Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Primary Extraskeletal Myxoid Chondrosarcoma: A Case Report Renuka Bangalore Nagaraj, Arshiya Sultana Extraskeletal Myxoid Chondrosarcoma (EMC) is a rare malignant soft tissue sarcoma with uncertain differentiation, most often seen in males. The incidence is 3% of all soft tissue tumours with limited literature available on its cytological features. EMC may arise from lower extremities, upper extremities, retroperitoneum, pelvis, and buttocks. This case report was an effort to understand the role of Fine Needle Aspiration Cytology (FNAC), histopathology and immunochemistry in the diagnosis of EMC. Authors hereby report a case of a 70-year-old male patient with slow-growing soft tissue swelling on the back just behind the right shoulder who was referred for FNAC. Patient complete history and clinical findings were recorded. Radiological images were suggestive of malignant soft tissue neoplasm with no involvement of underlining bone. FNAC reveled tumour cells which appeared monotonous and they were seen in a myxoid stroma background. Subsequently, the excised lesion was sent for histopathological examination and the report revealed the presence of abundant chondromyxoid matrix material within which were found numerous elongated spindly shaped cells. These cells had moderately pleomorphic elongated nuclei with focal solid fibrocollagenous areas along intersecting fascicles of the moderately pleomorphic spindly cell. Few of these cells had multilobulated bizarre nuclei with nuclear inclusions. Immunohistochemical stains showed diffuse positivity for S-100, vimentin, and focally positive for Epithelial Membrane Antigen (EMA). The FNAC, histopathology and immunohistochemical features confirm the diagnosis of EMC on right shoulder. It’s a rare tumour whose diagnosis is made depending on history, clinical location, growth pattern, histopathology, and immunohistochemistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ED01-ED03&id=15319 https://doi.org/10.7860/JCDR/2021/47753.15319 Papillary Carcinoma of Thyroid in Thyroglossal Cyst- A Case Report RB Namasivaya Navin, S Rajasekaran, PN Aswin Vaishali, K Priya, S Prabakaran Thyroglossal duct cysts are most commonly occurring congentinal midline swellling of the neck. Usually carcinomas in thyroglossal duct cysts is extremely rare, commonly known as papillary carcinomas. However, the diagnosis is only made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate but controversies exist, the need for thyroidectomy is based on histopathological findings. This is a case report of 43-year-old male presenting with swelling in the midline of the neck for one year. On examination, a cystic swelling was present in the midline of the anterior aspect of the neck. Ultrasonography (USG) neck revealed heteroechoic cystic lesion with solid component and microcalcifications present within the cyst suggestive of thyroglossal duct cyst probably neoplastic. The mass was surgically excised and sent for histopathological examination and reported as thyroglossal duct cyst with papillary carcinoma of thyroid. Appropriate history, clinical examination and investigation leads to the correct diagnosis and treatment. Incomplete removal of the mass leads to recurrence. Histopathological examination is a must postoperatively. The patient is still on follow-up and no recurrence have been noted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=MD01-MD02&id=15321 https://doi.org/10.7860/JCDR/2021/50276.15321 Non Clostridial Gas Gangrene Leading to Stroke in Postoperative Period- A Case Report Sukhvir Singh, Gazala Shabeen Gas gangrene is a life threatening infection of muscles and soft tissues which is associated with very high mortality rate. Non clostridial gas gangrene is a rare phenomenon that mostly occurs in diabetic patients. Gas gangrene leads to various systemic manifestations. A 66-year-old female patient, diabetic with chronic kidney disease, on haemodialysis was presented as a rare case of non clostridial right great toe gas gangrene, which progressed to systemic toxicity and stroke within a period of 72 hours in postoperative period. The source of infection in this case may have been <i>Acinetobacter</i> which is a gram-negative bacterium. Despite prompt diagnosis and intensive therapy, the patient died 15 days after the operation. After going through literature, no case was found to be reported of stroke in postoperative period due to non clostridial gas gangrene thus making it a unique case to report. Also, only few cases of life threatening non clostridial gas gangrene are reported in literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UD01-UD02&id=15328 https://doi.org/10.7860/JCDR/2021/49359.15328 Primary Percutaneous Coronary Intervention in an Anomalous Left Circumflex Artery: Search for the Hidden Culprit Cinosh Mathew, Ashish Sharma, Nishant Saxena, Jayesh Rawal Congenital coronary anomalies are rarely detected in patients undergoing diagnostic coronary angiography. They pose a challenge in delay to identify the anomalous artery as well as difficulty in engaging the anomalous vessel. The present case report was of 56-years-old male patient presented with acute onset of chest pain. On evaluation, his electrocardiogram was suggestive of ST segment elevation in inferior leads. He underwent diagnostic coronary angiogram which revealed totally occluded Left Circumflex Artery (LCx) arising anomalously from right coronary osteum. Primary Percutaneous Coronary Intervention (PCI) of LCx could not be performed with routine guide catheters necessitating the use of special multipurpose guide catheter with balloon support. The case highlights the need for the knowledge of coronary anatomy and anomalous origins of coronary arteries and the selection of appropriate guiding catheters and coronary wires. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OD01-OD03&id=15329 https://doi.org/10.7860/JCDR/2021/50511.15329 The Great Masquerade: A Rare Presentation of Spinal Tuberculoma Arnesh Bhattacharya, Ajay Chauhan, Ayushi Singhal Spinal tuberculomas form a meagre fraction of cases of Tuberculosis (TB). Most common presentation of spinal tuberculoma is weakness. A 45-year-old female presented with dysthesias, gait instability and numbness involving both lower limbs for a period of 7 to 10 days. Patient was vitally stable (blood pressure of 128/78 mm of Hg, pulse rate of 86 beats per minute and respiratory rate of 18 breaths per minute with a normal pattern), alert and co-operative. Neurological examination suggested non length dependant sensory involvement of lower limbs, sensory ataxia and areflexia, level of lesion being at the Dorsal Root Ganglia (DRG) (sensory neuronopathy). Contrast Enhanced Magnetic Resonance Imaging (CEMRI) spine revealed tuberculoma at D9 spinal level. Patient responded to Antitubercular Therapy (ATT) and recovered. The intention of sharing the clinical experience is with the sole purpose of remembering the fact that common pathologies may at times be great mimickers. In the present case, while a lot of rare causes (autoimmune, neoplastic) were searched for, tuberculoma happened to be the culprit. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OD04-OD06&id=15335 https://doi.org/10.7860/JCDR/2021/50136.15335 An Insight into Pyogenic Granuloma with Ossification: Exploring a Unique Association Aparna Dave, Manpreet Arora, Pulin Saluja, Ishita Singhal, Priyanka Singh Pyogenic Granulomas (PG) are reactive hyperplastic lesions that are formed in relation to some chronic irritation, physical trauma or hormonal factors. The PG may present in various clinical and histological forms. These often present as a smooth lobulated exophytic lesions and at times may show a marked resemblance to Peripheral Ossifying Fibroma (POF). However, the characteristic histologic presentation helps in differentiating both the lesions. Microscopically, presence of ossification in pyogenic granuloma is not common and could possibly indicate an altered response of the connective tissue stroma. The present case report shows occurrence of pyogenic granuloma in a 12-year-old female which on histological examination not only exhibited proliferating blood vessels, endothelial cells and inflammatory cells which are typical features of pyogenic granuloma but also exhibited areas of ossifications which are not frequently encountered in PG. It is important to explore the underlying aetiological factors that could lead to formation of such ossifications. It has been suggested that pyogenic granuloma and peripheral ossifying fibroma could represent part of same spectrum of focal reactive lesions. However, it is still considered that these two lesions are separate clinical entities and the histologic presentations are different and unique to both of them. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZD01-ZD03&id=15337 https://doi.org/10.7860/JCDR/2021/50298.15337 Primary Non Hodgkin's Lymphoma of the Lacrimal Sac-A Noteworthy Watery Eye Pavithra Thanigaivel, Leena Dennis Joseph, Vasugi Arumugam, Sanjeev Mohanty Lacrimal sac tumours are rare tumours in ophthalmology but may have serious complications when misdiagnosed. Lacrimal sac tumours can be either epithelial or non epithelial tumours. Epithelial tumours account for 60-94% of tumours. Pseudostratified ciliated columnar epithelium lines the lacrimal sac. Squamous cell carcinoma, transitional cell carcinoma, mucoepidermoid carcinoma, oncocytic adenocarcinoma, adenoid cystic carcinoma and metastasis are the commonly occurring epithelial tumours. Inverted papilloma is a locally aggressive tumour. Non epithelial tumours (25%) are rarer than the epithelial tumours. Lymphoproliferative, melanocytic, and mesenchymal tumours are the non epithelial tumours, among which the lymphoproliferative tumours constitute 2-8%. Very rarely Non Hodgkin’s lymphoma can occur as a primary in the lacrimal sac. Melanoma can occur as a primary from the melanocytes of the lining in the lacrimal sac or as a secondary from the conjuctival melanoma. Kaposi sarcoma and rhabdomyosarcoma are the mesenchymal tumours. Here is a case of Non Hodgkin’s Lymphoma (NHL) occurring in the lacrimal sac in an 80-year-old male. The patient came with the chief complaint of swelling around the right eye since two months. On radiological examination, Computed Tomography (CT) revealed a homogenous solid mass in the right medial canthus, causing bony erosions of the orbit and extending into the nasolacrimal canal. An incisional biopsy of the mass was consistent with the diagnosis of Non Hodgkin’s lymphoma which was further confirmed by immunohistochemistry. This unusual presentation and histopathological features are described. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ED04-ED06&id=15339 https://doi.org/10.7860/JCDR/2021/47763.15339 Adenomatoid Odontogenic Tumour Associated with Dentigerous Cyst: Case Report with Literature Review Pradipta Ramgonda Patil, Hirkani Attarde, Priyanka Prakash Kamble, Sangeeta Patankar, Gokul Sridharan Adenomatoid Odontogenic Tumour (AOT) is a relatively uncommon benign odontogenic tumour composed of odontogenic epithelium in a variety of histoarchitectural patterns. Conventional AOT is predominantly seen in females in second decade of life exhibiting predilection for anterior region of maxilla. Very few cases of AOT associated with dentigerous cyst have been reported till date. The present case is unique associated with an impacted lower first premolar in the front region of the mandible of an 18-year-old female patient. The patient reported to the institute with gradually increasing swelling. The orthopantomogram revealed a unilocular radiolucency with displaced premolar. Histopathological examination confirmed 4&#215;2.5&#215;2 cm lesion in dimension, brownish black in colour, firm in consistency with a smooth surface grossly while cut surface revealed a cystic lumen with an impacted premolar embedded into the lining, cystic wall being nodular. Microscopic evaluation revealed a well encapsulated lesion with a thin 2-3 cell layered non keratinised stratified epithelial lining in patterns such as nests, rosette like structures and duct like structures. Thus the diagnosis of AOT arising from dentigerous cyst was confirmed. Patient&#39;s six month follow-up was uneventful. Literature search of similar cases with the review of hypothesised aetiopathogenesis is discussed in brief. The available data can help researchers resolve the uncertainty whether the AOT derived from dentigerous cyst could represent a distinct hybrid variety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ED07-ED09&id=15345 https://doi.org/10.7860/JCDR/2021/50469.15345 Death, a Rare Complication of Cranioplasty in Emergency: A Case Report Nandakishore Sahoo, Sudarshan Bhat, Mohan Rangan Cranioplasty is a reconstructive procedure which is performed to restore the calvarial integrity with either a stored autologous bone flap or a custom synthetic prosthesis. It is performed to protect the brain and as a cosmetic procedure. It has been shown to improve patient&#8217;s functional outcome. This procedure has been performed as early as <14 days postdecompressive craniectomy. Cranioplasty in emergency which is a variant of secondary cranioplasty is rarely indicated after decompressive craniectomy. Complication rate associated with cranioplasty is relatively high. Infection, convulsions, and epidural haematoma are frequent complications of cranioplasty which are not life threatening. Fatal complications associated with this procedure are not well documented and that could be among one of the reason that death, as a complication following cranioplasty is substantially low. Here, a case of unexpected death of a 37-year-old female postcranioplasty which was performed as an emergency procedure is reported. She was a previous case of right mid one-third parasagittal meningioma who developed severe sinking skin flap syndrome after three months of parasagittal craniectomy. The patient was operated under general anaesthesia for reconstruction of the residual calvarial defect. However, the patient developed bacterial meningitis and on the 16<sup>th</sup> day postcranioplasty procedure, she died of cardiac arrest. The procedure had otherwise been uneventful and it was speculated that infection and cerebral oedema postcranioplasty might have been the cause of death. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZD04-ZD06&id=15355 https://doi.org/10.7860/JCDR/2021/43799.15355 Plasma Exchange as a Rescue Therapy for Acute Liver Failure Nupur B Patel, Anand Sharma, Itish Patnaik, Ashok Kumar Acute Liver Failure (ALF) is a life-threatening condition and often necessitates Liver Transplantation (LT). However, LT is not available to most patients in developing countries due to resource constraints. A 30-year-old female presented to us with ALF and fulfilled criteria for LT. The aetiology of ALF could not be diagnosed in her. Due to the lack of LT facilities, she was offered plasma exchange as a therapeutic option, which resulted in improvement in sensorium and Liver Function Tests (LFT) {bilirubin, International Normalised Ratio (INR), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)} over a period of two weeks. She was discharged and was doing well during follow-up. Plasma exchange is a less studied but potential treatment option for ALF when LT is not feasible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OD07-OD09&id=15371 https://doi.org/10.7860/JCDR/2021/49865.15371 Management of Unilateral Multiple Impacted Molars- An Interdisciplinary Approach of a Rare Clinical Case S Gopalakrishnan, Kamal, Karthikeyan, V Keerthi Narayan, D Gomathy Impaction of first, second and third molars at once comprise a rare clinical scenario with diverse therapeutic approaches and possess a great challenge for the dentist. Early detection of the eruption disturbances helps to manage and produce optimal outcomes. Here, the authors reported a case of 17-year-old male patient who reported with the chief complaint of pain in his lower left back tooth region with difficulty in mouth opening and chewing that revealed impacted mandibular left first, second and third molar on radiographic investigation. A proper decision making is required to satisfy the patient and also get an effective result. As the patient had severe pain in the left side of the jaw near the angle of the mandible, surgical removal of the impacted molars was planned and performed using extra oral submandibular approach. Following the removal of the teeth, implants were placed in the extracted site supported by bone graft material and fixed orthodontic appliance therapy was carried out to correct the supraerupted upper molars on the left side and arch expansion screw with upper Hawley’s appliance was given to expand the maxillary arch to aid in appropriate occlusion. Restoration of the implant was done after one year of orthodontic treatment using ceramic crowns. The combined surgical, orthodontic and periodontal interdisciplinary approach helped the patient to gain proper occlusion and satisfactory masticatory function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZD07-ZD11&id=15372 https://doi.org/10.7860/JCDR/2021/49901.15372 Acquired Chiari Type 1 Malformation Secondary to Paget’s Disease of the Bone: A Case Report Srestha Khan, Senthil Kumar Aiyappan, Abinesh Govindarajan, Vinayagam Shanmugam Chiari type 1 malformations are characterised by caudal descent of cerebellar tonsil into foramen magnum. Usually it is congenital. Paget&#8217;s disease causing acquired chiari type 1 malformation is rare with only five reported cases in the literature. The diagnosis is primarily by Magnetic Resonance Imaging (MRI). Authors reported a case of acquired chiari type 1 malformation due to paget&#8217;s disease in a 58-year-old male patient diagnosed by MRI and Computed Tomography (CT). The patient presented with complaints of headache, unsteady gait, slow movements with weakness in all the four limbs, difficulty in walking which aggravated since three days and stammering of speech. Initially a diagnosis of motor neuron disease was suspected and the patient was subjected for MRI examination of brain and spine. MRI revealed platybasia with cerebellar tonsillar herniation with calvarial thickening and multiple vertebral collapse. The CT of brain and spine was done to evaluate bones specifically in view of thickened cranial vault and multiple vertebral collapse on MRI which revealed features of paget&#8217;s disease in the form of widened sclerotic bone with lytic areas and thickened trabeculae. Hence, diagnosis of paget&#8217;s disease causing acquired chiari type 1 malformation was made which correlated with biochemical findings. The management is different in primary and acquired chiari type 1 malformation and hence it is important to diagnose this condition which is relatively rare. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=TD01-TD02&id=15373 https://doi.org/10.7860/JCDR/2021/50656.15373 Primary Cutaneous Plasmacytosis with Calcinosis: A Rare Case Report AS Sanjana Primary cutaneous plasmacytosis is a rare disorder. Cases have been mostly reported from Japan. Here, a rare case of cutaneous plasmacytosis with calcium deposits was reported from southern part of India. A 47-year-old male patient presented with solitary asymptomatic nodule on the left leg present for two decades. Skin biopsy showed sheets of plasma cells in mid-dermis with bony trabeculae extending upto subcutis which was unremarkable. Serum electrophoresis did not reveal any M band and Bence Jones protein was absent in urine. Radiograph of the left leg showed focal lesion with calcific areas in soft tissue shadow with probability of calcification. Novelty of the case lies in its rare clinical presentation in this population with histopathological documentation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=WD01-WD03&id=15381 https://doi.org/10.7860/JCDR/2021/48993.15381 A Unique Constitutional Robertsonian Translocation t(13;14) Associated with Severe Aplastic Anaemia Bhupendra Singh, Aparajita Singh Chauhan, Shailendra Prasad Verma, Anil Kumar Tripathi, Swasti Sinha Aplastic anaemia is characterised by cytopenias and hypocellular bone marrow without any evidence of marrow fibrosis or marrow infiltration. There is no specific cytogenetic abnormality associated with aplastic anaemia. Most common abnormalities are trisomies of chromosome 6, 8 and loss of 7. A 17-year-old female, presented with generalised weakness, exertional breathlessness and menorrhagia for last six months. She also gave a history of 12 units Packed Red Blood Cells (PRBC) transfusion, at the rate of 2-3 units per month in the last five months. Routine haematology showed severe pancytopenia with reticulocytopenia. Bone marrow evaluation revealed hypoplastic marrow with 15% bone marrow cellularity suggesting aplastic anaemia. Karyotyping using Giemsa (GTG) banding of unstimulated culture showed a very unique constitutional Robertsonian Translocation (RT) karyotype 45+XX, der(13;14)(q10;q10). Patient responded partially to treatment with cyclosporine and anabolic steroids. The final diagnosis was severe aplastic anaemia associated with constitutional RT t(13;14) karyotype. Although cytogenetic abnormalities are neither common nor specific in aplastic anaemia, some of them can have diagnostic and therapeutic implications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=GD01-GD03&id=15389 https://doi.org/10.7860/JCDR/2021/50176.15389 Hereditary Spastic Paraplegia Mimicking Cerebral Palsy-Heterozygous Mutation in ALDH18A1 Amit S Vatkar, Nisha Dolas, Vedashree Deshpande, Pallavi Wadhawan, Mumtaz Sharif Spastic paraplegias are characterised by progressive rigidity and weakness of the lower limbs. Spastic paraplegia is a standard differential diagnosis for spastic diplegic cerebral palsy. Hereditary Spastic Paraplegias (HSP) are genetically and clinically heterogeneous group of neurodegenerative disorders causing paraplegias. Eighty forms of HSP have been noted and 64 genes have been identified. The Aldehyde Dehydrogenase 18 family member A1 (ALDH18A1) gene is located at 10q24.1 and it encodes delta-1-Pyrroline-5-Carboxylate Synthetase (P5CS), a mitochondrial bifunctional enzyme which is used for catalysing various amino acids. Mutations in this gene causes P5CS deficiency, which is responsible for neurodegenerative diseases. One should suspect neurometabolic conditions when no definite history of birth asphyxia is present in a case of cerebral palsy. Hereby, the authors report a case of a one-year-old male child with heterozygous mutation in ALDH18A1 gene resulting in spastic diplegia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=SD01-SD02&id=15390 https://doi.org/10.7860/JCDR/2021/49813.15390 A Rare Clinical Scenario of Central Neurocytoma of Brain among Two Young Adult Patients G Haripriya, Pranabandhu Das, Bala Venkat Subramanian, Nandyala Rukmangadha, AY Lakshmi The Central Neurocytoma (CN) is a rare tumour of brain which is commonly seen in young adults. Two cases, A 24-year-old-male and a 37-year-old-female with CN of the lateral ventricles are reported here. Both patients presented with complaints of headache and seizures with no focal neurological deficits. Gross total excision of tumour was carried out via right frontoparietal craniotomy. Afterwards, they received adjuvant radiotherapy by Intensity Modulated Radiotherapy (IMRT), 56Gy in 28 fractions for residual lesion. There was marked improvement in terms of tumour response and improvement of patient’s performance status and quality of life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=XD01-XD02&id=15403 https://doi.org/10.7860/JCDR/2021/48755.15403 Atypical Presentation of Spindle Cell Carcinoma Harshika Singh, Sachin Khanduri, Anvit Krishnam, Poonam Yadav, Harleen Chawla Spindle Cell Carcinoma (SCC) of the lung is a rare entity. Computed Tomography (CT) and histopathology forms the basis of diagnosis. Here, authors presented a case of a 30-year-old male patient who reported with complaints of painless abdominal swelling associated with shortness of breath and fever. The patient underwent Contrast Enhanced CT (CECT) of chest, abdomen and pelvis with percutaneous CT guided biopsy. The final diagnosis was SCC of lung with transdiaphragmatic spread to abdomen. This case is clinically significant as it depicts unusual spread of SCC presenting as thoracoabdominal mass. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=TD03-TD04&id=15405 https://doi.org/10.7860/JCDR/2021/48474.15405 Diphtheria in an Adult: A Paradigm of Waning Immunity Lipika Singhal, Ivneet Kour, Varsha Gupta, Surinder Singhal In the past 10 years, there have been several reported cases of the existence of a vaccine-preventable disease from several Indian states. Diphtheria, re-emerge as a major public health problem as this fatal infection used to be noticed in toddlers and school-going has now been stated to occur amongst adults also despite the fully functional Universal Immunisation Program (UIP) in India. India contributed about 53.9% of diphtheria cases globally in the year 2016. In cases, the reason for the upsurge could be attributed to lack of proper immunisation or waning of vaccine-induced immunity with increasing age. Here, a case of a 24-year-old adult male was reported who presented with acute membranous tonsillitis, a preliminary diagnosis made on physical examination. Corynaebacterium diphtheriae was isolated. Finally, the isolate was confirmed as C. diphtheriae using Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) system. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=DD01-DD03&id=15409 https://doi.org/10.7860/JCDR/2021/49665.15409 Parapharyngeal Schwannoma- A Rare Case Report Aditi Venkat Goyal, Samarth Shukla, Sourya Acharya, Sunita Vagha The incidence of schwannomas is 25-45% in the head and neck region but less than 0.5% when restricted to the parapharyngeal space. The clinical presentation of this lesion varies depending on the anatomical location of its occurrence and thus does the treatment modality. Present report is a case of a 20-year-old female who reported to the Department of Otorhinolaryngology with swelling in the lateral part of the neck which was subsequently diagnosed as schwannoma and appropriate surgical excision was done. Histopathology of the excision lesion confirmed the diagnosis. It becomes crucial to report and revise the tumours of the parapharyngeal space because of the complexity of the area. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ED10-ED12&id=15414 https://doi.org/10.7860/JCDR/2021/49329.15414 Pranic Healing as a Complementary Therapy in Managing Fibromyalgia: A Case Report MKS Vinushree Fibromyalgia is a chronic pain syndrome with main symptoms including pain and tenderness in various parts of the body along with sleep deprivation, fatigue, cognitive dysfunction, and emotional distress. Pranic Healing (PH) is a traditional no-touch healing technique based on balancing the body&#8217;s energy centres or chakras. Here, a case of a 37-year-old female is presented who was diagnosed with fibromyalgia, with pain, stiffness, and sleep disturbances as major symptoms. These symptoms were measured using the Numerical Rating Scale (NRS) score. She received distant PH as a complementary therapy to manage chronic pain and exhaustion symptoms. PH was effective in significantly reducing the severity of fibromyalgia symptoms, including pain by 40% and stiffness by 40%, and improving the quality of sleep by 60% after eight sessions of PH. Thus, PH has the potential to be used as a complementary non pharmacological therapy besides conventional pharmacological approaches to manage fibromyalgia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=KD01-KD02&id=15436 https://doi.org/10.7860/JCDR/2021/50854.15436 Isovaleric Acidemia as a Rare Cause for Bad Obstetric History Sailatha Ramanujam, Shery Angel, Anuradha Coimbatore Ramachandran, Anu Bhargavi Basker Isovaleric acidemia is an inborn error of metabolism, inherited as an autosomal recessive disorder, caused by deficiency of isovaleryl-Coenzyme A (CoA) dehydrogenase, leading to elevated plasma isovaleric acid and urine isovalerylglycine levels. Isovaleric acidemia is an unusual disorder with an incidence of 1:67,000 in India. Parents of the child are assumed to be carriers and the offsprings have a one in four (25%) chance of inheriting the disorder. The present article reports a 33-year-old, Gravida 3 Para 2 Live 0 (G3P2L0) at 38 week + 1 day, with previous two Lower Segment Caesarean Surgery (LSCS) and two neonatal deaths, who delivered a term boy baby with incidental finding of isovaleric acidemia at birth. Isovaleric acidemia could sometimes be a rare case for bad obstetric history and should be considered while evaluating a patient. Also, it is now possible to diagnose the condition by early prenatal tests and even before pregnancy by Preimplantation Genetic Diagnosis (PIGD) and by taking necessary steps. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QD01-QD03&id=15434 https://doi.org/10.7860/JCDR/2021/49124.15434 Peroneus Brevis Muscle Flap as a Tissue Cover for Defect over Lower Mid Leg and Ankle Defects: A Case Series Sanjay Gordhanbhai Vaghani, Ganesh Sadashiv Chaudhari Mid leg and ankle area are more vulnerable for post-traumatic full thickness soft tissue loss. Implants used in osteosynthesis in this region are also at risk of exposure as its placement is in subcutaneous plane as well as precarious blood supply in shin region. Various options like local flap to free flap are described for reconstruction of small and medium size defects in this region. Peroneus brevis is also well described in literatures. In this case series which was done over the period of six years that includes 10 patients with post-traumatic as well as post orthopaedics surgical intervention defects in lower mid leg, ankle region. Patients were selected for proximally based and distally based peroneus brevis muscle flap according to the location of defects. Data regarding age, sex, aetiological factor, size of defect, type of flap, survival of flap, donor site complications were recorded. Out of 10 patients, eight were males and two were females. Major aetiological factor was two wheeler road traffic accident. Majority of the patient had orthopaedic surgical intervention for fracture fixation prior to or along with flap surgery. Only one patient, in this series had marginal flap necrosis. Rest of flaps survived well without any donor site complications. In authors experience peroneus brevis muscle flap is dependable for medium size defects over lower leg and ankle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PR01-PR04&id=15392 https://doi.org/10.7860/JCDR/2021/50475.15392 Paediatric Multisystem Inflammatory Syndrome Associated with COVID-19 Infection: A Case Series Aneesha Mathew, Akshay K Nair, Harish Kumar, Renoy Phillip, Rini Susan Varghese Multisystem Inflammatory Syndrome (MIS) is a newer, rarer and dangerous childhood disease that require early attention and is associated with Coronavirus Disease-2019 (COVID-19) infection. This article reports four clinically ill children of age 6-15 years admitted to Aster CMI Hospital, Bengaluru, Karnataka, India, during October and November 2020. The diagnosis was based on elevated laboratory values (D-Dimer, C-Reactive Protein (CRP), and Ferritin) and positive COVID-19 antibody test. No infectious aetiologies were identified. All patients presented at Emergency Room (ER) with hypotensive shock and were treated with inotropic support, Intravenous Immunoglobulin (IVIg), and steroids. Children responded well to treatment and were discharged within a period of 8-11 days. Clinical characteristics are necessary for understanding more about newly identified paediatric illness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=SR01-SR03&id=15332 https://doi.org/10.7860/JCDR/2021/49495.15332 Tetrasomy 8 in Haematological Malignancies-A Case Series Neeraja Koppaka, Sayli Kale, Deepak Chavan, Sandhya Kandoor, Ushang Kate, Anurita Pais Tetrasomy 8, a rare genetic abnormality in haematological disorders is associated with Acute Myeloid Leukaemia (AML), Myelodysplastic Syndrome, Myeloproliferative Neoplasms and Acute Non Lymphocytic Leukaemia. It may be found as a sole chromosomal abnormality or coexist with Trisomy 8. Tetrasomy 8 has shown to have proliferative advantage and aggressive clinical course with lower survival rates. Four cases of Tetrasomy 8 were reported in present series, of which one case showed Tetrasomy 8 as a sole chromosomal abnormality, two cases with it’s coexistence with Trisomy 8 and one case with complex rearrangement of chromosome 8. Trisomy 8 as a sole abnormality is associated with intermediate prognosis; hence the aggressive behaviour of the disease with Tetrasomy 8 can be attributed to increase in gene dosage of extra chromosome 8. The fourth case of AML with monocytic differentiation showed complex karyotype with presence of two isochromosomes 8, resulting in five copies for long arm of chromosome 8. This demonstrates presence of crucial genes for leukemogenesis in 8q region. From various studies, it is evident that the role of Tetrasomy 8 in poor prognosis and role of associated genes in leukaemogenesis needs further investigation on molecular deregulation mechanisms with biologic and clinical consequences. Building up on rare abnormalities by this study would help in a better understanding of the disease with appropriate classification and ultimately can lead to an effective clinical management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=GR01-GR03&id=15322 https://doi.org/10.7860/JCDR/2021/49618.15322 Non-Tubal Ectopic Pregnancy Shohei Tanabe, Takashi Suzuki, Satoshi Shiojima, Satoru Nakayama, Hiroshi Adachi Non-tubal ectopic pregnancies are risk factors for maternal death and require prompt diagnosis and treatment. However, there are no established guidelines for their treatment because of their rarity and care is individualized. We retrospectively reviewed the medical records of non-tubal ectopic pregnancies at our institution between May 2009 and September 2020. Thirty-four relevant cases were identified, including 14 interstitial, 7 cervical, 6 peritoneal, three caesarean scars, two ovarian, and two rudimentary horn pregnancies; 23 of the 34 cases were diagnosed before treatment using ultrasound or magnetic resonance imaging. All patients were examined before nine weeks of gestation, and 17 were examined for a positive pregnancy test without any symptoms. In conclusion, in our hospital, non-tubal ectopic pregnancies were identified early, resulting in successful treatment without serious complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QR01-QR02&id=15326 https://doi.org/10.7860/JCDR/2021/48986.15326 Comparison between Autologous Blood and Fibrin Glue for Adhering Conjunctival Autografts after Pterygium Excision- A Randomised Clinical Trial Mona Sune, Pradeep Sune <b>Introduction:</b> Fibrin glue is a biological tissue adhesive and acts on the principle of final stages of the coagulation cascade. The cost of commercially available products is very high and not affordable for the patients of low socio-economic strata. As an alternative, pterygium surgery was done using patient’s own blood to adhere the conjunctival autograft to scleral bed by the process of coagulation of fibrin from the oozing blood from the blood vessels under the flap. <b>Aim: </b>To compare autologous blood and fibrin glue for adhering conjunctival autografts after pterygium excision. <b>Materials and Methods:</b> It was a randomised clinical trial. Total 97 subjects with primary pterygium who visited the Ophthalmology Department were randomised into two groups. In group A (n=31), patients had undergone pterygium excision wherein conjunctival autograft was attached by fibrin glue. In group B (n=66) the graft was attached by autologous blood present on the scleral bed. Mean operative time for the procedures were compared. Follow-up was done for 12 months and all subjects were examined for postoperative pain, foreign body sensation, inflammation, graft stability and recurrence. <b>Results:</b> The mean age of patients in group A was 48.32&#177;14.3 years (21-65 years), and in group B was 54.48&#177;15.67 (23-74 years). Mean operating time in group A was 23.21&#177;9.4 minutes and 13.7&#177;4.3 minutes in group B, (p-value=0.001). Postoperative pain of mild degree was present in all the 31 (100%) subjects of group A. In group B, pain was absent in 32 (48.5%) and mild degree in 34 (51.5%) subjects. No recurrence was found in both the groups. Mean follow-up period was 11.4 months. <b>Conclusion:</b> This study concludes that autologous blood is a useful alternative method for graft attachment in pterygium surgery without the untoward complications related to fibrin glue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=NC01-NC04&id=15327 https://doi.org/10.7860/JCDR/2021/46334.15327 COVID-19 Associated Rhino-orbito-cerebral Mucormycosis: Clinical Profile and Imaging Spectrum Ritema Mangal, Prateek Singh Gehlot, Anuj Bang, Arushi Kaushal, Rishikesh Kolare <b>Introduction:</b> Rhino-orbito-cerebral mucormycosis is a fatal disease caused by saprophytic fungi seen almost exclusively in diabetic and immunocompromised patients. <b>Aim:</b> To describe various imaging findings of mucormycosis, and to emphasise the importance of imaging in its diagnosis and management. <b>Materials and Methods:</b> A retrospective, observational, single centre study was done including patients with clinical and microbiological evidence of rhino-orbito-cerebral mucormycosis, who had a history of Coronavirus Disease 2019 (COVID-19) infection and had undergone Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) scan of the head, orbit, and paranasal sinuses during the period of one month from 1st-31st May 2021. The clinical and imaging data of 67 such cases were interpreted and analysed by two radiologists. <b>Results:</b> The study included 67 patients out of which 44 were male and 23 were female, and the average age of patients was 49±13 years. During their treatment for COVID-19, 55 (82.08%) patients had a history of hospitalisation and administration of supplemental oxygen, all 67 (100%) patients had taken broad spectrum antibiotics, 56 (83.58%) patients had taken steroids, 20 (29.85%) patients previously had a history of diabetes with worsening of glycaemic control during COVID-19 infection, and 47 (70.15%) patients were diagnosed with new onset hyperglycaemia. On imaging i.e., on CT and/or MRI with or without contrast, the infection was found to primarily affect the sino-nasal region. There was unilateral or bilateral involvement of single or multiple paranasal sinuses in all 67 patients with involvement of nasal cavity in 42 patients. Maxillary sinus was the most common and consistently involved sinus seen in all 67 patients, followed by ethmoid sinus seen in 54 patients. Additionally, 56 patients had extra-sinus disease with spread along vessels, nerves, or via bone erosion. CT showed soft tissue thickening, oedema, and fat stranding with or without bone erosion as the predominant finding in involved areas, while MRI showed Short Tau Inversion Recovery (STIR) hyperintense soft tissue thickening and postcontrast enhancement as the main finding. <b>Conclusion:</b> There is a complex interplay of various COVID-19 infection and treatment related factors that are responsible for increased susceptibility to mucormycosis infection. Imaging plays an important role in aiding the diagnosis, determining the extent and spread of infection, guiding the extent of the surgical intervention, and determining the prognosis of these patients. The contrast enhanced MRI along with plain CT should be the preferred choice of imaging. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=TC01-TC06&id=15324 https://doi.org/10.7860/JCDR/2021/50888.15324 A Cadaveric Study of Superficial Palmar Arch with Surgical Importance Hemamalini Shetty, K Pushpalatha <b>Introduction:</b> Arterial supply of hand is by two arterial anastomotic arches formed by radial and ulnar arteries and their branches. The anastomoses between the branches of radial and ulnar arteries such as palmar carpal and dorsal carpal arches at the wrist and superficial and deep palmar arches in the palm, maintain a rich arterial supply to the wrist and palm. Effective collateral circulation in palm is essential in peripheral arterial diseases such as Raynaud&#8217;s disease and in harvesting radial artery or the ulnar artery for Coronary Artery Bypass Graft (CABG) surgery. <b>Aim:</b> To observe the variations in the formation of superficial palmar arch. <b>Materials and Methods: </b>A descriptive study was performed on 45 formalin fixed upper limbs of both sex in the Department of Anatomy, JSS Medical College, Mysuru, Karnataka, India. The study was conducted during routine dissection of upper limbs for undergraduates as per the Cunningham&#8217;s manual for practical anatomy. Few rare variations in the formation of superficial palmar arch and the arterial pattern of hand were noticed. The variations found were classified according to Coleman and Anson classification. <b>Results:</b> Out of 45 limbs, complete arch was found in 36 limbs and incomplete arch in nine limbs. In complete arch type, we found an arterial arcade, bifurcation of ulnar artery and in incomplete arch type, radial-radial anastomosis. Another rare findings of highly tortuous ulnar artery in forearm and in the palm. <b>Conclusion:</b> The findings in the variations of superficial palmar arch are essential in microvascular surgery, forearm fasciocutaneous flap, radial artery and ulnar artery harvesting in coronary artery bypass graft procedure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=AC01-AC06&id=15325 https://doi.org/10.7860/JCDR/2021/48300.15325 Abbreviated (8 hours) versus Traditional (24 hours) Postpartum MgSO<sub>4</sub> Prophylaxis in Severe Preeclampsia: A Randomised Control Trial Shyamal Dasgupta, Anindya Das, Anurag Mallick, Chiranjit Ghosh <b>Introduction:</b> Preeclampsia is a multisystem disorder affecting pregnancy after 20 weeks of gestation featured by hypertension and proteinuria. Magnesium Sulphate (MgSO<sub>4</sub>) has been used for 24 hours following delivery to prevent eclampsia in patients with severe preeclampsia. <b>Aim:</b> To determine the need to continue magnesium sulphate therapy 8 hours following delivery. <b>Materials and Methods:</b> The double blinded randomised controlled study was performed in the Department of Gynaecology and Obstetrics at R.G. Kar Medical College, Kolkata, West Bengal, India, from 1st July 2015 to 30th June 2016. Total 90 patients with severe preeclampsia were randomised in two group. In group A MgSO<sub>4</sub> was discontinued 8 hours following delivery (abbreviated group) and in the group B it was continued for 24 hours following delivery (traditional group). The primary objective of study was to determine the need to continue MgSO<sub>4</sub> therapy 8 hours following delivery. Secondary objectives were monitoring time by doctors, nursing care time, postpartum ambulation time, duration of urinary catheterisation, minor complication like urinary tract infection, duration and total dose of MgSO<sub>4</sub> therapy. In order to calculate statistical significance of the different variables in between two groups, Student’s independent sample’s t-test was used for normally distributed numerical values and Chi-square test or Fischer’s-exact test was used for unpaired proportion data. <b>Results:</b> In abbreviated group, the number of patients (n=1) who did not need to continue MgSO<sub>4</sub> therapy beyond 8 hours following delivery as safety measures were statistically significant (p-value <0.0001) in comparison to traditional group. Total duration and dose of MgSO4 therapy were significantly less (p-value <0.0001) in the abbreviated group. There was statistically significant reduction in time from delivery to postpartum ambulation and duration of indwelling urinary catheter in the abbreviated group. <b>Conclusion:</b> The abbreviated (8 hours) regime of postpartum MgSO<sub>4</sub> for seizure prophylaxis is a suitable alternative to the traditional (24 hours) regime. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QC01-QC04&id=15320 https://doi.org/10.7860/JCDR/2021/48570.15320 Questionnaire Based Study to Explore the Barriers of Willingness and Ability to Work among Indian Doctors during Initial Phase of COVID-19 Pandemic Suyog Sindhu, Medhavi Gautam, Neeraj Kumar Agrawal <b>Introduction:</b> Numerous doctors have been infected while treating the patients of Coronavirus Disease (COVID-2019). Expecting doctors to treat without any regard to their safety is an extreme and unrealistic approach. Apart from professional obligations, doctors have personal obligations to their families too. <b>Aim:</b> To understand the barriers of willingness and ability to serve during pandemics for Indian doctors. <b>Materials and Methods:</b> This cross-sectional study, Peer-tested web-based questionnaire was carried out at the King George’s Medical University, Lucknow, India, along with informed consent form incorporated into Google form, was posted on a WhatsApp group. Study was conducted from April to June 2020. The group included 400 Indian medical practitioners, selected randomly. It comprised of total 49 questions, including open and close ended type, in English language. Out of these, 14 questions were pertaining to the present study. The exploratory data analysis was used to analyse and interpret the data. <b>Results:</b> Responses were submitted by 256 (64% response rate) doctors out of which 121 were from males, 134 from females and 1 person preferred not to disclose the gender. Majority (64.8%) of the responses were obtained from doctors in age group of 20-40 years and 49% of the total responses were from faculty in government medical college. It was revealed that 9% doctors were willing to quit medical profession and 23% doctors preferred not to serve patients during pandemic of contagious disease. As many as 58.6% expressed that incidences of doctors facing public harassments abuse and social discrimination dissuaded them from serving COVID-19 patients. A 59.4% and 58.2% of doctors had responsibility of child-care and elderly-care respectively which was acting barrier to ability to serve during the pandemic. As many as 49.2% brought it to light that the infrastructure at their workplace was not up to the mark to deal with COVID-19 patients. <b>Conclusion:</b> This study has brought into light that fear of contracting the disease due to lack of Personal Protective Equipment (PPE), risking one’s family for getting infected, responsibility of child-care and elderly-care along with social ostracism as untouchables are the major deterrents for willingness to work. Distance from workplace, one’s illness and lack of proper infrastructure at workplace are barriers to ability to work during COVID-19 for Indian doctors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=IC01-IC05&id=15333 https://doi.org/10.7860/JCDR/2021/49697.15333 Ocular Toxicity due to Accidental Exposure to Plant Latex by <i>Calotropis procera</i> and <i>Calotropis gigantea</i> Shruthi Amalagondhi Manjunatha, Pradeep Addagadde Venkataramana, Rajshekar, Srinivas Siddegowda <b>Introduction:</b> Calotropis is a member of the milkweed or Asclepiadeae family. The latex of <i>Calotropis gigantea</i> <i>(C gigantea)</i> contains cardiac glycosides, fatty acids and calcium oxalate. The sap of <i>Calotropis procera (C procera)</i> produces acidic latex. Toxic effect of latex manifests after a few hours with diminution of vision due to corneal oedema with folds in Descemet’s membrane. <b>Aim:</b> To evaluate the ocular toxicity by the latex of calotropis procera and <i>calotropis gigantea</i> due to accidental exposure. <b>Materials and Methods:</b> This was a prospective observational study conducted for a duration of six months (September 2018 to February 2019) on 18 patients with alleged accidental exposure to calotropis latex. The patients were examined in the Department of Ophthalmology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India. After a thorough saline wash under topical anaesthesia, visual acuity was measured by using Snellen&#39;s chart, then patients were subjected for slit lamp biomicroscopy examination, Intraocular Pressure (IOP) measurement and undilated fundus examination and the findings were noted. Demographic details like age and sex, activity at time of injury, mode of injury were noted and follow-up was done for a period of 30 days. Data were analysed using Epi info software and descriptive statistics like mean and percentage were calculated. <b>Results:</b> Total 18 patients reported with calotropis associated eye toxicity, among which 11 (61.1%) were of <i>C gigantea</i> and seven (38.9%) were of <i>C procera</i>. Out of total, seven (38.9%) were males and 11 (61.1%) females. A total of 14 (77.8%) patients presented within 24 hours of injury. Eleven (61.1%) patients had involvement of both the eyes. The main symptoms were burning, irritation, foreign body sensation and diminution of vision. Best Corrected Visual Acuity (BCVA) varied from 6/9 to 6/60. Corneal oedema or striate keratopathy was the most common sign. Corneal oedema resolved in one week in case of <i>C procera</i> with use of topical corticosteroids except in three cases of <i>C gigantea</i> which took two weeks. <b>Conclusion:</b> <i>C procera</i> and <i>C gigantea</i> causes significant corneal oedema and ocular morbidity. By simple health education and occupational precaution, we can prevent ocular morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=NC05-NC08&id=15334 https://doi.org/10.7860/JCDR/2021/49510.15334 Effect of Cryotherapy on Lower Limb Flexibility and Power in Recreational Players: An Experimental Study Neha Kulkarni, Himani Parulekar, Zeel Patel, Arpita Patil, Unika Patil, Seema Saini <b>Introduction:</b> Cryotherapy has been a widely used thermotherapy modality in sports injuries. The main focus of research on cryotherapy was to find out its effects on functional performance measures of the players. Cryotherapy is known to dampen the stretch reflex and reduce muscle temperature which might indirectly influence the flexibility and power which are the important components of any performance. Hence, it becomes necessary to study the changes, if any, on the flexibility and power post cryotherapy application. <b>Aim:</b> To determine the effects of cryotherapy on lower limb flexibility and power in adult recreational players. <b>Materials and Methods:</b> The present study was an experimental study conducted on 40 recreational players of either gender, between the age range of 18-25 years, who played various forms of recreational sports and had hamstrings and calf muscle tightness were included in the study. Hamstring tightness was assessed by Active Knee Extension Test (AKET) and calf muscle tightness by Weight Bearing Lunge test (WBLT), while power was assessed by vertical jump test. Both the limbs were given cold pack on bilateral calf and hamstrings for 20 minutes for three days. Outcomes were measured on 3rd day and paired t-test was used to analyse the pre and post-treatment difference, p-value less than 0.05 was considered as significant. <b>Results:</b> A total of 40 recreational players were included in the study with the mean age of 22.15&#177;1.36 years, of which 20 were males and 20 were females with mean Body Mass Index (BMI) of 23.07&#177;3.36 kg/m<sup>2</sup> . The right calf muscle flex (pretreatment=13.7 cm to post-treatment=14.71 cm, p<0.05) along with left side flexibility (pretreatment=14.2 cm to post-treatment=15.07 cm, p<0.05). The hamstring flexibility improved significantly from mean, pretreatment=45.6 degrees to post-treatment=50.6 degrees (p<0.05) on the right side while on the left side, a non significant improvement from pretreatment=52.38 degrees to post-treatment=55.22 degrees (p=0.011) was seen. The power showed a non significant reduction from pretreatment=17.61 to post-treatment=16.76 (p=0.016). <b>Conclusion:</b> Cryotherapy increases the flexibility of calf and hamstring muscles and reduces lower limb power after three days of cryotherapy application. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=YC01-YC04&id=15336 https://doi.org/10.7860/JCDR/2021/50315.15336 Gene Expression Profiling and Clinicopathological Importance of Fer1L4 and DANCR Long Non Coding RNAs in Patients with Head and Neck Squamous Cell Carcinoma Maryam Pirhoushiaran, Sara Hesami, Naeim Ehtesham, Saman Mehrabi, Reza Shirkoohi, Nasrin Yazdani, Maryam Lotfi, Abbas Shakoori Farahani <b>Introduction:</b> Head and Neck Squamous Cell Carcinoma (HNSCC) entails a heterogeneous group of tumours that emerge from the interaction between molecular changes and environmental factors. Dysregulated long noncoding RNAs (LncRNAs) play a major part in tumourigenesis and could be used as cancer biomarkers and therapeutic aims. <b>Aim:</b> To evaluate the expression of two lncRNAs named Fer-1 Like Family Member 4 (Fer1L4) and differentiation antagonising non protein-coding RNA (DANCR) in tumoural tissue of HNSCCs patients in comparison to Adjacent Non cancerous Tissues (ANCTs) to appraise their diagnostic power and the relationship with clinicopathological parameters. <b>Materials and Methods:</b> The present case-control study was designed, in which fresh frozen cancerous tissues and ANCTs were taken from 50 sporadic HNSCC patients who were attended in Imam Khomeini and Amir Alam Hospitals (Tehran, Iran) from from January to December 2019. Real-time PCR was utilised for expression profiling of Fer1L4 and DANCR. By employing GraphPad Prism 8.0 GraphPad Software, Inc., San Diego, CA, the real-time quantitative PCR experiments(2-..Ct) method and the Mann-Whitney test were exerted to analyse the obtained data. The Receiver Operating Characteristic (ROC) curve analysis was employed for figuring out the discrimination potential of two selected lncRNAs between the subject tumour and ANCT. <b>Results:</b> The expression of Fer1L4 was significantly down-regulated in tumoural tissues by analogy to ANCTs (p-value <0.0001) and statistically significant associations were found between the stage and grade status of the tumour with the relative expression of this lncRNA (p-value=0.008 and p-value=0.002 for stage and grade, respectively). The findings in this study indicated that the expression of DANCR was not statistically significant different in different tumoural tissues compared with ANCTs (p-value=0.46). ROC curve unraveled that the Fer1L4 had good diagnostic power Area Under Curve (AUC) 0.9252; p-value <0.0001. The expression of DANCR and Fer1L4 was significantly, respectively, higher and lower in samples with lymph node invasion and metastasis than that of the counterpart group. Concerning Human Papillomavirus (HPV) as an important exogenous factor for the development of HNSCC, DANCR and Fer1L4 were over-expressed and underexpressed, respectively in the HPV+group in comparison to HPV-. <b>Conclusion: </b>This work represented that Fer1L4 could be used as a novel diagnostic biomarker for HNSCC. In addition, the statistically significant difference in the expression of Fer1L4 and DANCR in metastatic tumours demonstrated that these two lncRNAs are promising targets for therapeutic purposes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=GC01-GC06&id=15330 https://doi.org/10.7860/JCDR/2021/47575.15330 Nuclear Morphometry as an Adjunct to Cytomorphology in the Diagnosis of Thyroid Lesions Sabina Khan, Sayika Hameed, Mohd Jaseem Hasan, Musharraf Husain, Arun Sharma <b>Introduction:</b> Fine Needle Aspiration Cytology (FNAC) is a reliable and reproducible diagnostic technique for thyroid lesions. Recently, it has been suggested that evaluation of nuclear features may enhance the diagnostic utility of FNAC. However, the evaluation of nuclear morphometry is not well established in thyroid cytology. <b>Aim:</b> To evaluate the role of nuclear morphometry in cytological evaluation of thyroid lesions. <b>Materials and Methods:</b> This was a cross-sectional study conducted over a period from March 2019-February 2020 at Hamdard Institute of Medical Sciences and Research, New Delhi, India. Morphometry was done on 40 cases of thyroid aspirates which had histopathological concordance. Computerised nuclear morphometry was done by using photographs captured under Motic photomicrography system. Six parameters were measured- nuclear area, nuclear perimeter, minimal nuclear diameter, maximal nuclear diameter, nuclear compactness and LS ratio (Largest to Smallest dimension ratio). Data were entered in spreadsheet and then analysed using Statistical Package for Social Sciences (SPSS) version 20.0. <b>Results: </b>Out of total 40 thyroid aspirates studied, included non neoplastic (19 cases), benign (12 cases) and malignant lesions (9 cases). All nuclear morphometry parameters comprising of nuclear area, nuclear perimeter, minimal nuclear diameter, maximal nuclear diameter showed an increasing trend from non neoplastic to benign to malignant with a statistically significant difference between benign and malignant groups (p-values <0.05) except for LS ratio and nuclear compactness. <b>Conclusion:</b> Nuclear morphometry can aid in cytological diagnosis of thyroid lesions. If used judiciously, quantitative estimation of cytological nuclear features can be helpful in assessing thyroid lesions preoperatively thus complementing its cytomorphological features https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC01-EC04&id=15331 https://doi.org/10.7860/JCDR/2021/49980.15331 Assessment of Clinical Experience of Triple Drug Fixed-dose Combination of Glimepiride, Metformin and Voglibose in the Management of Type 2 Diabetes Mellitus: A Retrospective Study Ganapathi Bantwal, Vageesh Ayyar, Rajiv Kovil, Manoj Chawla, Tejas Shah, Sharad Kumar, Mahesh Abhyankar, Santosh Revankar <b>Introduction:</b> Poor adherence of patients to the polypharmacy approach is a crucial challenge in the management of Type 2 Diabetes Mellitus (T2DM) and use of triple Fixed-Dose Combination (FDC) of metformin, glimepiride, and voglibose is effective in achieving glycaemic control and would aid in improved drug adherence. <b>Aim:</b> To analyse clinical profile and treatment patterns of FDC of glimepiride, metformin, and voglibose with or without other antidiabetic therapy in patients with T2DM. <b>Materials and Methods:</b> A retrospective, observational, multi-centric study conducted during August 2019 to March 2020. Included patients of either sex, =18 years of age with T2DM and who had received treatment with FDC of glimepiride, metformin, and voglibose of varying strengths with or without other antidiabetic therapy. Data extracted from medical records included demographic characteristics, duration of disease, co-morbidities, concomitant medications and dosage pattern. Data were analysed using Chi-square test and Mann-Whitney U test. <b>Results:</b> A total of 2650 patients with T2DM were included, of which 1689 (63.7%) were males. The mean (standard deviation {SD}) age was 54.2 (11.4) years. The average Body Mass Index (BMI) was 27.2 (4.3) kg/m2 and hypertension 1656 (62.5%) and dyslipidaemia 1109 (41.9%) were the most common co-morbidities. Dipeptidyl peptidase-4 inhibitors 908 (34.3%) and antihypertensives 1601 (60.4%) were the most common concomitant diabetic and non diabetic medications received, respectively. Glimepiride (2 mg)+metformin (500 mg)+voglibose (0.2 mg) FDC twice-a-day 878 (33.1%) was a common triple FDC. A total of 2449 (92.4%) patients were compliant and 2585 (97.9%) achieved glycaemic goal with triple FDC treatment. During the therapy, the majority of patients had decreased weight 1106 (67.2%). The mean Haemoglobin A1c (HbA1c) levels significantly decreased post-treatment (mean change 1.45%; p-value <0.001). Family history of diabetes mellitus, obesity, sedentary lifestyle were the most common risk factors and smoking being prevalent in males. <b>Conclusion:</b> Overall results demonstrate that triple FDC of glimepiride, metformin, and voglibose was effective in reducing HbA1c and weight and was well tolerated. Also, it improves compliance in Indian patients with T2DM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OC05-OC12&id=15346 https://doi.org/10.7860/JCDR/2021/47919.15346 Comparison of Bupivacaine and 2-Chloroprocaine with and without Fentanyl for Subarachnoid Block in Inguinal Hernia Repair Surgery: A Randomised Controlled Study Avan Tiwari, Sarvesh Singh, Meena Singh, Mukesh Sanghwan <b>Introduction:</b> Providing an adequate intraoperative anaesthesia with a prolonged pain-free interval is the prime priority of an anaesthesiologist. Since the decline in use of 2-chloroprocaine in 1956, due to side-effects of its preservative sodium bisulfite, the preservative free drug has recently witnessed a comeback in clinical practice. <b>Aim:</b> To compare the efficacy of bupivacaine and 2-chloroprocaine with and without fentanyl in subarachnoid block for inguinal hernia repair surgery. <b>Materials and Methods:</b> This randomised controlled study was carried out on 102 male patients of 18-65 years of age, American Society of Anesthesiologists (ASA) grade I or II, scheduled for inguinal hernia repair. The study was conducted from May 2019 to November 2020. The patients were randomly divided into three groups of 34 each. In group A, the subarachnoid block was administered with injection 0.5% bupivacaine (H) 10.5 mg. In group B, patients were administered, injection 2-chloroprocaine 40 mg diluted with 0.5 mL of saline. In group C, the patients were administered with injection 2-chloroprocaine 40 mg with 25 µg of injection fentanyl (0.5 mL). The adequacy of intraoperative anaesthesia in terms of onset and duration of sensory and motor blockade, haemodynamic parameters, postoperative urinary retention and other side-effects were evaluated. The parameters were compared using Analysis of variance test (>2 groups). If statistically significant difference was found in ANOVA, appropriate post-hoc (LSD/Bonferroni) was used to assess statistical significance of pair-wise comparisons. <b>Results: </b>The mean time of onset of the motor and sensory block was faster in group B (3.57&#177;0.66, 2.68&#177;0.58 min), by almost 1 minute than in the bupivacaine and fentanyl group (4.57&#177;0.79, 3.59&#177;0.61 min) (4.99&#177;1.01, 4.04&#177;0.99 min) respectively. The mean difference was statistically significant (p-value <0.05). The mean duration of the motor and sensory blocks between the groups revealed statistically significant difference between groups A and B as well as groups A and C. However, between groups B and C, there was no significant difference as far as motor block duration is concerned. Group B had significantly shorter duration of the motor and sensory block amongst the three groups. <b>Conclusion:</b> Addition of intrathecal fentanyl significantly prolonged the onset and duration of sensory and motor block, with minimally extending the time to complete recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC01-UC04&id=15353 https://doi.org/10.7860/JCDR/2021/46404.15353 Comparison of Body Composition Parameters in Swimmers and Non Swimmers: A Cross-sectional Study Sruthi Parayil Kizhakkevalappil, Reena Alexander, Arun Chandran Nhattuvalappil <b>Introduction:</b> Swimming is an inexpensive isotonic exercise that is useful for health promotion and prevention of disease. While studies based on body composition and swimming in India are few, the analysis of body composition parameters can provide accurate body assessment and serve as an ideal mode for fitness analysis and promotion of health. <b>Aim:</b> To assess the body composition, anthropometric and cardiac parameters of healthy swimmers and compare these variables with that of healthy non swimmers. <b>Materials and Methods:</b> A comparative cross-sectional study was conducted in the Department of Physiology, Government Medical College, Thrissur, Kerala, India. Duration of study was from January 2017 to January 2018. A total 60 healthy individuals, 30 swimmers and 30 non swimmers were selected by simple random sampling method. Body composition parameters were estimated along with anthropometric measurements and cardiac parameters- height, weight, Body Mass Index (BMI), pulse rate, systolic and diastolic blood pressure. Quantitative variables like body composition parameters were analysed using mean standard deviation and 95% confidential interval. Comparison of body composition parameters were analysed using independent t-test and significant level was kept at 5%. <b>Results:</b> The mean age of swimmers was 19.93±1.59 years and that of non swimmer subjects was 22.87±1.88 years. Body composition parameters included Body Fat Percentage (BFP p-value <0.001), Fat Mass (FM p-value <0.001) and Basal Metabolic Rate (BMR p-value <0.001) were found to be significantly decreased (p-value <0.05) in swimmers when compared to non swimmers. However, the Fat Free Mass (FFM p-value=0.13) and Fat Free Mass Index (FFMI p-value=0.22) were also decreased but comparable (p-value >0.05). Weight and BMI along with pulse, systolic blood pressure and diastolic blood pressure (p-value <0.001) were lower in swimmers than non swimmers and statistically significant (p-value <0.05) by independent t-test. <b>Conclusion: </b>The results indicated that, swimming can improve body composition parameters to a more healthy state and therefore can be advised as a form of regular physical activity with a goal to achieve ideal health and fitness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=CC01-CC04&id=15354 https://doi.org/10.7860/JCDR/2021/50793.15354 Usefulness of TrueNat: A Chip-based Real-time PCR Test for COVID-19 Swarnim Swarn, Indu Prasad, Amit Kumar Anand, Binod Shankar Singh <b>Introduction:</b> For the containment of growing Coronavirus Disease (COVID-19) pandemic, rapid diagnostic facilities are need of today. Indigenously developed TrueNat assay is a point-of-care assay developed for early diagnosis of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2). It is a portable, fully automated, chip-based, real-time quantitative polymerase chain reaction system with a turnaround time of 1.5-2 hours. <b>Aim:</b> To assess the practical utility and diagnostic accuracy of TrueNat testing for COVID-19 in a pandemic situation. <b>Materials and Methods:</b> A cohort selection cross-sectional study was conducted from July to September 2020 at Department of Biochemistry, Vardhaman Institute of Medical Sciences, Pawapuri, Bihar, India, after obtaining Institutional Ethics Committee (IEC) approval. A total of 296 cases with symptoms of COVID-19 were selected for the study. Assuming real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) to be the gold standard, we collected oropharyngeal swabs from symptomatic COVID-19 suspected cases and tested by both TrueNat and standard RT-PCR. Agreement between both the assays were assessed by overall, Positive Percent Agreement (PPA) and Negative Percent Agreement (NPA) and Cohen&#8217;s kappa coefficient using Epitools (Ausvet 2020). <b>Results:</b> Out of 296 oropharyngeal swabs taken from suspected COVID-19 patients, 19 were read as &#8220;invalid&#8221; and discarded; hence only 277 samples were tested by TrueNat and RT-PCR both. Assuming RT-PCR as standard, TrueNat assay demonstrated an overall percent agreement of 99.64%, PPA of 95.65%, NPA 99.81%. The kappa coefficient was 0.9546. <b>Conclusion:</b> TrueNat assay offers a rapid, accurate and affordable technique for COVID-19. It may be deployed for mass screening and confirmation of COVID-19 cases in hospitals and remote areas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=BC01-BC03&id=15348 https://doi.org/10.7860/JCDR/2021/48193.15348 Seroprevalence of Chikungunya (CHIK) Infection during Non Epidemic Periods in Chennai, Southern India Kaliyamoorthy Kayalvili, Murugan Duraivel, Elangovan Nivedhitha, Subramanian Arul Selvan <b>Introduction:</b> Chikungunya (CHIK) infection has caused many outbreaks in India with more than 13 lac people affected by the disease. Epidemics of CHIK infection occur during post monsoon period when there is a high vector density. Evidences on the prevalence of CHIK infection during non epidemic periods are limited. <b>Aim: </b>To determine the seroprevalence of CHIK infection during non epidemic periods among patients attending fever clinic in Chennai, Southern India. <b>Materials and Methods:</b> This cross-sectional study was done in 180 suspected cases of CHIK infection between the months of September 2014 and February 2015. A 5 mL of blood samples were collected from the suspected cases and serum was separated to detect for the presence of CHIK-IgM antibody by using CHIKIgM antibody capture Enzyme Linked Immunosorbent Assay (ELISA) kit. Chi-square test was done to find out the statistical significance with p-value <0.05 kept as statistically significant. <b>Results: </b>The seroprevalence of CHIK infection during non epidemic periods was found to be 5.5% (10/180). Fever and joint pain were the major complaints present in all the study population. All the seronegative cases were tested for the presence of other infections and it was found that 13% were positive for typhoid, 9% were positive for leptospirosis, 4% for malaria and 2% for dengue infections. <b>Conclusion:</b> There are no vaccines or specific medications available till date. Prevention is the only effective approach against the disease. Even though the prevalence of CHIK infection is low during non epidemic periods, strict vector control and elimination of mosquito breeding sites are very important in controlling the disease transmission. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=DC07-DC10&id=15349 https://doi.org/10.7860/JCDR/2021/50545.15349 Management of Postcaesarean Delivery Analgesia-Diclofenac Suppository, Paracetamol Infusion and a Combination Mandem Sadana Reddy, Munikrishna Munisamaiah <b>Introduction:</b> One of the most important aspect of postoperative care is pain management which plays an important role in early recovery and improves patient’s general condition. Paracetamol and diclofenac have an excellent safety profile when compared to opioids. <b>Aim: </b>To assess and compare the analgesic efficacy and safety of individual use of Intravenous (IV) paracetamol, diclofenac suppository and in combination. <b>Materials and Methods: </b>This hospital-based cross-sectional study was conducted from October 2018 to June 2020 at Department of Obstetrics and Gynaecology. A total of 90 women who underwent caesarean section were recruited for the study and were randomly allocated (lottery method) into three groups with 30 participants in each group. The patients underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia with the same technique and medicine, (Bupivacaine 0.5%) without receiving any sedation. Group A patients received diclofenac suppository 50 mg every eight hourly, Group B received paracetamol infusion 1000 mg every eight hourly and Group C received 50 mg diclofenac suppository and 500 mg IV paracetamol every eight hourly. Pain severity (Visual Analogue Scale (VAS) score), Heart Rate (HR), Blood Pressure (BP) and side-effects were evaluated at 2,4,6,8,12 and 24 hours postoperatively. Patient satisfaction score was evaluated 24 hours after caesarean section. <b>Results:</b> Age range of participants was 19 to 28 years. Mean duration of surgery (minutes) in each group were- Group A-56.5&#177;7.49, Group B-58.27&#177;8.06 and Group C-56.97&#177;6.78, respectively. There was a significant reduction of pain in patients receiving paracetamol and diclofenac suppository combination group. The satisfaction score was categorised as excellent by 80% patients in Group C. In Group A 30% and in Group B 16.6% categorised as excellent patient satisfaction score. The adverse effects such as nausea and epigastric discomfort was higher (7.7%) with diclofenac suppository group followed by Paracetamol (2.2% side-effects) and minimal with combination (1%). <b>Conclusion: </b>Paracetamol infusion is as effective as diclofenac suppository in reducing postoperative pain following caesarean section. Diclofenac suppository and IV paracetamol combination provides more effective postoperative analgesia compared with individual usage of IV paracetamol or diclofenac suppository in patients following caesarean section. The combined use of paracetamol and diclofenac suppository has fewer side-effects compared with individual use of either IV paracetamol or diclofenac suppository. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QC05-QC08&id=15350 https://doi.org/10.7860/JCDR/2021/48814.15350 Effect of Hydroalcoholic Root Extract of <i>Aerva lanata</i> on Acetaminophen Induced Hepatotoxicity in Wistar Rats Parthiban Govindaraju, Swithraa Chandrasekaran, Nileshraj Govindaraj <b>Introduction:</b> Acute acetaminophen poisoning leads to fulminant hepatic failure and renal tubular damage. N-Acetyl Cysteine (NAC), an antidote for acetaminophen poisoning, carries its own adverse effect profile such as anaphylactoid reactions, cerebral oedema and hyponatremia at high doses. <i>Aerva lanata</i>, an erect or prostate herbaceous weed has a wide range of medicinal uses like, hepatoprotection, nephroprotection, antiasthamatic and antiamoebic. Previous study on rats have shown that hydroalcoholic root extract of <i>Aerva lanata</i> has significant hepatoprotective property when administered before acetaminophen. <b>Aim:</b> To evaluate the effect of hydroalcoholic root extract of <i>Aerva lanata</i> and NAC, as monotherapy and in combination, for acetaminophen induced hepatotoxicity in albino Wistar rats. <b>Materials and Methods:</b> This was an experimental animal study. Thirty adult male albino Wistar rats were equally divided into five groups: group I-vehicle, group II-acetaminophen only, group III-acetaminophen+NAC, group IV-acetaminophen+<i>Aerva lanata</i> root extract, group V-Acetaminophen+NAC+<i>Aerva lanata</i> root extract. Hepatotoxicity was induced in rats belonging to groups II, III, IV and V using acetaminophen (2 g/kg p.o). All rats were sacrificed after 72 hours of drug administration, blood samples were sent for biochemical analysis. Liver and kidney samples were sent for histopathological studies. Results were analysed using one-way ANOVA followed by post hoc Dunnett t-test. <b>Results:</b> Root extract of <i>Aerva lanata</i> significantly reduces the liver enzyme markers Aspartate Transaminase (AST), Alanine Transaminase (ALT), Gamma Glutamyl Transferase (GGT) and bilirubin) and blood urea concentration. The combination therapy (root extract with NAC) showed a highly significant decrease in AST, ALT, GGT (p<0.001), bilirubin (p<0.01) and blood urea (p<0.001) when compared with the paracetamol group. A significant reversal of liver injury was seen in histopathological studies. <b>Conclusion:</b> The combination therapy showed better improvement of liver enzyme and renal parameters, along with significant improvement in histopathological changes. Hence, combination of hydroalcoholic root extract of <i>Aerva lanata</i> along with NAC can be effective in treating acetaminophen poisoning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=FC01-FC05&id=15351 https://doi.org/10.7860/JCDR/2021/49837.15351 Patterns and Correlates of Alcohol Use- A Retrospective Study in a Secondary Care Hospital Setting Jibi Achamma Jacob, Rhenius Edward, Anju Kuruvilla <b>Introduction: </b>Alcohol use in India has been increasing over the years, and it results in myriad medical and psychosocial problems. Primary and secondary care physicians can play a unique role in the early recognition and treatment of patients with alcohol problems. <b>Aim:</b> To determine the prevalence of different patterns of use of alcohol and factors associated with it among patients presenting to the psychiatry clinic in a secondary hospital. <b>Materials and Methods:</b> A retrospective review of the medical records of patients attending the Psychiatry Department in a secondary care hospital in a semi-urban area of southern India who attended the clinic between 1st January 2016 to 31st December 2016 was made. Data regarding alcohol use and other clinical and socio-demographic details were analysed. Bivariate and multivariate statistics was used to identify factors associated with dependence pattern of alcohol use. <b>Results: </b>A total of 103 charts, which documented substance use were analysed of which 78 documented alcohol use in the subjects. The mean age of the sample was 44.09&#177;13.18 years and majority (97.43%) were males. The prevalence of a dependence pattern of alcohol use was 83.4%. Factors associated with alcohol dependence were being married, greater daily expenditure on alcohol, greater number of days of alcohol use in a month, presence of a co-morbid medical diagnosis, problems with employment and marital discord. Depression was present in 33 (42.3%) individuals and it was the most commonly associated psychiatric morbidity. <b>Conclusion:</b> There is a high prevalence of Alcohol Use Disorders (AUD) in secondary care settings. Tackling this problem requires a combination of strategies including early and effective medical and psychosocial intervention in addition to public health strategies and legislation to regulate the availability and consumption of the substance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=VC01-VC06&id=15341 https://doi.org/10.7860/JCDR/2021/49464.15341 Burden of Multidrug Resistant <i>Escherichia coli</i> among Patients with Urinary Tract Infections in a Tertiary Care Centre- A Retrospective Analysis Manjula Sidlagatta Ramakrishna, Gomathi Chitra Abimannan, Lavanya Jeyamani, Aparna Ramalingam, Karthik Anbalagan <b>Introduction:</b> Multidrug Resistant (MDR) <i>Escherichia coli</i> isolates causing Urinary Tract Infections (UTIs), capable of producing Extended Spectrum Beta Lactamase (ESBL), AmpC beta lactamase and resistance to carbapenems pose serious challenges to the clinicians causing worse clinical scenarios. The detection of these isolates has prime importance in infection control and improving therapeutic management of patients, as their prevalence is increasing worldwide. Injudicious use of antibiotics has led to selective pressure, resulting in the emergence of antibiotic resistance in gram negative bacteria globally. This rise in antimicrobial resistance has decreased the options for empirical therapy, causing a global health concern in infections associated with ESBL producing and AmpC producing isolates. <b>Aim:</b> To investigate the burden of ESBL producing, AmpC beta-lactamase producing, carbapenem resistant, and MDR <i>Escherichia coli</i> isolated from urine samples in a tertiary care centre. <b>Materials and Methods:</b> The present retrospective study conducted from January to December 2019. A total of 10,535 urine samples were received during the study period, to find out the burden of drug resistant <i>Escherichia coli</i> isolates in urine samples, analyse their antibiogram and patients’ socio-demographic information. Records of microscopic observations to antibiogram of each isolate was noted down from the register for urine samples, and further analysed. The data was coded, verified, entered and analysed using Statistical Package for Social Sciences (SPSS) version 18.0. <b>Results: </b>Among the total urine samples (10,535), 1434 (13.6%) <i>Escherichia coli</i> isolates were identified, of which 553 (38.6%) were found to be ESBL producing, 497 (34.6%) AmpC betalactamase producing, 172 (12%) Carbapenem resistant, and 765 (53.3%) MDR. Majority of the isolates were from the age group of 51-60 years 288 (20.08%). The least susceptibility of the isolates was detected against penicillin G 1410 (98.3%), followed by ampicillin 1160 (80.9%) and cephazolin 74 (67.9%). Among the MDR isolates, the maximum drug resistance (398, 52%) was seen in penicillin, cephems, quinolones and Folate pathway antagonist group of antimicrobials. <b>Conclusion:</b> Identification of the drug resistant isolates is of high priority and crucial for therapeutic management of the patients, and infection control. Stringent antimicrobial stewardship policies and judicious use of antimicrobials can decrease the spread of antimicrobial resistant genes in the hospital environment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=DC01-DC06&id=15343 https://doi.org/10.7860/JCDR/2021/50159.15343 Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study Sonali Das, Deepak Kumar Swain, Pravati Dutta, Rama Chandra Sethy <b>Introduction:</b> Infection of pleural space that arises due to complicated parapneumonic effusion and empyema is a common worldwide problem that is known since very ancient times. The microbial aetiology of pleural space infections has changed since introduction of antibiotics. Gram positive organisms are slowly and steadily losing their foothold in the pleural space to the more resilient and resistance gram negative bacteria. Incidence of these infections are increasing and delayed treatment causes significant morbidity and mortality. <b>Aim:</b> To study the age-sex profile, symptoms, microbiological findings, aetiology, management and treatment outcome of pleural space infections. <b>Materials and Methods:</b> This cohort study was conducted at Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India, from November 2016 to October 2017 on 48 consecutive patients. Each patient was followed-up for a minimum period of two months. The demographic data, clinical presentation, microbiological findings, aetiology, clinical course and management information were collected in a predesigned proforma and analysed. <b>Results: </b>The study population comprised of 33 (68.8%) male, 15 (31.2%) female patients. The mean age of the study population was 46&#177;14 years. The most common presenting complaints were fever {43 (89.5%)}, shortness of breath {42 (87.5%)}, chest pain {38 (79.1%)} and cough {36 (75%)}. Pneumonia was diagnosed in 30 (62.5%) cases as the major cause of pleural space infection. Common organisms isolated were Streptococcus pneumoniae 11 (23%), Streptococcus pyogenes 9 (18.7%), <i>Staphylococcus aureus</i> 7 (14.5%) and <i>Escherichia coli</i> 7 (14.5%). The treatment was with Intravenous (i.v.) antibiotics followed by oral antibiotics. Most cases 46 (95.8%) required both thoracocentesis and Intercostal Tube Drainage (ICTD). Follow-up chest X-ray after two weeks showed complete lung expansion in 25 (52%) cases. Pleural thickening of <2 cm found in 22 (45.8%) cases and >2 cm found in 26 (54.2%) cases. At the end of one month of discharge 35 (73%) patient had complete resolution, 8 (16.7%) patients had persistent infection, 3 (6.2%) died and 2 (4.1%) patients were loss to follow-up. Out of the eight patients with persistent infection one patient had empyema necessitans and seven patients had bronchopleural fistula. On follow up after 2nd month out of the 8 (16.6%) persistence cases, 5 (10.4%) cases were cured and remaining 3 (6.2%) cases the infection persisted (pus) and ICTD was kept in-situ. <b>Conclusion:</b> Pneumonia is the most common cause of pleural space infections. Most common pathogen isolated was gram positive organism Streptococcus pneumoniae. In significant number of cases gram negative organism Escherichia coli was isolated. Most cases required both thoracocentesis and ICTD for resolution. The key to successful management of pleural infection remains to be early diagnosis, initiation of empirical broad spectrum antibiotics, followed by specific antimicrobial therapy after microbial identification and drug sensitivity testing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OC01-OC04&id=15344 https://doi.org/10.7860/JCDR/2021/50769.15344 Reliability and Validity of Malayalam Version of 5-Item International Index of Erectile Function Aravind Karunakaran <b>Introduction:</b> Erectile Dysfunction (ED) is a common problem affecting men and it also negatively impacts mental health. A self administered questionnaire which is validated in local language will help in better detection of ED. <b>Aim: </b>To assess the reliability and validity of Malayalam version of 5 item International Index of Erectile Function (IIEF-5) in the Malayali population of India. <b>Materials and Methods:</b> This prospective observational study was done in Government Medical College, Thiruvananthapuram, India. A total of 136 subjects were recruited into the study after taking written informed consent. Subjects were divided into two groups. Group I included 68 subjects who had complaints of ED and group II included 68 subjects who had no complaints of ED. The subjects were administered Malayalam translated IIEF-5 at baseline and after four weeks. <b>Results:</b> Internal consistency of the Malayalam IIEF-5 was assessed using Cronbach’s alpha and the whole scale had an excellent internal consistency of 0.90. The 5 items had an overall Intraclass Correlation Coefficient (ICC) of 0.91 showing a good test retest reliability. The Malayalam version was also highly sensitive and specific to the change in ED after four weeks. <b>Conclusion:</b> This study shows that the Malayalam version of IIEF-5 is a reliable and valid tool for assessment of ED, making it useful as an initial screening tool in a clinical setting. The ease of administering and favourable diagnostic properties of Malayalam IIEF-5 can help in the reducing the number of undiagnosed cases of ED. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=VC07-VC10&id=15391 https://doi.org/10.7860/JCDR/2021/50571.15391 Influence of Stress on Quality of Sleep and QT Interval Variables among Young Adult Medical Students- A Cross-sectional Study Afreen Begum H Itagi, Amudharaj Dharmalingam, Satish Dipankar, Akshay Berad, Senthil M Velou, Senthil Kumar Subramanian <b>Introduction:</b> Stress affects different cardiovascular responses and trigger arrhythmias through Autonomic Nervous System (ANS) activation. Medical students generally tend to reduce their sleep, in order to adjust and cope with their stressful and demanding workload. <b>Aim:</b> To assess the correlation of QT intervals variables with quality of sleep and stress among young adult medical students. <b>Materials and Methods:</b> This cross-sectional study was undertaken in All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, among 60 medical students taken as internal match for collection of data at the beginning of the academic year (unstressed) and three weeks before the term-end examination (stressed) during October 2019 to March 2020. Two validated questionnaires namely, Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the Medical Student Stress Questionnaire (MSSQ) to measure the stressors and the intensity of stress were used among the medical students. Short-term Electrocardiogram (ECG) recording was used to measure QT interval variables. Descriptive statistics and paired t-test were applied using Statistical Package for the Social Sciences (SPSS) version 19.0. The p&#8804;0.05 was considered significant. <b>Results:</b> Academic Related Stress (ARS) showed a highly significant increase during the stressed conditions (p<0.001). The mean global PSQI score of 6.03&#177;2.76 was significantly higher (p-value <0.001; PSQI >5) during the stressed conditions indicating poor quality of sleep, when compared to 4.50&#177;2.87 recorded in unstressed conditions. In stressed conditions, QT interval measures had moderate correlation with ARS. Quality of sleep had negative correlations with all QT interval measures except for corrected QT interval (QTc) and QTC<sub>min</sub>. <b>Conclusion:</b> Stress affects the sleep quality and induced QT changes which reflected difference in variability between &#8216;stressed&#8217; and &#8216;unstressed&#8217; times. However, there is no significant impact on QT duration among the young adult medical students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=CC10-CC14&id=15386 https://doi.org/10.7860/JCDR/2021/50023.15386 Prophylactic Administration of Per Rectal Misoprostol vs Intramuscular Injection of Oxytocin in Third-stage of Labour for Prevention of Postpartum Haemorrhage: A Randomised Controlled Trial Sougata Kumar Burman, Ritwik Samanta, Kumari Kanak Lata, Jayeeta Mukherjee, Tapan Kumar Dey <b>Introduction:</b> In India, the routine Active Management of ThirdStage of Labour (AMTSL) with conventional intramuscular oxytocin, at the rural, resource-constrained areas, is often compromised due to lack of trained healthcare personnel and proper maintenance of cold chain system, causing maternal mortality and morbidity from Postpartum Haemorrhage (PPH). In these scenarios, tablet misoprostol, can be efficacious and convenient alternative. <b>Aim: </b>To evaluate efficacy and safety of misoprostol administered per rectum with respect to intramuscular oxytocin for effective control of PPH in a Randomised Controlled Trial (RCT). <b>Materials and Methods: </b>In this RCT, conducted in Sambhunath Pandit Hospital, kolkata, West Bengal, India from September 2015 to August 2016, total 80 eligible pregnant mothers in normal labour with prior consent and fulfilled criteria, were allocated to two separated groups (n=40) by computer generated randomisation table. Control group received 10 IU injection oxytocin and case group received 600 µg misoprostol tablet per rectally within one minute of cord clamping and cutting. The primary outcome measures were mean thirdstage and mean postpartum blood loss up to eight hours after delivery. Secondary outcome variables were Mean Arterial Pressure (MAP) after eight hours postdelivery, haemoglobin and haematocrit after 24 hours of delivery and reported side effects. Data was entered into a Microsoft excel spreadsheet and statistical analysis was done by Statistical Package for the Social Sciences (SPSS) version 20.0.1 and Graph Pad Prism version 5.0. <b>Results:</b> Total sample size was 80 equally divided into two groups, with a mean age of 23.20&#177;3.1558 years and 23.7750&#177;3.8927 years in case and control group respectively. The mean third-stage blood loss (332.4105&#177;72.6632 mL versus {vs} 329.0088&#177;59.4503 mL, p=0.8193) and mean total blood loss (426.5575&#177;80.0215 mL vs 424.8783&#177;61.5808 mL, p=0.9165) were statistically indifferent between misoprostol and oxytocin groups by two-sample t-tests. The mean for eight hours postpartum MAP (p=0.0894), 24 hours postpartum haemoglobin (p=0.4534) and haematocrit (p=0.1325) were statistically insignificant between the two groups by two-sample t-tests. Incidence of adverse effects like shivering, diarrhoea, compared by Pearson&#39;s Chi-square test, were found to be more but non significant in misoprostol group. <b>Conclusion:</b> This study concludes that per-rectal misoprostol is equally effective as intramuscular oxytocin to control PPH without significant adverse effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QC09-QC13&id=15387 https://doi.org/10.7860/JCDR/2021/50020.15387 Sealing Ability of Three Different Surface Coating Materials on Conventional and Resin Modified Glass Ionomer Restoration in Primary Anterior Teeth: An In vitro Study Anshula Deshpande, Chirag Macwan, Steffi Dhillon, Medha Wadhwa, Neelam Joshi, Yash Shah <b>Introduction:</b> Microleakage is an important property that has been used in assessing the success of any restorative material used in restoring a tooth. Immediate application of a surface coating agent is suggested to protect glass ionomer cement against moisture contamination and dehydration during early setting. <b>Aim:</b> To compare marginal microleakage of two different Glass Ionomer Cement (GIC)- Conventional GIC and Resin Modified GIC in primary anterior teeth using three surface coating materials. <b>Materials and Methods:</b> An in vitro study was conducted between January 2014 to October 2017 on freshly extracted 40 anterior primary teeth which were randomly assigned into two main groups (Fuji II GIC and Fuji II LC GIC) with four subgroups (control-no surface coating, A=GC Fují Varnish II, B=GC G-Coat Plus, C=Icon). A standardised Class V cavity preparation was prepared on the labial surface of each tooth. Specimens were coated with two layers of nail varnish, leaving a 1 mm window around the cavity margins and placed in a solution of Methylene blue Dye for 24 hour at 37&#176;C. The teeth were sectioned longitudinally in a buccolingual direction of the restorations and evaluated under stereomicroscope to check extent of dye penetration. The results were analysed by ANOVA and Tukey’s post-hoc test (p&#8804;0.05). <b>Results:</b> It was found that maximum microleakage was seen in group 1 (Fuji II GIC) as compared to group 2 (Fuji II LC GIC) and it was non-significant (p=0.53). Ascending order for mean microleakage for Group 1 was as follows: Control >GC Fuji Varnish >Icon DMG >GC G-Coat and for Group 2: Control >GC Fuji Varnish >Icon DMG >GC G-Coat. Icon when compared with Gc coat and Varnish also showed non-significant (p=0.137) difference in Group 2. <b>Conclusion:</b> All three different surface coatings can seal glass ionomer restorations. The GC G-Coat Plus has the least microleakage on Resin-Modified GIC (RMGIC) compared to the other surface coatings. This would aid the clinicians to make appropriate decision regarding the choice of material to be used for restoration and coating in anterior primary teeth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC17-ZC22&id=15382 https://doi.org/10.7860/JCDR/2021/49814.15382 Evaluation of Donor Ankle Function after Harvesting Peroneus Longus Tendon Graft for Anterior Cruciate Ligament Reconstruction- A Prospective Cohort Study Mamata Manjari Sahu, Arul S Pragassame, Patitapaban Mohanty, Pabitra Kumar Sahoo <b>Introduction: </b>Primary full thickness Peroneus Longus Tendon Graft (PLTG) for Anterior Cruciate Ligament Reconstruction (ACLR) has been used with good clinical outcome. Recently, it is designated as a promising graft option for ACLR. The effect of harvesting PLTG on donor ankle function is still not completely understood. Peroneus Longus Tendon (PLT) is thought to play a major role in proprioceptive regulation of the ankle joint. All the studies till date did cross-sectional assessments of ankle and foot function at or after 6 months that might have overlooked the timely detection of donor site morbidities. <b>Aim:</b> To evaluate the ankle function and compare the affected and sound limb function in subjects with an ACLR with autologous PLTG starting at an early postoperative visit upto six months. <b>Materials and Methods:</b> A prospective cohort study was conducted at a tertiary rehabilitation centre from March 2019 to March 2021 including the follow-up evaluation. As per the inclusion criteria, 63 participants after ACLR with PLTG were considered for assessment using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot scale and Foot and Ankle Ability Measure (FAAM) scale at 6 weeks, 3 months and 6 months post-ACLR follow-up. Comparison between sound and affected limbs was done during all follow-ups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 18.0. Both FAAM and AOFAS ankle and foot scores were analysed with non parametric tests. <b>Results:</b> Mean age of 63 participants were 29.25 years. Median of AOFAS and FAAM score at 6 week, 3 month, and 6 month post-ACLR follow-ups were (88, 98 and 100) and (97.22, 98.80 and 100), respectively. Statistically significant increase in AOFAS and FAAM scores were observed at 3 month and 6 month as compared to 6 week follow-ups with p=0.001 and p-value=0.001 respectively. The group comparison between the affected and sound side functional scores at different study visits showed statistically significant greater values for the sound ankle than the affected ankle (FAAM: 6 week: p-value=0.001; 3 month: p-value=0.001; 6 month: p-value=0.001 and AOFAS p-value=0.001; p-value=0.001; p-value=0.001, respectively). <b>Conclusion:</b> The evaluation of functional outcomes showed gradual and linear improvement at subsequent postoperative visits and restores fully to 100% at 6 month indicating a near-normal to normal donor ankle function following ACLR with PLTG by 6 months. The group comparison showed only marginal but significant difference between affected and sound ankle function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=YC13-YC17&id=15383 https://doi.org/10.7860/JCDR/2021/49882.15383 Role of Arterial Serum Lactate as a Predictor of Undifferentiated Shock on Admission and its Outcome- A Cohort Study Avadhesh Kumar Sharma, Nandakumar Beke, Dattatray Patki, Arun Bahulikar, Deepak Sadashiv Phalgune <b>Introduction:</b> Patients with elevated serum lactate levels may be at risk for considerable morbidity and mortality and require a prompt, thoughtful and systematic approach for diagnosis and treatment. <b>Aim:</b> To find an association of on admission arterial serum lactate with outcome in Intensive Care Unit (ICU) patients. Materials and Methods: This observational cohort study was conducted on 168 patients at Poona Hospital and Research Centre, Pune, India, between June 2018 to November 2019 after obtaining Institutional Ethical Clearance. The patients included were above 18 years of age who had Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) >100/min and Respiratory Rate (RR) >20/min. The arterial serum lactate level were examined on the day of admission, 12 hours and 24 hours. The need of ionotropic support, duration of ICU stay and mortality in one month was noted. The primary outcome measures were to study the association of on admission arterial serum lactate level with a duration of ICU stay and in-hospital mortality, whereas the secondary outcome measure was to study the association of on admission arterial serum lactate with the requirement of ionotropic support. Analysis of data was done using Statistical Package for Social Sciences for Windows, version 20.0. <b>Results: </b>The incidence in-hospital mortality was 20 (22.7%) out of 88 and 3 (3.8%) out of 80 in patients whose serum lactate levels on admission were >36 mg/dL and &#8804;36 mg/dL, respectively (p-value=0.002). The median duration of ICU stay was six and three days in patients whose serum lactate levels on admission were >36 mg/dL and &#8804;36 mg/dL, respectively (p-value=0.001). A 87 (98.9%) patients whose serum lactate levels >36 mg/dL on admission had the higher requirement of inotropes as compared to 35 (50.7%) patients whose serum lactate levels were &#8804;36 mg/dL. The percentage of patients whose serum lactate level >36 mg/dL, had a significantly higher Quick Sequential Organ Failure Assessment (qSOFA) scores and higher Shock Index (SI). There was a statistically significant positive correlation between serum lactate levels and qSOFA score (r=0.555) and SI (r=0.559). <b>Conclusion:</b> Initial serum lactate level was associated with higher in-hospital mortality, the higher requirement of inotropic support and longer duration of ICU stay. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OC13-OC16&id=15384 https://doi.org/10.7860/JCDR/2021/49761.15384 Does Dual Motor Tasks Provokes Posture Adaptations in Healthy Young Adults? A Cross-sectional Study Carley Bowman, Aleena Jose, Martin G Rosario <b>Introduction: </b>Most studies on postural deviations during single and dual tasks have been extensively studied in neuromuscular and older adult populations. Nevertheless, further research is warranted to identify whether such tasks can impose postural adaptations in young, healthy adults without sensory impairments. <b>Aim: </b>To assess postural stability modifications in young adults during single tasks and dual motor tasks (holding a cup filled with water) while concomitantly challenging the sensory systems. <b>Materials and Methods:</b> This was the cross-sectional study on 82 young adults (18-45 years old) from Texas Woman’s University (TWU) Health Science Center in Dallas, Texas, and surrounding areas. Standing postural control was measured by collecting total sway, direction of sway and velocity in the Anterior-Posterior (AP) and Medial-Lateral (ML) directions during different balance tasks. For single and dual tasks, the tests were performed with a bipedal stance on foam involving challenging the sensory input via Eyes Open (EO), Eyes Closed (EC), and head movements with eyes open (EO HUD) and closed (EC HUD). The dual motor tasks were similar to the single tasks with the addition of holding a cup full of water to split attention. Data were placed into the Statistical Package for Social Sciences (SPSS) Data Analysis 25.0 system and were analysed for repeated measures Analysis of Variance (ANOVA) analysis. <b>Results:</b> Eighty-two healthy young adults participated in this study (mean age of 24.6&#177;2.7 years, 13 males and 69 females). An ANOVA analysis revealed that postural stability was considerably altered during motor tasks. Sway in the AnteroPosterior (AP) direction, and velocity of sway increased as the complexity of the tasks intensified. A substantial difference in total sway during single tasks when eyes were closed compared to eyes open (p-value<0.01) was noted. There was a significant difference in total sway (AP and ML) during eyes open (EOM) to eyes closed (ECM) and during eyes open with head moving up and down (EOM HUD) (p-value 0.001). There were significant differences in mean AP velocity during EO (0.11&#177;0.12) compared to EC HUD (0.19&#177;0.15), and when comparing EOM (0.07&#177;0.04) to ECM HUD (0.13&#177;0.08) (p=0.01) <b>Conclusion:</b> This study identified postural changes when comparing single and dual tasks in healthy young adults, and the outcomes of this study showed definite distinctions in postural responses during single and dual motor tasks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=YC09-YC12&id=15374 https://doi.org/10.7860/JCDR/2021/49048.15374 Flowcytometry in Chronic B-Cell Lymphoproliferative Disorders: A Retrospective Study from a Tertiary Oncology Centre, Trivandrum, India CM Simi, Rekha A Nair, Priya Mary Jacob, AV Jayasudha Non-tubal ectopic pregnancies are risk factors for maternal death and require prompt diagnosis and treatment. However, there are no established guidelines for their treatment because their rarity and care is individualized. We retrospectively reviewed the medical records of non-tubal ectopic pregnancies at our institution between May 2009 and September 2020. Thirty-four relevant cases were identified, including 14 interstitial, seven cervical, six peritoneal, three caesarean scars, two ovarian, and two rudimentary horn pregnancies; 23 of the 34 cases were diagnosed before treatment using ultrasound or magnetic resonance imaging. All patients were examined before nine weeks of gestation, and 17 were examined for a positive pregnancy test without any symptoms. In conclusion, in our hospital, non-tubal ectopic pregnancies were identified early, resulting in successful treatment without serious complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC14-EC17&id=15375 https://doi.org/10.7860/JCDR/2021/46090.15375 Comparison of Serum Vitamin B12 Levels in Type 2 Diabetes Mellitus Patients with and without Diabetic Retinopathy: A Case-control Study Supriya, Mangala Narayan Sirsikar <b>Introduction:</b> Diabetes mellitus is characterised by hyperglycaemia. Chronic elevation of hyperglycaemia lead to generation of free radicals and Advanced Glycation End products (AGEs) which results in damage of many organs such as heart, kidney, eyes, nerves and blood vessels. Diabetic Retinopathy (DR) is the leading cause of blindness among diabetic patients. Vitamin B12 is a vital micronutrient that is essential for the proper functioning of the central nervous, cardiovascular and haemopoetic systems. It is also found that its deficiency is more prevalent in Type 2 Diabetes Mellitus (T2DM) and evident clinically. <b>Aim:</b> To compare the serum vitamin B12 levels and Glycated Haemoglobin (HbA1c) levels in patients with and without diabetic retinopathy. <b>Materials and Methods:</b> This was hospital based observational case-control study conducted in Biochemistry Department in collaboration with Ophthalmology Department at the Oxford Medical College, Hospital and Research Centre, Yadavanahalli, Bengaluru, Karnataka, India, from January 2018 to June 2018 with total of 90 subjects. Among 90 patients, 30 patients were with diabetes mellitus with Retinopathy (DR), 30 were with diabetes mellitus without retinopathy (NDR) and 30 were also recruited as control (healthy individuals). The mean and standard deviation were used to describe continuous data. Analysis of Variance (ANOVA) was used to statistically compare the mean difference between more than two sets of quantitative data. <b>Results:</b> The mean plasma blood glucose levels were higher in T2D patients with DR, Fasting Blood Glucose (FBG) (270.4&#177;94.2 mg/dL) and Postprandial Blood Glucose (PPBG) (425.6&#177;131.8 mg/dL) compared to control subjects FBG (95.4&#177;10.7 mg/dL). Among the T2D patients the plasma HbA1c concentration of DR group was found to be higher (11.0&#177;2.3%) compared to the NDR group (p-value <0.001). While, the blood levels of vitamin B12 were comparable between the groups, serum vitamin B12 levels were significantly lower (p-value <0.001) in T2DM group with DR (200.7&#177;201.9 pg/mL) compared to the control group (1004.8&#177;304 pg/mL). <b>Conclusion:</b> The patients with diabetic retinopathy showed that low serum vitamin B12 is associated with elevated Glycated haemoglobin (HbA1c) levels, as a result of poor glycaemic control, endothelial dysfunction and oxidative stress leading to development and progression of DR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=BC04-BC07&id=15376 https://doi.org/10.7860/JCDR/2021/48346.15376 Plasma Levels of Fetuin B and Fibrinogen in Chronic Obstructive Pulmonary Disease: A Preliminary Cross-sectional Study CV Shri Swathini, MVP Chowdary <b>Introduction:</b> Recent exploratory proteomics study reported increased blood levels of Fetuin B (FETUB) in Chronic Obstructive Pulmonary Disease (COPD). Growing body of evidence demonstrates fibrinogen not only as acute phase reactant but also possesses features advocating as biomarker of COPD. <b>Aim:</b> To determine the blood levels of FETUB and fibrinogen independently as well as in combination COPD and among severity of COPD. <b>Materials and Methods:</b> A single-centred cross-sectional study of eight months duration was conducted during May to December 2017. A total of 76 blood samples (38 COPD patients and 38 controls) were recruited. Based on distribution, parametric and non parametric statistical tools were used. Analysis of co-variance and multiple multivariate linear regression models were utilised to assess the influence of clinical data on FETUB. Steel-Dwass-Critchlow-Fligner method was employed for multiple pairwise comparisons. Receiver Operating Characteristic (ROC) curve were generated to compute cut-off of FETUB, fibrinogen and their combination. <b>Results:</b> The median age of subjects were 57 years with an IQR of 50-66 years for controls whereas 58 years (IQR 50-65 years) for COPD subjects. In comparison to controls, a significant increase in blood levels of both FETUB and fibrinogen in COPD and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages of COPD was prominent. Among COPD grades, differences of FETUB levels were significant in GOLD I vs II and GOLD IV vs I, II and III whereas fibrinogen levels in GOLD III from GOLD IV. FETUB showed independent correlation with Forced Expiratory Volume (FEV) 1% pred and severity of COPD. A moderate improvement in combined (FETUB+fibrinogen) analysis of control vs COPD was noticed. <b>Conclusion:</b> The present study demonstrates significant increase in blood levels of FETUB in COPD and among the severity of COPD in comparison to fibrinogen. Hence, FETUB can be a more promising probable inflammatory biomarker in COPD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=BC08-BC13&id=15377 https://doi.org/10.7860/JCDR/2021/49391.15377 Comparison of Clinical and Histopathological Parameters amongst Microsatellite Unstable and Microsatellite Stable Cases of Colorectal Carcinomas in an Indian Setting Divya Shelly, KV Vinu Balraam, Reena Bharadwaj, C Bharani <b>Introduction:</b> In this era of prognosis based medicine, it is important to identify microsatellite unstable Colorectal Cancers (CRCs) as they offer good prospects to the patient and they respond poorly to 5-fluorouracil and platinum based chemotherapeutic regime. <b>Aim:</b> To find out the prevalence of Microsatellite Instability-High (MSI-H) in CRC, to identify clinicopathological features associated with Microsatellite Instability (MSI) and assess the value of surgical pathology in predicting MSI-H. <b>Materials and Methods:</b> The present study was a case-control study conducted in a tertiary care centre of Pune in Western India from January 2013 to December 2020. Thirty-five CRCs deficient in Mismatch Repair (MMR) proteins contrasted with 206 Microsatellite Stable (MSS) CRCs were studied and analysed for a given set of clinical and histopathological parameters to find out any correlation between the occurrence of microsatellite unstable tumours and these variables were presented as percentages. <b>Results:</b> In the present study, the prevalence rate of MSI-H was found to be 14.5% and the statistical analysis was carried out using the software Statistical Package for the Social Sciences (SPSS) version 27.0. Univariate analysis revealed that right-sided/proximal location of tumours, age at diagnosis less than 50 years, no lymph node deposits (N0 disease), presence of Tumour Infiltrating Lymphocytes (TILs), peri-tumoural reaction, mucinous component, increased stromal plasma cells, histological heterogeneity, signet ring/medullary component and Crohn-like reaction were all statistically significant predictors of microsatellite instability (p-value <0.05). Multivariate analysis of these significant parameters revealed right-sided location of tumours, age at diagnosis less than 50 years, N0 disease, and presence of TILs, increased stromal plasma cells, histological heterogeneity and Crohn-like reaction to be independent predictors. <b>Conclusion:</b> Clinical parameters and histological evaluation is handy in screening for the MSI-H colorectal carcinomas. This would go a long way in selecting the patients who will require confirmatory molecular testing and thus precluding the need of Immunohistochemistry (IHC), which will be helpful in day-to-day practice as it is uncomplicated, cost-effective and easy to replicate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC18-EC23&id=15378 https://doi.org/10.7860/JCDR/2021/49545.15378 An Audit of Management of Chronic Pancreatitis with Pancreatic Ductal Disruption Resulting in Ascites and Pleural Effusion Mukund Prabhakar Kulkarni, Sanjeev Chatni, Nagaraja Nayakar <b>Introduction:</b> Pancreatic Ductal Disruption (PDD) may remain a localised collection to form pseudocyst or dissect into adjacent organs or rupture freely into the peritoneal cavity or pleural cavity resulting in massive or high-volume ascites or pleural effusions. The management of pseudocyst is well known among general and gastrosurgeons, but ascites and plural effusion remain difficult decisions. Depending on the availability of resources total parenteral nutrition, octreotide, pancreatic duct stenting are used with varying success. There are no guidelines as to which intervention is preferable in different clinical scenarios. <b>Aim: </b>To audit the clinical characters and management of patients with pancreatic ascites and pleural effusion. <b>Materials and Methods:</b> This study was done at the Department of Surgical Gastroenterology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. Fifty two patients with pancreatic ascites or pancreatico pleural fistula in the background of chronic pancreatitis satisfying both inclusion and exclusion criteria were identified and studied from the prospectively maintained database of patients with chronic pancreatitis in the period from September 2010 to September 2020. The patients were classified as conservatively managed, endoscopic main pancreatic duct stenting or surgery. Statistical analysis was done using windows excel. The results were expressed as percentage, mean and Standard Deviation (SD). <b>Results:</b> Five patients with ascites and two patients with pleural effusion responded completely to conservative measures (13.4%). In one of them ascites recurred at two months and one had left pleural effusion recurrence at one month. Fifteen patients died while on conservative management (68.2% mortality). Among eight patients undergoing endoscopic pancreatic duct stenting, ascites/pleural effusion resolved in six (75% success rate) and remained asymptomatic during mean follow-up of 12 months. Two patients who were not improving after stenting were lost to follow-up. Twenty-two patients underwent surgery namely lateral pancreatojejunostomy with resolution of symptoms. Two patients undergoing surgery died in postoperative period due to sepsis and chest infection (9.1% mortality). At a mean follow-up of 14 months they remained symptom free. <b>Conclusion: </b>Conservative management alone has high mortality. Early aggressive management can aim to stop leak either by pancreatic duct stenting or surgical lateral pancreatojejunostomy will help reduce mortality and morbidity https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PC01-PC04&id=15379 https://doi.org/10.7860/JCDR/2021/48478.15379 Comparison of Analgesic Efficacy of Erector Spinae and Oblique Subcostal Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy Lingaraj Sahu, Sanjaya Kumar Behera, Ganesh Chandra Satapathy, Shlok Saxena, Subhadra Priyadarshini, Rajendra Kumar Sahoo <b>Introduction:</b> The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) blocks. However, till date no study exists which compares the above blocks with addition of dexamethasone. <b>Aim:</b> To compare ESP with OSTAP block using low concentration of Local Anaesthetic (LA) and dexamethasone as part of MMA in elective LC. <b>Materials and Methods:</b> A total of 66 patients were included in this study and finally, 60 patients were analysed. They were randomised to receive either bilateral ESP at T7 level or bilateral OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone before starting anaesthesia. Primary outcome measures were total opioid consumption and mean Visual Analog Scale (VAS) in the first 24 hours postoperatively. Secondary outcome measures were intraoperative opioid consumption, opioids or block related complication, and patients’ feedback for procedural satisfaction and postoperative pain control. The results were analysed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. Continuous and categorical data were analysed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. <b>Results:</b> Both the blocks provided excellent pain relief. The mean (24 hours) opioid consumption in ESP group was 29.83&#177;54.74 mg and in OSTAP group was 73.17&#177;94.04 mg; p=0.034. The mean VAS was significantly lower in the ESP block at all point of time during first 24 hours in ESP group was 0.58 and in OSTAP group was 1.72 (p<0.001). The mean intraoperative opioid requirement in ESP and OSTAP group were 6.9&#177;1.8 mg and 7.6&#177;2.3 mg of nalbuphine, respectively. No complications were noted in any patients. <b>Conclusion:</b> Addition of dexamethasone in ESP block provides significant analgesia and less opioid consumption in patients undergoing LC. Hence, ESP block can be considered as part of MMA in LC surgery https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC09-UC13&id=15380 https://doi.org/10.7860/JCDR/2021/50795.15380 Awareness and Knowledge of General Dental Practitioners in Central India Towards Management of Patients with Temporomandibular Disorder: A Questionnaire-based Survey Jayashree Sajjanar, Minal Soni, Jaykumar Gade, Megha Agrawal, Arunkumar Basavaraj Sajjanar <b>Introduction:</b> Temporomandibular Disorders (TMDs) accounts for common Orofacial Pain (OFP) arising from musculoskeletal origins, affecting almost 80% of the overall population. The multifactorial nature of the disease makes it difficult to diagnose and treat and is challenging to a considerable number of General Dental Practitioners (GDPs). They’re increasingly approached by patients for advice on TMD, but little is understood about how this disorder is addressed with in primary health care. <b>Aim:</b> To assess the awareness and knowledge regarding management of TMDs among GDPs in Central India. <b>Materials and Methods:</b> The cross-sectional study was conducted at Central India, Nagpur, Maharashtra, India from 20th June 2020 to 12th December 2020, including 200 general dental practitioners, who were registered under the Dental Council of India. A questionnaire consisting of 17 questions with reference to TMDs was designed and the questionnaire was circulated through a web designed program. The responses were collected, and data were analysed descriptively using Statistical Package for the Social Sciences (SPSS) statistics for windows version 24.0. <b>Results:</b> The mean age of the participants in the study was 24.80&#177;1.63 years. Predominantly, participants were 164 females (82%). Among all the participants, about 181 (90.50%) of GDP&#39;s were practicing Dentistry. The study findings suggest that the overall general practicing dentists encounter TMD cases and 162 (81%) of GDP&#39;s treat patient at their clinic. A 76% of GDPs acknowledged the causative factor for TMD to be multifactorial and physical examination (88.50%) as the diagnostic tool. Most of the general practitioners around 126 (63%) preferred referring the patient to the specialist, maxillofacial surgeon. Among the practitioners who were confident in treating TMD, occlusal splint was the treatment of choice for 198 (96%) of the GDPs. <b>Conclusion: </b>Many GDPs lack standard protocol knowledge, felt insecure in TMD diagnosis, therapy decisions and treatment. There is a requirement for better quality evidence on which TMD diagnosis and treatment, including the event of a valid, reproducible patient-centered outcome measure to enable dental practitioners to feel confident in managing TMD. It is essential to train GDPs to identify individuals with TMDs through professional courses and training. It would be highly beneficial to educate the undergraduates regarding the diagnosis of TMDs in their curriculum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC01-ZC05&id=15356 https://doi.org/10.7860/JCDR/2021/48593.15356 Development of Minimal Pair Test in Tamil (MPT-T) Kavitha Vijayakumar, Saranyaa Gunalan, Ranjith Rajeshwaran <b>Introduction:</b> Speech perception testing provides an accurate measurement of the child&#39;s ability to perceive and distinguish the various phonetic segments and patterns of the sounds. From among the many types of speech stimuli used, minimal pairs can also be used to assess the phoneme recognition skills. Thus, the study focused on developing Minimal Pair Test in Tamil (MPT-T). <b>Aim:</b> The aim of the present study was to develop and validate the MPT in Tamil on Normal Hearing (NH) children and paediatric cochlear implantees (CI). <b>Materials and Methods:</b> It was an experimental study which included school going children in the age range of six to eight years and the duration of the study was 12 months. The test was developed in two phases. The first phase focussed on the construction of the word list, recording of the word pairs and the preparation of the test. The second phase was administration of the test on NH children and paediatric cochlear implantees. The test scores were analysed using Mann Whitney U test, Kruskal Wallis and Wilcoxon signed-rank test. The results showed a statistical significance between the NH group and the paediatric cochlear implantees. <b>Results:</b> The present study included 40 NH children and 15 paediatric cochlear implantees through purposive sampling method. The specific speech feature analysis of the paediatric cochlear implantees revealed that there was difficulty identifying the word pairs differing in Vowel Length (VL) and the best performed feature was Place of Articulation (POA). The results showed statistical significance between the NH group and the paediatric cochlear implantees. <b>Conclusion:</b> The developed test can be effectively used in clinic for assessing speech perception abilities of pediatric Cochlear Implantees and also in planning the rehabilitative goals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=MC01-MC04&id=15357 https://doi.org/10.7860/JCDR/2021/46807.15357 Study of Correlation of Cytomorphological Features of Lymphocytic Thyroiditis with Biochemical Parameters and Vitamin D Deficiency Preeti Patni, Shreeshail Belagavi, Priyanka Mishra, Tanu Choudhary <b>Introduction:</b> Fine Needle Aspiration Cytology (FNAC) of the thyroid is a reliable and common method used for diagnosis of chronic Lymphocytic Thyroiditis (LT) which is an autoimmune disease. Vitamin D (Vit D) deficiency, a prevalent health problem, is known to have correlation with various autoimmune diseases especially chronic LT. <b>Aim: </b>To evaluate the relationship between Vit D levels, biochemical parameters with cytomorphological features of LT. <b>Materials and Methods:</b> The present cohort study was conducted on 88 patients with cytological evidence of LT at a thyroid research centre in northern India between June 2017 to September 2018. Thyroid Stimulating Hormone (TSH), Antithyroid Peroxidase (ATPO) Antibody and Vit D levels along with patient’s clinical presentation, and thyroid ultrasound were evaluated for all subjects. The cytological grades and other cytomorphological features were correlated with these parameters. <b>Results:</b> Most of the patients were females (82, 93.2%) who presented with diffuse thyromegaly (69, 78.4%) and had hypothyroidism (58, 65.9%). By cytology grade I thyroiditis (40, 45.5%) was commonest followed by grade II (38, 43.2%). The Vit D deficiency and elevated ATPO were seen in 72 (81.8%) and 78 (88.6%) patients, respectively. Lowest level of Vit D (7.8&#177;4.9 ng/mL) was seen in grade III patients. Significant correlation was observed between ATPO and Vit D levels with cytomorphological grades and some cytomorphological features like Hurthle cell change and plasma cells presence. While TSH levels correlated significantly with cytological grades only in hypothyroid group. <b>Conclusion: </b>This study found that Vit D deficiency and ATPO levels significantly correlates with cytological grades of thyroiditis and affect certain cytomorphological features like plasma cells presence, suggesting lower levels of https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC05-EC09&id=15358 https://doi.org/10.7860/JCDR/2021/48991.15358 A Comparative Evaluation of Dimensional Accuracy and Surface Detail Reproduction for Polyvinyl Siloxane and Vinyl Siloxane Ether under Dry and Moist ConditionsAn In-vitro Study Amit Baban Pokharkar, Umesh Gopal Palekar, Veena Saraf, Deepak Machindra Vikhe, Shefali Sevakram Bhiwapurkar, Pallavi Madanshetty <b>Introduction:</b> The conventional impression procedure plays a major role in prosthodontics inspite of advancement in intraoral scanning devices and 3D imaging procedures. Dimensional accuracy and surface detail reproduction are important for recording an impression. <b>Aim: </b>The study evaluated and compared the dimensional accuracy and surface detail reproduction of Polyvinyl Siloxane (PVS) and vinyl siloxane ether impression materials when used under dry and moist conditions. <b>Materials and Methods:</b> An in-vitro study was conducted in the Department of Prosthodontics, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India, for a period of two years from October 2018 to September 2020. A total of 60 impressions were made with PVS (Group A) and vinyl siloxane ether (Group B) under dry (A1, B1) and moist (A2, B2) conditions of stainless steel dies which had lines engraved on superior surface of the die. Using a Harloc’s Tool maker’s microscope, dimensional accuracy was measured by comparing the width of line Y in each impression. Surface detail reproduction was evaluated by American Dental Association (ADA) specification no. 19 where it stated continuous replication of at least any two lines out of the three lines inscribed on the die. Data analysis processing was performed in the SYSTAT version 12 (made by Crane’s software, Bangalore). Student’s unpaired t-test and Chi-square test were performed to determine statistical difference between PVS and vinyl siloxane ether where the level of significance was set at 5% and 1%. <b>Results:</b> The mean dimensional change and SD values for PVS under dry condition ranged from 21.93&#177;2.46 to 22.40&#177;2.89 (in mm). The mean dimensional change and SD values for PVS under moist condition ranged from 22.87&#177;3.20 to 23.33&#177;3.42. The mean dimensional change and SD values for vinyl siloxane ether under dry condition ranged from 21.93&#177;3.61 to 24.73&#177;5.20. The mean dimensional change and SD values for vinyl siloxane ether under moist condition ranged from 21.93&#177;4.48 to 22.87&#177;4.15. No statistical difference was found under dry and moist conditions within 2 hours and after 24 hours for both the materials. <b>Conclusion:</b> The study revealed no significant difference between dimensional accuracy and surface detail reproduction for PVS and vinyl siloxane ether. Both the materials can reproduce the details under dry and moist conditions satisfactorily and remained dimensionally stable till 24 hours after impression making. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC06-ZC10&id=15359 https://doi.org/10.7860/JCDR/2021/49092.15359 Evaluation of Intubating Conditions during Direct Laryngoscopy using Sniffing Position and Simple Head Extension- A Randomised Clinical Trial Amanjot Singh, Rupinder Kaur, Gurpreet Singh, Kewal Krishan Gupta <b>Introduction:</b> Optimal laryngeal visualisation during direct laryngoscopy requires adequate positioning of the head and neck. Traditionally, Sniffing Position (SP) is the recommended position to provide superior glottic visualisation. However various studies in recent past have challenged the superiority of SP. <b>Aim:</b> To evaluate whether SP provides better glottic visualisation and ease of intubation {as assessed by total Intubation Difficulty Score (IDS) score as well as its individual components} compared to Simple Head Extension (SHE) during direct laryngoscopy and endotracheal intubation. <b>Materials and Methods:</b> The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from May 2019 to October 2020, on 220 patients. Patients undergoing elective surgeries under general anaesthesia were randomly divided into two groups. Laryngoscopy and tracheal intubation in Group I was done in SP, which was obtained by placing a non compressible pillow of height 8 cm under the patient&#8217;s head. Patients in Group II underwent laryngoscopy and tracheal intubation in SHE position. Glottic visualisation using modified Cormack and Lehane (CL) grades, IDS and sympathetic responses between the two groups were studied. The data was compared using student&#8217;s t-test and Chi-square test. <b>Results:</b> Cormack and Lehane Grade I was seen in 69 (62.7%) of patients in Group I as against 51(46.4%) of patients in Group II (p-value=0.015). Easy intubation (total IDS score=0) was seen in a greater number of patients in Group I (60.9%) as compared to Group II (40.95%) (p-value=0.003). Slight difficulty in intubation (total IDS score=1-5) was encountered in 50.0% of patients in group II (n=55) and 35.5% of patients in group I (n=39) (p-value=0.029). <b>Conclusion:</b> The present study concluded that use of SP resulted in better glottic visualisation and was associated with favourable intubation conditions as compared to SHE position. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC05-UC08&id=15360 https://doi.org/10.7860/JCDR/2021/50579.15360 Lifestyle Practices and Knowledge on Prevention and Control of Overweight and Obesity among Adolescents: A Cross-sectional Study Shycil Mathew, Jenifer Dsouza, Prakash Saldanha <b>Introduction:</b> Adolescent obesity is a major public health challenge and it is a growing epidemic. Change in diet and physical inactivity are the key factors affecting weight among adolescents. Due to this, the prevalence of non communicable diseases and their risk factors are alarmingly high among them. To tackle this issue, early identification and effective health promotion strategies at a young age need to be adopted. Hence, there is a need for understanding the current trend in overweight and obesity among growing adolescents. <b>Aim:</b> The study aimed to identify the lifestyle practices and to determine knowledge on prevention and control of overweight and obesity among overweight and obese adolescents in selected urban high schools at Mangaluru, Dakshina Kannada (D.K.), India. <b>Materials and Methods:</b> A descriptive cross-sectional study was conducted among adolescents at selected urban high schools of Mangaluru, D K, India. A sample of 360 adolescents was screened to identify the occurrence of overweight and obesity. Body Mass Index (BMI) was computed using the formula, BMI=weight (Kg)/ height<sup>2</sup> (m<sup>2</sup>). A total of 65 overweight and obese adolescents were assessed for lifestyle practices and level of knowledge on prevention and control of overweight and obesity. Demographic proforma, a structured knowledge questionnaire, and a self-report lifestyle practice rating scale were used to collect data. <b>Results:</b> The occurrence of overweight and obesity among adolescents was 18%. According to their BMI status, 9.7% of adolescents were overweight and 8.3% of them were obese. Self-reported lifestyle practice scores depicted that most (86.2%) of the overweight and obese adolescents follow unhealthy lifestyle practices. Majority (66.1%) of the adolescents had only average knowledge on prevention and control of overweight and obesity. <b>Conclusion:</b> Though a maximum number of adolescents had average knowledge on prevention and control of overweight and obesity, unhealthy lifestyle practices are major risk factors for overweight and obesity among growing adolescents. Overweight and obese adolescents should strictly follow healthy lifestyle practices. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LC01-LC05&id=15361 https://doi.org/10.7860/JCDR/2021/50200.15361 Impact of a Multidisciplinary Lifestyle Intervention on Weight Reduction in Overweight and Obese Adolescents- A Longitudinal Study Arivoli Kaliyan, Venkatesh Singa Kumaran, Sudhakar Prasanna, Narayanan Ethirajan, Reji Manjunath, Sathya Jeganathan <b>Introduction: </b>Domestic Violence (DV) on women during perinatal period is a major public health issue. DV is prevalent throughout the world and has huge adverse effects in postnatal period. <b>Aim:</b> To assess prevalence and to determine the association between DV and depressive symptoms among antenatal women. <b>Materials and Methods:</b> A cross-sectional study conducted in a tertiary care centre at Jawaharlal Nehru medical college, Dutta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, from September 2018 to September 2019. A 200 antenatal women between age range of 18-50 years attending the Outpatient Department were included in the study. They were administered the Edinberg Postnatal Depression Scale (EDPS) to evaluate for DV and its association with Antenatal Depression (AND). For the purpose of bivariate logistic regression, a variable for depression was computed based on EPDS scores, i.e., symptoms of depression during pregnancy, whereby an optimal cut-off of &#8805;13 was chosen as representing the presence of symptoms of depression. Statistical analysis was done by using descriptive and inferential statistics using chi-square test. The p-value less than 0.05 was taken as statistically significant. <b>Results:</b> The most common age range of participants were between 21-30 years. A 28 (14%) of 200 women were found to have a history of DV. Majority of them experienced psychological abuse (39.3%), followed by verbal (28.6%), physical (7.4%) and combined types of abuses (25%). The perpetrators were mostly husbands and in-laws. Reasons for abuse included husband&#39;s alcohol abuse, in-law&#39;s interferences and dowry demand. Based on EDPS, 41.5% had depression and 9.5% had probable depression. DV was found to be significantly associated with AND. Income of the family and occupation of the patient were found to be other significant associated factors. <b>Conclusion:</b> Domestic Violence (DV) has a significant correlation with AND. Proper prenatal screening for DV, early diagnosis and management of AND including family interventions are necessary to improve the health and wellbeing of pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=SC01-SC05&id=15362 https://doi.org/10.7860/JCDR/2021/50887.15362 Ultrasound Guided Suprascapular Nerve Block versus Intra-articular Steroid Injection in the Treatment of Periarthritis Shoulder: A Randomised Clinical Trial Sakshi Jain, Diganta Borah, Dharam Singh Meena, Junis Ali <b>Introduction:</b> Suprascapular Nerve Block (SSNB) and Intra-articular (IA) steroid injection are used for management of Periarthritis (PA) of shoulder with variable results. <b>Aim:</b> To compare the efficacy of SSNB and IA steroid injection for management of PA shoulder. <b>Materials and Methods:</b> In this randomised clinical trial, 100 patients of PA shoulder from Physical Medicine and Rehabilitation (PMR) Outpatient Department (OPD) were enrolled over the period of 18 months and were divided in two equal groups using computerised block randomisation. Group A patients received IA methylprednisolone while Group B patients were subjected to Ultrasound (USG) guided SSNB. Assessment was done at baseline and at 1, 4 and 12 weeks after the intervention, using Numerical Pain Rating Scale (NPRS), active and passive Range Of Motion (ROM) of shoulder and Shoulder Pain And Disability Index (SPADI). Statistical significance was determined by Chi-square for qualitative variables and by unpaired t-test or paired t-test for quantitative variables. The p<0.05 was taken as a level of statistical significance. <b>Results:</b> Both groups had significant improvement (p<0.0005) in pain, ROM and functional index at all follow-ups. Comparison between the groups revealed a better outcome in Group A, in terms of NPRS, SPADI score, internal and external rotations at 1, 4 and 12 weeks (p<0.0005). Both the groups were comparable in terms of abduction, flexion and extension at first week (p<0.0005) with Group A showing better improvement at subsequent follow-up. <b>Conclusion:</b> Both SSNB and IA steroid injection can be used for treatment of PA shoulder but IA steroid injections gave better results as compared to SSNB. SSNB may be used as an adjunct to exercise therapy and as an alternative to IA steroid injection if required. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=KC01-KC05&id=15363 https://doi.org/10.7860/JCDR/2021/50033.15363 Cone Beam Computed Tomography of Mesiobuccal Root and Canal Morphology of Maxillary Molars in Delhi-NCR Population- A Retrospective Study Jaynit Tandon, Sonali Taneja, Vidhi Kiran Bhalla, Akshay Rathore <b>Introduction:</b> Adequate knowledge of the anatomic variation and root canal morphology is paramount for long term endodontic success. The presence of two canals in Mesiobuccal (MB) root is commonly associated with maxillary molars in various populations. <b>Aim: </b>To retrospectively evaluate the prevalence of a second mesiobuccal canal (MB2) in maxillary first and second molars in Delhi-National Capital Region (NCR) population using Cone Beam Computed Tomography (CBCT) analysis. <b>Materials and Methods:</b> This retrospective study evaluated the records of complete maxillary CBCT scans of 204 maxillary first and second molars from January 2016 till May 2019 from different CBCT centres in Delhi-NCR region to determine the anatomy and morphology in June 2019. The prevalence of second MB2 canals was recorded and associated with age, gender and symmetry. The z-test for proportions was used to assess the differences among the subgroups. <b>Results:</b> The number of roots in 204 teeth in both maxillary molars were determined. The prevalence of 3-rooted configuration was 98.55% in maxillary first molars and 79.4% in maxillary 2nd molars. Also, in maxillary 2nd molars, 7.4% were single rooted and 13.2% had 2-rooted configuration. Three rooted configuration and variable canal number was commonly reported in maxillary molars. Prevalence of MB2 canal was 87.2% in maxillary 1st molars and 64.2% in maxillary 2nd molars. Also, the prevalence was 87.2% bilaterally in maxillary first molars and 65.7% on the right and 53.9% on the left in maxillary second molars respectively. Type IV canal configuration was most prevalent in 44.60% of maxillary first molars and type 1 configuration (35.78%) for the maxillary second molars. <b>Conclusion:</b> Prevalence of MB2 canals in maxillary first and second molars was found to be high in North Indian population and the clinician should suspect its presence in all cases. Prevalence of MB2 had bilaterally symmetrical distribution without any association with age or gender. The MB roots were more likely to exhibit type IV and type II canal configurations in maxillary first molars and type I and type II configurations in second molars. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC11-ZC16&id=15364 https://doi.org/10.7860/JCDR/2021/49780.15364 Histopathological Spectrum of Non Traumatic Scalp Swellings in a Tertiary Teaching Hospital of Western Uttar Pradesh, India Kamna Gupta, Meenakshi Tyagi, Alok Mohan, Rajnish Kumar, Roopanshi Mittal <b>Introduction:</b> Scalp is a region where pilosebaceous follicles are present in high density and a wide histopathological spectrum can be seen. Aetiology of a scalp swelling may be traumatic, inflammatory, allergic, infective or neoplastic. Malignant tumours are not uncommon in this region and the literature available is also limited. This makes the scalp an interesting site for study. <b>Aim:</b> The present study was to highlight the histopathological spectrum of non traumatic scalp swellings. <b>Materials and Methods:</b> The present study was a 10 year hospital-based observational ambispective study from February 2010 to January 2020, done in the department of Pathology in a tertiary teaching hospital in Western Uttar Pradesh, India. A total of 144 non traumatic scalp swellings were studied and analysed using Statistical Package for the Social Sciences (SPSS) version 19 software. <b>Results:</b> A total of 144 cases were studied. Male to female ratio was 1.4:1. Mean age was 40.94 years. Benign cases were 139 and five cases were malignant. Keratinous cyst was the common diagnosis (n=52), followed by lipoma (n=24). Most common malignant lesion was basal cell carcinoma (n=3), followed by squamous cell carcinoma (n=2). <b>Conclusion:</b> Scalp swellings vary from keratinous cysts to malignancies. The study of scalp swellings is a must so that a variety of histopathological manifestations can be widely understood and interdisciplinary approach can be implemented in the diagnosis and management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC10-EC13&id=15365 https://doi.org/10.7860/JCDR/2021/49711.15365 Contralateral Breast Primary in Breast Cancer Survivors-An Experience from a Tertiary Care Centre in Thiruvananthapuram, Kerala, India Manu Paul, Athul K Vasudev, Rexeena V Bhargavan, Kurian Cherian, Paul Augustine <b>Introduction:</b> Improved life expectancy after breast cancer treatment has led to increased incidence of contralateral breast cancers. There are no well established guidelines for the management of these cancers. There is a paucity of Indian data regarding contralateral breast cancers. <b>Aim:</b> To describe the clinicopathological profile and prognostic outlook of patients with contralateral breast cancers. <b>Materials and Methods:</b> All patients who underwent surgery for non metastatic breast cancer between January 2006-December 2010 at Regional Cancer Centre, Thiruvananthapuram, Kerala, India, were identified. The follow-up data of these patients (6240 patients) were retrieved from medical records division in January 2020. The medical records of all these patients who developed contralateral breast cancer were analysed. <b>Results:</b> A total of 98 patients (1.57%) developed contralateral breast cancer. Most of the second breast cancers were presented at a lower stage than index cancer. Twenty five patients (25.51%) contralateral breast cancers were detected after five years. A total of 58 patients (59.18%) had interval cancer. Among them, 32 (55.17%) were detected by the treating doctor and 26 patients (44.83%) were symptomatic. The median duration of follow-up was 98 months (range 24-150 months). The five year Overall Survival (OS) was 80.5% and five year Disease Free Survival (DFS) was 62.8%. The patients who developed contralateral breast cancer within three years had lower five year OS when compared to those who developed after three years (75.5% vs 86.7% p=0.85). Five year OS was 74.8%, 81% and 85% for patient reported interval cancer, physician detected interval cancers and mammogram detected cancers respectively (p=0.9). <b>Conclusion:</b> Most contralateral breast cancers presented in a lower stage than index cancer. Contralateral breast cancer has got a reasonably good five year OS. There is no significant OS difference between mammogram detected second cancer and interval cancer. There was a need for more frequent clinical breast examination even after five years to detect contralateral primary in an early stage. Cost effectiveness of frequent follow-up mammogram examinations compared to clinical examination should be evaluated in future prospective studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=XC01-XC04&id=15366 https://doi.org/10.7860/JCDR/2021/50983.15366 Effect of Distributed Versus Massed Practice on Reaction Time in Collegiate Volleyball Players: A Pilot Study Kiran Negi, SD Shahanawaz, Priya Chauhan, Basudeo Rajbhor <b>Introduction:</b> Reaction Time (RT) is the time taken by an individual to respond to external stimuli. It is one of the most important determinant ability in sports like Volleyball. Shorter RT leads to higher performance and success in Volleyball. Two types of training methods, massed and distributed practice have been used in researches to improve RT and other sports related skills in sports. In massed practice, there is persistent workout with hardly any rest periods even of minimal time period relative to the work interval while in distributed practice; it is interspersed with rest or other skill learning. There are mixed evidences on effectiveness of these practice methods which has led to the present study. <b>Aim:</b> To find the effect of distributed practice and massed practice in terms of RT among collegiate volleyball players. <b>Materials and Methods: </b>The study design was quasiexperimental pilot study that was conducted at the volleyball academy Gurugram, Haryana, India from September 2019 to December 2019. A total of 30 players, aged 18-22 years, from college volleyball team were invited to participate in the study. Subjects were randomly divided into two groups. Group A received massed practice (n=15), and group B received distributed practice (n=15) for 40 minutes, four days a week for four weeks. Players who were practicing daily for one hour were included in this study and they were excluded if they had any condition that limited their participation in the study or if they are suffering from any type of orthopaedic or neurological illness. RT was measured using Ruler Drop Test (RDT) and Red Light Green Light Test (RLGL). Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0 for statistical analysis. <b>Results: </b>The mean pre and post data of Group A, for RDT was 0.16 and 0.12 seconds, respectively; of Group B, it was 0.16 and 0.13. The mean pre and post data of Group A for RLGL was 0.42 and 0.38 seconds, respectively; Group B data for RLGL pre and post was 0.39 and 0.37 seconds, respectively. Both the groups showed significant improvement in scores of RDT (p-value for Group A=0.01, Group B=0.05) and RLGL (p-value for Group A=0.01, Group B=0.01) measured by the paired sample t-test (p<0.05). But there was no significant difference in between group analysis measured by independent sample t-test (p>0.05). <b>Conclusion: </b>This study showed that both massed and distributed practice was helpful in improving RT of collegiate volleyball players. As there was no significant difference between the two groups, consequently which practice method is superior in improving RT in collegiate volleyball players could not be stated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=YC05-YC08&id=15367 https://doi.org/10.7860/JCDR/2021/49981.15367 Arterial Parameters in Type-2 Diabetes and Healthy Subjects by using Impedance Plethysmography: A Case-control Study Yogesh Kishorbhai Kacha, Chetankumar Bhalabhai Desai, Hemant B Mehta, Chinmay J Shah <b>Introduction:</b> A reduced blood supply to lower limb, due to arterial disease, is a common cause of foot ulceration in patients with Diabetes Mellitus (DM). Impedance Plethysmography (IPG) is based on the measurement of changes in the electrical resistance (impedance) caused by blood volume changes. <b>Aim:</b> To compare parameters of type-2 diabetic subjects with those of healthy subjects along with different age group and to associate with Blood Flow Index (BFI), Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PP<sub>2</sub>BS) and Body Mass Index (BMI). <b>Materials and Methods:</b> This case-control study was conducted at Government Medical College and in UHTC, Bhavnagar, Gujarat, India, from May 2012 to August 2013 on 100 healthy subjects and 100 type-2 diabetic subjects. IPG arterial parameters like BFI, Pulse Arrival Time (PAT), Pulse Termination Time (PTT), Differential Pulse Arrival Time (DPAT), Z<sub>0 </sub>(Basal impedance) recorded. The data were analysed by unpaired t-test and ANOVA test. <b>Results:</b> This study had 200 subjects of age more than 30 years. The diabetic subjects included 56 males and 44 females whereas the healthy subjects included 67 males and 33 females. There was bilateral significant reduction of BFI, PAT at knee, ankle and calf segment among diabetics group in males and females; and a bilateral significant reduction of PTT at ankle segment among diabetic males and females. DPAT value increased at knee, calf and ankle segment on both sides in male and female; except right ankle segment in diabetic group in females as compared to healthy subjects. Z<sub>0</sub> increased at knee, ankle and calf segment in diabetic group on both side in males and females. BFI decreased with an increase in the duration of diabetes. The effect of FBS, PP<sub>2</sub>BS and BMI in diabetic subjects suggested a negative association with BFI. <b>Conclusion:</b> There was decrease in BFI, PAT, PTT and increase in DPAT in the knee, calf and ankle region of diabetic subjects.BFI negatively correlated with FBS, PP<sub>2</sub>BS and BMI among diabetics and decreased with increased duration of DM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=CC05-CC09&id=15368 https://doi.org/10.7860/JCDR/2021/49493.15368 Clinicopathological Profile of Oral Squamous Cell Carcinoma in Eastern India Surendra Nath Senapati, Dipti Rani Samanta, Ajitesh Avinash, Maitree Parida, Sugyan Nandan Mohanty, Sanat Kumar Bhuyan, Rabi Narayan Mallik <b>Introduction:</b> Head and Neck Squamous Cell Carcinoma (HNSCC) entails a heterogeneous group of tumours that emerge from the interaction between molecular changes and environmental factors. Dysregulated long noncoding RNAs (LncRNAs) play a major part in tumourigenesis and could be used as cancer biomarkers and therapeutic aims. <b>Aim:</b> To evaluate the expression of two lncRNAs named Fer-1 Like Family Member 4 (Fer1L4) and differentiation antagonising non protein-coding RNA (DANCR) in tumoural tissue of HNSCCs patients in comparison to Adjacent Non cancerous Tissues (ANCTs) to appraise their diagnostic power and the relationship with clinicopathological parameters. <b>Materials and Methods:</b> The present case-control study was designed, in which fresh frozen cancerous tissues and ANCTs were taken from 50 sporadic HNSCC patients who were attended in Imam Khomeini and Amir Alam Hospitals (Tehran, Iran) from from January to December 2019. Real-time PCR was utilised for expression profiling of Fer1L4 and DANCR. By employing GraphPad Prism 8.0 GraphPad Software, Inc., San Diego, CA, the real-time quantitative PCR experiments(2-..Ct) method and the Mann-Whitney test were exerted to analyse the obtained data. The Receiver Operating Characteristic (ROC) curve analysis was employed for figuring out the discrimination potential of two selected lncRNAs between the subject tumour and ANCT. <b>Results: </b>The expression of Fer1L4 was significantly down-regulated in tumoural tissues by analogy to ANCTs (p-value <0.0001) and statistically significant associations were found between the stage and grade status of the tumour with the relative expression of this lncRNA (p-value=0.008 and p-value=0.002 for stage and grade, respectively). The findings in this study indicated that the expression of DANCR was not statistically significant different in different tumoural tissues compared with ANCTs (p-value=0.46). ROC curve unraveled that the Fer1L4 had good diagnostic power Area Under Curve(AUC) 0.9252; p-value<0.0001. The expression of DANCR and Fer1L4 was significantly, respectively, higher and lower in samples with lymph node invasion and metastasis than that of the counterpart group. Concerning Human Papillomavirus (HPV) as an important exogenous factor for the development of HNSCC, DANCR and Fer1L4 were over-expressed and under-expressed, respectively in the HPV+group in comparison to HPV-. <b>Conclusion:</b> This work represented that Fer1L4 could be used as a novel diagnostic biomarker for HNSCC. In addition, the statistically significant difference in the expression of Fer1L4 and DANCR in metastatic tumours demonstrated that these two lncRNAs are promising targets for therapeutic purposes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=XC05-XC08&id=15369 https://doi.org/10.7860/JCDR/2021/50185.15369 Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT Kanti Rajkumari, Akoijam Joy Singh, Longjam Nilachandra Singh, Margaret Chabungbam, C Sreejith, Moirangthem Janet, Monica Moirangthem, Tasso Opo <b>Introduction:</b> Treatment for Low Back Pain (LBP) due to Prolapsed Intervertebral Disc (PIVD) includes conservative management, Epidural Steroid Injection (ESI), and surgery. Transforaminal Epidural Steroid Injection (TFESI) is a more recently described approach. All corticosteroid preparations used for TFESI are particulate except dexamethasone and betamethasone sodium phosphate. But while comparing methylprednisolone with dexamethasone, the latter has more potent anti-inflammatory action with least likelihood of causing embolic events and is also less expensive. <b>Aim:</b> To compare the efficacy of transforaminal epidural injection of dexamethasone and methylprednisolone in reducing LBP and disability in prolapsed lumbar intervertebral disc amongst the indigenous population of Manipur, India. <b>Materials and Methods:</b> This was a randomised controlled study on 80 patients with PIVD attending Outpatient Department (OPD) at physical medicine and rehabilitation was conducted from September 2016 to August 2018. A single dose of lumbar TFESI with dexamethasone in the study group and methylprednisolone in the control were given under C-arm guidance. The outcome variables Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) for function were measured at one week, one month and six months. Statistical tests like t-test, Chi-square test were used for intra group and inter group analysis. <b>Results:</b> In the total sample of 80 patients, 40 (15 males and 25 females, mean age: 38.28&#177;8.55 years) were categorised as Dexamethasone patients and 40 (17 males and 23 females; mean age: 39.28&#177;7.80 years) as methylprednisolone patients, there were significant improvement in mean score of VAS and ODI in both the groups (p-value <0.05). At six months, both treatment groups maintained initial observed improvements, with no significant differences between groups on the VAS {95% Confidence Interval (CI), -0.02 to 0.4; p-value=0.07} and ODI (95% CI,-0.21 to 3.43; p-value=0.08). <b>Conclusion:</b> Non-particulate steroid dexamethasone was similar in efficacy to the particulate steroid methylprednisolone in lumbar TFESI. However, in view of the greater safety profile of dexamethasone, it is suggested that dexamethasone may be used as the preferred agent in lumbar TFESI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=KC06-KC09&id=15370 https://doi.org/10.7860/JCDR/2021/48704.15370 Triple Arthrodesis for Equinovarus Foot using Ilizarov Technique: A Retrospective Study Ritesh Arvind Pandey, Richa <b>Introduction:</b> Equinovarus foot deformity is a significant problem in adolescents and its treatment remains challenging. Triple arthrodesis, even though an effective palliative tool in management of complex foot deformity, has its own limitations if it is done for acute deformity correction. Ilizarov technique offers gradual deformity correction, fusion and takes care of many known complications of acute correction. However, there are very few studies about effectiveness and functional outcome of triple arthrodesis for equinovarus deformity when done gradually with an Ilizarov fixator. <b>Aim:</b> To study the effectiveness of triple arthrodesis, performed with Ilizarov technique for equinovarus foot deformity in adolescents and adults and to evaluate the early functional outcome and patient satisfaction rate for this procedure. <b>Materials and Methods:</b> A retrospective analysis of 22 feet in 20 patients with equinovarus foot deformity between January 2015 and December 2018 was done. Patients underwent gradual deformity correction and triple fusion with Ilizarov fixator. Foot was assessed for any residual deformity and shortening. Functional outcome and patient satisfaction were assessed by Ankle Hind Foot Scale (AHFS) and Likert scale, respectively using paired t-test. Final analysis was done with Statistical Package for Social Sciences (SPSS) software version 21.0. <b>Results:</b> Twelve males and eight females with mean age of 15.9&#177;3.4 years fulfilled the inclusion criteria and were included for final analysis of results. Fusion rate was 86.1% with mean union time of 12.5 weeks. Mean AHFS improved from 61.27 before surgery to 76.9 which was statistically significant (p<0.0001). One or more complications were seen in 15 (68.1%) feet but were managed satisfactorily without any significant impact on final outcome. Patient satisfaction rate for the procedure was 80%. After a mean follow-up of 18.1 months, plantigrade foot with equal foot length was obtained in all patients. <b>Conclusion:</b> Triple arthrodesis with gradual deformity correction by Ilizarov technique effectively corrects equinovarus foot deformity and foot length discrepancy. Known complications of acute deformity correction can be avoided with equally good results. It corrects deformity and restores alignment of foot more accurately leading to a high patient satisfaction rate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=RC01-RC06&id=15393 https://doi.org/10.7860/JCDR/2021/48274.15393 Effect of Foetal Movement Counting on Prenatal Attachment and Maternal Worries among Primigravidas- A Longitudinal Study Jignya Vinodbhai Asari, Anjali Pushkar Tiwari <b>Introduction:</b> Pregnant woman experience various physical, emotional, and hormonal changes that may cause anxiety. The anxiety and worries can be decreased by sharing information about the developing child, like foetal body movement. <b>Aim:</b> To assess effect of Foetal Movement Counting (FMC) on prenatal attachment and maternal worries among primigravida mothers. <b>Materials and Methods:</b> A longitudinal study was carried out among primigravida mothers of selected Hospitals of Central Gujarat using proforma of Cranley’s maternal foetal attachment scale and Cambridge worry scale. The study was conducted from March 2019 to July 2020. Eighty participants were recruited by convenient sampling 40 in each study group and control group.The study group were provided with foetal movement chart and the participants were asked to record foetal movements for seven consecutive days, twice a day for 20 minutes. Post assessment of prenatal attachment and maternal worries was done using tools of data collection for both study and control group. Chi-square test was used to test the significance (p-value <0.05). <b>Results: </b>The study results revealed that in study group mean score for prenatal attachment was 79.43 at the start and improved to 101.25 (p-value <0.001) after seven days of FMC. In control group, the mean score for prenatal attachment did not show significant difference pre-test and post-test (74.20 vs 74.85, p-value=0.077). In study group, the mean Cambridge worry scale score was 36.55 which came down to 20.28 (p-value <0.001) after seven days, while in control group it was 41.38 at the beginning and 41.30 after seven days (p-value=0.998). <b>Conclusion: </b>Foetal Movement Counting was found to improve maternal foetal attachment and reduce maternal worries. FMC can be routinely and effectively promoted among the pregnant population to help them achieve a positive pregnancy experience and outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LC06-LC08&id=15394 https://doi.org/10.7860/JCDR/2021/48870.15394 Single Nucleotide Polymorphism of Insulin Receptor Gene rs2059806 in Polycystic Ovary Syndrome- A Case-control Study Satwika Sinha, Kaushik Kar, Partha Pratim Chowdhury, Anindya Dasgupta <b>Introduction:</b> One of the most common endocrinopathies faced in clinical practice is Polycystic Ovary Syndrome (PCOS). Furthermore, it is one of the major causative factors of anovulatory infertility affecting a large number of female population worldwide. They are also at a greater risk for developing impaired glucose tolerance, type 2 diabetes mellitus and cardiovascular disease. Decreased sensitivity to insulin is a common feature observed in women with this syndrome. <b>Aim:</b> To assess whether polymorphism of insulin receptor gene has a significant role to develop the PCOS. <b>Materials and Methods: </b>This was a case-control, observational, hospital-based study, conducted at Department of Biochemistry, Calcutta National Medical College, Kolkata from January 2018 to September 2018. Total 123 patients with PCOS cases and 111 normo-ovulatory normal control female subjects were selected. Blood samples were collected for estimation of serum testosterone and Deoxyribonucleic Acid (DNA) extraction. Polymerase Chain Reaction (PCR) followed by Restriction Fragment Length Polymorphism (RFLP) pattern of PCR fragments of DNA samples were determined. The study analysed and compared the genotyping and allele frequencies of rs2059806 polymorphism in control and case group. For comparison, chi-square test was performed (Odds ratio, p<0.05). <b>Results:</b> Amongst the 123 PCOS cases and 111 normal female subjects of the study, mean age of PCOS patients were 22.59&#177;4.7 years and that of control subjects was 21.9&#177;5.1 years. The present study observed an increase in mutant G allele in PCOS subjects (Odds ratio-2.18, p=0.0035). <b>Conclusion:</b> The polymorphism of insulin receptor gene rs2059806 may have a probable role in the development of PCOS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=GC07-GC10&id=15395 https://doi.org/10.7860/JCDR/2021/49653.15395 Reasons for Cancellation of Elective Surgical Operations: A Cross-sectional Study from a Tertiary Care Centre in North-East India Laltanpuii Sailo, Stephen Lalfakzuala Sailo, Nari Mary Lyngdoh, Rajani Thabah, Tridip Jyoti Borah, Prithwis Bhattacharyya <b>Introduction: </b>Cancellation of elective surgical operations is defined as an elective operation which is not performed on the scheduled date. The rates and the reasons for cancellation vary in different parts of the world. Cancellation causes increased cost of treatment, loss of daily wage and mental trauma. It also causes under utilisation of hospital resources and loss of training opportunities to surgical trainees. <b>Aim:</b> To estimate the rate of cancellation of elective surgical operations in a tertiary care centre in North-East India and determine the reasons for cancellation. <b>Materials and Methods:</b> A prospective cross-sectional study was conducted at a 500 bedded, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India, from January 2018 to September 2018. All consecutive elective surgical cases scheduled during this period were included in the study. The rate and the reasons for cancellation were noted. Descriptive statistics was used for analysis of the results. <b>Results: </b>Out of 1812 elective surgical operations scheduled during the study period, 491 operations (27.10%) were cancelled. The most common reasons for cancellation were shortage of time (78.62%), medical causes (10.79%) and administrative problems (4.48%). Cancellation rate was highest in the Department of Surgical Oncology (40.23%), followed by Departments of Orthopaedics (34.51%) and Obstetrics and Gynaecology (OG) (31.02%). <b>Conclusion: </b>The rate of cancellation of elective surgical operation was high (27.10%) and the most common reason was shortage of time and Surgical Oncology Department had highest rate of cancellation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC14-UC18&id=15396 https://doi.org/10.7860/JCDR/2021/49656.15396 Efficacy of Bilateral Erector Spinae Plane Block using Bupivacaine and Ropivacaine for Postoperative Analgesia following Lumbar Spine Surgeries- A Randomised Clinical Study Nimi Sreedhar, Hemlata, Megha Kohli Mehrotra, Prem Raj Singh, Ahsan Khaliq Siddiqui, Monica Kohli <b>Introduction:</b> Erector Spinae Plane Block (ESPB) is a safe and simple technique that provides favourable pain relief and reduced postoperative analgesia consumption. Both bupivacaine and ropivacaine have been used in ESPB and have been found to provide good postoperative analgesia. <b>Aim:</b> To compare the efficacy of bupivacaine and ropivacaine in bilateral ESPB for postoperative pain relief in lumbar spine surgeries. <b>Materials and Methods:</b> The randomised clinical trial was conducted from July 2019 to June 2020. The study included 60 patients posted for lumbar spine surgeries which were divided randomly into two groups. Group A patients (n=30) received ESPB using 0.25% bupivacaine and group B patients (n=30) received ESPB with 0.2% ropivacaine after induction of GA with endotracheal intubation. Visual Analog Scale (VAS) score, time to first rescue analgesic, haemodynamic changes and any complications were monitored at regular time intervals in the postoperative period. For quantitative data, a parametric test (Student’s t-test) and a non parametric test (Mann-Whitney U test) were used. The Chi-square test was used for parametric analysis of qualitative data. <b>Results: </b>The mean age (in years) in Group A was 36.93&#177;9.47 and Group B was 38.00&#177;8.43. There was significant difference in mean VAS scores between bupivacaine and ropivacaine groups at 4 hours (4.03&#177;0.93 vs 4.57&#177;0.94; p-value=0.033) and at 6 hours (5.63&#177;0.55 vs 5.26&#177;0.64; p-value=0.021), postoperatively. The mean time to first rescue analgesic requirement was significantly higher in bupivacaine group than ropivacaine group (6.33&#177;1.3 vs 5.27&#177;0.97 hours: p-value=0.001). Patients in both the groups remained haemodynamically stable throughout the study period. No significant change in saturation, Electrocardiogram (ECG) changes, postoperative nausea and vomiting was observed in any of the two groups. <b>Conclusion:</b> The ESPB with bupivacaine 0.25% provides better and prolonged analgesic effect postoperatively as compared to ropivacaine 0.2% with acceptable haemodynamic stability. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC19-UC23&id=15397 https://doi.org/10.7860/JCDR/2021/49463.15397 Open Technique Versus Blind Technique in Placement of Primary Ports in Laparoscopic Procedures- A Prospective Cohort Study Vivek Pahuja, Nisha Rani, Hershdeep Singh, Kuldip Singh, Pankaj Dugg, Devinder Pal Singh, Prem Chand <b>Introduction:</b> Laparoscopic access has always been a challenge because it has been associated with severe complications and sometimes fatal also. <b>Aim:</b> To compare open technique versus blind technique in placement of primary port in various laparoscopic procedures in terms of operative time, complications, ease of use and acceptability. <b>Materials and Methods:</b> This prospective cohort study was conducted at Government Medical College Patiala, Punjab, India, between June 2014 and August 2016. The study included 100 patients, which were divided into two groups. Group A (n=50) received placement of primary port by open technique and Group B (n=50) received placement of primary port by blind technique. The time taken for access into peritoneal cavity and duration of surgery was noted. Multivariate analysis was using Chi-square test, p-value of less than 0.05 was considered significant. <b>Results:</b> Mean age of patients in group A and group B was 42.66&#177;12.37 years and 43.06&#177;14.67 years, respectively. Majority of patients were females in both groups (n=45 in group A and n=39 in group B). There was no significant difference in time taken for access into peritoneal cavity (p-value >0.05). The duration of hospital stay (in hours) of the patients was 36.96 in Group A and 34.42 in Group B which was not statistically significant. The incidence of intraoperative and postoperative complications was not significant. Most common complication port site infections (3,6%) in Group A. <b>Conclusion:</b> There was no significant difference between the two techniques with respect to time taken for peritoneal access and https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PC05-PC07&id=15398 https://doi.org/10.7860/JCDR/2021/30610.15398 Prevalence of Anaemia in Patients with Type-2 Diabetes Mellitus in the Absence of Renal Impairment: A Cross-sectional Study Sandeep S Reddy, Ankita Sarma <b>Introduction:</b> Despite an increasing incidence of diabetic nephropathy, undermining the renal production of Erythropoietin (EPO), there are significant number of studies being reported with anaemia among diabetic patients with renal insufficiency, implicating numerous theoretical pathogenesis. Its impact being ignored over the years among Indian contexts, women and men in rural Southern India are particularly vulnerable to anaemia. The associated risk factors and occurrence of anaemia in Type-2 Diabetes Mellitus (T2DM) can be seen even in the absence of renal insufficiency. <b>Aim:</b> To determine the prevalence of anaemia in T2DM patients with normal renal function and assessment of its association with sociodemographic characteristics, biochemical and haematological variables. <b>Materials and Methods: </b>A descriptive cross-sectional study was conducted for a period of six months from December 2018 to May 2019 on total of 150 patients with T2DM, attending the Outpatient Department, Rajarajeswari Medical College and Hospital, Bangalore, India. All the patients of either sex, aged between 18-60 years, with a duration of Diabetes Mellitus (DM) more than five years, with no renal involvement, were included in the study. All statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test, Z-test was used for data analysis. <b>Results:</b> Among the 150 subjects, 86 (57.3%) were classified to be anaemic, with a mean age of 53 years whereas, 64 (42.6%) were classified as non anaemics with a mean age of 50 years. The mean duration of diabetes was found to be 10.5 years among anaemics and 9.7 years among non anaemics. Compared to non anaemics subjects, drug therapy with both Oral Hypoglycaemic Agents (OHA) and insulin showed a statistically significant difference among diabetic subjects with anaemia. The high prevalence of normocytic anaemia (52.3%) suggests the importance of non renal causes of anaemia in diabetic patients. <b>Conclusion: </b>Patients with T2DM have an independent risk for anaemia irrespective of renal insufficiency, posing a significant adverse effect on the quality of life and the progression of the underlying disease with high cardiovascular morbidity and mortality. Hence, management of diabetic patients should include mandatory routine haematological tests, with consideration of advancing age and poor glycaemic control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OC17-OC20&id=15399 https://doi.org/10.7860/JCDR/2021/47013.15399 Impact of Lockdown due to COVID-19 Pandemic on Undergraduate Ophthalmology Teaching: Students’ and Teachers’ Perspective Adnan Matheen, G Sruthi, DP Shinisha, Shankar Chokkalingam, Balaji Arumugam, Premnath Gnaneswaran <b>Introduction:</b> Coronavirus Disease-2019 (COVID-19) pandemic has forced the union government to close the educational institutions. The medical teaching had to go digital. Digital learning has advantages but not without limitations and challenges. <b>Aim:</b> To analyse the impact of lockdown due to COVID-19 pandemic on undergraduate ophthalmology teaching and learning and explore the perception of faculty and students regarding its advantages, limitations and recommendations. <b>Materials and Methods: </b>This cross-sectional survey was conducted among ophthalmology faculty and pre final year students from six government and 11 private medical colleges through online Google questionnaire which was initially validated by three faculty and 10 students had Cronbach’s value-0.70. Based on the pilot study, the questionnaire was modified. Valid responses were entered in data sheets and Statistical Package for the Social Sciences (SPSS) version 24.0 was used to analyse the data. Chi-square test was used to find out the association between symptoms post online classes and duration of online classes and gender of the students. The p-values <0.05 were considered significant. <b>Results:</b> Approximately, 1500 students and 65 faculty were approached online. Out of which there were 1015 respondents, 967 valid responses were considered for analysis (929 students and 38 faculty). More than 70% of the students used mobile phone for attending online classes. Zoom (˜40%) and Google meet (˜30%) were the commonly used applications. A total of 79.3% of medical students and 84.2% of faculty disagreed to continue with online classes after the pandemic. Lack of faceto-face interaction, practical demonstration and on-campus life, connectivity issues and eye symptoms post online classes were the major disadvantages. Availability of gadgets, internet connectivity and self-discipline were the major challenges faced. The ocular symptoms were marginally more in females (p-value >0.05) and in those with extended duration of attending online classes (p-value <0.05). Post online lectures, none of the faculty had non-ocular symptoms. In comparison to the medical students, 78.9% of the faculty (30/38) always maintained proper screen position whereas 64.4% of students (598/929) did not always maintain proper screen position. <b>Conclusion: </b>According to this study, learners preferred less duration of online classes, improvement in e-teaching quality with interactive lectures and demonstration. Teachers preferred improved infrastructure and network connectivity. This study gives an insight of students and teachers mentality towards the online ophthalmology classes https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=NC09-NC14&id=15400 https://doi.org/10.7860/JCDR/2021/48011.15400 Extraction Free Rapid Detection of SARS-CoV-2 from Oropharyngeal/Nasopharyngeal Swabs by Real Time PCR Parul Sinha, Sandeep Gupta, Megha Gupta, Dinesh Kumar Jain, Malvika Sharma, Kanika Sharma, Saroj Hooja, Nitya Vyas <b>Introduction:</b> The emergence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic has been troublesome particularly for developing countries that lack infrastructure and capacities to produce the kits locally. Simplification of the method can increase diagnostic efficiency which can benefit patients and help in infection control, consequently saving time and lives. <b>Aim:</b> To evaluate the diagnostic value of four methods (that omit extraction step) for detection of SARS-CoV-2 against the traditional extraction method. <b>Materials and Methods:</b> This was a cross-sectional analysis for evaluating diagnostic accuracy of four methods for detection of SARS-CoV-2 by real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR), conducted in the Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India, in October 2020. Ninety four SARS-CoV-2 RT-PCR positive samples and 20 negative samples were taken for this study. Automated extraction system was used for Ribonucleic Acid (RNA) extraction and four different approaches were compared to the traditional extraction method for detection of SARS-CoV-2 by RT-PCR. Data was entered and analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 24.0. <b>Results: </b>The automated RNA extraction method was compared to the method of direct addition of samples with (Heat processed Direct Viral transport medium Sample (HDVS)) and without heating (Direct Viral transport medium Sample (DVS)), directs addition of diluted (1:5) sample with (Heat processed diluted VTM sample (HdVS)) and without heating (Diluted VTM sample (dVS)) as well as after addition of Proteinse K (PK) to the diluted samples that came either negative/invalid. Out of four methods, the HdVS method gave the best results, considering extraction with Perkin Elmer as standard, this method showed sensitivity of 96.74%, specificity of 100%. <b>Conclusion:</b> In current pandemic, molecular testing is critically challenged by the limited supplies of reagents of nucleic acid extraction alternative method like diluting and heating of Viral Transport Media (VTM) samples and using them directly as elutes serve as an easy, fast and inexpensive alternative. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=DC11-DC15&id=15401 https://doi.org/10.7860/JCDR/2021/50193.15401 Correlation between Arterial and Venous Blood Electrolytes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study Bhavesh Ramji Sadariya, Amitkumar Virji Maheshwari, Hardik N Javia, Hariom Sharma <b>Introduction:</b> Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a common health problem coupled with huge mortality and morbidity across the world. Acute exacerbation in COPD patients leads to electrolyte disturbances. Routinely, electrolytes are measured from venous blood. Electrolytes can also be measured from whole blood by blood gas analyser along with blood gases measurement. <b>Aim:</b> To study the correlation between venous and arterial blood electrolytes in AECOPD patients. <b>Materials and Methods:</b> The cross-sectional study was conducted at Clinical Biochemistry Laboratory, Government Medical College and Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat, India, from December 2013 to May 2014. Arterial and venous blood were taken at same time from 150 patients of AECOPD and analysed for electrolytes (sodium, potassium and ionised calcium) in arterial blood gas analyser. Correlation of arterial and venous blood electrolyte levels was done by Pearson&#8217;s correlation. <b>Results:</b> This study comprised 109 (72.67%) male and 41 (27.33%) female AECOPD patients. Mean age of subjects was 59.01&#177;11.42 years. Mean level of arterial sodium was 143.1&#177;8.81 mmol/L and venous sodium was 144.8&#177;8.47 mmol/L (p-value=0.0973). Mean level of arterial potassium was 3.53&#177;0.73 mmol/L and venous potassium was 3.19&#177;0.56 mmol/L (p-value <0.0001). Mean level of arterial ionised calcium was 0.83&#177;0.13 mmol/L and venous ionised calcium was 0.76&#177;0.17 mmol/L (p-value <0.0001). Correlation coefficient values for sodium, potassium and ionised calcium were 0.878, 0.762 and 0.537, respectively. <b>Conclusion:</b> Arterial sodium and potassium can be used as a substitute of venous sodium and potassium in management of AECOPD patients, while arterial ionised calcium should not be used in place of venous ionised calcium in management of such patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=BC14-BC17&id=15402 https://doi.org/10.7860/JCDR/2021/50336.15402 Evaluation of Apical Root Morphology of Maxillary Incisors using Cone Beam Computed Tomography in Brazilian Subpopulation: A Cross-sectional Study Cristiane Martins Rodrigues Bernardes, Luiz Eduardo Gregoris Rabelo, Cyntia Rodrigues DE Araújo Estrela, Orlando Aguirre Guedes, Brunno Santos DE Freitas Silva, Carlos Estrela <b>Introduction:</b> The prevalence of Apical Root Resorption (ARR) after orthodontic treatment is high. It is associated with several factors, such as tooth group, type and duration of treatment, applied force and root morphology. <b>Aim:</b> To evaluate the apical root morphology of maxillary incisors in a Brazilian subpopulation using Cone Beam Computed Tomography (CBCT) images. <b>Materials and Methods:</b> In this retrospective and cross-sectional study, 400 maxillary incisors from 167 patients registered in the data base of Dental Radiology Clinics between January 2012 and April 2017 were analysed. The apical root configuration was verified by navigating 0.1 mm/0.1 mm, in the three planes, axial, coronal, and sagittal sections on CBCT images, from the root canal entrance to the apical foramen, as well as from the apical direction to the crown. The standard reference for apical root form corresponded to the long axis of the tooth. The root forms and their frequency were characterised according to the classification proposed by Levander and Malmgren (1988). The qualitative variables were analysed by the Chi-square test. The level of significance was p-value <0.05. <b>Results:</b> A total of 400 maxillary anterior teeth (central and lateral incisors; n=200 each) from 167 patients (101 women; mean age was 41.8&#177;16.20 years) were analysed. The most common apical root form presented in the central incisors was the blunt root {99 (49.5%)}, followed by pipette-shaped root {69 (34.5%)}. The less frequent was the short root {13 (6.5%)} (p-value <0.001). In the lateral incisors, the highest frequency presented was lacerated root {111 (55.5%)}, followed by blunt root {47 (23.5%)}, and pipetteshaped root {37 (18.5%)} (p-value <0.001). <b>Conclusion: </b>Maxillary central incisors had a higher frequency of rhomboid (blunt) root morphology, while lateral incisors had a higher frequency of curved (lacerated) root form. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC23-ZC26&id=15410 https://doi.org/10.7860/JCDR/2021/49776.15410 Postoperative Analgesic Efficacy of Nalbuphine vs Dexmedetomidine as Adjuvants to Ropivacaine in Ultrasound Guided Transversus Abdominis Plane Block for Abdominal Hysterectomies: A Randomised Clinical Study Sumanth Tarigonda, Vishnuvardhan Voleti, Dinesh Krishnamurthy, Sheela Shikaripura Rangappa <b>Introduction:</b> Transversus Abdominis Plane (TAP) block has been practised as an effective alternative to systemic analgesics to achieve adequate postoperative analgesia, with minimal systemic side effects. Dexmedetomidine, an alpha-2 agonist and nalbuphine, an opioid, have been studied as adjuvants to local anaesthetics to improve the analgesic profile of regional anaesthetic blocks. <b>Aim: </b>To compare the duration and quality of postoperative analgesia of dexmedetomidine and nalbuphine when used as adjuvants to ropivacaine for TAP block. <b>Materials and Methods: </b>This was a randomised double blinded study conducted on 60 patients undergoing total abdominal hysterectomies under spinal anaesthesia. Patients were randomly distributed into two groups of 30 patients each, to receive either 39 mL of 0.2% ropivacaine + 50 µg dexmedetomidine (1 mL) (group D) or 39 mL of 0.2% ropivacaine + 10 mg nalbuphine (1 mL) (group N), for bilateral TAP block. Postoperative pain scores, time for first rescue analgesic request and incidence of side effects were compared. <b>Results:</b> Duration of postoperative analgesia was similar in both groups (409.14&#177;48.92 minutes in group D vs 419.03&#177;54.11 minutes in group N) (p-value=0.462). Postoperative pain scores and total amount of rescue analgesic requirement (105.17&#177;42.98 vs 106.45&#177;46.08) was also similar in both the groups (p=0.912). In Nalbuphine group, 16.7% reported pruritis (p-value=0.02) and 13.3% reported nausea (p-value=0.213). However, in group D only one patient reported nausea two hours postoperatively. <b>Conclusion: </b>Nalbuphine when compared to dexmedetomidine, as an additive to ropivacaine for TAP block, provides similar postoperative analgesic duration and efficacy, but increases the incidence of pruritus and nausea. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC24-UC28&id=15411 https://doi.org/10.7860/JCDR/2021/50527.15411 Effectiveness of Planned Teaching Program on Knowledge and Practice Regarding Intravenous Therapy among Paediatric Nurses Anandhan Divya, Palani Vijayasamundeeswari, Dhandapani Geetha <b>Introduction:</b> Peripheral intravenous therapy is one of the most frequently used therapeutic interventions in the acute care setting. Paediatric intravenous cannulation is a fundamental part of medication and practised in almost every health care setting. Intravenous therapy is used to treat a wide variety of paediatric conditions. Although most hospitalised children receive intravenous (i.v.) therapy daily, treatment extends beyond this population to Out Patient (OP) settings, long term care and home care for the infusion of fluids, blood products, and medications. <b>Aim:</b> To assess the effectiveness of planned teaching program on knowledge and practice regarding intravenous therapy among paediatric nurses. <b>Materials and Methods:</b> The present pre-experimental, quantitative, non randomised, one group pre and post test design study was conducted in Paediatric Ward, Paediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) of ‘G’ block, Sri Ramachandra Hospital (SRH), Porur, Chennai, Tamil Nadu, India from 11th July 2016 to 20th August 2016. Self administered questionnaire and observational checklist was used to collect data about knowledge and practice respectively. Non probability purposive sampling technique was used to select the 30 staff nurses working in the paediatric department with less than one year of experience. <b>Results:</b> The difference between the mean post-test knowledge score (M=16.20, SD=2.041) and pretest knowledge score (M=7.43, SD=2.254) of paediatric staff nurses was highly significant (p-value <0.001) and the computed t-value was t=26.7. The difference between the mean post-test practice score (M=15.13, SD=2.063) and pretest mean practice score (M=10.70, SD=2.380) was also highly significant (p-value <0.001) and the computed t-value was t=8.215. <b>Conclusion:</b> The present study shows that there was a significant difference in the mean scores of knowledge and practice between pretest and post-test after the planned teaching program intervention at the level of paediatric nurses (p<0.001). So planned teaching program was effective on knowledge and practice regarding intravenous therapy among paediatric staff nurses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LC13-LC16&id=15412 https://doi.org/10.7860/JCDR/2021/49129.15412 Prosthetic Satisfaction and Body Image among Lower Limb Amputee: A Cross-sectional Study Sudhir Ramkishore Mishra, Dileep Kumar, Ganesh Yadav, AK Gupta, Satyasheel Asthana <b>Introduction:</b> Limb amputation not only brings functional and sensory loss, but also leads to loss or change of body image. These changes have significant effect on the Quality of Life (QoL) of an individual. Amputee adaptation varies widely between individuals. For an amputee a prosthesis not only bring back near normal physical appearance but also it significantly repair his disturbed body image. There is a significant correlation between body image and life satisfaction. <b>Aim:</b> To investigate the correlation between body image and prosthetic satisfaction among lower limb amputee. <b>Materials</b> <b>and</b> <b>Methods:</b> This cross-sectional study was conducted from July 2018 to January 2020 at King George&#8217;s Medical University, Lucknow, Uttar Pradesh, India. Participants with unilateral lower limb prosthesis using amputees of either sex from Regional Artificial Limb Centre, Lucknow were included in the study. Each participant was subjected offline questionnaire based assessment of satisfaction with respect to their prosthesis related to it&#8217;s function, aesthetic (cosmesis), weight of prosthesis and general (overall) by Revised Trinity Amputation and Prosthesis Experience Scale (R-TAPES). Change in body image was assessed by Amputee Body Image Scale (ABIS). Results were analysed by computer-based software Statistical Package for the Social Sciences (SPSS) windows version 20.0. Analysis of Variance (ANOVA) t-test was used for normally distributed and Mann-Whitney U test was used for abnormally distributed variables. <b>Results:</b> The study enrolled 119 patients in which the most common cause of amputation was an accident (69). Statistically significant difference was found for satisfaction between males and females for weight of prosthesis (p-value=0.038). Statistically significant difference was found between male and female for amputee body image with ABIS score (p-value=0.001). Significant correlation was found between ABIS and functional satisfaction (p-value=0.001; r=-0.38)) and between ABIS and weight satisfaction (p-value=0.001; r=-0.36). <b>Conclusion:</b> Amputation causes significantly deterioration of body image among the amputee, with such deteriorated body image prosthetic satisfaction remains a big challenge for healthcare worker and prosthetist. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=KC10-KC13&id=15404 https://doi.org/10.7860/JCDR/2021/49758.15404 White Spot Lesions on Teeth during or Postorthodontic Treatment: A Knowledge Based Cross-sectional Survey of Dentists Ullal Anand Nayak, Elaf Youssef Nawawi, Lama Mohammed Bazuhair, Maryam Nabeel Nasser, Renad Khalid Sait, Prathibha Anand Nayak <b>Introduction:</b> White Spot Lesions (WSLs) observed during or after fixed orthodontic therapy has known to cause several dental problems clinically and aesthetically. It becomes imperative to understand the perception of treating dentists of the paediatric dentists to whom the children first visit, and also of the treating orthodontists and restorative dentists. <b>Aim:</b> To assess the knowledge, attitude, and practices of dentists regarding WSLs related to orthodontic treatment, and also to assess the preferences of these dentists regarding its management. <b>Materials and Methods:</b> A cross-sectional survey was planned for a period of two months (15th August 2020 to 15th October 2020) using a close ended, multiple choice questionnaire directed to evaluate the perspective of 260 dentists of Saudi Arabia towards white spot lesions associated with orthodontic treatment. The self designed validated questionnaire was prepared and mailed to dentists across the Kingdom of Saudi Arabia. Descriptive statistics followed by Chisqaure test was done to compare variables in the questionnaire. <b>Results:</b> A total of 52 paediatric dentists, 53 orthodontists, 51 restorative dentists, and 104 general dentists participated in the study. Out of 260 dentists, 236 (90.8%) of them have observed WSLs in their patients during/after orthodontic treatment. Adolescent patients more commonly complained of undesirable aesthetics due to WSLs. Incisors were the most commonly affected teeth. All dentists except orthodontists believed that they were proficient in diagnosing superficial or deep WSLs (p-value=0.005). Most dentists preferred professional application of high concentration topical fluorides. Most patients demanded an instant correction of these WSLs as reported by all groups of dentists. <b>Conclusion:</b> WSLs are commonly observed by dentists during the initial 7 to 12 months period of starting orthodontic therapy, more commonly on incisor teeth among the adolescent age group. The dentists recommended maintaining good oral hygiene as the most effective way of preventing WSLs. They also believed that high concentration fluoride agents are well suited for treating superficial lesions and composite resin restorations for deeper lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC27-ZC34&id=15415 https://doi.org/10.7860/JCDR/2021/49658.15415 A Cross-sectional Study to Evaluate Causes of Maternal Mortality in Rural Areas of Punjab, India Sarbhjit Kaur, Navneet Kaur, Manjit Kaur Mohi, Manjeet Kaur, Neeraj Singh, Simmi Oberoi <b>Introduction:</b> Maternal mortality is an index of reproductive health of the society. In India illiteracy, late referrals, low socio-economic status of the community and direct causes are responsible for high incidence of maternal deaths which contributes to one-fifth of the global burden. <b>Aim: </b>To evaluate the causes of maternal death in rural areas of Punjab. <b>Materials and Methods:</b> The present retrospective crosssectional study was conducted in 10 districts of Punjab, India chosen from five different zones i.e., east, west, north, south and central zone for a period of one year from 2016 to 2017. Information of all the deaths was taken from the civil surgeon office of the chosen district and then data of maternal deaths occurring within 42 days of delivery was collected by visiting patient’s residence and verbal autopsy was conducted. The data was collected and entered in predesigned proforma and percentages were calculated in Microsoft Excel version 2016. Results: A total of 67 maternal deaths were noted from above five zones, out of total rural population of 94,59,553. Maximum (n=51) maternal deaths were between age range of 20-30 years. Of these 67, majority 29 (43.28%) were illiterate, 66 (98.5%) women belonged to middle and low socio-economic status, 55 (82.1%) deaths occurred in the postnatal period, 33 (49.25%) occurred at more than 37 weeks period of gestation and 51 (76.12%) were due to direct causes. Out of 67 deaths, haemorrhage (n=29) was the most common cause. Anaemia contributed to 16.7% (11) as an indirect cause of maternal death. <b>Conclusion:</b> The maximum maternal deaths were contributed by illiterate women from middle and low socio-economic status. The most common cause was postpartum haemorrhage followed by pre-eclampsia/eclampsia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QC14-QC17&id=15416 https://doi.org/10.7860/JCDR/2021/49569.15416 Nerve Conduction Velocity in Smokers and Gutka Chewers: A Case-control Study Bipin Kumar, Meenakshi Gupta <b>Introduction:</b> Chemicals that are present in cigarette/bidi smoke and gutka have been known to cause subclinical changes in myelin sheaths of peripheral nerves. Despite the antiquity and popularity of smoking and gutka chewing, its effect has not been investigated systematically in young adults. <b>Aim:</b> To investigate the chronic effects of smoking and gutka chewing on Nerve Conduction Velocity (NCV). <b>Materials and Methods:</b> The case-control study was conducted in the Department of Physiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from November 2018 to December 2020. A 40 male smokers (age group 20-60 years), 40 gutka chewers (age group 20-60 years) along with 40 age matched healthy male controls. The nerve conduction study was performed by using fully computerised Electromyography (EMG) and NCV machine. Sensory Nerve Conduction Velocity (SNCV) and Motor Nerve Conduction Velocity (MNCV) test of median and ulnar nerves was performed on subjects. Data was analysed by using unpaired t-test. <b>Results:</b> In this study of comparative analysis of total 120 subjects, [40 controls and 80 cases (40 cases of smokers and tobacco chewers each)], statistically significant changes (p-value <0.05) were found in the sensory NCV of both the nerves and motor NCV of median nerve in smokers whereas no such changes were found in motor NCV of both nerves in gutka chewers. <b>Conclusion:</b> It can be concluded that smoking causes more reduction in NCV than gutka chewing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=CC15-CC17&id=15417 https://doi.org/10.7860/JCDR/2021/49030.15417 Histopathological Spectrum of Male Genital System Tumours in a Tertiary Care Hospital Faridkot, Punjab Aradhana Singh Hada, Sarita Nibhoria, Vaneet Kaur Sandhu, Nitin Nagpal <b>Introduction:</b> The male genital system consists of the prostate, seminal vesicle, testes, epididymis, vas deferens, bulbourethral gland, ejaculatory duct, penis and scrotum. Male genital cancers are histologically diverse. They are difficult to detect and treat because of their anatomic locations, biological characters and complications. <b>Aim:</b> To study the histopathological spectrum of tumours of the male genital system according to World Health Organisation (WHO) classification. <b>Materials and Methods:</b> The present study is a hospital based descriptive study conducted in the Department of Pathology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India, during February 2019 to August 2020 which included 128 cases. All biopsies, specimens and review blocks and slides of male genital tract tumours were processed and slides were stained with Haematoxylin and Eosin (H&E) stain. Serum tumour markers and immunohistochemical stains were used. The clinical information including symptoms related to the male genital system, histopathological findings and diagnosis were recorded on the predesigned proforma. Other necessary information was collected from the requisition form received along with the biopsy material. The association between categorical variables was explored using Pearson’s Chi-square test. A p-value <0.05 was considered statistically significant for this study. <b>Results:</b> The present study included 128 cases, of which the majority of the cases 82 cases (64%) were that of prostate, 28 cases (21.9%) of the penis, 15 cases (11.7%) of testes, two cases (1.6%) were that of the scrotum and one case (0.8%) was of the epididymis. The histopathological spectrum showed adenocarcinoma was present in 80 (62.5%), leiomyosarcoma in 01 (0.8%), lymphoma in 01 (0.8%), mixed germ cell tumour in 9 (7%), seminoma in 5 (3.9%), postpubertal teratoma in 1 (0.8%), basaloid in 1 (0.8%), papillarybasaloid in 2 (1.6%). <b>Conclusion:</b> Prostate tumours outnumbered all other tumours of the male genital tract with adenocarcinoma of prostate followed by squamous cell carcinoma of the penis and mixed Germ Cell Tumour (GCT) of testes. The present study provides updated information regarding the histopathological spectrum of male genital system tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC24-EC28&id=15418 https://doi.org/10.7860/JCDR/2021/49233.15418 Correlation of Detrusor Wall Thickness with International Prostate Symptom Score: A Cross-sectional Study of Nigerian Men with Prostate-Related Diseases Obasi Augustine Ulebe, Timothy Uzoma Mbaeri, Joseph Amauzo Abiahu, Michael Echeta Aronu, Kingsley Chidi Oranusi, Alexander Maduaburochukwu Nwofor, Jideofor Chukwuma Orakwe, Okechukwu Obiora Mbonu <b>Introduction:</b> Bladder Outlet Obstruction (BOO) due to prostate-related diseases can lead to changes in bladder wall resulting in detrusor wall thickening. These changes are time-dependent and may reflect the severity of underlying BOO. Although urodynamic tests are considered to be the gold standard for the assessment of the severity of Lower Urinary Tract Symptoms (LUTS), these are time-consuming, invasive and expensive. The Detrusor Wall Thickness (DWT) measurement has emerged as a cheap, non invasive and reproducible alternative means of assessing the severity of LUTS in men with BOO. <b>Aim:</b> To determine the correlation between the DWT and International Prostate Symptom Score (IPSS) in men being evaluated for prostate-related BOO/LUTS. <b>Materials and Methods:</b> A cross-sectional hospital based study was conducted over a period of 12 months (May 2014 to April 2015), at Urology Clinics of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All 100 new consecutive male patients aged &#8805;40 years with prostate-related LUTS and who can achieve bladder volume of >250 mL were included in the study. The DWT was measured at three different sites (anterior, lateral and dome) at bladder volume >250 mL. Ethical approval was attained from the institutional ethical review board. Severity of LUTS was assessed using a validated IPSS questionnaire. Data was analysed using SPSS version 20. Spearman’s correlation was used to assess the correlation. The p-value <0.05 was considered significant. <b>Results: </b>A total of 100 men with the mean age of 71.02&#177;9.10 years were studied. The mean duration of symptoms was 30.63&#177;26.60 months with the average IPSS being 20.94&#177;6.13. A total of 43 patients and 57 patients had moderate and severe LUTS, respectively. None of the patients had mild LUTS. The mean anterior, lateral, dome and average DWT measurements were 4.95&#177;2.36 mm, 4.96&#177;2.37 mm, 5.02&#177;2.34 mm and 4.97&#177;2.35 mm, respectively. A total of 97 patients had DWT &#8805;2 mm. There was a significant positive correlation between the DWT and IPSS (r2=0.635 and p<0.001). <b>Conclusion:</b> The positive correlation between the DWT and IPSS has demonstrated that the DWT measurement can be used in assessing https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PC08-PC12&id=15419 https://doi.org/10.7860/JCDR/2021/45176.15419 Assessing the Attitude of Parents Towards Various Behaviour Management Techniques Used during Paediatric Dental Treatment: A Cross-sectional Study M Sunil Kumar, V Aravinth, Madhan Chenchugopal, Arun Elangovan, Arjun Thomas, V Aishwarya, GR Jerisha <b>Introduction:</b> Every child who enters the dental clinic is different. Some of them are anxious, some are scared, some are angry, and some are confused. Rarely, children exhibit a positive behaviour, most of them being uncooperative. The child&#8217;s behaviour in turn influences the efficiency and outcome of the dental treatment. <b>Aim:</b> To assess parents or caregivers&#8217; acceptance of various Behaviour Management Techniques (BMT) through direct observation and feedback received. <b>Materials and Methods:</b> A cross-sectional study was planned to assess the most preferred BMT. The study was conducted from November 1<sup>st</sup>, 2018 to October 31<sup>st</sup>, 2019 for a period of one year. Parents of children between the ages of four to nine years were included in the study using non random convenience sampling with 675 participants. Every parent was given an explanation about the study and briefed about nine major BMTs in regional language. Audiovisual aid for each technique in their own mother tongue was displayed via a projector and sound systems and parents were asked to watch it. Later they were given a Visual Analog Scale (VAS) of 10 mm length with markings, printed on a sheet of paper to assess the preference for each technique. Collected data was entered in an excel sheet and analysis was done using median test. <b>Results:</b> The results showed that 32.4% i.e., the highest percentage of people opted for Tell Show Do (TSD), indicating that TSD is the best BMT. Professional status of parent showed a significant impact on BMT selection. <b>Conclusion:</b> This study reveals that amongst all the behaviour management methods, &#8216;Tell-Show-Do&#8217; was the most accepted BMT by the parents and the professional background of the parent has a statistically significant role in the selection of BMT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC35-ZC40&id=15420 https://doi.org/10.7860/JCDR/2021/49797.15420 Comparison of Flexural Strength and Surface Hardness of Polymethyl Methacrylate Resin Reinforced with Silanised Aluminium Oxide Nanoparticles- An In-vitro Study Rajeswari Pokuri, Durga Prasad Tadi, Sunil Tripuraneni, Hemchand Surapaneni, Sri Harsha Babu Vadapalli, Aiswarya Suggala <b>Introduction:</b> In complete denture fabrication, the common denture base material used is heat activated Polymethyl Methacrylate (PMMA). Considering various advantages, still there are some disadvantages like poor flexural strength and poor wear resistance. The flexural strength of any material reflects its potential to resist catastrophic fracture under a flexural load. Another property that influences the surface characteristics of acrylic resins is the surface hardness, which indicates the ease of finishing a material and its resistance to in-service scratching during cleaning procedures and exposure to various oral fluids. Thus an ideal denture base material should exhibit greater flexural strength and high surface hardness for the longevity of the dentures. <b>Aim:</b> To evaluate the effects of adding different percentages of silanised aluminium oxide (Al<sub>2</sub> O<sub>3</sub> ) nanoparticles on the flexural strength and surface hardness of a conventional heat-polymerised acrylic resin. <b>Materials and Methods:</b> The in-vitro experimental study was conducted between October 2020 to Janaury 2021 at Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, Andhra Pradesh, India. A total of 120 samples were fabricated and were grouped into four groups coded A to D (n=30). Group A was the control group (without adding Al<sub>2</sub> O<sub>3</sub> ). Specimens in the other three groups (B to D) were reinforced with silanised Al<sub>2</sub> O<sub>3</sub> at loadings of 1%, 2.5% and 5% w/w. Flexural strength was assessed with a three-point bending test using a universal testing machine. Surface hardness test was conducted using a Vickers Hardness (VH) tester. Data was analysed using Analysis of Variance (ANOVA) and Tukey’s post-hoc test. <b>Results:</b> Among all the reinforced groups highest flexural strength value was seen in Group C- PMMA+2.5% w/w silanised aluminium oxide nanoparticles reinforced group (88.33 Mpa) and highest surface hardness value was seen in the Group D- PMMA+5% w/w silanised Aluminium oxide nanoparticles reinforced group (29.44 VH). <b>Conclusion:</b> Reinforcement of the conventional heat cured acrylic resin with 2.5% w/w silanised Al<sub>2</sub> O<sub>3</sub> nanoparticles significantly increased its flexural strength and hardness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC41-ZC46&id=15421 https://doi.org/10.7860/JCDR/2021/49788.15421 COVID-19 Seroprevalence Study in Asymptomatic Healthcare Workers at a Tertiary Healthcare Centre, India Bhuvanamha Devi Ramamurthy, Veena Raja, Balaji Radhakrishnan, Salim Javeedh, Balaji Ramraj, Shivashekar Ganapathy <b>Introduction: </b>The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has evolved into a pandemic disease. The present knowledge is mainly based on available numerator data of confirmed positive cases only. The asymptomatic and mildly symptomatic cases are not brought into picture for testing at all, which is a major contributor to the pandemicity and hence creating bias in the documentation and understanding of the disease. The magnitude of the exposure of Healthcare Workers (HCW) and their potential for asymptomatic transmission makes it critical to know the incidence of infection in the healthcare population. <b>Aim:</b> To evaluate the seroprevalence of Immunoglobulin G (IgG) SARS-CoV-2 among the asymptomatic HCW. <b>Materials and Methods: </b>This was a cross-sectional study conducted between January 2021 to February 2021 in SRM Medical College Hospital and Research Centre a tertiary care hospital in Potheri, Chengalpattu district, Tamil Nadu, India. The HCW were asked to complete the standardised questionnaire including the basic information, symptoms of COVID-19 illness and utility of Personal Protective Equipment (PPE) based on World Health Organization (WHO) risk assessment and management of exposure of HCW in the context of COVID-19. They were divided into two groups, the staff who had direct patient exposure as group 1 with 82 participants and staff without direct patient exposure as group 2 with 46 participants. The serodetection of IgG SARS-CoV-2 antibodies was done using the Chemiluminescence Immunoassay (CLIA). The obtained results were statistically analysed with Statistical Package for the Social Sciences (SPSS) version 20.0. A Chi-square test (&#967;<sup>2</sup> ) was performed and a p-value less than 0.05 was considered statistically significant. <b>Results:</b> A total of 128 HCW were studied. In group 1, there were 64.1% (n=82) of HCWs and in group 2 there were 35.9% (n=46) of HCWs. There were total of 74 (57.8%) males and 54 (42.2%) females. No gender-specific differences were observed. The mean age in group 1 was 28.93 years and group 2 was 32.2 years. The staffs older than 40 years were more commonly affected. Adherence to strict PPE protocol was observed in 92.6% (76/82) in group 1 and 82.6% (38/46) in group 2. The difference between the groups were statistically significant (p=0.025). In this study, though the seroprevalence of COVID-19 infection was 9.8% (n=8) in group 1 and 13% (n=6) in group 2, it was statistically not significant. <b>Conclusion:</b> SARS-CoV-2 Serology study helps to identify the asymptomatic (unestimated) cases. The results of the seroprevalence suggest that the strict adherence to PPE protocol helps to prevent COVID-19. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC29-EC32&id=15422 https://doi.org/10.7860/JCDR/2021/50235.15422 Expression of Matrix Metalloproteinase-9 in Different Histopathological Variants of Ameloblastoma: A Cross-sectional Study Revati Shailesh Deshmukh, Priya Nimish Deo, Surekha Laxman Chavan, Prasad Kango <b>Introduction:</b> Ameloblastomas are benign and the most common odontogenic neoplasms with many histopathological subtypes depending on the predominant pattern. They are known for their aggressive behaviour. As ameloblastomas have a high rate of recurrence, it is necessary to understand the biological behaviour of these neoplasms. Matrix Metalloproteinase-9 (MMP-9) is an enzyme that belongs to Metalloproteinases family and is known to degrade the Extracellular Matrix (ECM) and facilitate tumour progression. Evaluation of the expression of MMP-9 in ameloblastomas could contribute in understanding its biological behaviour. <b>Aim: </b>To analyse the expression of MMP-9 in different histopathological variants of ameloblastoma. <b>Materials and Methods:</b> A cross-sectional observational study was done in the Department of Oral Pathology and Microbiology, Bharati Vidyapeeth Deemed to be University, Dental College and Hospital, Pune, India. A total of 30 cases were selected for this study. The study was carried out for a duration of two years from April 2018 to April 2020. The MMP-9 expression was studied by immunohistochemical staining. The statistical comparison was done using Chi-square test between groups, p-value <0.05 was considered significant. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 22.0, IBM Corporation, USA for MS Windows. <b>Results:</b> A total of 30 paraffin embedded archival tissue blocks were selected for this study. Among them nine cases were of Plexiform Ameloblastoma, eight of Unicystic Ameloblastoma, three of Acanthomatous Ameloblastoma, four of Desmoplastic Ameloblastoma and six were of Follicular Ameloblastomas. The MMP-9 showed variable expression in different histopathological subtypes of ameloblastoma. This difference was statistically significant between Plexiform and Acanthomatous as well as Plexiform and Follicular variants (p<0.05). A 66.7% (6 out of 9 samples) of Plexiform Ameloblastoma showed intense staining for MMP-9. <b>Conclusion:</b> Expression of MMP-9 varies in different histopathological variants of ameloblastoma and may not have an association with biological behaviour and aggressiveness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC47-ZC50&id=15423 https://doi.org/10.7860/JCDR/2021/49261.15423 Histopathological Reporting of Actinomyces Colonies in Tonsils-Utility or Futility? A Retrospective Study Kalpana Sharma, Kalpana Singh Beniwal, Amit Lodha, Sunil Kasana <b>Introduction:</b> Actinomyces colonies in tonsillectomy specimens are often ignored as commensals and histopathology reports do not carry any information about them. But evidence suggests that under favourable conditions these may become invasive and pathogenic, serving as precursors to later systemic disease. Early identification of mucosal breach by these bacteria may have a role in the clinical management and future prognosis. <b>Aim:</b>To determine the frequency of occurrence of Actinomyces colonies in tonsillectomy specimens and study the various associated histological alterations which may provide a clue to their pathogenicity. <b>Materials and Methods:</b> This was a retrospective study on 140 tonsillectomy specimens, from 70 patients who had undergone elective, bilateral tonsillar surgery. Tonsils were examined for Actinomyces colonies and histological alterations as per two different grading criteria. Different clinicopathological features were associated, those with and without Actinomyces colonies using appropriate statistical tools (t-test, Chi-square and Fisher’s exact test; Statistical Package for the Social Sciences {SPSS} version 23.0). <b>Results: </b>A total of 140 tonsillar tissue specimens were analysed from 70 patients and divided into two groups Group 1 (with actinomycosis) and Group 2 (without actinomycosis) with a mean age of 13.6&#177;6.63 years and 11.8&#177;7.19 years, respectively. The frequency of Actinomyces colonies was found to be 40% (28 of 70 patients) with bilateral presence in 28.5% (8 of 28 patients). Tissue reaction was present in 36.11% (13/36 tonsillar specimens) of the tonsillectomy specimens harbouring Actinomyces. Deeply situated colonies elicited tissue reaction more frequently (11/19 tonsillar specimens; 57.89%) compared to superficial ones (2/17 tonsillar specimens; 11.76%). Tonsillar cryptitis was the most statistically significant histopathological finding associated with the presence of Actinomyces colonies (p=0.029). <b>Conclusion: </b>Tonsillar cryptitis was found to be a consistent histological finding in tonsillar actinomycosis. The frequent acute inflammatory responses generated by deeply located Actinomyces colonies refutes their role as mere commensals. It is suggested that tonsil histopathology reports should mention the presence/ location/ tissue reaction surrounding Actinomyces colonies to differentiate mere colonisation from invasion. This could have profound clinical implications in terms of necessity of antibiotic use for prophylaxis/ and or treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC33-EC37&id=15424 https://doi.org/10.7860/JCDR/2021/49326.15424 Burden of Musculoskeletal Disorders among Recent Dental Graduates in Saudi Arabia: A National Survey Hebah M Hamdan, Khawlah Alharbi, Hatton Alsaper, Shahad Alsubayae, Abrar Tounsi, Ayman Sulimany <b>Introduction:</b> Musculoskeletal Disorders (MSDs) are one of the most prevalent occupational hazards affecting dental professionals. <b>Aim:</b> To assess the prevalence and associated risk factors of MSDs among recent dental graduates in Saudi Arabia and evaluates their practice of ergonomics as well as the impact of MSDs on their daily activities. <b>Materials and Methods:</b> This cross-sectional study was carried out among all dental interns (n=1552) who graduated from dental schools in Saudi Arabia in the academic year 2018-2019. Data was collected between January 2019 to March 2019 through online survey via SurveyMonkey™. Through the questionnaire, data about participants’ demographics, symptoms of MSDs in the previous 12 months, preventive ergonomic working practices, effects of MSDs on their daily activities, and coping strategies were collected. Descriptive statistics, including mean&#177;Standard Deviation (SD) were computed for continuous variables, while frequencies and percentages were computed for categorical variables. <b>Results:</b> In total, 889 dental interns participated in this study (response rate of 57.3%). A total of 54.3% of the participants experienced symptoms of MSDs in atleast one body part in the previous 12 months. The neck (41%), shoulder (37%), and lower back (31.9%) were the most affected regions. Female interns demonstrated a significantly higher risk of presenting with MSDs than male participants (OR: 2.3, CI: 1.7, 3.1). Alternative therapy was the most reported strategy for dealing with pain (44%, n=190). In total, 58.2% of the interns who presented with MSDs had their daily activities affected (n=251). <b>Conclusion:</b> MSDs are significant health problems among recent dental graduates in Saudi Arabia affecting the daily activities of the majority of those affected. Females were at higher risk of developing MSDs than males. To prevent this issue, dental school authorities should develop and implement strategies to ensure effective integration of ergonomics education in dental school curricula. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC51-ZC55&id=15425 https://doi.org/10.7860/JCDR/2021/50990.15425 Comparative Evaluation of SOX2 and p16 Expression in Intraepithelial Neoplasia and Invasive Cancer of Cervix Sowmya Dayalan, Vijayashree Raghavan <b>Introduction:</b> SRY (Sex determining region Y)-Box Transcription Factor 2 (SOX2), a transcription factor functioning as a stem cell marker has been studied in many cancers for its role as an oncogene. This study evaluates the expression of SOX2 and protein 16 (p16) expression in cervical with the intent to establish their role as a diagnostic biomarker. <b>Aim:</b> To evaluate the nature of SOX2 expression in cervical cancer and in intraepithelial lesions of cervix and compare it with the expression of p16 with the intent to establish its role as a diagnostic biomarker. <b>Materials and Methods:</b> This study was a retrospective observational study conducted in the Department of Pathology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India from October 2018 to September 2019. Archival blocks for study were collected from cases between January 2012 to December 2017. Immunohistochemistry for SOX2 and p16 on 61 cases of cervical lesions including SCC, Low-grade Squamous Intraepithelial Lesion (LSIL), High-grade Squamous Intraepithelial Lesion (HSIL) and normal cervix were done. A chi-square analysis was used to determine the relationship of SOX2 and p16 expression in different lesions and compared the same. All collected data was tabulated and analysed by Statistical Package for Social Sciences (SPSS) version 23.0 and was compared by chi-square tests. <b>Results:</b> In the total 61 cases (majority with LSIL, n=21, 34.43%, SCC were 19 (31.15%), HSIL were 20 (32.79%) and adenosquamous carcinoma were 1 (1.64%), SOX2 (p-value <0.001) and p16 (p-value 0.0016) showed over-expression in SCC and HSIL with significant p-value, LSIL showed low expression. SOX2 and p16 expression was limited to the basal one-third in LSIL cases, whereas it was expressed up to two-third or full thickness in HSIL cases. Also, SOX2 and p16 had a significant relationship with p-value=0.001. SOX2 was sensitive for SCC with 84.21% sensitivity and p16 was sensitive for HSIL with 90% sensitivity. <b>Conclusion: </b>Both Sox2 and p16 show increasing expression as the lesion progresses from low grade dysplasia to high grade dysplasia and invasive cancer and can complement each other to make a definitive diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC38-EC42&id=15426 https://doi.org/10.7860/JCDR/2021/50358.15426 Impact of COVID-19 Pandemic on Dental Practitioners in Saudi Arabia: A Cross-sectional Study Sanjeev Balappa Khanagar, Abdul Salam Thekkiniy Akath Ali, Hamid Mohammed Alhamid, Turki Thear Alqahtani, Talal Salem Alghamdi, Khalid Ibrahim Alobailan, Mohammad Zaki Alaqeel, Mohammed Hussein Alassa <b>Introduction:</b> The outbreak of the Coronavirus disease-2019 (COVID19) pandemic has a major impact on health care professionals, especially the dental care professionals, who are operating in close contact with their patients. <b>Aim:</b> To assess the impact of COVID-19 pandemic on dental practitioners in Saudi Arabia in terms of mental status, dental practice changes and financial status. <b>Materials and Methods:</b> A cross-sectional analytical study was conducted among dental practitioners working in governmental and private sectors in Saudi Arabia from June to August 2020. The data was collected using a self-admistered questionnaire which included demographic data, the participants &#39; mental status with a focus on fear and anxiety, changes that occurred on the dental practice due to the pandemic in addition to its impact on the financial status and income. The data was entered and analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Descriptive statistics was calculated and Chi-square analysis was done. <b>Results: </b>A total of 156 subjects (95 (60.9%) male and 61 (39.1%) were female) participated in this study. Most of the respondents 122 (78.2%) were concerned about transmitting the infection to people around them, 149 (95.5%) planned to implement face shields in their practice among other practice changes, 104(66.7%) expressed concern regarding the impact of the pandemic on their future income. Majority of consultants consider that COVID-19 pandemic &#34;negatively affected&#34; their income which was statistically significant (p=0.028). Similarly, majority of participants private sector also considered that COVID-19 pandemic &#34;negatively affected/positively affected&#34; their income which was statistically significant (p=0.001). <b>Conclusion:</b> During the COVID-19 pandemic, dental practitioners are more affected than other health providers. This is evident by the fear and anxiety, which they are going through and the negative impact of the pandemic, which included drop in their income and limited clinical practice hours due to the deferral of elective treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZC56-ZC63&id=15427 https://doi.org/10.7860/JCDR/2021/49012.15427 Histomorphological Spectrum of Gonadal and Extragonadal Germ Cell Tumours at a Tertiary Cancer Centre in Southern Rajasthan, India Tarang Patel, Swati Jindal, Ayushi Saxena, Aruna Panchariya <b>Introduction:</b> Germ Cell Tumours (GCT) are heterogenous tumours believed to arise from primordial germ cells. The GCT predominantly affects gonads (testis and ovary) and also involves extragonadal sites, characteristically locations along midline of the body. The GCT of testis, ovary and extragonadal sites show peculiar histomorphological features and types subject to the age and site of patient. Definite histopathological typing of GCT is of vital importance to decide the further treatment. Till now, very few studies have been conducted in India on GCT of gonads and extragonadal sites. <b>Aim:</b> To study the pathologic findings of GCT including macroscopic and microscopic features and to classify the tumours according to latest World Health Organisation (WHO) classification of GCT for designated site of origin. <b>Materials and Methods:</b> Retrospective analysis was conducted including 141 cases of GCT of all sites, diagnosed at a tertiary cancer centre in Udaipur, Rajasthan, India between January 2016 to April 2021. Data were collected regarding demographic, clinical, gross and histopathological details. Results were analysed using Statistical Package of Social Sciences (SPSS) software Version 21.0. method. <b>Results:</b> Germinal cell tumours shows various age ranges for different site of origin. Ovarian GCT age varies from seven years to 65 years. Age group of testicular GCT varies from 1-55 years. Extragonadal GCT (EG GCT) was seen as early as in four-dayold newborn. Out of 141 cases, 103 were ovarian, 21 were testicular and 17 were EG GCT cases. Most common ovarian GCT is Mature Teratoma (MT) (85 cases, 82.53%) and most common malignant ovarian GCT is dysgerminoma (9 cases, 8.74%). Most common testicular GCT type is Malignant Mixed GCT (MM GCT) (9 cases, 42.86%) followed by seminoma (5 cases, 23.81%) and Yolk Sac Tumours (YST) (3 cases, 14.29%). EG GCT involves retroperitoneum (5 cases, 29.41%), anterior mediastinum (4 cases, 23.53%), Sacrococcyx (3 cases, 17.65%) and Central Nervous System (CNS) (2 cases, 11.76%) with most common EG GCT is teratoma (9 cases, 52.94%) <b>Conclusion:</b> Gonadal and extragonadal GCT share many common tumours, albeit, distinctive site-specific histopathological findings also present. These features often complicate the definitive diagnosis https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC43-EC46&id=15428 https://doi.org/10.7860/JCDR/2021/50598.15428 Effect of Povidone Iodine Versus Chlorhexidine Mouthwash on Oral Mucositis among Cancer Patients Jyothi, S Latha, K Pavithra, M Nalini, Sowmya J Rao, B Mamatha <b>Introduction:</b> Radiation therapy and chemotherapy are the standard treatment given for cancer, which leads to the variety of adverse effects of which Oral Mucositis (OM) is one of the common side-effects. It is responsible for patient discomfort and decreases their level of functioning. Both Chlorhexidine and Povidone Iodine have got antimicrobial and antifungal activity which decreases the severity of mucositis. <b>Aim:</b> To compare the effectiveness of Povidone Iodine and Chlorhexidine mouthwash on OM among cancer patients undergoing radiation therapy or chemotherapy. <b>Materials and Methods:</b> A prospective observational study was conducted in the tertiary care hospital of Mangaluru, Karnataka, India for the duration of one year and three months from December 2015-March 2017. Fifty cancer subjects aged between 25 to 65 years and who developed OM after radiation therapy or chemotherapy were selected by purposive sampling technique. Data were collected using the demographic profile, clinical proforma and World Health Organisation (WHO) OM grading scale (2004) from 19.09.2016 to 17.12.2016. Experimental group I received 10 mL of diluted Povidone Iodine mouthwash and group II received 10 mL of diluted chlorhexidine mouthwash. Level of OM in the group I and group II were assessed on the 1st, 3rd, 5th and 7th day using WHO OM grading scale (2004). The data were analysed by descriptive and inferential statistics (Wilcoxon signed-rank test, Mann-Whitney U test, Repeated measures ANOVA) using SPSS version 16.0. <b>Results:</b> Among the 50 cancer subjects, majority 30 (60%) were in the age group between 55-64 years and majority 35 (70%) were receiving radiation therapy. On day 7, in the group I (Povidone Iodine) majority 14 (56%) subjects had mild level of mucositis whereas in the group II (Chlorhexidine) majority 14 (56%) subjects had moderate mucositis. Comparison of the effect of Povidone Iodine and Chlorhexidine mouthwash using Friedman&#8217;s ANOVA showed that there was a difference in the level of mucositis (p<0.05) at 5% level of significance among two groups. The study findings also revealed a difference in the level of mucositis between day 1 to day 3, 5 and 7 (Mann-Whitney U test) (p<0.05) in both the groups. <b>Conclusion:</b> Povidone Iodine mouth wash was more effective than Chlorhexidine mouthwashes in reducing OM, and the patients were more comfortable after the use of the mouthwash. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=XC09-XC12&id=15429 https://doi.org/10.7860/JCDR/2021/46216.15429 Percutaneous Nephrolithotomy in Supine versus Prone Position in Tertiary Hospital in Mysore: A Prospective Cohort Study Ravikumar Banavase Ramesh, R Vijayakumar, V Manjunath, Abhilash Gautham, Amruthraj Gowda <b>Introduction:</b> Bladder Outlet Obstruction (BOO) due to prostate-related diseases can lead to changes in bladder wall resulting in detrusor wall thickening. These changes are time-dependent and may reflect the severity of underlying BOO. Although urodynamic tests are considered to be the gold standard for the assessment of the severity of Lower Urinary Tract Symptoms (LUTS), these are time-consuming, invasive and expensive. The Detrusor Wall Thickness (DWT) measurement has emerged as a cheap, non invasive and reproducible alternative means of assessing the severity of LUTS in men with BOO. <b>Aim:</b> To determine the correlation between the DWT and International Prostate Symptom Score (IPSS) in men being evaluated for prostate-related BOO/LUTS. <b>Materials and Methods:</b> A cross-sectional hospital based study was conducted over a period of 12 months (May 2014 to April 2015), at Urology Clinics of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All 100 new consecutive male patients aged &#8805;40 years with prostate-related LUTS and who can achieve bladder volume of >250 mL were included in the study. The DWT was measured at three different sites (anterior, lateral and dome) at bladder volume >250 mL. Ethical approval was attained from the institutional ethical review board. Severity of LUTS was assessed using a validated IPSS questionnaire. Data was analysed using SPSS version 20. Spearman’s correlation was used to assess the correlation. The p-value <0.05 was considered significant. <b>Results: </b>A total of 100 men with the mean age of 71.02&#177;9.10 years were studied. The mean duration of symptoms was 30.63&#177;26.60 months with the average IPSS being 20.94&#177;6.13. A total of 43 patients and 57 patients had moderate and severe LUTS, respectively. None of the patients had mild LUTS. The mean anterior, lateral, dome and average DWT measurements were 4.95&#177;2.36 mm, 4.96&#177;2.37 mm, 5.02&#177;2.34 mm and 4.97&#177;2.35 mm, respectively. A total of 97 patients had DWT &#8805;2 mm. There was a significant positive correlation between the DWT and IPSS (r2=0.635 and p<0.001). <b>Conclusion:</b> The positive correlation between the DWT and IPSS has demonstrated that the DWT measurement can be used in assessing https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PC13-PC17&id=15430 https://doi.org/10.7860/JCDR/2021/49642.15430 Lumbar Chordoma Presenting as an Epidural Collection with Vertebral Destruction- An Unusual Cause of Lumbar Canal Stenosis Sibhi Ganapathy, Rajesh Raykar, Renuka Malipatel, Preethilata Rout, Shailesh AV Rao Chordomas are locally aggressive neoplastic lesions that arise from physalipherous cell nests that originate from notochordal remnants left behind during early foetal development. Chordomas of the mobile spine (C3-L5) constitute less than 5% of the overall incidence of chordomas in the spine. They generally are osteodestructive leading to vertebral collapse and severe deficits including paraplegia and quadriplegia. Here authors presented a case of 26-year-old female presented with severe bilateral L5 radicular pain, no deficits and intact bladder and bowel control. The pain was progressive and resistant to analgesic medication. On imaging a collection in the lumbar spine emanating from the L5 vertebral body extending into the canal leading to secondary spinal canal stenosis was observed. On surgical exploration a soft friable vascular mass compressing the dural tube and the exiting nerve roots was observed and the mass was analysed and found to be a chordoma. Although, these lesions are seen to compress the vital neural elements of the spine, the presence of a collection in the spinal canal was unusual and resembled tuberculosis which is a much common lesion, or pyogenic osteomyelitis of the vertebral body. Both differentials were proven wrong. Such an approach not only detected and treated the lesion early, but good rehabilitation and adjuvant therapy was initiated enabling excellent overall quality of life to the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=XD03-XD05&id=15431 https://doi.org/10.7860/JCDR/2021/50060.15431 Use of Adipofascial Reverse Sural Artery Flap for Distal Leg and Ankle Region Reconstruction- A Prospective Cohort Study Archana Sinha, Suvashis Dash, Sneha Sharma, Sunil Sharma <b>Introduction:</b> Though distally based sural artery fasciocutaneous flap is a good choice for distal leg and ankle reconstruction, shortcomings like venous congestion and flap bulkiness are matters of concern. <b>Aim:</b> To assess the utility of adipofascial flap for distal leg and ankle reconstruction, complications, and long-term functional results with range of motion at ankle joint. <b>Materials and Methods:</b> A prospective cohort study (January 2018 to December 2019) was conducted at Safdarjung Hospital, New Delhi, India on patients having distal leg defect and ankle defects reconstructed with Distally Based Sural Artery Adipofascial Flap (DBSAAF). Participants of any age and aetiology were included in the study while polytrauma patients, life-threatening injuries, mangled extremity patients were excluded. Postoperatively flap survival, complications and functional outcome were assessed. <b>Results:</b> Total 21 patients with above defects had undergone DBSAAF reconstruction. Fifteen (71.4%) patients were males and 6 (28.6%) were females, with mean age of 34.85 years. Causes of defect were road traffic injury in 6 (28.6%) patients, additional Tendoachilles tear was repaired in 5 (23.8%) patients. Four (19%) patients had avulsion injury, 3 (14.3%) patients had postburn unstable scar, and chronic ulcer was found in 3 (14.3%) patients. The maximum defect size was 8.5×7 cm (mean of 5.24×4.34 cm). The width of flap pedicle was kept at 4 cm maximum (mean=3.04 cm). All flaps were transported to the defect site by incising the intervening bridge, tunneling was not done. Fourteen patients did not have any co-morbidity, whereas four patients were chronic smokers, and three were diabetics. Flap survived completely in all patients. Three patients had partial graft loss and one patient had chronic discharge. Follow-up for maximum of six months (mean=4.04 months) were done. <b>Conclusion:</b> DBSAAF is a reliable flap for defects of distal leg and ankle region. Advantages are aesthetically better donor area, normal contour, and minimal scarring. It does not require a secondary debulking making it a one stage procedure and allowing patients to use their normal footwear. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PC18-PC22&id=15432 https://doi.org/10.7860/JCDR/2021/49447.15432 Anterior Cervical Microdiscectomy and Fusion using Stand-Alone Polyetheretherketone Cage: A Retrospective Study Pradeep Kumar Jain, Sunil Malagi, Anoop Shastry, Pranoy Hegde, Deepankar Ramesh Devamane <b>Introduction:</b> Anterior Cervical Discectomy and Fusion (ACDF) constitutes the standard mode of treatment for cervical disc herniation due to degeneration. Stand-alone cage can be considered as effective treatment for single and two level disc prolapse. <b>Aim:</b> To examine the clinical outcomes of ACDF using stand-alone Polyetheretherketone (PEEK) cage in a single centre. <b>Materials and Methods: </b>This retrospective study was conducted from July 2015 to Dec 2020 in 224 consecutive patients who underwent successful ACDF using self-locking stand-alone PEEK cage, study was done at Shri Dharmasthala Manjunatheshwara tertiary care hospital, Dharwad, Karnataka, India for radiculopathy or myelopathy due to cervical degenerative disc disease. Data analysis was done upto March 2021. The patients were analysed with Visual Analogue Scale (VAS) pain score for neck and arm pain and Nurick grade preoperatively and at 3 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological evaluation. This study was statistically analysed using the Statistical Package for the Social Sciences (SPSS version 13.0) (IBM, Chicago, IL). <b>Results:</b> Out of 244, (73%)164 patients underwent single level ACDF and sixty (27%) two-level ACDF. The mean age of patients was 45.86&#177;12.07. It included 146 (65.2%) males and 78 (34.8%) female patients. In this study, the mean VAS neck score preoperatively was 4.04 and at 3 months postoperatively was 1.66 which was statistically significant (p<0.001). Even in VAS arm scores, there was a statistical significant difference (p<0.001) between preoperative (7.25) and 3 months postoperative (1.63) scores. The mean Nurick grade preoperatively was 1.46 vs 0.40 postoperatively which was statistically significant (p<0.001). No implant related complications or adjacent level disease was noted. <b>Conclusion:</b> This study demonstrated that treatment of cervical degenerative disc disease by ACDF withstand alone PEEK cage is an effective and safe method. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=PC23-PC25&id=15433 https://doi.org/10.7860/JCDR/2021/50187.15433 Delayed Fixation of Hip Fractures and Short-term Outcome in Coronavirus Positive Patients: A Prospective Cohort Study Ghulam Nabi Dar, Mohd Iqbal Wani, Mohd Umar Mumtaz, Altaf Ahmad Kawoosa, Nadeem Ali <b>Introduction:</b> Coronavirus Disease-19 (COVID-19) affected the healthcare system worldwide. The golden rules of fracture fixation and early mobilisation of patients was not strictly followed, because of fear of spread of the disease among the patients and healthcare workers. Early surgery and prompt postoperative ambulation improves outcomes for patients with hip fractures, but the morbidity and mortality were high in the patients who were operated upon, when having an active infection of COVID-19 virus. <b>Aim:</b> To study the short-term outcome of delayed fixation of hip fractures in coronavirus positive patient in terms of postoperative infection, union at the fracture, deep vein thrombosis and mortality. <b>Materials and Methods:</b> This was a prospective cohort study carried out in Government Medical College, Srinagar, Kashmir, India from April 2020 to September 2020. Delayed surgery using different methods of fixation was performed in patients with hip fractures who had active COVID-19 infection. The patients were followed for a period of six months. Short-term mortality and complications if any were recorded. Results were expressed in terms of frequency and percentages and analysed by Microsoft Excel 2016. <b>Results:</b> Among the 24 operated patients, males were 9 (37.5%) and females were 15 (62.5%). Of the total, 14 (58.33%) were intertrochanteric fractures, 6 (25%) were femoral neck fractures and 4 (16.67%) were subtrochanteric fractures. Dynamic hip screw was used to treat 15 (62.5%) patients. Age ranged from 39 to 82 years mean age was 51.04 years. Majority of patients, 16 (66.67%) sustained hip fractures after a low velocity fall from standing height. Delay in surgery was 15 to 21 days (Average-18.25 days). Two elderly patients died after 14 weeks of follow-up due to causes else than respiratory failure. Three patients developed superficial infection which settled with oral antibiotics. No case of deep venous thrombosis, pulmonary thrombo embolism was observed in the present study. <b>Conclusion:</b> Despite the delay, the mortality rate in the early postoperative period was less. The present study findings suggest that hip fracture patients who present with COVID-19 infection can safely undergo delayed surgical intervention after appropriate medical optimisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=RC07-RC10&id=15435 https://doi.org/10.7860/JCDR/2021/49264.15435 Utilisation of Supplementary Nutrition Service at Anganwadi Centres in a Block of Ganjam District, Odisha: A Cross-sectional Study Smaranita Sabat, Nivedita Karmee <b>Introduction:</b> In India, the Integrated Child Development Services (ICDS) scheme provides a package of services to different groups of the target population. The Anganwadi Centre (AWC) is the focal point for delivery of these services. At AWCs, supplementary food is provided to children below six years, adolescent girls, pregnant women and lactating mothers. <b>Aim:</b> To assess the pattern of utilisation of supplementary nutrition by the beneficiaries and to explore the factors leading to non utilisation of supplementary nutrition. <b>Materials and Methods:</b> This was a cross-sectional study conducted from October 2016 to October 2018 in AWCs in Ganjam district, Odisha, India. Multistage random sampling was used to select the AWCs. By using table of random numbers, 24 AWCs were selected. From each AWC, 12 beneficiaries were selected randomly. So a total of 288 beneficiaries were selected. Out of 288 beneficiaries, 240 beneficiaries were eligible for supplementary nutrition. Rates and proportions were calculated. The Chi-square test was used for testing association between variables. <b>Results:</b> All the AWCs were providing supplementary food as per menu chart and were using standard measure for distribution of raw food. Supplementary food was consumed by 188 (78.3%) beneficiaries. The reason given by most of the respondents {28 (53.8%)} for non utilisation of supplementary nutrition was that they did not like the taste of the food. A statistically significant association was found between utilisation of supplementary nutrition and factors like education, socio-economic status and occupation of women. <b>Conclusion:</b> Although supplementary nutrition was provided by all the AWCs, it was not consumed by some beneficiaries due to lack of variety, taste and bad quality of food. The Take Home Ration (THR) was shared among the family members resulting in dilution of the service. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LC09-LC12&id=15408 https://doi.org/10.7860/JCDR/2021/50762.15408 Correlation of Pirani Scoring with the Outcome of Treatment in Idiopathic Congenital Talipes Equinovarus Treated with Ponseti Method: A Prospective Cohort Study Karnakar Kolla, BD Athani, Shweta Jain, Vikas Gupta <b>Introduction:</b> Congenital Talipes Equino Varus (CTEV) is the most common congenital musculoskeletal malformation and Ponseti method of correction is most commonly used technique. Pirani score is the simplest, reliable and quick to use tool designed to assess the severity of deformity. <b>Aim:</b> To evaluate the results of Ponseti method in children with idiopathic CTEV using modified Pirani score. <b>Materials and Methods:</b> A prospective cohort study was conducted over a period of 18 months from September 2015 to February 2017 in the Departments of Physical Medicine and Rehabilitation (PMR) and Orthopaedics of Safdarjung hospital, New Delhi. Thirty cases representing 47 feet were recruited for the study. They were divided (15 in each) into 0-6 months (younger) and 6-12 months (older) group and were evaluated pre and post Ponseti correction using modified Pirani score in terms of number of casts required, necessity of Percutaneous Tendo-Achilles Tenotomy (PTAT) and the outcome after 12 months of follow-up. Spearman rank correlation coefficient was used for correlation. <b>Results:</b> There was preponderance of bilateral CTEV, 17 (56.6%) and 38 severe cases (80.85%) had mean Pirani score higher (5.52) in older group than in younger group (5.38). Number of casts required to correct the deformity with Pirani score 0 at the end of the treatment was related to severity (p=0.001) and not age (p=0.591). Present study showed 43 feet (91.48%) required PTAT to correct the equinus deformity (p=0.041). Satisfactory outcome was noted in 41 feet (87.23%) of cases at 12 months of follow-up out of which more were in younger age group. <b>Conclusion:</b> Requirement of number of casts and tenotomy was related with severity of CTEV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=KC14-KC17&id=15437 https://doi.org/10.7860/JCDR/2021/49976.15437 An Observational Cross-sectional Study on Dermatological Co-morbidities in Patients with Hemiplegia Secondary to Cerebral Stroke in a Tertiary Care Teaching Hospital in Eastern India Subhransu Sekhar Jena, Binayak Chandra Dwari, Roopam Panda, Nibedita Patro <b>Introduction:</b> Hemiplegia due to cerebral stroke is associated with various dermatological co-morbidities, arising out of motor, sensory and autonomic dysfunctions. <b>Aim:</b> To find out the different dermatological conditions prevalent in patients of hemiplegia secondary to cerebral stroke. <b>Materials and Methods:</b> An observational cross-sectional study was conducted in the Department of Neurology in collaboration with the Department of Dermatology at Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha from July 2017 to June 2020. Patients with hemiplegia of more than one month duration were included. The skin findings present before the neurological insult and patients with systemic conditions like atopic dermatitis, diabetes mellitus and thyroid disorders causing skin changes were excluded. Relevant tests for diagnostic confirmation of the skin lesions were done wherever needed. The software Statistical Package for the Social Sciences (SPSS) version 16.0 was used for the statistical analysis. <b>Results:</b> Study included 411 patients of cerebral stroke. A total of 382 (92.9%) patients were found to have dermatological manifestation. The male:female ratio in the study population was 2.6:1. A total of 549 and 128 skin conditions were diagnosed in the paralysed and non paralysed limbs, respectively. The common dermatological conditions diagnosed in the affected limbs were, xerosis {371 (97.12%)}, tinea corporis/cruris {61 (15.97%)}, onychomycosis {31 (8.12%)}, tinea pedis {28 (7.33%)} and nail dystrophy abnormalities {27 (7.07%)} patients. <b>Conclusion:</b> Knowledge of various dermatological conditions associated with hemiplegia helps in early intervention and better management during rehabilitation phase of patients with hemiplegia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=WC01-WC04&id=15438 https://doi.org/10.7860/JCDR/2021/49257.15438 Prevalence of Atrial Fibrillation in Patients with Acute Ischaemic Stroke: A Multicentric Cohort Study Indu Bhana, Archana Ojha, Rajendra Kumar Pandey, Durgvijay Singh, Mahendra Chourasiya <b>Introduction:</b> India reports high prevalence of stroke, both in rural and urban areas. Secondary prevention is very important in patients with stroke to reduce the morbidity and mortality associated with it. Atrial Fibrillation (AF) is an important risk factor for stroke which can lead to cerebrovascular insult. <b>Aim:</b> To study the prevalence of AF in patients with acute ischaemic stroke and to obtain the association between the parameters such as age, gender, stroke territory and stroke severity by National Institute of Health Stroke Scale (NIHSS). <b>Materials and Methods: </b>In this multicentric cohort study, 150 patients with acute ischaemic stroke (new onset or recurrent) were studied at tertiary care centres located in Indore (Madhya Pradesh), Prayagraj, Moradabad and Lucknow (Uttar Pradesh) from January 2020 to January 2021. Age, gender, stroke territory and stroke severity by NIHSS was recorded and compared between those with and without AF. The Chi-square test was used to assess the association and obtaining significance. <b>Results: </b>Prevalence of AF in patients with stroke was 8% (n=12), which was significantly high in female population (8 out of 12; p=0.025), those with age more than 60 years (10 out of 12; p=0.011), with atrial dilatation (9 out of 12; p=0.124), patients with severe stroke as per NIHSS (7 out of 12; p=0.001) and those with poor outcome (8 out of 12; p=0.012). <b>Conclusion:</b> In the present study, 8% of the stroke patients had AF with stroke. Elderly age, female sex, and large atrial size on Echocardiogram (ECHO) should be intensively investigated for AF in stroke patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OC21-OC24&id=15439 https://doi.org/10.7860/JCDR/2021/49603.15439 Clinical Spectrum and Severity of Poisoning in the Paediatric Intensive Care Unit of a Tertiary Care Centre in Uttarakhand: A Retrospective Cohort Study Sanober Wasim, Nitika Agrawal, Neerul Pandita, Kunal Das, Alpa Gupta <b>Introduction:</b> Acute poisoning causes significant mortality and morbidity among children worldwide. However, the pattern of poisoning and causative substances varies significantly in geo-demographic areas. <b>Aim:</b> To describe admissions due to acute poisoning in the Paediatric Intensive Care Unit (PICU) of a tertiary care centre in terms of demographics, clinical profile, specific agents involved and severity of poisoning. <b>Materials and Methods:</b> This was a retrospective cohort study conducted in PICU of a tertiary care level teaching institute of Uttarakhand, India over a period of three years on subjects of age group from one month to 18 years. Data was collected and analysed for demography, clinical presentation, substance, management, complications, and outcome. Poison Severity Score (PSS) was used to assess the severity of poisoning. Data was analysed using Statistical Package for the Social sciences (SPSS) software version 21.0. <b>Results:</b> During the study period, out of total 751 PICU admissions, 45 were due to poisoning. Organophosphates {20 (44%)} and aluminium phosphide {12 (26%)} were the most common substances used. Accidental poisoning was common {6 (46%)} among less than five years of age. However, suicidal attempts were noted more frequently {20 (64%)} among >15 years of age group. Vomiting 31(69%), altered sensorium 23 (51%), and pain abdomen 16 (35%) were the most common presentations. Nine (20%) patients required ventilatory support as well. Three (6.6%) patients died; all associated with aluminium phosphide poisoning. <b>Conclusion:</b> The most common poison consumed is organophosphate. Aluminium phosphide is the most lethal poison, accounting for all the deaths in the study. Accidental poisoning is common in children less than five years of age. Suicidal poisoning is common among adolescents which must be prevented by early detection of stress. Primary health care facility hesitates to intervene even for basic poisoning care before referring. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=SC06-SC09&id=15440 https://doi.org/10.7860/JCDR/2021/49611.15440 Clinico-bacteriological Profile of Pneumonia, Meningitis and Sepsis in under Five Children from a Tertiary Care Hospital in Central India Prachiti Karode, Manju Biswas, Anjali Bharani, Hemant Jain <b>Introduction:<b> Invasive Bacterial Diseases (IBD) are the major causes of morbidity and mortality in under five children in India. There is difference in the pattern and aetiology of IBD according to the geographical variation and the antimicrobial susceptibility of causative organisms are also variable. There is lack of data on patterns of IBD from central India. <b>Aim:</b> To generate the data on the burden of pneumonia, meningitis and sepsis among under five children in central India and the microorganisms associated with them. <b>Materials and Methods: </b>This prospective observational study was conducted from August 2019 to July 2020 at the Department of Paediatrics at Mahatma Gandhi Memorial Medical College and MY Hospital, indore, India on children of 1-59 months of age admitted with pneumonia, meningitis and sepsis. A detailed history was recorded for all the participants and thorough physical examination was done along with chest X-ray , routine laboratory examination and blood cultures were performed. Latex Agglutination Test (LAT) and Antibiotic Susceptibility Testing (AST) were performed on Cerebrospinal Fluid (CSF) samples. All the data collected were recorded in Microsoft (MS) excel sheet and frequency (n), percentages (%) and chi-square test for significance level, were calculated to analyse the collected data. <b>Results:</b> Of the total 450 cases enrolled, 283 (62.8%) had confirmed IBD. Out of the confirmed cases, 183 (64.6%) had pneumonia, 52 (18.3%) had meningitis and 48 (16.9%) had sepsis. Highest case fatality rate was seen with sepsis followed by meningitis and pneumonia. The most common organism isolated was <i>Staphylococcus aureus</b>. Overall, gram negative bacilli were found to be more resistant to the conventional antibiotics than gram positive organisms. An 40 (83%) of <b>Staphylococcus aureus</b> were susceptible to methicillin whereas only 12 (45%) of Klebsiella pneumoniae were susceptible to amikacin. <b>Conclusion:</b> The present study highlights the predominance of <b>staphylococcus aureus</b> and adverse outcomes of IBD in children with Severe Acute Malnutrition (SAM) and incomplete immunisation. Emergence of resistant bacterial strains to conventional antibiotics warrants the need to consider the locally prevailing antimicrobial susceptibility patterns for the effective management of these diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=SC10-SC14&id=15441 https://doi.org/10.7860/JCDR/2021/49410.15441 Assessment of Association between Domestic Violence and Antenatal Depression in Rural Indian Population Ashishkumar Shah, Sally John, Khushboo Chawla, Ganpat Kvankar, Arpita Jaiswal <b>Introduction: </b>Domestic Violence (DV) on women during perinatal period is a major public health issue. DV is prevalent throughout the world and has huge adverse effects in postnatal period. <b>Aim:</b> To assess prevalence and to determine the association between DV and depressive symptoms among antenatal women. <b>Materials and Methods:</b> A cross-sectional study conducted in a tertiary care centre at Jawaharlal Nehru medical college, Dutta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, from September 2018 to September 2019. A 200 antenatal women between age range of 18-50 years attending the Outpatient Department were included in the study. They were administered the Edinberg Postnatal Depression Scale (EDPS) to evaluate for DV and its association with Antenatal Depression (AND). For the purpose of bivariate logistic regression, a variable for depression was computed based on EPDS scores, i.e., symptoms of depression during pregnancy, whereby an optimal cut-off of &#8805;13 was chosen as representing the presence of symptoms of depression. Statistical analysis was done by using descriptive and inferential statistics using chi-square test. The p-value less than 0.05 was taken as statistically significant. <b>Results:</b> The most common age range of participants were between 21-30 years. A 28 (14%) of 200 women were found to have a history of DV. Majority of them experienced psychological abuse (39.3%), followed by verbal (28.6%), physical (7.4%) and combined types of abuses (25%). The perpetrators were mostly husbands and in-laws. Reasons for abuse included husband&#39;s alcohol abuse, in-law&#39;s interferences and dowry demand. Based on EDPS, 41.5% had depression and 9.5% had probable depression. DV was found to be significantly associated with AND. Income of the family and occupation of the patient were found to be other significant associated factors. <b>Conclusion:</b> Domestic Violence (DV) has a significant correlation with AND. Proper prenatal screening for DV, early diagnosis and management of AND including family interventions are necessary to improve the health and wellbeing of pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=VC11-VC15&id=15442 https://doi.org/10.7860/JCDR/2021/49204.15442 Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy-A Randomised Controlled Trial Anish Kumar Singh, Sanjay Johar, Sudesh Kumar, Mamta Jain, Kiranpreet Kaur, Jatin Lal, Preeti Gehlaut <b>Introduction: </b>Eighth Joint National Committee (JNC 8) has reclassified earlier prehypertension {Systolic Blood Pressure (SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP) 80-89 mmHg} as stage 1 HTN. These patients may be at greater risk of perioperative haemodynamic instability, more so in case of laparoscopic surgeries and alpha-2 agonists premedication may be useful in such patients. <b>Aim: </b>To assess perioperative haemodynamic fluctuations in untreated stage 1 hypertension (HTN) patients and the role of Dexmedetomidine (Dexmed) in it. <b>Materials and Methods:</b> This prospective, randomised, double blind study was conducted at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India from March 2019 to September 2020. Sixty-five patients with stage 1 HTN not on any anti-hypertensive drugs undergoing laparoscopic cholecystectomy were enrolled and randomly divided into group D (dexmedetomidine) and group NS (Normal Saline). Group D received Dexmed 1 &#956;g/kg over 10 minutes before induction, followed by continuous infusion of Dexmed at 0.2 &#956;g/ kg/h and Group NS received similar volume of normal saline. Serial recording of pulse rate, Mean Arterial Pressure (MAP) and oxygen saturation was done. Postoperative sedation scores, extubation time and time to first rescue analgesia were also assessed. For analysis, quantitative variables were expressed as mean&#177;SD and compared using unpaired and paired t-test. Mann-Whitney test was used for quantitative data that did not follow a normal distribution. Qualitative variables were expressed as frequencies/percentages and compared using Chi-square test. A p-value <0.05 was considered statistically significant. <b>Results:</b> A total of 60 patients (30 in group NS, mean age 38.40&#177;10.32 years and 30 in group D, mean age 42.5&#177;11.72 years) were analysed in the present study. In NS group, haemodynamic variations were seen at induction, Laryngoscopy and Intubation (L&I), creation and release of Pneumoperitoneum (PNP) and extubation but actual changes were within 10-12% of baseline value, whereas in group D, pulse rate and MAP remained stable and moderately lower than baseline throughout the perioperative period. An increase in extubation time was observed in group D (15.57&#177;3.16 vs.9.15&#177;1.60 min). Group D also had significantly higher sedation scores postextubation. Group NS patients demanded rescue analgesia early (18.33&#177;7.46 min vs.43.53&#177;8.57 min) (p=0.001). <b>Conclusion:</b> It was concluded that the administration of i.v. Dexmed 1 &#956;g/kg over 10 minutes followed by infusion at 0.2 &#956;g/Kg/h results in haemodynamic stability during surgical stress, slightly delayed but smooth extubation, delayed demand of postoperative rescue analgesia and mild sedation of short duration. Dexmed induced effects help in improving the recovery profile of the patient and keeping the patient more comfortable in the postoperative period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC29-UC33&id=15443 https://doi.org/10.7860/JCDR/2021/49934.15443 Maternal Pregnancy Associated Plasma Protein-A Levels in Late First Trimester as a Predictor of Miscarriage- A Cross-sectional Study Nivedita Sinha, Alpana Singh, BD Banerjee, Rachna Agarwal, Himsweta Srivastva <b>Indroduction:</b> Miscarriage is the most common complication of pregnancy. Defective implantation is one of the common causes of miscarriage. Pregnancy Associated Plasma Protein-A (PAPP-A) is secreted from syncytiotrophoblast and it enables trophoblast invasion. Few studies have shown association of PAPP-A with miscarriage. However, there is limited data available to establish the role of PAPP-A as a predictive marker of miscarriage, especially in Indian population. <b>Aim:</b> To determine the potential of maternal PAPP-A level estimation in asymptomatic women in late first trimester (10-13 weeks) with viable foetus in predicting subsequent miscarriage. <b>Materials and Methods:</b> This was an observational, cross-sectional study conducted from November 2016 to April 2018 at University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India. Asymptomatic pregnant women (N=500) at 10-13 weeks of gestation were recruited from an antenatal clinic after confirmation of foetal viability. A 2 mL of blood sample was collected and serum PAPP-A level was measured. Independent t-test and Chi-square test was used to compare continuous data and Mann-Whitney U test was used to compare PAPP-A Multiple of Median (MOM). Logistic regression was used to estimate risk of miscarriage. <b>Results:</b> Out of 500 participants, 9 were lost to follow-up. From remaining N=491, 32 (6.5%) women had a miscarriage. PAPP-A levels were significantly decreased in miscarriage group compared to ongoing pregnancy group with median MOM 0.116 (0.080-0.17) and 1.25 (0.665-3.249) respectively (p-value <0.001). PAPP-A MOM value of &#8804;10th percentile sensitivity and specificity of detection of miscarriage was 81.25% and 94.98% and at =5th percentile sensitivity and specificity was 40.62% and 97.82%, respectively. Lower the percentile cut-off of serum PAPP-A value, higher was the specificity and positive predictive value for prediction of miscarriage. By applying logistic regression we found that if PAPP-A MOM decreases by 1 unit the chances of miscarriage increased by 1.2 times. By this model 63.2% of cases could be explained (Nagelkerke R Square=0.632). For prediction of pregnancies likely to miscarry, the area under Receiver Operator Characteristic (ROC) curve (95% CI) was 0.969 (0.955-0.983). <b>Conclusion:</b> Low serum PAPP-A levels from asymptomatic women in late 1st trimester is a good predictive marker of miscarriage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=QC18-QC21&id=15444 https://doi.org/10.7860/JCDR/2021/50626.15444 Dexmedetomidine and Clonidine as an Adjuvant to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block- A Randomised Clinical Trial Yuvaraj Shastri, Nanjappa Nagaraju, MS Priyanka <b>Introduction:</b> Alpha-2 agonists are used as adjuvants with Local Anaesthetic (LA) agents to prolong the duration of regional nerve blocks. <b>Aim:</b> To compare clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of analgesia. <b>Materials and Methods:</b> In this randomised clinical trial, 70 American Society of Anesthesiologists (ASA) class I and class II patients, scheduled for elective upper limb surgeries under ultrasound guided supraclavicular brachial plexus block, were divided into two equal groups. Group-I received clonidine 1 µg/ kg and group-II received dexmedetomidine 1 &#181;g/kg added to bupivacaine 0.5% (20 mL). Onset and recovery time of sensory and motor block, duration of analgesia were studied in both the groups. Data analysis was done using Analysis of variance (ANOVA) and Student t-test for analysis of continuous data and Chi-square test used to know the difference of significance in categorical data. <b>Results:</b> A total of 70 subjects between age group of 1860 years were included in the study. The onset of sensory blockade was faster in group-I (3.54&#177;0.74 min) than groupII (3.86&#177;0.88 min) but statistically not significant. The onset of motor blockade was faster in group-I (5.4&#177;1.12 min) than group-II (6.34&#177;1.14 min) and difference was statistically significant. Duration of sensory blockade was longer in group-I (616.23&#177;62.05 min) than group-II (574.71&#177;61.14 min) and motor blockade in group-I (635.86&#177;57.82 min) was longer than group-II (562.80&#177;66.89 min) and the differences were statistically significant. The duration of analgesia was longer in group-I (797.29&#177;108.06 min) than group-II (695.00±91.14 min) and the difference was statistically significant. <b>Conclusion: </b>Dexmedetomidine shortens the onset, prolongs the duration of sensory and motor block and also provides longer postoperative analgesia as compared with clonidine when used as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=UC34-UC37&id=15445 https://doi.org/10.7860/JCDR/2021/49215.15445 Challenges in Timely Pharmacological Reperfusion Therapy of Acute ST-Elevation Myocardial Infarction Patients: A Cross-sectional Study Prakriti Snehil, Anwar Hussain Ansari, Praloy Chakraborty, Niveditha Devasenapathy <b>Introduction:</b> Acute ST-Elevation Myocardial Infarction (STEMI) is the most severe presentation of an Acute Coronary Syndrome (ACS) resulting from sudden occlusion of one of the major epicardial coronary arteries resulting in myocardial injury and necrosis within minutes to few hours. Despite Primary Percutaneous Coronary Intervention (PPCI) being the gold standard, thrombolytic therapy is still the most common form of reperfusion therapy in eligible patients of acute STEMI even in large metropolitan cities in India. <b>Aim:</b> To find the proportion of STEMI patients receiving thrombolytic therapy within four hours of the onset of symptoms and within 30 minutes of reaching the hospital and to explore factors related to Pain-To-Door (P2D) delay. <b>Materials and Methods:</b> This was a single-centre cross-sectional observational study of 147 STEMI patients conducted at a tertiary care hospital in the National Capital Territory (India). from February to May 2017. Ethical clearance was obtained from the Institute’s Ethics Committee. All patients were interviewed and their medical records reviewed. Factors related to delay in reaching hospital and association of patient characteristics with those receiving thrombolytic therapy were explored using univariable and multivariable logistic regression. <b>Results:</b> Mean age of the study population was 52.1&#177;13.1 years and 121 (82.3%) were men. Median P2D time was 4.7 hours (IQR- 2.2-17.0). Overall, 64 (43.5%) of 147 patients reached the hospital within four hours of chest pain. Only 5 (3.4%) patients availed ambulance to reach the hospital. Distance from the hospital, seeking care elsewhere and delay in reaction to symptom were reasons for the delay (>4 hours). Median Door-To-Needle (D2N) time was 45.9 minutes (IQR- 30.6-61.2). Patients who reached the hospital at night were more likely to be thrombolysed after adjusting for time to reach the hospital. <b>Conclusion:</b> Significant P2D and Door-To-Balloon (D2B) delays still exist in large metro cities in India. Action is needed both at the population level as well as system level to reduce these delays. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=OC25-OC31&id=15446 https://doi.org/10.7860/JCDR/2021/50082.15446 Role of Predonation Hydration in the Prevention of Postdonation Vasovagal Reactions in First Time Blood Donors: A Randomised Controlled Trial Vijayalakshmi Kuttath, Harikumaran Nair, Muraleedharan Nair <b>Introduction:</b> A crucial component of the effort to meet the growing demand for blood is the recruitment and retention of young novice blood donors. Reducing postdonation syncopal reactions could have a beneficial impact on donor convenience, safety, and desire to donate again. <b>Aim:</b> To evaluate the effectiveness of predonation hydration over standard blood donation in the prevention or decrease in severity of postdonation Vasovagal Reactions (VVR) in hydrated blood donors in comparison with the non hydrated group. <b>Materials and Methods:</b> The randomised controlled trial was conducted on 953 first time voluntary blood donors. Donors in the intervention arm drank 250 mL water 30 minutes before blood donation, while those in the control group did not receive any intervention. Blood was collected by standard protocol. Outcome, VVR, if present was graded as mild, moderate, and severe. Analysis of results were done using Statistical Package for the Social Sciences (SPSS) version 16.0. A sensitivity analysis was also done to consider the dropouts from the study. <b>Results: </b>A total of 900 participants were included in the study, of which 443 were controls and 457 were cases. An effect size of 6.1%, a Relative Risk (RR) of 0.54 {95% Confidence Interval (CI)=0.36-0.81} and a risk reduction of 45% was arrived at, pointing to a protective role for predonation hydration in preventing VVR. There was a significant reduction in the severity of VVR in the predonation hydration group compared to the standard blood donation group (p-value=0.002). The protective effect of hydration on decreasing the occurrence and severity of VVR had statistical support in males in the moderate and severe grades (p-value=0.017). A similar statistical significance was not established in females (p-value=0.173). Sensitivity analysis did not reveal a difference in the statistical significance of variables between compared groups. <b>Conclusion:</b> Predonation hydration was found to be effective in preventing and decreasing the severity of VVR in novice blood donors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=EC47-EC51&id=15447 https://doi.org/10.7860/JCDR/2021/47675.15447 Comparison of Molecular Method and Culture in Detection of Community Acquired Pneumonia in Under Five Year Children in Assam, India Aparna Sonowal, Partha Pratim Das, Mithu Medhi, Aditi Baruah, Ezaz Hussain <b>Introduction:</b> Pneumonia is the single largest infectious cause of death in children worldwide. Aetiology of pneumonia can be identified using multiple diagnostic tools including culture, serology and Polymerase Chain Reaction (PCR); common pathogens include <i>Streptococcus pneumoniae</i>, <i>Haemophilus influenzae, Staphylococcus aureus</i>, some atypical bacteria like Mycoplasma pneumoniae and Chlamydophila pneumoniae. <b>Aim:</b> To find out the bacteriological agents causing Community Acquired Pneumonia (CAP) in under five year children and to compare the conventional culture and PCR in identifying the pathogen. <b>Materials and Methods:</b> This cross-sectional study was undertaken in the Department of Microbiology and Department of Paediatrics in a tertiary care centre of Assam, India, between March 2016 to September 2018. The study was undertaken with 200 under five year old children who were clinically diagnosed as CAP. Oropharyngeal (OP) swabs and blood culture were processed for bacteriological culture. PCR assay of OP swabs for <i>Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus</i> etc., including atypical bacteria like <i>Mycoplasma pneumoniae </i>and <i>Chlamydophila pneumoniae</i> were performed. Data entry, database management and statistical analysis were performed using Epi-Info software version 7.0. <b>Results: </b>A total of 200 subjects were included in the present study with a male:female ratio of 1.63:1. Most of the study subjects were <11 months of age. Most common isolates were <i>Streptococcus pneumoniae</i> (26.5%) and <i>Staphylococcus aureus</i> (25%) from OP swabs; blood culture revealed mostly Staphylococcus aureus (59%) and <i>Streptococcus pneumoniae</i> (25%). PCR assay of OP swabs were found positive mostly for <i>Staphylococcus aureus</i> (47%), <i>Streptococcus pneumoniae</i> (21.5%) while two children were positive for Haemophilus influenzae; Bordetella pertussis was detected in one child. On evaluation, PCR assay in detecting the bacterial pathogen was found statistically more significant than conventional culture of OP swabs (p<0.05). <b>Conclusion:</b><i>Staphylococcus aureus</i> and <i>Streptococcus pneumoniae</i> were the most common bacterial organisms in the study. PCR assay was found to be more useful in diagnosing the pathogen for bacterial pneumonia including those difficult to grow in conventional culture. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=DC16-DC20&id=15448 https://doi.org/10.7860/JCDR/2021/50194.15448 Gestational Diabetes in Mid-trimester Pregnancy in South Asian Women Based on the Oral Glucose Challenge Test and Risk Factor Predictors: A Prospective Observational Study Ibtesam Nomani, Mehreen Y Rana, Grace Lindsay <b>Introduction:</b> Gestational Diabetes Mellitus (GDM) is a condition potentially occurring during pregnancy. It is associated with adverse foetal and maternal outcomes and is particularly prevalent in South Asian women who comprised this study sample. <b>Aim:</b> To provide a critical analysis of the information on GDM risk that can be identified from screening using the Oral Glucose Challenge Test (OGCT-50 g). <b>Materials and Methods:</b> A prospective cohort study was conducted over eight months. Purposive sampling was used to collect demographic and clinical data {age; Body mass Index (BMI); parity; history of Diabetes Mellitus (DM) in a first degree relative and histories of GDM, polyhydramnious, macrosomia, birth congenital abnormalities and still birth} from 300 South Asian women in mid-trimester pregnancy who consented to undertake an OGCT-50g. Excluded were primigravidas, women with DM or other medical conditions, and women who were unwilling or unable to give informed written consent. Descriptive, comparative and multivariate logistic analyses were used to investigate strengths of correlation between OGCT outcomes and clinical/historical risk factors. <b>Results: </b>The OGCT were 107 (35.7%) positive and 193 (64.3%) negative. The threshold for body mass risk was identified as 27.5 kg/m<sup>2</sup> . Women with two or more risk factors were OGCT positive on 72.9% occasions whereas women with one or no risk factor were OGCT negative on 81.9% occasions. Approximately, 50% of women had a family history of DM as their only risk factor and 24% of them were OGCT positive. <b>Conclusion:</b> The BMI was the strongest determinant of a positive OGCT result. The logistic regression analysis demonstrated that using the lower BMI threshold of 27.5 compared to 30.0 [as per National Institute for Health and Care Excellence (NICE) guideline] improved agreement between risk factors profile was assessed and OGCT results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=IC06-IC11&id=15449 https://doi.org/10.7860/JCDR/2021/49657.15449 Impact of Structured Patient Education and Outpatient Cardiac Rehabilitation Program on the Disability Profile of Conservatively Treated Medically Stable Postmyocardial Infarction Individuals: A Protocol Varoon Chandramohan Jaiswal, Lata Parmar, Snehal Ghodey <b>Introduction:</b> Cardiac rehabilitation and patient education are the two parallel components in the management of coronary heart disease. Although, it is recommended strongly to join an outpatient cardiac rehabilitation program, the enrollment rates are always low. The role of structured patient education in increasing the enrollment in an outpatient cardiac rehabilitation program and its impact on the disability profile of conservatively treated medically stable postmyocardial infarction individuals, after joining and completing the rehabilitation program has not been studied. <b>Aim:</b> To study the impact of structured patient education and outpatient cardiac rehabilitation program on the disability profile of conservatively treated medically stable postmyocardial infarction individuals. <b>Materials and Methods:</b> The study is a mixed method design and will be conducted in two steps. Step 1: It is a qualitative study in which a structured patient education program will be developed based on the framework given by the working Group of Exercise Rehabilitation and Sports (GERS). Step 2: Implementation of the developed program and an outpatient cardiac rehabilitation program in an open-label non randomised clinical trial. <b>Conclusion:</b> The findings of this study will evaluate the need for the development of structured patient education programs for coronary artery disease patients, which may increase the enrollment rates in outpatient cardiac rehabilitation programs and thereby, reducing their disability. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=YK01-YK04&id=15352 https://doi.org/10.7860/JCDR/2021/50434.15352 Proposed Expert System for Controlling Obesity and Overweight Issues among Urban and Semi-urban School going Children: An Epidemiological Study Anchal Garg, Madhulika Bhatia, Madhurima Hooda <b>Introduction:</b> The incremental swift pervasiveness and the associated health consequences, obesity is perceived as one of the most genuine health problems of the early 21st century. The predominance of obese and flabbiness expanded considerably over current decades. The reasons for stoutness are dramatic and multifactorial. Research on childhood obesity has shown the role of race, ethnicity, and social factors, for example, family income, family structure, and community protection. <b>Aim: </b>To devise an expert system that will provide timely educational resources to the children, parents and schools to educate about the impact of junk food, low physical activity and poor lifestyle, as well as effect of excessive weight on overall health of a person in the form of short videos. <b>Materials and Methods:</b> To create an expert system data will be collected, preprocessed and analysed statistically. Sample schools from urban and semi-urban regions would be identified for the study. Data from various sources will be integrated for better data analysis and a questionnaire will be structured to assess subject readiness. After assessing webbased and mobile-based expert system will be developed for counseling and bringing awareness on behaviour and lifestyle of the participant. <b>Conclusion:</b> The diet of kids is a serious concern now-a-days. The obesity leads to health concerns especially among even in the younger generations aging 5-12 years. There is an urgent need of system that can automatically track obese stages and recommend appropriate diet. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LK01-LK04&id=15323 https://doi.org/10.7860/JCDR/2021/45964.15323 McKenzie Mobilisation on Acute Lumbar Lateral Shift in Patients with Low Back Pain: A Narrative Review Shellette D Almeida, Vivek Vijayan Menon, Swathi Makam Vijay, Spoorthi Shetty Low back pain is often associated with a lateral shift in the lumbar spine. McKenzie mobilisation produces a rapid reversal of the deformity and reduction in pain. The purpose of this review is to present an overview of the effects of McKenzie exercises in reducing pain and disability in individuals with an acute lumbar shift. A literature review was performed using four databases. All studies comprising the McKenzie method of treatment in the lateral lumbar shift were included. In total 18 articles were retrieved from the databases, of which six articles were finally selected to be included in this review. Six studies reported a reduction in pain, improvement in range of motion and reduction in disability. The present review identified supportive research for McKenzie treatment in individuals with an acute lumbar shift. However, more robust interventional trials are required to conclude the effectiveness of the McKenzie method in the acute lumbar list. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=YE01-YE02&id=15347 https://doi.org/10.7860/JCDR/2021/49848.15347 Vaccines, Repurposed Drugs and Alternative Biomedicines for the Management and Prevention of COVID-19 Jeyalakshmi Kandhavelu, Ramesh Veeriah, Kumar Subramanian, Priyatharsini Rajendran, Olli Yli-Harja, Meenakshisundaram Kandhavelu, Akshaya Murugesan The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) popularly called as COVID-19, is a pandemic having affected >200 countries. Globally, quarantine measures have been implemented to slow down the spread of the virus. Yet, the available vaccines and drugs for treating COVID-19 are still in design and developmental stage, requiring clinical validation. This review is focused on the progress in the development of medicines against SARS-CoV-2. As an alternative approach, both conventional and traditional biomedicines are also reported to be in practice, to treat the SARS-CoV-2 infected patients. Considering the therapeutic values of the folk medicines, this review focuses on the usage of high value added products from plants, against COVID-19 in managing the symptoms like fever, cough, cold, sore throat, respiratory disorders and kidney dysfunctions enlisting a few used since time immemorial. It is ardently hoped that scientific intervention of such traditional plants can be integrated to harmonise with modern medicine, to ensure its dosage and safety in augmenting disease management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=KE01-KE08&id=15342 https://doi.org/10.7860/JCDR/2021/49523.15342 Revisiting the Delphi Technique in Orthodontics: A Systematic Review Gururajaprasad Kaggal Lakshmana Rao, Yulita Hanum P Iskandar, Norehan Mokhtar <b>Introduction:</b> The Delphi technique is an iterative, multi-stage process that consists of questioning a panel of experts through a structured group communication process to reach a consensus on specific issues. The study is a systematic review of the available literature in orthodontics which has utilised the Delphi technique to seek consensus on a range of issues. <b>Aim:</b> To identify and summarise the studies which have utilised the Delphi technique as a method for gathering consensus in the speciality field of orthodontics. The study evaluated the various characteristics of the Delphi technique. <b>Materials and Methods:</b> This systematic review followed the methodology of a pre-set article inclusion and exclusion criteria using an electronic database search using the keywords consensus, Delphi, Delphi technique, Delphi studies, expert opinion was conducted in March 2021. A range of electronic databases comprising PubMed, Excerpta Medica database(EMBASE), Google Scholar, Web of Science and Scopus were searched dated from (January 1990 to March 2021) to identify the studies which involved the use of Delphi in orthodontics. Following this, two authors reviewed and scored each of the studies before finalising a list of five studies to be included in this review. <b>Results:</b> The searches revealed a total of 187 studies out of which only five studies met the inclusion criteria and were included in this study. Each of the five studies was assessed by two independent assessors. The five studies involved an expert panel from multiple health professionals involving orthodontic specialists, maxillofacial surgeons, nurses, speech therapists, and nutritionists. Five domains (theme, panel constitution, panel size, number of iterations and the level at which consensus reached) were identified and assessed in each of the five studies. <b>Conclusion:</b> The study has identified and reviewed the Delphi technique and its usage in orthodontics but has also provided a sound description and elaboration of the various components and characteristics of the Delphi technique in addition to providing some correlations between expert panel size and the number of iterations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZE01-ZE05&id=15338 https://doi.org/10.7860/JCDR/2021/49628.15338 Quality of Marginal Seal at the Root Dentine- Margin Elevation Material Interface in Proximal Box Elevation Technique for Adhesive Indirect Aesthetic Restorations- A Systematic Review Sindhu Saeralaathan, Chakravarthy Arumugam, Manigandan Kuzhanchinathan, Arathi Ganesh <b>Introduction:</b> A subgingivally extending proximal carious defect can be adequately restored with an adhesive indirect aesthetic restoration only when the proximal margins can be raised coronal to the Cementoenamel Junction (CEJ) using various Margin Elevation Materials (MEM). This approach is commonly referred to as the Proximal Box Elevation (PBE) technique. However, there is a lack of evidence in the literature regarding the quality of the marginal seal at the root dentine- MEM interface when using PBE technique. <b>Aim:</b> The purpose of this systematic review was to summarise the available evidence on the the quality of the marginal seal at the root dentine- MEM when using the PBE technique during the placement of adhesive indirect aesthetic restorations. <b>Materials and Methods:</b> Comprehensive electronic search was performed in Pubmed Central, Cochrane Library and Google scholar from their inception to January 2021 at the Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research (SRIHER) between May 2020 and January 2021. Full text articles published in english language which have performed an indirect restoration with and without PBE technique were included in the review. A total of 249 articles were screened initially in the review. The main keywords used were: &#8220;PBE&#8221;, &#8220;Cervical Margin Relocation (CMR)&#8221;, &#8220;Deep Margin Elevation (DME)&#8221; and &#8220;coronal margin relocation&#8221;. The review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias assessment of the included studies was performed independently. <b>Results:</b> A total of 9 in-vitro studies were included in the present systematic review. Resin based composites of different viscosities seemed to perform adequately as MEM. It may be prudent to perform the margin elevation in multiple layers. Self etch adhesives had a better marginal seal than the total etch adhesives. Regarding the effect of indirect restoration on the marginal seal at the root dentine- MEM interface, there was no conclusive evidence. PBE may provide a congenial environment for predictable and efficient bonding of indirect adhesive aesthetic restorations. <b>Conclusion:</b> Based on the moderate quality of evidence from the included articles in this systematic review, it can be concluded that while performing a PBE technique, the quality of marginal seal at root dentine- MEM interface is satisfactory under in-vitro conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZE06-ZE12&id=15385 https://doi.org/10.7860/JCDR/2021/50161.15385 Latest Advancement in the Management of Xerostomia: A Review Venetia Aranha, SM Meghana, Sandip Kulkarni, Monica Yadav Xerostomia, also known as dry mouth, is a subjective sensation arising due to the reduced salivary flow. The dry mouth interferes with normal oral functions such as swallowing, chewing and speech. An increase in the incidence of dental caries and oral infections that may impact the oral health is also seen. The aetiology of dry mouth may be due to systemic diseases, drugs or by radiation to the head and neck, the causes hence being multifactorial. The prevalence of dry mouth is commonly seen in nearly half of the elderly population and one fifth of the younger individuals. Salivary substitutes are used to manage xerostomia. However, for long-standing xerostomia, a lot of potential systemic therapies exist. Oral health care providers are now making significant contributions to the diagnosis and are aware of the latest trends in the management of xerostomia. This review aimed to illustrate the current trends in the management of xerostomia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZE13-ZE16&id=15388 https://doi.org/10.7860/JCDR/2021/49970.15388 How Data is Helping to Fight COVID-19 Pandemic Harsh Arvind Athavale, Sunita Arvind Athavale, Amey Subodh Pathak, Tanmay Subodh Pathak Early in 2020, the COVID-19 pandemic emerged as a global public health concern requiring urgent attention, concerted efforts and intervention to avoid catastrophe. This necessitated optimal use of fast-emerging data to be analysed to draw out inferences that would shape our response. World Health Organisation (WHO) called this pandemic an infodemic where data played a crucial role. This paper reviews how data from varied sources and different types helped delay the outbreak, limit the spread, initiate social and public health measures, decide treatment regimes, optimise healthcare infrastructure and human resources and helped to initiate a multipronged strategy with emerging evidence for further course correction as the world progressed through the pandemic. The classical mathematical tools, i.e., Susceptible-Infected-Recovered (SIR) model and its variants, were the primary analytical techniques utilised to analyse such data. However, newer data analytical techniques utilising artificial intelligence and machine learning, were also extensively used. These techniques have the capability to handle large quantities of data and develop prediction models of various emerging situations that offer foreknowledge for policymakers and provide solutions. Data Science has witnessed a leap in the past few years, and the way it helped shape our response to this pandemic is a testimony to the promise that it holds for humankind. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LE01-LE05&id=15406 https://doi.org/10.7860/JCDR/2021/49455.15406 Advanced Chairside Diagnostic Aids for Periodontal Diagnosis- A Review Meghana Sri Sai Ivaturi, Amitha Ramesh Bhat, Raksha Suneel Potdar Periodontitis is an infection driven inflammatory disease caused by dental plaque accumulation that in turn causes microbial alterations which may lead to drastic consequences in the periodontium in susceptible individuals. Hence, the rationale of periodontal therapy is predominantly focused on the elimination or reduction of these periodontal pathogens. Despite following a wide range of preventive measures, controlling periodontal disease is challenging and treatment is usually initiated mostly after lesions become clinically detectable and tissues undergo irreversible damage. Microbiological diagnostic tests aid in the early detection of these lesions when they are still reversible giving an opportunity for non-invasive treatment. Microscopy, bacterial culture, immunological assays like Evalusite, Fluorescent In-Situ Hybridisation (FISH), Oraquick, enzymatic assays like Perioscan, Periogard, Pocketwatch, Periocheck, Matrix Metalloproteinase (MMP) dipstick test, Biolise, and molecular biology techniques like Polymerase Chain Reactions (PCR), Terminal Restriction Fragment Length Polymorphism (T-RFLP), 454 Pyrosequencing, Supported Oligonucleode Ligation and Detection (SOLiD) have been among the techniques employed. Some of these diagnostic aids were solely for scientific purposes, while others were adapted and updated for therapeutic use. The current paper focuses on the practical utility of the rapidly expanding plethora of microbiological diagnostic aids highlighting the concerns surrounding their applications in periodontal diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZE17-ZE22&id=15407 https://doi.org/10.7860/JCDR/2021/50417.15407 Role of Bacterial Flora in Oral Cancer- An Insight R Ananthalakshmi, M Priya, Nadeem Jeddy, LJ Sailakshmi The human body contains about 1014 bacteria which usually colonise different parts of the body. The bacterial flora is important for a person’s health as well as normal functioning of tissue and organ systems. Bacteria are single celled organisms and are found on almost all surfaces of human body. They act in synergy with host immune mechanism and provide protection against various undesirable foreign invasions, especially in the oral cavity, where they exist in a diversified form which survive in a symbiotic relationship with the host. When there is a disturbance in this equilibrium due to various factors like trauma or tobacco smoking, betel nut chewing and alcohol intake, which makes the mucous membrane more permeable to invading microorganisms, these commensal bacterial species can become virulent and give rise to oral diseases ranging from dental caries to oral carcinoma. The effects of these bacteria can be either direct or indirect initiation of chronic inflammation, formation of procarcinogens that contribute to the development of oral carcinoma. This article focuses on the role of oral bacterial flora in initiation and progression of oral carcinogenesis. Various bacterial and fungal species associated with oral carcinoma and predominant bacterial species in oral cavity and oropharyngeal region along with measures to prevent their adverse effects are described. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=ZE23-ZE27&id=15413 https://doi.org/10.7860/JCDR/2021/48929.15413 The Consequences of Conspiracy Theories in the Era of COVID-19 Utpreksha G Gaude The COVID-19 pandemic has overtaken the lives of millions around the world. While this has helped the virtual technology make advances, it has restricted social beings to their households for over a year. It is only natural to want a change from the boring view of the house and the Olympics being conducted itself is one of the global feats that showcase the resilience of people to strive forward without letting the virus command their lives. With frustration predominating the powerful emotions, people are slowly beginning to resign to the acceptance of the dangers of the deadly virus with its constantly evolving nature. The latest delta variant is the most dangerous one so far. Despite the extensive research being carried out by various diligent scientists, the ultimate cure has yet to be found. Until then, our best hope is the vaccination and following the guidelines of social distancing and protection with masks. These are simple, common-sense rules that need the least amount of instruction yet people seem to find it hard to adhere to these new norms. There is increasing hesitancy and fear due to lack of research but if people can be brave enough to weather the perils of the virus at a universal scale, they should be able to brave the tiny prick as well. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&month=September&volume=15&issue=9&page=LI01-LI03&id=15340 https://doi.org/10.7860/JCDR/2021/50305.15340