Journal of clinical and diagnostic research

Pelviureteric Junction Obstruction in Right Ectopic Pelvic Kidney and Left Blind Ureter: A Rare Case Report

Vilas Sabale, Ashish Gavade, Vikram Satav

One in seven neonates on antenatal scan detected hydronephrosis has Pelviureteric Junction Obstruction (PUJO), making PUJO one of the most common cause of congenital urinary tract obstruction, with an incidence of one in 1000 to one in 2000 live births. Hereby, the authors present a case report of 19-year-old female who presented with pain in abdomen since, two weeks. There was no history of dysuria, haematuria. No history of lower urinary tract symptoms. No history of fever. There was no history of co-morbidity. No similar episodes of pain in past. All blood investigations were within normal limits with serum creatinine of 0.78 mg/dL. Computed Tomography (CT) Intravenous Urography (IVU) showed right ectopic kidney with Pelviureteric junction obstruction with left small atrophic kidney. Diethylenetriaminepentaacetic Acid (DTPA) reported crossed fused kidneys. Two investigations gave two different diagnoses. It made diagnosis and treatment challenging. Cystoscopy showed two ureteric orifices are normal position. Retrograde pyelogram showed left blind ureter. Right pelvic kidney was seen. Delayed drainage of contrast made diagnosis of pelvi ureteric junction obstruction. So it ruled out diagnosis of crossed fused kidneys with help of cystoscopy and retrograde pyelogram. Such anomalous kidneys are rare to find in day to day life. As anomalous kidneys usually have abnormal blood supply it makes surgery challenging. Abnormal position of kidney, malrotation makes surgery difficult. So decision was made to do open surgery for present patient. Open pyeloplasty was performed for right pelvi ureteric obstruction. Also, DTPA interpretation as anatomical investigation should be used with pinch of salt.

Radiological Findings of Extramedullary Haematopoiesis of Spleen in Beta Thalassaemia Major: A Case Report

Soumyabrata Debnath, Pulkit Kumar Santoshi, Monali Debnath

Extramedullary Haematopoiesis (EMH) is a compensatory response occurring secondary to inadequate bone marrow function and is observed in many haematological conditions. EMH can occur in many haemoglobinopathies. Extramedullary haemopoiesis favours certain sites such as the liver, the spleen, and the paraspinal regions of the thorax. However, in addition to these common sites of extramedullary haemopoiesis, the process can involve virtually any organ or tissue and can often manifest as a mass mimicking a neoplasm. Although EMH is usually asymptomatic, clinical symptoms can appear due to mass effect. Radiological evaluation can be done using Ultrasonography (USG), Computed Tomography (CT) scan, and T2, T1 weighted Magnetic Resonance Imaging (MRI). Both conservative and surgical treatments are practiced depending on the organ involvement. Here, is a rare case of a young female in her mid-20s, who was a known case of beta thalassaemia major. She presented with a mass insidiously growing in left flank region, which on radiological imaging was found to be focal mass in the spleen. The pathological diagnosis after elective splenectomy was EMH of spleen. Due to chronic transfusions in patients of beta thalassaemia major, EMH is rarely seen. In-fact, the incidence of EMH in beta-thalassaemia major is thought to be less than 1%, which makes the present case a rare entity.

Phenytoin Intake in Mothers Resulting in Early Onset Infantile Tremor Syndrome in Children: A Report of Two Cases

Payal Mittal, Rohan Acharya, Dinkar Yadav, Kapil Bhalla, Shuchi Bhalla

Infantile Tremor Syndrome (ITS) is a complex neurological syndrome that affects exclusively breastfed infants, typically seen between 9 to 12 months of age. However, in the present case, it started at the ages of three months and four months, respectively. ITS is characterised by the presence of megaloblastic anaemia-like features, developmental regression, and the onset of tremors. Here, authors report two cases of ITS, whereby megaloblastic anaemia was present because of drug (phenytoin) intake in mothers. Phenytoin intake in mothers leads to low serum vitamin B12 levels in both the mother as well as the baby. Early onset of ITS in progeny has very rarely reported in the literature. Exclusive breastfeeding is generally considered nutritionally sufficient for infants below six months of age, and the onset of ITS is typically associated with the improper introduction of weaning foods beyond six months. However, in the present cases, although the babies were exclusively breastfed, they developed nutritional deficiencies that manifested as early onset ITS. Phenytoin intake and the associated vitamin B12 deficiency in the mothers are proposed as the causes of this presentation. Such an early presentation is also associated with severe pneumonia and was found to be fatal in one of the two reported causes. The authors would like to make a pertinent point that if pregnant mothers are taking any drugs that can lead to vitamin B12 deficiency, they should ideally be checked with relevant investigations and receive supplements if required, to prevent potentially fatal outcomes in their children.

Femoral Nerve Compression Secondary to Spontaneous Iliacus Muscle Haematoma in a Patient on Anticoagulant therapy: A Case Report

Uncommon spontaneous haematomas of the iliacus muscle are observed in patients on anticoagulant medication or in those with blood dyscrasias like haemophilia. Femoral neuropathy, which may involve pain and paralysis, can arise as a result of these haematomas. Delays in the evacuation of haematomas can lead to protracted or irreversible impairment, as therapeutic options for femoral nerve involvement are not well established. The case discussed in this report is an unusual instance of a spontaneous haematoma of the iliacus muscle in a 67-year-old female patient, who presented with left lower limb pain, swelling, and weakness. She had a history of long-term Warfarin use for cardiac prosthetic valve replacement. An ultrasonography and doppler study of the affected region quickly revealed the concerning presence of an iliacus haematoma causing femoral nerve compression. Further Computed Tomography (CT) imaging illustrated the extent of the haematoma, which ultimately required drainage. Following the drainage of the haematoma and relief of compression on the femoral nerve, the patient showed dramatic improvement in her presenting complaints. This report highlights the need for a high level of clinical acumen and suspicion for spontaneous bleeding episodes with atypical or unusual presentations in patients on Warfarin therapy. Furthermore, the case underscores the importance of rapid ultrasonographical evaluation of the involved region and subsequent non surgical intervention for drainage.

Indolent Yet Intriguing: High-grade Solid Papillary Carcinoma of the Breast

Dipti Singh, Sushama Gurwale, Arpana Dharwadkar, Charusheela R Gore

Breast Solid Papillary Carcinoma (SPC) is an uncommon malignancy that primarily affects elderly women, with an incidence of 1-2%. It is morphologically characterised by well-defined nodules with low-grade nuclear features, which are associated with fibrovascular cores and neuroendocrine development. Although SPC can be invasive or in-situ, the prognosis is generally quite good. Its morphology can mimic several precancerous conditions, leading to frequent misdiagnosis. Distinguishing this tumour from its various morphological equivalents is more straightforward when an appropriate Immunohistochemistry (IHC) panel is utilised. A 45-year-old woman presented with a retroareolar mass in her right breast. Sono-mammography revealed a firm, incompressible mass with irregular borders, calcifications, cystic changes, and necrosis. A right-side simple mastectomy was performed, and the tumour was diagnosed as triple-negative high-grade SPC of the breast with focal invasion. The tumour’s origin was ruled out, and the diagnosis was confirmed by a prominent histopathologist. This report discusses a case of SPC, emphasising invasion patterns and evaluating previous knowledge.

Thrombocytopenia and Hyperhaemolysis in a Patient with Non Sickle Cell Familial Anaemia: A Case Report

Hyperhaemolysis syndrome, often associated with sickle cell disease, can also occur in non sickle cell conditions following viral infections and autoimmune disorders. This case report presents a rare instance of hyperhaemolysis in the context of familial anaemia. A 41-year-old female with a history of unexplained anaemia presented with four episodes of haematemesis, abdominal pain, and headache. She had received a blood transfusion a month prior. Upon admission, she was diagnosed with pancytopenia and hypovolemic shock and was treated with packed cell volume transfusions. The patient had a significant family history of anaemia in her sisters, who also required intermittent blood transfusions. Following admission, she developed thrombocytopenia, a drop in Haemoglobin (Hb), petechiae, and subdural haemorrhage. Further investigations confirmed hyperhaemolysis syndrome. Treatment included blood transfusions, random donor platelet transfusions, and corticosteroids. The patient was discharged on prednisolone and cyclosporine. Over six months, her condition improved significantly, with no further bleeding episodes and stable Hb levels. Diagnosing hyperhaemolysis syndrome is challenging and requires a high index of suspicion. This case underscores the importance of considering hyperhaemolysis in patients with familial anaemia and unexplained haemolytic episodes. Early recognition and appropriate management are crucial for favourable outcomes.

Management of Vicharchika (Eczema) by Multi-model Ayurveda Intervention: A Case Report

Shruti Prakash Kapatkar, Sourabh Deshmukh, Trupti Thakre, Renu Rathi

Ayurveda, the ancient system of medicine, comprehensively categorises skin disorders under the term “Kushtharoga”, encompassing a wide spectrum of dermatological conditions. This classification is further elucidated into “Mahakushtha” and “Kshudra Kushtha”, representing major and minor skin diseases, respectively. Major skin ailments include psoriasis, eczema, leprosy, and vitiligo, while minor conditions encompass common issues such as acne and dermatitis. Vicharchika, a term in Ayurveda associated with symptoms akin to eczema, poses a challenge in contemporary medical practices, where treatment options are often limited to antihistamines and topical steroids. The present case report describes the successful Ayurvedic management of a patient presenting with complaints of itching, discharge and erythematous skin lesions on the foot. The 36-year-old female patient was diagnosed with Vicharchika (eczema) and received treatments such as Bahir Parimarjana Chikitsa (External treatment) and Shaman Chikitsa (alleviating treatment) in place of Shodhana (Purification therapy) due to Alpadoshaavastha (immature body tissues), which resulted in significant improvement. The present case underscores the potential efficacy of Ayurvedic interventions, emphasising the importance of personalised treatment strategies in addressing dermatological conditions.

Crouzon Syndrome with Acanthosis Nigricans: A Case Report

Ebin Roshan Paul, Jainy Jose, GK Surya, Meenakshi Bhat, GN Sanjeeva

Crouzon Syndrome (CS) with Acanthosis Nigricans is a disorder characterised by the premature joining of certain bones of the skull {Craniosynostosis (CSO)} during development and a skin condition called Acanthosis Nigricans. Two cases of CSO with abnormal facies were referred to the present tertiary genetic centre. The first case was a one-year-three-month-old female with CSO, normal Intelligence Quotient (IQ) and normal limbs, clinically diagnosed as CS. The second case was a two-year-two-month-old male child with CSO, choanal atresia, hydrocephalus, normal limbs, post-surgical follow-up and suspected as a syndromic CSO. Both cases showed the presence of diffuse Acanthosis Nigricans and the final diagnosis was CS with Acanthosis Nigricans. This condition is distinct from classical CS due to its dermatological features, hydrocephalus, choanal atresia and impaired glucose values. CS with Acanthosis Nigricans (CAN) showed a specific mutation in the Fibroblast Growth Factor Receptor 3 (FGFR3) gene, while Classical CS, in contrast, has a mutation in the FGFR 2 gene. Both of these cases were confirmed by molecular testing as CAN. This is a very rare condition in our population because of its peculiar clinical associations.

Ayurvedic Treatment as an Adjunct to Oral Hypoglycaemics in Diabetic Wound Management: A Case Report

The widespread occurrence of Type 2 Diabetes Mellitus (T2DM) is a significant public health issue in India. Diabetes severely impedes the wound healing process. Delayed wound healing in diabetes is caused by a decrease in nitric oxide generation, the presence of Advanced Glycation End products (AGEs), and impaired epithelial cell motility. In this case, a 38-year-old diabetic male presented seeking Ayurvedic treatment for a wound on his right lower limb, which resulted from a prick injury sustained 10 days earlier. He also had varicose veins in both legs and had been living with diabetes for five years. His medical history included slow wound healing. The condition was diagnosed as “Dushtvrana” associated with “Prameha” and was treated with Ayurvedic medicines in addition to oral hypoglycaemics. The Ayurvedic treatment included Panchavalkala Kwatha Vranadhavan, followed by the local application of Yashtimadhu Ghrita every third day, along with the oral administration of Nishadhatri Yoga (5 g) twice daily. Additionally, he was prescribed a daily evening dose of 500 mg metformin tablets for 25 days. There was no pain or inflammation observed, and the wound fully healed. This case demonstrates the effectiveness of Ayurvedic treatment-Panchavalkala Kwatha Vranadhavan, Yashtimadhu Ghrita for local application, and oral Nishadhatri Yoga-as an adjunct to the oral hypoglycaemic drug metformin in treating diabetic wounds.

Unforeseen Intrauterine Foetal Demise in Dichorionic Diamniotic Twin Pregnancy during the Second Trimester: A Case Report

Aishwarya Uday Beedkar, Neema S Acharya, Megha Karnik, Shivani Singh

The health of both mother and child during delivery is the cornerstone of a thriving nation; however, rare cases of unexpected Intrauterine Foetal Demise (IUFD) pose significant challenges to healthcare. This case report presents an unexpected IUFD in a dichorionic diamniotic twin pregnancy involving a primigravida female who conceived through In-vitro Fertilisation (IVF). At 18 weeks and two days of gestation, one twin was diagnosed with IUFD through an ultrasound examination, with an unknown aetiology. The patient underwent cervical cerclage to support the continued pregnancy. Ultimately, at 35 weeks, a caesarean section was performed to deliver one live female baby and one mummified foetus of unknown gender. This case underscores the challenges and management of IUFD in multiple pregnancies and highlights the importance of close monitoring and timely interventions.

Acute Post Streptococcal Glomerulonephritis with Persistent Hypertension in a Child of Holt-oram Syndrome: A Case Report

Balkrushna Garud, Sanjay Chavan, Shradha Salunkhe, Aryan Gupta, Shailaja Mane

Holt-Oram syndrome is a rare congenital autosomal dominant disorder caused by a mutation in the TBX5 gene. It is characterised by upper limb abnormalities and congenital heart lesions, such as Atrial Septal Defect (ASD), typically affecting children. In this case, a six-year-old boy presented with facial puffiness and decreased urine output following an upper respiratory infection. Upon examination, he was found to have Holt-Oram syndrome, a rare genetic disorder characterised by abnormalities in the bones of the upper limbs and congenital heart defects. He developed acute Post Streptococcal Glomerulonephritis (PSGN) following a streptococcal infection, resulting in persistent hypertension. Each condition independently poses significant health challenges, and their simultaneous occurrence complicates the clinical picture considerably. Following detailed investigations and management, the child required continued treatment with two antihypertensive medications upon discharge. The need for dual therapy in a paediatric patient highlights the severity of his condition and the challenges in managing it effectively. Close follow-up is essential to monitor disease progression and ensure optimal outcomes. This case features both a genetic disorder (Holt-Oram syndrome due to a TBX5 gene mutation) and an immune-mediated renal disease (PSGN), representing a rare intersection of genetic and postinfectious pathologies. The co-existence of these two conditions is unusual and complicates the clinical picture, necessitating a tailored approach to management. This case underscores the need for a multidisciplinary approach involving cardiology, nephrology, and genetics. Coordinated care is crucial for monitoring disease progression, managing complications, and ensuring comprehensive treatment.

Effect of Single Session Three Therapist-administered Posterolateral Mobilisation with Movement Glide on Shoulder Range of Motion: A Case Report

Santosh Channabasapa Metgud, Vaibhav B Ghodake, Omkar Anand Gaonkar

Frozen shoulder, or adhesive capsulitis, is a condition characterised by pain and stiffness in the shoulder joint. It gradually worsens over time, making it difficult to move the shoulder. The exact cause is not always clear, but it can be associated with injury, surgery, or certain medical conditions. Treatment typically involves physiotherapy and pain management. The authors present a case of a 41-year-old male who complained of acute pain in the right shoulder joint over a period of 15 days. Examination revealed a restriction in shoulder Range Of Motion (ROM). The case was treated with a single session of three therapist-administered posterolateral Mobilisation With Movement (MWM) glides. No medication was prescribed to the patient and he was asked to follow-up in the Outpatient Department (OPD) for three days. The single session of posterolateral MWM glide, along with conventional physiotherapy, led to an increase in shoulder ROM and a reduction in pain. This approach can be considered a viable treatment option for frozen shoulder.

Anaesthetic Management of Simultaneous Pancreas and Kidney Transplant Surgery: A Case Report

Shilpa Deshmukh, Vaishnavi Avirneni, Jayant Bhatia

End-stage renal disease is commonly attributed to chronic conditions such as Diabetes Mellitus (DM), a primary factor in the development of nephropathy. As awareness of organ donation grows, the availability of transplantable organs has also increased. Multiorgan transplants, such as Simultaneous Pancreas and Kidney (SPK) transplants, have become viable options, though very few cases have been reported, especially in India. The SPK transplant offers freedom from renal replacement therapy and dependence on insulin, drastically improving the quality of life for the patient. This case report discusses a 31-year-old male who was a known case of type I DM and had been on haemodialysis for end-stage renal failure for seven years. He was posted for an SPK transplant. A multidisciplinary approach was adopted, beginning in the preoperative period with the preparation of the patient through haemodialysis, immunosuppression, and optimisation of other co-morbidities. During the intraoperative period, the focus was done on maintaining sufficient tissue perfusion without maximising cardiac filling and managing fluctuations in blood glucose levels and electrolyte abnormalities. In the postoperative period, vigilance and utmost care were prioritised to ensure successful management of this SPK transplant. Given the benefits that SPK transplants can provide to patients, it is likely that this will become the treatment modality of choice for these long-term debilitating conditions. Therefore, in addition to understanding appropriate anaesthesia management for such cases, the importance of good team coordination should be emphasised to enhance graft survival and function, with the ultimate aim of improving the quality of life for transplant recipients.

Anaesthetic Challenges and Perioperative Management of Arnold Chiari Malformation Type 1: A Case Report

Bhagyashri Soor, Nayana Raveendran, Shubhangi Humane, Pallavi Jagtap

Arnold Chiari Malformation (ACM) is a group of deformities of the cranium and hindbrain, where there is herniation of cerebellar tonsils through the foramen magnum. Based on the morphology and degree of anatomic defects, Chiari malformations are categorised as type 1, 2, and 3, usually through imaging. While type 2 and 3 are more prevalent and occur in younger age groups, being present from birth, type 1 Chiari is the least severe and is more frequently found in adults. Numerous deformities, including spinal deformity, encephalocele, hydrocephalus, syrinx, and elevated intracranial pressure, are associated with it. Additionally, there are autonomic disturbances associated with it as well. As a result of all these factors, anaesthesiologists face significant challenges. Hereby, the authors present a case report of 52-year-old male patient of ACM type 1 associated with bony deformity at the craniovertebral junction and syrinx, who underwent cervical decompression with C1-C2 fixation. This patient had a tingling sensation and numbness in the left upper limb, with power in the left upper limb being 1/5 and progressive gait abnormalities. Additionally, the present patient had his right upper limb amputated below the elbow joint after a road traffic accident 10 years ago, which imposed more challenges regarding intravenous access. A well-thought-out, multidisciplinary approach is needed for its management. The management of adequate intraoperative anaesthesia in such cases will have an impact on the recovery after surgery of patients with ACM type 1.

Emanuel Syndrome with a Distinctive Phenotype: A Case Report and Review with an Indian Perspective

Mamta Belnekar, Shital Virulkar, Tasha Vasaya, Preetha Joshi, Bibhas Kar

Emanuel Syndrome (ES) is a chromosomal disorder characterised by the presence of an extra copy of chromosome 22, specifically a derivative 22 chromosome, which results from an unbalanced translocation involving chromosomes 11 and 22, due to 3:1 meiotic non disjunction. This leads to the gain of the 11q23-qter and 22pter-q11.2 regions. The syndrome is marked by developmental delay, facial dysmorphism, heart defects, genital abnormalities and renal anomalies. In most cases, one of the parents is a carrier of a balanced translocation, t(11;22). The present case is of a two-month-old male child suffering from failure to thrive and developmental delay, who was found to have a karyotype of 47,XY,+der(22)t(11;22)(q23.3;q11.2)dmat, resulting from a maternal balanced translocation, t(11;22)(q23;q11.2). Molecular cytogenetic testing confirmed the presence of partial trisomy 22q11.2 in the proband. This report presents a case of partial trisomy 22q11.2 resulting from a maternal balanced translocation between the long arms of chromosomes 11 and 22, associated with Congenital Heart Defects (CHD) and Congenital Diaphragmatic Hernia (CDH). Approximately, 11 comparable cases have been reported in the Indian population, with variations in breakpoints observed in some. However, none of these previous cases have identified CDH as a phenotypic feature, making this case particularly noteworthy.

A Case of Immune Reconstitution Inflammatory Syndrome (IRIS) in Musculoskeletal Tuberculosis: A Rare Clinical Presentation in a 14-year-old Patient

Eswaran Mythilisri, B Vijay Anand, Ashlee Isaac, C Rishab

Tuberculosis associated- Immune Reconstitution Inflammatory Syndrome (TB-IRIS) is a paradoxical deterioration or resurgence of pre-existing tuberculous lesions, or the emergence of new lesions, in individuals who are effectively undergoing anti-tuberculous treatment. This condition arises from an abnormal, excessive immune response to Mycobacterium in individuals who may, although rarely, not have Human Immunodeficiency Syndrome (HIV)-TB co-infection. This phenomenon may manifest during or even after the completion of therapy. In such cases, the initiation of concurrent steroid therapy has been found to improve symptoms by suppressing the excessive immune response. Hereby, the authors present a case report of 14-year-old teenage girl diagnosed with tuberculosis of the elbow who was started on anti-tuberculous therapy. After three months, she presented with multiple new lesions on her opposite forearm and leg. She underwent debridement of the lesions, and histopathological examination revealed a tuberculous aetiology. She was then started on concurrent steroid therapy for six weeks, following which her general condition improved, and there was no further development of new lesions.

A Case of Adenoid Cystic Carcinoma of Submadibular Salivary Gland: An Aggressive Neoplasm with Multiple Recurrences

Adenoid Cystic Carcinoma (ACC) is an uncommon form of malignant neoplasm of the salivary gland. ACC is a rare epithelial, slow-growing yet aggressive neoplasm with a remarkable capacity for recurrence. It most commonly develops in the salivary glands or other regions of the head and neck. Hereby, authors present a case of a 72-year-old female who presented with a rapidly enlarging swelling in the right submandibular region, which had recurred three times. Histopathological examination reported it as ACC grade II. ACC is known for its ability to invade perineurally, its high frequency of local and distant recurrence and its poor long-term prognosis. In the present case, the treatment provided was complete surgical resection. The patient underwent wide surgical excision of the lesion with appropriate margins, as well as a completion neck dissection of level IA. The histopathological diagnosis is based on tissue examination findings that exhibit typical histologic features. The presence and percentage of solid architecture reflect clinical outcomes and should be reported in the pathology report. Current diagnostics mainly rely on histomorphology, along with immunohistochemistry and cytogenetics. Poor prognostic factors include large tumour size, solid growth pattern, positive surgical margins, nodal status, nuclear atypia, high mitotic activity, high-grade transformation, lymphovascular invasion and tumour necrosis. The patient was kept on regular follow-up and there was no recurrence or metastasis noted over two years. ACC remains extremely difficult to treat due to its high recurrence and metastasis rates. The authors are presenting a case of right submandibular gland ACC for its rarity, multiple recurrences, aggressive clinical behaviour and associated radiological and histopathological findings.

Maternal Mortality Resulting from Signet-ring Cell Carcinoma of the Sigmoid Colon Presenting as Bilateral Krukenberg Tumours: A Case Report

Gwendolyn Fernandes, Manali Patil, Sonal Gupta

Krukenberg Tumours (KTs) during pregnancy are extremely rare, difficult to diagnose, and have a grave prognosis. Authors hereby, report an autopsy case of a 23-year-old primigravida at 29 weeks of gestation who presented at a tertiary care centre with preterm labour. She complained of severe abdominal pain, backache, and vaginal leakage for the past two days. Physical examination revealed an oedematous abdominal wall and a gravid uterus measuring 34 weeks, as the tumours could not be palpated separately. She underwent a normal vaginal delivery and delivered a live female foetus weighing 1.6 kg. However, she developed septicaemia and, on the fifth postnatal day, progressed to loss of consciousness and subsequently died. A complete autopsy was performed. Her past medical history indicated that at 20 weeks of gestation, bilateral ovarian masses were detected and biopsied. The biopsy revealed high-grade metastatic adenocarcinomas that were positive for CK20 and Epithelial Membrane Antigen (EMA) but negative for CK7, Alpha fetoprotein (AFP) and CD10, suggesting a primary tumour in the gastrointestinal tract. The autopsy revealed a signet-ring cell carcinoma of the sigmoid colon, along with bilateral large KTs and peritoneal metastasis.

Disseminated Tuberculosis Presenting as Transverse Myelitis with Bone Marrow Involvement: A Rare Case of Pyrexia of Unknown Origin

In India, both pulmonary and Extrapulmonary Tuberculosis (TB) are prevalent. Central Nervous System TB (CNS-TB) is rare, with spinal intramedullary TB (SIMT) presenting as Longitudinally Extensive Transverse Myelitis (LETM) being even rarer. Diagnosing LETM often involves considering alternative aetiologies, frequently overlooking TB, particularly in patients without primary pulmonary TB. A 31-year-old male presented with high-grade fever, weight loss, and right hypochondriac pain. Initial investigations revealed pancytopenia and hepatosplenomegaly. Bone marrow biopsy showed granulomas and Acid-Fast Bacilli (AFB), but there was no evidence of Mycobacterium tuberculosis on the Cartridge-based Nucleic Acid Amplification Test (CBNAAT), leading to a presumptive diagnosis of disseminated TB. The patient was started on Antitubercular Therapy (ATT) but was non compliant with his medication, resulting in worsening symptoms, including paraparesis and urinary bladder involvement. Further investigations revealed LETM and ring-enhancing lesions in the brain. Despite negative CSF CBNAAT tests, empirical ATT with corticosteroids was resumed, and Mycobacterium tuberculosis was later confirmed via Lowenstein-Jensen (LJ) culture of the bone marrow. This case underscores the diagnostic challenges of disseminated TB with LETM, highlighting the importance of a high clinical suspicion and thorough evaluation, especially in endemic regions.

A Rare Case of Primary Bone Lymphoma Masquerading as Langerhans Cell Histiocytosis

Saji Francis, Najila Cherikkal, Rajeev Mankada Parambil

Anaplastic Large Cell Lymphoma (ALCL) is an uncommon type of Non Hodgkin Lymphoma (NHL). It commonly arises in lymph nodes and can also involve extranodal sites such as the skin, soft tissues, lungs, bones, and liver. Here, a case of Anaplastic Lymphoma Kinase (ALK)-positive ALCL in a 17-year-old male patient who presented with swelling in the frontal and occipital bones is presented. The patient was clinically and radiologically diagnosed with Langerhans Cell Histiocytosis (LCH), and excision of the occipital lesion was performed. Preoperatively, lymphoma was not considered a differential diagnosis. Detailed histopathological examination, immunohistochemistry, and Positron Emission Tomography (PET) scan confirmed the diagnosis of primary bone ALK-positive ALCL. This T-cell NHL is composed of large lymphoid cells with abundant cytoplasm and pleomorphic horseshoe or kidney-shaped nuclei, with characteristic ALK and CD30 positivity. An isolated presentation of ALCL as a primary lesion in the bone is extremely rare. Clinicians and pathologists should be aware of this rare presentation, as prompt diagnosis and proper treatment can lead to favourable outcomes.

Non Operative Management of Complicated Appendicitis with Broad Spectrum Antibiotics in a Paediatric Patient: A Case Report

Vansh Vohra, Jyoti Jain, Dipesh Goel, Shaik Kareemulla, Wandeep Dagar

The therapy for complicated appendicitis presents a clinical challenge, as it is characterised by inflammation with a contained or localised perforation that results in the formation of an abscess. This case report describes the presentation, diagnosis, and effective non operative management of a 14-year-old girl with acute complex appendicitis. Investigations and clinical examination confirmed the presence of an appendicular abscess in the patient, who exhibited characteristic symptoms. The treatment course adhered to the Ochsner-Sherren protocol, which included fluid resuscitation, broad-spectrum intravenous antibiotics, and a Nil Per Oral (NPO) status. An ultrasound-guided aspiration of periappendicular pus indicated that an empirical upgrade to Piperacillin + Tazobactam was necessary. The patient showed improvement in all symptoms, including fever and abscess resolution, after the switch in antibiotics. This case adds to the increasing body of research that supports non operative therapy for complex appendicitis, particularly when assisted by diagnostic tools such as ultrasonography. The decision to forego emergency surgery aligns with current evidence advocating for conservative strategies, which demonstrate higher success rates and lower risks of postoperative complications. Although appendectomy remains the preferred treatment for perforated appendicitis without an abscess, this case highlights the viability and effectiveness of non operative interventions in certain situations. This report emphasises the significance of customised treatment strategies based on patient presentation and clinical response, contributing to the ongoing discussion regarding the best therapy for complex appendicitis.

Osteochondral Fragment Fixation in Transient Patellar Dislocation of an Adolescent: A Case Report

Vishal S Patil, Mohammed Talha Muneer, Setu Kaneria

Osteochondral Fractures (OCFs) of the patella are common in adolescents due to ligament laxity and weak osteochondral junctions. OCFs following patellar dislocation are particularly challenging in this age group. Magnetic Resonance Imaging (MRI) aids in comprehensive evaluation, and surgical fixation with bioabsorbable sutures is a reliable treatment option. Early intervention and proper rehabilitation are essential to ensure optimal outcomes and prevent long-term complications. The present case report details the presentation, diagnosis, surgical intervention and outcome of a 16-year-old male with an OCF following patellar dislocation. Examination revealed significant ligament laxity and patellar hypermobility, along with patella alta (Insall-Salvati ratio of 2.1) on the affected side. The neurovascular examination was normal. Initial X-rays showed no abnormalities; however, Computed Tomography (CT) and MRI scans revealed a displaced OCF fragment in the anterior intercondylar region, along with lateral patellar tilt, marrow contusion, chondral delamination and partial thickness tearing of the Medial Patellofemoral Ligament (MPFL). Surgical intervention involved open reduction and internal fixation using absorbable Vicryl sutures. Postoperatively, the patient was immobilised for six weeks, followed by a structured rehabilitation program. The patient achieved a full range of motion and restored knee function within six months, with satisfactory radiographic and functional outcomes. At the latest follow-up, the knee range of motion was from 0 degrees of extension to 130 degrees of flexion, with complete pain alleviation. OCFs of the patella in adolescents require timely diagnosis and intervention to prevent degenerative changes. MRI is essential for evaluating soft tissue injuries. Surgical fixation using bioabsorbable sutures provides effective treatment, offering strong fixation without the need for implant removal. Addressing associated injuries, such as MPFL tears, is crucial to prevent recurrent dislocation.

Vesical Artery Embolisation in Management of Haematuria due to Radiation-induced Haemorrhagic Cystitis: A Case Report

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

Radiation therapy is often utilised for the treatment of pelvic malignancies. Radiation-induced haemorrhagic cystitis can occur in such patients and may sometimes lead to uncontrolled haematuria. Various treatment modalities for managing this condition include urinary bladder irrigation, cystoscopy-guided procedures, hyperbaric oxygen therapy, fulguration, and other surgical techniques. Transarterial super-selective vesical artery embolisation has emerged as a modern management technique for patients with refractory radiation-induced haemorrhagic cystitis. Hereby, the authors present a case report of a 62-year-old elderly female patient diagnosed with radiation-induced haemorrhagic cystitis, which was refractory to continuous urinary bladder irrigation and medical management. She was successfully treated with super-selective vesical artery embolisation, resulting in complete resolution of haematuria, even on follow-up. This minimally invasive and effective modality can be utilised as a first-line therapy as well as in cases where other treatment options have failed.

Four Cases of Laboratory Acquired Q Fever: Lessons from the Past and a Brief Review of Literature

Jothimani Pradeep, Selvaraj Stephen

The aim of this communication is to highlight the dangers of Q fever outbreaks in laboratories attempting isolation of Coxiella burnetii (C. burnetii) and other rickettsiae without Bio Safety Level (BSL)-3 facilities. This series is reported for the benefit of Microbiologists who evince interest in Rickettsial research. Four cases of Laboratory-acquired Q fever is presented among the laboratory personnel in a tertiary care teaching Hospital in Karnataka in 1977, which has not been reported yet. Four persons (one Lecturer, one animal technician and two M.Sc. students) who assisted in blood collection from slaughtered domestic livestock from butcheries and/or participated in the isolation of C. burnetii by guinea pig inoculation became seropositive for Q fever. The presence of antibodies to C. burnetii was demonstrated by two specific serological tests, Micro Agglutination Test (MAT) and Complement Fixation Test (CFT) for Q fever. They responded well to treatment with oxytetracycline, the drug of choice. It should be known that even microscopic demonstration of C. burnetii and other rickettsiae in the ectoparasites is hazardous, due to liberation of infective aerosol in the process. A safe commercial Q fever vaccine for laboratory and farm workers is presently available in Australia alone. Therefore, preventive measures like use of BSL-3 facility in the laboratory as well as animal house, wearing N95 face masks and protective clothing (PPE) are some of the essential precautions to follow so as to prevent laboratory acquired Q fever infection, which is an important occupational hazard.

Rare Clinical Presentations of Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection: A Case Series from Eastern India

Biyas Koley, Disha Mukherjee, Partha Sarathi Kundu

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) occurs in the child and adolescent age group. It is characterised by the acute onset of Obsessive-compulsive Disorders (OCD) and/or tic disorders following an infection with Group A Beta-haemolytic Streptococci (GABHS), but it can also present with a variety of unique clinical manifestations. Despite the high prevalence of streptococcal infections in the Indian subcontinent, very few cases have been reported due to a lack of awareness. Hereby, the authors present a case series of four cases (one female and three males) of PANDAS with rare presenting symptoms, including dissociative (conversion) disorder and hoarding disorder, each with evidence of a preceding streptococcal infection.

Roth Spots in Sickle Cell Trait: Association or Chance Spot

K Harshitha Reddy, Manjeet Kothari, Vijaya Mallareddy, Sunil Kumar

Clinical Image of Tuberculosis Verrucosa Cutis: A Tropical Trouble

C Balakumaran, NR Vignesh, D Manoharan, M Athira Deepthi

Medullary Thyroid Carcinoma Presenting with Calcified Thyroid Nodule, Calcified Lung and Cervical Lymph Node Metastasis

A 64-year-old male patient was admitted to the General Medicine ward for uncontrolled type 2 diabetes mellitus and peripheral vascular disease. On examination, there was presence of neck swelling on the right-side. The swelling was insidious in onset, initially small in size, and slowly progressed to its current size over the past five years. There was no associated pain. There was no history of fever, nausea, vomiting or difficulty in swallowing or breathing. There was also no history of loss of appetite, weight loss, or weight gain. On examination, the swelling moved with deglutition and was noted in the right lower neck in the region of thyroid gland. The approximate size of the swelling was 4×4 cm and the lower border of the swelling was visible. On palpation, the swelling was firm in consistency and partially mobile. There were palpable lymph nodes on the right-side of the neck in level IB and III regions. Clinically, a diagnosis of thyroid carcinoma was kept, in view of palpable lymph nodes. Blood investigations showed a reduced haemoglobin level of 10.4 g/dL. Rest of the investigations, including thyroid function tests were normal. The patient was subjected to ultrasound and Contrast-enhanced Computed Tomography (CECT) of the neck for further evaluation. Ultrasonography (USG) of the neck showed a well-defined wider than taller heterogeneously hypoechoic lesion arising from the right lobe of the thyroid showing dense linear areas of macro calcifications within it (Table/Fig 1)a. On USG, Thyroid Imaging Reporting and Data System (TIRADS) 4 lesion which is moderately suspicious for malignancy was considered. In addition, a few enlarged cervical lymph nodes showing similar calcification were noted in right level IB, II, III, and IV, the largest measuring ~ 1.6×1.0 cm (Table/Fig 1)b. Non contrast and contrast CT of the neck confirmed the above findings with calcified right lobe thyroid lesion and multiple calcified right level IB, II, III, and IV group of lymph nodes (Table/Fig 2)a,b,c,d. There was no evidence of retrosternal extension. Chest CT revealed small calcified nodules in the right upper lobe, suggestive of lung metastasis (Table/Fig 3)a,b. The patient was further subjected to Fine Needle Aspiration Cytology (FNAC) of the right lobe of the thyroid lesion which revealed medullary carcinoma. Preoperative serum calcitonin was 309 pg/mL and carcinoembryonic antigen level was 5 ng/mL. The patient underwent total thyroidectomy and right functional neck dissection. Postoperative serum calcitonin was 92 pg/mL indicating improvement. In the present case, the adrenal gland and parathyroid glands were normal, hence this case was sporadic. The patient is presently on follow-up. Medullary Thyroid Carcinoma (MTC) is a rare malignancy of thyroid gland which arises from parafollicular C cells which secrete calcitonin (1). MTC can be hereditary or sporadic. The hereditary type is usually part of multiple endocrine neoplasm II syndrome (1). In our case, adrenal and parathyroid glands were normal ruling out Multiple Endocrine Neoplasia II (MEN II) syndrome. All patients with MTC diagnosed with FNAC usually require baseline calcitonin and carcinoembryonic antigen levels. Calcitonin levels greater than 500 pg/mL usually indicate metastatic disease (2). All patients with MTC should also undergo analysis for Rearranged during Transfection (RET) mutation to diagnose MEN II syndrome (3). In the present case, the patient could not afford to undergo genetic analysis. Ultrasonography is the primary modality for the evaluation of thyroid swelling. Currently, Fludeoxyglucose Positron Emission Tomography (FDG PET) is most used. On USG, MTC shares imaging findings of other thyroid carcinomas. It has ill-defined margins, mostly hypoechoic with calcifications. Sometimes it may have a hypoechoic halo like a benign nodule. Lymphadenopathy and extra thyroidal extension usually indicate an advanced stage (3). On Doppler, it usually shows increased colour flow. USG is also used to evaluate cervical lymph node metastases. The cervical lymph node metastases in MTC is usually seen in medial and infrahyoid compartments (3),(4). But in this case, both supra and infrahyoid compartments were involved. CT and MRI are usually advocated in patients with advanced disease to look for metastases. Most of the time, calcifications are noted both in primary and lymphnodal secondaries like in the present case of MTC. Nuclear Medicine imaging can provide both functional and morphological information especially the hybrid imaging techniques like PET-CT and Positron Emission Tomography-Magnetic Resonance Imaging (PET-MRI) which are useful for staging and restaging of MTC (1),(5). The primary modality of treatment is surgery, which is complete surgical resection of tumour and nodal metastases (2). In the present case, total thyroidectomy and radical neck dissection was performed. MTC has high mortality rate and shows less favourable prognosis compared to other thyroid carcinomas. Most of the patients usually have lymph node metastases at the time of diagnosis and recurrence can be seen in about 50% of cases (1). The factors that influence prognosis include baseline calcitonin, Carcinoembryonic Antigen (CEA) levels including their doubling time, genotype, histological findings, metastatic spread, gender, and age (1). In MTC patients with distant metastases, therapeutic options are limited as they do not concentrate radioiodine and show poor response to chemo and radiotherapy (1). In the present case, the patient was not willing to undergo chemo and radiotherapy and is currently on follow-up. Postoperative calcitonin levels were reduced in the patient, compared with preoperative values suggesting a response to treatment. Pombo F et al., reported a case of MTC with cervical 2lymph node metastases which also showed calcifications similar to our case (6). In a study conducted by Wang L et al., out of 73 patients with MTC, 45 patients (61.6%) showed the presence of calcifications within the thyroid nodules indicating calcifications are common in MTC nodules (7). In the present case also, there was calcification within the right lobe thyroid nodule which on histopathology turned out to be MTC. Jimenez JM et al., reported a case of MTC with calcified lung metastases, similar to the present case (8). The other differential diagnosis for calcified lymph nodes includes metastatic adenocarcinoma from breast or lung, metastatic squamous cell carcinoma of head and neck, and treated lymphoma. Benign conditions like tuberculosis, sarcoidosis, amyloidosis and Rosai-Dorfman disease also should be considered as differential diagnosis for calcified cervical lymphadenopathy (9). To conclude, MTC should be included in the differential diagnosis during evaluation of calcified thyroid nodule and cervical lymph nodes.

Sebocystomatosis of the Axillae: Unveiling a Rare Entity

Garima Chandrakar, Simran Khan

Exencephaly: A Visual Insight into Cranial Anomaly

Mohini Gokuldas, Dipak Kolate, Meenal Patvekar

Optimal Anaesthetic Management in Tracheal Reconstruction Surgery: The Role of High-frequency Jet Ventilation

Tanmay Chaudhari, Shweta Khatri

Recurrent Deep Vein Thrombosis Shrouding a Sinister Colorectal Carcinoma in a Young Adult

Nikhil Pantbalekundri, Shilpa Gaidhane

Dilemmas in Antenatal Reporting of Ambiguous Genitalia on Ultrasound, under Preconception and Prenatal Diagnostic Techniques Act, 1994

Karishma Santosh Krishnani

qRBBB: A Sinister ECG Pattern for Poor Outcome

Maharshi Patel, Satish Mahajan

Clinical Evaluation of Masticatory Performance of Pre and Post-mandibular Guidance Therapy in Hemi-mandibulectomy Patients: A Quasi-experimental Study

Introduction: Surgical removal of the lower jaw is the most common cause of mandibular deviation due to benign or malignant neoplasms. The Palatal Guide Flange Prosthesis (PGFP) is a recommended corrective appliance to reduce this clinical manifestation. The primary goals of rehabilitation with PGFP are to train the mandibular muscles and restore a healthy occlusal relationship so that the patient can effectively control their mouth opening and closing movements. In the present article, the Masticatory Performance (MP) of patients who had undergone hemi-mandibulectomy surgery was evaluated both before and after receiving an interim PGFP. Aim: To clinically evaluate MP pre- and post-mandibular guidance therapy in hemi-mandibulectomy patients. Materials and Methods: A quasi-experimental study was conducted on patients selected from the Outpatient Department of the Department of Prosthodontics at Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India, from January 2021 to July 2022, and were included as the sample size for the study. A total of 10 samples were selected. The study design was quasi-experimental. All cancer patients had lost their mandibular continuity and showed mandibular deviation toward the affected side. PGFPs were fabricated using Heat Cure Acrylic Resin (DPI) for each participant (n=10). Corn flakes (Kellogg’s) were given to the participants to chew, and the samples were sieved using a US standard 8-mesh sieve and collected at three different time intervals: T0 (preprosthesis), T1 (8^th week), and T2 (16^th week post-prosthesis). Data were entered into Microsoft Excel Version 13 and analysed using IBM Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive and inferential statistics were used, including mean and standard deviation for continuous variables and frequency analysis for categorical variables. For categorical variables, a Chi-square proportion test was utilised, and MP was evaluated between T0-T1 and T0-T2. We utilised a 95% confidence interval and a p-value of less than 0.05. Results: When comparing the MP between T0, T1 and T2 time intervals, it was found that the difference in mean MP was statistically significant (p<0.05), with MP increasing from 26.2% to 43% to 61.2%, respectively. Conclusion: The occlusion restored with the guide flange prosthesis, along with continuous use over a longer period, helped correct the deviated mandible and, in turn, improved the MP.

Prevalence of Hepatitis D Virus among the Patients at a Tertiary Care Hospital in Gujarat, India- A Cross-sectional Study

Introduction: Hepatitis D (Delta) Virus (HDV) infection is present worldwide, with an estimated 18 million people being infected. HDV can infect individuals who are already infected with the Hepatitis B virus (HBV), leading to severe liver disease. The global prevalence of HDV varies by geographical region. In India, there is a lack of data on HDV infection among individuals exposed to HBV. Detecting HDV infection in Hepatitis B surface Antigen (HBsAg)-positive patients can improve patient outcomes. Aim: To determine the seroprevalence of HDV in HBsAg-positive patients. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology, Shri M.P. Shah Government Medical College and Guru Gobind Singh Government Hospital in Jamnagar, Gujarat, India, over a period of one year from September 2022 to August 2023. A total of 350 HBsAg Enzyme-Linked Immunosorbent Assay (ELISA)-positive cases were included in the study. Serum samples from patients in various inpatient and outpatient departments of the hospital were tested for HBsAg infection using ELISA. After confirming positive results for HBsAg, all samples were tested for anti-HDV IgM antibodies by ELISA. Demographic and clinical findings were recorded for all patients. Statistical analysis was performed using means and percentages, and p-values were calculated using the Chi-square test to determine the seroprevalence of HDV. Results: Among the 350 HBsAg-positive cases, a higher prevalence was observed in middle-aged and older females. Ten (2.9%) cases were positive for anti-HDV antibodies. Of the 10 anti-HDV antibody-positive patients, 5 (50%) reported a history of blood transfusion. Conclusion: The seroprevalence of HDV was found to be 2.9% in HBsAg-positive patients in this study, with a predominance in middle-aged and older females. Additionally, the most common route of transmission identified was blood transfusion.

Sustainable Neck Pain Management for Homemakers: An Experimental Study

Prashant Prabhakar Naik, Jinal Naik, Sneha Katke, Sachin Shetti, Manaal Anthikat

Introduction: Neck Pain (NP), a major global disability, disproportionately affects women, especially homemakers performing repetitive domestic tasks with poor ergonomics. Regular exercise helps, but access might be limited. Telerehabilitation, using technology for remote care, emerges as a potential solution. Homemakers with NP often lack access to exercise programmes. This study tests if telerehabilitation with exercises and ergonomics improves their function. Aim: The aim of this study was to assess the effectiveness of a combined tele-rehabilitation programme incorporating structured neck exercises and ergonomic advice for the sustainable management of NP among homemakers experiencing non-specific NP. Materials and Methods: This experimental study was carried out at BV(DU), School of Physiotherapy on 63 female homemakers residing at Sangli city, Maharashtra. The duration of study was one year from March 2023 to April 2024. Participants aged 25-55, with moderate NP (VAS 2-5) and performing tasks like chopping, mopping, and lifting for more than 4 hours a day, were included. A 30-day telerehabilitation programme with daily supervised exercises and ergonomic advice was carried out. Wilcoxon Matched Pairs test was used to compare pretest and post-test VAS, Neck Disability Index (NDI), performance, and Manual Muscle Testing (MMT) scores. The p-value: 0.001 (at 5% level of significance). Results: The combined intervention significantly improved pain, strength, quality of life, and all components of the ICF Core Set, a standardised outcome measure for disability. 68.46% reduction was seen in VAS scores; 83.68% reduction was seen in NDI scores with effect size 0.9570. Maximum improvement of 100% was seen in code d4103 (sitting) and a minimum improvement of 40.86% was seen in code d4105 (bending). Conclusion: Telerehabilitation with structured neck exercises and ergonomic advice can effectively reduce pain, improve strength and quality of life, and enhance function in homemakers with NP. This study also highlights the ICF Core Set’s usefulness in evaluating NP interventions. Telerehabilitation offers a promising, accessible treatment option for individuals facing barriers to in-person care.

Perceived Stress, Depression and Anxiety in the Spouses of Patients with Alcohol Use Disorder: A Cross-sectional Study

Saranya Vivekanandan, S Preethi, Arnab Saha, R Jhamuna

Introduction: Alcohol Use Disorder (AUD) is a significant public health issue in India, where alcohol consumption is discouraged but often practiced excessively. In our country, with an emphasis on the family system, the spouses of individuals with alcohol dependence are also affected in many ways. The patients and their spouses are bound to affect each other, as spouses are usually the primary caregivers. Aim: To study the impact of AUD on the spouses of affected individuals, focusing on perceived stress, depression and anxiety. Materials and Methods: A cross-sectional study was conducted among 100 spouses of patients with AUD who visited the Psychiatry Outpatient Department (OPD) the Department of Psychiatry, ACS Medical College and Hospital, Chennai, Tamil Nadu, India, a tertiary hospital in the Chennai suburban area over a period of two months. Data were collected between November 2021 and December 2021 using a socio-demographic proforma to record age, education, employment and the ages of children, among other factors. Assessment tools used included the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A) and the Perceived Stress Scale (PSS) for assessing depression, anxiety and stress, respectively. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0 software. Independent t-tests and Analysis of Variance (ANOVA) were used for comparison. Results: The average age of the participants was 42.1±11.7 years, with moderate variability. Most participants were educated (81%), employed (84%) and residing in nuclear families (76%). The study revealed moderate levels of perceived stress (24.2), variable anxiety (19.2) and varying degrees of depression (16.4) among the spouses. Employed individuals had significantly lower anxiety and depression scores compared to non employed individuals. The correlations indicated positive associations between stress, anxiety and depression. Anxiety was positively correlated with the ages of male children (r=0.244, p=0.016) and female children (r=0.363, p=0.002). Similarly, depression was correlated with the ages of male children (r=0.258, p=0.011) and female children (r=0.292, p=0.014). Conclusion: The present study underscores the substantial impact of AUD on spouses, highlighting notable levels of stress, anxiety and depression. Employment status has emerged as a crucial factor influencing mental health outcomes.

Clinicopathological Analysis of GATA3 Positive Breast Cancers with Molecular Subtypes: A Cross-sectional Study

Vibhav Goel, Nisha Marwah, Renuka Verma, Sumiti Gupta, Ekta Lamba, Sunita Singh

Introduction: In breast carcinoma, a panel of various marker proteins are used to characterise tumour subtypes, confirm tissue of origin, distinguish metastatic tumours from primary tumours, and provide additional information that may be important for prognosis, predicting response to therapy, or evaluating residual tumours post-treatment. Aim: To investigate the immunohistochemical expression of GATA binding protein 3 (GATA3) in breast carcinoma. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Surgery at Pt. BD Sharma, PGIMS, Rohtak, Haryana, India over the period of one year from April 2023 to March 2024. Tumour specimens (n=60) were obtained after modified radical mastectomy. All clinicopathological parameters were noted. Histological tumour grading was performed using the Nottingham Modification of the Bloom-Richardson (MBR) grading system, and representative sections were subjected to immunohistochemical analysis for Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor 2/Neu (HER2/Neu), and Ki-67 for molecular subtyping, as well as GATA3 expression. The association between GATA3 expression and clinicopathological parameters and different breast cancer molecular subtypes was calculated using the Chi-square and Fisher’s exact Test. The collected data were analysed using the software package Statistical Package for the Social Sciences (SPSS) version 24.0. Results: The age of patients ranged from 28 to 75 years, with a median age of 50.0 years. Triple-negative/basal-like was the most common molecular subtype 20 (33.33%) among all cases. Sixteen cases (26.67%) were of the luminal A subtype. Other molecular subtypes included 12 cases (20%) each of luminal B and HER2-enriched types. GATA3 was positive in 45 of 60 cases, constituting 75% of all cases. A statistically significant relationship was observed between GATA3-positive tumours and histological grade (p-value=0.024), ER status (p-value<0.001), PR status of the tumour (p-value=0.001), and the luminal A and B molecular subtypes (p-value<0.001). No association was found between GATA3 expression and patient age, side of the breast involved, tumour size, histologic subtype, lymph node status, Nottingham Prognostic Index (NPI), or HER2/Neu status of the tumour. Conclusion: GATA3 is a sensitive marker of breast carcinoma and exhibits nuclear expression that aids in better interpretation. It can be especially useful in metastatic breast carcinoma when considered in conjunction with other immunohistochemical markers. GATA3-positive breast cancers demonstrate luminal differentiation and are characterised by high ER and PR expression.

Effect of Rotary and Reciprocating File System on Postoperative Pain in Single Visit Endodontic treatment: A Randomised Clinical Trial

Introduction: In modern times, endodontic intervention is preferred and tooth extraction is becoming increasingly rare. Root Canal Therapy (RCT) is well-established, with success rates exceeding 90%. A key contributor to post-endodontic pain is the extrusion of debris into the periapical region, which causes inflammation and nerve compression. The amount of debris extruded varies with instrumentation techniques and no current technology completely prevents it. Rotary and reciprocating Nickel-Titanium (NiTi) instruments, each with distinct designs and kinematics, play a critical role in managing this complication. Aim: To evaluate postoperative pain using rotary and reciprocating file systems in single visit endodontics. Materials and Methods: This prospective, parallel-group, single-centre, double-blinded, equivalence, randomised clinical study was conducted at the Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed To be University), Karad, Maharashtra, India, from October 2023 to March 2024, with the aim of comparing postoperative pain following endodontic therapy using two reciprocating systems, WaveOne Gold (WOG) and E-Flex Rec, versus two rotary systems, Mtwo and XP Endo Shaper (XPES). A total of 80 patients with symptomatic irreversible pulpitis were enrolled and randomly assigned to four groups, each treated with one of the four endodontic file systems. Patients were randomised into four groups: 1A-Mtwo (Dentsply-Maillefer, Ballaigues, Switzerland); 1B-XP Endo Shaper (XPS; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland); 2A-Eighteeth E-Flex Rec File; and 2B-WOG (Dentsply Sirona, York, PA). Postoperative pain scores were measured using the Visual Analogue Scale (VAS) at 24, 48 and 72 hours and seven days post-treatment. Statistical analysis was conducted using One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test and Chi-square tests for categorical data using Statistical Package for Social Sciences (SPSS) software version 21.0, with p-values<0.05 considered significant. Results: According to the study’s findings, postoperative pain was significantly higher in the rotary file systems compared to the reciprocating file systems at all time intervals (p-value<0.001). The mean ages were 39.00±12.70 years for Group 1A, 34.70±9.48 years for Group 1B, 42.15±12.59 years for Group 2A, and 39.10±13.65 years for Group 2B. Additionally, the consumption of analgesics was significantly higher in the rotary file systems compared to the reciprocating file systems at 24 hours (p-value=0.001) and 48 hours (p-value=0.003), highlighting the importance of file design and kinematics in managing postoperative pain. Conclusion: Compared to the rotary systems (XPES and Mtwo), the use of the reciprocating instrumentation systems (WOG and E-Flex) demonstrated noticeably less postoperative pain, both in terms of intensity and duration.

Impact of Walking Speed on Risk of Fall among Stroke Patients assessed using Cognitive Motor Dual Task: A Cross-sectional Study

V Aiswarya Babu, Nityal Kumar Alagingi

Introduction: Fall is a common complication of stroke. People must use both their higher cognitive abilities and their motor skills simultaneously in everyday situations. Falling is much more likely to occur when performing multiple tasks requires continuous attention. Implementing a Cognitive Motor Dual Task (CMDT) might give more accurate information regarding how stroke survivors function throughout daily activities. Aim: To identify the walking speed in stroke patients using CMDT and to determine the impact of walking speed on risk of fall. Materials and Methods: In this cross-sectional study, 23 Middle Cerebral Artery (MCA) stroke patients with and without the risk of fall according to morse fall scale were included from Justice KS Hedge Charitable Hospital, Mangaluru, Karnataka, India from March 2023 to March 2024. After which the selected participants performed CMDT, the step count and time taken to complete the test was recorded using a pedometer and stop watch, the total and correct number of cognitive responses was recorded manually. The walking speed was calculated in m/sec. Based on the outcome measures of the present study; the statistical analysis was performed. Data collected was analysed by using the Statistical Package for the Social Sciences (SPSS) software version 29.0. To compare the data Independent sample t-test, One-way Analysis of Variance (ANOVA) was used. Results: The study participants consisted of an average age of 54.6±14.8 years. Individuals categorised as low-risk exhibited a mean walking speed of 0.238±0.014 m/sec, while those in the moderate risk group had a mean walking speed of around 0.211±0.024 m/sec and individuals at high-risk showed a lower mean walking speed of approximately 0.177±0.020 m/sec. The statistical analysis revealed a significant difference in walking speeds among the risk groups, with an F-value of 15.486 and a p-value less than 0.001. Conclusion: The study showed that walking speed will impact the risk of fall in stroke patients while performing CMDT. The time and step count are more in patients with high fall risk compared to patients with low fall risk therefore, walking speed is reduced in patients with high-risk of fall.

Programmatic Assessment of Foundation Course for Undergraduate Medical Student’s Immediately following the Course and One-year thereafter: A Post-test Quasi-experimental Study

Sharmila Aristotle, Balakrishnan Ramamoorthy, Arunkumar Radhakrishnan

Introduction: The National Medical Commission (NMC) introduced a one-month “Foundation Course (FC)” at the commencement of medical school to promote better adaptation to the new competence-based medical education curriculum starting from the academic year 2019. The effectiveness of the program was studied in previous researches conducted over one month, and it was found to be effective. However, the effectiveness with which students could implement the acquired basic knowledge and skills in subsequent years of study has not been reported. Aim: To explore the effectiveness of various modules and their competencies in the FC immediately at the end of the program and to assess the usefulness of the acquired competencies in subsequent academic years. Materials and Methods: A post-test quasi-experimental study was conducted at SRM Medical College Hospital and Research Institute, Kattangulathur, South India, within the education department over a period of three academic years. A total of 450 student participants from the academic years 2019 to 2022 were involved in two stages. A total of 36 competencies were evaluated across the six prescribed modules by the NMC. A five-point Likert scale was used for the evaluation. Feedback questionnaires were administered immediately at the end of the program and again at the completion of the academic year. Analysis was conducted using the non parametric “Wilcoxon signed-rank test” to determine the usefulness of the program in subsequent years by comparing immediate feedback with responses after one year. Results: The mean scores for various competencies ranged between 3.5 and 4.5 out of 5, indicating that the overall competencies in the FC were very effective. The Wilcoxon signed-rank test showed a p-value of <0.0001, indicating high significance regarding the effectiveness of usage in subsequent years. Out of the 36 competencies, 16 were most frequently used by the students in the following year, 12 were moderately used, and 8 were least used. Conclusion: The evaluation of the NMC-mandated FC program, in terms of overall immediate performance and its effectiveness in subsequent years, yielded very promising results.

Effect of Unexpected Prolonged Fasting on Patients Undergoing Elective Surgery under Spinal Anaesthesia: An Observational Study

Chhaya M Suryawanshi, Fateh Pal Singh Gill, Sargam Dhaliwal

Introduction: Preoperative fasting is a standard practice aimed at minimising the risk of pulmonary aspiration during surgery. However, patients often experience prolonged fasting periods beyond the recommended duration due to unanticipated delays in the operating theatre, communication failures between teams, inadequate preoperative planning and other factors. Aim: To investigate the effects of unexpectedly prolonged fasting on intraoperative and postoperative parameters in patients undergoing elective surgery under spinal anaesthesia. Materials and Methods: This prospective observational study was conducted from October 2023 to June 2024 at the Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. The study included 70 patients undergoing elective surgery under spinal anaesthesia. Patients were divided into two groups: Group A (AM group, n=35), scheduled for surgery between 8:00 AM and 12:00 PM and Group B (PM group, n=35), scheduled for surgery after 12:00 PM or with delayed surgeries. Intraoperative parameters, including Mean Arterial Pressure (MAP), Heart Rate (HR), oxygen saturation (SpO2) and random blood glucose levels, were recorded at specific time points. Postoperative outcomes, such as nausea, vomiting and random blood glucose levels, were also assessed. Continuous and discrete variables were summarised as mean±SD and median, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were tested using Pearson’s Chi-square or Fisher’s-exact test, with p-values<0.05 considered statistically significant. Results: The PM group exhibited higher preoperative random blood glucose levels (102.3±18.7 mg/dL) compared to the AM group (89.2±12.5 mg/dL). Postoperative nausea and vomiting were observed in 5 (14.3%) patients in the AM group and 11 (31.4%) patients in the PM group. Both groups showed a gradual decrease in MAP and HR from the preoperative period to 30 minutes after spinal anaesthesia administration, with slightly higher values noted in the PM group. No significant differences in SpO2 were observed between the groups. Conclusion: Unexpected prolonged fasting before elective surgery under spinal anaesthesia may contribute to higher preoperative blood glucose levels and an increased risk of postoperative nausea and vomiting. These findings underscore the importance of adhering to preoperative fasting guidelines and exploring potential strategies to minimise prolonged fasting periods, such as carbohydrate loading or allowing clear fluids closer to surgery.

Impact of Cataract Surgery on Vision-related Quality of Life in Patients with Strabismus: A Quasi-experimental Study

AB Chirag, T Sangeetha, SM Darshan

Introduction: Reduction in visual acuity and glare are common indications for cataract surgery in patients with strabismus. The amblyopic eye is particularly sensitive to blur, despite reduced visual acuity and contrast sensitivity. However, the impact of cataracts on visual functions in strabismus patients is not well documented. Aim: To evaluate the Vision-related Quality of Life (VRQoL) after cataract surgery in strabismus patients. Materials and Methods: The present quasi-experimental study was conducted in the Department of Ophthalmology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from August 2023 to September 2023. Study included 44 strabismus patients, which was assessed by Hirschberg and alternate cover tests. All patients underwent unilateral manual small incision cataract surgery on the worse eye. VRQoL was assessed using the Indian Vision-related Quality of Life Functioning Questionnaire-33 (IND-VFQ-33) questionnaire preoperatively and postoperatively. Statistical significance was determined using paired t-tests (p-value<0.05). Results: In the present study, the mean±Standard Deviation (SD) age of patients was 64.34±8.09 years (range: 42-79 years), with a predominance of females, 29 (66%). All patients underwent unilateral manual small incision cataract surgery on their worse eye. The degree of strabismus among the patients varied: 27 (61.36%) exhibited a 15° deviation, 12 (27.27%) had a 30° deviation and 5 (11.36%) exhibited a 45° deviation. A total of 41 (93.1%) patients presented with exotropia, while 3 (6.9%) exhibited esotropia. The results demonstrated significant improvements in Corrected Distance Visual Acuity (CDVA) from the preoperative to postoperative period. The IND-VFQ-33 questionnaire revealed substantial reductions in scores for general functioning, mobility, activity limitation, psychosocial impact and visual symptoms across the entire study population and in all strabismus groups (15°, 30° and 45° deviations), with a p-value of <0.05. Overall, 84.09% of patients had no to mild visual impairment postoperatively, with 27 (100%) patients with 15° strabismus, 7 (58.3%) patients with 30° strabismus, and 3 (60%) patients with 45° strabismus reporting no to mild visual impairment. 3 (25%) patients with 30° strabismus and 1 (20%) patient with 45° strabismus had moderate vision impairment postoperatively. Two (16.66%) patients with 30° strabismus and one patient with 45° strabismus had severe vision impairment postoperatively. Conclusion: A significant proportion of strabismus patients with cataracts were elderly, predominantly females. Exotropia and 15° strabismus were the most common findings. Cataract surgery significantly improved VRQoL, with the most substantial benefits observed in patients with a 15° deviation and the least in those with a 45° deviation.

Effect of Education on Hemineglect Following Acute Stroke: A Randomised Controlled Trial

Dillu Roy, Purusotham Chippala

Introduction: Hemineglect is a condition in which patients are unable to report, respond to, or orient themselves to significant stimuli in the opposite side of space after a brain lesion that cannot be attributed to sensory or motor dysfunction. Patient as well as the caregivers is unaware of the poststroke symptoms. Educating both patients and caregivers about hemineglect is crucial for effective management and support. By providing education, patients gain a better understanding on their condition, its impact on daily life and strategies to cope with it. Caregivers on the other hand can learn how to provide appropriate support, create a supportive environment and assist with rehabilitation exercises. Aim: To determine the effect of education on hemineglect in patients with acute stroke. Materials and Methods: This parallel active controlled, randomised controlled trial with 32 participants who were hospitalised in Justice K.S Hegde Hospital, Mangaluru, Karnataka was conducted between January 2023-January 2024. Allocation was done by sequentially numbered opaque and sealed envelope method. The selected participants were randomly divided into Experimental Group-A (16 participants) and Group-B (control-16 participants). Group-A received education on cueing, environmental modification, shifting of representation of space and regarding sensory and perceptual awareness for 15 minutes once a day along with the standard care and control Group-B (16 participant) recieved the standard care only. Both the groups received standard care treatment for 40 minutes one session per day for five days. The Pre-post intervention evaluation was done for both groups using line bisection test, Catherine Bergego scale and Barthel Index. The collected data were summarised by using the descriptive statistics: frequency, percentage; mean and SD. The independent sample t-test was used to compare the effectiveness (Pre-Post) Line Bisection, Catherine Bergego Scale, and Barthel Index between groups. Results: Line bisection test, Catherine Bergego Scale and Barthel Index for the experimental group were 1.19±0.57, 8.13±2.16, -22.19±12.38, respectively and for the control group were 0.06±0.42, 2.50±2.92, -6.88±6.29. The group comparison of Line Bisection Test, Catherine Bergego Scale and Barthel Index were found to be statistically significant (p<0.001). Conclusion: The study concluded that patient and caregiver education coupled with conventional physical therapy is effective in improving the perceptual awareness and reduction in the presence and severity of hemineglect following acute stroke.

An In-vitro Evaluation of Grinding and Polishing on Surface Roughness and Flexural Strength of Monolithic Zirconia

Introduction: For a dentist, it is a matter of concern to restore the original luster or glaze on a Monolithic Zirconia (MZ) restoration after clinical adjustments. For a long time, the gold standard for surface restoration was reglazing; however, with advancements in technology, new polishing kits optimised for zirconia have become available for chairside polishing. Aim: To examine the effects of grinding, reglazing, and polishing techniques on the surface roughness and flexural strength of MZ specimens. Materials and Methods: This in-vitro study was conducted in the Department of Prosthodontics at MM College of Dental Sceiences and Research in Mullana, Haryana, India from April to December 2019 and 32 specimens of MZ, each measuring 20 mm × 5 mm × 3 mm, were fabricated and divided into four groups, with each group consisting of eight specimens. Group C was considered the Control group. Specimens in Group G were only Ground, specimens in Group GR were Ground and Reglazed, and specimens in Group GP were Ground and Polished using a zirconia polishing kit. All specimens were then analysed for surface roughness and flexural strength using a profilometer and a Universal Testing Machine (UTM), respectively. Statistical analysis was performed using Analysis of Variance (ANOVA), Honest Significant Test (HSD) post-hoc test, Pearson’s correlation, and other methods using International Business Machine (IBM) Statistics version 25.0 (Armonk, USA). Results: The surface roughness (Ra) of the control group (C) was 0.4403 μm, followed by the Polished Group (GP) at 0.656 μm and the Reglazed Group (GR) at 0.809 μm. The difference between the polished (GP) and reglazed (GR) groups, was statistically insignificant (p=0.53). There was a statistically significant increase in flexural strength in the reglazed samples (GR) when compared to the polished samples (GP). No significant correlation (p=0.58 and r=-0.1) was found between surface roughness and flexural strength. Conclusion: Chairside polishing can be an effective alternative to reglazing for restoring the surface finish of MZ. Additionally, polishing increases the strength of zirconia after adjustments.

Salivary pH Levels at Three Different Time Intervals after Application of Silver Diamine Fluoride in Children with Severe Early Childhood Caries: A Quasi-experimental Study

Introduction: Early Childhood Caries (ECC) is a major public health issue that negatively affects children’s physical and mental health. Silver Diamine Fluoride (SDF) is a novel material that has the potential to improve dentin hypersensitivity and enhance enamel remineralisation. This alkaline solution is known to be more resistant to acidic environments than hydroxyapatite. Aim: To measure the pH (Potential of Hydrogen) in saliva at three different intervals after the application of 38% SDF in children with ECC. Materials and Methods: This pre-post single-group quasi-experimental study was conducted in the Department of Paediatric and Preventive Dentistry at Rajarajeswari Dental College and Hospital in Bengaluru, Karnataka, India from September 2021 to February 2022. A total of 15 patients with ECC, aged 3-6 years, were selected for the application of 38% SDF. Saliva samples were collected before the application, immediately after the application, and one hour after the application of 38% SDF. pH analysis was then conducted. The data obtained were subjected to statistical analysis. Repeated measures of Analysis of Variance (ANOVA) and Bonferroni’s post-hoc test were used for multiple comparisons of salivary pH levels at different time intervals. Age and gender-wise comparisons of mean salivary pH levels at different time intervals were conducted using an independent Student’s t-test. Results: Among the 15 participants included in the study, the average age of the subjects was 4.60±1.06 years. Among the study participants, 9 (60.0%) were males and 6 (40.0%) were females. A comparison of mean salivary pH levels at different time intervals showed that the mean salivary pH levels before the SDF application were 6.45±0.22, immediately after the application were 6.95±0.18, and one hour after the application were 7.30±0.27. In the gender-wise comparison, a higher mean pH was recorded in males than in females. Conclusion: The change in mean pH was found to be statistically significant before and after the application of SDF, as well as at the one-hour time interval, showing an increasing trend. This indicates that the changes in salivary pH that occur after applying 38% SDF are clinically significant and can be used as an effective caries control and preventive strategy.

Time Series Forecasting and Projection of Diabetes Prevalence in India from 2023 to 2035: A Cross-sectional Study

Ariarathinam Newtonraj, K Senthamarai Kannan

Introduction: Diabetes is a significant public health problem in India, with an estimated 74 million Indian adults suffering from the condition as of 2021, and the prevalence is continuing to grow. Aim: To investigate the prevalence and forecasted trends of Diabetes Mellitus (DM) in India through time series analysis and forecasting models. Materials and Methods: A cross-sectional study was conducted in the Department of Statistics at Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India, from January 2024 to March 2024. The prevalence of diabetes in India was forecasted from 2023 to 2035 using existing diabetes prevalence data from 2009 to 2021, with the help of Gretl software and the Autoregressive Intregated Moving Average (ARIMA) model. Results: Authors observed a consistent upward trajectory in DM prevalence, with rates steadily increasing from 7.1% in 2009 to 9.6% in 2021. Time series analysis reveals non stationarity in the data, necessitating the use of ARIMA models for forecasting. Among the models considered, ARIMA (2,1,2) emerges as the best fit, demonstrating strong explanatory power with an R-squared value of 0.80. Forecasting projections indicate a continued rise in DM prevalence, with rates projected to increase from 10.35% in 2023 to 13.46% by 2035, which translates to an increase from 97.5 million in 2023 to 139 million in 2035. Conclusion: These findings underscore the urgent need for comprehensive public health interventions to address the escalating burden of diabetes in India, emphasising the importance of prevention, early detection, and effective management strategies.

Adherence to Self-care Practices among Type 2 Diabetes Mellitus Patients in Rural Area of Tamil Nadu, India: A Cross-sectional Study

AH Irfaunul Azees, R Rajkamal, S Jayakiruthiga, Merlin Jones

Introduction: Developing countries like India are facing an increased threat from both non communicable and communicable diseases. The prevalence of Type 2 Diabetes Mellitus (DM) among non communicable diseases has been rapidly increasing in India. The complications of diabetes, including both acute and chronic effects, impact the physical, mental, and social well being of patients. The effectiveness of diabetes management solely depends on the self-care practices adopted by individuals and their family members. Aim: To evaluate the patterns of self-care practices among diabetic patients and the factors associated with them. Materials and Methods: A community-based cross-sectional study was carried out among 206 diabetic patients in and around the rural field practice area of ACS Medical College and Hospital in Thiruvallur district, Chennai, Tamil Nadu, India, from June 2022 to November 2022. Type 2 DM patients aged ≥18 years were included in the study. The participants were interviewed about their diabetic status and various parameters of self-care practices, using the Summary of Diabetes Self-care Activities (SDSCA) score. The Chi-square test was applied to assess the relationship between self-care practices and factors such as age and gender. Results: The mean age of the participants was 47±10 years. The present study observed that the overall prevalence of poor self-care practices was low, with 92 participants (44.7%) exhibiting poor practices and 114 participants (55.3%) demonstrating good self-care practices. In the current study, the association between self-care activities and education level, as well as the clinical profile of the patients, was statistically significant. A negative linear correlation was found between self-care practice scores and blood glucose levels. Conclusion: Self-care behaviours among diabetes patients were found to be good in more than half of the study population. These behaviours were significantly associated with age, education level, and complications of diabetes. The results emphasise the complex nature of self-care behaviours among individuals with DM and highlight the necessity for customised therapies that target individual challenges and foster supportive environments.

Cardiac Sympathetic Nerve Activity among Passive Smokers and Smokeless Tobacco Users: A Cross-sectional Study

#b#Introduction:?b? Tobacco use and exposure to Second-Hand Smoke (SHS) are major health hazards for growing children and adolescents. Smokeless Tobacco (SLT) product consumption is a serious health issue both abroad and in India. Children and young people are more likely to be exposed to Secondhand Smoke (SHS) in India due to high population density. Aim: To assess physical anthropometric parameters and cardiac autonomic function tests among passive smokers and SLT users. Materials and Methods: This cross-sectional study was conducted in the department of Physiology Nootan Medical College and Research Centre, Visnagar from August 2023 to February 2024. The study was comprised of 100 participants including 50 non-smokers who chew tobacco and who have never been a passive smoker in Group-A (SLT) and 50 age-matched passive smokers who lived with at least one smoker or frequently interacted with smokers at work for at least three years before conducting this study was included in Group-B (Passive smoke or SHS). Anthropometric measurements were recorded. Cardiac autonomic function tests were done by using a Polyrite recording machine with mode “ECG” in Lead-II position among both groups. Results were expressed as mean±Standard Deviation (SD), and analysed by using unpaired student’s t-test. The p-value of <0.05 was considered as statistically significant. Results: Resting (Basal) heart rate was significantly increased in the SLT group (p-value≤0.001). Resting Systolic Blood Pressure (SBP) was significantly reduced in the passive smoker group when compared to SLT group (p-value≤0.001). It was noted that 30:15 ratio was statistically significant in the passive smokers as compared to that in the SLT group (p-value≤0.001). It was also noted that blood pressure response to immediate standing in passive smokers was highly significant (p-value≤0.001). Conclusion: The results of present study showed that sympathetic activity was increased and parasympathetic activity was decreased in tobacco users (SLT). The fall of SBP in response to immediate standing among passive smokers is suggestive of decreased central sympathetic activity and baroreceptor reflex sensitivity.

Clinicopathological and Prognostic Significance of PD-L1 Expression in Male and Female Breast Carcinoma Cases: A Cohort Study

Soumya Dey, Samir Rana, Sujit Nandy, Madhumita Mondal, Chhanda Datta

Introduction: Male Breast Carcinoma (MBC) is rare compared to Female Breast Carcinoma (FBC) and differs significantly in tumour biology. The expression of Programmed Death receptor-1 (PD-1) and its ligand, Programmed Death-ligand 1 (PD-L1), is extensively studied in FBC for the implementation of newer immunotherapies; however, the role of these immunomarkers in MBC is still not well understood. Aim: To evaluate the expression of PD-L1 in MBC and FBC patients and to assess its clinicopathological and prognostic significance. Materials and Methods: This cohort study was conducted in the Department of Pathology of IPGMER and SSKM Hospital in Kolkata, West Bengal, India, in collaboration with the Department of Surgery over a period of 4 years from January 2020-December 2023. Histopathological examinations were performed on 204 mastectomy specimens from male and female breast cancer patients. Immunohistochemistry for PD-L1, Oestrogen Receptor (ER), Progesterone Receptor (PR), and HER2/neu was conducted on Formalin-fixed Paraffin-embedded (FFPE) tissue. The clinicopathological parameters were analysed alongside PD-L1 expression in breast carcinoma for both genders. Kaplan’s-Meier graphs were plotted for survival analysis. The Statistical Package for the Social Sciences (SPSS) version 29.0 was used for data analysis, with a significance threshold set at a p-value of <0.05 (Chi-square test). Results: The age range was 48 to 65 years in the male population and 30 to 74 years in the female population. A total of 204 cases were included in the study, with 50 cases of MBC and 154 cases of FBC. PD-L1 expression was observed in 48% of MBC cases and in 52.59% of FBC cases. No significant difference in PD-L1 expression was noted between MBC and FBC (p-value=0.572). MBCs exhibited different biological characteristics, including a predominance in older age, smaller tumour size, and more frequent luminal molecular types compared to FBC, with the luminal A subtype being the most common in MBC (38%), while the triple-negative subtype was the most common in FBC (35%). Overall survival analysis also did not demonstrate significant survival advantages in PD-L1 positive cases (p-value=0.491 for MBC cases and 0.128 for FBC cases). Conclusion: PD-L1 expression in MBC does not differ significantly from that in FBC. Furthermore, PD-L1 expression did not confer significant survival advantages in either MBC or FBC cases.

Development and Validation of an Instrument for Upper Cross Syndrome: A Cross-sectional Study

Sharmila Chaudhuri, Meena Gupta, Vandana Phadke Jasmine Kaur Chawla

Introduction: A sedentary lifestyle causes muscular imbalances and may lead to upper cross syndrome. This syndrome occurs due to the muscular imbalance of tonic and phasic muscles. If left unidentified for long duration can lead to secondary complications. There is a paucity of reliable and valid tools to identify this syndrome. Aim: To develop a valid and reliable tool to identify upper cross syndrome. Materials and Methods: This cross-sectional study was conducted at the Amity Institute of Health Allied Sciences, Department of Physiotherapy, Amity University, Noida, Uttar Pradesh, India, from November 2023 to March 2024. The instrument for upper cross syndrome is a self-designed tool. After an extensive literature review and focus group discussions, items were identified, and rounds of Delphi were held until an agreement was reached. The psychometric properties of the instrument were assessed by content validity, construct validity, and reliability. The instrument was tested on 240 patients with upper cross syndrome. Statistical analysis for construct validity was done by exploratory factor method with principal component analysis and varimax rotation. Test-retest reliability and Cronbach’s alpha were calculated for reliability analysis. Results: The final version of the draft consisted of 20 items with satisfactory item-level Content Validity Index (I-CVI≥0.78) and scale-level Content Validity Index (S-CVI=0.90). Seven domains were identified, including postural alignment, movement patterns, muscle imbalance, joint dysfunction, pain, functional limitations, and psychosocial factors, with a total variance of 60.11% and good internal consistency (Cronbach’s alpha=0.81). Conclusion: This work contributes to the development of a novel, valid, and reliable technique for the identification of upper cross syndrome. Healthcare providers will find this tool useful in promoting health and creating an early rehabilitation plan, both of which will aid in the prevention of subsequent complications.

Perfusion Index as a Reliable Tool for Prediction of Hypotension during Subarachnoid Block in Caeserean Section: A Prospective Observational Study

S Sai Raghavendran, Monika, Deepshikha Tripathi

Introduction: Hypotension after subarachnoid block is a common occurrence due to sympathetic blockade leading to vasodilation, which causes a decrease in cardiac preload and results in a decrease in cardiac output. Early detection of hypotension and prompt treatment during caesarean delivery under subarachnoid block is the primary responsibility of the anaesthesiologist. Aim: To evaluate and validate the Perfusion Index (PI) as a predictor of hypotension following Subarachnoid Block (SAB) in patients undergoing Lower Segment Caesarean Section (LSCS) and to assess the usefulness of perioperative pulse oximetry-derived PI as a monitoring tool. Materials and Methods: This was a prospective hospital-based observational study was conducted in the Department of Anaesthesiology at BJMC Ahmedabad, Gujarat, India over a period from March 2020 to February 2021, that included 60 American Society of Anaesthesiolgy (ASA) II pregnant patients, divided into two groups (A and B) based on PI, who were planned for elective caesarean delivery under regional anaesthesia. Variables recorded included heart rate, blood pressure, SpO2, and PI at different time intervals. The quantitative data were presented as mean and standard deviation and compared using the Student’s t-test. Results: Demographic parameters of both groups A and B, such as mean age (26.93±3,24 years, 28.33±4.02 years), mean height (155.56±4.29 cm, 155.17±4.31 cm), mean weight (62.70±5.87 kg, 60.36±5 kg), Body Mass Index {BMI (25.92±2.42, 25.01±2.14 kg/m2)}, and gestational age (36.03±0.32, 36.53±0.32 weeks) respectively, were comparable between the two groups. There was a statistically significant drop in Mean Arterial Pressure (MAP) in both Group A and Group B after induction, from one minute to 70 minutes (p<0.05) from the baseline. The difference in the proportion of PI between the hypotension groups was statistically significant (p-value=0.002). The number of episodes of hypotension and the total dose of Mephenteramine were significantly higher in Group B (Chi-square=52.500 with 2 degrees of freedom; p<0.001) than in Group A. Conclusion: Parturients with a baseline PI>3.5 were at a higher risk of developing hypotension following a subarachnoid block compared to those with a baseline PI<3.5. Therefore, appropriate preventive measures can be instituted preoperatively to prevent hypotension and improve outcomes in such patients.

Expression of p16 in Urothelial Carcinoma of Urinary Bladder and its Association with Histologic Grade and Invasion: A Cross-sectional Study from Kerala, India

Ambili R Nath, Rebecca Mathews, MM Jessy

Introduction: Bladder cancer is the seventh most common cancer worldwide and is the most prevalent malignant neoplasm of the urinary tract. More than 90% of bladder cancer cases are urothelial (transitional cell) carcinoma. Histologic grading is one of the most important prognostic factors in bladder cancer. Based on infiltration, it is classified as invasive or non invasive, and further categorised as high-grade or low-grade carcinoma. The management and prognosis of patients is based on the accurate grading of these tumours. Loss of p16 has been found to be associated with high-grade tumours and invasion in urothelial carcinoma. Understanding the expression of p16 can aid in determining the grade of the tumour and predicting its invasive nature. Aim: To study the expression of p16 and its association with the grade and invasiveness of urothelial carcinoma of the urinary bladder. Materials and Methods: This study was a cross-sectional study, done over a period of one year and six months, from December 2019 to May 2021, in the Department of Pathology at Pushpagiri Institute of Medical Sciences in Thiruvalla, a tertiary care centre in South Kerala, India. A total of 37 cases of urothelial carcinoma were selected for histomorphological and Immunohistochemical (IHC) evaluation, and the results were analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. The IHC panel used was mouse monoclonal p16 antibody. The frequency of p16 expression, along with its association with age, gender, grade, and invasion in urothelial carcinoma, was studied. Results:There 14 cases of invasive urothelial carcinoma, among which 11 cases (78.57%) showed loss of p16 with a negative staining pattern, one showed normal staining, and two cases showed high expression. Most of the non invasive tumours, comprising 21 cases (91.30%) showed normal p16 expression, while two cases showed high p16. In the present study, there were 18 cases of high-grade urothelial carcinoma, 11 cases showed loss of p16 with a negative staining pattern, four cases showed normal staining, and three cases showed high p16 expression. There were 19 cases of low-grade urothelial carcinoma; 18 of which showed low/normal p16 expression, and one case showed overexpression of p16. Conclusion:p16 was found to be negative or lost in high-grade and invasive urothelial carcinomas. Analysing the expression of p16 can aid in determining the grade and invasive nature of the lesion, especially when biopsy samples are limited, in the absence of deep biopsy, or when muscle tissue is not sampled, and when tissue architecture is altered by cautery artifacts.

Evaluation of Entospletinib as a Novel Therapeutic Strategy Targeting Spleen Tyrosine Kinase in Retinoblastoma Treatment: An In-vitro Study

Sneha Krishnakumar, D Anusha, K Karthika, R Kavitha

Introduction: Retinoblastoma (RB) is the most common paediatric intraocular malignancy. The Spleen Tyrosine Kinase (SYK) acts as a proto-oncogene crucial for RB cell survival and is absent in the normal retina, making it a valuable therapeutic target. Aim: Entospletinib, a selective oral SYK inhibitor currently in phase 2 trials for chronic lymphocytic leukaemia, was evaluated for its activity on the RB cell line Y-79. Materials and Methods: The effects of Entospletinib on cell proliferation and death of the human RB Y79 cells were assessed by MTT (3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide) assay, phase contrast microscopy and AO/EtBr dual labeling. The Annexin-V kit was used to quantify the cell mortality following treatment using flow cytometry. The mRNA levels of caspase-3, BAX, BCL-2, SYK, p53, TNF-and NF-κB were measured using RT-PCR to better understand the mechanism of action of this drug. Western blot was used to further validate the data. Results: Entospletinib treatment led to a time- and dose-dependent reduction in cell viability, with significant cytotoxicity observed at an IC50 of 61.3 μM/ml. Annexin V/Propidium Iodide (PI) staining demonstrated a dose-dependent increase in apoptosis. The treatment upregulated mRNA levels of Caspase-3, Bax, and p53 while downregulating SYK, TNF-α, and Bcl-2. RT-PCR and Western blot analyses confirmed a dose-dependent decrease in NF-κB/p65 expression. Conclusion: The study findings suggest that Entospletinib inhibits cell proliferation and induces apoptosis in RB cells by downregulating SYK/TNF-α/NF-κB/p65, highlighting its potential as a promising therapeutic candidate for RB.

Psychometric Properties of Functional Reach Tests among Children: A Systematic Review

Kavita Sharma, Shantha Kumar

Introduction: Reach tests are commonly used outcome measures to assess balance among various populations. The psychometric properties of these outcome measures help in selecting the most effective tests to enhance the credibility of interventions. Aim: To determine the psychometric properties of reach tests among children aged 5 to 17 years. Materials and Methods: A comprehensive search was conducted across databases such as PubMed/MEDLINE, Scopus, and Cochrane from inception to November 2023. Cross-sectional studies involving children that assessed at least one psychometric property of a reach test and were written in English were included. An adapted version of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria were used for quality assessment of the psychometric properties. Results: A total of 944 articles were screened, of which 17 studies were included. Eleven studies recruited typically developing children, while six studies used Functional Reach Test (FRT) and its modifications as the primary outcome measure. Another six studies focused on the Sit-and-Reach Test (SRT) and its modifications. The Paediatric Reach Test (PRT) was also utilised in some studies. Conclusion: The FRT demonstrated excellent methodological quality. Other outcome measures showed limitations in their psychometric properties. Therefore, there is a need to refine reach tests in multiple ways to achieve excellent psychometrics that could be beneficial for children aged 5 to 17 years.

Cognitive Impairment in Long COVID Patients Presenting with Psychiatric Sequelae: A Cross-sectional Study

Riyal Das, Aniket Mukherjee, Sujit Sarkhel, Mayank Kumar

Introduction: Coronavirus Disease-2019 (COVID-19) affects mental health, causing various psychiatric symptoms, including cognitive impairment, which may persist for a long time. To develop effective strategies for combating this global health burden, it is necessary to ascertain whether COVID-19 itself causes cognitive decline or whether other factors also play any role. Aim: To determine the prevalence of cognitive impairment in long COVID patients who present with post-COVID-19 psychiatric sequelae, and to investigate its association with socio-demographic factors, depression, anxiety, and stress. Materials and Methods: A cross-sectional study was conducted from July 2022 to June 2023 at a ‘Post-COVID Mental Health Clinic’ in a tertiary care medical college in Kolkata, India. A total of 204 subjects were selected through simple random sampling, aged between 18 and 65 years, of both sexes, who had recovered from COVID-19 more than three months but less than six months prior, and who presented with post-COVID-19 psychiatric sequelae, excluding those with a history of psychiatric disease before contracting COVID-19. The dependent variable, cognition, was measured using the Montreal Cognitive Assessment (MoCA) score, while independent variables included socio-demographic factors, depression, anxiety, and stress, measured by the Depression Anxiety Stress Scale -21 (DASS-21) scores. The Chi-square test was used to find the association between cognition and socio-demographic variables and Pearson’s correlation test was applied to measure the association of cognition with depression, anxiety, and stress scores. Results: The prevalence of cognitive impairment was found to be 86.8%. Chi-square tests of association showed no significant association with socio-demographic factors. However, there was a significant correlation between the severity of depression (r-value=-0.337, p-value<0.001), anxiety (r-value=-0.275, p-value<0.001), and stress (r-value=-0.277, p-value<0.001) with cognitive impairment. When controlling for anxiety and stress, only depression showed a significant correlation (r-value=-0.221, p-value=0.002). Simple linear regression indicated that the severity of depression significantly predicted the severity of cognitive impairment {R2 =0.114, F(1, 202)=25.88, p-value<0.001}. Conclusion: Cognitive impairment was found to be unrelated to socio-demographic factors, post-COVID-19 anxiety, or stress, except for post-COVID-19 depression, which was identified as a significant predictor of cognitive dysfunction in some patients. This suggests that COVID-19 infection itself may be the most important factor contributing to post-COVID-19 cognitive impairment in patients with post-COVID-19 psychiatric sequelae.

Comparative Evaluation of the Efficacy of Probiotics and Triphala Herbal Oral Rinses against Candida Species in Denture Wearer Patients: A Randomised Clinical Study

Introduction: With increasing age, patients experience a reduction in immunity and an increase in systemic illnesses. These factors significantly contribute to the occurrence of candidiasis in the oral cavity. New approaches to treating and preventing a wide range of oral disorders may become possible through host immunity modulation. Natural agents are preferred for complete denture wearers to prevent candidiasis, which is one of the leading causes of denture stomatitis. Aim: To assess the efficacy of herbal oral rinses (Triphala) and probiotics against Candida species in denture-wearing patients. Materials and Methods: This randomised double-blinded study clinical study was conducted in the Department of Prosthodontics at MM College of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from August 2022 to January 2023. Ethical clearance was obtained and 60 patients were randomly divided into two groups (n=30): Group-A (Probiotics group) and Group-B (Triphala group). Sample collection was performed at baseline and after an 8-week experimental period. The collected samples were inoculated in Sabouraud Dextrose Agar with Chloramphenicol and incubated for 48 hours at 37°C±2°C in a Biological Oxygen Demand (BOD) incubator. The number of Candida colonies was scored and counted using a Digital Colony Counter, reported as Colony-forming Units (CFU) at baseline and after eight weeks. Data analysis was conducted using the Wilcoxon matched-pair test for comparisons within groups and the Mann-Whitney U-test for pair-wise comparisons (p<0.05). Results: The mean age of patients in Group-A was 61±3 years, while in Group-B it was 60±2 years. The mean CFU for the probiotics group was 44.70±72.5 and for the Triphala group, it was 79.60±58.7 before treatment. After treatment, the mean CFU for the probiotics group was 24.70±271.4 and for the Triphala group, it was 50.67±196.4. Although no significant difference (p-value>0.05) was observed between the two groups, both rinses proved effective against Candida species in denture-wearing patients. However, the mean reduction in CFUs was significantly higher for Triphala (p-value=0.021). Conclusion: Both probiotics and Triphala showed a significant reduction in CFU after eight weeks of use. However, Triphala was more effective in reducing Candida compared to probiotics. Therefore, it can be considered an efficient agent for denture-wearing patients against Candida species.

Effect of Diaphragmatic Breathing Exercise on Hamstring Length and Functional Disability in Subjects with Chronic Low Backache: A Quasi-experimental Study

S Nagaraj, KU Dhanesh Kumar, Pravin Aaron

Introduction: The diaphragm is one of the most significant skeletal muscles in the human body, performing vital respiratory functions. It is not only the primary inspiratory muscle but is also involved in non respiratory activities and plays a dynamic role in Postural stabilisation. Low Back Pain (LBP) is the leading cause of disability worldwide, presenting a significant health issue that imposes substantial social and economic costs on both the community and healthcare systems. Although the precise cause of non specific LBP is still unknown, its progression has been greatly affected by mechanical factors that are generally agreed upon. Aim: To determine the effect of diaphragmatic breathing exercises on hamstring length and functional disability in subjects with chronic LBP. Materials and Methods: A single-group pre- to post-test quasi-experimental study was conducted with 66 subjects at the Padmashree Rehabilitation Centre, Bengaluru, Karnataka, India from June 2023 to August 2023. Ethical clearance was obtained from the Padmashree Institutional Ethical Committee, and the subjects were recruited based on specific selection criteria. Baseline variables, including age, gender, and Body Mass Index (BMI), were recorded. The main outcomes measured were the Active Knee Extension (AKE) test and the Oswestry Disability Index (ODI) Questionnaire. Values before and after the intervention were recorded and a paired sample t-test was used to compare the scores before and after the intervention. Results: The pretest mean score was 27.85±2.40, while the post-test mean score was 24.77±2.26 (AKE RT). The paired t-test indicated a significant improvement in AKE postintervention for both the right and left lower limb (p-value<0.001). The ODI scores significantly decreased from a pretest mean of 40.41±12.86 to a post-test mean of 36.30±10.08 (p-value<0.001). Conclusion: The diaphragmatic breathing exercise demonstrated a significant improvement in AKE scores and the disability index. The improvements were statistically significant, indicating the effectiveness of the intervention in enhancing flexibility and reducing disability in participants with chronic LBP.

Impact of Exercise Intervention on Cardiovascular Fitness in Patients with Epilepsy: A Quasi-experimental Study

Geeta Bhatt, Neha Mukkamala

Introduction: Epilepsy is a disorder characterised by two or more recurrent seizures that are unprovoked by any immediately identifiable cause. Additionally, it can lead to psychological issues, including anxiety and depression, as well as societal problems such as increased social stigma and withdrawal. Physical exercise regimens incorporated into the treatment plan can benefit epilepsy patients; however, these are often not included by medical experts or epilepsy patients themselves due to the stigma associated with the condition, apprehension that exercise might trigger seizures, or a lack of knowledge about the benefits of physical activity. Aim: To evaluate the effect of physical exercise on cardiovascular endurance and fitness levels in adults with and without epilepsy. Materials and Methods: A quasi-experimental study consisting of a pre-and post-design with a control group was conducted over a duration of six months. For both groups, participants were given exercise interventions three times a week for six months (from March 2022 to August 2022), with each session lasting 60 minutes. The outcome measures evaluated included the Shuttle Walk Test (SWT) and maximal oxygen consumption (VO₂ max). For normally distributed data, an unpaired t-test was used to compare data between groups, while repeated measures Analysis of Variance (ANOVA) was used to compare data within the same group. A significance level of p-value ≤0.05 was considered. Results: The mean SWT scores in the control group at baseline, at the end of the 1^st month, the 3^rd month, and the 6^th month were 6.62±1.32 m, 6.94±3.62 m, 7.46±2.69 m, and 8.36±3.16 m, respectively. In the experimental group, the mean SWT scores were 5.96±0.02 m, 6.68±2.24 m, 7.02±1.41 m, and 7.90±2.08 m, respectively. The mean VO₂ max values in the experimental group at baseline, at the end of the 1^st month, the 3^rd month, and the 6^th month were 29.76±4.29 m, 30.24±4.01 m, 33.40±2.17 m, and 35.45±3.68 m, respectively. In the control group, the mean VO₂ max values were 29.59±5.68 m, 30.09±5.60 m, 31.22±3.48 m, and 33.88±4.26 m, respectively. Conclusion: The study concluded that the physical exercise intervention conducted for adults with and without epilepsy improved cardiovascular fitness and aerobic endurance. Therefore, patients with epilepsy should be encouraged to participate in some form of physical activity.

Electrophoretic Pattern of Serum Proteins in Pregnancy: A Cross-sectional Study

Introduction: Nutritional status during pregnancy is a determining factor for maternal and neonatal health outcomes. Protein is an essential nutrient for foetal development. If pregnancy is associated with an improper diet leading to protein deficiency, the prospects for maternal and foetal outcomes may be catastrophic. An electrophoretic study of serum protein patterns in pregnancy can help identify pregnancy-specific protein markers and facilitate the monitoring of feto-maternal health. Aim: The aim of this study is to assess serum protein levels and their fractions (albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, and gamma globulin) using gel electrophoresis in healthy pregnant women attending an antenatal clinic. Materials and Methods: This cross-sectional study was conducted in the Department of Medical Biochemistry in collaboration with the Department of Obstetrics and Gynecology at Sultania Zanana Hospital, associated with Gandhi Medical College, Bhopal, Madhya Pradesh, India, between January 2021 and February 2021. Fifty normal non-pregnant women of childbearing age and 50 normal pregnant women in the first trimester of pregnancy attending an antenatal clinic were enrolled and followed-up through the second and third trimesters for investigations. Serum total protein, albumin, and globulin levels were estimated using a fully automated chemistry analyser, and the electrophoretic patterns of serum protein fractions were analysed using an automated gel electrophoresis apparatus. Epi-Info statistical software was used for the statistical analysis of data, with p<0.05 considered the statistical significance level. Results: The serum total protein level in non-pregnant women was 6.36±0.40 g/dL, while in pregnant women, it was 8.01±0.40 g/dL, 8.00±0.42 g/dL, and 6.36±0.43 g/dL in the first (T1), second (T2), and third (T3) trimesters, respectively. The serum albumin level was 3.90±0.30 g/dL in non-pregnant women, while in pregnant women it was 4.24±0.38 g/dL, 4.58±0.34 g/dL, and 3.87±0.36 g/dL in T1, T2, and T3, respectively. The globulin level in non-pregnant women was 2.46±0.28 g/dL, while in T1, T2, and T3 it was 3.86±0.22 g/dL, 3.42±0.20 g/dL, and 2.49±0.24 g/dL, respectively. A significant difference was found among the groups for serum total protein, serum albumin, and serum globulin. In non-pregnant women, the protein fractions- albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, and gamma globulin- did not show any deviation from normal levels. However, there was a decrease in albumin and beta globulin levels, along with an increase in alpha-2 globulin levels in the first trimester. An increase in beta globulin and a decrease in gamma globulin levels were observed in the second trimester. In the third trimester, all these fractions did not show any significant alterations, except for gamma globulin. Conclusion: Serum total protein, serum albumin, and serum globulin levels showed a significant difference. However, a slight increase in serum globulin levels compensated for the fall in albumin levels during pregnancy. Variations in the levels of beta globulin, alpha-2 globulin, and gamma globulin were observed during pregnancy, while, on the other hand, alpha-1 globulin did not show any alterations in pregnant women during the first, second, and third trimesters, although its level was higher in pregnant women compared to non-pregnant women.

Clinical Profile, Prognostic Factors and Surgical Outcomes in Lens Induced Glaucoma: A Prospective Study from a Tertiary Care Centre in Western Maharashtra, India

Renu Magdum, Kalpita Goli, Shreya Gandhi

Introduction: Cataracts are a major cause of preventable blindness in India. A considerable number of patients continue to present with advanced cataracts, which can result in complications such as Lens Induced Glaucoma (LIG). LIG is a secondary glaucoma that occurs due to mature or hypermature cataracts, potentially causing significant visual impairment. Aim: To determine the clinical presentation, prognostic factors, and surgical outcomes in patients with LIG. Materials and Methods: A prospective study involving 60 patients with LIG was conducted at a tertiary care centre in Western Maharashtra, India from September 2022 to June 2024. All patients underwent Small Incision Cataract Surgery (SICS) and were followed-up postoperatively on day 1, day 7, and week 6. Results: The mean age of the patients was 69.03 years, with 66.7% being females. Symptoms such as pain, redness, headache and diminished vision were present in all patients. The mean duration of symptoms was 4.08 days. All patients presented with poor visual acuity (<6/60), and the majority had shallow Anterior Chamber (AC) depth (83.3%). The highest number of cases exhibited elevated Intraocular Pressure (IOP), with a range of 41-50 mmHg. Postoperative visual outcomes improved significantly by week 6 in 51.7% of patients. Conclusion: Early diagnosis and management of cataracts are crucial in preventing LIG and improving visual outcomes. Community outreach programs for early detection and management are essential in a developing country like India.

Survival of Endodontically Treated Maxillary Anterior Teeth with Aesthetic Post-Restoration: A Prospective Intervention Study

Rohit Sharma, Pankaj Dhawan, Harsimran Kaur

Introduction: There is much debate over the best choice of restorative material and the placement method for the most successful treatment. Many teeth that have undergone endodontic treatment may not have enough structure to support a restoration or crown. To improve retention for the restorative material, ferrule may be used. Adhesive techniques have transformed the way we restore teeth after root canal treatment, starting with the shift from using cast post-and-core to using fibre post. The use of fibre-reinforced posts has been found to prevent irreparable root fractures thereby improving the longevity of the treatment. Aim: To compare two different types of aesthetic fibre posts for 12 months. Materials and Methods: A prospective interventional study was carried out in the Department of Prosthodontics, Manav Rachna Dental College (Faridabad) for a period of 12 months from Nov 2022- Oct 2023. Forty participants with single rooted, endodontically treated, maxillary anterior teeth in the age bracket of 15-55 years, both males and females of the north Indian population were included in the study. Teeth were selected where a post-retained crown was indicated and post space was prepared using a piezo reamer drill at 5000 rpm. At least 4 mm of obturation is left in the canal to maintain the apical seal. Furthermore, Zircon-enriched silicon fibre and glass fibre-reinforced posts were cemented into the prepared post space. Metal-ceramic crowns were cemented and baseline periapical radiographs were obtained. At the interval of one month, three months, six months and one year, the patients were evaluated.The Fischer’s exact test was utilised to establish the association between categorical variables and the level of significance (p-value <0.05). Results: One year follow-up revealed no failures in crown movement when evaluated under finger pressure, recurrent caries, or root fractures. One case of glass fibre-reinforced post showed a fracture of the post and another case of glass fibre post showed periapical radiolucency at 6-month intervals on clinical and radiographical examination which was significant when compared to Zircon-enriched silicon fibre post group (p-value=0.02). Conclusion: Both aesthetic fibre-reinforced post systems used in single-rooted upper anterior teeth demonstrated similar success rates in restoring root canal treated teeth.

Validation and Analysis of an Integrated Device for Recording Bite Force and Masseter Muscle Activity in Dentate Participants: An Observational Study

Umamaheswari Mani, Aishwarya Arun, Kasim Mohamed

Introduction: The success of any prosthetic rehabilitation depends on acceptable occlusion and muscle coordination. Occlusal therapy should be an integral part of restorative and prosthetic treatment. A thorough diagnosis of bite force and muscle activity is required to ensure the patient’s masticatory function and comfort. The current system of digitisation lacks devices for the simultaneous evaluation of muscle activity and occlusal bite force, representing a significant limitation in understanding and managing restorative and rehabilitation therapy. Aim: To assess the efficacy of an ingeniously designed integrated device that records occlusal bite force and muscle activity. Materials and Methods: An observational study was conducted among 112 healthy volunteers in the Department of Prosthodontics at Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India, for a period of one month and 45 days, from February 5, 2024 to March 20, 2024. The study aimed to validate the efficacy of a device designed to record bite force and muscle action potential simultaneously. The device consists of two key components: a square Force-sensitive Resistor (FSR) that records changes in resistance in response to applied force and a MyoWare 2.0 muscle sensor with Arduino (Advancer Technologies) for measuring the electrical activity of muscles. Study participants, aged between 21 and 35 years, were seated in an upright position. Muscle activity was recorded with surface electrodes placed on the masseter region, following Surface Electromyography for the Non Invasive Assessment of Muscles (SENIAM) guidelines, while a ground electrode was placed on the neck. Maximum Bite Force (MBF) was measured by placing intraoral pressure sensors, with recordings taken in maximum intercuspation three times, spaced one minute apart for each recording. Both muscle activity and bite force were recorded simultaneously. The Pearson’s correlation coefficient was used to evaluate the correlation between bite forces and muscle action potential with standard average values. Results: The results revealed a strong positive correlation between the masseter muscle activity action potential and the bite force values of the right molar (r=0.964, p<0.001), left molar (r=0.980, p<0.001) and incisor (r=0.550, p=0.002). Conclusion: The device synergistically records muscle activation patterns and bite force distribution, displaying the values in an integrated digital interface. The results of the study reveal that this device can serve as a diagnostic tool in prosthodontic treatment planning.

Retrievability of Intracanal Medicament from Root Canals: An In-vitro CBCT Volumetric Analysis

Deebah Choudhary

Introduction: The complete removal of Calcium Hydroxide {Ca(OH)2} using various techniques remains a challenge in root canal therapy. One of the most commonly used methods for removing calcium hydroxide is by using a Master Apical File (MAF) along with sodium hypochlorite and Ethylenediaminetetracetic Acid (EDTA). Various new modalities, like Canal Brush, NaviTip and file systems, have emerged to tackle the residual calcium hydroxide in the canal; but none of these methods have been able to completely remove it from the canal. Aim: To evaluate and compare the efficacy of H-files, NaviTip FX and Canal Brushes in removing calcium hydroxide intracanal medicament from root canals. Materials and Methods: This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2023 to March 2024. To standardise the length at 14 mm, 30 mandibular premolar teeth (n=30) with a single root were decoronated at the Cementoenamel Junction (CEJ). The working length was determined, followed by the cleaning and shaping of all specimens using ProTaper Rotary Files. Intracanal medicament (Metapex) was placed and the canals were sealed with Glass Ionomer Cement (GIC). The specimens were then placed at 37±1ºC and 100% relative humidity for 30 days. The medicament was subsequently removed by three different protocols: H-file, NaviTip FX and Canal Brush (n=10 each). The residual volumes in the mesial, distal and apical thirds were assessed, referring to the volume of medicament left in the canal, which was measured using Cone-beam Computed Tomography (CBCT). The recorded variables were analysed using one-way Analysis of Variance (ANOVA) post-hoc tests (p<0.05). Results: The Canal Brush removed the maximum amount of Metapex in the apical third (0.108) of the roots of the premolars, followed by NaviTip FX and then H-file. In the middle third of the root, NaviTip FX removed more Metapex than the Canal Brush, followed by H-files. A comparison of retrieval between and within the groups it showed that none of the techniques were capable of removing all the Metapex from the specimens, with p>0.05. Conclusion: The present study demonstrated that the Canal Brush showed superior results in retrieving Metapex from the apical third of the root and the distal side (middle third), whereas NaviTip FX removed more Metapex from the mesial side (middle third) of the root, but H-file exhibited the least efficacy in the retrieval of Metapex. Total removal of calcium hydroxide from the entire canal is not possible regardless of the technique used.

Evaluation of Setting Time, Compressive Strength, Microleakage and Antibacterial Properties of Nano Hydroxyapatite Incorporated GIC: An In-vitro Study

Akshada Chougaonkar, Updesh Masih, Abhilasha Manker, Neelesh Gautam, Nidhi Soni

Introduction: Glass Ionomer Cement (GIC) is widely used as a restorative material, but it still exhibits some limitations that pose significant drawbacks in clinical use. The composition of Hydroxyapatite (HA) mimics the inorganic fraction of mineralised tissues such as bones and teeth. HA possesses osteoconductive and bioactive properties, making it favourable for orthopaedic and dental applications. Aim: The aim of this study was to evaluate and compare the setting time, compressive strength, microleakage and antibacterial properties of nano-HA incorporated GIC (NHa-GIC) at various concentrations with Type-II GIC. Materials and Methods: This in-vitro study was conducted in the Department of Paediatric and Preventive Dentistry at Sri Aurobindo College of Dentistry in Indore, Madhya Pradesh, India, for a duration of nine months, from May 2023 to January 2024. The study comprised five study groups as follows: Group-1-Type-II GIC (control), Group-2-NHA-GIC 4%, Group-3-NHA-GIC 8%, Group-4-NHA-GIC 10% and Group-5-NHA-GIC 15%. A total of 50 acrylic moulds containing the test material and Type-II GIC, with 10 in each group (n=10), were prepared to record the setting time, which was tested using a Gillmore needle. The compressive strength was checked using a Universal Testing Machine. Additionally, 50 primary molars were selected according to inclusion and exclusion criteria and randomly divided into five groups (n=10) to evaluate microleakage. Microleakage was assessed using the dye penetration method under a stereomicroscope. For antibacterial properties, 50 samples (n=10) were taken for each strain, i.e., Strain A: S. mutans and Strain B: L. fermentum and the disk diffusion method was employed. Thus, a total sample size of 250 was used. The preparation of GIC-NHAp was done by adding nano- HA to GIC at selected concentrations by weight/weight percentage (w/w%). The results were analysed using a one-way Analysis of Variance (ANOVA) test. Results: A statistically significant difference was observed (p<0.001) between Group-1 (GIC II) and Group-II (4% GIC-NHAp), III (8% GIC-NHAp), IV (10% GIC-NHAp) and V (15% GIC-NHAp) regarding setting time, compressive strength, microleakage and antibacterial properties. Conclusion: It can be concluded that adding NHAp crystals to GIC enhances its properties, such as compressive strength and antimicrobial efficiency, as the concentration increases. The microleakage property showed a consistent decrease with increasing concentration. However, the setting time increased with higher concentrations of NHAp in GIC.

Evaluation of Anti-inflammatory and Antioxidant Properties of Persea Americana and Syzygium Aromaticum-based Herbal Mouthwash Formulation: An In-vitro Study

S Dharini, Deepak Pandiar, S Rajeshkumar, Reshma Poothakulath Krishnan

Introduction: Medicinal plants and their substances are used as adjunctive therapies for a range of acute and chronic inflammatory diseases. Syzygium aromaticum and Persea americana, in particular, have demonstrated beneficial effects, including anti-inflammatory and antioxidant properties, in the management of inflammation. Although the extracts from these plants have been assessed in research, the possibility of combining them to synthesise a mouthwash and evaluate its effectiveness has not yet been investigated. Aim: To evaluate the combined anti-inflammatory and antioxidant properties of a mouthwash formulation based on the extensively nutritious avocado fruit (Persea americana) and clove (Syzygium aromaticum). Materials and Methods: This in-vitro investigation was carried out in the Oral Pathology and Microbiology Department at Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, between December 2021 and July 2022. A mouthwash was formulated with extracts from clove and avocado fruit, and its anti-inflammatory and antioxidant properties were evaluated using Bovine Serum Albumin (BSA) denaturation and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays, respectively. Microsoft Excel was utilised for data collection, and Statistical Package for the Social Sciences (SPSS) version 23.0 with independent t-tests was used for statistical analysis. A p-value of 0.05 was considered statistically significant. Results: The anti-inflammatory activity of the prepared mouthwash based on P. americana and Syzygium aromaticum at a concentration of 50 μL (86.62% inhibition) was comparable to that of the standard drug (diclofenac sodium) (84.82% inhibition); however, its antioxidant properties were significantly lower. Conclusion: The mouthwash synthesised from the edible part of P. americana in conjunction with Syzygium aromaticum exhibited superior anti-inflammatory properties, with the highest activity observed at a concentration of 50 μL. Therefore, the prepared formulation could be used for managing minor inflammatory conditions.

Awareness and Perception about Oral Cancer among the Rural Population at Chengalpattu District, Tamil Nadu, India: A Cross-sectional Study

S Gladwin, GR Karthikeyan, B Balaguhan, V Sakthisri

Introduction: The prevalence of oral cancer is extremely high in India, contributing significantly to morbidity and mortality. Public awareness of oral cancer may aid in the prevention and early detection of the disease. To achieve successful prevention, it is essential to analyse the level of awareness among the rural Indian population, who often lacks access to healthcare. Aim: To assess the awareness and perception of oral cancer, including its signs, symptoms and treatment options in the rural population. Materials and Methods: This cross-sectional study was conducted in the Department of Oral and Maxillofacial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Madhuranthagam, Tamil Nadu, India over a period of eight months (September 2022 to April 2023) among 350 participants who visited the Dental and Medical College, Outpatient Department (OPD) from the rural population of Chengalpattu district, Tamil Nadu, India. A pretested, self-administered questionnaire consisting of 15 questions was distributed. These questions addressed knowledge and awareness of the signs and symptoms of oral cancer, various aetiological factors, risk factors associated with tobacco use, treatment options, and the quality of life of patients after receiving treatment. Responses were collected and tabulated for data analysis. Statistical analysis was performed using the IBM Corp. Statistical Package for the Social Sciences (SPSS) software for Windows, version 22.0 (Armonk, NY). The Chi-square test with Yates correction was used to compare the associations between males and females regarding awareness and perception of oral cancer. A p-value of <0.05 was considered significant. Results: The mean age of the participants was approximately 38 years. Among the total of 350 participants, 190 (54.2%) were males and 160 (45.8%) were females. Among the participants, 80.6% (36.8% males and 43.8% females) believed that smoking and tobacco chewing were causative factors for oral cancer. Additionally, 66.3% of males and 70% of females were aware of the treatment options available after the confirmation of oral cancer. Furthermore, 42.6% of males and 43.1% of females stated that they were aware of the role of oral and maxillofacial surgeons in the treatment of oral cancer. Conclusion: Out of all participants, only 79.1% of the rural population was familiar with the term “oral cancer,” and 45.5% knew that a persistent, non healing ulcer is the most typical sign of oral cancer. Prevention and early identification of oral cancer, along with associated health education, are critical public health issues that require continued and heightened focus in the medical field.

Role of Pseudosac Fixation on Seroma Formation Following Totally Extraperitoneal Repair of Direct Inguinal Hernia: A Randomised Controlled Trial

Introduction: Seroma formation following inguinal hernia surgery is a significant concern, causing considerable morbidity for patients. It can lead to prolonged hospital stays and, most devastatingly, mesh infection. Every effort should be made to reduce seroma formation, and newer techniques are being advocated to address this issue. Aim: To assess the role of pseudosac fixation during Totally Extraperitoneal (TEP) repair for direct inguinal hernia in relation to postoperative seroma formation. Materials and Methods: The present single-blinded randomised controlled study was conducted in the Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from June 2019 to May 2021. A total of 60 patients (group A: 30 patients with pseudosac fixation; group B: 30 patients without pseudosac fixation) aged 18 years and above, presenting with direct inguinal hernia, were included. All patients underwent TEP repair. Seroma formation, postoperative pain and early recurrence were assessed in the postoperative period. Statistical analysis were performed using the Statistical Package for Social Sciences (SPSS) version 22.0. Fisher’s exact test and t-tests were employed, with a p-value of <0.05 considered significant. Results: The mean±Standard Deviation (SD) age in group 1 and group 2 was 60.7±7.26 years and 57.5±8.9 years, respectively. Postoperative seroma was observed in 3 (10%) patients each from both groups three months after surgery (p-value=1). Nine (30%) patients in group A and 12 (40%) patients in group B experienced mild postoperative pain (p-value=1). None of the patients in either group experienced recurrence at three months postsurgery. Conclusion: Based on the results observed and analysed, fixation of the pseudosac in direct inguinal hernias does not appear to have an impact on postoperative seroma formation, postoperative pain, or early recurrence.

Prevalence and Variations in the Mandibular Canal assessed using Cone Beam Computed Tomography: A Retrospective Observational Study

Samadrita Paul, Balaji Pachipulusu, Poornima Chandra, Poornima Govindraju

Introduction: Variations in the Mandibular Canal (MC) can be categorised based on shape (oval, round, or pear-shaped) and may include various accessory canals, such as bifid, trifid, or temporal crest canals. These variations are clinically significant because if, they are overlooked, they can lead to various complications. While both 2 Dimensional (2D) and 3D imaging modalities can evaluate these variations, Cone Beam Computed Tomography (CBCT) offers superior resolution, reduced radiation exposure, and a comprehensive 3D view. Aim: To analyse the prevalence and variations of the MC, as well as its diameter and length among the Indian population. Materials and Methods: A retrospective observational study was conducted in the Department of Oral Medicine and Radiology at Rajarajeswari Dental College and Hospital, Ramohalli Cross, Mysuru Road, Bengaluru, Karnataka, India over a period of six months from October 2023 to April 2024. Total of 190 CBCT images were randomly collected from the CBCT archives, spanning ages 16 to 75 years. The length and diameter of the MC were measured using CBCT tools. The prevalence of variations in the MC was determined according to the classification provided for bifid and trifid canals. The Chi-square test was employed to compare the anatomical variations of the MC based on age and gender, while an independent Student’s t-test was used to compare the mean length and mean diameter based on age groups and gender. Results: The mean age of the study population was 37.96±14.63 years. Among the 190 images, 105 (55.3%) belonged to males and 85 (44.7%) belonged to females. The frequency of bifid canals was comparatively higher than that of trifid and temporal crest canals, with incidence rates of 14.7%, 3.7%, and 5.3%, respectively, showing no significant association with age or gender. Females exhibited a bilateral reduction in vertical diameter (mean difference of 0.37 mm compared to males at 0.40 mm). The mean length of the MC was notably longer on the left-side among males (mean MC length on the left-side: 69.36 mm compared to the right-side: 67.64 mm). Conclusion: The present study highlights the importance of understanding variations in the MC. CBCT imaging enhances the comprehension of MC anatomy, facilitating accurate diagnostic and treatment strategies in dentistry and maxillofacial surgery.

Evaluation of Three Different Behaviour Management Strategies for Dental Management of Highly Anxious Children: A Randomised Clinical Study

Introduction: Children often experience anxiety and behavioural issues when exposed to dental stimuli such as the sight, sound, and sensation of the airotor. Behaviour modification techniques that involve familiarising children with dental equipment and procedures can help reduce this anxiety. Aim: To evaluate the effectiveness of three behaviour management techniques: Tell-Show-Do (TSD), Tell-show-play-do (TSPD), and a smartphone dental game application in managing Dental Fear and Anxiety (DFA) in children aged 4-8 years. Materials and Methods: This randomised clinical study included 60 children aged 4-8 years who required Class-I restorations (ICDAS Code 2 and Code 3) in maxillary or mandibular molars. Participants were randomly assigned to one of three groups: TSD (n=20), TSPD (n=20), or the smartphone dental game app (n=20). Preoperative anxiety levels were assessed using the Children’s Fear Survey Schedule Scale-Dental Subscale (CFSS-DS). Anxiety levels were evaluated pre- and postoperatively using the Modified Child Dental Anxiety Scale (MCDAS-f) and the Visual Analogue Scale (VAS). Physiological parameters, including pulse rate and SpO2 levels, were measured before and after treatment. Statistical analyses included paired t-tests for pulse rate, Wilcoxon signed-rank tests for VAS and MCDAS-f scores, Kruskal-Wallis tests for intergroup comparisons, and one-way ANOVA with Bonferroni post-hoc tests. Data were analysed using SPSS version 27.00. Results: The TSPD group exhibited a significantly greater reduction in dental anxiety compared to the TSD (p=0.01) and smartphone dental game groups (p=0.05), as evidenced by MCDAS-f (p<0.001) and VAS scores (16.7%). Physiological parameters indicated significant changes in the TSPD group, with a notable decrease in pulse rate post-treatment (p=0.014) and the lowest mean SpO2 level (96.55). One-way ANOVA with Bonferroni post-hoc tests confirmed significant anxiety reduction in the TSPD group both before (p=0.048) and after treatment (p=0.009). The Wilcoxon signed-rank test demonstrated a substantial decrease in DFA, with 16.7% of children in the TSPD group no longer experiencing anxiety post-intervention (p<0.001). These findings underscore the superior efficacy of the TSPD technique in managing DFA. Conclusion: Among the three techniques, the TSPD technique was the most effective overall, while the TSD technique was the least effective. It is crucial for paediatric dentists to employ child-friendly and pain-free methods to improve children’s behaviour during dental treatments.

Impact of Painful Diabetic Peripheral Neuropathy on the Quality of Life of Patients in Goa, India: A Cross-sectional Study

Jorida Fernandes, Sharmila Dudhani, Prashant Mukkannavar, Sejal Vaigankar

Introduction: The state of Goa has the highest prevalence of diabetes and prediabetes in India. Pain because of abnormalities in the somatosensory system due to diabetes is referred to as Painful Diabetic Peripheral Neuropathy (PDPN). A common complication associated with PDPN is poor Quality of Life (QoL), which can lead to lifelong disability. Aim: To estimate the prevalence of PDPN and its impact on QoL in patients in Goa, India. Materials and Methods: In this cross-sectional observational study, 320 participants were screened at Goa Medical College, Bambolim, Goa, India, from August 2021 to August 2022, and 288 were diagnosed with Diabetic Peripheral Neuropathy (DPN). Among those 288 individuals, 91 reported experiencing PDPN, as assessed using the Douleur Neuropathique 4 (DN-4) questionnaire. The investigator interviewed participants aged 18 to 75 years, of all genders, who were diagnosed with either Type 1 or Type 2 diabetes. Baseline characteristics, including age, weight, height, Body Mass Index (BMI), duration of diabetes, and results from the lateralisation test using the graded motor imagery app, were recorded. Participants were assessed using the Neuropathy Symptom Score, and only those who scored at least 1 were included, indicating the presence of DPN. These participants then completed the DN-4 questionnaire; those scoring 3 or more were diagnosed with PDPN. Subsequently, QoL was assessed using the RAND QoL questionnaire {RAND Short Form Survey (SF-36)}. Demographic and clinical characteristics were presented as mean±Standard Deviation (SD). Comparisons between patients with PDPN and those without PDPN were made using an Independent t-test. The normality of continuous variables was tested using the Kolmogorov-Smirnov test. All analyses were carried out using IBM Statistical Package for the Social Sciences (SPSS) (version 28.0). Results: The prevalence of PDPN was found to be 31.6%, with significant impairments in the physical functioning, social functioning, and pain domains (p-value <0.001). Conclusion: The prevalence of PDPN was found to be 31.6%. Significant impairments in various QoL domains were noted in participants with PDPN.

Gender-specific Association between Thyroid Stimulating Hormone and Haematological Indices in Hypothyroid Patients: A Cross-sectional Study

Lohitha Polisetty, Smriti Sinha

Introduction: Hypothyroidism has long been known to cause metabolic deceleration, including its effects on haematopoietic tissue, leading to anaemia. Anaemia and hypothyroidism can co-exist and present challenges for each other, resulting in a decline in quality of life. Aim: To address the gender-specific association of Thyroid Stimulating Hormone (TSH) with various haematological indices among a cohort of hypothyroid patients. Materials and Methods: A cross-sectional observational study was conducted at a tertiary care teaching hospital in Hyderabad, Telangana, India, from October 2022 to February 2023, after obtaining ethical clearance from the institutional ethics committee. A total of 347 newly diagnosed, biochemically proven hypothyroid patients attending the hospital were included in the study. The patients were divided into subclinical and overt hypothyroid groups based on their TSH values and thyroxine levels. All patients underwent blood tests for a complete blood count, including all haematological indices such as erythrocyte count, Haemoglobin (Hb), Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), and Red cell Distribution Width (RDW). Gender-based stratification of the study population was performed. Data were analysed using the Student’s unpaired t-test, Chi-square test, and univariate linear regression with Statistical Package for the Social Sciences (SPSS) version 22.0. Results: The study highlighted a high prevalence of anaemia among overt hypothyroid patients 88 (54%) compared to subclinical hypothyroid patients 63 (34.24%). Moreover, the prevalence of anaemia was higher in females than in males. The most common type of anaemia encountered was microcytic anaemia, followed by normocytic anaemia. Linear regression analysis yielded a positive correlation between TSH and all haematological parameters, including RDW. This correlation was especially significant among females. Conclusion: TSH affected all the haematological parameters, including RDW, and the association was stronger in females as compared to males in both subclinical and overt hypothyroidism.

Comparative Evaluation of Shear Bond Strength, Adhesive Remnant Index and Cytotoxicity of Different Orthodontic Adhesives: An In-vitro Study

Havisha Nookala, Ravindra Kumar Jain

Introduction: Orthodontic adhesives should possess adequate bond strength and biocompatibility. Inadequate bond strength may lead to bond failures, and if the adhesive is not biocompatible, it may result in allergic reactions. Therefore, it is of prime importance to study the cytotoxicity and Shear Bond Strength (SBS) of commercially available orthodontic materials. Aim: This study aimed to comparatively evaluate in-vitro cytotoxicity, the Adhesive Remnant Index (ARI), and SBS of various orthodontic adhesives. Materials and Methods: This in-vitro study was conducted in an institutional setting as a collaborative effort between the Department of Orthodontics and White Lab-Blue Lab at Saveetha Dental College and Hospital, Chennai, India, from July 2023 to August 2023. Forty extracted human premolar teeth were bonded with four different ARI adhesives (U Bond, Enlight, Transbond XT, Aqualine LC) (n=10/group) and mounted on acrylic blocks. They were evaluated for SBS using a Universal Testing Machine (UTM), ARI using Scanning Electron Microscopy (SEM), and cytotoxicity using the MTT {3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide} assay on Human Gingival Fibroblast Cells (HGFC). Statistical analysis was performed using One-way ANOVA, with a post-hoc test for pairwise comparison to evaluate the SBS values, and the Kruskal-Wallis Test to analyse ARI inter group scores and cytotoxicity levels. Statistical Package for the Social Sciences (SPSS) software (Version 23.0) was used to conduct the statistical tests. Results: Significant differences in SBS values (p=<0.001) and ARI scores (p=<0.001) were noted between the different adhesives. No significant difference (p-value=0.534) in cytotoxicity was observed among all adhesives, with all exhibiting acceptable levels of biocompatibility. Conclusion: Primer-based adhesive (Transbond XT) demonstrated the highest SBS and ARI scores among the various orthodontic adhesives, with acceptable levels of biocompatibility. No significant difference was found between the conventional primer-based adhesive (Transbond XT) and the Single Component Adhesive (SCA) (Aqualine LC). Therefore, this study advocates for the use of SCA in routine clinical practice.

Effectiveness of Maitland Mobilisation on Pain and Function in Individuals with Mechanical Low Back Pain: A Systematic Review

Geeta Gill, Vinay Jagga, Sajjan Pal

Introduction: Mechanical Low Back Pain (MLBP) is a prevalent condition that significantly impacts individuals’ quality of life and healthcare systems worldwide. The management of MLBP has explored various manual therapy techniques, including Maitland mobilisation; however, the immediate effects and comparative efficacy of these techniques remain subjects of ongoing investigation. Aim: To evaluate the immediate effects of Maitland mobilisation compared to other manual therapy techniques on flexion and extension Range of Motion (ROM) in patients with MLBP. Materials and Methods: The present systematic review involved a comprehensive search of electronic databases, including PubMed, Cochrane Library, and Google Scholar, from January 2017 to March 2024. The search utilised the keywords “Randomised Controlled Trials (RCTs)”, “Maitland mobilisation”, and “mechanical low back pain”. Studies comparing the immediate effects of Maitland mobilisation with other manual therapy techniques on flexion and extension ROM in patients with MLBP were included. Data extraction and quality assessment were performed using established protocols. Results: Nine studies met the inclusion criteria and were included in the review. The findings revealed that Maitland mobilisation demonstrated significant immediate effects on both flexion and extension ROM in patients with MLBP. Improvements were particularly noted in lumbar flexion following Maitland mobilisation, while lumbar extension showed greater enhancement after specific techniques such as Posteroanterior (PA) mobilisation. Additionally, combination therapies, such as core stability exercises coupled with Maitland manual therapy, showed promising results in reducing disability associated with MLBP. Conclusion: This review investigated the immediate effects of Maitland mobilisation on ROM in MLBP. While some studies indicated improvements in ROM, the evidence for its effectiveness compared to other interventions and its long-term impact on pain and function remains unclear. Future well-designed studies are needed to definitively assess the role of Maitland mobilisation in the management of MLBP.

Comparison of Escitalopram Alone versus in Combination with Jacobson’s Progressive Muscle Relaxation in Patients with Neurotic, Stress Related and Somatoform Disorders: A Randomised Clinical Study

Piyush Mahajan, Malvika Dahuja, Pranjal Tripathi, Shashank Saurabh Sinha

Introduction: Anxiety disorders have a prevalence rate of 2.57% and significantly impact well-being and productivity. The course of anxiety disorders is characterised by fluctuating symptom severity, a high relapse rate, and chronicity. Patients with anxiety disorders are typically prescribed antidepressants or anti-anxiety medications, but these treatments often have limited long-term efficacy. Combining pharmacotherapy with non-pharmacological techniques, such as Progressive Muscle Relaxation (PMR), may enhance the effectiveness of treatment for anxiety disorders. Aim: To assess and compare the Hamilton Anxiety Rating Scale (HAM-A) scores at six-month between Group-E (who received Escitalopram exclusively) and Group-E+PMR (who received Escitalopram in addition to PMR). Additionally, the aim was also to compare the baseline HAM-A scores with those obtained after six months within each group. Materials and Methods: A randomised clinical study was conducted in the Department of Psychiatry at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, Punjab, India, from March 2020 to March 2021. The study was carried out following approval from the Institutional Ethics Committee (IEC). Participants were individuals aged 18 to 45 years who visited the Psychiatry Department's Outpatient Department (OPD) and met the ICD-10 criteria for Neurotic, stress-related, and somatoform disorders (F40-F48). One hundred and seventeen participants were randomly allocated to the two groups using a simple randomization method. Group-E received a daily dose of 10 mg Escitalopram for six months, while Group-E+PMR received the same dosage of Escitalopram along with Jacobson’s PMR exercises lasting 20 minutes, twice daily, at their place of residence. The HAM-A scale was employed to assess anxiety levels in both groups. Paired t-tests were conducted to compare pre- and post-treatment HAM-A scores within each group, while independent t-tests were used to compare scores between the groups. Statistical analysis was carried out using SPSS version 24.0 and a significance level of p<0.05 was adopted for the statistical assessments. Results: Both groups were comparable in terms of socio-demographic variables, mean age, and baseline HAM-A scores. The majority of participants, 70 (70%), were females. Significant improvements were noted in the HAM-A scores at six-month mark compared to baseline for both, Group-E and Group-E+PMR (p<0.001). Furthermore, Group-E+PMR exhibited a significant decrease in the HAM-A score at six months compared to Group-E (p<0.001), indicating more substantial improvements. Conclusion: Escitalopram and Escitalopram combined with PMR treatment effectively lowered anxiety. However, the incorporation of PMR Exercises alongside Escitalopram demonstrated more favourable outcomes in individuals with anxiety disorders.

Use of Preoperative Lumbosacral Spine X-rays in Developing a Predictor Score for Facilitating Neuraxial Blocks in Patients undergoing Lower Limb Arthroplasty Surgeries: A Cross-sectional Study

Minnu Panditrao, Usha Devi, Shilpa Bansal, Gurleen Kaur

Introduction: Due to bony changes and narrow lumbar interspinous spaces, performing a neuraxial block becomes difficult in older patients undergoing lower limb arthroplasties. Aim: To formulate a difficulty predictor score (MUSG score) for anticipating difficult Central Neuraxial Blocks (CNB) and to compare lumbar spine radiological findings with clinical findings. Materials and Methods: A cross-sectional study was conducted on 166 patients admitted for knee or hip arthroplasties from March 2023 to March 2024 in the main operation theatre complex of a tertiary care hospital. All patients were advised to get X-rays of the lumbosacral spine in both anteroposterior and lateral views before surgery. The total difficulty predictor score was calculated from the X-rays based on the presence or absence of scoliosis, bony osteophytes, angulation of spinous processes, calcification of the ligamentum flavum, and the ratio of inner and outer visible interspinous space. The minimum score was 5 and the maximum was 12. The individual score at each interspinous level was calculated and selected the space with the minimum score for the CNB. A comparison was also made with the clinically selected best space, which was identified using the traditional palpation technique. A block was labeled difficult if there were more than two attempts for spinal and epidural block, respectively. All collected data were entered into a Microsoft Excel sheet and analysed using Microsoft Excel software. Results: The study patients had a mean age of 59.83 years. The total difficulty predictor score (MUSG Score) of the lumbar spine was 5 in 3 patients (1.8%), 6-9 in 140 patients (84.3%), and ≥10 in 23 patients (13.9%). However, the minimum score at the best interspinous space was 5 in 15 patients (9%), 6-9 in 151 patients (91%), and none had a score of 10 or more. From radiological imaging, the spaces with minimal scores were in the order of L2-L3 (76), L3-L4 (62), and L1-L2 (28); while on clinical examination, they were – L2-L3 (96), L3-L4 (43), L1-L2 (23). The difference between the two was statistically significant (p-value <0.05). The time required for the block procedure was longer in patients with a score of 6-9 (13.99 minutes) than in those with a score of 5 (11.13 minutes). Haemodynamic changes from baseline were also more pronounced in patients with a score of 6-9 compared to those with a score of 5. Conclusion: CNBs in patients undergoing hip and knee arthroplasties are easier to perform with the help of the difficulty predictor score (MUSG Score). A difficulty predictor score of 5 is associated with an easier block compared to higher scores.

Phytochemical Profiling and Cytotoxicity Evaluation of Wrightia tinctoria Extracts on Vero Cell Lines: A Comparative Analysis and Insight into the Bioactive Compounds

Introduction: : The utilisation of plant-based medicine is a continuing practice that remains prevalent even with modern times. Some therapeutic modalities have a long history, while others are quite recent. The lack of sufficient reporting on the utilisation of medicinal plants has resulted in an ongoing deficit in the understanding of their therapeutic benefits, as well as, their potential short-term and long-term side-effects. The Sweet Indrajao, commonly known as Pala Indigo Plant or Dyer’s Oleander, and scientifically identified as Wrightia tinctoria R. Br, is a member of the Apocynaceae family. It is known as the “Cure for jaundice tree” in southern India. Wrightia is a plant commonly found in India and Burma. The Wrightia tinctoria plant has been chosen for this study due to its long-standing medicinal usage and the variety of pharmacologically active compounds it contains. Despite of the fact, it is been widely used for medicinal uses, the information concerning its safety mentioned in the literature is scarce, particularly its cytotoxic effects on normal cellular systems, which this research aims to address. Aim: The study was aimed to analyse the therapeutic potential of Wrightia tinctoria plant extracts by evaluating the phytochemical composition and to assess the effect of the Wrightia tinctoria plant extracts on Vero cell lines, for a clearer understanding of its medicinal application and its safety profile. Materials and Methods: This in-vitro study was conducted at SRM Institute of Science and Technology, Chennai and the duration of the study was eight months (Jan to August 2023). For the phytochemical analysis of Wrightia tinctoria, dried plant material (leaves) was collected shade dried and extracted using Soxhlet solvent extraction methods followed by fractionation using techniques like column chromatography. Ethanol, ethyl acetate and aqueous solvents were used for the in-vitro study. The various standard protocols were employed to identify phytoconstituents. The cytotoxicity analysis on Vero cell line (Kidney epithelial cells of African green Monkey) was performed using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide) assay, where vero cells were cultured and seeded into 96-well microtitre plates. Different concentrations of Wrightia tinctoria extract were added to the wells, followed by incubation. After incubation, MTT solution was added, and formazan crystals formed by viable cells were solubilised using a suitable solvent. Absorbance was measured at a specific wavelength using a microplate reader to assess cell viability and cytotoxic effects. Results: Phytochemical analysis revealed the presence of phenols, steroids, terpenoids, alkaloids, flavonoids, and glycosides. Of the three solvents used in the study, ethanolic extract yielded maximum amount of phytochemicals when compared with the other solvents (aqueous and ethyl acetate) that were investigated. MTT assay was used to determine the cytotoxicity and the Wrightia tinctoria ethanolic extract demonstrated Half maximal Inhibitory concentration (IC50) >100, ensuring the safety profile of the extract on normal cells. Conclusion: Wrightia tinctoria was a significant plant with highly potent phytochemicals with therapeutic properties. Moreover the extract was also safe against the normal cell line (vero cell line).

Comparative Efficacy of Smart Burs vs Conventional Burs in Removing Infected Dentin and Preserving Affected Dentin in Primary Teeth: A Randomised Control Study
Introduction: With the advent of time, the removal of caries has shifted from hand instruments to rotary instruments. A disadvantage of conventional burs is that they non selectively lead to over-preparation. A new polymer bur can be substituted to eliminate these undesirable effects. Aim: To compare and evaluate the efficacy of smart burs and conventional burs in removing infected dentine while preserving affected dentin in carious lesions in primary teeth. Materials and Methods: This was a double-blinded randomised controlled trial conducted in the Department of Paediatric and Preventive Dentistry at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India over a period of three months, from August 2023 to October 2023. A total of 40 children aged 6-12 years were selected and evaluated for caries removal efficacy using visual and tactile criteria, which were further confirmed by dye application and numerically scored. Group 1 included 20 children who underwent caries excavation with smart burs, while Group 2 included 20 children who underwent the procedure with diamond points. Statistical analysis was conducted using descriptive and inferential statistics, specifically the Chi-square test. Results: A total of 40 children aged 6-12 years were divided into two groups: Group 1 comprised 11 boys and 9 girls, whereas Group 2 included 10 boys and 10 girls. Of these, 12 cases (60%) showed complete caries removal after the first application of dye, regardless of which burs was used. However, 4 cases (20%) showed some residual caries when using smart burs, while 6 cases (30%) exhibited residual caries with diamond points at the base of the cavity preparation. Additionally, there were 4 cases (20%) with caries present at the base and/or in one wall of the cavity preparation when using smart burs, compared to 2 cases (10%) with conventional burs. Nonetheless, there was no statistically significant difference between the smart burs and the conventional diamond points regarding caries removal. Conclusion: It can be concluded that smart burs are equally effective in removing soft caries compared to conventional methods. Although the results were statistically insignificant, polymer burs were found to be more convenient and can be considered a viable alternative to conventional caries removal techniques.

Assessment of Risk Factors for Postoperative Mortality Following Pancreaticoduodenectomy Performed for Malignancy: A Cross-sectional Study

Salih Demirelli, Mesut Tez, Yunus Nadi Yüksek
Introduction: Pancreaticoduodenectomy (PD) has been the primary curative-intent surgical option for resectable periampullary tumours. Despite advancements in relevant surgical techniques, PD-related morbidity and mortality rates continue to remain high. Therefore, the preoperative identification of high-risk patients is vital for tailoring PD approaches to the individual patient. Aim: To assess early postoperative morbidity and mortality following PD in a tertiary centre in Turkey and identify the associated risk factors. Materials and Methods: This cross-sectional, single-centre study conducted in the General Surgery Clinics of Ankara Numune Training and Education Hospital in Ankara, Turkey included a population of 64 patients undergoing PD for malignant periampullary tumours between May 2010 and May 2014. Patients’ demographic, clinical and intraoperative data were collected. The primary outcome of the study was the 30-day postoperative mortality rate. Pearson’s Chi-square, Fisher’s-exact and Fisher-Freeman-Halton tests were used to compare differences in categorical variables between the groups. Results: The study sample consisted of 64 patients with a mean age of 60.1±12.4 years. The 30-day postoperative mortality rate in the sample was 18.75%. Non survivors were significantly older (age >70 years) (p=0.006), had significantly higher American Society of Anaesthesiologists (ASA) physical status classes (>III) (p=0.008), had significantly lower Neutrophil-to-lymphocyte Ratios (NLR) (<2.5) (p<0.001) and had significantly lower serum albumin levels (<3.5 g/dL) (p=0.038) compared to survivors. The rate of patients experiencing intraoperative blood loss exceeding 1000 mL and consequently the median number of blood units transfused, was significantly higher in non survivors than in survivors (p<0.009 and p<0.001, respectively). Similarly, overall and major complications were significantly more common in non survivors than in survivors (p=0.002 and p=0.012, respectively). Conclusion: The findings of the study indicated that a higher ASA class, older age, lower NLR, hypoalbuminemia, higher intraoperative blood loss, the need for blood transfusion and postoperative complications were associated with increased 30-day mortality after PD.

Relationship of Clinical Profile with Neuroimaging and Electroencephalogram Changes in First Unprovoked Seizure in Children: A Cross-sectional Study

Anjana Vadakkutta Madanan, Poornima Karakkandy Nanu, Preethi S Pillai
Introduction: Unprovoked seizures are common events in children, occurring as single episodes or recurring, as seen in epilepsy. The First Unprovoked Seizure (FUS) poses diagnostic challenges and raises concerns about aetiology, the initiation of anti-seizure medication and prognosis. The roles of Electroencephalogram (EEG) and neuroimaging in the diagnosis and management of FUS are debated. While EEGs play a crucial role in identifying seizure onset and epilepsy syndromes, neuroimaging aids in diagnosing underlying pathologies. Despite recommendations for routine EEGs in evaluating FUS, the role of neuroimaging remains less defined. Aim: To characterise the clinical profile of children presenting with FUS and investigate the relationship between clinical features, EEG findings and neuroimaging findings. Additionally, it explores the aetiology of FUS based on patterns of neuroradiological abnormalities and EEG changes. Materials and Methods: A cross-sectional study was conducted from April 2021 to July 2022 in the Paediatric Intensive Care Unit (PICU) and Paediatric Ward at Government TD Medical College, Alappuzha, Kerala, India. A total of 72 children aged beyond the neonatal period up to 12 years who were admitted with FUS at a tertiary care centre over an 18-month period were included in the study. Clinical data were recorded and standard techniques were used to perform EEGs and Magnetic Resonance Imaging (MRI) on all subjects. Results: The minimum age of participants in the study was two months, with a median age of 3.9 years. Among the 72 participants, most were in the infantile age group, with 23 (31.94%) falling into this category. The most frequently observed seizure type was generalised onset, with 47 (65.28%) cases. EEG irregularities were noted in 25 (34.72%) subjects, while 21 (29.16%) showed MRI abnormalities. Most frequent EEG abnormalities included generalised spike-and-wave discharges in 7 (28%) cases and modified hypsarrhythmia in 6 (24%) cases. The MRI scans revealed ischaemic changes and cerebral dysgenesis, each occurring in 7 out of 21 cases. A considerable proportion of children with abnormal EEGs had abnormal neuroimaging findings. Conclusion: The study recommends that both EEG and MRI should be included as part of the routine evaluation for children presenting with FUS. In cases with abnormalities in EEG, the detection rate of abnormalities through MRI was statistically significant. Additionally, MRI should be performed even when the EEG results are normal.

Evaluation of Analgesic Effect of Lidocaine Patch 5% in Post-herpetic Neuralgia: An Interventional Study
Introduction: Herpes Zoster (HZ) is a very painful and debilitating condition caused by the reactivation of the Varicella Zoster Virus (VZV). HZ is characterised by a maculopapular or vesicular rash, usually accompanied by pain that is unilateral and restricted to dermatomes. Post-herpetic Neuralgia (PHN) is defined as pain that persists for more than 90 days after the onset of the HZ rash. Aim: To evaluate the analgesic efficacy of a lidocaine patch in PHN. Materials and Methods: This prospective interventional study conducted at the Department of Anaesthesiology and Critical Care, Pt. BD Sharma, PGIMS, Rohtak, Haryana, India, from February 2020 to March 2021. The study included a total of 24 patients (single group), with a male-to-female ratio of 11:13, aged between 18 and 75 years, all with a Visual Analogue Scale (VAS) score greater than 4. An evaluation of patient pain scores using the VAS and the total number of lidocaine patches used per week for four weeks or until the VAS declined to four was conducted. After obtaining informed and written consent, a medicated 5% lidocaine patch was applied to cover the appropriate area for a minimum period of 12 hours, followed by removal for the next 12 hours. This application continued until the VAS declined to four or up to a maximum of four weeks. The level of significance was set at p≤0.05. Results: In the present study, a total of 24 patients were included. The mean age was 59.5±12.85 years, with 54.2% being female and 45.8% male. The VAS scores at baseline were 8.71±0.999, which reduced to 7.08±1.349 at the end of one week, 5.67±0.007 at the end of two weeks, 4.25±0.442 at the end of three weeks and 3.58±0.830 at the end of four weeks. The VAS scores were significantly lower in all patients over the four weeks (p=0.001). The total number of patches used was 1.88±0.338 at one week, 1.46±0.509 at two weeks, 1.04±0.204 at three weeks and 1.00 at four weeks. The total amount of patches used was significantly reduced over the four weeks (p=0.001). No side-effects related to the lidocaine patch were noted. Conclusion: The 5% lidocaine patch demonstrated good tolerability with a minimal risk of systemic adverse drug reactions and is an effective modality for relieving moderate to severe pain. It is concluded that the 5% lidocaine patch is very effective in the treatment of PHN.

Prevalence of Post-traumatic Stress Disorder Symptoms among Road Traffic Accident Victims: A Cross-sectional Study from Gujarat, India

Hetal Jitendrabhai Shah, Sapna Patel, Sandeep Patel
Introduction: Road Traffic Accidents (RTAs) can develop Post-Traumatic Stress Disorder (PTSD) due to emotional trauma, which significantly affects the quality of life. Despite satisfactory psychological recovery for many RTA victims, a notable percentage of survivors continue to live with PTSD without diagnosis or treatment. In India, the rising number of RTAs necessitates research into their psychological impacts to inform healthcare strategies and interventions. Aim: To assess the prevalence of PTSD symptoms among RTA survivors and explore the association between PTSD and socio-demographic and clinical variables.Materials and Methods: A cross-sectional descriptive study was conducted and data was collected from selected trauma centres in Gujarat state, India, from April to May 2024. The study involved 380 participants who had experienced RTAs within 30-40 days prior to data collection. Data collection employed an interviewer-administered questionnaire with two sections: a demographic and clinical questionnaire and the PTSD Checklist (PCL-5) for PTSD symptom assessment. The PCL-5 is a 20-item tool, with scores ranging from 0 to 80, where a score of ≥33 indicates PTSD symptoms. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0, employing descriptive statistics, Chi-square tests, and Confidence Intervals (CI) to determine the significance of associations at a p-value<0.05 level. Results: The prevalence of PTSD symptoms among RTA survivors was 46.3%, with a mean±SD PTSD score of 29.41±10.68. The highest rates of PTSD were observed among younger individuals {18-25 years, 55 (52.4%)} and females 43 (47.3%). Education (p-value=0.027) and monthly income (p-value=0.011) were significantly associated with higher PTSD prevalence. Among clinical variables, the type of vehicle involved in the accident was associated with PTSD prevalence (p-value=0.012). Conclusion: The prevalence of PTSD symptoms among RTA survivors was 46.3%. Lower education levels, lower income, and involvement in two or three-wheeler accidents were significantly associated with a higher prevalence of PTSD.

Images in Medicine Representing the Management of Mesiodens in Different Dentitions

Simron Baishya, Aishwarya V Antala, Anshula Deshpande, Seema Bargale

Assessing the Process of Written Informed Consent for Surgical Procedures among Inpatients: A Cross-sectional Study from a Tertiary Care Teaching Hospital in Southern India

PV Dinesh, Imaad Mohammed Ismail, Kahkashan Azeez
Introduction: Informed Consent (IC) is a decision-making process wherein patients are provided with all necessary information regarding treatment to make an uncoerced, educated choice. There are gaps in the implementation of the IC process that need to be identified and addressed. Aim: To estimate the proportion of patients/surrogates who read, understood, and signed the IC form before undergoing surgical procedures; to identify the different healthcare team members involved in explaining the IC form; to evaluate the extent to which different components of the IC form were explained to patients/surrogates; and to determine the influence of the IC form on surgical decision-making, and the overall satisfaction with the IC process. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in the Dakshina Kannada District of Southern India from April 2020 to March 2021. It included 100 adult patients admitted to the postsurgical wards of general surgery, orthopaedics, obstetrics and gynaecology, otorhinolaryngology, and ophthalmology. Ethical clearance was obtained from the Institutional Ethics Committee. The parameters studied included socio-demographic variables, administration of the IC form, details on the person explaining the IC form along with its content, and the influence of the IC form on decision-making, as well as overall satisfaction with the IC process. Data were collected using a predesigned questionnaire and analysed using descriptive statistics in Statistical Package for the Social Sciences (SPSS) version 27.0. Categorical variables were presented as frequencies and proportions, whereas continuous variables were presented as means and standard deviations. Results: All participants received the IC form; however, only 21% read, understood, and signed it. The explanation of the IC form was given to 59% of the patients, with only 15% of these explanations provided by the treating surgeon. The components of the IC form, such as the surgical procedure and its benefits, were explained to the majority of the patients; however, the risks of the surgical procedure and alternative options were explained to only 53% and 7% of patients, respectively. The IC form had a minor influence on surgical decision-making for 61% of patients, and 43% expressed satisfaction with the IC process. Conclusion: The study revealed that the implementation of IC was inadequate. Surgeons should provide and explain the IC form well in advance, allowing time for patients to read, understand, and clarify their doubts. Hospital Ethics Committees need to enforce strict adherence to IC guidelines to ensure informed decision-making.b

Prevalence and Antifungal Susceptibility of Candida Infections in Patients with Pulmonary Tuberculosis: A Cross-sectional Study from the Union Territory of Puducherry, India
Introduction: Pulmonary Tuberculosis (TB) is a bacterial infectious disease caused by Mycobacterium tuberculosis. Candida albicans is the most commonly isolated fungal pathogen in bronchopulmonary patients. Invasive candidiasis due to Candida species has been on the rise in recent years. However, drug sensitivity studies of C. albicans isolated from TB patients are not routinely conducted in India and other developing countries. Aim: To isolate and identify Candida albicans from patients with TB and to determine its antifungal susceptibility. Materials and Methods: This cross-sectional study was conducted on 129 patients suspected of having pulmonary TB, analysed from August 2016 to January 2018 at the Department of Chest Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India. Sputum samples were collected and processed to identify Candida species through Gram staining, Ziehl-Neelsen staining, germ tube formation, and sugar fermentation. Antifungal resistance testing was performed using the disk diffusion method recommended by the Clinical and Laboratory Standards Institute (CLSI). The collected data were subsequently analysed using descriptive statistics and the Chi-square test to evaluate the results. Results: Candida infection was observed in 10 (7.75%) out of 129 patients with pulmonary TB. Among patients with co-infection, C. albicans was the most common, accounting for 4 (40%) cases, followed by C. krusei with 2 (20%) cases, C. tropicalis with 1 (10%) case, C. kefyr with 1 (10%) case, C. glabrata with 1 (10%) case, and C. parapsilosis with 1 (10%) case. Among the azole category, itraconazole and amphotericin B exhibited the highest sensitivity percentages against Candida. Conclusion: The current study revealed a high prevalence of co-infection between pulmonary TB and Candida spp., which may contribute to the symptoms of pulmonary lung disorders. The prevalence of Candida species could also be associated with an inadequate response to antitubercular drugs. Amphotericin B and itraconazole, two commonly used drugs in the community, are often employed as the preferred treatments for fungal infections. Early detection and treatment of this opportunistic candidiasis in patients with pulmonary TB will likely enhance outcomes for such individuals.

Association of XmnI Polymorphism with Foetal Haemoglobin Level and Severity of Thalassaemia in Children: A Cross-sectional Study
Introduction: The North-eastern Region of India has been a rich reservoir of haemoglobinopathies and thalassaemias. Genetic modifiers, commonly known as ameliorating factors, like co-inheritance of ?-thalassaemia, excess ? genes, the presence of the XmnI G? polymorphism and BCL11 Single Nucleotide Polymorphisms (SNPs), influence the reduction of the severity of Beta-thalassaemia. Early genetic diagnosis can aid in predicting a better prognosis and lower morbidity in thalassaemic children. Aim: To find out the XmnI polymorphism among thalassaemic children admitted to the Paediatric Department for regular blood transfusions and to assess the relationship between XmnI polymorphism, disease severity and foetal haemoglobin levels. Materials and Methods: This hospital-based cross-sectional study was done from June 2020 to May 2021 in the Department of Paediatrics and Anatomy at Assam Medical College and Hospital, Dibrugarh, Assam, India. A total of 96 thalassaemic children presenting to the thalassaemia daycare centre of the Paediatrics Department for repeated blood transfusions were included. Data collected from history and examination findings were recorded and the presence of XmnI polymorphism in their blood was tested using the Polymerase Chain Reaction-Restriction Fragment-length Polymorphism (PCR-RFLP) method. The association of XmnI polymorphism with disease severity and foetal haemoglobin levels was analysed using the Chi-square test, with a p-value of <0.05 considered significant. Results: The mean age of the children was 10.1±4.4 years (range: 2 to 18 years), with a male-to-female ratio of 0.95:1. Among the participants, 59 (61.46%) had Haemoglobin (Hb) E-? thalassaemia and 37 (38.54%) had ? thalassaemia homozygous type. A total of 47 (48.96%) children exhibited the presence of XmnI polymorphism, of which 16 (34%) had ?-thalassaemia homozygous and 31 (66%) had Hb E-? thalassaemia. A significant association was found between this polymorphism and disease severity (p<0.001), but no significant association was observed with HbF levels (p=0.089). XmnI polymorphism was associated with hepatomegaly and stunting. Conclusion: The present study demonstrated that the presence of XmnI polymorphism in thalassaemic children was associated with decreased disease severity, as these children presented at a later age and required fewer blood transfusions than those without this polymorphism. No association was found between XmnI polymorphism and HbF levels in the present study.

Pharmaceutical Challenges for Drug-Related Problems in Neonatal Intensive Care Un

Vaibhava Upadhyay, Bhaskar Jyoti Borah, Rajveer Singh Yadav
Introduction: Neonates are very sensitive and vulnerable individuals. They require multiple medications during their stay in the Neonatal Intensive Care Unit (NICU), which can lead to pharmacological errors and Drug-related Problems (DRPs), like drug-drug interactions and adverse drug effects. Aim: To assess DRPs in the NICU to improve the quality of pharmaceutical care. Materials and Methods: This prospective observational study was conducted from June 2023 to August 2023 in a tertiary-level, well-equipped NICU at JNU Hospital, Jaipur, Rajasthan, India. All 61 neonates admitted to the NICU were included, except for those who were admitted for less than 24 hours and had not been prescribed any medications. All DRPs were documented using the Pharmaceutical Care Network Europe (PCNE V9.1). The problems related to DRPs, their causes, planned interventions, acceptance of interventions, and outcomes were assessed. The final analysis was conducted with the Statistical Package for Social Sciences (SPSS) software version 25.0. A p-value <0.05 was considered statistically significant. Results: A total of 61 newborns were enrolled, of which 34 (55.74%) were males. DRPs were present in 47 (77.05%) of the total 61 patients. The total number of DRPs identified was 98. The most common problems were ‘unnecessary drug treatment’ 63 (64.29%) cases and ‘effect of drug treatment not optimal’ 28 (28.57%) cases. The most common cause of DRPs was ‘dose selection’ 105 (62.87%) cases. The intervention was accepted in 96 (97.96%) of the DRPs, and the problem was totally resolved in 70.41% of the cases. However, the problem remained unsolved in 17.35% of DRPs, primarily due to the ‘lack of cooperation from the prescriber’ in 9.18% of cases. Conclusion: Unnecessary and ineffective treatments, along with inappropriate doses, are the major problems and causes of DRPs. The need for clinical pharmacologists in NICUs, along with planned interventions and their acceptance, could help address these issues and ultimately lead to improved quality of care.

Aetiology, Risk factors, and Outcome of Central Line-associated Bloodstream Infections in Respiratory ICU Patients at a Tertiary Care Centre, Cuttack, Odisha, India: A Prospective Cohort Study
Introduction: Central Venous Catheters (CVCs) are used for monitoring and managing critically-ill patients. However, their use can lead to serious infectious complications, resulting in significant morbidity, additional medical costs and mortality. Aim: To analyse the causative pathogens and the associated risk factors involved in the causation of central line-related infections and their outcomes. Materials and Methods: This prospective cohort study was conducted among 66 patients admitted to the 10-bed Respiratory Intensive Care Unit (RICU) at the Department of Pulmonary Medicine, SCB Medical College and Hospital, a tertiary-care teaching hospital in Cuttack, Odisha, India, from March 2021 to October 2022, who required central line placement for 48 hours or more. These patients were followed daily and upon the development of new-onset sepsis after 48 hours, two blood samples were collected from both central and peripheral sites for culture and antibiotic susceptibility testing, after excluding other sources of infections. Results: The mean age of patients with CLABSI was 62.85±14.95 years, with the most commonly affected age group being 55-74 years. Total of 66 patients had CVCs in place for more than 48 hours, resulting in 664 catheter days. The overall rate of Central Line Associated Bloodstream Infection (CLABSI) was 30.12 per 1,000 catheter days. The risk factors significantly associated with the development of CLABSI were diabetes mellitus, duration of hospitalisation, APACHE score, length of ICU stay and days of catheter in-situ. However, multivariate analysis revealed that only the length of Intensive Care Unit (ICU) stay (p=0.003) and the presence of diabetes (p=0.012) were independent predictors of acquiring CLABSI. The most common pathogens isolated were Acinetobacter (30%), followed by Enterococcus (25%), Staphylococcus aureus (20%), Methicillin-resistant Staphylococcus Aureus (MRSA) (10%), Pseudomonas (10%) and Coagulase-Negative Staphylococcus (CoNS) (5%). All Gram-positive and Gram-negative pathogens showed 100% sensitivity to linezolid, teicoplanin, vancomycin and polymyxin B, as well as tigecycline, respectively. The remaining strains were Multidrug Resistant (MDR). The overall mortality rate was 66.7%, with CLABSI-associated mortality at 60%. Conclusion: The incidence of CLABSI was high, with significant risk factors significantly associated were prolonged duration of catheterisation, length of hospital and ICU stays, Acute Physiology and Chronic Health Evaluation (APACHE) II score and diabetes mellitus. Gram-positive bacteria predominated, followed by Gram-negative bacteria, with a significant proportion of MDR organisms.

Morphometric Analysis of Coronary Arteries: An Autopsy Study from a Tertiary Hospital at Kolar, Karnataka, India

Nikhil Chaudhary, Kalyani Raju, Srinivas YP Reddy
Introduction: The incidence and prevalence of Coronary Artery Disease (CAD) are rising worldwide, particularly in India. CAD can be asymptomatic in the general population. Aim: To analyse the significance of morphometric measurements of the coronary arteries in autopsy cases of unnatural deaths. Materials and Methods: This was a retrospective cross-sectional autopsy study conducted from January to December 2020 in the Department of Pathology in collaboration with the Department of Forensic Medicine at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Cases of deaths due to unnatural causes were considered. Morphometric parameters such as Luminal Area (LA), Internal Elastic Lamina Area (IELA), External Elastic Lamina Area (EELA), width of the intima at maximal thickness, width of the media at maximal thickness, intimal area, medial area, percentage of luminal narrowing, Intimal Thickness Index (ITI), and Intima to Media Ratio (IMR) were estimated using a Zeiss microscope on Verhoeff-Van-Gieson (VVG) stained tissue sections and analysed with ZEN software. All data were entered into a Microsoft Excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A total of 80 autopsy cases were considered for the current research, of which 62 were males and 18 were females. The mean age of the cases was 37.6 years. Two cases (11.1%) among females and nine cases (14.5%) among males had asymptomatic atherosclerotic lesions in their coronary arteries. With increasing age, the percentage of asymptomatic atherosclerotic cases also increased. The p-values for the width of the intima at maximal intimal thickness and IMR were 0.005 and 0.027, respectively, between the non atherosclerotic and atherosclerotic groups. Conclusion: The morphometric parameters, such as the width of the intima at maximal intimal thickness and IMR, predict the presence of atherosclerotic lesions/CAD in the asymptomatic general population. This information can be used to implement preventive measures and inform health policy by the medical community.

Multilocus Sequence Analysis of Aspergillus Species from Clinical Samples and the Surge of Cryptic Aspergillosis in Southern India: A Descriptive Cross-sectional Study
Introduction: Aspergillus species cause a broad range of infections, from Allergic Bronchopulmonary Aspergillosis (ABPA) to invasive aspergillosis. Accurate species-level identification is crucial for diagnosis and treatment, especially since some rare Aspergillus species exhibit increased resistance to common antifungal agents. Aim: To identify Aspergillus species at the species complex level and determine the emergence of cryptic Aspergillus species using Multilocus Sequence Analysis (MLSA). Materials and Methods: This descriptive cross-sectional study was conducted over eight months, from January 2023 to August 2023, in three tertiary care centres in Chennai, India. Sixty Aspergillus strains were isolated from various clinical samples. The primary inclusion criteria were patients with suspected aspergillosis, categorised based on the European Organszation for Research and Treatment of Cancer Mycoses Study Group (EORTC-MSG) criteria. Isolates were grown on Oatmeal Agar or Sabouraud Dextrose Agar (SDA) and phenotypically identified using tease mount and slide culture techniques. Genomic fungal Deoxyribonucleic acid (DNA) was extracted and amplified using specific primers for Internal transcribed spacer (ITS), beta-tubulin, hydrophobin, and calmodulin genes, followed by nucleic acid sequencing. Results: Among the 60 Aspergillus isolates, the Aspergillus flavus complex comprised 26 (43.3%), the Aspergillus fumigatus complex 16 (26.7%), the Aspergillus niger complex 12 (20%), and the Aspergillus terreus complex 6 (10%). Initial speciation relied on microscopic and cultural characteristics. Isolates were recovered from various clinical specimens: bronchial wash 6 (10%), Bronchoalveolar lavage (BAL) fluid 10 (16.7%), sputum 3 (5%), ear swab 20 (33.3%), endotracheal aspirate 8 (13.3%), pus and tissue from the nasal cavity and paranasal sinus 11 (18.3%), and tissue from other sites 2 (3.3%). MLSA identified common species such as A. flavus, A. fumigatus, A. terreus, and A. niger, as well as rare species including A. awamori, A. carneus, A. lentulus, A. oryzae, A. tamarii, A. tubingensis, and A. welwitschiae. Sequence identity ranged from 99% to 100%, confirming species diversity. Phylogenetic analysis using ITS, beta-tubulin, hydrophobin, and calmodulin genes supported species identification with robust bootstrap support (1000 replications). Conclusion: Cryptic Aspergillus species are prevalent in clinical samples from the South Indian population, with a notable presence from the section Nigri and the first-time isolation of Aspergillus carneus in clinical samples from India. Molecular identification is essential for determining the invasive potential and guiding appropriate antifungal therapy.

Efficacy of Vasantik Vaman Karma (Therapeutic Emesis) on Oxidative Stress Markers in Healthy Volunteers- A Pilot Randomised Controlled Study

Pradnya D Dandekar, Vaishali Kuchewar
Introduction: Vamana karma is a therapeutic emesis procedure recommended for maintaining health in healthy individuals. It is said to be conducted during the Vasant rutu (spring season) and is referred to as Vasantik Vaman. During this season, there is an aggravation of Kapha dosha, which can lead to various diseases. The bio-purification of the body in Vasant rutu through the Vaman procedure helps to detoxify and rejuvenate the body. To make this practice evidence-based, the present study was planned to evaluate the efficacy of Vamana karma, which is also considered a shodhana karma, in reducing oxidative stress. Aim: To compare the efficacy of Vasantik Vamana karma on Malondialdehyde (MDA) and Superoxide Dismutase (SOD) levels as markers of oxidative stress in healthy volunteers, compared to a non interventional group. Materials and Methods: The present randomised controlled study was conducted in the Department of Kriyasharir, Mahatma Gandhi Ayurved College, Hospital and Research Centre, under the auspices of Datta Meghe Institute of Higher Education University, Wardha, Maharashtra, India, from March 2023 to April 2023 during the Vasant rutu. A total of 58 healthy individuals aged between 20 years and 40 years were sensitised regarding the procedure and benefits of Vasantik Vamana karma. After sensitisation, 30 volunteers who provided written consent for participation in the study were enrolled, examined and randomly divided into two groups: Group A (non interventional) and Group B (interventional). Both groups were assessed on the 0th day and the 15th day for oxidative stress markers, specifically free radicals (MDA) and antioxidant (SOD) levels. Statistical analysis was done using descriptive and inferential statistics, including Student’s paired and unpaired t-tests. Results: The mean±Standard Deviation (SD) age of participants was 21.23±0.37 years, with participation almost equal from both genders. Before the intervention, SOD and MDA levels were similar in both the control and interventional groups. After the intervention of Vasantik Vamana karma, Group B showed an increase in SOD levels and a decrease in MDA levels, which were statistically highly significant according to the paired t-test (p-value≤0.001) in comparison to the non interventional group. In the non interventional group, p-value=0.951 for SOD levels and 0.551 for MDA levels by paired t-test, which were not significant. When both groups were compared using an unpaired test, at pre-intervention, both groups were at the same level, but after the intervention, statistically significant results were observed in Group B (p-value≤0.001). Conclusion: The present study concluded that Vasantik Vamana karma, as a bio-purification process, Vasantik Vamana karma has proven to be highly effective in detoxifying the body by reducing oxidative stress in healthy volunteers.

Morphometric and Morphological Study of the First Rib in the Population of Rajasthan, India: A Cross-sectional Study

Savita Yadav, Abhilasha Dadhich, Vijay Laxmi Sharma, Sunny Yadav, Sanjana Bansal
Introduction: The first rib is the shortest, most curved and atypical of all ribs. An angle is visible between the head and the tubercle at the inferior portion of the neck, which can indicate the sex of the individual when viewed in a non anatomical position. Aim: To determine the morphometric and morphological variations of the first rib in the population of Rajasthan. Materials and Methods: This cross-sectional study was conducted in the Anatomy Department of SMS Medical College, Jaipur, Rajasthan, India, from January 2023 to April 2024. A total of 90 adult human dry first ribs (45 right and 45 left) of unknown age and sex were studied. Intact right and left ribs were included, while damaged first ribs were excluded. Data were collected using a Vernier calliper and thread to measure length, height, angle, external length, internal length, shortest external length and shortest internal length. Morphological variations, such as the scalene tubercle and vascular groove, were observed. Independent samples t-tests were used to compare means between the right and left-sides and correlation analysis assessed relationships between angular orientation and anatomical dimensions. The statistical analysis was performed using Microsoft Excel 2020 and IBM Statistical Package of Social Sciences (SPSS) version 23.0. Results: The descriptive statistics for the measured variables are as follows: the mean height and length on the right-side were 6.99±3.45 cm and 26.69±2.41 cm, respectively, while on the left-side they were 7.35±2.55 cm and 26.10±2.80 cm, respectively. The angle was greater on the left-side (16.59±6.18º). Statistical analysis indicated non significant differences between all the variables of the right and left-sides (p-value >0.05), except for strong positive correlations between angle and height (Right: r-value=0.986, p-value=0.001; Left: r-value= 0.952, p-value=0.001). Conclusion: The morphometric parameters of the first rib indicate non significant differences between the right and left-sides. The strong positive correlations between angle and height have clinical significance, as they can assist in forensic and anatomical studies related to intervertical dimensions and anatomical alignment based on the angular orientation of the first rib.

Histomorphological Patterns of Skin Adnexal Tumours in a Tertiary Care Centre, Chhattisgarh, India: A Cross-sectional Study

Rabia Parveen Siddiqui, Vanita Adile, Sangam Lal Swain, Ruchi Varma
Introduction: Histologically, tumours of the epidermal appendages have been classified into four groups that exhibit histologic features analogous to hair follicles, sebaceous glands, apocrine glands, and eccrine glands. Aim: To investigate the histomorphological spectrum and distribution of Skin Adnexal Tumours (SATs). Materials and Methods: This observational descriptive cross-sectional study was conducted over a period of five years, from August 2017 to July 2022, in the Department of Pathology at Pt. JNMMC Raipur, Chhattisgarh, India. All histologically diagnosed cases of SATs in the pathology department during this period were included, along with relevant data such as age, sex, anatomical location of tumours, and clinical diagnosis. Results were presented in the form of frequency distribution in terms of numbers and percentages. Results: Out of a total of 51 SATs, the male-to-female ratio was 1:1.3, indicating a female preponderance. The highest number of cases was observed in the age group of 41-60 years, comprising 17 cases (33.3%). Benign tumours accounted for 35 cases (68.63%), while malignant tumours comprised 16 cases (31.37%). Tumours associated with hair follicles were the most common, with 25 cases (49.02%). The head and neck region was the most common site for SATs, comprising 30 cases (58.82%). Pilomatrixoma was the most common benign SAT, constituting 13 cases (25.49%). Among malignant SATs, sebaceous carcinoma was the most prevalent, comprising seven cases (13.73%). Conclusion: SATs present a diagnostic challenge for both clinicians and pathologists due to their diverse clinical presentations and overlapping histopathological features. While most SATs are benign, their malignant counterparts, although rare, have an aggressive course with metastatic potential and poor outcomes. Therefore, early detection of malignant SATs is crucial. Present study emphasised that histopathological examination is the gold standard for establishing early diagnosis and enabling appropriate therapeutic intervention.

Comparison of Image Quality and Radiation Dose between Filtered Back Projection and Sinogram Affirmed Iterative Reconstruction in CT Head: A Cross-sectional Study

Kanchan Maggo, Rohini Ghasi Gupta
Introduction: Computed Tomography (CT) scans account for only 15% of total diagnostic procedures but for over half of the collective dose of radiation. The increasing awareness about the harmful effects of radiation has also created a need for developing techniques that decrease radiation exposure while at the same time providing a reasonably good image quality. The majority of the CT units today use Filtered Back Projection (FBP) as the means of image reconstruction. However, FBP leads to coupling between image noise and radiation exposure and limits the dose reduction possible while providing diagnostic quality images. Second-generation Iterative Reconstruction (IR) techniques have caught the attention of medical researchers because they provide a superior image quality than FBP at the same radiation dose showing potential for dose reduction. Aim: To compare the image quality and radiation dose in standard dose CT head reconstructed with FBP and low dose CT head reconstructed with Sinogram Affirmed Iterative Reconstruction (SAFIRE) and FBP both. Materials and Methods: A cross-sectional analytical study was conducted on 100 patients in the emergency department of Vardhman Mahavir Medical College and Safdarjung Hospital in India from November 2018 to April 2020. Patients referred for emergency Non-contrast Computed Tomography (NCCT) head for any indication excluding post-op cases and those with metallic artifacts were included. Fifty patients chosen using systematic random sampling underwent low-dose CT head using the Care Dose 4D Automatic Exposure Control (AEC) system with reconstruction using SAFIRE (Group-A) and FBP (Group-B). Another 50 patients who were within five years of the corresponding Group-A and B patients underwent standard dose head CT reconstruction using FBP (Group-C). CTDI vol, DLP, and effective dose were recorded in all patients. Image quality was assessed objectively using the unpaired t-test for Group-A and C and paired t-test for Group-A and B. Subjective image analysis between the groups was done using a 4-point Likert scale. Results: Image quality parameters were found to be better in Group-A compared to Group-C (p<0.05). The mean values in low dose SAFIRE group, low dose FBP group, and standard dose FBP group were as follows: Grey Matter (GM) Signal-to-Noise Ratio (SNR) (14±3.29, 8.96±2 and 9.24±1.96), White Matter (WM) SNR (14.6 ±3.73, 6.9±3.79 and 7.11±1.68), Cerebrospinal Fluid (CSF) SNR (1.65±1.12, 0.86±0.80 and 1.08±0.61) and Contrast-to-Noise Ratio (CNR) (3.06±0.94, 1.81±0.69 and 1.74±0.69), respectively. Group-A had significantly improved image quality parameters than Group-B and Group-C. Radiation dose reduction of 42%, 39.34%, and 42.5% was achieved in CTDIvol, DLP, and effective dose respectively in low dose group. Conclusion: Low dose CT head reconstructed with SAFIRE were significantly better in image quality compared to standard-dose CT head images reconstructed using FBP, while allowing for up to 42% reduction in dose.

Effect of Isometric and Dynamic Resistance Exercises on Functional Performance and Glycoprotein-bound Haemoglobin of Type 2 Diabetes Mellitus Patients with Knee Osteoarthritis: An Interventional Study

N Divya, V Manoj Kumar, Alex Sabu, TE Winnie, P Praveena Shri
Introduction: Osteoarthritis (OA) is the most prevalent articular and rheumatologic condition, impacting over 80% of individuals aged 55 and above. There exists a significant correlation between Type 2 Diabetes Mellitus (T2DM) and OA. Both Diabetes Mellitus (DM) and OA are common afflictions. Physiotherapy plays a crucial role in alleviating pain and mitigating issues linked to the early stages of knee OA and DM. The rationale of this study is to determine whether isometric resistance exercise can achieve comparable or superior outcomes to dynamic resistance exercise in terms of long-term glycaemic control and physical function, while also being more tolerable for individuals with knee OA. Aim: To compare the efficacy of resistance exercises in diabetic patients with knee OA and specifically to examine how two resistance exercise protocols influence glycated haemoglobin (HbA1c) levels and functional performance. Materials and Methods: An interventional study was conducted using a convenience sampling technique. Approximately, 30 subjects were selected from the primary physiotherapy outpatient department in Chennai, Tamil Nadu, India. The study lasted for 12 weeks, from July 2022 to September 2022. The total population was split into two groups: Group-A received dynamic resistance exercises, whereas Group-B underwent isometric resistance exercises. Both pre- and post-treatment evaluations were performed using the Western Ontario and McMaster Universities OA Index questionnaire (WOMAC), alongside measuring HbA1c levels in all participants. Care instructions emphasised weight reduction, maintaining a balanced diet, and avoiding prolonged periods of standing. Paired t test was used to compare the pre and post test WOMAC scores and p<0.05 was considered statistically significant. Results: Significant changes were observed in WOMAC scores and HbA1c pre-post comparison. The study revealed a statistically significant difference in reducing pain, enhancing functional performance, and lowering HbA1c levels among both groups (p≤0.001). Conclusion: The results indicate that both groups experienced effective pain relief and reduced HbA1c levels after the treatment period. However, subjects treated with dynamic resistance exercises demonstrated greater enhancements in functional performance and reductions in HbA1c levels compared to the isometric resistance exercises.

Histopathological Spectrum of Liver Allograft Biopsies and Association with Clinical and Pathological Parameters in Transplant Patients: A Cross-sectional Study

Megha Bansal, Pushpa Mahadevan, Abhishek Yadav
Introduction: Transplantation is vital for acute and terminal irreversible liver conditions. While imaging and functional measurements are valuable for evaluating post-transplant hepatocellular or biliary issues, liver allograft biopsies are used to determine the underlying causes of these changes. Long-term Immunosuppression (IMS), complex clinical circumstances, and de novo complications present challenges in transplant pathology, necessitating a multidisciplinary approach. Aim: To conduct a histopathological assessment of allograft liver biopsies for differential diagnosis, timing (postoperative day), and prevalence of post-transplantation complications, including identifying the causes of graft damage. Materials and Methods: This retrospective cross-sectional study was conducted between January 2019 and June 2022 at Vayalil Parambath Shamsheer (VPS) Lakeshore Hospital, Kochi, Kerala, India. A total of 45 post-transplant needle biopsy samples were analysed, examining histological characteristics and clinical data extracted from hospital records. Over 3.5 years, 45 post-liver transplant biopsies were performed. All clinical records and biopsy findings were examined using staining, and immunohistochemical analysis was performed. The Banff Working Group’s criteria were used to grade rejection based on a semiquantitative index, the Rejection Activity Index (RAI), into indeterminate (Score 1, 2); mild (Score 3, 4); moderate (Score 5, 6); and severe (>6). The classic histologic findings are characterised by predominant portal-based lesions, including a classical triad of mixed inflammatory cell infiltrates, venous endothelial inflammation, and inflammatory infiltration of bile ducts. Results: Among 38 patients, a total of 45 needle biopsies were performed. The first specimen was collected within a few hours of transplantation, and the final specimen was collected after 770 days. Notably, T-Cell-Mediated Rejection (TCMR) was diagnosed in 9 out of 45 (20.00%) specimens. Other complications included Intrahepatic Cholestasis (IHC) in 11 out of 45 (24.44%) cases, biliary obstruction in 5 out of 45 (11.11%) patients, Herpes Simplex Virus (HSV) hepatitis in 3 out of 45 (6.67%) specimens, Plasma Cell-Rich Rejection (PCRR) in 2 out of 45 (4.44%), and Isolated Central Perivenulitis (ICP), Dengue Haemorrhagic Fever (DHF), and veno-occlusive-like disease in 2 out of 45 (4.44% each) specimens. One patient had ethanol-induced liver injury (1 out of 45, 2.22%). Conclusion: Post-transplant liver biopsies are essential for accurate and timely diagnosis of rejection and other complications, guiding therapeutic interventions. This study offers insights into the types, prevalence, and timing of critical complications following liver transplantation (LTx).

Comparison of the Mini-plate and Mini-screw for Retraction of Anterior Teeth in Severe Bimaxillary Protrusion Cases with Extraction of First Bicuspids: A Protocol for Randomised Controlled Trial

Aditya Vikram Pareek, Pallavi Daigavane, Ranjit Kamble
Introduction: Orthodontic treatment of severe Bi-maxillary protrusion cases involves extractions of all four premolars to provide space for anterior teeth retraction. Over the years different methods of retraction have been developed for individual tooth retraction and en-masse anterior teeth retraction utilising different types of mechanics for retraction purposes. Anchorage consideration has been a problem because of anchor loss, but it has been overcome by utilising absolute anchorage with Temporary Anchorage Devices (TAD). Need for the study: The TAD devices mini plates and mini-screw have been Known for providing absolute anchorage for retraction purposes but there has been limited evidence to prove which TAD device is better in terms of time taken for retraction and external root resorption. Therefore, the present clinical study aims to determine the superior treatment method using the two devices based on duration in terms of time taken and amount of retraction achieved in the specified time. Aim: Evaluation and comparison of the effectiveness of mini-plate and mini-screw for retraction of anterior teeth in severe bimaxillary protrusion cases with extraction of Ist bicuspids. Materials and Methods: A split-mouth randomised controlled trial will be carried out in the Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, from October 2024 to March 2026 with a total of 11 subjects. The sample will be selected from the Outpatient Department based on the study’s inclusion and exclusion criteria. Informed written consent will be gathered from all participants. The patient sample will be divided into two groups: Group-A: will receive a mini screw (control group) and Group-B: will receive a mini-plate (experimental group). The statistical analysis for comparing the en-mass rate of retraction of anterior teeth (mm) in the allocated groups will be done using the Mann-Whitney test, and student’s t-test, with the significance level set at 5%.

Comparison of Dentine Graft and Platelet Rich Fibrin in Bony Defects following Extraction of Impacted Mandibular Third Molars: Protocol for a Split-mouth Study

Divya Suvarna Dixit, Bhushan P Mundada, Nitin Bhola
Introduction: Third molar extraction is a common surgical procedure that can have unintended consequences, such as periodontal disease that results in bone loss on the distal part of the second molar. By halting the atrophy of the alveolar ridge, socket and ridge preservation procedures enable restorations that are both functional and aesthetically acceptable. Maintaining the volume of the alveolar socket after tooth extraction is the primary objective of alveolar management, as it prevents substantial resorption and facilitates socket repair. Numerous methods have been reported on socket healing following tooth extractions. Grafting materials may promote healing of the post-extraction socket in three separate ways: osteogenesis, osteoinduction and osteoconduction. Need of the study: This study is necessary because managing bony defects after the extraction of impacted mandibular third molars is critically dependent on successful interventions. Third molars that are impacted often need to be surgically removed, resulting in bony defects that require proper regeneration for the best possible outcome after surgery. An important consideration in this process is the selection of grafting materials. It is imperative to comprehend the relative effectiveness of dentine graft and Platelet-rich Fibrin (PRF) to assist clinicians in deciding the best treatment option. Both PRF and dentine graft have shown promise in fostering bone regeneration; however, to develop evidence-based guidelines for clinical practice, a direct comparison using a rigorous split-mouth study is essential. Aim: To compare and evaluate outcomes of dentine graft against PRF in postoperative impacted mandibular third molar bony defects. Materials and Methods: A prospective randomised split-mouth study will be conducted in the Department of Oral and Maxillofacial Surgery at Sharad Pawar Dental College, DMIHER, Sawangi, Wardha, Maharastra, India from April 2023 to January 2025. After the extraction of the 3rd molar, the patient will be instructed to bite on a sterile swab while waiting for the biomaterials to be ready. Following the examination of the extraction socket, the particulate dentine graft and liquid PRF preparation will be made and then placed in the extraction socket. The patient will then be instructed to use chlorhexidine mouth rinse (0.2%) twice a day in place of mechanical plaque management in the treated region for one week, as part of the postoperative regimen. Postoperative pain, wound healing, bone regeneration, and complications, if any will be assessed at a specified interval. Fisher’s-exact test will be used for statistical analysis, and the level of significance will be set at p<0.05.

Use of Levosimendan in Right Ventricular Dysfunction due to Sepsis and Septic Shock: A Research Protocol

VNK Srinivas Mudiganti, Amol Prakash Singam, Anjalee Chiwhane, Sneha Kakara
Introduction: Sepsis is a clinical condition that results from infection and systemic inflammatory response syndrome, which can progress to severe sepsis and septic shock. This condition leads to myocardial dysfunction and increased mortality rates, particularly in cases of septic shock. Inotropic agents are beneficial in improving cardiac contractility and cardiac output in septic shock. Need for the study: It is important to address myocardial dysfunction in sepsis and septic shock, as these conditions significantly contribute to patient morbidity and mortality. Calcium desensitisation is a key factor in the pathophysiology of septic myocardial depression, leading to impaired cardiac function. Levosimendan, a novel calcium sensitiser, offers a promising therapeutic option due to its unique pharmacologic and biologic profile. By enhancing calcium sensitivity in cardiac myocytes, levosimendan may improve cardiac function without the detrimental side-effects associated with traditional inotropic agents. Aim: The research protocol was planned with an aim to analyse the impact of intravenous levosimendan on Right Ventricular (RV) dysfunction in patients with septic shock. Materials and Methods: This prospective observational study aims to assess the effect of levosimendan on the improvement of RV dysfunction in patients with septic shock who are admitted to the intensive care unit of Acharya Vinoba Bhave Rural Hospital, DMIHER (DU) Sawangi (Meghe), Wardha, Maharashtra, India from July 2023 to March 2025, 45 patients who meet the inclusion criteria will be recruited. Transthoracic Echocardiography (TTE) will be performed using standard measures to calculate RV function. Patients diagnosed with RV dysfunction will be administered levosimendan, followed by a re-evaluation of RV function at designated intervals. Statistical analysis will be conducted using R software, and a paired t-test will be employed to determine significant differences at pre- and post-intervention timelines for the outcome variables of echocardiographic parameters, including Tricuspid Annular Plane Systolic Excursion (TAPSE), EF, RV Fractional Area Change (FAC), and Tricuspid Regurgitant jet Velocity (TRV), at a 5% level of significance.

Comparative Evaluation of Conventional Nasolabial Flap with and without Fishtail Modification in Patients with Oral Submucous Fibrosis: A Research Protocol

Nikhar Shyam Wadhwani, Nitin Dharampal Bhola
Introduction: Oral Submucous Fibrosis (OSMF) is a long-term condition characterised by the gradual buildup of fibrous tissue in the oral cavity, often extending to the throat and upper oesophagus. The primary symptoms include progressive limitation in mouth opening due to the formation of stiff fibrous bands in the oral mucosa, accompanied by muscle atrophy. However, the most concerning aspect of this restriction, known as trismus, is its hindrance to effective cancer monitoring. Surgical approaches typically aim to release these fibrotic bands, while medical interventions focus on managing inflammation and preventing further fibrosis. Need of the Study: A modification of the nasolabial flap has been suggested for the reconstruction of intraoral defects following ablative surgery for OSMF. The study will assess its merits in comparison to the conventional nasolabial flap. Aim: To evaluate and compare the aesthetic and functional outcomes of the rima oris between the Conventional Nasolabial Flap and the Nasolabial Flap with Fishtail Modification in patients undergoing surgical intervention for OSMF. Materials and Methods: A prospective, double-blinded, randomised controlled trial will be conducted in the Department of Oral and Maxillofacial Surgery at Acharya Vinoba Bhave Rural Hospital, associated with Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, from November 2023 to November 2024. Patients older than 18 years of age diagnosed with OSMF, without any superimposing cancerous lesions, will be included in the study. They will be divided into two groups: Group A will be treated with bilateral fibrotomy, coronoidotomy and reconstruction with the conventional nasolabial flap, while Group B will undergo the same surgical intervention, except that the reconstruction will be performed using the fishtail modification of the nasolabial flap. The parameters that will be compared include interincisal mouth opening, intercommissural width, dehiscence and flap necrosis. The analysis will be conducted using the Chi-square test and Fisher’s-exact test for categorical data and the independent t-test for continuous data that follow a normal distribution. These statistical tests will help evaluate the association between different demographic, clinical and etiological factors and the outcomes under consideration. A p-value of <0.05 will be considered statistically significant.

Immediate Effect of Breath Stacking and Buteyko Breathing on Physiological Parameters in post Laparoscopic Cholecystectomy Patients: A Research Protocol of a Randomised Controlled Trial

Deeksha Mehta, Pooja Mehra, Geetanjali Kaul, Nitesh Verma
Introduction: Laparoscopic cholecystectomy is frequently performed in acute, chronic, symptomatic, and asymptomatic cholelithiasis. It is simple, safer, and requires less recovery time than open cholecystectomy, which is why this procedure is increasingly utilised for various abdominal surgeries. Patients may experience postoperative pulmonary problems during the recovery phase and as per available literature there is a noticeable decline in the vital capacity of the patient. It was observed that Buteyko breathing and breath stacking breathing techniques has a good impact on the physiological parameters and vital capacity of patients with hypertension, asthma, Chronic Obstructive Pulmonary Disease (COPD), and other respiratory conditions. Need of the study: Buteyko breathing and breath stacking breathing techniques are effective in different conditions like hypertension, asthma, and cardiac surgery. The need of the study is to compare both techniques and find out which one is more effective and implement that with the standard exercises in the patients to help them improve their quality of life, reduce hospital stay, and improve lung capacity. Aim: To compare the effects of the Breath Stacking Technique (BST) and Buteyko Breathing Technique (BBT) on the physiological parameters of patients undergoing laparoscopic cholecystectomy. Materials and Methods: This will be a randomised controlled trial in which 140 patients will be included using purposive sampling via block randomisation. The study will be conducted in Surgery Intensive Care Unit (SICU) of Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, from December 2023 to May 2024. Patients in Group-A will perform the BBT and Group-B will perform the BST. Each cycle of breathing consists of five repetitions with five sets and 30 seconds of rest in between. Outcome measures will be taken at baseline and after intervention on Postoperative Day 1 (POD). The normality of the data will be checked by Kolmogorov- Smirnov test. A paired t-test will be used if the data is normal, and the Wilcoxon Signed Rank test will be used if the data is non-normal. A p-value < 0.05 will be considered significant.

Efficacy of Cissus Quadrangularis (Hadjod) Used Locally, Systemically and combination of both as an Adjunct to Osteon II and PRF in Class II Furcation Defects: A Protocol for Clinical and Radiographic Study

Khushboo Durge, Priyanka Jaiswal, Anita Wanjari, Unnati Shirbhate
Introduction: When there is significant furcation involvement, mechanical debridement without surgery can cause the disease to progressively worsen. To halt the disease process, surgery allows for odontoplasty, root debridement, osseous recontouring, and periodontal regeneration while preserving periodontal attachment. Need of the Study: In cases of furcation deficiencies, periodontal regeneration with different bone grafts is an effective method to both replace lost bone tissue and slow down the progression of the disease. In osseous abnormalities, the additive actions and features of Cissus Quadrangularis (CQ) demonstrate improved healing. Thus, the purpose of present clinical trial is to determine whether the combination of CQ, when utilised locally and systemically, is efficacious for the management of Class II furcation defects. Aim: To evaluate and compare the efficacy of CQ (Hadjod) used locally, systemically, and in combination as an adjunct to osteon II with Platelet Rich Fibrin (PRF) for the management of Class II furcation defects. Methodology: A randomised clinical trial will be conducted in the Department of Periodontics at Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, Maharashtra, India from April 2024 to March 2026. A total 60 systemically healthy individuals with Class II furcation invasions, either buccal or lingual, and moderate to severe chronic periodontitis will be selected. The study population will be categorised into three interventional groups and one control group as follows: Group A: Control group (n=15) will be treated with osteon II + PRF membrane + antibiotic coverage for Class II furcation defects, Group B: (n=15) will be treated with osteon II + PRF membrane + CQ graft (locally) for Class II furcation defects + antibiotic coverage, Group C: (n=15) will be treated with osteon II + PRF membrane + systemic dosage of CQ for Class II furcation defects + antibiotic coverage, Group D: (n=15) will be treated with osteon II + PRF membrane + CQ graft (locally) + systemic dosage of CQ for Class II furcation defects + antibiotic coverage. The data will be analysed and calculated using the Student’s t-test, with a significance level of less than 0.05.

A Narrative Review on Emergence of Digital Biomarkers as the Future Frontiers in Medical Practice

Jyotsna Needamangalam Balaji, Sreenidhi Prakash, Krishna Mohan Surapaneni
The healthcare landscape has undergone a profound transformation due to digitalisation in recent decades, shifting from manual practices to automated processes. Digital biomarkers have become increasingly important in healthcare across multiple domains for regular monitoring of health parameters, aiding in early disease detection and prevention. The present narrative review aims to explore the utility and advantages of digital biomarkers in healthcare. Notably, the literature emphasises portable biomarkers capable of actively recording user data. These advanced biomarkers efficiently identify physiological, biochemical and psychological parameters, offering predictive capabilities for health conditions and treatment outcomes. In this dynamic healthcare landscape, digital science has brought transformative changes. Investments in digital health show promising outcomes for disease management and patient care. Overall, the integration of digital biomarkers into healthcare represents a significant leap forward in improving healthcare delivery, diagnosis and treatment. It leverages technology to enhance the precision and efficiency of healthcare, ultimately benefiting both healthcare professionals and patients. While the scope of digital biomarkers continues to expand and is expected to grow in the future, addressing potential challenges is essential for sustained innovation in this field.

Strategies for Enhancing Impulse Control among Adolescents: A Narrative Review

Mamta Choudhari (Sahu), Vaishali D Tendolkar, Jaya P Gawai
Adolescent growth depends on impulse control, which impacts wellbeing, social interactions and academic achievement. The purpose of this narrative review is to assess the efficacy of therapeutic and educational initiatives aimed at enhancing impulse control during this crucial developmental phase. The review highlights various successful interventions that can be used to improve impulse control in adolescents. These interventions include self-regulation strategies, serious games, mindfulness practices, cognitive-behavioural approaches and biopsychosocial workshops. To support comprehensive adolescent development, future research should focus on long-term outcomes and the integration of these interventions into broader educational and therapeutic frameworks.

Rethinking Therapeutics: Drug Repurposing in Periodontal Therapy: A Narrative Review

Gauri Jayachandran, Biju Thomas, G Karthika
Drug repositioning investigates new uses for existing drugs, including both approved and discontinued medications. This strategy offers lower failure risks, faster development times and higher success rates while reducing reliance on antibiotics. Current treatments for periodontitis focus on modulating the immune response to combat pathogens. A promising approach involves using pharmaceuticals to reduce inflammation, which is the main cause of bone resorption, and to promote regeneration. Metformin, an antidiabetic drug, can enhance alveolar bone formation. Statins, known for lowering cholesterol levels, possess antimicrobial and anti-infective properties. Bisphosphonates, used to improve bone density, can affect osteoblast and osteoclast morphology and have antibacterial properties. Melatonin, typically used for sleep disorders, is an antioxidant that reduces the expression of proinflammatory cytokines. The present review explores the multifaceted benefits of repurposing these drugs for the management of periodontal disease.

Neurotoxicity of Amyloid Beta and its Association with other Biomarkers in Pathogenesis of Alzheimer’s Disease: A Narrative Review
Amyloid beta (Aβ) deposition in the brain is regarded as an early toxic effect in the aetiopathogenesis of Alzheimer’s Disease (AD). Currently, Aβ is considered a key marker for AD and a promising target for drug development for the future management of debilitating diseases such as AD. However, the pathomechanism of Aβ has not yet been precisely understood in terms of AD patients, specifically regarding the pathological forms of Aβ and how it associates with other biochemical markers to cause dementia. Identifying Aβ as a key hallmark, especially at the earliest stages of the disease, is essential for understanding the progression of AD and its applicability for the development of novel therapeutics aimed at managing cognitive impairment and AD. This review aims to explain the neurotoxicity of Aβ and its correlation with various other biological markers that contribute to the induction of AD and memory deterioration.

Pathogenesis of Odontogenic Tumour via Altered Signalling Pathways: A Comprehensive Review
Odontogenic tumours, derived from the epithelial, ectomesenchymal, and/or mesenchymal elements of the tooth-forming apparatus, constitute a heterogeneous group of lesions that include both benign and malignant neoplasms with metastatic capabilities. Several signalling pathways are involved in odontogenesis, with three major pathways being the Mitogen-Activated Protein Kinase (MAPK), Sonic Hedgehog (SHH), and Wnt signalling pathways. Understanding the biological behaviour of various odontogenic tumours is fundamentally important for determining the overall outcome. This review discusses the pathogenesis of various odontogenic tumours.

A Narrative Review on the Management of Diabesity: The Modern Epidemic

Pooja Garg, Aditya Aggarwal
Diabesity is a contemporary condition in which obesity and diabetes mellitus co-exist, suggesting a pathophysiological cause-and-effect relationship. The global decline in conventional lifestyles and dietary habits is contributing to a sharp rise in the prevalence of diabetes, which is expected to become a major global health concern. Diabesity is a complex phenomenon involving both obesity and impaired glycaemic control. The intricate pathogenesis of this condition, along with the role of antidiabetic medications that can lead to weight gain, complicates its management. Therefore, managing diabesity requires a multidisciplinary approach that includes lifestyle modifications, pharmacotherapy, and surgical intervention. Novel strategies for controlling and preventing diabetes in obese individuals need to be researched and evaluated. This review discusses the pathogenesis and management of diabesity. Due to changes in lifestyle and eating habits, the burden of diabesity is increasing globally. Thus, it is important to understand its pathophysiology and address this public health concern.

Tools and Techniques Used in Psychometric Evaluation of Quality of Life Tool: A Literature Review

Vipin Vageriya, Anil Sharma
The number of standardised tools is increasing day by day, and the demand for the development of novel and standardised tools is very high. One major reason for this demand is that either standardised tools are not available, or existing tools are not capable of measuring outcomes properly due to a lack of reliability and validity in specific settings. It has been noted that many researchers are not aware of the process of tool development, such as how to conduct a literature review, translate standardised tools, perform cross-cultural adaptations, create shortened versions of existing standardised tools, and construct new tools based on specific diseases. The objective of present review paper is to outline various techniques used in the development of tools and the psychometric testing of these tools. It explores the steps and processes needed to develop a valid, appropriate, and reliable tool that can be used by practitioners. It aimed to assist nurses and researchers in developing Quality of Life (QoL) tools based on their clinical settings and experiences. The common steps in the tool development process include in-depth interviews, item pool generation, and reliability checking. The tool must also include various forms of validity, such as face, concurrent, and content validity, for its development. Additionally, construct validity and factor analysis, including principal component analysis, are essential components of the process.

The Role of Lasers in Modern Endodontics: A Narrative Review

Ahmed Altuwalah
Laser technology has emerged as a promising tool in modern endodontics. Its ability to precisely target and interact with dental tissues offers several advantages. Studies have shown that lasers can reduce postoperative pain, eliminate bacteria and improve root canal cleaning. Additionally, lasers facilitate tissue healing and enhance the sealing process. The minimally invasive nature of laser treatment contributes to better patient comfort and overall treatment outcomes. The potential benefits of lasers in endodontic care are clear. However, current research lacks consistency in methodology, which makes direct comparisons challenging. It is essential to establish standardised protocols for laser parameters and study design to fully realise the advantages of laser technology. Further research is needed to explore the best ways to use lasers in various endodontic procedures, especially regarding tissue regeneration and long-term outcomes. Despite these limitations, lasers represent a significant advancement in endodontic care and have the potential to redefine treatment standards.

Bridging Ayurvedic Insights with Modern Medicine Perspectives of Arbuda (Tumour): A Comprehensive Review

Sheetal Asutkar
Ayurveda, the ancient Indian system of medicine, offers a unique perspective on Arbuda, correlating them with the condition known as tumours. According to Ayurveda, Arbuda arise due to the vitiation of the three doshas: Vata (the dosha responsible for movement and cognition), Pitta (the dosha responsible for regulating body temperature and metabolic activities), and Kapha (the dosha responsible for regulating body fluids and maintaining the cohesion of body constituents). This vitiation disrupts the Dhatu Pariposhana, which refers to the body’s metabolic and nutritional balance. The concept of Arbuda, as detailed in classical Ayurvedic texts, describes as progressively enlarging, globular masses that are fixed to deeper structures, usually non suppurative, and occasionally painful. They can occur in any part of the body, involving the Mamsa (muscle) and Rakta (blood) Dhatus due to the disturbance of the tridosha. Factors such as Mithya Ahara (improper diet) and Vihara (lifestyle) contribute to the vitiation of doshas and the subsequent formation of Arbuda. The ancient texts also classify Arbuda into various types, though there is limited evidence linking Ayurveda’s understanding to modern medical concepts of non tumour-forming cancers. However, descriptions of other diseases in Ayurvedic literature bear resemblance to cancer, suggesting that ancient physicians may have recognised the link between shotha (chronic inflammation) and malignant tumours. This review presents the existing literature on Arbuda, aiming to provide a comprehensive understanding of tumours from an Ayurvedic perspective and to offer integrative approaches for their management and eradication.

A Narrative Review on Healing Wisdom: Unveiling the Power of Pathya-Apathya in Wound Recovery

Dhruv Modi, Devyani Dasar, Naveen Singh, Krishna Shinde
Ayurveda’s distinctiveness lies in its use of Ahara-Vihara (dietic and daily regimes) as a therapeutic method. Sixty therapeutic protocols for wound healing have ahara (food) as one of the approach. Wound healing is a multifactorial mechanism where food plays a significant role in terms of micro and macro nutrients. In clinical practice, understanding Pathya Kalpana (conducive practises) is crucial as it considered as half of the treatment, Ardha Chikitsa (Partial Treatment) and it also stabilises digestive and metabolic fires (jataragni and dhatwagni). Prescribing medicines and ignoring a proper lifestyle and diet changes serve no purpose as it only defeats the symptoms of the disease without attending the root causative factors of a disease, as Apathya (non conducive practices) are the major causative factors of pathogenesis. Even a treatment protocol which can hit the bull’s eye would fail, when a patient has inappropriate diet and indulges in improper activities of routine. The knowledge of influence of shadrasa (six tastes) in healing, method of eating, conducive and non conducive foods and regimes given in scriptures, properties and effects of the wholesome foods and its indications is beneficial for establishing a structured treatment protocol. Various types of wounds and different phases of wound healing can be approached by a specifically designed diet and regimes.

Thyrotoxicosis Masquerading as Late Onset Mania: A Case Report on Treatment of Mania in Thyroid Storm

Janani Ravishankar, Madhusudhan Shivappa, Yamasandhi Jeevan
Manic episodes, typically associated with Bipolar Affective Disorder (BPAD), can also arise from medical conditions such as thyrotoxicosis, leading to “secondary” or “organic” mania. Thyrotoxicosis, characterised by excessive thyroid hormone levels, can cause neuropsychiatric symptoms and, in severe cases, result in a thyroid storm. Present case is of a middle-aged male patient without a prior psychiatric history who presented with manic symptoms such as overspending, over familiarity, and agitation, alongside physical signs of thyrotoxicosis, including weight loss and tachycardia. He was diagnosed with a thyroid storm secondary to Graves’ disease. Despite the rarity of the condition and the absence of established guidelines, management prioritised controlling sympathetic overactivity and restoring euthyroid status. Lithium, along with antipsychotics were chosen for their minimal impact on the QTc interval, was utilised to effectively address the manic symptoms. Aggressive medical management targeting both thyroid function and manic symptoms led to significant improvement. This case highlights the critical need to consider medical aetiologies in psychiatric presentations and underscores the importance of early diagnosis and multidisciplinary management to reduce morbidity. Collaborative efforts among medical specialties are essential to address the complexities of such cases.

Comparative Evaluation of Serum Vitamin D and IL-1ß in Patients with Oral Lichen Planus and Healthy Subjects:A Research Protocol

Hrishika Jawaharlal Chhattani, Aarti Panchbhai
Introduction: Oral Lichen Planus (OLP) is a chronic mucocutaneous immune-mediated disease that has been classified as a Potentially Malignant Disorder (PMD). The aetiology of OLP needs further exploration. Research indicates that the immune system plays a pivotal role in the progression of OLP. Need for the study: Vitamin D regulates the suppression of Interferon-Gamma (IFN-?) and Interleukin-1 beta (IL-1?) production within the epithelium and its insufficiency may play a role in the development of OLP. Aim: To evaluate and compare the serum concentrations of IL-1? and Vitamin D in patients affected by OLP and in healthy subjects. Materials and Methods: A case-control study will be conducted in the Department of Oral Medicine and Radiology at Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, located in Maharashtra, India, from August 2024 to August 2026. Patients who present to the Department of Oral Medicine and Radiology and express willingness to participate will be enrolled in the study. Each patient will undergo a comprehensive clinical examination and provide written consent after being informed about the study. A thorough intraoral clinical assessment of the lesions will be conducted. Once a patient is clinically diagnosed with OLP, serum sample collection will be performed. Similarly, healthy subjects who are willing to participate in the study will also undergo sample collection. The median cubital vein will be punctured to obtain 2.5 mL of blood under aseptic conditions. The electrochemiluminescence-binding assay will then be conducted to quantify the total amounts of 25-hydroxy vitamin D and Interleukin-1 beta. After sample collection, patients with OLP will be educated and counseled regarding the treatment of OLP and habit cessation. Statistical analysis will be performed using an unpaired t-test, with a p-value considered significant at a 5% level of significance.