Journal of clinical and diagnostic research

Mucormycosis, Acute Necrotising Pancreatitis and Haemorrhagic Stroke Occuring Simultaneously in an Immunocompetent Male: The Unwarned Apocalypse

Neha Phate, Dhruv Talwar, Sunil Kumar, Sourya Acharya, Samarth Shukla

Mucormycosis or zygomycosis is a life threatening invasive fungal infection, usually seen in patients with alteration of their immune system. It is a lethal and an aggressive fungal infection caused by the fungi of the order Mucorales. The angioinvasive property of mucormycosis can lead to fatal complications such as intracranial bleed. Acute pancreatitis refers to inflammation of the pancreas which presents mainly as acute pain in the abdomen and is a potentially fatal condition. The association of mucormycosis with acute pancreatitis is rare but dangerous. This case report highlights a case of 32-year-old male patient, with no co-morbidities, who was admitted to an rural central Indian hospital with four days of abdominal pain and two days of headache. Patient appeared to be in good health prior to this event. He was ultimately diagnosed with mucormycosis of paranasal sinus with acute pancreatitis. The patient was treated with intravenous antifungals, antibiotics and fluid therapy along with other supportive measures. Patient later developed intracranial bleed five days after admission, and ultimately succumbed on day seven of admission. After an extensive review of literature it was found that this is the first article to report mucormycosis, acute pancreatitis and intracranial bleed all occurring at once in an immunocompetent male.

Tailor-made Pulmonary Rehabilitation Program Aiding Return to Preinfection Fitness in Massive Cavitatory Lung Abscess: A Case Report

Lung abscess is a form of liquefactive necrosis of the lung tissue that causes the formation of cavities (greater than 2 cm) which are filled with necrotic debris and fluid because of microbial infection. Aspiration, which may happen while the patient is not conscious and end in a pus-filled cavity. It is very rare to find out lung abscess with a complicated infection of Streptococcus pneumoniae stereotype 6B. A 42-year-old male patient was referred to a tertiary care hospital with chief complaints of breathlessness of grade II on the Modified Borg Scale, cough with expectoration, and right-sided chest pain. Chest X-ray and High Resolution Computed Tomography (HRCT) High Resolution Computed Tomography (HRCT) scan of the thorax were done and the patient was diagnosed with right lower lobe lung abscess caused by Streptococcus pneumoniae. The patient was managed by bronchoscopy and bronchoalveolar lavage (washing). A complete plan of rehabilitation was designed to meet the patient's objectives, and it was executed and followed for 1 month. The patient showed considerable functional improvement in terms of aerobic capacity, endurance, and exercise tolerance ability. It was concluded that medical care combined with pulmonary rehabilitation, together as a multidisciplinary approach result in improved outcomes related to the quality of life of the patients.

Hereditary Haemorrhagic Telangiectasia of Nasal Mucosa- A Case Report

A Raghvi, K Gowthame, S Rajasekaran, VK Raghavan

Hereditary Haemorrhagic Telangiectasia (HHT) is also known as Osler-Weber-Rendu syndrome is a development disorder of blood vessels. It is characterised by multiple telangiectases and Arteriovenous Malformations (AVMS) that cause direct connections between arteries and veins bypassing intermediate capillaries. The most prominent sites for telangiectasia are the lips, tongue, face, mucosa of the nose, oral cavity, and gastrointestinal tract. Telangiectases can rupture and bleed easily due to their thin walls, narrow tortuous courses, and proximity to the skin’s surface or a mucous membrane. Depending on the organ affected, these symptoms include repeated persistent epistaxis, skin lesions, haemoptysis, gastrointestinal haemorrhage, and stroke. Complications of HHT include bleeding, anaemia, followed by stroke, pulmonary AVM, Transient Ischaemic Attack (TIA), hypovolemic shock due to severe intractable bleed, eventually leading to high output failure. Present case is of a 45-year-old female who presented with complaints of recurrent epistaxis. Diagnostic nasal endoscopy showed multiple telengiectasic spots which were cauterised with trichloroacetic acid. However recurrent episodes of bleed were encountered.

Minimally Invasive Therapy for Smile Correction using Gingivoplasty, Tooth Bleaching and Resin Composite Restorations

A multidisciplinary approach and minimally invasive therapies are essentials to obtain effective results from aesthetic dentistry. Minimally invasive dentistry requires minimal intervention for the placement and replacement of restorations. This paper reports a case of 24-year-old female, who was dissatisfied with her dark and unsatisfactory dental restorations. After the clinical examination, it was proposed to perform a gingivoplasty, tooth bleaching and replacement of the unsatisfactory restorations with resin composite. Initially, the gingivoplasty was performed, which consisted of the following steps- periodontal probing, measurement of new zeniths and marking of bleeding points, internal bevelled incision and removal of the gingival collar with periodontal curettes. After healing period, using the combined technique, in-office bleaching was done with 35% hydrogen peroxide followed by three weeks at-home bleaching with 16% carbamide peroxide. The unsatisfactory restorations were replaced with resin composite according to dental substrate. Sequentially, occlusal adjustment, finishing and polishing with sanding discs and felt discs were performed. The multidisciplinary approach in the execution of the treatment was fundamental for the aesthetic harmonisation of the smile, providing health, well-being of the patient and professional satisfaction.

Out of Site, Out of Mind- A Rare Case of Adrenal Histoplasmosis from a Non Endemic Area

Dhruvi Reddy Sanikommu, Chandni Chandramouli, KS Chenthil, K Bhavani, S Sowmya

There has been a rising trend in the number of histoplasmosis cases reported in the recent years. However, in southern India, the number of cases is relatively less. This report is about a 46-year-old Indian male from Tamil Nadu who presented with decreased appetite, vomiting, and giddiness. In view of persistent hyponatremia and hypotension, a work-up for adrenal insufficiency was done, and serum cortisol was found to be low. Contrast Enhanced Computed Tomography (CECT) showed bilateral adrenal enlargement with peripheral rim enhancement and hypodense areas within. There was a diagnostic dilemma between tubercular and fungal aetiology. Fine Needle Aspiration Cytology (FNAC) of the adrenal gland showed features suggestive of histoplasmosis. The patient was treated with itraconazole along with steroid replacement therapy, leading to marked improvement in his overall condition. In immunocompetent individuals, disseminated histoplasmosis with adrenal gland involvement is a rare occurrence. As an unusual presentation of histoplasmosis, this case adds to the body of literature available from Tamil Nadu, which is a non endemic region for histoplasmosis, with only 15 cases being reported as of 2018.

Bilateral Abducens Nerve Paresis: A Rare Manifestation of Dengue Fever

Dengue fever is endemic in over 100 countries, with the majority of cases reported in the World Health Organization (WHO) regions of the Americas, Southeast Asia and the Western Pacific. Dengue fever is endemic in almost every state in India, and it is the leading cause of hospitalisation. The presentation may vary from being asymptomatic to having mild syndrome. Among other neuro-ophthalmological manifestations, oculomotor neuropathy, optic neuropathy and unilateral abducens nerve palsy has been reported but to the best of authors' knowledge this is the first reported case of dengue virus related type three internuclear Ophthalmoplegia. A 47-year-old male patient presented with complaints of fever on and off for the last 3 days along with speech defects. At admission his blood pressure was 120/86 mmHg, pulse rate was 96 per minute. Oxygen saturation (SpO₂) was 94%. He was thoroughly investigated for various viral and bacterial infections, none of which was detected in Polymerase Chain Reaction (PCR) serum test. Hepatitis B virus surface antigen (HBsAg), antibody against Hepatitis C Virus (anti-HCV), antibody against Human Immunodeficiency Virus type 1/2 (anti-HIV 1/2) were all negative. Anti-dengue virus Immunoglobulin M (IgM) antibody was found to be positive. The patient complained of double vision and on examination diplopia in both lateral gaze with maximum separation of images in right gaze. Due to the wider range of possible presentations, it is imperative to consistently follow-up with all dengue patients to check for any neurological sequalae.

Rowell Syndrome: A True Entity or a Diagnostic Challenge?

S Sivaramakrishnan, K Manoharan, G Sukanya, Richa Jotwani

Lupus Erythematosus (LE) is an inflammatory condition of the connective tissue which manifests in variable forms. Rowell syndrome is a rare entity, with a female preponderance, where there is the presence of both LE and Erythema Multiforme (EM)-like lesions. Such patients are positive for antinuclear, anti-Ro/La and rheumatoid factor. Subcutaneous LE (SCLE) and EM can often share characteristics. The presence of lesions resembling both the conditions can pose a diagnostic difficulty, especially in the absence of complete clarity on the existence of Rowell syndrome. Present case is of a 47-year-old female, who presented with rashes over the face and trunk, along with photosensitivity. Cutaneous examination revealed multiple erythematous hyperpigmented plaques over the face with atypical targetoid lesions over the trunk and limbs. The diagnosis of Rowell’s syndrome was confirmed based on immunology and histopathology. This case has been reported to highlight the importance of delving into the various presentations of LE.

Salmonella Sepsis in a Preterm Neonate- A Case Report

Rakesh Kumar, Sanober Wasim, Girish Gupta, Suraj Singh

Sepsis in neonates may rarely be caused by Salmonella typhi, clinical features of which may remain undifferentiated from other causes of sepsis. The mode of transmission can be vertical or horizontal. This case report describes a 30-day-old female baby, born at 28 weeks of gestation, who presented with features suggestive of sepsis, and there was a growth of Salmonella typhi in the blood culture. The neonate showed evident clinical improvements after 48 hours of antibiotics. The neonate was discharged after three weeks without any immediate adverse effect. The case emphasises the consideration of salmonella sepsis and the possible source of infection in neonates.

Invisalign Therapy in a Case of Mandibular Incisor Extraction

Clear aligners have been sought by patients as an aesthetic alternative to conventional orthodontic treatment. Despite the limitation that the aligner system offers, its use has improved over time. Hereby, authors discusses case of a 35-year-old female with Angle’s Class I malocclusion patient with severe mandibular crowding who was treated with mandibular incisor extraction using the Invisalign system. Clinical and radiographic examination revealed skeletal Class I malocclusion, severe crowding of the lower incisors, light crowding of the upper incisors, crossbite of the mandibular right canine, a convex profile, prominent lower lip, and a Bolton discrepancy in the lower anterior region. Fourteen trays were used in the maxillary arch and 28 in the mandibular arch. Two additional refinements, one with 13 and the other with 10 trays were delivered. After 2 years and 2 months of active treatment, good posterior occlusion and alignment of the teeth with adequate occlusion function and a balanced smile were achieved. The maxillary retainer was used continuously for 1 year, and at night until now. Successful tooth alignment and space closure were maintained, and the patient was satisfied with the results on the 2 year follow-up.

Incidental Diagnosis of Swyer-James-MacLeod Syndrome: A Case Report and Review of Literature

Swyer-James-MacLeod Syndrome (SJMS) appears as unilateral hyperlucency on chest imaging and is documented as a rare sequela of frequent paediatric respiratory infections. Due to its rarity, various causes of haemithoracic radio-opacity and radiolucency were studied while evaluating this case. In individuals with bronchiolitis obliterans, SJMS has been observed in about 4% of cases. The left lung is preferentially involved in most cases for unknown reasons. The syndrome usually develops following viral respiratory infection in infancy or early childhood, such as adenoviruses or Mycoplasma pneumoniae. It is predicted to have a prevalence of 0.01%. This case study focuses on an incidental finding of abnormal radiography identified during assessing a 54-year-old man with low back pain in Chronic Kidney Disease (CKD). Patient and relative should be explained about the Chest X-ray finding and the reason for SJMS to avoid unscrupulous investigations in the future as index patient had no respiratory symptoms.

Frequent Fall: Seizure or Weakness? A Case Report of Alternating Hemiplegia of Childhood

Sundari Subramanian, Ramya Ramanathan, Srinithi Ravikumar

Alternating Hemiplegia of Childhood (AHC) is a complex disease which causes recurrent hemiplegic attacks. Although ATP1A3 gene has been identified as the cause of this neurological entity, many variants are being reported nowadays, adding to the spectrum of ATP1A3 gene-related disorders due to the advancement in genetic testing. Hereby, authors presents a case report of a 3-year-old male child who presented with a complaint of frequent falls while walking with gait abnormality and has been on treatment for seizure disorder since, 5 months of age. On assessing the history and evaluating the child, AHC was suspected and the same was confirmed using genetic tests.

Management of External Cervical Resorption in Maxillary Central Incisor with Biodentine and Collagen Membrane: A Case Report

Akansha Tilokani, Prasanti Kumari Pradhan, Gaurav Patri, Asutosh Das

Invasive cervical resorption is a relatively uncommon form of a chronic inflammatory process that results in loss of dentine and is usually initiated in the pulp space. It begins as a localised resorptive process that initiates in the area of the root beneath the epithelial attachment and the coronal part of the alveolar process. The lesion is mainly detected on radiographs and exhibits no external signs. The limitations of conventional radiography make Cone Beam Computed Tomography (CBCT) an effective and accurate method of diagnosing root resorptions. The tooth is normally asymptomatic, and the diagnosis is usually made based on a routine examination. Most authors refer to dental trauma, whitening agents, and orthodontic treatment as aetiologic factors. This disorder necessitates a thorough study of the pathologic process in order to determine the source and stop the resorptive phenomenon. The treatment should seek to completely remove the resorptive defect and rebuild it with an appropriate filling substance. Biodentine, a calcium silicate-based material, can be used to fill resorptive defects in the teeth. Furthermore, biodentine has some desirable additional properties over Mineral Trioxide Aggregate (MTA), such as improved antibacterial properties, bioactivity-inducing hard tissue formation, good handling, self-adhesion to dentine, and shorter setting time. Hence, this article presents a case report of external cervical resorption of the maxillary central incisor. Biodentine along with collagen membrane was used to fill the resorptive defect. One year radiographic follow-up showed stability of the resorption site.

Oral Etoposide for Dengue Induced Haemophagocytic Lymphohistiocytosis Presented as Acute Liver Failure

Dengue fever is not an uncommon arboviral infection in lieu of tropical geography. The gravity of the disease ranges from an Outpatient Department (OPD) visits for febrile illness to haemorrhagic complications like shock. Hereby authors report a case of a 33-year-old female patient with no prior morbidities. Initial fever episodes due to dengue resulted but she deteriorated clinically with second wave of continuous fever spikes. On evaluation, a diagnosis of Haemophagocytic Lymphohistiocytosis (HLH) was made. The patient was treated with steroids and oral etoposide following which patient recovered completely. Although scarce occurrence of HLH following viral illness needs strong suspicion, prompt investigation, and management to avoid potentially life-threatening complications. On a case-to-case basis HLH protocol can be modified to make an OPD base treatment by switching to oral etoposide.

SARS-CoV-2 Vaccination Associated Transverse Myelitis: A Case Report

While policy makers around the globe have meticulously organised mass immunisation against Coronavirus Disease 2019 (COVID-19), its safety concerns and adverse events that need prompt evaluation are also emerging. Acute Transverse Myelitis (TM) is a rare neurological phenomenon where motor, sensory or autonomic disturbance occurs as a result of spinal cord injury. The aetiology of transverse myelitis is thought to be immune-mediated as a result of infection, parainfectious disorder, autoimmune disease or malignancy. Though a rare disease, acute TM warrants prompt recognition and aggressive therapy for favourable neurological patient outcomes. Hereby, authors presented this case of a 61-year-old male patient who developed symptoms of acute TM, 20 days after receiving an adenovirus vectored ChAdOx1 nCoV-19 vaccine against SARS-CoV-2. The patient was treated with intravenous steroids, supportive care with Foley’s catheterisation and his weakness and bladder control improved over 1 week.

Malignant Transformation in a Case of Recurrent Sinonasal Inverted Papilloma

Farhat Qamruddin Khan, Prasad T Deshmukh, Sagar S Gaurkar

Inverted papilloma or Ringertz tumour is an uncommon benign tumour that arises from the Schneiderian membrane of the ectoderm. It accounts for approximately 70% of all sinonasal papillomas and 0.5-4.0% of all sinonasal tract neoplasms. It often originates in the middle meatus of the lateral nasal wall and is well-known for its local invasiveness and high recurrence rate. Nasal obstruction, nasal bleeding, and diminished sense of smell are the most common symptoms. Hereby, authors report a case of 58-year-old male complaining of right nasal obstruction since 3 months. Patient had nasal growth for which he underwent nasal endoscopy. History revealed that he had similar growth on left side 10 years ago. A nasal endoscopic biopsy was performed and the histopathological examination show an inverted growth pattern from the sinonasal papilloma. Surgical techniques must be extensively explored and customised, with enhanced radiological assessment of tumour borders, in order to adequately remove the tumour, since incomplete excision increases the risk of recurrence and malignant transformation of the residual disease.

Cytodiagnosis of Visceral Leishmaniasis in Lymph Node Aspirate: A Rare Case Report

Ruchi Agarwal, Prachi Garg

Leishmaniasis is a parasitic disease caused by leishmania species. There are three main forms of the disease: Cutaneous, Mucocutaneous and Visceral Leishmaniasis (VL). VL with lymphadenitis is an uncommon presentation. Visceral leishmaniasis is usually diagnosed by identification of parasite Leishman Donovan (LD) bodies in bone marrow aspirates but cytological diagnosis of VL on lymph node aspirates has rarely been reported. This is a case report of a 37-year-old male presenting with multiple isolated cervical lymphadenopathy for three months. The lymphadenopathy was initially suspected to be tubercular in nature which is highly prevalent in India and lymphadenopathy is its common presenting feature, but on Fine Needle Aspiration Cytology (FNAC) of the node, multiple leishmania parasites were identified. Lymphadenopathy due to leishmaniasis is rare in India and most of the previous cases reported have association of leishmaniasis with Human Immunodeficiency Virus (HIV) infection. But this case is unusual as it is not associated with HIV infection. Thus, leishmaniasis should be included in the differential diagnosis of lymphadenopathy, especially in patients coming from endemic region. Cytology can be very helpful in such cases for early diagnosis and further management.

Ectopic Enigma- A Case Series of Unusual Presentations of Tubal Ectopic Pregnancy

Sowmya Shree Thimmappa, S Mamatha

A pregnancy that develops outside of the uterus is referred to as an ectopic pregnancy. The fallopian tube is the most typical location for ectopic pregnancy. Two percent of reported pregnancies are ectopic pregnancy. Hereby, authors present a case series of three cases, of unusual presentation of tubal ectopic pregnancy. First case was 22-year-old female, para1 living1, presented with abdominal pain, vomiting and no history of amenorrhoea. Her beta Human Chorionic Gonadotropin (HCG) was 82042 mIU/mL. A live ectopic pregnancy of 11 weeks with intact gestational sac ruptured en caul was noted on laparotomy. She underwent right salpingectomy. Second case was a 36-year-old, Abortion 2 Ectopic1, with one and a half months of amenorrhoea, abdominal pain and spotting per vagina with beta HCG of 27472 mIU/mL. Laparoscopy revealed, left sided unruptured tubal stump ectopic pregnancy and was managed by excision of tubal stump ectopic . Third case was a 26-year-old, para 2 living 2, with history of 2 months of amenorrhoea, abdominal pain and spotting per vagina. Laparotomy revealed right infundibular ectopic pregnancy with incomplete abortion with active bleeding. She underwent right salpingectomy. Cases were managed successfully. This case series emphasises the significance of having a high index of suspicion for ectopic pregnancy in all reproductive-age women regardless of their presentation.

Thinking Beyond Adenocarcinoma of Prostate: A Case Series of T2W Hyperintense Prostatic Lesions

Swarna, Rohit Sharma, Shalabh Jain, Anuradha Sharma, Reeta Kanaujia

The T2-weighted sequences form an integral part of multiparametric Magnetic Resonance Imaging (MRI) protocol performed for evaluation of the prostate. Most commonly encountered prostatic pathologies are adenocarcinoma and benign prostatic hyperplasia, which are mostly T2W hypointense and heterogeneously hypointense, respectively. Apart from prostatic cysts, only a small proportion of prostatic lesions demonstrate predominantly high signal intensity on T2-weighted sequences. Herein, the authors present three such cases with T2W hyperintense prostatic lesions. The first case (60-year-old male) was a prostatic abscess, which apart from T2W hyperintensity, showed central restricted diffusion and peripheral enhancement. The second case (40-year-old male) was a cystic lesion in left side of prostate, which was an ectopic ureterocele opening into the prostatic urethra with associated left renal agenesis. The third case (35-year-old male) was of a metastatic prostatic malignancy, which was a rare prostatic sarcoma. Radiologists should be cognizant of such conditions so as to enable them to make accurate diagnosis and guide appropriate patient management.

Facial Nerve Weakness Following Retromandibular Transparotid Approach for Subcondylar Fractures of Mandible- A Series of Five Cases

Mandibular condyle fractures are the most commonly reported mandible fractures. The incidence of condylar fractures is 25-30% among all mandibular fractures and there are ongoing controversies about their management. The retromandibular transparotid technique is the most frequently employed technique to manage fracture of mandibular condyle. The benefits of this method have been reported to include a shorter working distance between the incision and the fracture site, less morbidity to the facial nerve as it can be identified and retracted under direct vision, cosmetically pleasing outcomes and ease of reduction/fixation of fractures. Nevertheless, surgical treatment of mandibular condyle fractures, can pose danger to facial nerve branches. With respect to condylar fracture surgical treatment, the prevalence of Facial Nerve (FN) injury has been reported to be around 12-48%. This case series reports the surgical and postoperative journey of five patients with subcondylar fracture. The retromandibular transparotid technique was applied in all patients for Open Reduction Internal Fixation (ORIF). Using the House-Brackman facial grading system, FN weakness was assessed. Postoperatively, FN weakness was evident after 24 hours of surgery in two patients. With a mean recovery period of two months, all patients maintained FN function at three months. None presented with persistent paralysis of the facial nerve. Parotid fistulation was not observed in any patient. Inconspicuous scar after six months was observed in four patients. The retromandibular transparotid approach is a safe and effective technique that gives less morbidity to the facial nerve, excellent access, good cosmetic results and patient satisfaction.

Multifocal Carcinoma of the Urinary Bladder: A Classic Case Image

Parents Attitude Towards Approaching the Paediatric Dentists During COVID-19 Pandemic: A Cross-sectional Study

Varshitha Yendodu, SVSG Nirmala, Sivakumar Nuvvula

Introduction: The infection potential of Coronavirus Disease 2019 (COVID-19) is remarkable due to its airborne transmission through droplets and aerosols. Paediatric dental needs were severely compromised during the COVID-19 lockdown period. Aim: To assess parents’ attitudes and concerns towards approaching paediatric dentists during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted in Department of Paediatric and Preventive Dentistry at Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India, from August 2021 to October 2021. The study included 200 parents to assess the attitudes and concerns towards approaching Paediatric dentists during the COVID-19 pandemic. A structured questionnaire was used through Google forms to collect from parents, information regarding precautions, mode of transmission of the virus and type of treatment option. The Chi-square test and Fischer-exact test were used to compare the parameters such as education and occupation with parents’ attitude and knowledge. Results: Out of the 200 parents, 37 were males and 163 were females with mean age of the parents was 34.8 years. Out of total 200, 153 (76.5%) of the parents were worried to visit a paediatric dentist. Only 56 (28%) of the children suffered from toothache during the pandemic. About 28 (14%) of parents believed that the virus is transmitted through the air and 70% of the parents preferred teledentistry. A 152 (76%) of them were willing to pay extra costs and 123 (61.5%) of respondents expected to treat the emergency condition alone. A statistically significant difference was not observed between different occupation in the answers given about transmission paths of a virus (p-value=0.39), extra payment (p-value=0.77), and preference of approach (p-value=0.223). Conclusion: Majority parents were worried to visit a Paediatric dentist and preferred teledentistry. They were ready to pay extra costs for the sanitisation.

Survival of Acute Myeloid Leukaemia Patients- A Retrospective Study from the Yopougon University Hospital, Abidjan, Ivory Coast

Introduction: The survival of acute leukaemia patients has improved significantly thanks to multidrug chemotherapy and the development of cell therapy and marrow transplantation. However, this is not the case in Middle Income Countries (MICs), particularly in Côte d’Ivoire, West Africa where much efforts are still needed to improve the treatment of these patients.This study raises the issue of the fate and survival of Acute Myeloid Leukaemia (AML) patients in these countries. Aim: To study the overall survival and survival factors of patients with AML under the present practice conditions. Materials and Methods: This retrospective study was conducted in the Department of Haematology of Yopougon University Hospital in Abidjan, Ivory Coast. The data was collected from January 2005-April 2019 and data processing happened over a duration of one year from November 2019-November 2020. The mortality and survival were studied on 75 AML patients.The socio-demographic, pretherapeutic and therapeutic characteristics were recorded. Statistical Package for the Social Sciences (SPSS) statistics version 26 was used for data analysis, comparisons were done using by the Chi-square test and survival through the Kaplan Meier method and the log rank test. Results: The patient’s age ranged from 1 to 74 years, with two peaks (37 and 49 years old) with a sex ratio at 1.03. Majority of patients (50.7%) had a low socio-economic level. Overall, 81.6% of patients started treatment within two weeks. Out of total patients 38 (50.7%) patients received chemotherapy, which was curative for 10 (13.33%) patients and palliative for 28 (37.33%) patients. There was not a single patient of complete remission. A total of 4 (5.3%) were alive, 51 (68%) died, and 10 (26.7%) were lost to follow-up. The average overall survival (OS) was 90 days and the probabilitý of Overall Survival (OS) was 62% at one month, 49% at six months, and 10% at one year. The predictive factors for prolonged survival were high socio-economic level (p=0.046) - absence of bleeding syndrome (p-0.04) - haemoglobin level ≥10 g/dL (p-0.02) - cytological type different from AML-M0 (p-0.05). Conclusion: The therapeutic results were inferior to those obtained in developed countries where high level diagnostic and therapeutic techniques give very promising results. This study highlighted the difficulties of AML management and identified five prognostic factors of survival in the care conditions of MIC.

Knowledge, Attitude, Practices and Risk of Psychological Distress among Frontline Healthcare Workers Towards COVID-19 in Second Wave

Ram Milan Prasot, Malik Faizan Ahmad, Anand Bihari, Ankit Srivastava, Madhu Khan

Introduction: Frontline Healthcare Workers (F-HCWs) are at the front position for medical care against Coronavirus Disease 2019 (COVID-19) pandemic which has life-threatening potentials. Poor level of knowledge, practices and negative attitudes as well as high-risk of psychological distress among F-HCWs can directly lead to delayed diagnosis, treatment and poor infection control practices. Aim: To assess the level of Knowledge, Attitude and Practices (KAP) as well as risk of psychological distress among F-HCWs for COVID-19 pandemic. Materials and Methods: This descriptive, hospital-based, cross-sectional study was conducted at Government Medical College, Azamgarh, Uttar Pradesh, India, located in tertiary care centre in rural area) from October 2021 to December 2021 among 223 F-HCWs using convenient sampling technique. To assess the level of KAP as well as risk of psychological distress among F-HCWs a prevalidated structured questionnaire was used consisting 15 knowledge questions, six attitude questions, 15 practices questions and six questions on risk of psychological distress. Chi-square test was performed to examine the association between risk of psychological distress and level of KAP as well as with demographic characteristics of F-HCWs. Results: Out of total 223 participants more than half of physicians (52.9%) and one-third of staff nurses (35.9%) were from age group of 25-35 years, respectively. Majority of both physicians (57.1%) and staff nurses (87.6%) were married and had nuclear type of family as of 64.3% and 74.5%, respectively. Most of the physicians (92.9%) had good level of knowledge but they had less positive attitude (84.3%) compare to staff nurses (92.8%). Majority of both physicians (64.3%) and staff nurses (58.2%) had no or low risk of psychological distress while only few of them had its high level. Conclusion: In this study majority of F-HCWs reported overall ‘good’ level of knowledge, attitude and practices for prevention of COVID-19. As for as risk of psychological distress was concerned, majority of F-HCWs had its no or low risk.

Urine Spot Protein Creatinine Ratio as a Predictor of Disease Severity and Adverse Outcome in Children with Dengue: A Cross-sectional Study

Introduction: Dengue is a viral infection with different presentations, hence predicting the disease severity at admission is essential to triage patients needing meticulous monitoring. In severe dengue there is increase of urinary protein clearance due to the increase in systemic vascular permeability. Simple urine protein excretion screening test could guide the triage and monitor the patients with suspected dengue infection. Aim: To evaluate the urine spot Protein Creatinine Ratio (PCR) as a tool in predicting the disease severity and adverse outcome in children with dengue. Materials and Methods: The present cross-sectional study was conducted in Institute of Child Health, Egmore, Tamil Nadu, India, from October 2021 to December 2021. All children aged 1 month to 12 years presenting with symptoms of fever, thrombocytopenia (less than 1, 50, 000 /μL) with or without dengue non structural protein component (NS1)/ Immunoglobulin M Enzyme Linked Immunosorbent Assay (ELISA) positivity were recruited for the study. Study parameters included were demographic factors, severity of dengue classification based on National Vector Borne Disease Control Programme (NVBDCP) guidelines, urine spot PCR. The UPCR (urine protein creatinine ratio) was compared between dengue and non dengue cases and within the different categories of dengue cases. Chi-square was used for comparing proportions. Results: Among 150 children enrolled in present study, 134 (89.3%) were dengue positive, 16 (10.7%) were non dengue. Most predominant age group involved was 6-9 years followed by 3 to 6 years. Among 134 children with dengue, 98 (73.1%) had high UPCR and among 16 non dengue children, 2 (12.5%) had high UPCR which was statistically significant (p<0.0001). Mean spot UPCR was 0.32±0.12 in mild dengue, 0.77±0.40 in moderate dengue and 1.68±1.67 in severe dengue which was statistically significant (p<0.0001). Children with severe dengue had higher PCR values in comparison to mild and moderate dengue. Conclusion: There was a statistically significant association of urine spot PCR with severity of dengue and this simple test can be used for triaging and monitoring children with suspected dengue.

E-Sports, Anxiety, Aggression and Psychological Well-being: A Cross-sectional Study

Lata Kumari, Usha Sharma, Sukhmani Singh

Introduction: Electronic sports or e-sports is also known as online gaming, professional gaming, computer gaming. Nowadays E-sports has gained a lot of popularity in the area of research. The people actively participate in it and most people even consider it as their career option. Although these sports has both positive and negative effects on the life of an individual. Aim: To investigate the relationship between E-sports, anxiety, aggression, and psychological well-being among adolescents and young males and females. Materials and Methods: This cross-sectional study was conducted in Delhi and National Capital Region (Noida, Gurugram, Faridabad), from November 2020 to April 2021, included 102 participants within the age range of 16-27 years. The quantitative research method was adopted using descriptive survey method. The following questionnaire were used i.e. Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) Hamilton Anxiety Scale (HAM-A); Buss-Perry Aggression Questionnaire (BPAQ) and Psychological Well-being scale-Short Form (PWB-SF). All these questionnaires were free to use. Pearson’s correlation method was used to assess the correlation between E-sports, anxiety, aggression, and psychological well-being and the p-value of 0.01 was considered as statistically significant. Results: There was no significant relationship found between eSports and anxiety among participants (r-value=0.112, p-value>0.01). There was a significant positive correlation between eSports and aggression (r-value=0.377; p-value<0.01). Which indicated that participants with high level of problematic gaming had high level of aggression. Also, a significant negative correlation was found between eSports and psychological well-being (r-value=-0.259; p-value<0.01). Conclusion: From the present study, it can be concluded that participants who scored higher in problematic E-sports had higher level of aggression and poorer psychological well-being.

COVID-19 Infection in a Sickle Cell Anaemia Patient from Sudan

Abdel Rahim Mahmoud Muddathir

Sickle Cell Disease (SCD) is an inherited disorder with variable clinical presentation and low immunity. Coronavirus Disease-2019 (COVID-19) is a pandemic disease with a high-risk in chronic disease patients and older adults. SCD is widely distributed in Sudan; many SCD patients are infected with COVID-19. Despite this, no published data is available. This case report demonstrated the haematological and clinical course of a Sudanese sickle cell anaemia patient with COVID-19. A 20-year-old male patient was admitted to a hospital for 15 days. Demographic and clinical data were obtained from his medical records. A blood sample was taken at the time of admission and during hospitalisation. Tests were performed during admission, including Complete Blood Count (CBC), liver function test, renal function test, coagulation studies, viral screening, and urine general. The patient was diagnosed with COVID-19 using the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test based on the nasopharyngeal swab and COVID-19 IgG and IgM using Enzyme Linked Immunosorbent Assay (ELISA) for the previous infection. The patient received intravenous fluids, antibiotics, analgesia, oxygen supplementation, and blood transfusion two times during hospitalisation, and there was no need for Intensive Care Unit (ICU) admission. The patient’s prognosis was good; he was discharged on day 16 with no symptoms and a negative result of the COVID-19 PCR test. A severe illness was expected because he was infected twice by COVID-19, the patient showed mild clinical symptoms with a good prognosis, so further studies are required to understand COVID-19 among Sudanese SCD patients.

WhatsApp Mobile Application as a Learning Tool for Teaching Dermatology to Undergraduates

Abhilasha Williams, Emy Abi Thomas, Anuradha Bhatia

Introduction: The mobile app WhatsApp is gaining popularity in Medical Education informally over the last few years because of its easy availability, instant access and ease in transferring high quality medical images. Dermatology being a highly visual subject, WhatsApp can be used as a learning tool in addition to didactic lectures. Aim: To assess the perception of undergraduate students and faculty about e-learning using WhatsApp in Dermatology. Materials and Methods: This cross-sectional study was conducted in the Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India, in August 2020 among second year undergraduate students. Two modules based on Case Based Learning (CBL) were made and posted on a dedicated WhatsApp group (including students and dermatology faculty). Students were asked to send responses to questions on the group. Students and faculty were also asked to fill a pre-structured, prevalidated feedback questionnaire to assess their perception regarding the use of WhatsApp as a learning tool. Descriptive analysis was used. Open ended questions were analyzed by thematic qualitative analysis and expressed as percentages. Results: Total 80 students participated in the study, 50 students who filled the feedback questionnaire, 30 were females, mean age of the study group was 20.25 years. Twenty seven students (54%) were of the opinion that WhatsApp was a good motivator for Self Directed Learning (SDL) while 20 (40%) of them remained neutral. Twenty nine (58%) students wanted WhatsApp as an online teaching method to be part of teaching in Dermatology. Thirty students (60%) felt WhatsApp was a flexible learning tool in terms of time and place. Among total four faculty, 3 (75%) agreed that WhatsApp was a good learning tool, increased teacher-student interaction and was a good motivator to self-directed learning. Conclusion: If used with a well-structured educational research model, WhatsApp becomes a highly effective tool in medical education.

Hand Grip Muscle Strength, Endurance and Anthropometric Parameters in Healthy Young Adults: A Cross-sectional Study

Jolly Bhattacharjya, Bobyjeet Goswami

Introduction: Hand grip muscle strength and endurance are non invasive simple diagnostic tool for diagnosis as well to check prognosis in health and disease. But there are many factors like age, ethnicity etc., that influence the hand grip muscle strength and endurance. Failure to understand the determinants that influence the strength and endurance would decrease the reliability of these tests as diagnostic and prognostic tool. Aim: To evaluate the influence of anthropometric parameters like height, weight, Body Mass Index (BMI) on handgrip muscle strength and endurance. Materials and Methods: The present cross-sectional study was conducted in the Department of Physiology, Gauhati Medical College and Hospital, Guwahati, Assam, India in the month of November and December 2019, after obtaining Institutional Ethical Committee (IEC) clearance. In this study 80 healthy young adults had given informed written consent to participate. After a brief history taking to ensure that participants met the inclusion criteria, height, weight were measured using measuring tape and weighing machine respectively and BMI was calculated using the formula weight (kg)/height (m)². Handgrip muscle strength and endurance were measured using hand grip dynamometer. Statistical Package for the Social Sciences (SPSS) 16.0 version software was used to calculate mean of all variables, Pearson correlation coefficient to analyse the correlation of variables and Analysis of Variance (ANOVA) test for analysis of significance. The p-value≤0.05 was considered statistically significance. Results: In this study, 47 (58.75%) were males, showed higher values in almost all parameters like height, weight, muscle strength except BMI, than the females who constituted 33 (41.25%) of the study participants. There was also significant moderate positive correlation of height (r=0.621, p<0.001), weight (r=0.519, p<0.001) with hand grip muscle strength and only height (r=0.438, p<0.001) showed correlation with muscle endurance. Conclusion: The present study showed positive correlation of height and weight with muscle strength and height with endurance, as such it can be concluded that height, weight are the anthropometric parameters that influence hand grip muscle strength. So, influences of these factors should be kept in mind while using hand grip muscle strength or endurance as diagnostic or prognostic tool.

Community Acquired Methicillin Resistance Staphylococcus Species and Inappropriate Antibiotics use among Women of Reproductive Age Group in Enugu, Nigeria

Introduction: The burden of community acquired antibiotic resistance is increasing with an alarming rate in the developing countries. Many factors, including inappropriate use of antibiotics, have been suggested as the causes of spread of resistant strains in the community. Aim: To compare antibiotics susceptibility pattern of community acquired gram positive isolates among women of reproductive age with history of recent inappropriate antibiotics use and those with no history of antibiotics use. Materials and Methods: The present study was a cross-sectional descriptive study carried out from August 2020 to February 2021 at the State Teaching Hospital in Enugu, Nigeria. The participants for the study were 713 apparently healthy women who presented to the family planning unit for preconception care. All the participants were screened for asymptomatic bacteriuria by culturing their Midstream Urine (MSU). The isolated organisms were identified, and Antimicrobial Susceptibility (AST) test performed using the Vitek 2. Polymerase Chain Reaction (PCR) was done for the presence of mecA gene among methicillin resistant Staphylococcus species. The antibiotic susceptibility pattern of the isolates from participants with positive history of recent antibiotic use was compared with the susceptibility pattern of those with no history of antibiotics using Chi-square test. Results: Out of the 713 participants, 59 (8.3%) had a positive history of recent antibiotics use. Only 1 (1.7%) participant had her antibiotics prescribed by the doctor while 13 (22) and 45 (76.3) obtain their antibiotics at the patent medicine dealer shop and through self-medication respectively. The commonest indication for inappropriate use was febrile illness followed by upper respiratory symptoms. Ciprofloxacin was the most abused antibiotics followed by amoxicillin-clavulanic acid. Twenty (83.3%) and 4 (16.7%) had Asymptomatic Bacteriuria (ASB) among those with recent antibiotic use and those with no history of recent antibiotic use respectively. All the Methicillin Resistant Staphylococcus aureus (MRSA) was isolated from the participants with recent history of inappropriate antibiotic use. Also, of significant among this group were quinolone resistant gram positive organisms. Conclusion: ASB and multidrug resistant gram positive isolates were common among the participants with recent history of inappropriate antibiotic use. There is need to regulate antibiotics use in the community to prevent selection of multidrug resistant organisms.

Determination of Reference Intervals for Platelet Parameters using Sysmex XN-1000 among South Indian Population

Introduction: Reference intervals are important for interpretation of clinical laboratory tests. The platelet parameters are recently reported newer haematological parameters and serve as clinically valuable biomarkers. It provides further information on platelet morphology and proliferation kinetics. The lack of information from manufacturers about the geographical reference ranges for the Complete Blood Count (CBC) parameters highlights the need for laboratories to establish reference intervals. Aim: To determine the reference interval for platelet parameters using Sysmex XN-1000 haematology analyser in South Indian population. Materials and Methods: The present retrospective record-based study was carried out during July 2021 to September 2021 and the data was retrieved from a continuous 12-month period (November 2018-October 2019) in the haematology laboratory at a tertiary care dental hospital, Chennai, Tamil Nadu, India. The data of CBC parameters were retrieved from the Sysmex XN-1000 analyser and a total of 1,883 reports labelled as negative/unflagged were included in the study. The reference intervals for platelet parameters which include Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Large Cell Ratio (P-LCR) and Plateletcrit (PCT) for male and female subjects were compared using the Mann-Whitney U-test. Kruskal-Wallis test was used to compare between the different age groups using Statistical Package for the Social Sciences (SPSS) version 24.0 software. Results: The data for the platelet parameters are shown as median, with statistically significant difference in the reference interval for all the parameters (p<0.001). There was no significant difference in age divided reference intervals, except for PCT (p=0.04) PDW was found to be 9-16.4 fL for males and 9.1-16.6 fL for females (p<0.001). Similarly, MPV was 9-12.3 fL for males and 9-12.6 fL for females (p<0.001); P-LCR was 16-42.1% for males and 16.6-43% for females (p<0.001); and PCT was 0.15-0.36% for males and 0.14-0.41% for females (p<0.001). Conclusion: The study has determined the reference interval for platelet parameters with respect to age and gender in area specific population and these results can be utilised for other laboratories using the same analyser system for south Indian population.

Role of Epidermal Growth Factor Receptor in Gallbladder Carcinoma and its Association with Various Clinicopathological Parameters: A Cross-sectional Study

Introduction: Carcinoma of gallbladder is an aggressive disease with poor outcome. The Epidermal Growth Factor Receptor (EGFR) is a transmembrane receptor that regulate growth, proliferation and differentiation in cells. Increased EGFR receptor expression has been studied in various cancers like lung, colorectal, breast and pancreatic tumours and antiEGFR antibody has been used successfully for therapeutic and diagnostic purposes. Aim: To evaluate EGFR expression in gallbladder carcinoma and its association with clinicopathological factors to reveal its relation to prognosis. Methods and Methods: The present study was a cross-sectional study in which 64 samples were collected of resected specimen of Gallbladder Carcinoma (GBC), from the Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India, for a period of one year and six months. Haematoxylin-eosin-stained sections were evaluated for tumour type and histopathological grading and TNM staging was done. Immunohistochemistry (IHC) was performed and analysed prospectively using ready to use anti-EGFR as per manufacturer’s protocols. Association between EGFR expression and clinicopathological factors were statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: EGFR expression was positive in 81.25% (52/64) cases of GBC which showed a highly significant association between tumour grade and stage. About 60% of poorly differentiated GBC displayed strong (3+) staining intensity as compared to 30% of moderately differentiated (3+) and 10% of well differentiated tumours (3+). It suggests that with decreasing differentiation of tumour EGFR staining intensity increases (p<0.001). Positivity rate of EGFR expression were also increased with increase of tumour TNM stage (stage I to stage IV). Strong EGFR expression was associated with decreased overall survival with significant p value (p=0.031, log rank test). Conclusion: EGFR expression is inversely related with tumour differentiation, and overall survival. EGFR expression increases with high TNM staging. So, it can be used as prognostic marker for gallbladder carcinoma and opening a hope towards the new therapeutic options.

Perception and Experience of Medical Students Regarding Hybrid Problem-based Learning Technique at a Medical College in West Bengal, India: A Cross-sectional Study

Introduction: Hybrid Problem-Based Learning (h-PBL) is a type of teaching-learning technique that incorporates both in-person learning and virtual learning via hybrid classroom tools. It reportedly increases student engagement, positively impact their learning process and improve communication skills. During Coronavirus Disease 2019 (COVID-19) times, its applicability was further enhanced as it allowed the flexibility of teaching as well as learning from home to both teachers and students. Aim: To assess the perception and experience of 2^nd phase MBBS students after undergoing training by the h-PBL method. Materials and Methods: A cross-sectional study was conducted on 2^nd phase MBBS students in the Department of Microbiology at College of Medicine and Sagore Dutta Hospital, Kolkata from 15^th March to 14^th April 2022. A total of 111 students of 2^nd phase MBBS of the college gave an informed consent to be part of the study. All inductees underwent a structured training by h-PBL technique following which their perception and experience about the exercise was sought via questionnaire. Data were presented in frequency and percentage. Association between mean scores of male and female participants was calculated by Chi-square test. Results: Out of the 111 participants, 58 (52.2%) were male and 53 (47.8%) were female with mean age of 19.5±0.5 years (range 18-22 years). The h-PBL technique was perceived to be motivating for self-directed learning by 97 (85.6%) of the respondents. A total of 107 (96.4%) students agreed that h-PBL is more effective than traditional teaching for acquiring both theoretical and practical knowledge, learning and understanding topics correctly and also identifying and rectifying their deficiencies in knowledge and skills. More than 90% participants (102 of 111) felt that h-PBL has more potential than traditional teaching to establish fruitful student-teacher interaction and provide better feedback opportunities. Overall student satisfaction in our study showed 96.4% agreement (107 of 111). Conclusion: The students considered h-PBL model to be better than traditional teaching to help them acquire theoretical knowledge and practical skills. They also felt that it improved their communication skills, teamwork ethics and motivated them to undertake self-directed learning.

Role of Anterior Colporrhaphy in Post Void Residual Urine Volume and Stress Urinary Incontinence: A Prospective Interventional Study

Nishtha Handa, Kamna Datta, Neha Pruthi Tandon, Bani Sarkar

Introduction: Pelvic floor disorders are quite debilitating for middle aged and elderly women. Post Void Residual (PVR) urine volume is a key marker for the efficacy of emptying of bladder. Both, preoperative and postoperative assessment of PVR volume helps to know about the voiding dysfunction and help to detect Stress Urinary Incontinence (SUI). There is a paucity of data available regarding postoperative outcome assessment of surgical intervention in terms of PVR urine volume. Aim: To identify the risk factors for elevated PVR and to evaluate the rate of resolution of elevated PVR in patients undergoing vaginal hysterectomy with anterior colporrhaphy for Pelvic Organ Prolapse (POP). Materials and Methods: A prospective interventional study was conducted at Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi from June 2019 to June 2021. A total of 50 patients with POP meeting the inclusion criteria were enrolled. Preoperative grade of prolapse, SUI and PVR urine volume was assessed. All patients enrolled in study, underwent vaginal hysterectomy with anterior colporrhaphy. Postoperative PVR urine volume and de novo SUI and occult stress urinary incontinence (OSUI) was assessed. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. The p-value <0.05 was considered significant. Qualitative variables were analysed using Fischer’s exact test. Results: Preoperative PVR (≥50 mL) was seen in 28 (56%) women. Advancing age (p-value 0.043) higher Body Mass Index (BMI) (p-value=0.033) higher POP (p-value=0.003) and higher degree of cystocele (p-value<0.001) staging were significantly associated with elevated preoperative PVR. In this study, only 22% of patients (11/50) had preoperative SUI and 12% (6/50) had preoperative OSUI. In this study amongst the six patients with preoperative OSUI, 100% had significant preoperative PVR. None of the patients with preoperative SUI and preoperative OSUI had postoperative persistent SUI or de novo SUI after undergoing anterior colporrhaphy with vaginal hysterectomy (p-value <0.001). Conclusion: PVR urine volume is increased with degree of prolapse. Raised PVR is also associated with OSUI, which is usually seen in patients with advanced prolapse and cystocele. Vaginal hysterectomy with anterior colporrhaphy significantly reduced postoperative PVR and SUI.

Advancing Pulmonary Rehabilitation Approach in Improving Well-being in a Long COVID-19 Syndrome Case

Pallavi Rajeshwar Bhakaney, Vishnu Vardhan

Being a highly contagious disease, Coronavirus Disease-2019 (COVID-19) has shown its impact throughout the world. Clinical manifestations are seen primarily involving the respiratory system. Fever, cough, fatigue, and breathlessness are the commonly seen symptoms. Several cases of COVID-19 manifest as viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS). COVID-19 symptoms appear not only during the course of the illness but also as its after effects. Long COVID-19 is said to be multisystem syndrome, categorised as postacute or chronic depending upon the time frame. It is characterized by the presence of symptoms beyond four weeks of the actual disease. Change in structural components in the lung leads to having a functional consequence on the body, affecting the cognitive, psychosocial, mental and physical well-being of the patients. Studies have shown alveolar damage same as ARDS. The most common pulmonary sequences seen are dyspnoea, cough (dry/with expectoration) and decreased diffusion capacity leading to reduced endurance. The present case report was of a 45-year-old nurse, who presented with the symptoms of postacute long COVID-19. Her previous scan of thorax showed a severity score of 11/25 after being tested COVID-19 positive. In view of the presenting complaints, a tailor-made pulmonary rehabilitation program was administered which showed great improvement in overall health condition. This case had been reported to document the effects of post COVID rehabilitation program on aspects such as functional capacity, quality of life, anxiety and depression using novel measures such as Incremental Shuttle Walk Test (ISWT), World Health Organisation Quality of Life-Brief Version (WHOQOL-BREF), and Depression, Anxiety and Stress Scale - 21 Items (DASS-21). Rehabilitation has been proven to be effective and safe in improving the exercise performance, quality of life affected due to COVID-19 and psychological function of the patients.

Comparison between Plain Ropivacaine, Ropivacaine with Buprenorphine and Ropivacaine with Clonidine for Intrathecal use in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

D Vasanth, Vijay Narayanan, SA Senthil Kumar

Introduction: Ropivacaine is an amide local anaesthetic agent. The lower limb surgeries involves the great somatic pain. By using these adjuvants such as buprenorphine and clonidine with local anaesthetic agent to know the effective intraoperative and postoperative analgesia. Aim: To compare the anaesthetic characteristics in terms of quality of blockade when intrathecal ropivacaine with buprenorphine and ropivacaine with clonidine as adjuvant. Materials and Methods: The present study was a double-blinded randomised control trial in which a total of 75 subjects were divided into three groups, with 25 per group-group R (Inj. Ropivacaine 0.75%-3 mL with 0.2 mL sterile water), group RB (0.2 mL Buprenorphine with Inj. Ropivacaine 0.75% 3 mL), and group RC (0.2 mL Clonidine with Inj. Ropivacaine 0.75% 3 mL). Onset and duration of blocks were observed. Haemodynamic parameters, and pain score were monitored intraoperatively and postoperatively. Data was entered in MS excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. The p-value <0.05 were considered as statistically significant. Results: The onset time of sensory and motor blockade for group RC was significantly more in comparison to R and RB groups (sensory block-5 minutes 50 seconds vs 3 minutes 39 seconds vs 3 minutes 50 seconds); and (motor block-6 minutes 52 seconds vs 4 minutes 39 seconds vs 4 minutes 74 seconds). Group RC had significantly longer duration of sensory block than R and RB groups (327 minutes 88 seconds vs 166 minutes 60 seconds (167 minutes) vs 222 minutes 44 seconds). Conclusion: Ropivacaine with clonidine showed significantly more duration of sensory block, motor block and time for first rescue analgesia with haemodynamic stability than ropivacaine and ropivacaine with buprenorphine.

Comparative Evaluation of Apical Extrusion of Debris Using Hand and Rotary Assisted Instrumentation in Primary Single Rooted Teeth: An In-vitro Study

Introduction: Extrusion of periapical debris is one of the common problem encountered during root canal treatment. As the endodontic instruments differ in terms of design and use, apical extrusion of debris may vary. Aim: To determine the quantity of debris extruded apically during various hand and rotary assisted instrumentation in extracted primary single rooted teeth. Materials And Methods: This in-vitro study was conducted in Department of Paediatric and Preventive Dentistry at Kannur Dental College, Anjarakandy, Kannur, Kerala, India, from December 2020 to May 2021. Four file systems were compared i.e, two hand files (Kedo SH and Protaper hand) and two rotary files (Kedo SG blue and Pro AF baby gold) among 60 therapeutically extracted single rooted primary teeth. The tooth was inserted into Eppendorf tube till cementoenamel junction, access opening was done, pulp extirpated, working length determined with 10 size k file. After instrumentation, the tooth was washed with 10 mL of distilled water for debris collection. Tube was incubated at 70^°c for drying and weighed to measure the collected debris. Data collected were analysed statistically using Independent t-test, One-way analysis of variance and Least Significant Difference (LSD) Post hoc test for multiple comparison to compare between the groups were done. Level of statistical significance was set at p-value<0.05. Results: There was significant difference in the amount of debris collected between the hand file and rotary files (p-value<0.001), between Kedo SG blue and Pro AF baby gold (p-value<0.001), and Kedo SH hand file and Protaper hand file (p-value<0.05). Conclusion: Rotary files shows lesser amount of debris extrusion than the hand files. Comparing the four file system Kedo SG Blue file shows least periapical debris extrusion, the second least is Pro AF Baby Gold (rotary), then Kedo SH hand file and last Protaper hand file.

A Comparison of Tracheal Intubation with Ambu® AuraGainTM, Fastrach® and BlockBuster® Laryngeal Mask Airway: A Randomised Clinical Trial

Introduction: Airway management has been a key to quality, efficacy and safety of anaesthesia. The Ambu^® AuraGain^™ is an anatomically curved Supraglottic Airway Device (SAD), which has gastric access port and is used for both ventilation and endotracheal intubation. Fastrach^® Intubating Laryngeal Mask Airway (FT-LMA) serves as a conduit for intubation and ventilation for difficult airway situation. It has an epiglottic elevating bar designed to lift the epiglottis as endotracheal tube passes. BlockBuster^® LMA is latest generation LMA used for ventilation and intubation. It has a short airway tube which has > 95° angulation to match the oropharyngeal curve and thus makes the insertion easy and less traumatic. Aim: To compare first attempt success rate of tracheal intubation using Ambu^® AuraGain^™, Fastrach^® and BlockBuster^® LMA in adult patients. Materials and Methods: The present randomised clinical trial was conducted in the Department of Anaesthesiology, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan, India from February 2021 to February 2022. The study comprised of 135 ASA physical status I and II patients of both sex, aged 18-60 years who were admitted and scheduled for elective surgery requiring general anaesthesia and tracheal intubation. The patients were randomly assigned into three groups (45 in each) - group A (Ambu^® AuraGain^™ group), group F (Fastrach^® group), and group B (BlockBuster^® group). Tracheal intubation was performed using appropriate size endotracheal tube after LMA placement. The outcome measures were first attempt successful intubation, time taken for intubation, glottis visualisation, and incidence of complications (blood stained LMA, nausea/vomiting). Results: The mean age of the group A, group B and group F were 35.8±15.0, 32.71±12.59, and 38.7.0±14 respectively which was statistically not significant. Group B had a significantly greater success rate of first attempt intubation (93.3%) in comparison with group F (64.4%), and group A (22.2%). LMA insertion score of 1 was found in 53.3% patients in group B, 42.2% patients in group F and 15.5% patients in group A. A Brimacombe score of 4 was found in 46.6% patients in group B as compared to 13.3% patients in group F and (33.3%) patients in group A, (p-value=0.020). Blood stained LMA was found in 1 patient in group B, 9 in group F and 7 in group A (p-value=0.030). Conclusion: BlockBuster^® LMA is a better conduit for tracheal intubation than Fastrach^® LMA and Ambu^® AuraGain^™ in adult patients with no anticipated airway difficulties.

Correlation between NEWS, CT Severity Score and RT-PCR Cycle Threshold Value among Mild and Moderate COVID-19 Patients

Introduction: The clinical diagnosis of COVID-19 is supplemented by clinical severity indices. These indices are the National Early Warning Score (NEWS, which aids in risk stratification), CT severity score (radiological severity score), and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) cycle threshold (Ct value, which provides a semi-quantitative measure of viral load). Aim: To assess the correlation between NEWS at admission, RT-PCR Ct value and CT severity score in mild and moderate COVID-19 patients. Methods and Materials: This prospective cohort study was conducted in Maulana Azad Medical College and Lok Nayak hospital, New Delhi, from January to June 2021. The study included 50 subjects (25 with mild COVID-19 and 25 with moderate COVID-19). NEWS was calculated at admission and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ct value was estimated using real-time RT-PCR. CT severity score was calculated based on High Resolution Computed Tomography (HRCT) chest findings. The correlation among the parameters was determined using Pearson correlation formula. Results: The mean age of subjects in the mild and moderate COVID-19 groups were 49.52 years and 51.84 years, respectively. The mean RT-PCR Ct value of E gene was 24.48 and Rdrp gene was 24.56 in the mild COVID-19 group; while in the moderate group it was 23.72 for both E gene and Rdrp genes. The correlation between NEWS and Ct value of E gene (r-value=-0.06, p-value=0.68), Ct value of Rdrp gene (r-value=-0.03, p-value=0.79) and the correlation between CT severity score and Ct value of E gene (r-value=-0.05, p-value=0.73), Ct value of Rdrp gene (r-value=-0.06, p-value=0.68) was negative and insignificant. The mean CT severity score in mild COVID-19 group was 3.92, and in moderate COVID-19 group was 9.88. A significant positive correlation was found between the CT severity score and NEWS at admission. Conclusion: The clinical severity of COVID-19 as estimated by NEWS corroborates with CT severity score while the relationship between RT-PCR Ct value and clinicoradiological severity needs to be ascertained by further research.

Factors Influencing Particulate Matter 2.5 Levels in Indoor Areas of Rural Houses: A Cross-sectional Study

Introduction: Almost 3 billion of the world’s poorest people still rely on solid fuels, with a concomitant increase in indoor Particulate Matter (PM 2.5) concentration resulting in deaths from respiratory diseases. Increased prevalence of respiratory diseases among never smoking young individuals and fairly among women compared to men point towards a causal relationship between chronic smoke inhalation resulting from the burning of biomass fuels. Aim: To assess the quantitative exposure levels of PM 2.5 in a rural setting in South India and determine the association between PM 2.5, type of house, ventilation available and fuel used. Materials and Methods: This community-based cross-sectional study was conducted for 3 months from September 2020 to November 2020 in the rural field practice area of Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu. The houses were classified into three types Kutcha (roof, walls, and floor made of poor-quality materials), semi pucca (two components made of good quality material and one component is of poor quality), and pucca (roof, walls, and floor made of good quality material) houses according to Census of India 1991. The air quality inside 127 houses was assessed by measuring PM2.5 levels for 24 hours in both kitchen and living rooms. The association between house characteristics, ventilation, type of fuel, and indoor air quality was Studied using student t-test and one-way Analysis Of Variance (ANOVA). Results: Among 323 included residents, 168 were males and 155 females with the mean age 36.99±13.24 years. The difference in average house area and living area between the three types of houses were statistically significant (p-value<0.001). The mean concentrations of PM2.5 were 290.07 μg/m³ and mean differences in PM2.5 levels in living room and kitchen of semi pucca (t=7.32, p-value<0.001) and pucca houses (t=5.47, p-value<0.001) were significant. The association between cross ventilation in kitchen (OR 3.24, p-value=0.042), artificial ventilation (OR 3.23, p=0.026), type of fuel (firewood OR 2.85, p-value=0.042) and PM2.5 levels is significant at 95% CI limits. Conclusion: Indoor air pollution is a silent killer responsible for several respiratory problems. Simple cost-effective measures could reduce indoor PM2.5 levels and thereby indoor air pollution.

Knowledge, Attitude and Practice towards COVID-19 Vaccination among Medical Students in a Tertiary Care Hospital of Southern India

Introduction: Coronavirus Disease-2019 (COVID-19) vaccination plays an important role in controlling the current pandemic. This may have an impact on other healthcare workers in understanding the importance of COVID-19 vaccination. Aim: To assess the Knowledge, Attitude and Practice (KAP) towards COVID-19 vaccination among medical students in a Tertiary care hospital, Southern India. Materials and Methods: This was an observational cross-sectional questionnaire based study done in Mahatma Gandhi Medical College and Research Institute, Puducherry, India. The study period was from April 2021 to September 2021. The study evaluated KAP on COVID-19 vaccination amongst medical students. After the content validity of the questionnaire, a google form was created and circulated among the I, II, III, IV-year students and interns, which was assessed by a scoring system for KAP. The results of the qualitative variables were tabulated as frequency and percentages. The statistical analysis was done using JASP software and the correlation between KAP was calculated using Spearman’s Correlation. Results: A total of 400 participants were included in the study. Their mean±SD age was 20.3±1.3 years. The second- and third-year students actively participated in the study. Adequate knowledge was observed in 33% of the medical students, moderately adequate knowledge in 61% and minimum knowledge in 6%. Spearman’s correlation between KAP showed a significant p-value. Conclusion: The majority of the medical students opined that their main source of information was social media. This indicates that social media campaigns had helped them gain adequate knowledge about vaccination. This knowledge might help them encourage their relatives and friends to get vaccinated against COVID-19, which will in turn help in breaking the chain of this pandemic.

Effect of Sleep Deprivation on Mood States of Junior Residents in Obstetrics and Gynaecology Department: A Prospective Observational Study

Swati Sagarika Panda, Raksha Jaipurkar, Rajesh Kumar Mishra

Introduction: Junior residents of highly demanding clinical specialties, like, Obstetrics and Gynaecology, are an integral part in the functioning of hospitals. They work round the clock donning the role of caregiver as well as learner and are in a constant state of stress. Any alteration in mood while working in intensive set ups like labor room and operation theatre can adversely affect not only the physician’s performance but also patient safety. Aim: To evaluate the effect of sleep deprivation on mood states of junior residents in Obstetrics and Gynaecology Department during call duty. Materials and Methods: This prospective observational study was conducted in Department of Obstetrics and Gynaecology at Armed Forces Medical College (tertiary care hospital), Pune, Maharashtra, India, from march 2019 to august 2019. The study included 37 junior residents of Obstetrics and Gynaecology Department, between age range of 25-40 years. Sleep diary was used to record resident’s sleep patterns, Karolinska Sleepiness Scale (KSS) was used to assess the day time sleepiness. Profile of Mood States (POMS) score was calculated during pre-call and post-call duty. This data was used to ascertain any changes in mood post-call due to sleep deprivation. Statistical analysis was done using paired Student’s t-test and Wilcoxon Signed Rank test and p-value <0.05 was considered as significant. Results: Out of 37 participants, 21 were males and 16 females. There was a significant worsening of post-call POMS score (5.24±27.82) from pre-call score (-6.86±23.70) following call duty associated with a decrease in mean night time sleep (p-value<0.001). Likewise increased KSS score was also noted after call duty (pre-call score was 3.03±1.65 vs post-call score was 5.73±2.05; p-value<0.001). This signifies that mood states are adversely affected by sleep deprivation in these residents. Conclusion: The study showed that there was a significant worsening of mood states due to sleep deprivation during call duties. This also mandates review of efficacy and feasibility of current policy regulating work hour schedule of junior residents in India.

Formalin Sediment Cytology of Small Biopsy Samples: An Adjunct to Histopathology

Jahnvi Vijay, B Deepak Kumar, V Srinivasa Murthy

Introduction: Cytological evaluation of malignant neoplasms forms an integral part of diagnostic work-up in any malignant disorders. Sediment cytology or more aptly called as biopsy sediment cytology is a technique that involves study of smears prepared from sediment of biopsy specimen fixatives. The preliminary diagnosis on sediment cytology helps in planning and early initiation of treatment. Aim: To evaluate the cytomorphological features of sediment cytology of small biopsy samples and compare the same with histopathological diagnosis. Materials and Methods: A cross-sectional study was conducted over a period of two months from July 2021 to August 2021 at ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India. A total of 51 samples were included for the study. The sediments of biopsy specimens were collected in a test tube, centrifuged at 2500 rpm for 10 minutes and smears were prepared. Stained smears were evaluated for presence and morphology of cells. The morphology was compared with histopathological diagnosis of biopsy specimens. The concordance rate was assessed by Pearson’s correlation coefficient in non neoplastic/benign lesions and malignant lesions separately. A p value of <0.05 was taken to be statistically significant. Results: Biopsies from gastrointestinal system accounted for the maximum number of cases (16 cases, 31.4%), followed by biopsies from oral cavity (15 cases, 29.4%) and female genital tract (11 cases, 21.5%). Sediment cytology yielded diagnostic material in 46 cases (90.2%). The diagnostic yield was 90.2% with an overall concordance of 60.8%. The sensitivity, specificity and diagnostic accuracy was 65.12%, 100% and 60.8% respectively. The concordance rate in non neoplastic/benign lesions was r=0.99, with p=0.0001, whereas with respect to malignant lesions, concordance rate was r=0.86 with p=0.0003. Conclusion: Cytological evaluation plays an important role in early and effective planning of appropriate treatment. Biopsy sediment cytology although an adjunct to histopathology has practical utility and fulfills the desired role of any cytological sample in providing a provisional diagnosis.

Clinico-aetiological Profile of Meningoencephalitis: A Prospective Observational Study in a Tertiary Care Centre, Hubli, Karnataka, India

Amruth, Sushma Shetty, Geeta Chintamani, G Krupashree

Introduction: Meningoencephalitis is a syndrome leading to fatality and neurological damages. Worldwide, infection of the central nervous system is the most common cause of meningoencephalitis. In encephalitis, a leptomeningeal involvement along with inflammation of brain parenchyma is invariably present and the clinical symptoms reflect both diffuse and focal cerebral pathology as well as meningitis. Correct immediate diagnosis and introduction of early symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury and also has major impact on the outcome. Aim: To study the clinical profile and aetiological causes of meningoencephalitis and also to analyse the mortality and morbidity due to meningoencephalitis in a tertiary care centre. Materials and Methods: It was a prospective observational study conducted between December 2018 to December 2020 in a tertiary care centre, Karnataka Institute of Medical Sciences, Hubali, Karnataka, in which 184 patients of meningoencephalitis who fulfilled inclusion criteria were included. Detailed history and clinical examination was done followed by laboratory investigations, complete hemogram, serum electrolytes, liver function tests, Fundoscopy, Electroencephalography (EEG). Cerebrospinal Fluid (CSF) analysis including CSF culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT), Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Brain were also done and results analyzed. Microsoft (MS) Excel and MS word was used to obtain various types of graphs such as bar diagram, pie diagram. Percentages, means were calculated using Statistical Package for Social Sciences (SPSS) statistics software version 22.0. Results: Out of 184 patients majority of patients were in the age group of 31 to 50 years accounting for 85 (46.2%) of cases. Majority of patients were males (n=113) than females (n=71). Tubercular aetiology was found in 51.6%, viral cause in 25%, bacterial cause in 21.2%, fungal cause in 2.17% of patients. Out of 184 patients of meningoencephalitis, 50% patients recovered, 27.17% patients recovered with residual neurological deficit, 11.95% patients died and 10.86% were discharged . Conclusion: Detailed history and clinical examination along with appropriate investigations are necessary to confirm the diagnosis of meningoencephalitis. The Tubercular (TB) Meningitis was common with high morbidity and mortality.

Evaluation of Histomorphological Spectrum of Skin Lesions at a Teaching Institute in Agra: A Cross-sectional Study

Introduction: The skin is the largest organ system in humans. Different skin diseases consist of non specific, non infectious and infectious diseases to various neoplastic lesions. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country and influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. The clinical presentation is restricted to only a few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and few others. However, the spectrum of histopathology of skin disorders is varied. Accurate diagnosis of skin disorders is of utmost importance as treatment is varied for different skin disorders presenting with the similar clinical lesions. Aim: To study histomorphological spectrum and distribution of skin lesions. Materials and Methods: This hospital-based cross-sectional study was conducted in Department of Pathology in collaboration with Department of Skin and Venereal Diseases, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years from September 2019 to August 2021. The biopsy sample taken from clinically diagnosed skin lesions sent to histology laboratory in 10% formalin. Sample was fixed in 10% neutral buffered formalin over a period of 12 to 24 hours. Paraffin wax blocks were made and 3-4 micrometer sections were taken and stained with Haematoxylin and Eosin (H&E) stain and histology was studied under microscope. Special stains such as Ziehl-Neelsen (Z-N) stain and Fite stain were done, whenever required. Data was entered in Microsoft Excel excel and descriptive data was obtained. Results: Out of total 105 cases, the maximum patients were of 21-30 years of age group 30 (28.57%) cases followed by 11-20 years of age group 25 (23.81%) cases with male and female ratio M:F=1.5:1. In this study, out of total 105 cases, the most common site involved was trunk in 42 (42%) cases followed by upper limb in 25 (23.81%) cases. The most common skin lesions were non infectious 70 (66.67%) cases, followed by infectious disease 22 (20.95) cases. In non infectious papulosquamous diseases group found 25 (23.81%) cases followed by vesiculobullous and vesiculopustular diseases group 24 (22.86%) cases. Infectious diseases were seen in 22 (20.95%) cases, out of which bacterial diseases being most common in 19 (18.10%) cases followed by parasitic infection 2 (1.90%) cases. Conclusion: According to the findings of the present study the major cases of skin lesions requiring biopsy in developing countries is still psoriasis in non infectious papulosquamous diseases group. Tuberculosis and leprosy in infectious diseases category were being the leading cause of morbidity.

Efficacy of Vitamin D Supplementation among Newly Diagnosed Cases of Rheumatoid Arthritis Proposed to be Managed by Methotrexate Monotherapy: A Randomised Controlled Study

Yashasvi Bansal, Pulkesh Singh, Prateek Agrawal, Hemraj Saini

Introduction: Methotrexate (MTX) has been the main drug that has been used worldwide for the treatment of Rheumatoid Arthritis (RA) either as a monotherapy or in combination with other Disease Modifying Antirheumatic Drugs (DMARD). Vitamin D deficiency has been shown to play an important role in the pathogenesis and progression of RA and its supplementation could have a promising role in management of RA. Aim: To evaluate the efficacy of vitamin D supplementation among newly diagnosed of RA cases scheduled for MTX monotherapy. Materials and Methods: This randomised controlled study was done at Era’s Lucknow Medical College and Hospital, Lucknow, India from January 2016 to December 2017. A total of 100 newly diagnosed patients of RA (p<0.001) were randomised to two groups: group A (n=50) received MTX monotherapy supplemented with 400 IU 25 Hydroxy [25(OH)] vitamin D twice a day (case group) whereas group B (n=50) received MTX monotherapy with placebo. Serum 25 Hydroxy vitamin D (S. 25 OH), American College of Rheumatology (ACR) score, Erythrocyte Sedimentation Rate (ESR) and Serum C-Reactive Protein (S. CRP) were assessed at enrolment, 3 months and 6 months. Data was analysed using Statistical Package for Social Sciences software (SPSS) version 21.0 software. Chi-square and Independent samples t test were used to compare the data. Results: Overall majority of patients were females 57% and 43% were males with mean age 40.98±8.83 years (range 26-60 years). At baseline, mean vitamin D levels were 22.94±12.41 and 25.54±12.79 ng/mL in groups A and B respectively (p-value>0.305). Mean ACR scores at baseline, 3 months and 6 months were 7.06±0.77, 5.16±1.11 and 4.42±0.93 respectively in group A and 7.02±0.74, 5.78±0.98 and 5.11±1.11 respectively in group B. At final follow-up, mean reduction in ACR scores and S. CRP levels was significantly higher in group A as compared to that in group B (p-value<0.001). Simultaneously, there was a significantly higher increase in vitamin D levels in group A as compared to that in group B (p-value<0.001). Conclusion: Vitamin D supplementation helped to potentiate the efficacy of MTX monotherapy in RA. Vitamin D deficiency causes diffuse musculoskeletal pain and its supplementation is needed for osteoporosis prevention.

Comparative Study of Clinical and Radiological Profile and Outcome of COVID-19 Patients with and without Co-morbidities: A Cross-sectional Study

Ummul Baneen, Mohammad Arif, Imrana Masood, Nader Abdul Razak, Zuber Ahmad

Introduction: Coronavirus Disease-2019 (COVID-19) had devastating effects on the healthcare and economic sector worldwide. India stands second in the list of most number of COVID-19 cases. Most of the deaths due to COVID-19 were seen in patients with associated co-morbidities like hypertension, diabetes, chronic kidney disease and obesity. This study would like to examine specific co-morbidities in relation to the COVID-19 disease progression and outcomes. Aim: To compare the clinicoradiological profile and outcome of COVID-19 in patients with and without co-morbidities (diabetes and hypertension). Materials and Methods: The present observational, cross-sectional study was conducted at Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh between June 2020 to September 2020, after obtaining Institutional Ethics Committee (IEC) approval. A total of 148 patients with COVID-19 were included in the study. The COVID-19 patients admitted in the hospital were divided into four groups as those having only diabetes, only hypertension, both diabetes and hypertension, and those without any co-morbidities. Those with any other co-morbidity were excluded from the study. The general clinical characteristics, laboratory parameters, disease severity, morbidity and mortality were compared among various groups and the data was analysed. Categorical data were analysed using the Chi-square test. Results: A total of 148 patients with COVID-19 were included in the study, of which 26 patients were diabetic, 36 were hypertensive, 24 were both hypertensive and diabetic and 62 patients didn’t had any significant co-morbidity. Severe COVID-19 disease was most commonly observed in those with diabetes (n=14) (53.8%). The highest proportion of patients requiring oxygen (84.6%) and Non Invasive Ventilator (NIV) support (46.1%) was also seen among diabetics. The presence of diabetes, severe disease and leukocytosis at presentation increased the risk of mortality. The association of hypertension with COVID-19 does not seem to affect the in-hospital mortality. Conclusion: COVID-19 in diabetics is associated with both increased risk of severe disease and increased odds of death. In diabetics, those with uncontrolled diabetes were more prone to severe disease and death than those with good glycaemic control. Hypertension, on the other hand, showed no association.

Utility of Umbilical Cord Blood Culture in the Diagnosis of Early Onset Sepsis: A Cross-sectional Study

Sujit Mulay, Rajib Chatterjee, Rahul Holkar, Deepika Bhalerao

Introduction: Umbilical cord is the first source of blood from the neonate. The clinical signs associated with sepsis are frequently non specific and subtle in the neonates making the diagnosis of infection difficult. Umbilical cord blood does not involve pain infliction, avoids iatrogenic blood loss and procedural complications. Aim: To evaluate the utility of Umbilical Cord Blood Culture (UCBC) in the diagnosis of Early Onset Sepsis (EOS). Materials and Methods: The present study was a cross-sectional study carried out in neonatology unit of Department of Paediatrics, Rural Medical College, Loni, Maharashtra, India, for the period of mid-March 2021 to mid-September 2021. Neonates delivered in Rural Medical College to the mothers having the risk factors for EOS were included in this study. Informed consent was taken prior to start of study. Thus, 68 samples were collected and studied. UCBC was collected with all aseptic precautions immediately after the umbilical cord was cut after the birth of the baby, venous blood sample was collected within one hour of birth. The data was presented as count and percentages. Results: Majority were female neonates 40 (58.8%). On analysing maternal risk factors it was seen 8.8% had previous low birth weight and 13.2% had Rh negative status. Analysis for presence of risk factors for sepsis majority 79.4% were multiple times examined per vaginally, followed by 36.8% had foul smelling liquor, 11.8% had febrile illness and 5.8% had birth asphyxia. On umbilical cord culture and sensitivity, most common microorganism identified was Staphylococcus aureus 8 (11.8%), followed by 8.8% Pseudomonas species. So, present study shows that 35.3% (24 cases) had positive culture reports using utility of UCBC in 68 patients. Conclusion: Study concludes that umbilical cord blood sampling and culture can be used as a tool for diagnosing bacterial sepsis in neonates especially the high-risk neonates.

Antibacterial and Antibiofilm Activity of Silver Nanoparticles Synthesised by Beetroot Containing Betalains Pigment on Clinical Bacterial Isolates

D Vijaya, N Thanga Raj

Introduction: Artificial colours have been used in foods for many years with adverse side effects. As a result, many studies have focused on natural dyes, and interest in natural dyes is increasing every day due to the lack of side effects. The betalains are pigments, which are present in the Beta vulgaris L (red beet) roots; these are exploited for native colouring and additive agents in food. These compounds possess many desirable properties such as antioxidant and antimicrobial activity etc., Nanotechnology is currently being used to enhance plant medicinal applications. It is an environmentally non toxic and low cost method. Aim: To examine the role of beetroot containing betalain on synthesising silver nanoparticles (AgNPs) and determine the antibacterial activity. Materials and Methods: This in-vitro study was carried in Department of Botany, KK College in Namakkal, Tamilnadu during the period of December, 2018 to December, 2020. The 2mM of AgNPs was utilised for the preparation of nanoparticles with beetroot containing betalains. The characterisation of synthesised AgNPs was done by Fourier Transform Infrared spectroscopy (FTIR), Ultraviolet-Visible (UV-Vis) spectroscopy, Transmission Electron Microscopy (TEM) and Scanning Electron Microscopy (SEM). In addition, the antibacterial activity of AgNPs was evaluated by the agar well-diffusion method. Results: In this study, the highest concentration of betalains observed at pH 5 in both solvents [ethanol (154.4 mg/100 mg) and water (131.2±0.15/100 mg)] was recorded. The acetone recorded a maximum of 143.8 mg/100 mg at pH 4. Bio sourced AgNPs had antibacterial activity against Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus sp, Salmonella sp and Acinetobacter baumannii. Furthermore, synthesised AgNPs inhibited the biofilm formation in all isolates. Conclusion: This study reveals that AgNPs exhibit strong antimicrobial activity so that they can be developed as new types of antimicrobial agents to treat bacterial infections, including biofilm bacterial infections, and are attractive and environmentally friendly.

First Trimester Prediction of Gestational Diabetes using a Predictive Model of Biochemical Parameters- A Longitudinal Study

Yegu Palaniappan, Sunita Samal, Muthu Lakshmi, Karthiga Prabhu

Introduction: Current international guidelines recommend screening for Gestational Diabetes Mellitus (GDM) between 24-28 weeks of gestational age. It has been proven that early diagnosis and prompt treatment can effectively reduce and can even avoid many of the maternal and foetal complications. There are no accepted methods of testing before the recommended 24-28 weeks which can predict the development of GDM. Aim: To develop a risk based predictive model using clinical and biochemical parameters for predicting the development of GDM in the first trimester. Materials and Methods: This longitudinal prospective observational study was conducted in the Department of Obstetrics and Gyanecology at the SRM Institute of Science and Technology, Kancheepuram, Tamil Nadu, India from January 2017 to July 2018 and included 120 pregnant women with gestational age <15 weeks over a period of 18 months. Detailed history, height, weight, Body Mass Index (BMI) and blood pressure were recorded followed by measurement of serum creatinine, uric acid and albumin. At 24-28 weeks of gestation, screening for GDM was performed according to Diabetes in Pregnancy Study group of India (DIPSI) criteria. Predictive modeling using stepwise linear regression to choose the best model that can predict the development of GDM was performed. A Receiver Operating characteristic Curve (ROC) was constructed to identify the best cut-off value that can predict the development of GDM. Results: A total of 130 pregnant women who fulfilled the inclusion criteria were enrolled for the study. Ten women were lost to follow-up in 2^nd trimester. Final cohort consisted of 120 women and 19 (15.8%) of them developed GDM based on DIPSI criteria between 24-28 weeks. Rest 101 (84.2%) did not develop GDM. Significant correlation was found between BMI (r=0.49, p<0.005), systolic Blood Pressure (BP) (r=0.35, p<0.005) and diastolic BP (r=0.33, p<0.005) with GDM. There was significant increase in creatinine and uric acid (p<0.005) and decrease in albumin (p<0.005) in GDM as compared to non GDM. First trimester uric acid >3.35 mg/dL showed sensitivity of 100% and specificity of 84.2% for predicting GDM. Predictive modeling showed that model containing uric acid, creatinine and albumin had a higher correlation (r=0.82) with Plasma Glucose (PG) as compared to other models containing uric acid alone or uric acid and creatinine. Conclusion: It is possible to predict the development of GDM early in the first trimester using this predictive model of biochemical parameters with high accuracy.

Assessment of Choroidal Thickness in Acute Central Serous Chorioretinopathy Using Swept Source Optical Coherence Tomography: A Case-control study

Arjun Bamel, Parag K Shah, Rahul Bharadwaj, Aeshvarya Dhawan, Anupam Singh

Introduction: Central Serous Chorioretinopathy (CSCR) is a disease characterised by localised Neurosensory Detachment (NSD) with or without focal Pigment Epithelial Detachments (PED) and altered Retinal Pigment Epithelium (RPE). Since CSCR being a pachychoroid entity the visualisation and evaluation of choroidal vessels have shown that vascular layers are altered in the disease process. Aim: To assess Sub Foveal Choroidal Thickness (SFCT), in acute Central Serous Chorioretinopathy (CSCR) patients in both affected and fellow unaffected eyes using Swept Source Optical Coherence Tomography (SS-OCT), and to compare these with age-matched control group. Materials and Methods: This was a hospital-based case-control study, conducted between July 2018 and May 2019 at Outpatient Department (OPD) of Aravind Eye Hospital, Coimbatore. Total of 41 patients and 41 controls from OPD were included. Uncorrected Visual Acuity (UCVA) and Best Corrected Visual Acuity (BCVA) were measured on Snellen’s chart. After pupil dilatation, posterior segment evaluation with slit lamp bio microscopy using a 90D lens and documentation with fundus photograph were done. All subjects were examined using SS-OCT which was done for both the eyes. Descriptive analysis such as mean, standard deviation and percentage were used to exhibit the clinical parameters. Independent t-test analysis was more suitable for this data. All the statistical tests were examined with 5% (p-value≤0.05) level of significance. Results: The age (mean±SD) of cases and controls were 38.44±6.14 years and 37.21±2.72 years, respectively. The mean SFCT of affected and unaffected fellow eye of cases were 465.39±60.02 μm and 407.12±57.29 μm respectively, (p-value<0.001). The mean SFCT of affected eyes of cases and control group eyes were 465.39±60.02 μm and 267.5±34.40 μm respectively, (p-value<0.001). Conclusion: The choroid was significantly thicker in affected as well as unaffected eye of CSCR patient. This implies that the CSCR affect the choroidal thickness in both affected as well as unaffected eye of patient as compared to control group.

Continued Mentorship Program for MBBS Students during COVID-19 Pandemic in Virtual Mode: A Questionnaire-based Observational Study

MD Shashikala, Kruttika Naik, K Narayana, CK Deepa

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic situation propelled the regular student mentorship program onto a virtual mode. Various surveys and studies have uncovered the ramifications on mental health and academic upheaval caused by the changing academic regulations and protocols. Aim: To evaluate the perception of mentors and mentees regarding the utility of virtual mentorship and to deduce barriers in continuing virtual mode mentorship program for 1^st-year medical students. Materials and Methods: The present observational study was conducted at Sri Siddhartha Institute of Medical Sciences and Research Centre, from April-June 2020. A feedback form was administered to all participants after two months of the online mentorship program, via a semistructured questionnaire. The questionnaire had four open and eight close-ended responses for mentees. The contents were related to the frequency of meetings, mode of communication, perceived barriers, and futility of course, along with one open and five close-ended responses for mentors on barriers to effective conduct and perceived level of the mentoring relationship forged with students. A total of 12 mentors and 125 students responded. Results: It was observed that 96% of mentees felt that the program helped to fight alienation and stay connected, 89.6% felt inspired to study and 83% felt oriented to the online teaching programs. Both 91.7% of mentors and 82.4% of mentees asked for better applications, connectivity, and network support. In fact, the major barrier to effective communication was quoted as being poor network connectivity and applications support (47%). A comparable trend was noted among both mentees and mentors with respect to the program being rated good and above (91.7% mentors and 85.6% mentees). Hence, in the observational study, via thematic analysis and content analysis of qualitative data, two points were observed-1. The virtual mentorship program helped mentees to get emotionally and academically connected, cleared their doubts, and helped to reduce stress. 2. Poor technical and connectivity support were deduced as major barriers to the successful conduct of virtual mentorship. Conclusion: A well-structured virtual mentorship program guides the mentors to effectively chaperone mentees through a stressful uninterrupted academic course period, enhance academic performances and help alleviate the feeling of alienation.

Assessment of Reliability of Advanced Lipid Parameters for Premature Coronary Artery Disease in Young Indians: A Case-control Study

Rahul Patil, Sheetal Kudineerakatte, Vikrant Vijan, Dimpu Edwin

Introduction: Coronary Artery Disease (CAD) appears even in patients with normal level of conventional lipid parameters. But due to lack of specific guidelines on Indian population, involving detection of advanced lipid indices, has resulted in inadequate finding, management, and control of cardiovascular disease risks. This emphasises the need of advanced lipid indices for prediction of CAD at younger age. Aim: To evaluate the reliability of advanced lipid indices compared to conventional lipid parameters for diagnosis of CAD. Also, to determine the effectiveness of advanced lipid indices in screening young Indian for the risk of Premature CAD (PCAD). Materials and Methods: A case-control study was conducted at a tertiary care centre in Bengaluru, Karnataka, India, between January 2020 to January 2022. The study enrolled total 983 subjects which were divided into cases and controls. The estimation of usual lipid profile (Triglycerides (TG), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Total Cholesterol (TC)) and advanced lipid parameters, oxidized LDL, Apolipoprotein A1 (Apo A1), lipoprotein (a), small density LDL (Sd-LDL), and Apolipoprotein B-100 (Apo B) was studied for each enrolled individual. These lipid parameters were used to calculate various lipid indices like Lipid Pentad Index (LPI), Lipid Tetrad Index (LTI), Atherosclerotic Index (AI), and Advanced Atherosclerotic Index (AAI); and TC/HDL ratio. Statistical analysis was performed using Chi-square test, Fisher’s exact test, multivariate logistic regression, and Student’s t-test/Analysis of Variance (ANOVA) test. Results: Mean age of patient in case group was 32.31±5.42 years and individuals in control group was 32.13±5.21 years. Among case group, 427 (88.04%) enrolled males had PCAD. In case group, total 45 (9.28%) had diabetes, 51 (10.51%) had family history of PCAD and 230 (47.42%) patients were smokers. The values of TC (p=0.009), LDL (p<0.001), Apo A1 (p<0.001), HDL (p<0.001) were significantly lower among cases compared to controls, lipoprotein (a) (p=0.04), Sd-LDL (p<0.001), TG (p<0.001) were significantly higher among cases compared to controls. Among the calculated lipid indices, the values of AI (p<0.001), LTI (p<0.001), LPI (p=0.001) and AAI (p=0.01) were significantly higher among cases as compared to controls. Conclusion: Advanced lipid indices are statistically more reliable than conventional lipid parameters. Newer advanced lipid indices are effective in screening young Indian individuals for the risk of PCAD.

A Prospective Study Comparing Arthroscopic Release, Intra-articular Steroid and Physical Therapy for Frozen Shoulder

Introduction: Frozen shoulder or Adhesive Capsulitis (AC) is a painful condition with fibrotic and contracted shoulder joint capsule. There is a lack of development of an effective treatment protocol for idiopathic AC. Aim: To evaluate the relative efficacy of Arthroscopic Capsular Release (ACR) and intra-articular steroid injections compared to standard physical therapy in isolation for frozen shoulder. Materials and Methods: This prospective interventional study was conducted at Maulana Azad Medical College, New Delhi, India between October 2012 to October 2015. Patients older than 40 years of age, with symptoms of AC for at least six months, without any related trauma or surgery or uncontrolled diabetes mellitus, and who did not respond to the conservative treatment, were selected. Ten patients were recruited each in the ACR, intra-articular steroids injection, and physical therapy groups. Shoulder Range of Motions (ROM), and the pre and post-treatment Shoulder Rating Questionnaire (SRQ) scores were calculated. Data analysis was performed using a Statistical Package for the Social Sciences (SPSS version 17). Results: The sample consisted of 12 male (40%) and 18 female (60%) patients with an average age of 52.2 years. There was no difference between the groups as far as the demographic characteristics were concerned. The SRQ scores and ROM in all the groups registered significant improvement compared to their pretreatment levels with a p-value of less than 0.005 for all three groups. However, the relative efficacy of different modes of treatment i.e. ACR, intra-articular steroid injection, and physical therapy, were found to be similar (p-value 0.165). Conclusion: The ACR does not provide any significant advantage over less invasive treatment alternatives. Therefore the authors recommend ACR only as a last option where other less invasive treatment modalities have failed.

Effects of Pregabalin versus Gabapentin on their Opioid Sparing Effects among Patients Undergoing Laproscopic Cholecystectomy: A Randomised Controlled Study

Kishore Kumar Arora, Sushma Handattu, Deepali Valecha, Nidhi Sharma

Introduction: Gabapentin and pregabalin were earlier used as antiepileptics. These have been also found to have analgesic, anticonvulsant and anxiolytic effects. Aim: To compare the pre-emptive use of pregabalin and gabapentin on their opioid sparing effects among patients undergoing laparoscopic cholecystectomy. Materials and Methods: This randomised controlled, single-blind study was conducted in Department of Anaesthesiology at Mahatma Gandhi Medical College and M.Y Hospital Indore, Madhya Pradesh, India, from August 2020 to August 2021. The study included 90 patients of American Society of Anaesthesiologists (ASA) physical status class I/II, undergoing elective laparoscopic cholecystectomy. Patients were allocated randomly into three groups, 30 patients each. Group P receiving tablet oral pregabalin 150 mg, group G receiving oral gabapentin 600 mg and group C receiving tablet multivitamin (control group), before induction of anaethesia. Intraoperative requirement of opioids, sedation score, Visual Analogue Scale (VAS) score, and postoperatively analgesia requirement in the form of opioid were noted. Association between two non parametric variables was done using Pearson Chi-square test. Comparison of means between three groups was done using One-way Analysis of Variance (ANOVA) followed by Post-hoc Turkey test. Statistical Package for Social Sciences (SPSS) version 20.0 software was used. Results: The mean age in group P, C and G was 39.73±13.55 year, 38.67±13.33 year and 41.03±5.62 years (p-value=0.726). The mean intraoperative requirement of opioid in pregabalin group was 100 μg, in gabapentin group was 100 μg when compared to control group 150 μg. Postoperative requirement of analgesic was later in pregabalin group (7.23±0.64 hours) compared to gabapentin group (5.78±0.49 hours) and control group (4.37±0.47 hours). Conclusion: Pregabalin and gabapentin have opioid-sparing effect intraoperatively and postoperatively and can be used pre-emptively as an attractive choice.

Awareness of the Role of Anaesthetists and Importance of Preanaesthetic Check-up among Patients: A Cross-sectional Study

Lata D Shetty, Kailash Veerareddy Reddy

Introduction: Patients scheduled to undergo elective surgeries should be assessed, well in advance, by anaesthetists with a view to plan optimal preparations and perioperative management regarding their anaesthetic requirements. Aim: To assess the knowledge of the role of anaesthetists during the perioperative period and the importance of preanesthetic check-up among patients undergoing elective surgery. Materials and Methods: A cross-sectional study was conducted in Khaja Bandanawaz Institute of Medical Sciences, Kalaburgi, Karnataka, India, from August 2019 to February 2020. The study involved 300 patients posted to the preanesthetic check-up clinic, over a span of six months for elective surgeries. Patients were asked to complete a questionnaire consisting of 17 questions. Statistical analysis was carried out using Statistical Social Science Packages (SPSS) version 16.0 for Microsoft Windows and Excel. Results: A total of 66% (198) patients were males. The mean age of participants was 38.68±10.35 years. Graduates made up 28.6% of the participants, and 44.3% of them either had some schooling (primary or secondary) and the rest 27% did not have any education. Overall, 23% (69) participants had a history of surgery and except one, all received both Preanaesthetic Check-up (PAC) and anaesthesia during their previous surgery. The mean percentage (89.3%) of awareness was highest among the participants with a history of previous surgery (p-value <0.001). Conclusion: The present study concluded that demographic characteristics such as age, sex, occupation, education and residence do not influence the awareness and importance of preanesthetic check-up clinic however, history of previous surgery was statistically significant.

Quantification of Microsomal Triglyceride Transfer Protein in Non Alcoholic Fatty Liver Disease Patients: A Cross-sectional Study

Mayuri Shukla, Mamatha Kunder, Prabhakar Kamarthy, Sharath Balakrishna

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is one of the common liver disease characterised by fat accumulation in hepatocytes. NAFLD is a broad spectrum of simple steatosis, Non Alcoholic Steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Triglycerides (TG) are exported in the form of Very Low Density Lipoprotein (VLDL). VLDL are formed by incorporation of TG into apo-B by Microsomal Triglyceride transfer Protein (MTP). Therefore, MTP is a key protein for lipid transport. Estimation of MTP protein levels and its correlation with simple steatosis and steatohepatitis can be helpful in understanding its role in NAFLD progression. Aim: To estimate the serum levels of MTP in simple steatosis and steatohepatitis and also to check its correlation with TG and VLDL in NAFLD patients with and without co-morbidities. Materials and Methods: The present cross-sectional study was carried out in Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, between November 2019 to January 2021. Study participants included 60 NAFLD subjects which were divided into simple steatosis (group 1, n=10) and steatohepatitis (group 2, n=50). These subjects were further subdivided into cases with co-morbidities and cases without co-morbidities. Serum levels of MTP, high sensitivity C Reactive Protein (hs-CRP), Fasting Blood Sugar (FBS), liver enzymes, lipid profile were assessed. Statistical analysis was done by using unpaired Student’s t-test and Pearson’s correlation. Results: The mean age was 46.5 years in steatosis group and 48.85 years in steatohepatitis group. In steatosis group, there were 5 (50%) males and 5 (50%) females, whereas in steatohepatitis group 32 (64%) were females and 18 (36%) were males. The serum levels of MTP were significantly decreased in simple steatosis cases with co-morbidities as compared to cases without co-morbidities (p=0.006). A significant negative correlation was observed between MTP v/s TG and MTP v/s VLDL (r=-0.665, p=0.036) in simple steatosis cases with and without co-morbidities. Same trend was observed in steatohepatitis cases but the correlation was insignificant (r=-0.08, p=0.563). Conclusion: The serum levels of MTP decreases as the NAFLD progresses. A significant decrease in serum levels of MTP was also observed in cases with co-morbidities as compared to cases without co-morbidities. Serum levels of MTP showed negative correlation with TG and VLDL in simple steatosis cases.

Analysis of Conjunctival Bacterial Flora among Patients Undergoing Multiple Intravitreal Injections for Diabetic Macular Oedema: A Cohort Study

Roopashree Kamisetty, SM Rudresh

Introduction: Intravitreal Injections (IVI) are frequently used for the treatment of Diabetic Macular Oedema (DME). Serial IVI in these patients along with topical antibiotics as prophylaxis for infection has raised concern about the probable detrimental effect on conjunctival flora. However, the risk of postoperative endophthalmitis is higher in diabetics, especially with poor glycaemic control or in the presence of Chronic Kidney Disease (CKD) owing to poor immunity. Hence, preoperative conjunctival microbial growth has been studied in these patients to understand the need for antibiotic prophylaxis. Aim: To evaluate the preoperative conjunctival microbiological profile in diabetic patients treated with serial IVI (minimum of three) for DME and its association to their glycated haemoglobin (HbA1c) levels and the presence of associated CKD. Materials and Methods: This retrospective cohort study conducted in the Department of Ophthalmology at ESIC Medical College and Research Institute, Bengaluru, Karnataka, India, in May 2021. Total 92 eyes of 79 patients with type 2 diabetes mellitus who had received a minimum of three serial IVI of anti-Vascular Endothelial Growth Factor (anti-VEGF) injections for DME between May 2018 and January 2020 were included in the study. Conjunctival swabs for culture were taken from each eye before the injection and were evaluated for microbial growth. The association between microbial growth and HbA1c levels and/or CKD was analysed statistically using the Chi-square test. Results: The conjunctival cultures taken before IVI, were positive in 29.3% (27 of 92 eyes). Among them, Coagulase Negative Staphylococcus (CONS) bacteria were isolated in 15 of 27 eyes (55.5%) followed by Micrococci in 10 eyes (37%) and Diphtheroids in two eyes (7.4%). The average HbA1c among the eyes with positive growth was 7.23±1.31 as compared to 6.64±1.08 in eyes with no growth (p-value=0.1). There was a statistically significant association of culture positivity in patients with CKD and having HbA1c ≥7% (p-value=0.01) with CONS being the most common organism. Conclusion: A statistically significant association of conjunctival swab culture positivity in type 2 diabetics with DME requiring multiple IVI having uncontrolled diabetes HbA1c ≥7% and the presence of CKD was observed in the present study. Hence, the routine use of topical antibiotics as infection prophylaxis may be recommended in these patients as an additional precaution against endophthalmitis.

Assessment of Epithelial to Mesenchymal Transition Markers in Breast Carcinoma and its Association with Histopathological Grading, Size and Metastasis

Hage Nobin, Sayeedul Hasan Arif, Afzal Anees, Mohd Khalid

Introduction: Carcinoma breast is the most common malignancy affecting women worldwide. Early detection is key to its effective management. Epithelial to Mesenchymal Transition (EMT) has implications in progression of breast carcinoma and metastasis. Aim: To assess use of EMT Immunohistochemical (IHC) markers in breast carcinoma. Materials and Methods: This is a hospital-based descriptive study and was carried on patients of breast carcinoma attending the Outpatient Department of Surgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India, from July 2011 to October 2013. Histopathological examination of 67 mastectomy specimen was done and graded using Scarff-Bloom-Richardson (SBR) grading system. Lymph nodes found were screened for metastasis. Subsequently IHC study with cytokeratin 5/6 and vimentin were done to assess EMT. Statistical analysis was done using Chi-square or Fisher’s exact test on Statistical Package for Social Sciences software (SPSS) version 15.0 USA. Results: Using SBR grading system, 11 (16.4%) cases were of grade I, 34 (50.7%) cases of grade II and 22 cases were of grade III (32.8%). Out of total, 27.3% (3/11) of grade I, 67.6% (23/34) of grade II and 90.9% (20/22) of grade III tumor were found to have metastasis. Positivity for cytokeratin 5/6 and vimentin were 27.3%(3/11) and 63.6% (7/11) respectively in grade I tumours. Grade II tumours showed 5.9% (2/34) positivity for cytokeratin 5/6 and 82.4% (28/34) for vimentin. Positivity for cytokeratin 5/6 was 0 and 95.5% (21/22) for vimentin in grade III tumors. Conclusion: Increase in metastasis was seen with progression of grade. Down regulation of cytokeratin5/6 and up-regulation of vimentin was observed as the grade of tumour increased.Cytokeratin 5/6 and vimentin may be used to assess EMT which in turn shows higher chances of metastasis.

Reliability and Validity of Gujarati Version of SARC-F Tool Used as Screening of Sarcopenia: A Cross-sectional Study

Kairavi Trivedi, Subhash Khatri

Introduction: Sarcopenia is a disease which causes gradual loss of muscle mass, strength, and physical capability of one’s health mainly seen in older age. Early detection of sarcopenia and good treatment with proper diet should be necessary to prevent it. Strength, Assistance in Walking, Rise from chair, Climbing stairs, Falls (SARC-F) is the English questionnaire used for early screening of sarcopenia. SARC-F questionnaire contains five components. It was recognised as the most up-to-date and coherent screening tool for screening the sarcopenia. Aim: To translate and validate the Gujarati version of SARC-F questionnaire. Materials and Methods: A cross-sectional study was conducted at the Nootan College of Physiotherapy, Visnagar, Ahmedabad, Gujarat, India between the 1^st week of May to 1^st week of June 2022 to translate the English origin SARC-F questionnaire in Gujarati language. For validation process, 190 individuals more than 60 years old, both male and female across Ahmedabad with normal cognition, able to walk independently were included in the study. Individuals were asked to complete the translated version of the SARC-F questionnaire over the gap of 48 hours for measuring the test-retest reliability. Face validity and content validity were assessed by the expert committee itself. Results: A total of 190 participants were included in the study in which 87 were males and 103 females. Out of total paricipants 51 (26.84%) were diagnosed with sarcopenia. The reliability was checked by Interclass Correlation Coefficient (ICC) value which was 0.811 suggesting good reliability. Face validity was checked by the team of eight experts. Content validity was assessed with Content Validity Ratio (CVR) value more than 0.75 which suggested good content validity. The Content Validity Index for each item on the scale (I-CVI) value was in the range of 0.84 to 1 that also suggested good content validity at individual item level. Conclusion: The translation process and validation of SARC-F Gujarati questionnaire demonstrated good content validity. The translated Gujarati questionnaire was a simple and reliable tool for diagnosing sarcopenia in daily clinical practice in older individuals.

Nucleic Acid Test versus Enzyme Linked Immunosorbent Assay for Screening of Human Immunodeficiency Virus in Donated Blood Units: A Comparative Study at a Blood Centre in Western Rajasthan, India

Rishi Mathur, NL Mahawar, DR Arya, Arun Bharti

Introduction: With a population of 1.3 billion people and a frequency of Human Immunodeficiency Virus (HIV) (0.17-0.29%), Hepatitis B Virus (3-4%), and Hepatitis C Virus (0.09-15%) in the general population, maintaining blood safety is a difficult undertaking in India. The fourth-generation Enzyme Linked Immunosorbent Assay (ELISA), which can be used in place of Nucleic Acid Amplification Test (NAT) testing in situations with limited resources, has been recommended as the minimal HIV test to increase the safety of blood transfusions. Aim: To compare the fourth generation ELISA with NAT in the screening of transfusion transmissible HIV infection in blood donors. Materials and Methods: A cross-sectional study was carried out at the Blood Centre, Department of Immuno-Haematology and Transfusion Medicine, Sardar Patel Medical College and Associated Groups of Hospitals, in Bikaner, Rajasthan, India. A total of 2000 voluntary and replacement blood donors were recruited consecutively between January 2020 to December 2021 (two years), and their samples were screened using fourth-generation ELISA. All of these samples were sent to AIIMS in Jodhpur for NAT to identify HIV RNA, HCV RNA and HBV DNA. Results: In this study, when the fourth generation ELISA negative samples were subjected to NAT, no sample was found to be reactive for HIV in NAT, i.e. there was no NAT yield for HIV. Conclusion: As a bare minimum, the fourth-generation ELISA test should be used for blood donor screening and can be considered a cost-effective and reliable test in a resource limited setting. However, additional tests can be advocated for an additional layer of blood safety.

Awareness and Practice Concerning Biomedical Waste Management with Special Reference to COVID-19 among Healthcare Providers at a Tertiary Care Centre in Karnataka, India

BI Vedavati, Nazeema Tabaseera, MR Vathsalya, Rahul Attavar

Introduction: Growing healthcare facilities to provide better health for patients have contributed in increased generation of Biomedical Waste (BMW). Emergence of Coronavirus Disease-2019 (COVID-19) has added to this burden. BMW carries a higher risk of infections, injuries and also environmental hazards. Effective management of BMW is a fundamental practice of healthcare providers in averting health and environmental hazards. Aim: To know about the awareness and practice concerning BMW management among healthcare provider at tertiary care hospital. Materials and Methods: The present cross-sectional study was conducted at district hospital attached to Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India, for seven months during July 2021 to January 2022. A total of 232 Healthcare Workers (HCWs) who were involved in patient caring participated in this study. Study included Questionnaires (30 questions) regarding awareness and practice of BMW management. The data was procured by structured self-administered questionnaire through Google forms. Results: The study showed that majority of participants had good awareness and modest numbers of participants were practicing proper method of waste management. About 93.5% were aware of BMW management categories, 98.7% of participants knew regarding which coloured bags are used for collection. Study identified some gaps in awareness and practices. About 49.1% participants dispose used Personal Protective Equipment (PPE) during COVID-19 into proper bag, only 27.6% participants knew correctly regarding maximum time limit to store BMW. Conclusion: Every healthcare provider must have proper knowledge and awareness of BMW management. It is necessary to contain transmission of infection and prevention of environmental hazards caused due to BMW. The study emphasises the need for regular monitoring and training requirement at all level to bridge the awareness gap. Proper BMW handling and disposal are components of infection control measures.

Effectiveness of Low Dose Dexmedetomidine for an Oligaemic Field in Middle Ear Surgery: A Randomised Control Trial

Nitin Agrawal, Smriti Sinha, Reena R Kadni, Shekhar Ramkrishnan

Introduction: Microscopic middle ear surgeries are best done under hypotensive anaesthesia to provide an oligaemic field. Dexmedetomidine is an α2 agonist which produces hypotension by sympathetic response blockade. Aim: To study the effectiveness of low dose dexmedetomidine in providing an oligaemic field. The additional requirement of inhalational agent required to maintain the oligaemic field in the control group, intubation response and postoperative analgesia were also assessed. Materials and Methods: The randomised, placebo-controlled double-blind study was conducted by recruiting 48 patients in the study, who were divided into two groups i.e, study group (n=24) and placebo group (n=24). The study group received low dose dexmedetomidine infusion (0.5 μg/kg loading dose followed by 0.2 μg/kg/hr) and placebo group received weight-adjusted saline. The quality of the surgical field was assessed on a score of 0-5. The Minimum Alveolar Concentration (MAC) of inhalational agent needed, postoperative sedation score and pain score were noted. All the data were recorded in Statistical Package for Social Sciences (SPSS) software, version 22.0. Results: The mean score of quality of the surgical field in the study group was 2.00±0.59, compared to 3.50±0.88 in the placebo group. The mean MAC of isoflurane was 1.32±0.31 in the placebo group and 0.85±0.23 in the study group (p-value=0.03). The study group had a Ramsay sedation score of 3.08±0.65 compared to 2.29±0.75 in the placebo group at 5 minutes after extubation (p-value <0.001). The mean pain score in the dexmedetomidine group in 10 minutes postoperative period was 1.83±2.25, while in placebo group it was 3.25±1.96 (p-value=0.025). However, over the next 20-60 minutes postoperative period the pain score between the two groups were comparable, with no significant difference in analgesia, postoperative shivering and other side-effects. Conclusion: A low dose dexmedetomidine can effectively provide a bloodless field for middle ear microsurgical procedures.

Effect of Mouthwash on Release of Elements from Dental Casting Alloys: An In-vitro Study

Shubha Joshi, Pronob Sanyal, Jyotsna Arun Patil

Introduction: Mouthwashes are regularly prescribed as a maintenance phase of treatment by the dentist. The pH of the mouthwash can enhance the elemental release from the cemented prosthesis. Aim: To evaluate the effect of two types (Oral-B and Listerine) of mouthwashes on the release of elements from Nickel-Chromium (Ni-Cr) dental alloys. Materials and Methods: An in-vitro comparative study was conducted in the Department of Prosthodontics, School of Dental Sciences, Karad, Maharashtra, India, from April 2018 to April 2022. A total of 90 crowns were fabricated using three different brands of dental casting alloys (DCA) using lost wax technique. The crowns were immersed into two different mouthwashes (Oral-B and Listerine) in polypropylene test tubes, and then incubated at 37°C to simulate the oral temperature for 1, 4, and 7 days. The leaching of the elements from the fabricated crowns into the mouthwashes was analysed using inductively coupled plasma mass spectrometry (ICP-MS). Data analysis was performed using the t test and repeated measure Analysis of Variance (ANOVA) followed by post hoc Dunnett Multiple Comparisons Test. Results: The Ni and Cr levels in the mouthwashes were significantly elevated in brand I (Ruby, Japan Dentistry Products Pvt. Ltd.), brand II (Dentmark, R&D Impex International), and brand III (BEGO, GmbH & Co KG). Presence of Ni released from all the three brands of DCA in mouthwash over a period of 1, 4, and 7 days was detected to be in the range of 16 to 39.9 μg/L. Cr released from all the three brands of DCA in mouthwash over a period of 1, 4, and days was detected to be in the range of 10.3 to 42.8 μg/L. Conclusion: The Ni and Cr were released in the mouthwash and the release increased with time. The acidic pH of Listerine adds to the increased release of Ni and Cr.

Safety and Efficacy of Enalapril Combined with Metoprolol in Patients of Hypertension Complicated with Coronary Heart Disease: A Randomised Clinical Trial

Ping Wang, Lijun Wang, Zhihui Liu, JI Feng

Introduction: Enalapril, which inhibits Angiotensin-Converting Enzyme (ACE), is a commonly used drug for the treatment of hypertension. Metoprolol, a β-blocker, is widely prescribed for patients with cardiac diseases. Essential hypertension has been identified as an independent risk factor of Coronary Heart Disease (CHD). Until now, there are few studies and reports on the application of the two drugs in patients with Hypertension and Coronary Heart Disease (HCHD). Aim: To assess the safety and efficacy of enalapril combined with metoprolol in patients with HCHD. Materials and Methods: The present single-centre randomised clinical trial was conducted on 109 patients with HCHD at Jingdezhen Municipal First People’s Hospital from April 2018 to January 2020. The participants were randomly divided into into two groups, one group on enalapril (n=58), and the other on enalapril and metoprolol combination (n=51). Patients in both groups were treated for eight weeks. The blood pressure, cardiac function index, serum C-Reactive Protein (CRP), Homocysteine (Hcy), and Matrix Metalloproteinase-9 (MMP-9) levels were compared between the two groups, and the adverse drug reactions of the two groups were statistically analysed using independent sample t-test or Mann-Whitney U test. Results: The mean age of enalapril group was 64.78±7.29 years, and the gender ratio was 1:1.42. The mean age of enalapril/metoprolol combination group was 63.90±6.91 years, and the gender ratio was 1:0.96. After treatment, both systolic and diastolic blood pressure of the enalapril/metoprolol combination group were significantly lower than that of enalapril group (p<0.05). Enalapril combined with metoprolol significantly improved cardiac function and significantly decreased the levels of serum inflammatory markers (CRP 18.57±3.61 vs 27.50±3.60, p<0.001; Hcy 12.14±2.07 vs 13.83±2.17 mmol L^-1, p<0.001; MMP-9 372.35±12.34 vs 436.69±13.89 pg L^-1, p<0.001; Transforming Growth Factor ALPHA (TGF-a) 8.18±1.38 vs 10.40±1.44 mmol L^-1, p<0.001). The overall rate of adverse reactions was not significantly different between the groups (enalapril/metoprolol combination group vs enalapril group, 15.69% vs 10.34%, p=0.406). Conclusion: The combined treatment of enalapril and metoprolol was more effective than enalapril alone in reducing the inflammatory response, reducing blood pressure, and improving cardiac function in patients with HCHD. This combinational therapeutic strategy may be a better choice for patients with HCHD.

Significance of HER2/neu Expression in Oesophageal Carcinomas and its Association with the Histopathological Grading

Saranya, Suriya Prabha, Surekha Bantumilli, Megala Chandrasekar

Introduction: Oesophageal carcinomas are one of the most aggressive human malignancies which are associated with a poor prognosis because most of the cases are in stage 2 or 3 at the time of diagnosis with a high frequency of lymph node metastases. It is important to know the prognostic factors can help us on therapeutic decisions and improve the survival of these patients. A member of Epidermal Growth Factor Receptor (EGFR) family, Human Epidermal Growth Factor Receptor 2 (HER-2/neu) is a very useful antigenic marker expressed in oesophageal carcinomas which has increasing evidence of therapeutic significance. Aim: To determine the immunological expression of HER2/neu in oesophageal carcinomas and associate it with the histopathological grading. Materials and Methods: This cross-sectional study was conducted in Department of Pathology at Coimbatore Medical College, Coimbatore, Tamil Nadu, India, from January 2015 to February 2016. Total 30 cases of histologically proven oesophageal carcinomas were subjected for HER2/neu immunoexpression. Membranous staining was considered as positive and the intensity of staining was scored and compared with various histopathological parameters. The p-value<0.05 using a two-tailed test was taken as level of significance for all statistical tests. Results: Among 30 cases, 24 were squamous cell carcinomas and six were adenocarcinomas. Out of 24 cases of squamous cell carcinomas, there were 20 males and four females. All the six adenocarcinoma cases were males. HER2/neu was positive in 10 cases(41.6%) of squamous cell carcinoma and 4 cases(66.6%) of adenocarcinoma. It was seen in 10% of well differentiated, 60% of moderately differentiated and 80% of poorly differentiated carcinomas. There was significant correlation with staging and lymph node metastases. Higher grade tumours had higher level of expression of HER2/neu. Conclusion: The HER2/neu immunoexpression was significantly higher with progression of tumour grade. Hence, such patients with high grade oesophageal carcinomas and with lymph node metastases could be benefitted with targeted therapy.

Neutrophil-lymphocyte Ratio as Independent Prognostic Factor among Breast Cancer Patients in a Tertiary Care Hospital, Kolkata, India

Nabanita Mayur, Anup Kumar Roy, Lahari Banik

Introduction: The most important prognostic factor for breast cancer is tumour stage and tumour grade. However, the assessment of the above parameters are time-consuming and require expertise. Thus evaluation of the prognosis of breast cancer is still limited to tertiary care hospitals, with appropriate facilities for histopathological techniques. Recently, inflammatory blood markers have shown a role as a prognostic factor. Out of all the inflammatory blood markers, neutrophil-lymphocyte ratio has emerged as the most useful. Abundant evidence suggests the role of NLR as an adverse prognostic factor in breast cancer. NLR is simple and inexpensive. It can be easily obtained, as the differential count of every patient is done routinely. Thus it can act as an indicator of high-risk patients who are likely to show poor prognosis. Though NLR has been found to play a role in prognosis prediction in breast cancer, much is unknown in this field. Aim: To assess the effectiveness of Neutrophil-Lymphocyte Ratio (NLR) as an independent prognostic parameter among breast cancer patients in a tertiary care hospital in Kolkata, India. Materials and Methods: This observational cross-sectional study was conducted in Department of Pathology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, where 140 female patients undergoing mastectomy for breast cancer were studied from 1^st February 2019 to 31^st January 2020. The clinicopathological parameters, histopathological parameters, and molecular subtypes were evaluated. NLR was calculated and related with the other prognostic parameters. Data entry was done in Microsoft Excel and analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. One way Analysis of Variance (ANOVA) test and Chi-square test was conducted to assess the relationship of NLR with various other prognostic factors. Results: Out of 140 patients, 78 patients showed NLR values within 1.8 to 3.33. Higher NLR (>3.33) was associated with poor prognostic factors like higher T stage (T4) {17 (53.1%)}, higher stage (stage III) 95 (67.8%), skin involvement 19 (47.5%), Lymphovascular involvement in 23 (39.7%), perineural involvement in 10 (71.4%) and in patients with HER2 positive molecular subtype in 8 (5.7%). Conclusion: This study suggests that a high NLR value was associated with poor prognosis in breast cancer patients. Thus, it can be used as an independent marker of poor prognosis and can help guide the treatment of breast cancer patients. The more we study the role of NLR, the more useful it will be in predicting the course of breast cancer as early as possible.

Safety and Immunogenicity Outcomes of an Inactivated Viral Vaccine against SARS-CoV-2 (Covaxin®)

Introduction: Bharat Biotech International Ltd in partnership with National Institute of Virology (NIV), has developed an indigenous whole virion inactivated Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) viral vaccine BBV-152 (Covaxin^®), formulated with Toll Like Receptors 7/8 agonist Imidazoquinoline (IMDG) molecule adsorbed to alum (Algel). Variety of factors other than environmental ones can affect vaccines efficiency outside the strict setting of clinical trials, like how the vaccine is stored or transported, and even how patients are vaccinated. In addition, the intrinsic capacity of the recipient to respond to a vaccine which is determined by sex, genetic factors, age, psychological stress, nutrition and other diseases are also likely to have an impact. Aim: To determine the safety, reactogenicity and immunogenicity of the inactivated whole virus vaccine (Covaxin^®) amongst hospital-based population groups. Materials and Methods: The prospective analytical study was conducted in the Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from January 2021 to March 2021.The study primarily included Healthcare Workers (HCWs) employed at SMS Medical college and attached hospitals. In-vitro quantitative IgG antibodies against SARS-CoV-2 spike Receptor Binding Domain (RBD) were measured using Chemiluminescence Immunoassay (CLIA) based Advia centaur SARS-CoV-2 IgG, manufactured by Siemens Pvt Ltd, Munich, Germany, as per manufacture’s instructions. Results: Out of total 223 individuals, 61.88 % (138/223) showed neutralising antibody titre of >1 index value by CLIA, rest 38.12% (85/223) were non reactive i.e., titre <1 index value, after four weeks of receiving first dose of Covaxin^®. After 2 to 4 weeks of receiving second dose 84.30% (188/223) showed neutralising antibody titre of >1 index value by CLIA, rest 15.70% (35/223) were non reactive i.e., titre <1 index value. After receiving first dose, 100% (223/223) of the participants developed localised pain and bodyache 33.63% (75/223). None of the participants showed any anaphylactic reaction or any emergency condition just after vaccination. Conclusion: Covaxin^® is a well-tolerated vaccine, and induces good humoral response against SARS-CoV-2 with a significant rise in the neutralising antibody titres.

The Importance of Estrogen Receptors in Aetiopathogenesis of Carpal Tunnel Syndrome in Postmenopausal Women

Introduction: Carpal Tunnel Syndrome (CTS) is a common peripheral neuropathy in postmenopausal women which is caused by compression of the median nerve in the carpal tunnel. Although mostly idiopathic, the aetiopathogenesis of CTS was not quite clear. Aim: To verify the possible role of the estrogen surges and the presence of Estrogen Receptor (ER) in tenosynovial tissue on postmenopausal period, in the pathogenesis of idiopathic CTS. Materials and Methods: The present study was a retrospective study conducted on, 16 patients with CTS in premenopausal group (group 1) and 18 patients with CTS in postmenopausal group (group 2). In the study, tenosynovial tissue samples of patients who had surgery due to CTS were used. Biopsy samples of 34 patients who were operated in the neurosurgery department of KSBU Medical Faculty Evliya Celebi Training and Research Hospital between January 2011 and January 2012 were included in the study. An examination was made by Haematoxylin and Eosin (H&E) in the tenosynovial tissue. ER was performed by immunohistochemistry on tissue samples. The non inflammatory fibrosis, vascular proliferation, oedema were observed. A nuclear staining for ER was observed in synovial lining cells and fibroblasts in the tenosynovial tissue. Results: The number of positive cells for ER in the tenosyvial tissue in postmenopausal patients with CTS was found higher according to premenopausal patients with CTS (p<0.01). A high association was found among patient age, severe EMG findings and ER positivity. Conclusion: There roles of hormonal surges in postmenopausal period and increased ER positivity in the tenosynovial tissue in the aetiopathogenesis of CTS.

Evaluation of Urinary Calcium, Creatinine and their Ratio in Preeclampsia: A Case-control Study

Sonia Jindal, Sunita Manhas, Monika Rathee

Introduction: Preeclampsia is a hypertensive disorder characterised by high blood pressure during pregnancy. It is the major cause of maternal and perinatal morbidity and mortality in females. Prediction of Pregnancy Induced Hypertension (PIH) can be done by using a valuable marker i.e. Urinary Calcium-Creatinine ratio (UCa/Cr). Aim: To evaluate the urinary calcium, creatinine and UCa/Cr ratio in patients with preeclampsia and also to check the association of UCa/Cr ratio with the severity of the disease. Materials and Methods: The present case-control study was conducted in the Department of Biochemistry in collaboration with department of Obsteritics and Gynecology, Maharishi Markandeshwar University, Ambala, Haryana from January 2018 to January 2021. Total of 120 pregnant women with gestational age ≥20 weeks (60 normal and 60 preeclampsia) were evaluated for urinary calcium, urinary creatinine and UCa/Cr ratio. For statistical analysis, Unpaired t-test and Chi-square test and was applied. Results: The mean age of control group was 27.51±5.05 years and for case group was 29.8±5.49 years. The level of urinary calcium and urinary creatinine was found to be significantly (p-value<0.001) lower in case group (3.54 mg/dL and 42.90 mg/dL respectively) as compared to control group (8.22 mg/dL and 80.40 mg/dL respectively). The level of UCa/Cr ratio was also significantly (p-value <0.001) lower in case group (0.08±0.04) than control group (0.11±0.04) (p<0.001). Conclusion: UCa/Cr ratio was significantly decreased in preeclampsia compared to normal pregnancy. UCa/Cr ratio in spot urine can be useful in identifying pregnant women at risk for preeclampsia.

Characterisation and Evaluation of Antimicrobial, Antioxidant and Antibiofilm Activities of Silver Nanoparticles Biosynthesised from Harpullia arborea Bark Extract

Introduction: In recent years, plant-based antibacterial substance has replaced the conventional chemical synthesis method. Harpullia arborea belongs to the Sapindaceae family; its bark, fruit, and seeds are used by Indians as leech repellent, hair wash, and antirheumatic agents. Plant-mediated green synthesis of nanomaterials is gaining popularity due to its environmental friendliness and cost-effectiveness. Aim: To synthesise Silver Nanoparticles (AgNPs) using bark extract of Harpullia arborea and evaluate their antibacterial efficacy against food borne pathogens. Materials and Methods: The in-vitro study of antimicrobial activity of Harpullia arborea bark extract was utilised for the synthesis of nanoparticles with 2 mM of silver nitrate. The study was conducted from March 2017 to April 2017. The synthesised nanoparticles were confirmed and characterised using Ultraviolet-Visible (UV-Vis) spectroscopy, while Fourier transform infrared, and electron microscopy utilised for the determination of shape and size of the synthesised particle. The synthesised AgNPs were subjected to antibacterial activity against food isolates using agar well diffusion method. Furthermore, Minimal Inhibitory Concentration (MIC) and antioxidant were also measured with titre plate and 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) method, respectively. Results: The UV-Vis spectra showed conformation of AgNPs with surface resonance peak of 430 nm, and Fourier-transform Infrared Spectroscopy (FTIR) spectra confirmed the involvement of biological molecules in AgNPs synthesis. In addition, Transmission Electron Microscopy (TEM), Scanning Electron Microscopy (SEM), and Energy Dispersive X-ray (EDX) analysis confirmed AgNPs with a spherical shape with diameters from 26.3-40.6 nm. The well diffusion method showed the antibacterial activity of AgNPs against bacterial isolates. The results showed that AgNPs possess higher antimicrobial potency than non AgNPs. The lowest Minimum Inhibitory Concentration (MIC) was observed against Staphylococcus aureus [3.5 mg] and followed by Enterococcus faecalis and Pseudomonas aeruginosa [4.5 mg]. The DPPH method has confirmed that silver nanoparticles have a similar antioxidant activity compared to ascorbic acid. Conclusion: It can be concluded that Harpullia arborea bark extract can be used effectively in the production of potent antimicrobial and antioxidants for commercial use.

Postoperative Analgesia in Laparoscopic Cholecystectomy following Intraperitoneal Magnesium Sulphate: A Prospective Cohort Study

Jose Jijo, Ravindran Rashmi, Komu Fijul

Introdution: Postoperative pain and discomfort after laparoscopic cholecystectomy is partly because of distension, tearing, separation of parietal peritoneum and surgical manipulation. Intraperitoneal administration of Magnesium Sulphate (MgSO₄) is thought to desensitise the after effects of pneumoperitoneum in addition to providing analgesia. Aim: To analyse the effect of intraperitoneal magnesium sulphate on postoperative analgesia and occurrence of shoulder pain after laparoscopic cholecystectomy. Materials and Methods: The present study was a prospective cohort study which was conducted at the Government Medical College, Kozhikode, Kerala, India, from February 2019 to December 2020, included 60 adult patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were selected and they were divided into two groups, group M and group N. Patients in group M received 30 mg/kg MgSO₄ which was instilled into the gallbladder bed intraperitoneally by the surgeon after resection of gallbladder and patients who did not receive MgSO₄ were included in group N. Postoperative pain was assessed using Visual Analog Scale (VAS) and VAS score> 3 was managed with Intravenous (IV) paracetamol 15 mg/kg. If pain was not relieved by this, IV tramadol 50 mg was supplemented. Time to first rescue analgesic, the total analgesic requirement and the incidence of shoulder pain in 24 hours were noted. Haemodynamics, recovery profile, incidence of Postoperative Nausea and Vomiting (PONV), any adverse events were also noted and analysed. Results: Mean pain scores (VAS) were significantly lower in group M and time to first analgesic requirement was longer in group M (4.23±2.31 hours) compared with group N (1.07±0.67 hours), PONV was significantly higher in group N. Sedation scores were significantly high in group M and there were no significant differences in haemodynamic and recovery profile and incidence of shoulder pain in both the groups. Conclusion: Intraperitoneal instillation of MgSO₄ provides effective postoperative analgesia and reduces nausea and vomiting in patients undergoing laparoscopic cholecystectomy without any significant side-effects.

Comparison of Efficacy of Combination Therapy with Chlorpromazine and Olanzapine with Chlorpromazine alone for Treatment of Hiccups in Traumatic Brain Injury Patients- A Randomised Control Trial

Introduction: Chlorpromazine belongs to the category of typical antipsychotics or neuroleptics, also known as First-Generation Antipsychotics (FGAs). It is found to be effective in hiccup management by its action as dopamine antagonist in the hypothalamus. Olanzapine act as an antagonist at postsynaptic serotonergic receptors which augment phrenic motoneuronal activity and play a role in the generation of hiccups. Aim: To compare the effectiveness of combination therapy (Olanzapine plus Chlorpromazine) with monotherapy (Chlorpromazine) in Traumatic Brain Injury (TBI) patient admitted to trauma Intensive Care Unit (ICU). Material and Methods: The present study was a control trial which was conducted between November 2020 to October 2021 on patients aged 18-65 years diagnosed with intracranial injury due to trauma. A total of 100 patients (50 in each group) were randomised into Group 1 (patients receiving chlorpromazine 25 mg thrice daily for five days) and Group 2 (patients receiving chlorpromazine 25 mg thrice daily and olanzapine 5 mg once daily for five days). The primary outcome measure was to compare cessation or reduction in the frequency of hiccups. Various laboratory parameters were investigated and compared between both the groups on day zero and day five. The secondary outcome was side-effects of the drugs. Results: In the present study, the distributions of age and gender were similar in both groups with mean age of patients being 39.16±13.88 years and 43.30±12.51 years in group 1 and 2, respectively. Cessation of hiccups were found in 29 (58%) of the patients in group 2 as compared to 27 (54%) patients in group 1, which was not statistically significant. However, improvement in the status of patients was observed in 18 (36%) in group 2, as compared to 10 (20%) in group 1 (p<0.05). No serious adverse events were documented in either groups. Conclusion: A better outcome was observed with combination of chlorpromazine and olanzapine than chlorpromazine alone, in treating hiccups due to TBI. The present trial has established the role of drugs for managing hiccups caused after TBI.

Recognising Nail Changes Induced by Chemotherapy with Taxane-based Regimens and their Dermoscopic Confirmation: A Prospective Observational Study from Northern India

Introduction: Taxanes are chemotherapeutic agents used in a variety of solid tumours. They are known to cause cutaneous as well as nail changes which are temporally associated with intake of drug. Nail involvement is reported in literature from some parts of the world. Aim: To study the pattern of nail changes occurring due to taxane-based chemotherapy regimens in patients suffering from malignancies. Materials and Methods: A prospective observational study was carried out in a tertiary care hospital in GMC, Patiala, Punjab, India from October 2020 to September 2021. A total of 160 adult patients undergoing cancer chemotherapy with taxanes were included in the study. After taking detailed history, nail changes were examined and confirmed by dermoscopy. The data was analysed using Epi Info 7 by CDC and Chi-square test was used to calculate the p-value. Results: A total of 144 patients (87 females and 57 males), with the mean age of 53.8 years, were screened for six chemotherapeutic cycles. Drug-induced Nail Pigmentation (DINP) was the most common nail abnormality seen in 43/144 (30%) patients after third cycle and in 105/144 (73%) patients after the sixth cycle. The most common pattern was diffuse nail pigmentation 40/105 (39%) followed by longitudinal melanonychia 22/105 (21%) after six cycles. Maximum pigmentation 52/60 (86%) was observed in patients who received taxane+adriamycin+ cyclophosphamide combination. On onychoscopy, DINP appeared as thin grey regularly arranged parallel longitudinal lines on homogenous grey background. Conclusion: Taxanes cause varied pattern of nail changes with DINP being the most common. It ranges from longitudinal bands after three cycles to diffuse pigmentation after six cycles.These nail changes show temporal relation with dose, duration, number of drugs, and colour of skin. Dermoscopy is a novel non invasive method with a good diagnostic accuracy.

Ilioinguinal Nerve Neurectomy vs Nerve Preservation in Lichtenstein Tension Free Mesh Hernioplasty: A Randomised Clinical Trial at a Tertiary Care Hospital in Udaipur, Rajasthan, India

Urmil Kumar Labana, Nilesh Mehta, Yashasvi Patel, Mitkumar V Patel, Ajay Chauhan

Introduction: A Lichtenstein tension-free mesh hernioplasty is the most commonly performed surgery for an inguinal hernia. Chronic inguinodynia is the most prevalent surgical complication, with a 25% overall incidence. The second most common complication is hypoesthesia. Ilioinguinal neurectomy has been proven in several studies to alleviate chronic inguinodynia. Aim: To compare the postoperative inguinal pain and aesthesia in Ilioinguinal Nerve (IIN) preservation patients with neurectomy patients in Lichtenstein tension-free mesh hernioplasty. Materials and Methods: This randomised clinical trial was conducted at GMCH, Udaipur, Rajasthan, India during January 2020 to June 2021 on 70 individuals (35 in each group). The IIN was excised in group A, while it was preserved in group B. Pain and aesthesia was assessed at day seven, one month and three month follow-up. Chi-square test was used for data analysis. A p-value<0.05 was considered significant. Results: Mean age of the study sample was 55.95±15.61 years in group A and 55.4±17.22 years in group B. At Postoperative Day-7 (POD-7), 33 (94.28%) patients in group A and 18 (51.43%) patients in group B reported mild pain after vigorous activity, whereas 2 (5.71%) patients in group A and 15 (42.8%) patients in group B reported moderate pain after vigorous activity, and 2 (5.7%) patients in group B reported severe pain after vigorous activity. At POD-7, 2 (5.7%) patients in group A reported hypoaesthesia, out of them only 1 (2.85%) patient reported hypoaesthesia at one month and at three months of follow-up, whereas no patients in group B reported hypoaesthesia at POD-7, one month, or three months of follow-up. Conclusion: It was evident in this study that prophylactic ilioinguinal neurectomy resulted in considerable reduction in incidence of post operative neuralgia, compared to nerve preservation.

Differential Expression of E-cadherin Gene by Real Time RT-PCR and Exon 1 Sequence Analysis in Invasive Breast Carcinoma

Introduction: Genomic alterations in key genes such as tumour suppressor genes have been reported to contribute to human cancers like breast cancer. Loss of E-cadherin (CDH1) mediated adhesion characterises the transition from benign lesions to invasive, metastatic cancer. Genetic changes occurring in the CDH1 gene has not yet been completely studied despite the remarkable biological function of the signal peptide of CDH1. Many of these genomic alterations have altered messenger ribonucleic acid (mRNA) and protein expression that play a role in the pathophysiology of cancers and warrant further studies. Aim: To identify mutations in CDH1 gene (Exon 1) in Invasive Breast Carcinoma and evaluate CDH1 expression by real time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Materials and Methods: The present study was a retrospective cross-sectional study in which tissue samples were collected from Madras Medical College and VS Hospitals, Chennai, Tamil Nadu, India between March 2010 to August 2011 and molecular biology work and analysis was carried out at the SRM-DBT (Sri Ramasamy Memorial Institute of Science and Technology – Department of Biotechnology) Platform for Advanced Life technologies, SRM Institute of Science and Technology (SRMIST) between June 2017 to September 2017. The Exon 1 region of the human E-cadherin gene of normal and breast cancer (Infiltrating Ductal Carcinoma) patients were sequenced by Sanger method. The sequences were compared using the National Centre for Biotechnology Information-Basic Local Alignment Search Tool (NCBI-BLAST) utility. The change in the sequence were identified between the normal and tumour samples. The fold change of E-cadherin gene expression in tumour was calculated by comparing with control non neoplastic breast tissue. The fold change in the relative expression level between tumour and normal sample was determined using real time RT -PCR. Results: In the present study upon comparing the exon 1 sequences of normal gene with that of tumour, two deletion mutation and one C?T transition was observed. In present investigation also a 0.08-fold down regulation of CDH1 mRNA was observed in the tumour tissue when compared with the normal tissue. Conclusion: The present study has attempted to study the alterations at genome level (CDH1 gene, exon 1, encoding for the biologically active signal peptide region), transcriptional and translational level with respect to CDH1. The effect of the mutations detected including two loci with deletion mutations and one single nucleotide change could affect the structural conformation of the protein and functional impact including aberrant expression. Molecular docking studies and in-vitro studies with cell lines and animal studies could be done to confirm these findings.

Prescription Pattern for Antimicrobials and the Potential Predictors for Antibiotics among Patients with COVID-19: A Retrospective Observational Study

Introduction: Long-term repercussions of Coronavirus Disease-2019 (COVID-19) on antimicrobial resistance have been raised as a grave concern due to the rampant use of antibiotics in the management of COVID-19. As per meta-analysis, the prevalence of antibiotic prescribing was 74.6% which was significantly higher than the estimated prevalence of bacterial co-infection. World Health Organisation (WHO) recommended that antibiotic therapy should not be used in patients with mild/moderate COVID-19 unless there is any bacterial suspicion. Also, the guidelines laid down by the Ministry of Health and Family Welfare, Government of India, does not recommend systematic empiric antibiotic therapy in patients hospitalised with COVID-19. Despite not being recommended, antimicrobials are still given in clinical practice. Aim: To analyse prescriptions for antimicrobials and to identify potential predictors for antibiotic prescription. Materials and Methods: A retrospective observational study was conducted at a tertiary care teaching institute. Data (demographic profile, co-morbidities, disease category, prescribed antimicrobials, laboratory investigations, and duration of hospital stay) were collected from case files of patients with laboratory-confirmed Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. These patients were admitted in the institute from January 2021 to May 2021. Logistic regression was used to analyse factors associated with the empirical use of antimicrobial agents. Results: A total of 184 case files were analysed. The mean age of patients was 55.84±15.72 years, with a male preponderance (70.10%). Among antimicrobials, antivirals were prescribed in 159 (86.41%) patients, and antibiotics in 152 patients (82.6%). Antivirals prescribed include Remdesivir [109(68.55%)] and Favipiravir [70(44.02%)]. Ceftriaxone was found to be the highest prescribed antibiotic, with a median duration of administration of six days. An association was found between disease severity and CRP level with antibiotic prescription. On multivariable analysis, the odds of receiving antibiotics were 6.7 times higher in patients with severe disease. Conclusion: More than 80% of COVID-19 patients received antibiotics. Duration of hospital stay was similar among patients whether they received antibiotics or not. Disease severity and raised CRP level were strong predictors for prescribing antibiotics for COVID-19.

Evaluation of Antimicrobial Efficacy of Titanium Dioxide on Dental Plaque Colonisers: An In-vitro Study

Kapil Raju, Shanmuganathan Natrajan, Preetha Krishnamurthy

Introduction: Denture Stomatitis (DS), a common inflammatory condition of the denture bearing mucosa amongst denture wearers is strongly related to poor denture hygiene. Various materials have been incorporated into denture base acrylic resins to have an antimicrobial effect. The antimicrobial efficacy of Titanium dioxide (TiO₂) on denture base acrylic resins has been demonstrated; however, studies are lacking in assessing the effective dose concentration of TiO₂ in inhibiting microorganisms present in denture plaque. Aim: To investigate the effectiveness of TiO₂ coating on denture base acrylic resin in inhibiting colonisers of denture plaque. Materials and Methods: The in-vitro study was conducted in the Department of Prosthodontics and Crown & Bridge and Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India between August 2021 to September 2021. Stock solutions of various concentrations of TiO₂ were prepared to evaluate the effective dose concentration. Forty specimens of heat cure acrylic denture base resin were divided into two groups: an uncoated group (n=20) and TiO₂ coated group (n=20). They were further subdivided into 4 groups, namely specimens containing Streptococcus sanguinis, Staphylococcus aureus, Candida albicans, and specimens containing a mixture of the above organisms. After inoculating, the specimens were UV treated, incubated for 24 hrs, and then washed with phosphate buffer saline. Subcultures were obtained and microbial growth colonies were measured using automated bacterial colony counter. The obtained results were subjected to statistical analysis (SPSS software version 21) and Mann-Whitney U test to compare between the groups, p value of less than or equal to 0.05 (p≤0.05) was considered significant. Results: Colonisers of denture plaque in the uncoated acrylic group was higher (mean:12973.33, 441998.33, 9126.66, and 13.3 CFU) when compared to the TiO₂ coated acrylic resin group (mean:1, 0.99, 1, and 1 CFU). The obtained results between the groups was statistically significant (p≤0.05). Conclusion: TiO₂ coating on denture base acrylic resin can inhibit the growth of microorganisms associated with denture plaque.

Effect of Antiepileptic Drugs on Serum Lipid Profile among Children with Epilepsy at a Tertiary Care Hospital, Chennai, India

Pon Divya, R Suresh Kumar, Velmurugan Lakshmi, Sivasambo Kalpana

Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidaemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care hospital. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for atleast 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding number of children, who attended the General Outpatient Department for acute Upper Respiratory Tract Infection (URTI) and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, Total Cholesterol (TC), High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), Very Low Density Lipoprotein-Cholesterol (VLDL-C) and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p<0.0001), significantly elevated TG (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p<0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/dL vs 56.73±12.56 mg/dL, p<0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p<0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/dL, p<0.0001), and TG (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p<0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p<0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p>0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p<0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p<0.0001) and TG (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p<0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of Serum Glutamic Oxaloacetic Transaminase (SGOT) and Serum Glutamic Pyruvic Transaminase (SGPT) when compared to mean levels 40.35±11.208 IU/L, and 40.70±8.809 IU/L, respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls 36.50±10.61 IU/L in cases vs 40.70±8.81 IU/L in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management, especially in children with baseline deranged lipid profile.

Neutrophil-lymphocyte Count Ratio as an Indicator of Culture Positive versus Culture Negative Sepsis: A Single-centre Cross-sectional Study

Meka Minni, G Rakesh Kumar, BN Raghavendra Prasad, A Raveesha

Introduction: In sepsis patients, the Neutrophil-lymphocyte Count Ratio (NLCR) is a laboratory statistic that can indicate bacterial infection. Aim: To measure NLCR in patients with sepsis and compare the NLCR in patient with culture positive and culture negative sepsis. Materials and Methods: This single-centre, cross-sectional study was conducted in the Department of General Medicine at R.L. Jalappa Hospital (Sri Devaraj URS Medical College), Kolar, Karnataka, India, from October 2021 to December 2021. A total of 120 patients above 18 years of age with sepsis, diagnosed as per the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), were included in the study. Participants were evaluated for sepsis and septic shock (society of critical care medicine conference definitions) the principles of initial resuscitation (fluid therapy, vasopressors, inotropic support), and infection issues (source identification and control, appropriate antibiotic therapy) were followed regularly and the outcome studied. Neutrophil count, lymphocyte count, and calculation of NLCR were done at the time of admission. The correlation studies of NLCR in culture-positive and culture-negative was done and compared. Data was analysed by using coGuide software (version 1.03). Results: The mean age of patients was 58.98±17.78 years, ranged from 20 to 96 years, 47 (39.17%) were male and 73 (60.83%) were female, majority 93 (77.50%) out of 120 patients had fever. Majority 78 (65%) had type 2 diabetes mellitus. Neutrophil-to-Lymphocyte ratio (NLR) was 10±1.67, ranging from 7.40 to 14.50. The area under the ROC curve was 0.522. There was no statistically significant relationship between the NLCR and culture report (p-value=0.216). The NLCR had poor predictive validity in predicting culture positive, as indicated by the area under the curve {0.522 (95% CI: 0.417 to 0.626, p-value= 0.988)}. Conclusion: NLCR can be considered as predictor for the initiation of treatment of patients with sepsis.

Design and Development of a 3D Printable Neck Brace- A Finite Element Approach

R Dhanush Babu, Mahesh Veezhinathan, S Siva Adithya, Nandhini Jagadeesan

Introduction: Neck braces are commonly used to immobilise and support the neck and spinal cord. Even though neck brace has given significant assistance for proper management of cervical spine injuries, it offers a false sense of security where it might prevent additional and further spinal cord injury. Customised neck brace can provide additional comfort. Furthermore, doctor’s views and opinions were taken into consideration and the design has been altered and also can be made customisable to suit every patient, ensuring their comfort at the same time. Aim: To design a 3D printable neck brace and to evaluate it numerically by means of Finite Element Modelling (FEM). Materials and Methods: The model was designed in Autodesk Fusion 360 software and then was imported into HyperWorks for further analysis. Polylactic Acid (PLA) was assigned as a material to the model and it was analysed under two conditions after assignment of materials properties such as young’s modulus, density and Poisson’s ratio. HyperView was utilised to visualise the results of the linear static analysis to further enhance the model. Results: The maximum displacement, stress and strain of the model was observed in the posterior and interior segments which was found to be 1.813E-06, 1.109E+0, 4.805E-02 respectively upon application of a force of 20 N and 1.656E-06, 1.202E+03, 2.286E-07 respectively when a force of 100 N was applied. Conclusion: The study found varying stress, strain and displacement values upon application of an external force which was used in the evaluation of the model. It was also found that PLA material led to better alignment and strength of the overall model and a mixture of PLA and natural rubber can be used as a viable 3D printing filament.

Assessment of Performance in Cognitive vs Affective Domain among First Year MBBS Students: A Cross-sectional Study

Sharmila Aristotle, Balaji Ramraj

Introduction: National Medical Commission (NMC) has revised MBBS curriculum and incorporated Competency Based Medical Curriculum (CBME) which describes various competencies. Most of the competencies are based on cognitive, psychomotor and affective domain, which an Indian medical graduate should attain. Both cognitive and psychomotor domains were taught as a part of curriculum however, students learned affective domain as a hidden curriculum only. Now CBME has incorporated affective domain as a part of MBBS curriculum in the form of Attitudes Ethics and Communication (AETCOM) module, teaching and evaluating the affective domain demands attention. Aim: To evaluate the performance of first year MBBS students in cognitive domain vs affective domain from their routine curriculum. Materials and Methods: This cross-sectional study was conducted in SRM Medical college Hospital and research center from September 2019 to October 2019 among 149 1st year MBBS students. Three students were absent on day of assessment. Hence, 146 students were assessed in both domains. The performance of both domains (cognitive and affective) were assessed in the form of Objective Structured Practical Examination (OSPE). Chi-square was used to compare the qualitative data and Unpaired t-test was used to compare the means. Results: The mean age of the students was 18.66±0.64 years. About 76 (52.1%) were male and 70 (47.9%) were female students. Out of total, 22 (15.1%) of students had scored less than minimum mark for pass in cognitive and 8 (5.5%) of students had scored less than minimum mark for pass in AETCOM. Only 2 (1.3%) of students had scored less than minimum mark for pass in both OSPE examinations. In addition, 49 (33.5%) students had scored more than average marks in cognitive and 94 (64.4%) students had scored more than average in AETCOM and 34 (22.8%) of students had scored more than average in both domains. The difference in the mean score was found to be statistically significant (p-value<0.0001). Conclusion: This study concludes that the learners performed better in affective domain, when compared to cognitive domain.

Comparative Efficacy of Lag Screw and 3D Plate in Fixation of Symphysis and Parasymphysis Fractures of Mandible- A Prospective Interventional Study

Ravi S Patil, Chitra Chakravarthy, MU Aishwarya, Shivaraj S Wagdargi

Introduction: Mandible is well known for its unique anatomy and is the second most prevalent facial bone to fracture followed by fracture of nasal bone. Fracture of the mandible causes deranged occlusion, trismus, mobility of fractured fragments, pain, oedema and results in functional as well as aesthetic deformity. Therefore, the fixation of mandibular fracture plays a major role in rehabilitation of the jaw. The goal of management is to restore the premorbid occlusion and function. Aim: To compare the efficacy of osteosynthesis of mandibular anterior fracture by two different methods of open reduction, i.e, titanium lag screw and titanium 3 Dimensional miniplate. Materials and Methods: This prospective interventional study was conducted in the Department of Oral and Maxillofacial Surgery of Navodaya Dental College and Hospital, Raichur, Karanataka, India from January 2019 to February 2021. A total of 10 patients with symphysis and parasymphysis fracture were included in this study and were divided into two groups, five patients for Group A (osteosynthesis by titanium lag screw fixation) and five patients for Group B (osteosynthesis by titanium 3D plate fixation) and were treated accordingly. Parameters such as occlusion, mobility of fracture segments, interincisal mouth opening, facial oedema, pain, approximation of the lower border and lingual cortex and hardware failure were assessed clinically and radiographically, and the patients were followed up for three months. Recorded data was compared and was analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent sample t-test was used for comparison between the groups. Chi-square test and Fisher exact test were used for qualitative data and p-value was set at 0.05. Results: There was no significant difference noted between two groups when assessed radiographically on 1^st day, one and a half month later and after three months. There was no significant difference noted in occlusion as well as in pain when measured postoperatively between the groups, but lag screw fixation provided normal immediate postoperative occlusion in all the cases. A significant improvement in the postoperative mouth opening was noted with lag screw group when compared to 3 Dplates with a p-value of 0.015 when measured after a week postoperatively. When oedema was measured in transverse direction, it was statistically significantly less in 3D plates group postoperatively first day with a p-value of 0.028 and after a week with a p-value of 0.044. Oedema when measured in vertical direction revealed no statistically significant difference between two groups. Conclusion: In the present study a significant improvement in the mouth opening as well as in terms of reduction in pain and oedema was noted with lag screw osteosynthesis group. Immediate postoperative occlusion was better with titanium lag screw osteosynthesis when compared to titanium 3D plates. Based on our study we conclude that both the osteosynthesis materials provide good interfragmentary stability in the management of anterior mandibular fractures and can be used satisfactorily for the fixation of mandibular fractures.

Short-term Heart Rate Variability to Evaluate Cardiovascular Autonomic Neuropathy in Newly Diagnosed Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: Cardiovascular Autonomic Neuropathy (CAN) may be seen in patients of Type 2 Diabetes Mellitus (T2DM). In many previous studies it was seen that there is reduced heart rate variability in DM patients. Reduced heart rate variability is earliest indicator for the CAN. In different earlier studies, it was found that results of Short-term Heart Rate Variability (HRV) analysis of five minutes is comparable to standard 24 hours HRV analysis. In DM patients CAN is mostly found to be associated with a longer duration of disease, but according to some studies CAN may be present in newly diagnosed diabetes patients also, but the percentage is lower. Aim: To assess the short-term HRV profile as cardiovascular risks among newly diagnosed T2DM patients and to find the correlation of HRV parameters with duration of disease and biochemical parameters; Fasting Plasma Glucose (FPG) and Postprandial Plasma Glucose (PPPG) for early detection and management of CAN. Materials and Methods: The present study was a cross-sectional study conducted in the Department of Physiology in collaboration with the Department of Endocrinology at R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India, from September 2020 to August 2021 on 56 newly diagnosed T2DM (age group 30 to 64 years). Study subjects were grouped according to the Standard deviation of NN intervals (SDNN) (millisecond) value as cardiovascular risk factor. Group 1 was the low risk group, group 2 was the moderate risk group, group 3 was the high-risk group. HRV testing was done with Physiograph Polyrite-D instrument with bio-amplifiers, 4 channels and accessories (RMS latest software-Version 3.0.16) in Autonomic Function Research Laboratory to measure HRV parameters. After collecting data, analysis was done using Statistical Package for Social Sciences (IBM, SPSS) version 23.0 Unpaired student’s t-test, Chi-square test, Analysis of Variance (ANOVA) test, Pearson correlation test were performed and statistical significance of different parameters were evaluated. It was considered statistically significant when p-value <0.05. Results: By assessing HRV parameters as cardiovascular risk factors among newly diagnosed T2DM patients the present study showed there was significantly (p-value=0.0065) high LF/HF ratio in males (1.70±1.19) than in females (0.99±0.69). The SDNN value was significantly highest in low cardiovascular risk group (137.29±25.49 ms) and lowest in high cardiovascular risk group (26.07±12.03 ms) (p-value=0.00001). Low Frequency and High Frequency Ratio (LF:HF ratio) was significantly more in age group of 51-60 years. Among all the patients, 34 (61%) patients had increased parasympathetic activity and 22 (39%) subjects had increased sympathetic activity. Female patients showed significantly more increased parasympathetic 24 (75%) activity than males 10 (41.7%). There was a significant association between SDNN values with the duration of disease (p-value=0.004). Conclusion: The present study showed that cardiac autonomic neuropathy is present even at the time of diagnosis of newly diagnosed T2DM as there was sympathovagal imbalance. Female patients have more parasympathetic drive than males which indicates that females are more cardioprotective.

Impact of the COVID-19 Pandemic Lockdown on Oral Health and Behaviour Change among Children in the Eastern Province of Saudi Arabia

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has been concomitant to a number of alterations in children’s dental health. The indoor activities and intermittent eating during the COVID-19 pandemic lockdown had an impact on oral hygiene practices and behavioural change in children. Aim: To assess the impact of the COVID-19 pandemic lockdown on oral health and behaviour change among children in the eastern province of Saudi Arabia. Materials and Methods: This cross-sectional study was conducted in Department of Paediatric Dentistry, Dammam Specialised Dental Center, Dammam, Eastern Province, Saudi Arabia, from 6^th October 2021 to 8^th March 2022, among 510 children. A well-structured questionnaire consisting of 24 closed-end items related to socio-demographic data, children’s behavioural change during lockdown and oral health practices in the eastern province of Saudi Arabia was tailored. All parents or legal guardians of children aged between 6 and 12 years old were asked to sign a written informed permission to complete a questionnaire voluntarily. Statistical analysis was executed by using Statistical Package for Social Sciences version 22.0 (IBM Product, USA). Results: Of 510 children to be evaluated for the impact of the COVID-19 pandemic lockdown, 284 (55.7%) mothers, 209 (41%) fathers, and 17 (3.3%) caregivers were the respondents. Although one-half of the children 273 (53.5%) had no change in oral health attention, 72 (14.1%) had increased, while 165 (32.5%) had decreased oral health attention during the COVID-19 pandemic lockdown. There were three significant predictors of children’s oral health behaviour during the COVID-19 pandemic lockdown including frequency of tooth brushing increased (OR=18.7), decreased brushing (OR=28.3), consumption of sugary meals (OR=4.6), and noticing of caries, toothache, bad breath, bleeding/ swelling of the gingiva (OR=3.1). Conclusion: Study findings demonstrated that the COVID-19 pandemic caused considerable behavioural and psychological alterations in children. The frequency of brushing, dental visits, and sugar consumption all decreased significantly.

Comparative Evaluation of Salivary Flow Rate in Smokers and Non Smokers: A Cross-sectional Study

Anushka Devidas Bhargave, Nilima Prakash, Amit Agrawal

Introduction: Saliva is a complex and significant body fluid which is exceptionally fundamental for oral health and is the most effectively available fluid in the human body. Structural and function changes in saliva occur when it is exposed to cigarette smoke that contains several toxic components and is known to be one of the main risk factors for developing numerous oral conditions. There are conflicting reports about the correlation between cigarette smoking and mouth dryness. Additionally, there is paucity of studies to investigate the Salivary Flow Rate (SFR) in smokers in India. Aim: To assess the salivary flow rate in smokers and non smokers and also to study the effect of duration and frequency of smoking habit on SFR. Materials and Methods: This analytical cross-sectional study was conducted in which unstimulated whole saliva of 50 smokers and 50 non smokers visiting Outpatient Department (OPD) at Mahatma Gandhi Vidyamandir’s, Karmaveer Bhausaheb Hiray Dental College and Hospital Nashik, Maharashtra, India, was from January 2019 to January 2020. Unstimulated SFR was measured and expressed in mL/minute using a graduated glass tube. Comparison of SFR was done among the smokers and non smokers using Unpaired t-test. One-way Analysis of Variance (ANOVA) test was used to compare the frequency and duration of smoking habit and SFR among smokers. Results: There was a statistically significant reduction (p-value <0.0001) in the salivary flow rate of smokers in comparison to non smokers. It was also observed that there was reduction in salivary flow rate with increase in the duration (p-value <0.001) and frequency (p-value=0.012) of tobacco smoking habit. Conclusion: Salivary flow rate is significantly reduced in smokers when compared to non smokers. The duration and frequency of smoking habit had a significant impact on the reduction in SFR. Reduced SFR has a high impact on oral health and may further lead to several oral complications. Therefore, measures should be taken by counseling the smokers to quit the habit and educating them about the ill-effects of xerostomia.

Effect of Consanguinity on the Audio Profile of Non Syndromic Sensorineural Hearing Impaired Children: A Cross-sectional Study

KS Gangadhara, Geetha Bhaktha, B Manjula, S Nirupama

Introduction: The incidence of bilateral sensorineural hearing loss is quite notable in live births worldwide. Among the etiologies, the primary aetiology is thought to be genetic, followed by non heritable, and unknown. Aim: To study the effect of consanguinity on audiological profile in children presented with non syndromic sensorineural hearing loss. Materials And Methods: This cross-sectional study was conducted in the Department of Ear Nose Throat, McGANN Teaching District Hospital (Shimoga Institute of Medical Sciences), Shivamogga, Karnataka, India, from January 2019 to December 2020, among 95 children with non syndromic sensorineural hearing loss. A Pure Tone Audiometry (PTA) test was done for each patient both air conduction and bone conduction thresholds were tested using different transducers. An audiogram was collected and the degree of hearing loss of each patient was analysed. Statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 34.0, Kruskal-Wallis test, one-way Analysis of Variance (ANOVA) was used for comparing the difference in PTA followed by the Mann-Whitney U test. Results: The mean age of the study population was 9.7 years; 39 subjects were female, and 56 were male. The PTA among the study population showed asymmetric audiograms in 17 (17.9%) children. A majority (60, 63%) of the participants were born out of consanguineous marriage. Total 80 (84.2%) children had bilateral hearing loss, among which 58 (72.5%) were cases of bilateral profound. One-way ANOVA showed that there was an overall significant difference between the consanguinity and non consanguinity groups and post-hoc analysis with the Mann-Whitney U test revealed a significant difference between the different degrees of consanguineous marriage. Conclusion: Consanguinity affects the audio profile (PTA) among the non syndromic hearing-impaired children.

Effectiveness of Educational Programme on Knowledge regarding Abuse and Age-related Changes among Elderly Population

Embhah Dkhar, Venkatesan Balu, Sonia Kamei

Introduction: Age-related changes are a universal and regular process of ageing. Normal ageing produces changes in structures and functions of organs, and abuses is widespread among the elderly population and is a highly complicated problem. Aim: Effectiveness of educational programme on knowledge regarding abuse and age-related changes among elderly population. Materials and Methods: A Quasi-experimental research study was conducted in India from 1^st December 2019 to 30^th December 2019 through a community-based survey in Padmashree Institute of Nursing in Kommaghatta Rural community, Bengaluru, India. This survey was conducted among 60 elderly people using a systematic random sampling technique. An educational programme was conducted as an intervention to impart knowledge to the elderly. Questionnaires were used to assess the knowledge of abuse and age-related changes. Data was analysed by Statistical Package For Social Science (SPSS) version 20.0. Results: The study findings showed that in the pretest level of knowledge, none of the subjects had adequate knowledge, whereas, post-test in the educational programme, the majority had moderately adequate knowledge (76.7%). The pretest mean score was 49.7% which showed adequate improvement in the post-test score level of 70.6%, which was statistically significant (p<0.001). Conclusion: The study finds evidence that nurses working in the community setting needs to use educational programmes to improve knowledge regarding abuse and age-related changes among the elderly, which helps in preventing elderly abuses.

Knowledge, Attitude and Perception of Pharmacovigilance Awareness among Interns at a Tertiary Care Teaching Hospital, Andhra Pradesh, India

G Ravindrakumar, Lakshmi Sativada, Dineshkanth Vudayana, Kirankanth Vudayana

Introduction: Pharmacovigilance plays an important role in the healthcare sector, in terms of health and economic burden. Studies on interns are limited and it is an aspect that requires further study. Aim: To evaluate the knowledge, attitude and perception of MBBS interns at a teaching hospital in southern India. Also to study the reasons for under-reporting of Adverse Drug Reactions (ADR). Materials and Methods: This questionnaire-based, cross-sectional study was conducted among the 112 MBBS interns at Konaseema Institute of Medical sciences and Research Foundation, Amalapuram, Andhra Pradesh, India, in December 2013. The interns were asked to complete 25 predesigned questionnaire based on the Knowledge, Attitude and Perception (KAP). The answered questionnaires were statistically analysed by using Microsoft Excel worksheet. Results: Out of total 112 MBBS interns, only 94 completed the questionnaire within the stipulated time. There were 41 males and 53 females, with a mean age of 25±2 years. The response rate was 83.9%. A 48 (51.1%) interns had come across Adverse Drug Reactions (ADR) cases during their practice, however, among them only 24 (50%) reported them. Difficulty to identify the causative drug was the major cause for under-reporting as per 23 (24.4%) interns. Majority (60.6%) were of the opinion that pharmacovigilance only covers drug-related side-effects, not other types of side-effects. Conclusion: Interns are the upcoming doctors, hence increased attention must be paid to their lack of pharmacovigilance knowledge in order to improve the clinical management and rational use of drugs.

Effect of Matrix Rhythm Therapy on Subjects with Asymptomatic Hamstring Tightness: A Quasi-experimental Study

Varun Chandrakant Naik, Vanshi Parekh, Shivani Patil

Introduction: Hamstring tightness is a decreased range of motion at the knee with an associated feeling of restriction in the posterior thigh. The hamstrings are a group of muscles that control hip and knee joint mobility as well as pelvis and spine alignment. Because hamstring tightness impacts body posture and causes musculoskeletal pain, finding a new effective approach to restore hamstring flexibility is critical. Matrix rhythm therapy is a class IIA medical device that enhances an increase in microcirculation and tissue flexibility and elasticity. Aim: To determine the immediate effect of Matrix Rhythm Therapy (MaRhyThe^©) on an individual with asymptomatic hamstring tightness between the age group of 18-25 years on an active knee extension test and ultrasonography. Materials and Methods: This quasi-experimental single session study was conducted in KAHER Institute of Physiotherapy (tertiary care hospital), Belagavi, Karnataka, India, from November 2020 to January 2021. A total of 63 people were screened for the study out of which 30 were included (17 Female and 13 Male) and were recruited using the Active Knee Extension (AKE) test and ultrasonographic assessment. The age criterion was 18-25 years. MaRhyThe^© was given for only one session of 60 minutes on both legs (30 minutes on each leg). After the session, the immediate effect of the treatment was noted by comparing the active knee extension test of both legs and conducting the ultrasonographic assessment. The pretest and post-test scores were analysed using the Kolmogorov Smirnov test. Results: The results showed that there was a 41.39% reduction in the AKE of the right leg and a 42.40% reduction in the AKE on the left leg of the participants which was statistically significant. Post-intervention statistically significant differences were found in an increase in the length, blood flow, and decrease in thickness of the hamstring muscle (p-value ≤0.001) after a 60 minute session of MaRhyThe^©. Conclusion: MaRhyThe^© for 60 minutes duration (30 minutes each leg) produces beneficial effects such as improved tissue extensibility, increased blood microcirculation, and decreased tissue thickness in subjects with asymptomatic hamstring tightness.

Clinical Evaluation of Analgesic Efficacy and Safety of IV Nalbuphine versus IV Butorphanol in Patients Undergoing Tympanoplasty: A Randomised Clinical Study

Introduction: Middle Ear Surgeries (MESs) are generally performed using local anaesthesia under sedation. Butorphanol and nalbuphine both are well-known synthetic opioid with agonist-antagonist characteristics. However, no reports present a direct comparison of the analgesic efficacy of these two drugs. Aim: To evaluate analgesic efficacy of intravenous butorphanol versus intravenous nalbuphine during Monitored Anaesthesia Care (MAC) in patients undergoing tympanoplasty. Materials and Methods: This randomised clinical trial was conducted at the Department of Anaesthesiology, School of Medicine, D.Y. Patil Deemed to be University, Mumbai, Maharashtra India, from March 2018 to March 2021. Total 112 adult patients, undergoing tympanoplasty, were randomly allocated into two groups. Group N received 0.2 mg/kg nalbuphine intravenous (i.v.) and group B received i.v. 0.02 mg/kg butorphanol. The patients were then evaluated for analgesic efficacy, sedation, blood pressure, Mean Arterial Pressure (MAP), Heart Rate (HR), Respiratory Rate (RR), blood oxygen levels (SpO₂), Visual Analogue Scale (VAS) Score, need for intraoperative rescue sedation/analgesia, duration of action and side-effects. Results: A significant difference was observed in the patients’ responses to needle prick, where only 8 (13.3%) subjects gave a vocal response in group N versus 22 (36.6%) in group B. A significant difference in the mean time of onset of pain amongst both the group was recorded (3.16±1.38 hrs in group N and 2.63±1.19 hrs in group B). A significant difference was also recorded in the mean VAS at 15^th (p-value=0.012) and 30^th min (p-value= 0.017). Only 7 patients (11.6%) from group N, and 12 patients (20%) from group B required rescue agent (0.5 mcg/kg/hour dexmedetomidine injection and 75 mg diclofenac sodium injection intravenous). Conclusion: Both 0.2 mg/kg nalbuphine and 0.2 mg/kg butorphanolprovide satisfactory results in terms of analgesic efficacy, sedation, hemodynamic and respiratory parameters, albeit, nalbuphine can be coined to be superior in terms of response to pin prick and duration of action.

Intravenous Labetalol vs Intravenous Clonidine for Attenuation of Haemodynamic Responses during Laryngoscopy and Intubation in Controlled Hypertensive Patients Undergoing General Anaesthesia- A Randomised Clinical Trial

Vijay Singh, Baisakhi Laha, Tapobrata Mitra, Debasish Bhar, Rita Pal

Introduction: Laryngoscopy and endotracheal intubation during general anaesthesia are associated with haemodynamic surges which can be detrimental, particularly if there is pre-existing hypertension or cardiovascular disease. Intravenous (i.v.) labetalol, a β-adrenergic blocker with additional α1-adrenoceptor blocking activity, and clonidine, a centrally acting α2 agonist, are known to attenuate this haemodynamic response. Aim: To compare the effects of i.v. labetalol and clonidine in attenuating haemodynamic changes during laryngoscopy and intubation in controlled hypertensive patients. Materials and Methods: This single centre, parallel-group, double-blind, randomised clinical trial was conducted in the Surgery Operation Theater (OT) of Midnapore Medical College, District Paschim Medinipur, West Bengal, India, from February 2018 to August 2019. The study included 90 adult patients of either sex, who were randomly allocated to receive either clonidine 1 mcg/kg or labetalol 0.15 mg/kg by intravenous route. After recording baseline parameters, patients were preoxygenated with 100% oxygen for 3 min and the study drug was given 5 min prior to induction. Heart Rate (HR), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) and the rate pressure product were recorded prior to induction, at the time of intubation and 1, 3, 5, and 10 min after intubation. General anaesthesia maintenance was done in a similar manner in both groups. Two-sample t-test was used to assess significance of difference in means between independent samples. Fisher’s exact test was employed for comparing categorical data. Analysis was two-tailed and p-value<0.05 was considered statistically significant. Results: Both the groups were evenly matched at baseline with respect to age and sex as well as standard anthropometric parameters (p-value>0.05). Both drugs were able to attenuate the expected rise in HR following intubation but labetalol was more effective than clonidine throughout the postintubation period. SBP and DBP were comparable between the two groups at baseline but underwent greater attenuation in the labetalol group at intubation and subsequent measurements. The differences were around 10 bpm for HR, 20-30 mmHg for SBP and 10 mmHg for DBP, in favour of labetalol. Adverse events like bradycardia, hypotension, sedation or undesirable ECG changes were not encountered. Conclusion: Intravenous labetalol is more effective than i.v. clonidine in controlling haemodynamic changes during laryngoscopy and intubation in controlled hypertensive patients undergoing general anaesthesia without any complications.

Achromobacter xylosoxidans Subspecies denitrificans Endocarditis in a Patient with Prosthetic Aortic Valve: A Case Report and Review of Literature

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

Achromobacter xylosoxidans subspecies denitrificans flourishes in presence of oxygen, commonly isolated from aquatic milieu. It is rarely implicated as the causative agent of endocarditis. It is not known to cause virulent infections in patients but causes severe infections in immunosuppressed patients with underlying co-morbidities. Present report is first case of Achromobacter xylosoxidans prosthetic valve endocarditis from India. This case report accounts for a 47-year-old man, suffering from Rheumatic Heart Disease (RHD), who presented to the cardiology emergency with chief complaints of remitting type high-grade fever for years years followed by persistent fever for 10 days. On echocardiography and positively flagged BACTEC blood culture reports was diagnosed as a case of Achromobacter xylosoxidans subspecies denitrificans bacteraemia and prosthetic aortic valve endocarditis. Antibiotics were started according to the susceptibility testing but the patient could not complete the course of treatment as he developed dyspnoea and cardiac arrest following which he could not be resuscitated.

Utility of 3D Double Inversion Recovery Sequence in Paediatric Epilepsy and its Comparison to 3D Fluid Attenuation Inversion Recovery Sequence and T1 Inversion Recovery Sequence: A Cross-sectional Study

Introduction: Epilepsy is a disease with predisposition to generate epileptic seizures, associated with neurobiological, cognitive, psychological, and social consequences. Nearly 30% of children undergoing medical treatment for epilepsy become refractive to the treatment. For those children, the ability to find the epileptogenic area is higher with Magnetic Resonance Imaging (MRI) of the brain. The traditional 2D spin-echo sequences used in epilepsy protocol for adults cannot be used alone in paediatric structural neuroimaging. Additional sequences are needed to identify epileptogenic areas due to differences in myelination. Here, present study compared the role of three volumetric sequences 3D-Fluid Attenuated Inversion Recovery (FLAIR) , 3D-T1 weighted Inversion Recovery (T1-IR) and 3D-Double Inversion Recovery (DIR) for paediatric epilepsy as part of structural neuroimaging. Aim: To assess the utility of 3D-DIR in paediatric epilepsy disorders and localisation of epileptogenic foci in brain, congenital malformations of brain and compare its findings with 3D-FLAIR and 3D-T1-IR. Materials and Methods: The present study was a cross-sectional study of children diagnosed with paediatric epilepsy, who were evaluated with MRI brain at Stanley Medical College, Chennai, Tamil Nadu, India, between April 2020 to April 2021 with three sequences, 3D-DIR, 3D-T1-IR and 3D-FLAIR. Lesions of atleast 3 mm in diameter were identified as foci of high signal intensity and counted in each of the three sequences separately and classified according to their location. Then, average signal intensities of the lesions were calculated manually on each of sequences using Region of Interest (ROI) analysis which had a mean size of 3 mm². Then the Signal-to-Noise Ratio (SNR), Contrast to-Noise Ratio (CNR), Contrast Ratio (CR), and Asymmetry Signal Ratio (ASR) were calculated. Results: Evaluation was done on 51 paediatric epilepsy patients and showed the total number of lesions detected (208 lesions) and measured contrast parameters (CR, CNR and ASR) which were found to be significantly higher in 3D-DIR, showed higher detection of the intracortical and white matter lesions than 3D-FLAIR and 3D-T1-IR. SNR was higher in 3D-FLAIR. Conclusion: Present study concluded that the greatest value of the DIR sequence has a higher ability in detecting epileptogenic foci and congenital malformations of the lesions in comparison with FLAIR and T1-IR.

A Longitudinal Study Evaluating Indications, Efficacy and Complications of Bronchial Artery Embolisation

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection. Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE). Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis. Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery. Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate.

PRISM-III and SNAPPE-II to Predict Outcome in Neonates undergoing Surgery under General Anaesthesia- A Prospective Cohort Study

Mohit Kumar Tyagi, Garima Daga, Maitree Pandey

Introduction: Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II) and Paediatric Risk of Mortality-III (PRISM-III) are scores which have been used in the Paediatric Intensive Care Unit (PICU) setting for quite some time now. However, these have never been utilised in a preoperative setting to predict outcome. Aim: To study the risk scores PRISM-III and SNAPPE-II to predict outcome in neonates undergoing surgery under general anaesthesia. Materials and Methods: This was a prospective observational cohort study conducted in Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India on 100 neonates. The PRISM-III and SNAPPE-II scores were calculated preoperatively to predict the postoperative outcome. Statistical Package for Social Sciences (SPSS) version 15.0 was used for analysis. Discriminatory capacity of scores was assessed using Receiver Operating Characteristic (ROC) curves. Specificity and sensitivity were calculated to identify the cut-off value of the scoring system that would predict outcome. The calibration of both the scoring systems was established by using Hosmer-Lemeshow goodness of fit test. Results: The mean age of population was 8.23±7.93 days, with 69% males and 31% females. The mortality rate was 12%. The maximum sensitivity (91.67%) and specificity (93.18%) for PRISM-III score was found at score 23, whereas best sensitivity (100%) and specificity (81.82%) for SNAPPE-II was at 26.5. The area under ROC for PRISM-III and SNAPPE-II was 0.946 and 0.944 respectively showing excellent discriminatory power. The Hosmer-Lemeshow test showed a good calibration for the study model. Conclusion: Both the scoring systems PRISM-III and SNAPPE-II are excellent predictors of postoperative outcomes. PRISM-III is marginally better than SNAPPE-II for diagnostic accuracy. Both scores are well calibrated for Indian population.

Efficacy of Rotary Retreatment Techniques Assisted with Passive Ultrasonic Activation of Resin Solvent in Removal of Gutta-percha with Epoxy Resin and MTA Based Root Canal Sealers: An In-vitro Study

Akash Kiran More, MV Sumanthini, Vanitha U Shenoy

Introduction: Endodontic retreatment is indicated in cases of failed primary endodontic treatment. The main goal of retreatment is to establish conditions that will enable the healing of the periapical tissue. Aim: To evaluate the efficacy of rotary retreatment with the ProTaper Universal Retreatment system supplemented with passive ultrasonic activation of solvent in retreatment of single-rooted mandibular premolar teeth obturated with gutta-percha and two different root canal sealers (AH Plus and MTA Fillapex). Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Mahatma Gandhi Mission’s Dental College and Hospital, Navi Mumbai, Maharashtra, India, from January 2019 to April 2019. Total 66 freshly extracted human single rooted mandibular premolars were used in this study. Root canal preparation was done using ProTaper Next rotary files. Teeth were decoronated to get a uniform length of 18 mm and were divided into three retreatment groups based on the technique used for retreatment. Group I included rotary retreatment, Group II involved rotary retreatment with solvent and paper point wicking, and Group III involved rotary retreatment with passive ultrasonic activation of solvent and paper point wicking. Based on the sealer used for obturation, teeth in each group were further divided into two subgroups, subgroup A with AH Plus sealer and subgroup B with MTA Fillapex sealer. Teeth were stored in an incubator for 30 days to allow sealer to set after which sectioning of the specimens was done buccolingually for examination under the stereomicroscope and photographed. Statistical analysis was done by using parametric Analysis of Variance (ANOVA) followed by Post-hoc tests and Unpaired t-test. Results: No statistically significant difference in percentage area of residual root canal filling material noted between the group I and II and when obturated with gutta-percha and AH Plus sealer (subgroup A) as p-value=0.215. Whereas, it revealed a statistically significant difference between the group I, II, and III when obturated with gutta-percha and MTA Fillapex sealer (subgroup B) as p-value<0.001. Conclusion: Passive ultrasonic activation of solvent after gutta-percha removal using ProTaper Universal rotary files could improve the quality of endodontic retreatment.

Lateral Thoracic Flap in Axillary Hidradenitis Suppurativa- A Prospective Interventional Study

KK Malar, Jayakrishnan Kolady, Anjali Ravikumar, Dakshin Sitaram Padmanabhan

Introduction: Hidradenitis Suppurativa (HS) is a chronic socially debilitating disorder of unknown aetiology. Surgical treatments include simple incision and drainage; excision followed by healing by secondary intention or split-skin grafting, and the more recent method of excision followed by local-flap reconstructions. In this study, the use of a lateral thoracic fasciocutaneous island flap based on vessels arising from the thoracodorsal or thoracic lateral vessels is described. Aim: To describe the benefit and outcomes of lateral thoracic flap reconstruction technique in treatment of axillary hidradenitis suppurativa. Materials and methods: This prospective interventional study was conducted at the Plastic Surgery Department at Amala Institute of Medical Sciences, Thrissur, Kerala, India (tertiary care center), from January 2017 to June 2018. The study included 36 patients with chronic axillary hidradenitis, who underwent lateral thoracic flap surgery on one or both axillae. These patients were studied closely preoperatively during surgery and during postoperative follow-up period. The basic demographic details, clinical parameters and Hurley stage; along with postoperative outcomes were recorded. Data was summarised using descriptive statistics. Results: The study sample consisted of 36 patients with a mean age of 38.33±13.11 years. There were 20 females and 16 males. Eleven patients were having co-morbidities in the form of type 2 diabetes mellitus or hypertension. The mean duration of illness was 3.17±1.44 years. Six patients had bilateral axilla involvement and underwent bilateral axillary reconstructions. Out of these 36 patients; 30 patients only had antibiotic treatment previously and five patients underwent excision of affected axillary skin previously without flaps; one patient was treatment naïve. Twenty four patients were Hurley stage 2 and 12 were stage 3. These patients were taken up for repair with a lateral thoracic flap. The mean postoperative hospitalisation was 6 days. There was no impairment of shoulder movement in the early or late postoperative period. There were no surgical complications in terms of vessel damage or flap viability. All flaps healed without complications and there was no recurrence of disease or scar contracture during the follow-up period. Conclusion: Lateral thoracic flap reconstruction for axillary hidradenitis suppurativa is without doubt the strategy for treating axillary HS due to its lower recurrence rates.

Comparison of the Effect of Pretreatment with Cisatracurium and Rocuronium on Succinylcholine Induced Fasciculation for Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospital-based, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and Group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection were observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Post Anesthesia Care Unit (PACU) on postoperative day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in Group 2 (mean 0.2187±0.4200) than Group 1 (mean 1.125±0.833, p<0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than Group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia.

Can Perinephric Fat Stranding be used as a Predictor of Renal Dysfunction in COVID-19 Patients? A Retrospective Study

NSL Susmitha, Anu Kapoor, Ramakrishna Narayanan

Introduction: High Resolution Computed Tomography (HRCT) of the chest is often performed in patients with Coronavirus Disease 2019 (COVID-19) to assess the severity of lung involvement. Multiorgan dysfunction is a well-known complication of COVID-19 infection. Bilateral Perinephric Fat Stranding (PFS) is often observed in cases of COVID-19 infection while reporting the chest Computed Tomography (CT) scans, which might represent associated acute kidney injury. It is still not known whether a correlation exists between the severity of COVID-19 infection and presence of PFS or renal dysfunction. Aim: To determine the association between PFS, Computed Tomography Severity Index (CTSI) and serum creatinine levels in patients with COVID-19 infection. Materials and Methods: This retrospective cohort study was conducted in Department of Radiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2021 to June 2021. A total of 90 COVID-19 positive patients of all ages and gender, who underwent HRCT of chest were included in the study. The chest scans were retrospectively reviewed for severity of lung involvement using a CTSI. The cases were divided equally into two groups A (n=45) and B (n=45). Group A included cases showing PFS on CT and group B included cases with no evidence of PFS. Serum creatinine levels (obtained within 24 hrs of the scan) of all patients were noted and analysed to determine any possible association between the PFS, CTSI and serum creatinine levels. Analysis was done using Mann-Whitney U test, for continuous variables and Chi-square test was used for categorical data. Results: The mean age of patients (p-value=0.047) and the male to female ratio (p-value<0.001) was significantly higher in group A than in group B. Statistically significant association was found between PFS and serum creatinine (W=1375.500, p-value=0.003) PFS as an indicator of renal dysfunction had a sensitivity of 73.3%, specificity of 54.7%, Positive Predictive Value (PPV) of 24.4%, Negative Predictive Value (NPV) of 91.1% and a diagnostic accuracy of 57.8%. with an odds ratio of 3.32. Conclusion: Presence of PFS at imaging can serve as a useful screening tool for detecting underlying renal dysfunction in patients with COVID-19 infection.

Serum Levels of Inflammatory Markers in Newly Diagnosed Hypothyroid Patients Before and After Levothyroxine Therapy

Shilpi Goyal, Abhinav Dixit, Neelam Vaney, SV Madhu

Introduction: Cytokines have a great significance in autoimmune thyroid disease. They are produced by thyroid follicular cells and have an indispensable role in T-cell and B-cell growth and differentiation. Tumour necrosis factor-alpha (TNF-α) is a cytokine having numerous immunological and metabolic activities and is an important stimulus for Interleukin-6 (IL-6) production. Interleukins play an important role in immune system function. Their deficiency causes autoimmune diseases or immune deficiency. Aim: To assess inflammatory markers IL-6 and TNF-α in hypothyroidism before and after attainment of euthyroid state by levothyroxine therapy and to find the correlation between serum levels of TNF-α and hypothyroid state. Materials and Methods: This quasi-experimental study was conducted at Department of Physiology at University College of Medical Sciences, Delhi, India, from January 2013 to October 2013. Total 30 newly diagnosed hypothyroid patients of the age group 18-45 years formed case group and 30 age and sex-matched subjects formed the control group, were recruited for the study. The patients were given levothyroxine replacement therapy for three months. The inflammatory biomarkers level was evaluated using solid-phase sandwich Enzyme Linked Immunosorbent Assay (ELISA), using kits from Diaclone. Paired and Unpaired t-tests respectively were used for hypothyroid patients in pre-post state and between two groups at baseline. Serum Thyroid Stimulating Hormone (TSH) levels of hypothyroid patients were correlated with serum levels of inflammatory markers using Pearson’s correlation test. Results: There was no statistical difference in age, sex, body mass index and lipid profile in the two groups. Hypothyroidism subjects achieved euthyroidism in three months months after obtaining levothyroxine therapy with the mean TSH levels 26.43±10.244 vs 3.4863±0.1963, mean free T3 levels 0.2980±.09408 vs 1.93±0.5690 and mean free T4 levels 0.2736±0.0973 vs 1.8986±0.2853 in pre-post states respectively. Serum levels of IL-6 and TNF-α were significantly higher (p-value<0.001) in hypothyroid subjects compared to euthyroid controls. A positive correlation between serum levels of IL-6 (r-value= 0.5778, p-value= 0.0008) and TNF-α (r-value= 0.521, p-value= 0.003) with serum TSH levels were found. Conclusion: The study reported a significant effect of levothyroxine therapy in restoring serum levels of raised inflammatory markers among hypothyroid patients. A decrease in low-grade chronic inflammation after treatment showed some clinical importance as chronic inflammation is known to be associated with atherosclerosis and cardiac disease.

Effect of Counselling on Compliance of Hydroxyurea Therapy and Frequency of Hospital Admissions among Patients with Sickle Cell Disease- A Longitudinal Study

Gaurav Kumar Prajapati, Shweta Sharma, Jyotsna Shrivastava

Introduction: Sickle Cell Disease (SCD) is an autosomal recessive multisystem disorder, characterised by anaemia, recurrent episodes of pain and chronic organ damage. Hydroxyurea (HU), a disease modifying agent with proven efficacy in reducing painful episodes in SCD patients thereby improving quality of life. Compliance to hydroxyurea therapy is a liming factor in management of SCD. Aim: To compare adherence to HU therapy and frequency of hospital admissions before and after counselling. Materials And Methods: This longitudinal study was conducted in Department of Paediatrics at Gandhi Medical College and associated Hamidia Hospital Bhopal, Madhya Pradesh, India, from 1st January 2020 to 30^th June 2021. Patients with SCD, between the age group of 1-14 years, in a study period were recruited for the study. After enrolment, data regarding HU therapy and admissions in the previous one year was recorded for each registered patient. This was followed by detailed counselling sessions, which were repeated at 3 monthly intervals for a period of 1 year. Post-counselling data collection was done to evaluate the response. The effect of counselling was assessed using Chi-square test (for categorical variables) and Analysis of Variance (ANOVA) or paired t-test (for continuous variables). A p-value<0.05 was considered statistically significant. Results: Initially, a total of 42 patients were registered, out of which only 31 patients could be followed-up till the last counselling. Mean age of the patients was 7.8±3.5 years, and 20 (64.5%) cases were males. As per history and previous year data total of 26 (83%) patients were already on HU therapy. Frequency of crises, hospital admissions, school absenteeism, and blood transfusion reduced significantly post counselling. The common factor associated with non adherence to therapy were non availability of drugs 21 (67.7%), followed by improper follow-up 20 (64.5%) and unawareness 17 (54.8%). Financial problems, non-palatability and distance from the hospital were other associated factors in 11 (35.5%), 4 (12.9%) and 2 (6.5%) cases, respectively. Conclusion: With counselling, better drug compliance to HU therapy was observed. This is expected to help in achieving better disease control in terms of reduced need for blood transfusion, hospital admissions as well as school absenteeism.

Correlation of Suppression of Tumourigenicity 2 with hsCRP, NT-proBNP and Left Ventricular Ejection Fraction in Patients with Myocardial Infarction

Introduction: Soluble Suppression of Tumourigenicity 2 (sST2) represents a clinically relevant biomarker and has predictive evidence in acute Myocardial Infarction (MI) and predicts cardiovascular death and risk of heart failure development in these patients. The data about the correlation of sST2, N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP)in the Indian population is lacking. Aim: To find a correlation of ST2 level at the time of admission with NT-proBNP, hsCRP and Left Ventricular Ejection Fraction (LVEF) in patients with MI, and the association of ST2 levels with mortality. Materials and Methods: This longitudinal observational study was conducted at Poona Hospital and Research Centre, Pune, Maharashtra, India, between June 2018 and August 2019, among 75 myocardial infarction patients above 18 years of age. ST2, NT-proBNP and hsCRP levels were checked within 6 hour of hospitalisation. The primary outcome measures were to study the correlation of ST2 levels at the time of admission with hsCRP, NT-proBNP and LVEF. The secondary outcome measures were to study the association of ST2 levels with in-hospital and one-month mortality. The medians of continuous variables of two groups and three groups were-tested using the Mann-Whitney U test and Kruskal-Wallis H test respectively. The correlation analysis was performed using Spearman’s method. Results: The mean age of the study population was 57.8±7.2 years. The mortality rate was 60% (12/75). ST2 levels showed a statistically significant positive correlation with NT-proBNP (r =0.703, p-value=0.001) and hsCRP (r=0.873, p-value=0.001), whereas, ST2 levels showed a negative correlation with LVEF (r=- 0.711, p-value=0.001) in MI patients. The median ST2 levels were significantly higher in-hospital (215.3 ng/dL vs 94 ng/dL) and one month (219.5 ng/dL vs 92.0 ng/dL) mortality as compared to survived MI patients. Conclusion: ST2 levels showed a statistically significant positive correlation with NT-proBNP and hsCRP and were associated with in-hospital and one month mortality in MI patients.

Comparison of Clinical and Radiological Parameters around Microthread Implants in Patients with and without History of Treated Periodontitis

Introduction: Maintenance of crestal bone level is crucial for the success of implant-supported prosthetic rehabilitation. Implant neck design plays an important role in maintaining crestal bone levels. The microring neck design is known to counteract the marginal bone loss and improving bone-to-implant contact by providing optimal load distribution as reported by the finite element studies and animal studies. Aim: The current study aimed to evaluate dental implants’ short-term (12 months) clinical and radiographic parameters in periodontally healthy patients versus those with history of treated periodontitis. Materials and Methods: The current prospective interventional study was performed at AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India from 2016 to 2018. In the study, 24 microthreaded implants were placed in periodontally healthy patients (group A, n=12) and patients with a history of treated periodontitis (group B, n=12). Peri-implant radiographic crestal bone loss, clinical measurements like probing pocket depths, bleeding on probing, and soft tissue complications were assessed around implants at time of implant loading, and 3, 6, and 12 months postloading. Statistical Package for the Social Sciences (SPSS) software version 22 was used for statistical analysis. Statistical significance was set at p<0.05. Results: At the end of one-year postloading, peri-implant crestal mean bone loss of 2.317±0.914 mm (mesial), 2.37±1.276 mm (distal) and 2.673±1.178 (mesial), 2.87±1.075 (distal) mm were observed in groups A and B, respectively. The probing pocket depths were 3.729±0.95 mm and 4.017±0.67 mm in groups A and B, respectively at the end of the study period. However, there was no statistical significance for probing depths among both groups. At the end of the study period, soft tissue complications were 16.67% in group B, while no complications were noted in group A. None of the groups showed any technical or mechanical complications. Conclusion: The results of the study revealed that crestal bone loss and pocket depths around implants are similar in both groups at various follow up periods. However, the incidence of peri-implant soft tissue complications is higher in patients with history of treated periodontitis.

Effect of Head Rotation on Efficiency of Face Mask Ventilation among Apnoeic Patients: A Cross-sectional Study

Amol Singam, Matturu Soumya, Ashok Chaudhary

Introduction: Respiratory function is crucial in the practice of anaesthesia. An in depth understanding of respiratory physiology is a must because it aids in the proper execution of daily general anaesthesia practice. Head and body postures have long been known to affect the patency of the upper airway. Head extension and a lateral recumbent position help to clear the upper airway. Head rotation is known to expand the upper airway’s cross-sectional area. Aim: To determine the effect of head rotation on efficiency of face mask ventilation among apnoeic patients, by measuring expiratory tidal volume. Materials and Methods: This cross-sectional study was conducted in the Department of Anaesthesiology at Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from May 2021 to November 2021. Total 40 patients belonging to the age group of 20 to 40 years, American Society of Anaesthesiologists’ (ASA) class I and II, undergoing surgeries requiring general anaesthesia with endotracheal intubation, were selected as study subjects. They were administered inj. fentanyl at a dose of 1 to 2 μg/kg, inj.propofol at a dose of 1 to 2 mg/kg, and inj.vecuronium bromide (0.08 to 0.1 mg/kg). Patients were mask ventilated with pressure-controlled ventilation, for a total of 3 minutes, during which they were ventilated in a neutral head position for 90 seconds and then rotated for another 90 seconds. Following induction, the expiratory tidal volume was measured every 30 seconds in both postures Software used was Statistical Package for Social Sciences for windows (SPSS Inc., Chicago, IL, USA), version 17.0. A p-value <0.05 was considered statistically significant. Results: The mean age of patients was 48±8.3 years. The 45° head rotation was beneficial to all patients, the mean expiratory tidal volume was 423±62.5 mL in the rotated head position compared to 397±52.5 mL in the neutral head position (p-value=0.045). It was also observed that some individuals profited more than others. Patients with airway obstruction, for example, had a greater V_TE at 45° head rotation than in a neutral head position. Conclusion: The most notable conclusion is that in apnoeic adult patients, a 45° head rotation showed a significant enhancement in V_TE when compared to a neutral position ofthe head.

Effect of Fentanyl and Dexmedetomidine as Additives to 0.5% Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block for Elective Upper Limb Surgeries: A Randomised Clinical Trial

M Umamaheshwar, KM Shwetha, Ramarao Bhogadi

Introduction: Supraclavicular brachial plexus block is a superior alternative to general anaesthesia for upper limb surgeries, and use of ultrasound makes it safe and efficient in implementation. Ropivacaine, having significantly higher threshold for cardiotoxicity and neurotoxicity and more potent blocker of A and C fibres, renders good sensory blockade and lesser motor. Hence, to overcome this, additives are added. Aim: To evaluate the block characteristics with addition of either fentanyl or dexmedetomidine to 0.5% ropivacaine for supraclavicular brachial block. Materials and Methods: This randomised double-blinded clinical trial, was conducted on 50 patients posted for upper limb surgeries under supraclavicular brachial plexus block were randomly allocated to either receive 30 mL of 0.5% ropivacaine with 50 μg fentanyl (Group RF) or 30 mL of 0.5% ropivacaine with 50 μg dexmedetomidine (Group RD). The time for onset of sensory block and motor block were noted. Intraoperative hemodynamics were monitored in all the patients. Postoperatively Visual Analog Scale (VAS) scoring for pain, the time for rescue analgesia and the duration of sensory and motor blockade were noted. Results: Both groups were comparable with respect to age, gender and American Society of Anaesthesiologists (ASA) grading. The onset of both sensory (p-value 0.008) and motor block (p-value 0.0005) was faster in Group RD compared to Group RF which was highly significant statistically. The duration of sensory (p-value 0.0005) and motor block (p-value 0.0005) was longer in Group RD compared to Group RF which was highly significant statistically. The requirement for rescue analgesia was lesser in Group RD since the mean VAS score was persistently low which was statistically significant (p-value <0.01) compared to Group RF. Conclusion: The blockade improved better with addition of dexmedetomidine than fentanyl to 0.5% ropivacaine. There were no increased incidence for side effects.

Incidence and Severity of Postdural Puncture Headache following Subarachanoid Block using 25G Quincke and 25G Whitacre Spinal Needles: A Double-blinded, Randomised Control Study

Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical Sciences- Imphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.

Effect of Oral Contraceptive Pill and Metformin on Metabolic and Endocrine Parameters in Polycystic Ovarian Syndrome: A Prospective Interventional Study

Mustafa Asad, Manab Nandy, Manasi Banerjee, Mayukh Mukherjee

Introduction: Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrinopathies, affecting women of reproductive age group worldwide. There is no comprehensive data, regarding the outcome of various treatment modalities. Aim: To assess the effect of Oral Contraceptive Pills (OCP) and metformin on metabolic and endocrine parameters in PCOS. Materials and Methods: It was a prospective interventional study, done over a period of 12 months from January 2017 to January 2018 at the Outpatient Department (OPD) of Gynaecology and Obstetrics, Medical College, Kolkata. A total of 162 PCOS patients were recruited. The selected patients were divided into two groups A and B, based on the clinician’s assessment with respect to the patient profile. Group A received lifestyle intervention plus metformin (started at 500 mg / day and according to patient’s response and the clinical judgement titrated upto 2000 mg/day for 6 months) and group B received lifestyle intervention plus oral contraceptive pill. (fixed dose combination of ethinyl estradiol 50 micrograms and cyproterone acetate 2 milligrams per day for 6 months). The patients were assessed for metabolic parameters [Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), Haemoglobin A1C (HbA1C), lipid profile] and endocrine parameters [testosterone, prolactin and Thyroid Stimulating Hormone (TSH)]. The Student t-test, Chi-square test and Analysis of Variance (ANOVA) test were used to compare the data. Results: A total of 162 patients were recruited for the present study with the mean age in group A was 23.75±1.7 and in group B was 22.40±1.6 years. The mean HbA1C levels of group A before the initiation of the treatment was found to be 7.51±0.89% which was reduced to 7.45±0.49% and 6.83±0.34% at the end of two months and six months respectively (p-value=0.001). In group B, serum testosterone was significantly reduced from 2.86±0.48 to 2.18±0.42 (p-value=0.0001), however the glycemic control worsened. Conclusion: OCPs and metformin do not significantly correct metabolic abnormalities associated with PCOS, although, gynecological symptoms are improved significantly. Comparatively, metformin helps in control of blood sugar levels but high BMI and deranged lipid profile remains unaltered by both metformin and OCP.

SARS-CoV-2 Antibody Response in Patients with Co-morbidities in Kashmir’s Ethnic Population: An Observational Cohort Study

Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection risks in co-morbid patients are still unknown two years after the pandemic began. The prevalence of antibodies against SARS-CoV-2 infection is crucial for determining disease preventive and mitigation strategies. Obesity, type 2 diabetes, and chronic cardiovascular disease can raise the risk of Coronavirus Disease-2019 (COVID-19), which has a greater morbidity and fatality rate. Aim: To determine the seroprevalence of SARS-CoV-2 (COVID-19) antibodies and their relationship to co-morbidities in Kashmir’s ethnic population. Material and Methods: The present observational cohort study was done in the Department of Pulmonary Medicine at Chest Disease Hospital Srinagar, Jammu and Kashmir, India, from September 2020 to September 2021 and 1,846 co-morbid unvaccinated patients were chosen for the study. As per standard methodology, a cohort study was undertaken, a questionnaire was prepared, and demographic and associated parameters were recorded. All participants had their immune profiles tested, and the existence of Immunoglobulin G (IgG) antibodies for SARS-CoV-2 was determined using the chemiluminisence immunoassay technique. Chi-square and Fischer exact test were used for stastical analyses and p-value <0.05 were taken as statistically significant. Results: As per the present study estimates, demographic and socio-economic characteristic affected test attendants. The SARS-CoV-2 IgG antibody response among co-morbid patients were found to be 54.3%. The hypertension and diabetes were most prevalent co-morbidity found in the individuals (p<0.001). Conclusion: Co-morbidities including hypertension and diabetes in an individual are more likely have COVID-19 which can lead to death. COVID-appropriate conduct is required to limit infection transmission in the community, and immunisation is of paramount importance for all individuals. More research is needed to determine the risk of co-morbidities among Kashmir’s ethnic community.

Flipped Classroom Approach in Undergraduate Medical Education: The Need of the Hour

Smita Priyadarshan Jategaonkar, Sachin Damke, Manish Jain

Introduction: In the era of changing medical education system, our teaching methods are not able to cope up with ongoing evolution of medical education. There is a definite need of introducing newer techniques of teaching-learning methods to improve the learning process to higher levels of Bloom’s taxonomy. Aim: To explore the perceptions and attitudes of final year undergraduate medical students and teachers in paediatrics towards Flipped Classroom (FCR) model. Materials and Methods: The present prospective observational study was conducted at the Mahatma Gandhi Institute of Medical Sciences Sevagram, a rural tertiary care institute of central Maharashtra, India from December 2020 to November 2021. The full class strength of 100 undergraduate final year medical students and all eight faculty members participated to conduct FCR sessions on Paediatric infectious diseases. Prereading study material in the form of videos and reading materials was provided for asynchronous learning, while classroom time was spent on solving problem-based questions based on “think-pair-share” with the faculty as facilitators. Student and faculty feedback was recorded via a five-point Likert’s scale. Consequently, small-group discussions were carried out to know the students’ reflections. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 software. Results: The students showed overall encouraging response to the flipped classroom method with active participation. Eighty two students (82%) were happy about the content of the reading material and time spent on preclass activity. More than 75% of students agreed it to be more interactive with peers and teachers and that it enhanced active learning with development of interest in the given subjects. Seventy-five students (75%) gave positive responses towards the utility of flipped model for future classes as it helped in self directed learning. The faculty members also enjoyed this activity, though they found it time-consuming. Conclusion: FCR is an effective way to motivate and enhance active and self-directed learning. Unlike didactic lectures, it helps the students in conceptual understanding of the subject and makes the teaching-learning experience enjoyable.

Prevalence of Asymptomatic Otitis Media with Effusion in Children with Adenoid Hypertrophy and its Relation to Adenoid Size: A Cross-sectional Study

Sherin Maria Augustian, Rajan Kezhaeplackal Vasu, Anjana Mary Reynolds

Introduction: Otitis Media with Effusion (OME) occurs as a sequela of adenoid hypertrophy. But most often hearing loss due to OME goes unnoticed in children. This causes poor cognitive development, inattention and thus poor scholastic performance. Aim: To estimate the frequency of asymptomatic OME in children with adenoid hypertrophy and to find the association between adenoid size and occurrence of OME and hearing loss. Materials and Methods: The present study was a prospective cross-sectional study conducted in a tertiary care centre in South India from November 2019 to November 2021. Children of 5-12 years of age, with symptoms suggestive of adenoid hypertrophy and with no complaints of hearing loss, were selected. A detailed ear, nose, throat examination, Pure Tone Audiometry (PTA) and tympanometry were done in all patients. Adenoid size was graded by nasal endoscopy using Mc Murray and Clements scale and also based on radiographs (comparing the distance between maximum convexity of adenoid and line drawn along basiocciput (A) and posterior part of hard palate and sphenobasioccipital synchondrosis (N)) using A/N ratio. All patients subsequently underwent adenoidectomy. Myringotomy was done along with adenoidectomy in cases with bilateral OME. All OME patients were followed-up with tympanometry, one month and three months postoperatively. The frequency of OME was presented as percentage. The association between adenoid size and asymptomatic OME as well as hearing loss was done using Fisher's exact test. Results: A total of 150 children between 5-12 years with adenoid hypertrophy were analysed. The mean age was 9 years. On analysing the association between adenoid size (both radiographically and endoscopically) and OME, 30 (20%) had bilateral effusion and 18 (12%) had unilateral effusion and prevalence of asymptomatic OME was calculated as 32%. Most of the patients had Grade 2 adenoids radiographically, and Grade 3 adenoids as per nasal endoscopy. Majority of patients had Type B Tympanogram. There was significant association between OME and adenoid size. Association between adenoid size with hearing loss showed significant association between the two with p=0.001 on right ear and p<0.001 on left ear (radiographically), and p=0.0027 on right ear and p=0.043 on left ear (as per nasal endoscopy). About 93% of children with bilateral Type B tympanogram and all children with unilateral Type B and bilateral Type C returned to normal on three months follow-up. Conclusion: There was association between adenoid size, and occurrence of OME and hearing loss. About 32% of the study population were detected to have asymptomatic OME.

Comparison of Uric Acid Levels in Hypertensive Patients with and without Heart Disease: A Case-control Study

Prathivadi Bhayankara Prathyusha, A Pullaiah, V Ratna Kumari

Introduction: Hypertensive heart disease is the 13^th leading cause of death worldwide. Uric Acid (UA) is an end product of purine metabolism in humans and higher serum UA is a potential independent risk factor for Cardiovascular Disease. Aim: To compare the levels of serum UA in hypertensive individuals with and without cardiovascular disease. Materials and Methods: This case-control study was done at RIMS, Telangana, India from October to December 2021 including 50 individuals with hypertension and without cardiovascular disease enrolled as controls and 100 individuals with Hypertensive Heart Disease (HHD) as cases. The HHD cases were subdivided into group 2A (age <=55 years) and 2B (age >55 years). Samples were collected and analysed for UA, lipid profile, serum creatinine, fasting blood sugar, etc. Independent samples T-test was used for statistical analysis using Statistical Package for Social Sciences (SPSS) software version 28.0.1.1 (15). Results: Males and females were taken in a ratio of 1:1. Mean age for control group was 54.6±9.6 years, for HHD ≤55 years was 50±3.232 and for HHD >55 years was 63.26±6.137 years. In males, mean values of serum UA was 5.1±0.5 mg/dL in controls, 9.2±1.0 mg/dL in HHD ≤55 years (p-value=0.03), 6.4±0.8 mg/dL in HHD >55 years (p-value=0.1). In females, mean values of serum UA was 4.8±0.4 mg/dL in controls, 10.5±0.4 mg/dL in HHD ≤55 years (p-value=0.009), 6.9±0.5 mg/dL in HHD >55 years (p-value=0.09) Standard Deviation (SD). Serum UA levels were significantly higher in patients of HHD less than 55 years of age than that of controls. Conclusion: Based upon the findings of the study, it was concluded that hypertensive individuals with cardiac disease had higher levels of serum UA than controls, especially in females.

Evaluation of Pregnancy Outcome in Women with First Trimester Vaginal Bleeding: A Longitudinal Study at a Tertiary Care Hospital, Kolkata, India

Animesh Naskar, Rupsha Chowdhury, Pradip Kumar Saha, Rup Kamal Das

Introduction: First trimester vaginal bleeding, a serious obstetric challenge to developing embryo, occurs in 15-25% of all pregnant women. It is a matter of great concern to both mother and obstetrician for its increased association of adverse maternal and foetal outcome. Aim: To measure the prevalence of patients with first trimester vaginal bleeding, to evaluate factors associated with it and to assess foeto-maternal outcome in those pregnant women. Materials and Methods: This was a prospective, hospital-based, longitudinal study carried out among 120 women with first trimester vaginal bleeding having normal bodyweight, and regular cycles and agreeing to follow-up, at Department of Obstetrics and Gynaecology in a tertiary teaching hospital, Kolkata, West Bengal, India, from January 2019 to June 2020. The incidence of vaginal bleeding in first trimester, its risk factors, foeto-maternal outcome in terms of Pregnancy Induced Hypertension (PIH), abortions, preterm deliveries, Antepartum Haemorrhages (APH), birth weight of baby, low APGAR (Appearance or colour of the baby, Pulse, Grimace, Activity, and Respiration) score at birth were assessed. The descriptive statistics to calculate percentage and mean and Chi-square-test with significance value considered at p-value <0.05. Results: Out of 4716 pregnant women attending in Obstetric clinic at their first trimester, 332 had vaginal bleeding, incidence being 7.04%. Out of 332 women, 120 study participants met inclusion criteria. Of 120 cases, 79 (65.8%) were from age group of 21-30 years. Highest incidence was 74 (61.7%) in primigravida. Incidence was high in poor socio-economic status (upper lower and lower) ie., 57 and unplanned cases, 87 (72.5%). On follow-up of 120 participants, 66 (55%) had threatened abortion, of them 51.5% (34/66) led to term pregnancy followed by preterm labour 39.39% (26/66) and only few, 9.09% (6/66) ended up with incomplete miscarriage. Spotting was most common nature of bleeding per vagina 41.66%, (50/120). On follow-up of 60 (90.9%) viable pregnancies, PIH was in 12 (20%) cases and abruption was seen in one (1.6%). Majority of preterm babies 65.4%, (17/26) Needed Neonatal Intensive Care Unit (NICU) admission. Conclusion: Vaginal bleeding in first trimester is an indicator of the maternal and foetal adverse consequences and results of this study can enrich our knowledge to plan and manage these pregnant women adequately.

Comparison of Preoperative Assessment of Gastric Volume and pH in Patients Undergoing Elective Surgery with Prior Two Hour Fasting versus Overnight Fasting- A Randomised Clinical Trial

Ajit Singh Baghela, Fateh Singh Bhati, Manish Jha, Manish Singh Chauhan

Introduction: Aspiration of gastric content is a known life-threatening, yet preventable complication of anaesthesia. While mostly all elective procedures do follow the preoperative fasting protocols as recommended by American Society of Anaesthesia (ASA), there are many situations where the fasting guideline cannot be followed considering the emergency. In such cases, bedside ultrasound assessment of gastric volume can become an important tool to stratify aspiration related risk. Aim: To find out the actual trends of gastric volume and pH in patients with two hour fasting with a prokinetic drug versus overnight fasting who are undergoing elective procedures. Materials and Methods: This single centre, randomised clinical trial was conducted in the Department of Anaesthesia at Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India, between December 2020 and July 2021, among 50 patients of ASA grade I undergoing elective procedures under general anaesthesia. Participants were divided into two groups. Group A patients were advised overnight fasting while group B participants were advised two hour fasting for clear liquids followed by intravenous (i.v.) metoclopramide injection. Assessment of gastric volume and other gastric parameters were done using a portable ultrasound machine. The pH of gastric content was measured using pH strips. Gastric content was obtained using Ryle’s Tube placed in the patient, postinduction of anaesthesia. Collected data was statistically analysed using Unpaired t-test for all qualitative data. Results: Significant difference in the anteroposterior diameter (3.46±0.34 in group A versus 2.24±0.30 in group B), cranio-caudal diameter (4.77±0.51 in group A versus 3.71±0.36 in group B), antral curved surface area (9.90±0.77 in group A versus7.77±1.04 in group B) and gastric volume (127.48±13.09 in group A versus 104.65±15.43 in group B) and pH (2.08±0.28 in group A versus 2.80±0.41 in group B) was observed (p-value=0.0001). However, no significant difference in any gastric parameter, mentioned above, was noted before and after injecting intravenous metoclopramide. Conclusion: Bedside ultrasound assessment of gastric volume is an important toolfor aspiration risk stratification especially in emergency, non-fasting patients.

Hypoalbuminaemia and Blood Urea Nitrogen/Creatinine Ratio as Early Markers of Acute Kidney Injury in Postoperative Cardiac Patients- A Prospective Study

KA Arul Senghor, Kopuri Manohar, VM Vinodhini, P Renuka

Introduction: Postoperative Acute Kidney Injury (AKI) occurs as the consequence of intraoperative risk factors associated with cardiac surgery. Biochemical monitoring of patients undergoing cardiac surgery enables early detection of AKI. Serum albumin and Blood Urea Nitrogen (BUN): creatinine ratio serves as a simple tool for identifying increased risk of AKI. Aim:To determine serum albumin and the BUN: creatinine ratio as a predictive tool for AKI risk in patients undergoing cardiac surgery. Materials and Methods: The present prospective observational study was conducted at Cardio Thoracic super specialty unit of SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, between July 2020 to March 2021. A total of 30 patients undergoing coronary artery bypass grafting in the age group between 40 to 70 years with normal serum creatinine levels were included. Preoperative and postoperative parameters such as urea, creatinine, total protein, serum albumin, BUN: creatinine ratio and estimated Glomerular Filtration Rate (eGFR) were calculated. Data were analysed statistically by Analysis of Variance (ANOVA) and Student’s t-test. Results: In present study, 24 (80%) were males and 6 (20%) were females. The mean age of the male and female patients was 57±0.72 years and 55.3±0.81 years respectively. Mean BUN: creatinine ratio was decreased on day 1 (16±0.78) and day 3 (8.19±0.87) postoperative phase as compared to preoperative day (14±0.63). Compared with preoperative albumin (3.65±0.1 g/dL), hypoalbuminaemia was found on first and third postoperative day, (3.07±0.05 and 3.04±0.05 g/dL) respectively. With Receiver Operating Characteristic (ROC) curve analysis, Area Under the Curve (AUC) for albumin and BUN: creatinine ratio was 0.72 and 0.67 which revealed the diagnostic sensitivity of 86% and 78% respectively. On day 3 postoperative eGFR fell by 12.5%, indicating a danger of kidney injury. Conclusion: Hypoalbuminaemia and BUN: Creatinine ratio are simple biochemical tools to predict AKI in postoperative phase after cardiac surgery.

Comparative Study of Efficacy of Kutaja Beeja Churna and Ayurvedic Herbal Compound in the Management of Mutrashmari (Urolithiasis)- A Research Protocol

Akshay Kumar, Devyani Dasar

Introduction: Acharya Sushruta, the father of surgery has included Ashmari in Astamahagada due to its fatal nature. “Ashman” the Sanskrit word, literally means “structure resembling stone”. While the word ‘Ari' means ‘enemy,' so it refers to a sickness in which stones grow and inflict intense pain, as if caused by an adversary. Mutrashmari can be associated with Urolithiasis which is the third most common affliction of the urinary tract. Acharya Sushruta has described medicinal treatment in the initial stage of the disease and advised that surgery to be done only on failure of conservative treatment and when death becomes inevitable if not operated. In Yogaratnakar, Ashmari chikitsa, Kutaja is described to be more effective in the treatment of Mutrashmari. Need of study: In modern medicine, the treatment of urinary stones is non surgical as well as surgical interventions but both have some limitations and also stone formation reoccurs after removal. There is a need for safe, cost effective and simple method of management of urolithiasis which is curative as well as preventive. Aim: Comparative assessment of efficacy of Kutaja Beeja Churna and Ayurvedic Herbal Compound in the management of Mutrashmari (Urolithiasis). Materials and Methods: A randomised control trial (single blind parallel) with 1:1 ratio on 2 groups and will be conducted in Mahatma Gandhi Ayurved College Hospital and Research Centre Salod (Hi) Wardha. Expected duration of the study is one and half year (February 2022 - August 2023). Approval from the Institutional Ethical Committee has been taken and for this trial the registration number is CTRI/2021/09/036297. For statistical analysis Wilcoxon signed-rank test, Mann Whitney U test, Student’s t-test and the Statistical Package for the Social Sciences (SPSS) software will be used in the study. After doing drug analysis, a total of 60 patients fulfilling the inclusion criteria will be selected and distributed in two groups having 30 each. In group A, Kutaja Beeja Churna and in group B, Ayurvedic Herbal Compound will be given twice a day for 45 days. Assessment will be done on day 15, 30 and 45 and after the intervention; follow-up will be taken on days 60 and 90. Results will be drawn from the observations of subjective parameters like pain and dysuria and objective parameters like size of the stone, site of the stone and haematuria.

Implementation of Modified Peyton’s Method for Skill Training among Undergraduate Students in Prosthodontics

Ashika Singhania, Sweta Kale Pisulkar

Introduction: Simulation training has been practiced in dental schools all throughout. The pertinent use of simulation in any professional education program allows the students to get clarity for their clinical skills without the danger of harming the patient during the learning process. The success of different teaching methods in skill laboratories is still debated in the literature. One of them is Peyton’s approach which is designed for student: teacher ratio of 1:1. To overcome this modified Peyton’s method was introduce which allows each of the trainees to perform respective skill at least once. Aim: To evaluate and compare Modified Peyton’s approach with conventional teaching for skill training among undergraduate students in Prosthodontics. Materials and Methods: This prospective interventional study will be conducted in Department of Prosthodontics at Sharad Pawar Dental College, Wardha, Maharshtra, India, from October 2022 to December 2023. The study will involve 70 third year BDS students randomly divided two groups equally. The study will be conducted in dental setting utilising the dental skill laboratory to make alginate impression. Group A will be taught using conventional method and group B will be divided into 10 groups and taught using modified Peyton method and evaluation will be done using Objective Structured Practical Examination and post-test. Expected Outcome: At the end of the study, student’s taught using modified Peyton’s method might show better result in OSPE and post-test. Conclusion: Modified Peyton’s method will prove beneficial to students learning new skill.

Smear Layer Removal Efficacy of Natural Root Canal Irrigants- A Literature Review

Seema Deshmukh, Indira Mysore Devraj, Arundhati Banerjee

An efficient chemomechanical preparation is essential for the success of endodontic treatment. There are various methods of instrumentation and irrigation, the canals are instrumented with either hand files or rotary. Chemical agents are used for irrigation during instrumentation to completely sterilise the canals. A lot of natural products are also used as irrigating agents as they have a lot of antimicrobial, anti-inflammatory, antioxidant and other biological properties. Several commonly used irrigants come with certain disadvantages. Certain chemicals like sodium hypoclorite can be toxic and weakens the dentine microstructure, but by using natural agents these side effects can be prevented. Less toxic and more biocompatible products are being increasingly used such as apple vinegar, citrus fruits, miswak, tulsi, chitosan, neem, turmeric, triphala etc. The natural preparations are derived from roots, seeds, leaves of plants preparations or shells of animals. This narrative review is aimed at highlighting various natural agents which can be considered as a potential adjunct for endodontic treatment.

Role of High Mobility Group Box 1 and Receptor for Advanced Glycation End Products in the Periodontal Disease Pathogenesis- A Review

R Ramya, Devapriya Appukuttan, Sangeetha Subramanian, PSG Prakash

Periodontitis is a multifactorial chronic inflammatory disease associated with increased secretion of several proinflammatory mediators such as Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-17 (IL-17), Tumour Necrosis Factor-α (TNF-α), Prostaglandins (PGs) in response to increased bacterial load on the tooth surface and within the gingival sulcus leading to the destruction of both hard and soft tissue of the periodontium. The Receptor for Advanced Glycation End-products (RAGE) binds multiple ligands, has a transmembrane configuration and is a part of the immunoglobulin receptor family. In healthy individuals RAGE is expressed at lower levels when compared to those with periodontitis and diabetes mellitus. Binding of RAGE to its ligands plays a key role in the inflammatory reactions that lead to disruption of a multitude of cellular processes. One such RAGE ligand involved in inducing hyperinflammatory phenotype is High Mobility Group Box 1 (HMGB1). HMGB1 is a chromatin binding protein predominantly localised in the nucleus and is associated with multiple functions such as Deoxyribonucleic Acid (DNA) repair, nuclear homeostasis, genome stability. In the presence of stressors, it migrates extracellularly and behaves like a Damage Associated Molecular Pattern (DAMP), has chemokine and cytokine activity. Extracellular HMGB1 binds to Toll Like Receptors (TLR)- 2,4 and RAGE, the HMGB1-RAGE interaction in particular has been associated with hyper inflammatory responses and currently hypothesised to be a bigger player in the pathogenesis of periodontitis as well as diabetes associated periodontitis. Therefore, understanding thoroughly the molecular mechanisms driving the tissue destruction in periodontal disease will effectively enable novel therapeutic drug based interventions based on interrupting the HMGB1-RAGE axis which in turn could mitigate the inflammation mediated tissue destruction.

A Review on COVID-19 Pandemic

Coronavirus associated with Severe Acute Respiratory Syndrome (SARS) has been identified as Coronavirus Disease-2019 (COVID-19) Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), first detected in Wuhan, Hubei province, China, the National Health Commission of China received reports of 27 cases of pneumonia, including seven severe cases of unknown origin, on 30^th December 2019. In order to diagnose COVID-19, the virus responsible for the pandemic, SARS-CoV-2, was analysed for its Ribonucleic Acid (RNA). It is possible to detect specific sequences of genes encoding the RNA dependent RNA polymerase (RdRP), nucleocapsid (I#INI?I), envelope (I#IEI?I), and spike (I#ISI?I) proteins of viruses using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). There are four major groups of drugs recommended by treatment guidelines worldwide: antiviral drugs (eight drugs), antimalarial drugs (two drugs), systemic corticosteroids (five drugs), and immune-based therapy (seven drugs). The recommendations for the treatment with these drugs in all of the guidelines differ depending on the severity of the case and the health conditions of the patient. A successful preventative vaccine is the most important and time-sensitive measure in combating the COVID-19 pandemic. There were 12 SARS-CoV-2 vaccines approved/authorised for full or emergency use in various parts of the world as of 25^th February 2021, with more than 200 million doses administered worldwide. Because the disease is still relatively new and healthcare is under considerable pressure, many questions remain unanswered. There is a lack of publications regarding the effectiveness and safety of these drugs in COVID-19 patients. In addition, community members with limited financial resources must still consider the costs associated with some of the proposed treatment regimens.

Non-syndromic Concomitant Hypo-Hyperodontia in the Anterior Region of Mandible- An Extremely Rare Phenomenon: Literature Review with Recent Updates

Resmije Ademi Abdyli, Genc Abdyli, Nora Berisha, Zana Agani, Jehona Ahmedi

Introduction: Hypo hyperdontia is a numeric mixed anomaly in which teeth may be supernumerary or absent, relative to the normal complement. The occurrence of this condition in the same individual is termed “Concomitant Hypo-Hyperdontia” (CHH). The presence of CHH in the same dental arch is uncommon, especially when it occurs in the front of the mandible in a Non-syndromic Concomitant Hypo-Hyperdontia (NCHH). Aim: To conduct a literature review of the published articles in the English language, regarding NCHH in the anterior region of the mandible covering the period from October 1977 to December 2021. Materials and Methods: An extensive electronic search was conducted in February 2022, from Google Scholar, PubMed, and Elton B. Stephens Company (EBSCO) databases, using keywords such as mandible, hypodontia, hyperdontia and non-syndromic. Manual sorting of the preselected literature, revealed only 19 published papers concerning NCHH in the frontal region of the mandible, spanning a period of 44 years. Results: The review analysed the data from 19 published studies, which presented 24 affected patients with a mean age of 12.36 years, with a male/female ratio of 1:1, involving a total of 41 missing teeth, including bilateral mandibular central incisors at 66.66%, followed by missing unilateral central incisor at 29.16% and 1 case (4.16%) displaying absence of both lateral incisors. Regarding 25 presented supernumerary teeth (ST), 72% of cases presented single midline ST, 20% were single unilateral ST, and one case presented double ST (8%) located bilaterally. The majority of ST (84%) were erupted conical-shaped. Conclusion: The study confirmed the exceptionally rare occurrence of NCHH in the anterior region of the mandible. Due to its interference with esthetics and function, the clinician should possess sufficient knowledge regarding NCHH diagnosis and management.

Pathophysiology of High Output Arteriovenous Fistula with Heart Failure: A Systematic Review and Meta-analysis

Introduction: Arteriovenous Fistula (AVF) is extensively used as vascular access for haemodialysis patients. It induces a high output state, which is associated with cardiac remodeling. With High Output Heart Failure (HOHF), the AVF occupies a low pressure; reduced vascular resistance and increased venous return. The High Output Arteriovenous Fistula with Heart Failure (HOHF-AVF) patients often undergo a comprehensive assessment of type of underlying diseases, the degree of vasodilatation along with laboratory investigations and cardiac imaging. Hence identification of the pathophysiological determinants of HOHF-AVF is intriguing. Aim: To identify the pathophysiological determinants of HOHF-AVF. Materials and Methods: This systematic review was conducted from May 2021 to December 2021 at the Department of Cardiovascular Surgery, Imperial College, United Kingdom. Randomised Controlled Trials (RCTs), cohort, case-control, cross-sectional and descriptive studies, conducted on adult patients who underwent AVF creation or ligation and addressed the pathophysiological determinants of HOHF-AVF were included. Studies conducted among Paediatric cases, case reports, and case series were excluded. Medline (PubMed), EMBASE, ProQuest, and the Cochrane database were searched, by utilising the key words {[(“HOHF” OR “High output heart failure”) AND (“AVF” OR “Arteriovenous fistula”)] AND (“LV parameters” OR “Structural Characteristics” OR “Echocardiographic indices)}. The searches were restricted from January 2000 to October 2021 with studies published in the English language. All the included studies were subjected to critical appraisal using the “Cochrane risk of bias assessment tool” for RCTs, and the “Joanna Briggs Institute (JBI) checklist” for cohort, case-control, cross-sectional and descriptive studies. For meta-analysis Mantel-Haenszel Odds Ratio (M.H. O.R.) with its 95% Confidence Interval (C.I), Mean Difference (M.D) with its 95 % C.I were computed. The Review Manager Software (Rev Man 5, Cochrane collabouration, Oxford, England) was used for data analytics. Results: Overall, 115 citations were identified from the initial search, of which 29 studies were retrieved. Later, 14 studies were excluded. Of the remaining 15 studies, 12 were subjected to meta-analysis. There was a change in Left Ventricular (LV) end diastolic diameter (M.D=2.0; p<0.001; 95% C.I=1.13 to 2.86), and cardiac index (M.D=0.63; p<0.001, 95% C.I=0.46 to 0.79) from baseline to atleast three months of postsurgery among HOHF-AVF patients. According to the AVF flow, there was a change in LV systolic diameter (M.D=-18.90; p<0.01; 95% C.I=-22.84 to-14.96), cardiac index (M.D=0.50; p=0.007; 95% C.I=0.14 to 0.86) and tricuspid annular plane systolic excursion (M.D=3.90; p=0.03; 95% C.I=0.30 to 7.50). Conclusion: Left ventricular end diastolic diameter and cardiac index were found to be the major determinants for a HOHF-AVF. The left ventricular mass index, ejection fraction, posterior wall thickness, interventricular septum were not associated with HOHF-AVF. Left ventricular systolic diameter, cardiac index and tricuspid annular plane systolic excursion were the determinants of AVF flow.

Pattern of Non Motor Symptoms in Parkinson’s Disease: A Prospective Observational Study From a Tertiary Care Centre, Bihar, India

Anand Kumar Rai, Abhay Ranjan, Sanaullah Mudassir, Ashok Kumar

Introduction: Non motor symptoms are highly prevalent in Parkinson’s Disease (PD) but are often overshadowed by the dominance of motor symptoms. Aim: To assess non motor symptoms in patients with Parkinson’s disease. Materials and Methods: In this prospective observational study, patients of PD fulfilling United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) criteria were recruited, between August 2019 to July 2021, in the Neurology Department of Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The pattern of Non Motor Symptoms (NMS) in PD was studied using detailed questionnaire and association of NMS with age, gender and modified Hoehn and Yahr stage were assessed. Chi-square test and Student's t-test was calculated where required. Results: Total 102 patients were included, with male constituting 73.5% patients. The mean age was 60.14±13.55 years. Constipation (74, 72.55%) was the most common non motor symptom. Most of the patients belonged to mild stage (52.94%) followed by moderate (40.20%) and severe (6.86%) stages, according to modified Hoehn and Yahr classification. Rapid eye movement sleep behaviour disorder (n=15) and sexual dysfunction (n=28) were significantly more prevalent in male patients. Depression, REM sleep behaviour disorder, olfactory disturbance, visual disturbance, urinary urgency, sweating abnormality, constipation, vomiting and visual blurring were significantly common in patients with earlier disease stages while psychosis in patients with advanced stage. Conclusion: This study showed the high prevalence of non motor symptoms in PD patient which is consistent with other studies, but there are differences in the frequency of individual symptoms which may relate to cultural and geographic differences.

Difference Between Erector Spinae Plane Block and Paraspinal Interfascial Plane Block in Analgesia after Posterior Cervical Laminectomy

R Arunkumar, V Sathyaprabu, S Parthasarathy

Spine surgeries are associated with severe intraoperative and postoperative pain which need a comprehensive management protocol. It is important to manage postoperative pain in such cases to improve early ambulation and discharge and hence the functional outcomes. A 46-year-old male, weighing 80 kg, was posted for cervical laminectomy with posterior stabilisation. After institution of general anaesthesia before surgical incision, 15 mL of 0.5% bupivacaine on each side at the level of C6 in the erector spinae plane on the left- side and the paraspinal posterior interfascial plane on the right-side was administered. The patient experienced significant postoperative pain relief for 12 hours. However, on clinical examination, there was a mild sensory loss on the left-side from C4 to T1, but no such sensory loss on the right-side. There was a complete recovery of sensory loss the following day. It is proposed that such volume in the Erector Spine plane can provide excellent analgesia for 12 hours, but with sensory loss. The drug may trickle to nerve roots, whereas it is unlikely to do so in the interfascial plane. It is also suggested that such volumes are needed for effective analgesia. It is also suggested that a technique without definitive sensory deficit is ideal in such cases to detect early surgical complication.

Haematological Malignancy Presenting in an Unusual Manner

Chronic lymphocytic leukaemia is a haematological malignancy that occurs due to an increased proliferation of mature B lymphocytes. It is considered to be the most common leukaemia in adults. Hyponatremia is commonly seen in such patients. This case report is about a 75-year-old male, who presented with giddiness, followed by altered sensorium. However, the patient had no motor weakness or sensory loss. Initially, a diagnosis of posterior circulation stroke was made but Magnetic Resonance Imaging (MRI) brain did not show associated signs. The routine investigations showed highly elevated total leukocyte count and hyponatremia. The patient was worked up for malignancy and diagnosed with Chronic lymphocytic leukaemia. Oncology reference was taken and treated with tablet Ibrutinib. On discharge, the patient’s mentation improved, and he is on regular follow-up.

Struma Ovarii: A Rare Presentation in a Paediatric Patient

Manjari Kishore, Avinash Kumar, Vandana Mohan

Struma Ovarii (SO) is a rare form of teratoma of ovary containing predominantly thyroid tissue, usually comprising more than 50% of the overall mass. It accounts for 1% of all ovarian tumours in adults. Due to its rare presentation in paediatric age group, the exact incidence is not known.The association of SO with hyperthyroidism has been noted in approximately 8% of cases. Radiological evaluation helps in preliminary diagnosis of a complex ovarian cyst, however, a definitive diagnosis of SO can only be made upon extensive histopathological evaluation. Present report is of SO in a 12-year-old female patient, who initially presented with pain abdomen, vomiting and hyperthyroidism with mildly elevated thyroid hormones Triiodothyronine (T3) and Tetraiodothyronine (T4). Magnetic Resonance Imaging (MRI) whole abdomen showed evidence of right-sided dermoid with mild ascites. An exploratory laparotomy was done followed by right ovarian cystectomy and histopathology revealed a mature teratoma predominantly comprising of thyroid tissue (>90% of total ovarian mass), thereby confirming the diagnosis of SO. After one month of surgical resection, the patient’s thyroid profile showed decrease in fT3 and fT4 levels. The index case highlights the unusual occurrence of SO in a paediatric patient along with the role of an extensive histopathological evaluation in diagnosis of the same.

Effectiveness of the Structured and Conventional Methods of Viva Examination in Medical Education: A Systematic Review and Meta-analysis

K Anbarasi, JV Karunakaran, Latha Ravichandran, B Arthi

Introduction: Oral examination (viva voce) is one of the common assessment methods for medical students. Literature shows that Conventional Oral Examination (COE), is a widely adopted method and uses a consolidated scoring system. There came an alternative method, Structured Oral Examination (SOE) that uses the recommended rating scale (prevalidated questions and markings). The emergence of a new method raised the research question of whether the conventional or structured oral examination is effective in assessing medical students. Aim: To evaluate the effectiveness of traditional and structured viva-voce examination across the specialties in medical education. Materials and Methods: A systematic review was conducted on 18 peer-reviewed articles about conventional and structured oral examination among medical students. Medical Education Research Study Quality Instrument (MERSQI) was used to assess the quality of evidence. Results: The level of evidence was moderate where the MERSQI score ranges from 7.5 to 15.5 for the 18 articles included in the review process. SOE overcomes COE by assessing students’ cognitive skills, communication skills, behaviour, and attitude whereas COE principally assesses the recall knowledge. Analytical and reasoning power remains the predominant domain in SOE. With psychometric properties like good reliability, sensitivity, and acceptability, SOE remains the best strategy for the evaluation of medical students. Pooled results in the forest plot showed no difference in the viva voce marks between COE and SOE with a mean difference of 0.46 (p=0.53). Conclusion: The review analysis revealed that there is no difference in the mean marks scored by COE and SOE. However, a SOE will allow examiners to assess the medical students’ learning achievement with no partiality, stress, and anxiety compared to COE.

A Review on Palliative Care Challenges and Benefits

Amit Agrawal, Dalwinder Singh, Roshan Chanchlani, Alejandro Pando

Palliative care is a treatment strategy that aims to improve the quality of life of patients suffering from various serious illnesses. Palliative care is provided to these patients by experts from multidisciplinary fields utilising a holistic approach. It reduces the burden on families and patients by providing services related to pain management, early diagnosis and assessment, and by addressing their psychological, spiritual, ethical, and cultural issues. The aim of this narrative review is to cast light on the cost-effectiveness, evolution, and challenges of palliative care. Databases including Medline/PubMed and Google Scholar were searched to retrieve relevant studies including clinical trials, case studies, and meta-analyses and reviews. Information obtained from these studies includes cost-effectiveness, palliative care evolution, and palliative care-related social issues among patients and family members as well as healthcare professionals.The purpose of this narrative review is to summarise the barriers and recent advancements of palliative care in terminally ill patient care.

Histomorphological Spectrum and Immunohistochemical Features of Gastrointestinal Stromal Tumour: A Series of Eight Cases

Sneha Samir Babaria, Anupama Dayal, Himali P Thakkar, Deepak S Joshi

Gastrointestinal Stromal Tumours (GISTs) are rare tumours of the Gastrointestinal Tract (GIT), consisting of <1% of all primary GIT neoplasms. Recent studies show an increased incidence, which may be due to improved diagnostic facilities. In contrast to the literature’s judgement and the findings of many Western research, which state that the stomach is the most common place, it was observed that the small intestine was more common. Consequently, the goal of this case series was to characterise the clinicopathological, histomorphological, and immunohistochemical spectrum of GISTs as well as their risk categorisation in accordance with the modified Miettinen and Lasota’s algorithm. Eight patients with GISTs diagnosed between January 2017 and December 2020 at tertiary care centre of Gujarat, India are presented in this case series. There was one young woman among the patients, others were middle or old age male or female and had a median age of 58.5 years. The most typical presentation was abdominal pain, albeit in one instance it was an unexpected discovery. One example of extra Extra GISTs (EGIST), where there were several retro and intraperitoneal masses, and one small intestinal GIST each had lymphoma as the tentative clinical diagnosis. Predominant spindle cell morphology was observed in contrast to other studies. Even if molecular studies are not available in resource-limited countries, the basic Immunohistochemistry (IHC) panel is the most useful in the final diagnosis. Risk stratification criteria are helpful for prognostication and further management with the use of appropriate targeted therapies.