Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR The Changing Face of Physiotherapy Practice in COVID-19: Perspective of an Indian Physiotherapist Zubia Veqar COVID-19 has taken up the world like a storm. It has placed unusual demands on healthcare delivery systems, including physiotherapy services worldwide. This challenge is even larger than the one placed by Severe Acute Respiratory Syndrome (SARS) or Ebola because of its sheer virulence. Times are changing; we need to do the same and accept the challenge head on. The role of a physiotherapist in the management of the COVID-19 patients is well established but an important issue is the management of non-COVID-19 as well as COVID-19 patients judiciously during these times. The various barriers to practice have increased manifold due to the condition as well as the associated problems which arose due to it. This commentary will comment on the likely impact of this pandemic over the existing physiotherapy delivery structure, challenges arising out of it and their probable solutions, ending with a brief note on India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YA01-YA03&id=14915 https://doi.org/10.7860/JCDR/2021/48242.14915 Haemorrhagic Retinopathy Associated with Zieve Syndrome Sadafnaz Sabah, Abdul Waris, Mohd Rameez Reza, Syed Asghar Rizvi Zieve syndrome, a rarely reported case is a triad of jaundice, haemolytic anaemia and hyperlipidaemia that develops secondary to alcohol-induced liver injury. Here in, a case of a 23-year-old young male with history of steatohepatitis is reported who presented with diminution of vision in both eyes. On fundoscopy, there were extensive retinal haemorrhages involving fovea. Workup was consistent with haemolytic anaemia with no source of active bleeding. The patient was managed with supportive treatment. No specific ocular treatment was given. However, the vision gradually improved during follow-up. A rare association of Zieve syndrome with haemorrhagic retinopathy is described here. Moreover, Zieve syndrome has been described in the literature, mostly in nonEnglish language case studies and is still under-recognised and under-reported. Diagnosis should be made quickly to avoid unnecessary invasive diagnostic interventions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ND04-ND06&id=14947 https://doi.org/10.7860/JCDR/2021/46504.14947 Clinical Spectrum of Corneal Epithelial Microsporidiosis Prabhakar Singh, Abhishek Gupta, Richa Gupta This case series aims to highlight three different clinical variants of microbiologically proven epithelial microsporidiosis, and their customised management wherein the current series, patients with suspected epithelial microsporidiosis were subjected to corneal scraping to confirm the diagnosis. Different microbiologically proven clinical variants were observed and documented. Three clinical variants of epithelial microsporidiosis were noted. The first was of 45-years-old male patient, presented with only raised punctate lesions, and responded to topical lubricants only. The second variant, 28-years-old male patient, had anterior chamber reaction (flare and cells), Keratic Precipitates and descemets folds. This variant also responded with topical lubricants over a period of one month. The third variant, 32-years-old male patient at presentation, had typical epithelial raised punctate corneal lesions, however at one week subepithelial infiltrates appeared. These lesions responded to topical steroids. The current series highlights three different clinical variants of microbiologically proven epithelial microsporidiosis and their customised management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ND01-ND03&id=14821 https://doi.org/10.7860/JCDR/2021/46304.14821 Endobronchial Hamartoma with Postobstructive Pneumonia- A Case of Successful Treatment with Endobronchial Interventions Jolsana Augustine, Rajesh Venkitakrishnan, VR Pattabhiraman, Arjun Srinivasan Airway hamartomas are of mesenchymal tissue origin and have predominance of adipose tissue. Hamartoma refers to a tumour-like structure within an organ composed of an abnormal arrangement of tissue components normally found in that organ. The pulmonary parenchyma and airways are commonly described sites for this lesion, although endobronchial location is far less common than its parenchymal counterpart. When present within a major airway, the usual symptoms of an airway lesion like cough, wheezing, stridor, haemoptysis and postobstructive consolidation ensue. Here, authors describe the case of a 60-year-old man who presented with cough from past 9 months. On evaluation he was found to have an endobronchial lesion in the right main bronchus. The histopathology revealed features of endobronchial hamartoma which was then subjected to endobronchial intervention with electrocautery and cryoablation achieving complete removal and restoration of luminal patency. This case underscores the ability of endobronchial treatment modalities to successfully treat benign airway lesions like hamartoma when undertaken in experienced centres. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OD06-OD08&id=14847 https://doi.org/10.7860/JCDR/2021/46269.14847 A Rare Case of Diffuse Intestinal Ganglioneuromatosis in a Child Presenting with Intussusception Anuradha Sekaran, Amruta Patil, Mahesh Shetty, Guduru Venkat Rao, Duvvur Nageshwar Reddy Ganglioneuromas are benign neurogenic neoplasms commonly seen in children which are originating from neural crest cells of sympathetic ganglia or adrenal medulla. Rarely, they may arise from the visceral organs like intestine. Diffuse intestinal ganglioneuromatosis is a rare disease, caused due to abnormal proliferation of ganglion cells, nerve fibres and schwann cells in the wall of intestine. Author hereby present a case of diffuse intestinal ganglioneuromatosis in an 18-month-old male child who presented with symptoms of small bowel obstruction. Resected segment of ileocecal junction revealed ulcero-nodular areas which on microscopy showed diffuse hyperplasia of nerve bundles and ganglion cells with immunohistochemistry confirmation. Intestinal ganglioneuromatosis is a rare condition having syndromic association with MEN-2B, Neurofibromatosis-1 and Cowden syndrome. As this disease has a low clinical suspicion, very nonspecific symptoms and radiological findings, histopathological examination becomes mainstay in diagnosis. Further workup is essential to rule out presence of associated syndromes. Surgical excision is the ultimate treatment with screening for genetic abnormalities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ED01-ED03&id=14848 https://doi.org/10.7860/JCDR/2021/48101.14848 Cystic Lymphangioma: A Rare Cause of Haemorrhagic Ascites Swanit Hemant Deshpande, Vishal Narkhede, Sunny Agarwal, Satish Balkrishna Dharap Lymphangiomas are congenital malformations of the lymphatic system. Multiple intra-abdominal cystic lymphangiomas are rare in adults. Author present a case of a 39-year-old male, presenting with recurrent episodes of haemorrhagic ascites. Laparoscopic biopsy and imaging investigations revealed multiple intra-abdominal cystic lymphangiomas involving the spleen, the liver and the retro-peritoneum. Surgical excision including splenectomy, excision of retroperitoneal and mesenteric lesions was done. The patient has been asymptomatic for 2 years on follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PD01-PD02&id=14849 https://doi.org/10.7860/JCDR/2021/47569.14849 A Rare Case of <i>Fasciola hepatica</i> and its Treatment Harsha Vardhan Mahalingam, Rajoo Ramachandran, Venkatesh Bala Raghu Raji, Prabhu Radhan Radhakrishnan, Venkata Sai Fascioliasis is a re-emerging food-borne parasitic zoonosis which presents with nonspecific clinical symptoms. Definitive diagnosis requires demonstration of parasitic ova in stool which may often be elusive. Imaging plays a crucial role in raising the possibility of this diagnosis early in the disease course. Contrast-Enhanced Computed Tomography (CECT) of the abdomen was performed in a 44-year-old male with fever, right upper quadrant pain and dyspepsia. The patient later underwent an ultrasound-guided biopsy of liver lesions. The stool examination for ova was negative. Biopsy of the liver lesions showed ill-defined granulomas. Imaging plays a crucial role in establishing the early diagnosis of hepatic fascioliasis especially in nonendemic regions where the clinical suspicion for this diagnosis is low. This article places emphasis on the description of typical imaging features of this condition and the usage of additional investigative/testing techniques recommended by the Center for Disease Control and Prevention (CDC). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=TD01-TD03&id=14850 https://doi.org/10.7860/JCDR/2021/46639.14850 Hereditary Bisalbuminemia in Sjögren’s Syndrome and Rheumatoid Arthritis Serdal Ugurlu, Bugra Han Egeli, Ibrahim Murat Bolayirli Bisalbuminemia is rare finding of bifid albumin bands in serum electrophoresis. The protein abnormality can be sporadic and inherited. So far, this albumin variant was not found to cause or coexist with a specific pathology. This is a case of bisalbuminemia in 43-year-old female patient with a past medical history of Rheumatoid Arthritis (RA) and Sjogren’s Syndrome (SS). Similar electrophoresis findings were seen in two siblings of the patient. Rheumatology work-up of the family was negative. Authors could not find an association between blood protein variant and the patient’s rheumatologic condition. Bisalbuminemia should not be a concern to the rheumatologist as it does not hint towards pathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OD01-OD02&id=14832 https://doi.org/10.7860/JCDR/2021/46650.14832 COVID-19 and Malaria Co-infection Management in Post Liver Transplant- A Case Report Saniya Wasim Shaikh, Sampathkumar Mahadevappa Mahendrakar, Sulaiman Sadruddin Ladhani, Azizullah Hafizullah Khan The current pandemic of Coronavirus Disease-2019 (COVID-19) has posted unprecedented challenges to the community of clinicians in various aspects, ranging from prompt and early diagnosis to preventing complications. What makes the challenge even tougher is to be able to distinguish between diseases presenting with similar complaints, especially in tropical regions, and yet be able to treat judiciously and give a targeted treatment. The level of difficulty escalates when a patient with Solid-Organ Transplant (SOT) on immunosuppressive therapy presents to the clinician as suspected COVID-19 along with a co-infection. Incidences like these carry an increased burden of higher morbidity and mortality, with or without immunosuppression, if not timely diagnosed and judiciously treated, thus heralding the need to be vigilant in the current pandemic. Thus, to the best of our knowledge, this was the first documented and successfully treated case of a patient with past history of Liver Transplant (LT) with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pneumonia with co-existing <i>Plasmodium vivax (P.vivax) </i>malaria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OD03-OD05&id=14838 https://doi.org/10.7860/JCDR/2021/49086.14838 Use of Computer Guided Tall and Tilted Pin Hole Immediately Loaded Implants Technique for Severe Atrophic Maxilla Rehabilitation: A One Year Follow-up Venkata Ratna Nag Puppala, Sarika Puppala, Smitha Daniel For successful placement of dental implants, the clinician needs adequate bone in three dimensions around endo-osseous implants to enhance Bone Implant Contact (BIC) area and primary stability. The absence of optimum bone calls for complex procedures such as sinus lifts, bone augmentations using grafts that aggravates patient morbidity, dramatically higher costs and limited patient satisfaction. To overcome disadvantages of grafting, graft-less solution used in combination or alone, such as tilted implants, use of long, narrow implants, bicortical implants, all-on-4 techniques have enhanced patient acceptance and clinical ease. Allon-4 protocol is one such combination treatment concept whose success has been demonstrated mainly in ideal/moderate osseous structures. Further, it accommodates 10-12 teeth per arch, mostly without second molars compromising chewing efficiency and creating cantilevers especially in rehabilitations opposing complete set of natural teeth. Additionally, optimal number of implants required to support full arch prosthesis remains unclear. Therefore, to circumvent the limitations of all-on-4 technique, 6 long (16- 25 mm) and tilted implants have been used to restore 14 teeth in severely atrophic maxillary arch of a healthy 75-year-old female in the following case report. Tall implants engage basal cortical bone aiding in immediate fixation and increase in surface area of osseo-integration. All implants were placed using minimally invasive flapless technique and immediately loaded within 3 days with a screw-retained multiunit Direct Metal Laser Sintering (DMLS) prosthesis. The pterygoid cortex engagement of distal implants does not have any deleterious biomechanical effect eliminating the distal cantilever https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZD01-ZD04&id=14843 https://doi.org/10.7860/JCDR/2021/48315.14843 Focal Periphyseal Oedema: A Physiologic Finding in Paediatric Knee Pain Susana Rosa, Margarida Freitas, Sara Antunes, Rute Pereira Knee pain is a common reason for adolescent calls or visits to a primary care clinician. The authors present a case of a 14-year-old male adolescent with progressive bilateral nociceptive somatic knee pain. The pain was worse with weight bearing, and relieved at rest. It was located over the medial joint line. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and a rehabilitation program. Magnetic Resonance Imaging (MRI) showed bone marrow oedema, and Focal Periphyseal Oedema (FOPE) diagnosis was made. After a total of 6 months of treatment, the patient was asymptomatic. The literature is limited to a few case reports and radiologic studies describing this symptomatic physeal pathology, not reporting physical examination or treatment. The goals of this case report were to elucidate physicians of this condition, a newly reported cause of knee pain in adolescent, and to elicit the importance of a patient-tailored rehabilitation program in the treatment of this finding. FOPE is a clinical entity that should not be ignored and must be treated for the patient’s comfort. It is a self-limited condition and has an excellent prognosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YD01-YD03&id=14866 https://doi.org/10.7860/JCDR/2021/48985.14866 Chronic Lymphocytic Leukaemia Presenting with Pancytopenia: A Rare Haematological Coincidence Iffat Jamal, Shuchi Smita, Ravi Bhushan Raman, Kaushal Kumar, Vijayanand Choudhary Chronic Lymphocytic Leukaemia (CLL) is commonly associated with autoimmune cytopenias but CLL presenting with pancytopenia is a rare occurrence. Here, we present a case of 56-year-old male patient, who presented with pallor, mild hepatosplenomegaly, right-sided pleural effusion in chest X-ray, pancytopenia and his bone marrow showed infiltration by mature appearing lymphoid cells making a diagnosis of CLL. Despite the frequency of these immune mediated cytopenia, only few cases of pancytopenia have been described so far to the best of our knowledge. Hence, to emphasise the rarity of such haematological coincidence we are presenting this case report. CLL generally presents with persistent absolute lymphocytosis on peripheral smear with an absolute monoclonal lymphocyte count of more than 5000/cumm. There is a common association with Autoimmune Haemolytic Anaemia (AIHA) and Immune Thrombocytopenia (ITP) and the association is called as Evan’s syndrome. Its pathogenesis is associated with autoimmune process. AIHA, ITP, and Pure Red Cell Aplasia (PRCA) are commonly associated complications seen in CLL. The pathogenesis of AIHA and ITP are antibody this inplace of the reactions and abnormal T cell activity is noted in the pathogenesis of PRCA. Despite of the frequency of these immune mediated cytopenias noted in CLL, bone marrow was seen to be hypercellular in most of the cases and marrow hypoplasia have been reported in only 2 cases reported in literature so far. In the present case, although pancytopenia was present on peripheral blood smear examination but bone marrow was hypercellular for age with diffuse infiltration by monoclonal mature appearing lymphoid cells which makes this case all the more interesting. Despite repeated blood transfusions,antiviral drug Tenofovir and aggressive supportive measures for 6 months, he developed right-sided pleural effusion and succumbed to his illness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ED04-ED06&id=14858 https://doi.org/10.7860/JCDR/2021/46541.14858 Reversal of Pulmonary Hypertension in a Patient with Chronic Mountain Sickness after Relocation to Low Altitude Abdirashit Maripov, Kubatbek Muratali Uulu, Samatbek Satybaldyev, Nadira Kushubakova, Akpay Sarybaev Long-term high altitude residence can be complicated by development of Chronic Mountain Sickness (CMS) characterised by excessive erythrocytosis and neurological symptoms. In some patients, CMS may be associated with various degrees of Pulmonary Hypertension (PH). There have been no reports on changes in the pulmonary circulation and Right Ventricular (RV) structure following translocation to low altitude of patients with CMS. Here, the authors report a case of 56-years-old female patient, resident of Sary-Mogol (3,000 m, Kyrgyzstan), diagnosed of CMS on clinical and laboratory examination. Transthoracic echocardiography revealed slightly dilated right ventricle and significantly enlarged pulmonary artery diameter was found. The patient undergone complete resolution of symptoms and alleviation of PH within three years of residence at low altitude. Thus, relocation to low altitude cures CMS and reverses PH. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OD09-OD10&id=14886 https://doi.org/10.7860/JCDR/2021/48309.14886 A Case Series of Lung Sequelae and <i>Aspergillus</i> Antigenemia: A Hidden Entity in Post-COVID-19 Critically ill Patients Sonali Banwait, Poonam Gupta Coronavirus Disease-2019 Associated Invasive Aspergillosis (CAPA) is a known entity with significant mortality. There is paucity of literature with secondary aspergillosis infection in post-COVID-19 patients. Serum galactomannan is a highly sensitive test for screening patients for Aspergillus antigenemia. Here, authors reported five post-COVID-19 patients with High Resolution Computed Tomography (HRCT) features and associated high risk factors for opportunistic aspergillosis (55-years-old-male, 46-years-old-male, 75-years-old-female, 55-years-old-female and 27-years-old-male) like prolonged intensive care stay, Acute Respiratory Distress Syndrome (ARDS), corticosteroid and broad spectrum antibiotic therapy like Meropenem, Colistin and Targocid etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UR01-UR03&id=14902 https://doi.org/10.7860/JCDR/2021/48272.14902 Interpretation of 24-hour Urinary Protein Level for Diagnosis of Nephrotic Syndrome in Marked Hypoalbuminemia Raghvendra Narayan, Shivani Singh Nephrotic syndrome is a common renal problem in childhood and is characterised by generalised oedema, massive proteinuria, hypoalbuminemia and hyperlipidemia. There are various laboratory methods to quantify proteinuria. Among them the 24-hour urinary protein estimation is considered to be a gold standard for diagnosis of nephrotic syndrome. Nephrotic range proteinuria is considered when 24-hour urinary protein is more than 40 mg/m<sup>2</sup> /hr. There is limited literature available regarding the changes in quantitative proteinuria when there is marked hypoalbuminemia (serum albumin less than 2.5 gm/dL). This series is about three patients of nephrotic syndrome (6-years-old, 4-year-old and 5 year-old male), having marked hypoalbuminemia and their 24-hour urinary protein level resulted into non-nephrotic range. All the patients underwent relevant physical, clinical examinations and laboratory blood and urine investigations (Haemoglobin, Mantoux test, chest x-ray, urine routine, urine culture and sensitivity, lipid profile, serum albumin and 24 hour urinary protein). All the cases were managed with Prednisolone and diuretics like Furosemide and were followed up till the subside of proteinuria and oedema conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=SR01-SR02&id=14937 https://doi.org/10.7860/JCDR/2021/48005.14937 Cadaveric Dissection to Demonstrate the Segment of the Axillary Nerve at Risk during the Latarjet Procedure Gunjar Jain, Rameshwar Datt, Hira Lal Nag, Vijaykumar Digge <b>Introduction</b> The axillary nerve lies posterior to the axillary artery and anterior to the subscapularis muscle at its origin. It then descends and runs along the lower border of subscapularis muscle before exiting posteriorly via the quadrangular space. This initial segment of the axillary nerve, which is about 12 mm apart from the inferior glenoid tubercle, is at risk of injury during open Latarjet procedure [1]. According to Burge P et al., the short course of axillary nerve predisposes it to a high risk of traction injury [2]. Though the musculocutaneous nerve is the most commonly injured nerve during the Latarjet procedure, axillary nerve injury which can occur in up to four percent of the patients, most often leads to long term disability and may require a repeat neurolysis procedure [3]. The purpose of this article is to demonstrate the relation of the axillary nerve with the surgical field of Latarjet procedure by a cadaveric dissection [Video-1]. <b>Cadaveric Dissection</b> <b>Surgical exposure: </b>The cadaver was positioned in a beach chair position, and a small towel was placed under the shoulder to stabilise the scapula. The limb was draped free to allow for abduction and external rotation of the shoulder. A limited deltopectoral approach was used. A 5 cm incision was given from the tip of coracoid towards the anterior axillary fold, then the deltopectoral interval was identified, and the cephalic vein was retracted medially. A sharp tip-Homman retractor was placed superior to the coracoid process, and the structures attached to the latter were identified. <b>Coracoid graft harvest:</b> The pectoralis minor muscle was released from the medial surface of the coracoid process. After placing the arm in abduction and external rotation, the coracoacromial ligament was incised from the coracoid process. A portion of the ligament was left intact on the coracoid process. An osteotomy was done at the knee of the coracoid, distal to the attachment of the coracoclavicular ligament. Any soft tissue attached over the deeper surface of the coracoid is released. The musculoskeletal nerve penetrates the conjoint tendon on its medial aspect, about 3-4 cm distal to the coracoid tip [4], and can be injured during the procedure. Hence the conjoint tendon should be freed from the soft tissue cautiously particularly from its medial aspect, and the surgeon should stay lateral to the tendon. <b>Glenoid preparation and graft fixation:</b> The subscapularis muscle was split at the junction of its superior two thirds and inferior one third, and two self-retaining Gelpi retractors were placed in the split. A longitudinal capsulotomy was done, and a Fukuda retractor was placed in the joint to retract the humeral head laterally after removing the lateral Gelpi retractor. At this step, the arm was adducted and externally rotated, and a Homman retractor was placed between the glenoid neck and the distal band of the subscapularis muscle. Then the anteroinferior aspect of glenoid was exposed by placing a Kolbel glenoid lever medially. The anterior rim of the glenoid was decorticated. Finally, the coracoid graft was prepared by decorticating its medial surface and was fixed to the anteroinferior aspect of glenoid with the help of two cannulated cancellous screws. <b>Exposure of the axillary nerve:</b> The incision was extended inferiorly to demonstrate the relation of the axillary nerve with the surgical field of the Latarjet procedure. The axillary nerve was found at the inferior border of the subscapularis and was seen to go posteriorly in quadrangular space [Table/Fig-1]. <b>Discussion</b> Improper retractor placement and arm positioning during the surgery may lead to excessive traction and contusion of the axillary nerve. Both McFarland EG et al. and Jobe FW et al. have recommended placement of a Homman or a similar retractor through the split subscapularis muscle along the inferior glenoid to prevent injury to the axillary nerve [5,6]. Abduction of the arm brings neurovascular structures closer to the operative site, while external rotation of the shoulder decreases the vulnerability of the nerve during surgery [6,7]. Therefore to prevent neurological injury, arm should be adducted and externally rotated during glenoid exposure. Furthermore, the use of self-retaining retractors in the subscapularis split can also injure the axillary nerve. Hence, it should be used cautiously and for a minimal duration only when exceedingly needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=RJ01-RJ02&id=14931 https://doi.org/10.7860/JCDR/2021/48691.14931 A Rare Case of Isolated Internuclear Ophthalmoparesis following Head Injury Teena Mariet Mendonca, Gladys R Rodrigues, Sreelakshmi Salim This draft is about a 46-year-old man, referred to the tertiary eye care center for limitation of eye movements in the right eye following head trauma. The patient had sustained head trauma due to a road traffic accident two days prior to the presentation. He had history of loss of consciousness for a few minutes and was under neurosurgical observation. He had no visual complaints, diplopia or vertigo on presentation. On examination, his best-corrected visual acuity of 20/20 in both eyes. The pupillary reactions were normal in both eyes. The patient was orthotropic in primary gaze position. Ocular motility examination showed adduction deficit in the right eye (-2 limitation) and jerky nystagmus in the left eye on left gaze. Range of ocular motility in left eye was normal. Convergence was found to be normal [Table/Fig-1]. Fundus examination was normal in both eyes. Non-enhanced CT scan of brain showed petechial haemorrhage in central midbrain with surrounding diffuse oedema [Table/Fig-2]. The patient was diagnosed with right Internuclear Ophthalmoparesis (INO). The patient showed spontaneous improvement in four weeks This draft is about a 46-year-old man, referred to the tertiary eye care center for limitation of eye movements in the right eye following head trauma. The patient had sustained head trauma due to a road traffic accident two days prior to the presentation. He had history of loss of consciousness for a few minutes and was under neurosurgical observation. He had no visual complaints, diplopia or vertigo on presentation. On examination, his best-corrected visual acuity of 20/20 in both eyes. The pupillary reactions were normal in both eyes. The patient was orthotropic in primary gaze position. Ocular motility examination showed adduction deficit in the right eye (-2 limitation) and jerky nystagmus in the left eye on left gaze. Range of ocular motility in left eye was normal. Convergence was found to be normal [Table/Fig-1]. Fundus examination was normal in both eyes. Non-enhanced CT scan of brain showed petechial haemorrhage in central midbrain with surrounding diffuse oedema [Table/Fig-2]. The patient was diagnosed with right Internuclear Ophthalmoparesis (INO). The patient showed spontaneous improvement in four weeks trauma being less common. Multiple sclerosis and cerebrovascular accidents constitute 70% of the cases of INO. Multiple sclerosis and other demyelinating disorders are considered as the most common causes of bilateral INO. Ischemic stroke is found to be the most common cause of unilateral INO [2-4]. INO is considered to be a rare entity after a blunt head injury [2,5,6]. Although pathophysiologic mechanism of post traumatic INO is unclear, traumatic displacement of brainstem and subsequent development of shearing forces within white matter tract is hypothesised to cause injury to MLF. Anterior portion of the brainstem is relatively better fixated by small perforating branches of basilar artery compared to posterior segment. Relative free movement of posterior portion of brainstem may cause shearing forces leading to tearing or stretching of the cerebral tissue [1,7]. In this patient, petechial haemorrhage which was seen in the central midbrain on CT scan, along with surrounding vasogenic oedema can explain the constellation of findings. Since convergence was found to be intact in the patient, site of injury appeared to be caudal to oculomotor nucleus. Absence of diplopia in this patient could be due to orthophoria in primary gaze. Magnetic Resonance Imaging (MRI) is a better imaging modality for axonal injuries with haemorrhage being more easily detected on T1 and susceptibility weighted imaging sequences. The prognosis of traumatic INO is usually good and these may resolve spontaneously [6,7]. In this case, the patient improved spontaneously within four weeks with conservative management. A comprehensive examination of ocular motility in a patient with head trauma can be very useful to understand the nature and impact of the trauma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=NJ03-NJ04&id=14940 https://doi.org/10.7860/JCDR/2021/47310.14940 Fatal Chronic Immune Thrombocytopenia with Co-existent Type-1 Neurofibromatosis Daisy Khera, Siyaram Didel, Abhishek Purohit, Swati Umashanker, Mohammed Ramzan Dear Editor, We would like to update about the follow-up outcome of the child, whose case report was published in this journal <a href=#fr1 name=ft1>(1)</a>. The child was previously managed by the primary unit with consultation of paediatric haematology team. A clinical diagnosis of immune thrombocytopenia with underlying neurofibromatosis was considered and she was managed with oral steroid and discharged on oral prednisolone. She responded well and her platelet count improved (Investigations dated 3rd September 2019 showed Heamoglobin (Hb), total leucocyte count and platelet count being 11.3 g/dL, 8.18&#215;103 mL, 256&#215;103 /mL, respectively). She was discharged but she could not attend haematology clinic on follow-up due to COVID-19 related nationwide lock down. She stopped all her medication and no follow-up blood counts were available for the next 14 months. She was doing fine for nearly one year. She presented again on 27th november 2020 with menorrhagia, severe anaemia and thrombocytopenia (Hb-3.2 g/ dL, total leucocyte count- 11.27&#215;103/mL, platelet 2&#215;103/mL). She was admitted under same primary unit and started on injection methylprednisolone 500 mg intravenous (i.v.) in view of poor response to the oral steroid therapy and persistent menorrhagia soon her condition worsened and she developed severe headache and raised Intra Cranial Pressure (ICP). Intracranial bleed was suspected and she was shifted to paediatric haematology unit for further management and was admitted to paediatric intensive care unit. Her Non Contrast Computed Tomography (NCCT) revealed acute-on-chronic intracranial bleed along with midline shift. She was started on i.v. methylprednisolone 1 gm/day along with i.v. immunoglobulin @ 2 gm/kg over 24 hours. But her platelet did not improve over next 72 hours. Her blood group was B Rh +ve, hence she was also considered for anti-D immunoglobulin but could not be given due to its non-availability in the market [2,3]. She was also given multiple single donor platelet in view of persistent severe thrombocytopenia and persistent headache over next one week, but her platelets never crossed 10000/mL and rapidly fell down to the range of 2000-3000 mL. She was also started on injection romiplastin for persistent thrombocytopenia. Her hepatitis B and C and Human Immunodeficiency Virus (HIV) serology was negative, Antinuclear Antibody (ANA), anti-ds Deoxyribonucleic Acid (DNA) were also negative. Other causes like malignancy or aplastic anaemia were ruled out with bone marrow examination which was reported as hypercellular marrow with all haematopoietic components and prominence of erythroid precursors and megakaryocytes <a href=#fr4 name=ft4>(4)</a>. In view of persistent thrombocytopenia, she was started on azathioprine and considered for emergency splenectomy <a href=#fr6 name=ft6>(6)</a>, but her clinical condition worsened further with recurrence of severe intracranial bleed and succumbed to her illness. This case highlights the severe nature of the illness and the need to ensure adequate compliance and regular follow-up to avoid catastrophic complication. This case also highlights the untoward effect of COVID-19 related problem faced by patients with chronic illnesses. The association of chronic immune thrombocytopenia with type-1 neurofibromatosis is co-incidental or does it have any true association of such severe immune thrombocytopenia still need to be established. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=SL01-&id=14846 https://doi.org/10.7860/JCDR/2021/48416.14846 Airway Management in Hypoxemic Patient using Modified Intubating Laryngeal Mask Airway Technique Mohd Mustahsin, Garima Singh Dear Editor, The Intubating Laryngeal Mask Airway (ILMA) is useful to facilitate blind oral tracheal intubation <a href=#fr1 name=ft1>(1)</a>. Both the recommended silicon wire reinforced tubes and the less expensive conventional Polyvinylchloride (PVC) tubes have been used with ILMA with comparable success rates <a href=#fr2 name=ft2>(2)</a>. After tracheal intubation, the ILMA is removed over the stabiliser rod engaged into the proximal end of the Tracheal Tube (TT). The 20 cm stabiliser rod that is supplied with the ILMA does not fit properly in the conventional PVC tube <a href=tableview.asp?id=14861&img_src=14861_1.jpg target=_blank>(Table/Fig 1)</a> and hence it is prone to disconnection and tube migration while removing the ILMA. The ventilation of the patient is also compromised during ILMA removal which can be dangerous in hypoxemic and critically ill patients. Previous attempts of using smaller TT as an alternative to stabiliser rod have similar difficulties during ILMA removal <a href=#fr3 name=ft3>(3)</a>. Dear Editor, The Intubating Laryngeal Mask Airway (ILMA) is useful to facilitate blind oral tracheal intubation <a href=#fr1 name=ft1>(1)</a>. Both the recommended silicon wire reinforced tubes and the less expensive conventional Polyvinylchloride (PVC) tubes have been used with ILMA with comparable success rates <a href=#fr2 name=ft2>(2)</a>. After tracheal intubation, the ILMA is removed over the stabiliser rod engaged into the proximal end of the Tracheal Tube (TT). The 20 cm stabiliser rod that is supplied with the ILMA does not fit properly in the conventional PVC tube <a href=tableview.asp?id=14861&img_src=14861_1.jpg target=_blank>(Table/Fig 1)</a> and hence it is prone to disconnection and tube migration while removing the ILMA. The ventilation of the patient is also compromised during ILMA removal which can be dangerous in hypoxemic and critically ill patients. Previous attempts of using smaller TT as an alternative to stabiliser rod have similar difficulties during ILMA removal <a href=#fr3 name=ft3>(3)</a>. which is another advantage of the stabilising rod over conventional stabilising rod. The authors have successfully used this device in many hypoxemic patients requiring intubation and mechanical ventilation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UL01-UL02&id=14861 https://doi.org/10.7860/JCDR/2021/48638.14861 Macular Pigment Optical Density and its Determinants among Adults: A Cross-sectional Study Pooja Goyal, Mitasha Singh, Shashi Vashishth, Satish Jayeria <b>Introduction:</b> Interplay exists between the risk factors of Agerelated Macular Degeneration (AMD) and the factors influencing Macular Pigment Optical Density (MPOD) level. Early diagnosis and antioxidants supplementation is the only intervention which may possibly slow down the macular degeneration. <b>Aim:</b> To measure MPOD and study the possible risk factors associated with subnormal MPOD among adults patients attending Outpatient Department (OPD). <b>Materials and Methods:</b> A cross-sectional study was conducted among patients aged 20 years and above who visited Ophthalmology OPD in a tertiary care centre during the month of August (between 1st to 31st) 2018. Only those having Best-Corrected Visual Acuity (BCVA) better than 6/60 were enrolled for the study. MPOD was measured using a macular densitometer (Macular Matrics II, USA). Patients found to have subnormal MPOD further underwent Optical Coherence Tomography (OCT) and fundus. Fischer’s-exact and Chi-Square tests were applied wherever applicable; differences were considered to be statistically significant at p-value <0.05. <b>Results: A total of 82 patients participated in the present study. Total of 45.1% participants were found to have subnormal MPOD using macular densitometer. Prevalence was least among <30 years of age (nil) and maximum after 50 years (58.8%) (p<0.05). Trends revealed that subnormal MPOD was more frequent among smokers (p=0.13), vegetarians (p=0.38) and those who were malnourished (under or over weight) (p=0.15), though not found to be statistically significant. Non-modifiable risk factors, an inverse relationship was observed between age and MPOD levels. <b>Conclusion:</b> The study noted associations between subnormal MPOD and multiple risk factors, several of which are modifiable factors. These modifiable risk factors included smoking and malnourishment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=NC04-NC07&id=14862 https://doi.org/10.7860/JCDR/2021/46330.14862 A Dosimetric Study of Volumetric Arc Modulation with RapidArc Versus Intensity-modulated Radiotherapy in Cervical Cancer Patients Brijesh Gos wami, Rakesh Kumar Jain, Suresh Yadav, Sunil Kumar, Saji Oommen, Sapna Manocha, Ganesh K Jadhav <b>Introduction:</b> The method of radiotherapy has moved away from two-dimensional and three-dimensional conformal radiotherapy towards Volumetric-Modulated Arc Therapy (VMAT) for advanced carcinomas. VMAT treatments often result in significant clinical advantage, particularly when concave dose distributions are required as is often the situation since these tumours are in close proximity to several critical structures. <b>Aim:</b> To investigate the potential clinical role of volumetric arc therapy on cervical cancer patients and its comparison with fixed-field Intensity-Modulated Radiotherapy (IMRT) was used as a benchmark. <b>Materials and Methods:</b> This retrospective study was conducted on 15 cervical cancer patients selected for radiotherapy treatment. These patients were previously treated with sliding window IMRT techniques during January 2020 to November 2020. For dosimetric comparison of sliding window IMRT techniques with RapidArc, a new set of plans were created using VMAT/RapidArc technique. For each patient two plans were generated and in this way total 30 plans were analysed. The prescription dose to Planning Target Volume (PTV) was 50.4 Gy in 28 fractions (1.8 Gy/ fraction) for the 6 MV photon beam. Comparison of each plan done on the basis of Organs at Risk (OAR) sparing, coverage index (C), Conformity Index (CI), Homogeneity Index (HI), dose Gradient Index (GI), and Unified Dosimetry Index (UDI). This study utilised UDI scoring for evaluation and comparison of RapidArc and IMRT plans. Treatment Time (TT) for patient comfort and the number of Monitor Units (MUs) for long-term side-effects was also taken into consideration. A paired two-tailed t-test was executed for the dosimetric study of volumetric arc modulation with RapidArc and its comparison with the IMRT technique in the radiotherapy treatment of cervical cancer patients. All the collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. The p-value <0.05 was contemplated for the level of statistical significance. <b>Results: </b>Comparable target coverage and better sparing of OARs were achieved with the RapidArc technique in comparison to IMRT. It was evident with results of present study, the values of CI (1.55&#177;0.07), HI (1.07&#177;0.07), GI (0.98&#177;0.01) and UDI (1.25&#177;0.11) of RapidArc technique showed significant difference from respective values of IMRT Technique (1.67&#177;0.06, 1.10&#177;0.06, 0.96&#177;0.01 and 1.38&#177;0.13). Values of MUs (1560.47&#177;52.16) and treatment time (3.71&#177;0.73 mins) were significantlly high in IMRT technique as compared to RapidArc technique (542.33&#177;51.09 and 2.39&#177;0.35 mins respectively). <b>Conclusion: </b>From this study, it is clear that a similar planning goal can be achieved by RapidArc in comparison to fixed-field IMRT with less normal organ toxicity. RapidArc is a faster and precise treatment technique. The most significant change comes to see in the number of MUs and TT, which is much lesser in RapidArc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=XC01-XC05&id=14863 https://doi.org/10.7860/JCDR/2021/48635.14863 Cellular Properties and Expression of Pluripotent Markers in Human Dental Pulp Stem Cells Cultured in Serum-Free Medium Chethan Kumar , Basan Gowda Sharanappa Kurkalli , Shishir Shetty , Akshay Bairapura Manjappa , Veena Shetty , Mohana Kumar Basavarajappa <b>Introduction:</b> The standard isolation and expansion of human Dental Pulp Stem Cells (DPSCs) under in-vitro conditions normally involve the usage of Fetal Bovine Serum (FBS). However, its animal-origin poses possible concerns for clinically relevant procedures. This critical issue compels the use of Xenogeneic-Free (XF) or human-origin alternatives to FBS for culture expansion and differentiation of DPSCs to determine the usefulness for translating into therapeutic clinical applications. <b>Aim:</b> To evaluate the cellular characteristics and expression of pluripotent markers in DPSCs cultured using SerumContaining Medium (SCM-DPSCs) and Serum-Free Medium (SFM-DPSCs). <b>Materials and Methods:</b> This in-vitro descriptive study was conducted at NITTE (Deemed to be University), Mangaluru, Karnataka, India, from June 2019 to August 2020. DPSCs were isolated from impacted third molars. The culture expanded DPSCs in serum-containing and serum-free media were analysed on their morphology, viability, proliferation rate, Population Doubling Time (PDT), Alkaline Phosphatase (ALP) activity, cell surface markers expression, osteogenic and adipogenic potential, and the relative expression of selected pluripotent genes. <b>Results:</b> The primary culture of DPSCs established in SCM and SFM showed spindle shaped fibroblastic morphology with >80% viability from Passage 1 (P1) to P4. A significant (p-value <0.05) difference in the proliferation rates in terms of cell numbers between SCM-DPSCs and SFM-DPSCs was observed (day 6: 3×105 vs 0.8×105 ; day 9: 5.8×105 vs 1.27×105 ; day 12: 7.8×105 vs 1.56×105 , respectively). The average PDT values recorded in SCM- and SFM-DPSCs were 44.33 hours and 58.41 hours, respectively. A slightly higher expression of ALP activity was observed in SCM-DPSCs than in SFM-DPSCs. Flow cytometry analysis showed that both DPSCs were positive for CD29, CD73, CD90, and negative for CD34 and CD45. The expression of OCT4 and NANOG was relatively higher in SCM-DPSCs compared to SFM-DPSCs. Further, SCM-DPSCs showed the higher levels of SOX2 and SSEA4, but did not exhibit any significant differences in their expression levels. <b>Conclusion:</b> The results showed that DPSCs in FBS displayed better growth kinetics and stemness markers expression along with more propensities towards lineage differentiation. SFM can be used to establish and expand DPSCs with characteristics of multipotent stem cells, but needs further research for its optimisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC05-ZC09&id=14864 https://doi.org/10.7860/JCDR/2021/48893.14864 Replacement Blood Donation Denials in Children: A Cross-sectional Study Muniba Alim, Rafey Abdul Rahman, Prabudh Goel <b>Introduction: </b>Developing countries like India still depend on Replacement Donors (RD) for their blood requirements. Healthcare providers in India often face Replacement Blood Donation (RBD) denials in children especially in rural areas. <b>Aim:</b> To find reasons for RBD denials in children. <b>Materials and Methods:</b> A cross-sectional study was done over six months at a tertiary care centre located in rural part of Northern India. Children requiring Blood Transfusion (BT) whose parents refused RBD were included in the study. Children were divided into three groups based on their age and data on various parameters were collected. Observation parameters included sex, birth order, number of siblings, disease for which children were admitted, duration between admission and need for transfusion, indication for transfusion, decision maker in the family, resistance to decision of denial by any other member of family, parental education, socioeconomic status and reasons for denial. Data were analysed using Statistical Package for the Social Sciences (SPSS) software, version 17.0, SPSS Inc, Chicago, Ill, USA). The p-values were computed for categorical variables using Chisquare (?2) test. A p-value of less than 0.05 was considered statistically significant. <b>Results:</b> Out of 356 children requiring BT, parents and relatives of 130 children (36.51%) refused RBD. Of these 130 children, 84 were females and 46 were males with male-female ratio of 1:1.8. Females were more likely to be denied RBD (p-value=0.001). Of these 130 children, only 77 could be included in the study because of various reasons. Age of the study group ranged between 2 days to 15 years. Denials were significantly higher (p-value=0.0032) in children with 3rd or higher birth order. Little benefit in terms of life expectancy was the most common reason for denials in neonates and was found statistically significant (p-value=0.00368). Fear of donation was the most common reason for denial in all the groups combined (38.9%). Considering themselves ineligible and religious beliefs were the other reasons for denials. <b>Conclusion:</b> RBD denial in children is common in India. Misconceptions, Illiteracy, poverty, sex discrimination and false beliefs are major contributory factors for denial. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC05-LC08&id=14865 https://doi.org/10.7860/JCDR/2021/48990.14865 Prevalence and Grading of Rotator Cuff and Labral Injuries in Shoulder Pain and Instability using MRI: A Cross-sectional Study Ashok Srikar Chowdhary, Naresh Babu Lakshmipathi Nikhil, Nidhi Hemendra Chandrakar, Nidhi Raj Buddaraju <b>Introduction: </b>Shoulder joint is a highly mobile joint but is prone for rotator cuff injuries and dislocations. It is necessary to accurately diagnose rotator cuff and labral injuries so that appropriate plan of action for treatment can be taken. Magnetic Resonance Imaging (MRI) can be used to diagnose and describe the extent of rotator cuff tendon and labral injuries and any secondary rotator cuff muscle abnormalities. <b>Aim:</b> To study the demographic profile of patients presenting with shoulder pain and instability, identify the various rotator cuff injuries causing shoulder pain, identify the rotator cuff interval lesions causing microinstability, identify the various labral and bony pathologies in instability, describe the MRI features of the rotator cuff, rotator cuff interval, labral and bony injuries. <b>Materials and Methods:</b> This was a cross-sectional study of 54 patients with symptoms of either shoulder pain or instability who underwent MRI evaluation of the shoulder in the Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India, from July 2018 to December 2020. All the MRI scans of the shoulder in this study were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. All the data was expressed in numbers and percentages. <b>Results:</b> The study population consisted of 54 patients comprising of 38 males and 16 females. The age of the patients ranged from 20-77 years. Majority of the patients were older than 50 years constituting about 33.33% of the total study population. Rotator cuff injury was the most common cause of pain. Tendinosis was the most common type of rotator cuff injury followed by partial-thickness and full-thickness tendon tears. The most common grade of tendinosis was mild or grade 1. Supraspinatus tendon was the most commonly affected tendon followed by subscapularis and infraspinatus tendons. Teres minor tendon was normal in all the cases. Anterior instability was the most common type of instability with equal prevalence of soft tissue Bankart, bony Bankart and Perthes lesions. Biceps pulley lesions resulted in long head of biceps tendon instability, microinstability and internal impingement. <b>Conclusion:</b> Rotator cuff injuries is the most common cause of shoulder pain and seen more frequently after the fifth decade. MRI can diagnose interstitial or intrasubstance tendon tears which are not visualised on arthroscopy. MRI description of tendon and labral tears, tendon retraction and muscle atrophy can guide the orthopaedician during arthroscopy and in treatment planning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=TC01-TC08&id=14845 https://doi.org/10.7860/JCDR/2021/48773.14845 Utility of Nucleic Acid Extraction Free COVID-19 Real Time PCR Protocol in Resource Limited Setting: A Pilot Study Santosh Karade, Pratik Thosani, Prashant Patil, Kavita Bala Anand, Sourav Sen, Rajiv Mohan Gupta <b>Introduction:</b> Coronavirus Disease-19 (COVID-19), a respiratory infection, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was first identified in Wuhan, Hubei province, China in December 2019. Alarming increase in the number of cases has put tremendous pressure on existing health resources. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR), a molecular diagnostic method, is considered gold standard for diagnosis of SARSCoV-2 infection. It involves Ribonucleic Acid (RNA) extraction as the preliminary step. Innovations to cut down cost and time involved in SARS-CoV-2 testing are need of hour. <b>Aim:</b> To assess the feasibility of Nucleic Acid Extraction Free (NEF) protocol for COVID-19 diagnosis in resource limited settings. <b>Materials and Methods:</b> In this pilot study, a panel of 148 Nasopharyngeal (NP) samples was subjected to the novel NEF RT-PCR protocol and results were compared to gold standard RT-PCR on RNA extracted from NP specimen. The cycle threshold value (Ct value) for each target was tabulated in MS Excel Spreadsheet and data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 15.0. <b>Results:</b> Out of 148 collected samples, 120 showed amplification of E and RNA polymerase gene (RdRp) targets by RNA extractionbased RT-PCR. Overall sensitivity and specificity observed for NEF protocol was 43.94% and 96.42%, respectively. <b>Conclusion:</b> Further refinement in the protocol would be required to improve the sensitivity of NEF protocol and widespread use in laboratories. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=DC01-DC03&id=14842 https://doi.org/10.7860/JCDR/2021/48363.14842 Effect of Surface Characteristics of Different Implant Abutment Materials on the Microbial Adhesion- An In vitro Study Vimal Munot, Ramesh P Nayakar, Raghunath Patil <b>Introduction:</b> While performing the two stage implants, microgap between the fixture, abutment and the superstructure are potential areas that can cause peri-implantitis. The surface roughness and surface energy of the implant abutment materials play an important role in the microbial colonisation on their surface and can help the clinician to choose a better implant abutment material in terms of microbial affinity. <b>Aim:</b> To evaluate the effect of surface characteristics of different implant abutment materials on microbial adhesion. <b>Materials and Methods:</b> The comprehensive analytical experimental study was conducted at KAHER KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India between January 2017-December 2017. Forty-five (n=45) identical disc shaped specimens were fabricated using; Zirconia (Group A), Titanium alloy (Group B) and Surgical Grade Stainless Steel (Group C). The surface roughness was assessed for all test groups by Profilometer and Scanning Electron Microscope (SEM). The Surface energy was evaluated for all the test group specimens using Goniometer. Microbial adhesion and assessment were performed using sonicating and vortexing method for all the three groups using three different bacterial strains. The Colony Forming Units (CFU) for all the specimens were tabulated and subjected to statistical analysis to draw the conclusions from the resultant data. The resultant data was analysed using SPSS software (Version 20). In order to collectively compare the means of the study groups pair-wise comparison of the test group was done using paired t-test with (p<0.05), and correlation between the surface parameters and CFU counts was done using Karl Pearson’s correlation coefficient. <b>Results:</b> On pair-wise comparison of three groups (A, B, and C) with respect to surface roughness, there were statistically significant differences in surface roughness (Ra values) between all the groups p<0.001. While comparing the three groups with respect to surface energy, there were statistically significant differences in Wetting Angle (WA) values between all the groups (p<0.001**) except between group B and A (p=0.15). Zirconia showed the least CFU counts for Prevotella intermedia (Pi) and <i>Actinobacillus actinomycetemcomitans</i> (Aa) though the differences were not statistically significant. Karl Pearson’s correlation coefficient between surface roughness and surface energy with CFU counts showed a strongly positive correlation for all microbial species and was statistically significant p<0.001**. <b>Conclusion:</b> There was a strong positive correlation of surface roughness and surface energy to CFU counts. Zirconia showed a low colonisation potential against <i>P.intermedia</i> and <i>A.actinomycetemcomitans</i> than titanium alloy and surgical grade stainless steel. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC10-ZC14&id=14867 https://doi.org/10.7860/JCDR/2021/47518.14867 A Randomised Blinded Comparison of Epidural Infusion of Ropivacaine and Ropivacaine with Fentanyl for PONV and Sedation in Elective Lower Abdominal Oncosurgeries SS Srihari, KS Henjarappa, BH Arathi, NR Rashmi, VB Gowda, Namrata Ranganath, Jeevanthy P Upadhya <b>Introduction: </b>Epidural analgesia is one of the preferred and convenient mode of perioperative management. Neuraxial opioids augment local anaesthetic effect, thus reducing their requirement for analgesia. The addition of fentanyl may cause side-effects like Postoperative Nausea and Vomiting (PONV), sedation which results in patient discomfort, thus effecting postoperative recovery. <b>Aim:</b> To estimate the incidence, compare the requirement of rescue antiemetics for PONV and Ramsay Sedation Scores within first 24 hours of postoperative period in patients undergoing elective lower abdominal oncological sugeries. <b>Materials and Methods:</b> The present study was a randomised study which was carried out from September 2016 to May 2018, in 70 patients of American Society of Anaesthesiologist (ASA) I and II, scheduled for elective lower abdominal oncological surgeries. The study population was divided into group R, comprising of patients receiving epidural infusion of 0.2% ropivacaine and group RF with patients receiving epidural infusion of 0.2% ropivacaine with 2 µg/ mL fentanyl. The incidence of PONV, rescue antiemetics for PONV and the incidence of sedation using Ramsay sedation score were evaluated in each group and compared. All data was statistically analysed and compared using Student’s t-test, Chi-square. The p-value <0.05 was considered to be statistically significant. <b>Results:</b> Groups were comparable with regard to demographic data. The incidence of PONV in group R was 37.1% and in group RF was 28.6%. The requirement of rescue antiemetic for PONV were comparable in the study groups. However, this was not statistically significant. Patients in group RF had higher mean Ramsay sedation scores at 0, 1, 2, 4, 6, 12, 18 and 24 hours but the observed difference in both the groups was statistically significant p<0.05 except at 0 and 2 hours which were not statistically significant (p>0.05). <b>Conclusion: </b>This study concludes that the patients receiving epidural infusion of ropivacaine with fentanyl should be given prophylactic antiemetic to minimise discomfort. Also, these patients when compared to patients receiving epidural infusion of ropivacaine alone require monitoring for sedation during the postoperative period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC13-UC15&id=14868 https://doi.org/10.7860/JCDR/2021/49337.14868 Glutamic Acid Decarboxylase and Islet Cell Cytoplasmic Autoantibodies Positivity in Latent Autoimmune Diabetes of Adults: Need for Early Insulinisation KS Priyadarshini, Deepti Gupta, Prashanth Kumar <b>Introduction:</b> Latent Autoimmune Diabetes of Adults (LADA) remains a poorly understood disease at both the clinical and research level and usually misdiagnosed as Type 2 Diabetes Mellitus (T2DM) and treated with Oral Hypoglycaemic Agents (OHA). This might lead to accelerated &#946;-cell destruction leading to early insulin-dependency in these patients. Screening of T2DM and determination of C-peptide and insulin antibodies helps to differentiate this disease from LADA. Early insulinisation of these patients prevents &#946;-cell destruction and preserves residual &#946; cell function. <b>Aim:</b> To screen type 2 diabetic patients for potential LADA subjects based on LADA clinical risk score and to confirm them as LADA based on Glutamic Acid Decarboxylase (GADA) positivity and Islet Cell Cytoplasmic Autoantibodies (ICA) positivity. <b>Materials and Methods:</b> The hospital based cross-sectional study was done on 945 T2DM patients attending Out Patient Department (OPD) of Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India from March 2017 to May 2019. Patients were screened using LADA clinical risk score and potential LADA subjects were identified and tested for C-peptide, GAD and IC Antibodies to confirm LADA. C-Peptide and GAD antibodies were measured by ELISA method. IC antibodies were observed using immunoflorescence microscopy. Inferential Statistics (Chi-square test, Z test, t-test) by using SPSS V20 and MS Excel was used. <b>Results:</b> Out of 945 T2DM patients, 188 patients (20%) were considered as potential LADA subjects based on LADA clinical risk score. All 188 subjects were tested for C-peptide, GAD and IC antibodies. 36% (68 subjects) of them had low C-peptide levels. Among them four subjects (6%) had high GADA titer confirming them as LADA subjects. Three (4%) of the subjects had low GADA titer, remaining 61 subjects did not show antibody positivity. Only one of them had both IC antibody positivity out of four subjects with high GADA titer. Remaining 64% (120 subjects) had normal C-peptide levels and antibody negative. <b>Conclusion:</b> Using 5-point LADA clinical risk score 20% were identified as potential LADA subjects out of 945 T2DM subjects. 6% of the potential LADA subjects had high GADA titer confirming them as LADA, who may be benefited by early insulinisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=BC11-BC15&id=14869 https://doi.org/10.7860/JCDR/2021/47396.14869 Comparison of Magnetic Resonance Hysterography and Sonohysterography in Women with Abnormal Uterine Bleeding: An Interventional Study Tsella Lachungpa, Radha Sarawagi, Sunitha Vellathussery Chakkalakkombil <b>Introduction: </b>Abnormal Uterine Bleeding (AUB) is very common and major public health issue. AUB along with its sub-group often affects 14.25% women of reproductive age and have a major impact on their physical, social, emotional and material quality of life. It not only has direct impact on the woman and her family, but also on both the economy and health services. <b>Aim:</b> To compare Magnetic Resonance (MR) hysterography and Sonohysterography (SSHG) for detection of uterine pathologies in women with AUB. <b>Materials and Methods: </b>An interventional cross-sectional study was conducted over a period from July 2019 to July 2020, among 30 patients with severe AUB. SSHG and MR hysterography were used to assess endometrial pathology, which was assessed by both the diagnostic modality and considering histopathology as gold standard. The sensitivity, specificity, positive predictive value and negative predictive value for both diagnostic modalities was calculated. <b>Results: </b>A very good agreement was noted in case of the cervical carcinoma whilst fibroid and endometrial hyperplasia showed good and fair agreement respectively by both the diagnostic modalities. Sensitivity of fibroid and cervical carcinoma was 100%, polyp was 33.33%, and endometrial hyperplasia was 87.50%. Whereas specificity of fibroid was 91.67%, endometrial hyperplasia was 86.30% and cervical carcinoma was 100%. Polyp and submucosal fibroid both showed 96.30% specificity. For pathology like cervical carcinoma, endometrial hyperplasia, fibroid had very high agreement with kappa value 1, 0.684 and 0.814 respectively, whereas agreement for two tests for pathology like submucous fibroid, dual pathology was less. <b>Conclusion:</b> MR Hysterography and Sonohysterography were having almost equal sensitivity and specificity for abnormal uterine bleeding and can be used as per patient preference, patient discomfort, and availability of investigation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=TC16-TC19&id=14870 https://doi.org/10.7860/JCDR/2021/46357.14870 Prevalence of Obesity, Dyslipidemia and Diabetes Mellitus in Patients with Gastrojejunostomy K Sunil Kumar, Abhishek Sasidharan <b>Introduction:</b> Billroth Gastrojejunostomy (GJ) is less invasive surgery as compared to Roux-en-Y Gastric Bypass (RYGB), which is performed for obesity and weight loss. There is sparse data on long term metabolic effects of GJ, which was performed frequently in the past. <b>Aim:</b> To determine the prevalence of obesity, dyslipidemia and Diabetes Mellitus (DM) in patients with GJ. <b>Materials and Methods:</b> This was a cross-sectional study conducted in the Department of Gastroenterology, Government Medical College, Calicut, Kerala, India, over a period of six years. All patients with history of GJ, done in past 15 years were included in the study. Presence of obesity, DM and dyslipidemia were noted among patients and was compared with their first degree relatives. Patients with family history of diabetes and without first degree relative were excluded from the study. Statistical analysis was performed using Chi-square test for qualitative variables and independent t-test for quantitative variables. Significance level was fixed as p-value of <0.05. <b>Results: </b>A total of 68 patients were studied. Mean age of patients was 64.01&#177;10.2 years with males predominating the population (92.6%). The most common three reasons for presentation in gastroenterology were dyspeptic symptoms 32 (47%), evaluation of anaemia 12 (17.6%), and history of malena 10 (14.7%). Prevalence of diabetes was significantly less in patients with GJ (2.9% vs 22%). Obesity and dyslipidemia was also common in patients without GJ (7.3%), with p-value <0.05. <b>Conclusion: </b>Prevalence of obesity, DM and dyslipidemia is significantly lower in patients with GJ. But the metabolic benefits of GJ surgery could possibly have a role in decreasing development of obesity and diabetes in long run. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC05-OC07&id=14871 https://doi.org/10.7860/JCDR/2021/45195.14871 A Randomised Clinical Trial to Compare the Efficacy of Tramadol and Nalbuphine for Treatment of Shivering after Spinal Anaesthesia in Patients Posted for Lower Limb Orthopaedic Surgery Sara Mary Thomas, Ananya Pradhan, Dinesh Chauhan <b>Introduction:</b> Shivering is a frequent complication after regional anaesthesia and the primary cause of shivering is perioperative hypothermia. Nalbuphine and tramadol are opioids which have been used to control postanaesthetic shivering. <b>Aim:</b> To compare the efficacy of nalbuphine and tramadol in the treatment of postspinal anaesthesia shivering. <b>Materials and Methods:</b> This was a randomised clinical trial conducted on 60 patients of either gender (20-60 years age group) from January 2019 to June 2020, American Society of Anaesthesiologists (ASA) Grade I or II, having postspinal anaesthesia shivering. The total sample was divided into two groups of 30 patients each. Group T received injection inj. tramadol 1 mg/kg intravenously (IV) and Group N received Inj. nalbuphine 0.1 mg/kg IV. Grade of shivering was assessed with a five point scale. The time taken for disappearance of shivering, assessment of improvement of shivering (complete- if grade of shivering becomes 0, partial- if grade of shivering deceased but not zero), recurrence rate and side-effects such as nausea, vomiting, deep sedation were noted. Independent t-test and Chi-square test were used to analyse the data. A p-value <0.05 were considered statistically significant. <b>Results:</b> The time taken for disappearance of shivering was shorter in group N than T (3.20&#177;0.96 minutes and 6.43&#177;0.97 minutes respectively, p=0.001). Significantly better sedation (p-value 0.04) was seen in nalbuphine group as grade 3 sedation were seen in 15 patients of nalbuphine group as compared to none in tramadol group. All the patients in group N had complete improvement of shivering and there was no recurrence, while in group T six patients had partial improvement in shivering and four (13%) had recurrence. Complications such as nausea (three patients) and vomiting (one patient) were seen in Group T while none were seen in Group N. <b>Conclusion: </b>The efficacy of nalbuphine is greater than tramadol in controlling postspinal anaesthesia shivering, with minimal side-effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC16-UC20&id=14872 https://doi.org/10.7860/JCDR/2021/49132.14872 Topical Ripasudil as First Line Treatment for Ocular Hypertension in Uveitis Cases: A Prospective Study Harvinder Nagpal, Mandeep Kaur <b>Introduction:</b> Uveitis can directly or indirectly lead to ocular hypertension which can lead to glaucoma. Ripasudil has a different mechanism of action than other anti-glaucoma medications available commercially and in contrary to these drugs, ripasudil also has anti-inflammatory properties providing an upper edge over other intraocular pressure lowering drugs. In addition to primary glaucoma, these new Rho kinase associated inhibitors can provide satisfactory results in glaucoma with secondary pathologies. <b>Aim:</b> To study the role of ripasudil as first line treatment for ocular hypertension in uveitis cases. <b>Materials and Methods:</b> A prospective randomised study comprising 40 patients of Ocular Hypertension (OHT) associated with uveitis was conducted in the Outpatient Department (OPD) of Ophthalmology at a tertiary care hospital in North India from October 2020 to January 2021. The diagnosis of uveitis was made clinically with detailed medical history and slit lamp biomicroscopic examination. All the diagnosed patients were started with topical ripasudil hydrochloride hydrate 0.4% eye drops twice daily along with anti-inflammatory medications. Intraocular Presure (IOP) was recorded after 4 weeks and 12 weeks at 8 am, 10 am and 4 pm. Effectiveness of the drugs was calculated in terms of mmHg fall in mean intraocular pressure using t-test and p-values. <b>Results:</b> Out of 40 patients with uveitis associated OHT, 20 cases were inflammation related (mean age was 56.2&#177;16.3 years,13 males, 7 females) and 20 cases were categorised as corticosteroid induced (mean age was 58.9&#177;15.69 years, 14 males, 6 females). At 12 weeks there was 5.67&#177;0.59 mmHg fall in IOP (22.70%) in inflammation related OHT and there was 6.37&#177;0.07 mmHg fall in IOP (25.34%) in corticosteroid related OHT. There was statistically significant fall in IOP (p-value=0.001). <b>Conclusion:</b> This study demonstrated that topical ripasudil hydrochloride hydrate 0.4% eye drops is effective in lowering the IOP, also there were no side effects, so it is safe and well-tolerated. So, ripasudil can provide a safe and effective alternative for lowering of IOP among uveitis related OHT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=NC01-NC03&id=14851 https://doi.org/10.7860/JCDR/2021/48878.14851 Management of Breast Abscess by Open Drainage with Primary Closure versus Standard Incision and Drainage- A Randomised Clinical Trial Monish Raj, Satyavrat Arya, Raj Kumar Chejara, Rohit Chaudhary, Vignesh Mani <b>Introduction:</b> Breast abscess is a localised collection of purulent material within the breast, which can be a complication of mastitis. In women of reproductive age, these are predominantly lactational but non-lactational abscesses are also seen in premenopausal women. Abscesses generally require drainage in conjunction with antibiotics. For the treatment of breast abscesses, surgical incision and drainage are usually carried out under general anaesthesia, as a traditional method. <b>Aim:</b> To compare conventional incision and drainage versus open drainage with primary closure with negative suction drain modalities of treatment of breast abscess in terms of different aspects including duration and quality of healing, number of dressings required, length of hospitalisation, postoperative complications. <b>Materials and Methods:</b> The present study was a randomised clinical study conducted in the Department of General Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. There were 30 patients in group A undergoing open drainage with primary closure with negative suction drain and 30 patients in group B undergoing conventional incision and drainage. They were evaluated for the study period of 18 months, between October 2018 and April 2020. The data collected were analysed with Statistical Package for the Social Sciences (SPSS) version 17.0. <b>Results:</b> The incidence of breast abscess was more common in age group of 21-30 years with right side affected more than left side. Both the surgical procedures were comparable with each other in terms of incidence of recurrence. The primary closure group fared better with less incidence of postoperative pain (duration of analgesics requirement 2.40 vs 5.43 days), reduced hospital stay (3.63 vs 6.67 days) and dressings requirement was also less (2.33 vs 12.27 days) compared to standard incision and drainage drainage which were statistically significant. <b>Conclusion:</b> Hence, it can be concluded that open drainage with primary closure with negative suction drain placement can be considered as a safe and effective alternative to the standard incision and drainage in patients with breast abscess. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PC05-PC08&id=14852 https://doi.org/10.7860/JCDR/2021/48187.14852 Effectiveness of Retro Walking and Forward Walking Treadmill Training on Abdominal Adiposity in Untrained Young Adults: A Quasi-experimental Study Ajith Soman, Muhammad Najeeb Kallidukkil, Bibin Scaria, Khalid Alkhathami <b>Introduction: </b>Retro walking or backward walking is an exercise mode which incurs an increased metabolic cost and results in a greater cardiopulmonary demand when compared to forward walking, while placing a lower stress on the joints of the lower limb. Abdominal adiposity, a part of metabolic syndrome, is an early risk-factor for morbidity and mortality in adulthood. <b>Aim:</b> To compare the effect of retro walking treadmill training and that of forward walking treadmill training, as potential modifiers of general obesity and abdominal obesity in untrained young adults. <b>Materials and Methods:</b> In this quasi experimental study, 111 untrained young men/young males aged 18-25 who were students of a medical university in Kingdom of Saudi Arabia were recruited and allocated randomly into two groups. One group underwent retro walking treadmill training five times a week for six weeks, and the other group underwent forward walking treadmill training for the same period. Waist-Hip Ratio (WHR), Waist- Height Ratio (WHtR) and Body Mass Index (BMI) were measured before and after the six-week intervention and subjected to statistical analysis. <b>Results: </b>There was a significant reduction in WHR and WHtR in the participants of the retro walking program when compared to participants of forward walking program. The decrease in BMI was not statistically significant. <b>Conclusion:</b> A retro walking training program is more effective in reducing BMI, WHR and WHtR in untrained young adults as compared to a forward walking program. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YC07-YC10&id=14853 https://doi.org/10.7860/JCDR/2021/46670.14853 Prevalence and Correlates of Mental Disability among Elderly Population Residing at Rural Block of Cuttack, India Navin Kumar, Animesh Gupta, Sampriti Samanta, Basant Kumar Behera <b>Introduction:</b> India is in demographic transition phase with increasing proportion of geriatric population. Along with chronic ailments during old age, mental health is also a growing matter of concern and often neglected. <b>Aim:</b> To estimate the burden of mental disability among elderly population of Cuttack, Odisha. <b>Materials and Methods:</b> This was a community-based, crosssectional study was carried out among the elderly people (aged 60 years and above) residing at villages of Barang block of Cuttack district, Odisha, which was a rural field practice area of Kalinga Institute of Medical Sciences (KIMS), Odisha from October 2013 to March 2014. The information regarding sociodemographic characteristics, family type, financial support, any existing disease was collected. Indian Disability Evaluation Assessment Scale (IDEAS) was used as a tool to assess mental disability among elderly participants. The data was entered into Microsoft Excel sheet and analysed using Statistical Package for the Social Science (SPSS) software 21.0. Chi-square test, Bivariate analysis and odds ratio were calculated, and the statistical significance level was fixed at p<0.05. <b>Results:</b> Among 793 participants, majority were female (51.3%) and in the age group of 60-69 years (53%). The mean of total IDEAS score was 6.14&#177;2.19 and global IDEAS score (total IDEAS score + duration of illness) was 9.38&#177;2.44, which represents moderate to profound disability. The prevalence of mental disability was 16.1%. Mental disability was found around 2 times more among 70 years and above aged people (p<0.001), 3.1 times more among those who had diabetes (p=0.0007) and 2.6 times more among those who had respiratory diseases (p<0.001) which was statistically significant. Mental disability was found to be 1.4 times more in those whose spouses were dead or separated (p=0.0512), but was not statistically significant. <b>Conclusion:</b> This study showed the prevalence of mental disability was more among females and it was significantly associated with increasing age and presence of chronic diseases. There is a need to raise awareness in public about unmet needs of geriatric mental health and an integrated approach should be taken regarding preventive and curative mental health care of geriatric people. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC01-LC04&id=14854 https://doi.org/10.7860/JCDR/2021/48230.14854 Quantitative Assessment of Interleukin-6 and Ferritin Levels and its Clinical Correlation among COVID-19 Patients Susanna Theophilus Yesupatham, Preethi Rathnasabapathy, MP Sujatha, SM Azeem Mohiyuddin, Ravishankar Suryanarayana <b>Introduction:</b> COVID-19 pandemic has emerged as a global challenge threatening human life worldwide. Early recognition of severe forms of COVID-19 infection is critically essential for timely triaging of COVID-19 patients. Biochemical Parameters correlating clinically with the severity of COVID-19 infection amidst testing of Peripheral Oxygen Saturation (SpO2 ) levels can serve in timely management of severe COVID-19 infections. <b>Aim: </b>To estimate the concentrations of proinflammatory cytokine serum Interleukin-6 (IL-6) and serum ferritin levels and to clinically correlate these markers with COVID-19 disease severity. <b>Materials and Methods: </b>A cross-sectional single center study conducted in a tertiary care hospital and research center from July 2020 to September 2020, 113 COVID-19 positive patients confirmed by Real Time-Polymerase Chain Reaction (RT-PCR) were included, Serum IL-6 and Serum Ferritin levels were measured in the patient’s blood sample using standard Enzyme linked Immunosorbent Assay (ELISA) and Vitros ECi Immunodiagnostics respectively. Data obtained was statistically analyzed using Statistical Package for the Social Science (SPSS) Software version 22.0. <b>Results:</b> Of the 113 COVID-19 infected patients, 53 were included in Group A, 27 patients in Group B and 33 patients in Group C. Mean&#177;SD of Serum IL-6 levels were 10.92&#177;2.65, 40.05&#177;11.66 and 120.92&#177;40.96 pg/mL (p<0.001) and Serum Ferritin levels 368.21&#177;374.85, 309.15&#177;291.58, and 433.45&#177;376.13 ng/mL, respectively. <b>Conclusion:</b> IL-6 correlated significantly with disease severity of COVID-19 infection and can be judiciously used for stratification and management of COVID-19 infected patients. Serum Ferritin concentration were found to be high in severe cases of COVID-19 infections and did not show any significant variation compared with mild to moderate COVID-19 infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=BC01-BC04&id=14855 https://doi.org/10.7860/JCDR/2021/48784.14855 Levels of C-reactive Protein, Total Protein and Serum Uric Acid among Cell Phone Addicted and Depressed Individuals: A Case-control Study from Uttar Pradesh, India Bhumija Sharma, Pradeep Kumar, Anil Sharma, Bhawani Shankar Modi, Preeti Sharma <b>Introduction:</b> Cell phone or smart phone abuse has become a daily phenomenon. Many diseases are found to be associated with cell phone overuse. It also leads to mental anxiety and mood disorder. <b>Aim:</b> To study C-Reactive Protein (CRP), Serum Uric Acid (SUA) and Serum Total Protein (STP) in cell phone addiction and depression together in the medical college campus. <b>Materials and Methods: </b>The present study was a case-control study in which total 150 subjects with 75 cases of depression and cell phone addiction and 75 healthy controls were involved from medical college of Uttar Pradesh, India. The diagnosis of depression and cell phone addiction was done by (Hamilton, Smart phone Addiction Scale-Short Version) scales. CRP, SUA and STP were quantified using Chem-7 Erba analyser from fasting serum samples. Data was analysed by Statistical Package for the Social Sciences (SPSS) 17.0 software. <b>Results:</b> Significant correlation between depression and cell phone addiction was found (p=0.023). Significant difference between cases and controls (p<0.001) was found for age, depression score, cell phone addiction score but CRP, SUA and STP were insignificant. <b>Conclusion:</b> Present research acknowledges many vital observations between cell phone addiction and depression with biochemical trajectories, which is novelty of this study. Youngsters are tending towards addiction and depression, which is an alarm for society and policy makers to rethink about modern gadgets advancements. It is strongly recommended to do further research in this area with more subjects and biochemical markers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=BC05-BC10&id=14856 https://doi.org/10.7860/JCDR/2021/48125.14856 Magnetic Resonance Imaging in Epileptic Children and its Association with Electroencephalography and Clinical Findings: A Cross-sectional Study Nilkanth Laxman Pal, Sanjay G Sardes Sai, Anant Lakshmikant Lawande, Swamini Digamber Panandikar <b>Introduction:</b> Epilepsy is a global health problem decreasing the quality of life of many children. Neuroimaging particularly, Magnetic Resonance Imaging (MRI), plays a crucial role in precisely identifying epileptogenic foci that are potentially amenable to surgical resection for a possible cure. <b>Aim:</b> To assess the diagnostic accuracy of MRI in the detection and characterisation of causes of paediatric epilepsy and evaluating association of the diagnostic yield of MRI with the electroencephalogram and the clinical features. <b>Materials and Methods:</b> This was a cross-sectional observational study comprising of 100 children with epilepsy in the age group of 1 month to 18 years from December 2017 to December 2019. The mean age of presentation was 8.79±6.12 years. The patient’s clinical data and surface electroencephalogram data were recorded. Subsequently performed brain-MRI was associated with the Electroencephalography (EEG) and neurological findings. Data obtained were recorded and statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 23 program. <b>Results: </b>Among 100 children 53% were boys and 47% were girls. The mean age of presentation was 8.79±6.12 years. In the present study, 57% of children had generalised tonic-clonic seizures, 21% had partial seizures, 16% had absence seizures and 6% had myoclonic seizures. On MRI investigation, 61% were found to be normal and 39% were MRI positive. Among the positive cases, the maximum numbers of cases were of cortical gliosis (10%). On statistical evaluation, a significant association was established between the MRI and EEG findings (p=0.03) and MRI and neurological findings (p=0.001). <b>Conclusion:</b> MRI plays a significant role in the evaluation of paediatric epilepsy and it is the imaging modality of choice to establish the correct diagnosis owing to its high spatial resolution and excellent soft-tissue contrast, making MRI the most versatile and useful diagnostic imaging tool for epilepsy patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=TC09-TC15&id=14857 https://doi.org/10.7860/JCDR/2021/48379.14857 Analysis of Surface Roughness and 3D Scanning Topography of Zirconia Implants Before and After Photofunctionalization by 3D Optical Profilometry- An In-vitro Study Arunjaikumar Ravindran, Suma Karthigeyan, Ramesh Bhat, Madhulika Naidu, Senthilnathan Natarajan, Shilpa Sinnurkar <b>Introduction:</b> Zirconia is considered as an alternative material for the fabrication of implants. Surface roughness of the implant plays a fundamental role in the initial bone formation. The rationale of using 3D optical profilometry in this study was to evaluate the surface roughness of the zirconia implants before and after Ultraviolet (UV) photofunctionalisation. Also, Moreso 3D optical instruments have a better resolution than the mechanical ones like Atomic Force Microscopy (AFM). <b>Aim:</b> To analyse the surface roughness and topography of zirconia implants after photofunctionalisation using optical profilometry. <b>Materials and Methods:</b> This is an in-vitro study conducted over a period of six months from March 2020 to August 2020. Ten commercially machined Zirconia implants, five each in study and control group, were micro analysed at three different regions (abutment, thread and crest) by optical profilometry. Study group was surface treated by UV radiation for 48 hours. Quantitative morphometric analysis was done between two groups and p-value less than 0.05 was considered statistically significant. The statistical test applied in this study was independent t-test. <b>Results:</b> Scanning micrographs of the study group revealed highest density of summits contributing to increased surface area in the study group. Quantitative analysis of surface roughness showed statistically significant higher mean roughness parameter for photofunctionalised implants in abutment, crest and thread region (p<0.05). <b>Conclusion:</b> Photofunctionalisation is a potentially synergistic technique in producing textured zirconia implants. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC01-ZC04&id=14822 https://doi.org/10.7860/JCDR/2021/48018.14822 Clinical Outcomes of Ventral Hernia Repair with Ventralex Patch- A Retrospective Study from a Tertiary Care Centre Coelho Victor, DK Titus, Beulah Roopavathana, Abinaya R Nadarajan, Suchita Chase, Sukria Nayak <b>Introduction:</b> There are several described techniques for ventral hernia mesh repair in both laparoscopic and open approach. Both approaches have their own pros and cons. Ventralex patch repair is an open technique using dual mesh in the intraperitoneal plane for ventral hernia repair. <b>Aim: </b>To describe an open technique with the use of ventalex patch in the repair of selected ventral hernias and to compare the open technique in terms of cost, operating time, complications and duration of hospital stay using Ventral patch and available literature for open and laparoscopic repair. <b>Materials and Methods: </b>This retrospective study was conducted on 248 patients over a period of seven years who underwent open ventral hernia repair with the Ventralex Patch, at a tertiary care hospital. A retrospective chart review and telephonic interview was conducted postoperatively and at the end of atleast 24 months to assess for outcomes, particularly recurrence. Descriptive statistics reported using frequency and percentage for categorical variables. Continuous variables were reported using mean&#177;Standard Deviation (SD). <b>Results: </b>A total of 248 patients underwent hernioplasty with ventralex patch. The mean age was 50.57 years and mean BMI was 28.37 kg/m<sub>2</sup> . The average duration of operation was 27.5 minutes and hospital stay was 2.275 days. The most common defect size was 2 cm (47.2%). The cost analysis of this technique revealed an average cost of INR 35,142 as opposed to an average cost of INR 88,601 for laparoscopic repair (including disposables) and INR 30,174 for open traditional sublay repair. Twenty-one patients developed surgical site infection (8.5%), and 27 patients (10.9%) developed seroma formation. A total of six patients developed superficial skin necrosis. The cumulative hernia recurrence rate at the end of 24 months was in 16 patients (6.5%). <b>Conclusion:</b> Ventralex patch repair is very efficient and effective in the treatment of selective umbilical, periumbilical, epigastric and incisional hernias with a comparable complication profile in terms of short term complications and recurrence rate compared to available literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PC01-PC04&id=14826 https://doi.org/10.7860/JCDR/2021/47550.14826 Clinical Characteristics and Outcome of Critically ill SARS-CoV-2 Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital in North India: A Retrospective Study Reetu Verma, Rajeev Kumar Nishad, Rohit Patawa, Alok Kumar <b>Introduction: </b>World Health Organisation (WHO) declared the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak a pandemic on 11th March 2020, due to the constantly increasing number of cases outside China. Previously, India had global record of highest single day spike of Coronavirus Disease19 (COVID-19) cases, with 97,894 cases on 17th September 2020. <b>Aim:</b> To find out the demographic and clinical characteristics of critically ill patients of SARS-CoV-2 and comparing the outcomes of patients admitted in COVID dedicated Intensive Care Unit (ICU) with and without co-morbidities and also in different age groups and sex. <b>Materials and Methods:</b> This retrospective study from July 2020 to December 2020 was a single centre observational experience of management of COVID-19 patients at COVID dedicated ICU in Firozabad, India. The following data were recorded: age, sex, comorbidities and mode of oxygen delivery (invasive mechanical ventilation, non-invasive mechanical ventilation, high flow nasal canula). Chi-square test was used to compare the outcomes of patients admitted in COVID dedicated ICU with and without comorbidities and also in different age groups and sex. <b>Results:</b> In this study, the data of 120 severely ill COVID-19 patients were reviewed. The mean age of patients were (58±15.29) years and male to female ratio was 3:1. At least one co-morbid condition was reported in 53.3% of patients-most common being hypertension (36.6%) followed by diabetes mellitus 2 (20%), Chronic Obstructive Pulmonary Disease (COPD) (15%) and then followed by cardiovascular diseases, renal and liver diseases. All patients admitted to COVID ICU had moderate to severe Acute Respiratory Distress Syndrome (ARDS). Older age (61 years and above, mortality 17%), male sex (16.7% deaths among 90 critically ill male COVID patients) and presence of co-morbid conditions appear to have higher mortality in this study. However apart from co-morbid conditions (p=0.001) none was statistically significant. The overall mortality in this study of 120 critically ill COVID patients was 14.2%. <b>Conclusion: </b>From this study, it can be suggested that survival of critically ill COVID patients can further be improved by better management of their co-morbid conditions and avoiding complications of invasive ventilation. However, further multicentric studies with large sample size are needed to confirm these findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC05-UC08&id=14827 https://doi.org/10.7860/JCDR/2021/48983.14827 Intercostal Nerve Block and Peritubal Infiltration with Bupivacaine for Postoperative Analgesia after Percutaneous Nephrolithotomy: A Randomised Clinical Study Karunakaran Binil, Kaniyil Suvarna, Kannammadathy Poulose Biji <b>Introduction:</b> Percutaneous Nephrolithotomy (PCNL), a common endourologic procedure for removal of renal stones is associated with significant pain. Regional blocks are being used for postoperative analgesia after PCNL. <b>Aim:</b> To compare the analgesic efficacy of intercostal nerve block and fluoroscopic guided peritubal infiltration in terms of duration of analgesia, postoperative pain scores and total analgesic consumption in first 24 hours. <b>Materials and Methods:</b> This was a randomised clinical trial conducted from May 2018 to October 2018 on total of eighty patients, randomly allocated to two groups of 40 each. Group IC received intercostal nerve block and group IF received fluoroscopy guided peritubal infiltration with 0.25% bupivacaine. Duration of analgesia was assessed from postoperative pain scores (Numerical Rating Scale (NRS) during rest and coughing). Total analgesic consumption for 24 hours was also noted. Data was analysed using Chi-square test for categorical variables and independent Student&#8217;s t-test for quantitative variables. <b>Results:</b> The duration of analgesia was 702.00&#177;140.022 minutes in Group IC and 346.50&#177;129.566 minutes in group IF which was significant statistically with a p-value of <0.001. Resting and dynamic NRS were lower upto 12 hours postoperatively in group IC (p-value less than 0.05). Both tramadol (50.00&#177;11.32 mg vs 82.50&#177;24.15 mg) and paracetamol (100&#177;303.82mg vs 850&#177;622.23mg) requirements were lower in group IC as compared to group IF with p-values less than 0.001. Total consumption of first rescue analgesic tramadol as well as second analgesic Paracetamol both were significantly lesser(p-value<0.001) in group IC than group IF. <b>Conclusion:</b> Intercostal Nerve Block (INB) provided superior analgesia compared to fluoroscopic guided peritubal infiltration after PCNL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC09-UC12&id=14828 https://doi.org/10.7860/JCDR/2021/49105.14828 Whole Body Vibration for Athletes: An Evidence Informed Review Saurabh Sharma, Sana Saifi, Nitin KR Arora, Shalini Sharma Whole Body Vibration (WBV) is a well-known modality which is increasingly being used by athletes to improve their conditioning levels. Muscle strength and power are major health related fitness components that contribute to marked success in athletic events. Recently, this exercise modality has been utilised by number of researches to investigate its role and efficacy in muscular conditioning. Muscle strength and power have been found to significantly increase when WBV is added to the conventional exercise program but the mechanism by which this strength and power increases has not been well documented. The present review aimed to highlight the impact of WBV on muscle strength, power, muscle activity, and the mechanism by which these gains occur in athletic populations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YE06-YE10&id=14829 https://doi.org/10.7860/JCDR/2021/47822.14829 Assessment of Online Learning Procedure through the Eyes of Medical Students in COVID-19 Scenario Tanwi Ghosal (Sen), Anirban Sadhu, Parijat Mukherjee, Paramita Mukhopadhyay <b>Introduction:</b> Coronavirus Disease 2019 (COVID-19) pandemic has necessitated closure of physical classroom for maintaining social distancing norms, prompting learning environment to shift from offline to online. Medical education has also undergone similar changes, and online education and assessment methods had to be implemented. Student’s perception regarding the same was assessed through this study. <b>Aim: </b>To assess the perception of first year MBBS students about the online education and assessment during the lockdown period of two months. <b>Materials and Methods:</b> A descriptive cross-sectional study was carried out on the first year MBBS students of North Bengal Medical College (NBMCH) during the COVID-19 Lockdown period (29th August to 9th September 2020). All first year MBBS students of NBMCH were added in WhatsApp groups created for academic purposes by Department of Anatomy, NBMCH during the lockdown period. Respective teachers in the academic groups carried out sharing of Digital Education Material (DEM), holding Online Interaction (OI) and correspondence with students, and taking Online Assessments (OA) through sharing questions framed in Google Forms. After two months, the perception of the students was assessed through a voluntary participation based online survey designed in google forms, the results of which were tabulated later and analysed. <b>Results:</b> A total 95 students (54 Male, 41 Female) out of 200 had participated in the survey. Most students were reliant on smartphones (n=90, 94.7%) and mobile internet (n=78, 82%). Most agreed on DEM being relevant (83.2%) and informative (80.7%) but showed diverging opinion on ease of understanding, revision and overall fulfillment of learning objective. On OI, majority students responded positively on promptness, relevancy, informative and helpfulness but only 46.8% considered DEM and OI fulfilled the overall learning objective. Regarding OA students had an overall positive opinion. Comparing the online mode with offline, students mostly preferred the latter, though agreeing that online method of education was effective and it was easier to score in OAs. <b>Conclusion:</b> While most students accepted online education, interaction and assessment positively, at the end most of them still preferred offline mode of education and assessment. This could reflect lack of student-student interaction and indicated need of further studies to explore the matter, to help us approach online education better. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=AC01-AC05&id=14830 https://doi.org/10.7860/JCDR/2021/47089.14830 Anaesthetic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Blockade: A Randomised Controlled Trial BT Arish, B Hariharasudhan, RV Ranjan, S Sivavakumar, Sagiev Koshy George, K Ravravichandran <b>Introduction: </b>Ultrasonography (USG) guided supraclavicular block is an excellent choice for upper limb surgeries. It not only allows smaller volumes of local anaesthetic usage but also provides optimal tourniquet coverage. Ropivacaine is structurally related to bupivacaine with reduced potential for toxicity and improved sensory and motor blocking profiles. Nalbuphine acquired a significant place in pain control but its efficacy as a local anaesthetic adjuvant is yet to be proved in peripheral nerve blockades. <b>Aim:</b> To evaluate the efficacy of adding nalbuphine to ropivacaine in supraclavicular brachial plexus blockade and to assess the quality of block for patients undergoing ambulatory forearm and hand surgeries. <b>Materials and Methods:</b> Seventy American Society of Anesthesiologists (ASA) grade I and II patients were randomised into two groups of 35 each. Group A (n=35): received 24 mL of 0.5% of ropivacaine+1 mL of nalbuphine (10 mg) and Group B (n=35): received 24 mL of 0.5% of ropivacaine+1 mL of normal saline. The parameters observed were duration of analgesia, onset of sensory and motor blockade, duration of motor blockade and haemodynamic changes during the procedure. Categorical variables were analysed using the Pearson’s Chi-square test. Continuous variables were analysed using the independent sample t-test and p<0.05 was considered as statistically significant. <b>Results: </b>The onset of sensory and motor blockades were faster in the nalbuphine group compared to the control group (p<0.001). The duration of sensory and motor blockades was similarly longer in nalbuphine group (p<0.001). Also, the mean duration of analgesia was significantly longer with nalbuphine group (p<0.001). <b>Conclusion:</b> Nalbuphine significantly prolonged the duration of analgesia and duration of block while accelerating the onset of blockade thereby improving the overall quality of blockade. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC01-UC04&id=14577 https://doi.org/10.7860/JCDR/2021/47540.14577 Renal Function among HIV Infected Patients on Combination Antiretroviral Therapy: A Longitudinal Cohort Study Bijaya Kumar Behera, Sritam Acharya, Sukanta Kumar Jena, Keshaba Chandra Budula <b>Introduction:</b> A large number of Human Immunodeficiency Virus (HIV) infected patients are taking combination Antiretroviral Therapy (cART) worldwide as it has led to dramatic improvements in them with a decreased viral load as well as an increase in Cluster of Differentiation (CD4+) T cell count. Though the incidence of HIV associated Chronic Kidney Disease (CKD) has decreased with the use of effective cART, the prevalence of End Stage Renal Disease (ESRD) in HIV positive patients has increased due to the risen longevity owing to them. <b>Aim: </b>To study the renal function abnormalities in HIV infected patients and to compare the change in renal function of treatment naïve patients with patients on triple drug regimen (cART). <b>Materials and Methods:</b> This prospective longitudinal cohort study was conducted on 54 Enzyme Linked Immunosorbent Assay (ELISA) positive HIV patients belonging to the age group of 18-70 years of both the genders over a period of two years from August 2017 to September 2019 in MKCG Medical College and Hospital, Berhampur, Odisha, India. Forty nine HIV infected patients naive to cART and five patients on cART for a minimum period of three months were included in this study. All patients were treated with triple therapy regimens of either ZLN (Zidovudine 300 mg+Lamivudine 150 mg+Nevirapine 200 mg) or TLE (Tenofovir 300 mg+Lamivudine 150+Efavirenz 600 mg) daily; in a single dose at bed time. Renal function parameters like serum urea, serum creatinine, Creatinine Clearance (CrCl), estimated Glomerular Filtration Rate (eGFR) and CD4+ T cell count of treatment naive patients were compared with the same patients on cART after six months duration. GFR was calculated by Modification of Diet in Renal Disease (MDRD) equation. Results were analysed using the Statistical Package for the Social Sciences (SPSS) software for Windows Version 17.0. <b>Results:</b> Out of 54 patients, 53.7% (n=29) were males and 46.3% (n=25) were females. The mean CrCl of HIV positive patients on cART (79.09&#177;25.705 mL/min) was higher than treatment naive (69.65&#177;25.506 mL/min) patients and was highly significant (p-value=0.003). The mean eGFR of HIV positive patients on cART (102.711&#177;26.9424 mL/min/1.73 m<sup>2</sup>) was higher than treatment naïve (90.189&#177;28.2575 mL/min/1.73 m<sup>2</sup>) patients and was highly significant (p-value=0.003). The mean serum urea of HIV positive patients on cART (25.78&#177;4.721 mg/dL) was lower than HIV positive treatment naïve (26.19&#177;4.742 mg/dL) patients but was non-significant (p-value=0.640). The mean serum creatinine of HIV positive patients on cART (0.815&#177;0.1393 mg/dL) was lower than HIV positive treatment naïve patients (0.906&#177;0.1687 mg/dL) and was also highly significant (p-value=0.003). The mean CD4+ T cell count of HIV positive patients on cART (401.63&#177;225.816 cells/&#956;L) was higher than HIV positive treatment naïve (287.13&#177;198.263 cells/&#956;L) patients and was very highly significant (p=0.001). <b>Conclusion: </b>Renal impairment (CrCl <60 mL/min) and eGFR (<60 mL/min/1.73 m<sup>2</sup>) were higher in HIV positive treatment naive patients than those on cART. Radiological parameters like size of the kidney and cortical echogenicity became normal after six months on cART. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC01-OC04&id=14814 https://doi.org/10.7860/JCDR/2021/48493.14814 Effect of Physiotherapy in the Prevention and Relief of Secondary Lymphoedema in Subjects with Postoperative Breast Cancer- A Systematic Review of Randomised Controlled Trials Mitali Naik, Priyanka Nayak, KU Dhanesh Kumar Introduction: Breast Cancer is the most common type of cancer in women and the 2nd leading cause of death. The treatment of breast cancer includes surgery, chemotherapy, radiation therapy, hormone therapy or combination of these treatments. One of the most important complications which occurs in one out of four women is lymphoedema. Physiotherapy plays an important role in creating awareness, prevention, early diagnosis and treatment of secondary lymphoedema. The systematic reviews which were already done focused on only one intervention or combination of two or more interventions for lymphoedema with or without other complication related to breast cancer. Aim: To systematically review the randomised controlled trials to evaluate the effect of various physiotherapy interventions that are used in the prevention and relief of secondary lymphoedema in postoperative breast cancer patients. Materials and Methods: Relevant studies were retrieved through PubMed, Cochrane, EMBASE and Google Scholar databases ranging from the year 2004 (January) to 2020 (March). The language of search was English. The keywords used for the search were breast cancer, interventions, physiotherapy, postoperative, secondary lymphoedema, treatment, prevention. Total 14 randomised controlled trials were included in this study according to the inclusion criteria. The trials included interventions like Manual Lymphatic Drainage (MLD), compression therapy, Range of Motion (ROM) exercises and massage. Results: A total of 244 relevant articles were found out of which 14 Randomised Controlled Trials (RCTs) were included in this study. MLD showed positive effects on lymphoedema prevention and treatment as an individual intervention or in combination with other interventions. Compression sleeves/corsets also showed positive effect on lymphoedema. Resistance exercises showed no risk of precipitating or increasing lymphoedema. Shoulder programs showed that delayed mobilisation of shoulder after one week is beneficial for reduction of lymphoedema. Physiotherapeutic stimulation showed positive effects on lymphoedema by increasing the lymphatic flow and velocity. Conclusion: Physiotherapy interventions like MLD, compression garments, stretching and strengthening, resistance exercises and ROM exercises have a potential effect in the treatment and prevention of secondary lymphoedema. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YE01-YE05&id=14815 https://doi.org/10.7860/JCDR/2021/45745.14815 Multiple Case Scenarios Based on Integrated Teaching among First Year Medical Students: A Cross-sectional Study Ashwin Kulkarni, Vanitha Gowda, Chandrika Rao, Medha Y Rao <b>Introduction:</b> Integrated teaching helps the students to understand the concepts well and conceptualise the subject well. Clinical cases introduced in the first year are interesting and stimulative for the student but may overwhelm and confuse the student. <b>Aim:</b> To know the perception and acceptance of integrated teaching among the first year Bachelor of Medicine and Medicine of Surgery (MBBS) students which include multiple case scenarios. <b>Materials and Methods:</b> This educational research is a crosssectional observational study involving first year medical students in Ramaiah Medical College, Bangalore. Study was conducted for a period of one year (August 2018 to June 2019). Horizontal integration of a system in the first year MBBS subjects were done. This was followed by an interactive session conducted by a Clinician basically comprising of multiple case scenarios on the particular system. The sessions focussed on integration of basic medical science subjects and their application in the case scenarios. Six organ-systems were similarly covered. The integrated sessions involved in class discussions of the clinical cases and were designed, implemented and moderated by two faculties (clinicians and basic science faculty). Collected data were entered into MS Excel, and analysis was done using Statistical Package for the Social Science (SPSS) software. The students’ feedback regarding the perception of integrated teaching was collected on the Five point likerts scale using a validated questionnaire and analysed. <b>Results: </b>The number of students included in the study was 140. About 135 (96.43%) of the students felt that integrated teaching using multiple case scenarios motivates them to learn in a better way. About 133 (95%) of students felt that integrated teaching helps them to understand concepts well, stimulates the critical thinking. About 136 (97.14%) of students felt that integrated teaching helped them to understand the topic in a holistic way. <b>Conclusion: </b>The students felt that the integrated teaching using multiple case scenarios enhanced their perception and comprehension of the diseases and helped them to understand the relevance of application of pre-clinical knowledge in clinical practise. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=JC01-JC05&id=14818 https://doi.org/10.7860/JCDR/2021/48157.14818 Project-Based Learning in Pharmacology during COVID-19 Lockdown for Second Phase Medical Undergraduates Jinish Jose, Irshad Ali, Dhanya Sasidharan Palappallil <b>Introduction:</b> Project-based learning has both constructionist as well as constructivist principles that engage the students in autonomous deep learning. <b>Aim: </b>To obtain the perceptions of participants on project-based learning in the subject of Pharmacology during COVID-19 lockdown. <b>Materials and Methods:</b> This was an online questionnairebased descriptive study done on the Google platform. A series of integrated lectures were conducted in the Department of Pharmacology and Internal Medicine on diabetes, lipid dysfunction and thyroid disorder for second year MBBS students. The study was conducted from August 2020 to November 2020 in a medical college in Kerala, India. Google-based project submission was done after identifying a patient at home or neighbourhood with the disease covered after each integrated lecture. A validated questionnaire was used to obtain feedback about the projectbased learning on a Likert scale. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Version 16 software for Windows. <b>Results:</b> The response rate was 76.9% (100 out of 130). The majority of the participants agreed/totally agreed to statements on professional attributes attained during project-based learning session like the ability to think creatively (60%), make observations (81%), compile information (80%), assess and make a decision (59%), analyse situations of professional practice (65%), develop oral communication skills (57%), develop Self-Directed Learning (SDL) (70%), develop skills needed for professional practice (54%), develop empathy towards patients with disease (79%) and develop self-confidence in learning the subject (63%) with a median score of 4. The majority of participants agreed/totally agreed to the effectiveness of the project-based learning in helping acquire various clinical and theoretical competencies during COVID-19 lockdown. The majority of the participants and the patient identified at home were happy to be part of the project-based learning. <b>Conclusion: </b>The majority of the participants were in agreement with the questions posed to them with a median score of 4, however, a neutral opinion was obtained on the acquisition of written communication skills as well as their family members having better compliance after getting involved in project-based learning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=JC06-JC09&id=14819 https://doi.org/10.7860/JCDR/2021/48919.14819 Comparison Study of Wobble Board and Bosu Ball along with Strength Training on Lower Limb Strength, Dynamic Balance, Agility and Functional Performance of Runners with Lateral Ankle Instability Roshni, Sheetal Kalra, Sajjan Pal, Sonia Pawaria, Joginder Yadav <b>Introduction:</b> Chronic Ankle Instability (CAI) is characterised by a subjective feeling of recurrent instability, continued episode of giving way and self-reported disability. A wealth of literature is available reporting causes and risk factors related to CAI, still there is a lack of understanding regarding rehabilitation procedures. <b>Aim:</b> To compare effect of BOSU ball and wobble board along with strength training on muscle strength, dynamic balance, agility and functional performance in recreational runners with CAI. <b>Materials and Methods:</b> It was an experimental study design conducted at Physiotherapy Outpatient Department (OPD) of SGT Hospital, Gurugram. Data collection was done from July 2019 to October 2019. Analysis and report writing took 2 months i.e from November 2019 to December 2019. Total 60 male runners in the age group of 18-35 years with CAI were randomly divided into two groups i.e. A (Wobble board) and B (BOSU Ball) with 30 players in each group. All subjects were evaluated for ankle muscle strength, agility, dynamic balance and functional performance as measured by Manual muscle tester, T-test, Y balance test and figure of eight hop test respectively on day one and last day of 3rd and 6th week of intervention. Statistical Package for the Social Science (SPSS) software version 20.0 was used to analyse result. Mean and Standard deviations were calculated. Analysis of Variance (ANOVA) and Student t-test was used for analysing inter group differences. <b>Results:</b> The statistical findings in this study postulate that both groups had significantly improved fitness and skill related variables but BOSU ball group showed highly significant improvement compared to wobble board group (p<0.05). <b>Conclusion:</b> The current results support that sensorimotor training can be progressed in difficulty by systematically reducing the base of support with help of BOSU ball. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YC01-YC06&id=14820 https://doi.org/10.7860/JCDR/2021/46588.14820 <i>Malassezia Species</i> Distribution in Cases of Pityriasis Versicolor and Dandruff in a Tertiary Care Rural Hospital: A Cross-sectional Study Hitendra Dev, Dipak C Thamke, Vijayashri S Deotale <b>Introduction:</b> Pityriasis Versicolor (PV), a commonly encountered superficial mycosis is a mild, chronic infection of the stratum corneum. Malassezia species are lipid dependent yeast that are commonly found on human skin and associated with PV and dandruff. <b>Aim: </b>To study the distribution of Malassezia species in cases of PV and Dandruff. <b>Materials and Methods: </b>A tertiary care rural hospital based cross-sectional study was undertaken. Skin scrapings were collected and cultured on Sabouraud’s Dextrose Agar (SDA) overlaid with olive oil and modified Dixon Agar (mDA). The isolates were identified by biochemical tests. Data was analysed using the Chi-square test. The p-value of <0.05 was considered statistically significant. <b>Results:</b> Out of the 127 samples of PV, 38.2% were 10% KOH positive. A total of 76 yielded growth. The most common isolate was M.sympodialis (53.06%), followed by M.furfur (26.53%), M.globosa (16.33%) and M.slooffiae (4.08%). Of the 51 cases of dandruff cases, 27 samples yielded growth and the most common isolate was M.sympodialis (62.96%), followed by M.furfur (25.93%), M.globosa (11.11%). <b>Conclusion:</b> PV and dandruff are the common surface infections in this rural region and Malassezia sympodialis is the commonest species associated with these conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=DC04-DC07&id=14889 https://doi.org/10.7860/JCDR/2021/43645.14889 Correlation between Second and Fourth Digit Length Ratio with Height, Body Mass Index and Axial Length of Eyeball in Adult Population of Burdwan, West Bengal, India Sabari Bhattacharya, Alipta Bhattacharya, Apala Bhattacharya, Kushal Banerjee, Jonaki Das(Sarkar), Mousumi Banerjee <b>Introduction:</b> Studies are being conducted to correlate second (2D) to fourth digit (4D) length ratio as an anthropometric marker of prenatal sex steroid exposure with human body. As 2nd digit: 4th digit (2D:4D) ratio is an anthropometric window into the interplay of sex hormones in-utero, this tool may be tested to note if there is any correlation between the sexual dimorphism of axial length and the Digit length ratio. <b>Aim: </b>To find a correlation between digit length ratio (2D:4D) with physical parameters like height, Body Mass Index (BMI) and axial length of eyeball in the adult population of South Bengal presenting in a tertiary care hospital, in Burdwan, West Bengal, India. <b>Materials and Methods: </b>A cross-sectional study with simple random sampling was conducted on 500 patients (age =20 years) from March 2016 to February 2017 in the Departments of Anatomy and Ophthalmology Out Patients Department (OPD) of a tertiary care Hospital and Medical College in West Bengal, India. Height, weight, axial length of eyeball were measured and the BMI was computed for the study population. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0. Unpaired t-test was used for determining possible group differences in 2D:4D length ratios. Pearson’s correlation coefficients were used to find a correlation between second and fourth digit length ratio (2D:4D) with height, BMI and axial length of eyeball in the study population. The p-value <0.05 was considered significant. <b>Results:</b> The study included 280 males and 220 females with a minimum age above 20 years and most of the patients belonged to the age group of 50-69 years. A 2D:4D length ratio was significantly lower in males compared to females (for Right hand t=34.91, p<0.001, and for left hand t=14.30, p<0.001). Correlation analysis of 2D:4D length ratio of right and left hands with height of males revealed significant negative correlation (Right hand: r=-0.679, p<0.001; Left hand: r=-0.0463, p<0.001). In females, the result was positively significant for both hands (Right hand: r=0.313, p<0.05; left hand: r=0.21, p<0.05). A 2D:4D length ratio and BMI of males showed significant positive correlation for both Right hand (r=0.18, p<0.05) as well as for the left hand (r=0.137 p<0.05). In case of females, however 2D:4D ratio and BMI showed weakly negative correlation for both hands but the values were not significant. Correlation of 2D:4D length ratio of right and left hands on axial length of eyeball in males revealed significant negative correlation (right hand: r=-0.706, p<0.001; left hand: r=-0.25, p<0.05) but in females, there was significant positive correlation for the right hand (r=0.145, p<0.05) and positive but non-significant correlation for the left hand at 95% CI (r=0.087, p>0.05). <b>Conclusion:</b> In this study, authors have tried to establish that 2D:4D ratio (which is significantly higher in females) can be used as a putative non-invasive anthropometric marker to differentiate between males and females, which presumably is prenatally determined by in-utero sex steroid hormone exposure. By correlation studies, authors have also tried to prove that this parameter correlates well with other anthropometric measurements like height, BMI and ocular axial length which are already known to be significantly different in males and females. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=AC06-AC10&id=14860 https://doi.org/10.7860/JCDR/2021/47134.14860 Association of Demographic, Clinical and Laboratory Parameters with Clinical Outcome of COVID-19 Patients of Bangalore: A Cross-sectional Study Ravi Krishnegowda, Avinash Hanbe Rajanna , B Abhiman Shetty, Rakshit R Desai,Thejaswi K Gurumurthy , Kiran Kumar Navalba, Vallish Shenoy , Bhargav V Bhat <b>Introduction:</b> Although the Coronavirus Disease-2019 (COVID-19) pandemic is creating a major global health crisis, the risk factors for mortality and the detailed clinical course of disease has not yet established. <b>Aim:</b> To determine association of the demographic data of COVID-19 patients with clinical profile and disease outcomes. <b>Materials and Methods:</b> The cross-sectional, single-center study considered adults patients of both the gender from March 2020 to June 2020 with an estimated sample size of 2000 patients diagnosed with COVID-19 infection by Reverse TranscriptasePolymerase Chain Reaction (RT-PCR) technique. Necessary demographic and clinical data were collected and selected subjects were followed-up until discharge or death. Subjects were classified as those who survived (1839 patients) and succumbed (138 patients) to death. Students t-test was used for comparing continuous variables and chi-square test for categorical data between the groups. <b>Results: </b>The study included 1977 patients with a male-to-female ratio of 1:0.62. Fever, dyspnoea and cough were noted as the major symptoms prevalent among patients who succumbed to death when compared to those who survived (p-value <0.001). Statistically significant variables noted between the groups were age (survived mean age of 42.74&#177;15.15 years vs mean age 59.12&#177;12.95 in those who succumbed to death, p-value <0.001), age groups (p-value <0.001), gender (p-value 0.042), haemoglobin, Total Leucocyte Count (TLC), neutrophil, lymphocytes,Neutrophil to LymphocyteRatio (NLR), Lactate Dehydrogenase (LDH), ferritin, all the co-morbidity variables and the asymptomatic status. Variables identified as significant predictors of disease outcomes were Haemoglobin (Hb), TLC, neutrophils, lymphocytes, NLR, LDH and ferritin (p-value <0.001). Most of the subjects belonging to the mortality group required oxygen and other Intensive Care Unit (ICU) facilities when compared to the survival group (p-value <0.001). The mean days of viral clearance noted in COVID-19 subjects was around 8.98&#177;3.54 days. <b>Conclusion:</b> Haemoglobin (HB), TLC, neutrophils, lymphocytes, NLR, LDH and ferritin are noted as significant predictors of COVID-19 outcome. Biochemical monitoring of COVID-19 patients helps in identifying critically ill patie https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC09-LC13&id=14874 https://doi.org/10.7860/JCDR/2021/48988.14874 Surgical Management of Supracondylar Fractures of the Humerus in Children by Closed Reduction and Percutaneous Pinning with Kirschnner Wires: A Cross-sectional Study Chavan Pramod Babu, K Shankara, T Lakshmeesha <b>Introduction:</b> Supracondylar Humerus Fracture (SCHF) is frequently encountered in paediatric age group and constitutes nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilisation with percutaneous pins. <b>Aim:</b> To find out the outcome and safety of percutaneous pinning techniques in terms of functional and radiological outcome and to note the associated complications with this method of fixation. <b>Materials and Methods:</b> This was a cross-sectional study, conducted on patients admitted to Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, between January 2017 to December 2019. Thirty paediatric cases were retrospectively reviewed. These were admitted with a supracondylar fracture and had reported to the hospital over a three-year period. All fractures were treated with closed reduction and fixation with percutaneus Kirschnner Wires (K-wire) followed by immobilisation in above elbow slab for three weeks. K-wires were removed at three weeks and mobilisation with physiotherapy was advised. Outcome was measured by Flynn’s Criteria. The results were analysed as per appropriate descriptive statistical tests. <b>Results: </b>The mean age of the patients was 7.4 years (range 4-12 years). Males outnumbered females. Total 22 (73.3%) patients had left-sided fracture and 8 (26.7%) had fracture on right side. Fracture union was seen in all the patients at a mean interval of 4.2 weeks (range 3-5 weeks), in a follow-up of 12 weeks. Most (90%) of the injuries were the result of trauma, including fall. 70% of the fractures were Gartland Type III supracondylar fracture. Cross K- wire fixation was done in 21 patients and lateral-only pin in 9 patients. Among the 21 patients, who had type III fracture, 4 of them were fixed with 2 Lateral K-wire pinning and 17 of them with crossed K-wire pinning configuration. The most common postoperative complication observed was a superficial pin tract infection, seen in 4 (13.3%) patients. Outcome according to the Flynn’s criteria 25 patients (83.3%) had excellent result, 3 (10%) patients had good result, 1 (3.3%) had fair result and 1 (3.3%) patient had poor functional result. <b>Conclusion: </b>The present study concludes that close reduction and percutaneous k-wire pinning techniques give a favorable outcome in displaced supracondylar fractures of the humerus in children, without any serious complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=RC01-RC04&id=14875 https://doi.org/10.7860/JCDR/2021/47835.14875 Knowledge, Attitude and Practices of Medical Students Regarding Self-Medication in Sore Throat: A Cross-sectional Study Nilank Saroha, Nitin Tomar, Varun Singh <b>Introduction:</b> Self-medication is a prevalent problem worldwide. Especially, knowing the pattern among medical students is pertinent as they would be future physicians. It would be interesting to find out their self-medication practices in common ailment such as sore throat. <b>Aim:</b> To study the patterns of self-medication in sore throat among medical students. <b>Materials and Methods:</b> This was a cross-sectional, online questionnaire based survey (via google forms) conducted in Muzaffarnagar Medical College from October 2020 to November 2020. Total 450 students from 2nd, 3rd and final year (150 per batch) were enrolled. Out of these, only 213 consented and participated in the study (82 students from 2nd year, 93 from 3rd year and 38 from final year). Results were expressed as counts (n) and percentages (%) statistical analysis was done wherever appropriate. <b>Results:</b> Out of 213 students (113 were females and 100 were males), who participated in the survey, 190 (89.2%) suffered from sore throat in last 1 year and 111 (58.42%) of these self-medicated for it. Self-medication practices increased with professional year, highest being in final year (27 of 38, 71.05%). Most common class of drug used was antibiotic (consumed by n=95, 85.59%). It was followed by analgesic/ antipyretic (n=82, 73.87%) and antihistaminic (n=75, 67.57%). Overall, azithromycin was the most favoured independent drug for sore throat (n=68, 71.58%). More than half of the students who preferred antibiotic other than azithromycin (n=14/27, 51.85%), discontinued it within 3 days. Majority of students (n=126, 59.15%) did not support self-medication whereas 87 students (40.85%) believed self-medication to be good. Almost 1/5th of the students (n=46, 21.60%) confirmed that they will self-medicate in future, 107 (50.23%) were not sure and only 60 (28.17%) refused to practice self-medication. One fifth students (n=42, 19.72%) felt that self-medication is a part of self-care and 30 (14.08%) would recommend it to others also. Prevalence of self-medication in sore throat was in 111 students (58.42%). <b>Conclusion:</b> A rising trend with progression of professional year was observed. An alarming fact in the present study was the high use of antibiotic in sore throat by our undergraduates. The students need to understand the indications of the medicines they prescribe to themselves or others. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=MC01-MC05&id=14876 https://doi.org/10.7860/JCDR/2021/48587.14876 COVID-19 Reinfection: A Case Series Surabhi Jaggi, Varinder Saini, Deepak Aggarwal Coronovirus Disease-2019 (COVID-19) manifests with a varied spectrum of symptoms ranging from asymptomatic disease to Acute Respiratory Distress Syndrome (ARDS) and death. Contrary to the expectation of the herd immunity in controlling the pandemic, reinfection with COVID-19 poses a new threat in the control of the pandemic. Authors hereby present three cases have been described who developed COVID-19 infection for the second time after complete recovery from the first infection. All three patients were less than 50 years of age with no co-morbidities. First case developed the second infection three weeks after having recovered from the first infection whereas second and third case developed repeat infection after two and four months of recovery respectively. The severity of the repeat infection along with the duration between the two infections has been discussed in this article https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OR01-OR04&id=14877 https://doi.org/10.7860/JCDR/2021/49433.14877 Screening and Allotting Completely Edentulous Patients using Prosthodontic Diagnostic Index in a Dental School, Jeddah, Saudi Arabia Mohammed Shammas, Nagihan Kuru Muhcu, Elaf Abdullah Alzahrani, Rana Ali Alsaadi, Elaf Mohammed Alshaqha, Jood Ahmed Balkhyoor, VT Abdurahiman, Shaiq Gajdhar <b>Introduction:</b> To formulate an ideal treatment plan for edentulous patients, data collected from various diagnostic aids need to be structured and classified according to their treatment needs. The lack of structured diagnostic findings for edentulous patients has always been a barrier to effective care for patients. To address these issues, the American College of Prosthodontists (ACP) established the Prosthodontic Diagnostic Index (PDI) based on specific criteria. <b>Aim:</b> To screen and allot completely edentulous patients to students using PDI in a dental school, in Jeddah, Saudi Arabia. <b>Materials and Methods:</b> This cross-sectional study was conducted on 122 completely edentulous patients who visited the outpatient clinic of a dental school in Jeddah, Saudi Arabia. The edentulous patients based on PDI were classified into four classes (Class I-IV) according to the diagnostic findings based on the complexities. The parameters studied were: mandibular bone height measured on a panoramic radiograph, residual ridge morphology of the maxillary arch, muscle attachments in the mandibular arch, and maxillomandibular relationship. Statistical analysis were performed using counts and percentages. <b>Results:</b> In the overall classification of PDI, maximum 52 (42.6%) patients were classified as Class IV. Among the different criteria of PDI, 48 (39.4%) patients exhibited Class III mandibular bone height of 11-15 mm, whereas 40 (32.8%) patients exhibited Class IV mandibular bone height of 10 mm or less. In the maxillary residual ridge morphology, 62 patients (50.8%) were classified as Class I. A large number of patients 84 (70%) had Type A mandibular muscle attachment criteria and were classified as Class I or II. In the maxillomandibular relationship, the maximum number of patients 74 (60.7%) was of Class I. <b>Conclusion:</b> The majority of patients in the study were categorised as Class IV (severely compromised). Edentulous patients must be classified according to PDI during the initial screening phase so that less complex cases (Class I and II) can be allotted to undergraduate students and more complex cases (Class IV) can be handled by prosthodontists or can be referred to specialist centers so that costly and time-consuming remake of complete dentures can be avoided. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC15-ZC20&id=14878 https://doi.org/10.7860/JCDR/2021/48343.14878 Association of Portal Vein Indices with Upper Gastrointestinal Endoscopic Findings in Patients with Cirrhosis of Liver MS Revathy , Ajay Kandpal , B Sumathi , S Chitra , M Manimaran , G Sathya <b>Introduction: </b>Upper Gastrointestinal (UGI) bleed is major cause of mortality and admissions in cirrhotics. Timely initiation of prophylaxis reduces the burden of disease. Few endoscopists at periphery are compelled to look at other options to identify at risk patients. This study explores Portal Vein Diameter (PVD) as an option while taking clues and corrections from past studies. <b>Aim:</b> To identify any association between increase in portal pressure with appearance of oesophageal varices. <b>Materials and Methods:</b> This was an observational cross-sectional study on 75 patients of cirrhosis of liver, from November 2018 to June 2019. Baseline characteristics were noted and assessment of the severity of disease was done. Endoscopy and Portal Vein (PV) Doppler was performed in same time frame. Analysis of Variance (ANOVA) and unpaired t-tests were used for analysis of the collected data. A p-value <0.05 was considered significant in both the tests. <b>Results:</b> Grade of varices was found to have a direct relationship with portal diameter and a statistically significant inverse relationship with Portal Venous flow Velocity (PVV) (p-value 0.037). Total 28 patients had active bleed or history of UGI bleed and showed higher mean portal diameter and lower average portal velocity compared to patients without any history of variceal bleeding. A statistically significant relation was found between diameter of Portal Vein (PV) and Child-Turcotte-Pugh (CTP) grade from A to C. Patients with grade C had on an average, the biggest portal diameter and lowest PVV. Patients with Model for End-Stage Liver Disease (MELD) scores values higher than 14 and had higher mean PV diameter and a lower mean PVV. Also, hepato-fugal flow was recorded with advanced cirrhosis. <b>Conclusion:</b> In advanced cirrhosis, the PV Doppler can be thought of as a substitute to endoscopy in starting primary medical prophylaxis, though more extensive study is needed to arrive at a definitive conclusion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC08-OC10&id=14879 https://doi.org/10.7860/JCDR/2021/47108.14879 Imaging of Complete Vertebral Duplication with Normal Neurological Status: A Rare Case Vishal Thakker, Nisarg Thakker, Manali Arora, Rajan Patel Vertebral Duplication represents the most severe aspect of the spectrum of Split Cord Malformations (SCMs). It is a rare anomaly with very few reported cases. Associated other spinal anomalies along with severe neurovascular and genitourinary anomalies may also co-exist. Hereby, authors report a case of a 21-years-old adult female, who presented with history of trauma, incidentally detected to be having complete lumbar duplication along with dural sac duplication and multiple complex segmentation anomalies in the form of incarcerated lateral hemivertebra, butterfly vertebra and non segmented lateral hemivertebra at D10 to D12 vertebrae. On Computed Tomography (CT) imaging these anomalies become well evident while the patient presented with no neurological manifestations or abnormalities. This is a rarely reported scenario in literature where no neurological symptoms are seen in a case of vertebral duplication. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=TD04-TD05&id=14880 https://doi.org/10.7860/JCDR/2021/45650.14880 Echocardiographic Assessment of Cardiac Function in Liver Cirrhosis: A Cross-sectional Study Apoorva Nirmal, Gajendra Agrawal, Sunil Kumar, Sourya Acharya, Akshay Dafal, Dwivedi Bhushan <b>Introduction:</b> Echocardiography is a non invasive method to assess the cardiac dysfunction in liver cirrhosis. Early detection of cardiac dysfunction helps prevent morbidity in patients undergoing haemodynamics altering procedures like liver transplant or Transjugular Intrahepatic Portosystemic Shunt (TIPSS) or those who have haematemesis. <b>Aim: </b>This study had been planned to assess the cardiac dysfunction and its incidence among patients of liver cirrhosis. <b>Materials and Methods:</b> In this cross-sectional study total of 150 individuals with liver cirrhosis were enrolled and cardiac assessment was done in the form of systolic and diastolic dysfunction by 2D Echocardiography. It was correlated with the aetiology and severity of liver cirrhosis was assessed by Child Pugh’s criteria. The grading of diastolic dysfunction was done on the basis of Early/Late (E/A) Left Ventricular (LV) filling ratio as Grade I (Impaired relaxation pattern) E/A<0.8, Grade II (Pseudo normal) as E/A 0.8-1.5, and Grade III (Restrictive filling) E/A >2. Statistical analysis was done by using Chi-square test and Pearson’s Correlation Coefficient and p<0.05 is considered as level of significance. <b>Results: </b>Out of the 150 patients of liver cirrhosis, cardiac dysfunction was noted in 51. Among 93 (62%) patients who had alcoholic aetiology, 4 (44.4%) had systolic dysfunction whereas 29 (69.0%) had diastolic dysfunction. Among 9 patients of Left Ventricular (LV) systolic dysfunction 2 (22.2%) patients were in grade A Child Pugh, 4 (44.4%) in grade B and 3 (33.4%) in grade C, all being statically significant (r=0.195; p=0.017). LV diastolic dysfunction was seen in 17 (20.2%) of Grade A, 14 (25%) of Grade B and 11 (100%) of Grade C of Child Pugh Score, all being statistically significant and well correlated according to severity (r=0.199; p=0.004). <b>Conclusion:</b> The cardiac dysfunction was directly correlated with severity of liver cirrhosis according to Child Pugh scoring criteria thereby suggesting that possible cardiac changes were due to cirrhosis and not alcohol. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC11-OC14&id=14881 https://doi.org/10.7860/JCDR/2021/45792.14881 Association of hs-CRP Levels and Medications Adherence Status among Heart Failure Patients at a Cardiac Referral Hospital in Tanzania Gabriel Maganga1, Pilly Chillo, Mohamed Janabi, Appolinary Kamuhabwa <b>Introduction: </b>Heart Failure (HF) is a global health problem, and despite much progress in new therapies, its prognosis remains poor. This is due to a number of factors including lack of adherence to HF medications. Previous studies have shown high sensitivity C-Reactive Protein (hsCRP) to change with HF progression, and that plasma hsCRP levels can be used to predict HF progression and assessment of adherence to medications. This association however has not been studied in Sub-Saharan African (SSA) countries, including Tanzania. <b>Aim:</b> To study the association between hsCRP levels and HF medications adherence among HF patients attending the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania. <b>Materials and Methods:</b> This was a hospital based crosssectional study, where all eligible adult HF patients were consecutively enrolled as they attended their regular clinics, until the sample size was reached. Patients’ socio-demographic and clinical information was collected through interviews and chart reviews. An 8-item Morisky tool was used to assess patients’ adherence to HF medications. Blood was collected and analysed for hsCRP, Complete Blood Count (CBC) and cholesterol panel. hsCRP was considered elevated when it was >5 mg/L. Data were analysed using Statistical Package for Social Sciences (SPSS) computer software, version 21. All tests were 2-sided, and a p-value of <0.05 was considered to indicate a significant association. <b>Results:</b> In total, 210 HF patients were enrolled. Their mean age was 54±15.9 years and 53.8% were females. In the total population, the mean hsCRP was 7.15&#177;4.94 mg/L, and 122 (58.1%) patients had elevated hsCRP. Poor medications adherence was present in 138 (65.7%) patients. Patients with poor medications adherence were more likely to have elevated hsCRP levels (68.1%) when compared to patients with good adherence (38.9%), p<0.001. In multivariate logistic regression analysis, elevated hsCRP independently predicted poor medications adherence (OR=4.27, 95% CI 2.14-8.51, p<0.001), irrespective of other variables. <b>Conclusion:</b> Heart Failure (HF) patients with poor medications adherence are 4-times more likely to have elevated hsCRP, irrespective of other clinical and socio-demographic factors in this study cohort. These findings suggest that hsCRP levels can be considered as surrogate to HF medications adherence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC15-OC20&id=14884 https://doi.org/10.7860/JCDR/2021/47582.14884 Knowledge and Attitude of Nurses in Organ Donation and the Influence of Interventions- A Systematic Review Manimuthu Reena, Pothipillai Arumugam, Sony Paul, Iyanar Kannan <b>Introduction: </b>Nurses are important paramedical staff taking care of potential organ donors, poor knowledge and attitude of nurses towards organ donation may worsen the non availability of organ for transplantation. Hence, in such scenario the nurses should be given interventions in the form of workshops, audiovisual presentations and certificate courses to develop their knowledge and attitude in organ donation. <b>Aim:</b> In the present systematic review, an attempt was made to find the current scenario of knowledge and attitude of nurses and the effectiveness of the programmes conducted to foster them. <b>Materials and Methods: </b>The MEDLINE database was used to retrieve the articles. The Medical Subject Heading (MeSH) term used was &#34;Knowledge, Attitude and Practice (KAP) study, organ donation, nurses, organ transplantation, workshop, education programme, intervention&#34;. The PubMed advanced search was used. Boolean operator ‘AND’ was used in between the MeSH terms in the advanced search. A descriptive analysis was done on the data available in the articles. <b>Results:</b> From the literature it was evident that in most of the circumstances the knowledge and attitude regarding organ donation among nurses is not satisfactory. However, few studies state that nurses do possess adequate knowledge regarding organ donation and are influenced by many factors like age, experience and the unit in which they work. The studies concluded that the knowledge of nurses has improved after the intervention programmes. <b>Conclusion:</b> From this systematic review it was found that the knowledge and attitude of nurses towards organ donation is not to the expected level and the interventions like workshop and peer education do improve their knowledge to considerable level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LE01-LE04&id=14885 https://doi.org/10.7860/JCDR/2021/47805.14885 Cross-sectional Study on Myocardial Infarction in Young Adults in the Emergency Department of a Rural Tertiary Care Hospital, Davanagere, Karnataka, India CH Karthik Reddy, Mahesh Krishnamurthy, Ashray Vasanthapuram, Girish Narayan, SS Narendra <b>Introduction:</b> The incidence of Acute Coronary Syndrome (ACS) in the young has been increasing globally. Research in the population has been limited in developed countries or urban areas in developing countries. Identifying the various epidemiologic features in this age group is crucial to understand the disease. <b>Aim:</b> To describe the clinical characteristics of young adults presenting with ACS in a rural tertiary care hospital. <b>Materials and Methods:</b> This cross-sectional study included 50 patients diagnosed with ACS. Data was collected from consecutive patients between the ages of 18 to 45 years diagnosed with ACS between January 2014 to January 2015 in the Emergency Medicine Department of a tertiary care hospital in Davanagere, India. Data was collected on demographic characteristics, risk factors, laboratory tests, and angiographic findings. Range, mean and percentages were calculated for continuous and categorical variables, respectively. A 95% confidence intervals were calculated for all variables. <B>Results: The mean age was 38.1&#177;5.8 years with male preponderance 46 (92%). Risk factors were smoking 36 (72%), diabetes 17 (34%), hypertension 6 (12%) and Body Mass Index (BMI) >23 kg/m2 , 36 (72%). Anterior Wall Myocardial Infarction (AWMI) was observed in 35 (70%) of subjects with angiography revealing Single Vessel Disease (SVD) 28 (56%), Double Vessel Disease (DVD) 5 (10%), Triple Vessel Disease (TVD) 3 (6%) and Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) 11 (22%). Three patients died during their course of treatment before initiating an interventional procedure. <b>Conclusion:</b> Smoking, diabetes mellitus and elevated BMI are associated with ACS among young patients. Interventions targeting these risk factors among younger individuals should be developed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC21-OC24&id=14903 https://doi.org/10.7860/JCDR/2021/49377.14903 Critical Level of Alanine Transaminase to Predict Foetomaternal Outcome in Intrahepatic Cholestasis of Pregnancy: A Case-control Study Nidhi Ahuja, Anjali Dabral, Sheeba Marwah, Rekha Bharti, Deepti Pachauri, Jyotsna Suri <b>Introduction:</b> Intrahepatic Cholestasis of Pregnancy (IHCP) is a disorder of the second and third trimester causing pruritis without a rash in the women. To avoid the adversities, early delivery is indicated before serum bile acids levels of >40 &#181;mol/L is reached. In the settings where bile acid testing is not available, serum transaminases can be used for diagnosis and management of IHCP. <b>Aim:</b> To find out critical levels of Alanine Transaminase (ALT) for the prediction of adverse foetomaternal outcomes. <b>Materials and Methods:</b> This case-control study was carried out from October 2018 to March 2020, enrolled 75 singleton women with IHCP and 75 controls in their third trimester. The diagnosis was based on the presence of pruritis without an identifiable dermatological cause along with raised serum transaminases. Serum ALT levels and the foetomaternal outcomes were noted. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Mann-Whitney test, Chi-square test and Fisher&#39;s exact test were used to compare all variables. The p-value of <0.05 was considered statistically significant. <b>Results: </b>The mean age of women in the IHCP and control groups was 24.81&#177;4.2 and 25.95&#177;5.13 years, respectively and the mean gestational age of women was 34&#177;2.89 weeks. Women with IHCP had increased incidence of induction of labour (p=0.0003) and meconium staining of liquor (p=0.002) as compared to controls. Serum ALT levels showed a significant positive association with meconium staining of liquor (p=0.041), Intrauterine Death (p=0.01), and Neonatal Intensive Care Unit (NICU) admission (p=0.006) in women with IHCP. An ALT value of 133 U/L was found to be predictive of adverse foetal outcomes with sensitivity, specificity and likelihood ratio of 65.7%, 82.5% and 3.76, respectively. <b>Conclusion:</b> The IHCP leads to adverse foetal outcomes. But pruritis is the only maternal distress. Alanine Transaminase >133 U/L is predictive of adverse foetal outcome, therefore, termination of pregnancy can be advocated above this level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=QC01-QC05&id=14904 https://doi.org/10.7860/JCDR/2021/49078.14904 Efficacy of Intravenous Fluid Plasmalyte and 6% Hetastarch in Preventing Spinal Anaesthesia Induced Hypotension in Patients undergoing Lower Abdominal Surgeries: A Randomised Clinical Study Prakriti Gupta, Suraj Kumar, Samiksha Parashar, Manoj Kumar Giri, Sujeet Rai, Deepak Malviya <b>Introduction:</b> Both crystalloids and colloid pre loading is recommended for spinal anaesthesia. Pre loading of intravenous fluids increases circulating volume and cardiac output; thus preventing spinal anaesthesia-induced hypotension. Crystalloids have a short intravascular half-life, poor plasma expanders and large volumes are thus required. <b>Aim:</b> To compare the efficacy of 5 mL/kg of 6% Hetastarch (colloid) to that of 15 mL/kg of Plasmalyte (crystalloid) solution to prevent hypotension during spinal anaesthesia in patients undergoing lower abdominal surgeries. <b>Materials and Methods:</b> This was a randomised clinical trial from June 2016 to April 2017 on a total 80 patients, belonging to American Society of Anaesthesiologist (ASA) Grade I and II scheduled for lower abdominal surgeries under spinal anaesthesia. They were divided into two groups- Group H and Group P. Patients in group H were preloaded with 5 mL/kg solution of 6% Hetastarch, whereas those in group P were preloaded with 15 mL/kg of Plasmalyte solution. After institution of spinal anaesthesia with 3.0 mL of hyperbaric bupivacaine using 25 G Quincke’s needle, Blood Pressure (BP) and other vital parameters were monitored intraoperatively every 3 minutes for first 30 minutes and then every 5 minutes till the end of surgery. Descriptive statistics, frequency and percentages were calculated and the variables between the groups were compared by Students t-test, Fischers-exact test and Mann Whitney U-test. <b>Results:</b> Both the groups showed a fall in Mean Blood Pressure (MBP) immediately after the block. Group P showed more decline in MBP and Diastolic Blood Pressure (DBP) after the block and the difference was statistically significant at 9, 12, 15, 18 and 21 minute (p-value <0.05). A 30% patients in groupP as comparison to 10% in Group H required ephedrine for the treatment of hypotension and found significant (p-value=0.025). Systolic Blood Pressure (SBP), pulse rate changes and nausea and vomiting among both groups was non-significant (p-value >0.05). <b>Conclusion: </b>Pre loading with 5 mL/kg of 6% Hetastarch is more effective than 15 mL/kg of Plasmalyte in preventing hypotension in patients undergoing lower abdominal surgeries under spinal anaesthesia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC26-UC30&id=14905 https://doi.org/10.7860/JCDR/2021/48211.14905 Awareness of Chronic Kidney Disease among Tamil Nadu Population- A Cross-sectional Study R Chandan Bala , M Jayabharathy , S Sheba Yesu Priya , S Ramya <b>Introduction:</b> Chronic kidney failure in India and around the world is a significant health problem. The most effective and affordable treatment may require screening for early detection, intervention and prevention. Public awareness is a key determinant to overcome the burden of Chronic Kidney Disease (CKD). However, there is a lack of information on CKD among South Indian people. <b>Aim:</b> To assess the awareness and knowledge of CKD among the South Indian population. <b>Materials and Methods:</b> A questionnaire-based cross-sectional study was conducted through an online form; the questions were generally based on the physiological role of kidney and awareness questions related to CKD. The sample size was 500 participants, with age group of 18-70 years and snowball sampling method was implemented. Among the study population, 68 participants had a family history of CKD and they were excluded. The data were analysed through Pearson Chi-square test. <b>Results:</b> The mean knowledge score was 13 (SD&#177;5.0), with values ranging from 0 to 22. The mean age of the population was 23.92&#177;8.49 years. Multiple regression on demographic data and knowledge yielded statistically negligible results. The study population included 432 participants and the result showed the realms that most responded incorrectly were physiology of kidney, CKD symptoms, risk factors and the domain of testing and diagnosis. <b>Conclusion:</b> The participants had ample knowledge of the risk factors, signs and symptoms of CKD and insufficient knowledge of the physiological function of the kidney and the diagnosis of CKD. Therefore, efforts are necessary to create awareness and educate people about the early detection and prevention of CKD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC14-LC16&id=14906 https://doi.org/10.7860/JCDR/2021/48167.14906 Trends, Awareness and Attitude of Patients Towards Replacement of Missing Teeth in the Western Region of Saudi Arabia Karunakar Bhoja Shetty , Elaf Mohammed Alshaqa , Abrar Bakri Koosa , Sara Faiz Jambi , Nouran Omar Jamal <b>Introduction:</b> These days, individuals seem to have more expectations regarding their dental health compared to the past. There are various treatment options available for the replacement of missing teeth and associated structures, which include removable prosthesis, fixed prosthesis and implant supported prosthesis. Most of the patients require aesthetics and functional comforts with prosthodontic treatment and it can be easily achieved with dental implants and tooth coloured restorations and prostheses. <b>Aim:</b> To assess the trends, awareness and attitude of patients towards replacement of missing teeth in western region of Saudi Arabia. <b>Materials and Methods:</b> A cross-sectional study was conducted among the 20-60 years aged population of western region of Saudi Arabia from 1st December 2018 to 1st March 2019. A questionnaire consisted of 10 close ended, pre-tested questions which was developed to determine patient’s attitude and need with regard to their dental prosthesis. The data were tabulated and analysed using Statistical Package for the Social Sciences (SPSS) version 21. Chi-square test was used to assess the attitude and awareness among the patients towards replacement of missing teeth. The p-value less than 0.05 was considered statistically significant. <b>Results: </b>The study included 350 patients; 162 males (46.3%) and 188 females (53.7%). Among the participants, 233 (66.6%) of them desired fixed treatment and 115 (33.40%) of them desired removable treatment. Treatment options explained by clinicians were as follows: 67 (19.1%) were suitable for Fixed Partial Denture (FPD)/dental Implant, 11 (3.1%) suitable for FPD, Removable Partial Denture (RPD) and dental Implant and 272 (77.7%) of them suitable for RPD and dental Implant. A total of 67 (19.1%) of them opted for FPD, 115 (32.9%) of them opted for RPD and 168 (48.0%) of them opted for dental Implant. <b>Conclusion:</b> Awareness and attitude of the participants towards prosthodontics treatment were mostly high. Majority of the participants wanted to replace missing teeth for mastication and aesthetics and had favourable knowledge and attitude towards implant as a mode of treatment for replacement of missing teeth. Participants preferred fixed treatment over removable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC21-ZC26&id=14908 https://doi.org/10.7860/JCDR/2021/47926.14908 Characterisation and Antibiotic Susceptibility Pattern of Enterococci in a Tertiary Care Hospital of North East India Antara Roy, Rajkumar Manojkumar Singh, Supriya Laifangbam <b>Introduction:</b> Enterococci are important agents of nosocomial infection, ranking as the second most common organisms causing complicated urinary tract infections, bacteraemia, endocarditis, intra-abdominal and pelvic infections, wound and soft tissue infections, neonatal sepsis and rarely meningitis. Infections by enterococci have traditionally been treated with cell wall active agents (e.g., penicillin or ampicillin) in combination with an aminoglycoside (streptomycin/gentamicin); however, emergence of High Level Aminoglycoside Resistance (HLAR), beta-lactam antibiotics resistance and vancomycin resistance by some strains has led to failure of synergistic effects of combination therapy. <b>Aim:</b> To characterise enterococci up to the species level and study their antibiotic susceptibility pattern. <b>Materials and Methods:</b> The present study was a crosssectional study in which a total of 14114 clinical specimens, obtained during the period from September 2018 to August 2020 in this cross-sectional study, were tested to identify and speciate enterococcal isolates using standard microbiological methodology. Antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method. Data was analysed using descriptive statistics (percentage and proportion). <b>Results:</b> During the study period of two years, 146 enterococci were recovered from 14114 different clinical samples, accounting for an infection rate of 1.03%. Among 146 enterococcal isolates, 116 (79.5%) were obtained from urine, 13 (8.9%) from blood, 10 (6.8%) from pus, 4 (2.7%) from wound swab and 3 (2.1%) from catheter tip. The predominant isolates were <i>E. faecalis</i> (82.2%) followed by <i>E. faecium</i> (15.8%), E.durans (1.3%) and <i>E.gallinarum</i> (0.7%). On studying the antibiotic susceptibility pattern, most of enterococcal isolates were predominantly resistant to ampicillin and ciprofloxacin (73.9% in both) and least resistant to linezolid (3.4%). <b>Conclusion: </b>Enterococcus faecalis and Enterococcus faecium were the predominant species in present study and majority of the isolates was sensitive to linezolid (96.6%). Therefore, it is necessary to implement infection control measures like antimicrobial stewardship especially restricting the use of antibiotics to minimum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=DC08-DC11&id=14910 https://doi.org/10.7860/JCDR/2021/48341.14910 A Prospective Study on Respiratory Viral Pathogens Causing Acute Lower Respiratory Tract Infections in Children below Five Years of Age at a Tertiary Care Hospital of India Apoorva T Raju, Rojaleen Das, Nikki Rai, Ajay Kumar, Rajni Gaind <b>Introduction: </b>The lower respiratory tract infections are a major cause of mortality in children below five years of age. Majority of the time the infection is self-limiting but often gets severe and fatal depending on various factors like age, aetiology, time of diagnosis, appropriate treatment, etc. <b>Aim:</b> To study viral aetiology of Acute Lower Respiratory tract Infections (ALRI) using multiplex real time qualitative Polymerase Chain Reactions (qPCR) among hospitalised children under five years of age. <b>Materials and Methods:</b> This was a hospital based prospective study conducted over a period of two years from June 2015 to May 2017, a throat and nasal swab was collected from 512 children =5 years who were being hospitalised for ALRI. The samples were tested by multiplex qPCR to detect the viral infection and p<0.05 was considered as statistically significant. <b>Results:</b> Out of 512 cases, 317 children were further studied. It was found that highest number of ALRI were observed in children of age less than six months i.e., 38.9% followed by 29.4%, 14.8% and 16.9% in the age group of 6-12 months, 12-24 months and 24-60 months, respectively. The one/more viral pathogens were detected in 58.3% (185/317) children. Respiratory Synctial Virus (RSV) was most common virus detected in 51.9% followed by Human Rhinovirus (HRV) in 23.2%. RSV was found to be statistically significant in infants and causes very severe ALRI. <b>Conclusion: </b>The use of multiplex qPCR has clarified the scenario of different respiratory viral aetiologies causing ALRI in different age group of children. The study results enhance knowledge for making strategy to prevent severity of ALRI in different age group, seasons and geographical area. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=DC12-DC16&id=14911 https://doi.org/10.7860/JCDR/2021/47237.14911 Zimmer Natural Nails in the Treatment of Unstable Intertrochanteric Fractures: A Longitudinal Study C Yashavanth Kumar , P Ashok Kumar , P Rahul , Harshad M Shah , Sandesh Patil , Rahul V Gawalkar <b>Introduction: </b>Cephalomedullary nails are preferred over intramedullary nails for internal fixation of unstable intertrochanteric fractures; however, they are associated with complications as they do not match the anatomy of the proximal femur to a great extent. <b>Aim:</b> To investigate functional and radiological results of Zimmer natural nails in the management of unstable intertrochanteric fractures. <b>Materials and Methods:</b> A longitudinal prospective study of 99 patients with unstable intertrochanteric fractures was carried out. All patients underwent closed reduction and internal fixation with 180 mm short Zimmer natural nails. Follow-up visits were scheduled for six weeks, three months, and six months for radiological healing and mobility measurements using Radiographic Union Score for Hip (RUSH) and Parker scores, respectively. Statistical analysis was performed using Chi-square and Analysis of Variance (ANOVA). <b>Results: </b>Mean age of patients was 69.77&#177;11.47 years with a male to female ratio of 1:0.98. A majority of patients had comorbidities like diabetes mellitus and hypertension. Average duration of surgery was 58.38 minutes with no statistically significant difference among the different categories of unstable intertrochanteric fractures. Fixation of fractures with Zimmer natural nails increased Parker score and RUSH score consistently with each follow-up visit (p=0.001). There were no postoperative complications in 93.94% cases. <b>Conclusion:</b> This study emphasised good functional and radiological results of Zimmer natural nails in the treatment of unstable intertrochanteric fractures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=RC05-RC08&id=14892 https://doi.org/10.7860/JCDR/2021/47772.14892 Proseal Laryngeal Mask Gel vs I-gel: A Randomised Clinical Trial among Paediatric Patients BR Uma, Sridhara <b>Introduction: </b>A Supraglottic Airway Device (SAD) is placed above the larynx to form a seal around it. SADs like paediatric Proseal Laryngeal Mask Airway (P-LMA) and I-geltm are increasingly used in recent times. <b>Aim:</b> To compare the efficacy of paediatric P-LMA and I-gel in clinical practise. <b>Materials and Methods:</b> This randomised clinical trial was conducted after obtaining parent/guardian consent among 60 paediatric patients aged 2-12 years belonging to American Society of Anesthesiologists (ASA) grade I and II posted for elective surgeries under general anaesthesia. After induction of general anaesthesia, either of the SAD was inserted and study parameters namely ease and number of attempts of insertion of the device, ease of insertion of gastric tube, leak airway pressure, efficacy during positive pressure ventilation and postoperative complications were evaluated. Statistical comparison was performed by repeated measures of variance followed by Unpaired Student t-test and Chi-square test. A probability value p-value <0.05 was regarded as statistically significant. <b>Results:</b> The device was easily inserted in 90% of the patients in both study groups (p-value=0.99). In P-LMA group, the device was inserted in first attempt in 83.3% against 90% in the I-gel group (p-value=0.70). In P-LMA group, gastric tube insertion was graded easy in 80% children while in I-gel group it was 90% children (p-value=0.47). The leak airway pressure measured at two different time intervals was statistically insignificant. Intraoperative dislodgement of the device was noted in one child in each group. Postoperative complications like sore throat and dysphagia were reported in four and two children, respectively in P-LMA group, while it was reported in two and one child in the I-gel group. Complications with P-LMA and I-gel were statistically insignificant. <b>Conclusion:</b> Paediatric P-LMA and I-gel are safe and noninvasive methods of securing the airway with regard to clinical safety parameters and hence can be used in paediatric population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC21-UC25&id=14893 https://doi.org/10.7860/JCDR/2021/46569.14893 Volumetric Measurement of the Maxillary Sinuses in Normal Sudanese using Computed Tomography: A Retrospective Study Abdalla Ahmed Elamin, Tolgahan Acar, Samih Kajoak, Saadeldin Ahmed Idris, Bushra Abdel Malik, Caroline E Ayad <b>Introduction:</b> Quantification of maxillary sinus volumes might be a complicated and annoying process, but it is beneficial for the clinicians, however not limited to plastic and maxillofacial reconstruction and artificial implants rehabilitation. Its volumetry may alter by many factors and may exhibit diversity. <b>Aim:</b> To determine the relationship of age and gender to the volume of the maxillary sinus in normal Sudanese subjects and to verify if there is diversity bilaterally in both sexes. <b>Materials and Methods:</b> A retrospective observational study was conducted in the Department of Radiology, Royal Care Hospital, Khartoum, Sudan, during the period from August 2018 to July 2019. It consisted of Computed Tomography (CT) images of adults aged more than 17 years from both genders of Sudanese subjects, who underwent a CT scan of the Paranasal Sinuses (PNS) that showed positive clinical signs and symptoms and proved to be normal. The obtained data was statistically analysed by Statistical Package for Social Sciences (SPSS) version 21.0. A paired-sample t-test was applied to compare between the volume of the right and left maxillary sinuses. An independent t-test was used to evaluate the difference between the gender and the volume of the maxillary sinuses. Pearson’s r test was used to find possible correlation between age and maxillary sinuses volume. <b>Results:</b> A total of 81 CT images (46 males and 35 females, aged 17-78 years) were studied. There is negative correlation between age and maxillary sinuses volume. The advancement of age seems to reduce the size of the maxillary sinuses in male and female groups (r=-0.029; p=0.9, and r=-0.313; p=0.07, respectively). Conversely, gender had no significant effects in the maxillary sinuses volume (p=0.9). The mean total volume of the maxillary sinuses in male and female was 38.70&#177;12.12 cm<sup>3</sup> and 38.34&#177;11.50 cm<sup>3</sup> , respectively. When bilaterally compared there was no significant difference in the volume of maxillary sinus in either sex {Male (p=0.07), female (p=0.11)}. <b>Conclusion:</b> The combination of CT scanning with the Cavalieri principle is a direct and accurate technique that can be safely applied to estimate the volume of the maxillary sinuses. Additional large prospective studies might be required to support the findings of this study https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=3&page=AC11-AC15&id=14894 https://doi.org/10.7860/JCDR/2021/48095.14894 Outcome of Proximal Hypospadias Repair in Children using Standard Surgical Technique with Intermediate Vascularised Flap- A Retrospective Cohort Study Harish Chandra Tudu, Amaresh Mishra, Subrat Kumar Mohanty, N Prashanthi, Indrani Roy, Piyush Bhardwaj, PS Pujari <b>Introduction:</b> Hypospadias is a very common congenital anomaly noted in children with reported incidence of 0.4-8.2% in 1000 live birth. Treatment of hypospadias is urethroplasty, but is a difficult procedure due to complex anatomy, nonavailability of adequate tissue for repair, prolonged postoperative course and increased incidence of complications even in experienced hands. <b>Aim:</b> To highlight the complications and functional outcome of various types of proximal hypospadias using standard surgical technique with intermediate vascularised flap. <b>Materials and Methods:</b> This was a retrospective cohort study conducted on 31 children, between the age of 2-13 years from June 2020 to August 2020. The children having proximal hypospadias with or without chordee were operated using primary procedure Tubularised Incised Plate (TIP) and staged procedure with a cover of intermediate vascularised flap. These children had peno-scrotal, proximal, mid and distal penile hypospadias with meatus placed 1.5 cm proximal from the glans tip. In all the cases, an intermediate layer of vascularised flap was put to cover the neourethra. Tunica vaginalis flap was used in 27 cases and dartos flap in 4 cases. The outcomes of surgical procedure, early and late complications with follow-up results were analysed using descriptive statistics of frequency and percentage. Final functional results of the procedures and cosmesis were observed during a two-year follow-up period. <b>Results:</b> Out of the 31 patients, 27 patients had urethroplasty (20 staged procedures and seven TIP) with tunica vaginalis as intermediate layer. Another four patients had TIP urethroplasty with dartos as intermediate layer. Four patients of tunica vaginalis as intermediate layer had early urethrocutaneous fistula (14.8%), one patient (3.7%) required closure of fistula and another three closed spontaneously. Two patients had meatal stenosis (7.4%) and four had slight pulled up ipsilateral testis (14.8%). One patient of TIP urethroplasty with dartos as intermediate layer was reoperated for late urethrocutaneos fistula at corona glandis (25%). <b>Conclusion: </b>The outcome of pediatric urethroplasty was favourable with routine use of intermediate vascularised flap in proximal hypospadias repair. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PC09-PC12&id=14896 https://doi.org/10.7860/JCDR/2021/46833.14896 Improved Diagnosis of Tuberculous Meningitis Using a Combination of Multiplex Antigens and Antibodies Testing Methods Amit Raju Nayak, Payal Rajendra Khulkhule, Vinita Rajendra Hutke, Arti Ramkumar Mishra, Nitin Harinarayan Chandak, Hatim F Daginawala, Lokendra R Singh, Rajpal Singh Kashyap 10.7860/JCDR/2021/47621.14897 Date of Submission: Nov 03, 2020 Date of Peer Review: Dec 22, 2020 Date of Acceptance: Mar 02, 2021 Date of Publishing: May 01, 2021 AUTHOR DECLARATION: &#8226; Financial or Other Competing Interests: Funded by Central India Institute of Medical Sciences, Nagpur, as part of their in-house project. &#8226; Was Ethics Committee Approval obtained for this study? Yes &#8226; Was informed consent obtained from the subjects involved in the study? NA &#8226; For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: &#8226; Plagiarism X-checker: Nov 05, 2020 &#8226; Manual Googling: Feb 11, 2021 &#8226; iThenticate Software: Apr 07, 2021 (17%) ETYMOLOGY: Author Origin https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=BC16-BC21&id=14897 https://doi.org/10.7860/JCDR/2021/47621.14897 Adenomyosis and Co-existing Gynaecological Pathologies Parul Garg, Harjot Kaur, Ishwer Tayal, Shilpa, Navjot Kaur <b>Introduction:</b> Adenomyosis is defined as presence of benign endometrial tissue comprising of both endometrial glands and stroma into the myometrium leading on to diffuse enlargement of the uterus. Adenomyosis co-exists with various pathologies such as leiomyomas, endometriosis, endometrial polyp, endometrial hyperplasia and carcinoma suggesting hyperestrogenism to be a factor in pathogenesis of adenomyosis. <b>Aim: </b>To study the associated pathological conditions and histopathological patterns of endometrium in patients presenting with Abnormal Uterine Bleeding (AUB) due to adenomyosis. <b>Materials and Methods:</b> This retrospective study was conducted in a tertiary care institute of Punjab, India for a period of two years (August 2018 to August 2020). All the patients who underwent hysterectomy were re-evaluated and cases diagnosed with adenomyosis were included in the study. Clinical details were recorded. A total of 101 patients were diagnosed with adenomyosis. These cases were reviewed for presenting symptoms and were associated with histological features of endometrium and other associated gynaecological pathologies. The quantitative variables were expressed as mean and qualitative variables as percentages. <b>Results:</b> The age of the patients who had adenomyosis ranged from 29 to 79 years, majority were in the age group of 41-50 years. Abnormal uterine bleeding was the most common symptom. The histopathological examination revealed associated pattern of endometrium from proliferative endometrium to endometrial hyperplasia and endometrial carcinoma. Other gynaecological pathologies included leiomyoma, adenocarcinoma ovary, serous adenomas of ovary and Cervical Intraepithelial Neoplasia (CIN) grade 3. Co-existence with leiomyoma is most common. Hyperestrogenemia can be considered as a risk factor as it is associated with leiomyomas, endometrial hyperplasia, endometrial carcinoma or polyps. <b>Conclusion: </b>Adenomyosis is one of the causes of AUB and this decreases the quality of life in women. It is also considered as a cause of infertility. The associated histopathological findings vary from leiomyoma, endometrial hyperplasia, endometrial polyps and rarely adenocarcinoma of endometrium and ovary. Meticulous and careful examination of gross and microscopic foci of adenomyosis and associated pathologies can help in better management of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=EC01-EC04&id=14898 https://doi.org/10.7860/JCDR/2021/47585.14898 Risk of COVID-19 among Spectacles Wearing Population of Northern India Amit Kumar Saxena <b>Introduction:</b> Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) spread mainly through respiratory droplets and contact routes. Long-term use of spectacles may prevent repeated touching and rubbing of the eyes. <b>Aim:</b> To know the association between infection with SARSCoV-2 and spectacles wearers. <b>Materials and Methods:</b> A cross-sectional study was conducted in which 304 patients of Coronavirus Disease-2019 (COVID19) were selected. Their spectacles wearing behaviour were assessed through a questionnaire. Spectacles wearing behaviour of general population were obtained from older studies (for comparison). Risk of COVID-19 was calculated in long-term spectacles wearers as well as in persons not using spectacles. Chi-Square test was used for statistical analysis. <b>Results:</b> In this study, total 58 patients showed the behaviour of using spectacles continuously during day time and always on outdoor activities. The risk of COVID-19 was found 0.48 in spectacles wearing population as compared to 1.35 in population not using spectacles. The calculated Risk Ratio (RR) was 0.36. It indicates that the risk of COVID-19 was 2-3 times less in spectacles wearing population than the population not using spectacles. The protective effectiveness of the spectacles was found to be statistically significant (p-value=0.00113). <b>Conclusion:</b> The present study showed that the risk of COVID19 was about 2-3 times less in spectacles wearing population than the population not wearing those. The nasolacrimal duct may be a route of virus transmission from conjunctival sac to the nasopharynx. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=NC08-NC11&id=14899 https://doi.org/10.7860/JCDR/2021/48079.14899 A Comparison between Early and Delayed Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study Amarjeet Singh, Manish Singh, Simran Preet Singh, Bhavna Sahni <b>Introduction:</b> A complete Anterior Cruciate Ligament (ACL) injury can result in a progressively increasing symptomatic knee instability, which can cause recurrent intra articular damage and eventually results in osteoarthritis if not treated on time. <b>Aim:</b> To analyse the effects of delaying ACL reconstruction beyond a period of 12 weeks and compare the results with cases managed before that time period. <b>Materials and Methods:</b> A prospective cohort study was conducted between July 2017 to October 2019 in Government Medical College, Jammu, India on two groups of patients divided into early (<12 weeks) and delayed (>12 weeks) on the basis of interval between the injury and definitive surgery. The ACL reconstruction was done using a quadrupled semitendinosusgracilis graft. A standard rehabilitation protocol was followed and the results were compared. Patients were followed-up till one year postsurgery. Software used for statistical analysis was EpiInfo Version 3.0 and Statistical Package for the Social Sciences (SPSS). <b>Results:</b> A total of 72 patients were included in the study. Forty patients were in the early group and 32 in delayed. Male patients outnumbered the females in both the groups and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by falls and road traffic accidents in both the groups. The incidence of grade 3/4 medial and Lateral Meniscal (LM) tears was more in the delayed group and the association was statistically significant (p<0.05). There was significant thigh wasting in the delayed group (p<0.05). Two patients were lost to follow-up and were not included in the study. <b>Conclusion:</B> Delay in ACL reconstruction surgery predisposes to higher grade meniscal lesions and significant thigh wasting and hence the surgery should be preferably done within the first 12 weeks after injury https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=RC09-RC12&id=14900 https://doi.org/10.7860/JCDR/2021/46239.14900 Evaluation of Salivary C-Reactive Protein and Psychological Factors in Patients with Oral Lichen Planus: A Case-control Study Shruti Anand Patil, Amita Aditya, Daya K Jangam <b>Introduction:</b> Aetiology and pathogenesis of Oral Lichen Planus (OLP) has been the focus of research since a long time and various aetiological factors like autoimmunity, heredity, drugs, dental materials, psychological factors, especially stress and anxiety have been reported to be associated with this disease. Few studies in the past have found significant elevations in C-Reactive Protein (CRP) levels in individuals who reported to be having chronic stress. Both altered salivary CRP levels and psychological stress have been reported in OLP patients. To the best of our knowledge no such studies have been conducted in the past, so a need was felt to conduct a study to evaluate and also correlate salivary CRP and psychological factors in OLP patients. <b>Aim:</b> To evaluate salivary CRP and psychological factors and assess the possible correlation between them in patients with OLP. <b>Materials and Methods:</b> This case-control study included two groups: group A- consisted of 33 individuals clinically diagnosed with OLP and group B- consisting of 33, age and gender matched healthy individuals. Hospital Anxiety and Depression Scale (HADS) was used for all the participants to evaluate the psychological factors. Salivary CRP levels were evaluated using Mispa i2 Nephelometry. Statistical analysis was done using SPSS software version 21. <b>Results:</b> Mean salivary CRP value among cases was 3.42&#177;2.786 and among controls was 2.84&#177;0.848. Mean HADS score among cases was 6.60&#177;2.796 and among controls was 2.70&#177;0.948. Mean Salivary CRP and HADS values were higher in OLP patients compared to controls. However, no statistical significant association could be established between CRP and HADS in patients with OLP (p=0.200). <b>Conclusion:</b> No correlation between psychological status and CRP levels could be established in patients with OLP. CRP could be used as a diagnostic marker in oral premalignant lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC47-ZC51&id=14941 https://doi.org/10.7860/JCDR/2021/47545.14941 Serum Aminotransferase Levels as a Marker in Assessment of Severity of Dengue Fever in Adult Patients- A Cross-sectional Study CB Bindu, Ravi T Chikkannanavar, K Venugopal, BS Harsha <b>Introduction:</b> Dengue Fever (DF) is the most common rapidly spreading mosquito-borne arboviral disease with a wide clinical spectrum that includes both severe and non severe clinical manifestations. Most patients with DF have liver involvement in the form of elevated serum Aminotransferase (AST). Severity of the disease is more in patients with elevated serum ASTs. Hence, this study was taken-up to assess the association of the elevated serum ASTs and severity of the disease. <b>Aim:</b> To measure and associate the serum AST levels as a marker in assessing severity of DF in adults. <b>Materials and Methods: </b>The cross-sectional study was conducted on 100 patients of DF admitted to General Medicine wards from May 2019 to April 2020 in Hassan Institute of Medical Sciences and hospital, Hassan, Karnataka, India. Serum AST levels were estimated at admission, on the day of discharge of the patient and related to prognosis of patient in DF. A predetermined proforma was used to record the details of history, physical examination and investigation and results were recorded in a Microsoft excel master chart. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software, version 20.0, Analysis of Variance (ANOVA) and student t-test were used for calculation of significance in all parameters within the groups while Fischer’s-exact test was used to compare the significance between the groups. The p-value <0.05 was to be considered level of significance. <b>Results:</b> In this study, 100 (mean age: 31.65&#177;12.08 years) patients of dengue Non Structural protein 1/Immunoglobulin M (NS1/IgM) positive patients were studied. Out of this 60% NS1 Antigen (Ag), 22% NS1 Ag and IgM Antibody (Ab) and 18% were IgM Ab positive. 63 were males and 37 were females. The AST/SGOT values on day 1 was 203.76&#177;360.87 U/L and on day of discharge was 55.96&#177;31.76 U/L (p-value <0.001). And ALT/SGPT on day 1 was 109.63&#177;146.01 U/L and on day of discharge was 41.05&#177;20.78 U/L (p-value <0.001). The above results indicate that dengue patients had raised AST/SGOT values on day 1 as compared to day of discharge. There was a significant difference (p-value <0.001) found on day 1 and at the time of discharge. <b>Conclusion:</b> Hepatic involvement, characterised by elevation of liver enzymes, is very common finding in Dengue Fever. Serum Aminotranferase (AST) levels are elevated more as compared to serum Alanine aminotransferase (ALT) . The present study found significant association of serum AST levels with the hospital stay and prognosis of the patient. Hence, serum AST levels are mandatory in DF to look for complications and it is of prognostic value. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC28-OC31&id=14942 https://doi.org/10.7860/JCDR/2021/47746.14942 Correlation between Intraocular Pressure and Visual Field Loss in Primary Open Angle and Primary Angle Closure Glaucoma: A Cross-sectional Study VR Raji , Susan Philip , S Ambily <b>Introduction:</b> Glaucoma is characterised by structural damage to optic nerve head with corresponding visual field defects and often associated with increased Intraocular Pressure (IOP). It may be broadly classified as Primary Angle Closure Glaucoma (PACG) and Primary Open Angle Glaucoma (POAG). It is one of the leading causes of global blindness, and a major proportion occurs in Indian population. <b>Aim:</b> To study the correlation between pretreatment IOP and extent of visual field loss in PACG and POAG. <b>Materials and Methods:</b> A cross-sectional observational study was carried out in Regional Institute of Ophthalmology, Trivandrum, Kerala, India from April 2016 to May 2017. Newly diagnosed cases of PACG (25 patients-13 males, 12 females, mean age 58.72&#177;10.07 years) and POAG (85 patients- 45 males, 40 females, mean age 60.28&#177;10.42 years) underwent a detailed glaucoma evaluation which included IOP measurement with Goldmann applanation tonometer and visual field testing using Humphrey Field Analysis (HFA) 24-2 pattern. Mean Deviation (MD), Pattern Standard Deviation (PSD) and Advanced Glaucoma Intervention Score (AGIS) was calculated from reliable visual field test result. All data were coded and entered in statistical software, Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. The correlation between pretreatment IOP and visual field loss in patients with PACG and POAG was determined by Pearson correlation of coefficient (r). <b>Results:</b> Amongst the total 110 patients of this study, 25 patients were of PACG while POAG were in 85 patients. A significant correlation between pretreatment IOP and the extent of visual field loss in PACG was noted. There was no significant correlation in POAG. Linear regression analysis demonstrated a significant positive correlation between IOP and AGIS score in PACG r=0.805, p<0.001), not in POAG (r=0.026, p=0.816). Correlation between IOP and MD was statistically significant in PACG (r=0.812, p<0.001) but not in POAG (r=-0.058, p=0.597). The correlation between IOP and PSD was not statistically significant in both groups (p-value=0.450). <b>Conclusion:</b> A significant correlation between IOP and visual field loss in PACG indicates that extent of visual field damage can be controlled by controlling IOP alone in PACG. The correlation between the pretreatment IOP and visual field loss in POAG is not statistically significant which agrees with the current proposed pathophysiology of optic neuropathy in which multiple factors influence in addition to IOP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=NC12-NC15&id=14943 https://doi.org/10.7860/JCDR/2021/48317.14943 Emphysematous Pyelonephritis: Role and Factors Affecting Renal Conservation- A Cross-sectional Study Amit Kumar Sharma, Sujata Pujari, Shweta Sharma, Suresh Kumar Rulaniya, Biswajit Mohapatra, Gourab Goel <b>Introduction:</b> Emphysematous Pyelonephritis (EPN) is a serious life threatening, necrotising infection which can affect renal parenchyma, collecting system and nearby tissue with the presence of gas within renal system. <b>Aim:</b> To check likelihood of kidney salvagibility by minimal invasive approaches in EPN and to see the prognostic factors that support kidney salvagibility in EPN. <b>Materials and Methods:</b> The cross-sectional study was conducted during October 2018 to June 2020 on 30 patients who were admitted in Department of Urology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India with features of EPN. Thirty patients with clinical and radio-logical features (Huang Tseng Classification) of EPN were enrolled in the study. All the biochemical parameters, clinical features and outcomes (patient who managed conservatively were included in good outcome group while the patients who required nephrectomy were included in poor outcome group) continuous variables were analysed with the Unpaired t-test and categorical variables were analysed with Fisher-exact test and multiple logistic regression test. Results were considered statistical significance when p-value was <0.05. <b>Results: </b>EPN was associated with diabetes mellitus in 80% of cases, 80% presented with complaint of fever and loin pain was a presentation in 70% of cases. Mean serum creatinine for good outcome was 1.4 and serum creatinine 2.5 or more was associated with poor outcomes. Reduced platelet count (p-value=0.0143), altered mental status (p-value=0.0073), severe proteinuria (p-value= 0.0213), renal function impairment (p-value=0.0493) and shock (p-value=0.0127) were statistically significant and associated with poor outcome. A 76% (n=21) cases were classified as good outcome group and 24% (n=9) cases classified as poor outcome group for which nephrectomy was done. Open nephrectomy was done in nine patients. <b>Conclusion:</b> There is a definite possibility of renal salvagibility by minimal invasive approaches in EPN in properly selected patients of EPN. Shock, altered mental status, raised serum creatinine, platelet count <120000/cumm, severe proteinuria are poor outcome factors which can lead to nephrectomy in conservatively managed cases of EPN. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PC17-PC20&id=14944 https://doi.org/10.7860/JCDR/2021/48156.14944 Prevalence of Malocclusion and its Relationship with Socio-demographic Factors, Dental Caries and Oral Hygiene Status in 12- 15 Years Children of Lucknow City Avnica Agarwal, Vamsi Krishna Reddy, Mayank Das, Mohsin Khan, Mandar Todkar <b>Introduction:</b> Oral health diseases and disorders can negatively affect a child’s life. Malocclusion is defined as any irregularity in occlusion beyond the accepted. Malocclusion is the most common oral health problem which can cause dental decay, gum problems, and fluorosis as well. The causes of malocclusion can be either genetic or environmental, along with other local factors like negative oral habits, dental abnormalities, shape and size of the teeth. <b>Aim:</b> To assess the prevalence of malocclusion and its relationship with socio-demographic factors, dental caries and oral hygiene status in 12-15 years old school children in Lucknow city. <b>Materials and Methods: </b>The present study was a descriptive cross-sectional study which was conducted in the Department of Public Health Dentistry, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India.The study included 12-15 years old school children with a sample size of 851 students. Data was collected regarding socio-demographic factors, dental caries (World Health Organisation (WHO) 2013), Oral Hygiene Index (OHI) status and Dental Aesthetic Index (DAI) (WHO, 1997) to evaluate it’s relationship with malocclusion. Categorical data was tested for independence using Chi-square test and Multiple Non linear Regression analysis was used to find the association of malocclusion with socio-demographic details, oral hygiene status and dental caries and p-value significant was set at <0.05. <b>Results:</b> A total of 851 children participated in the study, out of which 403 were males and 448 were females. Malocclusion prevalence (i.e. DAI >25) among the study population was found to be 23.1%. Malocclusion was found to be significant with age (p-value <0.023), Socio-Economic Status (SES) (p-value <0.001), dental caries (p-value <0.001) and Oral Hygiene Index (OHI) (p-value <0.001). <b>Conclusion: </b>Malocclusion prevalence in the present study was found to be 23.1%. The prevalence of definite, severe and very severe (handicapped) malocclusion was 13.6%, 8.1% and 1.4%, respectively. However, positive relationship was found between the age, socio-economic status, OHI and dental caries with DAI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC52-ZC56&id=14945 https://doi.org/10.7860/JCDR/2021/47914.14945 Outcome of Ulinastatin vs Metabolic Resuscitation using Ascorbic Acid, Thiamine and Glucocorticoid in Early Treatment of Sepsis- A Randomised Controlled Trial Arun Kumar Yadav, Vipin Kumar Singh, GP Singh, Vinita Singh <b>Introduction:</b> Sepsis is one the most common cause of morbidity and mortality worldwide. Sepsis and septic shock are lifethreatening disease which increases mortality with circulatory, cellular and metabolic abnormalities. Urinary trypsin inhibitor is an important protease inhibitor found in human blood and urine, it is known as Ulinastatin (ULI) or bikunin. It is an acidic glycoprotein (molecular weight 30 kDa) and Kunitz-type serine protease inhibitor. It is derived from the larger inter-&#945;-trypsin inhibitor molecule by action of neutrophil elastase in the presence of inflammation, and is believed to play an important anti-inflammatory role. <b>Aim:</b> To compare the outcome of intravenous ULI (protease inhibitor known as urinary trypsin inhibitor) versus the combination of hydrocortisone, ascorbic acid (vitamin C) and thiamine regarding outcome in sepsis and septic shock. <b>Materials and Methods: </b>In this randomised controlled trial conducted between July 2018 to June 2019 on total 60 sepsis patients were included and divided into two equal groups. Group A patients received combination of intravenous Hydrocortisone, Ascorbic acid and Thiamine (HAT) and group B recieved intravenous Ulinastatin in Intensive Care Unit (ICU) (Control group). Baseline demographic, clinical and laboratory data were recorded along with Acute Physiology and Chronic Health Evaluation (APACHE) 2 and Sequential Organ Failure Assessment (SOFA) scoring system at the time of admission in ICU. All statistical test were performed using Statistical Package for Social Sciences (SPSS) 21.0 windows software. Comparisons between groups were assessed by using student t-test and Chi-square test. <b>Results:</b> Mean age was comparable in both the groups (36.7&#177;12.5 years in group A vs 37.5&#177;12.9 years in group B). The SOFA Score were significantly lower in group B as compared to group A on day 3 (7.76&#177;3.67 vs 12.03&#177;4.77) and day 5 (4.79&#177;4.02 vs 12.10&#177;7.36). Rate of reduction in serum procalcitonin level was also found to be significant in group B (p=0.008) as compared to group A (p=0.103). Lactate clearance rate was also fast in group B as compared to group A on day 3 and day 5. There was significant mortality benefit in group B (20%) as compared to group A (50%). Patients were followed-up for 28 days till the start of treatment. <b>Conclusion: </b>This study showed that the ULI may play a beneficial role in early management of sepsis and septic shock. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC36-UC39&id=14946 https://doi.org/10.7860/JCDR/2021/47233.14946 Immediate Effects of Myofascial Release Technique on Muscle Flexibility, Vertical Jump Height in Recreational Badminton Players Deepak Panwar, Siddhartha Sen 10.7860/JCDR/2021/48093.14932 Date of Submission: Dec 11, 2020 Date of Peer Review: Jan 14, 2021 Date of Acceptance: Apr 08, 2021 Date of Publishing: May 01, 2021 AUTHOR DECLARATION: &#8226; Financial or Other Competing Interests: None &#8226; Was Ethics Committee Approval obtained for this study? Yes &#8226; Was informed consent obtained from the subjects involved in the study? Yes &#8226; For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: &#8226; Plagiarism X-checker: Jan 02, 2021 &#8226; Manual Googling: Apr 07, 2021 &#8226; iThenticate Software: Apr 30, 2021 (25%) ETYMOLOGY: Author Origin https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YC15-YC19&id=14932 https://doi.org/10.7860/JCDR/2021/48093.14932 Screening of Biochemical Abnormalities in Suicide Attempters Irrespective of Psychiatric Diagnosis: A Cross-sectional Study Ashwini Kamble, Vishwak Reddy Vatte, Bheemathati Ranga Rao, Sourya Reddy, C Pradyumna, PV Sai Satyanarayana, Satya Revanth Karri, Praveen Khairkar <b>Introduction: </b>Empirical studies have documented the impact of membrane cholesterol on serotonergic function which might influence the suicidality in various psychiatric disorders. Most studies in last two decades demonstrated low cholesterol as potential predictor of suicidality in depression but trends of metabolic disorders and current status of hypercholesterolemia and biochemical abnormalities in suicidal spectrum population is scarce. <b>Aim:</b> To comprehensively evaluate the blood levels of cholesterol and other biochemical abnormalities (serum electrolytes, proteins, blood pH etc.,) irrespective of any psychiatric disorders in suicide attempters. <b>Materials and Methods:</b> A cross-sectional study was conducted on a total of 202 patients who visited our emergency hospital services with a suicidal attempt from 1st January 2019 till 31st December 2019 for a duration of 12 months. Blood evaluation and analysis were done on the same day of hospitalisation for complete blood counts, serum electrolytes, proteins and cholesterol levels. Clinical and standardised psychological evaluations for psychiatric diagnosis were performed. The results were analysed and compared using descriptive and inferential statistics based on SPSS software 21.0. <b>Results:</b> Out of 202 total suicide attempters, 120 (59.4%) were males and 82 (40.6%) were females with 111 (54.9%) falling in the age range of 20-29; while 175 (86.6%) of patients had their first ever suicide or deliberate harm. A total of 169 (83.7%) of patients had normal complete blood counts but 106 (52.5%) showed acidic pH (<7.3) while only 5 (2.5%) of the patients had alkalosis. Serum potassium was abnormal in 43 (21.3%) patients. Further serum chloride was deranged in 13 (6.4%) while serum albumin was deranged in 17 (8.4%). About 27 (13.4%) found to have increased serum cholesterol and none of them had low cholesterol. <b>Conclusion:</b> Excessive and dampened reactivity of biomolecular parameters including hypercholesterolemia may modulate the neurobiological stress system associated with increased suicidality. This may be one of the predictors irrespective of the underlying psychiatric disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=BC22-BC26&id=14933 https://doi.org/10.7860/JCDR/2021/45810.14933 Role of Glycaemic Control in Predicting Severity of Illness in COVID-19 Patients with Diabetes Mellitus Jayanthi Hari Kishan, Vollala Shravan Kumar <b>Introduction:</b> Coronavirus Disease-2019 (COVID-19) pneumonia is a rapidly spreading disease which causes morbidity and mortality of many patients. Diabetes mellitus is a co-morbidity which is considered as a risk factor for COVID-19. Well-controlled diabetes is associated with better outcomes than poorly controlled diabetes. Measurement of glycated haemoglobin (HbA1c) is the standard method for assessing long term glycaemic control. Regardless of the level of hyperglycaemia, improvement in glycaemic control will lower the risk of diabetic complications. <b>Aim:</b> To identify the role of glycaemic control (HbA1c) in predicting the severity of illness in patients with COVID-19 pneumonia. <b>Materials and Methods:</b> This was a retrospective observational study of (51 diabetic and 51 non diabetic) patients at Kamineni Academy of Medical Sciences, Hyderabad, India. The patients diagnosed with COVID-19 pneumonia, were included both diabetics and non diabetics from June 2020 to September 2020. Patients age, sex, baseline HbA1c levels, and oxygen requirement during the hospital stay were analysed using Statistical Package for the Social Sciences (SPSS) software version 22.0. The Chi-square test was used to analyse qualitative data and p-value significant at level <0.05. <b>Results:</b> In the study among diabetics (n=51), 20 (39.2%) were on room air, 24 (47.1%) required intermittent oxygen support, 3 (5.9%) high flow oxygen, and 4 (7.8%) non invasive ventilator support. Among non diabetics (n=51), 28 (54.9%) were on room air, 18 (35.3%) on intermittent oxygen, 2 (3.9%) high flow oxygen, and 3 (5.9%) Non Invasive Ventilator (NIV) support. It was observed that patients with poor glycaemic control required more oxygen support during treatment in diabetics (p-value:0.469). <b>Conclusion:</b> In the present study, patients with poor glycaemic control required insignificantly, more oxygen support than patients with good glycaemic control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OC25-OC27&id=14934 https://doi.org/10.7860/JCDR/2021/48021.14934 Student Perception Regarding the Utility of Information Technology as a Facilitator of Learning in Medical Education Vatsala Khurana, Rashmi Verma, Binita Goswami, Vikas Malhotra <b>Introduction:</b> Information Technology (IT) has influenced all fields including healthcare and Medical Education (ME). The present generation of students have grown up in an IT enriched atmosphere and are comfortable with most IT tools and gadgets. <b>Aim:</b> To understand the perception of first year MBBS students regarding role of IT in ME. <b>Materials and Methods:</b> A cross-sectional, questionnaire based study was carried out on 250 first year MBBS students from August 1<sup>st</sup>, 2019 to August 31<sup>st</sup>, 2019 over a period of one month. A questionnaire containing three sections was administered to the students before the starting of IT module in foundation year. The responses to the items of the questionnaire were assessed on the basis of the student responses on the likert scale. <b>Results:</b> The study revealed that students acknowledged the utility of IT for academic purposes and were primed for its inclusion as an essential component of the medical curriculum. The students conceded to browsing internet on their computers and smartphones for social media handles. However, when it came to teaching methods, students were not comfortable with the idea of replacing traditional teaching methods with e-learning. Also, students were more comfortable in reading hard copies instead of e-books. <b>Conclusion:</b> It was concluded that there is a need to amalgamate the traditional teaching methods with the innovative e-learning platforms in such a way that they become mutually inclusive and facilitate the learning process. Also, ME practices need to be continuously re-evaluated to make the educational process more effective for learners, teachers and for the society in general. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=BC27-BC30&id=14935 https://doi.org/10.7860/JCDR/2021/47276.14935 Comparative Evaluation of Different Antioxidants on Reversal of Microtensile Bond Strength of Composite Resin in Endodontically Treated Tooth Surface Ramesh Bharti, Anil Chandra <b>Introduction:</b> The use of Sodium Hypochlorite (NaOCl) as an endodontic irrigant changes the properties of dentine and lowers the bond strength of resin cements to the dentine, but it can be reversed by the use of antioxidants. <b>Aim:</b> To evaluate the effect of antioxidants for restoring adhesion potential/reversal of microtensile bond strength of dentin in the pulp chamber treated with NaOCl and Ethylenediaminetetracetic Acid (EDTA). <b>Materials and Methods:</b> This is a laboratory based experimental in-vitro study in which 40 freshly extracted human incisors were selected and cut to expose the pulp chamber below the dentine. The specimens were distributed among five groups: Group I samples were irrigated with 5.25% NaOCl for 30 minutes followed by 17% EDTA for 3 minutes and final rinse was done with 5.25% NaOCl (Positive control). Group II samples were treated with distilled water only (Negative control). In Group III, samples were treated same as in group I followed by 10% Sodium Ascorbate (SA) for 10 minutes. Samples of group IV were also treated as in group I followed by application of 5% solution of Alpha tocopherol for 10 minutes. Group V samples were treated same as in group I followed by a rinse with 5% solution of Sodium Thiosulphate (Na<sub>2</sub>S<sub>2</sub>O<sub>3</sub> ) for 10 minutes. Composite resin build up was performed and interface was tested by using Universal testing machine for Microtensile bond strength. The resulting data was analysed by one-way Analysis of Variance (ANOVA) and Mann-Whitney U test (p<0.05). <b>Results: </b>The results demonstrated that irrigation with 5.25% NaOCl and 17% EDTA produce significant (p<0.05) reduction in resin dentin bond strength but this could be reversed by application of 5% Na<sub>2</sub>S<sub>2</sub>O<sub>3</sub> . Highest bond strength was observed in group V (22.38&#177;0.84) and lowest for group I (15.38&#177;1.22). <b>Conclusion: </b>Dentin bond strength was significantly reduced when bonding was performed immediately after use of NaOCl. Use of antioxidants after final irrigation with NaOCl can be recommended for better bonding of composite resin. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC43-ZC46&id=14936 https://doi.org/10.7860/JCDR/2021/46654.14936 A Qualitative Assessment of Stress among Frontline Health Workers during Covid -19 Pandemic Sonali Sain, Shuvankar Mukherjee <b>Introduction:</b> Being on the frontline, health care workers are most likely to get exposed to all kinds of stress in the ongoing Coronavirus Disease 2019 (COVID-19) pandemic. Both physical and mental stress can influence their well-being and also affect their work efficiency. There is a need of active intervention to restore and maintain the mental health of the frontline health workers. Thus, it is essential to gain an insight into their problems so that it would enable to identify appropriate solutions. <b>Aim:</b> To get an insight into the stress experienced by the COVID-19 community surveillance workers and to explore the perceptions of stress related trigger factors and coping strategies. <b>Materials and Methods: </b>This qualitative study was based on “Focus Group Discussion (FGD)” method and was associated with Nilratan Sircar Medical College and Hospital, Kolkata, India. The participants were COVID-19 community surveillance workers who mainly comprised of &#34;honorary health workers&#34; and &#34;100 days field workers (18-55 years)&#34;, employed in five different urban health centers in the Kolkata corporation area from April to June 2020. A total of 55 participants were included in the study in five sessions. Researchers took notes during the session, which was also recorded verbatim. Discussions were mainly conducted over four key areas namely positive aspects of COVID-19 surveillance activities, stress related to surveillance activities, precipitating factors related to stress and coping strategies for these stressful periods. Data was summarised and analysed qualitatively. <b>Results:</b> Participants felt that &#34;they provided service to the society and understood their importance in breaking the chain of transmission&#34;. &#34;This job gave them pride of being a part of health system along with income generation&#34;. However, they also expressed about the stressful situation related to the surveillance activity like social ostracisation, verbal and even physical abuse. Inadequate supply of Personal Protective Equipment (PPE) was revealed. Most of the surveillance workers were informally trained thus they sought help for formal training for surveillance activity. <b>Conclusion: </b>Although the frontline health care workers felt proud to be involved in the surveillance work, almost all of them expressed apprehension against social stigmatisation, verbal and physical abuse. The need for formal training in surveillance work was evident. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC27-LC30&id=14939 https://doi.org/10.7860/JCDR/2021/48731.14939 Impact of Drug Information Services on Promotion of Rational Use of Antimicrobial Agents: A Descriptive Retrospective Study Soanker Radhika, MVS Subbalaxmi, Butul Maleha, Pingali Usharani <b>Introduction:</b> Drug Information Services (DIS) is dedicated to provide information about drugs and pharmacotherapy, on request from health care professionals, organisations or patients. World Health Organisation (WHO) recommends DIS to promote rational use of medicines. <b>Aim:</b> The study was done to understand the impact of DIS on promotion of rational use of antimicrobial agents, at a tertiary care hospital. <b>Materials and Methods:</b> In this retrospective descriptive study, 126 cases with infection related medication issues requiring opinion related to appropriate antimicrobial therapy from January 2014-June 2018 were included and studied in September 2018. Data related to culture/susceptibility results, treatment offered, reason for referral and suggestions given by the DIS captured in the case details form were analysed. The number of antimicrobials prescribed per case before and after DIS opinion was compared using paired t-test. <b>Results:</b> Of the 126 cases (mean age: 35&#177;18.2 years), 82 were culture positive, of which 43 samples reported Multi-Drug Resistant (MDR) organisms. Of 126 case referrals, 53 (42.1%) were regarding opinion on appropriate antimicrobial therapy, 18 (14.3%) for suspected ADRs and rechallenge opinion, 27 (21.5%) for dosage adjustment of antimicrobials and 12 (9.5%) for suspected drug-drug interactions. Based on DIS recommendations, mean number of antimicrobials prescribed per patient reduced from 3.4&#177;1.85 to 1.62&#177;1.38 (p<0.0001) when tested by paired t-test. Sixteen culture-negative cases were referred for opinion on appropriate antimicrobial therapy. <b>Conclusion:</b> DIS is a very useful resource, which provides unbiased, factual drug information to clinicians and patients and must be established in all healthcare facilities. DIS strengthen rational use of antimicrobials. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=FC01-FC04&id=14916 https://doi.org/10.7860/JCDR/2021/49002.14916 Evaluation of Pathological Response in Post Neoadjuvant Chemotherapy Breast Carcinoma Specimens using Residual Cancer Burden System Lakshmi Manasa Perubhotla, Suseela Kodandapani, Sudha S Murthy <b>Introduction:</b> Many systems have been proposed to classify the degree of tumour response to therapy in post Neoadjuvant Chemotherapy (NACT) breast cancers. The Residual Cancer Burden (RCB) developed by MD Anderson Cancer Hospital is an online tool for the quantification of residual disease that is easy to practice, reproducible, and the RCB score has been clinically validated as independent prognostic factor for longterm survival. <b>Aim: </b>To evaluate the methodology for grossing and microscopic examination for assessing pathologic response in post NACT breast cancer specimens using RCB system developed by MD Anderson Cancer Institute and its feasibility for routine practice. <b>Materials and Methods: </b>The present cross-sectional study was conducted in Basavatarakam Indo American Cancer Hospital and Research Institute Hyderabad, Telangana, India over a duration of three months from May 2018 to July 2018. Histologically proven breast carcinoma patients who were treated with both NACT and surgery were included in the study. Before surgery, these patients were treated with either anthracycline-based chemotherapy regimen with or without additional taxanes or targeted therapy with transtuzumab. The RCB score and class were calculated to assess pathologic response to NACT. Analysis was performed individually by two senior pathologists, who has expertise in breast pathology and a junior pathologist. Consensus opinion was noted in case of discrepancies. <b>Results:</b> The study included 50 carcinoma breast specimens. All the cases were females. Forty nine cases were diagnosed as invasive carcinoma {No Special Type (NST)} and one was lobular carcinoma. The pCR (Pathological complete response) was seen in 9 (18%) and residual disease was seen in 41 (82%) patients. <b>Conclusion:</b> The present study highlights feasibility of application of RCB system in assessing pathological response following NACT in breast cancer. Incorporating RCB score and class in the reporting helps the surgical pathologist to overcome sampling errors caused by heterogeneously variable cellularity commonly encountered in these type of specimens. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=EC05-EC10&id=14917 https://doi.org/10.7860/JCDR/2021/48102.14917 Effect of Dexamethasone as an Adjunct on Efficacy of Ropivacaine in Caudal Block for Postoperative Analgesia in Paediatric Infra-umbilical Surgeries: A Randomised Double-blind Controlled Study Veena Patodi, Kavita Jain, Mukesh Choudhary, Surendra Kumar Sethi, Neena Jain, Veena Mathur <b>Introduction: </b>Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries. Various adjuvants have been used along with local anaesthetics like ropivacaine in singleshot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries. <b>Aim:</b> To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients. <b>Materials and Methods:</b> This was a randomised double-blinded controlled study conducted on 80 paediatric patients (8 months8 years), with American Society of Anaesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries, at a tertiary care teaching institute from April 2019 to September 2019. These total subjects were randomly allocated into two groups. Group R (n=40) administered 0.2% ropivacaine (1 mL/kg) while Group RD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block. The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and side-effects were noted. The rescue analgesic (paracetamol 15 mg/kg oral) was given whenever FLACC &#8805;4. Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained. <b>Results:</b> The mean duration of analgesia was significantly longer in Group RD (745.21&#177;146.91 minutes) as compared to Group R (440.38&#177;76.44 minutes); (p-value <0.001). The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05). The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value <0.05). No significant haemodynamic changes or side-effects were observed in both groups; (p-value >0.05). Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and Postoperative Nausea and Vomiting (PONV) in 2 patients (6.66%) in Group R. None complications were observed in the patients of RD group. <b>Conclusion:</b> Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=UC31-UC35&id=14918 https://doi.org/10.7860/JCDR/2021/47738.14918 A Prospective Longitudinal Study on the Predictability of Quadruple-D Score in the Success Rate of Extracorporeal Shock Wave Lithotripsy for Renal Stones 1-2 cm in Diameter Soumish Sengupta, Supriya Basu, Kadambari Ghosh <b>Introduction:</b> Quadruple-D, based on Computed Tomography (CT) derived metrics, is a scoring system that helps urologists to predict the Stone Free Rate (SFR) following Extracorporeal Shock Wave Lithotripsy (ESWL) in renal stones. <b>Aim:</b> To evaluate the efficacy of Quadruple-D scoring system to assess the SFR in individuals with renal stones measuring 1-2 cm in diameter after giving ESWL. <b>Materials and Methods: </b>The prospective longitudinal study was conducted on 120 patients. Systemic random sampling technique was applied with a sampling interval of two. Quadruple-D scoring, comprising of four Computed Tomography (CT) based metrics that is stone dimension, stone density in Hounsfield Units (HU), Skin-to-Stone Distance (SSD) and stone location, was done prior to ESWL. The scores ranged from zero (worst) to four (best) points. Plain abdominal radiography was done three weeks after ESWL to assess SFR. Complete clearance was considered the stone free status. Patients were divided into group A with complete stone clearance and group B with residual stone. All the statistical analysis was done using IBM Statistical Package for Social Science (SPSS) 26.0. Student&#39;s t-test or Mann-Whitney U-test was used to compare continuous variables. Fisher&#39;s-exact test and Chi-square test were used to analyse the cross charts between two categories. <b>Results:</b> The mean ellipsoid Stone Volume (SV) was 396.44&#177;163.23 mm<sup>3</sup> and 395.81&#177;227.52 mm<sup>3</sup> in group A and B, respectively. The stone density was 724.28&#177;210.90 in group A and 814.56&#177;190.63 in group B. In group A, 9.20% and in group B, 34.09% of the patients had stones in lower calyx. The difference between the groups based on the above parameters were statistically significant. The Quadruple-D score was 2.09&#177;0.65 and 1.54&#177;0.79 in group A and B, respectively. The Area Under the Curve (AUC) of Quadruple-D scoring system was 0.674. The age, sex, BMI, laterality of the stone and SSD did not predict stone-free status in this study. <b>Conclusion:</b> Quadruple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. Quadruple-D is an easy to use clinical tool to predict the success rate of ESWL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PC13-PC16&id=14919 https://doi.org/10.7860/JCDR/2021/48698.14919 Comparative Evaluation of Cavosurface Marginal Integrity by Assessing Microleakage Scores of Three Different Composites using a Universal Adhesive in Self Etch and Selective Etch Modes- A Stereomicroscopic Study Archie Khera, Arvind Shenoy <b>Introduction:</b> Composite resins are currently the most popular restorative materials due to their superior esthetics, strong mechanical properties and high resistance to dissolution. However, in spite of the improvements in resin composite formulations over the years, polymerisation shrinkage which necessitates incremental placement techniques still presents clinical challenges. <b>Aim:</b> To compare and evaluate cavosurface marginal integrity in Class I restorations by assessing microleakage scores using Tetric N-Flow Bulk fill, SureFil Bulk fill composites and Filtek Z350 XT and using selective etch and self etch modes of a universal adhesive. <b>Materials and Methods:</b> This in vitro research study was carried out in the Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India from April 2018 to May 2018. Sixty extracted non carious, intact human mandibular molar teeth were selected for this study. Standardised Class I cavities of 4 mm depth were prepared by a single operator with a high-speed hand piece using carbide fissure #245 (SS White Inc) bur under air-water coolant. Samples were randomly divided into two main groups in which Single Bond Universal was used: Group I: Selective Etch Mode (30), group II: Self Etch Mode (30). These main groups were then divided into three subgroups each subgroup TF: Tetric N- Flow Bulk fill (Ivoclar Vivadent), subgroup SB: SureFil Bulk fill (Dentsply) and subgroup FC: Filtek Z350 XT (3M ESPE). All the specimens were then sectioned longitudinally along the mesio-distal direction towards the centre of the restoration. Each specimen was viewed under a stereomicroscope and grading was done according to dye penetration at the tooth-restoration interface. Kruskal-Wallis and Mann-Whitney U-test were used to analyse the results. <b>Results:</b> The results showed that there was statistically significant difference in the microleakage scores of Tetric N- Flow Bulk fill, Filtek Z350 XT and SureFil Bulk fill (p<0.001). Group I subgroup TF yielded lower microleakage score 0.70±0.675 as compared to group II subgroup TF which had a higher score 1.60±1.578. This difference was not statistically significant (p-value=0.266). Group I subgroup SB yielded lower microleakage score 1.20±0.919 as compared to group II subgroup SB which had a higher score 2.10&#177;0.568. This difference was statistically significant (p-value=0.017). Group I subgroup FC yielded lower microleakage score 2.50&#177;1.354 as compared to group II subgroup FC which had a higher score 3.20&#177;0.789. This difference was not statistically significant (p-value=0.260). <b>Conclusion:</b> Tetric N flow bulk fill flowable composite resin can be considered as a better choice when compared to SureFil bulk fill and Filtek Z350 XT composite resins. Selective enamel etching with SureFil bulk fill should be considered as the better choice as compared to self-etch for providing adequate seal in mild universal adhesives in Class I cavities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC27-ZC31&id=14920 https://doi.org/10.7860/JCDR/2021/48178.14920 Occupational Stress and Metabolic Syndrome among Bus Drivers: Risk Factors for Cardiovascular Diseases Sanjeev Srinivas Walvekar, Jeevan G Ambekar, Basavaraj B Devaranavadagi, Deepa S Sajjannar <b>Introduction:</b> Bus drivers are more vulnerable to health complications due to the nature of their occupation. There is limited information available on the role of occupational stress and metabolic syndrome as the risk factors for Cardiovascular Diseases (CVD) among them. Metabolic syndrome is described by clustering of hypertension, hyperglycaemia, obesity, and dyslipidemia. <b>Aim:</b> To investigate the relationship between occupational stress and metabolic syndrome and assess its role among bus drivers as a predictive risk factor for CVD. <b>Materials and Methods:</b> A case-control study was conducted from June 2014 to March 2015, at the Department of Biochemistry, BLDE (DU) Shri BM Patil medical college, Vijayapura, Karnataka, India with randomly selected bus drivers (n=90) and age, sexmatched healthy participants (n=110) serving as controls. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) was used to describe metabolic syndrome. Data on socio-demographic features, anthropometric indexes, blood pressure, and biochemical parameters, including serum cortisol, were obtained. The questionnaire related to working patterns and Perceived Stress Scale (PSS) was used to assess the psycho-social hazards, and the Framingham Risk Score (FRS) model was used to predict the subsequent 10- year possible risk of developing CVD in bus drivers. Data was analysed using Statistical Package for Social Sciences (SPSS) software version 16.0. <b>Results:</b> The mean age of bus drivers was 44.60±6.74 years. According to the PSS, with 28 as the cut-off value, 36 (40%) bus drivers were under stress. As per FRS, 51 (56.7%) of bus drivers were at low CVD risk, 27 (30%) were at intermediate risk, and 12 (13.3%) were at a higher CVD risk. Statistically significant values for parameters such as Fasting Blood Sugar (FBS), glycosylated haemoglobin (HbA1c), serum triglyceride, serum cortisol, and PSS were seen among bus drivers with metabolic syndrome (p<0.001). A positive correlation between Waist Circumference (WC) and Triglycerides (TG) (r=0.215, p<0.001), WC and diastolic blood pressure (r=0.329, p<0.001), WC and HbA1c (r=0.409, p<0.001) was observed. <b>Conclusion:</b> The stress at work in the bus driver’s occupation is a crucial factor associated with metabolic syndrome, a significant risk factor for CVD. The awareness program in health camps and regular physical activity will prompt lifestyle modification that reduces diseases and moderate future cardiovascular events. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC17-LC22&id=14921 https://doi.org/10.7860/JCDR/2021/49089.14921 Effectiveness of Foot Exercise and Epsom Salt Water on Reduction of Foot Oedema among Antenatal Mothers Khevna Rameshbhai Macwan, Parasben Krunal Savaliya <b>Introduction:</b> Pregnancy is a very special time for both woman and her partner. Physiological lower leg oedema is one of the cutaneous manifestations of pregnancy. The weight increase during pregnancy and effect of gravity, slows down the blood circulation in lower limbs, thus leading to accumulation of fluids in that region. It is envisioned that about 75% of women suffer from this excessive accumulation of fluid around the legs and ankles during pregnancy. <b>Aim: </b>To evaluate the effect of foot exercise and Epsom salt water on reduction of foot oedema among the antenatal mothers at selected hospitals of Kheda district. <b>Materials and Methods: </b>This was a Quasi experimental study, conducted from January 17, 2020 to March 18, 2020 at Dr ND Desai Hospital and Medical College, Nadiad, Gujarat, on 40 antenatal mothers having foot oedema, from selected hospitals of Kheda district by purposive non probability sampling techniques. The total sample of 40 mothers was randomly allocated to group 1 (n=20 of foot exercise) and group 2 (n=20 of Epsom salt water). Foot oedema level assessment was done using tools of data collection for both groups which included the performa of demographic variables and Modified Standardised Erin oedema scale. <b>Results: </b>Amongst the total study subjects, 11 (55%) of those in group 2 were from 18-24 years of age. Oedema score analysis preinterventionally, showed moderate score in 18 (90%) of subjects in group 1 and 9 (45%) subjects in group 2. Severe score presented by 2 (10%) subjects in group 1 and 11 (55%) subjects in group 2. Postinterventionally, none of the subjects in group 1 and group 2 showed moderate and severe oedema. All gave the score of 0, trace or mild oedema. There was statistically significant difference found in level of foot oedema in group 1 and group 2 with mean difference of group 1 as 2.2 and Standard Deviation (SD) 0.51 and for group 2 mean difference was 2.95 and SD 0.68. The calculated value of Mann-Whitney test was group 1 (3) and group 2 (1.49). Among them the level of foot oedema reduced to 55% in group 1 (foot exercise) whereas in group 2 (Epsom salt water) it reduced to 73.75%. <b>Conclusion:</b> Epsom salt water is more effective then foot exercise on reduction of foot oedema among the antenatal mothers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LC23-LC26&id=14922 https://doi.org/10.7860/JCDR/2021/47879.14922 Understanding the Hazard Profile and Disaster Preparedness Levels of NABH Accredited Hospitals in North India: Evidence from a Cross-sectional Survey 2016 Nidhi Yadav, Gayatri Vishwakarma, Prahalad Rai Sodani, Preetham Kabbinahithlu, Priyanka Anchalia <b>Introduction:</b> Implementation of quality management systems and accreditation is the best way to understand disaster preparedness of any hospital. The National Board of Hospitals and Healthcare providers (NABH) has laid down standards for hospital. These standards along with the Disaster Management Act 2005 give direction and guidelines to the hospitals for ensuring that hospital prepare for unprecedented events or disaster situations. <b>Aim:</b> To assess the influence of NABH accreditation on disaster preparedness and response of accredited hospitals of north India. <b>Materials and Methods:</b> A cross-sectional, ex-post facto research was conducted in accredited hospitals on north India to understand their level of disaster preparedness and response. Purposive sampling was done and nine hospitals were selected. A validated questionnaire was used to collect data on demographic and disaster profile including procedural, structural and non structural elements. Statistical Package for the Social Sciences (SPSS) Version 22.0 was used for statistical analysis purpose. <b>Results: </b>Accreditation plays very important role in preparing the hospitals and curating their response towards a disaster event. This study found significant level of disaster preparedness in the accredited hospitals irrespective of the structural difference and age of the hospital. <b>Conclusion:</b> The 4th edition of NABH standards has its 8th Chapter on Facility Management and Safety, this chapter has seven Standards and 46 Objective elements. It guide the hospital regarding provision of safe and secure environment for patients, their families, staff and visitors. Accreditation is the best way to evaluate disaster preparedness of any hospital. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=IC01-IC06&id=14923 https://doi.org/10.7860/JCDR/2021/46194.14923 Effectiveness of Exercises in Glycaemic Control and Maternal Outcome among Women with Gestational Diabetes Mellitus- A Pilot Study Reena Wilma Frank, Kaipangala Raja Gopal, Devina E Rodrigues <b>Introduction:</b> Diabetes Mellitus (DM) is a common medical problem that is very often seen in pregnancy in the present era. Pregnant women should keep in mind their health and lifestyle considerations or else pregnancy will end up with many complications. Pre-existing factors and pregnancy factors will contribute and make pregnancy more complicated. Exercises are recommended as a healthy practice which prevents many diseases and provides a healthy life. <b>Aim:</b> To evaluate the glycaemic level by focusing on exercises to improve the maternal outcome. <b>Materials and Methods:</b> A Pilot study with Quasi-experimental pre-post control group design with 30 Gestational Diabetes Mellitus (GDM) women (15 in each group) were selected who met the inclusion and exclusion criteria. The study was conducted in tertiary care hospital between June 2019 and December 2019. Based on the convenience sampling technique, the setting was selected and a simple random technique was adopted to select the subjects. Fifteen subjects were included in each groups, both intervention and control group. Exercises were taught for the interventional group of women for 12 weeks. Regular treatment was continued for both groups which included medication, diet and regular walking. Pretest and post-test glycaemic scores were done for both the groups. Mann-whitney test, Analysis of Variance (ANOVA), post-hoc test, paired Eta square were also used and IBM Statistical Package for the Social Sciences (SPSS) version 23.0 was used. <b>Results:</b> The study shows there was a significant difference in the preFasting Blood Sugar (FBS) and postFBS values in the intervention group p-value <0.027. The paired Eta square value was 0.303 which showed a moderate effect of the exercise on the glycaemic value in the interventional group. There was a significant difference in the pre glycosylated haemoglobin (HbA1c) and post HbA1c values in both the intervention and control group was p-value <0.023 and p-value <0.025, respectively. The maternal outcome shows increased severity of the complications in the control group while comparing with the intervention group such as pre-eclampsia, operative interference, and preterm deliveries. But there was no significant difference in the maternal outcome observed between intervention and control group p-value >0.05. <b>Conclusion:</b> Regular moderate-intensity aerobic and resistance exercise training during pregnancy is associated with lower blood glucose level. Thus, study concluded that exercise has a moderate effect on glycaemic control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=QC06-QC10&id=14924 https://doi.org/10.7860/JCDR/2021/46594.14924 Assessment of Awareness and Behavioural Patterns among Children Regarding COVID-19 Ritesh Kalaskar, Shruti Balasubramanian, Ashita Kalaskar <b>Introduction:</b> Coronavirus Disease 2019 (COVID-19) has spread like wildfire across the globe affecting all age-groups. Children usually present with mild symptoms or may even remain asymptomatic. Due to the asymptomatic presentation, they may act as silent carriers and aid in the spread of infection, hence prompting greater vigilance. Therefore, it’s imperative to increase awareness among children and alter their habits in order to curb the pandemic. <b>Aim:</b> To assess the level of awareness among children regarding coronavirus infection and the behavioural changes they wish to make post-COVID-19. Additionally, it also recorded the recommendations of children for their schools to curb the COVID-19 infection. <b>Materials and Methods:</b> This cross-sectional study was conducted among 246 private school going children across India in the age group of 9-15 years. A questionnaire was circulated via online platform which assessed the level of awareness regarding COVID-19, its influence on their behavioural patterns and recommendations of children for their schools. The mean knowledge scores were recorded for first part and chi-square test was employed to evaluate the changes in behaviour before and after COVID-19 for the second part. For the third part, percentage for each response was determined. Data was compiled in MS Office Excel sheet (version 2019, Microsoft Redmond Campus, Redmond, Washington, United States). Statistical analysis was performed on Statistical Package for the Social Sciences version 16.0 (SPSS) software. <b>Results:</b> The average knowledge score was 85.50%. This increased awareness among children was reflected in the statistically significant difference in their behavioural patterns before and after COVID-19 (p-value <0.05) and also in the recommendations given by children to their schools. <b>Conclusion: </b>To the best of our knowledge, this is a pioneer study assessing the awareness of COVID-19 in children and its impact on their behaviour pattern. Children showed good knowledge about COVID-19 with the average knowledge score of the entire sample being 85.50% and also wished to make changes in their behaviour post-COVID-19. Additionally, schools are also required to make numerous amendments in their functioning in order to provide a safe environment. This study will serve as a basis for future awareness programmes which could be directed towards children belonging to various socioeconomic status and educational backgrounds highlighting the aspects in which they lack knowledge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC32-ZC37&id=14925 https://doi.org/10.7860/JCDR/2021/47485.14925 Effect of Migraine on Functional Performance and Self-reported Symptoms in Children with Concussion: A Cross-sectional Study Abdulaziz Abdullah Alkathiry <b>Introduction: </b>Several factors have been identified to influence concussion. Migraine has been identified as a common symptom reported after concussion which has been related to a worse prognosis. Concussion is a common brain injury that affects physical and cognitive performance. While several studies indicated that adolescents are more likely to develop concussion, in the last decade concussion has been mainly explored in adults. <b>Aim:</b> To investigate the effect of migraine on functional performance and self-reported symptoms in children with concussion. <b>Materials and Methods:</b> This cross-sectional study involved 35 symptomatic children with concussion aged 9-17 years recruited within one year from their concussion injury at a tertiary care centre in Pittsburgh, PA, Unites States of America. Participants’ symptoms and functional performance were assessed using the Postconcussion Symptoms Scale (PCSS) and the Functional Gait Assessment (FGA) respectively. Statistical Package for the Social Sciences (SPSS) Statistics for Windows (version 22; IBM Corp, Armonk, NY) was used for all statistical analysis. <b>Results:</b> Mann-Whitney U test showed that concussed children with migraine had significantly worse symptoms of fatigue and visual problems (p<0.05). The participants had a mean age of 14.03&#177;2.47 years and 66% were females. <b>Conclusion:</b> Although concussed children with and without migraine did not show any differences on functional performance, worse fatigue and visual symptoms were found in concussed children with migraine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=YC11-YC14&id=14928 https://doi.org/10.7860/JCDR/2021/49354.14928 Concepts and Perception of Restoring Endodontically Treated Teeth among Dental Practitioners in Western Region of Saudi Arabia- A Questionnaire Based Study Karunakar Shetty, Sara Abdulrhman Shugair, Ghada Saad Alshohaib, Riham Zamil Abulhamayel, Sara Taleb Alshawa, Nowf Nawaf Alturki <b>Introduction:</b> Endodontically Treated Teeth (ETT) are most likely to get fractured, if left unrestored compared with the vital teeth due to the loss of tooth structure and reduced modulus of elasticity. <b>Aim:</b> To gain insight into the rationale for choice of endodontic posts and the different endodontic post systems currently used by dental practitioners in western region of Saudi Arabia. <b>Materials and Methods:</b> For this survey-based study, a questionnaire was designed consisting of eight questions to assess the details of why, when and how general practitioners restore ETT and to determine contemporary use of endodontic post from first November 2018 till the end of January 2019. This questionnaire was sent online to 250 private dental practitioners in western region of Saudi Arabia, out of which 202 participants responded. Data was entered in the excel sheet. Descriptive statistics like frequency and proportion was calculated for qualitative data. <b>Results:</b> This study included 202 participants with the mean age group of 25-50 years, out of which there were 108 (53.46%) male participants and 94 (46.53%) female participants. Total 120 (59%) of the study sample were general practitioners and 82 (41%) of them were specialists. A total 60 (29.70%) of the general practitioners, reported restoring ETT with post and core followed by the crown, whereas, 30 (14.85%) of them did the crown without post, 15 (7.42%) of them completed restoration with composite and 15 (7.42%) of them did build-up with post and core. An 82 (40.59%) of the specialists, reported restoring ETT with post and core build-up and then proceed with crowns. An 80 (39.60%) of the study sample were into general practice, reported using prefabricated fibre post whereas, 23 (11.38%) of them using cast post and 17 (8.41%) of them using prefabricated metal posts. Total 72 (35.64%) of the specialists reported using prefabricated fibre posts and 10 (4.95%) of them used cast metal post. <b>Conclusion:</b> Based on the results of the study, it can be concluded that majority of the participants practiced reinforcement of ETT by using fibre posts with resin cements followed by crowns.. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZC38-ZC42&id=14929 https://doi.org/10.7860/JCDR/2021/48217.14929 The Burden of Methicillin Resistant <i>Staphylococcus aureus</i> in Surgical Site Infections: A Review Brajesh B Gupta, KC Soman, Lata Bhoir, Minakshi Gadahire, Bhavin Patel, Jaishid Ahdal Despite increased pre and postoperative care including screening procedures, improvement in the operating room environment, and controlled prophylactic antibiotic therapy, the health burden of Surgical Site Infections (SSIs) in India is far more escalated than that in developed countries. SSIs ranging from superficial skin infection to life-threatening septicemia affect one third of the patient population undergoing surgery, thereby contributing to morbidity and mortality. One of the most dominant bacterial species that causes SSIs is Staphylococcus aureus, wherein Methicillin Resistant S.aureus (MRSA) alone contributes to a significant increase in both the cost and the length of hospitalisation along with an increased mortality rate among patients with SSIs. The rising resistance pattern among pathogens coupled with the concerns over the tolerance and safety of currently available agents against MRSA limits treatment options available for patients with SSIs. Levonadifloxacin and its oral prodrug alalevonadifloxacin are novel benzoquinolizine anti-MRSA agents which have recently been approved in India to tackle gram positive ‘super-bugs’. Herein, the aim of this review article was to collate the possible factors contributing toward SSIs, its implications on health and economy, antibiotic resistance, possible preventive measures, and the need for new antimicrobial agents. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=PE01-PE06&id=14891 https://doi.org/10.7860/JCDR/2021/46922.14891 Lymphangioma of the Tongue: A Review Ahmed Hassan Mustafa Lymphangioma is considered as a congenital hamartomatous malformation of the lymphatic system, it is more prevalent in the maxillofacial region. Oral lymphangiomas are rare but if it occurs, the tongue is the most commonly affected site, it is rarely seen on other sites such as the palate, gingiva and alveolar ridge of the mandible. This study aims to throw light on lymphangioma of the tongue regarding pathogenesis, clinical signs and symptoms, and the different treatment modalities. Although lymphangioma is benign in nature and its occurrence in the tongue is extremely rare, healthcare providers including general dental practitioners must be vigilant and aware of the presence of such lesion to promote a precise diagnosis. So that, proper treatment can be delivered for this lesion, to avoid serious complications that might occur when it becomes traumatised or infected, in which case it obstructs the airway and leads to the death of the patient, if not promptly rescued. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZE01-ZE03&id=14901 https://doi.org/10.7860/JCDR/2021/46971.14901 Recurrent Multinodular Pleomorphic Adenoma of Parotid Gland- A Case Report Priya Kanagamuthu, Swetha Thirumurthi, S Rajasekaran, S Prabakaran, RB Namasivaya Navin Pleomorphic adenoma or benign salivary gland tumours predominantly affects the superficial lobe of parotid gland. It is a slow growing swelling with or without facial nerve involvement with female predilection in third and fifth decade of life. The origin of the tumour is both epithelial and connective tissue and hence it is of pleomorphic nature. After surgery, its recurrence rate varies considerably and seems to depend more on the surgical technique used. A 49-year-old male patient presented with complaints of swelling in front of right ear and right parotid region for past eight years. He gave previous history of similar swelling in the right parotid region and history of previous surgery done elsewhere in 2009. Right superficial parotidectomy was done following which he was asymptomatic for two years. On examination of right parotid- a multilobulated irregular swelling was present in right parotid region and the swelling extended till the right ear lobule. The swelling hid previous surgical scar. Facial nerve was clinically intact. Fine Needle Aspiration Cytology (FNAC) was suggestive of Pleomorphic Adenoma. Magnetic Resonance Imaging (MRI) with contrast revealed that the lesions were arising from superficial lobe of the parotid gland. Right superficial parotidectomy was planned. Mass was excised and sent for histopathological examination and was reported to be Pleomorphic Adenoma. Patient is still on follow-up and no recurrence has been noted. The rate of recurrence depends on tumour spillage, intra-surgical rupture, or any histopathological feature. There is significant risk for local recurrence if the microscopic finger like formation (pseudopodia) of tumour tissue extends beyond the main mass. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=MD01-MD03&id=14907 https://doi.org/10.7860/JCDR/2021/49465.14907 Iatrogenic Left Main Coronary Artery Dissection Treated with Bare Metal Stents: A Case with Twelve Years Angiographic Follow-up Shuvanan Ray, Sunil Jain, Sabyasachi Mitra Complications during the course of Percutaneous Coronary Interventions (PCI) are common. One of the complications is iatrogenic Left Main Coronary Artery (LMCA) dissection, which is considered as lethal in nature and prevails in around 0.07% PCI cases. Timely diagnosis and immediate revascularisation is mandatory to manage LMCA dissection in order to avoid worsening of patient’s haemodynamic condition and to re-establish antegrade coronary blood flow. Here, authors report a case of catheter-induced iatrogenic LMCA dissection developed during stenting of a lesion in Left Anterior Descending (LAD) coronary artery of a 32-year-old male patient. The patient was managed by implantation of two Matrix (Sahajanand Medical Technologies, Pvt., Ltd., Surat, India) Bare Metal Stents (BMS) using double barrel technique to treat the dissection in left main coronary bifurcation. The patient was regularly followed-up and even after 12 years of the index procedure, the angiographic data revealed good patency of stents in LMCA without any major cardiac events. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OD13-OD14&id=14890 https://doi.org/10.7860/JCDR/2021/48106.14890 Atypical Presentation of an Adrenal Mass Krishna Swathi Pavuluri, N Senthil, RB Sudagar Singh, L Suja Catecholamine-secreting tumours arise from chromaffin cells of the adrenal medulla, and the sympathetic ganglia referred to as pheochromocytomas and catecholamine secreting paragangliomas, respectively. The incidence of pheochromocytoma is less. This was about a 38-years-old male patient that complained of burning sensation while micturition and right loin pain. On evaluation, he was found to have a right adrenal mass of size of 6 cm. The patient was found to have right ureteric caliculi and right Double J Stent (DJ) was done. Patient was advised for further evaluation but he was not willing at that point of time. Thus, pheochromocytoma has to be one of the differentials in a young person presenting with hypertension or with atypical presentation. Because pheochromocytoma is one of the correctable causes of hypertension and a person can have a near normal or average life span after surgery. This patient presented with urinary symptoms followed by typical features of cholelithiasis rather than symptoms of pheochromocytoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=OD11-OD12&id=14888 https://doi.org/10.7860/JCDR/2021/47719.14888 Step Wise Management of Asyndromic Tooth Agenesis with Ankyloglossia: A Case Report Vandana R Gadve, Vijaya S Dhote Ankyloglossia or tongue tie refers to restricted tongue movements, diagnosed in early childhood and adolescence that may cause changes in bone growth and other orofacial tissues results in altered oral functions of the child. It also affects speech, mastication and oral hygiene as well as social environment. Patients with oligodontia and tongue tie may have psychological, aesthetic, phonetic and functional problems. Here the author presents a rare case in a 13-year-old female patient with congenital partial anodontia and associated ankyloglossia with its comprehensive step wise multidisciplinary management. The patient was advised for frenectomy to relieve tongue tie and functional fixed aesthetic space maintainer at an early age and was followed-up to be treated with definitive implant prosthesis with respect to the missing teeth. Early treatment and follow-up is the key to successful rehabilitation of young patients with congenitally missing teeth and ankyloglossia. It is imperative that oral rehabilitation to be started as early as possible to maintain and correct the oral functions. This clinical report describes a successful aesthetic, functional, and psychological rehabilitation of a young adolescent girl with partial anodontia in mandibular anterior region and associated extensive tongue tie with step by step surgical and prosthetic management in accordance with the physical growth pattern of patient. It also offers guidelines for comprehensive management which can be used by the treating pedodontist and oral surgeon for diagnosis and treatment of ankyloglossia and partial anodontia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZD05-ZD08&id=14949 https://doi.org/10.7860/JCDR/2021/47832.14949 Accuracy of 3D Curvilinear Measurements on Digital Models Generated by Light Emitting Diode Scanned Impressions: A Cross-sectional Study Ismatfatema Mohsin Nayani, Manish Suresh Agrawal, Jiwanasha Manish Agrawal, Shradhha Shetti, Bhakti Bhalekar, Akash Agarwal <b>Introduction:</b> The advantages of digital models include customisation of appliances such as retainers, expanders, and indirect bracket setups for which measurements made along a curved line (curvilinear), would offer clinically more relevant information as opposed to linear measurements. <b>Aim:</b> The purpose of this study was to evaluate and compare the accuracy of 3 Dimensional (3D) curvilinear measurements on Digital models generated from Light Emitting Diode (LED) scanned impressions, with manual measurements on study models. <b>Materials and Methods:</b> The cross-sectional study consisted of maxillary arch rubber based impressions of eight patients selected on inclusion criteria of intact dentition having complete set of teeth with erupted second molar. These impressions were scanned with LED scanner (Medit Identica) and converted to Stereolithography (STL) files to generate 3D models. With the help of Ansys software curvilinear measurements were obtained from these models. These impressions were poured in dental stone to prepare study models and manual measurements were directly carried out on it with the help of brass wire and digital caliper. Measurements were made on different locations on the dental arch in various directions as the labial and palatal surface of central incisors and canine on left side along the long axis of the tooth from the cusp tip to the gingival margin and the buccal and palatal surface between the two interdental contact points of 2<sup>nd</sup> premolars. Unpaired t test was used to check the significant difference in means of different parameters. <b>Results:</b> No significant differences were found between central incisors labial surface (p=0.845) and palatal surface (p=0.722) and the canine measurements labial surface (p=0.721) and palatal surface (p=0.544) on digital models compared to study models, whereas significant difference was observed in premolar measurements (p-value&#8804;0.05). <b>Conclusion:</b> STL files obtained by LED scanning the impressions did not exhibit significant deformation or loss of information while curvilinear measurements were evaluated, and higher accuracy was seen in the premolar measurement on palatal surface with digital models. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZG01-ZG04&id=14887 https://doi.org/10.7860/JCDR/2021/42316.14887 Protocol for a Systematic Review of School Based Educational Interventions on Prevention and Control of Malaria Chokkara Roja, A Seetha Lakshmi, M Anitha Rani, Alex Eapen <b>Introduction:</b> Schools are an integral part of the community and creating health awareness at the educational premises is one of the successful policies for the health promotion. School children play an active role as health changing agents in the community and hence, can be the health messengers for malaria prevention. The need of the current review is to strengthen the evidences towards malaria elimination. <b>Aim:</b> To evaluate the influence of school based educational interventions for the malaria control and prevention activities. <b>Materials and Methods:</b> This review on malaria will search the literature from databases such as PubMed, Medline, CINAHL Plus, Cochrane Library, Google Scholar and Science Direct using keywords. It will follow Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Quantitative studies (Randomised trials and Non randomised trials) published from 2001 to 2020 in English language will be included. Joanna Briggs Institute (JBI) critical appraisal checklist will be used to assess the quality of the studies. <b>Results:</b> Findings of the selected articles will be presented in the form of narrative summaries along with statistical interpretations. <b>Conclusion:</b> This review on school based educational interventions will provide evidences in order to take preventive and control measures on malaria. It will support the hypothesis that school based educational interventions play an essential role to enhance knowledge about malaria, reduce malaria prevalence and promote preventive measures in the community https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=LK01-LK03&id=14938 https://doi.org/10.7860/JCDR/2021/48381.14938 Prenatal Invasive Procedures during Peak of COVID-19 Pandemic Chanchal Singh, Gazala Shahnaz, Seema Thakur The current Coronavirus Disease-2019 (COVID-19) has had an immense adverse effect on provision of routine healthcare services including maternity care. Prenatal invasive procedures are amongst the most affected due to their availability at limited centres, reallocation of health resources, restricted mobility of individuals and the perceived ‘semi-elective’ nature of these procedures. However, these are essential procedures, even life-saving in cases of foetal anaemia, and time-sensitive especially considering the upper limit of legal age of medical termination of pregnancy in India. Data on COVID-19 is currently limited and the risk of vertical transmission is unknown. Here the author presents experiences of prenatal invasive procedure during April 2020 and May 2021, the peak months of COVID-19 and stringent lockdown. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=QI01-QI02&id=14948 https://doi.org/10.7860/JCDR/2021/48374.14948 There's More to a Bergmeister's Papilla Than Which Meets the Eye Shruthy Vaishali Ramesh, Prajnya Ray , Prasanna Venkatesh Ramesh ,Meena Kumari Ramesh , Ramesh Rajasekaran A 60-year-old female presented with bilateral immature cataract with best-corrected visual acuity of 20/200 in both eyes Oculus Uterque (OU). Fundus examination of left eye Oculus Sinister (OS) <a href=tableview.asp?id=14909&img_src=14909_1.jpg target=_blank>(Table/Fig 1)</a> revealed Bergmeister&#8217;s papilla. The remainder of OS examination, including the right eye Oculus Dextrus (OD), was unremarkable. Optical Coherence Tomography (OCT) revealed that the Bergmeister&#8217;s papilla was creating peripapillary traction on the adjacent nasal retina with disruption of inner retinal layers <a href=tableview.asp?id=14909&img_src=14909_2.jpg target=_blank>(Table/Fig 2)</a>. Vigilant monitoring of traction complex following cataract surgery was advised. Bergmeister&#39;s papillae is an uncommon anomaly that arises from the centre of the optic disc consisting of fibrous sheath, and represents the remnant of the hyaloid artery which is frequently observed as an incidental clinical finding <a href=#fr1 name=ft1>(1)</a>. The papillae are usually asymptomatic. The Bergmeister&#39;s papillae is a developmental congenital anomaly of the embryogenic hyaloid artery, which appears at the third week of gestation and reaches the lens by the fourth or the fifth week of gestation, to form tunica vasculosa lentis, eventually undergoing complete atrophy and disappearance at birth <a href=#fr1 name=ft1>(1)</a>. The remnant of anterior portion of the hyaloid artery is called the Mittendorf&#8217;s dot, which is commonly located on the infero-nasal aspect of the posterior lens capsule and the remnant of the posterior portion of the hyaloid artery is called the Bergmeister&#8217;s papillae which is present at the Optic Nerve Head (ONH) usually composed of glial tissue <a href=#fr2 name=ft2>(2)</a>. In most cases, the Bergmeister&#8217;s papillae is an occasional finding with no clinical impact. But in most severe cases it can be associated with, pigmentary changes, amblyopia, posterior polar cataract, microphthalmia, persistence of primitive vitreous, vitreo-macular traction, vitreous haemorrhages and sometimes tractional retinal detachment due to contraction of the residual fibrovascular tissue [3-5]. In this case scenario <a href=tableview.asp?id=14909&img_src=14909_2.jpg target=_blank>(Table/Fig 2)</a>, the condition is prone to contraction of the fibrovascular tissue, which may exert traction on the retina causing peripapillary traction on the adjacent retina with disruption of inner retinal layers. For diagnosis, slit-lamp examination, fundus examination and OCT have been used. Anticipating a sequential peripapillary area vitreous thickening, vigilant monitoring needs to be done for the development of vitreo-macular traction, tractional retinal detachment or retinoschisis as they may become a possible cause of future visual deterioration <a href=#fr6 name=ft6>(6)</a>. Though Bergmeister&#8217;s papillae is most often inconsequential, the need for OCT evaluation in view of a rare vitreoretinal adhesion proves to be a useful non invasive test, to monitor its clinical sequelae. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=NJ01-NJ02&id=14909 https://doi.org/10.7860/JCDR/2021/48931.14909 Retracted- 2021, 15(4): OC37-OC40 <b>Ravinder Singh, PV Sripadma, Vaibhav Mathur, Sujata Ganguly</b>, A Cross-sectional Study on Electrophysiological Evaluation of Neuropathy in Rheumatoid Arthritis, Journal of Clinical and Diagnostic Research, 2021; 15(4): OC37-OC40. This article has been retracted as it was bought to the editorial notice that the electrophysiological prerequisites of maintaining ambient temperature, correction for height and utilization of a single machine for all recordings were not uniformly executed leading to inaccuracies in data interpretation and statistical analysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZZ02-ZZ02&id=14912 https://doi.org/10.7860/JCDR/2021/.14912 Retracted- 2011, 5(3): 538-541 <b>Patil G., Kolagi S., Ramadurg U. Sexual dimorphism in the humerus: A study on South Indians.</b> Journal of Clinical and Diagnostic Research,  2011; 5(3): 538-541. This article has been retracted after it was brought to the notice of the editorial by a reader of high level of similarity with an earlier publication. Thus, making this work a redundant publication. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=May&volume=15&issue=5&page=ZZ01-ZZ01&id=14873 https://doi.org/10.7860/JCDR/2021/.14873