determine and quantify the nature of the effect, with a p-value of ≤0.05 considered statistically significant. Results: The participants had a mean BMI of 23.809±3.798 kg/m2 and a mean body fat percentage of 25.309±7.162%. The mean HGS and HGE of the participants were 36.08±9.956 kg and 18.46±14.2 seconds, respectively. Body fat percentage showed a negative and moderately significant correlation (p-value ≤0.001) with both muscle strength and endurance. Approximately one-fifth of the variations in muscle strength and one-third of the variations in muscle endurance were determined by body fat content. HGS and HGE were higher in males, while body fat percentage was higher in females. Gender variation in body fat contributed to more than 40% of the variance. Conclusion: The study revealed a negative correlation between total body fat and muscle strength and performance. Keeping body fat under control can improve muscle performance, which, in turn, enhances cardiometabolic health.

Evaluation of Adverse Drug Reactions Due to Fixed-dose Combinations at a Tertiary Care Hospital: An Observational Retrospective Study

Introduction: The mushrooming of Fixed-dose Combinations (FDCs) has been observed in the past decade in the Indian market. The majority of these FDCs are irrational and put patient safety at risk. Aim: To evaluate Adverse Drug Reactions (ADRs) due to rational as well as irrational FDCs available in India. Materials and Methods: This was an observational, retrospective study where recorded data of ADRs reported over a period of 10 years (January 2011-December 2021) at the Regional Training Centre and ADR Monitoring Centre (B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India) was analysed. The data evaluation was carried out from May 1, 2022, to December 15, 2022. Any ADR where FDC(s) was the suspected causal drug was included in the analysis. Out of a total of 8,218 reported ADRs in the ten-year duration, 1,575 ADRs were reported to have occurred due to FDCs. The data were analysed for age, gender, System Organ Class (SOC), suspected drug, seriousness of the ADRs, causality assessment, and outcome of ADRs, and presented in terms of numbers or percentages. Results: A total of 1,575 ADRs occurred due to 1,649 FDC(s). The most common SOC class of ADRs was Gastrointestinal (GI) disorders in 359 (23%) cases, followed by skin and subcutaneous disorders in 317 (20%). The common suspected groups were Anti-Retroviral (ARV) drugs in 787 (50%) ADRs, followed by antitubercular drugs in 298 (19%). Out of a total of 1,649 FDCs as the suspected drug, 1,551 (94%) were rational, and 98 (6%) were irrational. A total of 169 (11%) serious ADRs were reported, of which seven ADRs were due to irrational FDCs (prescribed for cold and cough). Causality assessment using the World Health Organisation-Upsala Monitoring Centre (WHO UMC) classification showed a possible causal association with the suspect FDCs for 1,385 (84%) ADRs. Conclusion: FDCs contribute to a significant proportion of ADRs, which could be prevented by avoiding the use of irrational FDCs and monitoring the patients for the possible development of ADRs.

Assessment of Responsibilities of Parents and Healthcare Workers in Routine Immunisation Practices: A Community-based Cross-sectional Study

Introduction: Every year, nearly two million children die before their 5th birthday, with 21.5% of all under five deaths attributed to vaccine-preventable diseases. Approximately 50% of under-vaccinated children come from three countries, including India. In India, the Universal Immunisation Program (UIP) has played a crucial role in eliminating polio and maternal and neonatal tetanus. Both parents and healthcare providers play vital roles in children’s immunisation, with healthcare providers raising awareness about the importance of immunisation and parents understanding its significance. Aim: To estimate and assess the responsibilities of parents and healthcare providers in routine immunisation practices. Materials and Methods: A cross-sectional study was conducted in the Department of Community Medicine, Shivamogga Institute of Medical Sciences (SIMS), Shimoga, Karnataka, India among 153 parents or guardians of children aged six months to five years in urban and rural areas of Shimoga district. A questionnaire designed for the study was used, and a pilot study was conducted to test its effectiveness. The study duration was three months, from July 2022 to September 2022. Socio-demographic details and information on child immunisation were collected. Data were described in terms of frequencies and percentages. The association between knowledge of immunisation and the parents’ residence was tested using the Chi-square test, with a significance level set at p<0.05. Results: Out of 153 children, 46 (31%) were aged between 1 to 2 years. Among the study participants (N=153), 104 (68%) correctly recalled the last vaccine administered to their child, but 117 (76.5%) were unaware of the specific disease it protected against. Additionally, 69 (45.1%) participants were not aware of the four key messages related to immunisation. However, the majority of participants (152, 99.3%) expressed willingness to receive other vaccines. There was a significant (p=0.007) difference in knowledge regarding the retention period of a Mother Child Protection card (MCP) for 16 years between rural and urban areas. Conclusion: The responsibilities of parents and healthcare workers were found to be unsatisfactory. Parents mainly relied on Accredited Social Health Activists (ASHAs) for keeping track of immunisation dates, while healthcare workers failed to communicate all four key messages effectively.

Fetomaternal Outcome of Referred Obstetric Patients in a Tertiary Centre in North East India: A Cross-sectional Study

PM Vandhana, Farzana Zahir, Dhurjyoti Nandan Das, Rajlakhi Khattiya Deori

Introduction: Referral of patients has improved fetomaternal outcomes in developing countries like India. Identifying high-risk obstetric cases, severe maternal complications, and promptly referring them to a centre equipped with Basic Emergency Obstetric and Newborn Care (BEmONC) helps reduce morbidity and mortality. Aim: To examine the clinical profile of referred obstetric patients admitted to a tertiary care centre and analyse the characteristics of admission, referral pattern, level of delay, and their fetomaternal outcomes. Materials and Methods: A hospital-based observational cross-sectional study was conducted from July 1, 2021, to June 30, 2022, at Assam Medical College and Hospital, Dibrugarh in Assam, India. The study included 700 referred obstetric patients from private and public healthcare settings. Variables such as place of referral, referrer (medical officer/self-referral/staff nurse/specialists), delay in referral, reasons for referral, pregnancy period during referral, diagnosis at admission and referral, availability of proper referral documents, and fetomaternal outcomes such as mode of delivery and gestational age at delivery were assessed. Categorical variables were summarised as proportions and percentages. Results: Out of the total 18,245 obstetric admissions during the study period, approximately 14,500 patients were referred, accounting for 80% of all admissions. Among the 700 study participants, 616 (88%) referrals were from nearby public sectors. A total of 147 (21%) experienced delay due to transportation. 644 (92%) had referral slips, but only 224 (32%) had proper documentation. A number of 322 (46%) were intrapartum referrals. A total of 350 (50%) were primigravida, while 344 (49%) were multigravida. Apart from these 694 pregnant mothers, six referrals were for babies without any maternal complications or high risk factors. 112 (16%) referrals were for cases of IUGR and oligohydramnios, and 98 (14%) were preterm referrals. A total number of 276 (47%) deliveries were performed via caesarean section. A total of 35 patients were discharged antepartum, and there were nine maternal deaths. Additionally, 148 neonates required ICU admissions, 225 were preterm, and 558 babies were discharged. Conclusion: Referrals were made for both maternal and foetal causes. The majority of obstetric admissions in our institution were referrals, resulting in an increased delivery rate and a higher trend of caesarean section. The presence of a well-equipped NICU also contributed to the referral pattern.

Comparison of Vantej and Dente 91 Toothpastes in the Management of Dentin Hypersensitivity: A Randomised Clinical Trial

Introduction: Dentinal hypersensitivity is a prevalent and distressing dental condition characterised by acute, transient pain or discomfort arising from exposed dentin in response to external stimuli, such as variations in temperature, mechanical stimuli, or consumption of acidic or sweet foods. Dentinal Hypersensitivity (DH) impacts daily activities, such as eating, drinking, and oral hygiene practices. Dentifrices are commonly used in the treatment of hypersensitivity, as they relieve sensitivity by obstructing nerve pathways through the formation of compounds. Aim: The aim of the study is to evaluate and compare the efficacy of two types of desensitising toothpastes, Vantej and Dente 91, in treating DH. Materials and Methods: A randomised controlled clinical trial was conducted with 40 patients who had a minimum of two hypersensitive teeth. The clinical investigation took place in a dental set-up in Bhubaneswar, Odisha, from July to August 2022. The patients were randomly allocated to two groups (20 in each group) in a 1:1 ratio for the Vantej and Dente 91 groups. Over a four-week period, the patients were instructed to use the prescribed toothpaste twice daily. DH assessment techniques included a Verbal Response Scale (VRS), air blast stimulation, and cold stimulation, both at baseline and after the four-week duration. Statistical analyses were performed using the Mann-Whitney U test and Wilcoxon signed-rank test, with the significance level set at p<0.05. Results: The fourth-week scores compared to baseline scores for the verbal scale, air blast stimulus, and cold sensitivity methods in both groups showed a reduction in DH. In the inter group comparison, the Dente 91 group exhibited greater effectiveness compared to the Vantej group, with a significant reduction in VRS (p=0.02) and air blast stimulus (p=0.01), but not in cold sensitivity (p=0.09). Conclusion: Both Vantej and Dente 91 toothpastes significantly reduced dentinal hypersensitivity. However, the percentage reduction was higher in the latter group, suggesting more effective management of DH. Dente 91 could be considered a promising alternative to the existing over-the-counter desensitising toothpastes.

Opioid Dependence Syndrome and Quality of Life: A Facility-based Exploratory Study among Drug Addicts at a Tertiary Care Hospital of Kolkata, India

Manika Pal, Dipendra Narayan Goswami, Madhumita Dobe

Introduction: Opioid dependence syndrome is considered a chronic-relapsing medical illness that can affect the Quality of Life (QoL) of Injecting Drug Users (IDUs). They are at risk of contracting Human Immunodeficiency Virus (HIV) due to unsafe injection practices. Opioid Substitution Therapy (OST) is an effective treatment option for opioid dependence as well as HIV prevention and intervention among IDUs, subsequently improving their QoL. Aim: To identify the opioids injected by addicts and evaluate QoL across different life areas among IDUs attending an OST centre. The authors also aimed to determine the factors affecting QoL regarding relationships with family and friends. Materials and Methods: A facility-based, observational cross-sectional study was conducted on 168 IDUs at an OST centre in Calcutta National Medical College from April 2016 to March 2018. A predesigned and pretested structured schedule was used, which included socio-demographic characteristics, pattern of substance abuse, and HIV status. To evaluate QoL, the authors used a Likert scale with five domains specific to chronic diseases. Logistic regression was employed to determine associated factors with two QoL domains regarding relationships with family and friends. The Statistical Package for Social Sciences (SPSS) version 16.0 was used for data analysis. Results: The mean age {Standard Deviation (±SD)} of the study participants was 36.53±9.514 years. The most common opioids injected by IDUs were buprenorphine (89.2%). Although QoL scores varied across different domains, it can be interpreted that the majority of participants had poor QoL. When assessing QoL in terms of relationships with family and friends, there was a significant association between better QoL and financial support {Adjusted Odds Ratios (AOR) Confidence Intervals (CI)} 2.550 (1.431-6.082), favourable living arrangements AOR(CI) 2.450 (1.010-4.443), and absence of seropositivity AOR(CI) 2.462 (1.141-7.476). Conclusion: Buprenorphine was the most common substance of abuse among IDUs. The study revealed a high proportion of IDUs with poor QoL. The findings of the study might be helpful in designing appropriate strategies to improve personal relationships and social situations among IDUs.

Association between Migraine Patterns and White Matter Hyperintensities in MRI Brain: A Cross-sectional Analytical Study

Jibin Antony, Athul Damodaran Namboothiri, Lenythomas Mathew

Introduction: Migraine is a neurological condition characterised by recurrent episodes of headaches. The role of Magnetic Resonance Imaging (MRI) as a diagnostic tool in evaluating migraines is yet to be fully understood. Changes that occur in the blood vessels during a migraine attack lead to hypoperfusion in the brain, causing neurovascular dysfunction and cortical spreading depression. These events are manifested as White Matter Hyperintensities (WMHs) in brain MRI. Aim: To determine the association between migraine patterns and WMHs in the MRI brain scans. Materials and Methods: A cross-sectional analytical study was conducted at Department of Neurology, Mar Baselios Medical Mission Hospital, a tertiary care centre for Neurology and Movement disorders in South India, from June 2021 to June 2022. The study included 100 patients aged between 18 and 50 years who had been diagnosed with migraine. A questionnaire was prepared, which included various parameters such as the presence or absence of aura, duration, frequency, tolerability, disability, intensity of pain, nausea, and resistance to treatment. The severity of migraine in the patients was evaluated using the Migraine Intensity and Severity Evaluation (MIGSEV) scale, which considers parameters such as pain intensity, attack duration, nausea, disability, tolerability, treatment resistance, and attack frequency. Based on this assessment, patients were classified into Grade I, II, or III. After obtaining informed consent, MRI brain scans were performed on all patients. Patients exhibiting WMHs underwent Gadolinium IV contrast, and those with contrast-enhancing lesions underwent whole spine screening and CSF analysis testing. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for data analysis. The statistical tests employed included the Mann-Whitney test, Kruskal-Wallis test and Spearman coefficient. Results: The mean age of the participants was 28.60±7.0 years. WMHs were present in 47 out of 100 patients (47%). A significant association was observed between WMHs and aura (U=487.50) (p-value <0.001). Multivariate analysis revealed that migraine severity grade, pain intensity during the attack, nausea, disability, tolerability, migraine duration, and resistance to treatment were statistically significant with a p-value of <0.001. Conclusion: WMHs in MRI were more significant in patients with Grade III MIGSEV scores. There was a statistically significant association between the number of WMHs, high intensity of pain, vomiting, severe disability, and tolerability during a migraine attack. Therefore, these parameters can be considered as risk factors for developing WMHs in the brain MRI of migraine patients.

Comparison of Recovery Profile and Cost-effectiveness of Sevoflurane and Desflurane using Low Flow Anaesthesia in Adults: A Randomised Clinical Study

Aparna Rao, Shweta Konnur, Abhay Sancheti

Introduction: Newer inhalational agents, like sevoflurane and desflurane, offer advantages of rapid induction and early recovery due to their low blood gas solubility. However, cost remains a major drawback of these agents, despite the reduction in agent consumption achieved through low flow anaesthesia. Aim: To evaluate the recovery profile and cost-effectiveness of sevoflurane and desflurane using low flow anaesthesia in adults. Materials and Methods: A randomised clinical study was conducted at, Department of Anaesthesia, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India, during October 2019 to August 2021, with 60 patients classified as American Society of Anaesthesiologists (ASA) I or II, aged 18-65 years, undergoing elective surgeries lasting 1-4 hours under general anaesthesia with the low flow technique. Group S received sevoflurane, while group D received desflurane. Anaesthesia was maintained using a 50/50 mixture of oxygen/air and either sevoflurane or desflurane, depending on the group. The inhalational agents were titrated intraoperatively to achieve a Minimum Alveolar Concentration (MAC) of approximately one. The amount of inhalational agent consumed was calculated, and recovery profiles were studied. The means of continuous variables were compared using an Independent sample t-test, with p-values <0.05 considered significant. Results: In Groups S and D, the mean ages were 39.17 years and 41.5 years, and the percentages of males were 30% and 50%, respectively. The mean times to swallowing, spontaneous eye opening, limb movements, establishing spontaneous regular breathing, responding to verbal commands, extubation, stating a name on command, and achieving a modified Aldrete score ≥9 in minutes were 6.13, 4.87, 5.07, 4.57, 7.40, 8.97, 10.40, and 11.50, respectively. These values were significantly lower in group D. The mean cost per hour and average volume consumption were significantly higher in group D. Conclusion: The study concludes that desflurane provides faster and better recovery from anaesthesia. Although the total cost of desflurane was higher compared to sevoflurane, its use can be beneficial for faster emergence, early transfer from the Post Anaesthesia Care Unit (PACU), and earlier discharge from the hospital.

Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India

Gincy Ann Lukachan, Anita Mathew, Deepak Varughese, Ashu Sara Mathai

Introduction: Optimal intraoperative fluid therapy can reduce postoperative complications and improve patient outcomes. The Enhanced Recovery After Surgery (ERAS) protocols emphasise fluid restriction. However, the recent randomised clinical trial (RELIEF trial) found a higher incidence of Acute Kidney Injury (AKI) with restrictive fluid therapy. Both excessive and restricted fluid therapy have adverse consequences. Despite various guidelines on perioperative fluid therapy, there is still wide variation in practise. Aim: To describe the volumes and types of intravenous fluids used during major abdominal surgeries and evaluate the association of intraoperative fluid administration with postoperative complications. Materials and Methods: This retrospective cohort study was conducted in a multispecialty tertiary care hospital in Thiruvalla, Kerala, India. The study collected data on volumes and types of fluid used in adults undergoing major abdominal surgeries over a one-year period. The incidence of postoperative complications, specifically Postoperative Ileus (POI), Surgical Site Infections (SSI), cardiac complications, and respiratory complications, was noted. The factors affecting intraoperative fluid intake were assessed using the Wilcoxon signed-rank test. Logistic regression was performed to determine associations between preoperative and intraoperative variables and postoperative complications. Adjusted Odds Ratios (OR) and Confidence Intervals (CI) were calculated. Results: The study included 133 patients with complete data. The mean age of the cohort was 62±18 years, and 69 (52%) patients were males. Patients received a median (IQR) total intraoperative fluid of 3000 (2000-4000) mL with a median infusion rate of 8.77 (6.39-12.35) mL/kg/hr. The majority (132 patients, 99%) received balanced salt solution (ringer lactate) as the main crystalloid. The volume of intravenous fluids infused intraoperatively was significantly greater in emergency surgeries (p-value=0.007), open surgical approaches (p-value <0.001), and surgeries under regional anaesthesia (p-value=0.012). The most common complication in this cohort was POI (38%), which had a significant association with the duration of the surgery (p-value=0.002). Cardiac complications were linked to the volume of intraoperative fluid intake (p-value=0.022), while respiratory complications were predominantly linked to upper abdominal surgeries (p-value=0.049). Conclusion: The volume of intraoperative fluids administered in major abdominal surgeries varies with the type of surgery (elective versus emergency, open versus laparoscopic) and anaesthesia (regional/general) and significantly impacts patient outcomes after surgery.

Management of Dermoid Cysts in Pregnancy at a Tertiary Care Centre: A Retrospective Observational Study

Tamma Anusha Reddy, SL Arathy RaJ, Minakshi Kumari, Swati Rathore, K Beena

Introduction: Ovarian masses are not uncommon in pregnancy. The increased use of Ultrasonography (USG) in recent years has led to the detection of asymptomatic ovarian masses in pregnant women. Dermoid cysts are the most common type of ovarian germ cell tumour in pregnancy. Most of them are asymptomatic and are incidental findings. However, a few can present with complications such as torsion and rupture. The diagnosis and management of dermoid cysts in pregnancy present a clinical dilemma. Aim: To evaluate the management and outcomes of antenatal patients diagnosed with dermoid cysts. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Christian Medical College, Vellore, Tamil Nadu, India, from January 2015 to January 2022. The study included 37 patients, and data regarding the diagnosis of dermoid cysts, their radiological and clinical characteristics, management, and pregnancy outcomes were collected from the electronic database. Descriptive statistics were used for reporting demographic and clinical characteristics. Categorical variables were presented as numbers with percentages, while continuous variables were presented as mean with Standard Deviation (SD) or median with Interquartile Range (IQR). Results: The dermoid cysts ranged in size from 2.2 cm to 30 cm, with a mean size of 7.28±4.51 cm. A total of 35 (95%) of them were incidentally detected. USG was the imaging modality used for diagnosis and follow-up. Only 30% (11/37) of the patients required surgical intervention during the antenatal period. Torsion was the indication for emergency surgical intervention in 46% (5/11) of cases. Laparoscopy was the preferred approach for surgical intervention in 91% (10/11) of patients. The remaining 70% (26/37) of patients were managed conservatively with serial USG, and no adverse outcomes were reported. Among the patients who underwent caesarean section for obstetric indications, 35% (13/37) also underwent surgical intervention for the dermoid cyst (either cystectomy or oophorectomy) during the same procedure. Conclusion: Antenatal patients diagnosed with dermoid cysts during pregnancy can be managed conservatively with serial USG, with a plan for surgical intervention if needed. In cases where surgical intervention is required, it can be safely performed as a laparoscopic procedure. In case of complications such as torsion, laparoscopy can be performed during pregnancy with appropriate precautionary measures.

Profile of Acute Poisoning in Adolescents from Southern India: A Prospective Cohort Study

Introduction: Poisoning in children is an important paediatric emergency and a worldwide problem. Poisonings from intentional substance abuse, as well as unintentional toxic exposures, remain significant health concerns for hospital emergency admissions. Understanding the precipitating causes and providing timely counseling play a key role in preventing intentional poisoning in adolescents. Aim: To study the profile of acute self-poisoning in adolescents and factors associated with poisoning. Materials and Methods: A hospital-based prospective cohort study was conducted at Vanivilas Hospital, which is affiliated with Bangalore Medical College and Research Institute in Bengaluru, India. The study duration was from November 2018 to June 2020. The study included 100 adolescents, aged 10-18 years, who were admitted with a history of poisoning during the 18-month study period. Informed consent was obtained, and participants were followed-up until discharge. Data was collected using a proforma that included demographic details, information about poisoning, examination findings, investigations, and treatment given. The data was analysed using descriptive statistics, and the Chi-square test was used to determine associations between variables. Results: The mean age of the study participants was 15.48 years. The maximum number of cases, 53 (53%), were seen in the 13-16 years age group, followed by 36 (36%) in the age group of 17-18 years, and 11 (11%) in the age group 10-12 years. There were 33 (33%) male children and 67 (67%) female children. In the present study, 43 (43%) children belonged to the insecticide group, 30 (30%) to the drugs group (most of them were in combination), 14 (14%) to the household group, 4 (4%) belonged to both the plant and unknown group, and 2 (2%) belonged to the corrosive, and 1 (1%) each for herbicide, hydrocarbon, and metal groups. A total of 87 (87%) cases were discharged after completion of treatment, 8 (8%) cases were discharged against medical advice, and the mortality rate was 5 (5%). The majority of the cases, 79 (79%), consumed poison as an impulsive act secondary to conflicts among family members. Conclusion: The present study found that acute poisoning in adolescents is mostly intentional, with insecticides being the most commonly implicated agents.

Evaluation of Serum Creatinine and Serum Uric Acid in Hypothyroid Patients: A Cross-sectional Study

Introduction: Hypothyroidism, a prevalent endocrine disorder, leads to a generalised metabolic slowdown due to insufficient thyroid hormone production, potentially resulting in elevated levels of serum uric acid and creatinine, thus affecting renal function and purine metabolism. Aim: To assess serum creatinine and serum uric acid levels in hypothyroid patients while establishing correlations with their thyroid-stimulating hormone (TSH), Free Triiodothyronine (FT3), and Free Thyroxine (FT4) levels. Materials and Methods: A comparative cross-sectional study was conducted in the Department of Biochemistry, Government Medical College, Kozhikkode, Kerala, India. The study involved 140 participants, including 70 recently diagnosed hypothyroid patients and 70 age- and sex-matched euthyroid individuals. Thyroid hormone levels (FT3, FT4) and TSH were quantified using the Cobas e411 electro-chemiluminescence technique. Serum creatinine levels were measured using the Modified Jaffe’s method, and serum uric acid levels were assessed through the Uricase method (Enzokit). Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, and tables and graphs were generated using Microsoft Word and Excel. Results: The mean age of study participants of control group was 39.02 years and of the hypothyroid group was 36.80 years. The comparative cross-sectional analysis revealed significantly higher levels of serum uric acid and serum creatinine in hypothyroid patients compared to euthyroid controls. Specifically, hypothyroid patients exhibited a mean serum uric acid level of 10.77±2.34 mg/dL, while euthyroid controls had a mean of 4.37±0.94 mg/dL. Mean serum creatinine levels for hypothyroid patients and euthyroid controls were 2.16±0.80 mg/dL and 0.75±0.14 mg/dL, respectively. Notably, a significant positive correlation was observed between serum uric acid and serum creatinine levels with TSH (r=0.42, p-value <0.001 and r=0.45, p=0.00, respectively). Conclusion: The study identified significantly higher levels of serum uric acid and creatinine in hypothyroid patients compared to euthyroid individuals, potentially attributed to haemodynamic changes and disruptions in purine metabolism. Regular monitoring of these parameters is crucial for individuals with hypothyroidism.

A Cross-sectional Observational Study to Assess the Influence of 1% Cyclopentolate and 1% Tropicamide on Intraocular Pressure in Children Undergoing Cycloplegic Refraction at a Tertiary Care Hospital in Southern India

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value ≤0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p≤0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve.

Postoperative Assessment of Cognitive Dysfunction in Patients Undergoing Transurethral resection of the Prostate under Spinal Anaesthesia: A Prospective Cohort Study

Introduction: Postoperative Cognitive Dysfunction (POCD) is a common disorder following surgery that threatens the quality of patients’ lives. POCD is closely associated with perioperative factors such as age, physical state, surgery duration, anaesthesia method, intraoperative hypotension, and infection. Among these factors, age is the only long-term risk factor for POCD. The relationship between anaesthesia depth and the incidence of POCD is debatable. Aim: To assess POCD in patients undergoing Transurethral Resection of the Prostate (TURP) and to examine the association between the duration of surgery and serum sodium levels with cognitive dysfunction. Materials and Methods: A prospective observational study was conducted at the Department of Anesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The study included 100 patients aged over 60 years who were scheduled for TURP surgery under Spinal Anaesthesia. The Mini-Mental State Examination (MMSE) test was performed in the preoperative holding area, and the results were recorded. A decline in cognitive function was defined as a loss of 2 or more points on the MMSE test compared to the preoperative value. Serum sodium levels and MMSE scores were measured before surgery. Serum sodium levels and MMSE scores were also recorded after the 1st hour and 6th hour postoperatively. The data were entered into MS Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: In the present study, out of 100 subjects, the majority of patients (33%) belonged to the age group of 66-70 years, and most of the study subjects (79%) were classified as American Society of Anesthesiologists (ASA) II status, followed by ASA III status. The mean age of the study participants was 69.3 years. The mean duration of surgery was 45.6 minutes. A statistically significant difference (p<0.05) was observed when comparing the mean serum sodium levels before surgery (138.1±1.5 mmol/L) with those at the 1st hour postoperatively (135.9±1.6 mmol/L) and 6th hour postoperatively (134.4±1.4 mmol/L). The mean MMSE score before surgery and at the 1st hour and 6th hour postoperatively was the same (27.6±0.8), and there was no statistically significant difference between them. The MMSE score did not vary with the serum sodium levels, and this difference was not statistically significant (p>0.05). Conclusion: In the present study, patients undergoing TURP procedures under spinal anaesthesia did not exhibit any POCD, despite a considerable drop in serum sodium levels. It is worth noting that all patients were asymptomatic.

Potential Determinants of Mass Shooting Perpetration and Casualties: A Systematic Review

Wit Wichaidit

Introduction: In the United States (US), mass shootings could be regarded as a public health issue due to their ubiquitous and public nature. Social-ecological models, commonly used to explain health behaviours, can contribute to the understanding of potential determinants of mass shootings based on current evidence. Aim: To conduct a systematic review on factors associated with the perpetration of mass shooting events and casualties (injuries or fatalities) at mass shooting events. Materials and Methods: The author searched the literature on PubMed using the term “mass shooting”. Inclusion criteria included titles containing the words “shoot*,” “firearm*,” or “gun*,” having an abstract or full text, and the study being either primary research or secondary data analysis on the perpetration or casualties of mass shootings. Results: The author reviewed 36 articles, nearly all of which focused on mass shootings in US. For the perpetration of mass shootings, gun ownership and access were present at all levels of the social-ecological model. Other factors for perpetration included mental illness, relationship issues, and permissive firearm laws. Mass shooting casualties were associated with the use of high-powered firearms at the intrapersonal level and permissive firearm laws at the policy level. Conclusion: Firearms-related factors were associated with both the perpetration and casualties of mass shootings at various levels of the social-ecological model. However, caveats, including a limited time frame of the review, limited sources of publications, and subjectivity in building the social-ecological model, should be considered in the interpretation of the study findings.

Morphometric analysis of the Proximal End of the Dry Adult Tibia : A Cross-sectional Study from Eastern India

Rashmi Rani Pradhan, Sushma Korukonda, Gopal Chandra Patro, Jami Sagar Prusti

Introduction: The morphometric measurement of the proximal tibia plays an important role in determining the clinical outcome of Total Knee Arthroplasty (TKA), including long-term survivorship and quality of life for patients. However, due to ethnic and geographical variations in these measurements, findings from western countries cannot be directly applied to the Asian population or any other subpopulation. Aim: To describe the anatomical morphometry of the proximal tibia in the East Indian population and to explore any associations of these measurements with sex and laterality. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, MKCG Medical College, Berhampur, Odisha, India, from August 2020 to August 2022. A total of 200 fully ossified, dry, and processed bones from both sides, which were grossly normal and complete, were obtained from the Department of Anatomy of various medical colleges in Odisha, India. Different measurements of the tibia, such as Mediolateral Length (ML), anteroposterior length of the medial and lateral condyles, circumference, intercondylar region, and tibial tuberosity, were measured using standard procedures and standardised vernier calipers. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM Corporation, Armonk, New York, USA). A comparison of means between two groups was conducted using an independent sample t-test, and correlation between two quantitative variables was assessed using Pearson correlation. Results: Out of the included bones, 114 (57%) were male tibiae, and 116 (58.0%) were right-side tibiae. The ML, anteroposterior length of the lateral and medial condyles, intercondylar area, tibia to tibial tuberosity length, and circumference were measured as 67.91 mm, 39.44 mm, 42.72 mm, 42.73 mm, 33.48 mm, and 19.37 mm, respectively. The ML showed a significant positive correlation (p-value <0.001) with the anteroposterior length of the lateral tibial plateau, medial tibial plateau, and intercondylar area, with correlation coefficients (r) values of 0.726, 0.762, and 0.747, respectively. All morphometric parameters were comparable between the right and left sides of the tibia. ML, anteroposterior length of the lateral and medial condyles, intercondylar area, circumference, and tibia to tibial tuberosity length were significantly higher in males compared to females. Conclusion: This study provides a description of the morphometric parameters of the tibia among the Eastern Indian population. Although there was no significant difference in laterality, the parameters of male tibiae were significantly higher compared to females.

Altered Liver Function Test in Type 2 Diabetes Mellitus Subjects and its Association with Dyslipidaemia and Fasting Blood Sugar: A Cross-sectional Study

S Ramya, S Sindu Priya, Arun Kannan Selvaraju

Introduction: Multiple organ systems are affected due to the metabolic dysregulation associated with Diabetes Mellitus (DM). Altered lipoprotein metabolism and liver enzymes have been identified as independent risk factors for the development of Cardiovascular Disease (CVD). Routine screening of liver function and ultrasound imaging of the liver should be done at the time of diagnosis of type 2 DM and thereafter at regular intervals. Aim: To determine the association between liver function parameters and glycemic status in type 2 diabetics. Additionally, the study aimed to correlate liver enzymes and lipid profiles in Type 2 DM patients. Materials and Methods: A cross-sectional study was conducted from August 23rd, 2021 to October 23rd, 2021 on 100 Type 2 diabetic patients attending the diabetic Outpatient Department of Biochemistry, at Annapoorana Medical College and Hospital, Salem, Tamil Nadu, India. Fasting glucose, total cholesterol, triglyceride, and High-Density Lipoprotein Cholesterol (HDL) were measured using the direct enzymatic method, while Low-Density Lipoprotein Cholesterol (LDL) was calculated using Friedewald’s formula. Total bilirubin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), total protein, and albumin were analysed using the ERBA EM-200 auto analyser based-on the wet chemistry principle. Pearson’s correlation analysis was performed to examine the relationship between variables. Results: Among the total of 100 type 2 diabetic patients who participated in present study, 59 were males and 41 were females. The mean±SD age of diabetic patients was 51.23±10.810 years, ranging between 35 and 76 years. The frequency of altered liver enzymes in the study sample was found to be 33, with 25 being males and 8 being females. The mean fasting blood sugar levels with normal liver function and abnormal liver function were observed to be 128.37±13.16 mg/dL and 133.79±15.68 mg/dL, respectively, but the difference was not statistically significant. The mean values of total cholesterol, triglyceride, and low-density lipoprotein with normal liver function were observed to be 137.18±34.44 mg/dL, 175.12±65.19 mg/dL, and 75.55±9.78 mg/dL, respectively, while with abnormal liver function, they were observed to be 196.05±52.67 mg/dL, 143.28±47.63 mg/dL, and 138.83±38.11 mg/dL, respectively, showing statistical significance. Conclusion: The present study found a strong association between deranged liver enzymes with fasting blood sugar and dyslipidaemia.

Clinicomicrobiological Profile and Antibiotic Susceptibility Pattern of Burkholderia cepacia Complex Isolates from a Tertiary Care Hospital in Southern India: A Cross-sectional Study

Suja Star Padma, B Appalaraju, R Someshwaran

Introduction: Burkholderia cepacia Complex (BCC) is a group of Gram negative betaproteobacteria with complex taxonomy that causes healthcare-associated infections and hospital outbreaks. BCC is the fourth most pathogenic non fermentative Gram negative bacilli worldwide, following Burkholderia cepacia, Acinetobacter baumannii, and Stenotrophomonas maltophilia, with a prevalence ranging between 10-20% for non fermentative Gram negative bacilli and 5-15% for BCC. Human infections are caused by 22 known species and 14 novel species. Pulmonary BCC infections lead to “Cepacia syndrome,” a fatal illness that results in progressive respiratory failure and necrotising pneumonia, leading to early death in 20% of cases. Aim: To emphasise the disease burden and clinical outcomes of BCC infections, as well as to assess the performance of various methods for BCC detection. Materials and Methods: A cross-sectional study was conducted at PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. A total of 91,778 samples were received between April 2021 and December 2022, over a period of one year and nine months, to determine the disease burden of BCC. The identification of BCC was carried out using manual culture and sensitivity, VITEK®-2 ID/AST system, Matrix Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-ToF-MS), recA gene virulence determinant by Polymerase Chain Reaction (PCR), and 16S Ribosomal ribonucleic acid (rRNA) sequencing. Out of 115 manually identified BCC isolates, 56 (48.70%) underwent automated Vitek® 2 ID/AST, MALDI-ToF-MS, recA gene PCR, and 16S rRNA sequencing for identification and characterisation. The results were entered into Microsoft Excel, and statistical analysis was performed using the International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 28.0. Results: Culture positivity was observed in 16,949 samples (18.47%), among which 3,387 (29.25%) were non fermentative gram negative bacilli. The incidence of Burkholderia spp. isolation was 115 (3.4%) out of 3,387 non fermentative gram negative bacilli. The prevalence of BCC among the study population was 115 (0.13%) out of 91,778. Conclusion: BCC, causing a wide array of infections, results in profound morbidity and mortality, especially in hospital settings. Early identification using Vitek-2 and MALDI-ToF-MS, along with molecular methods like PCR and 16S rRNA sequencing, could be the key to confirming the diagnosis and initiating appropriate management.

A Study on Subsite-specific Prevalence of Candidiasis in Head and Neck Cancer Patients and its Antifungal Susceptibility Pattern: A Cross-sectional Study

Neethu Babu, Chitralekha Saikumar, Jomon Raphael Chalissery

Introduction: The incidence of candidiasis can vary across various subsites within the head and neck region and is associated with various co-morbidities and risk factors. The increase in the incidence of resistant Non-albicans Candida (NAC) species among these patients and the limited number of available antifungal agents make treatment difficult. A better understanding of the subsite-specific prevalence of candidiasis and its antifungal susceptibility is crucial in enhancing effective control and treatment. Aim: To determine the subsite-specific prevalence of candidiasis among Head and Neck Cancer (HNC) patients undergoing radiotherapy. Materials and Methods: A cross-sectional study was conducted on patients undergoing therapy for head and neck malignancies at the Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India over a four-year period (January 2019 to December 2022). A total of 276 patients aged 18 to 85 years with squamous cell carcinoma were included. Oral samples were collected from patients who developed candidiasis, and co-morbidities and risk factors were documented. Candida species were isolated and identified. Antifungal susceptibility was determined using the VITEK system, and fluconazole susceptibility was compared with the standard disc diffusion method. Data were entered into an Excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) software. Results: Pharynx was the most frequent site of head and neck malignancy, accounting for 104 cases (37.7%), followed by the oral cavity with 83 cases (30.1%). Among patients with malignancies in the pharyngeal region, a high rate of Candida infection was observed in 42 (43.3%) out of 97 cases. Candida species isolated included C. albicans (56, 57.7%), C. tropicalis (26, 26.8%), C. krusei (8, 8.3%), C. glabrata (3, 3.1%), and C. parapsilosis (4, 4.1%). Sixty-five patients (23.5%) had diabetes, which was statistically significant (p-value <0.05). All C. albicans strains were sensitive to fluconazole. The Minimum Inhibitory Concentration (MIC) of voriconazole was very low for all tested Candida species. Conclusion: Patients with pharyngeal and oral cavity carcinomas are at an increased risk of developing candidiasis during radiotherapy. Diabetes is significantly associated with candidiasis. While C. albicans was the most common species isolated, a significant number of NAC species were also identified. Voriconazole exhibited low MIC values for C. krusei and C. glabrata, suggesting its potential as an alternative treatment option. Obtaining VITEK system identification and susceptibility reports is advisable for borderline values that may not be evident using conventional disc diffusion methods.

Prevalence of Thyroid Dysfunction in Patients with Gallstone Disease: A Cross-sectional Study

Introduction: Patients with gallstone disease have already been investigated for the prevalence of previously undetected thyroid dysfunction, and the findings point to a possible link between hypothyroidism and gallstone disease. This research was carried out to support the need for assessment of the thyroid status in patients presenting with gallstones. Aim: To determine the prevalence of thyroid disorders and to study the relationship between thyroid dysfunction and sociodemographic variables in patients with gallstone disease. Materials and Methods: A cross-sectional, observational, hospital-based study was carried out at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, in 117 patients with gallstones from January 2021 to June 2022. The sampling method was consecutive sampling. Standard baseline investigations and thyroid profiles were conducted. Operative and perioperative factors such as age (ranging from 18-80 years), sex, co-morbidities, radiological findings (number and size of stones, presence of Common Bile Duct (CBD) stones), thyroid profile, surgeries performed, and significance (p-value) of these factors were assessed based on the Chi-square test. Results: The mean age of participants was 44 years. There were 37 (68%) males and 80 (32%) females. Of the 117 patients, 49 patients (41.9%) were found to have hypothyroidism, and the remaining 68 patients (58.1%) were euthyroid. Among these 49 patients, only 15 were known to have hypothyroidism, while the remaining 34 patients were newly diagnosed. Of the 49 patients, 30 were females and 19 were males. There was no significant association between hypothyroid state and gallstone formation in either males (p-value: 0.154) or females (p-value: 0.194). Conclusion: A low prevalence of hypothyroidism was observed in both sexes. Further large population studies are needed to compare these findings.

Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study

Introduction: Total Knee Arthroplasty (TKA) is a routinely used procedure for the management of knee osteoarthritis. Various haemodynamic changes can occur during TKA, especially during cementing and tourniquet deflation, which can have a significant impact on the patient’s clinical condition. This study emphasises the importance of close haemodynamic monitoring for the timely detection of potential complications during this procedure. Aim: To evaluate the haemodynamic changes occurring during spinal anaesthesia, bone cementation, and tourniquet deflation using Transthoracic Echocardiography (TTE) along with routine non invasive haemodynamic monitors in patients undergoing TKA. Materials and Methods: The present study was a prospective, observational single-arm study conducted at a tertiary care centre from February 2019 to March 202.Thirty patients of either sex, belonging to American Society of Anaesthesiologists physical status I (aged between 40-70 years) and scheduled for TKA under regional anaesthesia, were enrolled in the study. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), SpO₂ levels, respiratory rate, and End-Tidal CO₂ (EtCO₂) were recorded at various time intervals, including baseline value, after spinal anaesthesia, before cement implantation, after cement implantation, before tourniquet deflation, after tourniquet deflation, and at the end of the surgery. Blood gas analysis and TTE were recorded preoperatively, five minutes after cementation, and five minutes after tourniquet deflation. Data were collected and analysed using Student’s t-test for continuous variables and Chi-square test or Fisher’s exact test for nominal categorical variables. Statistical analysis was performed using the SPSS statistical package (version SPSS 17.0). Results: The mean age, weight, and height of the patients were 54.46±6.78 years, 66.43±5.31 kg, and 152.5±7.71 cm, respectively. The mean HR increased from 82.27±6.11 beats/minute to 101.43±5.23 and 104.33+4.70 beats/minute after three and six minutes of cementation (p-value=0.001). The mean SBP increased from 121.67 mmHg to 144.13 mmHg and 138.87 mmHg after three and six minutes of cementation (p-value=0.001). The preoperative mean pH was 7.44, which decreased to 7.39 at five minutes after cement implantation and 7.38 after five minutes of tourniquet deflation (p-value=0.001). The preoperative mean PaCO₂ value was 44.83 mmHg, which increased to 62.30 mmHg after five minutes of cement implantation and 55.17 mmHg after five minutes of tourniquet deflation (p-value <0.05). Conclusion: There was a significant increase in HR, blood pressure, and PaCO₂, as well as a decrease in pH after bone cement implantation. However, TTE performed at various time points did not suggest any significant changes during TKA. Hence, this study demonstrates that routine haemodynamic monitoring is sufficient, and no additional monitoring like ECHO is required in ASA 1 patients undergoing TKA.

Comparison of Levels of Telomerase, Oxidative Stress, Adiponectin, Leptin, and Interleukin-6 in First Degree Relatives of Diabetics, Prediabetics, and Diabetics: A Cross-sectional Study

Introduction: Rapid beta-cell senescence caused by telomere shortening is associated with type 2 diabetes. Hence, studying telomere dynamics in prediabetic stages or First Degree Relatives of Diabetics (FDRD) is crucial. Telomere attrition is influenced by oxidative stress, which is prevalent in diabetics, prediabetics, and FDRD due to dyslipidaemia. The relationship between telomerase activity and glycaemic control, insulin resistance, oxidative stress, dyslipidaemia, adipocytokines, and inflammatory markers remains unclear and requires further investigation. Aim: To assess and compare telomerase levels, oxidative stress (malondialdehyde), adipocytokines (leptin, adiponectin, and Interleukin-6 (IL-6), lipid profiles, and Body Fat Percentage (BF%) across the glycaemic spectrum in the Indian population. Materials and Methods: This cross-sectional study was conducted at the Department of Physiology, JIPMER, Puducherry, from 2016 to 2018, involving four groups: Group I (control group, non diabetic, healthy, non FDRD, n=63), Group II (FDRD, non diabetic, n=63), Group III (prediabetics, n=63), and Group IV (diabetics, n=63). Participants aged 30-50 years, matched for age and gender, were recruited. Anthropometric variables, cardiovascular parameters, telomerase levels, Malondialdehyde (MDA), adiponectin, leptin, IL-6, and lipid profiles were assessed. Mean differences were analysed using one-way Analysis of Variance (ANOVA) or Kruskal-Wallis test, while Pearson’s correlation analysis was performed to assess the correlation between telomerase levels, glucose concentration, and BF%. Results: An increasing trend in circulating telomerase levels, lipid profiles, and BF% was observed across the glycaemic spectrum. Circulating leptin concentrations did not differ between the groups. However, there was a decrease in circulating adiponectin concentration as the glycaemic status progressed. Increased MDA levels were observed only in the diabetics group. Telomerase levels showed a significant association with circulating glucose concentration (fasting and postprandial) and BF%. Conclusion: The circulating telomerase level increased along the glycaemic spectrum (non FDRD< FDRD< Prediabetics < Diabetics). The major finding was that telomerase level increases even in normoglycaemic FDRD. Oxidative and inflammatory parameters did not significantly differ in FDRD compared to non FDRD individuals. Notably, adiponectin, Tumour Necrosis Factor (TNF)-α, Low-Density Lipoprotein (LDL), and High-Density Lipoprotein (HDL) were the parameters that showed changes in FDRD.

Stress, Anxiety, and Depression among Nursing Students at a Tertiary Teaching Hospital in Karnataka, India: A Cross-sectional Study

Rachana K Nair, Mansoor Ahmed

Introduction: Nursing students are valuable human resources in the health profession. During their student life, they face a great deal of stress, which can negatively affect their mental and physical health, as well as their academic performance. However, there is limited evidence regarding stress, anxiety, and depression among nursing students in Karnataka, India. Aim: To estimate the prevalence of stress, anxiety, and depression among nursing students and determine the factors associated with these conditions amongst them. Materials and Methods: A cross-sectional study was conducted at Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru from March 2022 to August 2022, involving 200 undergraduate nursing students. The study included nursing students from the 1st year to the 4th year. Data was obtained using a predesigned and pretested questionnaire consisting of two parts: the first part collected details on socio-demographic and academic parameters, and the second part assessed psychological parameters using the Depression, Anxiety and Stress scale (DASS) 21 Scale. Data were entered into an excel spreadsheet and presented as frequencies and percentages using Statistical Package for Social Sciences (SPSS) software version 24.0. Factors associated with stress, anxiety, and depression were analysed using the Chi-square test, with a p-value <0.05 considered statistically significant. Results: A total of 200 nursing students participated in the study. The mean age of the participants was 20.22 years, with a standard deviation of 1.42. A total of 39 students (19.5%) reported moderate stress, while 26 (13%) reported severe to extremely severe stress. Approximately 35 (25%) participants experienced moderate to severe depression. Among the participants, 63 (31.5%) reported moderate anxiety, while 78 (39%) reported severe to extremely severe levels of anxiety. Factors such as academic year, lack of time for leisure activities, financial crisis in the family, and addiction to internet use were significantly associated with stress (p<0.05). Conclusion: The prevalence of depression, anxiety, and stress was high among nursing students in the study. These statistics can help nursing educators understand the challenges faced by nursing students and assist in promoting the quality of clinical practice.

Evaluation of Root Dentin Removal and Apical Debris Extrusion during Root Canal Preparation Related to the Different Endodontic Access Cavities: An In-vitro Study

Introduction: The restricted access cavity and the remaining roof of the pulp chamber may change the angle at which the instrument enters the root canal, which could have an impact on the effectiveness of chemo-mechanical canal preparation, potentially leading to endodontic mishaps. Aim: To evaluate the effect of the Traditional Endodontic Cavity (TEC) and Conservative Endodontic Cavity (CEC) on the amount of Root Dentin Removal (RDR) and the related Apical Debris Extrusion (ADE) in the curved root canals prepared with ProTaper Next (PTN) and TruNatomy (TN). Materials and Methods: The in-vitro study included a total of 120 extracted human mandibular molars, separated into four groups (n=30) based on the type of endodontic cavity and file used: TEC-TN, CEC-TN, TEC-PTN, and CEC-PTN. Before biomechanical preparation, Cone Beam Computed Tomography (CBCT) scans were taken. During the preparation, apically extruded debris was collected in Eppendorf tubes. After canal preparation, a post-CBCT scan was performed, and the RDR was evaluated by comparing the pre- and post-CBCT scans. To determine the amount of ADE, the weight of the clear tubes was subtracted from the weight of the tubes containing the debris. The data were analysed using one-way analysis of variance and post-hoc Tukey test. The significance level was set at p<0.05. Results: Analysis and comparison of four groups each with n=-30 extracted mandibular molars was done in the present study. The CEC-PTN group showed the highest total RDR of 0.32. Additionally, the CEC-PTN group produced the highest ADE with statistically significant differences between the TEC-TN, CEC-TN, and TEC-PTN groups (p<0.05). Conclusion: The CEC causes engagement of the rotary instrument with the dentinal wall, leading to RDR, debris production, and ultimately more ADE compared to TEC. The TN file caused less RDR and ADE in both endodontic access cavities compared to the PTN file.

Double J Stent an Indispensable Device in Modern Urology Practice-Timely Removal Prevents Catastrophic Complications: A Retrospective Observational Study

Introduction: Double J (DJ) stent placement is routinely used for various urological procedures. The potential complications of retained or forgotten stents include haematuria, infection, pain, ureteral injury, displacement, fragmentation, encrustation, stone formation, sepsis, renal failure, or even mortality. Various methods have been used alone or in combination for the retrieval of these encrusted stents. Their timely removal is crucial as the potential complications of retained or forgotten stents are very catastrophic and not cost-effective. Aim: To highlight the importance of timely removal/replacement of DJ stents. Materials and Methods: A retrospective observational study was conducted in the Department of Urology at Government Medical College, Patiala, Punjab, India, and data were collected from March 2021 to March 2023. A total of 149 patients who underwent DJ stenting for various procedures in the department or were referred from outside with attempted difficult removal were included in the study. Relevant investigations were performed. Data were collected from the registers maintained in the operation theatre. Data are presented as mean, numbers, and proportions as appropriate. Various procedures were used alone or in combination for stent removal. Results: The mean age of the study participants was 41.50 years with a range from 16 to 70 years. A total of 149 patients were included, and 163 procedures were performed to remove the DJ stents. A total of 24 (14.81%) stents patients developed complications in the form of mild encrustation of the renal and urinary bladder end of the stent, up migration, down migration, broken stents, heavy encrustations at both renal and bladder ends, partial intraperitoneal placement and stone formation at renal and bladder ends. Out of 163 total procedures,149 (91.41%) endoscopic retrievals were done, and 14 (8.59%) multiple procedures were done to remove stent fragments and stones. Postoperative complications were seen in 25 (16.78%) patients. Conclusion: Timely removal of DJ stents prevents catastrophic complications. The phrase by Desiderius Erasmus, “Prevention is better than cure,” holds merit in the present study.

Evaluation of Gastric Contents and Volume After Ingestion of Apple Juice versus Pure Complex Carbohydrate Using Gastric Ultrasonography: A Randomised Clinical Study

Ashritha Kumary Shetty, Aabidhussain Jangi, Madhuri S Kurdi, L Yashaswini

Introduction: Gastric ultrasound is a non-invasive tool for assessing gastric content and volume. Aspiration of gastric contents is a serious perioperative complication that contributes to mortality and morbidity following general anaesthesia. The Enhanced Recovery After Surgery (ERAS) protocol and Indian Society of Anaesthesiology (ISA) fasting guidelines recommend consuming a carbohydrate drink two hours before surgery in adults. However, evidence supporting this recommendation, particularly regarding volume, is still limited and variable. Aim: To examine Gastric Residual Volume (GRV) using Ultrasonography (USG) six hours after a light breakfast and compare it with GRV two hours after consuming clear liquids. Materials and Methods: A randomised clinical study was conducted involving 100 patients who were assigned randomly to two groups: Group-C (Oral Carbohydrate, CHO) and Group-A (Apple juice), with 50 patients in each group; each patient underwent gastric USG twice: once within the first six hours after a light breakfast and again two hours after consuming 400 mL of clear liquid. USG was performed with the patient in a supine position and a Right Lateral Decubitus (RLD) position, and GRV was estimated by measuring the Antral Cross-sectional Area (ACSA) using a mathematical model. The final reading was taken from the RLD position, and qualitative analysis of the antrum was conducted using the Perlas grading system. A GRV of <1.5 mL/kg is considered low risk for aspiration. Statistical tests such as Chi-square, paired t-test, and one-way Analysis of Variance (ANOVA) were applied. Results: A total of 100 patients were analysed in the present study. The mean age was 41.04 years and 39.94 years in Group-A and Group-C, respectively. There was no significant difference in GRV between six hours after a light breakfast and two hours after clear liquid intake in either group (p>0.05). The mean GRV was 7.75 (7.23) mL and 8.01 (7.58) mL six hours after a light breakfast, and 7.71 (8.92) mL and 8.49 (9.47) mL two hours after clear liquid intake in Group-A and Group-C, respectively, among non-CKD patients. GRV was higher in CKD patients and those with an increased Body Mass Index (BMI). Conclusion: The GRV remains within safe limits after consuming 400 mL of clear liquid two hours before surgery. This finding supports the recommended volume of preoperative clear liquid intake in the ERAS protocol and ISA fasting guidelines. However, careful consideration is necessary for patients with CKD and an increased BMI.

Cytohistopathological Association and the Use of a Dual Immunohistochemical Regimen in the Diagnosis of Lung Malignancies: A Cross-sectional Study

Uma Balasundararajan, Jaison Jacob John, Sithy Athiya Munavarah

Introduction: Lung cancer is a highly aggressive malignancy that causes significant morbidity and mortality. The incidence of lung cancer has been increasing in the past few decades. Cytology aids in the initial evaluation and diagnosis of patients with lung cancer. Currently, the classification of lung carcinoma has expanded beyond small cell lung carcinoma and Non-Small Cell Lung Carcinoma (NSCLC). Precise subtyping of poorly differentiated NSCLC into adenocarcinoma and Squamous Cell Carcinoma (SCC) has a direct impact on patient management and prognosis. The morphologic diagnosis forms the basis and is further supplemented by a panel of immunohistochemical markers. Immunohistochemistry (IHC) is important in cases with poorly differentiated morphology or partial sampling. The IHC panel used includes Tumour Protein p63 (p63) and Thyroid Transcription Factor (TTF1) for subtyping lung cancer. Aim: The present study was conducted with the aim of studying the age and gender distribution, risk factors, cytohistopathological association, and formulating an effective IHC panel for the precise yet effective subtyping of poorly differentiated lung malignancies. Materials and Methods: This cross-sectional study included cases retrieved from the Archives of Pathology Department, SRM Medical College and Research Centre, Chennai, Tamil Nadu, India, between July 2012 and July 2016. The cases included had a diagnosis of lung malignancy (confirmed by cytology/biopsy) or were suspected of having malignancy based on clinical/radiological findings. The study period was from July 2015 to August 2016. The cytology and biopsy slides were reviewed, and the malignancy was classified according to the World Health Organisation (WHO) classification of lung malignancies (2021). IHC was performed on the cases using the markers p63 and TTF1 as a dual regimen. Diagnosis and subtyping of tumours were done based on histomorphology, and the tumours were reclassified based on IHC findings. The data were statistically analysed using SPSS software version 25 and the ROC curve. Results: The mean age of the patients was 60.9 years. The study included a total of 50 cases of lung carcinoma, with an average age of 60.9 years (ranging from 30 to 88 years). Among the cases, 35 (70%) had a positive smoking history. A concordant cytohistopathological association was observed in 26 (52%) of cases. Adenocarcinoma was the predominant subtype, accounting for 21 (42%) of cases. Tumour cells in adenocarcinoma showed positive staining for TTF-1, with the marker exhibiting 100% sensitivity and 83% specificity. In SCC, tumour cells were positive for p63, with the marker demonstrating 92% sensitivity and 82% specificity. Both markers showed effective sensitivity and specificity when used as a dual regimen. Conclusion: Although lung cancer is typically diagnosed in the elderly population, there has been an increase in cases among younger individuals due to urbanisation. Smoking remains an important risk factor for lung malignancy. Exfoliative cytology alone is not sufficient for the diagnosis of lung malignancies and should be supplemented with biopsy for more accurate results. Adenocarcinoma was found to be the most common subtype in our study. The IHC panel of p63 and TTF-1 proved to be an effective regimen for classifying poorly differentiated lung carcinomas.

Effectiveness of the ChAdOx1 nCoV-19 Vaccine against Laboratory-confirmed Cases of COVID-19: A Test-negative Case-control Study from Central Kerala, India

Introduction: The COVID-19 pandemic continues to impact livelihoods worldwide, and in the absence of specific antivirals, the vaccine remains the main weapon against it. Assessing the effectiveness of vaccines against Coronovirus Disease 2019 (COVID-19) in practice is crucial as COVID-19 variants continue to emerge, and public health decisions must be supported by scientific risk-benefit considerations. Aim: To determine the Vaccine Effectiveness (VE) of two doses of the ChAdOx1 nCoV-19 (Covishield) vaccine in preventing laboratory-confirmed COVID-19. Materials and Methods: A test negative case control design was used to determine the VE in total of 702 individuals which included 351 laboratory confirmed cases using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) and 351 controls who tested negative among those who attended the testing sites of the Urban Family Health Centre of Government Medical College Kottayam, Kerala, India from July 2021 to September 2021. Details regarding vaccination status, sociodemographic factors, symptoms, and co-morbidities were collected from consented and eligible participants. The collected information was entered into a proforma, which was later entered into MS Excel and analysed using R software version 4.1.3. The groups were compared using binary logistic regression to calculate the adjusted Odds Ratio (aOR) with adjustment for gender, age group, education, occupation, presence of symptoms, and co-morbidity status. VE% was calculated as 100 * (1-aOR). Results: The median age (interquartile range) of cases and control was 44 (33-57) years and 50 (35-60) years, respectively. The VE of two doses of the ChAdOx1 nCoV-19 vaccine in protecting against laboratory-confirmed COVID-19 was 87% (95% CI 78-92), with an aOR of 0.13. A separate analysis was conducted to determine the VE among symptomatic individuals, which showed a VE of 89% (95% CI 79-94), with an aOR of 0.11. Conclusion: Two doses of the ChAdOx1 nCoV-19 vaccine are protective against laboratory-confirmed cases of COVID-19.

Gingival Depigmentation by Application of Diode Laser at 810 nm (Denlase) and 470 nm (Bluelase) Wavelengths: A Split-mouth Randomised Clinical Trial

Introduction: Gingival hyperpigmentation is a common aesthetic concern that often requires treatment to achieve a pleasing smile. While various methods for depigmentation have been described in the literature, the scalpel method is widely advocated. Laser technology, particularly diode lasers, has emerged as a preferred treatment option due to their unique properties. Aim: To compare the efficacy of two different diode wavelengths, namely Denlase and Bluelase lasers, in terms of pain intensity, aesthetic appraisal, and the rate of repigmentation. Materials and Methods: This split-mouth randomised clinical trial was conducted in the Department of Periodontics at Vishnu Dental College, Bhimavarm, Andhra Pradesh, India. over a period of one year with follow-up. A total of 16 patients were included, and the right and left quadrants (both maxilla and mandible) were randomly assigned to either the Denlase or Bluelase group using the coin toss method. Depigmentation using diode lasers at 810 nm and 470 nm wavelengths was carried out in the respective groups. Pain perception, aesthetic appraisal, and recurrence of pigmentation were evaluated at 1, 3, 6, 9 months, and one year. The data were analysed using Friedman’s analysis and the Mann-Whitney U-test. Results: A total of 16 subjects, with a mean age of 27.64±7.64 years and of both genders, were included in the study. Statistically significant differences (p=0.001) were reported in pain perception, aesthetic appraisal, and the rate of repigmentation at 1, 3, 6, 9 months, and one year, respectively. Intergroup comparison revealed an increase in the mean amount of repigmentation at three months in the Denlase group, indicating a recurrence of pigmentation after three months. Conclusion: The Bluelase diode laser (470 nm) demonstrated superior results compared to the Denlase diode laser (810 nm) in terms of pain intensity, aesthetic appraisal, and repigmentation.

Maternal and Foetal Blood Analysis in Term Pregnancies with and without Gestational Diabetes Mellitus: A Prospective Cohort Study

Krishnaveni Bandi, Mamatha Shivanagappa, C Chaithra

Introduction: Gestational Diabetes Mellitus (GDM) is the development of carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Iron is essential for the beta cell functioning of the pancreas and glucose homeostasis in adequate quantities. However, excess iron levels can lead to the generation of an increased amount of free radicals, which can cause toxicity to the pancreatic beta cells, leading to insulin resistance by impairing glucose metabolism. Aim: To compare maternal and foetal blood analysis in term pregnancies with and without GDM. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, JSS Medical College and Hospital Research Centre, Mysuru, Karnataka, India, on 120 term pregnant women, with 60 cases of GDM and 60 non GDM controls. Maternal blood and cord blood samples were used to measure Haemoglobin (Hb), Packed Cell Volume (PCV), serum iron, and serum ferritin in the mother and newborn at the time of delivery. Foetal blood analysis was performed in terms of foetal haemoglobin, iron, and ferritin. Birth weight was also measured. Statistical analysis was performed using the Chi-square test and Independent t-test, with a p-value <0.05 considered significant. Results: The serum ferritin level of the mother was higher in GDM cases (mean value 89.47 ng/mL) than in non GDM controls (mean value 47.62 ng/mL), and this difference was statistically significant. Serum ferritin levels in newborns were significantly lower in the GDM group (85.43) compared to the non GDM group (102.71). Mean values of haemoglobin, PCV, and iron levels were not significantly higher in newborns of GDM mothers compared to non GDM mothers. Conclusion: In GDM, serum ferritin was increased, indicating a marker of inflammation or iron overload, which increases oxidative stress that might affect placental iron transfer and haemoglobin synthesis in the foetus.

Prevalence of HIV Infection among Pregnant Women attending Antenatal Clinics at a Tertiary Care Hospital in Hardoi, Uttar Pradesh: A Retrospective Observational Study

Madhulika Shukla, Saurabh Shukla

Introduction: Determining the seroprevalence of Human Immunodeficiency Virus (HIV) in pregnant women offers essential data for monitoring the trend of HIV and assists in prevention from mother-to-child transmission. Aim: To determine the prevalence of HIV infection among pregnant women. Materials and Methods: A retrospective observational study was conducted at Autonomous State Medical College, Hardoi, Uttar Pradesh, India from July 2016 to June 2019. A total of 6,974 pregnant females were referred to the antenatal clinic during the study period, and all were included in this study. HIV antibodies were tested using the three ELISA/Rapid/Supplemental tests protocol. A woman was identified as HIV infected if tested positive on more than two HIV ELISA tests. The data were entered into MS Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. A Chi-square test was employed to assess the association between the variables. Results: Out of 6,974 females, a total of 32 (0.46%) pregnant females were found to be seropositive (13 patients from July 2016 to June 2017, 10 patients from July 2017 to June 2018, and 9 patients from July 2018 to June 2019). Among the 32 HIV-positive pregnant women, 2 (6.3%) were aged <20 years, 19 (59.4%) were aged 21-30 years, 9 (28.1%) were aged 31-40 years, and 2 (6.2%) were aged over 40 years. Illiteracy was associated with seropositivity, as 53.1% of seropositive patients were illiterate. Conclusion: Seroprevalence has been decreasing in recent years, indicating that we are on the right track. However, efforts should be made to provide universal access to antenatal care and services for prevention parent-to-child transmission of HIV/AIDS.

Utility of the Modified Sick Neonatal Score to Predict the Mortality in Outborn Neonates: A Cohort Study

Rajkumar Motiram Meshram, Saira Merchant

Introduction: Illness severity scoring systems are essential tools for reducing mortality by identifying disease severity and providing early intervention. The application of the Modified Sick Neonatal Score (MSNS) in resource-limited settings has been studied in inborn neonates, but there is a lack of data regarding outborn neonates. Aim: To predict mortality in outborn transported neonates by applying the MSNS score. Materials and Methods: This cohort study was conducted from June 2020 to November 2021 in the Department of Paediatrics at Government Medical College, Nagpur, Maharashtra, India. Parameters of the MSNS scoring system (respiratory effort, heart rate, axillary temperature, capillary refilling time, random blood sugar, oxygen saturation, gestational age, and birth weight) were evaluated in all admitted outborn neonates upon admission, and outcomes (discharge or death) were noted. The score and individual parameters were correlated with the outcome. Chi-square test, Fischer’s-exact test, and Mann-Whitney U test were applied to statistically analyse the data. A receiver operating curve was plotted to determine the cut-off value for the score to predict mortality. Results: In the present study, 866 (58.2%) neonates were male, while 622 (41.8%) were female, and the mean age at admission was 43.3±58.9 hours. Nearly two-thirds of the neonates were born at term, and the mean birth weight was 2191.62±595.47 gm. A total of 91.7% of the neonates were referred by government facilities, and 82.8% of the neonates were transported by ambulance, but only one-third of the ambulance-transported neonates were accompanied by a health assistant. The mean traveling distance was 83.57±72.79 km, and the mean transport duration was 2.14±1.07 hours. The common clinical diagnosis were sepsis (42.68%), respiratory distress (19.89%), and birth asphyxia (14.78%). The neonatal mortality rate was 29.3%. The total MSNS score for neonates who survived was 11.26±2.34, compared to 8.52±2.23 for the neonates who died (p-value <0.0001). The sensitivity was 80.5%, with a specificity of 63.1% and an area under the curve of 0.79 (OR-24.72, 95% CI 0.77-0.81, p-value <0.001) when using the optimal cut-off score of ≤10. Conclusion: The MSNS score of ≤10 has better sensitivity and specificity in predicting neonatal mortality in outborn transported neonates.

Perceived Stress and Sleep Quality among Medical Students and their Relationship with Body Mass Index and Body Fat: A Cross-sectional Study

Yusra Amin, Sonia Mushtaq, Rukhsana Taj, Sunil Sachdev, Sami Manzoor Magray

Introduction: Medical students tend to reduce their sleep in an effort to cope with their workload and stressful environment. This results in unhealthy lifestyles among students, which may lead to changes in Body Mass Index (BMI) and Body Fat Percentage (BF%). Thus, there is a need to investigate the stress level and sleep quality among medical students and their relationship with BMI and body fat. Aim: The aim of the present study was to assess the perceived stress level and sleep quality in medical students and to correlate the stress and sleep quality with BMI and body fat. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Jammu from November 2019 to October 2020 using stratified random sampling. A total of 200 medical students, aged 17-25, were recruited for this study. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and stress level using the Perceived Stress Scale (PSS). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 21.0. Categorical variables were analysed using the Chi-square test, and Pearson correlation was used to find correlations among the variables. A p-value less than 0.05 was considered significant. Results: Out of the total 200 medical students, 116 (58%) had a PSQI score of <5, 62 (31%) had a score in the range of 5-7, and 22 (11%) had a score >7. The PSS score showed moderate stress (14-26) in 138 (69%) students, low stress (0-13) in 32 (16%) students, and high stress level (27-40) in 30 (15%) students. A statistically significant correlation was observed between PSS and PSQI (p-value=0.001). However, there was no statistically significant correlation observed between PSQI and PSS with BMI and body fat. Conclusion: While a notable correlation was observed between perceived stress and sleep quality, the impact of sleep quality and stress levels on BMI and BF% appears to be insignificant. Therefore, it is important to understand the impact of stress on sleep quality, particularly among medical students. There is a need for interventions and support systems aimed at managing stress and promoting better sleep hygiene to improve overall well-being.

Evaluation of Ocular Perfusion Pressure in Migraine Patients: A Case-control Study

S Rashmi, KS Divyalakshmi, K Soujanya, B Anupama, H Pavithra

Introduction: Vascular dysregulation is a common underlying factor between migraine and glaucoma. Fluctuations in Ocular Perfusion Pressure (OPP) can lead to ischaemia and damage to the optic nerve head. It is unclear if the risk of glaucoma in migraine patients is due to low OPP. Aim: To compare the OPP of migraine patients with healthy controls and assess the role of OPP as a risk factor for glaucoma in migraine patients. Materials and Methods: This case-control study was conducted from June 2019 to May 2020 at Yenepoya Medical College Hospital, Mangaluru, Karnataka, India. Adult patients of either gender, aged between 18 and 40 years, diagnosed with migraine, were included in the study. Intraocular Pressure (IOP), blood pressure, and OPP were measured in 94 migraine patients and compared with 94 age-matched controls. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Independent t-tests were used for comparison. Adjusted odds ratios were calculated using binary logistic regression, and a p-value <0.05 was considered statistically significant. Results: The mean IOP was 13.27±2.02 mmHg among cases and 13.38±1.87 mmHg among controls. The mean Systolic Blood Pressure (SBP) was 118.91±4.67 mmHg among cases and 116.09±5.18 mmHg among controls. The mean Diastolic Blood Pressure (DBP) was 77.72±4.48 mmHg among cases and 75.77±4.89 mmHg among controls. The mean OPP was 47.69±2.43 mmHg among cases and 46.08±2.46 mmHg among controls. The t-test values showed a statistically significant difference in SBP, DBP, and OPP between the two groups (p-value <0.05). Conclusion: The OPP in migraine patients differed significantly from that of the controls. However, further studies are needed to evaluate the relationship between perfusion pressure abnormalities and the risk of glaucoma in migraine patients.

Exploring the Staining Potential of Zingiber Officinale Extracts (Ginger) as a Natural Alternative to Eosin in Haematoxylin & Eosin Staining: A Cross-sectional Study

Mitulkumar Rameshbhai Prajapati, Prakhar Agarwal, Bhoomika Jadav

Introduction: Most synthetic dyes are carcinogenic, and chronic exposure to these dyes has an impact on the health of laboratory technicians and pathologists. Eosin, a widely used synthetic dye in routine histopathological staining, poses potential risks. Zingiber officinale contains phenols and several colouring compounds that have the ability to stain tissues. Aim: To explore and compare the staining efficacy of ginger extract as a natural dye with synthetic eosin dye. Materials and Methods: This cross-sectional study was conducted at the Oral Pathology Department of Ahmedabad Dental College and Hospital from April 2023 to June 2023. Fresh rhizomes of Zingiber officinale were collected and air-dried. A staining solution of Zingiber officinale was obtained by dissolving 25g of powder in 90% alcohol. This solution was used to stain 30 sections of oral biopsy specimens. The stained slides were evaluated by two independent observers using various parameters such as nuclear and cytoplasmic detail, overall histologic appearance, intensity, and contrast. Statistical significance was determined using the Chi-square test. Results: Z.officinale (Ginger) stain the cytoplasm of the cell and connective tissue elements with pale eosin colour, yellowish golden to the RBCs and deep brownish to the bony tissue. Statistical analysis comparable staining intensity, contrast, nuclear staining, cytoplasmic staining and overall histologic appearance between the two groups with p-values of 0.531, 0.917, 1.000, 0.924 and 0.7003, respectively. Conclusion: Z.officinale (Ginger) can be utilised as a natural alternative to eosin in routinely used Hematoxylin and Eosin staining.

Epidemiology of Mucoepidermoid Carcinoma of Minor Salivary Glands: A Single-Institution Experience in Mumbai, Maharashtra over 20 Years

Introduction: Encountering a soft tissue swelling in the oral cavity during routine dental practice is infrequent yet practical. Salivary gland tumours of the oral mucosa are associated with minor salivary glands, although they are uncommon and can be considered as a differential diagnosis. Mucoepidermoid Carcinoma (MEC) constitutes a significant percentage of salivary gland tumours of minor salivary glands and exhibits varied biological behaviour. Aim: The aim of the present study was to investigate the clinical and histological characteristics of MEC of the minor salivary glands to comprehend the epidemiological pattern of these tumours and compare the findings with those of other studies. Materials and Methods: For this cross-sectional study, data on salivary gland tumours were accessed from the Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, archives spanning from 2003 to 2022 (a 20-year period). Out of the 22 reported cases of salivary gland tumours, 12 cases were identified as MEC. Clinical details and slides of these MEC cases were obtained from the departmental archives and graded according to Brandwein MS grading. The patients’ clinical features were described through descriptive analysis using SPSS software. Results: Based on gender distribution, there were 8 (66.66%) females and 4 (33.33%) males. The age distribution of the patients revealed that the maximum number of patients (n=4, 33.33%) belonged to the 4th decade of life. The site involvement, in ascending order, included the palate (n=10; 83.83%), alveolus (n=1), and upper anterior gingiva (n=1). Regarding laterality, 7 (58.33%) cases were on the right-side, and 5 (41.66%) were on the left-side of the palate. Conclusion: The study found that females in their 4th decade were commonly affected, with the palate being the most commonly affected site. MEC is one of the common differential diagnosis to consider, and its aggressiveness and treatment planning are related to histological grading. Therefore, epidemiological studies from different parts of the globe are needed to provide a better understanding of the lesion’s biological behaviour, common sites, gender, and age predilection.

Diagnostic Tests for Confirmation of Mating in Adult Female Wistar Rats: An Experimental Study

Kesavamoorthy Yugesh, Senthil Kumar Sampath Kumar, P Kalaivani

Introduction: The assessment of confirmation of mating in rats is a procedure which requires expertise with caution, and careful execution. Rats are spontaneous ovulators and are widely used to study the reproductive system. Aim: The aim of the present study was to compare diagnostic tests for confirming mating in adult female wistar rats. Materials and Methods: The present experimental research was duly approved by the Institutional Animal Ethical Committee and conducted at the Centre for Toxicology and Developmental Research (CEFTE) at Sri Ramachandra Institute of Higher Education and Research (Deemed to be University). The study was conducted in December 2019. A total of 72 adult Wistar rats (36 males and 36 females) were used in the study. To identify the event of mating, the rats were subjected to the following confirmatory methods: naked eye examination, non invasive vaginal lavage method, and abdominal palpatory method. Data were subjected to statistical analysis using non parametric tests with SPSS software (version 25.0). The level of significance was set at p<0.05. Comparison of all three methods was done using non parametric tests (post hoc with Wilcoxon signed-rank test). Results: The non invasive vaginal lavage method was found to be more accurate (72.22%) compared to the visual method (16.66%) and the abdominal palpatory method (11.11%). A significant difference was seen when comparing the three methods using post hoc with Wilcoxon signed-rank test (p≤0.05). Conclusion: Based on the findings, it can be concluded that the vaginal lavage method is more specific and easy to confirm the occurrence of mating in adult female Wistar rats. The non invasive vaginal lavage method is a simple, easy, and accurate method for estimating pregnancy in cohabitating/generation studies.

p16INK4a and γ-H2AX as Biomarkers of Senescence in Skin Tissue: A Cadaveric Cross-sectional Study at a Tertiary Care Centre in Punjab, India

Richa Gupta, Anjali Aggarwal, Tulika Gupta, Chiman Kumari

Introduction: Baseline expression of p16INK4a characterises cellular senescence. Similarly, the measurement of γ-Gamma-H2AX (γ-H2AX) foci levels in cells provides a reliable method for quantification of Deoxyribonucleic Acid (DNA) damage. Aim: To explore the role of p16INK4a and γ-H2AX as biomarkers of senescence in skin tissue. Materials and Methods: This was a cross-sectional study conducted in the Department of Anatomy, PGIMER, Chandigarh, Punjab, India from June 2022 to January 2023. Skin tissue was obtained from 30 cadavers, aged 20-90 years, from the anterior abdominal wall. The time duration of sample collection after death varied from six hours to 12 hours. Samples were divided into two groups: Group-I <30 years and Group-II >70 years, with n=15 in each group. The relative change in the expression pattern of p16INK4a and γH2AX markers, as well as the microstructure of the skin (thickness of epidermis and dermis, distribution of collagen I/II/III fibres, architecture of sebaceous glands), were statistically analysed using an unpaired t-test. Results: Intense staining was observed with p16INK4a in Group-II, showing positivity in 60.75% of the cells, while Group-I depicted a weak staining pattern (15%). On immunostaining with γ-H2AX, only Group-II cells showed intense positivity (45%). Significant differences were observed in the epidermal and dermal thickness: Group-I (165.5267±37.73 μm; 2394.6±874.13 μm); Group-II (54.6±22.79 μm; 566.67±242.23 μm), and collagen Type-II/III fibres were found predominantly in aging skin tissue. Conclusion: The present study provides comprehensive data regarding age-associated changes between p16INK4a, γ-H2AX, and skin microstructure, which result in decreased repair and regenerative capacity of skin tissue and various age-related skin diseases.

Role of Platelet to Lymphocyte Ratio, Neutrophil to Lymphocyte Ratio and Lymphocyte to Monocyte Ratio in Acute Ischaemic Stroke Severity: A Prospective Cohort Study

Shifa Prabhu, L Harshavardhan

Introduction: Stroke is one of the leading causes of mortality and morbidity worldwide, with ischaemic stroke being the most common . Inflammation plays a key role in the pathogenesis of ischaemic stroke and the tissue injury that occurs poststroke, leading to stroke severity. Aim: To assess whether the Neutrophil to Lymphocyte Ratio (NLR), Lymphocyte to Monocyte Ratio (LMR), and Platelet to Lymphocyte Ratio (PLR) ratios correlate with the severity of ischaemic stroke in acute ischaemic stroke cases. Materials and Methods: This was a prospective cohort study conducted at KR Hospital, Mysore, Karnataka, India from July 2021 to June 2022, wherein 106 ischaemic stroke cases presenting within 24 hours of symptom onset were assessed, and the outcomes at discharge or at the end of one week were noted. Routine investigations and Non Contrast Computed Tomography (NCCT) brain scans were performed at the time of admission. National Institute of Health Stroke Scale (NIHSS) scoring was conducted at admission, and patients were grouped into mild to moderate stroke (<16) and severe stroke (≥16) categories. The values of PLR, NLR, and LMR were calculated from the blood routine performed at admission. The data was entered into Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) 25.0 software. A p-value of <0.05 was considered statistically significant. Results: The mean age in this study was 62.67±14.225 years, of which the majority 76 (71.7%) were males. Co-morbidities included hypertension 53 (50%), diabetes 26 (24%), previous history of stroke 13 (12.3%), chronic alcohol consumption 44 (41.5%), and smoking 47 (44.3%) within the study population, and no significant association was found with stroke severity. Approximately 17% presented with severe stroke, while 83% presented with mild to moderate stroke. The total count in the mild to moderate stroke (<16) group was 10.5345±3.91 103/mm3 and in the severe stroke group (≥16), it was 15.445±10.27 103/mm3. In the mild to moderate stroke group (<16), the mean NLR, PLR, and LMR were 5.93±5.16, 179.79±120.72, and 6.14±6.98, respectively. In the severe stroke group (≥16), the mean NLR, PLR, and LMR were 13.83±24.62, 175.1±89.20, and 3.96±3.89, respectively. Conclusion: The PLR, NLR, and LMR ratios can be used to assess the severity of stroke cases, especially in resource-limited settings.

Effect of Ice Pack on Pain and Activities of Daily Living after Episiotomy: A Randomised Controlled Trial

Raksha Raju Suvarna, Purusotham Chippala

Introduction: Episiotomy is a common surgical procedure used during childbirth. Approximately 52% of women who have vaginal births undergo episiotomy, with 93.3% of primiparous women and 30.2% of multiparous women being affected. Perineal pain is a prevalent issue among mothers and can negatively impact their daily functioning and early experiences of motherhood. The use of an ice pack on the perineum is a simple, non pharmacological treatment for pain relief that may have an impact on postpartum recovery. However, no study has been conducted to determine the effect of an ice pack on postnatal mothers’ compliance with Activities of Daily Living (ADL) following episiotomy. Aim: To evaluate the effect of an ice pack on pain and ADL after episiotomy. Materials and Methods: This trial is an experimental, parallel, and assessor-blinded allocation with a computer-generated randomisation sequence. A randomised controlled trial conducted in the Department of Obstetrics and Gynaecology at Justice KS Hegde Charitable Hospital in Deralakatte, Mangaluru, India. The study duration was one year, from March 2022 to March 2023. A total of 64 postnatal mothers (32 in each group) were included. This trial is an experimental, parallel, and assessor-blinded allocation with a computer-generated randomisation sequence. The inclusion criteria were primiparous women aged between 18-35 years, who underwent episiotomy within 6 to 24 hours postpartum, delivered a live baby, complained of pain at the incision site, had a full-term labour, and had no other complications during pregnancy or labour. The participants were also required to be literate. Age, Numerical Pain Rating Scale (NPRS), and Barthel Index (BI) were compared between the groups using the independent sample t-test. The paired t-test was used for within group (pre to post-test) comparison of NPRS and Barthel index. A p-value of <0.05 was considered significant. Results: There was a significant difference in pain experienced by the groups, as assessed by NPRS (p<0.001). However, there was no difference in ADL between the groups (p>0.05). No side effects or harms were reported. Ice pack application, once daily for two days, was found to be safe and feasible for post-episiotomy patients. Conclusion: The current randomised controlled trial concludes that the application of an ice pack once daily for two days is significantly effective in reducing pain after episiotomy. However, it does not improve ADL in patients with post-episiotomy.

Persistent Bowel Loop in the Left Upper Quadrant: An Indication for Relaparotomy in Paediatric Adhesive Intestinal Obstruction: A Retrospective Cohort Study

Jagadeesh Nelluvayil Puthenvariath, Sarath Kumar Narayanan

Introduction: Abdominal surgery in children is known to contribute to Adhesive Small Bowel Obstruction (ASBO). No X-ray findings have been validated for predicting management in ASBO. Various imaging modalities often cannot predict complications or if a conservative line of management would be successful. Aim: To determine if a persistent prominently dilated small bowel loop in the Left Upper Quadrant (LUQ) on plain X-rays (Omega loop) would suggest early operative intervention. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India from January 2016 to December 2018. Diagnosis was based on history, clinical features, and radiologic findings. Demographic, clinical, radiologic, and operative data were collected. After exclusions, the study population was divided into two groups: Group A- ASBO patients with the characteristic Omega loop, and Group B- patients without the Omega loop. Appropriate statistical methods were used to compare the groups, with significance defined as p<0.05. Results: Among the 72 cases of ASBO that met the inclusion criteria, 40 (55%) were successfully managed conservatively, and 32 (45%) required non urgent relaparotomy. The median age was 6.9 years (range: 2-12 years), and 55% were male. Group A comprised 16 patients (22.2%), and the remaining patients were in Group B 56 (77.8%). Group A showed higher rates of failure of conservative management (n=14, p=0.0002), with higher rates of single-band obstruction, bowel loss, perforation, matting of bowel loops, and difficult dissection. The Omega loop had a low sensitivity (43.7%) but high specificity (95%) and positive predictive value (87.5%) for the need for relaparotomy. Conclusion: The Omega loop suggests the possibility of more complications, and therefore, earlier operative intervention should be considered.

Inflammatory Marker Levels in Preeclampsia versus Normal Pregnancies and Prediction of Preeclampsia Occurrence: A Prospective Mixed Methods Study

Introduction: Preeclampsia is an important cause of adverse maternal and perinatal outcomes. However, this condition remains poorly understood, and since the only cure is delivery, prediction and prevention are crucial to prevent preterm birth or maternal compromise. Aim: To determine the levels of acute phase reactants, namely high-sensitivity C-reactive Protein (hsCRP) and fibrinogen, between preeclamptic and non preeclamptic pregnancies. Additionally, the study aims to determine the predictive value of these acute phase reactants for preeclampsia. Materials and Methods: A prospective mixed methods study was conducted in two tertiary hospitals and two specialist hospitals in the Ijebu/Remo axis of Ogun state, Nigeria. Preeclamptic participants were recruited during pregnancy and postpartum and matched with non preeclamptic controls (case-control arm, n=179, comprised of 87 preeclamptics and 92 controls). Additionally, a cohort of non preeclamptic women (n=71) was recruited and biomarker-assayed before 20 weeks gestation, followed-up for the development of preeclampsia. The biomarker assay was performed using the ELISA technique. The Student’s t-test was used to compare the mean levels of markers between the studied groups. Categorical data were compared using the Chi-square test. A p-value <0.05 was considered to be statistically significant. Results: The levels of hsCRP were significantly higher in pregnant preeclamptic women (12.71±1.99 mg/L) compared to non preeclamptic women (4.39±3.41 mg/L) (p-value=0.001). Similarly, fibrinogen levels were elevated in preeclamptic women (9.45±1.28 g/L) compared to non preeclamptic women (7.19±1.86 g/L) (p-value=0.001). This trend was also observed among postpartum women, with hsCRP levels of 10.39±2.43 mg/L in preeclamptics compared to 2.53±2.06 mg/L in non preeclamptics (p-value=0.001). The mean fibrinogen level was 8.63±1.91 g/L in preeclamptics compared to 4.09±1.66 g/L in non preeclamptics. Fibrinogen demonstrated a higher specificity (88.9%) and Negative Predictive Value (NPV) of 100% compared to hsCRP (specificity=47.1% and NPV=76.1%). The biomarker levels also correlated significantly with the severity of preeclampsia. For hsCRP, there was a correlation with Systolic Blood Pressure (SBP) (r-value=0.385, p-value=0.001), Diastolic Blood Pressure (DBP) (r-value=0.364, p-value=0.001), and proteinuria (r-value=0.314, p-value=0.001). For fibrinogen, there was a correlation with SBP (r-value=0.252, p-value=0.014), DBP (r-value=0.378, p-value=0.001), and proteinuria (r-value=0.356, p-value=0.001). Conclusion: Although hsCRP and fibrinogen levels were significantly higher and correlated well with the severity of preeclampsia, their use for prediction may be limited. However, fibrinogen appears to have better prospects.

Assessment of Indices of Vascular Involvement in Children with Idiopathic Nephrotic Syndrome: A Case-control Study

Introduction: Nephrotic Syndrome (NS) is characterised by proteinuria, oedema, hypoalbuminaemia, and hypercholester-olemia. The latter is a risk factor for atherosclerosis, suggesting a higher risk of cardiovascular disease in children with NS. Atherosclerosis is proposed to be caused by vascular endothelial dysfunction, reflecting the inflammatory response to tissue damage. Aim: To investigate indices of early vascular involvement in children with Idiopathic Nephrotic Syndrome (INS). Materials and Methods: This case-control study was conducted at a tertiary-care hospital, Pt. BD Sharma PGIMS Rohtak, Haryana, India, over a period of two years and two months. The study included 50 children aged <14 years with NS. Vascular indices, including Carotid Intima Media Thickness (CIMT), high-sensitive C Reactive Protein (hs-CRP), and Atherogenic Index of Plasma (AIP), were evaluated. Analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. The correlation of cardiovascular risk in children with NS was calculated by measuring CIMT, AIP, and CRP levels, and the relationship was analysed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The study found that the thickness of CIMT in group 1 was 0.67±1.39 mm, while in group 2, it was 0.31±0.04 mm. The calculated p-value was <0.001, which was statistically significant. The hs-CRP level in group 1 was 4.64±5.87 mg/L, higher than the control group (0.85±0.10 mg/L), with p-value of <0.001. Furthermore, AIP was higher in children with NS (0.80±0.19) compared to the control group (0.02±0.16). There was a statistically significant difference between both groups (p<0.001). Conclusion: Early assessment of indices of vascular involvement, such as CIMT, hs-CRP, and AIP, in children with INS can aid in the early identification and prevention of cardiovascular complications.

Characterisation of Anaerobes Isolated from Various Clinical Samples: A Cross-sectional Study

Zobiakhlui Chhakchhuak, Rakesh Kumar Mahajan

Introduction: Anaerobes are an important cause of infections but are often neglected. These infections can range from simple abscesses to life-threatening infections. The isolation of anaerobes is crucial for administering appropriate antibiotic therapy. Aim: To investigate the profile of anaerobes in various clinical samples, including deep-seated skin and tissue infections, aspirated body fluids, and tissue biopsies. Materials and Methods: A cross-sectional study was conducted on a total of 100 samples at the Department of Microbiology, ABVIMS and Dr. RML Hospital, New Delhi, from November 2019 to March 2021. Aspirations from deep-seated abscesses, body fluids, intraoperative samples, and tissue biopsies meeting the criteria for anaerobic culture were included. Simultaneous processing for the detection of aerobes was also performed. Anoxomat III anaerobic culture system was used to create an anaerobic environment. Robertson Cooked Meat (RCM) broth was used, and subculture was conducted on 10% Blood Agar (BA). Presumptive identification was performed using gram stain, catalase test (15% hydrogen peroxide), metronidazole disc (5 μg), special potency disc (vancomycin 5 μg, kanamycin 1000 μg, colistin 10 μg), and aerotolerance test. The Vitek 2 compact ID system was used for the final identification of anaerobes. Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, ver 21.0, was utilised. Results: The isolation rate of anaerobes was 17 (17%), with Bacteroides fragilis being the predominant organism (6; 35.29%), followed by Actinomyces (2; 11.76%), Clostridium (2; 11.76%), Peptostreptococcus (2; 11.76%), and Prevotella species (2; 11.76%). Isolation was observed from diverse anatomic sites, with pus aspirates constituting the majority of the isolates (9; 52.94%), followed by brain abscesses (3; 17.65%), liver abscesses, peritoneal fluid (2; 11.76%), and tonsillar abscess (1; 5.89%). Five (29.41%) infections were polymicrobial, while 12 (70.59%) were monomicrobial in nature. Conclusion: Anaerobes are emerging as an important causative agents in a variety of diverse and heterogeneous pyogenic infections. This study demonstrates their isolation from various infection sites. Therefore, routine anaerobic cultures should be conducted alongside aerobic cultures, and the importance of anaerobes in clinical infections should not be underestimated.

Effect of Preoperative Counselling on Intraoperative and Postoperative Satisfaction among Pregnant Women Undergoing LSCS in a Tertiary Care Centre in Manipur, India: A Quasi-Experimental Study

Introduction: For optimal maternal outcomes during Caesarean Section (CS) under spinal anaesthesia, proper counselling regarding the intraoperative and postoperative effects of spinal anaesthesia is required to enhance postoperative patient satisfaction. Aim: The present study aimed to assess the effects of preoperative counselling on intraoperative and postoperative anxiety, fear, and other physiological responses associated with spinal anaesthesia. Additionally, it aimed to determine the level of perioperative satisfaction among patients during anaesthesia and surgery. Materials and Methods: In this quasi-experimental study, a total of 214 American Society of Anaesthesiologists (ASA) physical status II patients scheduled for elective Lower Segment Caesarean Section (LSCS) were randomly assigned to either group A or group B. Group A received preoperative counselling about intraoperative events and postoperative care, along with routine pre-anaesthetic clinic assessment. Group B only underwent routine pre-anaesthetic clinic assessment. Intraoperative and postoperative satisfaction were assessed using the Visual Analogue Score (VAS), and physiological responses such as heart rate, blood pressure, and oxygen saturation were monitored. Statistical analysis was performed using SPSS version 16.0, and descriptive statistics, Chi-square test, and t-test were used. A p-value <0.05 was considered significant. Results: The results showed that the mean age in group A was 28.7±5.1, while in group B it was 27.54±5.0. In group A, 70% of patients were multiparous, compared to 48.6% in group B, with a p-value >0.05. The majority of patients in both groups were homemakers, with 99.1% in group A and 86.9% in group B. The distribution of VAS scores indicated that no pain and mild pain were more prevalent in the study group, while moderate pain was more common in the control group, which was statistically significant. Therefore, pain was reduced in the preoperative counselling group, and overall patient satisfaction was higher in the counselling group due to guidance throughout the anaesthetic and surgical procedures, leading to better anxiety and haemodynamic control. The distribution of patient satisfaction indicated that all patients reported reduced fear and anxiety due to preoperative guidance. A total of 69.2% of patients were very satisfied with preoperative counselling, and 30.8% were satisfied with preoperative counselling. Conclusion: This quasi-experimental study concludes that preoperative counselling regarding the anaesthetic procedure, intraoperative and postoperative events, and guidance throughout the procedure improves patients’ pain tolerance, cooperation, and behaviour during the perioperative period.

Role of Prophylactic Intramuscular Glycopyrrolate in Preventing Hypotension and Bradycardia in Patients Undergoing Elective Lower Limb Surgeries under Spinal Anaesthesia: A Randomised Placebo-controlled Study

Souvik Choudhury, Sudeshna Bhar Kundu, Mausumi Niyogi

Introduction: Spinal anaesthesia is an extensively used anaesthetic technique for infraumbilical surgeries. Despite its many advantages, hypotension and bradycardia are two common complications. The incidence of bradycardia following spinal anaesthesia is higher in young adults. Although a few previous studies have observed that intramuscular glycopyrrolate is effective in preventing spinal-induced bradycardia and hypotension in elderly and parturient patients, there is a lack of reported studies in the young population. Aim: To evaluate the role of intramuscular glycopyrrolate in the prevention of bradycardia and hypotension in adult patients undergoing lower limb surgeries. Materials and Methods: A randomised, parallel-group, double-blind, placebo-controlled study was conducted in the Department of Anaesthesiology at Calcutta National Medical College, Kolkata, West Bengal, India. The duration of the study was 15 months, from July 2021 to September 2022. A total of 60 patients aged 18-45 years, of either sex, with American Society of Anaesthesiologists (ASA) physical status I and II, undergoing elective lower limb surgeries under spinal anaesthesia. The patients were randomised into two groups: group G received intramuscular glycopyrrolate 1 mL (0.2 mg) and group N received intramuscular normal saline 1 mL 15 minutes prior to spinal anaesthesia. Hyperbaric bupivacaine (0.5%) 3 mL and fentanyl (25 mcg) 0.5 mL were injected intrathecally. Haemodynamic parameters were monitored. All data were analysed using appropriate statistical tests. A p-value of <0.05 was considered statistically significant. Changes in Heart Rate (HR) were considered the primary outcome variable. The secondary outcome variables were changes in Mean Arterial Pressure (MAP), incidence of bradycardia and hypotension, phenylephrine requirement, and incidence of dry mouth. Results: The mean age of the study participants of group G and group N was 34.17 years and 33.63 years. The two groups were comparable in terms of demographic profile. In comparison to group N, patients in group G showed a significantly higher HR throughout the intraoperative period (p<0.001) and at 60 minutes in the postoperative period. The incidence of hypotension was significantly higher in group N (53.33%) compared to group G (3.33%, p<0.001), and the MAP was lower in group N compared to group G in the intraoperative period. The number of patients requiring phenylephrine was also higher in group N (53.33%) compared to those in group G (3.33%). Conclusion: Prophylactic use of intramuscular glycopyrrolate can maintain stable haemodynamics in patients undergoing lower limb surgeries under spinal anaesthesia. It can maintain a higher HR and reduces the incidence of hypotension following spinal anaesthesia.

Assessment of Cardiac Autonomic Functions in Prehypertensive Individuals with and without a Family History of Hypertension: A Cross-sectional Study

K Vanathy, IJV Pradeep Vaiz, A Parthiban Prashanth

Introduction: Individuals with prehypertension are at an increased risk of developing hypertension. Family history is one of the paramount non modifiable risk factors for developing hypertension. Hence, it becomes mandatory to assess the cardiac autonomic functions, which play an important role in the regulation of Blood Pressure (BP), in prehypertensive individuals with a family history. Aim: To compare the variations in parameters of cardiac autonomic function tests in prehypertensive individuals with and without a family history of hypertension. Materials and Methods: This cross-sectional study was conducted at the Institute of Physiology and Experimental Medicine, Madras Medical College, Chennai, Tamil Nadu, India from October 2020 to October 2021. The study included 30 prehypertensive individuals without a family history of hypertension and 30 prehypertensive individuals with a family history of hypertension, aged between 20 and 50 years, of both genders. They were recruited from the non communicable diseases Outpatient Department (OPD) at Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. The prehypertensive range refers to a Systolic Blood Pressure (SBP) of 120-139 mmHg or a Diastolic Blood Pressure (DBP) of 80-89 mmHg. After obtaining informed consent, baseline parameters such as resting Heart Rate Variability (HRV) using AD instruments powerlab recorder, deep breathing test, Valsalva maneuver, isometric handgrip test, and Cold Pressor Test (CPT) were evaluated. The data obtained was statistically analysed using a Student’s t-test. Results: The mean age of prehypertensive individuals without a family history was 36.90±4.6 years, and in prehypertensive individuals with a family history, it was 36.43±5.3 years. The male to female ratio was higher. The resting SBP and DBP, as well as the basal heart rate, were significantly increased in the prehypertensive subjects with a family history. Time domain variables such as the mean RR, Root Mean Square of Successive Difference (RMSSD), and pRR50 were reduced in prehypertensive individuals with a family history. Among the frequency domain variables, the total power was reduced, while the low-frequency component and LF:HF ratio were significantly increased. The E/I ratio and Valsalva Ratio (VR) were also significantly reduced in prehypertensive individuals with a family history. Thus, the results emphasise that there is significant autonomic dysfunction in prehypertensive individuals with a family history of hypertension compared to prehypertensive individuals without a family history. Conclusion: Cardiac autonomic function tests in prehypertensive individuals with a family history indicate a definite sympathovagal imbalance in the form of sympathetic overactivity. This may substantiate the role of genetic predisposition in them. Chronic activation of the sympathetic nervous system makes them more prone to developing early hypertension.

Impact of COVID-19 on Pregnancy Outcome in the First Wave, Second Wave, and Third Wave of the Pandemic at a Tertiary Care Centre Mysuru, Karnataka, India: A Prospective Cohort Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has subjected us all to difficult times in managing patients, particularly pregnant women. Numerous studies have been conducted during each wave, but limited data is available on maternal and neonatal outcomes. Given that people must co-exist with COVID-19, it is crucial to enhance the understanding of antenatal patient management. Aim: To compare the clinical presentation, co-morbidities, and maternal and neonatal outcomes among pregnant women with COVID-19 during the first, second, and third waves of the pandemic. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology (OBG) at JSS Hospital, Mysore, Karnataka, India, from January 2020 to February 2022. A total of 33 expectant mothers with COVID-19 presented during the first wave (from January 30, 2020, to the end of February 2021), 50 expectant mothers with COVID-19 during the second wave (from March 2021 to the end of September 2021), and 19 expectant women with COVID-19 during the third wave (from January 2022 to the end of February 2022). Data were collected for each wave, and a comparison of different variables in all three waves was performed. Microsoft Excel was used for data entry, and analysis was conducted using Statistical Package for Social Sciences (SPSS) version 22.0. Chi-square test was employed to compare the different variables as a test of significance. Results: The mean age of the expecting mothers in the first wave was 27.12±4.35 years, in the second wave was 25.86±3.98 years, and in the third wave it was 24.61±3.98 years, with a p-value=0.103. Symptoms like cough, cold, running nose were highest in the second wave (22 cases, 44.0%), followed by breathlessness in 6 (12.0%) cases, and fever, chills, myalgia, generalised weakness, vomiting in 45 (90.0%) cases. Hypertensive disease of pregnancy was highest in the first wave (8 cases, 24.2%). In the first, second, and third waves, a total of 23 (69.7%), 30 (60.0%), and 12 (63.1%) individuals, respectively, did not have any co-morbidities. The majority of women in the first wave 18 (54.6%) cases and second wave 27 (54.0%) cases were multigravida, while in the third wave, they were primigravida 14 (73.7%) cases. Pre-term deliveries 22 (44.0%) cases and intrauterine deaths 8 (16.0%) cases were highest in the second wave. There was a higher frequency of Preterm Premature Rupture of Membranes (PPROM) and Premature Rupture of Membranes (PROM) in the first wave 6 (18.2%) cases. Neonatal Intensive Care Unit ( NICU) admission of babies was found to be highest in the third wave 8 (42.1%) cases, compared to the first two waves. There was no statistically significant association between these parameters and the waves of the pandemic. The mean Haemoglobin (Hb) levels of the study subjects were least in the first wave, compared to those in the rest of the waves (p-value=0.499). Mean Erythrocyte Sedimentation Rate (ESR) levels were significantly lower in the first wave (p-value=0.041), and C-reactive Protein (CRP) was highest in women in the second wave (p-value=0.036). Conclusion: It is important that always study the features of the disease over a period of time so that the management protocols can be modified.

Prevalence of Different Attachment Styles in 9 to 12 years old School Children: A Cross-sectional Study

Supriya Thambireddy, SVSG Nirmala, Sivakumar Nuvvula

Introduction: Bowlby suggests that children develop internal working models in earlier stages depending on their attachment relationships with parents. In paediatric dental clinics, children tend to display various behaviours depending on their attachment style, which can affect the communication and treatment outcomes with the child dentist. Aim: To determine the prevalence of attachment styles in 9 to 12 years old school children and to assess the association of attachment styles with the age and gender of the children. Materials and Methods: A descriptive cross-sectional study was conducted on a total of 384 school children aged 9 to 12 years, in the Nellore district using the cluster sampling method. Attachment styles were measured using a 15-item questionnaire developed from the Attachment Questionnaire for Children (AQ-C). The children were instructed and then asked to read and rate the extent to which each questionnaire item described themselves. Data were analysed statistically using the chi-square test for prevalence of attachment styles, Pearson correlation, and multiple regression analysis for age and gender associations. The level of significance was set at p≤0.05. Results: The study found that 64.10% (n=246) of all participants exhibited a secure attachment style, while 7% (n=27) and 28.9% (n=111) displayed avoidant and ambivalent attachment styles, respectively. Age showed a significant association with secure (p=0.006) and ambivalent (p=0.026) attachment styles. However, gender did not show any association with attachment styles. Conclusion: The study concluded that the secure attachment style was the most prevalent, followed by ambivalent and avoidant attachment styles, regardless of gender. Age was found to be significantly associated with secure and ambivalent attachment styles.

Effect of Fragrance on Electroencephalographic Waves and Blood Pressure during Problem-solving Activity among Healthy College Students: A Cross-sectional Study

Rahul S Jain, D Rekha, Subhasis Das

Introduction: The influence of fragrance, such as perfumes and room fresheners, on the psycho-physiological activities of humans has been known for a long time. However, very few studies have been conducted to investigate its effects when a person is under stress. Aim: To determine the effect of fragrance on electroencephalo-graphic waves and blood pressure during a problem-solving activity. Materials and Methods: This cross-sectional study was conducted among 55 college students aged 18-22 years in the electrophysiology laboratory of the Department of Physiology at Pondicherry Institute of Medical Sciences, Puducherry, India from May 2019 to June 2019. After obtaining a history and conducting an olfactory examination, participants were asked to be in the electrophysiology laboratory to record Electroencephalogram (EEG) and blood pressure before and after exposure to fragrance for five minutes. Data were statistically analysed using Fischer’s-exact test and paired t-test. Results: The study included 55 college students (38 males, 17 females) with a mean age of 19.46±1.004 years. EEG changes were compared at rest, including alpha waves (n=55), beta waves (n=55) during the problem-solving activity, and theta waves (n=55) during exposure to lavender fragrance. EEG changes were analysed using Fischer’s-exact test, and the results were statistically significant (p-value <0.001). The mean±Standard Deviation (SD) of Systolic Blood Pressure (SBP) during fragrance exposure (110±11.82 mmHg) vs solving the puzzle (123.44±15.97 mmHg) was significantly lower (p-value=0.048*). The mean±SD of Diastolic Blood Pressure (DBP) during fragrance exposure (74.44±11.27 mmHg) vs solving the puzzle (74.40±12.92 mmHg) was slightly higher, but not statistically significant (p-value=0.516). Conclusion: The present study demonstrated that the use of fragrance can have a relaxing effect on the mind and body, as it increases theta wave activity in the brain and significantly reduces SBP.

Clinical and Prognostic Significance of PD-L1, Beclin 1 and Fascin 1 Immunohistochemical Expression in Colorectal Carcinoma

Introduction: Colorectal Cancer (CRC) is a leading cause of death worldwide, and its incidence has been rising. It is important to identify novel markers that could predict the prognosis of the disease. Aim: To identify the impact of Programmed cell death-ligand 1 (PD-L1), Beclin 1, and Fascin 1 immunohistochemical expression on CRC behaviour and disease prognosis. Also, to assess the different surgical options (laparoscopic versus open) in the management of these patients. Materials and Methods: This cohort study included 72 cases of CRC, conducted in the Pathology, General Surgery, Internal Medicine, Clinical Oncology, and Medical Oncology Departments of the Faculty of Medicine, Zagazig University Hospitals, Egypt between June 2018 and June 2022. PD-L1, Beclin 1, and Fascin 1 expression were assessed immunohistochemically, and their prognostic significance were evaluated. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) 23.0 for Windows (SPSS Inc., Chicago, IL, USA) and NCSS 11 for Windows (NCSS LCC., Kaysville, UT, USA) in the Community Medicine Department, Faculty of Medicine, Zagazig University, Egypt. Results: A significant association was found between PD-L1 expression and grading (p-value=0.02), lymphovascular invasion, distant metastasis (p-value=0.001), peritoneal spread (p-value=0.002), tumour budding (p-value=0.005), lymph node metastasis, and American Joint Committee on Cancer (AJCC) stage (p-value <0.001). A significant association was also found between Beclin 1 expression and distant metastasis (p-value=0.001), lymphovascular invasion (p-value=0.004), lymphocytic infiltration (p-value=0.006), perineural invasion (p-value=0.01), peritoneal spread (p-value=0.002), and AJCC stage (p-value=0.007). A highly significant association between Fascin 1 expression and grading, lymphovascular invasion, tumour budding, lymph node metastasis, lymphocytic infiltration, perineural invasion, metastasis, peritoneal spread, and AJCC stage (p-value <0.001) was detected. In patients with negative PD-L1 or high Fascin 1 expression, survival rates were lower. Beclin 1 expression was not associated with a favourable prognosis (p-value >0.05). Conclusion: PD-L1, Beclin 1, and Fascin 1 expression are significantly elevated in CRC tissues and closely associated with adverse prognostic factors. PD-L1 and Fascin 1 expression have important prognostic value and may be of great help in identifying high-risk patients who will benefit the most from treatment.

Analysis of Risk Factors and Outcomes of Fontan Procedure in Single Ventricular Repair: A Retrospective Observational Study

Gradlin Roy Justin, Revanth Maramreddy, Sirisha Peesapati, Sachin Mahajan

Introduction: The Fontan operation is a surgical technique used to treat cyanotic heart diseases with single ventricle physiology. Although it has undergone several modifications since its inception in 1971, it is still associated with significant morbidity and mortality. Aim: To examine the outcomes of the Fontan operation and identify various risk factors associated with it. Materials and Methods: This retrospective observational study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India from January 2014 to December 2017. All patients who underwent the Fontan operation at PGIMER were included in the study. The study analysed outcomes such as survival, arrhythmias, neurological complications, heart failure, cirrhosis, and Protein Losing Enteropathy (PLE) following the Fontan operation. Various risk factors that could potentially influence the outcome of the Fontan operation were assessed, including preoperative, intraoperative, and postoperative factors. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 25.0. The Chi-square test was utilised to determine predictors of survival and other long-term outcomes, with a p-value of <0.05 considered statistically significant. Results: A total of 35 patients underwent the Fontan operation during the study period and completed five years of follow-up. Out of these, 28 were known to be alive at the last contact. There were six early deaths (less than one year). The overall one-year and five-year survival rates from the time of the operation were 29 (83%) and 28 (80%), respectively. Graft thrombosis/thromboembolism was observed in three cases (8.6%) and neurological complications in three cases (8.6%) during the early postoperative period. Arrhythmias in 6 cases (14%) were the most common late postoperative complication. Conclusion: The Fontan procedure is currently the best available palliative treatment for cyanotic heart diseases with single ventricle physiology. Patient selection is crucial in this procedure, as the presence of risk factors may adversely affect the outcome.

Analysis of Achievement of Radiological Parameters in Uncemented Total Hip Replacement: A Retrospective Cohort Study

Introduction: The Total Hip Replacement (THR) procedure is indicated to the treatment of choice in chronic refractory joint pain and some types of proximal femoral fractures. Component malalignment is a major cause of THR failure, making it crucial to position the components anatomically for long-term joint survival. Aim: To assess the radiological parameters of uncemented THR surgery. Materials and Methods: This retrospective cohort study was conducted in the Department of Orthopaedic Surgery, King’s George Medical University (KGMU), Lucknow, Uttar Pradesh, India, from June 2017 to May 2021. It included 72 patients who underwent unilateral uncemented THR for isolated hip diseases. Data was collected over the first two years and analysed. Demographic information and radiographic characteristics such as acetabular cup inclination and anteversion, femoral stem placement, vertical and horizontal centers of rotation, and limb length discrepancy were determined. Data was entered into Microsoft Excel 2018-19, and Statistical Package for the Social Sciences (SPSS) software version 28.0 was used for statistical analysis. Results: The average age of the patients was 50.75±9.1 years. Comparison of acetabular cup inclination (preoperative 41.4±3.9° and postoperative 42.2±5.1°) and anteversion (preoperative 13.1±2.96° and postoperative 14.5±3.75°) showed non significant differences following treatment with a normal hip. However, there was a significant difference in the horizontal and vertical Centers Of Rotation (COR) following treatment with a normal hip. Conclusion: Preoperative radiological characteristics of the damaged hip were significantly restored to normal anatomy and alignment following surgery.

Predictability of Proximal Enamel Thickness Assessment using Intraoral Periapical Radiographs: A Cross-sectional Study

Nisshitha Rao Setvaji, Ravindra Kumar Jain

Introduction: Measurements of tooth crown dimensions and enamel thickness are useful guides for interproximal stripping procedures aimed at creating space. In borderline non extraction orthodontic treatment cases, interproximal stripping is performed to gain space. Intraoral periapical radiographs and bitewing radiographs are commonly used to determine Proximal Enamel Thickness (PET). Aim: To determine the predictability of using IOPA-based PET measurements for assessing real/anatomic PET. Materials and Methods: This was a single-centre, cross-sectional study conducted at Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, between March 2022 and April 2022. Digital Intraoral Periapical Radiographs (IOPAs) of 40 premolar teeth with intact crown structures were obtained using the paralleling technique. The PET of both the mesial and distal sides of the same teeth was measured using Carestream Imaging software. Subsequently, the extracted teeth were sectioned and examined under a Stereomicroscope (SM), and PET measurements of the mesial and distal surfaces were obtained along the heights of contour using ImageJ analysis software. Pearson’s correlation, along with linear and polynomial regression analyses, was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software. Results: A low but significant positive correlation between the PET of the sectioned teeth and the PET measured from IOPAs was observed (p=0.002, R=0.55). A significant difference in PET between the two methods for both sides was noted (p<0.05). The mean distal enamel thickness was significantly greater than the mean mesial enamel thickness for both the IOPA and SM methods (p<0.05). A polynomial regression equation, Y=2.084-1.234X+0.318X3, was established to predict PET of the sectioned teeth (Y) based on PET measured from IOPAs (X). Conclusion: The present study establishes a correlation between the true PET of teeth measured using cut-sections and PET measured from IOPAs, which are readily available in clinical practice. A correlation coefficient was determined, and PET can be predicted using IOPAs, although not with absolute accuracy. Distal PET was found to be higher than mesial PET, with no significant difference in enamel thickness between the two sides.

Estimation of Lipid Profile, Hepatic Enzymes, Malondialdehyde, and Uric Acid in Preeclampsia: Implications for Early Intervention

Introduction: Preeclampsia, a serious pregnancy complication, poses significant risks to both maternal and foetal health, potentially leading to morbidity and mortality. This condition is characterised by changes in lipid profiles, hepatic enzymes, Malondialdehyde (MDA), and uric acid levels. Despite significant medical advancements, identifying precise biomarkers for preeclampsia remains complex. Moreover, there is a lack of epidemiological research on preeclampsia within the southern Indian population. Aim: To estimate the levels of serum lipid profiles, hepatic enzyme levels, MDA, and uric acid levels in pregnant women with preeclampsia. Also, to examine the association between MDA and uric acid levels among women with preeclampsia and those with normal pregnancies. Materials and Methods: This cross-sectional study included 162 pregnant patients aged between 18 and 35 years, who attended the Outpatient Department (OPD) or were admitted to a tertiary care hospital in Visakhapatnam, Andhra Pradesh, India between February 2021 and October 2021. The participants were divided into three groups: Group A (54 normotensive pregnant women), Group B (54 pregnant women with non severe preeclampsia), and Group C (54 pregnant women with severe preeclampsia). Lipid profiles, hepatic enzymes, MDA, and uric acid were evaluated in all subjects, and their relationship with preeclampsia severity was assessed. The data were statistically analysed using one-way Analysis of Variance (ANOVA) followed by the Tukey post-hoc test. Results: The study groups (A, B, and C) had comparable age and gestational periods. However, significant variations were observed in lipid profiles, hepatic enzymes, MDA, and uric acid levels among them, which associated with the severity of preeclampsia. Increasing severity was associated with higher cholesterol and triglyceride levels, as well as a decrease in High Density Lipoprotein (HDL) cholesterol. Furthermore, disease progression led to significant elevations in Alkaline Phosphatase (ALP) , uric acid, and MDA levels. In particular, Group A displayed total cholesterol levels of 138.3±20.32 mg/dL, triglycerides of 109.98±15.22 mg/dL, and a negative association with HDL-cholesterol at 30.57±3.65 mg/dL. In contrast, Group C exhibited considerably higher levels of total cholesterol, triglycerides, AST, ALT, uric acid, and MDA compared to Group A. Conclusion: As preeclampsia worsens, cholesterol and triglyceride levels increase, while HDL-cholesterol decreases, indicating a deteriorating metabolic profile. Additionally, ALP, uric acid, and MDA levels rise, indicating increased oxidative stress and liver function impact with the progression of the ailment.

Comparison of Postoperative Outcomes of Laparoscopic Cholecystectomy with or without Abdominal Prophylactic Drainage: A Prospective Interventional Study

Naveen Kumar Maurya, Osman Musa Hingora, Manish Kumar, Ashish Katiyar

Introduction: With increasing surgeon experience and advancements in instrumentation and equipment, Laparoscopic Cholecystectomy (LC) continues to progress as a safer and less invasive procedure. Drainage should not be regarded as obligatory or standard after elective LC, according to the majority. Aim: To evaluate the efficacy of elective LC with and without abdominal drainage and to compare the postoperative outcomes among the groups. Materials and Methods: This prospective interventional study was carried out among all patients admitted for elective LC at the Department of Surgery, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India from October 2022 to July 2023. A total of 200 patients scheduled for LC were divided into a drain group (n=92) or a no-drain group (n=108). Allocation was non randomised and based on surgeon preference. Along with demographics, surgical details including operation time, estimated blood loss, time to first flatus and tolerance of water and solid nutrition, postoperative hospital stay duration, and postoperative complications were noted and compared. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software (SPSS Inc., Chicago, IL, USA) for the Windows program (version 26.0). The continuous and dichotomous variables were evaluated using student’s t-test and Chi-square test. Results: The mean age of patients in the drain and no-drain groups was 57.18±14.39 years and 55.61±14.83 years, respectively, with a female predominance. The no-drain group had a significantly shorter mean operation time than the drain group (93.27±30.81 min vs 124.86±38.64 min). Hospital stays in the no-drain group were substantially shorter (5.47±2.61 days) than those in the drain group (7.56±3.91 days). The postoperative morbidity rates were 14 (15.22%) in the drain group and 10 (9.26%) in the no-drain group. There was no significant difference between the groups in terms of postoperative complications. During the study, no patients in either group required reoperation. The most frequently cited reasons for drain placement were intraoperative haemorrhage (n=11) and difficult operation (n=11). Conclusion: The use of drains after simple, elective, uncomplicated LC could be safely restricted to patients deemed appropriate by the surgeon. Regarding postoperative complications, the no-drain group is superior in its use.

Nutritional Status’ Impact on the Management of Vesical Calculi: A Systematic Review of a Twenty-Two-Year Database

Harshal Madavi, Hemant Chaudhari

Introduction: Acidogenic diets cause a drop in urinary pH, and increasing features of metabolic syndrome are associated with increased calcium oxalate precipitation. Nowadays, it is well accepted that dietary variables promote the formation of vesical calculi, contributing to the prevalence of vesical stones. Aim: The aim of this study is to estimate the impact of nutritional status on the management of vesical calculi. Materials and Methods: A literature search was conducted in PubMed, Medline, Web of Science, Cochrane library, as well as additional sources such as Google Scholar and ClinicalTrials.gov, covering the period from 2001 to 2022. The most important electronic databases were checked, and all types of studies, including expressive studies, trials, commentaries, and editorials, were considered due to the nature of the studies. The risk of bias was assessed using the recommended methodology. A two-part tool was used to address five specific domains: selection bias, performance bias, attrition bias, selective reporting, and other biases. Quality diagnostic accuracy studies were evaluated using a quality assessment tool. Results: This study included 12 literature sources, of which five were nutrition-based studies and seven were focused on vesical calculi. Dietary modifications and medical treatments were found to be the most important factors in preventing recurrence. Conclusion: Dietary and medical treatments are of utmost importance in preventing recurrence. As per physician advice for vesical calculi, a proper dietary plan that includes a mineral-rich diet is needed. Consumption of ample fluids is essential for the removal of stones.

Foetomaternal Outcomes of Jaundice in Pregnancy at a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Jaundice complicates 3 to 5% of pregnancies and is one of the important causes of maternal and neonatal morbidity and mortality worldwide. It is responsible for approximately 10% of maternal deaths. Aim: To study the prevalence of jaundice in pregnancy, evaluate the important causes of jaundice encountered in pregnancy, and study the effects of jaundice during pregnancy on both maternal and foetal outcomes. 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, from March 1, 2021, to August 31, 2022. A total of 90 cases of pregnancy with jaundice were included in the present study. Detailed history, clinical examination, laboratory investigations, diagnosis, management, and outcomes in terms of maternal and perinatal morbidity and mortality were recorded. Data were analysed using the Chi-square test, with a statistical significance level set at p<0.05. Results: The total number of deliveries was 20,087, out of which 90 (0.45%) patients had jaundice. The prevalence of jaundice in pregnancy was 4.5 per 1000. The aetiologies of jaundice were viral hepatitis in 23 cases (25.55%), followed by intrahepatic cholestasis in 22 cases (24.44%), preeclampsia in 13 cases (13.33%), and Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome in 6 cases (6.66%). There were 12 (13.33%) maternal deaths and 17 (18.88%) neonatal deaths. Two (2.22%) babies were stillborn, and 1 (1.11%) case experienced Intrauterine Foetal Death (IUFD). The maternal death rate due to HELLP syndrome was 66.66% (4 deaths out of 6 cases). Conclusion: Viral hepatitis is the most common cause of jaundice in pregnancy. Although viral hepatitis due to the faeco-oral route is more common in India, the present study showed that Hepatitis B is more common during pregnancy.

Foetal Kidney Length as a Criterion for Gestational Age Estimation

Gestational Age (GA) is important because it helps guide prenatal care. The foetus plays a pivotal role in assessing its progress and establishing the anticipated delivery date. As GA increases, standard biometric markers like biparietal diameter, head circumference, and foetal length become less accurate, making accurate determination of Foetal Gestational Age (FGA) a significant barrier for patient care. The accuracy of Foetal Kidney Length (FKL) in predicting FGA in the third trimester has been established in several populations. The growth of foetal kidneys is linear with GA, and they are easily identifiable around 18 weeks, following the mid-trimester. The present paper discusses various related research, including the relationship between GA and the length of the foetal kidney.

Effect of Cyriax Manipulation on Individuals with Text Neck Syndrome: A Research Protocol for Quasi-experimental Study

Rahul Kumar, Sunita Sharma, Kunal Setia

Introduction: Text Neck Syndrome (TNS) is a modern-day problem resulting from prolonged and excessive use of electronic devices such as Smartphones (SP), tablets, and laptops. This condition is characterised by the forward tilting of the head and neck, leading to strain on the cervical spine. Symptoms may include neck pain, stiffness, headaches, and shoulder discomfort. As technology continues to dominate our lives, understanding and addressing the implications of TNS is crucial for maintaining musculoskeletal health in the digital era. Need for the study: Although the Cyriax approach is widely used to treat musculoskeletal issues, there is no literature on its application to treat TNS. Aim: To evaluate the significance of Cyriax manipulation in individuals with TNS in terms of pain and disability. Materials and Methods: A quasi-experimental design will be applied. The study will be conducted in the Department of Musculoskeletal Outpatient Department (OPD), Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India, from December 2021 to March 2023. Participants will be chosen from a group of 18-30-year-olds who have been using SP for a long duration for the present quasi-experimental study. Each subject’s complete demographic information, including name, age, gender, weight, and height, will be recorded. Normal distribution of the data will be verified by Shapiro-Wilk’s test. The level of significance or alpha level will be set at a p-value <0.05 to be considered statistically significant. Two treatment sessions will be provided per week. Neck Disability Index (NDI), Visual Analogue Scale (VAS), and Craniovertebral Angle (CVA) will be used to assess pain, disability, and forward head posture.

Effect of Continuous Training versus Interval Training on Functional Parameters of Stage-1 Hypertensive Patients: A Randomised Clinical Study

Akansha Ajay Gajbhiye, Vishnu Vardhan

Introduction: Hypertension is one of the major risk factors for heart attack and stroke, often referred to as the “silent killer.” Non pharmacological therapy can be used to manage hypertension in addition to pharmacological therapy. Exercise such as continuous and interval training are types of physical exercises. Findings indicate that Moderate-Intensity Continuous Training (MICT) and High-Intensity Interval Training (HIIT), lower average blood pressure in Stage-1 hypertensive patients. Need of the study: To evaluate the effectiveness of interval training and continuous training on patients with Stage-1 hypertension and to prevent the progression to the next stage of hypertension. Aim: To compare the effects of continuous training versus interval training on blood pressure, heart rate, and Rate of Perceived Exertion (RPE) in Stage-1 hypertension. Materials and Methods: This randomised clinical study will be conducted at the Cardiovascular and Thoracic Surgery Unit, Acharya Vinobha Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, for a duration of six months. In this study, 130 patients diagnosed with Stage-1 hypertension will be divided into two groups. The first 65 will be randomly assigned to Group A as the interval training group, while the remaining 65 will be assigned to Group B as the continuous training group. Each patient’s demographic information, including name, age, gender, height, and weight, will be recorded. Before the intervention, patients’ blood pressure and heart rate will be measured, taking an average of three readings. Training will then commence, and patients will be reassessed to determine the effectiveness. Statistical analysis will be performed using paired and unpaired t-tests.

Analysis of BRAF V600E in Precancerous and Cancerous Lesions of Colorectum by Immunohistochemistry: A Research Protocol

Shreya Giri Goswami, Arvind Bhake, Sunita Vagha

Introduction: Colorectal cancers have been extensively studied in recent years to understand their molecular abnormalities and their impact on treatment outcomes, as they continue to be a major global health burden. The Adenomatous Polyposis Coli (APC) β-catenin pathway and the Mitogen-activated Protein Kinase (MAPKs) pathway are the topic of extensive research in colorectal pathology. Need of the study: The mutation in B-type Rapidly Accelerated Fibrosarcoma (BRAF) kinase is known to be associated with the pathogenesis and progression of precancerous lesions to cancerous lesions. Precancerous lesions carry a high risk of developing Adenocarcinoma. Therefore, the expression of BRAF can serve as a useful predictive and prognostic biomarker for disease outcomes and establish correlations with other clinicopathological parameters. Aim: The present study aims to assess the immunoexpression of BRAF V600E in precancerous and cancerous lesions of the colorectum, as well as the relationship between BRAF expression, histological grading, and the Tumour, Lymph Nodes, and Metastasis (TNM) staging of colorectal cancers. Materials and Methods: This will be an ambispective observational study (both prospective and retrospective) conducted at the Department of Pathology, Rural Hospital, Wardha, Maharashtra, India, over a two-year period (Retrospective data: August 2021 to July 2022, Prospective data: August 2022 to July 2023). A total of 25 cases each of precancerous and cancerous colorectal lesions will be included. Immunohistochemical expression of BRAF V600E will be performed on tissue sections from each case, and scoring will be conducted. The relationship between BRAF expression and clinicopathological parameters (such as tumour site, tumour size, number of positive lymph nodes, and perineural invasion), histological grade, and TNM stage will be assessed. The results will be analysed using Statistical Package for the Social Sciences (SPSS) software, version 27.0. The Chi-square test will be used to investigate the relationship and association between BRAF V600E expression and clinicopathological parameters. Furthermore, Pearson’s correlation coefficient method will be utilised to determine the correlation between two parameters. A significance level of 95% (p-value <0.05) will be considered.

Metabolomics: A Pioneering Technology for Periodontal Research and Personalised Medicine

Metabolomics involves the identification and quantitative analysis of all small metabolites present in cells, tissues, and bodily fluids that are formed as a result of biochemical reactions within the cell. These metabolites form a large pool of substrates and can be modified by serving as a substrate for enzymes involved in other metabolic pathways. Therefore, the metabolome in an organism is so dynamic that there is variation in their quantity and chemical composition over time. Nuclear Magnetic Resonance (NMR), Gas Chromatography Mass Spectrometry (GC-MS), and Liquid Chromatography Mass Spectrometry (LC-MS) are the most commonly used technologies in metabolomics. The metabolites are first isolated based on their polarity, chemical composition, and structural resemblances, after which they undergo specialised processes and are then analysed. Metabolomics, coupled with MS, has advanced rapidly and found widespread use in periodontal research. The presence of distinct metabolic and microbiological profiles in different types of periodontitis, as well as their link to clinical indicators of periodontal inflammation, has demonstrated the usefulness of metabolomics in screening, preventing, and monitoring prognosis. Conventional diagnostics fail to detect periodontitis in its early stages, cannot discriminate between past and present disease activity, and are incapable of analysing the entire repertoire of biomarkers in the biological system. Therefore, metabolomics, in conjunction with other omics technologies, can provide tailored periodontal disease therapy. The present review aimed to explore metabolomics, its applications in periodontics, and the potential for personalised treatment.

Immune System and Malnutrition: The Inseparable Duo in Managing HIV: A Narrative Review

Priyanka Nitin, R Shashidara, Usha Hegde, HP Jaishankar, HS Sreeshyla

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are among the greatest public health challenges around the globe. India ranks the third largest HIV epidemic in the world. People Living With HIV (PLWH) are highly susceptible to life threatening conditions as HIV destroys the body’s immune system. Despite anti-retroviral treatments, tackling HIV and AIDS has been an uphill task for decades with all the countries contributing their best to decrease the incidence and mortality rate. But this has been difficult as there are problems in plenty across the globe. Loss of life, economic burden, psychological effects, stigma, discrimination are the perennial problems of HIV and AIDS. Awareness about HIV/AIDS and factors influencing the disease progression is the key to break this cycle. One of the important factors influencing the disease outcome is immune status of an individual. The immune system is highly influenced by nutrition which is an integral part in managing HIV. Nutrition has always contributed to the robust functioning of the immune system of an individual. PLWH almost always have malnutrition which, if not corrected, influences the outcome of HIV infection drastically. With people across the globe showing malnutrition, either under or excess, the immune system functioning is impaired, particularly so in PLWH. Unfortunately, nutrition has been ignored or sidelined in managing HIV/AIDs. This review gives an overview of the interrelation of nutrition and immune system and how these influence the outcomes in PLWH.

To Refer or Not to Refer Periodontally Compromised Patients- What Does Literature Suggest?

Laboni Ghorai

Periodontal disease is one of the most common diseases worldwide. Hence, regular and thorough periodontal screening and care is imperative and should be a basis of all oral examinations. General dental practitioners often being the first to diagnose periodontal disease, might play a significant role in the management of periodontally affected patients. It is also necessary to focus on management of the risk factors and modifying factors which might affect periodontal disease and its treatment plan. Irrespective of the treatment being administered by a specialist or general practitioner, it should be ensured that the patients receive the same and best quality treatment. The level of speciality education being limited in the curriculum for undergraduates, general dentists need to be well acquainted with the criteria of timely and appropriate referrals to periodontists. The speciality of periodontology is growing in diverse aspects and various advancements in this field of dentistry have given success predictability level to previously considered unsalvageable periodontal issues. The present article provides useful guidelines for periodontal referral. It elaborates the levels of complexity associated with periodontal treatment and care of periodontally compromised patients in a secondary care setting.

Robotic-assisted Surgery and its Impact on Patient Outcomes: A Narrative Review

Simran Chauhan, Raju K Shinde, Yashraj Jain

Robotic-assisted surgery is an advanced surgical technique that combines the skill of a surgeon with the precision and capabilities of robotic systems. This approach has revolutionised the field of medicine by providing enhanced visualisation, improved dexterity, and greater control during surgical procedures.The most widely used robotic system is the da Vinci surgical System, which allows surgeons to perform minimally invasive surgeries with smaller incisions, reduced blood loss, and faster recovery time for patients. Robotic-assisted surgery has been successfully applied in various specialities, including gynaecology, urology, general surgery, and thoracic surgery. It offers benefits such as enhanced surgical precision, better outcomes, and improved postoperative quality of life. However, the decision to use robotic-assisted surgery depends on factors such as patient suitability, surgeon expertise, and the availability of robotic systems. Ongoing advancements in robotic technology continue to shape the future of surgical practice, with the potential for further improvements in surgical techniques and patient care. Overall, robotic-assisted surgery represents a significant milestone in surgical innovation, providing a promising approach to improve surgical outcomes and patient well-being. The present narrative review describes the effect of robotic surgery in different disciplines and its effects on surgical outcomes.

Internal Assessment in Phase I of Medical Undergraduates as per the New Competency-based Medical Education Curriculum

Nitin Agrawal, Harshita Bhardwaj

The new Competency-Based Medical Education (CBME) curriculum was introduced in August 2019. Phase-I of the CBME curriculum encompasses preclinical subjects, each with its own set of competencies to be assessed according to the new CBME guidelines. Internal Assessment (IA) serves as the foundation of the CBME curriculum and is an essential component of medical education. It is included in Module three of the CBME curriculum and aids in the assessment of various competencies. IA consists of both formative and summative assessments, and employing multiple methods can enhance its effectiveness. The incorporation of regular feedback and remedial measures is crucial within the IA framework. The purpose of present review is to provide a review of the IA in Phase I based on CBME and previous research papers.

Efficacy of Various Lavaging Agents and Intra-articular Injections in Temporomandibular Joint Arthrocentesis: A Narrative Review

Preeti Yadav, V Raj Kumar, Priya Yadav

Arthrocentesis is a minimally invasive technique used in treating various temporomandibular disorders. There are various lavaging agents and intra-articular injections used in arthrocentesis viz., Normal Saline (NS), Ringer’s Lactate (RL), Sodium Hyaluronate (SH), Platelet-rich Plasma (PRP), Non-steroidal Anti-inflammatory Drugs (NSAIDs) etc. The present review was conducted to compare the published literature about the efficacy of various lavaging agents and intra-articular injections used in arthrocentesis. It was found that NS and RL are currently the best proven agents for Temporomandibular Joint (TMJ) lavage. It has been observed that lavage combined with intra-articular injections produces better outcomes than lavage alone. Patients who received treatment with arthrocentesis in conjunction with Hylauronic Acid (HA) injection, displayed faster and more noticeable improvement in their perception of pain and maximal mouth opening.

Impact of Physical Inactivity Following the COVID-19 Pandemic on the Overall Quality of Life among Cancer Patients

Mansi Jain, Sakshi Vats, Aksh Chahal, Himani Kaushik, Kamran Ali

The human population’s health, economy, and way of life have been seriously threatened by the Coronavirus Disease (COVID-19) pandemic. Patients with cancer are one of the special patient groups who faced additional difficulties during COVID-19, with additional problems in their basket. To minimise the sufferings, regular physical activity of any intensity lowers the chance of cancer progression while enhancing survival rates and Quality of Life (QoL). The lengthy indoor stay during the COVID-19 lockdown prompted inactivity among cancer patients, reducing their overall QoL. The purpose of this article is to ascertain how COVID-19-related physical inactivity affected cancer patients and their QoL.

Indiscriminate Nodule Sampling in Goitre: A Series of 5 Cases of Thyroid Microcarcinoma

Papillary Thyroid Carcinoma (PTC), which is a form of thyroid cancer, originates from follicular epithelial cells and can be identified histopathologically by distinct nuclear characteristics and architecture. It is the most common thyroid neoplasm and is typically found in young females, with a good prognosis. Within the subset of PTC, exists incidentally detected lesions called papillary microcarcinomas (IPMC), having a size ≤1 cm which are usually clinically not suspected, radiologically undetected, and often missed in gross pathological examinations. The present case series highlights five cases (2 males and 3 females) of papillary microcarcinomas that were detected over the course of one year. The patients’ ages ranged from 31 to 60 years, with a mean age of 48.8±10.1 years. The male-to-female ratio was 1:1.5. These patients presented with complaints of neck swelling and were initially diagnosed with benign nodular goitre in 47 cases based on clinical and radiological evaluations. The detection rate of papillary microcarcinomas was 10.6%, with one case showing bilaterality (20%). The authors of the present case series adopted a novel approach of indiscriminate nodule sampling of thyroidectomy specimens to observe changes in detection rates. This approach facilitated a higher yield of papillary microcarcinomas. The authors also considered the dilemma of surgical measures and prognostic outcomes in such cases.

High-performance Liquid Chromatography based Methods for Determination of Antitubercular Drugs in Urine Samples: A Scoping Review

Shilpa Manish Upadhyay, Archana Dhok, Zahiruddin Syed Quazi

Introduction: Tuberculosis (TB) is a contagious disease and is one of the leading causes of death worldwide. TB is primarily caused by Mycobacterium Tuberculosis (MTB) and the percentage of Multi-Drug Resistance TB (MDR-TB) and Extensively Drug Resistance TB (XDR-TB) is increasing daily in many developing countries. Aim: To summarise different High-performance Liquid Chromatography (HPLC)-based methods for checking treatment adherence and drug monitoring of patients by estimating the amount of Anti-tubercular (Anti-TB) drugs in urine samples. Materials and Methods: The authors conducted a search and screened various databases (PubMed, Scopus, Web of Science, Google Scholar) using different keywords between April 2023 and June 2023. The authors included original research articles, clinical trials, and observational studies that focused on estimating anti-TB drugs in urine samples using HPLC. The authors excluded articles that employed methods other than HPLC for drug estimation in urine samples. A total of 13 articles were included in this review. Results: The authors identified 296 articles from different electronic databases and four articles from other sources (Google Scholar, ResearchGate, etc.). Ultimately, 13 articles were included describing HPLC-based methods for determining anti-TB drugs in urine samples. Data was extracted focusing on mobile phases and sample preparation/extraction procedures. Two articles of 2004 and 2014 reported simple mobile phases and sample preparation methods for estimating rifampicin and isoniazid. Additionally, articles published in the last five years have employed simple mobile phases with minimal or no extraction procedures. Conclusion: The present review summarises various HPLC-based methods reported in the literature, as it is considered the gold standard method for checking treatment adherence in TB patients. Urine samples were chosen for ease of collection, particularly from patients of different age groups, including the paediatric population. This review highlights the need for more HPLC-based methods with simple mobile phases and extraction procedures for early detection of anti-TB drugs in resource-poor settings.

Correction: 2022 Feb,Vol-16(2): NC19 - NC22

Francis Kwasi Obeng, Vipan Kumar Vig, Preetam Singh, Rajbir Singh, Yao Ahonon, Analysis of Best Management of Proliferative Sickle Cell Retinopathy in African Population- A Retrospective Analytical Study (Published in Journal of Clinical and Diagnostic Research. 2022 Feb, Vol-16(2): NC19-NC22) Since the emailid of the corresponding author has been hacked,it has been changed from "fobeng37@yahoo.com" to "0bengfranzis@gmail.com".

Correction: 2017 Mar,Vol-11(3): NC09 - NC13

Francis Kwasi Obeng, Vipan Kumar Vig, Preetam Singh, Rajbir Singh, Bodhraj Dhawan, Nikhil Sahajpal,Posterior Chamber Scleral Fixation of Intraocular Lenses in Post-Vitrectomised Aphakic Eyes (Published in Journal of Clinical and Diagnostic Research. 2017 Mar, Vol-11(3): NC09 - NC13) Since the emailid of the corresponding author has been hacked,it has been changed from "fobeng37@yahoo.com" to "0bengfranzis@gmail.com".